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SOUTHERN 


MEDICAL  AND  SURGICAL  JOURNAL. 


EDITED  BY 

HENRY  F.  CAMPBELL,  A.M.,  M.  D., 

PROKES-OR  OK  BPECIAL  AND  COMPARATIVE  ANATOMY  IN  TBI  MEDICAL  COLLEGK  OF  GEORGIA 


ROBERT   CAMPBELL,   A.M..M.D., 

DBMOSrtTRATOB    OF    ANATOMY    IN  THE  MEDICAL  COLLEGE 


MEPICAL  COLLEGE  OF  GEORGIA. 


YOL.  XIV.— 1858.— NEW  SERIES. 


AUGUSTA,  G  A: 

J.  MORRIS,  PRINTER  AND  PUBLISHER. 

1858. 


;.*ff 


SOUTHERN 

MEDICAL  AND  SURGICAL  JOURNAL. 

(SEW  SERIES.) 

Vol.  XIV.]  AUGUSTA,  GEORGIA,  JANUARY,  1558.  [No.  1. 

ORIGINAL  AXD  ECLECTIC. 

AKTICLE  I. 

A  Clinical  Lecture  upon  some  of  the  Effects  of  Intemperance;  de- 
livered at  the  Augusta  City  Hospital,  by  L.  A.  Dugas,  M.  D., 
aud  written  out  by  special  request 

Gextlemex, — 

The  case  of  the  woman  we  have  just  left  in  a  moribund  condi- 
tion, is  well  calculated  to  arrest  our  attention.  This  woman, 
who  now  seems  to  be  about  40  years  of  age,  and  who  presents  to 
us  so  lamentable  a  picture  of  the  effects  of  vice,  is  one  of  the 
frail  sisterhood,  who,  having  in  her  youth  forfeited  her  social 
position,  fled  from  the  parental  roof  to  a  den  of  infamy,  and  has 
been  ever  since  endeavoring  to  drown  her  remorse  in  alcoholic 
and  other  narcotic  potations.  She  was  a  short  time  since  taken 
from  a  miserable  negro  hovel  and  brought  here  to  die  and  to 
be  buried  at  the  expense  of  the  city.  You  may  have  observe  :1 
when  we  first  saw  her,  a  few  days  ago,  that  she  was  still  able  to 
speak,  although  her  articulation  was  slow  and  somewhat  diffi- 
cult— that  she  lay  upon  her  back  without  the  power  to  move 
either  her  limbs  or  her  trunk,  but  still  retaining  her  sensibility 
as  well  as  her  mental  faculties  comparatively  unimpaired — that 
she  was  not  laboring  under  paralysis,  properly  so  called,  but 
that  she  was  suffering  from  a  real  exhaustion  of  nervous  power 
throughout  the  whole  system,  which  had  been  gradually  pro- 
s. — VOL.  xiv.  no.  i.  1 


4  DuGAS^on  Effects  of  Intemperance.  [January, 

gressive,  and  without  any  indication  whatever  of  local  organic 
disease.  She  now  appears  to  be  asleep  with  her  eyes  half  open, 
but  breathes  quietly,  and  presents  none  of  the  phenomena  of 
apoplexy.  She  has  passed  into  this  state  gradually  since  you 
last  saw  her,  and  her  small  and  rapid  pulse  indicates  an  early 
termination  of  this  process  of  resolution.  The  energies  of  life, 
long  undermined  by  dissolute  habits,  have  gradually  yielded, 
and  she  now  dies  evidently  from  mere  nervous  exhaustion. 

It  is  in  the  presence  of  cases  like  these  that  the  physician  re- 
alizes in  its  fullest  force  one  of  the  evils — perhaps,  alas,  a  neces- 
sary evil — of  the  social  system  of  refined  civilization ;  I  mean 
that  which  condemns  to  perpetual  infamy  the  unfortunate  female, 
who,  in  a  moment  of  infatuation  yields  to  the  designs  of  an 
artful  and  heartless  deceiver !  She  soon  realizes  her  dreadful 
error,  and  yet  dares  not,  as  she  had  always  done  before,  appeal 
to  the  parents  who  would  affectionately  overlook  any  other 
guilt  and  endeavor  to  palliate  it — for  sh*  knows  that  this  is  an 
unpardonable  sin,  even  in  the  sight  of  those  who  gave  her  birth ! 
Oh,  if  she  could  only  be  allowed  to  throw  herself  upon  her 
knees,  implore  their  forgiveness,  and  receive  from  them  even  a 
look  of  kindness,  she  would  do  so,  continue  to  dwell  with  them, 
and  probably  lead  a  virtuous  life  the  remainder  of  her  days. 
But,  no ;  she  must  fly,  or  be  driven  from  the  midst  of  those  she 
loves,  and  be  an  outcast  among  the  vilest  refuse  of  society, 
where,  with  a  broken  heart  and  lacerated  conscience,  she  natur- 
ally seeks  relief  in  the  obtunding  use  of  narcotics  of  one  kind  or 
another!  The  effects  of  these  are  before  us — we  here  behold, 
however,  only  one  of  the  sad  consequences  of  intemperance,  and, 
if  you  will  pardon  me  for  dwelling  upon  a  topic,  perhaps  trite, 
I  will  take  this  opportunity  to  make  a  few  comments  upon  some 
of  the  evils  of  intemperance  to  the  individual  who  indulges  in 
this  vice,  to  his  offspring,  and  to  his  race. 

I  beg  leave,  Gentlemen,  at  once  to  say  that  I  am  not  one  of 
those  who  think  that  a  good  cause  is  ever  benefitted  by  exag- 
geration and  by  positions  unsustained  by  truth.  I  would  not 
therefore  have  you  to  give  credence  to  the  ridiculous  stories 
about  alcohol  being  found  in  the  ventricles  of  the  brain, 
about  the  spontaneous  combustion  of  drunkards,  &c. — nor  would 
I  tell  you  that  a  moderate  and  well  regulated  use  of  intoxicating 


1858.]  Dugas,  on  Effects  of  Intemperance.  5 

beverages  is  always  injurious,  when  the  most  casual  observation 
might  falsify  the  assertion.  It  is  of  intemperance  I  wish  to  speak, 
and  not  of  temperance, — and  yet,  I  am  free  to  say,  that  if  a  man 
cannot  drink  without  drinking  too  much,  he  ought  not  to  drink 
at  all. 

There  are  two  forms  of  intemperance — the  one  periodical  and 
the  other  continued.  Those  addicted  to  the  former  will  drink 
profusely  for  days  or  weeks,  until  the  stomach  rebels  and  rejects 
the  potations,  and  they  cannot  take  any  more.  They  will  then 
suffer  greatly,  mentally  and  physically,  a  few  da}^s,  and  gradual- 
ly get  over  their  "spree,"  to  resume  it  again  after  the  lapse  of 
weeks,  months,  or  even  years.  This  is  the  most  inveterate,  the 
most  incurable  form  of  intemperance.  Indeed,  I  may  say  that 
I  look  upon  such  cases  as  utterly  hopeless,  for  I  have  never 
known  a  single  instance  of  permanent  reformation,  in  those  ad- 
dicted to  periodical  intemperance.  The  victims  of  this  form  are 
more  violent  and  uncontrolable,  more  disagreeable  and  danger- 
ous to  society,  more  subject  to  delirium  tremens,  and  more 
liable  to  permanent  insanity,  than  habitual  inebriates. 

The  continued  form  of  intemperance  is  that  in  which  the 
individual  habitually  takes  too  much ;  some  will  attend  to  their 
business  during  the  day  more  or  less  efficiently,  and  yet  be  sur- 
feited every  night — others  are  sober  enough  to  attend  to 
business  only  in  the  forenoon — and,  finally,  there  are  many 
who  can  scarcely  ever  be  found  entirely  sober.  I  recollect  a 
case  in  court  in  which  a  will  was  set  aside  upon  the  testimony 
of  the  neighbors  that  the  maker  had  not  been  sober  enough  in 
ten  years  to  know  what  he  was  about !  The  will  had  been 
executed  six  or  seven  years  before  his  death.  And  yet  this 
man  lived  seventy-five  years,  and  had  been  intemperate  all  his 
life!  I  believe  it  to  be  a  general  rule,  that  the  habitually  intem- 
perate live  longer  than  those  who  are  only  periodically  so.  But 
the  habitual  inebriate  is  more  liable  to  liver  disease,  to  dropsy 
and  to  rheumatism — neither  of  which  affections  have  I  ever 
known  cured  under  such  circumstances.  The  periodical  drunk- 
ard is  more  apt  to  be  carried  off  by  an  attack  of  mania-a-potu, 
or  of  some  other  acute  disease.  "While,  with  most  persons  in- 
temperance induces  more  or  less  of  plethora  and  corpulency, 
there  are  some  in  whom  it  produces  an  opposite  effect,  and  we 


6  Du 'GAS,  on  Effects  of  Intemperance.  [January, 

find  these  pale  or  sallow,  and  thin.  When  it  terminates  in 
dropsy,  this  seems  to  be  in  consequence  of  hypertrophy  of  the 
cellular  tissue  of  the  liver,  by  which  the  portal  veins  are  com- 
pressed to  such  a  degree  as  to  impede  the  free  passage  of  blood, 
and  to  cause  its  undue  accumulation  in  the  intestinal  canal  and 
its  investing  membrane.  In  such  cases  the  vessels  may  relieve 
themselves  by  an  abundant  secretion  from  the  mucous  surface, 
constituting  diarrhoea,  or  by  an  exhalation  into  the  peritoneal 
cavity,  so  as  to  produce  dropsy.  Either  of  these  symptoms  may 
be,  in  general,  regarded  as  the  precursor  of  early  dissolution. 

Intemperance  deeply  affects  the  nervous  system  of  animal 
life,  as  is  evinced  by  the  uncertain  gait,  the  tremulous  hand, 
convulsions,  and  various  painful  diseases.  But  the  brain,  this 
great  seat  of  intellect  and  of  the  moral  perceptions,  reveals  its 
baneful  influence  under  the  forms  of  mania-a-potu,  perverted 
reason,  and  moral  depravity.  Who  has  not  seen  instances  in 
which  the  noblest  intellect  and  the  most  refined  sense  of  pro- 
priety have  been  thus  changed  into  stupid  vagaries  and  knavish  * 
as  well  as  brutal  propensities  ?  With  reason  dethroned  and  the 
moral  perceptions  blunted,  the  victim  drags  a  miserable  exist- 
ence himself,  and  embitters  that  of  all  who  loved  and  esteemed 
him! 

Let  us  now  look  at  some  of  the  effects  of  Intemperance  upon 
the  offspring  and  upon  the  race.  I  think  it  susceptible  of  easy 
demonstration,  that  the  children  of  an  habitual  inebriate  will 
have  but  little  stamina — that  is  to  say,  that  their  powers  of  re- 
resistance  to  morbid  influences  will  be  more  or  less  impaired, 
and  that  they  will  therefore  be  more  liable  to  disease  than  they 
would  otherwise  have  been ;  that  they  will  often  be  scrofulous, 
and  occasionally  insane,  or  idiotic.  These  effects  will,  moreo- 
ver, become  more  and  more  apparent  the  longer  the  parent  has 
been  a  drunkard — so  that  if  he  have  a  large  family  during  his 
intemperance,  the  deterioration  of  his  children  will  be  progress- 
ive, and  the  last  may  be  so  puny  as  never  to  reach  maturity, 
although  the  first  may  be  comparatively  healthy.  Nay,  there 
are  some  drunkards,  whose  own  constitution  being  poor,  will 
rear  a  few  children,  and  then  lose  in  infancy  or  childhood  all 
those  they  may  subsequently  have.  Just  reflect  a  little  upon 
the  condition  of  the  families  in  your  respective  neighbourhoods 


1 858.]  Dugas,  on  Effects  of  Intemperance.  7 

and  I  think  that  each  one  of  you  will  recall  to  mind  some  illus- 
tration of  the  correctness  of  these  propositions. 

Well,  Gentlemen,  what  is  true  with  regard  to  the  influence  of 
intemperance  upon  the  oflspring  of  the  first  drunken  parent, 
becomes  most  painfully  so  if  the  offspring  himself  follow  the 
example  of  his  father  and  become  also  a  drunken  parent.  The 
issue  of  this  second  generation  of  drunkards  will,  in  all  proba- 
bility, be  few  in  number,  and  their  stamina  will  be  so  much 
impaired  that  it  will  be  with  the  utmost  difficulty  that  any  of 
them  can  reach  maturity.  Let  us  follow  this  third  generation, 
and  if  it  perchance  also  take  to  the  bottle,  it  will  be  the  last  of 
that  family — for  I  do  not  hesitate  to  proclaim  it  as  a  law  of 
almost  universal  applicability,  that  three  successive  gene-rations  of 
drunkards  will  leave  no  issue  !  The  third  generation  may  have 
children,  but  not  one  of  these  will  be  reared  to  manhood ! — 
This  may  appear  to  you  a  startling  announcement;  but  I  believe 
that  you  will  find  it  based  upon  truth.  As  I  have  long  since 
entertained  these  views  of  the  effects  of  intemperance  upon  fami- 
lies, I  would  like  to  adduce  some  of  the  evidence  I  have  collect- 
ed from  personal  observation,  were  it  not  manifestly  improper 
to  lift  the  veil  from  the  private  history  of  families  who  have 
passed  away.  But  we  can,  without  the  least  impropriety,  study 
the  history  of  families,  in  connection  with  that  of  the  race  to 
which  they  belong,  and  if  you  will  bear  with  me  a  few  moments 
more,  I  will  endeavor  to  illustrate  my  proposition  by  a  reference 
to  the  sad  history  of  our  aboriginal  savages. 

I  need  not  repeat  what  you  all  know — that  tribe  after  tribe  of 
the  children  of  the  forest  have  vanished  from  before  the  sun — 
and  still  continue  to  do  so  with  awful  rapidity.  Why  is  this 
so  ?  Is  there  anything  in  their  physical  organization  that  inca- 
pacitates them  for  the  perpetuation  of  their  species,  or  race,  if 
you  prefer  the  term  ?  Certainly  not.  Then,  I  again  ask  the 
question,  why  is  it  so?  In  order  to  answer  this,  let  us  examine 
the  influences  that  have  been  brought  to  bear  upon  this  race  in 
the  different  portions  of  our  continent,  and  let  us  see  if  they 
have  suffered  equally  in  these  several  regions. 

America  has  been  colonized  by  two  classes  of  people :  in  the 
one  we  find  the  Spaniards,  the  Portuguese,  and  the  French ;  in 
the  other  the  British  and  their  American  descendants.     Now 


8  Dug -as,  on  Effects  of  Intemperance.  [January, 

how  have  the  Indians  fared  under  the  dominion  of  these  two 
classes  ?  Under  the  former  they  have  increased  and  multiplied — 
whereas,  under  the  latter  they  have  been  annihilated!  The 
Spanish,  the  Portuguese,  and  the  French,  are  temperate  people, 
and  the  British  and  Anglo-Americans  intemperate — and  while 
the  former  have  propitiated  the  good- will  of  the  savages,  have 
fraternized  with  them,  have  civilized  and  christianized  them, 
probably  as  far  as  their  nature  will  permit;  the  latter  have  done 
neither,  but  have,  on  the  contrary,  introduced  among  them  their 
own  vices  and  intemperance,  and  driven  them  from  their  hunt- 
ing grounds  to  perish  like  outcasts.  Contrast  the  history  of  the 
Indian  in  Mexico,  with  that  of  the  same  race  in  the  United 
States — or  even  in  Georgia.  Towards  the  close  of  the  last  cen- 
tury the  population  of  Mexico  was  about  four  millions,  of  which 
the  pure  Indian  element  constituted  about  two  millions. — The 
population  of  that  Eepublic  is  now  about  seven  millions,  of 
whom  at  least  four  millions  are  pure  Indians,  two  millions  mix- 
ed races,  and  one  million  pure  castillians.  Sixty  years  ago,  one 
half  of  the  State  of  Georgia  was  peopled  with  savages — and 
where  are  they  now?  With  the  exception  of  a  small  remnant 
of  Cherokees  and  Creeks,  who  have  been  driven  across  the  Mis- 
sissippi, these  mighty  tribes  have  ceased  to  exist!  In  South 
America,  it  is  highly  probable  that  the  Indian  population  is 
fully  as  great  as  it  ever  was,  if  not  greater.  Under  the  French 
dominion,  the  Canada  Indians  prospered  as  they  do  in  South 
America ;  but  they  have  been  deteriorating  and  dwindling  away 
rapidly  ever  since  the  British  have  acquired  those  provinces. 
Look  at  the  influence  of  the  boasted  civilization  introduced 
by  the  drinking  races  among  the  Sandwich  islanders!  The 
third  generation  of  drunkards  is  now  living  there,  and  it  is  esti- 
mated that  in  fifteen  or  twenty  years  more  there  will  not  be  left 
a  solitary  representative  of  that  people.  The  sailor  with  his 
bottle  has  doubtless  had  more  followers  than  the  missionary 
with  his  Bible  in  that  unhappy  land.  Look  at  the  dissolute  and 
drunken  habits  of  our  frontier  Indians,  and  you  cannot  be  long 
in  discovering  the  true  reason  of  their  extinction.  The  same 
baneful  influence  operates  upon  the  free  blacks  who  seek  refuge 
in  the  large  cities  at  the  North.  The  climate,  may,  it  is  true, 
account  in  some  degree,  for  the  great  mortality  among  them ; 


1858.]  DtJGAS,  on  Effects  of  Intemperance.  9 

but  intemperance  is  unquestionably  their  greatest  enemy.  The 
philanthropist  will  look  in  vain  for  a  solution  of  these  stubborn 
facts,  unless  he  attribute  them  to  intemperance,  the  most  potent 
destroyer  of  mankind. 

I  hope,  gentlemen,  that  you  will  pardon  the  length  of  the  di- 
gression into  which  I  have  been  insensibly  led  from  the  case 
under  our  special  consideration,  I  did  not  intend  to  make  you 
a  temperance  address — but  I  never  see  a  victim  of  this  awful 
propensity,  without  feeling  that  something  ought  to  be  done  to 
put  a  stop  to  it.  I  have  therefore  endeavoured  to  direct  jour 
attention  in  as  forcible  a  manner  as  I  could  under  the  inspira- 
tion of  the  moment,  to  some  of  its  pernicious  effects.  You  are 
destined,  I  trust,  to  exert  some  influence  upon  the  communities 
in  which  you  may  fix  your  abode.  No  member  of  society  has 
it  more  in  his  power  to  do  good,  than  the  intelligent  and  moral 
physician.  The  subject  before  us  affords  a  noble  field  for  the 
exercise  of  enlightened  benevolence.  Unite  your  efforts  to  ex- 
tirpate this,  as  you  will  do  to  stay  the  ravages  of  other  diseases. 
Let  us  look  upon  intemperance  as  a  disease  and  treat  it  as  such. 
Must  it  not  indeed  be  a  veritable  mental  derangement,  that 
would  lead  a  man  irresistibly,  as  it  were,  to  the  destruction  of 
self,  of  family  and  of  race  ?  Let  us  but  call  it  a  species  of  in- 
sanity^ and  the  remedy  will  suggest  itself  immediately. 

That  intemperance  is  a  disease,  will,  I  think,  be  very  general- 
ly conceded  by  enlightened  physieians.  Like  other  morbid/ 
conditions,  it  may  be  inherited,  or  acquired.  When  derived  by 
inheritance,  the  patient  may  not  be  so  much  to  blame  as  when 
it  is  acquired  by  improper  indulgence.  It  nevertheless,  in  all 
cases,  reveals  a  morbid  condition  of  the  brain,  not  unlike  that 
which  constitutes  other  forms  of  monomania.  The  patient  is  as 
irresistibly  impelled  to  drink,  as  some  monomaniacs  are  to  thieve, 
notwithstanding  all  the  influences  of  education  and  of  other  in- 
centives to  good  conduct.  Some  will  say  that  it  is  only  a 
depraved  appetite,  or  a  want  of  proper  self  control — but  this  does 
not  change  the  matter.  This  depraved  appetite,  or  this  inability 
to  control  one's  propensities,  is  a  morbid  state — often  as  much 
deplored  by  the  patient  himself,  as  by  his  friends.  I  have  fre- 
quently heard  these  patients  in  their  lucid  intervals,  declare 
most  solemnly  that  they  would  cheerfully  give  all  they  possess- 


10  DuGAS,  on  Effects  of  Intemperance.  [January, 

ed  to  gat  rid  of  this  dreadful  propensity.  And  I  believe  that 
they  were  sincere. 

But  how  shall  we  treat  such  cases  ?  Place  them  in  an  asy- 
lum as  you  do  those  affected  with  other  forms  of  insanity ;  and 
let  them  undergo  such  treatment  as  may  be  deemed  best  adapted 
to  the  restoration  of  the  brain  and  nervous  system  to  their  pro- 
per and  normal  functions. 

I  am  aware  that,  under  existing  circumstances,  this  cannot  be 
done.  We-  need  legislation  upon  the  subject,  before  we  can 
carry  out  our  views;  and  I  can  see  no  good  reason  why  some 
men  should  be  sent  to  the  lunatic  asylum,  and  their  property  be 
placed  in  the  hands  of  trustees,  until  they  be  relieved  of  certain 
forms  of  insanity,  while  others  equally  injurious  to  society,  and 
unable  to  manage  their  affairs,  in  consequence  of  intemperance — 
another  species  of  insanity — are  allowed  to  run  at  large,  squand- 
ering their  estate,  embittering  the  lives  of  their  family,  annoying 
whole  communities,  and  committing  every  variety  of  crime.  I 
verily  believe  that  a  majority  of  the  inmates  of  lunatic  asylums 
would  be  found  less  dangerous  and  less  annoying  to  the  commu- 
nities from  which  they  were  sent  than  any  equal  number  of 
drunkards. 

I  think  that  the  legislature  of  New  York  has  taken  the  initia- 
tive in  chartering  a  voluntary  Asylum  for  Inebriates.  This  is 
a  step  in  the  right  direction,  and  may  of  itself  be  productive  of 
much  good.  But  inebriates  ought  to  be  put  upon  the  same 
footing  as  other  lunatics.  Let  a  writ  of  lunacy  bring  them  be- 
fore a  jury — and  upon  conviction,  let  them  be  ordered  to  the 
asylum,  and  their  estate  be  placed  in  the  custody  of  trustees  un- 
til their  recovery — and  I  firmly  believe  that  permanent  cures 
may  in  very  many  instances  be  the  result. 

The  sufferers  from  intemperance  are  entitled  to  our  sympathy, 
and  we  should  come  to  their  relief,  however  loathsome  they  may 
be  in  the  sight  of  the  non-professional  members  of  society.  Let 
us  not  apply  to  them  degrading  epithets  and  treat  them  like 
brutes  ;  but  on  the  contrary,  extend  to  them  the  hand  of  kind- 
ness and  the  offices  of  christian  charity.  It  is  thus  alone  that 
we  may  obtain  their  confidence  and  become  useful  to  them. 

The  fact  being  once  established  by  the  legislation  of  the  coun- 
try, that  intemperance  is  a  disease,  and  that  it  can  only  be  treated 


1858.]  Battey,  on  Sub-  Carbonate  of  Bismuth.  11 

successfully  in  an  institution  humanely  and  properly  devised  for 
this  special  purpose,  much  of  the  odium  that  now  attaches  to 
this  condition,  and  which  might  otherwise  result  from  the  con- 
finement, will  be  removed.  I  believe  that  such  a  system  would 
do  more  good  than  all  our  temperance  societies.  The  combined 
influence  of  both,  however,  would  in  all  probability  erase  from 
our  national  escutcheon  one  of  its  foulest  blots.  If  you  agree 
with  me,  let  us  unite  our  endeavors  to  bring  about  in  our  re- 
spective communities  such  a  state  of  public  opinion  as  may  result 
in  the  legal  establishment,  in  every  state,  of  Asylums  for  the 
Inebriate. 


AETICLE    H. 


Sub-  Carbonate  of  Bismuth. — New  Mode  of  Preparation.     By  Rob- 
ert Battey,  M.  D.,  of  Rome,  Ga. 

The  attention  of  the  Profession  having  been  called  to  the  sub- 
carbonate  of  bismuth — in  connection  with  the  operose  process  of 
Prof.  Hannon,  of  Brussels,  for  obtaining  it — it  would  seem  de- 
sirable that  a  simple  and  easy  mode  of  manipulation  should  be 
more  generally  known. 

The  repeated  fusion  of  the  impure  bismuth  with  nitrate  of 
potassa,  to  free  it  from  arseniurets  and  sulphurets,  with  which  it 
is  usually  contaminated,  may  well  be  replaced  by  the  simple 
solution  in  nitric  acid,  and  precipitation  (as  sub-nitrate)  by  dis- 
tilled water.  This  precipitate,  if  not  absolutely  pure,  is  suffi- 
ciently so  for  all  medical  purposes — it  should  be  well  washed 
with  distilled  water.  By  this  process  the  impurities  are  oxidized, 
and  rendered  soluble  in  water,  or  left  behind  undissolved  by 
the  acid ;  in  both  cases  they  are  gotten  rid  of  very  satisfacto- 
rily. 

To  prepare  the  sub-carbonate,  dissolve  the  sub-nitrate  in  a 
sufficiency  of  nitric  acid  to  effect  the  solution  when  warmed — 
decant  the  clear  liquid,  and  add  it  slowly  to  a  filtered  solution 
of  carbonate  of  soda — collect  the  precipitate  upon  a  filter — wash 
well  with  distilled  water,  wrap  in  filtering  paper,  and  dry  by  a 
gentle  heat. 


12  Battey,  on  Subcarbonate  of  Bismuth.        [January, 

For  the  physician,  it  will  be  convenient  to  use  the  sub-nitrate 
which  he  has  upon  his  shelf.  If  it  be  entirely  soluble  in  nitric 
acid,  without  effervescence,  and  is  not  clouded  on  the  addition 
of  a  few  drops  sulphuric  acid,  it  may  be  esteemed  pure ;  other- 
wise, decant  the  clear  solution  and  precipitate  with  distilled 
water  to  render  it  so. 

Eain-water,  boiled  and  filtered,  may  be  used  in  place  of  the 
distilled  water. 

A  sample  of  the  sub-carbonate,  made  by  the  above  process,  was 
subjected  to  Marsh's  test,  and  found  entirely  free  of  arsenic. 

[By  reference  to  the  October  number  of  the  13th  volume  of 
this  Journal,  page  625,  Mr.  Hannon's  mode  of  preparation  will 
be  found.  Compared  with  the  above,  it  is  difficult  and  incon- 
venient, only  practicable  to  the  regular  chemist — while  that 
proposed  and  effected  by  our  contributor  is  easily  adopted  by 
the  ordinary  practitioner,  and  is  therefore,  in  our  opinion,  pre- 
ferable. 

This  sub-carbonate  of  bismuth,  if  it  answers  the  expectations 
which  we  have  every  right  to  entertain  from  a  soluble  salt  of 
this  metal,  is  destined  to  become  a  most  valuable  therapeutic 
agent.  The  insoluble  salt,  the  sub-nitrate,  is  every  day  become 
ing  more  extensively  and  variously  applied,  and  the  results  of 
its  action,  in  a  variety  of  cases,  are  often  very  surprising — even 
startling  to  the  practitioner.  Its  action,  however,  is  generally 
slow,  and  it  is  inefficient  in  many  cases  on  account  of  its  insolu- 
bility. "The  sub-carbonate  is  soluble  in  the  gastric  juice,  its 
action  is  rapid,  it  produces  no  sensation  of  weight  at  the  stomach, 
it  rarely  constipates,  colors  the  stools  less  than  the  sub-nitrate, 
and  may  be  employed  for  a  long  time  without  oppressing  the 
stomach.  The  action  of  the  sub-carbonate  appears  to  be  seda- 
tive during  the  first  days  of  its  employment,  and  subsequently 
to  excite  all  the  phenomena  which  result  from  the  action  of 
tonics." 

We  quote  farther,  from  the  article  above  mentioned,  in  order 
that  our  readers  may  have  before  them,  in  connection  with  this 
new  mode  of  preparation  proposed  by  Dr.  Battey,  the  whole 
amount  of  facts  at  present  known  in  relation  to  the  therapeuti- 
cal action  of  the  sub-carbonate  of  bismuth. 


1858.]     Campbell's  Classification  of  Febrile  Diseases,  &c.        13 

"As  to  its  therapeutical  action,  it  may  be  noted  that  all  cases 
of  gastralgia  consecutive  upon  phlegmasia  of  the  digestive  pas- 
sages, cases  in  which  the  tongue  is  red  and  pointed,  and  cases  in 
which  the  digestion  is  laborious  and  accompanied  with  putrid 
or  acid  eructations,  or  in  which  there  is  a  tendency  to  diarrhoea 
or  spasmodic  vomiting,  demand  the  employment  of  the  sub- 
carbonate  of  bismuth.  This  salt  is  also  required  in  the  vomiting 
of  children,  whether  caused  by  dentition  or  succeeding  to  fre- 
quent fits  of  indigestion,  and  in  the  diarrhoea  of  weak  children, 
especially  when  occurring  at  the  time  of  weaning.  One  great 
advantage  possessed  by  the  sub-carbonate  of  bismuth  is,  that  it 
neutralizes  the  acids  in  excess  which  are  found  in  the  stomach. 
The  sub-nitrate,  as  is  well  known,  fails  always  in  this  respect 
In  all  the  cases  where  the  subcarbonate  has  been  taken,  the 
pain  in  the  digestive  passages  is  first  found  to  disappear ;  then 
the  eructations  cease,  together  with  the  vomiting  or  diarrhoea; 
the  digestion  becomes  less  and  less  laborious,  the  tongue  gradu- 
ally receives  its  normal  form  and  color ;  and  if  the  use  of  the 
subcarbonate  is  continued,  the  appetite  increases  from  day  to  day, 
the  yellow  tint  of  the  countenance  disappears,  and  the  face  be- 
comes colored  at  the  same  time  as  it  ceases  to  be  shrivelled. 

The  subcarbonate  of  bismuth  is  perfectly  insipid,  and  excites 
no  repugnance.  It  is  given  before  meals.  Adults  take  it  in  a 
little  water,  and  children  in  honey.  It  may  also  be  made  into 
lozenges.  The  dose  for  adults  is  from  one  to  three  grammes, 
taken  three  times  a  day  in  increasing  doses."] 


ARTICLE    III. 


Classification  of  Febrile  Diseases  by  their  Relation  to  the  Nervous 
System*  By  Henry  F.  Campbell,  M.  D.,  Professor  of  Anat- 
omy in  the  Medical  College  of  Gerogia — and  Chairman  of 
Committee  on  Nervous  System  in  Febrile  Diseases. 

During  the  examination  of  our  subject  since  the  time  of  our 
appointment  as  a  special  committee,  by  this  Association,  we 
have  been,  at  each  step,  more  and  more  impressed  with  its 
importance,  and  at  the  same  time  with  the  extreme  difficulty 
attending  its  full,  clear,  and  thorough  elaboration.  "A  man," 
says  Lord  Bacon,  "  must  collect  facts,  in  order  to  know  the  law 

*  A  partial  Report  read  before  the  American  Medical  Association,  Nashville, 
May,  1857. 


14      Campbell's  Classification  of  Febrile  Diseases,  &c.  [January, 

of  facts ;"  diligently  and  earnestly  engaged  for  the  year  past,  in 
collecting  and  interrogating  the  facts  which  have  a  bearing  on 
the  important  subject  of  Febrile  Diseases,  in  the  relation  assign- 
ed us  for  examination,  we  have  scarcely  had  time  to  do  more 
than  note,  here  and  there,  the  gleam  of  truth  which  has  been 
evolved  during  a  bare  hasty  collocation  of  data ;  much  less  to 
determine  satisfactorily  any  fixed  law  in  relation  to  the  vast 
subjects  involved  in  the  investigation.  That  such  laws  will  be 
recognized,  and  that  the  careful  generalization  of  the  facts  will 
be  productive  of  important,  fruitful  results,  we  have  already 
seen  enough  fully  to  persuade  us.  Pleading  then  the  magnitude, 
as  well  as  the  embarrassments  of  the  subject,  we  ask  of  this  As- 
sociation the  previlege  of  having  our  special  committee  contin- 
ued for  another  year,  allowing  us  at  present  to  lay  before  this 
body  a  few  conclusions  arrived  at,  as  the  result  of  the  investiga- 
tion in  its  present  state  of  progress. 

I.  As  all  the  normal  phenomena  of  the  living  organism  are 
known  to  occur  under  the  superintending  influence  of  the  ner- 
vous system,  and  are  dominated  by  it,  so  it  is  but  rational  to 
regard  all  morbid  actions  as  being  more  or  less  influenced  in 
their  manifestations  by  aberrated  nervous  action.  In  that  class 
of  diseases  ordinarily  designated  fevers,  our  researches  and  ob- 
servations have  led  us  to  the  confident  belief  that  the  above  law 
applies  with  sufficient  prominence  to  constitute  the  basis  of  their 
classification,  and  we  would  here  respectfully  claim  for  it,  that 
it  is  the  only  reliable  basis  of  their  clasification,  and  further,  that 
in  its  more  extended  application,  it  will  hereafter  be  found  to 
constitute  what  may  be  called  par  excellence,  the  Law  of  Febrile 
Diseases.  Simply  to  assert  the  recognition  of  this  law,  and  to 
suggest  a  new  and  more  comprehensive  classification  of  Fevers 
based  upon  it,  is  the  sole  object  of  the  present  brief  exposition. 

II.  As  in  the  Nervous  System,  we  recognize  two  grand  de- 
partments, viz :  1st.  The  Cerebro-spinal  System,  all  the  normal 
actions  of  which  are  subject  to  cessations  and  interruptions ;  and 
2dly.  The  Ganglionic  System,  all  the  normal  actions  of  which 
are  of  a  continuous  and  ^interrupted  character,  so  in  the  mani- 
festations of  febrile  diseases,  do  we  distinctly  recognize  two  grand 
distinguishing  characteristics  respectively  typifying  the  normal 
actions  of  these  two  systems  of  nerves  :  thus  a  character  of  par- 


1858.]    Campbell's  Classification  of  Febrile  Diseases,  &c.  15 

oxysm  obtains  in  certain  cases,  while  a  character  of  continuous- 
ness  as  plainly  marks  the  others. 

III.  Again :  as  in  the  Cerebro-spinal  System,  we  find  that 
its  normal  action  pertains  almost  exclusively  to  sensation  and 
to  motion,  with  only  a  secondary  and  comparatively  somewhat 
remote  influence  (which  we  have  termed  Excito-Secretory)  upon 
nutrition  and  secretion,  while  in  the  normal  action  of  the  Gan- 
glionic System  the  entire  function  is  known  to  be,  to  preside 
over  nutrition  and  the  secretions ;  so  in  paroxysmal  fevers  do  we 
find  intense  pain,  modified  sensation,  and  symptoms  allying 
them  to  neuralgic  and  convulsive  diseases  very  prominent, 
while  in  continued  fevers,  modified  nutrition  and  altered  secre- 
tion, are  the  marked  and  most  prominent  characteristics.  We 
would,  therefore,  announce  as  our  classification  of  febrile  diseases, 
two  grand  divisions  of  fevers  corresponding  with  the  two  grand 
divisions  of  the  nervous  system,  thus : — 

I.  Cerebrospinal  Fevers. 
All  Paroxysmal.     The  secretions  und  nutrition  only  seconda- 
rily affected. 

IT.  Ganglionic  Fevers. 
All  Continued.     The  secretions  and  nutrition  primarily  affec- 
ted. 

I.  Under  the  head  of  Cerebrospinal  Fevers,  we  would 
place  the  whole  family  of  Paroxysmal  Fevers,  whatever  type 
they,  may  assume,*  and  also  the  various  forms  of  neuralgia, 
which  are  nearly  always  intermittent,  as  well  as  the  sthenic  forms 
of  Traumatic  Fever,  together  with  the  Fever  accompanying 
simple  Pharyngitis,  Pneumonitis,  Dysentery,  and  many  other 
diseases  of  malarial  districts. 

II.  Under  the  head  of  Ganglionic  Fevers,  or  Fevers  of 
the  Secretory  System  of  Nerves,  we  think  that  we  find 
ample  ground  for  bringing  together  many  diseases  heretofore 
widely  estranged  from  each  other.     Thus,   as  the  archetypal 

*  The  primitive  location  of  these  fevers,  in  the  cerebro-spinal  system,  vras  de- 
veloped by  Prof.  L.  D.  Ford,  of  the  Medical  College  of  Georgia,  in  the  Soulhcm 
-   rgical  Journal,  in  1836,  and  called  by  Maillot,  "Cerebro-spinal 
Intermittent  Irritations," 


16      Campbell's  Classification  of  1  diseases,  <tc  [January, 

forms  of  ganglionic  fevers,  we  place  at  the  head  of  the  list. 
phus  and  typhoid  fever,*  then,    allied  to  these   in  various   de- 
grees of  affinity,    but  all  equally,   in  the  one  essential   element, 
that  they  present  themselves  as  manifestations  of  disease  through  the 
Gan  ^sierra,  are  variola,  scarlatina,  rubeola,  varicella,  and 

many  other  forms  of  eruptive  fevers,  heretofore  not  classified  by 
nomologists.  All  of  these  last  diseases  are  marked  by  fever  of  a 
nued  or  non  paroxymal  character,  all  present  marked  aber* 
rations  of  nutrition  and  secretion,  and  each  has  its  own  peculiar 
eruptive  character;  and,  further,  each  one  is  definitely  self 
ted  in  its  duration,  as  yet,  no  remedical  interference  having 
been  found  competent  to  arrest  or  shorten  their  progre- 

TTe  will  here  make  the  remark,  that  we  do  not  wish  to  be 
mistaken  as  classifying  these  diseases  in  relation  to  their  eruptive 
feature,  but  only  as  signifying  a  recognition  of  the  common 
influence  of  the  secretory  system  of  nerves  in  all  of  them  by  the 
eruption.  In  typhoid  fever  itself,  it  must  be  recollected  that 
the  eruption  is  not  a  prominent  feature,  and  yet,  we  consider  the 
secretory  system  of  nerves  primarily  deeply  affected,  and  place 
this  at  the  head  of  the  list,  notwithstanding  the  fact,  that  the 
ganglionic  implication  manifests  itself  but  little  upon,  the  skin  and 
mainly  in  the  intestinal  canal.f 

It  may  be  asked,  if  all  of  these  fevers  are  due  to  aberration  in 
the  innervation  of  the  ganglionic  or  secretory  system  of  nerves, 
why  should  they  present  such  marked  specific  differences  ?  A 
satisfactory  answer  may  be  given  thus :  that  specificity  of  mor- 
bific cause  must  rationally  be  expected  to  secure  a  specificity  of 
morbid  manifestation ;  thus  the  virus  of  variola,  when  taken 
into  the  system,  gives  rise  to  the  morbid  manifestations  peculiar 
to  smallpox,  while  the  morbific  influence  (of  whatever  nature 
it  may  be)  of  typhoid  fever,  produces  a  specific  form  of  disease 
entirely  different,  but  not  the  les3  for  that  reason,  locatable  in 

*  As  first  developed  in  an  essay  entitled:  "An  Inquiry  into  the  Nature  of  Ty- 
phoidal  Fevers,  based  tepoa  a  Consideration  of  their  History  and  Pathology?  pre- 
sented to  the  American  Medical  Association  at  its  Session  of  May,  IS 5.3,  by  Henry 
npbeU,  Chairman  of  Committee  on  Typhoid  Fever.  The  implication  of  the 
ganglionic  system  of  nerves,  in  typhus  and  typhoid  fever,  has  been,  in  the  above 
essay,  argued  at  length. 

.uiry,  <fcc,  pp.  53  and  54. 


1858.]     Campbell's  Classification  of  Febrile  Diseases,  &e.         17 

parts  of  the  organism  entirely  controlled  by  the  secretory  ner- 
vous system. 

Blending  of  Types  of  Fever. — Much  interest  has  been 
taken  by  this  Association,  for  the  last  five  years,  in  the  subject 
of  the  Blending  of  the  Types  of  Fever.  We  would  claim  for 
the  present  Pathology  and  Classification  of  Fevers,  that  it  is  the 
only  one  which  admits  of  any  plausible  explanation  of  the  mys- 
terious phenomena  comprehended  under  the  term,  "Blending 
of  Types  ;"  thus,  a  cerebro- spinal  or  paroxysmal  fever  may  as- 
sume, under  certain  circumstances,  some  of  the  characteristics 
of  some  one  or  other  of  the  forms  of  continued  fever.  This  we 
hold  can  be  explained  by  attributing  it  to  a  propagation  of  the 
irritation,  originally  located  in  the  spinal  marrow,  to  the  gan- 
glia of  the  secretory  system.  Then,  again,  the  reverse  may 
obtain ;  we  may  find,  and  do  often  find,  in  continued  fevers, 
especially  in  malarious  districts  (whether  the  case  be  typhoid 
fever,  rubeola,  or  scarlatina.)  intermittent  paroxysms,  interrupt- 
ing the  even  course  of  the  continued,  form,  sometimes  obscuring 
the  diagnosis,  and  making  it  necessary  to  modify  the  treatment. 
The  use  of  quinine,  it  is  well  known,  will  generally  break  up 
these  paroxysms,  but  not  in  the  least  modify  the  course  of  the 
continued  fever.  In  the  first  of  these  cases,  the  morbific  influ- 
ence has  been  "centripetal"  and  in  the  second  "centrifugal," 
and  thus  the  "blending  of  types"  may  be  rationally  and  phil- 
osophically explained. 

We  are  aware  that,  in  presenting  thus  a  condensed  exposition 
on  the  obsoure  subject  of  "  The  Nervous  System  in  Febrile 
Diseases,"  without  more  argument  and  fuller  elaboration,  we 
are  running  the  risk  of  being  charged  with  "bare  assertion," 
but  we  will  honestly  avow  that  each  proposition  has  been  earn- 
estly and  carefully  considered,  keeping  constantly  in  view  all 
the  phenomena  of  febrile  diseases — comparing  them  faithfully 
with  the  normal  actions  of  the  two  grand  departments  of  the 
nervous  system. 

It  will  be  remarked,  that  we  have  not  attempted  to  define 
what  is  the  exact  morbid  condition  of  the  nervous  centres,  or 
of  the  nerves,  which  gives  rise  to  the  phenomena  in  the  two 
classes  of  fever.  Such  a  process  of  reasoning  we  have  careful- 
ly abstained  from,  because  such  a  discussion  would  be  conver- 


18  Indigenous  Races.  [January, 

sant  about  subjects  which  cannot  as  yet  be  said  to  have  been 
brought  within  the  legitimate  domain  of  science.  We  can  only 
as  yet  trace  the  effects  to  their  causes ;  it  is  a  different  thing  to 
discuss  the  nature  of  the  causes  themselves ;  and  as  Professor 
Whewell  has  made  a  distinction  between  the  Laws  of  Phenom- 
ena and  the  Causes  of  Phenomena,  so  we  only  here  claim  to 
have  recognized  a  Law,  leaving  the  more  recondite  inquisition 
into  the  Causes,  for  a  more  advanced  and  enlightened  age  of 
science.  In  conclusion,  we  will  say,  we  may  have  been,  in  the 
above  exposition,  unfortunately  obscure  in  presenting  to  others 
what  has  become  a  clear  and  well  defined  conviction  to  us ;  but 
in  the  pertinent  language  of  another,*  whose  deep  philosophy 
has  charmed  us,  while  it  has  been  of  unspeakable  service  to  us 
in  many  of  our  investigations,  we  will  say,  that  "  to  our  mind 
this  doctrine  stands  firm  and  impregnable — assailable  by  no 
known  fact  consistent  with  every  established  truth." 


ARTICLE  IV. 


Indigenous  Races  of  the  Earth  ;  or  a  few  Chapters  of  Ethnological 
Inquiry ;  including  Monographs  on  special  departments  of 
Philology,  Iconography,  Cranioscopy,  Paleontology,  Patholo- 
gy, Archeology,  Comparative  Geography,  and  Natural  Histo- 
ry :  contributed  by  Alfred  Maury,  Francis  Pulszky,  and 
J.  Aitken  Meigs,  M.  D.,  presenting  fresh  investigations, 
documents  and  materials ;  by  J.  C.  Nott,  M.  D.,  and  Geo.  K. 
Gliddon,  authors  of  "Types  of  Mankind.  Philadelphia: 
J.  B.  Lippincott  &  Co.     1857.    Large  8vo.,  pp.  655. 


Although  we  have  had  this  volume  upon  our  table  for  some 
length  of  time,  circumstances  have  prevented  an  earlier  notice 
of  it.  As  indicated  by  the  title  page,  it  is  made  up  of  contribu- 
tions from  several  writers — and  we  may  add,  from  men  of  well 
established  erudition.  The  first  paper  is  by  A.  Maury,  "  on  the 
distribution  and  classification  of  Tongues, — their  relation  to  the 
geographical  distribution  of  Paces ;  and  on  the  inductions  which 
may  be  drawn  from  these  relations."  The  second  by  T.  Pulszky, 
being  "  Iconographic  researches  on  Human  Paces  and  their  Art." 

*  Dr.  M'Cosh,  on  the  Method  of  the  Divine  Government. 


1858.]  Indigenous  Races.  19 

The  third  by  J.  A.  Meigs,  on  the  "  Cranial  characteristics  of  the 
Kaces  of  Men."  The  fourth  by  Dr.  J.  C.  Nott,  on  "  Acclimation ; 
or  the  comparative  influence  of  Climate,  Endemic  and  Epidemic 
diseases,  on  the  Kaces  of  Men."  The  fifth  by  G.  K.  Gliddon, 
entitled,  "  The  Monogenists  and  the  Polygenists ;  being  an  ex- 
position of  the  doctrines  of  schools  professing  to  sustain  dogmati- 
cally the  unity  or  the  diversity  of  the  human  races ;  with  an 
inquiry  into  the  antiquity  of  mankind  upon  Earth,  viewed 
chronologically,  historically  and  palseontologically."  And,  final- 
ly, the  sixth,  also  by  Mr.  Gliddon,  is  a  "  Commentary  upon  the 
principal  distinctions  observed  among  the  various  groups  of 
Humanity — and  on  the  Geographical  distribution  of  the  Simiae 
in  relation  to  that  of  some  inferior  types  of  Men."  It  will  thus 
be  seen  that  however  much  these  disquisitions  may  interest  the 
Naturalist,  the  contribution  by  Dr.  Nott  is  the  only  one  which 
strictly  comes  within  the  domain  of  medical  studies,  and  should 
alone,  therefore,  occupy  our  attention  as  conductors  of  a  period- 
ical devoted  exclusively  to  medicine.  We  may,  nevertheless,  be 
permitted  to  express  our  appreciation  of  the  learning  displayed 
by  the  other  contributors,  and  although  we  cannot  admit  the  cor- 
rectness of  all  their  views,  we  derived  especial  pleasure  from  the 
perusal  of  Mr.  Pulszky's  interesting  sketch  of  the  history  of  the 
fine  arts,  as  illustrative  of  national  instincts  or  proclivities. 

The  following  extract  will  indicate  the  object  of  Dr.  Nott's 
paper :  "In  the  preceding  chapters,  man  has  been  viewed  from 
opposite  stand-points;  and  each  new  group  of  facts  would  seem 
to  lead  more  and  more  directly  to  the  conclusion,  that  certain 
distinct  types  of  the  human  family  are  as  ancient  and  as  perma- 
nent as  the  Faunas  and  Floras  that  surround  them. 

"  We  propose  in  the  present  chapter,  to  investigate  of  Accli- 
mation ;  that  is  to  say,  of  Eaces  in  their  relations  to  Climate, 
Endemic  and  Epidemic  Diseases ;  and  if  it  should  be  made  to 
appear  that  each  type  of  mankind,  like  a  species  of  animals  or 
plants,  has  its  appropriate  climate  or  station,  and  that  it  cannot 
by  any  process,  however  gradual,  or  in  any  number  of  genera- 
tions, become  fully  habituated  to  those  of  opposite  character, 
another  strong  confirmation  will  be  added  to  the  conclusion 
above  alluded  to." 

While  admitting  that  man,  in  common  with  certain  of  the 


20  Indigenous  Races.  [January, 

lower  animals  and  plants  possesses  a  sufficient  degree  of  "  consti- 
tutional pliability"  to  enable  him  to  bear  great  changes  of  clim- 
ate, the  author  objects  to  the  opinion  entertained  by  many,  that 
he  (man)  is  a  cosmopolite  in  the  strict  sense  of  the  word.  The 
Jews,  who  originally  inhabited  a  region  in  which  they  were 
exposed  to  cold  winters  and  warm  summers,  are  well  adapted 
to  the  dispersion  to  which  they  have  been  subjected,  but  "the 
Eskimau  on  the  one  extreme,  and  the  Negro,  Hindoo,  and  Malay 
on  the  other,  have  no  power  to  withstand  the  vicissitudes  of 
climate  encountered  in  traversing  the  70  deg.  of  latitude  between 
Greenland  and  the  equator.  Each  race  has  its  prescribed  salu- 
brious limits.  The  fair  races  of  northern  Europe,  below  the 
arctic  zone,  of  which  the  Anglo-Saxon  are  impure  descendants, 
will  serve  as  another  illustration.  These  races  are  now  scattered 
over  most  parts  of  the  habitable  globe;  and  in  many  instances, 
they  have  undergone  far  greater  physical  changes  than  the  Jews. 
The  climates,  for  instance,  of  Jamaica,  Louisiana,  and  India,  are 
to  them  much  more  extreme  than  to  the  Jewish  race.  The 
Israelite  may  be  recognized  anywhere;  but  not  so  with  the 
Scandinavian  and  his  descendants  in  the  tropics.  The  latter 
becomes  tanned,  emaciated,  debilitated ;  his  countenance,  energy, 
everything  undergoes  a  change :  and  were  we  not  familiar,  from 
daily  observation,  with  these  effects  of  climate  upon  northern 
races,  we  should  not  suspect  the  original  ancestry  of  many  of 
the  present  inhabitants  of  hot  climates.  In  these  cases  we  be- 
hold, not  simply  a  healthful  modification  of  the  physical  and 
intellectual  man,  but  a  positively  morhid  degradation.  The  pure 
white  man  carried  into  the  tropic,  deteriotes  both  in  mind  and 
body;  the  average  duration  of  his  life  is  lessened  ;  and,  without 
fresh  importations,  his  race  would  in  time  become  extinct. 
When,  however,  his  descendants  are  taken  back  to  their  native 
climes,  they  revert  to  the  healthful  standard  of  their  original 
types :  the  latter  may  have  been  distorted,  but  can  never  be 
lost,  except  in  death",     (p.  356.) 

The  author  then  refers  to  the  deteriorating  effects  of  climate 
upon  the  English  in  Hindostan,  the  Indian  Archipelago,  Africa, 
the  West  Indies,  and  South  America ;  upon  the  Dutch  in  Bata- 
via  and  other  Indian  Islands ;  upon  the  French  in  Algeria,  &c; 
in  neither  of  which  colonies  can  the  European  cultivate  the  soil 


1858.]  Indigenous  Faces.  21 

nor  engage  in  other  laborious  pursuits  with  impunity.  "  The 
negro,  too,  obeys  the  law  of  climate.  Unlike  the  white  man, 
his  complexion  undergoes  no  change  by  climate.  While  the 
white  man  is  darkened  by  the  tropical  sun,  the  negro  is  never 
blanched  in  the  slightest  degree  by  a  residence  in  northern  lati- 
tudes. Like  the  quadrumana  of  the  tropics,  he  is  inevitably 
killed  by  cold ;  but  it  never  changes  his  hair,  complexion,  skel- 
eton, nor  size  and  shape  of  brain." 

With  regard  to  the  effects  of  the  climate  of  our  Southern 
States  upon  Europeans,  we  find  the  following  language :  "  Let 
us  suppose  that  a  thousand  inhabitants  of  Great  Britain  or 
Germany  should  be  landed  at  Mobile  about  the  month  of  May, 
and  one-third  placed  on  the  hills,  one-third  in  the  town,  and 
the  remainder  in  the  fenny  lands  around  the  latter,  and  ask 
what  would  be  the  result  at  the  end  of  six  months.  The  first 
third  would  complain  much  of  heat,  would  perspire  enormous- 
ly, become  enervated ;  but  no  one  would  perhaps  be  seriously 
sick,  and  probably  none  would  die  from  the  effects  of  the  clim- 
ate. The  second  third,  or  those  in  the  city,  if  it  happened  to  be 
a  year  of  epidemic  yellow  fever,  would,  to  say  the  least,  be  deci- 
mated, or  even  one-half  might  die,  while  the  resident  acclimated 
population  were  enjoying  perfect  health.  The  remaining  por- 
tion, or  those  in  the  fenny  district,  would  escape  yellow  fever, 
but  would,  most  of  them,  be  attacked  with  intermittent  and 
remittent  fevers,  bowel  affections,  and  all  forms  of  malarial  or 
marsh  diseases ;  fewer  would  die  than  of  those  in  the  city,  but  a 
large  proportion  would  come  out  with  broken  down  constitu- 
tions."   "  In  our  cotton -growing  States,  the  malarial  climate 

is  by  no  means  confined  to  the  low  and  marshy  districts;  on  the 
contrary,  in  the  high,  undulating  lands  throughout  this  exten- 
sive region,  wherever  there  is  fertility  of  soil,  the  population  is 
subjected  more  or  less  to  malarial  diseases.  These  remarks  ap- 
ply, as  will  be  seen  further  on,  more  particularly  to  the  white 
population,  the  negroes  being  comparatively  exempt  from  all 
the  endemic  diseases  of  the  South."*    (p.  363.) 

*  A  medical  friend  (Dr.  Gordon)  who  has  had  much  experience  in  the  diseases 
of  the  interior  of  Alabama,  South  Carolina,  and  Louisiana,  has  been  so  kind  as  to 
look  over  these  sheets  for  me,  and  assures  me  that  I  have  used  language  much 
too  strong  with  regard  to  the  exemption  of  negroes.  He  says  they  are  quite  as 
liable  as  the  whites,  according  to  his  observations,  to  intermittents  and  d}'sen- 
tery." 


22  Indigenous  Races.  [January, 

We  must  differ  with  the  learned  author  when  he  affirms  that 
negroes  are  comparatively  exempt  from  all  the  endemic  diseases 
of  the  South.  Such  is  certainly  not  the  case  in  this  section  of 
Georgia,  and  in  the  adjacent  portions  of  South-Carolina,  and 
Alabama,  where  every  planter  knows  that  his  negroes  suffer 
equally  with  the  whites,  annual  attacks  of  intermittent  and  re- . 
mittent  fevers,  dysentery,  malarial  pneumonia,  &c.  We  had 
occasion  a  number  of  years  ago,  to  point  out  the  same  error  in 
the  work  of  a  distinguished  Southern  medical  writer,  and  have 
since  found  these  views  to  be  pretty  generally  entertained  by  the 
physicians  on  our  seaboard.  The  error  seems  to  have  originated 
in  the  fact  that  negroes  are  comparatively  exempt  from  fever 
upon  the  rice  and  cotton  plantations  of  the  low-country,  the  field 
of  their  professional  observation  ;  and  this  fact  had  led  us  long 
since  to  the  inference  that  the  low-country  fever,  is  essentially 
different  from  that  of  the  up-country.  In  the  low  country  ne- 
groes become  acclimated  and  comparatively  exempt  from  fevers, 
but  in  the  up-country  no  length  of  residence,  nor  even  nativity, 
affords  the  least  immunity  either  to  the  white  or  to  the  black 
man ;  on  the  contrary,  we  may  safely  affirm  that  the  liability  to 
our  fevers  are  in  a  direct  ratio  with  the  length  of  time  the  indi- 
vidual has  resided  in  the  malarial  district,  and  that  natives  are 
the  most  susceptible.  With  yellow  fever  and  perhaps  low-coun- 
try fever,  one  attack  usually  secures  immunity  from  a  second : 
but  with  up-country  fever,  'an  attack  one  year  is  almost  invari- 
ably followed  by  similar  ones  the  subsequent  autumns,  and  the 
oftener  it  is  repeated,  the  more  susceptible  does  the  individual 
become.  The  negroes  born  and  reared  upon  the  plantations  of 
the  middle  portions  of  Georgia  and  South- Carolina,  are  fully  as 
liable  to  fever  as  new  comers,  and,  we  think,  much  more  so. 
We  know,  from  long  observation,  that  in  this  city  (Augusta), 
while  we  frequently  see  fevers  among  natives  (white  and  black), 
it  is  exceedingly  rare  that  we  meet  a  case  among  our  Northern 
people,  who  constitute  a  large  portion  of  the  permanent  mercan- 
tile population.  These  views  are  sustained  by  the  mortuary 
statistics  of  this  city  through  a  long  series  of  years,  published  in 
the  Southern  Medical  and  Surgical  Journal  (volume  for  1836). 
The  low-country  fever,  like  yellow  fever,  must  then  be  essen- 
tially different  from  any  form  of  fever  in  the  upper  sections  of 


1858.]  Indigenous  Races.  23 

the  Southern  States.  What  constitutes  the  pathological  differ- 
ence is  yet  to  be  determined,  and  should  be  studied  by  those 
who  have  the  opportunity.  It  is  an  interesting  subject  of  re- 
search, worthy  of  the  attention  of  some  of  the  eminent  patholo- 
gists of  the  sea-board. 

When  penning  the  remarks  just  made,  we  did  not  expect  to 
find  the  author  advocating  pretty  much  the  same  views  a  little 
farther  on.  In  order,  therefore,  to  do  him  justice,  we  shall  quote 
his  own  language : 

"  The  fact  is  so  glaring,  and  so  universally  admitted,  that  I 
am  really  at  a  loss  to  select  evidence  to  show  that  there  is  no 
acclimation  against  the  endemic  fevers  of  our  rural  districts.  Is 
it  not  the  constant  theme  of  the  population  of  the  South,  how 
they  can  preserve  health  ?  and  do  not  all  prudent  persons,  who 
can  afford  to  do  so,  remove  in  the  summer  to  some  salubrious 
locality,  in  the  pine-lands  or  the  mountains?  Those  of  the 
tenth  generation  are  just  as  solicitous  on  the  subject  as  those  of 
the  first.  Books  written  at  the  North  talk  much  about  acclima- 
tion at  the  South ;  but  we  here  never  hear  it  alluded  to  out  of 
the  yellow-fever  cities.  On  the  contrary,  we  know  that  those  who 
live  from  generation  to  generation  in  malarial  districts  become 
thoroughly  poisoned,  and  exhibit  the  thousand  Protean  forms 
of  disease  which  spring  from  this  insidious  poison. 

"  I  have  been  the  examining  physician  to  several  life-insur- 
ance companies  for  many  years,  and  one  of  the  questions  now 
asked  in  many  of  the  policies  is,  lIs  the  party  acclimated?1  If 
the  subject  lives  in  one  of  our  southern  seaports,  where  yellow 
fever  prevails,  and  has  been  born  and  reared  there,  or  has  had 
an  attack  of  yellow  fever,  I  answer,  '  Yes.'  If,  on  the  other 
hand,  he  lives  in  the  country,  I  answer,  '  No ;'  because  there  is 
no  acclimation  against  intermittent  and  bilious  fevers,  and  'other 
marsh  diseases.  Now,  I  ask  if  there  is  an  experienced  and  observ- 
ing physician  at  the  South  who  will  answer  differently  ?  An 
attack  of  yellow  fever  does  not  protect  against  marsh  fevers,  nor 
vice  versa. 

"  The  acclimation  of  negroes,  even,  according  to  my  observa- 
tion, has  been  put  in  too  strong  a  light.  Being  originally 
natives  of  hot  climates,  they  require  no  acclimation  to  tempera- 
ture, are  less  liable  to  the  more  inflammatory  forms  of  malarial 
fevers,  and  suffer  infinitely  less  than  whites  from  yellow  fever: 
they  never,  however,  as  far  as  my  observation  extends,  become 
proof  against  intermittents  and  their  sequelae.  The  cotton 
planters  throughout  the  South  will  bear  witness,  that,  wherever 
the  whites  are  attacked  with  intermittents,  the  blacks  are  also 


24  Indigenous  Races.  [January, 

susceptible,  though  not  in  so  great  a  degree.  My  observations 
apply  to  the  region  of  country  removed  from  the  rice  country. 
We  shall  see,  further  on,  that  the  negroes  of  the  rice-field  region 
do  undergo  a  higher  degree  of  acclimation  than  those  of  the 
hilly  lands  of  the  interior.  I  know  many  plantations  in  the 
interior  of  Alabama,  South  Carolina,  Georgia,  Mississippi,  and 
Louisiana,  on  which  negroes  of  the  second  and  third  generation 
continue  to  suffer  from  these  malarial  diseases,  and  where  gangs 
of  negroes  do  not  increase."     (p.  376.) 

And  again  :  "Certainly,  negroes  do  suffer  greatly  on  many 
cotton  plantations  in  the  middle  belt  of  the  Southern  States ; 
and  I  have  seen  no  evidence  to  prove  that  negroes  can,  in  this 
region,  become  accustomed  to  the  marsh  poison  ;  and  my  observ- 
ation has  been  extensive  in  four  States.  A  question  here  arises: 
Is  there  any  difference  in  types  of  those  malarial  fevers  which 
originate  in  the  flat  tide-water  rice-lands,  and  those  of  the  clay- 
hills,  or  marsh  fevers  of  the  interior?  I  am  inclined  to  think 
there  is."    (p.  381.) 

Having  already  extended  this  notice  of  Dr.  Nott's  able  and 
interesting  paper,  beyond  the  limits  we  had  intended,  we  must 
bring  it  to  a  close,  by  adding  the  author's  conclusions. 

"  1.  That  the  earth  is  naturally  divided  into  zoological  realms 
— each  possessing  a  climate,  Fauna,  and  Flora,  exclusively  its 
own. 

"  2.  That  the  Fauna  of  each  realm  originated  in  that  realm, 
and  that  it  has  no  consanguinity  with  other  Faunas. 

"  3.  That  each  realm  possesses  a  group  of  human  races,  which, 
though  not  identical  in  physical  and  intellectual  characters,  are 
closely  allied  with  one  another,  and  are  disconnected  from  all 
other  races.  We  may  cite,  as  examples,  the  white  races  of  Eu- 
rope, the  Mongols  of  Asia,  the  blacks  of  Africa,  and  the  aborig- 
ines of  America. 

"  4.  That  the  types  of  man,  belonging  to  these  realms,  ante- 
date all  human  records,  by  thousands  of  years ;  and  are  as 
ancient  as  the  Faunas  of  which  each  forms  an  orginal  element. 

"  5.  That  the  types  of  man  are  separated  by  specific  charac- 
ters, as  well  marked  and  as  permanent  as  those  which  designate 
the  species  of  other  genera. 

"  6.  That  the  climates  of  the  earth  may  be  divided  into  phys- 
ical and  medical;  and  that  each  species  of  man,  having  its  own' 
physiological  and  pathological  laws,  is  peculiarly  affected  by 
both  climates. 

"  7.  That  no  race  of  man  can  be  regarded  as  cosmopolite ;  but 
that  those  races  which  are  indigenous  to  latitudes  intermediate 


1858.]  On  Scarlatina.  25 

between  the  equator  and  poles,   approach  nearer  to  cosmopolit- 
ism than  those  of  the  Arctic  or  the  Torrid  Zone. 

"  8.  That  the  assertion,  that  any  one  race  ever  has,  or  ever 
can  be,  assimilated  to  all  physical  or  all  medical  climates,  is  a 
hypothesis  unsustained  by  a  siDgle  historical  fact,  and  opposed 
to  the  teachings  of  natural  history."    (p.  401.)  D. 


On  Scarlatina.  A  Clinical  Lecture  delivered  in  Paris,  by  M. 
Trousseau.  (Translated  from  the  Gaz.  Hebdomadaire.)  Con- 
cluded from  page  730,  vol.  xiii. 

We  have  now  come  to  a  more  difficult  part  of  the  question — 
to  the  consideration  of  that  which  I  have  called  latent  (fruste) 
scarlatina. 

You  know  what  is  meant  in  archaeology  by  a  latent  (fruste)  in- 
scription; that  a  greater  or  less  part  of  it  is  wanting,  a  line,  a 
letter,  a  point  even  only  remaining.  In  speaking  of  pneumonia, 
we  have  seen  that  that  disease  could  be  latent,  that  often  there 
was  only  a  word  in  the  symptomatological  phrase,  and  that  from 
this  word  alone  the  physician  should  find  out  the  whole  phrase.  It 
is  with  the  physician  as  with  the  numismatist  and  archaeologist. 
At  the  commencement  of  their  studies  these  have  to  read  from 
well  preserved  medals,  from  stones  intact,  while  the  student  of 
medicine  requires  that  all  the  symptoms  which  usually  character- 
ize a  disease  should  be  found  in  a  case  which  falls  under  his  ob- 
servation. After  a  while,  however,  the  archaeologist  only  requires 
a  word,  a  letter,  to  be  enabled  to  decipher  the  effaced  inscription. 
So  it  is  with  the  more  experienced  physician ;  he  divines  from  a 
single  symptom  of  a  disease  the  whole  disease.  Of  all  the  latent 
diseases,  scarlatina  presents  these  desiderata  the  oftenest. 

In  1829,  one  of  my  friends  told  me  that  scarlatina  prevailed  in 
a  little  village  near  Mennecy,  in  the  department  of  Seine-et-Oise, 
and  principally  in  the  communes  of  the  Chateau  de  Villeroy. 
Wishing  to  study  this  epidemic,  I  could  do  it  more  easily  from 
the  fact  that  as  the  chateau  was  perfectly  isolated,  the  evolutions 
of  the  disease  could  be  easily  followed. 

I  saw  individuals  of  the  same  family  affected  with  sore  throat, 
without  eruption,  and  although  they  remained  in  the  midst  of 
those  who  were  afterwards  attacked  with  scarlatina,  these  persons 
escaped.  Their  sore  throat  was  violent,  accompanied  with  high 
fever,  redness,  and  desquamation  of  the  tongue.  Others,  who 
were  attacked  lightly,  being  slightly  unwell  for  eight  or  ten  days, 
sudenly  became  swollen,  and  passed  blood.  Albuminuria  was 
not  known  at  that  period.     These  facts  struck  me,  and  caused 


26  On  Scarlatina.  [January, 

me  to  think  these  persons  having,  some  of  them  the  eruption  and 
consecutive  anasarca,  others  the  anasarca  of  sore  throat  only, 
were  differently  attacked,  but  that  all  had  the  symptoms  of  scar- 
latina. 

Three  years  since  at  Meaux,  an  analogous  fact  came  under 
my  observation,  occurring  in  the  same  house.  A  young  girl, 
fourteen  years  old,  was  taken  with  a  violent  scarlatina,  character- 
ized by  croupal  angina,  the  eruption,  and  an  intense  fever.  A 
few  days  afterwards,  her  sister  was  also  taken  sick  with  the  same 
symptom  ;  almost  at  the  same  time  a  chambermaid  fell  sick ;  two 
or  three  days  after,  a  man-servant,  who  staid  in  the  room  the 
whole  day,  was  affected  with  a  severe  sore  throat,  with  croupal 
exudations  on  the  tonsils,  redness  and  exfoliation  of  the  tongue, 
high  fever,  but  without  cutaneous  eruptions.  It  was  clear  to  me, 
as  the  physician  of  the  family,  M.  Saint  Armand,  also  thought, 
that  all  these  patients  had  scarlatina,  and  in  fact  the  man-servant, 
although  remaining  in  the  midst  of  the  epidemic  locality,  did  not 
take  the  disease  with  which  he  had  been  inoculated  in  the  same 
degree  as  the  rest  of  the  family  ;  while  the  scarlatinous  phase  was 
complete  in  the  others,  in  him  the  inscription  was  latent  (fruste). 
There  still  remained  a  young  boy,  six  years  old.  Suddenly,  with- 
out having  been  sick  a  single  instant,  he  became  swollen.  M. 
Blache  and  myself  were  called  in  consultation,  and  we  recog- 
nized the  anasarca  of  scarlatina  presenting  itself  at  the  outset;  it 
was  considerable,  and  accompanied  with  haematuria.  The  father 
and  mother,  who  were  very  attentive  to  the  health  of  their  son, 
declared  that  in  the  morning  he  had  breakfasted  as  usual.  This 
child  had  neither  fever  nor  eruption,  and  the  disease  manifested 
itself  in  time,  by  the  single  symptom  which  we  have  indicated. 
Eight  days  afterwards  he  had  a  double  pleurisy,  and  came  near 
dying.  Called  again  in  consultation,  M.  Blache  and  I  recognized 
this  affection  ;  four  days  after,  we  found  one  of  the  sides  of  the 
chest  cured,  while  the  other  had  taken  on  an  enormous  develop- 
ment. We  performed  paracentesis  of  the  chest,  and  drew  off  one 
pound  and  a  half  of  pus.  During  two  to  three  months,  Dr.  Saint 
Armand  made  iodine  injections  into  the  pleura;  notwithstanding 
a  pulmonary  perforation,  the  child  recovered,  and  is  now  in  good 
health. 

I  have  not  myself  had  any  cases  like  these.  Graves  cited  sev- 
eral, a  few  of  which  I  shall  translate  for  you. 

"Young  F was  taken  home  from  school  when  scarlatina 

prevailed.  He  complained  of  sore  throat  upon  swallowing,  head- 
ache, nausea.  The  next  day  the  tonsils  were  swollen,  and  he 
experienced  a  greater  difficulty  in  swallowing.  His  pulse  was 
quick,' — skin  hot,  but  no  traces  of  eruption.  These  symptoms 
continued  three  days  without  increasing  in  severity,  and  then  dis- 
appeared.    Before  he  entirely  recovered  his  two  sisters  and  his 


1858.]  On  Scarlatina.  27 

father  were  attacked.  The  eruption  appeared  upon  the  skin  in 
his  two  sisters,  and  ended  in  desquamation,  while  in  his  father 
there  were  only  a  few  red  points  upon  his  skin,  without  ulterior 
desquamation." 

"Master  O also   returned   from   school  with   scarlatina. 

During  his  sickness  his  two  sisters  and  his  brother  were  taken 
with  the  same  disease.  In  all  these  it  manifested  itself  under  the 
form  of  small  eruptions,  or  maculae,  upon  the  skin.  At  the  same 
time  the  man-servant  and  maid-servant  suffered  from  violent  an- 
gina, with  high  fever,  which  lasted  several  days." 

These  facts  are  identical  with  those  I  have  myself  seen.  In 
the  following,  which  occurred  in  the  family  of  a  physician,  you 
will  observe  that  the  disease  developed  itself  by  anasarca : 

"  The  following  case,"  says  Graves,  u  was  communicated  to  me 
by  a  very  eminent  practitioner  of  Dublin.  A  few  years  since 
scarlatina  broke  out  in  the  family  of  this  physician,  and  attacked 
all  the  children,  with  the  exception  of  a  young  lady  who,  although 
taking  care  of  her  sisters  during  their  sickness,  had  no  symptom 
of  it.  When  they  were  convalescing,  the  family  was  sent  into 
the  country  for  the  sake  of  the  change  of  air,  ihe  sister  who  had 
not  been  sick  accompanying  them.  There,  to  their  great  aston- 
ishment, she  was  suddenly  taken  with  that  peculiar  anasarca 
which  is  observed  in  those  who  have  had  scarlatina.  Her  father, 
who  took  care  of  her  during  this  sickness,  was  struck  with  this 
singular  fact :  he  paid  particular  attention  to  it,  and  became  con- 
vinced that  it  was  a  latent  scarlatina." 

"  These  cases,  and  those  of  which  I  have  already  spoken,"  con- 
tinues Graves,  "are  very  interesting  in  a  pathological  point  of 
view  ;  they  tend  to  prove  this  fact,  that,  in  many  circumstances, 
diseases  produced  by  contagion  do  not  present  the  same  series  of 
symptoms  which  ordinarily  characterize  them." 

These  extracts  from  the  English  author  prove  that  the  same 
things  occur  in  Dublin  as  in  Paris.  It  is  very  certain  that  you 
will  see  these  latent  scarlatinas ;  you  cannot,  therefore,  become 
too  familiarly  acquainted  with  them.  Graves  insists  upon  these 
facts  as  a  means  of  demonstration,  and  he  positively  indicates 
that  these  are  cases  of  scarlatina ;  for,  says  he,  the  disease  being 
essentially  contagious,  it  would  be  impossible  that  those  who  only 
had  the  sore  throat  or  the  anasarca  should  be  alone  exempt  in  the 
midst  of  their  family  sick  with  scarlatina,  which  had  attacked  all 
the  rest. 

Treatment. — The  eruptive  diseases,  whether  the  eruption 
takes  place  on  the  skin  or  upon  the  internal  viscera,  as  is  the  case 
in  putrid  or  typhoid  fever,  which  is  an  eruptive  disease  of  the  di- 
gestive tube,  the  eruptive  diseases  have  a  fatal  course ;  that  is  to 
say,  they  have  determined  phenomena  against  which  we  cannot 
n.s. — vol.  xrv.  no.  i.  2 


28  On  Scarlatina.  [January, 

cope  with  success.  In  the  treatment  of  these  diseases,  the  physi- 
cian  should  not  forget  this  grand  fundamental  fact ;  that  whatever 
may  be  said,  he  cannot  prevent  the  progress  of  a  putrid  fever,  nor 
can  he  cut  short  a  case  of  variola  or  rubeola.  Doubtless,  unskil- 
ful attention  can  retard  or  modify,  in  a  certain  manner,  the  ap- 
pearance of  the  eruptions  ;  but  whatever  means  may  be  employed, 
art  is  powerless  against  the  evolution  of  an  exanthematous  fever, 
whatever  it  may  be.  In  these  diseases,  more  than  any  other,  the 
physician  should  be  minister  natural  et  interpres  ;  for  in  these  dis- 
eases, more  than  any  other,  quicquid  meditetur  etfaciat,.  si  natural 
non  obteinperat  natural  non  imperat;  his  duty,  when  everything 
progresses  regularly,  should  be  essentially  passive,  otiosus  crisium 
spectator,  as  Fizer  said  ;  if  no  severe  symptom  arises,  he  has  only 
to  fold  his  arms;  in  a  few  days  the  disease  will  have  accomplish- 
ed its  evolution  naturally. 

When  the  eruptive  fevers  become  in  some  particulars  men- 
acing, our  intervention,  let  us  avow  it,  is  generally  of  little  avail. 
In  some  circumstances,  however,  we  can  be  useful.  These  for- 
tunate circumstances  in  which  art  interferes  efficaciously,  are 
more  frequently  met  with  in  scarlatina  and  rubeola  than  in  vario- 
la and  putrid  fever. 

I  shall  show  you  what  the  physician  can  do  in  the  first  of  these 
diseases.  Above  all,  it  is  well  to  recollect  that  scarlatina  varies 
greatly  in  its  form  and  severity ;  that  sometimes  it  is  of  an  extra- 
ordinary mildness,  sometimes,  on  the  contrary,  its  malignancy 
renders  it  a  terrible  disease,  the  equal  of  the  plague  and  typhus. 
This  should  be  taken  into  account,  for  success  should  not  be 
attributed  to  the  medication  which  he  may  have  used,  the  honor 
of  which  belongs  entirely  to  the  benignity  of  the  epidemic  itself; 
nor  should  his  failures  be  laid  to  the  treatment  wThich  could  not 
prevail  against  the  essentially  malignant  nature  of  the  disease. 

Epidemics  can  be  generally  severe  for  a  whole  population ; 
they  can  also  be  severe  for  a  single  family.  The  malignancy  can 
be  circumscribed,  so  to  say,  within  a  small  compass ;  but  in  these 
cases,  it  is  malignant  for  almost  all  those  it  attacks  within  the  cir- 
cle to  which  it  is  confined.  In  this  connection  I  will  recall  to 
your  recollection  the  sad  fact,  published  lately  in  the  English 
journals,  of  scarlatina  carrying  off,  in  one  week,  six  or  seven 
children  of  a  clergyman  of  York. 

It  seems  that  the  poison  with  which  those  attacked  with  scar- 
latina are  infected,  has  a  particular  activity,  or  that  the  constitu- 
tion of  each  of  the  patients  is  disposed  in  a  special  manner  for 
receiving  it.  Whether  the  malignancy  depends  upon  the  nature 
of  the  disease,  upon  its  epidemic  character,  as  Sydenham  and 
others  say, — whether  it  depends  upon  the  particular  constitution 
of  the  individuals,  according  to  the  opinion  of  Stoll,  this  grand 
fact  always  remains,  namely  :  that  when  scarlatina  breaks  out  in 


1858.]  On  Scarlatina.  29 

a  family,  with  its  terrible  phenomena,  destroying  the  first  it  at- 
tacks, it  is  well  to  mistrust  and  fear  it,  for  it  will  probably  take 
off  other  victims ;  and  also  when  its  first  severity  has  moderated, — 
when  it  appears  from  the  start  benign,  it  is  well  to  hope,  for  gen- 
erally it  will  remain  benign. 

This  should  be  said  before  entering  upon  the  study  of  the  treat' 
ment,  in  order  to  put  you  upon  your  guard  against  yourselves.  I 
cannot  repeat  it  too  often  that,  if  the  disease  is  in  itself  severe, 
the  best  medication  will  most  frequently  fail ;  if  it  is  in  itself  be- 
nign, recovery  will  most  usually  result,  and  the  most  inappropriate 
medication  will  not  be  injurious. 

There  is  a  point  upon  which  all  epidemiographists  agree  ;  it  is, 
that  the  antiphlogistic  treatment,  bleeding,  too  energetic  purgatives, 
and  rigorous  diet,  are  pernicious.  There  is  not,  perhaps,  an  au- 
thor,— I  speak  of  those  who  have  followed,  studied,  and  described 
many  successive  epidemics, — who  has  not  established  the  danger 
of  this  treatment  in  severe  scarlatina,  and  even  when,  in  the  pnv 
gress  of  this  disease,  acute  inflammatory  phenomena  arise,  such 
as  phlegmons  of  the  tonsils,  of  the  lymphatic  ganglions,  of  the 
cellular  tissue,  that  bleeding  and  leeches  do  not  generally  succeed, 
probably  because  they  are  directed  to  symptoms  of  a  septic  dis- 
ease,— of  a  disease  of  a  bad  character,  mali  maris, — one  of  those 
malignant  diseases  in  which  the  antiphlogistic  treatment  is  always 
invariably  injurious. 

Still  these  epidemiographists,  in  giving  the  sad  results  of  their 
experience, — in  condemning  the  antiphlogistic  means  of  which 
they  have  observed  the  bad  results, — these  epidemiographists'  teach 
you  that,  if  the  energetic  purgatives  are  hurtful,  the  milder  mer- 
curials, the  neutral  salts,  given  in  a  proper  proportion,  are  of  real 
utility.  They  say  that,  under  the  influence  of  laxatives  which 
produce  two  or  three  passages  a  day,  the  febrile  movement  will 
be  most  usually  moderated.  However,  they  are  far  from  pretend- 
ing that  the  disease  is  always  cured  by  these  means. 

We  have  seen  that,  in  Scarlatina,  and  particularly  when  at  its' 
height,  patients  seem  to  succumb  to  a  nervous  exaltation,  at  least 
to  nervous  disturbances,  arising  either  in  the  centres  of  organic 
life,  characterized  by  an  extra  ordinary  elevation  of  the  tempera- 
ture, vomiting,  obstinate  diarrhoea,  or  in  the  centres  of  animal 
life,  manifested  by  delirium,  coma  vigil,  subsultus  tendinum,  and 
convulsions.  For  these  nervous  symptoms  there  is  a  treatment,  the 
value  of  which  has  been  proved  by  experience, — a  treatment 
which  the  physician  adopts,  however,  with  great  caution.  I  speak 
of  the  cold  affusions  extolled  by  Currie. 

Currie  was  the  first  to  recommend  their  use.  He  treated  a 
large  number  of  patients  afflicted  with  the  severe  form  of  scarla- 
tina, and  had  considerable  success  from  the  use  of  cold  affusions. 
Emboldened  by  his  fortunate  results,  he  insisted  upon  this  mod© 


30  On  Scarlatina.  [January, 

of  treatment,  and  established  its  application  as  a  general  rule  in 
scarlatina  accompanied  with  severe  nervous  symptoms,  such  as 
delirium,  convulsions,  diarrhoea,  excessive  vomiting,  and  a  high 
temperature  of  the  skin. 

How  should  this  treatment  be  applied?  The  patient  placed 
naked  in  an  empty  bath-tub,  three  or  four  pails  of  water,  at  a 
temperature  of  20°  centigrade  (68°  Fahrenheit)  are  thrown  over 
his  body.  This  affusion  lasts  from  a  quarter  of  a  minute  to  a 
minute,  at  the  longest.  The  patient  is  immediately  enveloped  in 
blankets,  placed  in  bed  without  being  wTiped  off,  and  properly 
covered ;  reaction  generally  follows  in  fifteen  or  twenty  minutes. 
The  allusions  are  repeated  once  or  twice  in  the  twenty-four 
hours,  according  to  the  severity  of  the  symptoms.  They  should 
be  administered  at  that  moment  when  the  nervous  phenomena 
assume  such  an  intensity  as  to  excite  our  fears  of  imminent  dan- 
ger; they  are  to  be  repeated  until  these  symptoms  cease,  relieving 
the  mind  of  the  physician  from  further  cause  of  alarm. 

To  suggest  in  private  practice  a  treatment  apparently  so  bold, 
one  would  have  to  have  grown  old  in  practice,  to  be  beyond  the 
necessity  of  being  sustained  by  public  opinion.  He  should  be 
fortified  by  a  deep  sense  of  duty — by  a  consciousness  of  doing 
well,  in  order  to  strive  successfully  against  the  popular  prejudice, — 
of  all  prejudices  perhaps  the  most  unfortunate, — which  demands 
that,  in  eruptive  fevers,  patients  should  have  warm  drinks  and  be 
wrapped  in  more  coverings  than  they  are  accustomed  to  in  health. 
There  is  no  prejudice,  we  say,  which  is  more  unfortunate  than 
this ;  there  is  none  which  more  frequently  occasions  the  death  of 
the  patient.  Yet  the  voice  of  Sydenham,  which  has  spoken  for 
two  hundred  years, — the  authority  of  the  most  distinguished  phy- 
sicians who  still  object  to  it,  resist  in  vain. 

You  understand,  then,  the  difficulties  which  the  young  physi- 
cian will  have  to  encounter  who  believes  he  should  have  recourse 
to  these  cold  affusions.  These  difficulties  are  the  greater  because 
it  is  in  the  severe  cases,  where  the  scarlatina  threatens  to  be  fatal, 
that  the  indications  of  this  treatment  are  found.  In  adopting  this 
treatment,  you  know  that  the  disease  gives  one  chance  of  recove- 
ry to  two  of  death,  and  you  can  foresee,  if  you  are  not  successful, 
what  will  be  the  opinion  of  the  family  afflicted  with  the  loss  they 
have  sustained. 

I  have  employed  these  affusions  for  a  long  time.  I  tried  them 
in  private  practice  before  adopting  them  in  hospital  practice,  for 
I  have  never  made  use  of  anything  there  which  I  had  not  previ- 
ously tried  in  my  private  practice.  As  to  these  cold  affusions,  I 
can  assure  you  that  I  have  never  used  them  without  gaining 
some  beneficial  effect  from  them.  I  do  not  pretend  to  say  that 
all  my  patients  were  cured.  Far  from  it.  I  have  lost  a  great 
many,  but  they  died  notwithstanding  the  treatment.     The  affu- 


1858.]  On  Scarlatina.  31 

sions,  instead  of  being  injurious,  seemed  to  moderate  the  symp- 
toms and  retard  the  fatal  termination.  By  acting  in  this  way  in 
private  practice,  my  reputation  ran  great  risks,  and  I  have  been 
often  badly  recompensed  for  doing  what  my  profound  conviction 
dictated;  but  I  remained  firm  in  my  course  which  duty  marked 
out  for  me,  and  I  persist  in  it  up  to  this  hour,  for  a  stronger  rea- 
son than  formerly ;  for  now,  my  position  being  established,  my 
responsibility  does  not  influence  me  as  much.  I  understand  your 
fears — not  that  you  doubt  the  advantages  of  the  treatment  which 
you  dare  not  adopt,  but  because,  while  consulting  before  all  the 
interest  of  the  sick  entrusted  to  your  care,  you  yet  have  to  watch 
over  your  own  reputation,  which  is  so  easily  affected  at  the  com- 
mencement of  your  career  as  practitioners.  Still,  when  the  voice 
of  duty  speaks  to  you,  when  your  conscience  tells  you  that  this 
treatment  you  dare  not  adopt  because  it  is  contrary  to  the  preju- 
dices of  the  world,  is  a  useful  treatment,  it  is  still  necessary  to  try 
it,  it  is  right  that  you  should  do  it.  But  then,  instead  of  resisting 
this  prejudice  face  to  face,  instead  of  taking  the  bull  by  the 
horns — if  you  will  pardon  me  this  vulgar  expression — avoid  the 
difficulty,  by  administering  these  useful  cold  affusions,  leaving  the 
patient,  and  especially  the  attendants,  in  the  belief  that  the  affu- 
sions are  warm. 

Scarlatina,  as  I  have  already  said,  especially  in  its  malignant 
form,  has,  of  all  diseases,  the  highest  elevation  of  the  temperature 
of  the  body.  In  some  cases.  I  have  also  told  you.  it  is  as  high  as 
106°  Fahrenheit,  consequently  about  six  degrees  above  the  normal 
temperature.  Now,  do  not  make  use  of  the  affusion,  but  of  sim- 
ple lotions,  and  with  water  at  seventy-seven  degrees  Fahrenheit, 
that  is,  29°  less  than  the  temperature  of  the  skin  of  the  patient; 
relatively  it  is  cold.  Put  the  patient  upon  a  cot-bedstead  and 
sponge  the  body  with  this  water,  first  in  front  and  then  behind,  and 
then  replace  him  in  his  bed,  wrapped  in  blankets,  as  I  have  already 
indicated.  Although  less  efficacious  than  cold  affusions,  this  kind 
of  affusion  has  a  positive  effect,  and  following  its  application,  you 
will  perceive  that  the  skin,  which  was  before  very  dry  and  ex- 
tremely hot,  will  become  in  half  an  hour  cooler  and  moist.  What 
is  still  more  remarkable,  is  the  diminution  in  the  frequency  of  the 
pulse.  Instead  of  beating  in  the  infant  160,  170,  180 ;  in  the 
adult  140,  150  ;  it  falls  to  130,  135,  140,  in  the  former;  to  120, 
115,  in  the  latter;  consequently,  30,  35,  40,  pulsations  less.  At 
the  same  time  the  cerebro-spinal  phenomena  diminish  in  intensi- 
ty, the  vomiting  and  excessive  diarrha?a,  symptoms  depending 
upon  disturbances  of  ganglionary  innervation,  also  diminish. 
Thanks  to  these  lotions,  then,  you  obtain,  for  a  short  time  I  grant, 
a  remarkable  sedation.  I  say  for  a  short  time,  for  in  two  or  "three 
hours  the  symptoms  sometimes  return,  when  the  lotions,  or  affusions, 
should  also  be  repeated  two,  three,  or  four  times  in  the  twenty-four 
hours,  and  sometimes  five  or  six  days  in  succession. 


32  On  Scarlatina.  [January, 

What  becomes  of  the  eruption  ?  You  will  observe  this  fact, 
which  will  surprise  the  assistants  and  reconcile  the  family  to  the 
'lotions,  the  affusions  which  they  mistrusted;  that,  almost  invaria- 
bly, from  the  beginning  of  the  affusion,  the  skin,  which  was  pale, 
or  of  a  faint  red  color,  becomes  more  developed.  These  affusions, 
therefore,  not  only  do  not  decrease  the  eruption,  but  bring  it  out, 
so  that  the  parents  themselves  notice  it,  and  as  long  as  danger 
continues,  they  are  often  the  first  to  solicit  its  employment, 
unable  to  refuse  to  recognize  the  amelioration  which  this 
method  of  treatment  has  produced,  particulary  struck  with  the 
fact  that  the  eruption  reappeared  more  distinct.  Yet,  in  verity, 
if  the  result  of  this  amelioration  is  not  favorable,  if  death  takes 
place,  they  forget  the  encouragement  they  gave  you,  they  accuse 
you  of  the  misfortune  which  can  only  be  attributed  to  the  char- 
arter  of  the  disease. 

To  meet  these  terrible  symptoms  of  scarlatina,  other  internal 
remedies  can  be  administered  with  advantage.  And  first,  the  am- 
moniacals,  the  carbonate  of  ammonia,  spirits  of  mindereri,  which 
is  an  acetate  ammonia,  mixed  with  some  empyreumatic  products ; 
these  two  medicaments  in  the  dose  of  \  a  drachm  to  1  drachm, 
— ammonia  itself  in  the  dose  of  10  to  20  drops, — can  be  very 
useful.  I  shall  say  as  much  of  musk,  of  which  3,  4J,  6  grains, 
and  even  15  grains,  is  given  in  the  course  of  twenty-four  hours. 
These  means  should  be  used  with  prudence;  they  constitute  an 
accessory  treatment  in  those  cases  where  the  cold  affusions  are 
employed ;  when  they  are  not  employed,  they  comprise  the  prin- 
cipal therapeutical  means. 

The  angina  of  scarlatina,  which  is  accompanied  with  croupy 
exudations,  when  they  are  not  very  abundant,  is  not  very  dan- 
gerous. But  in  malignant  scarlatina  the  disease  attacks  the 
throat,  and  generally  the  physician  cannot  prevent  it. 

I  have  tried  cauterizations  with  nitrate  of  silver,  with  chlorohy- 
dric  acid;  I  have  tried  borax  in  collutories;  I  have  given 
chlorate  of  potassa  within,  and  I  must  say  that  all  these  remedies 
have  very  often  failed  in  my  hands.  However,  of  all  these  thera- 
peutic agents,  the  most  to  be  depended  upon,  chlorohydric  acid, 
applied  twice  a  day,  has  seemed  to  be  of  some  use.  This  caustic 
is  to  be  used  with  great  prudence  and  precaution.  In  children, 
during  the  stuggle  to  overcome  their  resistance,  you  may  burn  . 
the  tongue,  the  teeth,  the  internal  walls  of  the  mouth,  and  thus 
increase  the  evil  without  cauterizing  as  it  should  be  done.  By 
holding  the  child  properly,  and  opening  his  mouth  by  means  of  a 
spatula,  you  can  sometimes  obtain  good  results  from  these  cauter- 
izations, touching  the  diseased  parts  twice  a  day,  for  five  or  six 
days,  with  a  camel's  hair  pencil  saturated  in  the  acid.  Insuffla- 
tions of  alum  and  tannin,  used  alternately,  are  also  very  useful. 
As  to  that  form  of  angina  which  is  not  observed  during  the  height 


1858.]  On  Scarlatina.  33 

of  the  disease,  but  comes  on  suddenly  about  the  ninth  or  tenth 
day,  with  an  abundant  exudation  from  the  nose,  with  deafness, 
or  severe  pain  in  the  ears,  foetid  breath,  frequent  pulse,  and  great 
depression,  as  to  that  angina  which  is  probably  only  a  diphtheri- 
tic complication  of  scarlatina,  it  resists  all  our  efforts.  All  kinds 
of  treatment  which  I  have  tried  have  failed — nasal  injection  with 
styptics,  with  the  solutions  of  sulphate  of  copper,  of  sulphate  of 
zinc,  nitrate  of  silver,  with  the  decoction  of  rhatany,  with  tannin, 
the  cauterizations  of  the  throat — all  have  failed  ;  patients  almost 
invariably  succumbing,  whatever  you  do.  In  these  cases  you  must 
Tely  upon  generous  treatment,  upon  sulphate  of  quinine,  coffee, 
and  especially  upon  a  strengthening  alimentation. 

And  now  of  the  anasarca  of  scarlatina  and  the  symptoms 
which  complicate  it.  I  have  already  stated  that  it  follows  less 
frequently  the  severe  forms  than  the  benign  eruptions.  Often  it 
constitutes  a  complication  of  the  greatest  importance,  in  other 
cases  this  complication  is  not  serious.  When  it  is  slight,  I  have 
also  said  that  hygienic  means,  rest  in  bed,  lukewarm  drinks,  a 
moderate  diet,  is  all  that  is  necessary.  When,  however,  the  urine 
contains  blood,  acid  drinks,  lemonade,  the  decoction  of  uva  ursi, 
sweetened  with  the  syrup  of  turpentine,  small  quantities  of  digita- 
lis, mild  laxatives,  will  meet  these  symptoms.  But  when  the 
haemorrhage  is  quite  large  from  the  commencement,  when  the 
anasarea  increases  with  great  rapidity,  it  will  be  necessary  to 
resort  to  other  means  to  prevent  the  threatning  symptoms. 

Sulphuric  acid  given  internally  either  pure  or  in  alcohol  (eau 
de  rabel),  in  the  dose  of  \  a  drachm  to  \\  drachms  a  day,  in  a 
draught  sweetened  with  syrup  of  rhatany,  will  be  found  useful 
when  the  haemorrhage  is  abundant. 

The  anasarca  which  comes  on  rapidly  and  in  a  great  degree, 
is  ordinarily  accompanied  with  convulsions,  which  sometimes 
destroy  the  patient  with  the  first  attack.  Energetic  purgatives 
are,  in  these  cases,  useful,  by  causing  a  part  of  the  serum  effused 
into  the  celular  tissue  to  be  thrown  out  upon  the  surface  of  the 
intestine.  It  is  also  important  to  place  the  lower  limbs  of  the 
patient  hanging  over  the  side  of  the  bed,  and  the  head  raised  by 
pillows.  By  this  means  imminent  convulsions  may  be  prevented. 
But  in  some  cases  these  convulsions  are  present  from  the  begin- 
ning, coming  on  without  giving  warning  of  their  approach.  The 
patient  complains  of  a  severe  headache,  difficulty  in  the  sight, 
upon  one  side  alone  or  both  together,  sometimes  ringing  in  the 
ears  and  deafness.  In  these  cases,  scarifications  of  the  inferior 
extremities  may  be  of  advantage.  What  is  sometimes  better,  in 
attaining  the  same  result,  is  the  application  of  very  large  blisters 
upon  the  legs,  and  not  upon  the  thighs.  After  seven  or  eight 
hours,  phlyctenne  will  be  formed,  and  when  they  are  opened 
serum  will  flow  abundantly  from  them,  relieving  the  patient,  and 
enabling  him  to  pass  the  crisis  of  his  anasarea. 


31  On  Scarlatina.  [January, 

If  the  convulsion  takes  place,  give,  during  the  attack,  mush  in 
connection  with  small  doses  of  belladonna.  For  a  child  eight  or 
ten  years  old,  musk,  in  the  dose  of  from  3,  4£,  or  6  grains ;  bella- 
donna in  that  of  one-tenth  of  a  grain  for  a  single  dose.  At  the 
same  time  you  should  make  use  of  a  means  I  have  employed 
for  more  than  twenty  years,  and  from  which  I,  as  well  as  other 
physicians,  have  experienced  great  service :  I  speak  of  the  com- 
pression of  the  carotids.  This  compression  requires  to  be  carefully 
made,  and  in  a  certain  manner.  When  the  epileptiform  convul- 
sion predominates  upon  one  side,  the  compression  should  be 
exercised  upon  the  opposite  side.  If,  then,  the  convulsion  be 
predominant  upon  the  right  side,  it  is  the  left  carotid  which  should 
be  compressed,  and  reciprocally  if  the  convulsion  be  predominant 
upon  the  left  side  the  right  carotid  should  be  compressed.  If  the 
convulsion  be  equilateral  the  compression  should  be  alternately 
produced  upon  the  two  carotids, — I  speak,  be  it  well  understood 
of  the  primitive  carotids — and  even  simultaneously  upon  both, 
if  it  is  possible  to  do  so  without  interfering  too  much  with  the 
respiration  of  the  child. 

This  compression  is  easier  to  perform  than  you  would  suppose. 
Place  yourself  so  that  the  right  hand  can  compress  the  left 
carotid,  and  the  left  hand  the  right  carotid  ;  push  aside  the  sterno- 
cleidomastoid muscle,  while  with  the  back  of  the  ungual  phalanx 
you  push  aside  the  trachea,  and  you  will  feel  the  beatings  of  the 
carotids.  Seizing  it,  then,  from  within  with  the  ends  of  the 
fingers,  carry  it  backwards  a  little  and  press  it  against  the  verte- 
bral column.  You  will  instantly  perceive  that  it  is  compressed, 
by  the  absence  of  pulsation  in  the  corresponding  temporal  artery, 
by  the  paleness  which  sometimes  suddenly  succeeds  to  the  previ- 
ous redness  of  the  child's  face,  and  again  by  the  fact  that  in  some 
fortunate  cases  the  compression  is  no  sooner  established  than  the 
eclamptic  convulsion  ceases.  Continue  this  compression  upon 
one  of  the  arteries  for  fifteen  to  twenty  minutes,  then  compress 
the  other.  If  you  have  an  aid  that  can  assist  you,  his  assistance 
will  be  useful  to  you  in  this  operation;  the  mother,  whose  solicitude 
renders  her  so  intelligent,  can  replace  you.  By  this  means,  having 
patience,  the  convulsions  accompanying  the  anasarea  of  scarlatina 
can  be  arrested,  in  a  certain  number  of  cases,  in  a  few  hours. 

There  still  remains  that  form  of  anasarea  which  if  it  becomes 
chronic,  can  be  relieved.  When  the  convulsions,  which  are  so 
often  mortal,  have  ceased ;  when  the  hematuria,  which  precedes 
or  accompanies  the  anasarca  has  passed,  give  the  patients  diure- 
tics, nitrate  of  potassa  principally,  in  connection  with  small  doses 
of  digitalis,  give  also  a  remedy  prescribed  by  Graves,  the  iodide 
of  potassium  in  large  doses. 

In  some  cases  the  anasarca  and  the  albuminuria,  which  are 
ordinarily  cured  in  fifteen  days,  three  weeks  or  a  month,  can  be- 


ISoS.]  Artificial  Rupture  of  the  Amniotic  Sac.  35 

come  the  commencement  of  Bright's  disease.  The  acute  symp- 
toms disappear,  the  albuminuria  persists  ;  if  it  persists  a  month 
or  six  weeks  after  scarlatina,  beware  of  this  symptom:  it  indi- 
cates the  commencement  of  Bright's  disease  ;  the  kidney  is  infil- 
trated with  fibroplastic  tissue,  after  six  weeks  the  fatty  element 
predominates,  and  a  few  months  later  the  patient  succumbs  to 
this  new  afFection. 

Finally,  there  are  a  few  more  serious  symptoms  which  are 
developed  in  this  last  period  of  scarlatina  about  the  same  time  as 
anasarca.  They  are  the  serous  effusions  of  the  pleura  and  peri- 
cardium. 

For  these  the  repeated  applications  of  fly-blisters,  and  if  the 
hydrothorax  or  the  hydro-pericarditis  is  very  great,  puncture 
may  be  useful. 

In  large  pleural  effusions,  thoracentesis  sometimes  becomes 
necessary  after  a  very  few  days.  But  often,  as  I  have  already 
observed,  with  the  first  puncture,  even  when  the  effusion  has  not 
existed  more  than  ten.  fifteen,  or  twenty  days,  you  will  find  a  lactes- 
cent serum,  sometimes  pus,  already  formed.  Then  you  have 
empyema,  a  formidable  complication,  which  you  can  frequently 
cure  in  young  persons  by  puncture,  and  repeated  iodine  injec- 
tions ;  but  which,  in  adults,  notwithstanding  these  means,  you 
will  rarely  cure. — [American  Med.  Monthly. 


Artificial  Rupture  of  the  Amniotic  Sac  during  Labor. —  Objections 
to  the  Practice.  By  B.  F.  Richardson,  M.  D.,  Adjunct  Pro- 
fessor of  Obstetrics  and  Diseases  of  Women  and  Children,  in 
the  Medical  College  of  Ohio. 

[The  above  being  a  subject  of  much  interest,  we  present  to  our 
readers  Dr.  Richardson's  second  paper,  from  the  Western  Lancet^ 

In  the  last  number  of  this  Journal,  quotations  were  made  from 
numerous  standard  obstetrical  authorities,  which,  directiy  and 
by  fair  implication  embody  the  doctrine,  that  the  amniotic  sac  is 
the  only  proper  and  efficient  agent  in  the  production  of  dilatation 
of  the  os  uteri ;  that  after  it  is  well  dilated,  or  dilatable,  there 
remain  no  important  objections  to  rupturing  the  membranes ; 
and  that,  therefore,  it  is  undesirable  to  maintain  the  integrity  of 
the  amniotic  sac  beyond  that  period.  At  the  conclusion  of  that 
article  we  promised  to  show,  "  that  one  of  its  most  important 
-  remains  unfulfilled  until  the  presenting  part  has  passed 
through  the  superior  strait ;  and  that  in  all  natural,  uncomplica- 
ted labors,  especially  primipera,  the  membranes  should  not  be 
ruptured  at  any  time." 

If  this  proposition  can  be  sustained  by  argument  and  numer- 


36  Artificial  Rupture  of  the  Amniotic  Sac.       [January, 

ous  facts,  the  inference  is  patent,  that  the  views  entertained  and 
inculcated  by  obstetrical  writers  generally,  in  regard  to  the  office 
and  treatment  of  the  amniotic  sac,  are  well  calculated  to  serious- 
ly mislead  those  who  exercise  their  memory  more  than  their 
reason.  He  who  conceives  of  no  objection  to  the  rupturing  of 
the  membranes  after  the  os  uteri  is  well  dilated,  will,  almost 
certainly,  rupture  them,  in  expectation  of  exciting  more  vigor- 
ous uterine  contractions. 

Perhaps,  on  no  other  point  connected  with  obstetrics  has  there 
been  so  much  misinterpretation  of  facts,  assumptive  reasoning, 
and  erroneous  conclusions,  on  the  part  of  writers,  as  in  regard  to 
the  mechanism  and  phenomena  of  the  first  stage  of  labor.  As 
the  views  entertained  by  Professor  Murphy  on  this  point  are  in 
accordance  with  those  of  most  writers,  and  as  he  has  elaborated 
the  argument  through  which  these  views  have  generally  been 
derived,  a  review  of  his  positions  will  be  appropriate,  in  the 
course  of  my  remarks. 

Is  the  amniotic  sac  the  only  proper  and  efficient  agent  in  the  pro- 
duction of  dilatation  of  the  os  uteri  ? 

Are  there  any  important  objections  to  rupturing  the  membranes 
after  complete  dilatation  of  the  os  uteri  has  taken  place  f 

The  discussion  of  these  questions  will  embody  the  answer  to 
the  first :  Is  it  desirable  to  maintain  the  integrity  of  the  amniotic  sac 
during  labor? 

Prof.  DeweeSj  by  an  ingenious  argument,  attempts  to  show 
that,  ordinarily,  the  amniotic  sac  has  nothing  to  do  in  the  pro- 
duction of  dilatation  ;  but  unfortunately  he  admits,  in  part,  that 
which  he  undertakes  to  disprove ;  and  moreover  is  guilty  of 
palpable  inconsistency.  At  the  conclusion  of  paragraph  515,  he 
writes:  "  but  in  this  admission,  let  it  be  recollected  that  I  con- 
sider the  waters  as  useful  by  their  equal  pressure  upon  the  lower 
part  of  the  uterus,  and  by  distending,  and  at  the  same  time,  by 
the  same  agency,  weakening,  the  circular  fibres  of  the  part,  and 
thus  indirectly  favoring  the  dilatation  of  the  mouth  of  the  ute- 
rus." Now  turn  to  paragraph  518.  "  When  the  os  uteri  does 
dilate,  it  is  not  by  its  edges  being  stretched  mechanically ;  it  is 
an  absolute  inability  in  the  circular  fibres  to  maintain  a  state  of 
contraction,  and,  for  the  time  being,  may  be  considered  as  par- 
alyzed;  or  excessively  fatigued;  or,  perhaps,  more  properly 
speaking,  it  is  the  relaxation  of  a  sphincter  not  subject  to  the 
control  of  the  will."  Where  a  proposition  is  faulty,  the  reason- 
ing is  apt  to  be  illogical.  This  gifted  and  lamented  author  was 
endowed  with  a  spirit  of  controversy  to  an  extent  that  some- 
times led  him  into  the  adoption  and  support  of  views,  which  his 
acknowledged  powers  of  argumentation  were  insufficient  to 
sustain.  However,  in  attempting  to  exclude  entirely,  the  amni- 
otic sac  as  a  usual  participant  in  the  dilatation  of  the  os  uteri, 


1858.]  Artificial  Rupture  of  the  Amniotic  Sac.  37 

he  assumed  a  task  perhaps  not  more  difficult  than  that  of  Prof. 
Murphy,  who  undertakes  to  demonstrate  that  it  is  the  only  pro- 
per and  efficient  dilating  agent. 

We  have  heretofore  stated  that  the  argument  and  assumptions 
of  Prof.  Murphy  involve  "a  total  disregard  of  well  known  hy- 
drostatic and  mechanical  laws ;  and  that  he  takes  the  position 
"  that  the  amniotic  sac  is  a  better  dilator  of  the  os,  than  the 
smooth,  round,  and  comparatively  unyielding  vertex."  At  page 
55,  commenting  upon  the  argument  of  Dewees,  he  remarks : 
"  It  would  make  the  membranes  not  only  useless  as  a  means  of 
dilatation,  but  rather  a  difficulty  in  its  accomplishment.  The 
head  of  the  child,  directly  applied  to  the  cervix,  would  over- 
come the  resistance  of  the  circular  fibres  much  more  efficiently 
than  the  liquor  amnii,  so  that  the  most  favorable  kind  of  dilata- 
tion would  be  that  which  occurs  when  the  membranes  are  rup- 
tured at  the  commencement  of  labor.  It  is  very  well  known 
that  this  does  not  happen ;"  and  after  giving  Dewees'  explana- 
tion of  the  difficulty,  proceeds :  "  But  in  place  of  the  waters,  there 
is  the  large,  round,  and  unyielding  head  of  the  child  forced  down 
upon  the  lower  part  of  the  uterus,  which  one  would  suppose 
more  efficient  for  the  purposes  of  mechanical  distension." — Ac- 
cording to  the  opinion  of  Dewees,  and  not  his  own,  as  we  may 
fairly  infer.  Again,  at  page  50,  "If  the  uterus  exerted  its  fuU 
power  upon  the  un  dilated  os  uteri,  and  if  the  unyielding  head 
of  the  child  were  driven  forcibly  against  it,  the  almost  certain 
consequence  would  be,  that  the  irritation  would  excite  increased 
resistance,  and  ultimately  terminate  in  inflammation  of  the 
mouth  of  the  uterus.  To  obviate  such  an  effect,  nature  interpo- 
ses a  fluid  medium  between  the  power  and  the  resistance.  The 
liquor  amnii  contained  within  the  membranes,  occupies  the 
cavity  of  the  uterus,  and  when  its  parietes  contract  upon  it,  the 
force  exerted  is  (as  we  have  explained)  by  this  means,  accurate- 
ly conveyed  to  the  os  uteri.  When  the  latter  dilates  in  the 
slightest  degree,  the  fluid  insinuates  itself  within  the  smallest 
opening,  and  expands  it  by  a  direct  lateral  pressure  against  its 
edges.  The  power  of  the  uterus  is  thus  made  to  act  in  the  most 
favorable  manner  for  distending  its  mouth." 

On  same  page,  he  says:  "  Further,  so  long  as  the  tissue  of  the 
uterus  intervenes,  it  is  necessary  to  moderate  the  great  power 
which  the  uterus  is  capable  of  exericising  to  dilate  it :  this  is 
effected  by  the  liquor  amnii."  Again,  on  page  108 :  "  The  gra- 
dual escape  of  the  liguor  amnii  also  gives  rise  to  tediousness.  If 
this  take  place  when  the  os  uteri  is  slightly  dilated,  in  other 
words,  when  the  latter  is  so  long  exposed  to  the  pressure  of  the 
head  of  the  child  as  to  become  irritated  by  it,  the  result  is  rigidi- 
ty of  the  os  uteri,  etc."  On  page  55  we  also  read:  "  If  they  are 
ruptured  when  the  dilatation  is  very  slight,  the  suddenly  in- 


38  Artificial  Rupture  of  the  Amniotic  Sac.       [January, 

creased  power  of  the  fundus,  forcing  the  head  of  the  child  against 
the  os  tineas,  soon  excites  irritation,  prevents  its  expansion,  and 
sometimes  causes  inflammation.  But  if  they  are  broken  when 
the  uterus  is  sufficiently  open  to  allow  the  membranes  to  protrude 
into  the  vagina,  and  the  contractions  of  the  fundus  to  increase, 
it  is  probable  that  the  dilatation  will  be  advanced  more  rapidly, 
etc."  This  last  quotation  contains  its  own  refutation.  I  have 
been  thus  copious  in  my  citations,  for  the  reason,  that  they  em- 
body the  views  of  all  authors  within  my  knowledge,  Dewees 
excepted. 

Now,  what  inferences  are  fairly  deducible  from  the  foregoing 
quotations  ?  I  shall  state  and  answer  them  as  I  proceed :  First- 
ly, the  amniotic  sac  is  the  essential  agent  in  the  production  of  dila- 
tation of  the  os  uteri,  producing  it  uby  a  direct  lateral  pressure 
against  its  edges."  The  fact,  that  in  a  fair  proportion  of  multi- 
paras labors,  the  uterine  orifice  opens  readily  and  to  some  con- 
siderable extent,  before  either  the  head  or  membranes  have 
engaged  within  it,  is  fatal  to  this  theory.  Further,  it  is  a  well 
known  fact  to  those  who  have  made  careful  observation,  that 
occasionally  in  multiparas  labors,  where,  from  fragility  of  the 
membranes,  the  liquor  amnii  has  been  evacuated  early,  and  be- 
fore the  head  has  descended  sufficiently  to  press  upon  the  os ; 
enlargement  of  the  orifice  proceeds  without  interruption. 

There  are  three  agencies  concerned  in  the  production  of  dila- 
tation. Firstly:  and  essentially,  contraction  of  the  cervico- 
fundal  fibres  acting  upon  the  circle  of  the  os  uteri  through  their 
free  extremities.  Secondly,  a  body  (the  amniotic  sac  or  presen- 
ting part)  over  which  to  retract  the  border  of  the  os  ;  and,  Third- 
ly :  pressure  by  descent  of  the  amniotic  sac,  or  presenting  portion 
of  the  foetus. 

Secondly :  The  amniotic  sac  is  a  more  efficient  dilating  agent 
than  the  vertex,  for  the  reason,  that  the  force  exerted  by  the  uterine 
contractions  is  " accurately  conveyed  to  the  os  uteri'"  tuhereas  the 
same  force  transmitted  through  the  vertex,  would  "  soon  irritate"  the 
os,  and  " prevent  its  expansion."  Here  we  have  groundless  as- 
sumption, misinterpretation  of  facts,  and  erroneous  conclusions. 
By  what  law  of  mechanics  does  a  yielding  body  like  the  am- 
niotic sac,  become  a  more  efficient  mechanical  dilator  than  a 
solid  body  like  the  vertex  ?  If  the  force  of  the  contractions  is 
(as  is  asserted)  accurately  conveyed  to  the  edges  of  the  os  uteri, — 
the  membranes  being  non-distensible,  and  therefore  unable  to 
absorb  any  of  the  force —  why  is  the  amniotic  sac  incapable  of 
irritating  and  inflaming  the  os  and  arresting  its  dilatation,  no 
matter  how  great  the  power  exerted  by  the  uterine  walls  ?  Can 
the  vertex  do  more  than  transmit  this  force  to  the  edges  of  the 
os  uteri  ? 

Again,  it  is  assumed  that  the  whole  force  of  the  uterine  con- 


1858.]  Artificial  Rupture  of  the  Amniotic  Sac.  39 

tractions  is  accurately  conveyed  by  the  amniotic  liquor  to  the 
edges  of  the  os  uteri,  as  soon  as  the  latter  is  opened  in  the 
"  slightest  degree."  Now,  the  exact  measure  of  force  which  the 
liquor  amnii  is  capable  of  conveying  to  the  edges  of  the  os  uteri, 
is  determined  by  the  force  which  the  "unsupported  membranes  at 
the  orifice  are  capable  of  sustaining.  Who  can  suppose  for  a 
moment,  that  these  frail  membranes  can  support  the  whole 
power  generated  by  vigorous  uterine  contraction  ?  Let  us  take 
even  Prof.  Murphy's  own  statement,  when  combatting  the  argu- 
ment of  Dewees,  in  regard  to  the  antagonism  of  the  circular  and 
longitudinal  fibres :  "  but  how  the  membranes  could  resist  the 
effect  of  this  struggle  it  would  be  difficult  to  understand,  when 
we  know  that  change  of  position,  walking  across  the  room,  or 
other  such  trifling  causes,  are  sometimes  sufficient  to  rupture 
them,  from  the  gravitation  of  the  fluid  alone,  and  therefore  the 
greater  force  arises  from  the  action  of  the  fibres  of  the  uterus 
against  each  other,  must  break  them  more  frequently  than  what 
we  know  to  be  the  case."  Prof.  Murphy  therefore  supposes,  that 
antagonism  between  the  vertical  and  transverse  fibres,  imparts 
to  the  liquor  arnnii,  greater  force,  than  when  they  contract  con- 
jointly. Such  a  view  evinces  a  defective  knowledge  of  hydros- 
tatic laws.  The  simultaneous  contraction  of  all  the  uterine 
fibres,  will  distend  the  membranes  at  the  orifice  more  forcibly 
than  any  partial  contraction  possibly  can. 

Further,  it  is  assumed,  that  when  the  amniotic  sac  is  prema- 
turely ruptured,  it  is  replaced  by  the  vertex,  which  transmits 
the  power  of  the  uterine  contractions  to  the  os  uteri,  thereby 
irritating,  and  rendering  it  rigid  and  unyielding ;  and  the  con- 
clusion is,  that  the  tediousness  of  delivery,  and  apparent  change 
in  the  condition  of  the  os  uteri,  which  usually  attend  this  acci- 
dent, are  attributable  to  the  alleged  fact,  that  the  vertex  is  in- 
capable of  dilating  the  os  as  efficiently  as  the  amniotic  sac.  I 
have  dwelt  at  length  on  this  point,  as  the  most  important  con- 
nected with  our  discussion ;  and  an  exposition  of  the  mechan- 
ism and  phenomena  of  the  first  stage  of  a  primiperoa  labor,  will, 
I  think,  show  wherein  obstetrical  writers  have  been  led  into 
fallacious  reasoning,  and  false  conclusions,  by  the  oversight  and 
misinterpretation  of  facts.  At  the  commencement  of  labor,  and 
before  the  os  uteri  begins  to  open ;  we  find  the  child  occupying 
the  uterine  cavity,  with  its  pelvic  extremity  in  contact  with  the 
fundus,  and  its  head  resting  upon  the  pelvic  brim,  presenting 
the  occipitofrontal  diameter  more  or  less  modified, — the  liquor 
amnii  filling  up  the  inequalities.  As  the  contractions  continue, 
the  liquor  amnii  is  displaced  in  that  direction  in  which  there  is 
least  resistance — the  inferior  segment ;  for  it  is  a  well  known 
fact,  that  the  muscular  tissue  diminishes  in  quantity,  and  there- 
fore, in  power,  from  the  fundus  towards  the  orifice.     Whilst  the 


40  Artificial  Rupture  of  the  Amniotic  Sac.       [January, 

inferior  segment  is  undergoing  distension  by  the  downward  pro- 
jection of  the  liquor  amnii,  the  superior  portion  of  the  cavity  is 
lessened,  and  the  walls  of  the  body  and  fundus  permitted  there- 
by to  apply  themselves  more  closely  upon  the  child.  Then, 
as  the  cervix  continues  to  dilate,  and  the  os  begins  to  open, 
further  descent  of  the  liquor  amnii  is  allowed;  so  that  the  pro- 
portion of  the  uterine  force  transmitted  to  the  pelvic  brim, 
through  the  body  and  head  of  the  child,  increases  step  by  step: 
As  the  os  continues  to  open,  and  the  membranes  are  more  and 
more  exposed  to  rupture  from  diminishing  support  inferiorly, 
the  increasing  contractile  power  of  the  uterus  would  certainly 
rupture  them,  were  it  not  that,  as  the  labor  progresses,  the  pro- 
portion of  force  transmitted  to,  and  extended  upon  the  pelvic 
brim,  through  the  child,  is  gradually  increased.  This  is  a  wise 
provision  of  nature,  for  if  the  undivided  power  of  the  uterus 
should  be  exerted  upon  the  unsupported  membranes  at  the 
orifice  as  alleged  by  Prof.  Murphy  and  others,  rupture  of  them, 
unless  preter naturally  strong,  would  be  inevitable  at  an  early 
period  of  dilatation,  in  a  large  majority  of  first  labors.  As  the 
labor  progresses,  the  uterine  walls  are  applying  themselves  more 
firmly  upon  the  child,  during  each  contraction,  and  the  head  is 
being  flexed,  so  as  to  bring  its  smallest  circumference  in  relation 
to  the  superior  strait.  Now  suppose  that  at  an  early  period  of 
dilatation,  and  before  flexion  of  the  head  has  proceeded  to  any 
considerable  extent,  the  amniotic  sac  is  ruptured,  either  from  fra- 
gility of  the  membranes,  or  interference  on  the  part  of  the  medi- 
cal attendant;  what  results?  Usually,  abnormal  protraction  of 
delivery,  and  injury  to  the  child  and  mother  proportionate  to  its 
duration.  The  cervical  segment  being  relieved  from  distension, 
by  the  evacuation  of  the  liquor  amnii,  retracts  by  its  elasticity, 
and  applies  itself  closely  upon  the  presenting  part,  and  does  not 
come  to  be  pressed  upon  until  the  head  is  completely  flexed,  and 
its  sub-occipito-pregmatic  circumference  is  passing  through  the 
superior  strait.  When  the  head  is  of  due  relative  size,  this  step 
in  the  mechanism  is  never  attained  in  the  early  period  of  dilata- 
tion, unless  the  cervical  tissue  is  preternaturaily  unyielding.  I 
therefore  venture  to  assert  that  the  statement  of  obstetrical  wri- 
ters,— Prof.  Murphy  included— that  the  ruptured  amniotic  sac 
is  replaced  by  the  vertex,  which,  by  pressing  upon  the  os  uteri, 
irritates  and  renders  it  unyielding,  thereby  causing  the  tedious- 
ness  which  usually  results  where  the  liquor  amnii  is  early  evacu- 
ated ;  is  entirely  and  radically  erroneous.  Further,  it  is  a  mere 
assumption  to  assert,  that  when  the  vertex,  (covered  by  the  soft, 
well  lubricated  scalp,)  does  come  to  press  upon  the  os,  it  will 
irritate,  inflame,  and  render  it  unyielding  ;  for  when  in  the  pro- 
gress of  labor,  the  occiput  descends,  it  will  dilate  the  orifice  as 
favorably  and  as  rapidly  as  the  other  unfavorable  conditions 


1858.]  Artificial  Rupture  of  the  Amniotic  Sac.  41 

will  admit.  Again,  the  theory  implies  that  the  delay  will  termi- 
nate with  the  full  dilatation  of  the  os,  whereas  it  is  a  fact,  that 
the  delivery  is  delayed  at  evey  step  throughout,  by  the  two  early 
evacuation  of  the  liquor  amnii.  We  have  heretofore  stated,  that 
at  an  early  period  of  dilatation,  the  head  is  but  imperfectly 
flexed,  and  is  not  yet  so  adapted  to  the  pelvic  orifice  as  to  pre- 
vent the  outflow  of  liquor  amnii,  produced  by  the  recurring 
"uterine  contractions.  Complete  flexion,  and  adaption  of  the 
sub-occipito-pregmatic  circumference  of  the  head  to  the  pelvic 
brim,  is  by  far  the  most  tedious  step  in  the  mechanism  of  a 
primiperae  labor ;  usually  requiring  many  hours  for  its  accom- 
plishment. The  liquor  amnii  being  thus  gradually  and  com- 
pletely expelled,  the  uterine  parietes  are  permitted  to  close  upon 
the  unequal  surface  of  the  child.  The  circular  fibres  of  the  body, 
meeting  with  the  least  resistance,  contract  upon  and  constrict 
the  abdominal  region  of  the  foetus.  Each  succeeding  contrac 
tion  increases  the  constriction,  until  the  compressed  part  be- 
comes as  resisting  as  the  other  portions.  The  child  can  only 
be  expelled  from  the  uterus  by  being  made  to  glide  upon  its  inner 
surface,  and  anything  that  militates  against  this  process,  will 
retard  delivery  proportionately.  Now,  as  the  resistance  of  the 
presenting  part,  conjoined  with  the  resistance  of  this  constriction, 
must  be  overcome  by  the  contraction  of  the  cervico-fundal  fibres  ; 
the  true  cause  of  tediousness  is  at  once  made  manifest ;  for  the 
amount  of  power  absolutely  lost,  is  exactly  equal  to  that  which  this 
constricted  portion  of  Hie  uterus  is  capable  of  exerting.  And  this 
relation  of  the  uterine  parietes  will,  at  least,  be  partially  main- 
tained at  every  subsequent  step  of  the  labor,  until  the  head  is 
delivered ;  thereby  causing  abnormal  delay  throughout. 

Through  the  foregoing  explanations,  it  will  be  perceived,-  that 
protraction  and  injury  are  liable  to  result,  whenever  the  liquor 
amnii  is  evacuated  before  the  head  is  properly  adapted  to  the  pelvic 
orifice,  no  matter  what  degree  of  dilatation  may  have  taken  place. 

We  have  thus  undertaken  to  show,  "  that  one  of  its  most 
important  uses  (the  amniotic  sac)  remains  unfulfilled  until  the 
presenting  part  has  passed  through  the  superior  strait ;  and  that 
in  all  nutural,  uncomplicated  labors,  especially  primiperae,  the 
membranes  should  not  be  ruptured  at  any  time." 

In  case  of  actual  inertia,  the  practitioner  must  exercise  his 
judgment,  in  view  of  the  conditions  present;  but  rigidity  of  the 
membranes  can  in  no  way  impede  the  descent  of  the  presenting 
part  through  the  pelvic  brim.  Therefore  it  is  my  deliberate 
opinion,  derived  from  careful  and  extended  observation,  that 
rupture  of  the  amniotic  sac,  especially  in  primiperae  cases,  before 
the  head  is  properly  adapted  to  the  pelvic  orifice;  is  injudicious, 
and  generally  injurious,  and  sometimes  fatal, — especially  to  the 
child,  in  its  results.     For,   the  altered  condition  of  the  uterine 


42  Cathartics  in  Dysentery.  [January, 

sinuses  and  the  placenta,  consequent  upon  prolonged  and  undue 
retraction  of  the  uterine  parietes,  in  conjunction  with  the  violent 
pressure  to  which  the  infant  is  subjected;  are  well  calculated 
seriously  to  impair  the  child's  viability,  even  though  it  may  be 
born  alive. 

There  are  other  and  important  objections  to  rupturing  the 
membranes,  even  when  the  os  uteri  is  well  dilated.  Who  knows 
at  what  period  of  a  labor  eclampsia  may  occur?  Version  may 
be  desirable,  but  difficult  and  dangerous  if  the  waters  have  been 
long  evacuated.  The  same  may  be  said  in  regard  to  rupture  of 
the  uterus.  So  also,  of  haemorrhage  ;  the  first  expedient  being 
rupture  of  the  membranes,  the  next,  version. 

In  conclusion  :  as  it  is  difficult  to  estimate  in  a  given  case  of 
labor,  to  what  extent  its  bad  results  may  be  fairly  attributable 
to  improper  management,  we  may  feel  disposed  to  rest  satisfied 
with  our  preconceived  ideas  and  modes  of  practice.  Let  us, 
however,  be  reminded  of  the  statistical  fact, — established  by  the 
observations  of  Burns,  Collins,  JNTagaele,  Simpson  and  others ; 
that  the  liability  to  injury  and  death,  upon  the  part  of  the  mother 
and  child,  increases  proportionately  with  the  duration  of  labor. 


Cathartics  in  Dysentery.     By  0.  C.  Gibes,  M.  D.,  Frewsbury, 
New  York. 

At  the  meeting  of  the  Buffalo  Medical  Association,  Sept.  2d, 
1856,  as  per  report  of  proceedings  in  the  October  number  of 
the  Buffalo  Medical  Journal,  a  discussion  took  place  in  regard 
to  the  propriety  of  using  cathartics  in  dysentery  ;  also  the  kind 
of  cathartics  best  calculated  to  fulfill  the  indications  in  that  dis- 
ease. As  this  question  is  fairly  before  the  readers  of  the  Jour- 
nal above  mentioned,  we  suppose  it  is  open  for  the  expression 
of  opinion  or  experience,  by  any  of  its  many  readers.  Hence 
we  give  expression  to  a  few  thoughts,  based  partially  upon  our 
individual  experience,  and  partially  upon  the  generally  received 
opinions  in  regard  to  the  nature  of  the  affection  under  consider- 
ation. A  knowledge  of  the  nature  or  pathology  of  any  disease, 
is,  perhaps,  the  surest  guide  to  the  appropriate  indications  of 
treatment.  The  public  generally,  are  apt  to  look  upon  all 
diseases  accompanied  with  frequent  evacuations  from  the  bow- 
els, as  similar  at  least,  if  not  identical  in  character.  Physicians 
themselves  are  not  always  free  from  this  vagueness  of  nomen- 
clature. In  muco- enteritis,  as  well  as  milder  forms  of  mucou9 
irritation,  each  case  is  accompanied  with  a  diarrhoea  or  frequent 
alvine  evacuations,  and  the  public  generally  do  not  discriminate 
between  such  cases  and  dysentery,  and  we  have  seen  physicians 
not  unfrequently,  if  not  guilty  of  the  same  error  in   diagnosis, 


1858.]  Cathartics  in  Dysentery.  43 

at  least  of  the  same  vagueness  of  nomenclature.  Dysentery  con- 
sists in  an  inflammation  of  the  mucous  membrane  of  the  colon 
and  rectum,  and,  though  the  evacuations  may  be  over  in  ten 
minutes,  yet,  except  it  may  be  in  the  incipiency  of  the  disease, 
they  are  not  fcecal,  but  consist  almost  wholly  of  mucous  and 
blood.  Hence,  though  the  griping  pains  in  the  abdomen  and 
the  tenesmus  may  be  never  so  great,  though  the  characteristic 
muco-sanguineous  evacuations  may  be  never  so  frequent,  or  the 
straining  at  stool  never  so  persistent,  the  case  may  be  accompa- 
nied with  obstinate  constipation.  The  public  generally  look 
upon  the  frequent  bloody  evacuations  as  constituting  the  whole 
of  the  disease,  and,  consequently,  urge  the  importance  of  power- 
ful astringents,  which,  if  unadvised  by  the  attending  physician, 
they  sometimes  clandestinly  and  injuriously  bring  to  bear  upon 
the  disease.  But  the  physician  who  resorts  to  them,  to  the  ex- 
clusion of  evacuants,  will  certainly  have  no  reason  to  boast  of 
his  success. 

Permit  us  to  say,  that  we  do  not  propose  to  discuss  the  nature, 
cause,  or  symptoms  of  dysentery,  nor  to  enter  into  full  details 
of  treatment.  We  propose  only  to  make  a  brief  expression  of 
our  opinion,  upon  the  question  under  discussion,  viz :  the  pro- 
priety of  cathartics  in  dysentery. 

Some  authorities  have  condemned  the  use  of  evacuants  in 
dysentery,  on  the  ground  of  their  supposed  irritating  influence 
upon  the  inflamed  mucous  membrane.  But  we  feel  confident 
that,  when  the  evacuant  is  judiciously  selected,  and  repeated 
with  due  discrimination,  and  with  proper  adjuncts,  its  irritating 
influence  is  more  fancied  than  real.  The  object  of  the  cathartic 
seems,  at  first,  to  be  to  free  the  bowels  from  irritating  secretions, 
and  the  object  of  their  repetition  is,  conjoined  with  the  above, 
to  prevent  constipation,  which  is  the  inevitable  sequence  of  the 
inflammation  and  consequent  fever.  A  second,  and  not  less 
important  object  to  be  secured  by  the  evacuant,  is  to  unload  the 
portal  veins,  thus  diminishing  congestion  in  that  important 
circulatory  system,  and  to  stimulate  the  capillary  circulation  in 
the  liver,  which  is  often  sluggish,  resulting  in  a  deficient  biliary 
secretion. 

In  regard  to  the  choice  of  a  cathartic  there  has  been  and  is  a 
great  discrepancy  of  opinion.  Some  have  advised  calomel  at 
first,  to  be  succeeded  by  castor  oil ;  others  have  advised  castor 
oil  from  the  first.  Ehubarb,  compound  powder  of  jalap,  cream 
tartar,  epsom  salts,  rochelle  salts,  &c.,  have  all  had  their  advo- 
cates. 

We  were  formerly  in  the  habit  of  giving,  at  first  calomel  in- 
timately commingled  with  rhubarb  and  a  little  pulverized  opium, 
and  afterwards,   whenever  an   evacuant    seemed    demanded, 
gave  castor  oil  with  a  few  drops  of  laudanum.     But  recently 
2* 


44  Cathartics  in  Dysentery.  [January, 

we  have  made  choice  of  a  different  evacuant,  and,  so  far,  have 
been  much  pleased  with  the  change.  In  the  June  number  of 
the  Western  Lancet,  for  1855,  Dr.  D.  B.  Dorsey  communicated 
the  result  of  twenty  years'  experience  with  a  cathartic  mixture, 
first  proposed  to  him  by  Dr.  Lemoyne,  of  Washington,  Pa. 
Summing  up  his  result  he  said  "  in  a  practice,  not  very  limited, 
in  the  cities  of  Wheeling,  Ya.,  and  Steubenville,  0.,  in  the  lat- 
ter of  which  dysentery  prevailed  as  an  epidemic  twice  or  thrice 
during  my  residence  there,  I  had  the  high  gratification  of  seeing 
all  recover  who  were  treated  with  this  remedy  from  the  com- 
mencement of  the  attack."  With  this  high  encomium  before  us, 
we  made  trial  of  the  combination  in  the  next  case  that  came 
under  our  observation,  and  with  such  happy  results  that,  except 
in  young  children,  we  have  used  it  in  all  dysenteric  cases  since, 
with  success  in  all  cases. 

We  quote  Dr.  Dorsey's  formula  and  directions  from  the  paper 
above  referred  to.  "  Take  of  saturated  solution  sulph.  magnesia, 
seven  fluid  ounces  ;  aromatic  sulphuric  acid,  one  fluid  ounce — mix. 

"  The  saturated  solution  is  prepared  by  dissolving  epsom  salts 
in  an  equal  quantity  of  water,  by  weight,  at  60  deg.  Fahrenheit. 
It  will  be  ready  for  use  in  eight  or  ten  hours.  During  that 
time  it  should  be  shaken  occasionally. 

''The  medium  dose  of  this  medicine  for  an  adult,  is  one  table- 
spoonful,  delivered  with  two  or  three  ounces  of  water,  every 
four  to  six  hours,  until  it  gently  moves  the  bowels.  It  should 
be  given  regularly,  and  perseveringly,  until  the  bowels  are  man- 
ifestly under  its  influence,  which  will  be  evinced  by  feculant 
discharges,  abatement  of  tenesmus,  and  general  feeling  of  relief. 
The  size  of  the  dose  and  time  of  repeating  it,  must  be  varied  by 
the  practitioner's  judgment,  according  to  many  circumstances 
of  age,  violence  and  stage  of  disease,  &o.  Sometimes  it  will  re- 
quire two  tablespoonfuls  of  the  medicine,  every  three  or  four 
hours ;  at  others  a  teaspoonful  every  six  or  eight  hours  will  be 
sufficient. 

"  Accompanying  each  dose,  when  the  pain  and  tenesmus  are 
great,  one  sixth  of  a  grain  of  sulph.  morph.  may  be  given.  But 
this  remedy,  also  must  be  varied,  both  in  quantity  and  frequen- 
cy of  repetition,  according  to  circumstances." 

We  have  seldom  or  never  exceeded  tablespoonful  doses,  and' 
oftener  fallen  below  that.  But  instead  of  giving  once  in  four 
or  six  hours  throughout  the  twenty-four,  we  have  usually  com- 
menced with  it  in  the  morning,  to  be  repeated  every  three  hours 
until  it  operates,  always  combined  with  a  small  quantity  of 
morphine.  This  course  we  repeat  every  day  so  long  as  the  in- 
dications demand.  During  the  remainder  of  the  twenty-four 
hours,  we  give  ipecacuanha  with  morphine,  or  such  other  rem- 
edies as  the  circumstances  of  the  case  seem  to  require.    It  may 


1858.]  Puerperal   Vomiting.  45 

not  be  amiss  to  say  here  that  mercurials  are  incompatible  with 
the  mixture. 

The  acid  doubtless  stimulates  the  capilliary  circulation  in  the 
liver,  promoting  bilious  secretion,  while  the  sulphate  of  magne- 
sia relieves  the  portal  congestion  and  frees  the  bowels  from  ir- 
ritating secretions.  From  the  relief  which  speedily  follows  its 
action,  to  the  tormina  and  tenesmus,  greater  than  that  following 
any  other  evacuant,  we  cannot  help  thinking  the  acid  has  a 
direct  sanitary  influence  upon  the  inflamed  mucous  membrane. 

With  young  children,  where  smallness  of  dose  and  pleasant- 
ness of  taste  are  always  considerations  of  much  importance,  the 
above  mixture  is  decidedly  objectionable.  The  taste  is  rather 
disagreeable,  and  the  necessity  for  diluting  the  mixture,  renders 
the  bulk  such  as  no  child  will  readily  take.  In  such  cases  we 
have  been  in  the  habit  of  scorching  rhubarb,  adding  boiling 
water  and  extract  of  hyosciamus,  the  dose  of  such  proportion  to 
the  age  and  condition  of  the  patient,  sweetening  the  mixture 
and  flavoring  with  nitre. 

This  is  to  be  given  in  repeated  doses  in  the  morning,  sufficient 
to  produce  a  laxative  effect,  and  during  the  balance  of  the  day 
we  give  hydrargyrum  cum  creta,  in  small  doses,  with  Dover's 
powders,  or  such  other  medicines  as  the  circumstances  of  the 
case  may  indicate. — [Buffalo  Med.  Journal. 


Puerperal  Vomiting  cured  by  the  Induction  of  Labor.     By  Fran- 
cis W.  Sheriff,  M.  D.,  L.K.C.S.E. 

Having  recently  read  your  article  on  Professor  Cazeau's  late 
work  on  the  Diseases  of  Pregnancy,  &c,  I  thought  it  might  be 
interesting  to  some  of  your  readers  to  relate  a  case  of  severe 
Puerperal  Yomiting  which  lately  came  under  my  care.  My 
patient,  Mrs.  Moore,  first  consulted  me  four  years  ago,  being  in 
the  eighth  month  of  her  fifth  pregnancy.  She  complained  of 
almost  constant  vomiting,  and  had  been  reduced  to  great  debil- 
ity by  absolute  inanition.  A  few  doses  of  hydrarg.  cum  creta 
and  opium  checked  the  vomiting,  and  she  was  delivered  of  a 
healthy  child  at  the  proper  time.  The  placenta  was  retained, 
and  she  had  considerable  hemorrhage  before  I  reached  her  resi- 
dence, which  was  about  nine  miles  distant.  She  became  anae- 
mic and  was  confined  to  bed  for  nearly  three  months.  She 
eventually  was  quite  restored  to  health,  and  has  not  been  preg- 
nant since  until  this  time.  On  the  26th  of  July  last  I  was 
requested  to  visit  her.  I  found  her  aparently  healthy,  and  robust 
looking,  pulse  natural.  She  stated  that  she  was  in  her  seventh 
month  of  pregnancy  and  that  since  its  commencement  she  had 
vomited  a  great  deal,  but  that  lately  it  had  become  much  more 


46  Puerperal  Vomiting.  [January, 

troublesome,  and  that  she  was  afraid  of  relapsing  into  her  for- 
mer condition,  as  her  bowels  were  rather  costive.  I  prescribed 
the  pills  and  a  mixture  of  chloroform  and  tinct.  lavand.  comp. 
and  at  the  same  time  paid  great  attention  to  the  state  of  her 
bowels.  On  the  10th  of  August  I  was  again  called  to  visit  her. 
She  stated  that  since  the  7th,  the  vomiting  had  been  almost  con- 
stant, that  she  retained  nothing  on  her  stomach  and  that  she 
vomited  a  great  deal  more  than  she  swallowed.  She  complain- 
ed of  great  thirst,  pain  in  the  epigrastrium,  great  anxiety  and 
restlessness,  and  was  urgently  calling  for  relief.  Pulse  120  of 
good  strength,  breath  foetid,  having  the  odour  of  chloroform.  I 
bled  her  to  the  amount  of  !  viii.  without  causing  fainting,  and 
prescribed  at  different  times  calomel  and  opium,  senna,  enemas, 
warm  applications  to  the  epigrastrium,  creosote  mixture,  &c,  but 
all  of  no  avail,  the  vomiting  continued  as  bad  as  ever.  The 
swallowing  of  a  little  fluid  of  any  kind  was  almost  immediately 
followed  by  great  retching  and  vomiting.  The  fluids  vomited 
were  colourless  and  inodorous,  and  largely  exceeded  what  had 
been  swallowed.  In  addition  to  the  medicines  prescribed,  I 
ordered  nourishing  enemas  to  be  frequently  administered. 

11th.  Symptoms  rather  more  favorable,  vomiting  not  so  severe, 
and  has  slept  a  little,  complains  more  of  debility,  >skin  rather 
cool.  Has  retained  a  little  opium,  which  she  thinks  has  relieved 
her. 

12th,  8  a.  m. — Is  much  worse,  vomiting  as  bad  as  ever,  ex- 
tremities cold,  skin  wrinkled  and  withered  like  a  person  in  col- 
lapse of  cholera.  Has  very  great  anxiety,  and  calling  urgently 
for  fresh  air.  Had  to  get  her  bed  elevated  to  the  height  of  the 
window  so  that  she  might  have  her  head  in  the  open  air.  Pulse 
130,  weak  and  variable.  As  it  was  evident  that  death  must  soon 
ensue  if  relief  was  not  obtained,  I  determined  to  bring  on  labor; 
but  before  doing  so,  I  requested  that  Dr.  Anderson,  a  neighbor- 
ing practitioner,  might  be  sent  for.  He  arrived  at  3  p.  m.,  and 
agreed  with  me  on  the  propriety  of  immediately  inducing  labor. 
I  introduced  a  flexible  catheter  into  the  uterus,  ruptured  the 
membranes,  and  drew  off  about  8  oz.  of  liquor  amnii.  My  pa- 
tient was  relieved  almost  immediately,  and  the  vomiting  ceased. 
I  prescribed  1  drachm  of  tincture  of  Ergot  every  two  or  three 
hours,  supporting  her  strength  at  the  same  time  with  stimulants 
and  nourishing  enemas.  She  remained  easy  and  comfortable 
all  night,  and  next  morning,  about  twelve  hours  after  the  rup- 
ture of  the  membranes,  labour  pains  came  on,  and  continued 
regarly  all  day,  but  at  long  intervals.  About  8  p.  m.,  I  admin- 
istered an  enema  of  infusion  of  ergot,  which  soon  had  a  most 
powerful  effect,  and  within  an  hour  afterwards  she  was  safely 
delivered  of  a  living  child  which  cried  lustily.  It,  however, 
lived  only  about  eight  hours.    My  patient  rapidly  recovered, 


1858.]  Physiology  of  the  Ear.  47 

and  in  two  or  three  weeks  was  entirely  restored  to  her  usual 
health.  In  this  case  so  urgent  were  the  symptoms  and  so  rapid 
had  been  the  approach  of  sinking  and  colapse,  that  I  had  no 
doubt  that  the  delay  of  the  operation  for  a  few  hours  more  would 
have  proved  fatal.  From  the  immediate  relief  experienced  after 
drawing  off  the  liquor  amnii,  it  would  appear  as  if  the  cause  of 
the  vomiting  had  been  the  pressure  of  the  gravid  uterus. 

[Medical  Chronicler 


On  the  Physiology  of  the  Human  Ear.     By  "W.  Kramer  of  Berlin. 

Our  knowledge  of  the  physiology  of  the  auditory  apparatus 
is  still  very  incomplete,  partly  on  account  of  the  difficulty  of 
experimenting  on  the  organs  of  hearing,  and  partly  on  account 
of  the  imperfection  of  the  science  of  acoustics.  We  are  happy, 
therefore,  to  record  the  results  of  the  investigations  of  Dr.  Kra- 
mer, (Deutsche  Klinik,  1855.)  whose  vast  experience  in  the 
treatment  of  aural  affections  is  universally  known.  In  review- 
ing the  researches  of  his  predecessors,  this  author  points  out  the 
impossibility  of  determining  what  takes  place  in  the  living  ear 
from  experiments  on  inert  matter.  His  own  experiments  have 
been  made  upon  the  ear  itself,  in  the  healthy  and  diseased  states. 
It  would  be  out  of  the  question  for  us  to  reproduce  the  details 
of  these  experiments ;  we  must  be  satisfied  with  the  author's 
conclusions : — 

1.  The  cartilage  of  the  ear  conducts  more  than  a  third  of  the 
sonorous  waves  which  reach  the  membrana  tympani. 

2.  The  concha  is  the  most  important  part  of  the  auricula 
cartilage. 

3.  The  cartilage  of  the  ear,  in  its  natural  position,  simply  re- 
ceives and  conducts  the  sonorous  vibrations  to  the  auditory  pas- 
sage. 

4.  The  cavity  of  the  auditory  passage  transmits  about  500 
times  as  many  undulations  as  the  solid  parts  enclosing  it. 

5.  The  curvatures  of  the  meatus  and  the  cerumen  have  no 
influence  on  the  sonorous  vibrations. 

6.  These  arrangements  serve  to  protect  the  canal  and  the 
membrana  tympani  from  external  agents. 

7.  The  membrana  tympani  transmits  the  sonorous  undula- 
tions in  due  quantity  and  quality,  only  while  its  structure  is 
normal. 

8.  The  membrana  tympani  also  serves  as  a  protection  to  the 
drum. 

9.  The  ossicula  have  but  little  agency  in  transmitting  the 
vibrations  of  members  of  the  membrana  tympani  to  the  laby- 


48  On  Rheumatism,  &c.  [January, 

rinth.     Their  office  is  rather  to  support  the  membrane  between 
two  strata  of  air. 

10.  The  membrane  of  the  fenestra  rotunda  is  designed  espe- 
cially to  transmit  to  the  labyrinth  the  vibrations  of  the  tympa- 
nal cavity. 

11.  The  mastoid  cells  are  of  trifling  acoustic  importance. 

12.  The  Eustachian  canal  is  an  open  tube.  (Dr.  Toynbee 
had  announced  a  contrary  opinion.) 

13.  Through  this  tube  the  air  of  the  tympanum  is  renewed, 
and  the  sero-mucous  secretion  of  that  cavity  eliminated. 

14.  Hearing  is  not  entirely  destroyed  by  the  absence  of  the 
fenestra  rotunda  and  the  loss  of  the  liquor  cotunnii. — [lb. 


On  Rheumatism  oftlie  Epithelial  and  ISl on- Epithelial  Fibrous  Tis- 
sues :  Its  Sequence  to  Scarlatina  and  other  Exanthemata.  On 
Rheumatic  Grout,  Chorea,  &c.  &c*  By  H.  P.  DeWees,  M.  D. 
New  York. 

The  term  "Kheumatism"  is  derived  from  a  Greek  word  sig- 
nifying "  a  fluxion,  or  catarrh."  It  is  divided  into  acute  and 
chronic,  although  a  third  form  may  be  correctly  added,  viz :  the 
flying,  or  fugitive."  The  tissues  affected  are  chiefly  of  the  fibrous 
or  sero-fibrous  class.  But  muscular  structure  itself  may  become 
the  seat  of  the  affection,  from  its  component  elementary  fibrous 
structure. 

The  true  disorder  consists  in  a  certain  more  or  less  altered 
condition  of  the  blood,  from  its  normal  composition.  This  con- 
dition may  arise  from  causes  apparently  most  opposite,  but  which 
resolve  themselves  into  one  and  the  same  action,  namely :  their 
power  to  change  the  constitution  of  the  blood  from  its  healthful 
state. 

The  bedside  statements  confirm  this  view.  By  some,  the  ex- 
citing cause  of  the  attack  is  attributed  to  cold,  or  to  "check  of 
perspiration."  By  others,  to  waste  of  nervous  force  by  long- 
continued  watching,  to  strains,  or  over-exertion,  to  being  "out 
of  order"  for  a  long  time,  though  not  conscious  of  having  been 
exposed  to  damp  or  cold,  to  the  sudden  suppression  of  a  skin 
eruption,  to  indigestion  after  a  debauch,  and  so  on,  till  one  would 
be  led  to  believe  that  any  imprudence  might  be  followed  by  an 
attack  of  rheumatism. 

In  some  families  it  is,  apparently,  as  hereditary  as  the  gout ; 
whilst  in  the  gouty  it  is  not  unfrequently  a  conjoined  affection. 

_  *  Some  of  the  views  announced  in  this  paper  are  so  like  those  given  in  the  ar- 
ticle on  Scarlatina,  published  in  our  pages,  that  our  readers  may  suppose  they 
were  suggested  by  it.  It  is  due  to  the  author  to  state,  that  the  present  paper 
has  been  ready  for  publication  three  years. — [Eds.  Monthly. 


1858.]  On  Rheumatism,  &c.  4& 

But  the  gouty,  from  their  mode  of  life,  are  more  apt  to  superin- 
duce rheumatism,  than  are  the  rheumatic  to  earn  gout.  Where 
the  parents  of  the  patient  have  been  subject,  one  to  gout  and 
the  other  to  rheumatism,  a  sort  of  hybrid  attack  may  sometimes 
result,  rendering  diagnosis  difficult,  whilst  relief  can  only  be 
obtained  by  conjoining  the  remedial  measures  of  each.  This 
coalescence,  however,  is  not  always  the  case,  as  I  have  seen 
gout  and  rheumatism  run  their  distinct  course  in  separate  attacks 
in  the  same  person.  Eheumatism  may  safely  be  termed  a  blood 
disease.  This  blood  condition  may  arise  from  causes  apparent- 
ly very  different,  but  which  resolve  themselves,  in  their  final 
result,  by  producing  alike  morbid  changes  not  only  in  the  cir- 
culating fluids,  but  in  the  nutritive  action  of  the  tissues  them- 
selves. Xor  does  time,  or  any  specific  interval,  form  a  necessa- 
ry element  in  the  anormal  production.  It  may  result  suddenly, 
or  may  be  the  sequence  of  the  gradual  want  of  integrity  in  the 
healthful  assimilative  functions.  The  sudden  cutaneous  sup- 
pression (so  prolific  a  cause  generally,)  by  which  certain  excre- 
tory elements  are  forced  to  remain  in  the  blood,  loading  it  with 
a  specific  poison,  and  resulting  in  the  phenomena  of  rheumatism, 
may  be  represented  in  a  like  manner  by  the  errors  of  an  organ 
or  organs,  by  which  a  similar  toxic  condition  of  tlte  blood  may  be 
induced.  Kor  is  it  necessary,  that  the  superficial  excretory 
actions,  or  the  internal  assimilative  organs  themselves  be  impair- 
ed— both  may  work  in  their  perfect  normal  role,  yet  from  the 
supply,  by  diet,  being  improper  or  in  excess,  a  state  of  blood 
similar  in  its  impurities  may  be  produced,  with  the  exhibition  of 
rheumatism  or  gout  as  its  index.  It  is  only  thus  that  the  various 
accounts  as  to  the  origin  of  the  attack  can  be  reconciled. 

The  acute  rheumatism  of  children,  in  almost  all  cases,  can  be 
readily  traced  to  improper  exposure  or  to  damp.  The  recession 
of  so  much  highly  animalized  excretion  as  is  constantly  being 
thrown  from  their  surfaces,  loads  the  blood  with  excrementitious 
products,  whilst  the  proper  actions  of  the  kidney,  liver,  &c,  are 
interfered  with ;  or  congestions  may  be  superinduced,  which 
cannot  but  serve  to  usher  in  the  disorder.  The  young  are  more 
liable  to  general  rheumatism  than  are  the  more  advanced  ;  and 
heart  disorder  is  more  prone  to  ensue  in  them  than  in  the  latter. 
This,  most  probably,  is  owing  to  the  higher  condition  of  irrita- 
bility of  the  cardiac  tissues  from  the  altered  blood,  and  from  the 
fact  of  the  exanthematous  diseases,  as  scarlet  fever,  measles,  &c,  being 
of  later  occurrence  ;  leaving  the  great  excretory  organs  in  a  more 
or  less  damaged  state.  The  determination  of  the  disease,  both 
in  the  young  and  the  more  advanced,  to  become  local  or  general, 
apart  from  the  considerations  just  mentioned,  is  in  strict  accor- 
dance to  the  blood  condition,  and  the  resisting  power  of  the  part 
exposed.     For  example:  two  individuals  of  the  same  age  may 


50  On  Rheumatism^  &c.  [January, 

be  subjected  to  similar  atmospheric  causes,  yet  the  result  may  be, 
and  generally  is,  different :  one  being  attacked  with  rheumatism 
of  a  single  part,  whilst  the  other  may  be  taken  down  not  only 
with  the  local  selection,  as  in  the  first,  but  with  every  joint  in 
the  body  affected.  Or  he  may  escape  the  like  local  manifesta- 
tion, and  be  attacked  in  the  knee  or  feet,  although  these  parts 
were  not  only  well  protected,  but  not  exposed  at  the  time  to  the 
impinging  draught ;  thereby  clearly  showing  the  relation  of  the 
blood  condition  to  the  disorder.  In  many  cases,  the  selection 
for  the  rheumatic  outbreak  is  in  some  part  previously  weakened, 
as  by  strain  or  fracture,  or  by  local  nervous  loss.  These  cases, 
however,  require  great  discernment,  as  local  phlebitis  or  puru- 
lent deposit  in  or  near  a  joint  may,  and  has  been  frequently  mis- 
taken for  true  articular  rheumatism,  giving  rise  to  the  opinion  of 
its  terminating  in  suppuration,  more  often  than  it  does.  To 
these  and  other  points  I  shall  again  refer  in  their  proper  order. 

Although  for  the  most  part  the  attack  of  the  acute  rheumatism 
is  sudden,  yet  in  some,  distinct  warnings  occasionally  take 
place  before  a  "  first  instalment"  is  paid  in.  These  premonitions 
vary  in  different  persons  according  to  the  attack  dating  from 
exposure,  or  from  its  being  kindled  spontaneously  by  previous 
disorder  of  the  blood,  without  any  outward  exciting  cause  of  a 
recognizable  kind.  Disturbance  of  the  digestive  organs,  attended 
by  flitting  pains  through  the  joints  or  in  the  muscles — the  sud- 
den eruption  on  the  skin  of  some  herpetic  or  other  disorder, 
attended  with  burning,  itching,  or  aching,  and  its  rapid  evanes- 
cence— or,  the  drying  up  of  any  chronic  discharge,  the  appear- 
ance of  a  singular  sour-smelling  perspiration  whilst  in  bed  during 
sleep — these,  with  other  premonitions,  serve  as  sufficient  data  of 
the  impending  evil,  to  those  who  have  already  suffered,  or  are 
remembered  with  dread  at  their  subsequent  appearance,  by  those 
who  did  not  translate  their  bearing  correctly.  In  others,  no 
such  unpleasant  " avant-couriers"  announce  the  attack;  but  a 
peculiar  nervous  excitability,  attended  with  moist  skin,  and  a 
sensation  of  feeling  better  than  usual,  is  recorded  by  the  patient 
— the  attack  being  generally  attributed  to  check  of  perspiration 
on  going  into  cold  air  from  a  warm  room,  although  others  who 
were  in  the  same  atmosphere  did  not  feel  over-heated. 

Here  the  disease  early  manifests  itself  by  the  usual  sweating, 
but  in  advance  of  the  pain.  This,  however,  soon  invades  the 
insteps,  ankles,  knees,  or  wrists,  attended  with  more  or  less 
chilliness,  hot  flashes,  and  increased  perspiration.  The  arteries 
throb  quickly  through  the  now  swollen,  mottled,  hot,  and  shin- 
ing parts,  whilst  the  superficial  veins  leave  their  dark-blue 
traces  through  the  sensitive  skin.  As  the  location  is  variable, 
so  is  the  duration  of  the  intolerable  agony  uncertain.  One  or 
both  corresponding  articulations  may  be  attacked,  alternately  or 


1858.]  On  Rheumatism,  &o  61 

simultaneously  ;  or,  shifting  from  ankle  to  knee,  a  running  fire 
from  joint  to  joint  may  be  kept  up,  till  apparently  reinforce- 
ments of  the  disease  arrive,  and  every  joint  be  tensely  invested 
by  the  relentless  enemy.  Voluntary  motion  now  becomes  im- 
possible,  or  is  effected  under  the  greatest  torture.  Change  of 
position  by  any  aid  is  rendered  agonizing,  whilst  the  desire  to 
move  increases  hourly ;  and  the  patient  is  worn  out  between  the 
increasing  sweats,  which  bring  no  relief  to  the  severity  of  the 
pains,  and  the  sleepless  restlessness  for  change  of  posture,  which 
adds  no  comfort.  The  pulse  hammers  on,  increasing  in  rapidity 
and  pain-bearing  force  through  the  disabled  parts.  Fever  seems 
firmly  established  in  every  essential  form,  save  the  dripping 
skin,  whose  sour  sweatings  fail  to  moderate  the  heart's  over- 
action  ;  and  that  the  after  effects  are  unlike  those  which  would 
be  dreaded  in  other  fevers,  attended  by  so  much  apparent  in- 
flammation, and  with  local  disorder  of  nutrition  of  such  threat- 
ening aspect. 

A  respite  is  generally  gained  during  the  sun  hours,  but  the 
night  comes  loaded  with  terror.  Sleep  is  now  broken  from  the 
startled  slumberer,  by  spasmodic  jerkings  of  the  limbs;  and  the 
dread  of  their  re-occurrence,  robs  the  pain-snatched  hours  of 
their  balmy  gift.  And  thus  passes  night  into  day,  pain  into  ex- 
haustion, and  labored  conversation  into  incoherent  wanderings, 
or  delirium,  more  or  less  persistent  during  the  weary  night 
hours.  The  appetite  is  gone,  whilst  the  thirst  is  unquenchable. 
The  countenance,  for  a  time  flushed  with  dark  purple  blood, 
bearing  evidence  of  the  riot  of  the  heart,  and  its  over-loaded 
condition  from  the  wasting  tissues,  becomes  at  length  heavy  and 
pale-sodden,  whilst  the  forehead  drips  with  outstanding  perspi- 
ration, and  the  sclerotic  tissues  of  the  eyes  become  finely  pen- 
cilled, and  the  mucous  tears  drain  from  the  sticky  and  often  shut 
lids.  ' 

From  the  seventh  to  the  ninth  day  such  is  the  course  of  acute 
rheumatism,  when  relief  may  come  permanently,  or  by  shifting 
the  scene  of  action  to  other  parts,  with  moderation  in  degree  and 
duration  of  the  pain ;  whilst  the  limb  previously  affected  be- 
comes less  unpliant,-  although  aching  with  an  almost  paralytic 
stiffness,  as  regards  progression  or  action.  The  patient  is  a  child 
once  more,  every  motion  is  uncertain ;  he  totters  with  his  weight,- 
and  has,  as  it  were,  to  learn  to  grasp  again.  In  some,  at  this 
period,  gloomy  inaction,  or  heart-desponding  forebodings  har- 
ass the  tedious  convalescence.  In  others,  although  the  recovery 
seems  certain,  the  hopes  are  found  delusive,  and  they  again  be-- 
come  victims  to  a  re-attack.  Pain  renews  its  seat,  the  clothes 
become  drenched  in  the  sour  sweats,  and  the  morrows  are  mort- 
gaged in  nights  of  agony.  Nor  is  this  relapse  always  to  be' 
dated  from  imprudence  of  motion,  or  of  exposure,  or  of  diet, 

N.S. VOL.  XIV.  NO.  I.  3 


On  Rheumatism,  &c.  [January 

which,  from  the  improving  appetite,  or  greater  constitutional 
demand  of  the  patient,  had  been  more  generous.  It  may  and 
frequently  does  result  from  many  causes  unconnected  with  mo- 
tion, atmospheric  change,  or  regimen.  Amongst  these  may  be 
mentioned  in  this  place,  renewed  blood  disorder,  encroaching 
purulent  disturbance,  the  impairment  of  an  organ  by  a  more  or 
less  rapid  hindrance  of  action  from  effusion,  or  by  partial  degen- 
eracy of  normal  structure,  etc.,  etc.  It  is  here  that  the  skilful 
physician  is  required  ;  not  only  to  guard  against  present  impend- 
ing difficulties,  but  to  restrain,  if  possible,  the  disposition  to 
organic  damage  in  the  various  organs;  which,  if  allowed  to 
proceed  in  their  stealthy  progress,  may  suddenly  shorten  life 
before  its  prime,  or  leave  it  as  a  dreary  tenure  to  the  joyless 
sufferer. 

The  prognosis,  in  many  cases  of  rheumatism,  depends  upon 
the  previous  condition  of  the  patient.  Whether  he  has*been 
more  given  to  vegetable  or  animal  diet,  or  to  alcoholic  drinks; 
also,  as  regards  the  state  of  the  primary  and  secondary  diges- 
tion,— if  he  has  had  syphilis,  or  been  lately  subjected  to  gonor- 
rhoea,— whether  the  kidneys  have  been  for  a  long  time  diseased 
or  disordered,  the  origin  dating  from  the  exanthemata  or  not, — 
or  if  the  heart  has  been  affected.  In  females  especially  it  is  im- 
portant to  know  whether  they  have  been  subject  to  hysteria, 
with  or  without  convulsion,  or  if  chorea  has  at  any  period  of 
life  been  present,  or  if  the  patient  has  at  any  time  been  affected 
by  Marsh  malaria  or  intermittent, — whether  extensive  suppura- 
tion had  been  present,  or  chronic  eruptions  been  repelled.  These, 
and  many  other  conditions,  in  connection  with  the  habits,  occu- 
pation, and  the  history  of  the  parents,  have  to  be  fully  entered 
into,  before  a  just  opinion  can  be  formed  as  regards  the  progno- 
sis and  rational  treatment. 

For  no  disease  does  there  exist  in  general  a  more  unsatisfact- 
ory selection,  or  a  more  discrepant  account,  as  regards  effective 
remedial  measures,  and  this  amongst  medical  as  well  as  non- 
medical observers.  The  indisposition  amongst  many  to  regard 
rheumatism  as  a  blood  disorder,  the  real  difficulty  at  times  in 
making  a  satisfactory  determination  as  regards  the  tissues  affect- 
ed, and  the,  lithic  or  lactic  acid  excesses  in  the  circulation,  with 
an  apparent  natural  skin  excretion,  or  their  non -elimination  from 
the  blood,  with  deficient  cutaneous  action, — these,  and  many 
other  causes,  together  with  the  inaccuracy  that  will  attend  the 
diagnosis  of  even  the  most  skilful,  render  at  times,  the  treatment 
vague,  unsteady,  and  in  most  cases  purely  empirical.  For  every 
one  you  meet  has  a  remedy  with  a  list  of  cures. 

The  remedial  selection,  therefore,  often  requires  much  acumen 
in  distinguishing  simple  acute  or  true  fibrous  inflammatory 
rheumatism,  from  the  affection  upon  which  the  various  organs 


1858.]  On  Rheumatism,  &c.  53 

have  engrafted  their  assisting  vices ;  as  witnessed  in  some  dis- 
guised states  of  Bright's  disease,  or  after  scarlet  fever,  or  spinal 
derangement,  local  phlebitis,  insidious  tumor,  long  continued 
and  unrecognized  constipation,  etc.,  etc. 

As  acute  rheumatism  does  not  necessarily  resolve  itself  into 
chronic,  so  may  it  be  said  that  the  latter,  as  a  general  thing, 
starts  its  onward  course  of  injury  and  disfigurement  in  a  stealthy 
and  insidious  manner,  without  much  painful  inconvenience  in 
the  early  steps.  There  is,  as  is  well  known,  what  may  be 
termed  chronic  acute  rheumatism ;  that  is,  where  the  patient, 
after  an  acute  attack,  is  never  entirely  free  from  aching  pain  or 
slowly-increasing  disablement  of  the  joints,  till  seized  with  an- 
other attack,  But,  as  above  remarked,  chronic  rheumatism,  in 
most  cases,  begins  stealthily.  Antecedent  impairment  of  health, 
at  first  scarcely  noticeable ;  fitful  pains  shooting  here  and  there, 
stiffness  of  the  back  or  in  the  joints,  on  rising  suddenly  from 
the  sitting  or  lying  posture ;  skin-aching  more  intolerable  whilst 
warm  in  bed ;  deep,  heavy,  and  weakening  pains  in  the  larger' 
muscles,  rendering  sleep  uncertain  and  uncomfortable  ;•  frequent 
desire  to  urinate,  sometimes  attended  with  more  or  less  scalding, 
and  even  with  muco-purulent  urethral  or  vaginal  discharge^  ren- 
dering a  suspicion  of,  and  at  times  mistaken  for,  gonorrhoea! 
disorder, — the  slow  but  increasing  enlargements  of  the  joints, 
unaccompanied  with  desquamation  or  irregular  disfigurement,  as 
in  gout ;  the  general  stiff-hinge  movements, — these,  and  many 
others,  being  the  intelligence  to  the  afflicted  that  the  record  of 
their  assimilative  imperfections,  or  their  imprudence  of  all  hygi- 
enic rules,  is  most  ineffaceably  written  in  their  persons.  The 
symmetrical  disposition  to  disfigurement  is  peculiarly  noticeable 
in  chronic  rheumatism,  the  distortion  of  one  joint,  or  of  its 
burse,  being  apt  to  be  daguerreotyped  in  the  corresponding  part 
of  the  other  side, 

But  chronic  rheumatism  may  exist  unwritten  in  joint  or  mus- 
cle, and  even  unsuspected  by  the  practitioner  and  patient,  the 
brunt  of  the  disorder  falling  upon  organs  hidden  to  view  during" 
life,  and  whose  altered  organic  condition,  with  the  cause,  is  only 
revealed  by  the  knife.  For  what  is  true  in  the  diffused  form  of 
gout,  is  also  true  in  chronic  rheumatism.  The  patient  may  be 
tortured  under  the  belief  of  an  existing  and  incurable  organic 
disease  of  an  organ  important  to  life ;  whilst,  in  reality,  it  is  only 
laboring  under  the  insidious  functional  poisoning  of  unrecog- 
nized rheumatic  infection.  It  has  been  my  frequent  opportunity 
to  see  both  the  young  and  the  old  treated  for  organic  cardiac 
disease,  attended  with  disturbance  of  action,  and  all  the  bruits 
that  play  their  JEolian  strains  over  the  strings  of  the  heart, 
when,  by  addressing  the  treatment  to  the  rheumatic  condition 
of  the  blood,  relief  has  been  gained  in  a  satisfactory,  and  i» 


54  On  Rheumatism,  &c.  [January, 

many  instances,  in  an  almost  magical  manner.  And  the  same 
may  be  said  of  the  apparent  heart-disease  in  the  gouty, — colchi- 
cum  and  hydriodate  of  potash  being  their  best  friends. 

In  what  may  be  properly  termed  chronic  acute  rheumatism — 
that  is,  in  persons  subject  to  frequent  attacks  of  the  acute  form 
with  slow  recuperation — the  heart  is  liable  to  become  affected  in 
about  thirty  in  one  hundred  cases,  and  this,  especially  in  chil- 
dren, from  seven  to  fifteen  years  of  age.  In  the  plurality  of 
these  cases,  the  previous  exanthemata,  as  scarlatina  or  measles, 
"most  likely  laid  the  foundation,  or  were  associated  in  the  rheuma- 
tic attack.  For  the  valvular  lesions  so  frequently  attending 
rheumatism,  are  not  uncommonly  preceded  by  kidney  derange- 
ments, which  date  their  origin  from  causes  as  above  mentioned. 
It  therefore  becomes  needful,  whilst  seeking  into  the  existence 
and  date  of  an  hypertrophied  ventricle,  (which,  of  itself,  is  so 
frequently  conjoined  with  disease  of  the  aortic  valves,  or  if  di- 
latation exist,  with  adhesion  to  the  pericardium,)  to  enquire  if 
the  exanthemata  had  at  any  time  been  suffered  from.  For  it  is 
undeniable  that  kidney  disease,  from  whatever  cause,  frequently 
exists  with  altered  muscular  structure  of  the  heart  and  a  high 
irritability  in  its  serous  lining  membrane.  This  state  is  more 
frequently  found  in  females  than  in  males,  and  thus  in  part, 
may  account  for  the  greater  prevalence  of  choreic  disease  in 
them. 

As  regards  selection,  the  left  side  of  the  heart,  from  its  greater 
tendinous  structure,  is  more  subject  to  rheumatic  inflammation 
than  the  right.  From  the  considerations  above-mentioned  of  the 
liability  of  the  heart  to  previous  damage  from  kidney  derange- 
ment, the  fact  of  rheumatic  pericarditis  being  less  frequent  than 
valvular  inflammation,  may  be  accounted  for.  In  many  cases 
of  rheumatic  pericarditis,  the  lining  membrane  of  the  heart  is 
found  more  or  less  involved,  and  pleurisy  by  extension  may 
result.  Where  extensive  kidney  disorder  has  existed  previous- 
ly, suppurative  or  purulent  inflammation  may,  and  frequently 
does  ensue,  whilst  the  ursemic  symptoms  are  prominent ;  and 
this,  especially,  if  the  patient  has  been  lately  subjected  to  the  scarlati- 
nal poison. 

Indeed,  pleurisy  unconnected  with  pericarditis,  is  rare  in 
rheumatism,  and  in  some  cases,  apparently,  will  be  proportioned 
to  the  amount  of  urea,  remaining  uneliminated  from  the  blood. 
The  pleuritic  effusions  sometimes  are  so  great  as  to  displace  the 
lower  organs,  and  especially  the  liver ;  leading,  on  hasty  exam- 
ination of  the  abdomen,  to  the  belief  of  enlargement  of  that 
organ,  or  of  tumor,  as  has  been  witnessed  by  me  on  post-mortem 
inspection,  where  the  serous  or  sero-purulent  collection  in  the 
left  side  was  so  extensive,  as  to  cause  a  large  bag  to  descend  low 
down  towards  the  crista  of  the  ileum  ;  rendering,  during  life,  all 


1858.]  On  Rheumatism,  &c.  55 

diagnosis  unsatisfactory  and  obscure.  Where  the  effusion  is  on 
the  right  side  in  excessive  quantity,  and  accompanied  with 
ascites,  the  liver  may  be  floated,  as  it  were,  and  pushed  far  over 
into  the  left  side,  giving  rise,  also,  to  the  supposition  of  a  tumor 
existing  there. 

Hypertrophy  of  the  left  ventricle  is  a  most  common  sequence 
or  associate,  of  disease  of  the  kidneys;  and  in  these  cases  is  fre- 
quently independent  of  valvular  disorder,  whilst  apoplexy 
forms  one  of  the  modes  of  death.  Where  rheumatism  attacks 
an  individual,  who  previously  may  have  been  laboring  under 
hypertrophy  of  the  heart,  the  prognosis  is  of  course  more  unfa- 
vorable as  regards  the  ultimate  result ;  as  the  vessels  of  the  brain 
are  apt  to  become  diseased  or  degenerated  in  this  condition  of 
the  heart.  If  disorganization  of  the  kidney  co-exist,  the  danger 
to  the  patient  is  also  increased ;  as  the  hypertrophic  state  of  the 
heart  has  a  double  association.  What  exact  proportion  in  these 
cases  have  been  affected  by  scarlatina,  I  do  not  know,  but  it 
appears  to  me  that  the  number  is  in  greater  ratio. 

The  peculiar  irritable  manner  and  appearance  in  the  patient 
at  first,  but  changing  to  a  dull  yet  anxious  expression,  in  rheu- 
matism with  previously  disorganized  or  impaired  kidney,  is  to 
be  accounted  for,  by  the  gradual  poisoning  of  the  brain  and 
great  organic  centres,  from  the  retention  of  urea  and  other  ex- 
crementitious  matter  in  the  blood.  This  condition  may  be  par- 
tially relieved  by  the  occurrence  of  effusions ;  but  only  for  a 
time,  as  resorption,  fresh  accumulation,  and  functional  impedi- 
ment by  dropsical  extent,  ensue,  whilst  convulsion,  or  coma, 
ends  the  scene. 

The  absorption  of  urea  is  by  no  means  to  be  measured  by  the 
drowsiness  of  the  patient ;  in  some  it  acts  as  an  excitant,  produc- 
ing sleeplessness  or  vivid  fancies,  as  is  not  unfrequently  witness- 
ed after  opiates.  Indeed,  I  have  seen  the  utmost  watchfulness 
persist ;  sleep  or  coma,  only  ensuing  just  before  death.  It  is  the 
object  of  this  paper  to  more  than  call  the  attention  of  the  pro- 
fession, to  the  fact  of  the  frequency  of  rheumatism  after  scarlati- 
na, or  other  exanthemata,  and  to  extreme  liability  of  the  epithe- 
lial serous  linings  of  the  various  parts  of  the  body,  to  become  the 
seat  of  the  disorder,  after  the  kidneys  have  been  disturbed,  or 
diseased  in  their  epithelial  structure.  Hence,  the  frequency  of 
sero-fibrous  rheumatism  after  scarlatina ;  and  where  no  kidney 
disorder  exists,  the  preference  of  this  rheumatic  affection  to  the  pure 
fibrous  structures.  In  the  former,  purulent  effusions  are  apt  to 
take  place,  whilst  in  the  latter  they  are  very  rarely  witnessed, 
though  the  swelling,  etc.,  is  greater. 

The  student  should  carefully  divest  himself  of  the  too  preva- 
lent idea  of  the  metastasis  in  rheumatism,  gout,  and  other  dis- 
eases not  strictly  confined  in  certain  regional  bounds.   ;  The 


56  On  Rheumatism,  &c.  [January, 

endeavor  should  be  to  classify  anatomically,  the  tissues  endowed 
with  the  same  organic  elements,  and  having  alike  functions.  By 
bo  doing,  identity  of  structure  with  their  liability  to  functional 
error  will  usurp  the  vague  idea  of  the  so-called  metastasis ;  and 
the  disturbances  of  other  organs,  will  resolve  themselves  into 
their  own  legitimate  actions  and  re-actions.  It  is  also  important 
to  weigh  the  mechanical  association,  or  situation  of  parts  involv* 
ed,  and  their  disturbing  influences.  For  instance,  pericarditis 
with  adhesion,  although  highly  interfering,  still  will  allow  the 
function  of  the  heart  to  be  carried  on  better  than  in  endo-cardi? 
tis  with  valvular  narrowing  of  the  orifices,  or  where  the  natural 
elasticity  of  the  inner  mechanism  is  hampered  by  thickening,  or 
by  restraining  adhesions ;  or,  by  roughening  vegetations  oppos^ 
jug  an  obstacle  to  the  uniform  current  of  the  blood,  etc.,  etc. 

The  various  compounds  remaining  in  the  blood  from  deranged 
elective  balance,  may  act  as  other  poisons  do  when  introduced 
from  without.  These  toxical  influences  may  become  directly 
injurious,  by  completely  paralysing  the  functions  of  an  single 
organ,  highly  essential  to  life;  or  they  may,  by  inducing  a  grad- 
ual degeneracy  of  all  the  nutritive  centres,  so  leaven  the  whole 
circulating  mass,  as  to  render  every  structure  more  or  less  attaint- 
ed in  their  vital  uses.  Nor  are  these  effects  subjected  to  any 
regularity,  as  regards  their  exhibition.  In  one,  paralysis  of  mo- 
tion  may  ensue, — whilst  in  another,  disorder  of  any  special  sense 
may  result;  and  blindness,  deafness,  or  insanity,  be  the  product, 
leading,  too  generally,  to  the  belief  of  structural  degeneration, 
rather  than  of  functional  derangement.  This  subject  is  full  of 
the  highest  importance,  and  must  ultimately  form  the  platform 
of  future  improvement  in  the  treatment  of  disease,  before  medi- 
cine can  be  safely  called  a  science. 

These  blood  poisons  act  by  excess  or  deficiency  of  the  normal 
ingredients — or  by  new  combinations,  not  existing  in  the  health- 
ful state — or  from  the  introduction  of  a  specific  poison,  such  as 
the  syphilitic,  cadaveric,  etc.,  which  have  the  power  either  to 
arrest  the  natural  blood  formations,  or  to  impress  upon  them  a 
new  formative  growth  and  self-like,  not  consonant  with  the 
normal  organic  constitution.  Cancers  seem  to  be  an  illustration 
of  this.  Each  of  these  specific  entities,  or  poisons,  have  a  given 
type -life— in  some,  without  the  power  of  reproduction  in  the 
same  individual  (as  witnessed  in  small-pox,  measles,  scarlatina, 
etc.),  running  through  their  periods  of  incubation,  growth,  and 
decline,  in  a  regular  manifestation  of  events.  In  other  blood 
poisons  no  such  self-limitation  of  developement,  nor  after-inocu- 
lative exemption  exists.  A  disposition  to  increase  without  limit, 
and  to  perpetuate  their  destructive  changes  in  every  tissue,  forms 
a  prominent  feature  in  them ;  as  seen  in  syphilis  and  cancer. 
J3ut  these  latter  kinds  are  more  amenable  to  early  treatment,  or 


1858.]  On  Rheumatism,  dx.  57 

to  death  by  remedy ;  or,  in  other  words,  to  cure,  than  the  form- 
er. It  is,  however,  a  curious  fact,  as  regards  the  development 
of  syphilis  amongst  the  Northern  Esquimaux,  that  even  this 
poison,  so  frightful  in  its  ravages  amongst  civilized  and  warmer- 
climed  people,  runs  in  them  from  the  primary  stage  to  complete 
eradication,  in  six  months,  without  treatment  of  any  hind.  For 
this  fact  I  am  indebted  to  my  distinguished  friend  Dr.  Kane.* 

A  slight  outline  of  some  of  the  disorderly  associates  of  rheu- 
matism, and  of  those  affections  attended  with  pain  apparently 
rheumatic,  but  dating  their  origin  from  other  morbid  conditions, 
may  be  proper  here.  Rheumatism  is  not  only  frequently  con- 
joined with  scarlet  fever,  but  is  exceedingly  prone  to  afflict 
persons  who  have  been  subjected  to  this  disease,  or  to  other  of 
the  exanthemata.  From  the  views  early  mentioned,  this  might 
be  suspected,  since  the  kidney  is  also  liable  to  suffer  greatly  in 
this  fever.  "Where  the  renal  derangement  is  early  manifested, 
the  pains  in  the  joints  is  apt  to  make  a  corresponding  appear- 
ance, and  will  frequently  mask  the  attending  scarlatinal  affection, 
or  cause  it  to  be  entirely  overlooked  if  feebly  developed ;  the 
delirium,  convulsions,  or  increasing  coma  that  may  attend,  giv- 
ing rise  to  the  surmise  of  translation  of  the  rheumatic  action  to 
the  brain,  or  its  coverings.  In  these  cases  of  apparent  rheumatic 
origin,  it  therefore  becomes  important  to  investigate  closely  into 
the  exact  condition  of  the  child,  as  to  its  exposure  to  scarlatinal 
infection,  or  to  the  epidemic  influence  at  the  time  prevailing. 

The  subsequent  difficulty  about  restoration  to  general  good 
health — the  desquamations — the  sudden  chest  difficulties,  or 
dropsical  effusions,  ensuing  shortly  after,  and  even  without  in- 
cautious exposure,  on  the  subsidence  of  arthritic  pains — these 
many  times  serve  to  point  out  what  has  been  overlooked.  In 
none  of  the  exanthemata  is  untimely  exposure  more  severely 
witnessed  than  after  scarlatina.  Another  fact  is  well  worthy  of 
consideration,  viz :  the  albuminal  persistence  in  the  urine,  to- 
gether with  tubular  casts,  epithelial  deposits,  etc  If  this  condi- 
tion is  found  to  exist  in  a  case  of  sudden  but  ill-defined  rheuma- 
tism— and  more  especially  in  children  who  have  never  been 
known  to  have  had  scarlatina,  attention  should  at  once  be  di- 
rected to  the  probability  of  the  incurrence  of  this  affection,  and 
to  the  fact  of  the  engagement  of  the  kiclnej'S. 

The  rheumatic  symptoms  generally  do  not  exhibit  themselves 
in  the  commencement.  The  scarlatinal  disease  may  have  been 
declared  some  time,  even  to  the  period  of  desquamation,  before 
the  joints  are  complained  of.  But  whenever  this  may  happen, 
and  the  kidneys  are  becoming  more  or  less  deranged,  the  danger 

*  This  paper,  it  will  be  remembered,  was  written  before  the  death  of  this 
noble  man. 


58  On  Rheumatism,  &c.  [January, 

is  great,  not  only  for  the  present  but  for  the  future ;  since  the 
effusions  into  the  joints  are  at  times  amongst  the  lesser  evils,  the 
heart  and  brain  being  the  special  organs  for  anxiety.  The  effu- 
sions within  the  joint,  although  they  may  not  be  great,  may 
eventuate  in  suppuration  (as  in  purulent  synovitis),  producing 
more  or  less  permanent  alteration  of  structure  and  model,  from 
mere  thickening  to  articular  caries. 

In  all  cases  of  diseased  joints  in  children,  the  strictest  inquiry  . 
into  the  preceding  disorders,  and  especially  as  to  scarlatina,  then 
becomes  of  vital  importance.  As  is  found  in  the  destruction  of 
the  aural  bony-chain  and  surfaces,  being  confined  mostly  to  one 
side,  so,  in  the  articular,  is  one  joint,  especially  the  knee,  more 
frequently  injured.  Where  the  history  of  the  case  is  imperfect 
or  obscure,  still,  by  the  careful  examination  of  the  urine,  even 
at  a  late  date,  much  information  can  be  gained ;  as  by  it,  we 
can  often  obtain  a  satisfactory  diagnosis  between  the  affection 
being  the  result  of  true  fibrous  rheumatism,  to  which  it  may 
have  been  attributed,  or  of  the  involvement  of  the  articular  fibro- 
serous  membrane,  with  kidney  derangement.  This  portion  of 
the  pathology  of  joint  affections  is  worthy  of  serious  considera- 
tion, and  the  prognosis  must  ever  be  uncertain  without  it.  Most 
medical  and  surgical  men  can  recall  cases  where  the  history  of 
the  affection,  or  the  successful  result  of  treatment,  will  prove  the 
truth  of  these  views.  It  is  nothing  new  to  attribute  the  abscess- 
ular  conditions  of  the  ear,  or  the  ossicular  caries,  with  sloughing 
of  the  tympanum,  to  the  after  effects  of  scarlatina.  But  the  in* 
juries  to  the  joints,  and  other  parts,  have  not  met  as  ready 
observation,  owing  probably  to  the  descriptive  statements  given 
of  the  pain,  leading  to  the  idea  of  simple  rhematism  of  the  non- 
epithelial  fibrous  tissue, 

Both  old  and  young  have  been,  and  will  be  time  and  again, 
treated  for  apparent  rheumatism,  where  the  affection  owed  its 
origin  to  sub-fascial  abscess,  or  impinging  deposits  of  pus,  either 
of  local  origin  or  from  purulent  absorptions.  Scarlatina,  typhus 
fever,  local  injuries,  etc.,  may  all  produce  this  condition,  and 
the  errors  of  treatment  may  at  times  be  pardonable,  but  in  gen- 
eral are  dependent  upon  ignorance  or  carelessness.  In  children, 
rheumatism  more  frequently  terminates  with  suppuration  than 
in  adults ;  and  their  more  recent  exposure  to  scarlatina  readily 
accounts  for  this.  But  in  the  older,  a  diseased  condition  of  the 
kidney,  with  epithelial-disintegration,  frequently  takes  place. 
In  these,  rheumatism  of  the  internal  sero-flbrous  membranes  of 
the  joints  is  prone  to  ensue,  and  pus  may  be  generated.  The 
results,  then,  are  nearly  the  same,  the  difference  being  marked 
chiefly  in  the  higher  nutritive  changes  which  take  place  in  the 
young.  In  scarlatinal-rheumatism,  the  joints  are  not  the  only 
sufferers  when  the  kidney  has  been  damaged.     Any  parts  hav- 


1858.]  On  Rheumatism,  d-c. 

ing  the  fibro-serous  element,  may  become  the  seat  of  derange- 
ment. Hence  heart  disease,  pleurisy,  arachnitis,  with  intra- 
cranial effusions,  may  result ;  and  the  time  of  their  demonstra- 
tion will  be  variable.  It  may  be  shortly  after  the  attack,  or 
proceed  so  stealthily  or  slowly,  that  even  adult  age  may  be 
reached.     For  disease  is  not  a  running  horse,  to  be  timed  exactl}*. 

The  modes  of  death  in  the  child  and  in  the  adult  are  some- 
what different.  In  the  child,  the  hypertrophic  condition  of  the 
heart  is  less  frequently  attended  with  valvular  disorder ;  and  the 
changes  in  the  vessels  of  the  brain,  by  which  apoplexy,  from 
rupture,  is  so  often  accomplished  in  the  adult,  rarely  proceed  to 
very  great  disorganization.  But  a  fatal  issue  may  speedily 
attend  with  convulsion  and  coma,  from  the  higher  impressibility 
of  their  nervous  system.  The  arachnitis  of  the  convexity  of  the 
brain  is  rapidly  ushered  in  with  alarming  symptoms.  The  pain 
is  intense,  and  the  sleepless  irritability  attending  from  the  first, 
alternates  with  delirium  more  or  less  marked,  till  convulsion  or 
coma  may  close  the  scene.  But  the  symptoms,  when  the  base 
of  the  brain  is  affected,  though  less  prominent,  are  more  on  that 
account,  to  be  dreaded,  from  their  insidious  character.  Pain  is 
not  much  complained  of,  and  the  delirium,  if  any,  is  less  pro- 
found ;  but  the  coma  is  more  sudden  and  quickly  fatal. 

In  the  adult,  the  hypertrophy  of  the  left  ventricle,  (sometimes 
of  the  heart,  independent  of  any  valvular  disorder,)  accompanied 
by  kidney  disease,  gives  rise  to,  or  at  least  is  often  associated 
with,  alteration  of  the  vessels  of  the  brain,  extending  to  more  or 
less  profound  degeneration  of  their  coats.  Hence,  apoplexy — 
sometimes  sudden  and  fatal,  as  from  the  stroke  of  a  hammer — 
is  not  an  unfrequent  consequence ;  or  softening  of  the  brain 
may  come  on  with  rapid  strides  or  stealthy  step,  rendering  life 
uncertain,  or  held  at  expense  of  motion,  or  intelligence,  accord- 
ing to  the  extent  and  its  seat. 

In  the  child,  the  pale,  pasty  skin,  the  fretful  restlessness,  or 
the  listless  inactivity,  varying  according  to  the  greater  or  less 
power  in  the  surface  and  kidney  to  depurate  the  blood — the 
errors  of  motion,  or  perception,  or  of  any  special  sense ;  these, 
and  many  other  indications,  should  always  attract  to  the  threat- 
ening condition.  That  much  permanent  benefit  can  be  obtained 
by  any  treatment,  where  organic  changes  have  proceeded  so  far, 
is  not  always  to  be  expected ;  but  it  will  be  satisfactory  to  know 
that  the  state  of  the  patient  had  been  noticed,  and  that  death  did 
not  claim  its  victim  before  any  rational  measures  for  the  pro- 
mulgation of  life,  or  mitigation  of  suffering  had  been  entered 
into. 

The  choreic  disturbances  in  children  (and  especially  if  they 
have  been  subjected  to  scarlatinal  infection)  dating  their  origin 
more  or  less  closely  after  an  attack  of  rheumatism,  are  well  wor- 


60  On  Rheumatism,  Sec.  [January, 

thy  of  notice.  In  many  cases  the  chorea  is  the  first  symptom 
attracting  notice  to  the  condition  of  the  heart.  When  rheumatic 
inflammation  has  been  seated  in  the  lining  membrane,  St.  Vitus's 
dance  has  been  so  frequently  a  sequence,  that  it  is,  by  many 
viewed  in  the  relation  of  cause  and  effect.  And  this  opinion, 
in  many  cases,  seems  verified.  As  above  observed,  the  muscu- 
lar irregularities  sometimes  cause  the  detection  of  the  heart's 
injury  for  the  first  time.  The  interval  between  the  occurrence 
of  the  rheumatic  disturbance  and  the  chorea  is  irregular ;  whilst 
the  prognosis  as  to  the  subsidence  of  the  choreic  motions  from 
heart  complications,  depends  on  the  power  of  arresting  the 
damage,  and  the  capability  of  improving  the  general  nutritive 
system.  If  the  latter  can  be  accomplished,  the  remodeling  as  it 
were,  of  the  heart,  keeps  pace  with  the  progress  of  growth  in 
the  patient.  At  times,  however,  the  heart  is  so  slightly  disturb- 
ed as  not  to  indicate  any  appreciable  organic  difficulty,  although 
sufficient  irritability  is  established  to  reflect  upon  the  spinal 
nerves  the  disturbances  of  relation.  It  is  in  these  latter  cases 
that  the  metallic  tonics,  such  as  arsenic,  zinc,  oxide  of  silver,  act 
so  rapidly  in  cure.  But  in  the  graver  cases,  where  the  heart  is 
more  seriously  affected,  time  forms  one  of  the  chief  elements,  by 
allowing  the  reproductive  changes  to  ensue  with  the  growth. 
In  these  cases  is  witnessed  the  reason  of  the  insignificance  of 
remedies  which  had  proved  so  beneficial  in  others.  Independ- 
ent of  any  heart  or  kidney  disease,  the  errors  in  the  composition 
of  the  blood  after  rheumatism,  or  any  other  blood  disorder,  may 
act  as  frequent  causes  of  disturbances  of  innervation.  Hence, 
stimulant  tonic,  or  sedative  treatment,  may  be  called  for :  in 
one  the  reproductive  actions  being  below  par ;  whilst  in  the 
other,  a  want  of  relation  between  the  blood  and  the  assimilative 
power  of  the  tissues  themselves  may  be  at  fault.  A  third  cause,  ap- 
parently, may  be  independent  of  any  blood  relation,  and  exist 
in  the  nervous  centres,  or  the  nerves  themselves.  In  this  way 
the  proneness  of  chorea  to  be  a  one-sided  disease  may  be  ac- 
counted for. 

The  tendency  to  rheumatic  complaints  in  a  family  where 
scarlatina  has  been  irregularly  developed,  sometimes  affords  a  clue 
both  as  to  the  nature  of  the  attack  and  its  relief.  For  it  is  not 
uncommon  to  find  one  child  subject  to  rheumatism,  and  another 
having  chorea  without  any  apparent  rheumatic  affection.  In 
these,  fright,  which  in  general  is  a  highly  productive  agent,  acts 
readily  and  violently.  After  twelve  or  fourteen  years  of  age, 
private  abuse,  through  the  reflex  actions  of  the  spermatic 
branches  over  the  heart  and  the  nervous  masses  at  the.  base  of 
the  brain,  may  produce  alike  disturbances.  The  bellows  sound 
of  the  heart  and  in  the  great  arteries  in  tjiese  cases  resemble,  in 
a  measure,   the  bruits  from  more  serious  organic  difficulty. 


1858.]  On  Rheumatism,  <Cr.  61 

Fright  is  more  commonly  an  excitor  in  the  rheumatic  or  debili- 
tated, than  in  sound  and  robust  children.  The  development  of 
the  attack  is  also  more  immediate  after  fright,  than  after  rheu- 
matic disorder.  "Where  the  urine  is  of  high  specific  gravity, 
depositing  lithates  or  oxalates,  and  overcharged  with  urea,  and 
the  patient  does  not  become  correspondingly  weak  and  emaciat- 
ed, the  error  lies  chief!}'  in  the  diet  being  in  excess  to  the  assim- 
ilative powers.  The  blood  here  represents  the  conditions  favor- 
able to  acute  rheumatism ;  and  if  previous  kidney  derangements 
had  been  engrafted  from  exanthematous  disease  or  other  cause, 
an  attack  is  apt  to  follow.  But  if  the  individval  be  free  from 
any  renal  difficulty,  the  rheumatic  attack  may  not  be  fully  gen- 
erated, but  disturbances  of  nutrition  or  in  the  assimilative  bal- 
ances may  ensue,  with  chorea  as  a  result. 

Stammering  in  children,  may  sometimes  be  traced  to  the  same 
causes  and  yield  to  proper  treatment.  As  in  chorea,  fright,  or 
other  emotional  excitement,  has  also  been  a  prolific  agent  in  this 
affection.  Indeed,  stammering  might  be  called  a  chorea  of  the 
tongue^nd  larynx.  Almost  every  practioner,  and  layman,  can 
recall  cases  of  early  impediment,  which  subsided  gradually  with 
the  increasing  growth  and  strength  of  the  person. 

Excepting  in  those  cases  of  sudden  and  continued  violent 
chorea,  where  the  nervous  exhaustion  is  so  great  as  to  defy 
timely  repair,  the  prognosis,  for  the  most  part,  is  favorable ;  and 
even  in  choreic  paralysis,  a  happy  termination  may  be  safely 
anticipated,  if  the  kidneys  regain  their  normal  actions. 

It  is  not  difficult  to  understand,  when  the  conditions  of  the 
blood  or  of  the  heart  and  kidneys  in  rheumatism  are  known, 
that  dropsy  may  be  a  sequence — its  severity  dating  from  its  de- 
gree, time,  and  place.  Nor  would  it  be,  as  it  often  is,  a  matter 
of  surprise  to  the  relatives  of  the  patient,  who  have  wondered  at 
the  apparent  over-attention  of  the  skilled  practitioner,  were  his 
anxieties  as  to  the  issue  of  the  case  known,  as  long  as  the  purr- 
ing sounds  of  the  heart  and  the  cellular  puffiness  about  the  eyes, 
and  the  epithelial  and  albuminous  deposite  continue. 

Diffused  gout  is  sometimes  mistaken  for  rheumatism;  the  lia- 
bility to  cardiac  pains,  palpitation,  etc.,  adds  to  the  belief.  But 
the  history  of  the  patient,  his  mode  of  living  and  appearance, 
the  family  diathesis,  and  the  success  that  may  have  attended  the 
previous  administration  of  remedies,  serves  to  clear  away  any 
difficulty  in  the  diagnosis. 

As  instances  of  rheumatic  origin  may  be  mentioned,  the  sud- 
den attack  of  lumbago,  pleurodynia,  crick,  stitch  in  the  inter- 
costals,  the  muscular  achings  whilst  at  rest  or  after  getting  warm 
in  bed,  or  the  dull  and  heavy  pains,  attended  with  a  sense  of 
coldness  in  the  part,  etc  Yet  it  may  be  well  to  mention  that 
all  these  may  be  the  result  of  long-continued  constipation,  and 
will  frequently  take  their  flight  after  a  brisk  purge, 


62  On  Rheumatism,  &c.  [January, 

There  is  a  painful  affection  of  the  skin,  termed  dermalgia,  that 
I  will  refer  to.  This  affection,  so  afflicting  to  the  patient  at 
times,  is  by  no  means  unfrequent.  It  is  a  somewhat  common 
companion  of  hysteria;  and  from  this  fact,  I  have  been  led  to 
regard  some  of  the  forms  of  this  protean  malady,  as  offshoots  of 
rheumatism,  or  at  least  as  indicating  a  rheumatic  tendency  in 
the  blood.  In  many  cases  I  have  detected  epithelial  deposits, 
tubular  casts,  etc.  From  much  opportunity  in  witnessing  ute- 
rine disease,  the  frequent  connection  of  hysteria  with  painful 
menstruation,  has  satisfied  me  that  rheumatism  plays  an  import- 
ant part  in  it,  and  it  also  does  in  many  cases  of  dysmenorrhcea 
unattended  with  hysteric  phenomena.  In  apparent  spinal  dis- 
order, this  painful  tenderness  in  the  skin  is  a  common  attendant, 
and  sometimes  exists  to  such  an  extent  over  the  processes,  as  to 
lead  the  unwary  examiner  into  the  belief  of  severe  local  injury. 
By  pinching  up  the  skin,  and  then  making  the  same  amount  of 
downward  pressure,  this  suspicion  can  be  frequently  dispelled, 
as  the  pain  will  be  found  much  lessened,  or  at  least  not  increas- 
ed. The  same  condition  exists  also  in  certain  gouty  individuals, 
the  increasing  tenderness  in  the  skin  being  many  times  a  fore- 
runner of  an  acute  attack. 

I  cannot  refrain  from  attracting  attention,  in  this  place,  to  a 
painful  condition  of  the  surface  in  children,  the  slightest  touch 
being  complained  of.  It  is  frequently  the  forerunner  of  severe, 
if  not  fatal  convulsions,  and  evidences  great  functional  or  organic 
derangement  of  the  nervous  centres.  When  noticed,  no  time 
should  be  lost  in  making  such  applications  to  the  spine,  and 
base  of  the  brain  as  may  be  demanded.  If  fortunate  enough  to 
be  attracted  early  to  this  symptom  of  superficial  pain,  the  con- 
vulsions may  be  rendered  lighter,  and  of  less  duration.  But 
unfortunately  this  condition  sometimes  remains  unnoticed,  or 
has  made  such  progress  when  noticed,  that  the  exhaustion  from 
the  convulsions  is  so  profound,  that  organic  repair  and  nervous 
recuperation  do  not  ensue ;  and  the  child  dies,  either  after  a 
succession  of  rapid  convulsive  efforts,  or  becomes  comatose,  and 
sinks  without  a  sign  into  its  last  sleep.  These  cases  I  have  seen, 
especially  after  scarlatinal  kidney  disorder — in  some  an  interval 
of  comparative  health  had  supervened,  but  after  a  time  an  icte- 
rode  hue  assumed  the  place  of  the  natural  complexion,  with  a 
certain  puffy  appearance,  leading  the  parents  or  a  common  ob- 
server to  think  indicative  of  increasing  flesh.  If  the  kidney  had 
been  damaged,  the  violence  of  the  convulsions  by  their  contin- 
ued succession,  acts  in  a  doubly  dangerous  manner — in  the  first, 
by  the  exhaustion,  and  in  the  second  by  the  extra  amount  of 
animalized  matter  that  is  thrown  into  the  circulation,  and  which 
cannot  be  voided  by  the  natural  emulgent  channel  of  the  kid- 
neys.   As  in  chorea,  where  the  muscular  movements  are  exces- 


1858.]  Catamenial  Gonorrhoea  and  Syphilis.  63 

sive,  the  sulphates  as  well  as  urea  will  be  found  in  excess  in  the 
uriner  evidencing  the  rapid  waste  of  muscular  structure,  by  the 
inordinate  movements  during  convulsions. — \_Am,  Med.  Monthly, 

(To  be  continued.) 


Lecture. — Catamenial  Gonorrhoea  and  Syphilis. 

Mr.  Frederick  C.  Skey,  Surgeon  to  St.  Bartholomew's  Hos- 
pital, has  recently  lectured  on  Gonorrheeal  Rheumatism.  The 
London  Medical  Circular  gives  us  the  lecture,  from  which  we 
make  the  following  extract,  bearing  upon  a  point  of  great  inter- 
est: 

I  saw  some  time  ago  another  most  remarkable  case  of  this 
kind — the  splitting  in  pieces  of  a  family  might  have  occurred 
from  the  raillery  and  ignorance  of  the  hospital  surgeon,  but  he 
could  not  see  it.  A  respectable-looking  married  man  came  with 
this  catamenial  gonorrhoea ;  he  was  very  much  puzzled  about 
it,  but  the  surgeon  laughed  at  him.  "So  ho,  my  find  friend,"  he 
said,  "you've  simply  gone  and  done  it;  you've  been  with  the 
girls."  The  man  said  not — that  from  the  nature  of  his  business 
it  was  impossible.  "  Then  some  onehas  been  with  the  girls  or 
with  your  wife,  for  you  have  the  bad  disorder— that's  the  short 
and  long  of  it."  The  man  protested,  till  at  last  he  swore  an 
enormously  large  oath  at  the  ignorance  of  us  all.  "  Why,  I  have 
committed  as  many  crimes  as  many  men,  and  why  should  I  be 
such  a  fool,  if  I  wished  to  be  cured,  as  to  say,  if  I  had,  that  I 
had  not  had  intercourse  with  a  woman."  I  don't  believe  he  had, 
but  that  it  was  one  of  the  dozens  of  cases  where  the  irregulari- 
ties of  married  life  had  given  rise  to  a  gonorrhoea,  or  blenhorr- 
hcea,  that  I  defy  you  to  distinguish  from  common  gonorrhoea, 
I  say  there  is  a  "tertium  quid  engendered  during  the  period 
of  ovulation  or  menstruation  in  the  female,  that  may  give  rise 
to  gonorrhoea,  but  I  do  not  believe  in  syphilitic  inoculation.  If 
you  know  how  to  treat  rheumatism,  you  know  a  great  deal  also 
of  this  disease.  Mr.  Abernethy,  as  I  said,  already  went  to  the 
threshold  on  the  subject,  as  regards  "rheumatic  gonorrhoea,"  or 
what  you  will  see  copied  in  the  books  and  manuals  as  gonorrheeal 
rheumatism.  Evans  and  Rose  and  Hennen,  away  from  the 
coteries  of  London,  settle  the  thing  forever.  You  are  probably 
aware,  the  prostitutes  in  France  are  all  examined  at  stated  times,, 
and  are  furnished  with  clean  bills  of  health  ?  Well,  Evans  saw 
several  hundreds  of  these  women  examined,  and  only  three 
were  diseased ;  but  he  had  one  hundred  and  fifty-three  soldiers 
under  his  care  at  that  moment  with  syphilis !  I  say,  how  did 
these  153  soldiers  become  diseased  from  three  women  ?  How 
did  they  get  it  ?  Where  was  it  to  come  from  ?  To  my  mind,- 
now,  it  is  as  clear  as  that  chloroform  will  produce  insensibility, 


64:  Catamenial  Gonorrhoea  and  Syphilis.  [January, 

or  any  other  fact  in  surgery  ;  they  got  it  from  the  clean  women, 
and  not  from  the  diseased.  I  told  you  of  Torres  Yedras.  This 
army  was  inaccessible  for  a  long  time,  and  dozens  of  officers  had 
intercourse  with  the  couple  of  girls  dancing  at  the  theatre. 
These  girls,  mind  you,  in  good  health,  yet  shoals  of  these  officers 
came  to  England  with  bad  phagedenic  sores.  Do  you  think 
they  got  phagedene  directly,  as  Mr.  Hunter  would  think,  from 
these  girls  ?     I  don't. 

Well,  I'll  tell  you  another  case,  and  within  a  very  short 
period  of  the  present — not  to  go  back  to  Torres  Vedras  or  Wa- 
terloo, or  tire  you  with  what  you  will  find  decked  out  in  the  books 
of  the  schools — the  case  of  a  lawyer.  [I  am  glad  it's  a  lawyer,  if 
it  must  be  somebody  (laughter ;)  lawyers  are  so  wedded  to  do 
nothing,  if  erroneous,  to  the  decision  of  their  judges.]  It  was, 
in  a  word,  the  counterpart  of  the  first  case— seduction,  love  (the 
old  story) — seduction,  gonorrhoea  and  a  crop  of  sores.  I  exam- 
ined the  lady  with  the  utmost  minuteness.  I  sifted  this  case 
carefully.  I  believe  there  was  no  disease  whatever  in  the  lady 
nor  in  the  gentleman  previous  to  the  occurrence ;  yet  all  the — 
what  shall  I  call  it — legal  evidence  was  the  other  way.  Legal 
proof  on  medical  subjects  at  present  is  the  greatest  absurdity 
Under  Heaven,  because  Well  bound  books  on  surgery  say  one 
thing  to  a  man  with  a  wig  and  gown  on,  and  because  a  sur- 
geon's opinion  which  is  not  only  viva  voce  and  original,  but  fair- 
ly worked  out  after  thirty  or  forty  years'  analysis  of  facts  and 
cases  in  hospitals,  must  be  thrown  to  the  winds,  in  favor  of  the' 
dictum  of  some  old  book,  or  some  new  book  copying  the  old. 

I  say,  this  material  syphilitic  infection  is  all  a  fallacy,  I  don't 
believe  either  in  all  that  black  letter  lore  of  syphilis  coming  from 
St.  Domingo  with  Columbus  in  the  fifteenth  century.  Gonor- 
rhoea is  detailed  in  our  oldest  and  most  sacred  of  books. 

Mr.  Skey  next  stated  the  particulars  of  a  very  interesting  case 
—a  case  of  most  frightful  phagedenic  sores  in  a  gentleman,  like 
those  of  the  officers  sent  from  Lisbon,  but  where  the  disease  was 
clearly  the  result  of  scrofula,  or  some  such  constitutional  taint  in 
the  gentleman's  system  aggravated  by  those  injudicious  courses 
of  mercury,  ordered  for  a  very  simple  affection  at  first.  The  case 
was  one,  also,  where  the  nymen  was  ruptured  for  the  first  time, 
but  not  a  trace  of  disease  existed  in  the  lady. 

"This  old  mercurial  school,  however,  still  holds  out,"  Mr. 
Skey  continued  to  say  ;  "I  am  sorry  that  even  men  like  Sir  B. 
Brodie  still  belong  to  it.  It  is  not  true  that  a  woman  who  will 
allow  one  man  to  her  embraces,  will  allow  any  other  ;  and  if  the 
disease  be  checked  by  mercury — -post  hoc,  &c. — that  we  should  go 
on  giving  it !  In  this  last  patient  it  made  all  this  difference,  that 
whereas  Eose,  or  Evans,  or  Carmichael  would  have  cured  this 
gentleman  without  mercury,  in  following  the  plan  of  the  older 


1858.J  Treatment  of  Primary  Syphilis.  65 

schools  he  was  at  the  point  of  death,  owing  to  the  mercury, 
under  the  first  advice  in  London,  affecting  the  membranes  of 
his  brain.  We  shall  not  speak  of  the  hideous  mutilations  of 
face  and  nose,  the  time  sacrificed  away  from  business  on  the  sick 
list,  and  the  marks  which  rupia  too  often  leaves  on  the  forehead 
and  face,  I  am  satisfied,  and  you  will  be  so  too,  when  you  see 
some  practice,  that  all  this  old-fashioned  dosing  system  with 
mercury  is  bad.  I  would  almost  go  so  far  as  to  say,  that  the 
very  worst  cases  of  syphilis,  so  called  in  men  that  I  have  seen, 
have  been  the  result  of  something  wrong  with  the  man  rather 
than  the  woman,  and  where  the  "tertium  quid"  was  aggravated 
by  this  system  of  giving  mercury,  as  a  piece  of  murderous  old 
routine  in  all  cases  alike. 

Well,  a  few  words  now  as  to  gonorrhoea  and  rheumatism.  Is 
there  such  a  thing  as  spontaneous  gleet?  Yes;  it  is  a  catarrh 
of  the  parts.  I  know  a  gentleman  who  has  had  gleet ;  but  he 
has  been  several  months,  aye  years,  in  bed  for  another  disease, 
and  he  had  no  possible  manner  of  getting  gleet. 

You  will  find  gonorrhoea!  rheumatism  in  excentric  gonorrhoea, 
mostly  in  oldish  people,  the  disease  mild  or  the  opposite,  fond  of 
fits  and  starts  or  aberrations ;  it  is  gonorrhoea  in  a  rheumatic  sys- 
tem, but  not  rheumatism  connected  as  a  secondary  symptom  or 
as  cause  and  effect  with  gonorrhoea.  I  am  satisfied,  gonorrhoea! 
rheumatism  and  gonorrhoea  are  children  of  one  parent,  and  not 
related  as  rheumatism  the  child  of  gonorrhoea,  the  parent, 

I  will  now  tell  you  more:  I  have  seen  every  form  of  syphilitic 
disease  as  obtained  from  healthy  women.  These  cases  occur  in 
the  better  ranks  of  society,  with  men  who  are  above  suspicion. 
"What  is  sometimes  shocking  in  a  moral  point  of  view,  is  of  the 
utmost  value  to  us  pathologically.  But  I  must  not  dwell  on 
these  cases.  The  gentlemen  come  to  me  expressing  their  un- 
bounded astonishment,  yet  if  you  make  the  most  careful  search, 
even  with  the  speculum,  there  is  no  disease  in  the  lady ;  it  would 
be  almost  a  relief  to  one's  mind  to  find  something,  but  there  is 
no  disease  whatever.  No,  it  is  all  fallacious. — [Ohio  Medical  and 
Surgical  Journal. 


Treatment  of  Primary  Syphilis  hy  Preparations  of  Iron. — Xtfcord  sug- 
gested the  employment  of  potassio-laetate  of  iron  in  phagenic  chancre, 
and  Mr.  Acton  recommends  it  very  highly.  Mr.  Behrend  (Lancet),  be- 
lieving in  the  essential  identity  of  the  virus  of  every  form  of  chancre,  and 
attributing  the  apparent  differences  to  special  circumstances,  was  led  to 
employ  this  preparation  of  iron  in  the  treatment  of  the  common  chancre. 
He  reports  the  details  of  a  number  of  cases  thus  treated,  with  the  most 
satisfactory  results.  His  method  of  administering  the  iron,  is  to  make  a 
mixture  of  one  ounce  to  six,  of  which  two  teaspoonfuls  are  to  be  taken 
three  times  a  day.    The  local  applications  are  simple. — [Med.  Independent 


66  Editorial  [January, 


EDITORIAL  AND  MISCELLANEOUS. 

The  Fourteenth  Volume,  of  the  New  Series,  of  the  Southern 
Medical  and  Surgical  Journal. — In  presenting  the  first  number  of  the' 
fourteenth  volume  of  this  Journal  to  our  readers,  we  would  call  their 
attention  to  the  enlargement  of  the  work,  which,  by  the  liberality  of  the 
pulisher,  presents  to  the  subscriber  as  large  an  amount  of  valuable  read- 
ing matter,  as  any  similar  work,  at  the  same  price,  in  the  country. 

Having  its  circulation  principally  in  the  Southern  and  Western  States,- 
we  have  endeavored  to  embody  in  each  number  of  the  journal,  such 
original  and  selected  matter,  as  our  own  judgment  and  the  advice  of  our 
more  experienced  colleagues  have  indicated  to  be  most  valuable  for  the 
exigencies  of  the  Southern  Practitioner.  No  new  principle  in  medicine, 
no  new  view  of  pathology,  or  rational  mode  of  treatment,  has  met  our 
eye,  throughout  the  whole  range  of  our  fifty  or  sixty  exchanges,  Domes- 
tic or  Foreign,  but  what  we  have  endeavored,  so  far  as  we  had  space,  to 
treasure  up  in  our  pages  for  the  benefit  of  our  readers.  This  we 
shall  still  do,  so  long  as  our  connection  with  the  work  shall  con- 
tinue. Having  been  in  long  and  intimate  relations  with  a  large  number 
of  Physicians  throughout  the  country,  we  have,  we  hope,  acquired  a 
sufficient  knowledge  of  the  wants  of  the  Soul  hern  Practitioner,  to  pre- 
pare for  him  a  useful  and  efficient  journal.  We  are  aware  that  the 
thirteenth  volume  of  the  Southern  Medical  and  Surgical  Journal,  will  be 
found  deficient  in  some  of  the  departments  of  Medical  Literature ;  thus 
in  the  department  of  Reviews,  our  estimation  of  the  true  intent  and  ob- 
ject of  a  monthly  journal  has  induced  us  not  to  occupy  our  space  with 
extended  analyses  of  works,  unless  in  so  doing  we  could  embody  views 
and  suggestions,  of  a  practical  nature,  for  the  benefit  of  the  reader.  We 
have  given  each  work,  sent  us  by  authors  and  publishers,  a  diligent  and 
careful  examination,  and,  when  found  worthy  of  recommendation,  have 
given  it  our  approval,  or  we  have  carefully  pointed  out  its  defects.  We 
look  upon  the  department  of  Reviews  as  belonging  more  particularly  to 
the  Quarterly  and  Bi-monthly  journals,  one  of  which,  each  member  of 
the  Profession  should  subscribe  for,  but  in  no  case,  to  the  exclusion  of  the 
monthly  journals ;  for  in  these  last  he  finds  the  supply  for  his  daily,  and, 
indeed,  his  hourly  necessities.  "  Knowledge  (says  a  distinguished  writer) 
evaporates  like  water ;  and  as  the  ocean  itself,  unless  replenished,  would 
become  empty,  so  the  brain,  unless  its  avenues  to  improvement  are  kept 
open  and  well  trodden,  becomes  but  a  barren  waste,  haunted  by  the 
ghosts  of  worn-out  and  obsolete  thoughts :" — a  fatuous  and  somnolent 
demain,  a  "  Sleepy  Hollow"  and  its  occupant  a  veritable  Rip  Van  Win- 


1858.]  Editorial  67 

tie — dozing  while  the  whole  world  has  been  advancing — his  mental 
status  being  the  index  to  its  condition  just  twenty  years  gone  by ! 

In  making  these  remarks,  of  course,  we  have  no  fear  of  giving  offence, 
for  none  from  this  sleepy  region  will  ever  be  offended  by  these  distaste- 
ful animadversions,  for  what  is  written,  is  for  them,  u  as  though  it  never 
had  been  writ." 

The  volume  of  our  journal,  just  now  commencing,  will,  we  hope,  be- 
sides the  liberal  enlargement  by  the  publisher,  present  an  increased 
interest  to  its  readers,  in  the  many  valuable  original  papers  now  in  prepa- 
tion  for  its  pages.  We  have  also  on  hand,  lignographic  illustrations  of 
several  interesting  articles,  which  are  intended  to  embellish  the  work 
and  add  to  its  value. 

We  continue  to  invite  contributions  from  our  brethren,  and  with  their 
countenance  and  support,  we  enter  upon  the  labors  of  this  fourteenth 
volume  with  that  hope  and  confidence,  which,  a  determination  to  do  our 
duty,  alone  can  inspire.  Henry  F.  Campbell. 

Robert  Campbell. 


Materia  Medica  and  Therapeutics :  with  ample  illustrations  of  Practice 
in  all  the  departments  of  Medical  Science,  and  very  copious  Notes  of 
Toxicology,  suited  to  the  wants  of  Medical  Students,  Practitioners,  and 
Teachers.  A  new  edition,  revised  and  enlarged.  By  Thomas  D. 
Mitchell,  A.  M.,  M.  D.,  Professor  of  Materia  Medica  and  General  The- 
rapeutics in  Jefferson  Medical  College,  and  formerly  Professor  of 
Chemistry,  Materia  Medica,  and  Theory  and  Practice  in  the  Medical 
College  of  Ohio,  Transylvania  University,  and  the  Kentucky  School  of 
Medicine ;  Author  of  u  Elements  of  Chemical  Philosophy,"  &c,  &c. 
Philadelphia:  J.  B.  Lippincott  &  Co.  1857.  8vo.,  pp.*820.  (For 
sale  by  T.  Pachards  &  Son.) 

This  last  edition  of  Professor  Mitchell's  work  has  been  brought  up  to 
the  very  last  hour  of  the  Science  of  Therapeutics.  Every  thing  new  per- 
taining to  the  subjects  under  discussion  has  been  collected  from  journals 
and  books  to  enrich  this  volume ;  and  yet  it  is  neither  cumbrous,  un- 
wieldy or  expensive.  We  regard  it  as  perhaps  the  most  practical  of  all 
the  treatises  on  its  special  subject.  This  work  perhaps  would  not  answer 
as  the  sole  treatise  of  Therapeutics  possessed  by  the  Practitioner,  nor  do 
we  know  any  work  that  would ;  but  the  neglect  of  the  practical  good 
sense  and  honest  labor  stored  away  in  its  pages  will  deprive  the  Physi- 
cian of  some  most  valuable  suggestions  and  expedients. 

In  the  miscellany  of  the  present  number  of  our  journal  will  be  found  a 
simple  test  for  Quinine  and  morphine.  We  select  it  for  its  practical  va- 
lue and  convenience,  and  also  as  a  specimen  of  the  many  treasures  gar- 
nered up  in  Dr.  Mitchell's  book.  The  style  of  the  work  does  much  credit 
to  its  publishers,  Messrs.  J.  B.  Lippincott  <fe  Co. 


68  Editorial.  .  [January, 

A  Dictionary  of  Medical  Science  ;  containing  a  concise  explanation  of 
the  various  subjects  and  terms  of  Anatomy,  Physiology,  Pathology, 
Hygiene,  Therapeutics,  Pharmacology,  Pharmacy,  Surgery,  Obstetrics, 
Medical  Jurisprudence,  Dentistry,  etc. ;  Notices  of  Climate,  and  of 
Mineral  Waters ;  Formulae  for  Officinal,  Empirical,  and  Dietetic  Pre- 
parations, etc. ;  with  French  and  other  Synonymes.  By  Robley  Dun- 
glison,  M.  D.,  LL.  D.,  Professor  of  the  Institutes  of  Medicine,  etc.,  in 
the  Jefferson  Medical  College  of  Philadelphia.  Revised  and  very  great- 
ly enlarged.  Philadelphia :  Blanchard  &  Lea.  1857.  8vo.,  pp.  992. 
(For  sale  by  T.  Richards  &  Son.) 

Professor  Dunglison — the  Samuel  Johnson  of  Medical  nomenclature — 
lias  brought  forth  the  Fifteenth  Edition  of  his  great  work,  "  The  Medical 
Dictionary." 

The  above  announcement  speaks  volumes ;  a  good  reliable  dictionary 
is  a  necessity  which  admits  of  no  choice;  we  may  neglect  other  depart- 
ments of  Medical  literature,  but  the  words,  "  the  vesture  of  our  thought," 
must  be  at  our  command,  or  we  must  be  dumb.  The  number  of  editions 
through  which  this  work  has  passed  indicates  its  appreciation  by  the 
Profession.  The  labor  bestowed  on  this  last  edition  is  immense,  and 
speaks  well  for  the  industry  and  power  of  research  of  its  distinguished 
author.  In  its  style  and  typographical  excellence  Messrs.  Blanchard  & 
Lea  fully  sustain  their  well  established  reputation  as  publishers  of  medi- 
cal works. 

Lectures  on  Diseases  of  Women.  By  Charles  West,  M.  D.,  Fellow  of  the 
Royal  College  of  Physicians  ;  Examiner  in  Midwifery  at  the  Royal  Col- 
lege of  Surgeons  of  England  ;  Physician  Accoucheur  to  St.  Bartholo- 
mew's Hospital,  and  Physician  to  the  Hospital  for  Sick  Children. 
Part  I. — Diseases  of  the  Uterus.  Philadelphia :  Blanchard  &  Lea. 
1857.     8vo.,  pp.  316.     (For  sale  by  T.  Richards  &  Son.) 

We  have  given  the  above  work  a  careful  examination.  We  are  familiar 
(as  who  is  not?)  with  the  previous  writings  of  Dr.  West,  and  all  we 
know  of  them  speak  much  in  favor  of  the  present  treatise.  A  fairer, 
more  honest,  more  earnest,  and  more  reliable  investigator  of  the  many 
diseases  of  women  and  children  is  not  to  be  found  in  any  country.  His 
own  Preface  will  give  a  better  idea  of  the  intents  and  objects  and  uses  of 
the  book,  than  any  exposition  of  ours.     We  therefore  quote  briefly : 

"  These  Lectures  are  a  first  instalment  towards  the  discharge  of  that 
debt  which  the  opportunities  of  a  hospital,  and  the  responsibilities  of  a 
teacher,  impose  upon  me.  A  second  volume,  which  will  treat  of  all  the 
remaining  diseases  of  the  female  system,  will  appear,  if  health  and  strength 
are  spared  me,  within  three  years  from  this  time.  I  have  published  this 
part  separately,  because  I  believe  that  students  and  junior  practitioners 
stand  in  much  need  of  that  help  which,  with  reference  to  an  important 
class  of  these  ailments,  it  may  perhaps  afford  them." 

For  the  Student  and  junior  Practitioner  the  work  has  been  particularly 
prepared,  and  to  this  class  we  would  earnestly  commend  it. 


1858.]  Editorial.  69 

A  Case  of  Excision  of  the  Hip  Joint  for  Morbus  Coxarius,  with  remarks 
upon  the  pi'opriety  of  such  an  operation,  and  a  summary  account  of  the 
recorded  cases  up  to  the  present  time.  By  R.  A.  Kinloch,  M.  D.,  Sur- 
geon to  the  Roper  Hospital,  and  Lecturer  on  Surgery  in  the  Charleston 
Summer  Medical  Institute. 

This  valuable  paper,  sent  to  us  by  our  friend,  the  author,  has  been 
upon  our  table  for  some  time,  but  by  some  mischance  overlooked.  It 
details  an  operation  by  the  reporter,  which,  though  unfortunate  in  its 
result,  constitutes  a  valuable  record  in  this  department  of  operative  sur- 
gery. The  value  of  the  paper  consists  in  the  research  made  by  the  author 
and  the  bringing  together  of  a  number  of  cases,  with  their  peculiarities 
and  their  results.  This  he  has  done  in  a  tabular  form,  so  that  the  main 
points  of  each  case  are  conveniently  presented  to  the  reader.  "We  com- 
mend the  article  to  all  those  who  are  interested  in  cases  of  Morbus 
Coxarius,  and  to  all  who  wish  to  become  familiar  with  the  statistics  of 
the  operation  of  Excision  of  the  Hip  Joint. 


Books  received  for  Review. — Besides  the  works  noticed  in  our 
present  number,  we  have  received  from  Messrs.  Blanehard  &  Lea  the 
following : 

"  Dunglison's  General  Therapeutics  and  Materia  Medica.  Sixth  edition, 
revised  and  improved." 

M  Peasley's  Human  Histology :"  a  new  and  valuable  work,  to  be  noticed 
in  our  next  number. 

From  Messrs.  Lindsay  &  Blakiston — 

"  MendenhalPs  Students  Vade  Mecum.  Fifth  edition,  enlarged  and 
improved." 

"  A  Practical  Treatise  on  Diseases  of  Women  and  Children.  By  J. 
Forsyth  Meigs.    Third  edition,  carefully  revised." 

From  Messrs.  J.  B.  Lippincott  &  Co. — 

"Essays  on  the  Secretory  and  the  Excito-Secretory  System.  By 
Henry  F.  Campbell,  M.D." 

The  above  works  came  to  hand  too  late  for  a  careful  notice ;  they 
shall  meet  with  full  attention  in  our  February  number. 


Atlanta  Medical  College — Resignations  and  Appointments. — 
Professors  Boring  and  Means  have  resigned  their  respective  Chairs  of 
Obstetrics  and  Chemistry  in  the  above  Institution. 

To  fill  the  vacancy  caused  by  the  retirement  of  Professor  Boring,  Dr. 
T.  S.  Powell,  of  Sparta,  has  been  appointed  by  the  Trustees ;  we  hope 
that  the  Institution  will  be  able  to  secure  as  able  a  successor  to  Professor 
Means. 

Dr.  Means  retains  his  connection  as  Professor  of  Chemistry  with  the 
Medical  College  of  Georgia. 


70  Editorial  and  Miscellaneous.  [January, 

Binding  of  Thirteenth  Volume. — We  would  suggest  to  our  readers 
the  binding  of  their  volumes  of  the  Journal,  thus  adding  a  book  to  their 
libraries,  instead  of  having  their  tables  cumbered  with  twelve  perishable 
pamphlets,  which  must  soon  disappear  from  their  possession. 

Discriminating  Test  for  Quinine  and  Morphia. — Although  the 
following  is  in  a  book,  which  all  our  readers  should  possess,  on  account 
of  its  simplicity  and  importance,  we  record  it  prominently  in  our  ex- 
tracts : 

"  As  mistakes  have  been  made,  and  may  be  again  committed,  in  con- 
founding sulphate  of  morphia  with  sulphate  of  quinine,  it  is  important  to 
distinguish  accurately.  The  labels  may  have  been  rubbed  from  the  bot- 
tles, and  it  would  not  do  to  rely  on  taste  or  smell.  Both  salts  are  bitter, 
but  one  is  decidedly  poisonous.  If  we  add  a  drop  or  two  of  strong  nitric 
acid  to  small  portions  from  each  bottle,  placed  on  a  watch-crystal,  the 
quinine  salt  will  be  made  yellow,  while  the  salt  of  morphia  will  be 
changed  to  a  bright  red.  The  experiment  is  performed  with  ease,  and 
is  sufficiently  accurate  for  practical  purposes,  and  every  physician  should 
keep  the  test  in  his  mind." — [MitchelVs  Materia  Medica,  last  ed.y  p.  324. 


Sympathetic  Inflammation  of  the  Eyeball. — Mr.  "Walton  remarks 
(British  Med.  Journal),  that  the  horse  doctor  is  in  advance  of  the  accom- 
plished ophthalmologist  in  their  knowledge  of  some  diseases  of  the  eye. 
It  has  been  a  practice  among  farriers,  in  certain  ophthalmic  diseases  of 
the  horse,  to  destroy  the  eye  by  suppuration,  knowing  well  that  the 
other  eye,  which  is  in  great  peril,  could  be  saved  by  this  means.  Mr. 
Wardrop,  taking  advantage  of  this  hint  many  years  since,  practiced 
evacuating  the  humor  of  the  affected  eye,  and  thereby  relieved  the  sound 
organ  from  the  dangers  of  a  sympathetic  inflammation. 

[This  has  been  the  uniform  practice  of  Professor  L.  A.  Dugas,  of  this 
College,  for  years,  and  we  believe  it  is  a  measure  now  very  generally 
adopted  by  surgeons  in  such  cases.] — Eds.  S.  M.  &  S.  Jour. 


Oil  of  Tansy. — Dr.  Chapin,  of  Winchester,  introduced  (to  the  notice 
of  the  Middlesex  East  District  Medical  Society,  Nov.  4th,  1857)  the  sub- 
ject of  oil  of  tansy  in  its  ecbolic  and  toxicological  relations,  and  related  a 
case  in  which  he  was  summoned  at  midnight  to  visit  a  married  female, 
"  in  a  fit."  The  patient  was  found  in  bed,  partly  conscious,  and  in  par- 
oxysms. A  distinct  smell  of  the  oil  pervaded  the  apartment.  Vomiting 
had  occurred.  He  immediately  exhibited  ipecacuanha  and  sulphate  of 
zinc,  which  was  followed  by  free  emesis.  In  an  hour  the  mind  became 
clear  and  she  got  along  very  well.  The  woman  was  four  months  advan- 
ced in  pregnancy,  and  took  the  oil  for  abortion.  The  quantity  taken 
was  half  a  fluid  ounce.     Dr.  C.  stated  that  some  cases  have  been  fatal. 

Drs.  B.  Cutter  and  Drew,  of  Woburn,  adduced  similar  cases,  and  Dr. 
Underwood,  of  West  Cambridge,  spoke  of  a  young  woman  in  a  hotel 


1858.]  Miscellaneous.  71 

who  took  the  oil  to  procure  abortion.  The  immediate  effect  was  violent 
convulsions.  At  full  term  a  child  was  born,  not  larger  than  a  rat.  The 
child  lived  three  weeks.  This  case  was  mentioned  to  show  that  the  oil 
sometimes  arrests  growth.  Dr.  Toothaker,  of  Wilmington,  spoke  of  a 
middle-aged  married  woman  who  took  two  fluid  ounces  of  oil  of  tansy 
in  divided  doses  without  effect.  She  then  resorted  to  the  woods,  al- 
though it  was  midwinter,  and  the  snow  knee-deep,  and  gathered  a  quan- 
tity of  savin  leaves,  an  infusion  of  which  was  freely  taken  without  success. 
At  term,  she  bore  a  medium-sized  child,  which  for  some  time  was  esteem- 
ed non  compos.  Now,  however,  at  the  age  of  ten,  the  child  is  a  bright 
boy. 

Oil  of  Cedar. — Dr.  Ingalls,  of  Winchester,  spoke  of  the  exhibition  of 
half  a  fluid  ounce  of  oil  of  cedar,  which  was  followed  by  nausea  and 
fright.  The  girl  took  it  for  an  emmenagogue.  Dr.  Hodgedon,  of  West 
Cambridge,  said  he  attended  a  woman  who  had  been  in  convulsions 
three  or  four  hours  on  taking  cedar  oil.  After  an  emetic  she  recovered, 
with  no  ill  effects.  The  patient  was  chlorotic,  and  dosed  for  amenor- 
rhcea.  Dr.  Underwood  asked  if  the  use,  by  midwives,  of  an  infusion  of 
raspberry  leaves,  in  place  of  ergot,  was  known  to  the  Society.  Drs.  B. 
Cutter  and  Drew  had  found  draughts  of  cold  water  useful  to  increase 
pains,  and  allowed  their  patients  a  free  use  of  the  article  during  labor, 
Dr.  Toothaker  inquired  if  the  uva  ursi  wonld  act  as  ergot.  In  one  case 
he  used  the  infusion  very  freely,  with  no  effects.  On  exhibiting  a  moder- 
ate dose  of  ergot,  contractions  immediately  ensued. — [Boston  Med.  and 
Surg.  Journal. 

Colica  Pictonum  produced  by  the  White-lead  Treatment  of  a  Severe 
Scald. — Dr.  G.  A.  Kunkler  relates  the  case  of  an  Irish  servant  girl,  who 
severely  scalded  the  fore-arm  and  hand.  Extensive  vesication  followed. 
The  blisters  were  punctured,  and  common  white  paint,  of  the  consistence 
of  cream,  was  freely  applied  with  a  camel-hair  brush,  the  part  was  covered 
with  cotton  and  a  roller  applied  over  the  whole.  This  dressing  was  re- 
peated on  the  following  day.  On  the  third  day  she  exhibited  unmistaka- 
ble signs  of  colica  saturnina — acute  abdominal  pain,  retraction  of  the 
umbilicus,  constipation,  and  slight  discoloration  of  the  gums.  The  symp- 
toms yielded  to  opium  and  purgatives,  and  the  linseed-oil  and  lime-water 
dressing  was  substituted  for  the  lead,  under  which  treatment  the  burn  got 
well.  Dr.  Kunkler  states  that  he  has  freely  used  the  white  paint  in  a  num- 
ber of  other  cases,  some  of  them  of  great  severity,  without  meeting  with 
a  bad  result.  The  editor  believes  this  to  be  the  only  well-authenticated 
case  of  colic  resulting  from  the  application  of  white  lead  to  burns  or 
scalds. — [Medico-  Chirurgical  Review. 

On  the  Physiological  and  Toxicological  Properties  of  Woorara. — M. 
Pelikan  has  communicated  to  the  Academy  of  Sciences  the  results  of  his 
experiments  on  woorara  poison.  With  regard  to  its  physiological  effects, 
the  author  arrives  at  the  same  results  as  M.  CI.  Bernard.  As  to  its  toxico- 
logical action,  M.  Pelikan  finds  that  an  aqueous  solution  introduced  into 
the  stomach  by  an  elastic  tube  produces  poisonous  effects,  but  more  slowly 
and  less  energetically.  This  cannot  be  explained  on  the  supposition  that 
woorara  contains  a  certain  quantity  of  serpent-poison,  for  it  is  characteristic 


72  Miscellaneous.  [January, 

of  nearly  all  the  narcotic  poisons  which  are  easily  absorbable.  Curarine 
possesses  all  the  active  properties  of  woorara.  Five  centigrammes  of  the 
alkaloid  introduced  under  the  skin  of  a  rabbit  caused  death,  with  all  the 
symptoms  of  poisoning  by  woorara.  When  woorara  is  absorbed  in  a  suffi- 
cient dose  to  produce  death,  there  can  be  no  question  as  to  the  antidote. 
Strychnia  can  provoke  its  peculiar  symptoms  only  in  the  case  where  the 
dose  of  woorara  has  been  insufficient,  and  vice  versa.  Solution  of  woorara 
precipitated  by  tannin  loses  its  effect  in  an  ordinary  dose,  but  in  powder 
mixed  with  powdered  tannin,  and  introduced  into  a  wound,  it  preserves  its 
poisonous  action.  The  action  of  the  poison  is  not  destroyed  by  iodine  dis- 
solved in  iodide  of  potassium,  neither  in  the  case  of  the  two  solutions  mix- 
ed, evaporated,  and  the  residue  introduced  into  the  subcutaneous  tissue. 
[Archives  Generates,  and  Brit.  <£  For.  Med.  Rev. 

Pulmonary  Epithelium. — In  the  July  number  of  the  British  and  For- 
eign Medico-Chirurgical  Review,  we  notice  an  article  by  Dr.  C.  Radclyffe 
Hall,  on  the  epithelium  of  the  air  vesicles  of  the  human  lung. 

Some  of  our  readers  may  recollect  a  paper  by  Dr.  Hall  in  the  last  Oc- 
tober number  of  the  Review,  in  which  he  states  that  in  chronic  pulmonary 
consumption,  "  fatty  atrophy  of  the  epithelium  of  the  air  vesicles  is  ante- 
cedent to  the  formation  of  tubercle ;  in  the  same  number  we  have  a  paper 
by  Mr.  Rainey,  against  the  existence  of  epithelium  in  the  air  vesicles. 
This  paper  by  Dr.  Hall  assumes  to  demonstrate  these  epithelial  cells,  and 
is  illustrated  by  wood  cuts  of  their  microscopic  appearance  as  seen  by 
Dr.  Hall  and  Dr.  Brittan.  Assuming  that  these  illustrations  are  correct, 
and  we  have  no  reason  to  doubt  it,  there  seems  no  doubt  but  that  epithe- 
lial cells  can  be  demonstrated  in  the  human  lungs,  and  the  lungs  of  the 
mammalia.  We  cannot  but  agree  with  Dr.  Hall,  that  on  a  question  of 
relative  authority,  "  the  positive  evidences  of  one  trustworthy  observer  is 
usually  allowed  to  overrule  the  negative  evidence  of  many."  An  exam- 
ination of  this  article  by  Dr.  Hall,  with  the  drawing  of  the  microscopic 
appearances  by  Dr.  Brittan,  will  not  fail  to  convince  any  one  of  the  exist- 
ence of  epithelium  in  this  situation.  If  this  were  not  the  fact,  the  state- 
ment of  Dr.  Hall  that  fatty  degeneration  of  the  epithelium  of  the  air  cells 
preceded  the  deposition  of  tubercle,  (an  observation  which  we  conceive 
to  be  of  value,  and  which  we  hope  may  be  further  elaborated,)  would  of 
course  be  entirely  without  foundation. — [Buffalo  Med.  Jour.  f. 

Treatment  of  Anatomical  Wounds  with  Lotions  of  Chlorine  Water. — 
M.  Nonat,  Physician  to  the  Hospital  of  La  Charite,  recommends  the  use 
of  lotions,  with  solution  of  chlorine,  in  cases  of  anatomical  wounds,  which 
unfortunately  are  far  from  being  always  exempt  from  danger.  Be  the 
wound  large  or  small,  be  its  surface  united  or  unfractuous,  the  solution  of 
chlorine  destroys  the  putrid  matter,  which  acts  like  a  virus,  and  which 
causes  so  bad  an  influence  on  the  system  when  absorbed.  This  agent 
may  perhaps  be  absorbed,  mix  itself  with  the  blood,  and  thereby  prevent 
the  mischief  arising  from  them,  or  destroy  those  bad  symptoms  which 
have  already  appeared. 

The  way  to  use  it  is  very  simple.  The  wound  is  first  well  washed  with 
water,  then  with  the  solution  of  chlorine.  If  the  wound  is  one  of  some 
days'  standing,  if  it  is  inflamed,  if  the  lymphatic  vessels  and  glands  are 


1858.]  Miscellaneous.  73 

obstructed,  if  the  general  appearance  is  favorable,  and  provided  there  are 
no  symptoms  of  putrid  infection, — the  lotions  of  chlorine  may  arrest 
these  accidents.  It  is  useful  in  these  cases,  to  use  at  the  same  time  inha- 
lations of  chlorine. 

M.  Xonat  has  often  had  opportunities  of  testing  these  means,  and  in 
very  serious  cases.  He  thinks  chlorine  ought  to  be  put  at  the  disposal  of 
the  students,  in  the  dissecting  halls,  and  would  have  the  following  in- 
scription upon  the  walls  of  the  amphitheatre — "Wash,  as  soon  as  possi- 
ble your  anatomical  wounds  with  solution  of  chlorine." — [  Union  Medicalc, 
and  Medical  Circular. 


Cod-Liver  Oil  Solidified  with  Gelatine, — Take  of  pure  gelatine,  half 
an  ounce ;  water,  simple  syrup,  of  each  four  ounces ;  cod-liver  oil,  eight 
ounces ;  aromatic  essence,  as  much  as  may  be  sufficient.  Dissolve  the 
gelatine  in  the  boiling  water,  and  add  successively  the  syrup,  the  oil,  and 
the  aromatic  essence ;  place  the  vessel  containing  the  entire  in  a  bath 
of  cold  water ;  whip  the  jelly  for  five  minutes  at  most,  and  then  pour  it, 
while  still  fluid,  into  a  wide-mouthed  glass  bottle,  furnished  with  a  cork, 
or  with  a  pewter  cap,  or  if  a  bottle  be  not  at  hand,  into  a  porcelain  or 
earthenware  pot,  which  should  be  carefully  closed-  [Bel.  Gen.  de  Therap. 
and  American  Med.  Monthly. 


Lichen  and  Cod-Liver  Oil — Take  of  Iceland  moss  jelly,  four  ounces; 
gelatine,  four  scruples  ;  hydrocyanated  cod-liver  oil  (to  which  two  drops 
of  essence  of  bitter  almonds  have  been  added,)  six  drachms.  Prepare 
the  Iceland  moss  jelly  in  the  usual  manner ;  melt  the  gelatine  and  pass 
it  into  the  vessel  which  is  to  hold  it ;  then  add  the  cod-liver  oil ;  stir  the 
entire  with  a  spatula,  until  the  mixture  be  homogeneous  and  the  jelly 
begins  to  congeal.  Dose — two  or  three  spoonsfuls  daily. — [Bulletin 
General  de  Therapeutique  and  Dublin  Hospital  Gazette 


Lnteresting  Case  of  Transfusion  of  Blood. — This  operation  was  success- 
fully performed  on  the  16th  of  September,  by  Mr.  "Wheatcroft,  surgeon, 
of  Cannock,  Staffordshire,  England,  on  the  person  of  a  woman  named 
Wood,  residing  there.  Immediately  after  her  accouchment  fearful  hae- 
morrhage set  in,  draining  the  woman  of  blood.  She  felt  herself  dying, 
and  summoned  her  husband  to  her  bedside,  bid  him  "good  bye,"  and 
earnestly  requested  him  to  take  care  of  the  children  when  she  was  no 
more.  She  then  became  pulseless  and  gasping,  occasional  breathing 
being  the  only  indication  of  life.  A  vein  was  opened  in  her  arm,  and 
one  in  the  arm  of  her  husband,  and  as  the  blood  flowed  from  the  latter, 
it  was  transmitted,  by  suitable  apparatus,  into  the  veins  of  the  wife.  After 
seventeen  ounces  had  been  thus  injected,  the  pulse  became  perceptible, 
the  colorless  lips  reddened,  the  glassy  eyes  brightened,  and  she  thank- 
fully said,  "  I  am  better.  The  case  has  progressed  very  favorably,  and 
the  woman  is  recovering. — [Medical  Circular. 

Chloroform  Liniment  in  Burns. — M.  Bargiacchi  states  that  he  has 
found  the  extreme  suffering  produced  in  bad  burns  completely  relieved 
by  means  of  a  liniment  composed  of  chloroform  and  cod  liver  oil. — [Bull, 
de  Therap.,  and  Med.  Times  and  Gaz. 


74  Miscellaneous. 

Glycerine  is  found  to  be  a  solvent  for  almost  all  substances,  and  as  a 
pharmaceutic  agent  and  vehicle,  has  an  extensive  range  of  applicability. 
One  is  as  a  vehicle  for  the  external  application  of  Iodine,  particularly 
where  it  is  desirable  to  have  the  article  absorbed  by  the  skin.  Used  in 
the  proportion  of  one  part  of  Iodine  to  five  of  Glycerine,  it  produces  some 
smarting,  but  can  be  well  borne.  After  painting  it  upon  a  part,  it  may 
be  covered  with  gutta  perch  a  paper  to  prevent  evaporation  ;  and  in  this 
way,  fifteen  grains  of  Iodine  may  be  absorbed  into,  and  eliminated  from 
the  system  per  day,  for  several  weeks  together  without  any  injury  to  the 
general  health.  This  at  least  is  the  testimony  of  Dr.  Szukits,  a  German 
physician,  who  has  tried  it  in  24  cases. — [Peninsular  Jour,  of  Med. 

Glycogenic  Function  of  the  Liver. — Dr.  Louis  Figuier  read  on  the  27th 
July,  before  the  Academy  of  Sciences,  a  paper  in  which  he  aims  to  dis- 
prove the  glycogenic  function  of  the  liver,  on  which  so  much  stress  has 
been  laid  by  M.  Bernard.  He  maintains  that  this  function  belongs  to  all 
of  the  parenchymatous  organs  that  receive  blood,  such  as  the  heart, 
lungs,  spleen,  <fec,  and  also  in  the  blood  of  the  general  circulation. 

[  Western  Lancet. 

Tetanus. — The  last  number  of  Guy's  Hospital  Reports  contains  a 
paper  by  Mr.  Poland,  on  Tetanus.  He  gives  an  analysis  of  all  the  cases 
treated  in  Guy's  Hospital,  since  1825.  The  whole  number  of  cases 
treated  was  seventy-two.  The  great  majority  were  fatal,  and  in  those 
that  recovered,  it  was  impossible  to  assign  the  cure  to  any  particular 
remedy.  Mr.  Poland  is  of  the  opinion,  that  the  best  plan  of  treatment 
is  to  strengthen  the  patient,  and  thus  enable  him  to  pass  through  the 
disease— [lb. 

The  Daguerrean  Art  in  Medicine  and  Surgery. — For  some  time  the 
daguerreotype  has  conferred  much  benefit  upon  the  profession,  by  en- 
abling practitioners  to  secure  representations  of  disease  externally  mani- 
fested, and  also  copies  of  internal  lesions  observed  post  mortem.  In 
surgical  cases,  especially,  much  advantage  has  been  derived  from  thus 
taking  views  of  the  diseased  part  at  different  times,  and  also  in  exhibiting 
the  final  result. 

A  few  days  since,  Dr.  John  B.  Brown,  of  this  city,  showed"  to  us  certain 
daguerreotype  views  of  individuals  residing  at  a  distance — some  of  them 
in  Canada — who  were  affected  with  distortion  of  the  feet,  of  different 
degrees  of  intensity.  The  representations  thus  sent  enabled  him  to  de- 
cide what  procedure  should  be  adopted,  and  whether  it  would  be  neces- 
sary for  the  patient  to  be  under  daily  inspection  or  not.  The  results  of 
operations  done  to  remedy  club-foot  have  often  of  late  thus  been  sent  to 
Dr.  B.  The  same  plan  has  been  effectively  adopted  in  cases  of  spinal 
distortion.  The  many  advantages  secured  both  to  patients  and  their  ad- 
visers by  this  method,  must  be  evident,  and  the  daguerreotype  apparatus 
may  be  fairly  considered  one  of  the  articles  of  the  surgeon's  armamenta- 
rium. The  Talbotype  process  is  even  better  suited  than  that  of  Da- 
guerre  for  sending  these  views  to  a  distance — paper  being  used  to  receive 
them  instead  of  a  heavy  plate. — [Boston  Med.  and  Surg.  Jour. 


SOUTHERN 

MEDICAL  AID  SURGICAL  JOUMAL. 

(NEW  SERIES.) 

-i' 

Vol.  XIV.]  AUGUSTA,  GEORGIA,  FEBRUARY,  1858.  [No.  I 

ORIGINAL  AND  ECLECTIC, 

ARTICLE    V. 

The  Treatment  of  Dysentery — A  Clinical  Lecture  delivered  at 
Jackson- Street  Hospital.  By  EGBERT  Campbell,  A.M.,  M.D.,- 
Demonstrator  of  Anatomy  in  the  Medical  College  of  Georgia/ 

"  Pathology  is  only  valuable  when  it  has  a  tendency  to  the  prevention,  ameli- 
oration, or  cure  of  disease,  and  the  results  of  our  most  successful  labors  in  this 
department  are  but  nugatory,  unless  in  them  can  be  found,  a  clue  to  a  more' 
rational  and,  perfect  management  of  the  affections  to  which  they  refer." 

[ Transactions  of  American  Medical  Association,  vol.  vi 

Gentlemen  : 

In  our  recent  consideration  of  the  "  Pathology  of  Dysentery, ,y 
we  attempted  to  present  to  you  a  brief  analysis  of  the  nature  of 
that  disease.  We  now  propose  to  inquire  as  briefly,  into  the" 
character  of  the  remedial  means  and  measures  which  are  to  be" 
employed  for  the  relief  of  that  condition,  and  which  must  neces- 
sarily be  derived  from,  and  depend  upon — as  in  the  treatment 
of  all  diseases — a  full  appreciation  of  the  ends  to  be  attained,- 
and  a  proper  understanding  of  the  qualities  of  the  agents  appro- 
priate for  their  accomplishment. 

Now,  from  the  very  naming  of  this  disease,  as  well  as  from 
the  foregoing  pathological  deductions,  if  they  be  just,  you  might 
almost  sufficiently  anticipate  us  in  the  reeital  of  the  measures  to' 
be  adopted,  as  necessarily  depending  upon  the  application  of  the 
indications  therein  set  forth,  and  which  are  to  be  fulfilled  in  the 
treatment ;  so  much  so  as  well  nigh  to  render  a  farther  discus- 
sion of  the  subject  but  a  work  of  supererogation — were  rt  not,- 
that  experience,  the  impartial  teacher,  is  a  better  verifier  of  theo^- 

N.  8. — VOL.  XIV.    NO.  II.  4 


76  Campbell's  Lecture  on  Dysentery.        [February, 


ry,  than  is  conjecture;  and  hence,  by  the  aid  of  the  former,  may 
we  endeavor  to  show,  that  Pathology  must  ever  find  its  proof  in 
Therapeutics. 

It  will  be  perceived,  that  there  are  four  important  elementary 
conditions  presented  for  our  consideration  in  the  study  of  this 
disease,  which  must  be  observed  throughout,  and  also  reconciled 
to  each  other's  demands  and  from  these  four  conditions  arise  the 
four  indications  of  Treatment :  they  are — 

First.  The  existence  of  Fever,  dependent  upon  spinal  disease, 
which  confirms  and  enhances,  at  each  return  or  exacerbation,  all 
the  other  evils  of  the  case.    Hence  prevent  this  fever. 

Second.  There  is  inflammation  of  a  mucous  membrane,  re- 
quiring ITS  OWN  PECULIAR  TREATMENT. 

Third.  This  mucous  membrane  lines  the  interior  of  an  excretory 
canal — the  seat  of  the  inflammation — WHICH  MUST  BE  KEPT  OPEN — 
it  will  not  do  to  obstruct  it;  for  besides  the  ordinary  and  necessary 
demands  of  health,  that  this  prima  via  should  be  unencumbered, 
and  which  also  has  a  tendency  (notwithstanding  all  interposed 
efforts)  to  convey  its  contents  onward  to  their  exit — if,  from 
any  cause,  the  detritus  of  the  process  of  digestion  is  detained 
within  its  calibre,  it  would  become  concrete  and  consolidated, 
and  would  act  as  an  irritating  body  to  the  inflamed  mucous 
lining — especially  as  every  excited  contraction  of  the  muscular 
coat  of  this  canal,  would  compress  its  inflamed  lining,  firmly 
against  this  resisting  substance,,  where  it  would  probably  be  held 
for  some  time,  on  account  of  the  loss  of  normal  tone  in  the  mu- 
cous and  muscular  coats  at  this  point,  and  would  greatly  enhance 
the  difficulty — therefore  prevent  constipation. 

Fourth.  There  is  a  state  of  Exhaustion  or,  more  properly, 
Fatigue — Kegular  rest  and  resuscitation  of  strength  are 
TO  BE  secured  TO  the  patient — by  whatever  means  attainable, 
provided  they  can  be  reconciled  to  the  three  other  obligations  to  be 
fulfilled — in  order  to  indemnify  his  vital  energies  for  the  effect 
of  the  harassing  influences  preying  upon  them. 

In  answer  to  the  First,  it  is  of  the  last  importance,  during  an 
intermission  or  remission,  to  stave  off  a  return,  or  an  exacerba- 
tion, of  fever,  with  the  well  known  specific,  Quinine — that 
magnificent  boon  of  Heaven  to  Earth.  Quinine  should  be  given 
unconditionally,  and  irrespectively  of  the  other  elements  of  treat- 
ment, at  such  time  and  in  such  quantity  as  will  accord  with  the 


1858.]  Campbell's  Lecture  on  Dysentery.  77 

typal  arrangement  and  suit  the  degree  of  the  fever.  As  some 
of  you  may  not  be  acquainted  with  the  mode  of  administering 
this  medicine,  we  would  say  that,  if  the  period  of  accession  or 
increase  of  fever  is  distinct,  20  grs.  of  quinine  should  be  given,  to 
an  adultj  in  four  doses— 5  grs.  every  two  hours,  commencing  eight 
hours  before  the  expected  paroxysm,  that  the  last  dose  may  be 
taken  at  least  two  hours  before  its  effect  is  required  to  be  dis- 
played, that  each  dose  may  be  fully  absorbed,  and  place  the 
system  decidedly  in  that  condition  which  supplants  or  resists  the 
invasion  of  fever.  But  should  the  paroxysmal  character  of  the 
fever  be  more  indistinct,  or  even  so  as  not  to  be  recognisable, 
commence  at  any  stage  of  the  case  and  give  quinine,  until  its' 
effect  upon  the  patient  is  heralded  in  by  the  ringing  of  bells,  so 
fortunately  characteristic  of  its  adequate  exhibition ;  after  which, 
continue  to  give  it  at  longer  intervals,  just  so  as  to  keep  up  its 
influence;  as  indicated  by  the  tinnitus  aurium  or  "ringing  in 
the  ears,"  for  several  days  if  need  be,  that  you  may  be  sure  of 
falling  in  with  the  paroxysmal  period — -though  at  some  point  in 
the  mean  time,  your  perseverance  will  be  amply  rewarded  by  a 
decided  abatement,  or  an  entire  absence  of  fever,  and  the  conse- 
quent diminution  or  discontinuance,  even,  of  every  other  symp- 
tom. Many  cases  occur  wherein,  during  the  first  paroxysm  of 
fever,  the  dysenteric  symptoms  are  very  intense,  but  on  the 
timely  administration  of  quinine,  a  return  of  fever  is  prevented 
and  there  is  no  further  trouble  from  the  Dysentery. 

As  to  the  modus  operandi  of  this  agent,  there  are  many  who 
advocate  the  opinion  of  its  sedative  properties,  ascribing  all  its 
powers  to  its  quieting  effect — the  quality  of  inducing  sedation  \ 
while  as  many,  perhaps,  are  as  confident  in  the  opposite  belief— 
viz.,  of  its  stimulating  influence,  (among  whom  are  the  Homoeo- 
paths,) attributing  its  virtues  to  the  stimulation  which  they  ima- 
gine it  produces.  Now,  Gentlemen,  while  we  may  see  excuses 
for  the  entertainment  of  either  opinion,  we  think  we  have  better 
grounds  for  deciding  that  neither  is  correct,  Although,  in  ex- 
planation of  our  tolerance  for  the  retainers  of  these  opposite 
views,  we  will  cite  the  evidences  of  two  cases,  which  very  re- 
cently came  under  our  observation : —  One,  a  case  of  Typhoid 
fever;  the  subject,  a  little  boy,  aged  5  years,  wherein,  always, 
when  under  the  influence  of  quinine,  the  frequency  of  the  pulse 
was  twenty  beats  lower,  than  it  was  uniformly,-  when  he  had 


75  CAMPBELL'S  Lecture  on  Dysentery.        [February, 

taken  none.     7 

during  his  attack,  which  lasted  about  th:  a.     The  other, 

a  little  girl,  about  the  same  age,  affected  with  Intermittent : 
with  croupy  symptoms,  wherein,  quinine,  given  during  an  in- 
termission, induced  a  quick  pulse,  hot  and  dry  :  nderness 
in  the  epigastric  region,  pain  in  the  stomach,  nausea  and  pe: 
ent  vomiting              t,  the  whole  jfcsemblage  of  symptoms  simu- 
lating g;                hich  condition  generally  foil.  introduc- 
tion of  quinine  into  her  stomach.     The  mother  of  this  child  has 
been  affected  with  the  most  violent  urticaria,  accompanied  with 
the  semblance  of  inte:                     variably,  during  the  past  three 
or  four  years,  (but  not  before,)  upon  the  ingestion  of 
qninine.     Thus,  it  will  be  perceived  that  these  phenomena  re- 
sulted from  the  action  of  an  irritant  (in  upon  the 
stomach — the  three  cases  cited,  in  our  opinion,  being  instances 
of  idiosyncrasy  of  constitution,  or  were  dependent  upon  a — then 
r  condition  of  the  organism,  giving  rise  to  these 

.^ordinary  manil^  as  neither  class  of  these  results 

uniformly  or  commonly  follows  its  exhibition,  and  yet  it  n 
•foil>  in  either  case  to  prevent  the  recurrence  of  a  parox; 

"We  would  rather  adopt  the  opinion,  which  attributes  its  em- 
to  its  power  of  disseminating  or  equalizing  the  nervous 
influence.     And  if  we  take  into  account  the  known  effect  of 
this  agent  upon  enlarged  spleen  and  such  like  engorgem 
we  might  venture  tc  s  a  disseminator  or  equal- 

izer of  the  circulation,  and  acts  by  dispersing,  wherever  found, 
all  vascular  accumulations,  possibly  r  by  giving  tone  to  the  vascular 
tissue,  and  that  it  has  control  over  the  nerve  m,  under 

.  drcumstances,  by  dispersing  such   engorgements  in  its 
centres.    Hence,  in  cong:  rr  affecting  the  brain,  remark- 

able results  have  been  often  witnessed,  from  large  doses  of  quinine, 
Hitroduced  into  the  rectum,  during  the  existence  of  the  coma. 

jod  here  we  would  remark,  that  it  is  difficult  to  convince 
or  even  argue  with  those  who  shrink  from  the  admin  :- 
tion  of  quinine  in  all  cases  of  fever,  where  there  are  any  "  head 
symptoms"  present — thu3  denying  the  patient  often,  the  only 
means  of  escape  from  :_ce  and  progression  into 

and  far  more  serious  and  fatal  results.    Xot  to  give  quinine 
when  there  is  ion  or  inflammation  of  the  brain,  or  its 

membranes,  as  well  as  in  acute  inflammation  of  any  organ,  ac- 


1858.]  ,3£PBKLLrs  Lecture  on  Dysentery.  W 

companied  with  paroxysmal  fever — and  it  is  always  paroxysmal, 
if  it  were  but  detected — is  a  prejudice,  or  an  error,  which  is  un- 
pardonable, because  of  murderous  consequence.  When  did 
quinine  ever  produce  an  inflammation,  or  increase  it?  For 
instance,  in  traumatic  fever,  which,  in  its  sthenic  form,  belongs 
t:  :~e  :--:.ii  :=:  t: ::.r;z~5z:il  :':T::;/  ":  =::.  --rinr  :lr  tit-: z~=:i^ 
:i:.-  v,-:-.;-_.I  ■;::—  :::::::_  ill  :::  ~~i~:::c>  : :  in ::~ .'^d  in  £:nirii  To- 
ry action,  but  on  the  use  of  quinine,  the  paroxysm  is  prevented 
and  the  increased  action  is  found  to  subside.  We  will  say  to 
5';::::s::-::::r:.;,  --;:£:,  lisrlzriiiiird  tt.'.-.t.  in  £T^:innr  :: 
some  mooted  point — "get  first  into  the  sphere  of  thought  by 
which  it  is  so  much  as  possible  to  judge  of  this  thing,  otherwise 
than  distractedly ;  we  may  then  begin  arguing  with  you?" 

T_^:7  ii  ::.::  I'l^rv ;„::::_  —  L::\l  ~e  :iii.Lk.  :.:  ie;,i~,  ^T^^7  S:iii- 
ern  practitioner  will  bear  us  out  in  affirming.  It  is,  in  the  1st 
r/n:r.  :"_;.:  ;.;■-. •-..;■:•: n.  ^linine  ~le~  riTen  ririni"  in  ii'friiifii:- 
or  a  remission  of  fever,  prevents  the  return  of  the  paroxysm ; 
2d,  that  in  ordinary  doses  it  wiE  not  reduce  the  fever  after  the 
rir:z"5n  i-ii  "::-.-t ".::::  :ci  i:L  :"_.:.:  ii  riTrn  in  '.:"-.  ";: Tf  i;.=e=» 
during  the  paroxysm,  it  will  often  abate  the  fever,  apparently 
by  overwhelming  it  Of  course  we  refer  to  paroxysmal  fever 
alone. 

It  hence  does  appear,  that  quinine,  in  any  disease  depending 
on  spinal  irritation,  probably  acts  by  dispersing  the  cause  of  that 
irritation,  whether  active  or  passive  hyperemia  in  the  spinal 
c-:r:I — ini  :lerel~  rriiiTrS  :he  ^eirril  r-fsil:az:  :•: ::  lirion.  Tie 
explanation  which  we  would  offer  for  these  phenomena  is  the 
following : 

When  quinine  is  given  only  during  a  paroxysm  of  fever,  no 
opportunity  is  allowed  for  the  display  of  its  power  over  the 
distended,  congested  or  excited  vessels;  for  the  universal  vascu- 
lar excitement  which  pervades  the  organism,  with  the  heart's 
i-:Tz.ml  :.i-;.  m::-  ::r:i:le  a::::-  rnniiing  iLe  :i:-:-i  in  ~r:n 
these,  already  surcharged  local  vessels,  and  maintaining  or 
increasing  their  derangement,  the  display  of  its  powers  is  pre- 
vented, its  effects  are  canceled.  Hence,  it  is  only  during  the 
absence  of  fever,  unle^  extraordinary  doses  are  employed,  when 

'.  issi&taiioa  of  Febrile  Diseases,9  by  their  Eelasion  to  the  >~erroa» 
m,  in  Introdoetion  to  xoiiame  oa  "The  Secretory  mad  EmJUhSeerete: 
tern."    By  Henry  F.  CampbdO^lL  D.rju5t  pohtished. 


80  Campbell's  Lecture  on  Dysentery.        [February, 

it  has  not  these  opposing  influences  to  contend  with,  that  it 
readily  overcomes  the  local  condition,  and  thus  suspends  its 
symptomatic  results, 

So,  may  it  be  perceived,  that  in  the  treatment  of  Dysentery, 
quinine  forms  necessarily  an  essential  element — we  had  almost 
said,  without  the  single  exception  of  a  case — for  in  those  instances 
unaccompanied  with  fever,  if  they  do  not  yield  promptly  to 
that  management,  of  which  this  does  not  consitute  a  part,  we 
believe,  that  by  acting  upon  the  idea  of  its  spinal  basis,  in  ac- 
cordance with  our  previous  pathological  suggestions,  its  addition 
to  the  course  would  be  acknowledged  the  desideratum  in  almost 
every  case, 

We  are  aware  that,  as  regards  the  employment  of  this  agent 
unorthodoxly,  or  otherwise  than  for  "chills  and  fevers"  there  is 
Borne  opposition  on  the  part  of  the  community,  who,  consulting 
their  own  prejudices  will,  through  intentional  and  covert  neglect 
of  the  strictest  injunctions,  cause  the  failure  of  its  object,  to  the 
serious  detriment  of  the  patient's  safety  and  the  physician's  re- 
putation. We  know  also — and  the  knowledge  is  humiliating 
in  our  climate,  where  almost  all  acute  diseases  appear  to  be  im- 
pressed with  the  type  of  periodicity  more  or  less  decidedly — • 
that  there  are  members  of  our  own  profession,  (charged  as  it  is 
with  so  awful  a  responsibility — the  arbitership  of  human  life,) 
whose  minds  being  impregnated  with  the  spawn  of  that  popular 
medical  doctrine,  above  alluded  to,  or  from  some  ill-begotten 
prejudice,  or  some  ill-fated  notion,  legitimately  inherited,  per- 
haps,  from  some  outlandish  Alma  Mater,— some  we  say,  who 
look  upon  this  invaluable  and  indispensable  remedy,  as  "danger- 
ous," something  not  far  short  of  a  poison,  and  therefore  fail  to 
see  its  applicability  to  disease,  or  use  it  so  daintily,  as  not  to 
allow  themselves  the  opportunity  of  witnessing  its  efficacy; 
whilst  the  devoted  patient,  deluded  and  lulled  by  the  semblance 
of  a  systematic  course  of  attack  being  made  upon  the  disease,  is 
cheated  by  periodical  gradations  into  irrevocable  ruin — the 
malady  still  raging  with  increasing  fury  against  him,  with  every 
reinforcement  of  its  morbific  armament— the  returns  of  fever 
with  the  accompanying  increase  of  all  the  other  ills — derived 
from  its  cerebro -spinal  ally — until  life  "  is  sunk  amid  its  foes." 
Such  is  an  unfortunate  prejudice,  and  melancholy  have  been  its 
results — for  which  the  lives  of  many  patients  have  doubtless 
been  made  to  atone. 


1858.]  Campbell's  Lecture  on  Dysentery.  81 

But  what  argument  shall  we  employ  against  that  stubborn 
stupidity  which,  in  this  late  day,  still  questions  the  right  of  this 
agent  to  hold  the  rank  it  does  in  the  Materia  Medica ;  or  what 
logic  can  avail  to  assure  that  doubting  pusillanimity  which  yet 
does  not  dare,  or  affects  to  fear,  to  use  this  remedy  in  efficient 
quantity,  after  the  mammoth,  though  innocuous  doses,  of  Mail- 
lot, of  Dundas,  and  of  others.  Let  such  seek  the  first  opportunity 
by  experiment  upon  his  fittest  subject,  to  divest  himself  of  so 
dangerous  and  criminal  a  delusion.  Yes,  let  him  take  40  grains 
of  this  poison  at  one  dose,  (as  we  had  occasion  to  administer  to 
a  forlorn  case  of  congestive  fever,  which  actually  recovered,)  and 
if  he  does  not  die,  he  will  be  convinced  of  its  harmlessness,  but 
if  he  does — well  then,  his  patients  in  this  region  will  stand  the 
better  chance  for  living.  We  would  not  have  you,  Gentlemen, 
to  understand  us  to  recommend  such  doses  in  ordinary  practice, 
as  they  are  unnecessary ;  for  remember,  that  the  two  cases,  (both 
that  of  the  doctor  and  that  of  the  more  pitiable  patient,)  here 
coupled,  are  of  a  desperate  type. — But  what  we  say  is ;  give 
Quixine  in  Dysentery  ! 

The  most  important  and  efficient  adjuvant  in  the  treatment 
of  that  element  of  the  disease,  embraced  in  the  condition  of  the 
great  nervous  centre,  is  manifestly  to  be  found  in  the  applica- 
tion of  revulsives  along  the  spinal  column  ;  dry  cupping  and 
sinapisms,  or  if  any  portion  of  the  cord  is  discovered  to  be  de- 
cidedly irritable,  by  acute  sensitiveness  on  pressure  upon  the 
corresponding  spinous  processes,  it  may  be  necessary  to  resort  to 
vesication  or  to  cupping  with  the  abstraction  of  blood.  TVe 
have  known  the  whole  aspect  of  affairs  in  a  case,  wherein  un- 
controlable  tenesmus  was  a  very  threatening  accompaniment,  to 
be  most  astonishingly  improved  by  the  application  of  a  blister 
to  the  lower  part  of  the  spine. 

So  much  for  the  consideration  of  the  remedial  means,  which 
are  necessary  for  the  relief  of  the  cerebrospinal  ingredient  of  this 
disease ;  let  us  examine  now  into  the  demands  of  the  other  ex- 
isting condition — that  of  the  large  intestine.  These  are  com- 
prised in  the  2nd  and  3rd  indications,  which  may  be  treated  of 
in  connection — the  latter  being  in  this  instance,  involved  in, 
and  forming  a  necessary  condition  to,  the  former — that  is, 
whilst  the  mucous  membrane,  here,  requires  the  treatment 
appropriate  to  mucous  membranes  elsewhere, — here,  it  is  besides 


82  Campbell's  Lecture  on  Dysentery.      [February, 

the  lining  of  an  excretory  canal,  which  conveys  a  material  of 
more  or  less  solid  consistence ;  therefore,  it  is  also  necessary  to 
combine  with  that  specific  treatment,  some  peculiar  method  of 
procedure  to  prevent  the  irritation  of  the  contained  solid  excre- 
ment, in  its  transit  through  the  inflamed  canal— since  it  must 
pass  through;  and  this  is  best  accomplished  by  reducing  its 
consistency  from  a  solid  to  a  fluid  state,  preventing  its  accumu- 
lation and  solidification,  and  also,  by  shielding  the  sore  surface, 
if  possible,  with  some  emollient  or  soothing  application.  These 
two  indications,  then,  together  with  derivative  measures,  com- 
prise the  treatment  of  the  local  or  intestinal  element  of  this  dis* 
ease. 

Now,  let  us  examine  briefly  into  the  rationality  of  a  few  of 
the  most  prominent  among  the  various  measures  which  have 
been  proposed  and  are  much  practiced,  for  the  relief  of  Pysen^ 
tery,  the  accomplishment  of  which  can  alone  be  attained,  we 
conceive,  in  accordance  with  the  specifications  just  laid  down, 
whatever  be  the  means  put  into  requisition,  for  their  fulfillment 

The  procedure  which  we  have  designated  the  M  Opiate  and 
Astringent  routine,"  or  the  system  of  giving,  indiscriminately,  a 
specified  quantity  of  some  opiate  and  astringent  compound,  a£ 
ter  each  discharge,  mistaking  them  for  passages,  in  order  more 
fully  to  clog  up  the  bowels,  cannot  be  too  severely  reprehended, 
as  it  is  indicative  of  pure  ignorance  or  an  entire  misapprehend 
$ion  of  the  nature  of  things,  and  is  in  this  instance  attended 
with  no  ordinary  amount  of  pernicious  result.  For  the  adminis- 
tration of  astringents,  there  can  be  found  no  shadow  of  excuse — . 
their  avowed  attribute,  being  their  capability  of  inducing,  just 
that  condition  which  already  exists  as  the  chief  difficulty  in  Dys» 
entery,  and  which  should  be  one  of  the  prime  objects  of  the 
physician,  speedily  to  overcome.  But  the  demand  for  opiates, 
in  view  of  their  anodyne  effect,  is  rather  more  plausible,  as  this 
disease  is  attended  with  much  suffering,  and  the  unwary  and 
irresolute  might  perhaps  be  decoyed,  through  so  urgent  a  plea, 
into  disregarding  the  admonitions  of  his  better  judgment,  for 
the  sake  of  temporary  respite,  at  the  expense  of  radically  in- 
creasing the  difficulty,  even  to  fatality,  or  delaying  in  so  much, 
the  fortunate  termination  of  the  case.  This,  Gentlemen,  has  re- 
ference to  the  error  of  giving  opium  systematically,  as  a  part  of 
the  radical  treatment  of  Dysentery,  in  the  same  manner  that 


1858.]  Campbell's  Lecture  on  Dysentery.  83 

diarrhoea  is  treated  by  it — and  here  let  it  be  well  understood, 
that  with  this  object,  opium  is  never  indicated  in  this  disease; 
because  there  is  constipation  already  existing  as  an  element  of, 
and  a  very  serious  aggravation  to  it — and  also  as,  very  unfortu- 
nately, one  of  the  most  prominent  effects  of  this  agent,  is  to 
induce  or  increase  that  very  same^condition,     But,  although 
opiates  are  not  admissible,  as  part  and  parcel  of  the  regular  treat- 
ment, yet  there  are  frequent  circumstances  under  which  their 
pro  re  nata  employment  is  demanded  for  another  purpose — that 
of  procuring  rest  and  sleep,  notwithstanding  their  very  incon- 
venient and  pernicious  quality,  here  obtaining,  of  suspending  the 
peristaltic  action  of  the  intestine,  and  thus  increasing  constipa- 
tion  ;  which  effect  has  to  be  guarded  against  and  overcome,  by 
the  unremitting  pursuance  of  some  procedure  which  will  prevent 
or  neutralize  this  deleterious  influence,  by  keeping  the  bowels 
in  a  relaxed  condition— that  procedure,  fortunately,  being  the 
proper  and  only  appropriate  treatment,  under  this  head,  for  Dys* 
entery,  as  has  been  indicated  and  will  be  further  shown. 

The  secondary  position  assigned  to  this  agent  then,  will  be 
found  to  be  in  the  fulfillment  of  another  and  far  different  indi- 
cation ;  not  in  the  treatment  of  the  disease  itself,  but  for  the  relief 
of  some  of  the  untoward  evils  consequent  upon  the  disease,  and 
will  be  noticed  in  its  proper  place.  And  it  is  to  be  esteemed  a 
great  misfortune,  in  reference  to  this  class  of  remedies  in  this 
disease,  that  their  valuable  anodyne  effects  cannot  be  put  in 
requisition,  except  at  the  expense  of  enhancing  the  diseased 
condition,  through  the  consequent  evil  of  their  constipating  ef- 
fect. Hence,  you  perceive,  that  the  M  opiate  and  astringent" 
treatment  is  worse  than  no  treatment  in  the  end — that  in  fact, 
the  disease  demands  the  reverse  interpretation,  to  what  is  here 
evident,  as  the  basis  of  an  opposite  treatment. 

The  practice  with  Cold-water  or  other  soothing  enemata,  cannot 
take  the  place  of  treatment  in  Dysentery,  but  is  valuable  as  an 
adjuvant  in  some  cases,  to  allay  irritation.  This  subject  has  been 
treated  of  at  length,  by  Dr.  Brown  of  Alabama,  who  in  regard  to 
it,  employs  the  following  extravagant  language,  viz.,  u  I  will 
now  briefly  consider  the  superior  advantages  of  the  Cold  Water 
Treatment,  as  pursued  in  the  foregoing  cases,  and  particularly 
its  topical  application  by  enemata.  The  immediate  effect  of  its 
introduction  is  remarkable — the  patient  generally  expressing 


84  Campbell's  Lecture  on  Dysentery.       [February, 

entire  relief  from  the  pain  and  burning  sensation,  which  suspen- 
sion of  suffering  lasts  for  a  considerable  time.  Thus,  in  its 
anodyne  effect,  surpassing,  by  promptness  and  completeness,  all 
the  ordinary  means.  The  nervous  irritability  which  is  excited 
in  these  cases,  with  nausea  and  intense  thirst,  especially  in  fe- 
males, and  the  high  febrile  excitement,  yield  equally  to  its 
sedative  and  cooling  effects.  The  evacuant  and  cleansing  proper- 
ties of  the  measure,  are  unsurpassed  by  purgatives,  and  without 
the  danger  of  reducing  the  patient  by  hypercatharsis  or  inter- 
ference with  nutrition.  While  hydragogue  cathartics  may  re- 
duce the  inflamed  condition,  by  a  draught  upon  the  turgid 
vessels  of  the  part — the  cold  application,  by  a  more  economical 
process,  would  suppress  the  inflammatory  action,  by  contracting 
these  distended  vessels,  driving  out  their  superabundant  blood, 
and  fortifying  them  against  a  continuance  of  the  phlogosis." 

Dr.  B.  recommends  two  modes  of  applying  cold  water  in  Dys- 
entery : — 1st.  By  towels,  wrung  out  of  the  coldest  water,  kept 
constantly  to  the  abdomen,  and  renewed  as  often  as  they  assume 
the  temperature  of  the  body ;  and,  2ndly,  by  the  introduction 
into  the  bowel,  with  a  syringe,  of  a  pint  of  cold  water,  after  each 
dejection.  The  suggestion  is  certainly  a  rational  one,  having 
afforded  much  comfort  to  the  patient,  under  our  own  observa- 
tion ;  and  it  is  worthy  of  being  borne  in  mind,  to  be  brought 
into  requisition,  to  quiet  the  excessive  irritation  in  the  bowel, 
inducing  frequent  tenesmus,  as  an  accessory  to  the  treatment  of 
some  cases,  where  there  is  present  no  contra-indication. 

The  Mercurial  practice  has  been  recommended  according  to 
two  different  modes  of  application,  for  the  accomplishment  of 
two  distinct  objects — viz:  1st.  By  the  repetition  of  large  doses 
of  calomel  or  blue  mass,  for  the  purpose  of  effecting  continuous 
mercurial  purgation.  2nd.  By  the  administration  of  small  doses, 
combined  perhaps  with  some  opiate,  Dover's  powder  most  fre- 
quently, with  the  view  of  inducing  ptyalism — on  account  of  the 
supposed  virtues  of  that  condition,  in  controlling  inflammation. 
Now,  we  conceive  the  wholesale  administration  of  mercury,  in 
any  disease,  to  be  an  unnecessary  and  unwarrantable  procedure — 
as  also  is  the  indiscriminate  and  unscrupulous  subjection  of  the 
patient  to  its  poisonous  effects,  in  the  employment  of  complete 
salivation,  upon  all  occasions,  as  is  common  with  some  practi- 
tioners^— small  doses  of  calomel  and  Dover's  powder  seeming  to 


1858.]  Campbell's  Lecture  on  Dysentery.  85 

be  their  panacea  for  every  diseased  state,  supplying  with,  this 
convenient  compound,  the  place,  often,  of  diagnosis;  and  whe- 
ther the  patient  suffers  through  the  intentional  design  of  his 
physician  or  his  want  of  judgment  as  regards  the  danger  of  in- 
ducing that  state,  with  this  medicine,  the  injury  is  the  same — it 
is  mercurial  salivation  notwithstanding. 

We  would  suggest  to  those  who  habitually  give  mercury,  as 
a  routine  or  mechanically,   because  they  cannot  interpret  the 
manifestations  of  disease,  that  they  might  disguise  their  ignor- 
ance in  some  less  hurtful  manner — by  giving  bread-pills,  for 
instance.     And  for  those  who  wish  to  purge  the  patient  in  Dys- 
entery, we  would  remind  them,  that  they  might  employ  some 
agent  of  equal  or  superior  activity,  which  would  not  be  obnox- 
ious to  the  same  objections,  from  untoward  consequences,  owing 
to  the  peculiar  therapeutic  properties  of  this  article.     Hear  what 
Mr.  Annesley  says  upon  this  subject  in  his  Sketches  of  the  Diseases 
of  India — (He  performed  many  experiments  with  the  express  ob- 
ject of  testing  the  true  operation  of  calomel) — he  says,  "These 
experiments  presented  uniform  results,  viz.,  that  while  the  stom- 
ach and  duodenum  of  dogs  that  had  taken  large  doses  of  this 
preparation  were  much  paler  and  less  vascular  than  in  ordinary 
circumstances,  the  colon  and  rectum,  from  the  caecum  to  the  verge 
of  the  anus,  were  most  acutely  inflamed,  thereby  explaining  the  re- 
sults of  clinical  observation,  namely,  that  although  large  doses  of 
calomel  calm  those  symptoms  usually  caused  by  increased  vascu- 
lar action,  or  inflammation  of  the  mucous  surface  of  the  stomach 
and  duodenum,  they  lower  the  vital  energy  of  these  important  or- 
gans, and  occasion  tenesmus,  griping  pains  in  the  course  of  the  colon, 
mucous  or  bloody  stools,  hemorrhoids ;  and  if  persisted  in,  many 
more  of  the  symptoms  of  Dysentery,  or  even  structural  change  of  the 
colon  or  rectum.     I  am  confident  that  Dysentery  becomes  chronic ; 
that  an  occasional  indigestion  lapses  into  a  constant  dyspepsia ; 
and  that  habitual  constipation  often  passes  into  strictures  of  the 
rectum,  and  hemorrhoids  into  fistulas,  from  the  frequent  exhibition 
of  large  doses  of  this  medicine*     Ingenuity  cannot  devise  a  more 
successful  method  of  converting  a  healthy  person  into  a  confirm- 
ed invalid,  of  destroying  many  of  the  comforts  of  existence,  and 
of  occasioning  hypochondriasis  and  melancholy  than  the  prac- 
tice of  prescribing  large  doses  of  calomel  on  every  trifling  occa- 

*  These  italics  are  ours. 


86  Campbeli/s  Lecture  on  Dysentery.       [February, 

sion,  or  when  the  bowels  require  gentle  assistance;  or  because 
the  patient  erroneously  supposes  himself  to  be  bilious,  or  is  told 
so  by  those  who  should  know  better.  The  unfortunate  word 
'bilious,''  is  the  scape-goat  of  the  ignorant" 

As  to  the  indispensableness  of  mercurialization  for  the  cure  of 
acute  diseases,  generally,  the  dogma  has  long  since  been  explod- 
ed by  the  introduction  of  quinine  into  general  use.  And  with 
special  reference  to  this  disease,  it  is  satisfactorily  evidenced  that 
no  additional  benefit  accrues  to  its  employment  Dr.  Bell  re- 
marks, that  "  As  regards  the  use  of  mercury  in  Dysentery,  it  is 
mere  empiricism  to  look  to  salivation,  either  as  a  necessary  proof 
that  enough  of  mercury  has  been  administered,  or  as  an  indis- 
pensable means  of  curing  the  disease.  Salivation  is  an  occasional 
result  to  be  deprecated  and  avoided  rather  than  sought  for." 

Now,  gentlemen,  we  would  not  be  understood  to  wish  to  de- 
tract from  this  agent,  a  whit  of  its  value  and  importance  as  a 
remedial  means ;  but  would  claim  for  it,  as  such,  an  appropriate 
place,  and  for  its  use,  a  specific  object,  with  due  regard  to  its 
potency  and  its  peculiar  properties — and  would  have  you  recol- 
lect, that  we  only  caution  you  against  its  abuse,  the  deplorable 
effects  of  which,  there  is  much  recorded  testimony  to  establish. 

Moreover,  after  all  that  has  been  said,  should  you  ask  us  if 
we  give  mercury  in  Dysentery— we  would  answer,  that  we  do 
give  it ;  not  in  all  cases,  but  in  many — though,  expressly,  with- 
out either  of  the  objects  which  we  have  been  hitherto  discussing. 
We  use  it  but  as  an  aid  to  the  treatment — yet  not  as  &  purgative, 
for  our  doses  would  be  insufficient  for  that  purpose :  not  to  sali- 
vate, for  it  is  given  under  such  circumstances  as  would  render 
such  a  result  next  to  impossible.  Formerly  ptyalism  was  attri- 
buted to  the  patient's  taking  cold,  or  drinking  cold  water  after 
taking  calomel;  and  doubtless  many  a  poor  victim  has  been 
goaded  on  his  way  and  been  initiated  prematurely  into  the  in- 
conveniences of  a  warmer  climate,  by  this  merciless  notion— 
"  without  one  drop  of  water  to  cool  his  parched  tongue."  For- 
tunately, for  the  sake  of  humanity,  this  error  has  subsided,  and 
it  has  now  become  an  acknowledged  fact,  that  mercury  will  not 
affect  the  system  thus,  except  it  be  retained  from  want  of  ac- 
tion— unless  this  peculiar  property  should  be  determined  by 
idiosyncrasy  of  constitution.  We  remember  the  case  of  a  lady, 
of  our  acquaintance,  who  cannot  take  the  slightest  dose  of  any 


1858.]  Campbell's  Lecture  on  Dysentery.  87 

of  the  preparations  of  mercury,  although  it  be  followed  immedi- 
ately by  an  active  purgative,  without  suffering  all  the  horrible 
realities  of  a  complete  salivation. 

As  was  premised  in  our  lecture  upon  the  "  Pathology  of  Dys- 
entery," that,  either  as  a  co-incident  event,  or  in  consequence 
of  the  pyrexic  condition  which  constitutes  a  part  and  parcel  of 
this  disease — the  Liver,  in  some  eases,  is  found  to  be  in  a  state 
of  disorder  or  inaction,  as  is  manifested  by  the  yellow,  furred 
tongue,  tenderness  on  pressure  over  the  right  hypochondriac  re- 
gion, and  by  the  persistent  stubbornness  with  which  the  bowels 
remain  in  a  state  of  constipation — the  retained  scybala  resisting 
their  disintegration  and  dislodgment. 

Now,  it  is  well  understood  in  Therapeutics,  that  the  different 
elements  of  the  Materia  Medica  are  classified  from  the  fact,  that 
they  are  found  to  exert  their  specific  agency  upon  different  and 
particular  organs.  It  is  also  well  known,  that  among  the  effects 
of  mercury,  is  its  peculiar  property  of  u  stimulating  the  torpid 
liver  into  action  ;"  and  it  is  as  well  recognized  in  Physiology, 
that  the  product  of  this  secerning  organ,-  the  bile,  is  the  natural 
solvent  of  the  heterogeneous  residuum  of  digestion,  the  faeces,  as 
well  as  the  ordinary  excitant  of  peristaltic  action,  and  thus  it  has 
been  styled  "the  natural  laxative  of  the  system." 

Well,  in  such  cases  as  are  here  indicated,  and  only  in  such, 
have  we  found  it  necessary  to  resort  to  the  use  of  this  agent. 
And  we  use  it,  not  as  constituting  the  basis  of  the  treatment,  as 
others  do,  but  to  counteract  an  embarrassment  in  the  manage- 
ment of  the  disease,  i.  e.,  the  co-incident  or  consequent  derange- 
ment of  an  important  organ,  whose  suspension  in  function 
materially  interferes  with  the  natural  processes,  which  are  ordin- 
arily contributive  to  relief.  With  this  view,  we  administer  the 
mildest  preparation,  in  small  doses,  and  repeat  them  as  seldom 
as  the  demands  of  the  hepatic  disorder  will  warrant.  And  we 
probably  anticipate  when  we  say,  that  in  the  appropriate  treat- 
ment of  the  intestinal  element  of  this  disease,  no  opportunity  is 
allowed  for  its  retention  in  the  system  and  the  consequent  effect 
of  ptyalism. 

The  preparation  which  we  prefer  is  the  following  :— 
ty.  Blue  mass,     .     .      3j. 

Prepared  chalk,       3iij.     Triturate  well  together. 
It  forms  a  blue  powder,  very  similar  in  physical  properties  to 


88  CAMPBtfLl/s  Lecture  on  Dysentery.       [February, 

the  officinal  hydragyrum  cum  creta,  to  which,  we  scarcely  know 
why,  (as  they  are  almost  identical  in  constitution) ;  but,  be  it 
fancy  or  fact,  the  former  seems  much  superior  and  more  satisfac- 
tory,  in  many  respects.  And  this  is  probably  somewhat  owing 
to  the  fact,  that  this  preparation  does  not  have  the  effect  of  sick- 
ening the  stomach,  so  common  to  the  officinal  article.  At  any 
rate,  the  impression  has  weighed  sufficiently  with  us,  to  have  the 
effect,  for  many  years  past,  of  substituting  the  one  for  the  other 
preparation,  with  children,  as  well  as  in  all  other  cases,  wherein 
its  use  was  formerly  indicated.  Of  this  compound,  we  prescribe 
10  grs.  morning  and  night,  or  20  grs.  at  night,  as  long  as  neces- 
sary, irrespective  of  the  other  means  employed,  for  the  purposes 
of  acting  upon  the  liver,  and  thereby  operating  upon  the  faecal 
mass  contained  in  the  intestinal  canal,  to  effect  its  evacuation, 
and  we  give  it  with  no  other  design,  than  thus  to  assist  in  the 
accomplishment  of  the  third  indication  of  the  treatment  that  we 
have  already  distinctly  laid  down,  the  requirements  of  whichy 
being  now  under  our  consideration. 

The  Saline  or  purgative  treatment,  so  strenuously  advocated 
by  MM.  Bretonneau  and  Trousseau,  is  entitled  to  our  consider- 
ation, as  a  practice  now  much  in  vogue,  and  which,  it  cannot  be 
denied,  is  not  without  favorable  evidence  in  the  result  of  its 
operation  in  many  cases. 

This  treatment  originally  consisted  of  one  or  two  drachms  of 
the  sulphate  of  soda,  dissolved  in  any  vehicle  and  given  in  di- 
vided doses ;  and  has  been  said  "  usually  to  arrest  Dysentery  in 
twelve,  twenty -four,  or  forty-eight  hours  f  and  that  "  any  acute, 
Dysentery  which  is  not  suppressed  in  this  time  by  it,  demands 
the  closer  attention  of  the  physician,  as  presenting  complica- 
tions or  being  of  extreme  gravity."  But  this  article  has  been 
replaced  pretty  generally,  in  our  country,  where  there  has  been 
ample  opportunity  for  testing  the  relative  value  of  all  the  vari- 
ous practices  ever  recommended— and  where,  we  must  say,  all 
the  suggestions  ever  made,  have  had  a  full  and  thorough  trial 
with  various  results— we  say  that  this  treatment  has  been  super- 
seded by  the  substitution  of  the  sulphate  of  magnesia,  used 
pretty  much  in  the  same  way,  as  less  liable  to  irritate  the  sto- 
mach and  bowels.  A  tablespoonful  of  its  saturated  aqueous 
solution  is  given  at  various  intervals  to  suit  the  exigencies  of 
the  case.     The  acidulated  solution  is  sometimes  used,  prepared 


1858.J  Campbell's  Lecture  cm  Dysentery.  89 

according  to  the  formula,  and  given  as  recommended  by  Dr. 
Henry  of  Dublin,  viz.— "  To  seven  ounces  of  a  saturated  aque- 
ous solution  of  the  salt,  add  an  ounce  of  the  diluted  sulphuric 
acid  of  the  Pharmacopoeias,  and  give  a  tablespoonful  of  the  mix- 
ture for  a  dose,  in  a  wineglassful  of  water." 

Now,  the  action  of  these  salts  is  similar,  and  their  modus 
operandi  and  effect  in  Dysentery,  precisely  the  same.  That  is, 
they  deplete  by  producing  watery  stools,  or  by  exciting  from  the 
mucous  membrane  of  the  small  intestines,  the  exhalation  or 
secretion  of  large  quantities  of  serum,  the  fluid  element  of  the 
blood — probably,  through  the  agency  of  a  species  of  irritation 
there  determined,  as  the  specific  therapeutic  property  of  this 
class  of  agents. 

It  presents  itself  to  our  mind  in  considering  the  applicability 
of  this  class  of  remedies  to  Dysentery,  that  they  must  act  without 
any  special  reference  to  suitableness,  or  correspondence  of  their 
peculiar  therapeutic  properties,  to  this  particular  diseased  state, 
as  well  as  the  ordinary  and  characteristic  requirements  of  the 
organ  and  tissue  affected,  when  used  under  the  operation  of  this 
disease;  and  that  the  good  they  accomplish,  whenever  it  is  man- 
ifest, must  be  by  virtue  of  their  depleting  properties,  as  well  as 
that  of  revulsion  or  derivation,  through  the  species  of  irritation 
which  is  engendered  in  one  portion  of  the  canal,  deriving  from 
that  previously  existing  in  another.  They  also  have  the  effect, 
during  their  exhibition,  of  keeping  the  canal  clear  of  solid  ma- 
terial, thus,  as  long  as  their  use  is  continued,  placing  out  of  the 
question  the  danger  of  irritation  thereby,  to  the  sore  mucous 
lining  of  the  faecal  receptacle,  the  large  intestine,  which  is  the 
seat  of  the  disease.  But  it  is  an  observation  which  has  probably 
presented  itself  to  every  practitioner,  that  as  soon  as  the  use  of 
this  class  of  purgatives  is  suspended,  there  is  a  proneness  to 
constipation  more  determined  than  ever.  Now,  let  us  consider 
these  effects,  in  relation  to  the  case  in  question,  and  with  refer- 
ence to  the  physiological  attributes  of  the  organs  involved,  with 
their  dependencies,  as  well  as  with  reference  to  the  natural* pro- 
clivities of  these  organs  under  this  condition  of  disease,  which, 
you  recollect,  we  endeavored  to  develop  to  you  on  a  former 
occasion,  when  considering  the  Pathology  of  Dysentery.  And 
reasoning  upon  these  premises,  it  is  evident,  that  those  cases1 
which  are  relieved — (and  there  are  many,  when  they  are  treated 


90  Campbell's  Lecture  on  Dysentery.       [February, 

thus,  in  the  inception  of  the  attack)— are  relieved  by  virtue  of 
dejiletion,  as  would  blood-letting  relieve  them,  and  often  does. 
And  here  let  us  remark,  as  we  may  not  recur  to  this  subject, 
that  there  are  cases  which  not  only  admit  of  depletion  by  hydra- 
gogue  cathartics,  but  demand  the  use  of  the  lancet — although 
these  cases  are  rare.  But  when  the  symptoms  are  extremely 
violent  in  the  onset  of  the  attack,  or  where  there  is  enteric  he^ 
inorrhage  threatening  danger ;  or  when,  after  the  appropriate 
management  of  the  two  elements  of  this  disease,  the  symptoms 
do  not  relax  in  violence,  in  a  reasonable  time — then  may  re- 
course be  had  to  blood-letting  for  their  abatement,  as  under  the 
same  circumstances  in  any  other  one  of  the  phlegmasia.  And 
we  would  prefer  depletion  from  the  arm,  in  these  rare  cases  of 
Dysentery,  to  depletion  to  any  great  extent,  from  the  mucous 
lining  of  the  small  intestine— a  surface  continuous  with,-  and 
connected  to,  the  diseased  membrane  by  nervous,  reflex  associ- 
tion,  as  we  have  endeavored  to  show — for  the  following  reasons, 
which  we  may  say  are  borne  out  by  experience.  In  the  first 
place,  after  a  case  has  been  relieved  by  the  depletion  of  the  sa- 
line treatment  and  the  medicine  is  discontinued,  the  bowels 
become  constipated,  as  is  usual  after  the  exhibition  of  these 
purgatives — the  contained  solid  excrement  passing  over  the  re- 
cently sore  surface,  has  a  tendency  to  re-establish  irritation  from 
that  point,  restore  the  difficulty  and  "tear  agape  the  healing 
Wound  afresh."  And  we  believe  that  this  is  the  explanation  of 
the  frequent  relapses  occurring  in  cases  treated  thus.  And 
again,  we  have  the  phenomenon  referred  to,-  in  the  pathology  of 
this  disease,  viz :  that  it  has  a  tendency  to  run  into  diarrhoea, 
in  the  latter  stages — the  interpretation  of  which,  you  recollect, 
was  by  attributing  it  to  reflected  irritation,  producing  an  excito- 
secretory  result.  Now,  if  this  treatment — which  operates  by 
exciting  irritation  at  this  point,  which  point  is  also  liable  to  re- 
flected irritation — -should  be  carried  too  far,  or  be  continued  too 
long,  it  must  have  the  effect  of  predisposing  or  determining  to 
a  metastasis  of  excitement,  or  so  derange  the  organization  of 
the  tissue,  that  when  it  does  occur,  as  to  render  it  incapable  of 
recuperation,  and  the  patient's  strength  and  vitality  must  speed- 
ily be  exhausted  in  the  diarrhoea  which  supervenes.  We  have 
had  the  unenviable  opportunity  of  witnessing  two  cases,  which 
followed  this  course  ad  finem,  through  the  patients'  or  their  at- 


1858.]  Campbeli/s  Lecture  on  Dysentery.  91 

tendants'  disobeying  or  mistaking  instructions,  and  continuing 
the  purgation  too  far.  And  since  then,  we  must  say,  that  as  for 
ourselves,  we  have  abandoned  in  toto  the  saline  treatment  of 
Dysentery,  without  the  entertainment  of  a  single  regret  for  its 
banishment,  for  another —  one  by  which  the  patients  or  their 
attendants  can  effect  no  serious  injury  by  mistakes  or  disobedi- 
ence of  injunctions — and  more  especially  without  regret,  as  we 
have  felt  that  its  loss  was  more  than  recompensed  in  the  adoption 
and  amendment  of  a  treatment  of  general  applicability,  and  one 
more  rationally  satisfactory  to  our  mind,  inasmuch  as  it  supplies 
fully,  what  we  conceive  to  be,  every  demand  for  the  relief  of 
that  condition  of  the  organism,  which  we  have  endeavored  to 
interpret  to  you — a  remedy  having  none  of  its  disadvantages, 
but  more  than  its  every  advantage. 

Although  we  have  thus  spoken  of  the  Saline  treatment,  and 
of  its  rejection  by  us,  for  a  better  plan — yet  in  justice  to  the  re- 
sult of  its  action  in  many  cases,  and  to  the  somewhat  appropri- 
ateness of  the  rationale  of  its  operation — in  which,  after  all, 
there  is  more  of  the  semblance  of  reason,  than  in  the  application 
of  the  various  other  practices,  to  which  we  have  heretofore  re- 
ferred— we  deem  it  but  fair,  before  quitting  the  subject,  to  assign 
to  this  mode  its  proper  place,  in  strict  accordance  with  the  con- 
sideration it  deserves.  * 

Then,  we  would  say — that  it  is  next  in  importance,  and  next 
in  reason  to  that  treatment,  which  it  now  remains  for  us  to  in- 
vestigate, as  supplying  fully  the  requirements  of  the  two  indica- 
tions under  consideration :  and  well  deserves  to  be  borne  in 
mind,  as  second  to  none  other  than  the  latter,  in  the  earlier  sta- 
ges of  the  disease,  when  from  any  cause  its  practicability  is 
impossible — yet  its  use  should  be  always  in  subjection  to  the 
proper  restrictions,  that  its  dangers  may  not  lurk,  too  long  con- 
cealed, in  its  more  deceptive  advantages. 

The  appropriate  Treatment  of  Dysentery  will  form  the  sub- 
ject of  another  Lecture. 


4* 


92  Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  [February, 


ARTICLE  VI. 

Notes  to  a  Report  on  Diseases  of  the  Cervix  Uteri.  By  Joseph  A. 
Eve,  M.  D.,  Professor  of  Obstetrics  and  Diseases  of  Women 
and  Children,  in  the  Medical  College  of  Georgia. 

Note  1st. — Chlorate  of  Potash, 

In  the  July  number  of  the  American  Journal  of  the  Medical 
Sciences,  Br.  Bedford  Brown  of  Caswell  county,  N.  C,  proposes 
chlorate  of  potash  as  an  efficacious  and  certain  remedy  in  the 
treatment  of  inflammation  of  the  cervix  and  cervical  canal.  Dr. 
Brown  says: 

"The  discovery  of  some  simple  aud  efficient  means  as  a  sub- 
stitute for  the  uncertain  astringent  injections  in  common  use, 
and  the  tedious  and  often  unsuccessful  caustic  and  speculum, 
would  relieve  the  physician  of  an  extremely  disagreeable  duty, 
and  the  patient  of  an  almost  intolerable  necessity. 

"  In  those  cases  of  leucorrhoea  attended  with  ulceration  of  the 
os  uteri  or  cervical  canal,  and  enlargement  of  the  muciparous 
glands  of  the  vagina,  or  simple  ulceration  without  leucorrhoea, 
I  believe  the  injections  of  the  cKrorate  far  more  certain  and  effi- 
cient than  the  ordinary  astringent  injections,  or  the  local  appli- 
cation of  caustic.  In  these  cases  I  have  not  thought  proper  to 
give  detailed  reports  of  their  symptoms  and  progress." 

Since  reading  Dr.  B.'s  communication,  I  have  several  times 
prescribed  the  chlorate  of  potash,  and  intend  to  give  it  a  fair 
trial ;  for  if  nearly  as  efficacious  as  he  asserts,  it  would  be  a 
valuable  addition  to  our  resources  in  the  management  of  those 
affections.  But  when  Dr.  B.  speaks  of  "  the  tedious  and  often  un- 
successful caustic  and  speculum ;"  he  shows  that  he  has  not  a  tho- 
rough practical  acquaintance  with  cauterization,  or  at  least  that 
he  has  not  been  sufficiently  persevering  in  his  employment  of  it: 
for  if  there  be  certainty  in  medicine,  it  is  seen  in  the  treatment 
of  simple  inflammation  and  ulceration  of  the  cervix  by  caustics, 
when  properly  and  perseveringly  used ;  and  although  oftentimes 
tedious,  it  is  less  so  than  any  plan  hitherto  devised.  Chlorate 
of  potash  will  probably  succeed  well  in  many  of  the  lighter  and 
more  recent  cases  of  inflammation  of  the  cervix  without  or  with 


1858.]         Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  93 

superficial  abrasion,  and  it  will  I  trust  prove  at  least  a  more 
valuable  adjuvant  to  caustics  than  other  vaginal  injections;  but 
I  would  rejoice  to  find  it  prove  as  efficacious  as  nitrate  of  silver 
in  the  more  inveterate  and  serious  cases.  It  would  indeed  be  a 
great  benefaction  both  to  patient  and  practitioner;  and  Dr. 
Brown  should  be  justly  regarded  as  a  friend,  not  only  to  the 
ladies,  but  to  his  professional  brethren. 

My  friend,  Prof.  Campbell,  used  chlorate  of  potash  with  bis- 
muth with  perfect  success  in  a  case  of  inflammation  of  the  cervix 
and  vagina,  in  the  City  Hospital.  This  patient  had  an  extensive 
vesico- vaginal  fistula,  before  operating  for  which,  it  was  neces- 
sary to  remove  the  inflammation.  Dr.  Campbell  prescribed  vag- 
inal injections  of  this  salt  and  subnitrate  of  bismuth,  three  times 
per  day ;  at  the  end  of  a  few  weeks,  he  examined  and  found  the 
inflammation  had  entirely  disappeared.  This  patient,  it  is  true, 
was  favorably  circumstanced  for  the  success  of  any  plan  of  treat- 
ment, but  none  could  possibly  have  succeeded  better. 

Patients  generally  speak  of  it  as  pleasant  in  its  effect ;  one 
patient,  however,  complained  of  its  causing  great  pain.  This 
was  an  elderly  lady  who  had  for  some  time  complained  of  symp- 
toms of  prolapsus,  for  which  astringent  vaginal  injections  were 
prescribed  ;  as  she  was  not  relieved,  a  digital  examination  was 
made,  which  detected  moderate  prolapsus,  but  nothing  abnor- 
mal in  the  cervix  except  that  the  os  was  somewhat  more  patulous 
than  usual.  A  globular  pessary  was  inserted,  which  caused 
considerable  pain  and  which  she  succeeded  in  removing  herself: 
after  which  the  chlorate  of  potash  was  prescribed  and  its  admin- 
istration followed  by  much  pain,  which  is  only  explicable  upon 
the  supposition  that  in  consequence  of  the  patulousness  of  the 
os,  it  passed  into  the  cavity  of  the  body  of  the  uterus.  "When 
this  patient  had  used  vaginal  injections  of  cold  water  a  few 
days,  a  specular  examination  was  made ;  the  cervix  externally 
was  perfectly  healthy,  but  intense  inflammation  was  observed 
extending  from  the  os  deep  into  the  cervical  canal.  There  was 
in  this  case  a  very  unusual  occurrence,  a  remarkable  exemption 
from  leucorrhcea,  which  induced  me  to  suppose  there  could  be 
very  little,  if  any,  inflammation,  and  therefore  to  defer  so  long 
the  use  of  the  speculum.  In  cases  wherein  there  is  much  prolapsus 
with  relaxation  of  the  vagina,  it  is  very  doubtful  whether  injec- 
tions of  chlorate  of  potash  will  succeed  as  well  as  alum  and 


94  Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  [February, 

tannin  in  promoting  the  restoration  of  the  uterus  to  its  normal 
position. 

Note  2nd. — Dr.  Tyler  Smith  and  Dr.  Eigby. 

In  the  first  part  of  this  Keport  the  testimony  of  these  gentle- 
men was  said  to  be  strongly  in  favor  of  the  frequency  of  ulcera- 
tion of  the  cervix :  a  little  explanation  may  be  proper.  Dr. 
Tyler  Smith  certainly  recognizes  the  frequent'  occurrence  of 
ulceration,  especially  of  the  lighter  grades — "  epithelial  abrasion 
and  superficial  ulceration  "■ — but  he  considers  it  to  depend  on 
leucorrhoea  and  not  to  be  a  consequence  of  inflammation.  He 
observes  (page  92) :  "  The  loss  of  portions  of  epithelium,  the  first 
step  towards  ulceration,  is  so  common  in  cases  of  confirmed  leu- 
corrhoea, that  there  must  be  some  very  frequent  and  simple  cause 
which  produces  it,  and  it  appears  to  me  that  it  is  far  more  rea- 
sonably accounted  for  by  looking  to  the  irritant  discharges  than 
in  any  other  way."  But  for  full  confirmation,  we  would  refer 
to .  the  whole  of  the  fifth  chapter  in  his  able  treatise  on  leucor- 
rhoea. 

Dr.  Eigby,  employing  the  term  in  its  most  restricted  sense, 
excluding  all  except  deep  ulcers,  does  say,  (page  105,)  "Ulcera- 
tion of  the  os  and  cervix  uteri,  not  connected  with  malignant 
disease  of  the  uterus,  is,  in  fact,  a  rare  affection."  But  from  the 
following  paragraphs  (page  94),  and  other  passages  in  his  work 
on  Diseases  of  Women,  he  plainly  admits  the  frequency  of  in- 
flammation of  the  cervix,  and  what  Dr.  Bennet  and  others  con- 
sider, and  very  properly,  lighter  degrees  of  ulceration. 

"  The  female  generative  organs,  situated  at  the  lower  part  of 
the  trunk,  supporting  the  chief  weight  and  pressure  of  the  intes- 
tines, and  subject  to  such  great  periodic  alterations  of  vasculari- 
ty, not  to  mention  the  wonderful  changes  they  undergo  during 
pregnancy  and  parturition,  are  rendered  peculiarly  disposed  to 
be  affected  by  any  morbid  action  which  may  occur,  especially  in 
the  great  machinery  of  the  chylopoietic  system,  and  liable  to  be 
fixed  upon  in  the  various  blood  diseases,  on  which  to  localize 
their  energy  and  expend  their  virulence. 

"  It  will  therefore  be  seen  that  there  are  few  affections  of  the 
general  health  in  a  female,  in  which  the  generative  system  is  not 
more  or  less  involved ;  and  although  these  local  affections,  which 
in  the  first  instance  are  mostly  effects  of  deranged  health,  react 


1858.]         Eve's  Xotes  on  Diseases  of  the  Cervix  Uteri.  95 

and  produce  in  their  turn  considerable  sympathetic  derange- 
ment, yet  it  must  be  borne  in  mind  that,  unless  a  distinct  local 
cause  be  present,  they  must  be  looked  upon  as  "the  local 
manifestations  of  a  general  derangement,  in  order  that  we  may 
form  correct  and  rational  ideas  respecting  their  nature  and  treat- 
ment. 

"Inflammation  of  the  os  and  cervix  uteri  seldom  occurs  as  an 
acute  affection,  but,  in  far  the  majority  of  cases,  in  a  subacute  or 
chronic  form." 

It  is  true,  he  regards  them  as  most  frequently  secondary  or 
sympathetic  affections,  depending  on  the  state  of  the  general 
system,  disappearing  and  reappearing  as  the  patient's  health  im- 
proves or  declines,  for  he  says,  (page  103) : 

"  Allowing  for  the  difference  of  position,  &c,  I  would  say  that 
the  os  uteri  presents  as  great  a  variety  and  frequent  change  of 
appearance  as  the  tongue  and  throat  do ;  and  I,  moreover,  feel 
convinced,  that  if  these  parts  could  be  as  readily  inspected,  ex- 
perience would  soon  enable  us  to  recognize  the  appearances 
which  they  present  as  indications  of  the  state  of  the  patient's 
health — much  as  we  are  accustomed  to  do  in  examining  those 
presented  by  the  tongue." 

How  this  may  be  when  these  affectious  are  recent  and  slight, 
I  do  not  know  ;  nor  can  I  conceive  how  Dr.  Rigby  has  arrived 
at  this  conclusion  ;  for  when  sufficiently  intense  to  indicate  and 
justify  a  specular  examination,  they  have  been  found  remarka- 
bly persistent,  varying  very  little,  until  they  have  been  properly 
treated ;  after  which  I  have  never  known  a  case  relapse.  My 
experience  cannot  recall  a  single  instance  in  which  a  patient, 
after  having  been  cured,  has  had  a  return  of  the  disease ;  although 
suffering  once  does  not  afford  any  immunity  for  the  future. 

Dr.  Bennet  says,  (page  277,)  "Since  I  have  made  it  a  rule 
minutely  to  investigate  the  state  of  the  cavity  of  the  cervix,  and 
never  to  dismiss  a  patient  so  long  as  there  is  the  slightest  vestige 
of  disease  remaining,  I  am  much  longer  in  curing  my  patients, 
but  when  they  are  once  cured,  I  never  have  any  relapse  of  the 
ulcerative  disease.  The  relapses  which  I  formerly  used  continu- 
ally to  witness  in  the  practice  of  the  French  surgeons,  were 
clearly  owing  to  the  disease  not  being  followed  into  the  interior 
of  the  cervical  canal,  and  thus  not  being  entirely  eradicated." 

From  the  very  first,  in  employing  caustic,  I  have  adopted  this 


96  Eve's  Notes  on  Diseases  of  (lie  Cervix  Uteri.  [February, 

rule  with  respect  to  the  cervical  canal,   and  therefore  I  do  not 
remember  ever  to  have  had  a  relapse. 

Dr.  Kigby  says,  "  Inflammation  of  the  os  and  cervix  seldom 
occurs  as  an  acute  affection,  but  in  far  the  majority  of  cases,  in 
a  subacute  or  chronic  form."  Is  it  usual  for  chronic  affections  to 
present  great  variety  and  frequent  change  of  appearance  ? 

Note  3rd. — Repetition  of  Caustics. 

It  is  very  important  not  to  repeat  caustic  applications  too 
often — once  weekly  is  often  enough :  every  sixth  day  is  the  short- 
est interval  admissible.  The  eschar  does  not  always  fall  off  in 
a  week.  After  several  applications  have  been  made,  from  four 
to  six,  it  is  advisable  to  allow  a  period  of  two  or  three  weeks  to 
intervene,  that  the  effect  of  the  caustic  passing  entirely  off,  the 
real  amount  of  improvement  may  appear.  If  the  cauterizations 
be  kept  up  without  intermission,  it  would  be  impossible  to  de- 
termine when  the  patient  was  cured.  A  physician  expressed 
his  surprise,  that  although  he  had  cauterized  the  cervix  every 
other  day  for  a  considerable  time,  he  had  not  succeeded  in  curing 
his  patient — he  was  advised  to  stop  and  give  her  an  opportunity 
to  get  well.  In  another,  cauterization  was  repeated  weekly  for 
a  year :  if  curable,  she  ought  to  have  been  cured  in  less  time, 
and  with  fewer  applications. 

Cauterizatian  ought  not  to  be  too  often  repeated,  or  too  long 
continued.  Few  cases  require  more  than  from  five  to  ten  ap- 
plications. I  have  known  four  to  suffice,  and  two,  even  one,  to  do 
much  good ;  though  sometimes  from  fifteen  to  twenty  have  been 
required. 

Note  4th. — "  Dishonest  Use  of  Caustics." 
Among  the  causes  of  inflammation  of  the  cervix,  Dr.  Rigby 
mentions  what  he  terms  the  "  dishonest  use  of  caustics,"  a  favor- 
ite phrase  which  he  uses  several  times,  and  which  savours  more 
of  sensoriousness  than  of  sense.  That  the  injudicious  use  of  caus- 
tics may  keep  up  inflammation,  or  may  cause  it,  when  through 
error  unnecessarily  applied,  is  highly  probable — all  are  liable  to 
make  mistakes,  especially  the  young  and  inexperienced;  but  I 
cannot  comprehend  what  he  means  by  "dishonest:"  certainly 
an  unscrupulous  money -loving  physician  can  charge  what  he 
pleases  for  his  advice  and  visits,  without  resorting  to  means  so 


1858.]        Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  97 

unpleasant  to  practitioner  as  well  as  patient ;  most  assuredly 
physicians  of  the  great  metropolis,  Dr.  Rigby's  confreres,  must 
have  much  less  repugnance  to  making  such  examinations  and 
manipulations,  unnecessarily,  than  physicians  in  this  latitude, 
who  are  much  more  apt  to  neglect  them  when  proper. 

According  to  my  experience,  patients  are  much  more  profita- 
ble, when  treated  without  caustics ;  for  if  relieved  at  all,  they  are 
constantly  relapsing  and  requiring  professional  assistance.  But 
it  is  to  be  hoped  no  one  would,  for  an  instant,  be  so  uncharitable 
as  to  suppose  that  those  gentlemen,  who  adopt  such  practice,  are 
actuated  by  a  love  of  lucre.  However  erroneous  their  views,  it 
is  presumed  they  do  what  they  conscientiously  believe  best  for 
their  patients. 

Xote  5th. — Effects  of  Nitrate  of  Silver  in  overcoming 

Sterility. 
Dr.  Tyler  Smith  says,  in  reference  to  his  35th  case,  (page  164.) 
"In  this  case,  as  in  several  others,  I  attributed  the  result  of 
pregnancy  to  the  application  of  the  nitrate  of  silver.  On  both 
occasions  the  patient  became  pregnant  after  a  free  use  of  this  ap- 
plication immediately  before  the  catamenial  period.  It  appears 
as  though  the  application  of  the  solid  nitrate  of  silver  is  either 
followed  in  a  few  days  by  a  healthy  secretion  from  the  surface 
to  which  it  is  applied,  or  the  irritating  discharges  are  neutralized 
by  its  use.  Of  its  influence  in  removing  sterility  in  leucorrhcea 
I  have  had  many  examples.  Some  cases  of  this  kind  which  I 
have  seen  in  consultation  with  Mr.  Guthrie,  and  Mr.  "Walter 
Bryant  in  particular,  leave  no  doubt  upon  my  mind  of  the  effects 
of  this  remedy,  in  cases  where  the  disordered  condition  of  the 
secretions  of  the  os  and  cervix  is  the  cause  of  sterility."  This 
accords  with  my  own  observation,  for  in  a  review  of  cases  treat- 
ed by  nitrate  of  silver,  as  very  frequent  consequences,  are  ob- 
served conception  in  patients  previously  sterile,  and  fortunate 
gestation  in  those  previously  subject  to  repeated  abortions.  Its 
influence  in  removing  sterility  probably  depends  on  its  curing 
the  leucorrhcea,  which  usually  attends  and  which  in  many  in- 
stances is  doubtless  the  principal  obstacle  to  conception.  It  pre- 
vents abortion,  by  removing  the  inflammation  and  restoring  the 
natural  condition  and  healthy  action  of  the  cervix  in  which 
resides  the  retentive  power  of  the  uterus  in  gestation. 


98  Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  [February, 

Many  cases  might  be  adduced  in  illustration :  very  few  may 
suffice. 

Mrs.  ■ ,  from  Carolina,  had  been  married  3  or  4  years,  and 

was  in  wretched  health  as  long.  She  had  been  under  the  care  of  a 
number  of  eminent  physicians  and  had  undergone  a  variety  of 
treatment  for  various  diseases,  but  as  the  true  pathology  of  the  case 
was  overlooked  no  relief  was  experienced.  This  lady  suffered 
so  many  severe  local  and  constitutional  symptoms  that  life  had 
almost  become  a  burden,  and  she  had  very  little  hope  of  ever 
being  restored  to  health.  Upon  careful  investigation,  she  was 
found  to  have  prolapsus,  with  inflammation  of  the  cervix  and 
cervical  canal,  to  which  I  thought  all  her  sufferings  were  fairly 
referrible,  that  this  was  probably  the  primary  affection  and  the 
others  secondary  and  sympathetic.  The  local  affection  was 
treated  by  cauterization  with  nitrate  of  silver  and  astringent 
vaginal  injections.  The  principal  constitutional  remedies  em- 
ployed were  preparations  of  iodine  and  iron  and  other  tonics. 
Very  many  intercurrent  symptoms  and  sympathetic  affections 
were  met  by  such  medicines,  as  were  severally  indicated  for 
them ;  these  were  indeed  so  numerous  that  it  would  be  tiresome 
to  attempt  to  particularize.  The  treatment  of  this  case,  local  and 
general,  extended  over  more  than  two  years.  The  first  cauter- 
ization was  on  the3rd  of  March,  1853,  and  the  last  on  the  24th 
November  of  the  same  year — sixteen  in  all,  through  a  space  of 
nine  months;  few  cases  have  ever  required  as  many;  but  after 
all  traces  of  uterine  inflammation  had  disappeared,  she  was 
under  prescription  for  the  secondary  affections  during  the  whole 
of  the  following  year. 

It  often  happens,  when  cases  have  been  of  long  standing,  that 
the  secondary  affections  do  not  subside  for  a  long  time,  and  not 
unfrequently  demand  considerable  treatment. 

Fewer  cauterizations,  perhaps,  might  have  sufficed,  if  they 
could  have  been  made  with  more  regularity,  but  as  this  lady 
lived  at  a  distance,  they  were  frequently  unavoidably  deferred 
too  long. 

After  all  traces  of  inflammation  had  been  removed  and  leu- 
corrhcea  had  entirely  ceased,  this  patient  was  subject  to  menor- 
rhagia  at  nearly  every  menstrual  period  until  June,  1855,  when 
she  became  pregnant,  and  in  the  following  April  gave  birth  to  a 
fine  little  daughter,  since  which  Mrs. has  generally  enjoyed 


1858.]        Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  99 

very  good  health.  And  thus  a  most  amiable  and  excellent 
couple  were  rendered  as  happy  as  they  well  could  be,  who  before 
were  perhaps  equally  miserable — the  husband  from  sympathy 
with  his  wife  in  her  sufferings,  and  she,  perhaps,  less  from  her 
own  sufferings  than  from  the  distress  they  caused  him.  Last 
October  this  lady  was  in  Augusta,  looking  as  young,  and  more 
blooming  and  happy  than  previous  to  her  marriage,  five  years 
before. 

This  case  exemplifies  the  happy  effects  of  the  most  patient 
perseverance  under  the  most  adverse  and  discouraging  circum-- 
stances.  It  required  a  longer  course  of  treatment  than  any  I 
have  ever  attended,  Had  this  lady  not  possessed  and  exercised 
the  most  indomitable  patience,  she  would  have  given  up  in  utter 
hopelessness,-  long  before  a  cure  was  accomplished. 

Some  two  years  past,  a  Scotch  lady  about  30  years  of  age* 
some  years  married,  consulted  me  occasionally  for  leucorrhoea^ 
for  which  I  prescribed  medical  treatment  and  vaginal  injections.- 
In  1855  she  had  an  alarming  hemorrhage  from  the  womb,  which 
might  probably  have  depended  upon  an  early  abortion,  but  no 
embryo  or  ovum  was  discovered.  She  had  another  excessive 
hemorrhage  Nov.  12th,  1856— no  embryo  or  ovum  being  seem 
Vaginal  examination  detected  very  considerable  enlargement 
and  congestion  of  the  uterus,  but  no  evidence  of  pregnancy .- 

She  was  informed  that  she  probably  had  inflammation  or  ul- 
ceration of  the  neck  of  her  womb,  and  that  as  soon  as  she  had 
recovered  sufficiently  from  the  effects  of  the  hemorrhage,  she 
ought  to  submit  to  specular  examination,  by  which  alone  it 
could  with  certainty  be  determined.  On  the  29th  of  the  same 
month,  the  speculum  revealed  a  deep  pus-secreting  ulcer,  extend- 
ing from  the  anterior  lip  into  the  cervical  canal,  which  was 
freely  cauterized  by  nitrate  of  silver*  Chalybeate  tonics  and 
astringent  vaginal  injections  were  also  prescribed.  Caustic  Was 
applied  again  on  the  12th  and  27th  of  December  and  on  the  10th 
and  27th  of  the  following  February— in  all,  five  times.  At  the 
last  examination,  in  February  j  there  was  great  improvement. 
Having  called  two  or  three  times  afterwards,  without  finding 
her  at  home,  and  for  a  long  time  not  having  heard  from  her,  I 
lost  sight  of  the  case,  supposing  that,  tired  of  this  treatment,  she 
had  sought  assistance  elsewhere. 

But,  to  my  surprise,  in  August  she  called  to  inform  me  that 
n.s. — vol.  xrv.  NO.  II.  5 


100  Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  [February, 

since  I  saw  her  last,  not  only  the  whites,  but  "the  reds,"  too,  had 
ceased,  that  she  had  no  discharge  at  all  for  some  months — re- 
marking, with  perfect  artlessness,  what  alarmed  her  most  was  a 
large  lump  in  the  lower  part  of  her  stomach,  and  that  her  prin- 
cipal distress  was  being  very  sick  to  her  stomach,  especially  of 
mornings.  Her  gloomy  apprehensions  were  very  easily  and 
pleasantly  dispelled  by  assuring  her  that  the  tumor  was  perfect- 
ly natural,  and  that  she  was  just  "  as  ladies  wish  to  be  who  love 
their  lords," 

This  worthy  lady  and  her  kind  husband  were  made  perfectly 
happy  in  December  by  the  birth  of  a  little  daughter. 

This  case  is  remarkable  for  such  happy  results,  from  so  com- 
paratively small  an  amount  of  treatment — affording  great  en- 
couragement to  patients  whose  circumstances  may  not  admit  of 
regular  systematic  treatment. 

A  lady,  twenty-two  years  of  age,  who  had  been  married  about 
two  years,  during  which  time  she  had  one  premature  birth,  came 
from  Muscogee  county,   and  remained  in  Augusta  five  weeks, 
She  had  been  suffering  since  her  labor,  some  nine  months  before 
with  the  usual  functional  symptoms  of  prolapsus  and  inflamma 
tion  of  the  cervix,  which  were  verified  by  digital  and  instru 
mental  examination.    Nitrate  of  silver  was  applied  four  times 
first,  on  the  28th  day  of  January,  1854 — on  the  8th  and  22nd 
of  February,  and  on  the  4th  of  March ;  in  a  few  days  after  which 
she  returned  home,  with  a  silver-gilt  globular  pessary. 

Some  six  months  after  her  return,  I  heard  from  her  friends 
that  she  was  enjoying  good  health,  with  good  prospects  ahead, 
which  were  in  due  process  of  time  happily  realized. 

This  patient  also  used  astringent  vaginal  injections.  As  she 
was  very  feeble,  thin  and  pale,  chalybeate  and  other  tonics  were 
prescribed.  She  suffered  exceedingly  from  vesical  irritation,  for 
the  relief  of  which  she  took  a  comp.  syrup  of  buchu,  uva  ursi,  &c, 
with  very  good  effect. 

The  medical  treatment  was  continued  some  time  after  her  re- 
turn home. 

This  case  is  remarkable  for  the  promptness  of  its  recovery 
from  such  a  distressing  state. 

Many  more  cases  might  be  adduced,  but  it  would  be  unneces- 
sary and  tiresome ;  for  to  me  nothing  appears  more  dull  and 
uninteresting  than  a  narration  of  many  cases  substantially  the 


1858.]         Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  101 

same.  The  general  rale  has  been,  that  married  ladies,  during 
the  reproductive  age,  have  borne  children  after  having  under- 
gone treatment  by  nitrate  of  silver  for  inflammation  or  ulceration 
of  the  cervix :  there  are,  however,  some  exceptions ;  many  of 
these,  we  believe,  are  due  to  displacements,  such  as  retroflex- 
ion, retroversion,  &c,  which  sometimes  persist  after  recovery, 
and  are  not  easily  corrected. 

Note  6th.— The  Speculum. 

"Whilst  it  must  be  acceded  that  the  speculum,  like  every  other 
valuable  medical  or  surgical  means,  has  been  abused  by  being 
employed  in  cases  to  which  it  is  not  applicable— in  which  it 
could  neither  throw  light  on  the  pathology,  nor  prove  of  any 
benefit  in  the  treatment.  But  attemps  have  been  made  to  throw 
unjust  and  undeserved  obloquy  upon  its  use,  by  some  from 
whom  better  things  might  have  been  expected :  As  an  instance 
in  point ;  Dr.  Eobert  Lee  makes  the  following  illiberal  and  ill- 
natured  remark: — "  The  speculum  emanates  from  the  syphilitic 
wards  of  the  hospitals  at  Paris,  and  it  would  have  been  better  for 
the  women  of  England,  had  its  use  been  confined  to  those  insti* 
tutions." 

It  is  true,  that  all  of  the  most  important  discoveries  in  patholo* 
gy,  and  valuable  improvements  in  practice,  have  not  resulted 
from  experiments  and  investigations  made  in  the  Parisian  hos* 
pitals  ;  but  if  physicians,  from  pride  or  prejudice,  were  to  ignore 
or  repudiate  all  that  has  emanated  from  that  same  source,  who 
could  calculate  the  immense  loss  to  science  and  to  humanity  ? 

Admitting,  for  argument,  that  the  speculum  emanates  from 
the  venereal  wards  of  Parisian  hospitals— does  not  Providence 
often  bring  good  out  of  evil  ?  And  on  whom  could  it  be  more 
justifiable  to  make  investigations  and  experiments,  that  might 
redound  to  the  benefit  of  the  good  and  virtuous,  than  on  the 
vicious  and  profligate  of  the  same  sex  ? 

There  is  no  doubt  but  that  the  speculum  has  often  been  mis- 
used—that is,  applied  in  cases  wherein  no  knowledge  could  be 
obtained  or  benefit  secured,  as,  for  example,  in  some  cases  of 
large  polypi  and  other  tumors,  and  of  cancer,  especially  when 
far  advanced,  and  in  the  various  displacements  and  malpositions 
of  the  uterus. 

But  the  speculum  frequently  reveals  much  important  informa~ 


102  Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  [February, 

tion,  which  cannot  be  obtained  by  the  finger  alone.  Many- 
morbid  changes  which  are  not  palpable  to  the  touch  are  easily 
detected  by  the  eye. 

Dr.  Churchill  (page  29,  Dr.  Con  die's  edition)  makes  the  fol- 
lowing very  sensible  remarks  in  reference  to  the  employment  of 
the  speculum : 

"It  enables  us  to  ascertain  accurately  the  length  and  thickness 
of  the  cervix  uteri,  to  detect  variations  from  the  natural  color  of 
the  mucous  membranes,  slight  erosions  which  might  be  passed 
over  by  the  finger,  elevations  on  the  cervix  uteri  or  walls  of  the 
vagina,  too  little  raised  to  impress  the  sense  of  touch ;  small 
vesicular  polypi  within  the  os  uteri,  eruptions  upon  the  cervix, 
and  we  are  enabled  to  discover  the  color  of  the  surface  of  an 
ulcer.  It  will  also  confirm  many  characters  recognized  by  the 
touch.  On  the  other  hand,  we  must  be  careful  that  we  do  not 
mistake  for  morbid  changes  those  appearances  which  are  caused 
by  the  instrument  itself.  For  instance,  pressure  en  the  outer  end 
of  the  instrument  may  change  the  elevation  and  position  of  the 
uterus,  and  produce  swelling  and  pufrmess  of  the  cervix.  There 
can  be  no  doubt  of  the  great  value  of  the  speculum!  both  for  the 
detection  of  disease,  and  the  application  of  remedies ;  but  it  is  pos- 
sible that  injury,  beyond  the  violation  of  delicacy,  may  be  occa- 
sioned by  it.  It  should  never  be  used,  if  it  be  possible  to  avoid 
it,  in  virgins ;  or  when  there  is  any  alteration  of  tissue,  involv- 
ing its  greater  liability  to  laceration,  and  as  rarely  as  possible 
with  nervous  women." 

Dr.  Churchill  has  omitted  inflammation  and  ulceration  ex- 
tending into  the  cervical  canal,  which  are  of  very  frequent  occur- 
rence, and,  generally  at  least,  are  not  at  all  discoverable  by  the 
finger. 

His  caution  against  mistaking  "for  morbid  changes  appear- 
ances caused  by  the  instrument,"  is  very  well  timed  and 
judicious,  especially  in  using  Kicord's  four-branch  speculum, 
which  he  recommends  very  highly  and  which  formerly  I  em- 
ployed much  oftener  than  any  other.  This  speculum  pos- 
sesses the  advantages  of  being  very  easily  introduced  when 
the  blades  are  closed,  and  of  giving  a  good  view  by  the  sepa- 
ration of  the  blades  in  the  vagina,  but  it  is  perhaps  more 
liable  than  any  other,  in  expanding,  to  give  pain,  and  by 
irritating  the  vagina  and  cervix  to  cause  temporary  discolora- 


1858.]         Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  103 

tions,  which  might  deceive  the  unpractised  eye  and  possibly 
mislead  the  more  experienced.  Another  great  objection  is  that 
if  necessary  to  change  its  position  at  all,  it  must  be  withdrawn 
and  re-introduced,  for  otherwise  the  expanded  blades  could  not 
fail  to  irritate  and  cause  pain :  it  is  also  very  apt  to  give  pain  in 
being  withdrawn ;  unless  closed  with  great  care,  the  extremities 
of  the  blades  will  almost  certainly  irritate,  and  if  not  withdrawn 
gradually  and  cautiously  while  closing,  the  mucous  membrane 
of  the  vagina  will  be  pinched. 

Having  tried  and  rejected  a  large  number  of  complicated  and 
expensive  specula,  I  now  decidedly  prefer  the  glass  mirror  spec- 
ulum, in  general  at  least,  to  all  others.  Although  it  has  no 
obturator,  by  introducing  the  projecting  lip  first  carefully,  and 
pressing  it  gently  backward  against  the  perineum,  it  may  be  in- 
troduced almost  if  not  quite  as  easily  as  the  bivalve  or  quadri- 
valve  with  the  obturator ;  and  then  it  may  be  moved  freely  in 
any  direction  after  its  introduction  so  as  to  bring  the  os  and 
cervix  in  view,  if  needs  be  to  hook  them  up  and  bring  them  for- 
ward, when,  as  often  found,  inclined  too  far  back  to  be  readily 
seen. 

Much  has  been  said  against  the  speculum  on  the  score  of  deli- 
cacy ;  but  I  cannot  perceive  that  it  is  any  more  indelicate  to 
make  a  specular  than  a  digital  examination ;  it  is  the  necessity 
of  the  case  that  renders  either  proper,  and  I  do  believe  a  truly 
sensible  and  delicate  lady  would  submit  to  the  one  as  readily  as 
the  other — indeed,  were  it  not  that  a  digital  examination  almost 
necessarily  precedes  the  introduction  of  the  speculum,  the  spec- 
ular would  involve  less  indelicacy  than  the  other;  for  example — 
were  it  practicable  for  the  speculum  to  be  introduced  without 
the  intervention  of  the  physician,  as  I  have  known,  in  a  few 
instances,  by  the  patient  herself,  or  a  female  friend,  and  the 
physician  only  required  to  look  through  it  and,  if  necessary, 
make  an  application,  would  it  not  wound  her  delicacy  less  than 
a  digital  examination  ?  It  is  said  that  it  involves  more  expo- 
sure, but  this  is  not  necessary ;  for  it  certainly  can,  by  proper 
care,  and  ought  always  to  be  avoided. 

"When  the  speculum  gives  much  pain,  its  use  ought  to  be  de- 
ferred, until  the  patient  is  better  prepared  for  it,  by  soothinc 
and  sedative  vaginal  injections.  I  cannot  conceive  that  any  in- 
jury can  result  from  the  speculum,  when  used  with  proper  care 


104  Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  [February, 

and  caution,  and  under  circumstances  to  indicate  and  warrant 
its  application. 

Dr.  Churchill  says,  il  it  should  never  be  used,  in  virgins,  if  it 
be  possible  to  avoid  it,"  that  is,  if  at  all  compatible  with  the 
proper  treatment  of  their  diseases,  and  the  same  may  be  said  in 
reference  to  all ;  but  besides  the  greater  physical  difficulty  and 
liability  to  inflict  pain  and  injury,  it  is  proper,  on  other  consid- 
erations, to  defer  it  longer  in  the  former,  and  wait  until  the 
necessity  is  great  indeed. 

But  when  there  is  truly  a  necessity  for  a  specular  examination 
in  virgins,  the  physical  obstacle  is  generally  not  so  great  as  the 
objection  we  naturally  feel  to  subject  them  to  any  such  investi- 
gations ;  for  the  long  continuance  of  uterine  disease  has  the  effect 
of  so  relaxing  and  dilating  the  vagina,  that  an  examination  is 
attended  with  comparatively  little  difficulty.  A  respectable 
young  lady  had,  at  13  years  of  age,  about  the  time  of  the  first 
eruption  of  the  menses,  been  thrown  from  a  horse  with  great  vio- 
lence, alighting  on  her  pelvis,  ever  since  which,  she  had  been 
subject  to  symptoms  of  prolapsus,  "When  examined  at  17,  her 
womb  was  very  much  hypertrophied,  and  at  the  orifice  of  the 
vagina  which  was  so  relaxed,  that  almost  any  speculum  could 
be  introduced  with  ease. 

On  a  distant  visit,  in  1856,  I  was  requested  to  see  a  married 
lady,  about  20  years  of  age,  who  had  a  decided  procidentia,  the 
uterus  projecting  about  two  inches  beyond  the  vulva:  she  and 
her  mother  told  me,  she  had  had  this  affection  five  years  before 
her  marriage,  which  had  taken  place  a  few  months  before  I  saw 
her.  She  was  of  very  respectable  family,  and  of  unimpeachable 
character. 

These  are  indeed  extreme  cases,  but  more  or  less  relaxation 
always  results  from  uterine  disease  of  long  standing.  In  any 
case  wherein  it  may  be  at  all  proper  to  make  a  specular  ex- 
amination, Whitehead's  bivalve  speculum  may  be  used  with 
safety. 

As  respects  the  position ;  in  many  cases,  it  answers  very  well 
to  have  the  patient  on  her  back,  or  on  her  side,  with  the  pelvis 
near  the  edge  of  the  bed ;  but  very  frequently  there  is  a  great 
advantage  in  having  the  patient  on  her  knees  and  elbows,  as 
recently  advised  by  Dr.  Churchill,  and  many  years  ago  by  Pro- 
fessor  Antony.     In  this  position,  with  the  thorax  lower  than  the 


1858.]         Eve's  Notes  on  Diseases  of  the  Cervix  Uteri.  105 

pelvis,  gravity  causes  the  womb  to  pass  from  the  floor  of  the 
pelvis  toward  the  abdominal  strait,  elongating  the  vagina  to  its 
full  extent,  so  that,  if  not  shortened  by  the  long  existence  of 
prolapsus,  the  os  will  be  about  the  centre  of  the  pelvis,  and  there 
will  be  ample  room  to  inspect  the  whole  sub  vaginal  portion,  and 
to  make  a  satisfactory  application  to  any  part  of  it ;  whereas, 
when  the  patient  is  on  her  back  or  side,  situated,  as  the  womb 
often  is,  low  down  and  in  the  axis  of  the  superior  strait,  the 
speculum  passing  in  the  direction  of  the  axis  of  the  inferior 
strait,  they  necessarily  meet  at  such  an  angle  that  it  is  often  im- 
possible to  obtain  a  good  view  of  the  os,  or  to  insert  a  piece  of 
caustic  into  the  cervical  canal.  When  the  uterus  has  approach- 
ed so  near  the  vulva,  as  to  have  necessarily  changed  its  direc- 
tion from  the  axis  of  the  brim  to  that  of  the  outlet,  it  is  of 
course  most  easily  inspected  while  the  patient  is  on  her  back 
or  side. 

The  position  of  the  uterus  in  the  pelvis  and  the  condition  of 
the  vagina,  must  determine  what  position  of  the  patient  will  be 
most  eligible  in  each  particular  case. 

It  is  utterly  futile  to  declaim  against  the  speculum  in  cases  de- 
manding its  use,  when,  in  Europe  and  the  United  States,  so  many 
hundreds  and  thousands  of  the  most  interesting  and  valuable  of 
the  sex,  whose  health  was  wrecked,  and  whose  lives  were  ren- 
dered miserable,  with  an  untimely  grave  in  view,  have,  by 
treatment  involving  its  use,  been  restored  to  health  and  to  happi- 
ness, and  have  become  again  blessings  to  their  families  and  to 
society,  without  the  slightest  diminution  of  purity,  or  even  of 
delicacy,  and  in  the  highest  possession  of  every  moral  and  reli- 
gious excellence  that  can  beautify  and  adorn  the  female  char- 
acter. 

With  such  witnesses  in  its  favor,  the  opponents  of  the  specu- 
lum will  exhaust  their  disapproval  in  vain  declamation. 


106  Report  upon  the  Topography  and  [February, 

Dr.  Posey's  Eeport. 

[The  following  very  able  Eeport  was  presented  to  the  Ameri' 
can  Medical  Association  by  Professor  K.  D.  Arnold,  of  Savannah, 
at  its  last  meeting,  in  Nashville,  J)r,  Posey,  the  reporter,  not 
being  able  to  attend  the  meeting.  Appreciating  its  deep  inter- 
est to  the  Southern  Physician,  and  especially  those  of  our  own 
State,  in  a  statistical  point  of  view,  we  begin  its  publication  in 
our  present  number.  The  balance  of  the  paper,  relating  to  Epi- 
demic Diseases,  will  find  a  place  in  our  March  number. 

Georgia  certainly  has  no  reason  to  complain — she  has  record* 
ed  herself  pretty  fully  in  the  last  volume  of  our  National  Trans* 
actions, 

Report  upon  the  Topography  and  Epidemic  Diseases  of  the  State  of 
Georgia.    By  Jo#N  F.  Posey,  M,  P.,  of  Savannah,  Ga, 

The  State  of  Georgia  must,  for  purposes  of  medical  topogra* 
phy,  be  divided  into  three  unequal  parts. 

The  largest  occupying  more  than  half  the  area  of  the  State, 
extends  from  the  sea-coast  and  Florida  line  on  the  south  to  the 
head  of  navigation  of  the  larger  rivers. 

The  second  division  is  separated  from  the  first  by  a  line  be* 
ginning  at  Augusta,  at  the  head  of  navigation  in  the  Savannah 
Eiver,  and  running  nearly  west-southwest,  by  Milledgeville  and 
J^acon,  to  Columbus,  at  the  head  of  navigation  in  the  Chatta* 
hoochee ;  and  is  bounded  on  the  northwest  by  a  line  drawn 
from  the  northeastern  corner  of  the  State,  and  running  nearly 
southwest  till  it  reaches  the  western  boundary  line  of  the  State, 
about  half  way  between  Columbus  and  Nicajack,  on  the  Ten* 
nessee  Eiver. 

The  third  occupies  all  the  space,  within  the  State,  lying  north- 
west of  the  last  mentioned  line,  and  is  much  smaller  than  the 
second. 

The  first  division  is,  geologically,  of  tertiary  formation,  vary* 
ing  in  height  and  quality  of  alluvium  according  to  the  distance 
from  the  sea-coast. 

Dr.  P.  M.  Kollock  describes  the  part  nearest  to  the  sea  thus : 

u  The  topographical  features  of  this  district  may  be  distin* 
guished  into  three  separate  orders,  marked  by  strips  or  sections 
extending  lengthwise  from  northeast  to  southwest. 

*' Commencing  with  the  Sea  Islands  on  the  east,  we  remark  a 
series  of  sand-knolls  or  hillocks,  apparently  washed  up  by  the 
gea  from  its  bottom,  varying  in  elevation,  intersected  by  salt- 
marshes  and  creeks,  and  inclosing  frequently  brackish  ponds 
and  lagoons. 


1858.]  Epidemic  Diseases  of  the  State  of  Georgia.  107 

M  The  growth  of  these  islands  is  live-oak,  water-oak,  bay,  gum, 
and  pine.  The  live-oak  predominates  on  the  southern  parts  of 
the  islands,  almost  to  the  exclusion  of  the  pine ;  while  this  last 
is  found  at  the  northern  end, 

"  The  soil  is  a  grayish  and  yellowish-brown  sand,  mixed  with 
shells  and  vegetable  mould,  without  any  mixture  or  substra- 
tum of  clay.  This  soil,  for  the  most  part,  is  thin,  extending  only 
a  few  inches  in  depth. 

"  These  islands  are  separated  from  the  mainland  by  extensive 
salt-marshes,  which  are  intersected  by  numerous  creeks,  and 
overflowed  by  every  high  tide. 

"  The  islands  are  also  separated  from  each  other  by  sounds, 
or  arms  of  the  sea,  which  are  the  outlets  of  the  rivers  to  the 
ocean. 

"Leaving  the  islands,  and  crossing  over  to  the  main,  we  enter 
upon  another  section  or  strip  of  country,  varying  in  its  topo* 
graphical  features  from  the  islands ;  a  low  pine-barren,  intersect- 
ed with  the  rivers  and  swamps  before  mentioned. 

"The  growth  of  these  barrens  is  the  short-leaved  pine,  mim 
gled  with  scrub-oaks  and  gums.  The  soil  is  sandy,  with  here 
and  there  a  sprinkling  of  red  clay. 

"  In  wet  seasons,   while  the  swamps  are   full  of  water,   this 

Eine-barren  soil  is  kept  in  a  sobbed  state,  the  drainage  being  bad 
y  reason  of  its  flatness. 

"Passing  across  this  section,  inland,  twenty  or  thirty  miles 
in  width,  we  strike  a  somewhat  more  elevated  and  rolling  region 
of  sand-ridges  and  hills,  intersected  with  bay -galls  and  branches, 
and  sometimes  ponds, 

"  The  soil  is  sandy,  with  a  substratum  of  clay  at  varying 
depths.  The  long- leaved  pine  takes  the  place  of  the  short,  and 
predominates,  to  the  exclusion  of  almost  every  other  tree." 

The  mainland  adjoining  the  salt-marshes,  which  divide  it 
from  the  Sea  Islands  between  the  Savannah  and  Altamaha 
Rivers,  usually  commences  with  a  line  of  bluffs,  which  rises 
twenty  or  thirty  feet  above  the  level  of  high  water,  separated 
by  arms  of  salt-marsh  and  small  streams  of  fresh  water,  carrying 
the  water  springing  from  a  line  of  sand-hills  twenty  or  thirty 
miles  further  inland. 

These  streams  have  a  tide  flowing  a  distance  of  ten  or  fifteen 
miles  above  the  bluflfe,  and  for  about  the  same  distance  further 
they  are  margined  by  a  fresh- water  marsh  and  swamp,  from  half 
a  mile  to  a  mile  in  width,  with  strips  of  higher  land  between 
them,  which  are  of  an  older  formation  than  the  alluvium  of  the 
swamps,  this  last  being  yet  in  the  process  of  deposit. 

Some  of  these  strips  of  higher  ground  are  remarkable  for  the 
growth  of  plants  not  usually  found  growing  so  near  the  sea- 
coast. 


108  Report  upon  the  Topography  and  [February, 

Between  the  line  of  bluffs  and  the  line  of  sand-hills  the  great- 
est part  of  the  rice  which  is  grown  in  Georgia  is  produced,  and 
also  much  of  the  long-stapled  cotton. 

The  line  of  sand-hills  is  an  abrupt  rise  from  a  comparatively 
level  plain,  of  about  sixty  feet,  which  height  is  very  gradually 
increased  as  the  distance  from  the  beginning  line  is  increased, 
with  a  succession  of  undulations  of  no  great  altitude,  except 
near  the  river  swamps.  These  swamps  are  like  wide,  shallow 
valleys  cutting  through  the  undulations,  in  which  the  streams 
meander  from  one  side  to  the  other,  without  any  apparent  cause 
for  keeping  any  particular  course. 

These  valleys  are  filled  to  their  present  surface-level  with  the 
most  recent  alluvium,  the  vegetable  mould  now  forming  on  the 
spot,  sometimes  covered  with  water  and  a  growth  of  cypress,  and 
in  other  places  dry,  with  a  heavy  growth  of  such  trees  and  bush- 
es as  delight  in  a  damp,  rich  soil. 

Into  these  swamps  and  lowlands  the  above-mentioned  undu- 
lations project  more  or  less,  producing  an  irregular  line  of  river 
hills,  having  the  valleys  between  them  gradually  rising  from  the 
level  of  the  river  swamps  to  that  of  the  innumerable  ponds  that 
are  scattered  all  over  the  face  of  this  part  of  the  country.  These 
valleys,  which  carry  off  the  surface  water  after  rains,  wind 
about  among  hills  of  but  little  height  above  them,  until  ap- 
proaching the  river  swamps,  where  they  seem  to  have  been 
washed  deeper,  but  are  accompanied  in  their  whole  course  by 
that  kind  of  water-drain  called  by  the  inhabitants  "  bay-galls," 
which  are  from  thirty  to  sixty  yards  or  more  in  width ;  these 
are  like  the  river  swamps,  on  a  smaller  scale,  and  often  resem- 
ble vast  hedges  dividing  fields  of  open  pine-barren,  or  dense 
thickets  of  low  whortleberry-bushes,  or  species  of  Andromeda 
called  by  the  people  "  tie-tie." 

When  these  bay-galls,  in  their  course  to  the  river,  meet  to- 
gether, they  make  considerable  streams,  which  seldom  run  dry, 
and  in  some  places  have  cut  for  themselves  channels  with  fall 
sufficient  to  drain  the  swamps  on  their  sides  for  some  distance ; 
these  channels  are  commonly  filled  more  or  less  thickly  with 
silicious  stones,  often  being  casts  of  some  bivalve. 

What  is  here  called  "rotten  limestone,"  probably  underlies 
this  whole  region,  and  is  found  in  digging  wells,  where  they 
have  to  be  sunk  deeply ;  and  where  this  is  the  case,  the  water 
is  commonly  impregnated  with  what  seems  to  be  putrid  animal 
matter,  which  renders  it  exceedingly  disagreeable,  and,  in  the 
general  opinion,  unhealthy. 

At  the  distance  of  about  one  hundred  and  twenty  miles  from 
the  sea,  the  rotten  limestone  ceases,  and  mica-schist  begins  to  be 
found  in  the  beds  of  rivers  and  other  deep  excavations ;  here, 
also,   the  hills  are  higher  and  steeper,  and  oak  and  hickory 


1858.]  Epidemic  Diseases  of  the  State  of  Georgia.  109 

are  mixed  with  the  pines ;  cypresses  are  no  longer  found,  and 
the  small  water-courses  have  high,  steep  banks,  without  swamps; 
here,  also,  the  long-leaved  pines  cease,  and  soon  the  primitive 
formation  crops  out. 

South  of  the  Altamaha  Kiver,  after  leaving  the  tide- way,  the 
face  of  the  country  is  described  by  Dr.  Kollock  thus: — 

u  The  soil  varies  in  its  equalities  and  appearance,  "  being 
either  a  dark-gray  or  a  black  mould,  and  is  superficial,  with  an 
argillaceous  substratum  to  the  depth  of  five  or  six  feet,  and  in  a 
dry  time  becomes  so  hard  that  it  is  almost  impervious  to  the 
plough  or  hoe,  and  cracks  in  every  direction,  forming  exten- 
sive fissures  of  considerable  depth."  In  such  localities  it  is  rare 
to  find  good  water.  According  to  Dr.  T.  S.  Hopkins,  of  Wayne 
County,  white  clothing,  washed  in  this  water  for  a  time,  will 
assume  a  yellowish  hue,  analogous  to  that  which  would  be  pro- 
duced by  a  very  weak  solution  of  sulphate  of  iron. 

"  This  section  of  country,  says  the  same  gentleman,  is  known 
as  the  "  lowlands,"  and  is  invariably  abandoned  by  the  plan- 
ters in  the  early  part  of  June. 

"In  a  very  dry  or  very  wet  season,  the  negroes  on  the  plan- 
tations seem  to  enjoy  almost  an  entire  immunity  from  the  severe 
grades  of  bilious  remittent  and  congestive  fevers  which  are 
common  at  other  seasons, 

"  Immediately  above  the  lowlands,  in  Glynn  County  and  the 
great  Buffalo  Swamp,  the  land  rises  at  least  eighteen  feet,  the 
soil  is  sandy  and  poor,  the  growth  chiefly  pine  and  blackjack, 
intersected  occasionally  by  spring  branches,  which  afford  at 
almost  all  seasons  of  the  year  an  abundant  supply  of  fine  water. 
The  well-water  throughout  this  section  cannot  be  surpassed  in 
purity  and  coolness  even  by  our  mountain  springs." 

On  the  south,  in  Ware  County,  is  the  great  Okefonokee 
Swamp,  of  which  it  is  not  necessary  to  say  more  than  that  it  is 
but  little  known  as  yet ;  but  a  survey,  by  order  of  the  legislature 
of  the  State,  is  now  in  progress. 

On  the  west,  and  further  inland,  "the  face  of  the  country," 
says  Dr.  H.  Briggs,  of  Troupville,  "  is  level,  rolling  somewhat 
in  the  southern  half,  interspersed  throughout  with  shallow  ponds 
and  bays,  some  of  which  are  timbered,  others  destitute  of  trees ; 
filled  to  overflowing  with  water  during  the  rainy  seasons  of 
winter  and  spring,  but  usually  nearly  or  quite  dry  during  the 
latter  part  of  summer  and  autumn. 

"There  are  some  ponds  of  a  different  kind  in  the  southern 
part.  They  appear  to  have  been  formed  by  portions  of  land 
settling  down,  and  the  water  rising  to  a  considerable  height 
above  the  depressed  portions. 

"  These  were  formed  a  long  time  since,  as  the  banks  are  now 
very  evenly  sloped,  and  covered  with  trees  of  mature  growth. 


110  Report  upon  the  Topography  and         [February, 

They  are  usually  round  or  elliptical,  varying  in  depth  from 
three  to  fifteen  or  twenty  feet,  not  very  sensibly  affected  by  rain 
or  drought. 

"  There  are  in  almost  all  sections  some  evidences  of  lime  un- 
derneath the  clay,  such  as  lime-sinks  and  sundry  subterranean 
passages,  into  which  the  creeks  pour  a  part  of  their  waters ;  also 
some  lime-water  springs. 

aThe  country  lies  upon  the  Mexican  Gulf  slope,  the  declivity 
being  from  fifteen  to  eighteen  inches  to  the  mile.  The  water- 
courses have  a  general  southern  course,  and  are  all  tributaries 
of  the  Suwanne  or  Ocklockonnee  Eivers.  The  creeks  and  bran- 
ches spread  far  and  wide  after  a  rainy  season ;  and  after  a  long 
dry  summer  they  are  either  dry,  or  nearly  destitute  of  running 
water.     The  largest  are  mere  drains  for  the  surface  water. 

"  The  soil  is  a  sandy  loam,  underlaid  with  clay  at  various 
depths,  from  six  inches  to  several  feet. 

"  The  well  water  is  soft  and  generally  free  from  lime,  except 
after  protracted  drought. 

"  The  country  is  generally  covered  with  pine  forests,  and  the 
wild  grasses  and  flowering  plants  indigenous  to  all  this  region. 

"There  are  some  isolated  portions  of  country  covered  with  a 
heavy  growth  of  oak,  hickory,  magnolia,  &c.  The  bays  and 
margins  of  the  creeks  and  branches  are  wooded  with  cypress, 
bay,  gum,  water-oak,  live-oak,  and  a  dense  undergrowth  of 
evergreen  shrubs. 

"  The  pine  lands  are  moderately  productive,  yielding  corn, 
cotton,  potatoes,  rice,  sugar-cane,  wheat  and  oats. 

"  The  hammock  lands  are  more  productive,  but  probably  not 
more  durable.  Very  little  has  been  done,  as  yet,  in  the  way  of 
reclaiming  bay  or  swamp  lands. 

"  Oyster  and  other  marine  shells  abound  in  the  beds  of  all  the 
larger  streams ;  they  have  undergone  silicious  petrifaction. 

"  In  the  southern  part,  along  the  banks  of  the  streams,  speci- 
mens of  chalcedony,  large  masses  of  yellow  limestone,  and  orbi- 
tulite  are  frequent. 

"  About  midway  between  the  Atlantic  and  Gulf  coasts,  the 
temperature  in  summer,  during  the  day,  is  often  as  high  as 
ninety  or  an  hundred  degrees ;  I  have  not  known  it  to  exceed 
one  hundred  and  two  degrees  at  any  time.  The  nights  are  sel- 
dom oppressively  warm  after  nine  P.  M.  The  gales  that  so  fre- 
quently prove  disastrous  upon  the  Atlantic  coast,  are  scarcely 
observed  here,  Those  of  the  Gulf  coast  are  sometimes  severely 
felt,  particularly  in  the  western  part  of  the  district," 

The  second  division  of  the  State  begins  on  a  line  running 
from  Augusta  by  Milledgeville  and  Macon,  to  Columbus,  being 
the  head  of  navigation  in  the  principal  rivers  of  the  State,  and 
differs  entirely  from  the  first  in  geological  formation,   being 


1858.]  Epidemic  Diseases  of  the  State  of  Georgia.-  Ill 

primitive ;  and  the  face  of  the  country,  which  is  more  hilly,  and 
the  streams  being  mostly  confined  between  high  banks,  and 
without  any  marginal  swamps,  with  rocky  beds,  over  which  the 
current  is  generaDy  very  rapid. 

The  hills,  near  the  larger  water-courses,-  are  commonly  very 
steep,  often  with  large  masses  of  coarse-grained  granite  piled  up 
like  houses,  and  rapidly  disintegrating,  from  the  effects  of  the 
weather.  These  hills  are  composed  of  clay  of  various  colors,  red 
predominating  on  the  higher  parts,  while  in  the  deep  cuts  made 
by  the  streams,  a  white,  extremly  tough  plastic  clay  is  found, 
mixed  with  a  very  fine  white  sand,  with  white  flint  stones,  often 
in  oblique  cubes,  with  unpolished  surfaces. 

In  some  places  dikes  of  silex,  or  of  coarse  mica,  cut  into  the 
hills  like  veins  of  a  mine,  as  if  immense  masses  of  granite  had 
been  decomposed  into  clay,  leaving  veins  of  silex  or  mica  in 
place. 

The  red  clay  always  contains  grains  of  silex,  and  sometimes 
mica  in  very  considerable  quantities.  Transparent  crystals  of 
qnartz  abound,  sometimes  single,  but  mostly  covering  a  mass  of 
agate,  or  lining  a  cavity  in  the  same.  Small  masses  of  felspar 
are  found  on  the  surface,  and  geodes,  an  ineh  or  less  in  diame- 
ter, containing  a  quantity  of  red  ochre. 

There  are  places  in  the  central  parts  of  this  division,  where  the 
granite  lies  bare,  like  an  old  field  of  some  acres,  having  banks 
around  it  like  those  of  a  tranquil  water-course,  green  with  moss- 
es and  constantly  damp. 

The  soil  is  a  light  gray,  and  strong,  and  very  productive 
while  new,  but  very  quickly  destroyed  by  careless  cultivation, 
such  as  has  been  practiced  ever  since  the  first  settlement  of  the 
country,  leaving  bare  the  clay,  upon  which  scarcely  any  vege- 
table can  grow. 

The  most  productive  lands,  and  those  which  are  longest  in 
being  exhausted  by  the  slovenly  cultivation  aforesaid,  are  those 
called  here  "  river  low  grounds,"  where  the  surface  to  a  varying 
depth,  sometimes  more  than  ten  feet,  is  composed  of  vegetable 
matter  intimately  mixed  with  the  washings  from  the  hills.  This 
land  is  always  highest  immediately  at  the  edge  of  the  stream, 
and  gradually  becomes  lower,  until  it  reaches  the  foot  of  the 
hills,  where  there  is  often  standing  water. 

A  large  portion  of  the  cultivated  land  in  this  part  of  the  Stater 
is  in  what  is  called  "the  Flat-woods,"  being  table  land  on  a 
small  scale,  at  a  distance  from  the  largest  streams,  having  a  stiff 
clayey  soil,  not  very  pervious  to  water,  and  therefore,  in  a  wet 
season  liable  to  be  soaked,  and  sometimes  overflowed,  the  water- 
shed not  always  being  very  obvious. 

The  forest  growth  is  oaks  of  several  species,  hickory,  chestnut, 
black  walnut,  pine,  beach,  maple,  dogwood,  buttonwood,  here 


112  Report  upon  the  Topography  and  [February, 

called  sycamore,  crab-apple,  &c.,  in  the  order  of  frequency  here 
indicated. 

The  northern  part  of  this  division  contains  most  of  the  rich 
mines  of  gold,  copper,  &c,  with  mineral  springs  in  various 
places;  but  the  springs  and  wells  in  general  furnish  very  pure 
' 'freestone"  water. 

The  temperature  varies  much  in  the  different  parts  of  this 
division ;  along  the  southern  boundary  line  the  summer  days, 
in  dry  weather,  are  oppresively  hot,  with  little  wind,  while  the 
nights  are  cool  and  pleasant  Thunder  squalls  are  frequent, 
stirring  up  the  atmosphere,  bringing  down  the  cold  air  from 
above,  while  the  rain  washes  the  dust  from  the  vegetation,  re- 
freshing everything. 

In  the  winter  the  thermometer,  seldom  below  zero,  is  very 
variable ;  light  snows  are  common,  sometimes  lying  in  the 
woods  two  or  three  weeks. 

Approaching  the  mountain  region,  the  summer  heat  is  miti- 
gated and  the  cold  of  winter  is  increased,  and  the  temperature 
is  more  governed  by  the  course  of  the  winds,  snow  lying  on  the 
mountains  till  late  in  the  spring. 

The  third  division  comprehends  the  limestone  region  of  Upper 
Georgia. 

For  information  from  this  region,  I  am  indebted  to  Dr.  Kobert 
C.  Word,  formerly  of  Cassville,  now  of  Borne.  "There  is  no 
material  difference,"  says  Dr.  Word,  "  in  the  geological  features 
of  the  several  counties.  There  is  in  each  the  same  succession 
of  broad  valleys  of  rich  fertile  land,  separated  by  intervening 
ridges,  from  one  to  several  miles  across,  of  various  degrees  of 
elevation,  rising,  in  some  instances,  to  the  magnitude  of  moun- 
tains, originally  covered  by  a  dense  forest,  now  rapidly  disap- 
pearing. These  valleys  are  well  watered  by  streams  fed  by 
large  springs,  which  gush  up  from  beneath  the  substratum  of 
limestone  underlying  the  surface  at  various  debths,  through- 
out their  whole  extent. 

"  The  rains  of  winter  and  spring  fill  the  stratum  of  earth 
above  the  limestone  with  moisture,  and  give  rise  to  innumera- 
ble temporary  fountains  (called  wet  weather  springs)  at  the  base 
and  on  the  sides  of  the  hills,  and  all  over  the  valleys.  These 
all  flow  into  the  permanent  streams,  and  occasion  a  great  dis- 
proportion in  the  height  of  their  waters  between  wet  and  dry 
seasons. 

"  The  stratum  of  limestone,  and  in  many  places  one  of  alumina 
above  it,  presents  a  great  obstacle  to  the  absorption  or  ready 
penetration  of  the  superabundant  water  deeply  into  the  earth, 
and  consequently  there  is  excessive  humidity  of  the  surface,  and 
in  many  places  large  pools  of  water,  or  shallow  lakes  of  consid- 
erable extent,   during  the  months  of  January,  February,   and 


1858.]  Epidemic  Diseases  of  the  State  of  Georgia.  113 

March.  The  three  succeeding  months  are  generally  delightful 
in  temperature.  The  genial  warmth  of  the  vernal  sun  quickly 
evaporates  the  excess  of  moisture — the  dreariness  of  winter  is 
dispelled,  and  its  fathomless  abyss  of  cohesive  mud  forgotten  in 
the  contemplation  of  the  gorgeous  scene  displayed  with  magical 
celerity  by  the  luxuriant  vegetation. 

"  The  summers  are  by  no  means  so  depressing  as  upon  the 
seaboard,  or  in  the  middle  portion  of  the  State.  The  thermom* 
eter  occasionally,  in  the  hottest  part  of  the  day,  rises  as  high  as 
90°  or  92°  of  Fahrenheit,  but  the  nights  are  cool  and  refreshing, 

"The  same  geological  formation  which  favors  the  accumula- 
tion of  water  near  the  surface  of  the  earth  in  winter  explains 
also  the  remarkable  absence  of  it  during  the  months  of  August, 
September,  and  October,  when  in  dry  seasons,  the  ground  is 
parched  and  cracked  in  many  places,  the  atmosphere  filled  with 
dust,  vegetation  languishing,  and  where  the  stratum  of  earth  is 
thin,  totally  destroyed ;  the  temporary  springs,  branches,  and 
lakes  all  dried  up,  many  of  the  wells  exhausted,  and  the  water 
in  the  permanent  streams,  reduced  to  its  minimum,  creeps  slug- 
gishly through  the  accumulated  piles  of  drift-wood,  which  par- 
tially block  up  the  channels  through  which  it  flows. 

"  The  highest  heat  of  summer  is  of  short  duration,  and  the 
temperature  of  the  entire  autumn  is  delightful, 

"  The  two  principal  streams  in  this  section  of  Georgia  are  the 
Oostenaula  and  the  Etowah,  which,  meeting  at  Eome,  in  Floyd 
County,  form  the  Coosa,  a  stream  navigable  for  steamboats 
many  miles  into  the  State  of  Alabama. 

"  These  rivers  drain  nearly  the  whole  of  the  fifth  congression- 
al district,  and  are  of  great  size,  but  not  different  in  their  cir- 
cumstances from  their  smaller  tributaries,  though  much  of  the 
alluvial  land  upon  their  banks,  subject  to  inundation,  is  still 
covered  with  primeval  forest 

"Throughout  all  the  limestone  region  numerous  sinks  and 
depressions  are  observable  on  the  earth's  surface.  Many  con- 
tain water  during  the  winter,  but  become  dry  on  the  approach 
of  warm  weather.  Others  are  permanently  filled  with  clear  pure 
water.  Subterranean  caves  are  also  numerous,  especially  in 
the  counties  of  Cass,  Waker,  and  Dade. 

"The  great  alternations  of  moisture  and  temperature,  so  com- 
mon to  our  winters,  are  probably  due  to  the  character  of  the 
prevailing  winds,  which  are  exceedingly  variable,  not  unfre- 
quently  shifting  their  position  to  all  the  points  of  the  compass- 
in  a  period  of  less  than  twenty-four  hours,  each  change  in  direc- 
tion being  attended  with  a  corresponding  change  of  tempera- 
ture. The  southeast  winds,  blowing  from  the  Atlantic  coast 
during  the  greater  part  of  fall  and  winter,  are  attended  with 
frequent  rains,  cold   and  penetrating   in  their  effects  upon  the' 


114  On  Rheumatism.  [February, 

system.  East  winds  are  attended  with  cold  drifting  rains,  and 
frequently  with  sleet ;  south  winds  with  copious  showers,  not 
quite  so  cold  ;  southwest  winds  with  frequent  showers,  rather 
warm.  As  the  wind  approaches  the  west,  the  rain  ceases, 
though  the  clouds  continue  until  it  reaches  a  point  north  of  west, 
when  the  weather  becomes  fair  and  cool.  Due  north  winds  are 
very  cold,  though  not  usually  of  long  continuance.  Northeast 
winds  are  not  common,-  and  when  they  do  occur,  are  apt  to 
bring  with  them  snow.  In  the  spring,  we  have  rains  and  pas- 
sing showers  from  the  west  and  southwest.  In  summer  we  have 
showers  mostly  from  the  west  and  northwest. 

11  Situated  and  forming  the  dividing  line  between  the  grains 
growing  sections  of  Tennessee  and  the  cotton  region  of  Georgia, 
the  limestone  counties  of  Cherokee  Georgia,  are  not  wholly  un- 
suited  to  the  production  of  either.  Though  best  adapted  to  the 
growth  of  grain,  grasses,  and  stock,  the  more  southern  counties 
have  been  found  to  produce  abundant  crops  of  cotton.  The 
soil  on  the  creek  and  river  bottoms  is  rich  with  alluvial  deposit. 
In  many  places,  both  in  the  valleys  and  more  elevated  country, 
the  soil  is  strongly  impregnated  with  iron,  constituting  the  "red" 
or  "  chocolate"  land,  exceedingly  fertile,  but  u  thirsty." 

[To  be  concluded  in  March  No.] 


On  Rheumatism  of  the  Epithelial  and  Non- Epithelial  Fibrous  Tis- 
sues :  Its  Sequence  to  Scarlatina  and  other  Exanthemata.  On 
Rheumatic  Gout,  Chorea,  &c.  &c.  By  H.  P.  DeWees,  M.  D. 
New  York. 

(Concluded  from  January  No.  p.  63.) 

The  secondary  abscesses  following  rheumatism,  result  in  most 
cases,  from  local  phlebitis,  or  from  the  detention  of  minute  fibrin- 
ous plugs  arresting  the  circulation  in  the  small  vessels.  Some- 
times, the  breaking  down  of  larger  plugs  with  interior  pus,  causes 
irritation  to  be  established,  with  more  or  less  serous  infiltration 
into  the  adjacent  cellular  tissue,  the  abscess  varying  according  to 
the  local  arrest.  The  limits  of  this  paper,  however,  will  not  allow 
more  than  mention  of  these  conditions.  I  will  merely  refer  to1 
the  pathological  facts  of  the  vessels  becoming  inflamed,  and  sub- 
sequently thickened  or  plugged  up,  so  that  more  or  less  perfect 
closure  ensues,  with  resolution  into  abscess,  or  into  mortification, 
either  local,  or  at  a  distal  point,  if  the  large  vessels  are  arrested  in 
their  circulation.  The  nature  of  the  gangrene,  whether  moist  or 
dry,  will  in  great  measure  depend  on  the  perfection  of  the  closure. 
Sometimes,  however,  the  surrounding  parts  become  so  agglutina- 
ted by  the  adhesive  action  of  repair,  as  to  render  the  neighboring 
tissues  anatomically  unrecognizable,  and  totally  unfit  for  their  pur- 
poses of  secretion  or  of  motion.     If  such  deposit  take  place  in  the 


1858.]  On  Rheumatism.  115 

lungs,  the  damage  is  the  same,  and  in  this  way  vomicae  may  arise 
perfectly  independent  of  tubercular  origin,  a  plug  of  fibrin  not 
as  large  as  the  head  of  a  pin  arresting  the  local  circulation,  with 
consecutive  destructive  changes;  so  that  rheumatism,  by  its  re- 
sults, may  become  the  parent  of  evils,  equal,  in  their  destructive 
tendencies  over  life,  to  tubercle  in  its  highest  state  of  develop- 
ment and  disintegration.  If  the  vessels  of  the  brain  become  the 
seat  of  arrest,  its  nutrition  will  be  more  or  less  interfered  with, 
and  local  atrophy  or  softening  may  ensue,  with  lesions  of  motion, 
or  of  intelligence,  as  resultants.  And  thus  paralysis  and  imbecil- 
ity may  follow  in  the  train  of  that  so-called  "  simple  rheumatism/' 
*  The  cases  of  paralysis  after  rheumatism  of  the  spinal  invest- 
ments are  not  unfrequent.  On  dissection,  this  apparently  high 
inflammatory  action,  so  complete  in  its  functional  arrest  as  even 
to  eventuate  in  death,  cannot  at  times  be  recognized  by  the  eye, 
as  regards  structural  change.  And  the  same  can  be  said  of  it 
when  seated  in  the  serous  membranes  of  the  brain;  the  so-called 
inflammation  being  a  specific  poisoning  of  the  very  centres  of  life, 
leaving  neither  trace  nor  residue, 

In  the  gouty  the  blood  poison  is  not  always  exhibited  by  the 
';  big  toe"  attack,  with  increasing  demand  for  flannel.  The  skin 
may  become  the  beacon  of  its  approach.  Lichenous,  herpetic, 
or  other  eruptions,  painful  to  bear  and  obstinate  to  treat,  may  not 
only  mask  the  attack,  but  for  a  long  time  keep  it  in  "  masterly 
inactivity."  And  the  same,  at  times,  may  be  said  of  the  poison 
of  rheumatism. 

It  would  appear,  from  reasoning  on  the  facts  adduced  in  the 
study  of  rheumatism  and  gout,  that  if  the  lactic  acid  formations 
are  in  excess,  either  by  over-generation  or  by  non-elimination, 
that  an  attack  of  acute  rheumatism  is  apt  to  follow,  and  especially 
after  the  sudden  drying  up  of  these  eruptions.  If  this  does  not 
take  place,  but  the  skin  disorder  recedes  slowly,  and  there  is  ap- 
parently but  a  small  excess  of  lactic  acid  retained,  the  rheumatic 
pains  are  irregular,  flying  from  spot  to  spot,  or  the  joints  become 
more  or  less  stiff,  not  from  any  difficulty  in  their  opposing  surfa- 
ces, but  from  muscular  inability  to  apply  the  necessary  force  to- 
wards movement.  If,  on  the  other  hand,  the  uric  acid  is  not  ex- 
pelled, or  is  generated  in  excess,  gout  is  the  frequent  successor. 
At  this  moment  I  have  two  cases  that  would  apparently  verify 
these  views. 

The  white  fibrous  tissue  is  the  chief  texture  affected  in  simple 
acute  or  true  fibrous  rheumatism,  either  as  it  occurs  in  the  for- 
mation of  the  ligaments  connected  with  joints,  or  in  the  mem- 
branous form  covering  tendons,  or  in  the  aponeurotic  expansions 
of  the  large  muscles,  as  the  fascia  lata  of  the  thigh,  with  its  deep 
prolongations,  or  in  the  cranial  dura  mater,  sclerotica,  &c. 

It  will  be  necessary  to  bear  in  mind  that  the  sheathes  of  ten- 


116  On  Rheumatism.  [February, 

d0Ils — the  bursae  (sometimes  called  the  bursal  synovial  mem- 
branes) between  the  tendons  of  muscles,  between  tendons  and 
bones,  and  between  the  projecting  parts  of  bones  and  skin,  as  the 
olecranon,  &c,  have  no  epithelium, — although  in  function  they 
resemble  the  true  synovial  membranes,  yet  they  differ  from  them 
anatomically  and  in  exact  analysis.  But  this  is  not  the  case  in 
the  bursa?  communicating  with  the  synovial  capsules ;  these  as  well 
as  the  articular  cartilages,  have  an  epithelial  layer.  These  ana- 
tomical peculiarities  are  to  be  remembered,  as  they  form  the  dis- 
tinctive features  in  the  pathology,  diagnosis,  and  treatment. 

Although  the  synovial  membranes  are  not  so  prone  to  the  effu- 
sion of  plastic  lymph,  as  are  the  serous,  yet  the  bursae  are  at  times 
found  not  only  traversed  by  adhesive  bands,  but  even  completely 
obliterated.  The  movements  in  such  conditions  are  greatly  im- 
peded, but  not  so  completely,  as  when  the  sheaths  of  the  tendons 
are  in  a  like  manner  affected,  the  free  play  of  the  attached  mus- 
cles being  rendered  more  or  less  impossible. 

The  fact  is  not  to  be  lost  sight  of,  that  a  large  proportion  of  the 
urea  is  derived  from  the  disintegration  of  the  body  tissues,  espe- 
cially of  the  gelatinous  and  albuminous  orders,  independently  of 
the  introduction  of  nitrogenized  food  into  the  system.  It  is  chiefly 
or  at  least  frequently,  in  rheumatic  disorders  which  are  the  off- 
spring of  deranged  secondary  assimilation,  that  urea  forms  so  fatal 
an  agency,  although  nervous  depressions  and  coma  arise  in  non- 
rheumatic  diseases ;  as  those  of  the  kidney,  or  from  puerperal 
causes,  &c.  Indeed,  in  many  diseases  involving  the  serous  mem- 
branes with  kidney  difficulty,  urea  forms  a  dread  element,  whilst, 
by  its  non-elimination,  or  selective  error,  it  lies  at  the  secret  cause 
of  disturbance,  not  only  in  the  sclerotic  membranes,  but  also  in 
many  of  the  diseases  of  the  aqueous  and  vitreous  humors  of  the 
eye.  This  is  now  only  alluded  to,  and  may  form  the  subject  of 
another  paper,  or  will  serve  to  call  notice  from  other  medical  ob- 
servers. Not  less  important  would  be  a  series  of  observations  as 
regards  the  action  of  oxygenated  remedies  in  a  high  lithic  condi- 
tion of  the  system,  as  the  uric  acid  might  thus  be  converted  into 
urea.  In  the  gouty  this  change  of  uric  acid  into  urea  might  take 
place  by  the  action  of  oxygenated  remedies,  and  suppuration  of 
the  synovial  capsules  and  serous  membranes  ensue,  as  in  rheuma- 
tism, whilst  arachnitis  and  coma  form  the  modes  of  death,  espe- 
cially if  kidney  disorder  exist  at  the  same  time.  In  other  cases — 
those  in  which  death  is  sudden,  and  the  organic  lesions  are  inap- 
preciable or  insufficient  to  account  for  the  fatal  termination — the 
urea,  by  a  re- arrangement  of  its  elements,  may  be  converted  into 
cyanate  of  ammonia,  thus  poisoning  the  centres  essential  to  life. 

It  is  not  always  that  in  rheumatism  there  is  a  deficiency  of  sur- 
face excretion,  nor  in  gout  that  the  kidneys  are  chiefly  in  fault. 
The  materies  morbi  may  be  generated  by  the  imperfect  compos*- 


1858.]  On  Rheumatism.  117 

tion  and  quantity  of  the  blood  itself,  so  that  the  tissues  of  selection 
cannot  be  properly  nourished, — their  structural  assimilation  being 
more  or  less  destroyed. 

The  excretion  of  soda  in  tophaceous  deposits  or  articular  incrus- 
tations, does  not  take  place  in  rheumatism  as  in  gout ;  it  is,  how- 
ever, partially  witnessed  in  the  hybrid  affection,  viz :  rheumatic 
gout.  This  in  part,  may  be  accounted  for ;  as  in  the  gouty  the 
primary  digestion  is  disturbed,  whilst  in  the  rheumatic  the  secon- 
dary assimilations  are  more  at  fault.  Hence,  the  first  are  apt  to 
use  soda  as  a  corrective  of  acidity,  or  "  to  bring  the  wind  off  the 
stomach ;"  whilst,  probably,  from  the  inactivity  of  the  liver,  the 
alkali  from  the  salt  used  at  table  is  not  called  on  in  the  forma- 
tion of  bile,  and  thus  collects  in  the  blood.  In  rheumatism,  how- 
ever, we  have  at  times  such  fusion  of  the  immediate  tissues  about 
the  joints,  rendering  anatomical  division  almost  impossible,  that  it 
would  seem  by  the  excessive  attraction  of  lactic  acid  to  the  parts, 
it  possessed  the  power  to  act  as  a  solvent  of  the  elementary  fibres, 
as  I  have  found  it  for  many  years  useful  for  that  purpose  in  dys- 
pepsia of  animal  substances. 

It  is  well  known  that  rheumatism  more  frequently  attacks  the 
weakly,  the  intemperate,  the  irregular  in  diet  (and  especially  if  of 
unwholesome  nature,)  those  who  may  be  exposed  to  vicissitudes 
of  temperature,  or  who  long  labor  mentally  or  physically  with  in- 
sufficient food,  or  under  anxiety  and  mental  depression.  But  the 
strong,  well-fed  and  able-bodied,  young  or  old,  are  liable  to  its  suf- 
ferings ;  in  these,  if  the  exanthemata,  or  accident,  have  not  engraft- 
ed a  kidney  vice,  and  the  blood  is  not  overloaded  with  nitrogen- 
ized  products,  the  attack  will  be  of  the  simple  inflammatory  type, 
affecting  the  nonepithelial  fibrous  structures  or  surfaces ;  whilst 
heart  disease,  and  especially  of  the  mitral  valve,  will  be  infrequent. 
On  the  other  hand,  if  kidney  disease,  accidental  or  exanthematous, 
be  present,  then  structures  more  important  in  their  uses  and  ana- 
tomical arrangements,  viz :  the  interior  capsular  parts,  the  heart 
and  the  arachnoid  serous  membrane,  &c,  are  liable  to  become  af- 
fected, whilst  the  prognosis  is  against  the  patient,  either  immediately 
or  remotely.  Delirium  or  coma,  more  or  less  profound,  is  the  dis- 
tinguishing feature  in  these  cases.  In  the  others,  where  the  ex- 
terior cranial  fibrous  dura  mater  is  attacked,  although  the  suffer- 
ings are  intense  and  the  venous  suffusion  alarming,  yet  the  chan- 
ces to  the  patient  are  more  favorable,  and  delirium  and  coma  do 
not  follow  in  so  fatal  a  train  if  present,  unless  the  effusion  be  great ; 
and  even  here,  the  disturbances  are  more  of  position  than  of  nu- 
tritive function. 

The  rich  or  the  pampered  are  not,  however,  the  sole  proprie- 
tors of  the  gout ;  the  poor,  the  half-starved  have  also  their  gout ; 
it  is  the  offspring  of  their  very  poverty.  Dives,  introduces  into 
his  blood  from  without  the  sreat  sources  of  his  evil ;  whilst  Laz- 


118  On  Rheumatism.  [February 

arus  produces  a  condition  almost  similar,  by  the  rapid  disintegra- 
tion of  his  own  tissues,  loading  his  ill-fed  blood  with  uric  acid  and 
other  compounds,  from  the  wear  and  tear  of  his  system.  There 
is  no  compensation  by  proper  supply  of  food  ;  and  the  kidneys  and 
other  emunctory  organs  are  too  enfeebled,  though,  perhaps,  not 
diseased,  to  extract  the  uric  acid  or  urea  from  the  blood.  These 
cases,  though  rare,  yet  take  place — it  is  the  gout  of  the  impover- 
ished. They  are,  in  general,  inebriate  from  necessity  and  from 
physiological  instinct;  their  systems  cry  aloud  for  carbon, — for 
liquor, — that  the  oxygen  of  the  air  they  breathe  shall  not  burn  up 
their  pittance-saved  bodies,  but  attack  the  free  carbon  and  hy- 
drogen of  the  alcohol,  and  leave  in  respite  their  meagre  frames. 
It  is  the  gout  of  demand  and  not  of  supply.  And  here  we  find  a 
vivid  example  of  the  fact  above  stated,  that  the  tissues  suffer  dis- 
integration, or  death,  not  only  from  deficiency  of  nutritive  supply, 
but  from  defective  quality  of  the  blood.  In  the  gout  of  the  impo- 
verished, nitrogenized  food — the  bane  of  the  rich  man — and  those 
remedies  having  the  power  to  retard  the  decomposition  of  tissue, 
as  tea,  coffee,  hop,  &c,  must  be  trusted  in ;  and  thus  the  waste 
of  the  system  being  restrained,  the  blood  will  not  be  surcharged 
from  the  structures  themselves,  and  the  local  disintegration  will 
be  arrested,  and  the  organs  return  to  their  uses  ;  but  mostly  with 
deformity  as  an  index  of  their  past  trials. 

The  urinary  deposits,  both  in  gout  and  rheumatism,  sometimes 
mask  the  condition  of  urine  as  secreted  by  the  kidney — the  uric 
acid  formations  being  disguised  by  the  alkaline,  or  earthy  phos- 
pates.  This  is  chiefly  owing  to  chronic  vesical  irritation  or  in- 
flammation, the  muco-pus  acting  on  the  urea,  and  converting  it 
into  carbonate  of  ammonia,  which  precipitates  the  alkaline  salts. 
It  is  thus  that  the  condition  of  the  urine  may  be  masked  by  the 
presence  of  pus,  or  of  a  mucoid  body,  in  its  rout  from  the  kidneys. 
Indeed  the  highly  acid  state  of  the  secretion  may  be  the  very 
cause  by  which  the  bladder  may  be  irritated.  The  prognosis  in 
these  cases  depends  on  the  nature  of  the  bladder  or  kidney  irrita- 
tion, the  possibility  of  calculous  formation,  the  recent  or  long 
previous  existence  of  the  affection,  &c. 

The  space  allotted  me  is  nearly  exhausted,  and  will  necessarily 
oblige  me  to  condense  the  chief  features  of  treatment,  with  a  run- 
ning statement  on  some  other  points.  From  the  preceeding  views 
the  treatment  almost  explains  itself.  In  the  acute  rheumatism 
of  the  robust,  at  whatever  age,  the  seat  of  attack  is  in  the  white 
fibrous  tissues,  the  fever  high,  attended  generally  with  great  sweat- 
ing, the  pain  and  swelling  intense,  but  greater  than  when  the  epi- 
thelial jibro-serous  tissues  are  affected.  Venesection  is  rarely  called 
for,  though  by  some  regarded  as  not  only  a  mitigator  of  pain,  but 
as  instituting  a  better  condition  for  subsequent  remedial  action. 
As  a  lessener  of  fibrin  it  is  useless — its  chief  value,  if  used,  being 


1858.]  On  Rheumatism.  119 

the  relief  to  the  vascular  tension,  and  the  rather  more  rapid  ab- 
sorption of  neutralizing  remedies.  In  my  own  practice  I  have 
not  used  it  for  many  years.  The  local  applications  of  leeches  is 
warrantable,  but  more  troublesome  in  general  than  the  affection. 
A  light  antimonial  emetic,  however,  answers  more  fully  the  desir- 
ed end,  followed,  on  the  subsidence  of  its  action,  by  an  active  pur- 
gative of  Hyd.  chlor.  mit.,  with  Ext.  Colocynth  Comp.  The 
advantage  of  early  emptying  the  bowels  is  realized,  when  the  in- 
creasing disablement  of  the  joints  renders  the  efforts  to  rise  not 
only  agonizing  but  injurious.  The  affected  parts  should  be  bathed 
with  a  warm  mixture  of  Potassa-bi-Carb.  and  laudanum,  and  af- 
terwards wrapped  up  in  cloths  saturated  with  the  solution,  and 
covered  with  oil-silk  or  rubber,  which  can  be  gradually  removed 
if  the  heat  is  complained  of.  Potato  water,  as  left  after  boiling 
the  vegetable  or  its  parings,  has  proved  a  most  soothing  applica- 
tion, when  freely  sponged  quite  warm  over  the  swollen  and  pain- 
ful joints,  which  can  afterwards  be  wrapped  up  in  it,  as  directed 
for  the  alkaline  wash.  The  Tinct.  Actea  Racemosa,  in  6  to  12 
drop  doses,  can  be  given  in  or  followed  by  a  solution  of  Nitrate, 
Bi-Carbonate,  or  Acetate  of  Potash  ;  or  the  Tart,  of  Potash  and 
Soda,  if  preferred,  can  be  substituted.  Frequently,  in  children, 
the  Actea  alone  serves  to  cut  short  the  attack  after  a  few  doses, 
in  conjunction  with  alkaline  fomentations.  The  necessity  for  pur- 
ging generally  ceases  after  the  bowels  have  been  well  moved  in 
the  beginning.  At  all  events,  intestinal  irritation  is  to  be  avoided. 
It  is  well  to  remember  that  the  expectant  treatment  of  acute 
rheumatism  is  nearly  as  favorable  in  its  results  as  the  active. 
Colchicum,  in  the  acute  attack  of  the  strong,  who  have  deranged 
hepatic  action,  combined  with  opium,  after  due  operation  from 
the  bowels,  also  forms  a  valuable  remedy.  Its  purging  and  emetic 
effect  is  unnecessary  and  to  be  avoided.  It  is  more  as  a  chola- 
gogue  and  an  excretor  of  lithic  acid,  than  as  a  specific  in  rheu- 
matism. Where  the  liver  is  already  acting  freely,  it  does  not 
form  an  agent  of  trust,  and  when  frequently  employed  serves  to 
injure  the  system.  Hence  the  discrepancy  as  to  its  value.  In 
alkaline  combination  it  is  frequently  useful.  The  Nitrate  of 
Potash,  so  much  lauded  of  late,  will  be  found  beneficial  where  a 
high  condition  of  fibrin  exists  in  the  blood,  its  solvent  action  over 
that  element  being  called  for.  Otherwise  it  is  no  more,  and  many 
times  not  so  valuable  a  remedy  as  the  other  alkaline  salts.  It  is, 
therefore,  not  from  any  specific  eliminating  power  of  the  rheuma- 
tic poison  that  is  called  for,  but  from  its  defibrinating  action,  and 
its  value  as  a  diuretic,  and  its  probably  converting  the  lithic  acid 
into  a  more  soluble  compound,  urea.  After  proper  evacuation, 
the  Pulv-Doveri,  in  full  doses,  will  generally,  though  not  always 
produce  refreshing  sleep  and  quiet  the  pain.  If  found  stimulant 
to  the  brain,  watchfulness  or   flightiness  taking  place,   it   either 


120  On  Rheumatism,  [February, 

must  be  increased  or  left  off.  Opium  acts,  in  many  cases,  as  an 
expeller  of  the  lithic  acid — in  chronic  cases,  conjoined  with  tur- 
pentine, it  sometimes  causes  immense  quantities  to  be  evacuated. 

All  things  considered,  time,  forms  as  valuable  an  element  in 
the  treatment  as  the  remedies  selected.  A  certain  amount  of  ma- 
teries  morbi,  and  the  disposition  to  its  reproduction,  has  to  be  bro- 
ken up,  and  time,  sweating,  and  sometimes  urination  are  at  work 
in  the  process  of  elimination.  Remedies  may  assist,  but  if  injudi- 
ciously employed  they  will  retard,  the  patient  suffering  from  both 
disease  and  doctor.  The  diet  should  be  unstimulating,  meat, 
soups,  and  jellies  avoided,  toast  and  water,  with  light  gruels,  being 
the  best  regulators.  As  the  attack  subsides,  vegetable  diet  should 
be  adhered  to, — the  local  applications  and  internal  remedies  can 
be  moderated.  Clam  soup,  and  raw  salt  oysters  may,  after  a  time, 
be  allowed ;  and  now,  if  the  blood  shows  decrease  of  its  red  cor- 
puscles, the  mild  preparations  of  iron  may  be  cautiously  com- 
menced on.  If  loss  of  flesh  be  increasing,  coffee  and  tea  will 
prove  beneficial  as  preventers  of  tissue  waste.  In  the  anasarca 
of  the  debilitated,  squill  with  quinine  will  be  found  most  servicea- 
ble. 

By  these  means  the  immediate  re-attack  may  be  warded  off,  but 
mental  quiet  and  bodily  rest  are  imperative.  The  supply  being 
small,  the  demand  should  be  lessened.  But  the  low  diet  system  is 
not  to  be  carried  too  far  ;  it  is  well  to  remember  that  the  fibrin  is 
increased  in  the  blood  by  starvation,  as  well  as  by  high  feeding. 
Rest,  however,  is  absolutely  necessary.  No  blood  is  to  be  thrown 
into  the  parts  in  and  about  the  joints,  by  the  invitation  of  exer- 
cise. Even  in  the  very  robust,  acute  rheumatism  sometimes  at- 
tacks the  joints  after  long-continued  and  violent  exercise.  But 
where  the  parts  have  been  "affected,  with  the  system  lowered  by 
diet,  remedies,  and  wear  and  tear  from  pain  and  loss  of  rest,  great 
caution  as  to  exercise  is  requisite  ;  as  other  structures,  and  of 
higher  importance,  may  become  involved,  and  simple  acute  fibrous 
rheumatism,  be  merged  into  an  attack  of  the  epithelial  bursal  and 
synovial  membranes  of  the  interior  of  the  joint,  besides  endan- 
gering the  heart,  pleura,  and  other  organs,  when  their  liability  to 
become  engaged  was  not  at  first  probable. 

It  is  this  small  point  which  makes  the  utmost  watchfulness  ne- 
cessary, as  regards  keeping  the  system  in  good  general  working 
order,  and  which  has  made  the  pathological  statements  so  variable, 
as  respects  the  engagement  of  the  heart  in  acute  rheumatism. 
Every  practitioner  has  observed  that,  when  in  the  first  attack  in 
sound  persons,  the  swelling,  heat,  redness,  and  pain  have  been 
very  great,  the  heart  is  not  so  liable  to  become  affected,  as  when 
all  the  symptoms  are  more  moderate.  In  some  cases,  however, 
both  the  tissues  in  and  without  the  joint  are  attacked,  and  then 
the  diagnosis  is  to  be  carefully  viewed,  as  the  renal  disturbance 


1858.]  On  Rheumatism.  121 

is  mostly  present,  though  perhaps  later  to  observation,  at  the 
time. 

The  friction  with  liniments,  whilst  the  thickning,  &c,  remains, 
after  the  subsidence  of  the  acute  pain,  will  be  found  beneficial. 
The  following  recipe  I  am  Jn  the  habit  of  using ; — 

$     01.  Origon, |i 

OL  Lavend.  Spicat.,    .     .  Iss 

Tinct.  Aconite  Sat.,     .     .  3  i 

01.  Amyg.  dulc,      ...  3  Hi 

Aq.  Ammon.  fort.,  ...  3ii 

YeL, 5ss 

M. 
A  light   covering,    with  cotton   batting  and  oil-silk,  should  be 
applied,  unless  the  heat  is  complained  of.     The  gradual  reduction 
of  the  envelopes  should  take  place  after  a  time,  so  that  chilliness 
be  avoided,  which  would  attend  its  speedy  withdrawal. 

The  treatment  in  chronic  fibrous  rheumatism  has  the  same 
features,  differing  more  in  degree  than  method,  excepting  in  the 
employment  of  iodide  of  potassium  in  small  doses.  The  system 
is  to  be  carefully  watched,  exercise  is  to  be  judiciously  and  regu- 
larly taken,  the  surface  made  to  excrete  properly,  the  bowels  to 
be  kept  soluble  but  unirritated,  sleep  should  be  rather  longer  than 
in  health,  as  a  promoter  of  insensible  transpiration  and  nervous 
recuperation,  whilst  stimulant  embrocations,  oil-silk  sweatings, 
and  light  galvanic  applications  should  be  employed  to  the  part. 
The  color,  quantity,  and  specific  gravity  of  the  urine  should  be 
watched,  as  giving  evidences  of  approaching  danger,  or  of  increas- 
ing constitutional  vigor. 

In  the  heart  complications  in  rheumatism,  the  treatment  re- 
quires great  circumspection.  The  difficulty  of  breathing,  the 
precordial  pain,  the  out-of-breath  manner  of  speech,  the  desire  to 
be  propped  up,  the  increasing  effusions  into  the  legs,  scrotum, 
chest,  or  abdomen,  with  diminished  urine  and  rapid  pulse — these 
point  out  the  imminent  peril  of  the  sufferer,  from  which  nothing 
but  a  strong  constitution  and  skillful  treatment  can  save  him. 
The  drain  on  the  pent-up  fluids  is  to  be  made  through  the  bowels, 
as  the  kidneys  are  generally  too  occluded,  or  broken  down  in 
functional  power,  to  be  of  any  use.  The  Pulv.  Jalapae  Comp. 
with  Elaterium,  or  other  hydragogues,  with  digitalis  over  the 
heart,  or  internally  3  to  6  drops  of  the  Tinct.  Veratrum  Yiride 
must  be  administered,  and  watched  during  their  operation.  Sup- 
port by  brandy  or  champagne  must  be  proportioned  to  the  exhaus- 
tion or  nervons  necessity,  but  no  more.  The  stimulous,  and  not 
the  carbon,  is  wanted  now — neither  lung  nor  liver  can  dispose  of 
it.  If  alcoholic  drinks  disagree,  coffee  and  camphor  can  be  sub- 
stituted, sometimes  with  most  excellent  results.  During  purlins:.. 
the  position  of  the  patient  is  to  he  kept  unchanged^  or  even  with  iht 


122  On  Rheumatism.  [February, 

head  lower  if  possible — at  all  events,  he  is  not  to  be  raised  sudden- 
ly— whilst  stimulants  should  be  snuffed  through  the  nostrils,  &c. 
If  these  means  are  successful  in  reducing  the  effusions,  the  kid- 
neys can  now  be  gently  invited  into  action.  The  palpitation 
sometimes  yields,  most  gratefully  to  the  patient,  after  the  adminis- 
tration of  champagne,  the  carbonic  acid  serving  to  allay  the  irri- 
tability of  the  heart's  action.  By  conjoining  the  infusion  of  the 
wild-cherry  bark — or,  where  its  bitter  tonic  property  seems  to 
disagree  with  the  stomach,  a  few  drops  of  the  dilute  Hydrocyanic 
Acid, — a  most  happy  effect  may  sometimes  be  obtained  when 
the  irritability  is  excessive.  But  great  caution  is  requisite  in  the 
administration  of  organic  sedatives,  as  will  be  mentioned  further 
on. 

In  the  convalescence,  if  the  liver  still  should  continue  at  fault, 
the  preparations  of  iron  are  to  be  avoided,  as  they  will  serve  to 
induce  congestion,  and  lock  up  the  proper  secretions  of  the  organ. 
At  this  period,  however,  the  kidneys  will  sometimes  resume  their 
functions,  and  labor  not  only  for  themselves,  but,  by  taking  off 
the  purpurates  and  other  highly  carbonaceous  compounds,  so  re- 
lieve the  liver,  that  the  system  daily  rises  refreshed  from  their 
effects.  The  urine  becomes  more  and  more  abundant,  and  loaded 
with  the  urates  of  ammonia  and  soda.  It  is  here  I  would  parti- 
cularly caution  the  young  practitioner,  in  his  testing  the  urine 
with  nitric,  or  nitro-muriatic  acid,  lest  he  should  mistake  the 
very  copious  deposits  of  the  white  crystals  of  lithic  acid,  for  albu- 
men. This  I  have  seen  done  more  than  once.  The  deposit  of 
the  phosphates  by  heat,  is  corrected  from  wrong  interpretation 
on  the  addition  of  the  acid,  which  re-dissolves  them.  This  dense 
condition  of  the  urine  by  the  urates  of  ammonia  and  soda,  is  the 
very  salvation  of  the  patient.  Beware  then  of  administering  any 
acid,  either  alone  or  in  combination  with  a  vegetable  or  mineral 
tonic,  as  it  will  serve  to  neutralize  just  so  much  ammonia  and 
soda,  and  thus  prevent  the  elimination  by  the  kidneys  of  the  very 
lithic  acid  so  poisonous  in  its  action  to  the  general  system,  but 
especially  to  the  serous  membrane  of  the  chest,  and  of  the  heart, 
which  will  be  again  tortured  by  the  acrid  blood  into  renewal  of 
its  exhausting  efforts,  whilst  convulsion  and  coma  stand  threaten- 
ingly near. 

In  the  early  part  of  this  tumult  of  the  system,  when  the  organic 
force  is  consuming  by  the  overtask  of  the  functions,  I  would 
strenuously  caution  against  the  abuse  of  opium,  or  of  any  narco- 
tic, to  produce  sleep  or  relieve  from  pain.  And  I  will  only  reiter- 
ate a  maxim  which  I  have  before  published,  and  often  repeated, 
viz  :  that  in  all  organic  diseases  attended  with  pain  and  excretory 
impediment,  opium  and  other  organic  sedatives  are  to  be  avoided, 
as,  by  paralyzing  the  organic  centres,  dropsies  may  collect  in  the 
cavities. 


1858.]  On  Rheumatism.  128 

Lemon-juice,  in  some  cases  of  acute  and  chronic  rheumatism,, 
is  at  times  beneficial,  though  rarely  to  be  trusted  to  alone.  Yet 
I  have  seen  cases  where  it  seemed  to  act  as  a  perfect  specific.  It 
will  prove  chiefly  beneficial  in  uncomplicated  cases,  where  the 
urea  fails  in  its  urinary  quantity,  and  where  an  excess  of  ammonid 
exists  in  the  blood.  Benzoic  acid,  in  these  conditions  of  chronic 
rheumatism,  acts  at  times  most  favorably. 

The  children  of  gouty,  rheumatic,  and  dyspeptic  parents,  are 
prone  to  a  lithic  condition  of  the  blood,  or  at  least  to  its  elimina- 
tion by  the  kidney.  It  is  early  marked  in  them  by  incontinence  of 
urine,  or  "  wetting  the  bed."  Although  the  heart  does  not  evidences 
organic  disease  in  them,  yet  its  motions  are  violent  and  frequent 
whilst  crystalline  lithic  acid  is  formed  in  the  Urine ;  or  they  are 
variable  in  their  diet  and  irritable  in  their  dispositions,  the  urine 
being  pale,  abundant,  but  free  from  lithk?  acid  deposit  07,'in  solu- 
tion. The  acid  condition  of  the  blood  is  irritating  to  the  internal 
membrane  of  the  heart,  and  the  contractions  are  sharp  and  fre- 
quent. There  is  a  loss  of  true  tone  in  the  system,  and  rheumatism 
is  apt  to  set  in  spontaneously,  or  after  violent  anger  or  any  undue 
exhaustion,  exercise,  or  exposure.  Here,  opium  forms  a  most 
valuable  remedy  from  its  sedative  influence  and  its  power  to  dis- 
engage the  lithic  acid  from  the  blood. 

Children  given  to  masturbation,  but  whose  urine  alternates 
from  lithic  to  the  phosphatic,  the  intermediate  depositions  of  the 
urates  of  soda  and  ammonia  taking  place,  with  increase  of  urea,- 
are  also  subject  to  rheumatic  attack  or  pains.  Substantial  diet, 
with  opium  at  night,  is  the  chief  remedy.  The  furtive  look,  the 
desire  for  solitude,  the  uncalled-for  sighing,  the  vesical  irritability,- 
the  irregular  languor,  and  the  blowing  sound  in  the  heart  and  large 
vessels,  with  more  or  less  palpitation,  will  serve  to  direct  suspicion 
to  the  solitary  acts  of  the  patient,  which  careful  watching  may 
verify.  Organic  changes  may,  and  frequently  do,  establish  them- 
selves from  these  long  continued  functional  disturbances.  But  it 
is  always  well  to  remember,  in  the  disorders  of  nutrition  of  the 
heart,  that  the  young  are  reproducers — their  organic  desire  to  re- 
model is  ever  at  work ;  that  the  hypertrophy,  if  it  exist,  is  mostly 
from  interstitial  deposit,  and  not  a  true  fibrillar  increase  of  the 
heart  itself.  Restraint  from  the  abuse,  chemical  changes  afforded 
to  the  blood,  and  the  supply  of  fresh  material  by  proper  food,  with 
attention  to  moderation  of  exercise,  and  sometimes  to  complete 
bodily  rest,  will  form  not  only  the  treatment,  but,  in  many  a  new 
organ.  Of  this  I  have  seen  several  most  excellent  examples.  In 
later  life,  an  individual  ceases  to  be  an  active  remodeler ;  he  is 
on  the  waste  account ;  his  capital  has  no  interest  accruing,  and 
he  is  forced  to  use  it  up  for  the  common  necessities  of  his  sys- 
tem. These  are  distinctions  as  well  as  differences.  Had  these 
views  been  more  common,  so  many  heart-disturbed  children  would 

n.  s. — vol.  xrv.  no.  n.  6 


124  On  Rheumatism.  [February, 

not  have  filled  an  early  grave,  or  been  moored  to  the  stake  of  life, 
to  waste  away  an  aimless  existence  in  later  years. 

In  scarlatinal  rheumatism,  all  treatment  at  times  is  rendered 
impossible  by  the  condition  of  the  patient ;  as  in  scarlatina,  the 
do  nothing  system  is  frequently  the  best.  Good  nursing,  attention 
to  the  skin  by  sponging  or  moist  wrappings,  are  better  than  the 
"  nimia  diligentia  medici."  During  the  fever,  the  pain  is  mostly 
in  the  wrists,  or  in  one  or  two  joints.  The  scarlatina  and  the 
rheumatic  complication  are  offspring  of  the  same  poison.  There 
is  pain,  as  in  true  fibrous  rheumatism,  but  it  is  seated  in  different 
structures,  and  attended  with  different  implications  as  regards  the 
head,  the  heart,  and  the  chest.  In  the  robust,  the  diet,  or  rather 
the  absence  of  it,  forms  the  treatment.  All  animal  food  is  to  be 
avoided — the  blood  is  yet  too  overloaded  with  nitrogenized  pro- 
ducts. If  too  early  indulged  in,  the  articular  pains  recommence 
or'  increase,  chest  or  heart  difficulties  are  renewed,  and  convul- 
sions endanger  the  life  of  the  patient.  Farinaceous  and  vegeta- 
ble diet  must  be  continued  a  while  longer.  The  debility  is  de- 
ceptive ;  it  is  more  the  result  of  the  oppressive  action  of  urea  over 
the  great  nervous  centres,  than  loss  of  power  from  nutritive  want. 
The  return,  then,  to  animal  food,  must  be  cautiously  watched. 

But  in  the  weakly,  these  fears  have  to  be  in  a  measure  given 
rap.  At  the  first  ingress  of  the  rheumatism,  a  little  abstinence 
may  be  enjoined  ;  but  after  that,  the  position  is  different.  Death 
by  debility  would  ensue  more  rapidly  than  by  the  disease.  It  is 
the  rheumatism  of  demand.  Food  and  stimulus  must  be  given. 
Ulcerations — pus  makings,  about  and  in  the  joints,  are  to  be  check- 
ed; food  and  drink  must  do  it;  for  specific  medicines  are  useless, 
unless  quinine,  iron  and  other  tonics  can  be  so  called.  Under  a 
lowering  plan  the  coffin  is  sure  to  close  over  the  wretched  victims ; 
and  life  to  most  of  us,  is  better  with  a  stiff  leg  or  disabled  joint, 
than  the  kind  attention  of  an  undertaker. 

In  the  convulsions  attending  both  cases  as  above  stated,  the 
directions  should  be : — for  the  robust,  feet  and  legs  in  hot  water, 
with  head  up,  or  at  an  easy  reclining  angle ;  for  the  debilitated, 
the  horizontal  posture,  and  no  warm  bath,  but  cold  water  sprinkled 
©n  the  face  and  chest,  in  the  order  of  natural  respiration.  Here, 
the  brain  must  have  blood,  though  diseased  blood  it  be.  From 
the  neglect  of  this  simple  precaution,  I  have  seen  a  child  killed  as 
though  struck  on  the  head, — the  feet,  and  not  the  brain,  being 
supplied  with  blood ! 

In  syphilitic,  and  also  in  chronic  rheumatism,  iodide  of  potas- 
sium acts  more  than  well ;  in  the  former  it  is  almost  specific.  Its 
combination  with  colchicum  and  with  opium,  may  at  times  be 
required.  It  is  not  only  diuretic,  but  possesses  the  property  to 
re-establish  assimilative  vigor.  Small  doses,  in  repetition,  act 
more  favorably  than  large  doses  at  longer  intervals. 


1858.]  On  Rheumatism.  125 

In  rheumatic  gout,  especially  where  the  fibrous  sheaths  of 
nerves  are  attacked,  the  combination  of  Hyd.  Pot.  with  Colchi- 
cum  acts  most  favorably,  the  Tinct.  Aconite  Sat.,  with  Acid  Hy- 
drocyan.  being  painted  freely  over  the  route  of  the  affected  nerves 
and  kept  from  evaporating  by  strips  of  oil-silk  or  rubber.  In  the 
cranial  effusions,  the  Hyd.  Potass,  is  the  most  reliable  remedy. 

Calomel  is  chiefly  useful  as  a  defibrinator,  as  a  promoter  of  in- 
terstitial absorption,  and  as  a  specific  stimulant  to  the  liver,  by 
which  the  decarbonation  of  the  blood  shall  be  promoted  through 
the  secretion  of  bile.  In  the  debilitated  it  is  positively  harmful, 
if  continued;  although  the  balance  at  times,  even  in  them,  may 
be  in  favor  of  its  use,  where  the  brain  is  oppressed  by  black  blood.- 

Guaiacum  has  long  enjoyed  a  reputation  in  chronic  rheuma- 
tism, and  with  apparent  good  right.  It  seems  to  possess  the  power 
of  increasing  the  excretion  of  both  lithic  and  lactic  acid,  by  the 
kidney  and  skin.  In  rheumatic  dysmenorrhea,  in  leucorrhoeal 
discharges  attending  this  disorder — in  the  dermalgia,  so  painful 
on  pressure  or  warmth — in  hysteria  and  hysteric  knee-joint  com- 
plaints, mostly  of  a  rheumatic  nature,  &c,  this  remedy,  in  con- 
junction with  others,  or  in  the  form  of  the  Vol.  Tincture,  will  be 
found  serviceable.  The  cases,  however,  are  to  be  selected  pro- 
perly, whilst  time  forms  an  element  in  its  action.  I  have  known 
it  not  only  cure,  but  eradicate  some  of  these  disorders. 

Rheumatic  chorea  has  already  been  adverted  to,  with  partial 
mention  of  remedies.  The  irritability  of  the  heart,  or  the  ner- 
vous propagation  is,  in  many  cases,  to  be  quelled  before  any  per- 
manent success  can  be  attained.  Arsenic,  as  in  Fowler's  solution, 
in  six  drop  doses,  with  the  endermic  application  of  morphine,  and 
quinine  (if  after  malarial  influence)  over  the  cervical  spine,  is  at 
times  very  valuable.  In  the  rheumatic  form,  colchicum  and 
aetea  racemosa,  in  small  doses,  have  been  found  useful.  The 
same  rheumatic  condition  of  the  system  haVe  been  attended, 
in  both  male  and  female,  with  globus  hystericus.  Stammering, 
as  before  remarked,  is  sometimes  the  result  of  rheumatism,  in 
children  whose  systems  have  been  Weakened,  and  who  are  thus 
more  liable  to  mental  emotions,  as  fright,  &c.  The  heart  palpi- 
tates readily,  and  the  muscular  nervous  branches  to  the  larynx, 
and  more  rarely  the  hypo-glossal,  or  motor  of  the  tongue,  become 
the  channels  of  the  disordered  reflex  action.  I  have  many  times 
noticed  the  sudden  hesitancy  of  speech,  from  sudden  emotion,  in 
the  rheumatic,  differing  from  the  arrest  of  power  in  the  organs 
from  emotional  acts  in  the  unaffected. 

In  conclusion,  I  shall  only  refer  to  acupuncture  in  sciatica  with 
effusion  into  the  sheath,  and  in  muscular  pains,  having  been  at 
times  serviceable.  Chloroform,  blisters,  the  hot  button,  the  ender- 
mic applications  of  veratrine,  morphine,  delphine,  aconitine, 
strychnine,  and  other  alkaloids,  have  had  reputation  for  a  time, 


126  Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.  [February, 

but  chiefly  in  neuralgic  affections.  In  the  gouty  and  rheumatic, 
local  applications  may  relieve  temporarily,  but  it  is  only  by  the 
patient  study  of  the  blood  changes,  with  the  appropriate  antago- 
nistic remedies,  and  food,  that  any  permanent  benefit  can  be  real- 
ized, or  security  against  attack  be  obtained. — [American  Med. 
Monthly. 


Exsection  of  the  Trunk  of  the  Second  Branch  of  the  Fifth  Pair  of 
Nerves,  beyond  the  Ganglion  of  Meckel,  for  Severe  Neuralgia  of 
the  Face:  with  Three  Cases-.  By  J.  M.  Carnochan,  Professor 
of  Surgery  in  the  New  York  Medical  College,  Surgeon -in- 
chief  to  the  State  Hospital  (New  York),  etc. 

The  accounts  heretofore  given  by  authors  of  neuralgia,  or  tic 
douloureux  of  the  face,  are  of  a  very  vague  and  indefinite  char- 
acter. Numerous  essays  and  monographs  have  been  written  on 
this  subject,  since  the  time  of  Fothergillr  who  published,,  in  1776, 
an  elaborate  description  of  the  disease,  which  attracted  consider- 
able attention.  In  all  these  efforts,,  the  pathology  of  tic  doulour- 
eux is  described  with  ambiguity.  In  practice  the  treatment 
has  been  as  empirical  as  it  has  proved  to  be  unsuccessful.  The 
seat  of  the  disease  has  been  referred  to  distant  irritations,  espe- 
cially in  the  splanchnic  cavities — to-  a  foreign  body  acting  upon 
the  nerve — to  the  pressure  of  bone  upon  some  portion  of  the 
nervous  trunks.  By  some  authorities,  it  is  referred  to  increased 
vascularity  and  thickening  of  the  nerves;  while  Astley  Cooper, 
on  the  contrary,  states,  that  the  nerves  present  their  natural  co- 
lour, and  are  rather  diminished  in  size  than  enlarged.  It  can 
scarcely  be  supposed  that  beneficial  results  should  follow  from 
treatmant  based  upon  theories  so  different  in  character. 

Tic  douloureux  of  the  face,  proper,  or  of  the  second  branch  of 
the  fifth  pair  of  nerves,  is  by  far  the  most  common  form  of  facial 
neuralgia.  This  may  be  explained  by  the  more  numerous 
branches,  which  are  given  off  by  this  trunk,  and  by  the  position 
which  these  branches  occupy — in  some  places  pent  up  in  osse- 
ous canals,  and  in  others  subjected  to  exposure,  to  changes  in 
temperature,  as  well  as  to  the  agency  of  morbific  influences,  from 
which  the  other  two  trunks  of  the  fifth  pair  are  exempt. 

The  same  laws  which  govern  neuralgic  disease  of  one  of  the 
branches  of  the  fifth  pair,  must  be  applicable  to  the  disease  in 
the  other  trunks.  I  believe  that  the  phenomena  of  neuralgia 
can  be  explained  with  as  much  precision  as  in  any  other  disease, 
when  well  understood.  In  cases  similar  to  those  described  be- 
low, whatever  may  have  been  the  original  exciting  cause,  I  have 
no  doubt  that  the  real  seat  of  the  disease  is  in  the  trunk  of  the 
nerve,  in  front  of  the  foramen  rotundum — in  some  parts  of  it,  or 


1858.]    Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.        127 

in  the  whole  of  it.  The  causes  of  the  disturbed  and  changed 
condition  of  the  trunks  of  the  nerve  may  be  numerous — prolong- 
ed irritation  upon  the  periphery— exposure— injuries— tumours; 
diseases  of  the  teeth — pressure  resulting  from  periosteal  or  osteal 
thickening  of  the  osseous  foramina  or  canals — sudden  suppres- 
sion of  any  of  the  important  secretions,  as  of  the  catamenial  dis- 
charge. From  one  or  more  of  these  causes,  the  trunk  itself  may 
be  primarily  affected,  or  acting  upon  its  ramifications,  the  irrita- 
tion may  be  propagated  to  it.  Prolonged  irritation  induces  in- 
flammation, and  this  generally  remains  passive  or  chronic.  Some 
of  the  terminations  of  inflammation — such  as  the  effusion  of 
lymph  among  the  interstices  of  the  neurilemma  or  the  nervous 
tissue  itself — may  become  developed ;  leading  to  a  vascular,  en- 
gorged, thickened  and  enlarged  condition  of  the  nerve,  or  to  a 
softening  of  it,  at  one  or  more  points.  In  fact,  vascular  engorge- 
ment, or  inflammation,  with  some  of  its  consequences,  of  the 
neurilemma  alone,  or  of  it  and  the  nerve  together,  by  whatever 
cause  produced,  is  the  condition  which  constitutes  the  patholo- 
gical changes  in  the  trunk. 

The  three  cases  related  below  afford  proof  of  what  has  just 
been  stated.  In  each  instance,  the  exsected  nerve  was  found  to 
be  red,  vascular,  engorged  and  considerably  enlarged. 

The  diffused  character  of  the  pain  can  be  easily  understood,  if 
we  take  into  consideration  the  numerous  ramifications  of  the 
second  branch  of  the  fifth  pair,  and  the  extensive  surface  over 
which  their  ultimate  filaments  are  distributed.  The  periphery 
of  the  nerve  occupies  not  only  the  superficial  parts  of  the  face, 
but  extends  deep  among  the  bones  of  the  upper  jaw,  to  the  nasal 
fossae,  to  the  septum  nasi,  to  the  hard  and  soft  palate,  to  the  phar- 
ynx, to  the  inner  ear,  to  the  orbit,  and  to  the  temporal  and 
malar  regions. 

It  is  well  established,  that  if  the  trunk  of  a  nerve  be  irritated 
along  its  course,  the  painful  sensation  will  be  referred  to  its  pe- 
riphery. If  the  ulnar  nerve,  for  example,  be  struck  where  it 
passes  behind  the  internal  condyle,  a  sensation  of  pain  is  excit- 
ed, which  is  referred  to  the  little  finger  and  to  the  ulnar  border 
of  the  ring  finger;  and  if  a  prolonged  irritation  be  kept  up  at 
this  point,  the  skin  of  these  fingers  becomes  tender  to  the  touch, 
the  sensibility  being  very  much  increased. 

It  is  by  this  principle — which  governs  the  action  of  the  stim- 
uli upon  the  nerves  of  sensation — in  connection  with  the  ana- 
tomical distribution  of  the  nervous  ramifications,  that  the  various 
phenomena  of  neuralgia  can  be  explained.  The  disease  being 
seated  in  the  trunk  of  the  nerve,  we  can  readily  understand  that 
the  pain  must  be  referred  to  the  peripheric  extremities  of  the 
nerves,  and  will  there  be  felt,  as  long  as  the  branches  are  in 
communication  with  the  encephalon. 


128  Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.  [February, 

From  these  views,  we  can  perceive  how  futile  the  operation  of 
division  of  the  nerve  at  the  foramen  infra-orbitale  must  bef 
Where  the  trunk  of  the  nerve  is  extensively  diseased,  no  opera- 
tion can  rationally  lead  to  a  successful  result,  unless  all  the 
branches  emanating  from  the  trunk  are  cut  off  from  communis 
cation  with  the  brain. 

I  believe  that,  in  such  aggravated  cases  of  neuralgia,  the  key 
of  the  operation  is  the  removal  of  the  ganglion  of  Meckel,  or  its  in^ 
sulationfrom  the  encephalon.^-Wheie  even  a  large  portion  of  the 
trunk  of  the  second  branch  of  the  fifth  pair  has  been  simply  ex- 
sected  from  the  infra-orbital  canal,  the  ganglion  of  Meckel  con- 
tinues to  provide  to  a  great  extent  the  nervous  ramifications, 
which  will  still  maintain  and  keep  up  the  diversified  neuralgic 
pains.  Besides,  the  ganglion  of  Meckel,  being  composed  of 
gray  matter,  must  play  an  important  part  as  a  generator  of  nervous 
power,  of  which,  like  a  galvanic  battery,  it  affords  a  continual 
supply ;  while  the  branches  of  the  ganglion,  under  the  influence 
of  the  diseased  trunk,  serve  as  conductors  of  the  accumulated 
morbid  nervous  sensibility. 

Case  I. — Henry  Rousset,  a  French  physician,  residing  in 
Greenesborough,  Caroline  County,  Maryland,  consulted  me  in 
the  early  part  of  October,  1856,  for  severe  neuralgia,  which  had 
for  several  years  rendered  him  incapable  of  following  his  profes- 
sion. He  was  of  nervous  temperament,  good  constitution,  and 
sixty -nine  years  of  age. 

The  disease  first  made  its  appearance  in  September,  1851, 
commencing  with  severe  and  lancinating  pains  about  the  region 
of  the  left  cheek  and  orbit.  These  pains  continued  for  five  or 
six  days,  and  then  disappeared,  leaving  him  almost  free  from 
them  for  about  four  months.  At  the  expiration  of  that  time, 
the  neuralgic  pains  again  returned  with  more  violence,  extend* 
ing  over  the  region  of  the  left  cheek,  and  continuing  almost 
without  intermission,  for  more  than  a  week.  After  this  exacer? 
bation,  the  patient  again  became  comparatively  free  from  pain 
for  a  short  interval ;  after  which,  the  attacks  returned  with  in-r 
creased  severity,  and  were  renewed  with  greater  frequency,  more 
especially  in  the  cold  season,  and  in  damp  weather.  As  the 
disease  progressed,  the  pain  was  not  confined  alone  to  the  eye 
and  cheek,  but  would  also  attack  the  lip  and  nose ;  each  paroxr 
ysm  being  of  longer  duration  than  the  preceding.  "With  but 
slight  variation,  the  disease  went  on  this  way  to  harass  and  dis* 
tress  the  patient  for  four  years.  About  the  commencement  of 
March,  1856,  the  neuralgic  exacerbation  assumed  a  more  violent 
form,  marked  by  excruciating  and  almost  unremitting  suffering. 
He  was  at  this  time  unable  to  eat,  drink,  converse,  or  laugh, 
without  having  a  most  violent  paroxysm,  causing  him  to  shriek 


1858.]    Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.        129 

in  anguish.  The  paroxysms  were  more  severe  during  the  night 
than  day:  sleep  left  him;  his  constitution  began  to  give  way, 
and  his  mind  became  much  enfeebled.  The  slightest  touch  upon 
the  surface  of  the  face,  a  current  of  air  or  a  mouthful  of  water 
acting  upon  the  palate,  would  throw  the  patient  into  a  violent 
paroxysm  of  agony.  During  this  long  period  of  suffering,  all 
the  known  remedies  which  have  at  times  been  extolled  for  neu- 
ralgia of  the  face  had  been  tried — narcotics,  tonics,  antispasmo- 
dics, with  counter-irritants,  and  galvanism,  without  producing 
any  appreciable  result.  In  this  distressed  condition,  the  patient, 
wearied  of  existence  and  unable  any  longer  to  endure  a  life  so 
made  up  of  excrutiating  torture,  presented  himself  to  me  for  my 
advice,  at  the  beginning  of  October,  1856.  He  expressed  him- 
self willing  to  undergo  any  operation,  however  severe,  which 
held  out  the  prospect  of  relief  Having  no  internal  remedy  to 
propose  which  had  not  already  been  administered,  and  having  no 
faith  in  the^mere  division  of  the  nerve  upon  the  face,  I  proposed 
to  him  the  exsection  of  the  trunk  of  the  second  branch  of  the 
fifth  pair  of  nerves  to  a  point  beyond  the  ganglion  of  Meckel. 
Being  a  physician  himself,  I  explained  at  length  my  views  (as 
expressed  above)  in  regard  to  this  malady.  He  immediately 
consented  to  have  the  operation  performed,  and  desired  that  the 
earliest  time  should  be  appointed.  I  consequently  agreed  to 
perform  the  operation  the  following  day,  the  16th  of  October. 

Operation. — The  principal  instruments  necessary  for  this  oper- 
ation are  a  trephine,  the  crown  of  which  is  three-quarters  of  an 
inch  in  diameter,  an  elevator,  chisels  of  different  shapes  and 
sizes,  a  leaden  or  iron  mallet,  the  bone  forceps  of  Luer,  small 
pieces  of  sponge  tied  to  a  stick  or  a  piece  of  whalebone,  and  a 
small  fixed  trephine  of  half  an  inch  in  diameter,  which  may  be 
used  to  perforate  the  posterior  wall  of  the  antrum.  The  assist- 
ants being  properly  arranged,  the  patient  was  seated  upon  a 
solid  chair,  opposite  a  good  light,  and  was  put  under  the  influ- 
ence of  chloroform.  The  head  was  rested  upon  the  breast  of  an 
assistant,  who  maintained  it  in  this  position.  An  incision  was 
now  made  on  the  cheek,  commencing  near  the  internal  angle  of 
the  eye,  on  the  inferior  edge  of  the  orbit,  opposite  the  anterior 
lip  of  the  lachrymal  groove.  This  incision  was  carried  down- 
wards and  slightly  outwards,  for  about  an  inch,  to  a  point  oppo- 
site to  the  furrow  on  the  lower  portion  of  the  ala  of  the  nose; 
another  incision,  which  also  terminated  at  this  point,  was  made, 
commencing  about  half  an  inch  below  the  external  angle  of  the 
eye,  opposite  the  edge  of  the  orbit,  thus  forming  a  V  incision,  in 
the  area  of  which  is  situated  the  foramen  infra-orbitale.  The 
flap  thus  resulting  was  thrown  upwards,  and  the  branches  of 
the  second  branch  of  the  fifth  sought  for ;  some  of  these  being 
found,  they  served  as  a  ready  guide  to  the  trunk  of  the  nerve. 


130  Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.  [February, 

This  was  now  isolated  from  the  surrounding  tissues  up  to  the 
point  of  exit  upon  the  face  from  the  foramen.     The  lip  was  now 
everted,  and  the  mucous  membrane  detached  from  the  superior 
maxilla  along  the  line  of  junction  between  the  cheek  and  the 
gum.     A  sharp-pointed  bistoury  was  now  inserted  at  the  apex 
of  the  Y  incision,  into  the  mouth,  and  carried  downwards,  so  as 
to  divide  entirely  the  tissues  of  the  cheek  and  upper  lip,  along  a 
line  passing  midway  between  the  ala  of  the  nose  and  the  com' 
missure  of  the  lips,     The  two  flaps  thus  formed  were  now  dis- 
sected from  the  osseous  tissue  beneath,  one  being  reflected  out* 
wards,  towards  the  ear,  the  other  internally,  towards  the  nose, 
The  whole  front  wall  of  the  antrum  maxillare,  with  the  nerve 
passing  through  the  foramen  infra-orbitale,  was  thus  exposed, 
The  crown  o?  the  trephine  was  now  applied  on  the  anterior 
wall  of  the  antrum,  immediately  below  the  foramen  infra-orbitale, 
?md  an  irregular  disk  of  bone  removed,  so  as  to  expose  freely 
the  cavity  of  the  antrum.     The  circumference  of  the  foramen, 
the  hardest  portion  of  the  canalis  infra-orbitalis,  was  now  des* 
troyed  by  Iter's  forceps,  and  a  small  chisel,     The  trunk  of  the 
nerve  was  now  traced  along  the  osseous  canal  in  the  floor  of  the 
orbit,  which  was  broken  down  with  care,  so  as  not  to  encroach 
upon  the  tissues  in  the  cavity  of  the  orbit,     Arriving  at  the 
back  of  the  antrum,  the  posterior  wall  of  this  cavity  was  broken 
down  with  a  small  chisel,  and  the  portions  of  bone  removed. 
The  trunk  of  the  nerve  was  now  still  further  isolated  from  the 
other  tissues  in  the  spheno-maxillary  fossa.     The  posterior  dental 
nerves  being  divided,  and  the  dissection  being  carried  still  fur- 
ther, the  branches  given  off  to  form  the  ganglion  of  Meckel  were 
reached,     These  were  divided,  and  also  the  branch  given  off  to 
run  up  towards  the  orbit,     Lastly,   by  the  use  of  blunt-pointed 
scissors,  curved  on  the  flat  side,  the  trunk  of  the  nerve  was  di- 
vided from  below  upwards,  close  up  to  the  foramen  rotundum. 
The  hemorrhage  was  not  very  profuse,  the  labial  arteries  being 
easily  controlled  by  pressure  of  the  fingers,  and  the  branches  of 
the  internal  maxillary  artery,  in  the  sphenomaxillary  fossa,  by 
dry  lint,  or  what  is  better,  the  compressed  sponge.     The  lips  of 
the  wound  were  brought  together  and  maintained  in  place  by 
thirteen  points  of  twisted  suture,  the  German  or  Carlsbad  pins 
being  used. 

This  severe  and  trying  operation  is  perfectly  justified  by  the 
fearful  nature  of  the  disease  for  which  it  was  projected.  It  is 
one  of  those  operations  which  could  not  be  supported  by  the 
patient  without  the  influence  of  chloroform,  The  handling  of 
so  large  a  nervous  trunk  with  the  forceps,  and  the  necessary 
contact  with  the  hard  instruments,  while  separating  it  from  its 
surrounding  connections^  would,  I  suppose,  be  beyond  human 
endurance,  without  the  aid  of  the  anaesthetic  influence  of  chloro» 


1858.]    Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.        131 

form  or  ether,  For  the  rest,  the  effects  of  the  cicatrices  upon 
the  countenance  can  scarcely  be  called  disfiguring,  and  the  pa- 
tient speedily  recovers  without  suffering  from  much  constitu- 
tional disturbance. 

In  this  operation,  and  in  those  connected  with  the  two  suc- 
ceeding cases,  I  was  assisted  by  my  colleague  Prof.  Cox,  by  Drs. 
Proudfoot,  Abrahams,  Selden,  Guleke,  and  Casseday ;  and  by 
my  pupils,  Messrs,  Dougherty,  Henry,  Scudder,  and  others. 

Condition  of  the  Nerve.— The  trunk  of  the  nerve  in  this  case 
was  much  larger  than  natural  in  nearly  its  whole  extent.  The 
neurilemma  was  very  vascular,  and  the  nervous  tissue  proper 
was  also  engorged  and  red ;  the  trunk,  after  its  removal,  was  so 
red  as  to  have  somewhat  the  appearance  of  muscular  tissue.  The 
length  of  the  nerve  removed  was  a  little  more  than  an  inch  and 
three-quarters.  The  lining  membrane  of  the  antrum  was  sound, 
as  well  also  as  the  bones  of  the  antrum  and  the  osseous  wall  of 
the  canalis  infra-orbitalis. 

Progress  of  Union  and  After-treatment. —  Oct.  lGth.  Six  hours 
after  the  operation,  the  patient  was  visited.  His  pulse  was  100; 
there  was  a  slight  fever ;  he  complained  of  thirst,  and  lemonade 
was  ordered.  t  He  spoke  of  a  desire  he  had  to  vomit,  which  he 
ascribed  to  the  chloroform.  He  stated  that  he  felt  slight  twitch- 
ings  on  the  nose,  and  at  the  corner  of  the  lip, 

17th  (Friday).  The  patient  was  remarkably  well  under  the 
circumstances;  sitting  up;  pulse  90;  tongue  lightly  covered 
with  a  white  fur ;  complained  of  pain  in  the  wound,  also  of 
shooting  pains  in  the  left  eye ;  he  remarked  that  he  could  stick 
a  pin  into  the  upper  lip  and  cheek  without  causing  pain,  there 
being  no  sensation  in  that  region.  Ordered  chicken  broth,  and 
wine  and  water. 

ISth  (Saturday),  Patient  improving ;  wound  healing ;  pulse 
natural;  no  fever;  spoke  of  the  numbed  sensation  in  his  face. 

19th  (Sunday).  Pulse  full  and  natural ;  good  appetite ;  par- 
took of  a  beefsteak;  in  the  afternoon  four  suture  pins  were 
removed ;  slight  pain  in  the  wound  ;  no  return  whatever  of  the 
neuralgia. 

20th  (Monday).  Cure  progressing;  healthy  suppuration  from 
wound  ;  appetite  excellent ;  general  health  much  improved. 

(Tuesday,  Wednesday,  Thursday.)  During  these  days  the 
rest  of  the  pins  were  removed ;  patient  felt  no  pain  whatever 
either  in  the  wound  or  cheek;  wound  in  the  antrum  syringed 
with  tepid  water, 

25th  (Sunday,)  Patient  attended  church  ;  feels  no  pain  what- 
ever ;  incision  of  the  upper  lip  and  cheek  entirely  healed. 

28th.  Patient  entirely  well. 

30th.  Eeturned  home  to  Maryland  in  high  spirits,  and  deligh- 
ted at  the  result  of  the  operation. 


132  Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.  [February, 

December  7th,  1857.  Fourteen  months  after  the  operation  he 
writes  to  me  that  he  is  enjoying  excellent  health,  and  has  been 
entirely  free  from  neuralgic  pain. 

Case  II. — Florence  Cordello,  a  native  of  Italy,  aged  54  years, 
of  lymphatic  temperament,  chocolate  maker  by  trade,  was  ad- 
mitted to  the  State  Hospital  on  the  14th  of  September,  1857, 
suffering  from  severe  lic-douloureux  of  the  left  side  of  the  face. 
The  following  is  the  account  handed  to  me  by  the  Assistant 
Surgeon,  Dr.  Guleke.  In  the  year  1828,  the  patient  contracted 
a  very  severe  cold  from  exposure,  and  about  this  time  he  was 
seized  with  the  pain  for  the  first  time.  According  to  his  own 
description,  the  pain  started  from  the  foramen  infra-orbitale,  ex- 
tending upwards  to  the  forehead,  and  downwards  into  the  teeth ; 
the  paroxysm  lasting  about  ten  minutes.  He  supposed  it  to  be 
toothache,  and  had  one  or  two  teeth  extracted.  An  interval  of 
eight  years  took  place,  when  he  was  again  attacked  with  neu- 
ralgic paroxysms,  lasting  from  five  to  ten  minutes.  Again,  after 
the  lapse  of  a  year,  the  paroxysms  reappeared  in  a  more  severe 
form,  and  at  snorter  intervals. 

The  patient,  still  believing  his  teeth  to  be  the  source  of  the 
disease,  had  all  of  them  extracted  on  the  left  side  of  the  upper 
jaw,  but  without  any  benefit.  During  these  attacks  he  had  been 
subjected  to  many  kinds  of  treatment,  both  internally  and  ex- 
ternally ;  he  also  repaired  to  some  of  the  mineral  springs  on  the 
Bhine,  but  still  to  no  purpose.  He  continued  thus  to  suffer 
more  or  less  intensely  from  the  neuralgic  paroxysms,  for  a  period 
of  time  extending  from  1837  to  1846,  and  with  detriment  to  his 
general  health.  In  1846,  while  passing  through  the  city  of 
Heidelberg,  in  Germany,  he  consulted  the  celebrated  Chelius 
with  the  hope  of  obtaining  some  beneficial  result  from  his  ad- 
vice. That  professor  divided  the  nerve  as  it  emanated  from  the 
infra-orbital  foramen,  by  incisions  from  the  mouth,  and  six  weeks 
after,  again  performed  the  same  operation,  without  any  favora- 
ble result.  During  the  next  six  years  the  patient  continued  to 
suffer  from  the  neuralgic  paroxysms  of  more  or  less  intensity. 

Oppressed  by  extreme  suffering,  he  again  sought  relief  from 
an  operation,  and  in  1852  the  nerve  was  again  divided  from  the 
mouth  by  forcing  up  the  lip ;  the  actual  cautery  being  at  the 
same  time  applied,  by  pushing  the  instrument  from  the  mouth 
upward  into  the  wound  as  far  as  the  foramen  infra-orbitale.  This 
operation  appeared  to  give  some  relief,  and  during  the  two  suc- 
ceeding years,  the  patient's  sufferings  were  somewhat  alleviated. 
About  two  years  ago,  the  paroxysms  returned  in  the  most  aggra- 
vated form,  progressed,  and  continued  without  much  abatement. 
He,  on  the  1st  of  September  last,  being  in  New  York,  again 
submitted  to  an  operation  for  division  of  the  nerve.     This  time, 


1858,]    Exsection  of  Second  Branch  of  Fifth  Pair  ofXerves.        133 

the  branches  of  the  nerve  were  divided  by  cutting  through  the 
integuments  directly  upon  the  infra-orbital  foramen  ;  this  oper^ 
ation  caused  no  other  effect  than  insensibility  to  the  touch  in  the 
soft  tissues  near  the  infra-orbital  foramen.  Two  weeks  after 
this,  he  entered  the  State  Hospital  The  condition  of  the  pa- 
tient was  then  as  follows;  Notwithstanding  the  repeated  divis- 
ion of  the  nerve,  there  was  sensibility  to  the  touch  over  the 
whole  region  of  the  cheek;  the  inner  side  of  the  lip  alone  ap- 
pearing to  be  insensible.  The  patient  describes  the  pain  as 
starting  from  the  foramen  infra-orhitale  and  extending  up  as  far 
as  the  lig amentum  palpebral  internum,  and  also  to  the  external 
corner  of  the  eye;  from  the  latter  point,  the  pains  shot  dowrn  in 
nearly  a  straight  line  to  a  point  about  one  inch  to  the  outside  of 
the  left  corner  of  the  mouth,  and  a  little  below  a  line  drawn  hor- 
izontally on  a  level  with  the  commissure  of  the  lips.  The  pains 
also  extended  backwards,  through  the  more  deeply  seated  por- 
tions of  the  face,  shooting  from  the  inner  corner  of  the  eye,  along 
the  base  of  the  nose,  and  striking  backwards  towards  the  spheno- 
maxillary fossa.  The  pain  was  of  the  true  neuralgic  character, 
and  so  intense  as  to  drive  the  patient  into  a  condition  verging 
on  delirium.  A  slight  touch  on  the  cheek,  the  inside  of  the 
mouth,  or  on  the  hard  or  soft  palate,  swallowing,  or  speaking, 
excited  almost  instantaneously  the  paroxysms  in  their  severest 
form. 

The  operation. — -The  operation  in  this  case  was  performed  after 
the  same  manner  as  the  preceding,  and  was  modified  only  by 
the  greater  depth  of  the  antrum  and  face.  There  was  also 
more  hemorrhage  from  the  spheno-maxillary  fossa;  this  was 
controlled  by  compressed  sponge  pressed  into  the  fossa.  Sup^ 
posing  that  hemorrhage  might  return,  the  lips  of  the  wound 
were  brought  together  by  adhesive  plaster,  one  suture  only 
being  used.  The  other  sutures  were  inserted  the  following  day. 
The  nerve  wras  cut  from  above  downwards.  The  ganglion  of 
Meckel  was  drawn  out,  hanging  to  the  trunk  of  the  nerve. 

Progress  of  Union  and  After-treatment. — Compressed  sponge 
was  applied  in  the  deeper  portion  of  the  wound;  the  external 
surface  was  closed  with  one  suture;  an  anodyne  was  ordered  for 
the  night. 

Oct.  11  (Sunday.)  Patient  slept  well  during  the  night;  pulse 
76 ;  no  bleeding ;  five  suture-pins  applied ;  ordered  an  anodyne. 

12th.  Patient  slept  well ;  no  pain  whatever ;  pulse  84 ;  com- 
plained of  thirst ;  but  little  appetite ;  speaks  and  swallows  with- 
out pain. 

12>ih.  Slept  badly;  had  an  attack  of  dysentery;  pulse  96; 
felt  a  slight  pulsating  pain  in  the  wound,  which,  however,  was 
doing  well ;  states  that  there  is  no  feeling  over  the  surface  of  the 
left  cheek  from  the  inner  angle  of  the  eye,  descending  along  the 


134  Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.  [February, 

nose  to  the  lip,  and  upwards  to  the  outer  angle  of  the  eye,  includ- 
ing the  lower  lid;  ordered  opium  and  quinine.  (Afternoon,) 
dysentery  subdued ;  pulse  96 ;  more  cheerful. 

L&th.  Patient  improving ;  pulse  92 ;  a  portion  of  the  pins 
removed. 

15th.  Kemaining  pins  removed;  wound  presents  a  healthy 
appearance ;  pulse  natural ;  slight  pain  felt  in  the  course  of  the 
wound. 

16^.  Eemoved  the  piece  of  compressed  sponge,  which  had 
been  placed  at  the  back  of  the  antrum  during  the  operation,  to 
restrain  the  bleeding  from  the  spheno-maxillary  fossa. 

18^,  Patient  doing  well ;  eats  well,  and  sleeps  naturally. 

26th.  Still  entirely  free  from  neuralgic  pain ;  the  whole  ex- 
pression of  the  face  changed  from  that  of  suffering  and  anxiety, 
to  cheerfulness  and  serenity. 

28th.  Discharged  from  the  hospital  entirely  cured,  and  in  good 
health  and  spirits. 

Dec.  8.  Visited  the  hospital ;  still  free  from  pain  and  in  good 
condition. 

Condition  of  the  Nerve. — The  nerve  in  this  case,  as  in  the  pre- 
vious one,  exhibited  a  similar  appearance.  It  was  thickened, 
vascular,  and  engorged.  The  neurilemma  and  proper  tissue  of 
the  nerve  were  both  affected.  The  length  of  the  trunk  removed 
was  two  inches. 

Case  III. — Mrs.  Mary  Gr.  Stevenson,  a  native  of  Portsmouth, 
England,  and  who  had  borne  children,  55  years  of  age,  of  full 
habit  and  sanguineous  temperament,  consulted  me  in  the  month 
of  September,  1857,  for  severe  neuralgia  of  the  left  side  of  the 
face.  She  had  been  a  resident  of  the  Northern  States  for  thirty 
years,  and  had  enjoyed  generally,  remarkably  good  health. 

On  the  12th  of  August,  1851,  while  eating  a  plum  in  her  gar- 
den, she  was  suddenly  seized  with  a  vivid  shock  of  pain,  com- 
mencing on  her  cheek,  and  passing  through  her  jaw,  as  if  caused 
by  a  sharp-pointed  instrument,  suddenly  driven  through  her 
face  ;  shooting  pains  of  this  character,  with  intermissions  of  en- 
tire abatement,  continued  for  several  days.  A  dentist  was  con- 
sulted, who  attributing  the  symptoms  to  the  teeth,  extracted 
several  of  them,  but  without  the  slightest  benefit  to  the  patient. 
The  paroxysms  continued  with  more  or  less  severity  for  two 
months. 

At  the  end  of  this  time,  they  suddenly  abated  in  their  severity, 
and  the  respite  lasted  for  about  six  weeks.  Upon  hearing  of 
the  sudden  death  of  a  friend  to  whom  she  was  much  attached, 
the  paroxysms  were  again  renewed;  they  became  more  frequent ; 
the  intervals  were  shorter,  and  the  intensity  of  pain  was  increas- 
ed more  and  more  with  each  succeeding  attack.    During  the 


1858.]   Exsection  of  Second  Branch  of  Fifth  Pair  of  Nerves.        135 

year  1852,  the  pain  and  paroxysms  still  continued  with  unyield- 
ing severity.  The  tic  would  now  last  for  two  and  three  months, 
with  scarcely  any  of  the  intervals  which  had  heretofore  occur- 
red. Cold  air,  the  drinking  of  fluids,  the  slightest  touch  upon 
the  cheek,  or  any  sudden  mental  emotion,  would  invariably 
excite  the  most  fearful  paroxysms,  Daring  the  year  1854,  her 
condition  was  not  in  any  way  ameliorated ;  the  pain,  if  possible, 
was  more  severe,  and  her  general  health  suffered  from  the 
want  of  rest.  During  the  year  1855,  the  disease  progressed  with 
the  same  severity,  In  the  early  part  of  the  year  1856,  the  par' 
oxysms  became  still  more  aggravated  J  the  patient,  at  times, 
becoming  almost  delirious — starting  up,  running  about  her  room, 
and  screaming  like  a  maniac.  In  the  latter  part  of  September, 
she  sought  relief  from  a  surgeon  in  this  city,  who  divided  by 
subcutaneous  incision  the  branches  of  the  infra-orbital  nerve, 
as  it  issues  from  the  infra-orbital  foramen. 

About  this  time,  she  also  took  large  quantities  of  various  nar- 
cotics, and  of  the  carbonate  of  iron.  After  the  operation,  she 
experienced  some  relief.  The  amelioration  continued  from  Octo- 
ber, 1856,  until  May,  1857,  when  the  paroxysms  were  again 
renewed  in  their  severest  form. 

The  pain  now  became  almost  continual,  depriving  her  nearly 
entirely  of  sleep  ;  she  was  unable  to  eat  without  torture,  the  act 
of  swallowing  invariably  bringing  on  a  paroxysm.  During 
these  exacerbations,  the  pain  was  diffused  in  different  directions, 
extending  from  a  point  a  little  below  the  infra-orbital  foramen, 
or  from  the  ridge  of  the  gums,  and  striking  through  the  superior 
maxillary  bone  towards  the  deeper  portions  of  the  face,  and 
towards  the  orbit,  and  sometimes  extending  towards  the  region 
in  front  of  the  ear.  She  described  the  pain  as  of  a  beating 
character  at  times;  each  shock  succeeding  another  in  rapid  suc- 
cession, as  if  keeping  time  with  the  ticking  of  a  clock.  During 
this  long  period  of  suffering,  she  had  been  under  the  alternate 
care  of  several  physicians ;  the  various  remedies  moet  approved 
of  in  this  kind  of  disease  had  all  been  faithfully  and  sedulously 
tried  -,  stramonium,  aconite,  belladonna,  hemlock,  opium,  mor- 
phia, chloroform,  carbonate  of  iron,  valerianate  of  ammonia,  and 
other  medicaments  had  been  administered  internally  ;  while  ex- 
ternally, in  addition  to  the  division  of  the  nerve,  blisters,  sinap^ 
isms,  hydrocyanic  acid  liniment,  tincture  of  aconite,  and  chloro' 
form  had  beeai  resorted  to- — also  electricity  and  galvanism.  At 
the  time  I  was  consulted,  she  was  suffering  night  and  day  from 
repeated  and  excruciating  attacks,  and,  as  she  herself  stated,  she 
had  visited  the  city  to  have  an  operation  performed  at  all  haz- 
ards, however  desperate  it  might  be,  if  I  could  only  hold  out  any 
prospect  whatever  of  its  affording  relief.  Her  general  health 
was  tolerably  good,  and  she  did  not  complain  of  loss  of  appetite.- 


136  Exsectionof  Second  Branch  of  Fifth  Pair  of  Nerves.  [February, 

I  explained  to  her  the  nature  of  the  operation  which  I  believe 
to  be  the  only  one  suited  to  her  case.  She  immediately  assent- 
ed to  submit  to  it  as  early  as  possible. 

The  operation  was  performed  after  the  same  procedure.  The 
face  Was  in  this  instance,-  also,*  very  deep.  The  hemorrhage  from 
the  spheno-maxillary  fossa  was  considerable,  and  was  stopped 
by  a  piece  of  compressed  sponge  to  which  a  strong  ligature  was 
attached,  by  which  it  could  be  removed. 

Progress  of  Union  and  After-treatment. — Nov.  5.  (Thursday 
evening.)  As  soon  as  the  operation  was  completed,,  the  patient 
retired  to  her  bed.  Yomiting  came  on  a  few  hours  after,  owing,, 
probably,  to  the  quantity  of  chloroform  which  had  been  used. 

6th,  Had  slept  tolerably  Well  during  the  night  ;■  felt  very  little 
pain  ;  pulse  80 ;  no  fever ;  complained  of  some  pain  in  the 
Wound,  but  had  no  neuralgic  pain. 

7th.  Left  side  of  the  face  slightly  swollen ;  puffiness  about  the 
eyelids ;  has  no  pain  ;  has  slept  well  without  any  anodyne ; 
states  that  she  feels  better  than  she  has  for  months;  pulse  80;- 
skin  natural  ;•  slight  thirst  ;•  five  of  the  suture  pins  removed ; 
line  of  incision  looks  as  though  union  by  first  intention  was 
going  on  favorably.  Still  kept  on  fluids  for  nurishment — gruel,- 
rice-water,-  ice-water,  toast-water,  and  chicken  tea.  Ordered  a 
gentle  aperient. 

8th.  Had  slept  well}  tumefaction  of  face  subsiding;  com- 
plains of  headache ;  cloth  wetted  with  cold  water  applied  on 
forehead ;  same  diet  continued ;  pulse  natural ;  removed  the 
sponge  which  was  used  to  stop  the  bleeding  from  the  spheno- 
maxillary fossa  ;  this  came  away  without  any  difficulty  by  slight 
traction,-  a  little  blood  following.-  Complains  of  slight  pain  in 
the  orbit.  Eemoved  six  suture  pins,  leaving  one  only— that 
Uniting  the  free  border  of  the  lip.-    Fluid  diet  as  before.- 

9th.  Patient  slept  well ;  headache  less  ;•  pulse  78  ;  no  neural^ 
gic  pain ;  a  Weak  solution  of  the  tincture  of  arnica  ordered,  to 
bathe  the  cheek  with  ;  removed  the  last  pin  ;  union  by  first  in- 
tention, along  the  line  of  incision,  complete.- 

From  the  9th  Until  the  16th  all  has  progressed  favorably.  No 
neuralgic  pain  whatever  ;  sleeps  well ;•  swelling  on  cheek  dimin- 
ishing; pain  has  entirely  left  the  orbit ;  secretion  into  the  mouth 
from  the  wound  in  the  antrum  diminished.  Ordered  a  gargle 
of  the  tinture  of  myrrh.  Appetite  has  also  returned.  Had 
been  sitting  up,  and  walking  about  her  room  without  any  incon- 
venience. Has  taken  a  little  sulphate  of  magnesia ;  has  not  re- 
quired any  anodyne. 

Bee.  3.  The  patient  has  been  progressing  favorably  up  to  this 
time.  The  wound  has  healed  entirely,  the  line  of  cicatrix  is 
becoming  effaced ;  not  the  slightest  trace  of  tic  douloureux  re- 
maining. There  is  no  paralysis  of  the  muscles  of  the  face  upon 
the  side  operated  on. 


1858.]      Insanity  connected  with  alleged  Criminal  Acts.  1#7 

In  the  case  of  this  patient,  the  nerve  was  enlarged,  very  vas- 
cular, thickened  and  red.  Two  inches  of  the  nerve  were  remc 
ved.[ — American  Jour,  of  Med.  Sciences. 


The  Lancet,  (Dec.  19th,)  is  rather  severe  upon  Lawyers,  oil 
account  of  their  ignorance  concerning  insanity.  Hear  what  the 
editor  says  : — [American  Med  Monthly. 

"On  Monday  evening,  Dr.  Forbes  Winslow  read  his  paper 
before  the  Juridical  Society,.  "  On  the  Legal  Doctrines  of  Kes-- 
possibility  in  Cases  of  Insanity  connected  with  alleged  Criminal 
Acts.'*  There  was  a  much  larger  attendance  at  the  meeting  than 
usual,-  the  Vice-Chancellor  Sir  John  Stuart  being  in  the  chair, 
and  amongst  the  members  present  was  Mr.  Bramwell,  as  well 
as  many  of  the  most  distinguished  members  of  the  bar.  This  is 
the  first  time  that  the  attention  of  lawyers  has  been  directed  to 
this  important  subject  by  means  of  a  paper  written  by  a  medical 
man,-  and  communicated  to  a  legal  society  in  which  free  discus* 
sion  is  permitted;-  and  we  cannot  but  rejoice  that  a  Way  has  at 
last  been  opened  whereby  the  views  entertained  by  the  medical 
profession  upon  what  ought  to  be  the  legal  responsibilities  of 
the  insane  can  be  distinctly  enunciated  and  tested  by  that  "touch' 
stone  of  truth,"  oral  discussion.  We  look  upon  the  proceed- 
ings of  Monday  night  as  constituting  an  era  in  the  history  of 
criminal  jurisprudence,  and  we  venture  to  predict  that  when  a 
few  more  such  papers  shall  have  been  read  and  discussed  at  the 
Juridical  Society,  it  will  be  impossible  for  that  body  to  listen 
with  common  patience  to  views  to  which  Mr.  Baron  Bramwell 
gave  utterance  in  the  course  of  the  debate  on  Monday.  We 
have  always  believed  that  the  great  differences  existing  between 
the  doctrines  of  lawyers  and  medical  men  on  these  subjects  de- 
pended chiefly  on  the  want  of  practical  acquaintance  with  insan- 
ity under  which  the  former  labor ;  but  we  confess  we  were 
unprepared  for  the  appalling  ignorance  of  the  first  principles  of 
moral  and  mental  philosophy  which  was  displayed  by  a  lawyer 
who  has  within  the  last  two  years  been  deemed  worthy  of  ele- 
vation to  the  bench.  In  reference  to  Dr.  Winslow's  remarks  on 
the  distinction  between  the  intellectual  and  moral  feelings,  Mr. 
Baron  Bramwell  positively  declared  that,  "for  his  pari,  he  doubt- 
ed the  existence  of  moral  faculties,  or  a  moral  sense  /"  We  are 
acquainted  with  another  learned  judge  who,  on  being  asked  to 
read  a  well-known  medical  work  on  Criminal  Insanity,  abso- 
lutely declined  to  do  so,  stating  that  he  never  read  anything  of 
the  sort,  and  in  fact  rejoiced  in  his  ignorance.  With  such  mate- 
rials to  work  upon,  progress  must  necessarily  be  slow,  but  it 
will   be  sure;  and  the  time  is  not  far  distant  when  the  judges 


138  Editorial.  [February, 

will  shrink  with  as  much  horror  from  hanging  a  lunatic  as  they 
would  now  do  from  burning  a  witch.  Dr.  Winslow's  paper  was, 
as  might  have  been  expected,  an  extremely  well-written  and 
philosophical  essay,  and  was  listened  to  with  a  degree  of  atten* 
tion  which,  at  any  rate,  argued  a  desire  on  the  part  of  the  mem* 
bers  of  the  Juridical  Society  to  learn  what  they  could.-  It  was 
painfully  evident,  however,  from  the  discussion  which  followed, 
that  the  minds  of  the  audience  were  unprepared  to  grasp  the 
great  truths  laid  before  them,-  and  we  therefore  hope  that  the 
author  will  follow  up  this  paper  with  another,  in  which,  by 
giving  copious  details  of  cases,  he  may  furnish  the  legal  mind 
with  a  species  of  food  which  it  can  assimilate  more  readily  than 
the  recondite  truths  of  psychological  philosophy." 


Researches  on  Arsenic. —Dr.  Blofidlot,  of  Nancy,  has  just  observed  a 
fact  which  explains  the  contradictions  encountered  by  inexperienced 
chemists  in  attempts  to  detect  arsenic  in  connection  with  organic  mat- 
ters.- It  is  this: — that  when  substances  poisoned  have  been  left  to 
putrefy,  some  sulphuret  of  arsenic  is  formed  at  the  expense  of  the  sulph- 
uretted hydrogen,  and  this,  as  is  well  known,  escapes  detection  "by  Marsh's 
apparatus.  Sulphuret  of  arsenic  also  forms  when  the  suspected  matters 
are  carbonized  by  the  action  of  sulphuric  acid  after  the  process  of  Flan- 
din  and  Danger.  The  sulphuret  of  arsenic  may  be  extracted  by  washing 
the  carbonized  mass  with  ammonia ;  this  dissolves  the  sulphuret ;  then 
convert  the  arsenic  into  arsenic  acid  (AsO5)'  by  means  of  boiling  nitric 
acid,  so  as  to  obtain  a  second  solution ;  this,  added  to  the  first,  may  then 
be  tested  in  March's  apparatus. — [Amer.  Jour,  of  Sci.  and  Arts. 


EDITORIAL  AND  MISCELLANEOUS. 

Meckel's  Ganglion. — In  the  January  number  of  the  Amer.  Journal 
of  Medical  Sciences,  we  find  a  paper  from  the  pen  of  Professor  J.  M. 
Carnochan,  of  New  York,  on  the  Exsection  of  the  Second  Branch  (Su- 
perior Maxillary)  of  the  Fifth  Pair  of  ^serves,  for  the  cure  of  facial 
Neuralgia.  On  account  of  the  originality  of  the  operation,  its  uniform 
success,  and  the  heretofore  almost  hopeless  character  of  this  disease  in 
certain  forms,  we  have  deemed  it  proper  to  transfer  from  that  valuable 
quarterly,  the  entire  article  to  our  own  pages.  The  operation  proposed, 
and  thrice  successfully  performed,  by  the  distinguished  reporter,  meets 
with  our  unreserved  approval.  If  it  is  objected  by  any  one,  that  the 
operation  is  horrible,  he  can  be  answered,  that  it  is  to  eradicate  a  worse 
than  horrible  disease,  a  living  and  unending  agony,  to  which  even  death 
itself  is  preferable,  and  that  the  use  of  chloroform,  insisted  on  by  the 


1858.]  Editorial  139 

surgeon,  removes  in  a  great  degree,  the  strongest  objection  any  one  can 
advance  against  it. 

It  is  not,  however,  simply  to  signify  our  approbation,  that  we  have 
begun  the  present  notice.  Dr.  C,  in  his  remarks  previous  to  detailing 
his  cases,  in  endeavoring  to  account  for  the  success  of  his  operation 
when  other  modes  of  procedure  had  failed — inadvertently,  we  are  con- 
vinced— makes  the  statement  of  an  opinion  in  regard  to  certain  points 
in  the  physiology  of  the  nervous  system,  which  to  our  mind,  with  the 
experimental  facts  before  him,  should  have  been  given  with  at  least,  a 
certain  degree  of  hesitancy,  for  it  involves,  either  the  correctness  or  the 
incorrectness  of  news  loner  held  as  among  the  established  truths  of  the 
science. 

After  presenting  a  rapid,  but  a  sufficiently  lucid  sketch  of  the  many 
forms  of  facial  neuralgia  and  of  the  various  operations  proposed  for  their 
relief  and  after  reasoning,  we  think  very  justly,  on  the  several  causes 
operating  to  produce  a  continuance  or  a  recurrence  of  the  affection  after 
measures  taken  for  its  relief,  he  says :  "  from  these  views  we  can  perceive 
how  futile  the  operation  of  division  of  the  nerve  at  the  foramen  infra- 
orbital e  must  be.  When  the  trunk  of  the  nerve  is  extensively  diseased, 
no  operation  can  rationally  lead  to  a  successful  result  unless  all  the 
branches  emanating  from  the  trunk  are  cut  off  from  communication  with 
the  brain.  I  believe  that  in  such  aggravated  cases  of  neuralgia,  the  key 
to  the  operation  is  the  removal  of  the  ganglion  of  Meckel  or  its  insulation, 
from  the  encephalon.  Where  even  a  large  portion  of  the  trunk  of  the 
second  branch  of  the  fifth  pair  has  been  simply  exsected  from  the  infra- 
orbital canal,  the  ganglion  of  Meckel  continues  to  provide  to  a  great 
extent,  the  nervous  ramifications  which  will  still  maintain  and  keep  up 
the  diversified  neuralgic  pains.  Besides,  the  ganglion  of  Meckel,  being 
composed  of  gray  matter,  must  play  an  important  part  as  a  generator  of 
nervous  power,  of  which,  like  a  galvanized  battery,  it  affords  a  continued 
supply,  while  the  branches  of  the  ganglion  under  the  influence  of  the  dis- 
eased trunk,  serve  as  conductors  of  the  accumulated  morbid  nervous 
sensibility." 

Now,  the  objections  which  might  be  urged  against  the  confident  state- 
ment of  the  above  theory,  are  many  and  various ;  some  of  which  we  will 
here  venture  to  suggest.  In  the  first  place,  it  is  at  least  questionable, 
whether  or  not  the  centres  of  the  Ganglionic  System  can  be  productive 
of  sensitive  phenomena.  Secondly :  The  nervous  ramifications,  provided 
by  the  Ganglion  of  Meckel,  are  not  distributed  upon  parts  where  the 
"diversified  neuralgic  pains  are  kept  up,"  and  especially  is  this  certain, 
after  the  trunk  of  the  superior  maxillary  has  been  removed  ;  but  they 
are  distributed  to  surfaces  and  parts  located  internally,  as  the  fauces  and 
6* 


140 


Editorial. 


[February, 


the  roof  of  the  mouth,  to  the  Schneiderian  membrane  lining  the  nasal 
fossse,  and  probably,  conjunctiva  cornea,  &c. — at  least,  so  anatomical 
investigation  and  experimental  physiology  have  uniformly  determined 
their  distribution. 

[We  here  introduce  a  cut,  from  Wilson's  Anatomy,  which  illustrates 
the  position  and  some  of  the  branches  and  connections  of  this  nervous 
centre.] 


The  Cranial  Ganglia  of  the  Sympathetic  Nerve.— 1.  The  ganglion  of  Kibes.  2.  The  filament 
by  which  it  communicates  with  the  carotid  plexus  (3).  4.  The  ciliary  or  lenticular  ganglion,  giv- 
ing off  ciliary  branches  for  the  supply  of  the  globe  of  the  eye.  5.  Part  of  the  inferior  division  of 
the  third  nerve,  receiving  a  short  thick  branch  from  the  ganglion.  6.  Part  of  the  nasal  nerve, 
receiving  a  longer  branch  from  the  ganglion.  7.  A  slender  filament  sent  directly  backwards  from 
the  ganglion  to  the  sympathetic  branches  in  the  cavernous  sinus.  8.  Part  of  the  sixth  nerve  in 
the  cavernous  sinus,  receiving  two  branches  from  the  carotid  plexus.  9.  Meckel's  Ganglion 
(spheno-palatine).  10.  Its  ascending  branches,  communicating  with  the  superior  maxillary  nerve. 
11.  Its  descending  branches,  the  posterior  palatine.  12.  Its  anterior  branches,  spheno-palatine 
or  nasal.  13.  The  naso-palatine  branch,  one  of  the  nasal  branches  *  The  point  where  Cloquet 
imagined  the  naso-palatine  ganglion  to  be  situated.  14.  The  posterior  branch  of  the  ganglion, 
the  Vidian  nerve.  15.  Its  carotid  branch,  communicating  with  the  carotid  plexus.  16.  Its  petro- 
sal branch,  joining  the  angular  bend  of  the  facial  nerve.  IT.  The  facial  nerve.  18.  The  chorda 
tympani  nerve,  which  descends  to  join  the  gustatory  nerve.  19.  The  gustatory  nerve.  20.  The 
submaxillary  ganglion,  receiving  the  chorda  tympani  nerve  from  the  gustatory.  21.  The  superi- 
or cervical  ganglion  of  the  sympathetic. 

But  in  the  third  and  last  place,  the  most  important  objection  which 
now  presents  itself,  in  our  mind,  to  Dr.  Carnochan's  ingenious  theory  is, 
that  the  results  of  both  experiment  and  observation  are  diametrically 
opposed  to  his  deductions. 

The  trunks  and  ganglia  and  branches,  of  the  ganglionic  system,  have 
been  the  subjects  of  physiological  experiment  for  a  period,  now  extend- 
ing over  more  than  a  hundred  years;  since  the  year  1*732,  when  Petit 
made  a  division  of  the  trunk  of  the  sympathetic  in  the  dog,  down  to  the 
present  day,  we  find  ranged  along  the  whole  interval,  a  number  of  illus- 
trious names,  whose  multiplied  and  varied  experiments  have  only  con- 
firmed his  results,  and  go  to  prove  that  this  ganglionic  system,  has  but 
little  agency  in  either  sensation  or  motion,  but  has  mainly  confided  to  itr 


1858.]  Editorial  141 

the  important  and  more  silent  processes  of  secretion  and  nutrition. 
Whenever  a  nervous  trunk  in  any  part  of  this  system  has  been  divided, 
in  experiment,  or  a  ganglionic  centre  disturbed  or  removed,  either  by  the 
knife  of  the  physiologist  or  in  the  progress  of  diseased  action,  there  have 
ever  been  found,  signs  of  modified  nutrition  or  altered  secretion;  the  only 
modification  of  sensation,  we  are  aware  of,  is  that  observed  by  M.  Ber- 
nard and  others,  where  exaltation  of  temperature  takes  place  in  the  parts 
answering  to  the  branches  of  distribution  of  the  divided  nerve,  or  of  the 
ganglion  which  has  undergone  evulsion.  (See  Archives  Generates.)  So 
much  for  observations  and  experiments  upon  the  ganglionic  system  in 
general.  Now  let  us  examine  if  any  experiments  can  be  referred  to,  as 
illustrating  the  effect  of  the  disturbance  of  Meckel's  Ganglion  in  parti- 
cular. There  may  have  been  others,  but  recent  research  has  made  us 
more  familiar  with  those  of  Dr.  Alcock,  of  Dublin,  reported  in  Todd's 
Cyclopedia  of  Anatomy  and  Physiology.  "We  will  premise  that  Dr.  Al- 
cock did  not  draw  the  same  conclusions  from  the  results  of  his  experi- 
ments which  we  have  considered,  taking  them  in  connection  with  analo- 
gous experiments  on  other  portions  of  the  ganglionic  system,  as  unavoid- 
able deductions.  He  instituted  the  series  to  determine,  as  he  says,  the 
function  of  the  nerves  of  Taste ;  and  yet  he  more  plainly  established,  than 
any  one  had  done  before  him,  the  function  of  Meckel's  Ganglion.  In 
order  to  determine  the  nerves  of  taste,  he  undertook  the  removal  of 
Meckel's  ganglion  from  the  dog :  he  attempted  it  several  times  and  fail- 
ed at  different  stages  of  the  operation ;  but  in  almost  every  case,  the  eye 
of  the  same  side  became  bleared  within  the  next  two  days,  a  whitish  pu- 
riform  matter  exuded  from  it,  in  quantity  proportioned  to  the  case ;  and 
in  one  instance  in  which  the  ganglion  was  removed,  it  actually  produced 
opacity  of  the  cornea  and  ulceration  in  that  structure. 

It  will  be  seen,  in  the  above  account,  that  the  effect  of  the  injury  or 
removal  of  Meckel's  ganglion  was  always  well  marked,  and  of  an  entirely 
different  character  from  that  which  results  from  injury  or  section  of  any 
sensitive  nerve. 

Returning  now  to  Dr.  Carnochan's  Explanation  in  his  history  of  the 
cases  reported ;  we  find  in  none  of  the  incidents  there  related,  anything 
which  indicates  the  occurrence  of  any  of  those  results  which  uniformly  have 
followed  upon  the  evulsion  of  Meckel's  ganglion. — We  can  account  for  the 
absence  of  these  sequences  on  three  different  principles  of  reasoning: 

1st.  That  these  results  may  possibly  have  obtained  in  a  certain  de- 
gree, but  Dr.  Carnochan  regarding  them  as  only  the  effect  of  the  injury 
(traumatic  results)  inflicted  on  the  adjacent  parts,  did  not  deem  them 
worthy  of  record.  Yet,  still,  the  removal  of  the  ganglion  should,  accord- 
ing to  all  antecedents,  have  produced  such  an  amount  of  perturbation  in 


142  Editorial.  [February, 

the  nutrition  and  circulation  of  the  eye,  as  to  have  compelled  his  atten- 
tion, and  if  they  were  present,  he  certainly  would  have  reported  them. 

2ndly.  We  might  reason  that  this  removal  of  Meckel's  Ganglion  in  the 
human  subject,  (not  previously  performed,  so  far  as  we  know,  by  any 
one,)  is,  perhaps  not  followed  by  the  same  results  as  when  it  is  experi- 
mentally done  in  the  case  of  the  lower  animals,  as  the  dog,  <fcc. — This,  it 
would  be  difficult,  without  farther  repetition,  to  admit ;  for  the  admission 
would  strike  at  the  very  root  of  the  whole  principle  of,  and  destroy  the 
confidence  on  which,  Experimental  Physiology  is  based — viz :  the  identity 
of  function  in  the  various  parts  and  organs  in  man  and  the  lower  animals. 

Then,  3rdly,  another  explanation  suggests  itself  to  us,  in  this  dilemma, 
which  is,  that  Dr.  Carnochan  might  possibly  have  been  mistaken  in  his 
belief,  that  he  had  removed  the  ganglion  of  Meckel,  in  the  operations 
reported  by  him.  This  last,  with  all  the  lights  before  us,  would  appear 
to  us  the  most  probable  supposition,  were  it  not,  that  Dr.  C.'s  high  reputa- 
tion and  acknowledged  familiarity  with  the  parts  in  question,  which, 
while  they  have  given  the  subject  importance  in  our  eyes,  have  also  ren- 
dered us  averse  to  adopting  this  remaining  supposition  as  our  final 
conclusion.  We  therefore  respectfully  leave  the  conciliation  of  the  ad- 
verse facts,  to  himself. 

Our  object,  in  the  foregoing  remarks,  has  been  neither  to  deny,  nor 
captiously  to  question  any  conclusions  which  Dr.  C.  may  have  hastily  put 
forth  in  his  report  of  his  remarkable  operation.  These  conclusions  of 
his  are  but  incidental  to  the  main  object  of  his  report,  and  perhaps  no 
considerable  amount  of  importance  was  attached  to  them  by  him,  and 
no  great  thought  or  trouble  expended  upon  them.  They  do  not,  in  any 
way,  lessen  the  merit  of  his  operations  for  the  relief  of  neuralgia.  We 
were  struck  with  the  remarkable  difference  in  the  results  reported  by 
him,  and  in  those  results  which  have  been  so  long  accumulating  in  the 
records  of  Experimental  Physiology.  Perhaps  ere  this,  the  discrepancy 
may  have  occurred  to  himself,  but  his  manner  of  referring  to  this  ques- 
tion, so  important  in  a  physiological  point  of  view,  was  such  as  to  leave 
it  open  for  discussion.  We  have  endeavored  to  do  this  fairly,  and  we 
know,  in  a  kindly  spirit,  carefully  avoiding  every  expression  which  might 
bear  any  semblance  to  disrespectful  or  uncourteous  criticism. 


Physicians  and  Lawyers.  Technicalities  before  Juries. — We  have 
transferred  to  our  pages,  an  article  from  The  London  Lancet,  commenting 
upon  a  paper  read  by  Dr.  Forbes  Winslow  before  the  Juridical  Society, 
"  On  the  Legal  Doctrines  of  Responsibility  in  cases  of  Insanity  connected 
with  alleged  Criminal  Acts."  These  comments  bear  rather  heavily  upon 
the  Legal  gentlemen  on  account  of  their  ignorance  concerning  Insanity 


1858.]  Editorial  143 

in  its  forensic  and  other  aspects.  It  is,  doubtless,  true,  that  the  subject 
of  Insanity  has  received  too  little  attention  both  from  that  Profession  and 
our  own,  and  we  would  commend  to  the  attention  of  all  interested  in 
such  subjects,  a  work  which  has  recently  delighted  us,  viz.,  "Mind  and 
Matter,"  from  the  able  pen  of  Sir  Benjamin  Brodie.  In  this  work  the 
subject  of  "  Moral  Insanity,"  soon  to  be  discussed  before  the  American 
Medical  Association,  is  pertinently  touched  upon,  while  many  other  ab- 
struse points  are  handled  with  that  philosophic  clearness  and  happy  fa- 
culty of  illustration,  for  which  this  great  man  is  so  remarkable. 

We  would  here  remark,  with  due  respect  to  gentlemen  of  that  learned 
Profession,  that  we  think,  upon  the  whole,  Lawyers  estimate  too  lightly, 
the  important  and  intimate  relations  subsisting  between  the  Science  of 
Medicine  and  their  own  calling.  Medical  Jurisprudence,  though  ably 
taught  at  the  present  day  in  most  of  our  Schools  of  Medicine,  and  we 
suppose  of  Law  also,  is  still  a  branch,  in  which  much  greater  excellence 
might  most  advantageously  be  sought  by  both  Physicians  and  Lawyers. 
Nothing  so  intimidates  the  young  practitioner  of  medicine,  as  the  appre- 
hension of  having  to  undergo  a  medico-legal  examination ;  and  yet  at 
the  same  time,  nothing  can  be  less  pertinent  and  more  irrelevant  than 
the  questions  projected  at  him  on  such  occasions,  by  the  gentlemen  of 
the  Bar.  They  both  proceed  with  great  caution.  It  is  delicate  ground 
for  both;  the  one  is  afraid  of  developing  ignorance  before  the  intelligent 
audience  usually  assembled  on  such  occasions,  while  the  other  is  afraid 
of  developing  something  which  may  damage  his  interest  in  the  case  be- 
fore the  intelligent  Jury.  We  know  from  personal  experience,  that  the 
Physician  is  afraid  of  the  examining  Lawyer,  and  we  take  comfort  by 
strongly  opining  that  the  Lawyer  is  sometimes  a  little  afraid  of  the  de- 
posing Physician.  The  latter,  however,  has  decidedly  the  advantage  • 
he  need  only  break  such  ground  as  he  has  had  the  opportunity  and  the 
precaution  to  prepare  for,  previous  to  the  opening  of  Court.  A  careful 
study  of  some  work  on  Forensic  Medicine  would  place  them  both  on  a 
level  in  this  latter  regard,  for  then  the  Physician  would  soon  learn  to 
appreciate,  as  well  as  the  Lawyer,  what  points  in  the  case,  were  liable  to 
have  an  important  bearing  in  the  evidence  about  to  be  elicited,  and  he 
too,  could  prepare  and  brighten  up  for  the  approaching  ordeal. 

These,  however,  are -not  our  only  comments;  but  we  deem  it  prudent  to 
premise  our  remaining  remarks  by  a  quotation  from  that  most  useful  and 
most  treasured  of  all  j  uvenile  journals,  "  Peter  Parley's  Magazine."  Here, 
many  will  remember,  that  in  each  number,  there  was  a  department 
headed — "  To  our  Youngest  Readers  ;"  so  in  all  our  remarks  on  this 
subject,  both  foregone  and  to  follow,  do  we  address  ourselves  to  our 
"  youngest  readers."     We  would  ask,  then  :  Are  there  not  faults  which 


144  Editorial.  [February, 

attach  exclusively  to  our  own  Profession  in  its  relations  to  the  Courts  of 
Justice  ?  Do  we  always  maintain  our  dignity  and  that  of  our  Profession, 
and  are  our  depositions  such  as  will  serve  most  fully  in  answering  the 
ends  of  justice,  by  clearing  the  (so  to  speak)  medical  obscurities  invest- 
ing it  ? — The  Lawyers  may  indeed  be  deficient  in  certain  attainments 
necessary  for  the  proper  administration  of  Justice  in  particular  cases, 
but  we  are,  also,  certainly  often  greatly  at  fault,  both  in  the  method 
and  in  the  wording  of  our  depositions.  We  sometimes  appear  to  forget 
entirely  that  we  are  not  deposing  before  a  body  of  highly  enlightened 
Physicians,  but  before  a  Jury,  composed  of  men  utterly  unfamiliar  with 
medical  nomenclature  and  the  technicalities  of  Science.  We  couch  our 
answers  in  such  terms  as  to  render  them  worse  than  "  meaningless  jargon  " 
to  the  Jury,  whereas  the  plainest  and  most  familiar  synonyms  should,  in 
our  opinion,  be  selected  to  indicate,  the  organs,  their  conditions,  the  re- 
sults of  injuiries  or  of  diseases,  and,  indeed,  everything  pertaining  to  the 
point  in  question.  What  Jury  on  Earth,  except  a  jury  of  scientific  men, 
could  form  any  definite  idea  of  the  course  of  a  Pistol-ball,  for  instance, 
which,  "  after  penetrating  the  integument  above  the  superciliary  ridge, 
passed  through  the  external  table,  diploic  structure  and  vitreous  layer 
of  the  os  frontis,  then  rupturing  the  three  meninges  ; — dura  mater, 
pia  mater  and  arachnoid,  traversed  the  entire  anteroposterior  diameter 
of  the  cerebrum,  and  in  the  post-mortem  examination,  was  finally  dis- 
covered resting  upon  the  tentorium,  in  close  relation  with  the  torcula 
Herophili  ? — Yet  pistol-balls,  penetrating  exactly  these  structures  and 
pursuing  precisely  the  above  course,  have  been  known  to  produce  death, 
in  cases  which  afterwards  became  the  subject  of  medico-legal  testimony. 
It  would  have  been  more  comprehensible  to  the  Jury,  and  sufficiently 
definite,  to  have  deposed,  that;  the  ball  entered  the  front  part  of  the 
head  and  passed  through  the  brain,  and  was  found,  after  death,  lodged 
against  the  back  of  the  head,  on  the  inner  side. — Technical  terms  an- 
swer very  well  for  the  records  of  Science — they  give  a  definiteness  and 
an  accuracy  to  our  reports,  which  no  other  expression  can  secure;  they 
are  the  language  in  which  the  scientific  man  thinks,  and  these  words 
thus  become  "  the  current  counters  of  the  mind ;"  but  in  our  humble 
opinion,  they  have  no  place  whatever,  unless  we  intend  to  mystify,  in  our 
communications  with  the  uninitiated,  and  especially  have  they  no  place, 
in  medical  depositions  before  any  ordinary  Jury.  Simplicity,  laborious 
simplicity  of  language,  alone  is  applicable  before  the  Court.  Should  we 
inadvertently,  or  through  embarrassment,  (for  these  examinations  are 
sometimes  very  embarrassing,)  use  a  term  which  is  too  professional, 
we  should  hasten  to  render  it  into  one  which  can  be  readily  appre- 
hended ;  and  by  pursuing  this   plan  on  all  such  occasions,   we  have 


1858.]  Editorial  145 

little  doubt  but  that,  we  will  secure  more  confidence  and  respect  for  our- 
selves, and  maintain  a  position  of  greater  dignity  for  our  Profession, 
before  Judges,  Lawyers,  Jurymen  and  lookers-on,  than  we  could  gain  by 
all  the  technicalities  furnished  in  all  the  copies  of  the  whole  fifteen  edi- 
tions of  u  Dunglison's  Medical  Dictionary." 

We  may  be  as  "  wise  as  serpents,"  but  we  had  as  well  be,  as  dumb 
41  as  serpents."  unless  we  speak  in  language  simple  enough  to  be  com- 
prehended by  those  we  address. — We  may  be  like  Moses,  "  learned  in 
all  the  wisdom  of  the  Egyptians,"  but  if  we  unfortunately  employ  the 
Egyptian  dialect,  in  which  to  communicate  our  thoughts  to  others,  the 
generality  of  mankind,  at  the  present  day,  will  never  be  "  a  whit  the 
wiser"  for  it.  Simplicity  of  language  is  indicative  of  meekness,  and 
meekness  we  are  told,  on  the  authority  of  Holy  "Writ,  qualifies  wisdom 
itself;  for  there  it  is  urged,  that,  we  "show,  out  of  a  good  conversation, 
our  works, — with  meekness  of  wisdom" 

Honors  conferred  on  American  Physicians. — We  collect  from  va- 
rious sources,  the  recountal  of  Foreign  honors  bestowed  on  American 
physicians.  We  regard  such  evidences  of  appreciation  as  highly  import- 
ant, as  they  not  only  indicate  the  favor  in  which  Americans  are  held 
abroad,  but  their  recountal  must  have  the  effect  of  encouraging  our 
younger  brethren,  and  stimulating  them  to  deserve  honors  even  though 
they  may  never  receive  them  ; — 

"  Tis  not  in  mortals  to  command  snccess: 
TVe  can  do  more — deserve  it." 

Among  the  number  of  those  honored  with  the  Emperor  of  Russia's 
marks  of  favor,  we  are  gratified  to  find  the  name  of  a  graduate  of  the 
Medical  College  of  Georgia,  our  friend  and  fellow-citizen,  Dr.  W.  J.  Holt, 
now  of  Alabama,  who  has  received  still  another  mark  of  the  Czar's  distin- 
guished and  distinguishing  consideration,  since  the  one  reported  below. 

uDr.  E.  B.  Turnipseed,  now  of  Xew-York.  a  native  of  South-Carolina, 
has  recently  received  from  the  Emperor,  through  Baron  Stceckel,  Puissian 
Minister  at  Washington,  the  decoration  of  the  Russian  order  of  St.  Anne, 
of  the  third  class,  accompanied  by  two  medals  attached  to  the  ribbons 
of  the  orders  of  St.  George  and  St.  Andrew,  in  acknowledgment  of  his 
services  during  the  war.  The  Emperor  has  also  conferred  the  orders  of 
St.  George  and  St.  Andrew  upon  Drs.  Harris,  Holt.  Smith,  Eldridge, 
Johnson,  and  Matthews,  all  American  physicians,  who  were  associated 
with  Dr.  Turnipseed. 

"  The  cross  of  the  order  of  St.  Anne  is  a  neat  piece  of  workmanship, 
set  in  gold  and  enamel.  The  decoration  of  St.  George  is  the  highest 
military  insignia  in  the  empire,  permitted  only  to  those  whose  live?  have 
been  risked  in  the  service  of  the  Emperor.  The  St.  Andrew  ribbon  is 
the  highest  civil  honor.  The  above  facts  we  gather  from  the  Xew-  York 
Daily  Times'' — [Surg.  Reporter. 


106  Editorial  and  Miscellaneous. 


Honors  for  Dr.  Jackson. — "  We  are  gratified  to  record  this  morn- 
ing, that  another  honor  has  been  bestowed  upon  Dr.  Charles  T.  Jackson 
of  this  city,  in  token  of  appreciation  of  the  services  which  he  has  con- 
ferred upon  humanity  as  well  as  science,  by  his  discovery  of  anaesthesia 
by  ether.  The  King  of  Prussia  has  bestowed  upon  him  the  cross  of 
Chevalier  of  the  Red  Eagle,  making  the  fourth  order  of  merit  which  he 
has  received  for  the  same  cause,  besides  one  gold'  medal.  The  cross  of 
Chevalier  of  the  Red  Eagle,  sent  to  Dr.  Jackson,  is  of  solid  silver,  and  is 
of  the  Maltese  form.  It  bears  in  the  centre,  on  obverse,  the  figure  of  the 
red  eagle,  with  shield  on  breast  and  a  wreath  of  laurel  in  his  talons,  this 
being  executed  in  fine  colored  enamel.  On  the  reverse,  the  crown  of 
Prussia,  over  the  initials  of  Frederic  William,  the  King.  The  cross  is 
suspended  on  a  white  ribbon,  bordered  with  a  broad  stripe  of  cinnamon 
color. 

"  We  subjoin  the  letter  of  the  Prussian  Minister,  notifying  Dr.  Jackson 
of  the  new  honor  conferred  upon  him  : — 

"New  York,  30th  November,  1857. 

"  Sir: — With  reference  to  my  letter  to  you  of  the  5th  of  May  last,  I 
have  the  pleasure  of  informing  you  that  his  Majesty  the  King  of  Prussia 
has  been  pleased,  agreeably  to  the  wish  expressed  to  me  in  your  letter 
of  the  18th  April  last,  to  confer  upon  you  the  order  of  Chevalier  of  the 
Red  Eagle,  as  an  acknowledgment  of  your  merits  in  the  discovery  and 
the  application  of  Anaesthesia. 

"  The  said  decoration  I  enclose  hereby,  with  the  printed  '  Thema/ 
marked  No.  19,396,  which  I  beg  you  to  fill  up  by  your  hand  writing, 
and  to  send  it  back  to  me  to  Washington. 

"  I  have  the  honor  to  be,  with  high  consideration, 
"  Your  obedient  servant, 

"Ferd.  Gerolt, 

"  Prussian  Minister. 
u  Chevalier  Charles  T.  Jackson,  Doct.  of  Med.  at  Boston." 

[Boston  Advertiser,  Dec.  2. 

Dr.  Jackson  has  recently  also  had  conferred  upon  him,  by  the  King 
of  Sardinia,  "  the  orders  of  Saints  Maurice  and  Lazarus,"  in  recognition 
of  his  eminent  services  to  humanity,  and  the  patent  and  decoration  of 
the  order  have  been  sent  to  him. 

"  We  have  certainly  every  reason  to  be  proud  (says  the  Buffalo  Med. 
Journal,)  of  the  appreciation  which  the  services  of  our  countrymen  met 
with,  during  the  last  war,  from  Russia  and  the  French.  The  restless 
spirit  of  a  true  American  is  so  powerful  that  it  cannot  be  subdued  even 
by  the  studies  and  experiences  of  medical  life,  and  the  opportunities 
open  to  the  medical  man  for  gratifying  this  propensity,  are  so  few,  that 
a  war  such  as  the  last,  is  a  perfect  Godsend.  We  see  this  exemplified 
in  the  numberless  applications  for  appointments  in  the  army  and  navy, 
where,  on  this  account,  the  examinations  have  been  made  so  rigid,  and 
the  standard  of  merit  has  been  placed  so  high,  that  a  comparatively 
small  proportion  are  accepted.  Wherever  our  countrymen  go,  however, 
they  leave  the  impress  of  characteristic  energy  and  zeal  in  doing  what 
they  have  to  do,  as  is  exemplified  by  the  gratifying  testimonials  which 
have  been  presented  to  them  by  the  Russian  Emperor." 


SOUTHERN 

MEDICAL  AID  SURGICAL  JOUMAL. 

(NEW  SERIES.) 

Fol.  XIV,]  AUGUSTA,  GEORGIA,  MARCH,  1858.  [No.  S. 

■  '  ■  ■       ■        ,  — ; 

ORIGINAL  AND  ECLECTIC. 

ARTICLE   VII. 

The  Appropriate  Treatment  of  Dysentery. — A  Clinical  Lecture, 
delivered  at  Jackson-street  Hospital.  By  Kobert  Campbell, 
A.M.,  M.D.,  Demonstrator  of  Anatomy  in  the  Medical  Col- 
lege of  Georgia. 

"  All  practical  medicine  depends  upon  a  knowledge  of  three  things — to  wit : 
1st.  Pathology;  2nd,  The  articles  or  agents  of  the  materia  medica;  and,  3rd.  The 
relations  between  these  two  elements" — [Baktlett's  Philosophy  of  Med.  Science. 

Gentlemen  : 

In  our  discussion  of  the  "Treatment  of  Dysentery,"  so  varied, 
inappropriate  and  often  irrational  and  incompatible  were  the 
measures,  found  to  have  dominion  over  this  most  important  and 
common  field  of  interest — that  it  became  necessary  for  us  to 
inquire  into  their  value,  as  well  as  the  appropriateness  of  their 
application  to  the  existing  state  of  this  disease,  and  also  into  the 
probabilities  which  were  derived  therefrom,  in  favor  or  against 
accomplishing,  by  them,  the  relief  of  that  condition. 

And  thus,  were  we  obliged  to  lead  you  back  to  "first  princi- 
ples," in  giving  you  a  common-sense  view  of  these  different 
systems,  that  you  might  apply  the  gauge  of  reason  to  whatever 
of  error  or  assumption  might  have  obtained  sanction  in  these 
premises,  and  so  be  enabled  to  select  from  the  varied  and  an- 
tagonistic doctrines  in  vogue,  whatever  of  good  they  might 
contain,  to  the  rejection  of  that  which  might  operate  in  direct 
opposition  to  the  attainment  of  the  ultimate  object  in  view.  In 
n.  s. — VOL.  XIV.  no.  in.  1 


108  Campbell's  Lecture  on  Dysentery.  [March, 

short,  we  have  thus  dwelt,  to  some  extent  upon  this  subject,  for 
the  express  purpose  of  co-ordinating  and  systematising  the  treat- 
ment of  this  disease.  And  we  have  been  able  to  gather,  in  our 
survey  of  this  field,  some  facts  which  were  good  and  fit  to  garner 
up,  but  so  scatteringly  have  they  been  strewn,  and  so  commingled 
have  they  been  with  the  greater  amount  of  worse  than  useless 
and  pernicious  chaff — so  much  have  these  principles  been  found 
to  operate  to  the  effect  of  "  blowing  hot  and  cold  together" — as 
to  call  for  the  exercise  of  much  discrimination  and  the  adoption 
of  a  system  of  stern  and  uncompromising  selection. 

Some  of  the  plans  of  treatment  in  use — and  by  far  the  most 
valuable — we  have  yet  to  notice. 

There  have  been  proposed,  from  time  to  time,  many  valuable 
remedies  for  the  relief  of  this  disease — and  would  it  not  have 
been  remarkable,  at  this  stage  of  the  world's  history,  if  accident 
or  experiment  had  not  pointed  out  the  fact,  that  the  exhibition 
of  certain  medicinals  was  followed  by  good  results  in  this  dis- 
ease ;  and  this  knowledge  had  not  come  in  reference  to  those 
agents,  under  these  circumstances •,  empirically ;  especially,  when 
we  consider,  that  thus,  is  first  derived  almost  all  of  our  know- 
ledge concerning  the  action  of  remedies  in  general  ? 

But  in  this  case,  whether  from  the  conflict  between  a  false 
conception  of  the  pathology  of  this  disease  and  the  manifest  re- 
sults of  these  agents;  or  from  the  stubbornness  of  preconceived 
notions  in  perverting  the  interpretation  of  these  manifest  results, 
it  appears  always  to  have  happened — that  although  there  has 
been  long  in  use,  some  appeopei ate  teeatment  for  this  disease, 
yet  it  has  existed  in  such  fragmentary  parcels,  and  has  been  so 
mixed  up  and  incongruously  yoked  with  so  much  of  counter- 
vailing force,  as  steadily  to  have  maintained,  here,  an  unsettled 
state  of  our  science,  or  an  entire  stasis  in  this  particular. 

And  this  brings  us  to  notice  a  certain  class  of  remedial 
agents,  which  constitute  what  we  may  call  the  "appropriate 
treatment"  of  this,  the  intestinal  element  of  Dysentery,  on  ac- 
count of  the  applicability  and  the  correspondence  of  their  thera- 
peutic action — their  specific  agency,  in  supplying  the  demands 
incident  to  this  diseased  state,  as  determined  by  the  characteris- 
tic qualities  of  the  organ  and  tissue  involved,  as  well  as  the 
circumstances  in  which  they  are  found,   and  whose  abnormal 


1858.]  Campbell's  Lecture  on  Dysentery.  109 

condition  constitutes  this  disease ;  and  especially,  as  experience 
has  taught  us,  that  all  or  most  of  this  group  of  remedial  agents 
have  been  found  invaluable  for  the  cure  of  this  very  disease. 

Let  us  now  return  and  see,  what  are  the  indications,  which 
are  involved  in  this  local  condition,  and  what  are  these  reme- 
dies, whose  specific  properties  of  action,  experience  has  taught 
us  to  be  of  that  character,  which  would  be  best  adapted  to  meet- 
ing the  exigencies  of  this  case.  We  have  seen,  that  there  were 
two  indications  derived  from  our  consideration  of  the  state  and 
circumstances  of  the  intestinal  element  of  Dysentery.  We  will 
now  consider  them  separately. 

First — There  is  Inflammation  of  a  Mucous  Membrane — requir- 
ing ITS  OWN  PECULIAR  TREATMENT. 

Now,  the  Science  of  Therapeutics  may  be  said  to  have  been 
based  upon  the  fact,  that  certain  agents,  derived  from  the  three 
great  kingdoms  of  Nature,  are  found  to  exert  a  decided  influ- 
ence upon  the  living  organism  when  brought  in  relation  with 
it;  and  farther,  that  "they  have  particular  tendencies  towards  cer- 
tain parts  of  the  body,  over  which  parts  they  exert  a  peculiar  and 
special  influence"*  The  arrangement  of  medicines,  or  their 
classification,  is  made  according  to  the  knowledge  of  what  these 
tendencies  are.  And,  says  Headland,  (in  his  recent  and  very 
valuable  "Essay  on  the  Action  of  Medicines,")  "This  classi- 
fication is  certainly  more  scientific  than  a  mere  empirical  ar- 
rangement ;  and  it  will  be  so  far  of  use,  that  it  will  enable  us 
when  we  wish  to  make  an  impression  on  a  certain  organ  or  set 
of  organs,  to  select  those  medicines  which  especially  influence  it 

or  them There  is  no  doubt  whatever,"  says  he,  "of  the 

existence  of  these  local  tendencies  or  partialities, — their  proof," 
he  continues,  "depending  in  part  upon  the  fact,  that  medicinal 
agents  are  actually  detected,  in  many  cases,  in  the  very  organs 
over  which  they  exert  a  special  influence." 

It  is  maintained,  on  the  high  authority  above  quoted — "  that 
medicines  must  (as  a  general  rule)  obtain  entry  into  the  fluids  of 
the  body — pass,  that  is,  from  the  intestinal  canal  into  the  system 
at  large — before  their  action  can  begin" — unless — we  would 
suggest — the  part  to  be  affected  by  them  be  external  or  superfi- 
cial and  their  immediate  application  is  thus  rendered  practicable. 

*  Headland. 


110  Campbell's  Lecture  on  Dysentery.  [March, 

And  just  here,  we  would  object  to  the  proposition,  as  a  general 
rule,  which  requires  in  all  cases,  that  every  particle  of  all  kinds 
of  medicines  must  be  absorbed  into  the  circulating  mass,  before 
they  can  manifest  their  peculiar  action  in  the  direction  of  their 
appropriate  organ  or  tissue.  For  instance,  in  the  case  of  the 
mucous  tissue  of  the  alimentary  canal — the  very  surface  upon 
which,  as  a  general  thing,  all  medicines  are  thrown — why  may 
not  these  agents  be  applied  in  sufficient  quantity,  as  not  to  ad- 
mit of  an  entire  absorption  of  every  particle,  to  travel  the  round 
of  the  circulation  and  be  directed  to  the  same  surface  by  which 
they  were  taken  up,  before  they  can  manifest  their  peculiar 
agency — when  their  application  is  primarily  and  immediately 
made  to  that  superficial  surface  ? 

The  advantage  here  is,  that  whilst  such  a  surface  is  acted  upon 
in  the  usual  way,  that  is — according  to  this  author — by  impart- 
ing its  impression  or  influence  to  the  tissue  or  organ  in  its  transit 
through  it,  or  its  elimination  by  it,  (for  this  is  the  manner  in 
which  he  accounts  for  the  action  of  medicines  upon  secerning 
organs  and  tissues,  generally) ;  in  this  case,  the  tissue  has  the 
advantage  of  its  first  contact  and  its  transit  through  it,  into  the 
circulation,  as  well  as  its  return  through  the  tissue,  to  be  elimin- 
ated in  its  proper  form,  by  the  mucous  follicles  of  this  surface. 
Take,  for  instance,  the  action  of  Turpentine,  whose  modus 
operandi  he  explains  in  the  manner  just  given — Are  we  to  un- 
derstand, that  all  the  Turpentine  voided  in  the  alvine  discharges, 
has  gone  the  round  of  the  circulation  and  has  been  secreted,  as 
Turpentine,  by  the  mucous  follicles  of  the  intestinal  canal?  Be 
it  so — its  operation  must  be  the  same,  and  upon  the  same  tissue. 
But  we  prefer  to  believe,  that  a  good  portion  of  it  becomes  mix- 
ed with,  and  impregnates,  the  contents  of  the  canal,  and  thus 
passes  by  the  shorter  route,  in  contact  with,  and  imparting  its 
influence  to,  this  surface. 

But  to  return — There  is,  in  Dysentery,  an  inflammation  of 
a  mucous  membrane,  REQUIRING  ITS  OWN  peculiar  treat- 
ment. 

Now,  the  treatment  of  this  inflamed  mucous  membrane  is  to 
be  derived  from  that  class  of  remedies,  unquestionably,  whose 
known  specific  qualities  of  action,  affect  the  condition  of  this 
tissue,  wherever  it  exists.     Then  let  us  see,  what  articles  of  the 


1858.]  Campbell's  Lecture  on  Dysentery.  Ill 

Materia,  Medica,  are  found  to  be  suitable  for  supplying  the  de- 
mands conveyed  in  the  proposition  here  reiterated. 

There  is  Ipecac — a  "  mucous  membrane  remedy,"  whose  value 
as  a  remedial  agent  was  first  disclosed  by  the  benefit  derived 
from  its  use  in  Dysentery;  and  consequently,  this  has  ever 
since  been  considered,  by  many,  a  reliable  form  of  treatment  for 
this  very  disease. 

It  is  recorded,  that  "  John  Helvetius,  grandfather  of  the  cele- 
brated author  of  that  name,  having  been  associated  with  a  mer- 
chant who  had  imported  a  large  quantity  of  Ipecacuanha  into 
Paris,  employed  it  as  a  secret  remedy,  and  with  so  much  success 
in  Dysentery  and  other  bowel  affections,  that  general  attention 
was  attracted  to  it ;  and  the  fortunate  physician  received  from 
Louis  XIV.,  a  large  sum  of  money  and  public  honors,  on  the 
sole  condition  that  he  should  make  the  remedy  public.  From 
this  period  it  has  maintained  its  standing  among  the  most  useful 
articles  of  the  Materia  Medica." 

Dr.  "Wood  says  that — "  In  Dysentery  it  has  been  supposed  to 
exercise  peculiar  powers,  but  is  at  present  less  used  than  former- 
ly, in  doses  sufficient  to  excite  vomiting." 

Now,  these  peculiar  powers,  we  would  venture  to  suggest,  are 
alone"  dependent  upon  the  specific  properties  of  this  remedy,  in 
altering  the  condition  of  the  mucous  tissue,  wherever  it  exists — 
this  being  a  disease  whose  local  element  is  an  inflamed  mucous 
membrane — hence  the  benefit  derived  from  its  use.  And  if 
proof  of  this  proposition  is  demanded,  it  may  be  established 
from  the  experiments  of  Magendie,  with  the  active  principle  of 
this  agent,  from  which  it  was  shown  "  to  have  a  peculiar  direc- 
tion to  the  mucous  membrane  of  the  alimentary  canal  and  the 
bronchial  tubes.  Ten  grains  of  the  impure  alkali,  administered 
to  dogs,  were  generally  found  to  destroy  life  in  twenty-four 
hours,  and  the  mucous  membranes  mentioned  were  observed  to 
be  inflamed  throughout  their  whole  extent."  And  further,  it  is 
stated,  that  the  "same  result  took  place  when  emetia  was  inject- 
ed into  the  veins,  or  absorbed  from  any  part  of  the  body." 
And  with  the  same  testimony  may  be  placed  the  effect  of  the 
inhalation  of  the  powder  of  Ipecac  into  the  lungs,  producing 
bronchitis,  as  well  as  its  injection  into  the  veins,  giving  rise  to 
pneumonia,  as  was  shown  by  Magendie's  experiments.     When 


112  Campbell's  Lecture  on  Dysentery.  [March, 

Ipecacuanha  is  employed  in  this  disease,  it  is  not  used  as  an 
emetic,  but  as  an  "  anti-dysenteric" — for  its  introduction  into 
the  rectum,  without  causing  vomiting,  is  said  to  be  just  as  effi- 
cacious as  when  taken  into  the  stomach ;  and  that  it  has  been 
found  to  be  most  beneficial  when  tolerated.  This  tolerance  is 
urged  by  some  practitioners  to  the  extent  of  causing  the 
retention  of  very  large  doses,  without  inducing  vomiting,  even 
3j.  doses  being  administered  every  two  or  three  hours  in  some 
cases. 

Although  Ipecac  is  a  remedy  whose  specific  properties  are 
determined  to  the  mucous  tissue,  and  therefore  being  appropri- 
ate in  its  application  to  Dysentery ;  and  although  it  still  has 
many  advocates — yet  there  are  elements  to  be  derived  from  the 
same  group  of  agents,  to  which  it  belongs,  which  are  less 
objectionable  in  many  respects,  and  which  appear  far  more 
suitable  and  are  more  decidedly  efficacious  in  the  cure  of  this 
disease. 

Now,  among  this  group  of  remedies,  which  may  be  said  to  be 
rationally  specific  in  this  disease,  we  find  also,  Benzoin,  Balsam 
Copaiba,  Creosote,  Turpentine  and  the  like — all  which  are  well 
known,  rightly  to  merit  a  place  in  this  class  of  remedial  agents — 
each  presenting  sufficient  testimony  in  its  favor,  to  prove  its  ap- 
plicability to  the  disease  under  consideration ;  and  were  all  other 
evidences  absent,  of  the  ultimate  nature  of  this  disease — the  fact 
that  these  remedies,  whose  operations  were  manifested  in  the 
production  of  certain  phenomena,  whether  under  health  or  dis- 
ease, in  the  mucous  tissues  of  the  body,  as  found  in  other  situa- 
tions— the  very  remarkable  results  of  their  exhibition  in  the 
relief  of  Dysentery,  might  be  taken  as  rational  grounds  for  de- 
termining the  situation  and  character  of  this  affection.  And 
thus  might  Therapeutics  furnish  the  link  and  clue  in  a  broken 
and  obscure  Pathology. 

The  tincture  of  Benzoin,  or  "  Tinctura  Benzoini  Composita" 
of  the  Pharmacopoeias  has  been  recommended  in  doses  of  from 
f  3ss  to  f  3ij,  as  a  valuable  agent  in  some  of  the  stages  of  Dysen- 
tery, and  our  limited  experience  of  a  single  case  would  bear 
testimony  thus  far,  to  the  validity  of  its  claims  to  consideration. 
That  case  was  one  in  which,  after  a  very  severe  attack  of  Dy- 
sentery, in  an  extremely  feeble  constitution,  it  became  compli- 


1858.]  Campbell's  Lecture  on  Dysentery.  113 

cated  with  Diarrhoea,  and  the  appropriate  response  to  either  of 
the  indications,  manifested  in  the  mixed  character  of  the  symp- 
toms, having  failed  to  relieve,  or  having  appeared  even  to 
aggravate  this  condition — the  plan  was  adopted  of  treating  the 
inflamed  tissue,  irrespective  of  the  number  and  character  of  the 
discharges,  and  the  effect  was  magical — the  patient,  a  physician's 
wife,  was  convalescent  very  shortly  after  the  change  of  treat- 
ment, and  perfectly  recovered.  We  are  aware,  that  by  citing  a 
single  case  to  establish  any  point,  we  are  laying  ourselves  liable 
to  the  charge  of  driving  a  post  hoc,  propter  hoc  conclusion,  but 
we  give  you  that  isolated  fact  at  what  it  is  worth,  supported  as 
it  is  by  the  commendation  of  the  remedy,  by  others,  based  upon 
a  more  extended  scale  of  experience ;  and  would  advise  you  to 
bear  that  fact  in  mind,  to  serve  you,  if  ever  a  similar  set  of 
complex  circumstances  as  above  recounted,  should  demand  its 
application,  as  the  only  alternative. 

"We  quote  from  an  article*  in  the  London  Lancet,  the  follow- 
ing paragraph,  viz. — "  When  the  functions  of  the  colon  are 
performed  in  a  healthy  manner,  the  fasces  are  figured,  of  a  firm 
consistence,  and  of  the  well-known  color.  In  Dysentery,  or,  as 
is  sometimes  called,  colitis,  this  function  is  completely  in  abey- 
ance ;  but  whether  this  is  produced  by  the  relaxed  state  of,  and 
consequent  want  of  tone  in,  the  muscular  coat,  or  from  the  ex- 
treme irritability  of  the  mucous  membrane  of  the  intestines,  or 
of  the  character  of  its  contents,  or  all  combined,  I  cannot  deter- 
mine. The  compound  tincture  of  Benzoin  I  have  found,  when 
administered  in  this  disease,  particularly  useful  in  restoring,  and 
that  in  a  very  short  time,  this-  function  of  the  colon.  Whether 
it  also  acts  beneficially  by  protecting  and  sheathing  the  ulcer- 
ated portions  of  the  gut,  or  by  its  stimulating  qualities  induces, 
just  as  it  does  in  chronic  ulcers  of  the  surface,  the  reparative 
processes  to  go  on  more  rapidly,  I  am  unable  to  determine.  The 
tincture  of  Benzoin,  I  need  scarcely  say,  consists  of  Benzoin, 
Styrax,  Tolu,  a  small  quantity  of  Aloes,  and  spirit.  The  dose 
generally  given  is  from  fifteen  to  twenty  minims."  The  writer 
then  reports  a  number  of  instances  in  which  he  had  met  with  its 
striking  beneficial  effects. 

The  marked  benefit,  so  long  known  to  be  derived  from  the 

*  On  the  Treatment  of  Chronic  Dysentery.     By  R.  W.  Ellis,  M.R.C.S.E.,  Bristol 


114  Campbell's  Lecture  on  Dysentery.  [March, 

application  of  this  balsam,  to  ulcers  and  wounds,  may  have  some 
reference  to  its  mode  of  operation,  when  applied  to  the  sore  sur- 
face of  the  mucous  membrane,  in  this  disease. 

The  influence  of  Balsam  Copaiba  over  the  mucous  membrane 
lining  the  urethra  is  familiar  to  every  tyro  in  medicine.  Ac- 
cording to  Pereira,  "it  also  acts  as  a  stimulant,  but  in  a  less 
marked  manner,  to  other  mucous  membranes;  namely,  the 
bronchial  and  gastro-intestinal  membranes."  He  states  further, 
that  "  the  greater  influence  of  Copaiba  over  the  urethral  than 
over  other  mucous  membranes  is  by  some  explained  thus : — 
Besides  the  influence  which  this  receives  in  common  with  the 
other  membranes  of  the  same  class,  by  the  general  circulation, 
it  is  exposed  to  the  local  action  of  Copaiba  contained  in  the 
urine,  as  this  fluid  is  expelled  from  the  bladder.  If  this  hypo- 
thesis were  correct,  the  influence  of  Copaiba  over  the  mucous 
lining  of  the  bladder  would  be  greater  than  that  over  the  urethral 
membrane."  Now,  the  fact  is  here  plainly  enough  enunciated — 
that  whilst  this  group  of  medicines  are  classified  because  of  their 
peculiar  property  of  spending  their  agency  upon  the  mucous 
tissue  wherever  it  exists,  there  are  at  the  same  time  individuals 
of  this  group,  which  although  exerting  their  influence  upon  this 
tissue  everywhere,  yet,  having  a  more  decided  control  over  its 
condition  in  certain  parts — owing  perhaps  to  the  slight  modifi- 
cation of  structure  in  those  special  localities,  dependent  upon  the 
variable  office  required  of  this  component  tissue  to  perform,  as 
involved  in  the  function  of  its  own  complex  organ.  And  it  is 
equally  true,  that  some  of  the  members  of  this  class  of  agents 
are  found  to  be  of  more  restricted,  while  others  are  of  more 
general,  applicability : — i.  e.,  that  some,  whilst  they  act  on  all 
mucous  membranes  more  or  less,  act  upon  that  tissue  in  a  very 
decided  manner,  only  as  it  exists  in  one  or  two  situations — while 
others,  operate  in  a  marked  degree  in  all  or  nearly  all  its  distri- 
butions, as,  for  instance,  is  the  case  with  Turpentine. 

J&  regards  Balsam  Copaiba  otherwise,  than  in  its  special  ap- 
plication, Dr.  Cullen  spoke  favorably  of  its  use  in  hemorrhoids, 
about  a  century  ago.  He  says,  "  I  have  learned  from  an  empi- 
rical practitioner,  that  it  gives  relief  in  hemorrhoidal  affections ; 
and  I  have  frequently  employed  it  with  success.  For  this  pur- 
pose it  is  to  be  given,  from  20  to  40  drops,  properly  mixed  with 


1858.]  Campbell's  Lecture  on  Dysentery.  115 

powdered  sugar,  once  or  twice  a  day."  Since  his  time,  it  has 
been  used,  variously  combined,  with  happy  results,  in  other 
affections  of  the  intestinal  canal,  as  for  instance,  "in  chronic  in- 
flammation of  the  mucous  membrane  of  the  bowels,  especially  of 
the  colon  and  rectum."  One  of  the  properties  of  this  medicine, 
as  generally  laid  down  in  its  history,  and  as  is  familiar  to  every 
practitioner,  is  that  of  acting  somewhat  upon  the  bowels  as  a 
purgative,  or  rather  laxative.  And  there  are  to  be  obtained,  by 
a  perusal  of  the  recorded  history  of  practical  medicine,  glimpses 
of  evidence  scattered  here  and  there,  of  the  great  value  of  this 
agent  in  the  treatment,  not  only  of  the  chronic,  but  of  every 
stage  of  the  disease  now  under  consideration.  In  fact,  the  term 
chronic,  is,  for  the  most  part,  of  arbitrary  significance — some  de- 
signating such  cases  thus,  which  are  not  relieved,  in  what  they 
consider  a  reasonable  length  of  time ;  while  others,  especially  in 
reference  to  this  disease,  apply  this  qualification  to  such  cases  as 
those  in  which  the  symptoms  are  prolonged  by  persistent  ulcer- 
ations in  the  mucous  membrane  of  the  intestine,  which  owed 
their  existence  to  an  attack  of  Dysentery. 

Dr.  LaHoche,  in  an  essay  on  this  subject,  bears  staunch  testi- 
mony to  the  efficacy  of  Balsam  Copaiba  in  this  disease.  As 
likewise  does  Dr.  Meigs,  of  Philadelphia.  This  is  used  accord- 
ing to  Eberle's  formula,  that  is,  in  emulsion  made  with  sugar 
and  gum  arabic,  or  dropped  upon  sugar.  A  friend  of  ours,  who 
is  an  intelligent  physician,  informs  us,  that  he  has  no  other 
treatment  for  Dysentery  than  the  Balsam  Copaiba ;  and  that  his 
success  with  this  agent  leaves  no  room  for  a  desire  to  improve 
his  treatment. 

Such  is  the  written,  as  well  as  the  un-recorded  testimony  in 
behalf  of  this  measure ;  and  although  we  are  not  able  to  bespeak 
its  adoption,  from  our  own  experience,  yet,  we  must  say,  upon 
the  testimony  of  others,  and  considering  the  acknowledged  at- 
tributes of  the  remedy  in  relation  to  our  conception  of  its  appli- 
cability to  the  peculiar  requirements  of  the  diseased  condition, 
organ,  and  tissue  involved,  we  would  heartily  endorse  it,  as  a  mode 
of  treatment,  never  to  be  lost  sight  of,  with  reference  to  Dysentery. 

Creosote  has  recently  gained  much  advocacy  in  the  treatment 
of  Dysentery.  It  was  first  used  by  Dr.  Wilmot,  as  a  remedy  in 
this  disease,  in  its  local  application  by  enema.     Thus,  it  is  re- 


116  Campbell's  Lecture  on  Dysentery.  [March, 

corded  in  Banking's  Abstract  for  1846,  that — "In  a  severe  form 
of  Dysentery  which  occurred  near  Tunbridge  Wells,  and  in 
which  all  methods  of  treatment  appeared  unsuccessful,  the  mor- 
tality being  as  high  as  25  per  cent.,  Dr.  Wilmot  thought  of 
trying  Creosote  enemata  in  the  strength  of  3j.  to  fxij.  of 
Starch.  This  remedy  produced  a  speedy  amelioration  of  the 
disease.  It  will  be  perceived,  that  this  agent  must  have  acted, 
under  these  circumstances,  for  the  most  part,  by  its  immediate 
application  to  the  diseased  tissue.  More  recently,  valuable  re- 
sults have  been  obtained  nearer  home,  and  principally  in  the 
West,  from  the  internal  or  per  orem  administration  of  this 
remedy. 

In  our  Lecture  on  the  Pathology  of  Dysentery,  delivered  in 
November,  you  will  recollect,  that  we  had  occasion  to  quote 
from  an  article  entitled  "Creosote  in  Dysentery,"  by  Dr.  Wm. 
H.  McMath,  which  furnished  decided  proof  of  the  value  of  that 
agent,  in  the  treatment  of  this  disease.  We  have  just  had  the 
good  fortune  to  meet  with  another  very  excellent  contribution 
to  the  New  Orleans  Medical  and  Surgical  Journal — "  An  Essay 
on  the  ^Etiology,  Pathology,  and  Treatment  of  Epidemic  Dys- 
entery,"* which  adds  a  volume  of  evidence  in  favor  of  the  great 
consideration  to  which  this  agent  is  entitled,  as  a  remedy  for  this 
disease.  The  author,  after  dwelling  upon  the  Pathology,  &c, 
of  the  disease,  in  which  we  are  gratified  to  find,  that  some  of  his 
views  are  in  accordance  with  our  own — viz.,  in  this,  that  "  A 
Dysentery  having  its  origin  from  the  general  condition  of  the 
atmosphere  differs  from  the  intermitting  and  remitting  fever 
only  in  the  intestinal  affection,  and  requires  a  similar  treat- 
ment"— then  makes  the  following  record  of  his  practice,  and 
that  of  others,  upon  the  same  plan — viz :  "I  have  usually  open- 
ed the  treatment  by  administering  some  mild  purgative,  and  a 
favorite  one  with  me  has  been  a  combination  of  Hydrarg.  Cum 
Creta  and  Pulvis  Ehei ;  assisted,  if  necessary,  with  the  Syrup  of 
Ehubarb.  After  the  action  of  which,  I  prescribe  the  following 
mixture : 

$. — Creosote,  gtt.  x.;  Acetic  Acid,  gtt.  xx.;  Sulphate  of  Mor- 
phine, gr.  ij.;  Oil  of  Sassafras,  gtt.  iv.;  Distilled  Water,    I  j.;  in 

*  By  Joseph  B.  Payne,  M.  D.,  of  Magnolia,  Arkansas. 


1858.]  Campbell's  Lecture  on  Dysentery.  117 

teaspoonful  doses  every  three  hours,    until  the  discharges  are 
checked,  and  the  bowels  quieted.* 

If  there  was  any  visible  remission  in  the  febrile  symptoms,  I 
usually  anticipate  that  period  with  the  administration  of  Quin- 
ine. Such  is  the  treatment  I  have  followed,  in  passing  through 
two  epidemics,  and  success  has  crowned  it  in  nearly  every  effort. 
I  could  enumerate  case  after  case  where  this  course  has  been 
followed,  and  success  the  result.  I  have  seen  and  assisted  in 
treating  in  all,  more  than  two  hundred  cases  of  Dysentery.  In 
the  October  number  of  the  Nashville  Journal  of  Medicine  and 
Surgery,  (page  306,)  there  is  a  short  article  by  J.  W.  Brown,  on 
the  use  of  Creosote  in  Dysentery.  He  says,  "  Drs.  McMath  and 
Gilder,  of  Louisville,  Arkansas,  tell  me  they  have  treated  as 
many  as  three  hundred  cases,  and  in  all  proving  perfectly  satis- 
factory, under  the  use  of  Creosote."  Their  prescription,  as  is 
given  by  Dr.  Brown,  is  the  same  as  I  have  given  it,  except  the 
oil  of  Sassafras,  which  is  an  addition  of  my  own,  merely  to  cover 
the  disagreeable  smell  and  taste  of  the  Creosote,  which  it  effect- 
ually does.  "  Now,  if  there  is  any  honor  due  to  the  builder  of 
this  recipe,  and  its  use  advised  in  the  treatment  of  Dysentery 
(which  there  undoubtedly  is),  that  honor  is  due  to  Professor  A. 
P.  Merrill,  of  the  Memphis  Medical  College.  I  saw  him  use  it 
both  in  Dysentery  and  Diarrhoea,  with  the  happiest  effects. 
When  I  returned  home,  I  informed  my  preceptor,  Dr.  Gilder, 

*  As  to  "  checking  the  discharges"  with  an  opiate,  we  think  the  Doctor  is  in 
error;  and  we  would  here  beg  leave  to  object  to  the  Morphine,  as  an  ingredient 
in  the  Creosote  mixture — as  we  conscientiously  believe  the  indiscriminate  and 
unconditional  routine  of  administering  Morphine  every  three  hours,  to  be  detri- 
mental— a  drawback  to  the  plan  of  treatment — and  that  the  Creosote  in  these 
cases  manifests  its  curative  powers,  in  spite  of  the  hindrance.  Mr.  Headland's 
opinion,  as  regards  certain  effects  of  Opium,  is  the  following : — He  says,  "  Opium 
is  a  diaphoretic ;  but  it  diminishes  all  the  other  secretions,  and  most  especially 
that  of  the  bowels.  It  is  certain  that  there  are  other  narcotics  and  sedatives 
which  are  able  to  relieve  pain,  but  which  neither  cause  constipation,  nor  produce 
cerebral  congestion."  And  again,  "  Opium  is  a  general  paralizer  to  muscular 
fibre,  both  of  the  voluntary  and  involuntary  kind,  but  particularly  of  the  latter. 
And  the  only  reasonable  attempt  that  can  be  made  to  explain  the  action  of  Opi- 
um in  producing  constipation,  is  by  a  reference  to  this  its  paralyzing  influence  on 
the  coat  of  the  bowel,  taken  in  conjunction  with  the  torpid  condition  of  the  gen- 
eral system,  and  suspension  of  the  animal  functions,  produced  by  the  secondary 
action  of  this  narcotic  on  the  nervous  forces." 


118  Campbell's  Lecture  on  Dysentery.  [March, 

of  the  use  of  Creosote  in  Dysentery,  and  we  both  passed  through 
the  epidemic  of  1855,  as  above-mentioned.  Drs.  McMath  and 
Gilder  have  since  used  it  with  unequalled  success." 

Now,  as  to  the  therapeutic  properties  of  this  agent — accord- 
ing to  Mr.  Headland — "  Creosote  stands,  as  a  medicine,  between 
Hydrocyanic  Acid  and  Turpentine.  It  has  a  double  action; 
being  anodyne,  like  the  former ;  and  a  mucous  stimulant,  like 
the  latter."  Also,  that  "  Creosote  is  a  sedative,  and  cannot  be 
well  given  in  such  large  doses  as  to  act  upon  distant  parts."  As 
such  a  practice  would  be  attended  with  danger. 

It  will  be  perceived  from  the  foregoing,  that  the  treatment  of 
Dysentery  with  this  element,  from  among  that  class  of  remedies 
which  exert  an  influence  upon  the  mucous  tissue — constitutes  it 
an  "  appropriate  treatment" — the .  importance  of  which  is  suffi- 
ciently established,  and  it  is  amply  commended  to  you  as  such, 
by  the  recorded  results  of  its  wonderful  operation.  Although, 
from  our  want  of  practical  experience  with  the  remedy,  we  can 
furnish  no  additional  support,  from  our  own  observation  upon 
this  subject ;  yet,  we  would  have  you  ever  to  be  mindful  of  the 
tenor  of  the  commanding  testimonials,  in  relation  to  the  efficacy 
of  Creosote  in  the  treatment  of  Dysentery. 

Now,  with  reference  to  the  modus  operandi  of  this  class  of 
agents,  Mr.  Headland  remarks — that  "  Certain  stimulant  elimin- 
atives  are  employed  for  the  purpose  of  checking  mucous  fluxes, 
and  so  far  simulate  the  action  of  true  astringent  medicines.  Thus 
we  administer,  with  more  or  less  advantage,  Aromatics  in  Diar- 
rhooa ;  Cubebs,*  Copaiba,  and  Turpentine  in  Gonorrhoea ;  and 
Balsam  of  Peru,  and  other  Oleo-resins  in  Catarrhal  affections. 
These  medicines  may  act  upon  and  pass  through  the  glands  of  the 
several  mucous  surfaces  which  they  affect ;  while  so  doing,  they  may 
stimulate  the  healthy  function  and  secretion  of  the  glands,  and  cause 
it  to  displace  the  morbid  one.  Dr.  Williams  thinks  that  they  first 
cause  dilatation  of  the  vessels  of  a  gland,  and  that  this  is  follow- 
ed by  contraction.  There  is  no  apparent  reason  why  the  latter 
effect  should  succeed  the  former.  But  supposing  contraction  to 
take  place  in  this  way,  then  these  medicines  would  be  true  as- 

*  We  see  that  Dr.  Stokes  mentions  Cubebs,  as  being  a  good  addition  to  prepa- 
rations of  Balsam  Copaiba,  when  used  in  Dysentery. 


1858.]  Campbell's  Lecture  on  Dysentery.  119 

tringents.  But  it  cannot  be  so,  for  they  do  not  diminish  any  of  the 
natural  secretions,  hut,  on  the  contrary,  increase  them.  Turpentine, 
Cubebs,  and  Copaiba,  are  diuretics,  and  it  is  possible  that  while 
passing  out  in  the  urine  they  may  simply  stimulate  the  mucous 
surface  of  the  inflamed  urethra,  and  excite  it  to  a  healthy  action." 
And  in  speaking  of  eliminatives  again,  he  further  remarks,  that 
"it  is  laid  down  as  a  rule,  that  they  act  by  themselves  passing  out 
of  the  blood  through  the  glands,  and  that  while  so  doing  they  excite 
them  to  the  performance  of  their  natural  function."*  And  as  re- 
gards their  ultimate,  special  influence  over  the  tissue  with  which 
they  come  in  intimate  relation,  whether  by  being  applied  to  its 
surface,  or  by  being  eliminated  through  it — it  may,  for  conven- 
ience, be  reduced  to  the  interpretation  which  attributes  it  to  an 
alterative  effect ;  for  beyond  this,  any  speculation  possessed  of 
plausibility,  will  subserve  the  purposes  of  explanation : — that  is, 
"  Alterative,  because  the  manifestations  of  vital  action  are  some- 
what different  after  its  use  from  what  they  were  before."f 
Then  we  would  say,  that  this  class  of  remedies  exhibit  their  bene- 
ficial effects  by  inducing  a  healthy  change  in  the  condition  of  that 
tissue,  (when  under  diseased  action,)  over  which,  their  influence 
is  known  to  have  control. 

And  now,  gentlemen,  we  rest  assured  that  we  are  not  taking 
too  much  for  granted,  when  we  express  the  confidence  we  feel, 
that  ere  this,  your  minds  are  fully  persuaded  of  the  truth  of  the 
proposition  laid  down  to  you  as  the  basis  of  the  investigations 
just  made — viz.,  that  the  rational,  the  successful,  and  therefore 
the  appropriate  treatment  of  Dysentery,  is  unquestionably  to  be 
derived  from  that  class  of  remedies,  which  are  known  to  expend 
their  activity  upon  that  character  of  tissue,  which  is  involved  in 
inflammation,  to  constitute  the  intestinal  affection  embraced  in 
this  disease.  And  we  esteem  ourselves  most  fortunate  in  being 
enabled  to  adduce  such  a  weight  of  testimony  (which  we  were 
not  aware  of  until  instituting  our  researches,)  to  maintain  the 
stability  of  our  position,  as  have  been  derived  from  the  experi- 
ence of  others,  with  so  many  of  the  prominent  elements  of  the 
Materia  Medica,  constituting  this  class  of  remedies.  It  but  re- 
mains for  us,  now,  to  supply  you  with  our  own  humble  testi- 

*  All  these  italics  are  our  own.  -{-Headland. 


120  Campbell's  Lecture  on  Dysentery.  [March, 

mon  y,  in  a  farther  substantiation  of  this  position,  with  regard  to 
another  member  of  this  class — the  only  one  in  fact  with  which 
we  have  a  practical  acquaintance  in  this  application — the  reme- 
dy, which  we  prefer  to  all  others,  as  the  safest,  the  best,  and 
most  efficient  in  its  operation  upon  the  affections  of  the  mucous 
tissue  in  general;  and  which,  besides  being  of  the  most  general 
applicability  in  the  affections  of  this  tissue — is  pre-eminently  to 
be  chosen  as  the  agent  for  the  treatment  of  Dysentery.  This 
remedy  is  Tukpentine  ! 

"We  have  dwelt  to  sufficient  extent  upon  the  therapeutic 
action  of  this  class  of  agents,  with  an  occasional  reference,  by 
way  of  example,  to  this  one,  to  render  it  unnecessary  to  detain 
you  with  a  repetition  of  those  considerations.  The  Turpentine 
treatment  of  Dysentery  has  long  been  in  use,  to  some  extent, 
popularly,  as  well  as  with  the  profession ;  but  always  so  com- 
plicated and  obscured  by  other  and  antagonistic  elements  of 
treatment,  as  to  have  its  benefits  lost  sight  of  and  very  soon, 
perhaps,  to  fall  into  disrepute  in  each  particular  case.  And 
thus,  no  fixed  opinion  seems  ever  to  have  been  entertained  as  to 
its  efficiency  and  mode  of  action,  and  no  lasting  confidence  has 
been  established  in  its  reliability  as  a  form  of  treatment,  until 
comparatively  recently. 

Some  years  ago,  Dr.  John  Long,  of  Pleasantville,  Kentucky, 
made  the  following  statement  in  the  St.  Louis  Medical  and  Sur- 
gical Journal,  viz. — "For  more  than  twelve  months  past,  I  have 
been  in  the  habit  of  using  Turpentine  in  the  treatment  of  Dys- 
entery, as  it  has  occurred  in  this  section  of  country,  and  find  it 

to  be  a  most  valuable  remedy  in  this  often  formidable  disease 

Dose,  ten  drops,  for  an  adult,  every  eight  hours ;  with  mucilagin- 
ous drinks  and  farinaceous  diet.  I  was  first  induced  to  resort 
to  Turpentine  in  the  treatment  of  Dysentery,  at  the  suggestion 
of  Dr.  Wood,  of  Philadelphia,  who  recommends  it  in  Typhoid 
fever.  During  the  past  summer,  I  treated  thirty  cases  accord- 
ing to  the  above  method,  twenty -nine  of  which  recovered  and 
one  died ;  the  latter  resided  fifteen  miles  off,  and  I  did  not  see 
him  but  once."  Some  years  ago,  also,  Dr.  Wm.  C.  Brandon,  of 
Hermitage,  Georgia,  through  the  pages  of  the  Southern  Medical 
and  Surgical  Journal,  advocated  the  use  of  Turpentine,  com- 
bined with  Castor  Oil,  as  a  treatment  for  Dysentery.     He  says, 


1858.]  Campbell's  Lecture  on  Dysentery.  121 

"My  usual  prescription  was  1  ounce  of  Castor  Oil  with  from  1 
to  2  drachms  of  Oil  of  Turpentine,  for  an  adult;  diminished  in 
proportion  to  the  age  of  younger  subjects.  Often  this  dose  had 
to  be  repeated,  sometimes  twice,  before  a  fecal  dejection  could 
be  procured.  The  Turpentine  was  left  out  in  some  instances, 
and  my  opinion  is,  with  disadvantage  to  the  patient.  I  used 
no  saline  cathartics,  for  in  every  instance  where  they  had 
been  used  prior  to  my  visit  to  the  patient,  I  believe  they  had 
acted  injuriously,  especially  where  the  stomach  and  small  bow- 
els were  implicated  to  any  great  extent."* 

And  this  brings  us  to  consider  the  Turpentine  Treatment,  com- 
bined with  Castor  Oil:  as  thus  united  it  acts  upon  the  inflamed 
mucous  membrane,  and  at  the  same  time  relieves  and  prevents 
any  accumulation  in  the  faecal  reservoir,  the  large  intestine, 
which  is  the  seat  of  this  local  element  of  the  disease.  And  this 
is  the  treatment,  of  whose  adoption  and  amendment  we  spoke,  in 
our  introductory  remarks,  when  considering  the  u  Nature  and 
Pathology  of  Dysentery."  And,  now,  we  may  here  recall  to 
your  minds  with  advantage,  the  Third  condition,  existing  in  the 
nature  and  circumstances  of  this  disease,  with  its  dependent 
indication,  viz. — Third.  This  mucous  membrane  lines  the  interior 
of  an  excretory  canal — the  seat  of  the  inflammation — WHICH  MUST 
BE  kept  OPEN — it  will  not  do  to  obstruct  it ;  for  besides  the  ordin- 
ary and  necessary  demands  of  health,  that  this  prima  via  should 
be  unencumbered,  and  which  also  has  a  tendency,  (notwith- 
standing all  interposed  efforts,)  to  convey  its  contents  onward 
to  their  exit — if,  from  any  cause,  the  detritus  of  the  process  of 
digestion  is  detained  within  its  calibre,  it  would  become  con- 
crete and  consolidated,  and  would  act  as  an  irritating  body  to 
the  inflamed  mucous  lining — especially  as  every  excited  con- 
traction of  the  muscular  coat  of  this  canal,  would  compress  its 
inflamed  lining,  firmly  against  this  resisting  substance,  where  it 
would  probably  be  held  for  some  time,  on  account  of  the  loss  of 
normal  tone  in  the  mucous  and  muscular  coats  at  this  point,  and 

*  This  is  a  remarkable  coincidence  of  impressions — as  regards  the  action  of 
salts  in  this  disease,  with  our  views  given  while  considering  that  plan  of  treat- 
ment; and  also  has  some  reference  to  a  condition  in  its  pathology,  as  heretofore 
suggested  by  us — especially,  as  we  do  not  recollect  to  have  had  our  attention 
called  to  thi«  article  until  now. 


122  Campbell's  Lecture  on  Dysentery.  [March, 

would  greatly  enhance  the  difficulty — therefore,  prevent  con- 
stipation. 

Thus,  it  will  be  perceived,  that  the  demands  of  the  intestinal 
affection  are  comprised  in  the  Second  and  Third  indications, 
which  may  be  treated  of  in  connection — the  latter  being  in  this 
instance  involved  in,  and  forming  a  necessary  condition  to,  the 
former — that  is,  whilst  the  mucous  membrane,  here,  requires  the 
treatment  appropriate  to  mucous  membranes  elsewhere, — here, 
it  is  besides  the  lining  of  an  excretory  canal,  which  conveys  a 
material  of  more  or  less  solid  consistence ;  therefore,  it  is  also 
necessary  to  combine  with  that  specific  treatment,  some  peculiar 
method  of  procedure  to  prevent  the  irritation  of  the  contained 
solid  excrement,  in  its  transit  through  the  inflamed  canal — since 
it  must  pass  through ;  and  this  is  best  accomplished  by  reducing 
its  consistency  from  a  solid  to  a  fluid  state,  preventing  its  accu- 
mulation and  solidification,  and  also,  by  shielding  the  sore 
surface,  if  possible,  with  some  emollient  or  soothing  application. 
These  two  indications,  then,  together  with  derivative  measures, 
comprise  the  treatment  of  the  local  or  intestinal  element  of  this 
disease. 

Now,  let  us  see  how  far  these  indications  have  been  fulfilled 
in  the  following  history  of  our  experience  as  to  this  disease,  with 
our  peculiar  form  of  treatment. 

At  the  time  we  commenced  the  practice  of  medicine — 10  years 
ago — the  few  sporadic  cases  of  Dysentery  which  occurred  from 
time  to  time,  were  treated  orthodoxly,  or  in  accordance  with 
the  most  approved  modes,  prescribed  by  the  text-book  authors 
of  the  day — many  of  which  cases  (a  large  proportion  for  the  few 
that  occurred  at  that  time),  went  their  way,  secundum  artem; 
until  Dysentery  became  an  opprobrium  to  our  skill — an  incubus 
upon  our  peace.  A  year  or  two  afterwards,  when  the  disease 
began  to  appear  epidemically,  it  became  necessary  to  inquire 
into  the  respective  value  of  the  various  suggestions,  as  regards 
its  treatment,  which  emanated  from  different  sources.  If  we 
mistake  not,  it  was  the  London  Lancet  which  first  directed  our 
attention  to  the  Castor  Oil  and  Turpentine  method.  About  that 
time,  we  recollect  to  have  been  attending  a  case — an  old  lady, 
about  60  years  of  age — the  worst  case  we  ever  saw,  to  recover. 
We  had  been  called  to  her,  two  weeks  after  the  inception  of  her 


1858.]  Campbell's  Lecture  on  Dysentery.  163 

attack,  which  she  said  came  on  after  prolonged  constipation,  and 
found  her  in  that  state,  which  the  complication  of  age,  an  appa- 
rently feeble  constitution,  and  the  unabated  violence  of  this 
disease,  was  well  calculated  to  place  her.  She  was  on  Black- 
berry cordial  and  Laudanum.  The  tormina  and  tenesmus  were 
exceedingly  violent,  the  stools  very  frequent,  imperative,  irre- 
sistible, and  of  a  purulent  character.  Altogether,  "  passing 
away  " — as  we  thought — was  impressed  visibly,  upon  every  fea- 
ture of  this  case.  .  .  .  "Why  hadn't  she  died?1' — thought  we, 
as  enormous  quantities  of  opium  and  astringents  foiled  to  make 

any  impression  on  her  disease. "Why  doesn't  she  die?" — 

was  the  inquiry  presented  to  our  minds,  when  the  slightest 
quantity  of  salts  purged  her  almost  to  death,  without  abating, 

perceptibly,  the  affection  of  the  large  intestine. "  Why  cant 

she  die?'1 — was  the  pitying  interrogation,  when  she  continued 
to  vomit  small  doses  of  the  simple  Castor  Oil  and  Turpentine, 
without  any  relief  to  her  excruciating  sufferings.  It  then,  first 
occurred  to  us,  to  saponify  the  Oil  with  Soda ;  to  mix  in  the 
Turpentine;  to  suspend  these  in  an  emulsion  of  Gum  Arabic 
and  Sugar ;  and  to  add  some  Sedative  or  Anodyne,  (which  did 
not  contain  opium);  as  well  as  some  Aromatic,  to  cause  it  to  be 
retained  by  the  irritable  stomach.  The  following  Kecipe  was 
the  result — viz: 

$.     Castor  Oil, Hij. 

Bi-Carb.  Soda, 5j. 

Spts.  Turpentine, Iss. 

Powdered  Gum  Arabic,  .     .     .      I j. 

Loaf  Sugar, 5j. 

Compound  Spts.  Lavender,  .     .      I  j. 

Camphor  Water,     q.  s.  to  make  8  oz  emulsion." 
Flavor  with  oil  of  Peppermint  or  Lemon. 

Of  this,  she  took  1  tea-spoonful  every  two  hours,  and  the  dose 
was  gradually  increased  to  1  table-spoonful,  as  her  stomach  was 

*  Some  of  the  ingredients  in  the  above  recipe  may  be  altered,  occasionally,  with 
advantage, — for  instance,  Sweet  oil  may  be  sometimes  substituted  for  the  Castor 
oil;  and  the  proportion  of  Turpentine  may  be  varied  according  to  circumstan- 
ces.    The  Spirit  or  the  Oil  of  Turpentine  may  be  used  indiscriminately. 

About  the  time  we  commenced  using  this  recipe  for  Dysentery,  Ave  found  that 
the  same  formula,  with  the  Castor  oil  left  out,  was  an  excellent  mode  of  adminis- 
tering Turpentine  in  Typhoid  fever,  and  have  used  it  ever  since. 

7* 


164  Campbell's  Lecture  on  Dysentery.  [March, 

able  to  bear  it ;  for,  after  making  an  effort  to  retain  the  first 
dose,  the  irritability  of  her  stomach  seemed  rapidly  to  subside. 
And  very  soon — being  confident  of  the  opposite  result — we  were 
astonished  to  see  the  marked  improvement  in  the  condition  of 
the  patient — who,  upon  this  treatment,  steadily  advanced  to 
recovery — for  verily,  "  her  time  had  not  yet  come !" 

This  Recipe,  Gentlemen,  has  constituted  the  basis  of  our  inter- 
nal treatment  of  the  local  affection  of  Dysentery,  ever  since — 
and  we  have  never  since  found  cause  to  set  aside  that  basis — as 
it  has  never  yet,  forfeited  the  confidence,  thus  engendered  in  it. 

We  would  call  your  attention  to  some  of  the  principal  ele- 
ments in  this  formula,  and  their  probable  effects  under  these 
circumstances,  to  determine  how  far  they  rationally  fulfill  the 
two  indications  under  consideration. 

Now,  it  will  be  recollected  that,  in  a  former  Lecture,  we  en- 
deavored to  show,  that  there  were  four  elements  or  conditions, 
making  up  the  sum  of  that  form  of  disease  which  is  termed 
Dysentery,  and  that,  from  these,  necessarily  proceeded  the  four 
consequent  indications  of  treatment. 

First. — The  existence  of  Fever,  dependent  upon  a  cerebro- 
spinal condition — which  was  probably  the  origin  of  the  Dysen- 
tery— demanding  the  prevention  of  that  fever.  Conse- 
quently, on  a  former  occasion,  we  dwelt  to  some  length,  upon 
the  great  importance — yea,  the  indispensableness,  of  giving 
Quinine,  as  the  appropriate  remedy  for  answering  this  first  indi- 
cation, which,  together  with  revulsives,  constitutes  the  treatment  of 
the  cerebrospinal  element  of  this  disease. 

Second. — There  being  disease  of  a  mucous  membrane — re- 
quiring ITS  OWN  PECULIAR  TREATMENT,  the  action  of  TURPEN- 
TINE was  sufficiently  considered,  as  an  appropriate  agent,  for 
supplying  this  second  indication,  and  need  not  be,  here,  revert- 
ed to. 

Third. — There  is  Constipation  existing  and  having  a  tendency 
to  persist — being  an  element  of  the  disease  and  an  obstacle  in 
the  way  of  its  relief,  (because  the  retained,  inspissated  contents 
of  the  canal,  constantly  irritate  the  sore  surface  of  the  interior 
lining  of  that  canal,  over  which  it  must  pass) — therefore,  the 
third  indication  was,  to  relieve  and  prevent  Constipation. 

Now,  let  us  examine  into  the  appropriateness  of  some  of  the 


1858.]  Campbell's  Lecture  on  Dysentery.  165 

other  elements  in  the  formula  which  we  have  given  you,  and 
which  are  combined  with  the  Turpentine,  for  the  fulfillment  of 
this  third  indication. 

Castor  Oil,  it  is  generally  accorded,  acts  principally  by  lubri- 
cation— i.  e.,  by  anointing  the  interior  surface  of  the  intestinal 
canal  and  allowing  substances  to  pass  the  more  easily  over  it. 
It  is  also  admitted,  that  it  acts  as  a  mild  stimulus  to  the  intestinal 
mucous  membrane,  inducing  mucous  stools — and  for  this  reason, 
it  is  thought  principally  to  act  upon  the  large  intestine,  as  this 
is  the  characteristic  excretion  from  this  portion  of  the  canal. 

The  effect  of  the  Soda,  which  is  here  combined  with  the  Oil, 
would  probably  be,  first,  as  a  solvent  of  the  faecal  mass,  and  if 
given  in  large  doses,  it  acts  as  a  laxative.  So,  may  it  be  per- 
ceived, that  the  two  combined,  would  probably  have  the  effect 
of  overcoming  the  constipation  by  their  laxative  effect,  in  an  inof- 
fensive manner — assisted,  if  necessary,  by  exciting  the  biliary 
secretion  with  the  preparation  of  Mercury,  (viz.,  Blue  Mass  and 
Chalk — 1  part  of  the  former  to  three  of  the  latter,)  of  which 
we  have  spoken,  as  the  one  we  preferred  to  all  others,  when  the 
obstinacy  of  the  constipation,  as  well  as  other  indications  of 
suspended  hepatic  secretion,  demanded  its  employment.  These, 
together  then,  may  be  considered  the  appropriate  treatment  for 
the  relief  of  this  condition,  in  answer  to  the  Third  indication. 

Some  of  the  secondary  effects  of  the  Soda  may  be  considered 
of  much  benefit  in  this  disease.  For  instance,  in  connection 
with  Turpentine  it  proves  a  most  powerful  diuretic,  and  perhaps 
advantageously,  as  it  is  known  that  in  all  fevers,  the  secretion 
of  this  great  emunctory  is  more  or  less  suspended.  And  if  the 
opinion  be  correct,  which  has  long  been  entertained,  .that  in  all 
fevers,  there  is  the  generation  or  formation  of  zymotic  elements 
in  the  system,  from  the  more  rapid  disintegration  of  the  tissues 
owing  to  the  consequent  over-wrought  condition  of  the  whole 
organism  in  that  state — the  effect  of  these  two  powerful  diuret- 
ics, as  combined  in  the  formula,  should  serve  the  valuable  pur- 
pose of  their  elimination  from  the  blood,  by  the  urine. 

And  further :  May  there  not  be  some  advantage  in  the  alka- 
line quality  of  this  agent,  which  may  tend  to  counteract  that 
6tate  of  the  fluids  of  the  body,  which  is  favorable  for  the  devel- 
opment and  maintenance  of  that  condition,  in  an  important 


166  Campbell's  Lecture  cm  Dysentery.  [March, 

portion  of  the  organism,  from  which  results  the  manifestations 
of  this  disease?  This  opinion  does  not  seem  so  "far-fetched," 
when  we  are  able  to  refer  you  to  an  interesting  article,  in  the 
Dublin  Journal  of  1848,  with  the  very  pertinent  caption  of 
"  Alkaline  Treatment  of  Dysentery" — which  is  too  long  to  quote 
entire,  but  where  the  author*  says  in  relation  to  one  of  his  case3 
there  reported,  "  The  feature  of  most  importance  in  this  case 
was  the  almost  magical  effect  of  the  alkali  in  allaying  the  tor- 
mina, tenesmus,  and  purging,  the  tincture  of  Opium  appearing 
to  exert  no  influence  whatever  over  the  disease  till  combined 
with  the  liquor  Potassae  ;  the  patient  remarking,  when  I  visited 
him  in  the  evening,  that  the  last  medicine  produced  a  feeling  of 
ease  and  rest  from  pain  quite  cheering  to  him."  The  writer 
had  administered  10  minims  of  the  liquor  Potassae  every  se- 
cond hour,  and  applied  Turpentine  to  the  abdomen.  He  also 
mentions  Soda  as  one  of  the  alkalies  used. 

In  several  cases,  wherein  the  simple  Oil  and  Turpentine 
were  administered,  we  have  to  state,  that  we  did  not  see  such 
very  remarkable  results  manifested,  or  so  promptly,  as  from  the 
exhibition  of  the  Emulsion.  One  of  these — a  very  bad  case — 
having  been  treated  by  a  friend,  in  the  former  manner,  (when, 
during  his  sickness  or  absence,  the  case  fell  into  our  hands,)  was 
signally  benefited  by  the  change  to  the  Emulsion,  and  pretty 
soon  recovered. 

The  Lavender  is  used  here  as  an  anodyne  or  sedative,  devoid 
of  any  constipating  quality — yet,  having  amply  sufficient  power 
to  allay,  in  a  remarkable  degree,  the  nervous  irritability  and 
agonizing  pangs,  consequent  upon  this  torturing  disease,  by  its 
anodyne  or  sedative  influence  without  a  narcotic  effect.  We  are 
aware  that  this  medicine  is  pretty  generally  disregarded,  as  of  no 
force,  and  that  it  has  been  consigned  to  a  place  among  that  class 
of  medicinal  agents,  contemptuously  designated  "Old  Women's 
Kennedies;"  but  it  is  our  opinion,  that  this  class  of  our  race,  are 
often  the  venerable  conservators  of  important,  though  obsolete, 
medical  ideas,  as  well  as  valuable,  though  discarded,  medicinal 
agents — and  of  such,  we  consider  the  one  in  question.  There 
is  in  reason  no  foundation  for  an  objection  to  this  assertion,  on 
the  score  of  "  impossibility,"  in  reference  to  its  activity — as  the 

*  D.  Kelly,  L.  A.     Mullingar. 


1858.]  Campbell's  Lecture  on  Dysentery.  167 

potent  narcotic  itself,  is  but  the  product  of  a  plant,  and  that,  a 
comparatively  delicate  and  succulent  one;  and  where  is  the 
sense  of  denying  to  this  plant,  the  credit  of  its  own  powerful 
virtues  ? — We  do  not  pretend  to  say,  that  their  effects  agree  in 
kind,  but  we  have  long  been  of  the  opinion,  that  the  importance 
of  this  agent,  has  been  very  much  overlooked.  It  has  been 
long  in  use  for  "  nervous  irritability,"  "palpitation,"  "  hysteria," 
&c. — and  with  good  reason.  We  contend,  that  it  might  have 
served  a  valuable  purpose,  in  a  more  extended  application,  and 
with  more  decided  evidences  of  its  power: — as,  for  instance,  for 
the  purpose  of  diminishing  the  irritability  of  the  nerves,  conse- 
quent upon  the  effect  of  other  causes  and  in  other  localities  of 
irritation.  For  we  know,  that  under  the  operation  of  such 
causes,  its  continued  use  has,  under  our  observation,  been  at- 
tended with  remarkable  results,  which  have  led  us  to  indulge  in 
the  projection  of  an  hypothesis,  in  relation  to  its  therapeutic  ac- 
tion, as  compared  with  that  of  opium.  It  is  this,  that  while  opium 
seems  to  act  upon  the  central  portions  of  the  nervous  system,  as 
well  as  the  peripheral  portions,  but  more  especially  upon  the 
cerebral  mass,  inducing  a  suspension  of  the  functions  of  this 
organ,  in  somnolence,  coma,  &c. — this  other  plant,  may  exhibit 
its  therapeutic  properties,  by  expending  its  obtunding  influence 
upon  the  nerves,  and,  perhaps,  the  spinal  cord,  (their  more  im- 
mediate termination,)  without  affecting  the  brain  :  or,  perhaps 
its  influence  is  of  a  totally  different  character,  and  may  not  be 
manifested  in  similar  results. 

This  is  but  a  theory,  concocted  for  our  own  satisfaction,  in 
explanation  of  the  valuable  facts,  connected  with  the  exhibition 
of  this  remedy — and  whatever  be  their  philosophy,  we  deem  the 
facts  have  been  sufficiently  evident  to  be  worthy  of  remark. 

The  tranquilizing  effect,  which  has  been  generally  accorded 
to  this  vegetable  principle,  in  ordinary  doses,  is  but  a  moiety  of 
the  almost  paralyzing  sedation  it  is  capable  of  inducing, 
when  frequently  repeated,  or  administered  in  sufficiently  large 
doses.  That  property  would  seem  to  be  almost  identical  with 
that  of  Valerian,  and  is  displayed  apparently  upon  the  same 
portions  of  the  nervous  system.  The  tranq uilizing  power  of  the 
latter  agent,  is  plainly  to  be  recognized,  in  its  marked  control 
over  the  subsultus  tendinum  (if  not  extreme),  of  Typhoid  fever. 


168  Campbell's  Lecture  on  Dysentery.  [March, 

Really,  many  practitioners  seem  to  have  a  proclivity  for  re- 
ducing the  practice  of  medicine  to  a  very  simple  process — viz., 
the  application  of  a  very  limited  number  of  medicinal  agents — 
by  selecting  one  (the  most  potent,  perhaps,)  from  each  class  of 
remedies,  and  for  convenience,  striving  to  force  its  application, 
under  all  circumstances,  when  the  demands  of  all  of  these  cir- 
cumstances, are  alone  able  to  be  fully  supplied  from  a  whole 
class  of  therapeutic  agents — each  agent,  probably,  being  adapt- 
ed, from  the  peculiarity  of  its  properties,  to  meet  one  or  more  of 
the  varying  phases  or  stages  of  pathological  condition,  which 
may  occur  in  any  organ  or  sj*stem — all  which,  go  to  make  up 
the  manifestations  of  disease,  occurring  in  any  particular  organ 
or  set  of  organs,  and,  perhaps,  requiring  the  employment  of  the 
whole  of  that  class  of  medicines,  which  is  known  appropriately 
to  belong  to  that  organ  or  system. 

We  might  adduce  numerous  instances  of  the  most  unmistaka- 
ble and  powerful  effects,  attendant  upon  the  administration  of 
the  Lavender,  as  forming  an  ingredient  in  the  formula,  above 
given  you,  but  one  or  two  will  suffice  for  illustration.  For  ex- 
ample: Mrs.  V.,  an  intelligent  lady,  residing  in  this  place, 
during  a  very  severe  attack  of  Dysentery,  in  which  tormina  and 
tenesmus  were  excessively  harassing  to  her  nervous  system, 
after  taking  the  Emulsion  every  three  hours  during  one  day, 
was  entirely  relieved  of  her  dysenteric  symptoms,  but  complain- 
ed bitterly  of  the  paralyzing  effect  of  the  "Laudanum  Mixture," 
as  she  called  it — saying  that,  she  could  not  take  any  more,  that 
she  "could  scarcely  raise  her  hand,"  and  "felt  such  a  calmness 
and  lassitude,  that  it  was  distressing"  to  her.  It  is  a  common 
thing  for  patients  to  call  the  Emulsion,  the  "  Laudanum  Mix- 
ture," or  insist  that  they  had  been  taking  Laudanum,  from  the 
marked  relief  they  experience;  and  yet,  without  being  particu- 
larly disposed  to  sleep — their  mental  faculties  being  altogether 
unembarrassed.  Again:  for  example — our  estimable  friend 
and  your  erudite  Professor  of  Physiology,  Dr.  Miller,  stated  to 
us,  that  on  one  occasion  he  was  required  to  administer  to  a  case 
of  violent  cramp-colic,  and  there  being  no  other  medicine  in 
reach,  he  gave  the  patient  from  two  to  three  ounces  of  this 
Emulsion,  and  he  was  entirely  relieved,  with  an  astonishing 
promptness.     This  marked  and  sudden  effect,  we  could  attribute 


1858.]  Campbell's  Lecture  on  Dysentery.  169 

to  no  other  element  than  the  Lavender,  acting  as  a  powerful 
anodyne,  in  such  quantity.  This  is  an  effect  pre-eminently 
called  for  in  the  nature  of  Dysentery,  and  most  remarkably  ap- 
propriate for  its  accomplishment  here,  is  this  agent,  which  is 
devoid  of  a  constipating  quality. 

The  Gum  Arabic  in  the  formula,  would  probably  have,  only 
an  emollient  or  soothing  effect  upon  the  inflamed  mucous  surface, 
as  it  may  be  considered  proven — by  the  experiments  of  Bous- 
singault,  and  others,  upon  fowls,  and  of  Dr.  Wra.  A.  Hammond, 
Surgeon  U.  S.  A.,  one  of  the  Prize  Essayists  of  the  American 
Medical  Association,  in  May,  1S57 — by  experiment  upon  him- 
self— that  this  gum,  as  well  as  others,  are  entirely  indigestible — 
the  whole  quantity  in  weight,  within  a  bare  fraction  of  that 
ingested,  being  collectible  from  the  alvine  discharges." 

Now,  Gentlemen,  having  considered  the  three  first  indications, 
and  also  having  determined  their  appropriate  requirements,  as 
regards  internal  medication,  we  have  but  to  refer  to  an  import- 
ant aid  for  the  relief  of  the  intestinal  inflammation — viz.,  that 
of  derivative  measures. 

\Ye  stated  before,  that  if  the  inflammation  existed  anywhere 
in  the  course  of  the  ascending,  transverse,  or  descending  colon, 
it  might  generally  be  detected  by  manual  pressure  along  the  ex- 
tent of  that  organ  ;  but  if  in  the  rectum,  its  situation  was  to  be 
inferred,  from  the  violence  of  the  tenesmus,  as  well  as  (when 
used)  the  intolerance  of  all  enemata.  Then,  the  application  of  a 
blister,  cupping,  or  leeches,  over  the  tender  part,  when  situated 
in  the  colon,  will  be  found  to  be  a  valuable  adjuvant  in  the 
treatment.  We  have  generally  used  a  small  blister,  the  size  of 
the  hand,  in  the  more  violent  cases.  This  may  be  kept  open, 
with  advantage,  by  poulticing,  until  the  symptoms  of  the  disease 
subside ;  or  may  be  placed,  alternately,  over  different  portions 
of  the  canal,  which  are  found,  upon  examination,  to  be  affected. 
\Ye  would  deprecate  the  barbarity  of  blistering  the  whole  of  the 
front  surface  of  a  man's  body,  in  order  to  reach  the  small  portion 
of  surface  corresponding  to  the  extent  of  inflamed  structure,  in 
the  interior.  "When  the  disease  exists  in  the  rectum,  a  blister 
applied  to  the  sacrum,  will  very  readily  influence  it,  on  account 
of  the  anatomical  position  of  that  organ.     AVe  have  thought  that 

*  See  Prize  Essav,  in  Transactions  of  Amer.  Med.  Association,  for  1857. 


170  Campbell's  Lecture  on  Dysentery.  [March, 

a  blister  to  the  sacrum  proved  the  turning  point,  in  an  extreme 
case  of  this  kind,  where  tenesmus  was  the  prevailing  symptom. 

We  would  now  notice  briefly  the  requirements  of  the  Fourth 
condition,  and  its  consequent  indication  of  treatment,  viz  : 

Fourth.  There  is  a  state  of  exhaustion,  or,  more  properly,  Fa- 
tigue— Kegular  rest  and  resuscitation  of  strength  are 
TO  BE  SECURED  TO  THE  patient — by  whatever  means  attainable, 
provided  they  can  be  reconciled  to  the  three  other  obligations  to  be  ful- 
filled— in  order  to  indemnify  his  vital  energies  for  the  effect  of 
the  harassing  influences  preying  upon  them. 

The  vast  importance  of  rest,  or  relief  from  the  racking  and 
consuming  torture,  which  we  sometimes  witness  in  this  disease, 
should  be  constantly  kept  in  view,  or  the  patient  will  often  sink 
from  exhaustion  of  the  vital  forces,  through  neglect  in  this  im- 
portant quarter.  We  once  saw  a  patient  treated  on  the  saline 
plan,  which  failing  to  relieve  him,  he  got  no  rest  at  night,  and 
grew  worse  every  day — until  he  was  allowed  some  Morphine 
at  night — when  he  slept  and  appeared  much  refreshed  and  re- 
vived the  next  morning.  The  Oil  and  Turpentine  Emulsion 
was  now  substituted  for  the  Salts,  when  he  rapidly  recovered. 

A  patient  with  Dysentery  should,  at  all  events,  be  secured 
his  accustomed  rest  at  night,  by  every  possible  means,  that  he 
may  have  the  great  advantage,  so  imperatively  demanded,  and 
so  essential  to  his  well-doing,  here,  of  the  compensation  for  the 
damage  done  during  the  day,  by  sleep — 

"  Tired  nature's  sweet  restorer,  balmy  sleep." 

And  here  is  the  only  appropriate  place,  which  opiates  can  occu- 
py, in  the  treatment  of  Dysentery.  With  this  object,  we  prefer 
the  administration,  by  enema,  of  \  to  \  gr.  of  sulph.  Morphine, 
in  from  1  to  2  ounces  of  cold  water,  (as  the  least  irritating  pre- 
paration,) every  night  at  bed-time;  which  may  be  repeated,  if 
necessary,  until  sleep  is  induced.  It  will  be  perceived  that  there 
is  no  danger  of  restoring  the  constipation,  under  these  circum- 
stances, so  long  as  is  kept  up  during  the  day,  the  unremitted 
application  of  the  other  element  of  the  treatment,  embraced  in 
the  exhibition  of  the  Emulsion. 

The  patient's  strength  should  also  be  supported  by  nourish- 
ment, such  as  beef  essence,  chicken  soup,  corn -meal  gruel,  etc.; 


1858.]  Campbell's  Lecture  on  Dysentery.  171 

for,  until  the  latter  stages,  general] j,  the  stomach  and  small  in- 
testines are  capable  of  performing  their  function  of  digestion. 
After  an  attack  of  Dysentery,  it  may  be  of  importance  to  instruct 
the  patient  to  select  such  articles  of  diet,  as  will  be  favorable  for 
preventing  constipation,  and  the  consequent  re-establishment  of 
the  disease.  Ripe  fruit,  if  in  season,  will  prove  often  an  agreea- 
ble, harmless  and  very  efficient  laxative.  We  remember  the 
case  of  an  old  lady,  about  sixty,  who,  after  a  very  severe  and 
prolonged  attack  of  Dysentery,  and  even  before  she  had  entirely 
recovered,  regularly  ate  a  cantelope  every  day,  which  she  con- 
tinued until  the  season  was  over  for  them — her  physicians,  who 
allowed  her  the  indulgence,  recognizing  the  fact,  that  the  fruit 
could  do  no  harm,  as  the  upper  portion  of  the  canal,  was  not  the 
part  involved  in  this  disease. 

Xow,  Gentlemen,  we  have  seen  the  full  consummation  of  the 
FOUR  indications,  which  we  derived,  from  the  study  of  this  dis- 
ease, in  accordance  with  our  plan.  We  will  very  briefly  reca- 
pitulate the  four  cardinal  points  of  treatment,  as  if  in  connec- 
tion with  the  management  of  any  particular  case. 

1st.  Give  Quinine,  in  sufficient  quantity,  and  often  enough, 
to  break  up  the  paroxysmal  character  of  the  disease.  Also  ap- 
ply sinapisms,  or  cupping,  or  a  blister  to  the  spine,  according  to 
the  severity  of  the  case,  or  the  degree  of  spinal  irritation  present. 

2nd.  Commence  immediately,  and  give  the  Emulsion,  every 
hour,  or  every  two,  or  three,  or  four  hours,  according  to  the 
severity  of  the  symptoms ;  for  the  more  intense  the  symptoms,  the 
more  often  is  it  to  be  given,  until  they  are  relieved.  If  the  stomach 
is  delicate  at  first,  commence  with  1  tea-spoonful,  and  gradually 
increase  it  to  1  table-spoonful,  the  ordinary  dose  for  an  adult ; 
but  give  the  Emulsion  in  every  case,  whatever  may  appear  to  be 
the  obstacle — and  continue  to  give  it,  until  the  patient  is  quite 
well,  diminishing  the  dose,  or  increasing  the  interval,  as  he  re- 
covers. 

3rd.  If  the  constipation  has  been  of  long  standing,  or  is  ob- 
stinate— probably,  from  want  of  action  in  the  liver,  as  manifested 
by  the  yellow -furred  tongue,  tenderness  on  pressure  over  the 
right  hypochondriac  region,  &c. — give  from  10  to  20  grs.  of  the 
Blue  Mass  and  Chalk,  or  moderate  doses  of  Calomel,  or  Blue 
Mass — though  we  prefer  the  former.     Also,   apply  a  blister, 

If.  s. — VOL.  XIV.   NO.  III.  8 


172  Campbell's  Lecture  on  Dysentery.  [March, 

when  the  case  is  of  sufficient  severity,  over  the  diseased  portion 
of  the  canal,  to  be  kept  open,  or  repeated,  if  necessary. 

4th.  If  the  patient  does  not  sleep  at  nightr  give  from  a  quar- 
ter to  a  half  grain  of  Morphine,  in  cold  water,  by  injection  into 
the  rectum,  at  bed-time  every  night,  and  repeat  if  necessary — 
also  have  regard  to  supporting  hia  strength  with  nourishment. 

Such  is  the  treatment  which  we  have  practiced,  in  every  de- 
gree of  Dysentery ,  from  the  time  of  our  first  commencing  the 
use  of  the  Emulsion.  And  so  anxious  are  we  to  do  justice  to  a 
measure,  in  which  we  have  such  unbounded  confidence,  that  we 
hope  you  will  pardon  us  for  introducing,  here,  some  evidences 
of  its  successful  application,  which  are  partly  derived  from  our 
own  experience,  and  have  partly  come  to  our  knowledge  from 
its  employment  by  others. 

Should  we  endeavor  to  establish  its  value,  by  all  the  testimo- 
ny we  could  furnish,  it  would  be  in  effect,  but  the  record  of 
every  case  of  Dysentery,  which  has  occurred  within  that  time, 
in  our  practice,  as  well  as  that  of  your  Professor  of  Anatomy, 
our  brother  and  associate,  with  the  exception  of  but  two,  if  our 
memory  serves  us,  which  did  not  terminate  fortunately — and 
which  probably  owed  their  result  to  the  existence  of  a  more 
serious  complication. 

But  where  is  the  necessity  of  forcing  this  testimony  from  the 
result  of  our  own  experience,  when  all  this  evidence  can  be 
furnished  from  the  practice  of  our  professional  friends,  whom 
we  have  induced  to  adopt  this  mode  of  treatment,  many  of 
whom  have  been  long  in  practice,  and  are  occupying  such  posi- 
tions as  will  command  for  their  medical  dictum,  that  confidence 
which  admits  of  no  incredulous  gainsaying.  Many,  in  this 
place,  have  adopted  this  plan ;  and  in  various  portions  of  this, 
and  the  adjoining  States,  there  are  those,,  who  have  for  several 
years  used,  and  are  still  using  this,  as  their  only  treatment  for 
Dysentery.  A  friend  in  Alabama,  who  has  an  extensive  prac- 
tice, informed  us  recently,  that  since  receiving  our  letter,  recom- 
mending this  plan,  he  has  treated  all  his  cases  accordingly,  and 
although  he  has  passed  through  a  severe  epidemic  of  this  disease, 
has  not  lost  a  single  case. 

Another,  in  this  State,  remarked  to  us,  that  the  overseers 
on  the  plantations,  within  the  range  of  his  practice,  thought  it 


1858.]  Campbell's  Lecture  on  Dysentery.  173 

necessary,  often,  only  to  send  to  him  for  a  large  quantity  of 
the  Emulsion,  on  the  occurrence  of  several  cases  of  Dysentery, 
on  their  places— thus,  saving  him  the  trouble  of  attending. 
From  this,  it  may  be  judged  to  be  a  safe  practice. 

And  again  :  we  have  it  from  the  most  reliable  authority,  that 
a  druggist  of  one  of  the  cities  of  Georgia,  stated,  that  he  had 
prepared  and  sold  during  an  epidemic  of  Dysentery,  sixteen 
gallons  of  the  Oil  and  Turpentine  Emulsion,  according  to  this 
formula ;  and  that  in  this  region,  it  had  been  peddled  about  the 
country,  as  a  secret  remedy  in  this  disease.  And  here,  gentle- 
men, we  would  acknowledge,  that  it  was  as  much  the  wish,  to 
rescue  this  compound  from  so  illegitimate  a  prostitution  and 
foul  perversion  of  its  original  design,  as  anything  else,  that  sug- 
gested  to  our  minds  the  propriety  of  making  it  more  generally 
known — and  to  this  end,  has  it  claimed  your  attention. 

It  now  remains  for  us,  but  to  notice  that  condition  into  which 
Dysentery  often  runs,  unless  timely  arrested,  and  to  which  we 
called  your  attention  in  the  latter  part  of  our  Lecture  on  the 
Pathology  of  this  disease— wherein,  as  we  said,  the  irritation  of 
the  disease  in  the  large  intestine,  having  been  reflected  for  so 
long  a  time,  upon  the  upper  portion  of  the  primce  vice,  we  see, 
in  addition  to  the  purulent  or  bloody  evacuations,  a  continuous 
and  wasting  Diarrhcea.  Higher  up,  the  stomach  becomes  in- 
volved in  some  instances,  and  there  are  loss  of  appetite,  nausea, 
and  vomiting  even  of  the  blandest  fluids — together  with  a  red, 
dry  tongue,  quick  and  feeble  pulse,  entire  prostration  of  strength, 
cold  extremities  and  dullness  of  the  mental  faculties.  And  thus, 
the  vital  spark  grows  dim,  flickers  and  goes  out,  unless  again 
rekindled  by  its  appropriate  stimuli.  The  nervous  system  hav- 
ing been  over- wrought,  loses  its  excitability— becomes  paralyz- 
ed. The  mucous  membrane  of  the  large  intestine,  having  been 
racked  and  bruised,  remains  a  passive,  purulent,  secretory  sur- 
face. 

And  further — that,  in  this  entire  metamorphosis,  the  charac- 
ters of  the  original  disease  have  disappeared.  It  is  not  Dysen- 
tery, and  requires  a  change  of  management.  It  is  not  Typhoid 
Fever,  as  shown  in  its  history,  and  as  is  manifested,  often,  by 
the  sudden  and  almost  miraculous  recovery  of  cases,  upon  the 
application  of  its  appropriate  treatment. 


174  Campbell's  Lecture  on  Dysentery.  [March, 

We  can  best  illustrate  this  condition  and  its  character,  by  the 
brief  report  of  the  following  case— with  the  facts  concerned  in 
the  history  of  which,  several  of  our  professional  friends,  in  this 
place,  are  perfectly  familiar — viz : 

One  of  our  professional  friends,  on  leaving  the  city,  to  be  ab- 
sent a  few  weeks,  placed  several  patients  in  our  hands,  and 
among  them,  Philip — a  spare-made  mulatto  boy,  about  20  years 

old,  the  property  of  Mr.  H ,  stating,  that  this  patient  was 

in  the  last  stage  of  Dysentery,  and  would  not  long  trouble  us,  as 
he  was  moribund. 

We  found  him — in  complete  prostration,  with  a  quick,  almost 
imperceptible  pulse,  red  and  dry  tongue,  cold  and  tremulous 
extremities,  mental  faculties  very  obtuse,  and  occasionally  wan- 
dering and  muttering;  also,  passing  watery  discharges,  with 
some  pus,  involuntarily,  and  with  his  stomach  rejecting  every 
thing,  apparently  without  effort. 

This  case  had  had  the  full  benefit  of  the  Saline  treatment. 
We  prescribed — Brand}^  to  be  repeated,  until  his  stomach 
retained  it,  and  then^to  be  continued  without  limit.  Also,  when- 
ever it  was  apparent  that  be  had  had  a  discharge  from  the  bow- 
els, he  was  to  take,  by  enema,  |  gr.  Morphine  in  1  oz.  cold 
water;  and  perorem,  5  grs.  Bismuth  (sub-nitrate)  in  a  spoonful 
of  cold  water.  Besides,  whenever  his  stomach  could  retain  it — 
Beef  essence  and  Rice  gruel,  freely. 

Being  now,  called  away  and  detained  in  attendance  upon 
the  wife  of  a  particular  friend,  we  heard  nothing  from  Philip, 
until  about  ten  days  after  our  visit  to  him,  when  we  wished  to 
be  satisfied  of  the  result,  and  also  thought  courtesy  to  our 
professional  brother  required  us  to  go  and  express  to  the  boy's 
"  owners,  our  regret  for  their  loss,  &a  On  reaching  his  room, 
we  found  it  swept  out,  his  bed  made  up,  and  a  hat  lying  in 
the  floor — unmistakable  evidences,  to  us,  of  the  reality  of  our 
inevitable  convictions.  We  went  to  his  mistress,  stating,  that 
we  were  sorry  at  not  finding  the  patient  where  we  left  him,  but 
really  expected  nothing  else,  &c.  When,  without  appearing  to 
appreciate  what  we  were  saying,  or  even  hearing  it,  she  inter- 
rupted us  with  the  interrogation — "Doctor — have  you  seen 
Philip?" — Imagine  our  great  astonishment,  when  she  continued 
to  say — "He  was  sitting  on  the  steps,  but  a  few  minutes  ago — I 


1858.]  De  Witt's  Case  of  Empyema.  175 

suppose  he  has  walked  out." — And  so  he  had,  and  continues  to 
walk  out  and  in,  to  this  day. 

And  here,  Gentlemen,  you  may  take  a  precept,  from  the 
memorable  injunction  of  the  heroic  Lawrence — "Don't  give  up 
the  ship!" — So,  never  abandon  the  frail  craft  of  humanity, 
though  all  the  machinery  of  its  proud  organization,  be  o'er-done 
and  disabled,  with  battling  against  the  unequal  violence  of 
tempestuous  disease! — Don't  give  up  this  ship — though  left  a 
wrecked  and  powerless  victim  of  the  storm's  furious  rage,  drift- 
ing headlong  toward  the  boundless  ocean  of  Eternity !  No — 
never  give  up  the  wreck — so  long  as  there  is  any  evidence,  of  a 
human  life  within  it — for  God  may  bless  your  efforts! 

And  now,  Gentlemen,  in  conclusion,  having  labored  to  con- 
vince you  of  the  fact,  that  there  is  an  Appropriate  Treatment 
of  Dysentery — we  hope  that  you  will  never  be  deceived — 
"  by  the  occasional  brillianc}'  of  a  few  surprising  cures,  which 
dazzle  the  minds  of  men,  and  blind  them  to  those  innumerable 
instances  of  failure,  which  ought  to  teach  them  the  madness  of 
confiding  in  a  practice  founded  upon  no  rational  principle,  and 
conducted  upon  no  consistent  plan."* 


ARTICLE    Till. 


A  Case  of  Empyema,  treated  by  Injections  of  Water  into  the  Cavi- 
ty of  the  Pleura.  Reported  by  Sterxes  De  Witt,  M.  D.,  of 
Baker  county,  Ga. 

When  I  first  saw  the  case,  the  patient,  which  was  a  girl,  aged 
sixteen,  had  been  sick  for  four  weeks — was  very  feeble  and 
much  reduced  in  flesh:  pulse  quick  and  weak;  had  some  fever; 
was  very  restless,  could  lay  no  other  way  than  on  her  left  side ; 
breath  very  short  and  quick.  According  to  the  best  informa- 
tion that  I  could  draw  from  her  parents,  she  was  taken  with  a 
chill  after  being  on  the  road  on  a  journey  five  or  six  days.  She 
had  been  confined  to  her  bed  for  four  weeks — had  been  laboring 
under  febrile  symptoms,  and  had  cough,  which  grew  worse ;  had 

*  Hamilton — History  of  Medicine. 


176  De  Witt's  Case  of  Empyema.  [March, 

spit  some  blood.  She  had  felt  considerable  pain  in  her  left  side, 
which  was  in  the  wall  of  her  chest,  rather  than  deep-seated. 
After  two  days,  she  had  in  that  locality  considerable  swelling, 
which,  in  two  or  three  days,  had  increased  to  a  remarkable  ex- 
tent, reaching  as  far  as  the  sternum.  On  one  side,  and  filling 
completely  the  cellular  tissue,  around  to  the  spinal  column  on 
the  other  side.  This,  however,  did  not  much  alarm  the  parents. 
In  the  lapse  of  about  four  days  more  there  had  formed  over  the 
false  ribs,  an  abscess  about  the  size  of  the  top  of  an  ordinary 
coffee-cup,  having  the  appearance  of  an  enormous  boil.  This 
was  the  state  of  things  when  I  first  saw  the  patient. 

On  examination,  I  found  that  the  upper  swelling  was  very 
hard ;  and  at  about  the  third  intercostal  space  the  motion  of  the 
heart  could  be  seen  at  a  distance  of  several  feet — the  movement 
communicated  to  the  chest,  extending  over  a  space  of  3  or  4 
square  inches.  My  attention  was  next  called  to  the  tumor,  low- 
er down,  which,  as  I  have  said,  was  on  the  false  ribs.  This  felt 
hard,  did  not  fluctuate,  was  very  red,  with  little  tumefaction 
around  it,  except  in  the  upward  direction ;  here  I  could  hardly  be 
satisfied  that  there  was  any  connexion  between  the  two,  as  the 
swelling  was  diffused  from  the  axilla  half  way  round  the  body 
in  either  direction,  and  nearly  down  to  the  false  ribs,  on  which 
was  situated  the  pointed  and  more  determined  tumefaction. 

Being  inexperienced,  and  having  never  seen  a  similar  affection 
before,  I  told  the  parents  I  would  see  the  case  on  the  next  day, 
having  determined  to  operate  on  the  lower  swelling,  as  I  had 
no  doubt  it  contained  pus ;  thinking  that  it  could  have  no  con- 
nexion with  the  difficulty  above,  and  suspecting  the  upper 
swelling  might,  possibly,  be  an  aneurism,  of  which  I  knew  no- 
thing by  experience. 

The  abscess,  which  I  had  determined  to  open,  had  by  this 
time  got  considerably  softer  and  less  inflamed.  I  made  an  incis- 
ion about  three-fourths  of  an  inch  long,  down  to  the  pus,  which 
flowed  freely  for  several  minutes.  In  the  meantime,  I  had  no- 
ticed that  the  upper  tumor  had  wonderfully  abated,  and  the 
breathing  had  become  easier,  The  matter  was  quite  thin,  and 
darker  colored  than  ordinary  pus ;  this  continued  to  run  from 
this  opening  until  the  swelling  above  was  almost  entirely  gone, 
I  inquired  into  the  state  of  the  patient's  bowels,  and  found  that 


'  3.]  De  Witt's  Oaue  of  Empyema.  177 

she  had  not  had  a  passage  for  several  days ;  I  gave  her  a  gentle 
cathartic,  and  directed  a  poultice,  which  had  been  used  hot,  to 
be  applied  cold. 

I  returned  on  the  second  day  after;  the  matter  had  ceased  to 
be  discharged,  and  the  swelling  had  increased  above,  aline  b 
much  as  at  first.  On  examining  the  lungs  by  auscultation,  I 
found  that  the  patient  did  not  breathe  at  ail  in  the  left  side,  and 
that  the  other  lung  was  laboring  under  great  compression — 
nearly  as  much  so  as  when  I  first  saw  the  case ;  pulse  feeble, 
with  some  fever. 

The  next  day,  I  saw  the  patient :  the  swelling  had  become  as 
large  as  at  first,  and  the  breathing  very  difficult;  the  pulsation 
in  the  tumor  as  apparent  as  before.  I  immediately  decided  to 
let  out  the  matter ;  which  I  did,  by  making  an  opening  in  the 
centre  of  this  pulsating  tumor,  three-fourths  of  an  inch  long. 
The  matter  flowed  in  a  large  stream  with  such  force  as  to  jet 
from  the  eral  inches;  this  time  it  did  not  discharge 

than  two  quarts  of  matter  in  five  minutes,  and  continued  to  dis- 
charge slowly  for  several  days.  In  the  meantime,  I  bandaged 
the  body  and  placed  a  plaster  over  the  opening  to  prevent  the 
ingress  of  air,  removing  the  same  every  day,  with  the  patient 
reposing  on  her  knees  and  breast,  thereby  aiding  the  discharge 
of  matter,  which  was  materially  facilitated  by  the  introduction  of 
a  small  tube  through  the  opening,  to  expedite  the  escape  of  the 
matter,  which  continued  to  discharge  one  or  two  ounces  per  day 
for  several  days,  which  discharge  did  not  abate  as  rapidly  as  I 
had  anticipated. 

I  prescribed  Iron  by  hydrogen,  three  grains,  three  times  per 
day.  The  patient  improved,  grew  stronger,  ate  heartily,  but 
still  the  discharge  did  not  abate ;  the  lung  did  not  expand  on 
the  left  side,  breathing  confined  entirely  to  the  right  side ;  left 
side  seemed  to  lack  its  fullness,  and  the  spine  was  flexed  lateral- 
ly, the  concavity  on  the  affected  side.  I  now  tried  injection, 
first  preparing  two  quarts  of  tepid  spring  water,  and  with 
Matson's  patent  injecting  instrument,  introduced  two  or  three 
inches  into  the  opening — threw  the  entire  quantity  of  water 
prepared,  into  the  chest,  it  escaping  around  the  nozzle  of  the 
ument,  after  the  full ;  thus  effectually  washing 

out  the  part     I  afterwards  bandaged  the  body  as  tight  as  the 


178     Typhoid  Fever :  the  Thoracic  Form — its  Treatment.  [March, 

patient  could  tolerate  it,  applying  an  adhesive  plaster  to  the 
opening,  and  permanently  closing  it.  After  this,  loosening  the 
bandage  daily. 

On  this  treatment,  the  lung  began  to  expand,  which  continued 
until  the  function  of  the  lung  was  entirely  restored.  The  opening 
cicatrized,  and  the  patient  was  discharged,  apparently  well. 


Typhoid  Fever:  The  Thoracic  Form.  Its  Treatment  By  Dr. 
Behier,  Physician  to  the  Hospital  Beaujon  and  Adjunct 
Professor  to  the  Faculty  of  Medecine,  Paris.  Translated  for 
the  Southern  Med.  and  Surg.  Journal,  by  J.  J.  West,  M.  D., 
Demonstrator  of  Anatomy  in  Savannah  Medical  College. 

The  assemblage  of  symptoms  which,  in  the  course  of  certain 
Typhoid  fevers,  are  manifested  on  the  part  of  the  respirato- 
ry apparatus,  known  as  predominant  phenomena,  constitutes,  by 
common  consent,  one  of  the  most  serious  forms  of  these  affec- 
tions. Observed  separately  in  each  patient,  this  form  can  show 
itself  under  an  appearance  more  or  less  distinct,  and  thus  evince, 
not  an  epidemic,  as  it  has  been  too  often  called  by  an  abuse  of 
the  word,  but  a  peculiar  physical  constitution.  If  it  is  desired 
to  study  attentively  the  circumstances  in  which  these  sorts  of 
constitution  are  developed,  it  would  be  easy  to  demonstrate,  I 
believe,  that  in  the  larger  number  of  cases  these  pathological 
manifestations,  thus  attributed  to  a  certain  number  of  individu- 
als, ought  to  be  classed  among  constitutions  influenced  by  sea- 
son, upon  which  the  older  physicians  insisted  so  justly,  and 
the  study  of  which  has  been  perhaps  too  much  neglected  in 
later  times  and  even  at  present. 

But  it  is  not  with  this  part  of  the  question  that  I  wish  to  oc- 
cupy myself  here ;  the  part  upon  which  I  propose  to  insist, 
relates  to  the  thoracic  form  of  continued  fevers,  and  is  more 
immediately  practical.  I  desire  to  call  attention  to  a  mode  of 
treatment  which  has  yielded  the  most  satisfactory  results  in  the 
cases  in  which  I  have  put  it  in  use,  and  which  has  equally  well 
succeeded  in  the  hands  of  another  hospital  physician,  my  friend, 
Dr.  H.  Bourdon,  to  whom  I  had  mentioned  it.  It  is  the  appli- 
cation, in  great  numbers,  of  dry-cups  upon  the  thoracic  parietes, 
and  also,  and  especially,  upon  the  inferior  extremities.  It  was 
in  reflecting  upon  the  following  observations  that  I  was  led  to 
the  trial  of  this  means :  experience  has  since  demonstrated  its 
efficacy. 


1858.]    Typhoid  Fever :  the  Thoracic  Form — its  Treatment.       179 

The  thoracic  phenomena  which  may  be  observed  in  typhoid 
fever  are  of  a  peculiar  nature,  of  which  it  is  necessary  to  render 
an  exact  account.  Exclusive  of  cases,  very  rare  however,  in 
which  a  phlegmasic  complication,  a  true  pneumonia  unites  itself 
to  the  primitive  pathological  element,  the  disorders  that  are 
manifested  in  the  pulmonary  organs,  are  nothing  less  than  a 
congestion  analogous  to  that  which  might  occur  at  different 
parts  of  the  surface.  These  wide  surfaces,  of  a  sombre  red,  not 
painful,  presenting  no  augmentation  of  heat,  which  may  be 
observed  at  diffused  points  of  the  skin  in  subjects  attacked  by 
typhoid  fever,  and  which  sometimes  occupies  the  arm  or  fore- 
arm, sometimes  the  face,  the  nose  or  cheeks,  can,  it  seems  to  me, 
explain  the  mechanism  of  pulmonary  congestions  which  are 
found,  but  with  a  variable  degree  of  intensity,  in  all  the  subjects 
attacked  by  this  disease. 

They  offer,  as  cutaneous  congestions,  the  passive  character ; 
even  the  toeight  plays  a  part  in  its  development,  to  which  the 
attention  of  pathologists  has  been  called  for  a  considerable  time. 
These  congestions  answer,  in  effect,  to  that  which  has  been  de- 
signated at  first  under  the  name  hypostatic  pneumonia,  a  designa- 
tion which  Prof.  Piorry  has  since  modified  into  that  of  pneumonia 
hypostatic.  At  the  present  time,  nothing  more  is  seen  in  these 
states  of  the  lung  than  a  phlegmasia  of  the  parenchyma,  a  verit- 
able pneumonia.  The  diminution  of  sound  observed  on  per- 
cussion, in  almost  the  whole  of  the  chest  behind,  and  which  is 
not  enough  to  constitute  a  true  dullness  ("matile"),  the  rudeness 
of  the  "bruit  respiratoire,"  which  is  far  from  being  a  bronchial 
souffle,  the  more  marked  distinctness  of  the  voice,  which  does 
not  amount  to  broncophony,  and  the  mucous  or  subcrepitant 
rales  which  persist  without  offering  the  true  character  of  the 
crepitant,  and  without  passing  to  the  bronchial  souffle;  all  these 
signs,  I  say,  indicate  plainly  a  certain  augmentation  of  the 
density  of  the  luug,  but  cannot  suggest  the  idea  of  a  true  hepa- 
tization. The  anatomical  examination  itself  establishes  clearly 
the  order  of  lesion  to  which  these  signs  correspond,  and  it  would 
now  be  awkward  to  consider  as  a  proof  of  a  phlegmasia  of  the 
pulmonary  parenchyma,  the  dark  red  colour  of  this  tissue,  even 
after  observing  that  the  lung  does  not  contract  upon  the  opening 
of  the  chest,  as  does  the  lung  in  a  healthy  state;  that  it  is  a  little 
more  friable,  that  it  does  not  crepitate  under  pressure  of  the 
fingers,  and  that  it  sinks  in  a  vessel  of  water,  instead  of  swim- 
ming upon  this  liquid  when  a  small  part  is  subjected  to  this  proof. 
Insufflation,  in  fact,  renders  to  the  lung  thus  modified,  a  part 
of  its  normal  appearance,  which  is  impossible  in  the  truly  in- 
flamed lung,  and  shows  clearly  that  if  the  lung  is  densified  by 
the  determination  to,  and  stasis  of,  a  sufficiently  considerable 
quantity  of  blood,  there  is  not  in  the  substance  of  its  tissue  any 


180     Typhoid  Fever :  the  Thoracic  For m — its  Treatment.  [March, 

effusion  of  a  plastic  nature,  the  only  anatomical  character  of  a 
phlegmasia.  Besides,  in  a  case  of  simple  congestion,  a  direct 
inspection  of  the  incised  surfaces  permits  the  recognition  of  the 
different  elements  which  compose  the  pulmonary  parenchyma — 
elements  which,  in  inflammation,  are  no  longer  perceptible,  ag- 
glomerated and  confused  as  they  are  by  the  plastic  infiltration 
which  determines  the  phlegmasia. 

MM.  Legendre  and  Bailly,  in  insisting  upon  these  distinctions, 
have  assuredly  rendered  a  great  service  to  the  science. 

The  pulmonary  lesions  observed  in  typhoid  fever,  are  then,  ■ 
the  result  of  a  simple  congestion,  of  little  intensity  in  some  pa- 
tients, very  violent  in  others,  either  on  account  of  individual 
disposition,  or  of  a  more  general  influence.  This  influence  may 
even  add  another  element,  and  in  some  patients,  it  is  perceived 
that  to  the  congested  state  mentioned,  is  added  an  affection 
of  the  bronchiae,  a  kind  of  capillary  bronchitis  of  which  the  finer 
rales,  and  the  expectoration  of  puriform  sputa,  of  almost  num- 
mular form,  with  dyspnoea  as  the  most  prominent  traits.  One 
of  the  patients  that  we  have  observed,  and  whose  history  we 
give  further  on,  (obs.  6,)  offered  an  example  of  this  complication. 
When  it  exists,  this  catarrhal  bronchitis,  as  it  has  been  called, 
is  a  new  cause  of  a  more  considerable  congestion  in  the  pulmo- 
nary tissue;  it  there  exaggerates  the  already  existing  dispo- 
sition. 

It  is  when  this  congestion  takes  a  considerable  development, 
whether  or  not  it  be  exaggerated  by  the  bronchitic  element  I  have 
indicated,  that  the  signs  of  a  pulmonary  asphyxia  appear — signs, 
the  augmentation  of  which  is  rarely  rapid,  but  ordinarily  gradu- 
al. Among  these  signs  should  be  mentioned  the  anxious  aspect 
of  the  face,  the  bluish  coloration  of  the  cheeks  and  lips,  dilata- 
tion of  the  alae  of  the  nose,  more  marked  dyspnoea,  which,  how- 
ever, hardly  ever  increases  as  far  as  a  state  of  orthopnea ;  it  is 
then  that  the  rales  are  multiplied  in  the  chest,  and  a  danger 
which  is  immediate  and  often  very  difficult  to  remove,  menaces 
the  patient. 

The  therapeutic  indication  in  such  a  case  is,  then,  to  free  the 
lung  of  blood  which  flows  to  and  rests  there,  and  serves  to  ren- 
der this  organ  too  passive  to  expel  the  liquids  which  obstruct  it, 
on  account  of  the  elasticity  which  it  has  lost  and  which  is  neces- 
sary to  the  integrity  of  its  functions.  Blood-letting,  often  prac- 
ticed in  like  circumstances,  removes  from  the  pulmonary  tissue 
a  part  of  the  venous  blood  which  "accumulates  there,  but  it 
cannot,  on  one  side,  be  pushed  very  far  without  inconvenience 
to  the  general  condition  of  the  patient,  always  under  the  influ- 
ence of  an  adynamic  tendency ;  and  upon  the  other  side,  in 
drawing  from  the  patient  a  part  of  his  strength,  these  blood- 
lettings tend  to  augment  the  passive  condition  of  the  lung. 


1858.]   Typhoid  Fever :  the  Thoracic  Form — its  Treatment.       181 

These  considerations  should  tend  to  banish  from  practice,  in  such 
cases,  the  use  of  sanguineous  abstractions — even  the  local.  It 
has  been  sought  again,  to  fulfil  the  indication  by  disengaging  a 
part  of  the  bronchia  of  their  mucosities,  by  the  use  of  emetics, 
at  the  same  time  that  tonic  preparations,  especially  those  of  cin- 
chona, aid  in  sustaining  the  advantages  obtained  with  the  aid  of 
the  concussion  produced  by  vomiting.  This  treatment  is  assur- 
edly reasonable,  but  it  ought  to  be  limited.  Struck  with  the 
insufficiency  of  these  means,  I  have  sought  to  aid  them,  and,  in 
considering  the  mobility  of  cutaneous  congestions  in  persons 
laboring  under  an  attack  of  this  disease,  convinced,  above  all, 
of  the  congestive  nature  of  the  pulmonary  disorders,  I  found 
myself  forced  to  discover  a  means  of  disgorging  the  lung — a 
means  not  borrowed  from  a  spoliative  therapeutics,  and  only  a 
simple  means  of  displacement. 

I  at  first  thought  of  employing  the  Junod  cup ;  but  besides 
its  never  being  procured  with  promptness  in  our  hospitals,  it  has 
the  inconvenience  of  easily  producing  syncopes,  accidents  which 
might  be  attended  by  the  saddest  consequences  in  the  patients 
we  have  to  treat.     It  was  then  that  I  attempted  the  application 
of  dry-cups,  placed  in  considerable  numbers  on  the  chest,  and 
particularly  upon  the  inferior  extremities.     I  have  gone  so  far 
as  to  apply  on  one  patient  from  60  to  80  of  these  cups,  morning 
and  evening.     The  evening  application  is  necessary,  for  oppos- 
ing the  return  of  the  congestion  removed  momentarily  by  the 
derivation  already  exercised  in  the  morning;  and  this  tenacity 
of  action  is  not  too  much  against  a  disposition  equally  tenacious. 
Under  the  influence  of  these  cups  may  be  observed  very  large 
ecchymoses,  which  are  formed  in  the  places  where  the  cups  had 
been  placed.     These  ecchymoses  persist  during  a  time  more  or 
less  long,  but  I  have  never  seen  them  followed  by  any  accident 
whatever,  although  upon  some  patients  the  nnmber  of  cups  has 
been  more  than  500  in  ten  days.    iNever  have  I  seen  gangrene, 
nor  even  suppuration,  against  the  presence  of  which  evils  I  have 
always  prepared  myself,   especially  in  my  first  trials  of  this 
means,  which  was  two  years  ago.     I  desired  to  wait  some  time, 
and  to  multiply  experiments,  before  publishing  the  utility  of  this 
mode  of  treatment. 

The  following  facts  will  serve  as  examples  in  confirmation  of 
what  I  have  advanced : 

Observation  I. — Typhoid.  Fever,  of  the  thoracic  form,  in  a 
young  woman;  emetic ;  120  dry-cu])s  in  three  days.      Cure  rapid. 

Nickley  (Sidonie),  20  years,  a  servant,  unmarried,  habitu- 
ally well  regulated,  has  never  borne  children,  has  never  had 
any  other  disease  than  the  measles.  Actual  affection  com- 
menced May  12th ;  its  accession  was  slow ;  the  patient  had  pain 


182     Typhoid  Fever :  the  Thoracic  Form — its  Treatment.  [March, 

in  the  head ;  strength  diminished ;  at  the  commencement  she  had 
a  slight  diarrhoea  and  a  little  cough ;  difficulty  of  respiration 
during  several  days.  She  has  had  no  treatment,  and  has  not 
even  remained  in  bed  until  her  entrance  into  the  hospital,  the 
20th  May,  1855. 

May  21st.  104  pulsations  per  minute,  pulse  small,  tolerably 
hard ;  skin  hot,  face  red,  cheeks  and  lips  bluish ;  eyes  promi- 
nent, humid ;  extreme  difficulty  of  respiration ;  sound  of  the 
chest  normal ;  mucous  and  sonorous  rales  very  abuhdant  on 
both  sides,  especially  at  the  base  of  the  lung  behind ;  tongue  a 
little  shining;  loss  of  appetite ;  abdomen  slightly  enlarged ;  gar- 
gouillement  in  the  right  iliac  fossa;  no  diarrhoea;  some  rose- 
colored  lenticular  spots  disseminated  upon  the  abdomen  and 
lower  part  of  the  thorax  ;  head  heavy ;  great  muscular  debility. 
Prescription:  15  grs.  pulv.  ipecac;  sinapisms  upon  the  inferior 
extremities. 

May  22nd.  Has  vomited  well;  two  stools;  112  pulsations, 
small;  extreme  difficulty  of  respiration ;  sound  of  chest  less  nor- 
mal, without  real  matite ;  expectoration  of  white  mucus;  some 
rales  in  whole  extent  of  the  chest;  face  and  integument  of  the 
hands  still  violet ;  she  breathes  better  in  the  almost  sitting  pos- 
ture she  has  been  made  to  assume.  15  grs.  ipecac,  40  dry-cups 
upon  the  thorax. 

May  23rd.  Abundant  vomiting  of  colorless  mucous  matter. 
Oppression  has  greatly  diminished  since  the  application  of  the 
cups;  the  skin  is  still  of  the  same  dark  red  color;  headache  less; 
abdomen  soft;  skin  cool;  has  a  little  appetite;  110  pulsations, 
small  and  hard.     15  grs.  ext.  cinchona,  40  dry-cups. 

May  24th.  Sound  of  the  chest  perfect ;  still  a  few  rales  at  the 
base  behind;  pulse  small,  sufficiently  developed ;  skin  cool;  face 
less  colored  and  less  anxious;  she  regains  her  natural  express- 
ion.    40  dry-cups,  lichen  two  portions,  23  grs.  ext.  cinchona. 

May  25th.  From  this  time  the  patiect  does  well;  appetite 
has  returned;  the  skin  and  mucous  membranes  lose  iiioir  yiolet 
hue ;  the  respiration  is  natural ;  abdomen  soft ;  bowels  quiet ; 
no  more  headach ;  and  the  3rd  June  the  patient  eats  her  full 
allowance. 

This  observation  offers,  at  the  same  time,  an  example  of  the 
predominance  of  thoracic  phenomena,  and  the  rapid  effect  of 
dry-cups  applied  in  great  numbers.  The  thoracic  form  was  so 
plainly  the  predominant  element,  that  once  this  order  of  acci- 
dents was  removed,  convalescence  was  rapidly  established. 

Observation  II. — Typhoid  Fever,  with  adynamic  state — pre- 
dominance of  thoracic  symptoms  ;  4  cups  {scarified)  ;  160  dry-cups; 
extract  of  cinchona  ;  cure. 

Jette  (Francois),  28  years,  brick-layer,  enters  hospital  Oct.  16, 


1858.]   Typhoid  Fever :  the  Thoracic  Form — its  Treatment.       183 

1855,  "Salle  Beaujon/'  Xo.  62  :  Says  he  had  the  same  disease 
five  years  since ;  remained  about  two  months  in  the  Brick-lay- 
ers ward,  "hospital  Beaujon  ;"  has  lived  at  Paris  since  he  was 
8  years  of  age.  For  the  last  fifteen  days  has  kept  his  bed  with- 
out calling  a  physician  or  doing  anything  for  himself;  has  had 
severe  diarrhoea — no  epistaxis.  This  period  had  been  preceded 
by  a  state  of  general  debility  and  occasional  giddiness,  which, 
however,  still  permitted  him  to  work. 

Oct.  17th.  120  pulsations,  pulse  small;  skin  hot;  violet  co- 
lor of  the  skin,  especially  of  the  face  and  extremities;  lips 
violet ;  nares  dusky ;  abdomen  tympanitic,  numerous  lenticu- 
lar rose-spots ;  diarrhoea  considerable ;  tongue  covered  with  a 
grayish  coat,  very  thick  ;  trembling  of  the  tongue ;  difficulty  of 
speech;  no  headache;  cough  frequent,  without  expectoration; 
in  the  whole  extent  of  the  chest,  an  abundant  rale  presenting  a 
mixture  of  the  sibilant  and  mucous  rales;  no  absolute  matile; 
sonorousness  is  only  moderate  in  all  the  chest,  posteriorly ;  want 
of  sleep  ;  agitated  during  the  night.  Ext.  cinchona  7-J  grains,  4 
scarrified  cups  on  the  chest. 

Oct.  18th.  Eestlessness  during  the  night — 104  pnlsations ; 
skin  hot  and  dry ;  tongue  trembling;  abdomen  tympanitic;  gar- 
gouillement  in  the  right  iliac  fossa ;  violet  color  of  the  integu- 
ment; troubled  respiration;  conjunctiva  injected;  same  state 
of  the  chest  on  auscultation  and  percussion.  Julep,  with  cxt. 
cinchona  30  grains ;  30  dry-cups  on  the  chest ;  bath  in  the  ward ; 
beef-tea  twice. 

Oct.  19th.  The  cups  have  considerably  relieved  him — they 
have  left  on  the  chest  spots  of  deep  red  color,  with  no  trace  of 
vesication ;  tongue  trembling,  still  covered  with  a  thick  coat, 
but  not  completely  dry ;  nares  dusky ;  diarrhoea  abundant,  in- 
voluntary ;  agitation,  no  sleep ;  the  cough  is  less,  rales  a  little 
less  abundant.     Julep,  cinchona  10  dry  cups. 

Oct.  20th.  108  pulsations;  skin  cool ;  desires  to  eat;  dissemi- 
nated rales  heard  in  the  chest ;  cyanosis  of  the  face  is  less  intense. 
Julep  cinchona,  10  dry -cups  on  the  chest. 

Oct.  21st.  Does  well ;  has  slept  during  the  night ;  wants  to 
eat;  tongue  clean  ;  thorax  is  sensibly  relieved ;  rales  rarer;  less 
mucus.     30  dry  cups  on  inferior  extremities. 

Oct.  22nd.  Same  state.  80  dry -cups  on  inferior  extremities; 
soup  four  times. 

Oct.  23rd.  Color  of  the  integument  almost  normal ;  abdomen 
soft,  indolent ;  chest  almost  freed;  diarrhoea  still  involuntary; 
has  appetite.     Soup  four  times. 

Oct.  24th.  Amelioration  increasing;  tongue  clean;  respira- 
tion normal  in  the  whole  extent  of  the  chest;  has  become  more 
sonorous ;  diarrhoea  still  involuntary ;  has  appetite.  Injections 
of  starch  and  laudanum ;  soup  four  times. 


184     Typhoid  Fever :  the  Thoracic  Form — its  Treatment.  [March, 

Nov.  1st.  Appetite  strong;  80  pulsations,  small;  skin  cool; 
sleeps  well;  tongue  moist;  still  a  little  diarrhoea  in  bed;  some 
cough,  but  without  rales  perceptible  to  the  ear.  The  state  of 
the  intestines  becomes  gradually  modified,  and  the  patient  quits 
the  hospital  about  twelve  days  after,  cured. 

In  this  patient,  as  has  been  seen,  the  relief  was  prompt,  espe* 
cially  at  the  moment  when  the  cups  were  applied  in  great  num- 
bers (18th  October). 

The  employment  of  this  means  has  not,  however,  appeared  to 
have  any  effect  upon  the  intestinal  phenomena,  which  continued 
many  days  after  the  favorable  termination  of  the  thoracic  symp- 
toms. 

[The  history  of  the  four  following  cases,  would  occupy  more 
space  than  is  necessary  to  prove  the  success  of  this  mode  of 
treatment.  I  therefore  abridge  the  account  of  the  author,  noting 
only  those  complications  which  might  influence  the  practitioner 
in  deciding  on  its  employment,  and  perhaps  prevent  it,  if  he  had 
not  the  experience  of  others  to  support  him. — Translator,] 

Observation  III. — Typhoid  Fever — "d  forme  Thoracique  ;" 
employment  of  dry -cups  to  the  number  of  460.     Cure. 

Jan.  31st,  1857.  Mary  Poussot,  domestic.  The  answers  of 
the  patient  are  short,  announcing  an  intelligence,  either  natural- 
ly weak,  or  enfeebled  by  the  disease ;  sick  fifteen  days ;  chills, 
pains  in  back  and  limbs,  diarrhoea,  want  of  appetite,  great  thirst; 
cough  intense,  without  expectoration.  These  symptoms  have 
existed  from  the  commencement. 

Feb.  1st.  Actual  state,  decubitus  dorsal ;  extreme  debility ; 
complete  immobility — rising  impossible,  even  to  take  medicines ; 
face  bloated;  eyes  dull  and  half  closed  ;  tongue  dry,  rough,  of 
a  dirty  gray  in  the  middle,  bright  red  at  the  point,  lanceolated ; 
lips  and  gums  sooty ;  upper  teeth  black  ;  mouth  bitter ;  tympani- 
tic; gargouillements  abundant;  five  or  six  stools  a  day  ;  pulse 
112,  small,  contracted,  regular ;  skin  hot ;  respiration  painful ; 
humid  rales  in  whole  extent  of  the  chest ;  cough  frequent  and 
fatiguing;  no  expectoration;  diminution  of  sonorousness,  but 
not  real  matite ;  sensation  of  heat  general ;  almost  complete 
deafness;  no  headache ;  continual  somnolence  ;  tranquil  deliri- 
um ;  very  numerous  spots  on  the  abdomen  and  the  whole  of  the 
chest.  22  grs.  ipecac,  in  three  doses,  60  dry-cups  on  the  inferior 
extremities,  30  grs.  ext.  cinchona. 

Feb.  2nd.  A  little  better ;  is  less  oppressed  ;  cough  trouble- 
gome;  less  delirium;  less  somnolence;  less  diarrhoea;  pulse  112. 
Eales  about  the  same  ;  face  less  bloated.  Extract  cinchona,  30 
grs.;  80  cups  on  inferior  extremities — 40,  morning  and  evening. 


1858.]   Typhoid  Fever:  the  Thoracic  Form— its  Treatment       185 

Injection  of  12  gtt.  laudanum,  and  5  grs.  musk ;  sweetened  gum 
water. 

The  cups  of  yesterday  have  left  large  eccbyrnoses  upon  the 
thighs  of  the  form  of  the  glasses  used. 

Feb.  3rd.  A  little  coma ;  sleep  agitated ;  respiration  easier ; 
cough  less  fatiguing  and  loose;  the  rales  have  diminished  nota- 
bly; expectoration  mucous,  but  not  abundant;  pulse  96;  skin 
hot;  some  tinnitus  aurium;  giddiness.  Same  prescription ;  80 
cups  in  two  applications;  18  grs.  ipecac. 

Feb.  4th.  In  about  the  same  condition;  rales  "a  grosses 
bulles,"  throughout  the  chest ;  pulse  92 ;  skin  less  hot.  Same 
prescription  ;  80  cups ;  ipecac. 

Feb.  5th.  The  patient  is  sensibly  better ;  pulse  8-4 ;  skin  less 
hot;  deafness  decreased;  rales  diminishing;  oppression  sensibly 
ameliorated  j  coma  less ;  delirium  hardly  appreciable ;  80  cups  1 
beef- tea  twice,  soup  twice.     Same  prescription. 

Feb.  6th.  Oppression  hardly  exists ;  general  improvement ; 
tongue  about  the  same ;  pulse  80  to  84 ;  skin  without  great  heat ; 
80  cups.     Same  injection,  same  prescription. 

Feb.  7th.  Eespiration  free;  few  rales;  no  cough  ;  no  expec- 
toration; general  state  satisfactory;  pulse  72  to  80;  intellectual 
state  much  better.     Omit  the  cups,  continue  rest  of  prescription. 

Feb.  8th,  9th  and  10th.  General  improvement ;  continue 
prescription  and  diet. 

Until  the  19th,  when  she  left  the  hospital,  there  was  the  same 
improvement,  with  the  exception  of  pain  in  the  right  shoulder, 
on  the  loth,  which  was  speedily  dissipated  by  the  use  of  a  small 
blister. 

Observation  TV.  Typhoid  Fever  ;  vomitives;  application  of 
530  dry-cups  on  the  inferior  extremities. 

Feb.  19th,  1857.  Elizabeth  Pausser,  aged  22  years,  a  domes- 
tic— has  resided  in  Paris  six  months — was  confined  two  months 
since ;  has  never  been  perfectly  well  since,  on  account  of  too 
severe  work, 

Feb.  20th.  Actual  state. — Extreme  prostration  ;  complete 
immobility  :  gums  are  brown,  covered  with  sordes  to  the  teeth  J 
tongue  dry,  brown  in  the  centre,  red  at  borders  and  point  ; 
mouth  dry  ;  deglutition  easy;  no  nausea,  no  pain  in  the  abdo- 
men;  four  liquid  stools,  yellow,  sometimes  involuntary;  urine 
scanty,  difficult  and  painful  to  emit;  complete  inappetence; 
thirst  great ;  sonorous  rales  throughout  the  chest  *  cough  fre- 
quent; expectoration  mucous  and  tolerably  thick:  dyspnoea; 
pulse  112,  small ;  skin  hot  and  dry ;  severe  headache,  eyes  half 
closed;  complete  deafness;  spots  on  the  abdomen  pretty  numer- 
ous. Sweetened  gum  water,  two  glasses  of  seidlitz  water  in  the 
morning,  15  grs.  ext.  cinchona  in  the  evening;  beef- tea  4  times. 


186     Typhoid  Fever :  the  Thoracic  Form — its  Treatment.  [March, 

Feb.  21st;  Pulse  112 ;  skin  hot  and  dry  ;  tongue  very  dirty  ; 
little  diarrhoea;  thoracic  phenomena  the  same,  without  any 
more  intensity.  On  account  of  the  state  of  the  tongue,  tart,  an- 
timony gr.  |,  15  grs.  ext.  cinchona,  for  the  evening. 

Feb.  22nd.  Emetic  acted  three  times;  little  diarrhoea;  pulse 
112,  small,  compressible;  skin  less  hot.  Same  prescription,  less 
of  tart,  antimony. 

_  Feb.  23rd.  Inspiration  much  more  embarrassed.  On  both 
sides,  and  at  the  summit  of  the  chest  sibilant  rales  are  heard, 
mucous  rales  very  abundant  everywhere  else  ;  otherwise,  same 
general  state.  30  dry  cups  on  inferior  extremities,  rest  of  pre- 
scription ut  supra. 

Feb.  24th.  She  says  that  the  cups  have  given  her  great  re- 
lief, and  asks  for  them  again ;  in  fact,  the  chest  dilates  better, 
and  respiration  is  less  painful.  The  pulse  is  116,  comrpessible ; 
skin  hot ;  tongue  more  humid  ;  epistaxis  for  the  first  time.  30 
dry  cups,  ext.  cinchona  15  grs.,  beef-tea  4  times. 

Feb.  25th.  A  little  delirium;  pulse  112;  sacral  region  red; 
state  of  chest  nearly  the  same.  50  cups,  injection  of  5  grs.  musk, 
3  iss*  laudanum. 

Feb.  26th.  Less  oppression  ;  the  rales  and  dyspnoea  are  less 
marked ;  delirium  more  calm.     50  cups. 

Feb.  27th  to  March  7th.  50  cups,  40,  40,  40,  30,  30,  30,  30, 
30.  Other  treatment  consisted  of  ipecac,  cinchona,  wine,  beef- 
tea,  etc.,  according  to  indication.  On  the  28th,  she  left  the 
hospital  perfectly  cured. 

Obsekvation  V.  August  14th,  1857.  Eliza  Eoger,  aged 
22  years — sick  more  than  a  month — miscarried  ten  days  since, 
at  six  and  a  half  months ;  the  lochia  flows  still.  Actual  state, 
very  much  like  that  of  Observation  IV.  2  glasses  seidlitz  water, 
100  dry  cups  (50  morning  and  evening),  beef-tea  and  soup. 
The  treatment  of  this  case,  up  to  the  21st,  was  that  of  the  cases 
mentioned  above,  consisting  of  cinchona,  laudanum,  enemas, 
soups,  etc.;  50  dry  cups  morning  and  evening,  daily.  The  im- 
provement of  the  patient  was  marked — cough  lessening;  rales 
diminishing ;  tongue  becoming  cleaner ;  sleep  good ;  diarrhoea 
less;  pulse  less  frequent.  On  the  21st,  the  cups  were  discontin- 
ued, diarrhoea  became  abundant,  but  the  chest  seemed  to  be 
doing  well.     Laudanum  enema. 

[Although  the  cups  were  no  more  used  in  this  case,  still  the 

*  The  original  reads  6  grammes,  equal  to  3iss  of  our  measurement,  evidently 
an  error.  From  what  I  have  seen  of  the  practice  of  French  physicians,  I  "would 
hardly  believe  that  the  amount  given  was  one-fourth  of  that  quantity.  They 
give  opium  in  much  smaller  quantities  than  we  do. — Translator. 


1858.]   Typhoid  Fever:  the  Thoracic  Form — its  Treatment.       187 

disease  having  assumed  a  new  phase,  demanding  a  different 
course  of  treatment,  and  the  treatment  of  this  particular  patient 
illustrating  that  of  the  French,  generally,  I  will  give  the  author's 
account  in  full ;  and  as  it  was  successful  in  this  instance,  it  may 
be  of  practical  benefit  to  some  of  the  readers  of  the  Journal.    Tr.] 

Aug.  22nd.  The  cough  became  again  very  painful ;  rales 
are  heard  anew  throughout  the  chest ;  the  sputa  are  bronchial 
with  some  filaments  of  brownish  blood ;  sleep  is  impossible,  on 
account  of  the  frequency  of  stools.  Gooseberry  syrup ;  continue 
enema  (laudanum  gtt.  xij.);  beef-tea,  4  times. 

Aug.  23rd.  Diarrhoea  still  more  frequent.  Add  to  prescrip- 
tion a  potion,  with  4  gtt.  laudanum. 

Aug.  24th.  At  night,  on  the  22nd  and  23rd,  she  had  some 
vomiting,  of  which  no  mention  was  made  at  the  visit  of  yester- 
day. Yesterday  evening,  the  vomiting  recommenced,  accom- 
panied by  a  liquid  diarrhoea,  very  abundant,  white,  persisting  ; 
dejected  aspect ;  eyes  sunken,  surrounded  by  a  bluish  circle  ; 
indifference  to  surrounding  objects ;  immobility;  visage  wasted; 
speech  feeble,  slow — complains  of  suffocating;  pulse  100,  hardly 
perceptible ;  blue  voluminous  veins  are  seen  upon  the  chest ; 
skin  cold;  pulsations  of  the  heart  barely  perceptible.  It  is  im- 
possible to  know  if  the  patient  urinates,  the  stools  being  invo- 
luntary, may  be  mixed  with  urine.  The  potion  of  laudanum 
prescribed  yesterday  was  vomited  on  the  spot ;  in  the  evening, 
the  interne  of  the  ward,  prescribed  ice;  gum  julep  3v,  with 
rum  3  ij  ;  diet. 

Aug.  25th.  She  vomited  but  once  during  the  day  of  the 
24th,  but  in  the  evening,  the  vomiting  recommenced  and  lasted 
all  night.  She  has  had  but  one  stool,  which  is  yellow  ;  she  ap- 
pears a  little  better.  Her  pulse  is  a  little  increased  in  frequency 
(112) ;  the  skin  has  resumed  its  heat ;  face  less  pale,  but  the  eyes 
are  as  much  sunken.     Same  prescription. 

Aug.  26th.  Eeaction  is  fully  established ;  pulse  108 ;  skin 
hot ;  face  red ;  eyes  sunk.  Still  some  vomiting,  but  no  diar- 
rhoea.    Urinated  yesterday.     Ice  ;  beef-tea  twice. 

Aug.  27th.  In  the  night,  vomited  considerable  quantity  of 
bile,  in  which  there  floated  numerous  white  clots;  pulse  108, 
small,  dicrotic;  skin  hot;  face  red;  eyes  less  sunken  ;  extreme 
debility;  three  diarrhceal  stools;  tongue  moist,  lighty  white;  no 
headache ;  great  thirst.  2  large  enemas,  with  12  gtt.  laudanum 
in  each  ;  ice  ;  soup  twice. 

Aug.  28th.  Pulse  108;  skin  very  hot;  vomiting  continues; 
diarrhoea.     Continue  enema  potion  with  rum  5iij  ;  ice;  diet. 

Aug.  29th.     She  has  again  vomited  this  morning,  a  green 
liquid ;  tongue  a  little  swollen,  yellowish  gray;  pressure  upon 
8* 


188     Typhoid  Fever :  the  Thoracic  Form — its  Treatment.  [March, 

the  right  iliac  fossa  determines  pain  ;  abundant  diarrhoea ;  urin- 
ates easily;  pulse  100,  dicrotic;  eyes  less  sunken,  visage  good. 
The  patient  says  she  does  not  suffer  ;  aspect  better.  Continue 
the  treatment. 

Aug.  30th.  She  has  vomited  a  little,  but  her  visage  has  as- 
sumed its  normal  aspect ;  slept  all  night  and  without  waking; 
mouth  bad;  diarrhoea;  pulse  96,  dicrotic.  2  large  enemas  with 
laudanum  12  gtt.;  beef-tea  4  times. 

Aug.  31st.  Has  not  vomited  since ;  tongue  humid,  hardly 
white ;  thirst ;  a  little  appetite ;  no  diarrhoea  ;  sleep  good.  Laud- 
anum  enema;  half  portion  (hospital  diet). 

September  1st.  No  more  vomiting  ;  no  stools  for  two  days  ; 
aspect  good  ;  face  rose  color ;  eyes  not  sunken  ;  pule  96,  scarce- 
ly dicrotic ;  tongue  humid ;  sleep  good ;  ate  with  pleasure.  Demi- 
portion. 

Sept.  2nd.     Continues  better.     One  portion. 

Sept.  5th.  Doing  very  well ;  tongue  rose-color,  humid  ;  ap- 
petite ;  little  thirst ;  no  diarrhoea;  pulse  68 ;  skin  cool.  1  portion. 

On  the  7th,  she  ate  some  unripe  grapes,  followed  by  diarrhoea 
*  on  the  8th  :  that  evening  vomited  a  little,  also  at  night.     Pulse 
96 ;  skin  hot.     2  enemas,  laudanum  gtt.  xij,  in  each. 

Sept.  10th.  This  new  indisposition  was  followed  by  no  re- 
sults.    Left  the  hospital  well. 

Here  again  is  seen  the  modification  obtained  by  the  use  of  the 
dry-cups,  and  the  return  of  the  epi-phenomena  at  the  moment 
they  were  suspended ;  the  intercurrent  choleraic  symptoms  ren- 
dered a  new  employment  of  this  means  useless. 

In  the  observation  about  to  follow,  the  commencement  of 
which  did  not  pass  under  my  eyes,  I  will  call  attention  to  the 
nature  of  the  expectoration,  which  was  at  first  composed  of 
sputa  of  a  yellowish  color,  thick,  rounded,  nummular,  quite  an- 
alogous to  those  observed  towards  the  end  of  the  measles,  and 
which  presented  afterwards  some  sanguinolent  striae. 

The  generalization  of  the  rales,  their  seat  the  summit,  the 
lively  heat  of  the  skin,  the  small  number  and  doubtful  appear- 
ance of  the  spots — all  in  a  woman,  blonde,  chlorotic — could  give 
rise  to  doubts,  at  first  sight,  upon  the  diagnosis,  and  lead  to  the 
impression  that  we  had  to  do  with  an  acute  phthisis.  The  in- 
testinal phenomena,  and  the  march  of  the  disease,  assisted  us  in 
avoiding  that  error. 

Observation  YI. — Typhoid  Fever,  "  d  forme  Abdominale  in 
its  debut;  thoracic  phenomena  towards  the  twenty -second  day.  200 
cups  ;  ext.  cinchona.     Cure. 

Eliza  Legarois,  age  15  years,  domestic ;  always  of  good  health ; 
not  yet  menstruated — has  lived  in  Paris  only  one  month.  Two 
or  three  days  after  her  arrival  at  Paris,  she  was  taken  with  a 


1858.]   Typhoid  Fever :  the  Thoracic  Form — its  Treatment.       189 

bad  headache,  which  persisted,  eblouissernents,  (to  which  she  is 
subject);  cough,  with  oppression ;  diarrhoea  not  abundant ;  com- 
plexion dull  and  white,  hair  light,  mucous  membranes  pale, 
continued  souffle  in  the  vessels  of  the  neck. 

On  her  entrance,  Sept.  23rd,  about  the  eighth  or  tenth  day  of 
the  disease,  a  typhoid  fever  "a  forme  abdominale,"  with  symp- 
toms not  grave,  was  diagnosed. 

During  the  first  days  of  October,  the  cough  augmented  in 
frequency  and  intensity ;  she  became  more  oppressed. 

Oct.  11th.  Besides  the  abdominal  phenomena  slightly  mark- 
ed, I  found,  in  the  chest,  numerous  rales,  offering  towards  the 
two  snmmits,  characters  of  the  sibilant,  and  towards  the  middle, 
as  far  as  the  base,  a  mucous  stamp,  especially  on  the  right  side. 
Apply  40  dry-cups  on  inferior  extremities;  sweetened  gum  wa- 
ter ;  ext.  cinchona  1\  grs. 

Condition  of  the  patient  Oct.  12th.  Coughs  as  much  as  dur- 
ing the  preceding  days,  but  says  she  is  less  oppressed  since  the 
cups  were  applied,  and  expectorates  more  easily.  The  sputa 
resemble  those  of  a  bronchitis  at  the  period  of  coction  ;  they  are 
yellowish,  thick,  rounded,  much  striated  with  brown  blood, 
(proceeding  from  the  fauces,)  and  in  no  way  analogous  to  that  of 
pneumonia :  tongue  tolerably  humid,  glutinous,  wide  at  the 
points,  yellowish-gray  at  base  and  middle ;  mouth  bad ;  no  ap- 
petite; considerable  thirst;  a  little  diarrhoea;  two  to  five  stools ; 
gargouillement  pretty  abundant  in  right  iliac  fossa ;  no  pain  on 
pressure  of  the  abdomen  ;  no  well-marked  rose-spots ;  no  sleep  ; 
pulse  96,  skin  a  little  hot.  Percussion  indicates  nothing  very 
abnormal  in  the  chest,  which,  however,  does  not  resound  well ; 
without  real  matite,  especially  on  the  right  side.  Auscultation 
reveals  mucous  and  sonorous  rales  in  all  the  chest — thej^  are  sibi- 
lant towards  the  two  summits,  and  mucous  at  the  base  and 
middle  parts,  posteriorly,  particularly  on  the  right  side.  Ext. 
cinchona,  grs.  xxx.;  pil.  opium,  gr.  §;  coffee,  f^iv. ;  40  dry- 
cups. 

Oct.  loth.  Coughs  as  much — is  also  oppressed;  does  not 
sleep;  same  sputa,  still  sanguinolent,  abundant.  Same  pre- 
scription. 

Oct.  14th.  Oppression  a  little  less;  rales  still  abundant,  al- 
though less  numerous  ;  tongue  cleaner ;  pulse  less  frequent  (88), 
skin  but  little  hot.     40  cups. 

Oct.  loth.  Still  much  oppressed ;  sonorous  rales  throughout 
the  chest;  intermixed  with  less  of  the  mucus ;  little  sleep,  pulse 
at  88,  skin  less  warm.     40  cups. 

Oct.  16th.  Says  she  is  much  better ;  she  respires  more  easily ; 
the  rales  have  much  diminished,  and  the  sonorous  rales  are 
rarer;  sonorous  rale  is  better  marked;  cough  less  painful ;  ex- 
pectoration easy  ;  the  sputa  are  less  thick,  less  yellow,  but  little 


190     Tyhhoid  Fever :  the  Thoracic  Form — its  Treatment.  [March, 

striated;  tongue  moist,  wide,  whitish;  no  thirst;  a  little  appe- 
tite ;  pulse  68,  regular ;  skin  cool.  Omit  the  cups ;  two  eggs, 
and  a  little  bread ;  ext.  cinchona  30  grs. ;  sweetened  gum  water 
for  drink. 

Oct.  17th.  Pulse  48,  regular ;  skin  cool.  It  is  with  difficul- 
ty that  one  hears  a  few  rales  in  the  chest.  No  diarrhoea ;  ex- 
pression much  better  and  more  gay :  on  the  whole,  she  does  well. 
Bordeaux  wine,   §  iiiss.,  cinchona  30  grs.,  one  portion. 

Oct.  18th.  Pulse  60 ;  skin  cool :  does  well.  19th.  The  pa- 
tient feels  well,  has  a  good  appetite,  sleeps  well ;  only  she  is 
feeble,  and  when  she  desires  to  rise  and  walk  she  falls — not  that 
she  has  attacks  of  giddiness,  but  her  legs  bend  under  the  weight 
of  her  body. 

This  condition  still  improves ;  the  respiration  to  day  (22nd 
October)  is  everywhere  pure,  without  mixture  of  rales ;  no  ex- 
pectoration :  the  diarrhoea  has  disappeared ;  pulse  from  60  to  64, 
it  assumes  a  little  consistence;  appetite  is  excellent;  debility 
and  palor  are  the  only  symptoms  which  persist. 

I  could  add  to  these  facts,  many  others,  which  would  only  be 
a  repetition.  I  hope  those  which  precede  will  appear  conclu- 
sive in  favor  of  the  means  which  I  propose — which,  I  repeat, 
has  given  most  satisfactory  results  to  my  friend,  Dr.  H.  Bourdon, 
upon  the  patients  observed  by  him  at  the  "HopitalLaribosiere." 
I  will  insist  upon  the  complete  harmlessness  of  this  mode  of 
treatment ;  never  have  I  observed  any  local  disorder  follow  the 
application  of  dry  cups,  and  never  has  this  derivation,  although 
very  energetic,  determined  any  trouble  in  the  economy,  proba- 
bly because  it  is,  so  to  say,  gradually  effected.  This  harmless- 
ness is,  then,  one  motive  the  more,  why  we  should  not  hesitate 
before  the  employment  of  this  means. 

It  has  been  remarked,  also,  in  some  of  these  observations, 
(obs.  2,  3,  4,)  that  somnolence,  tranquil  delirium  and  deafness, 
have  seemed  happily  modified  by  the  use  of  this  means.  I  have 
seen,  in  some  other  cases,  the  application  of  dry-cups  in  great 
numbers,  calm  the  tranquil  delirium  and  dissipate  promptly 
both  somnolence  and  coma,  notably,  in  a  little  patient  of  15 
years,  observed  in  October,  1855,  at  the  "Hopital  Beaujon." 
In  these  last  cases,  the  cerebral  phenomena  were  predominant, 
and  nothing  very  well  marked  was  determined  on  the  side  of 
the  lungs.  The  utility  of  this  powerful  derivative  in  comatose 
forms  of  the  disease,  appears  to  me,  more  than  probable;  but  I 
have  not,  so  far,  studied  the  fact  in  a  sufficiently  rigorous  man- 
ner to  form  a  precise  opinion  on  the  subject.  As  for  the  ataxic 
forms,  with  violent  delirium,  in  three  cases  where  I  attempted  to 
employ  this  method,  it  gave  me  no  result,  and  the  opiate  pre- 
parations, in  doses  sufficiently  strong,  united  with  musk,  appear 
to  me  to  be  much  preferable. — [Archives  Generates. 


1858.]         Report  on  the  Epidemic  Diseases  of  Georgia.  191 

Report  upon  the  Topography  and  Epidemic  Diseases  of  the  State  of 
Georgia.     By  John  F.  Posey,  M.  D.,  of  Savannah,  Ga. 

[Concluded  from  p.  114,  Feb.  No.] 

Diseases,   &c. 

The  diseases  of  the  eastern  part  of  the  first  division  or  tertiary- 
formation  of  Georgia  are  thus  treated  of  by  Dr.  P.  M.  Kollock, 
of  Savannah,  beginning  with  the  Sea  Islands  : — 

11  The  inhabitants  enjoy  very  great  immunity  from  the  diseases 
of  the  opposite  main.  And  such  as  have  few  or  no  brackish 
ponds  or  lagoons,  are  more  healthy  than  such  as  contain  a  greater 
number. 

"  In  very  wet  seasons,  the  different  forms  of  miasmatic  and 
bilious  fevers  prevail  to  a  considerable  extent,  but  they  are  ex- 
empt from  every  species  of  malignant  and  fatal  epidemics.  I 
have  never  known  cholera  asphyxia  to  occur  on  any  of  the  outer 
islands.  In  winter,  sporadic  cases  of  pneumonia  are  occasional- 
ly met  with,  together  with  ordinary  catarrhal  and  pleuritic  affec- 
tions. 

M  The  main  opposite  the  Sea  Islands  is  decidedly  sickly,  and  in 
fested  by  the  various  forms  oi  miasmatic  disease. 

"In  winter  and  spring,  epidemic  pneumonia,  of  typhoid  type, 
is  not  unfrequent,  particularly  on  the  rivers  and  swamps.  In 
summer  and  fall,  the  various  forms  of  bilious  fever,  sometimes 
congestive,  and  occasionally  exhibiting  typhoid  symptoms,  pre- 
vail. 

"Passing  further  inland  to  the  region  of  sandhills  and  long- 
leaf  pines,  the  inhabitants  enjoy  a  very  large  share  of  health,  and 
when  the  possessors  of  the  comforts  of  life,  as  regards  shelter,  foody 
and  raiment,  exhibit  an  embonpoint,  a  ruddiness  of  complexion,  and 
contented,  happy  expression  of  countenance,  seldom  surpassed 
in  any  climate.  As  a  general  rule,  they  are  strangers  to  epidem- 
ics of  all  kinds. 

"  In  winter  and  spring,  cases  of  pneumonia  are  met  with,  and 
in  summer,  particularly  in  seasons  prolific  of  fruit,  there  may  be 
dysentery ;  it  is  rare  for  severe  cases  of  fever  to  occur  in  this 
section. 

"The  winter  of  1852  was  the  coldest  that  has  been  known  for 
many  years  in  this  district.  Two  snow  storms  occurred  at  Sa- 
vannah, but  very  little  rain.  There  was  no  great  amount  of  dis- 
ease— a  few  cases  of  pneumonia  occurred  in  my  own  practice — 
and  I  observed  a  very  strong  tendency  to  the  formation  of  whit- 
lows, resulting  from  slight  injuries  to  the  hands. 

"Towards  August,  cases  of  fever  began  to  multiply  in  the  city 
of  Savannah  and  its  vicinity,  and  between  that  period  and  the 
month  of  November,  very  few  of  the  laboring  population  escaped. 


I    _  Report  cm  the  Epidemic  Diseases  of  Georgia.      [March, 

-Daring the  month  ac- 

: :  v .-  ; -.  -  :       :_.  :  iz'n  =r.    :=:■".   ;jte  :;   v.  :; .=-.  =:  :.v.^:-.    -vere   re- 
ported; the   number  increased  as  the  season  advanced. 
greatest  number  occurred  as  the  season  advanced  to  the  mouth 
of  October,  when  h  proved  fatal  in  almost  every  instan: 

low  fever  was  bat  little  known  until  after  the  war  of 
It  was  not  until  the  winter  of  1816  that  for^ 
began  to  resort  to  Savannah,  and  the  next  summer  the   harbor 
was  crowded  ;  no   care  was  taken  to  time   the  arrivals   to   the 
healthy  months,  and  the  seamen  were  strar,  _  unaccli- 

mated. 

In  the  man  -  -gust,  the  veflow  Ae  out     It 

was  confined  to  the  seamen,   and  continued  until   the  shipping 
departed;  there   were  not   many  cases.     During   the   folio 
ere  were  few  arrivals,  and   all  had  left  port  b^ 
the  wwurr  had  fairly  set  in,  and  there  was  bat  little  sickne 

In  the  year  1819  many  ships   arrived  br  at  many 

sliangeis,   totally  unused  to  the  climate  and   unacquainted  with 
the  diseases  to  which  they  were  exposed.     Early  in  the  autumn, 
the  yellow  fever  commenced  its  ravages,  and  in  less  than  a  month 
the  whole  number  of  passengers  who  had  been  brough 
ship  had  fallen  victims  ;  the  disease  A  until 

an:  ~  \\     r.'rr-/:  ~r.*.  --.      *:  strsr.rer^ 

.he  beginning  of  the  year  K  part  of  the  city  was 

burned  down,  and  the  population  was  consequently  crowded  into 
the  narrow  Emits  left  by  the  fire.     The  fi  the  most 

part  left  in  a  state  of  total  neglect,  and  ma  ered 

sinks  and  vaults  remained  open,  exposed  to  the  weather  until 
they  were  filled  up  by  the  sand  washed  into  them  by  the  rain, 
which  was  more  than  usually  copious  in  the  latter  part  of  the  sea- 
son. The  excavations  made  forthefoun:  f  new  build- 
ings were  highly  offensive,  particularly  duri- 

In  the  latter  part  of  the  summer,  the 
increased  to  a  frightful  extent,  but  its  ravages 
among  the  unacclimated,  few  natives  or  old  resident  The 

disease  continued  until  late  in  the  win: 

In  1821  the  yellow  fever  began  as  in  the  year  before,  and  now 
attacked  the  natives  and  old  residents,  more  of  whom  died  than 
the  year  befc 

The  citizens  were  now  thoroughly  alarmed  ;  a  board  of  health 
was  organized,  and  a  system  of  visitation  (A  the  yards  and  build- 
ings was  put  in  operation;  a  new  sea  lent  was 
made,  and  the  city  was  thoroughly  cleansed,  so  that  the  Cathar- 
tes  aurea  and  C.  atratus,  commonly  known  as  Turkey  buzzards, 
winch  were  as  tame  as  barnyard  fowls,  at  :tive 
scavengers  before,  became  wikL  The  yellow  fever  also  disap- 
peared, and  for  five  years  was  not  seen.     The  dread  of  'tis  v 


1858.]         Report  on  the  Epidemic  Diseases  of  Georgia.  193 

tion  seemed  to  have  been  forgotten,  the  members  of  the  Board  of 
Health  soon  became  tired  of  their  "useless*'  labors,  and  ceased 
to  attend  to  their  duties.  An  officer  was  appointed  to  inspect 
the  lots,  &c.  but  his  visits  soon  became  odious  to  those  who  most 
needed  them,  and  the  city  became  very  exactly  in  the  condition, 
as  to  cleanliness,  that  it  was  in  before  the  beginning  of  the  three 
years  of  fever.  The  Cathaites  aur.  and  atr.  returned,  and  in  the 
early  part  of  the  summer  of  1527  they  were  seen  in  the  most 
populous  part  of  the  city  fighting  for  offal  in  the  street.  Xot  Ions 
after  this,  the  yellow  fever  made  its  appearance  and  carried  off 
seven  of  the  most  prominent  citizens,  being  all  old  residents,  in 
rapid  succession.  This  opened  the  eyes  of  the  people  to  the  ne- 
cessity of  a  more  constant  attention  to  sanitary  measures:  the 
city  was  again  thoroughly  cleansed,  the  buzzards  again  took  to 
the  woods,  and  have  never  returned. 

The  yellow  fever  has  not  since  been  epidemic  until  the  vear 
1S54.  when  the  city  being  crowded  with  Foreigners,  mostly  Irish 
laborers,  it  broke  out  again  with  such  mortality  as  to  produce 
general  consternation;  however,  but  few  of  the  acclimated  were 
severely  attacked. 

The  epidemic  spread  more  widely  in  the  State  than  it  ever  had 
before. 

In  the  autumn  of  1834,  the  epidemic  cholera  commenced  on 
some  plantations  twelve  or  fourteen  miles  above  Savannah  on  the 
river,  and  gradually  approached  the  city,  where  it  continued  for 
nearly  two  months,  when  it  ceased  its  ravages  verv  suddenlv ; 
negroes  were  the  principal  sufferers,  and  upon  its  appearance"  a 
few  years  afterwards,  it  was  confined  almost  entirelv  to  them. 

Dr.  O.  P.  Bealer,  of  Effingham  County,  in  a  communication 
to  Dr.  Kollock.  in  1853.  says  :  "  The  prevalent  disease  of  the  last 
year,  1852,  was  typhoid  fever,  in  the  majority  of  cases,  the  result 
of  neglected  bilious  fever ;  it  was  remarkably  fatal ;  the  deaths 
in  this  county  the  last  year  numbered  more  that  those  of  anv  one 
year,  as  far  back  as  the  oldest  citizens  can  recollect,  and*  thev 
were  principally  from  typhoid  fever. 

Dr.  T.  R.  Dunham  says,  that  "the  prevailing  diseases  of  Cam- 
den County  in  winter  and  spring,  are  typhoid  pneumonia  and  in- 
fluenza. These  yield  during  the  summer  and  fall  to  diarrhoea,  re- 
mittent and  intermittent  fevers,  accompanied  with  the  most  violent 
headaches,  and  great  irritability  of  stomach." 

Dr.  T.  S.  Hopkins,  of  Waynesville,  writing  of  the  diseases  of 
the  low  lands  in  Glynn  and  Camden  Counties,  in  the  neighborhood 
of  the  Great  Buffalo  Swamp  (which  section,  he  savs.  is  healthy 
in  very  wet  or  very  dry  seasons.)  in  the  year  1852.  says:  "The 
past  season  has  been  extremely  wet,  and  I  have  onlv  to  "report,  for 
the  spring  months,  a  mild  form  of  influenza.,  and  for  the  fall,  quo- 
tidian and  tertian  intermittents." 


194  Report  on  the  Epidemic  Diseases  of  Georgia.      [March, 

Dr.  H.  Briggs,  of  Troupville,  speaking  of  Lowndes  County, 
says:  "The  climate  disease  which  manifests  itself  more  or  less, 
during  some  part  of  every  year,  is  the  remittent  or  intermittent 
malarial  fever,  usually  of  a  mild  form,  but  with  occasional  cases 
of  malignant  intermittent,  congestive,  alged,  and  other  varieties 
of  pernicious  fever. 

"  Hooping-cough,  mumps  and  varicella  have  repeatedly  prevail- 
ed in  all  this  region  as  epidemics. 

"  Scarlatina  prevailed  co-extensive  with  the  limits  of  the  county 
during  the  years  1838  and  1839.  It  has  appeared  twice  since,  in 
1844  and  1855,  but  could  scarcely  be  considered  an  epidemic, 
either  of  the  two  last  times. 

"Abscess,  in  the  form  of  whitlow,  furunculus,  anthrax,  and 
deep-seated  abscess,  has  sometimes  appeared  as  an  epidemic,  more 
especially  during  the  summer  and  fall  of  1854,  continuing  several 
months,  the  ordinary  climate  fever  disappearing  altogether  during 
the  time. 

"Dysentery  appeared  as  the  prevailing  disease  in  the  autumn 
of  1843,  from  which  time  till  the  spring  of  1853,  there  were  only 
a  few  sporadic  cases.  It  has  prevailed  more  or  less  at  all  seasons, 
and  in  all  parts  of  the  county  from  that  date  up  to  the  present.  In 
some  neighborhoods  the  accompanying  fever  is  of  typhoid  type, 
in  others  most  decidedly  inflammatory. 

"  Rubeola  made  its  appearance  in  June,  1856,  for  the  first  time 
since  1837.  The  disease  was  of  a  grave  character,  often  attended 
with  low  form  of  fever,  and  dysenteric  symptoms,  often  succeeded 
by  a  most  obstinate  diarrhoea,  oedematous  swellings  of  the  lower 
limbs — a  tendency  to  passive  hemorrhages,  and  sometimes  ulcer- 
ations and  sloughing  of  the  integument. 

"  Influenza,  or  grippe,  often  becomes  epidemic.  It  seems  to 
act  as  a  predisposing  cause  of  bronchitis,  pneumonia,  pleurisy  and 
catarrhal  ophthalmia.  Sometimes  a  patient  complains  of  violent 
pain  in  the  head  for  a  few  hours  without  any  signs  of  pneumonic 
inflammation,  quickly  followed  by  prostration,  coma,  difficult  res- 
piration from  mucus  accumulating  in  the  bronchial  tubes ;  death 
soon  ensues. 

"  A  continued  fever  prevailed  in  the  western  part  of  the  county 
in  the  latter  part  of  the  year  1839,  and  first  half  of  the  succeeding 
year.  Again  in  the  southeastern  part  of  the  county,  through  all 
the  winter  and  spring  from  November,  1846,  to  April  or  May, 
1847.  A  malignant  fever  and  highly  contagious  typhoid  fever 
have  prevailed  in  some  section  of  the  county  more  or  less  every 
year  since  1850;  a  half  dozen  or  more  cases  in  one  family  or 
neighborhood,  then  appear  somewhere  else.  The  county  has 
not  been  entirely  clear  of  cases  of  that  variety  of  fever,  but  very 
few  months  in  all  the  last  six  years. 

"  In  the  spring  and  summer  it  very  much  resembles  ordinary 


1858.]        Report  on  the  Epidemic  Diseases  of  Georgia.  195 

remittent  for  a  few  days  at  first.  In  the  colder  part  of  the  year 
it  is  usually  without  any  regular  remission,  a  straightout  continued 
fever  from  the  beginning. 

"  Puerperal  fever  is  sometimes  for  a  few  months  much  more 
prevalent  than  at  others  ;  I  do  not,  however,  believe  it  has  occur- 
red as  a  true  epidemic  disease. 

"  The  same  is  true  as  regards  jaundice,  uterine  hemorrhage 
and  many  other  non-febrile  diseases. 

"  Dirt  eaters  and  anaemic  patients  are  always  extant." 

Dr.  G.  F.  Cooper,  of  Houston  County,  in  1853,  thus  gives  the 
prevalent  diseases  of  that  county.,  which  may  be  taken  as  the 
sample  of  all  the  upper  part  of  the  first  or  tertiary  division.  "  Ru- 
beola, diarrhoea,  dysentery,  and  idiopathic  fevers,"  he  says,  "con- 
stitute the  list  of  diseases  which  have  been  treated  during  the  last 
year. 

During  the  months  of  April  and  May,  we  had  an  extensive 
epidemic  rubeola,  so  called,  and  in  some  parts  of  our  county  it 
was  attended  with  a  fearful  mortality.  This  was  especially  the 
case  where  a  typhoid  type  obtained.  Many  of  the  cases  which 
came  under  our  observation  did  not  possess  the  usual  character- 
istics of  rubeola,  and  even  those  in  which  the  eruption  conformed 
nearest  to  the  genuine  form  of  the  disease,  desquamation  did  not 
follow.  It  appeared  to  me  to  be  a  blending,  in  many  cases,  of 
rubeola  and  roseola.  The  rubeolous  eruption  was  evolved  upon 
a  roseolous  base,  the  latter,  I  believe,  appearing  invariably  first, 
followed  by  the  papulous  eruption  of  measles.  The  eruption 
usually  appeared  on  the  third  or  fourth  day,  and  was  shorter  Jived 
than  in  genuine  measles,  particularly  in  those  cases  where  roseola 
prevailed,  and  was  observed  to  be  wanting  in  that  crescentic  ar- 
rangement laid  down  by  authors.  It  also  attacked  a  number 
who  were  known  to  have  had  rubeola  previously.  No  age,  se% 
or  race  was  exempt.  In  those  cases  where  roseola  appeared,  the 
attack  was  not  accompanied  by  any  catarrhal  symptoms. 

"  In  all  cases  there  was  an  unusual  proclivity  to  diarrhoea ;  this 
appeared  to  be  independent  of  the  eruption,  for  in  many  cases 
where  it  was  standing  out  in  full  crop,  diarrhoea  would  be  persist- 
ent, with  griping  pains  and  vomiting,  and  not  unfrequently,  the 
former  were  exceedingly  severe. 

"It  was  also  remarked  that,  after  the  entire  subsidence  of  the 
eruption,  the  diarrhoea  would  continue  for  days. 

"  During  the  prevalence  of  this  epidemic,  there  was  a  high 
range  of  temperature,  the  thermometer  not  unfrequently  rising 
above  90°.  Rains  were  frequent;  it  was  almost  continually 
cloudy,  with  a  high  dew-point. 

"  As  is  usual  in  wet  seasons,  intermittent  and  remittent  fevers 
prevailed  to  a  great  extent,  but  we  had  less  typhoid  fever  than 
the  previous  year." 

N.  8. — VOL.  XIV.   NO.  III.  9 


196  Report  on  ike  Epidemic  Diseases  of  Georgia.      [March, 

The  diseases  of  the  lower  part  of  the  second  or  primitive  geolo- 
gical division  of  the  State  vary  considerably,  according  as  the 
locality  approaches  the  lower  or  upper  limits  of  the  old  settlements 
below  the  mountains. 

Dr.  Wynn,  in  a  letter  to  Dr.  G.  F.  Cooper,  says :  "  in  Monroe 
County  they  are  free  from  the  usually  called  'local  causes'  of 
disease,  and  from  their  usual  consequences,  intermittent  and  bil- 
ious remittent  fevers,  and  they  have  been  very  rare  for  several 
years. 

"In  the  early  spring  and  winter,  we  have  a  little  pneumonia, 
catarrhal  influenza,  &c.  In  summer,  enteric  affections  prevail, 
diarrhoea,  dysentery,  and  cholera  morbus. 

"Our  fevers  of  summer  are  those  that  have  received  among  us 
the  name  of  typhoid,  though  I  must  say  I  have  seen  none  that  I 
thought  approximated  in  its  symptoms  the  specific  typhoid  fever 
of  the  books.  But  for  all  the  cases  that  I  have  seen,  I  like  better 
the  title  of  nervous,  for  they  all  have  wanted  the  enteric  lesion., 
the  large  spleen,  the  eruption,  &c. 

"  In  fact,  they  have  seemed  to  me  entitled  to  be  considered  con- 
gestive fever,  with  cephalic  tendency, 

"Dr.  Hood,  of  Harris  County,  says:  'In  the  spring  of  1851, 
typhoid  diseases  became  epidemic,  and  were  the  prevailing  dis- 
eases until  May,  1852,  when  we  were  visited  with  another  and 
more  fatal  form  of  disease,  though  I  considered  it  a  modification 
of  typhoid  fever." 

"  Another  class,  or  modification  of  the  same  disease,  prevailed 
at  the  same  time,  and  with  fearful  fatality.  It  presented  all  the 
features  of  the  foregoing,  attended  with  frequent  bloody  sanious 
stools,  recurring  at  regular  intervals  in  many  cases,  in  spite  of  all 
treatment;  opium,  morphine,  tannin,  acetate  of  lead,  anodyne 
enemata,  &c,  &c,  and  continuing  week  after  week,  to  death  or 
recovery.  The  small  bowels  were  evidently  the  seat  of  the 
disease  ;  no  griping  or  tenderness  in  the  region  of  the  colon  or 
rectum." 

Dr.  Knott,  of  Griffin,  Spalding  County,  communicating  to  Dr. 
Cooper,  in  1853,  says:  "The  most  prevalent  diseases  among  us 
in  winter,  are  pneumonia,  typhoid  pneumonia,  pleuro-pneumonia, 
bronchitis,  inflammatory  fever,  rheumatism,  neuralgia,  &c.  In 
spring,  diarrhoea,  especially  among  children,  dysentery,  among  all 
classes,  ages  and  sexes.  In  summer  and  autumn,  occasional  cases 
of  bilious  fever,  with  a  marked  tendency  from  the  first,  to  run  into 
the  typhoid  form.  The  most  remarkable  feature  of  pneumonia, 
is  its  complication  with  the  typhoid  form  of  fever,  and  in  some, 
cases,  not  characterized  by  marked  remissions  or  exacerbations. 
In  all  the  cases  of  diarrhoea  and  dysentery,  the  bilious  diathesis 
was  present,  consequently  I  directed  my  remedies  to  that  function. 

"  In   the  treatment  of  typhoid  fever,  as  well  as  pneumonia  of 


1858.]         Report  on  the  Epidemic  Diseases  of  Georgia.  197 

like  character,  my  reliance  was  upon  mercurials,  with  a  view  to 
their  alterative  effect,  and  antimonials,  as  a  sedative,  combined 
with  opium,  aided  by  mild  saline  cathartics,  and  as  valuable  aux- 
ilaries,  counter-irritants." 

In  approaching  the  mountainous  part  of  the  second  division, 
it  is  found  that  the  diseases  are  more  inflammatory  in  type,  seem- 
ing to  be  more  the  effect  of  the  great  and  sudden  changes  in  the 
temperature  and  moisture,  than  of  any  local  causes,  especially  in 
the  winter  and  spring  months,  but  in  some  places  spring  inter- 
mittents,  attributed  to  malaria,  are  frequent. 

In  the  summer  months,  bilious  remittents  and  intermittents  are 
occasionally  met  with,  and  in  wet  seasons,  diarrhoea,  cholera  mor- 
bus, and  other  disturbances  of  the  digestive  function,  are  not  un- 
common, especially  during  the  greatest  heat. 

In  the  fall  of  the  year,  bilious  fevers  put  on  a  more  malignant 
form,  most  commonly  with  someone  symptom, or  some  complica- 
tion seeming  to  take  the  lead,  and  to  give  character  to  the  disease 
in  one  year,  and  some  other  peculiarity  in  the  next :  thus,  if  in 
the  commencement  of  a  sickly  season,  we  see  a  case  of  fever  be- 
ginning with  the  usual  feeling  of  lassitude,  uneasiness,  pain  in  the 
head  and  back,  but  with  less  flush  on  the  skin,  and  the  pulse  not 
so  full  and  bounding  as  in  other  cases,  with  slow  deep  breathing, 
and  a  torpid,  careless  state  of  mind,  with  constricted  skin — "goose- 
flesh" — on  the  application  of  cold  air  or  water  to  any  part  of  the 
surface,  indicating  an  irregular  circulation,  with  determination 
to  the  deep  seated  bloodvessels — we  have  a  case  of  congestive 
fever.  And  we  are  exceedingly  apt  to  find  it  followed  shortly  by 
other  cases  very  much  like  it.  In  fact,  for  some  unknown  cause, 
every  disease  of  whatever  kind,  even  if  caused  by  mechanical 
injury,  will  show  more  or  less  proclivity  to  this  same  congestion. 

Again,  if  in  the  beginning  of  the  fall  fever  season,  we  see  a 
case  of  urticaria  running  into  fever,  with  great  heat  of  the  surface, 
anxiety,  oppressed  breathing,  restlessness,  and  violent  pain  in  the 
head  and  back,  we  have  a  case  of  "  rash-fever,"  which  will,  most 
probably,  tax  our  skill  and  industry  to  the  utmost:  and  will  doubt- 
lessly be  followed  by  like  cases  during  all  the  remaining  season. 

Thus  we  have  once  in  a  while,  an  epidemic  fever  of  one  name, 
and  then  of  another,  as  one  symptom  or  another,  or  one  complica- 
tion or  another  may  happen  to  prevail. 

Scarlatina,  rubeola,  varicella,  pertussis,  parotitis,  erysipelas, 
dysentery,  and  some  other  diseases  of  minor  importance  have 
prevailed  as  epidemics  at  uncertain  intervals  of  time,  in  the  whole 
of  the  primitive  division  of  the  State. 

We  now  come  to  the  diseases  of  the  third  division  of  the  State, 
the  transition,  or  blue  limestone  region ;  the  last  part  of  the 
State  settled. 

I  am.  indebted  to  Dr.  Robert  C.  Word,  formerly   of  Cassville, 


298  Report  on  the  Epidemic  Diseases  of  Georgia.      [March, 

Cass  County,  but  now  of  Rome,  Floyd  County,  for  all  that  I  can 
say  on  this  subject. 

Dr.  Word  prefaces  his  account  of  the  diseases  of  this  country 
by  a  notice  of  the  domestic  habits  of  the  people. 

"  Much  of  the  disease,"  says  he,  "  peculiar  to  the  country  is  un- 
questionably due  to  a  disregard  of  the  laws  of  health.  Imprudent 
exposure  to  the  multifarious  changes  of  climate,  is  the  most  fre- 
quent exciting  cause  of  disease  in  the  colder  seasons.  Though,  of 
late  years,  it  may  be  said  that  a  majority  of  the  inhabitants  are 
well  clothed,  yet  their  houses  are  generally  too  open  to  furnish 
adequate  protection  from  the  chilling  moisture  of  the  winter  sea- 
son. Defective  ventilation  in  cities  is,  perhaps,  not  more  injuri- 
ous to  health  than  excessive  ventilation  in  the  country.  Much  of 
disease,  also,  may  be  attributed  to  cold,  wet  feet,  consequent  upon 
the  muddy  nature  of  the  soil,  for  which  the  country  is  proverbial, 
and  to  which  long  custom  has  rendered  the  people  careless  and 
indifferent. 

"  As  would  be  inferred,  from  the  varying  circumstances  which 
we  have  mentioned,  different  diseases  prevail  during  different 
seasons  of  the  year,  and  furnish  to  the  practitioner  a  more  diver- 
sified experience  than  is  found  in  some  other  localities.  Catarr- 
hal lever,  rheumatism,  pleurisy,  pneumonia,  and  kindred  phleg- 
masia?, are  common  in  winter  and  the  early  part  of  spring.  Ty- 
phoid fever,  a  few  years  since,  was  only  observed  in  winter,  and 
is  still  most  generally  designated,  in  popular  language,  as  winter 
fever.  More  recently,  it  has  occurred  also  in  summer  and 
autumn.  With  the  commencement  of  the  heat  of  summer,  a  few 
sporadic  cases  of  dysentery  and  diarrhoea  make  their  appearance, 
becoming  gradually  more  numerous,  until  they  are  so  generally 
prevalent  as  to  deserve  the  name  of  epidemic.  Not  unfrequently 
having  so  prevailed  for  a  few  weeks  in  June  and  July,  thy  subside 
for  a  timer  to  reappear  in  a  more  fatal  form  during  the  autumn, 
a  few  cases  of  remittent  and  intermittent  fever  are  met  with  in 
the  early  part  of  summer ;  they  usually  increase  in  number  and 
violence  as  the  season  advances,  and  shortly  before  the  return  of 
cool  weather,  occasional  examples  of  the  congestive  form  of  this 
disease  are  observed,  rarefy,  however,  at  an  earlier  period.  Not 
unfrequently  these  febrile  attacks  make  their  appearance  during 
the  suspension  which  has  been  remarked  in  the  prevalence  of 
bowel  affections,  and  continuing  conjointly  with  them,  but  attack- 
ing different  subjects  until  the  end  of  the  warm  weather. 

"The  autumn  is  marked  often  by  the  prevalence  of  influenza, 
of  a  mild  form,  which  some  persons  have  attributed  to  the  great 
difference  between  the  temperature  of  the  days  and  nights  at  this 
period,  and  others  to  the  constant  inhalation  of  the  dust,  with 
which  the  atmosphere  is  loaded. 

"  The  almost  regular  succession  of  annually  prevalent  maladies, 


1858.]         Report  on  the  Epidemic  Diseases  of  Georgia.  199 

and  many  others  of  occasional,  but  irregular  occurrence,  together 
with  the  marked  peculiarities  impressed  upon  all  in  particular 
years,  or  during  particular  seasons,  by  prevailing  epidemical  or 
atmospherical  influences,  exact  an  unusual  amount  of  caution 
and  practical  tact  in  diagnosis. 

"  A  few  years  after  the  first  settlement  of  the  country,  malarious 
diseases  were  uncommon,  inflammatory  diseases  more  frequent 
than  at  present,  the  inflammation  of  higher  grade,  and  vigor- 
ous antiphlogistic  treatment  better  borne,  and  more  successful 
than  at  present.  With  the  clearing  up  of  the  land,  exposing  a 
larger  surface,  covered  with  a  rich  vegetable  mould,  and  satura- 
ted with  the  rains  of  winter,  to  the  action  of  a  summer's  sun, 
there  has  been  a  marked  increase  of  all  the  afflictions  which 
malaria  is  supposed  to  produce,  and  a  very  observable  modifica- 
tion in  the  general  sanative  condition  of  the  population,  or  in  the 
character  of  many  diseases  which  it  is  not  pretended  that  malaria 
originates,  but  over  which  it  appears  to  extend  its  mysterious  in- 
fluence. Many  of  the  inflammatory  attacks,  occurring  in  winter 
in  the  last  few  years,  have  been  found  to  assume  the  livery  of  this 
subtile  morbific  agent,  evincing  a  decided  tendency  to  periodicity, 
and  demandimg  the  administration  of  quinine.  Many  others,  it 
is  true,  offer  no  such  peculiarity,  but  are  truely  and  frankly  phleg- 
masise,  requiring  for  their  successful  treatment  free  and  bold 
employment  of  the  lancet,  and  all  the  antiphlogistic  expedients  so 
familiar  to  the  past  generation  of  physicians.  This  intermingling 
of  symptoms,  blending  of  lights  and  shadows,  is  still  more  com- 
mon in  autumn  and  spring,  and  more  embarrassing,  because  a 
just  diagnosis  is  often  difficult,  and  a  mistake  highly  dangerous. 
To  subject  a  patient  previously  enfeebled  my  miasmatic  influence, 
or  actually  laboring  under  an  irregular  form  of  miasmatic  disease, 
though  simulating,  with  astonishing  accuracy,  an  acute  inflamma- 
tion, to  the  debilitating  effects  of  the  antiphlogistic  treatment  is 
not  simply  unnecessary,  but  as  has  been  too  often  sadly  demon- 
strated, hazardous  or  fatal,  producing  prolonged  debility,  tedious 
convalescence,  or  else  speedily,  or  more  remotely  death.  To 
omit  to  do  so,  upon  the  other  hand,  when  an  important  organ  is 
truly  the  seat  of  active  inflammation,  is  to  expose  him  to  immedi- 
ate peril,  or  to  the  doubtful  consequences  of  the  pathological  chan- 
ges by  which  that  condition  is  followed.  In  a  more  malarious 
region,  as  well  as  in  districts  where  the  influence  of  malaria  is 
less  marked,  the  nice  discrimination  so  often  demanded  here  is, 
perhaps,  less  important,  but  the  ability  to  make  it,  in  this  section, 
decides  between  success  and  the  want  of  it. 

"  Tubercular  disease,  although  it  cannot  be  said  to  be  preva- 
lent amongst  us,  is  by  no  means  unfrequent.  Tubercles  in  the 
lungs  are  more  common  than  in  more  southern  and  less  elevated 
regions,  where  there  are  fewer  alternations   in  the  weather,  and 


200  Report  on  the  Epidemic  Diseases  of  Georgia.      [March, 

less  humidity.  Experience  has  shown  that  the  locality  is  not  a 
good  one  for  consumptive  persons,  or  those  who  are  predisposed 
thereto.  Whether  originating  in  the  country,  or  introduced 
from  abroad,  the  disease  runs  rapidly  through  its  various  stages 
to  a  fatal  termination. 

"  Typhoid  fever,  I  believe,  made  its  first  appearance  in  this 
part  of  the  State  in  the  winter  of  1842,  at  which  time  a  number 
of  cases  were  seen  in  the  immediate  vicinity  of  Cassville.  For 
a  few  years  subsequently,  the  disease  was  confined  entirely  to  the 
winter  season,  and  it  was  not  until  about  the  year  1846  that  it 
began  to  occur  in  the  spring  and  fall.  In  the  years  1846  and 
1847,  it  prevailed  extensively  throughout  the  greater  portion  of 
Cass  County.  More  than  sixty  cases  came  under  our  observation 
in  those  two  years,  and  though  the  fatality  was  not  very  great, 
the  cases  were  generally  obstinate  and  tedions,  running  their 
course  in  a  period  of  from  three  to  six  weeks,  with  a  tendency  to 
a  favorable  termination  when  unmolested  by  drastic  remedies. 
Most  of  the  fata]  cases  which  occurred  we  believe  to  have  been 
due  to  the  injudicious  use  of  purgative  medicines,  usually  pre- 
scribed by  the  patients  themselves  before  consulting  a  physician. 
Since  the  period  above  referred  to,  the  disease  has  continued  to 
prevail,  varying  in  extent  and  violence  at  different  times,  and  ex- 
tending its  baneful  influence  to  other  and  milder  maladies.  Occa- 
sionally it  breaks  out  afresh  in  different  or  in  the  same  localities, 
complicated  with  features  and  peculiarities  not  previously  obser- 
ved. Many  cases  present  malarial  peculiarities,  and  are  marked 
with  tertian  exacerbations.  Others  are  complicated  with  pneumo- 
nia or  rheumatism.  It  has  been  followed  by  the  congestive  form 
of  the  disease,  which  in  a  large  majority  of  cases,  proved  rapidly 
fatal." 

Dr.  T.  J.  Word,  of  Floyd  County,  in  ]853,  said  that  "typhoid 
fever  has  prevailed  in  Floyd  as  an  epidemic  for  two  or  three 
years  past  mostly  between  the  months  of  October  and  the  begin- 
ning of  spring,  during  which  time  it  has  taken  the  field  to  the  ex- 
clusion of  most  other  diseases,  or  compelled  them  to  form  an 
alliance  with  it.  In  the  fall,  it  was  occasionally  associated  with 
remittent  fever;  in  the  winter  with  pneumonia.  In  the  nervous, 
it  was  sometimes  associated  with  neuralgia,  and  in  the  female, 
with  hysteria. 

"  The  cause  of  its  general  prevalence  for  a  few  years  past  can 
only  be  satisfactorily  explained  by  admitting  it  to  be  an  epidemic. 
Upon  no  other  ground  can  we  explain  its  appearance  in  regions 
where  not  one  of  the  local  or  endemic  causes  exist  to  which  its 
production  has  been  ascribed. 

"  It  occurs  in  the  hilly  and  broken  sections  of  the  country,  and 
in  families  who  enjoy  all  the  comforts  of  life,  and  are  exempt  from 
every  apparent  local  cause  of  disease.     Other  causes  than  confin- 


1858.]         Report  on  the  Epidemic  Diseases  of  Georgia.  201 

ed  or  vitiated  air.  decomposing  animal  or  vegetable  matter,  or 
standing  water,  mast  be  adduced,  as  it  is  known  to  occur  in  a 
malignant  form  where  none  of  these  causes  exist.  '  The  presence 
of  the  typhoid  principle  in  the  surrounding  medium  exercises  a 
controlling  influence  over  the  cause  and  duration  of  other  diseases/ 
In  further  confirmation  of  this  view  is  mentioned  the  increased 
or  altered  sensibilitv  of  the  gastro-intestinal  canal  to  the  impres- 
sion of  cathartics,  that  part  of  the  economy  to  which  the  force 
and  violence  of  tvphoid  fever  is  directed.  '  The  smallest  doses  of 
the  mildest  cathartics  have  been  known  to  occasion  exhausting 
purgation.'  '  That  there  has  been  for  some  time  an  epidemic 
constitution  of  the  atmosphere,  and  that,,  under  different  states  and 
temperatures,  it  may  produce  different  effects,  and  give  rise  to  a 
variety  of  morbid  actions  according  to  the  predisposition  of  the 
system  at  the  time,  does  not,  I  think,  admit  of  a  question  of  doubt.' 

"  Dysentery  prevailed  extensively  in  the  years  of  1851  an  J  852. 
During  the  summer  of  the  last,  it  was  attended  with  a  considera- 
ble mortality,  especially  among  children. 

"The  inhabitants  of  the  valleys  and  creek  bottoms  suffered 
most.  The  weather  was  warm  and  rather  dry  during  the  pre- 
valence of  the  disease. 

"  During  the  epidemic  last  summer,  diarrhoea  prevailed  also, 
and  not  unfrequently  was  found  associated  with  dysentery  in  the 
same  subject.  Copious  sanguineous  or  serous  discharges  would 
sometimes  alternate  with  dysenteric  discharges.  This  form  of 
diarrhoea  was  usually  very  prostrating  in  its  effects,  and  in  some 
instances  proved  suddenly  fatal.  It  was  attributed  by  many  to 
the  cholera  atmosphere  then  supposed  to  pervade  the  greater  por- 
tion of  the  United  States.  The  occurrence  of  fatal  cases  of  cholera 
morbus  at  the  same  time  give  credibility  to  this  opinion. 

"The  months  of  July  and  August  seldom  pass  by  without  the 
occurrence  of  many  cases  of  bilious  dysentery,  in  some  of  which 
the  influence  of  malaria  is  very  perceptible. 

"Influenza,  or  epidemic  catarrhal  fever,  is  of  frequent  occur- 
rence. It  may  be  said  to  be  a  regular  visitnt  of  the  spring  and 
fall  seasons,  each  visitation  being  characterized  by  some  new  pe- 
culiarity. In  the  fall  of  1851  a  form  of  the  disease  prevailed, 
marked  by  the  following  symptoms  :  pain  in  the  head,  back,  and 
extremities,  cold  shivering  sensations,  deep  bronchial  cough,  and 
occasional  slight  fever.  All  of  these  symptoms  were  worse  in  the 
early  part  of  the  day.  The  weather  was  dry,  but  had  been  preceded 
by  heavy  rains  ;  previous  to  the  rains  there  was  a  great  drought. 

u  Neuralgic  affections  are  quite  common  in  this  country.  They 
appear  generally  to  be  of  malarious  origin,  and  yield  to  quinine, 
cupping,  &c.  In  the  colder  seasons  the  disease  is  frequently  blend- 
ed with  rheumatism,  and  appears  to  be  developed  bv  exposure 
to  cold  and  damp  weather.     The  facial  variety  is  most  common." 


202  The  Uses  of  Chlorate  of  Potash.  [March, 

I  have  now  finished  the  work  assigned  to  me,  to  the  best  of  my 
ability,  and  hope  that  it  may  meet  the  views,  and  fulfil  the  require- 
ments of  the  Association. 

And  now,  also,  I  make  my  acknowledgements,  gratefully,  for 
the  assistance  which  I  have  received  from  those  gentlemen  of 
the  profession  who  have  given  me  the  benefit  of  their  knowledge. 

To  Dr.  P.  M.  Kolcock  I  am  indebted  for  most  of  the  part  be- 
longing to  the  neighborhood  of  the  sea,  and  through  his  instru- 
mentality to  Dr.  Bealer,  of  Effingham,  Dr.  Dunham,  of  Camden, 
and  Dr.  Hopkins,  of  Wayne  County. 

Dr.  H.  Briggs,  of  Troupville,  Lowndes  County,  communicated 
all  that  I  have  given  of  Southwestern  Georgia. 

I  owe  to  Dr.  G.  F.  Cooper,  of  Perry,  Houston  County,  much  of 
what  I  have  said  of  the  upper  part  of  the  first,  and  lower  part  of 
the  second  division. 

Dr.  Robert  C.  Word  is  my  authority  for  all  concerning  the 
third  or  limestone  division. 

I  have   endeavored   carefully  to   distinguish  the  parts   due  to 
each  contributor,  as  vouching  for  the  correctness  of  whatever  I 
have  written,  whenever  it  was  not  from  my  own  observation. 
[Transactions  Amer,  Med.  Association,  1857. 


The   Uses  of  Chlorate  of  Potash. 

I,  On  the  Therapeutical  action  of  Chlorate  of  Potash, 

WITH  A  NEW  MODE  OF  ADMINISTEING  IT.      By  Dr.   DETHAN, 

(IJ  Union  Medicate,  and  Brit,  and  For.  Med.  Chir.  Rev. 

II.  On  the  use  of  Chlorate  of  Potash  in  Pregnancy. 
{Liverpool  Med.  Chir.  Journal,  and  Banking's  Abstract.) 

The  use  of  Chlorate  of  Potash. — In  the  August  number 
of  the  last  volume  of  this  Journal  we  collected  from  various 
sources,  several  articles  on  the  different  applications  of  the  Chlo- 
rate of  Potash  in  the  treatment  of  disease.  We  have  since 
made  frequent  tests  of  its  usefulness,  and  find  that  it  answers  an 
admirable  purpose  as  a  lotion,  in  many  cases  of  leucorrhoea,  and 
other  affections  of  the  vagina — and  also  in  some  cases  of  stoma- 
titis, either  from  mercurial  salivation  or  other  causes.  In  one 
instance  of  sore  throat,  attended  with  great  fetor,  which  occur- 
red at  the  end  of  a  protracted  case  of  Typhoid  fever,  its  appli- 
cation as  a  gargle,  was  followe4  by  surprising  results.  We 
understand  that  Dr.  W.  L.  Felder,  of  this  city,  has  used  Chlorate 


1858.]  The  Uses  of  Chlorate  of  Potash.  203 

of  Potash,  internally,  strength  3j.  to  8  oz.  water,  for  twenty- 
years,  as  a  remedy  in  Typhoid  fever.  Dose  of  this  solution,  as 
used  by  him,  was  1  teaspoonful  every  three  or  four  hours.  The 
strength  of  the  solution  used  in  all  of  our  cases,  above-mentioned, 
was  two  drachms  of  the  salt  dissolved  in  8  oz.  of  water.  This 
was  applied  to  the  affected  mucous  surfaces  four  or  five  times 
during  the  day,  either  as  a  gargle  or  as  an  injection,  as  the  na- 
ture of  the  case  required. 

We  here  present  to  our  readers  some  other  applications  of  this 
valuable  article,  and  its  use  in  certain  cases  of  pregnancy.  We 
do  not  pretend  to  explain  the  manner  of  its  action ;  but  the  facts 
here  reported,  though  not  entirely  conclusive,  are  certainly  very 
striking,  and  should  at  least  arrest  our  attention. 

"Dr.  Dethan  considers  that  chlorate  of  potash  is  a  powerful 
sialagogue,  and  that  its  elective  action  on  the  bucco-pharjmgeal 
mucous  membrane  is  well  marked.  To  this  physiological  action 
is  added  a  very  remarkable  and  valuable  success  in  pathology  ; 
its  rapid  and  incontestable  effects  in  mercurial  salivation,  by 
checking  the  formidable  mercurial  affection,  have  permitted 
practitioners  to  continue  the  mercury  without  fear,  and  thus  to 
contend  without  remission  against  the  constitutional  infection. 
As  an  especial  and  incontestable  remedy  in  ulcero-membranous 
stomatitis,  this  medicine  need  not,  according  to  the  physicians  of 
the  Hopital  Sainte-Eugenie,  be  swallowed ;  its  topical  applica- 
tion is  sufficient,  and  in  a  short  time  the  mucous  membrane 
recovers  its  normal  qualities  and  functions.  Dr.  Dethan  con- 
cludes that  the  chlorate  of  potash,  administered  under  a  special 
form,  which  would  permit  the  local  action  to  be  exercised  slow- 
ly and  certainly,  although  leaving  the  medicine  to  be  carried 
into  the  stomach  in  a  state  of  solution  with  the  mixed  liquids  of 
.  the  salivary,  buccal  and  pharyngeal  glands,  would  be  the  mode 
of  administration  which  would  combine  all  indications  and  all 
opinions.  He  therefore  suggests  the  use  of  the  remedy  in  the 
form  of  pastiles,  so  that  the  patient  may  have  at  hand  a  remedy 
against  the  injurious  effects  of  a  mercurial  treatment  which  he 
may  be  undergoing.  The  experiments  of  Dr.  Ricord,  and  the 
publications  of  M.  A.  Fournier,  testify  incontestably  in  favor  of 
this  successful  simultaneous  medication.  In  certain  forms  of 
angina  attended  with  fibrinous  exudations,  it  prevents  the  inti- 
mate adherence  of  the  false  membranes  to  the  mucous  mem- 
brane, and  facilitates  their  expulsion,  and  assists  the  action  of 
emetics.  In  this  affection  the  topical  action  of  the  chlorate,  fa- 
voured by  the  bruising  between  the  teeth,  the  natural  solution 


204  The  Uses  of  Chlorate  of  Potash.  [March, 

in  the  liquids  of  the  mouth,  and  its  penetration  into  all  the  points 
interested,  will  be  certainly  efficacious.  In  debilitating  diseases, 
such  as  diphtheritis,  and  gangrene  of  the  mouth,  the  child  will 
find  an  agreeable  and  reparative  kind  of  food,  together  with  the 
most  appropriate  remedy  hitherto  discovered,  against  these  dis- 


"  Every  one  engaged  in  midwifery  practice  will  have  met 
with  cases  in  which  the  child  is  carried  successfully  into  the 
viable  period,  but  some  time  between  this  and  the  full  term  of 
pregnancy,  is  born  still,  or  very  weakly ;  and  this  perhaps  for 
several  successive  pregnancies,  without  any  external  or  acci- 
dental cause  to  explain  the  premature  death  and  delivery,  and 
with  no  evidence  of  syphilitic  taint  in  the  parents. 

"  It  is  in  such  cases  that  Mr.  Grimsdale  (in  accordance  with  a 
suggestion  thrown  out  some  years  ago  by  Dr.  Simpson)  has  been 
in  the  habit  of  prescribing  chlorate  of  potass  with  some  appa- 
rent benefit. 

"  Case  1. — Mrs.  Darbyshire,  a  stout,  healthy  looking  woman, 
get.  34,  was  delivered  of  a  female  child,  after  a  labor  of  eleven 
hours'  duration,  in  the  Lying-in  Hospital,  on  the  24th  March, 
1852.  During  labor  there  was  a  large  discharge  of  very  offen- 
sive, dark-colored  muddy  water ;  the  nurse  told  me  she  filled 
two  chamber-pots  with  it,  besides  what  escaped  in  the  bed.  The 
child  was  with  difficulty  made  to  breathe.  It  was  jaundiced 
from  birth,  and  died  of  hemorrhage  from  the  umbilicus,  on  the 
seventeenth  day. 

"  The  placenta  was  diseased ;  portions  of  its  maternal  surface 
were  seen  to  be  of  a  pale  yellowish  color,  and  these  were  firm 
to  the  touch,  and  penetrated  nearly  to  its  foetal  surface ;  at  least 
one-fifth  of  the  bulk  of  the  placenta  must  have  been  occupied 
with  these  firm  pale  portions.  The  centre  of  each  patch  was 
firmer  than  its  circumference,  and  it  seemed  to  pass  insensibly 
and  gradually  into  healthy  placental  structure,  having  no  accu- 
rately defined  boundary.  On  the  maternal  surface  were  also 
several  stellated  patches  of  vessels,  distinctly  gritty  to  the  touch. 

"Dr.  Inman  kindly  examined  this  placenta  under  the  micro- 
scope, and  he  did  not  regard  the  changes  observable  in  it  as  due 
to  inflammation,  neither  was  it  an  instance  of  fatty  degeneration. 
This  woman  had  had  four  previous  pregnancies,  in  which  she 
had  been  attended  by  a  midwife  at  her  own  home.  The  child- 
ren were  all  still-born,  and  said  to  have  been  yellow.  Of  the 
state  of  the  after-births  I  could  learn  nothing  satisfactory. 

"About  the  middle  of  April,  1853,  the  patient  came  to  me, 
stating  that  she  was  five  months  in  the  family  way,  and  would 
be  glad  if  anything  could  be  done  to  avoid  the  birth  of  another 
diseased  child.    I  gave  her  chlorate  of  potass,  5  grains  three 


1858.]  The  Uses  of  Chlorate  of  Potash.  205 

times  daily,  to  be  increased  in  a  fortnight  to  10  grains.  She  con- 
tinued this  with  but  little  intermission  to  the  time  of  her  deliv- 
ery, on  the  13th  of  August,  when  she  gave  birth  to  a  healthy 
child,  which  is  now  (October,  1855)  living  and  thriving.  The 
placenta  was  large,  and  quite  healthy  looking.  I  may  remark, 
that  before  commencing  the  chlorate  of  potass  treatment,  I  made 
careful  inquiry  as  to  the  probability  of  any  syphilitic  taint  in 
either  husband  or  wife,  and  could  detect  nothing  in  their  histo- 
ry to  warrant  any  suspicion. 

"  Case  2. — Mrs.  Egan,  a  poor  woman,  ael  21,  pale  and  rather 
delicate  looking,  presented  herself  at  the  dispensary  of  the  LyiDg- 
in  Hospital,  in  April,  1855,  and  stated  herself  to  be  four  months 
in  the  family  way.  She  said  that  she  had  been  four  times  preg- 
nant before,  and  had  on  each  occasion  given  birth  to  a  dead 
child.  Her  labors  had  been  of  no  great  severity,  and  of  moder- 
ate duration ;  the  midwile  who  attended  her  told  me  that  the 
children  were  small,  and  appeared  to  have  been  dead  some  days; 
the  after-births,  she  said,  were  'pale  in  parts,  and  queer  look- 
ing.' The  husband  was  a  steady  working  man.  I  saw  him ;  he 
looked  strong,  and  denied  having  had  syphilis. 

"  The  former  pregnancies  had  been  attended  with  no  pain.  I 
ordered  chlorate  of  potass,  20  grains  a  day.  She  continued  this 
for  four  months.  On  the  5th  September  she  was  delivered  of  a 
fine  healthy  child,  which  is  still  (October  10th)  thriving  and 
without  ailment.     The  placenta  was  large  and  healthy. 

"  Case  3. — Mrs.  D.,  set.  33,  of  spare  conformation,  hysterical 
temperament,  became  pregnant  about  six  months  after  her  mar- 
riage. After  quickening,  the  movements  of  the  child  were  dis- 
tinct, and  increasing  in  power  up  to  the  end  of  the  sixth  month 
of  her  pregnancy  ;  she  then  began  to  feel  them  decidedly  weak- 
er; not  much  notice  was  taken  of  this,  as  she  had  no  pain,  until 
in  about  three  weeks  she  ceased  to  feel  any  movement.  I  saw 
her,  and  on  examining  with  the  stethoscope,  could  hear  no 
foetal  heart  sound.  In  about  a  week  from  this  she  gave  birth  to 
a  dead  child,  the  cuticle  of  which  was  beginning  to  desquamate. 
It  was  well  formed,  but  the  skin  was  wrinkled,  and  it  looked 
ill-nourished.  The  placenta  was  in  parts  pale,  firmer  than  na- 
tural, and  its  vessels  in  these  parts  deficient  in  blood. 

"In  March,  1853,  I  again  saw  her;  she  was  then  pregnant 
three  months  and  a  half.  I  recommended  her  to  take  the  chlor- 
ate of  potass  at  once.  She  began  with  15  grains  in  the  day  ; 
she  had  only  taken  it  three  or  four  days  when  she  complained 
that  it  made  her  head  ache.  I  ordered  its  discontinuance,  but 
in  a  few  days  again  prescribed  it  without  her  knowledge ;  again 
she  complained  of  intense  headache,  and  I  left  it  off  for  a  month. 
She  tried  it  once  more,  but  declared  it  gave  her  a  most  fearful 
headache,  which  she  could  not  bear.     This  second  pregnancy 


206  The  Uses  of  Chlorate  of  Potash.  [March, 

followed  as  nearly  as  possible  the  same  course  as  the  first,  and 
with  the  same  results. 

"  In  December,  1853,  she  was  again  pregnant ;  I  saw  her 
when  she  was  four  months  advanced,  and  wished  her  to  try  the 
chlorate  in  smaller  doses.  She  took  3  grains  thrice  daily  with 
impunity ;  this  was  continued  for  three  weeks  or  a  month ;  she 
then  increased  the  dose  to  4  grains,  and  subsequently  to  5  grains. 
All  seemed  to  go  on  well.  The  movements  of  the  child,  she 
said,  were  considerably  stronger  than  in  her  former  pregnan- 
cies. 

"  When  well  into  the  seventh  month,  she  was  riding  out  in 
her  carriage,  a  low,  four-wheeled  phaeton,  when  another  vehi- 
cle ran  into  them,  smashed  the  carriage,  and  upset  its  occupants. 
My  patient  was  of  course  much  frightened ;  she  felt,  she  stated, 
a  violent  commotion  in  her  inside  for  some  hours,  but  after  that 
day  did  not  feel  any  movement.  She  was  from  home  at  the 
time:  in  two  or  three  days  she  returned;  I  then  saw  her,  could 
detect  no  foetal  heart-sound,  and  believed  the  child  to  be  dead. 
In  ten  days  from  the  date  of  the  accident  labor  came  on,  and  she 
was  delivered  of  a  dead  child. 

"  Nothing  could  be  more  marked  than  the  contrast  presented 
between  this  child  and  its  placenta,  and  those  of  the  two  former 
deliveries.  The  child  was  plump,  and  had  all  the  appearance 
of  a  healthy  seven  months'  child ;  the  placenta  was  everywhere 
soft  and  spongy  and  its  vessels  seemed  to  have  been  uniformly 
full  of  blood, 

"  This  lady  became  pregnant  for  the  fourth  time  in  the  begin- 
ning of  October,  1855.  About  the  end  of  the  third  month  she 
commenced  to  take  the  chlorate  in  3  grain  doses,  and  gradually 
increased  it  to  5  grains,  thrice  daily.  She  was  occasionally  com- 
pelled to  intermit  its  use,  in  consequence  of  the  headaches,  as 
before ;  but  with  these  exceptions  it  was  persevered  in  until  the 
full  time  of  pregnancy,  when  she  was  delivered  (June,  1856)  of 
a  healthy  male  child,  now  living  (June,  1857).  The  placenta 
was  quite  healthy. 

Case  4. — Mrs. ,  a  stout,  healthy-looking  woman,  came  to 

me  in  November,  1854.  She  was  between  three  and  four  months 
gone  in  the  family  way.  She  had  been  seven  times  pregnant 
before,  but  had  never  given  birth  to  a  living  child.  One  child 
she  carried  to  nearly  the  full  time;  five  had  been  born  between 
the  sixth  and  eighth  month,  and  one  was  aborted  at  an  early 
period  of  pregnancy.  I  ordered  her  to  take  the  chlorate  in  5 
grain  doses,  thrice  daily;  and  after  the  fifth  month  especially 
enjoined  the  immense  importance  of  rest;  this  latter  injunction 
she  seemed  determined  not  to  comply  with. 

"  She  went  on  well  until  February,  1855,  frequently  stating 
that  she  felt  the  movements  of  the  child  stronger  than  usual. 


1858.]  The  Phosphates  in  Tuberculosis.  207 

On  the  12th,  after  having  kneaded  a  large  pan  of  dough,  and 
performed  sundry  other  laborious  domestic  exercises,  labor  came 
on  unexpectedly,  and  she  was  delivered  in  five  or  six  hours  of 
a  living  child — the  first  of  all  her  children  that  had  ever  breath- 
ed. It  was  a  breech  presentation ;  the  child  seemed  of  about 
six  and  a  half  or  barely  seven  months'  development,  and  only 
lived  a  few  hours.     The  placenta  was  healthy. 

"Case  5. — Jane  D.,  set.  86,  presented  herself  at  the  Lying-in 
Hospital,  September  12th,  1853.  She  said  that  last  year  she  had 
miscarried  at  six  months,  without  any  apparent  external  cause. 
The  child  had  been  dead  some  time ;  she  learned  this  from  the 
midwife  who  attended  her.  She  was  now  four  months  advanced. 
She  commenced  the  chlorate  15  grains  in  the  day,  continued  it 
on  and  off  during  the  rest  of  her  pregnancy,  and  was  delivered 
of  a  healthy  child  at  full  time. 

"  I  have  notes  of  ten  other  cases  similar  to  this  last.  I  do  not 
think  they  are  worth  much  as  evidence;  they  will,  therefore, 
scarcely  add  to  the  interest  of  this  paper,  and  I  refrain  from  giv- 
ing the  details. 

"In  two  cases  apparently  likely  to  have  received  benefit  from 
the  chlorate,  and  in  which  it  was  exhibited  as  usual,  I  failed  to 
perceive  any  favorable  result.  In  one  of  the  cases,  death  of  the 
foetus,  and  miscarriage,  at  the  seventh  month,  occurred,  as  it  had 
done  in  three  previous  pregnancies.  In  the  other,  the  child  was 
born  dead  and  ascitic,  at  eight  months  and  a  half,  the  placenta 
being  hydropic.  The  mother  had,  before  taking  the  chlorate, 
given  birth  to  four  still-born  children  in  succession. 

"  Of  the  nature  of  the  diseased  action  in  these  cases,  I  am  not 
prepared  to  say  much.  It  would  seem  to  be  located  primarily 
in  the  placenta,  and  to  cause  the  death  of  the  child  secondarily, 
by  the  consequent  effects  on  the  placental  function.  The  mor- 
bid appearances  in  the  placenta  would  seem  to  be  tolerably 
uniform :  I  can  see  no  evidence  of  their  inflammatory  nature ; 
and  there  certainly  were  no  previous  symptoms  indicative  of 
inflammation  in  any  of  the  cases.n 


The  Phosphates  in  Tuberculosis. — If  Dr.  Churchill's  opin- 
ion with  regard  to  the  beneficial  action  of  the  Phosphates,  in 
Phthisis,  is  correct,  of  course  these  remedies  will  be  found  appli- 
cable, at  least  rationally  so,  in  all  the  other  manifestations  of  the 
strumous  diathesis,  as  the  multitudinous  affections  pertaining  to 
the  eye,  the  lymphatic  glands  of  the  neck  and  of  the  axilla; 
affections  of  the  hip-joint,  knee-joint,  elbow,  and  shafts  of  the 
long  bones. — Calculating  strongly  on  the   chemical  action  of 


208  The  Phosphates  in  Tuberculosis.  [March, 

medicines  within  the  organism,  we  are  aware,  is  not  always 
safe  from  disappointment; — that  is,  practice  does  not  every  time 
confirm  what  theory  a/firms;  but  when  experience  plainly  de- 
monstrates what  reason  will  approve,  we  may  ever  feel  safe  in 
following  their  joint  indications. 

On  the  Proximate  Cause  and  Specific  Remedy  of  Tuberculosis.    By 
Dr.  John  Francis  Churchill. 

The  following  is  the  abstract  of  a  paper  which  was  laid  before 
the  Academy  of  Medicine  at  Paris,  on  the  21st  of  July,  1857 : 

The  total  number  of  cases  of  phthisis  treated  by  the  author 
amounts  to  35.  All  were  in  either  the  second  or  the  third  stage 
of  the  complaint — that  is,  they  had  either  softened  tubercles  or 
cavities  in  the  lungs.  Of  these,  9  recovered  completely,  the 
physical  signs  of  the  disease  disappearing  altogether  in  8  out  of 
that  number;  11  improved  considerably,  and  14  died;  1  still 
remains  under  treatment. 

The  proximate  cause,  or  at  all  events  an  essential  condition  of 
the  tubercular  diathesis,  is  the  decrease  in  the  system  of  the 
phosphorus  which  it  contains  in  an  oxygenizable  state. 

The  specific  remedy  of  the  disease  consists  in  the  use  of  a  pre- 
paration of  phosphorus,  uniting  the  two  conditions  of  being  in 
such  a  state  that  it  may  be  directly  assimilated,  and  at  the  same 
time  at  the  lowest  possible  degree  of  oxydation. 

The  hypophosphites  of  soda  and  lime  are  the  combinations 
which  hitherto  seem  best  to  fulfil  these  two  requisites.  They 
may  be  given  in  doses  varying  from  ten  grains  to  one  drachm 
in  the  twenty-four  hours.  The  highest  dose  which  I  have  been 
in  the  habit  of  giving  to  adults  is  twenty  grains. 

The  effect  of  these  salts  upon  the  tubercular  diathesis  is  im- 
mediate, all  the  general  symptoms  of  the  disease  disappearing 
with  a  rapidity  which  is  really  marvellous. 

If  the  pathological  deposit  produced  by  the  dyscrasy  is  of 
recent  formation,  if  softening  has  only  just  set  in  and  does  not 
proceed  too  rapidly,  the  tubercles  are  absorbed  and  disappear ; 
when  the  deposit  has  existed  for  a  certain  time,  when  the  soften- 
ing has  attained  a  certain  degree,  it  sometimes  continues  in  spite 
of  the  treatment,  and  the  issue  of  the  disease  then  depends  upon 
the  anatomical  condition  of  the  local  lesion,  on  its  extent,  and 
upon  the  existence  or  non-existence  of  complications.  The  au- 
thor has  made  numerous  attempts  to  modify  the  local  condition 
of  the  lungs  by  the  inhalation  of  different  substances,  but  has 
never  obtained  any  satisfactory  result  independent  of  what  was 
to  be  attributed  to  the  specific  treatment.  The  hypophosphites 
of  soda  and  lime  are  certain  prophylactics  against  tubercular 
disease. 


1858.]         Non-Mercurial  Plan  of  Treatment  in  Syphilis.         209 

The  physiological  effects  which  he  has  observed  to  be  pro- 
duced by  the  use  of  the  hypophosphites  of  soda,  lime,  potash 
and  ammonia,  show  these  preparations  to  have  a  two-fold  action. 
On  the  one  hand  they  increase  the  principle,  whatever  that  may 
be,  which  constitutes  nervous  force;  and  on  the  other,  they  are 
the  most  powerful  of  hsematogens,  being  infinitely  superior  to 
all  medicines  of  that  class  hitherto  known.  They  seem  to  pos- 
sess in  the  highest  degree  all  the  therapeutical  properties  former- 
ly attributed  by  different  observers  to  phosphorus  itself,  without 
any  of  the  danger  which  attends  the  use  of  that  substance,  and 
which  has  caused  it  to  be  almost  forgotten  as  a  medical  agent. 
The  different  preparations  of  hypophosphorous  acid  will,  accord- 
ing to  these  views,  occupy  one  of  the  most  important  places  in 
the  Materia  Medica. — [Dublin  Hosp.  Gaz.}  and  Banking's  AbsH. 


The  Non-Mercurial  Plan  of  Treatment  in  Syphilis.     Read  before 
the  Western  Medical  and  Surgical  Society.     By  Dr.  Cahill. 

He  commenced  by  narrating  a  number  of  cases  in  which  the 
constitutional  effects  of  syphilis  had  been  very  severe,  and  had 
extended,  in  spite  of  treatment,  through  many  years,  in  all  of 
which  the  early  stage  of  the  disease  had  not  been  attacked  by 
mercury.  After  detailing  these  very  carefully,  he  entered  into 
the  history  of  this  plan  of  treatment,  remarking  that  most  of  the 
Irish  surgeons  who  had  adopted  it  have  since  changed  their 
opinions  respecting  it.  He  maintained  that  the  severest  and 
worst  forms  of  constitutional  syphilis  occur  when  no  mercury 
whatever  has  been  given  for  the  primary  disease,  and  that  the 
notion  that  the  severe  cases  of  secondary  disease  are  mainly  due 
to  the  mercury  administered  is  not  founded  in  fact.  Mercury, 
to  be  of  use,  must  be  persevered  in  for  at  least  six  weeks,  and 
to  produce  its  good  effects  need  not  to  be  given  lavishly  or 
recklessly.  If  attention  be  not  paid  to  this  fact,  no  permanent 
effect  is  produced,  and  other  forms  of  the  disease,  as  secondary 
or  tertiary,  are  apt  to  follow  immediately  after.  He  recommend- 
ed the  use  of  the  bichloride  in  doses  of  one-twelfth  to  a  quarter 
of  a  grain,  together  with  the  inunction  of  the  strong  mercurial 
ointment,  until  the  gums  showed  that  the  system  was  affected 
by  the  mercury.  The  bichloride  is  borne  better  than  any  other 
form  of  mercury,  and  can  be  continued  with  safety  longer  than 
any  other  mercurial  preparation,  not  only  in  these  cases,  but 
even  in  scrofulous  diseases,  in  which  its  use  is  advisable;  hence 
its  peculiar  value.  Iodide  of  potassium,  given  with  iodine,  is 
the  next  remedy  to  be  relied  upon,  though  it  is  chiefly  valuable 
in  secondary  and  tertiary  affections  of  the  periosteum.  In  ter- 
tiary symptoms,  the  iodide  is  our  sheet-anchor,   and  mercury 


210  Pathology  of  Convulsions,  d-c.  [March, 

should  never  be  given  in  such  cases  to  the  extent  of  producing 
its  specific  effects;  should  a  mercurial  be  required,  the  hyd.  c. 
creta  is  to  be  recommended  in  conjunction  with  the  iodide  of 
potassium.  Iron,  arsenic,  and  mineral  acids,  under  certain  cir- 
cumstances, are  useful,  especially  after  mercury  has  been  fairly 
tried;  these,  with  the  ordinary  means  of  restoring  health,  as 
good  food,  pure  air,  and  rest,  will  generally  promote  a  cure. 
He  then  alluded  to  the  difficulty  of  distinguishing  primary 
chancre,  and  the  means  employed  by  inoculation,  and  the  pecu- 
liar hardness,  of  the  true  Hunterian  chancre,  and  to  the  chance 
there  was  of  a  chancre  in  the  urethra  being  overlooked,  and  to 
other  sources  of  error  as  to  the  curability  of  syphilis  without 
mercury.     He  concluded  with  the  following  observations : — 

1st.  That  the  severest  and  most  prolonged  forms  of  the  disease 
have  arisen  where  no  mercury  has  been  given  for  the  primary 
or  early  secondary  affection. 

2ndly.  That  as  no  symptoms  identical  with  those  of  constitu- 
tional syphilis  are  produced  by  mercury,  the  notion 'that  mercury 
is  a  cause  of  constitutional  syphilis  is  founded  in  error. 

3rdly.  That  the  administration  of  mercury  may  be  so  regu- 
lated as  to  preclude  any  of  its  severe  effects  ;  and  supposing  any 
are  produced,  it  is  manifest  that  they  would  be  less  severe  than 
those  caused  by  constitutional  syphilis. 

4thly.  That  the  constitutional  effects  of  mercury  should  be 
avoided  in  tertiary  syphilis. 

5thly.  That  the  supposed  successful  treatment  of  syphilis 
without  mercury  is  founded  on  erroneous  diagnosis,  or  the  cases 
have  occurred  in  individuals  already  protected,  or  the  subjects 
have  been  of  that  class  who  seem  to  enjoy  immunity  from  the 
worst  part  of  the  complaint. — London  Lancet. 


Pathology  of  Convulsions,  with  especial  reference  to  those  of  Children. 
Bead  before  the  North  London  Medical  Society.  By  Dr. 
Beynolds  (of  which  the  following  is  an  abstract) : 

I.  All  vital  actions  are  accompanied  by,  and  depend  on,  phy- 
sical changes  in  the  living  organism. 

II.  Modifications  of  vital  action  depend  on  modified  physical 
conditions.  Some  symptoms  of  disease  are  modifications  of  vital 
actions,  and  there  are  two  general  modes  in  which  they  are,  or 
may  be,  related  to  the  nutrition-change : 

1.  Negative  symptoms — i.e.  those  which  consist  in  the  nega- 
tion of  vital  properties,  such  as  paralysis,  anaesthesia,  etc.— may 
depend  directly  on  a"  solution  of  continuity,"  or  some  other 
distinct  organic  disease ;  but 

2.  Positive  symptoms — i.e.,  those  which  consist  in  the  altera- 


1858.]  Pathology  of  Convulsions,  &c.  211 

tion  or  excess  of  vital  action — cannot  depend  directly  on  such 
textural  condition,  but  must  have  for  their  immediate  cause  some 
modification  of  the  minute  interstitial  proceasea 

III.  Convulsions,  being  essentially  modifications  of  vital  ac- 
tions, must  depend  on  modifications  of  physical  conditions. 
Though  no  "lesion"  is  discoverable,  we  are  warranted  in  the 
conclusion  that  nutrition  is  affected. 

IV.  Convulsions  depend  on  modified  nutrition  changes  in  the 
nervous  centres. 

V.  The  proximate  cause  of  convulsions  is  the  same  in  all 
cases  when  the  convulsions  are  the  same ;  and  the  lesions  dis- 
covered in  the  nervous  centres  or  elsewhere  are  not  the  proxi- 
mate causes  of  convulsions,  for  they  differ  in  locality  and  kind, 
and  have  no  constant  proportion  to  the  symptom  in  question. 

VI.  The  proximate  cause  of  convulsions  is  an  abnormal  in- 
crease in  the  nutrition  changes  of  the  nervous  centres — an  in- 
crease in  relation  to  time  or  to  mobility. 

VII.  The  remote  causes  are  such  as  induce  the  abnormal 
increase.  There  are  three  general  modes  in  which  these  causes 
operate : 

1.  The  nervous  centres  may  be  involved  in  a  general  nutrition 
change — e.g.,  as  during  dentition,  at  puberty,  in  Bright's  dis- 
ease, scrofulosis,  rickets,  etc. 

2.  The  nervous  centres  may  be  the  seat  of  special  disturbance, 
owing  to  organic  lesion,  as  tumour,  spiculae  of  bone,  etc. 

3.  Eccentric  irritations  may  affect  their  nutrition  through  dif- 
ferent nerves. 

VIII.  The  diagnosis  in  convulsions  is  that  of  the  remote  cause, 
and  the  first  step  is  to  ascertain  to  which  of  the  above  three  ca- 
tegories the  case  belongs.  In  children,  the  diagnosis  will  turn 
on: — 

1.  The  duration  of  the  paroxysm ; 

2.  The  frequency  of  its  repetition ; 

3.  Its  local  or  general  distribution  ;  and, 

4.  Interparoxysmal  symptoms. 

The  last  are  of  the  most  value ;  and  the  positive  or  negative 
character  of  the  symptoms,  together  with  local  distribution,  af- 
ford material  assistance  in  this  process. 

IX.  The  treatment  of  convulsions  is  guided  by  the  diagnosis, 
and  will  consist  in  the  removal  or  palliation  of  eccentric  irrita- 
tions, the  improvement  of  general  nutrition,  and  the  treatment 
of  local  disease. — [Ibid. 


9* 


212  Editorial,  [March 


EDITORIAL  AND  MISCELLANEOUS. 

Pacific  Medical  and  Surgical  Journal. — We  have  just  received 
the  first  issue  of  this  new  journal.  The  present  number,  in  the  character 
of  its  papers,  its  style,  and  typographical  execution,  gives  promise  of  this 
new  comer  to  our  sanctum,  being  a  most  valuable  addition  to  the  med- 
ical literature  of  the  country.  "  Every  civilized  nation,"  to  use  the  lan- 
guage of  its  Editors,  "  has  sent  some  of  the  boldest  and  most  enterprising 
of  her  medical  scholars,  to  earn  fortunes  and  fame  from  the  babel  popu- 
lation of  California.  In  this  city,  besides  numberless  American,  English, 
French,  German  and  Italian  physicians,  there  are  medical  savans  of  the 
Mongol  race,  who  practice  both  surgery  and  medicine."  Therefore,  we 
repeat,  this  journal  must  become  an  important  exponent  of  a  variety  of 
medical  opinion,  and  we  look  forward  to  its  future  success  with  much 
interest.  The  work  is  edited  by  John  B.  Trask,  M.D.,  and  David  Woos- 
ter,  M.D.  It  is  published  monthly,  at  San  Francisco,  California,  at  five 
dollars  per  annum,  and  the  editors  are  also  the  publishers. 

We  take  great  pleasure  in  placing  this  new  member  upon  our  Ex- 
change List,  and  in  welcoming  its  editors,  cordially,  into  the  fraternity 
of  journalists. 


A  Manual  of  Medical  Diagnosis  :  being  an  Analysis  of  the  Signs  and 
Symptoms  of  Disease.  By  A.  W.  Barclay,  M.D.,  Cantab  et  Edin. 
Fellow  of  the  Royal  College  of  Physicians,  Assistant  Physician  to  St. 
George's  Hospital,  etc.,  etc.  Philadelphia:  Blanchard  &  Lea.  1858, 
Pp.  423,  8vo. 

In  the  circle  of  attainments  necessary  to  constitute  the  rational  and 
reliable  practitioner,  no  one  of  them  is  more  important  than  a  correct 
and  philosophical  system  of  diagnosis.  Without  it,  all  treatment  is  em- 
piricism, every  measure,  a  bare  assumption,  and  Therapeutics  itself  but  a 
guess.  Of  works  exclusively  devoted  to  this  important  branch,  our  Pro- 
fession has  at  command,  comparatively,  but  few,  and,  therefore,  in  the 
publication  of  the  present  work,  Messrs.  Blanchard  &  Lea  have  conferred 
a  great  favor  upon  us.  Dr.  Barclay,  from  having  occupied,  for  a  long 
period,  the  position  of  Medical  Registrar  at  St.  George's  Hospital,  pos- 
sessed advantages  for  correct  observation  and  reliable  conclusions,  as  to 
the  significance  of  symptoms,  which  have  fallen  to  the  lot  of  but  few, 
either  in  his  own  or  any  other  country.  He  has  carefully  systematized 
the  results  of  his  observation  of  over  twelve  thousand  patients,  and  by 
hu  diligence  and  judicious  classification,  the  Profession  has  been  present- 


1858.]  Editorial  and  Miscellaneous.  213 

ed  with  the  most  convenient  and   reliable  work  on  the  subject  of  Diag- 
nosis, that  it  has  been  our  good  fortune  ever  to  examine. 

We  dislike  to  recommend  any  book,  except  a  dictionary  as  "  a  book 
of  reference,"  for  no  author  can  ever  obtain  his  full  meed  of  considera- 
tion, unless  he  is  read  diligently  through — page  by  page :  but  we  are 
aware  that  in  the  present  unavoidable  relations  of  the  practitioner  to  the 
Science  of  Medicine,  this  "  reference"  phase  of  a  book,  is  ever  a  recom- 
mendation ;  we  can  therefore  say  of  Dr.  Barclay's  work,  that  from  his 
systematic  manner  of  arrangement,  his  work  is  one  of  the  best  works  "  for 
reference"  in  the  daily  emergencies  of  the  practitioner,  with  which  we 
are  acquainted ;  but,  at  the  same  time,  we  would  recommend  our  read- 
ers, especially  the  younger  ones,  to  read  thoroughly  and  study  diligently 
the  whole  work,  and  the  "  emergencies"  will  not  occur  so  often. 


To  Readers  and  Correspondents. — We  have  on  our  table,  many 
other  valuable  works,  pamphlets  and  communications,  kindly  sent  us  by 
publishers  and  correspondents.  The  notices  of  these,  together  with  other 
important  editorial  matter,  have  necessarily  been  excluded  from  our  pre- 
sent number,  on  account  of  the  engrossing  duties  imposed  upon  us  at 
this  season,  by  our  relations  to  the  Medical  College  of  Georgia.  Still,  it 
will  be  seen  that,  we  have  done  some  work  for  the  present  issue,  as  the 
original  and  eclectic  department  will  show. 


Professor  Means. — As  in  the  January  number  of  this  journal,  we 
announced  that  our  friend,  Professor  Alexander  Means,  had  resigned  the 
Chair  of  Chemistry  in  the  Atlanta  Medical  College,  we  now  state  that 
Professor  Means  has  subsequently  withdrawn  that  resignation,  and,  there- 
fore, retains  his  connection  with  that  institution. 

Professor  Means  has  since,  resigned  the  Chair  of  Chemistry  and  Phar- 
macy in  the  Medical  College  of  Georgia. 

The  candor  of  Professor  Syme,  in  making  this  correction  through  the 
London  Times,  is  truly  commendable  and  worthy  of  imitation,  by  all 
members  of  our  profession,  under  like  circumstance.  There  is  true  man- 
liness in  it. 

An  Excision  of  a  Mail's  Tongue. — The  following  letter  has  been  ad- 
dressed, by  Professor  Syme,  to  the  editor  of  the  Times :  "  I  regret  to 
learn  that  an  operation  which  I  happened  to  perform  in  the  Royal  Infir- 
mary of  Edinburg  has  got  into  the  newspapers;  but  as  it  has  unfortunate- 
ly done  so,  the  public  should  be  correctly  informed  on  the  subject.  Par- 
tial removal  of  the  tongue,  for  the  remedy  of  Cancer,  having  been  found 
worse  than  useless,  it  was  thought  that  extirpation  of  the  whole  organ 
might  afford  effectual  relief;  upon  this  principle  I  proceeded.     The  pa- 


214  Editorial  and  Miscellaneous,  [March, 

tient  suffered  no  bad  consequences  directly  from  the  operation ;  but  at 
the  end  of  a  week,  when  the  external  wound  was  quite  healed,  died  sud- 
denly from  an  internal  disease,  which  might  have  been  excited  by  any 
other  irritation  in  a  person  of  his  constitution  and  habits." 


Novel  Method  of  Extracting  a  Foreign  Body  from  the  (Esophagus. — 
We  have  before  us,  in  the  pages  of  the  Boston  Medical  Journal,  an 
account  of  an  extremely  ingenious  and  novel  method  of  extracting  a 
foreign  body  from  the  oesophagus,  by  Dr.  David  Rice.  "  Mrs.  Field,  a 
lady  aged  70,  while  eating  chicken  soup,  accidentally  swallowed  a  piece 
of  bone  the  size  of  an  American  quarter  of  a  dollar,  cut  into  a  triangu- 
lar form.  The  bone  lodged  in  the  oesophagus,  about  two  inches  below 
the  top  of  the  sternum.  Thinking  that  it  might  fall  into  the  stomach, 
she  neglected  to  apply  for  surgical  aid,  until  the  fifth  day  after  the  acci- 
dent. In  the  mean  time,  she  had  swallowed  neither  food  nor  drink, 
both  regurgitating  back  into  the  mouth  with  every  attempt  to  do  so." 

The  Doctor  was  called  on  the  fifth  day,  but  was  unable  to  remove  the 
foreign  substance  by  any  instrument  which  he  had  at  his  command. 
He  finally  took  a  piece  of  sponge  of  such  a  shape,  as  when  dry,  to  fill 
about  half  of  the  tube,  and  introduced  it  rapidly  in  a  dry  state,  then,  by 
introducing  a  little  water  into  the  mouth,  the  sponge  became  moistened, 
and  enlarged  it  to  twice  its  natural  size,  completely  filling  the  gullet. 
On  drawing  it  out  the  bone  was  brought  with  it,  much  to  the  gratifica- 
tion of  patient  and  practitioner. 

There  is  a  certain  readiness  of  invention  and  expedient  which  is  neces- 
sary to  a  surgeon,  and  without  which  he  will  often  be  nonplused  and 
harassed.  The  same  means  cannot  be  applied  to  every  case,  and  com- 
mon sense,  with  a  share  of  ingenuity,  frequently  is  all  that  is  necessary 
to  overcome  difficulties  which  seem  to  be  very  great.  It  is  desirable  to 
have  in  our  minds  the  expedients  which  have  been  resorted  to  by  others 
in  difficult  cases,  for  we  are  liable  at  any  time,  to  have  a  case  to  which 
they  are  precisely  applicable.  We  conceive  that  this  mode  of  swabbing 
the  gullet  from  below  upward,  by  introducing  a  dry  sponge  below  a 
foreign  body,  allowing  it  to  imbibe  moisture  and  then  withdrawing  it, 
might  be  applicable  to  a  great  many  cases  where  the  substance  could 
not  be  removed  by  other  means. — [Buffalo  Med.  Journal. 

[We  add,  from  memory,  to  the  above,  a  very  ingenious  device  of  Dr. 
E.  Leroy  Antony,  of  Georgia,  for  removing  a  certain  kind  of  foreign 
body  from  the  throat.  The  patient  by  some  means  had  swallowed  a 
fish-hook  !  (what  will  not  people  swallow  ?)  it  had  passed  out  of  reach 
and  became  fixed  in  the  gullet  by  the  barbed  end,  in  the  efforts  of  the 
patient  to  relieve  himself  by  pulling  at  the  line  which  was  attached  to 
the  hook  and  hung  out  of  the  mouth.  Dr.  A.  removed  the  foreign  body 
by  passing  a  drilled  bullet  down  the  oesophagus  upon  the  line,  which, 
when  it  arrived  at  the  hook-end,  disengaged  the  barb,  and  protected  the 
soft  parts  from  being  wounded  with  it,  during  its  removal  from  the 


1858.]  Miscellaneous.  215 

throat.  As  Dr.  Flint  remarks,  "  it  is  desirable  to  have  every  possible 
expedient  in  our  mind" — this  last  is  also  one  which  certainly  deserves 
recording  and  recollecting.] 

Surgery  in  San  Francisco. — Dr.  E.  S.  Cooper,  of  this  city,  has  recent- 
ly ligated  the  primitive  carotid  artery  in  two  cases, — the  external  iliac 
in  one,  the  axillary  in  one,  removed  a  large  fibro-cartilaginous  tumour 
from  the  uterus ;  made  the  Caesarian  section  in  one ;  exsected  parts  of 
three  ribs,  and  removed  a  foreign  body  from  beneath  the  heart ;  exsected 
the  sternal  extremity  of  the  clavicle  and  a  portion  of  the  summit  of  the 
sternum  ;  together  with  the  exsection  of  nearly  all  the  joints,  in  different 
cases,  all  successfully. 

This  embraces  a  list  of  formidable  operations,  which,  being  attended 
with  favorable  results,  are  worthy  of  note.  This  uniform  success  in 
operations  of  such  magnitude,  must,  in  part,  be  attributed  to  the  effects 
of  our  climate,  which,  for  the  recovery  of  patients  after  receiving  serious 
injuries,  is,  at  least,  unsurpassed  in  any  part  of  the  w< 

There  have  been  many  other  capital  operations  succ  5sfully  performed 
in  various  parts  of  this  State,  which  we  are  unable,  for  want  of  data  from 
the  operators,  to  specify.  There  is  no  country  in  the  world,  where,  in 
the  absence  of  war,  mutilation  and  deformities  from  injuries  are  so  com- 
mon and  so  serious,  as  in  California  ;  and  it  is  n  emarkable 
that  our  surgeons  have  opportunities  of  practice  which  can  be  found  only 
in  the  hospitals  of  other  countries. — [Pacij 


On  the  Temperature  of  the  Body  in  Intermittent  Fever.  By  Dr.  S.  Th. 
Michael. — These  observations  were  made  in  different  types  of  intermit- 
tent fever,  and  repeated  at  intervals  of  five  minutes,  so  as  to  determine 
with  exactness  the  precise  variations  of  temperature. 

Their  result  is  that  the  temperature  begins  to  rise  at  the  rigor,  and  rises 
by  slow  degrees;  and  that  after  this  it  falls  by  slower  degrees,  and  with 
intermissions.  At  the  commencement  of  the  rigor,  and  at  the  end  of 
the  period  of  sweating,  the  temperature  is  below  the  natural  standard, 
sometimes  to  the  extent  of  some  degrees,  sometimes  to  certain  portions 
of  a  degree. 

In  the  majority  of  cases,  the  maximum  elevation  was  between  32°  and 
33°  Reaumur,  rarely  below,  more  frequently  above.  The  highest  point 
ever  attained  was  33.4  Reaumur. 

After  the  administration  of  sulphate  of  quinine  the  temperature  did  not 
attain  to  the  same  degree  of  elevation  as  previously  ;  and  during  conval- 
escence it  remained  below  the  normal  standard,  or  only  occasionally  be- 
came raised  to  the  fraction  of  a  degree  above  it. — [Archivfur  Physiolog. 
Heilkunde.     Ranking  $  Abstract. 


Glycerine  in  Corns. — These  troublesome  things  Mr.  TVakley  is  in  the 
habit  of  treating,  at  the  Royal  Free  Hospital,  by  the  application  of  gly- 
cerine, which  has  the  effect  of  soft  (filing  them,  when  they  are  easily 
scooped  out.  We  saw  as  many  as  -<\enteen  corns  entirely  removed  in 
twelve  days  in  this  manner. — [London  Lancet. 


216  Miscellaneous.  [March, 

"On  the  Signs  of  Pregnancy? — It  seeins  strange  that  Dr.  Montgome- 
ry should  have  deemed  it  necessary  to  write  so  elaborate  a  treatise  on 
this  subject,  when  the  old  sage  of  Cos  summed  up  the  whole  matter  in 
three  lines.  Thus,  in  the  41st  Aphorism  of  Hippocrates,  we  find  the 
following : 

"  If  you  wish  to  know  whether  a  woman  is  pregnant  or  not,  instead 
of  supper,  give  her  hydromel  (water  impregnated  with  honey)  at  bed- 
time ;  if  she  experiences  griping  pains  in  the  abdomen,  she  is  pregnant ; 
otherwise,  she  has  not  conceived." 

Hippocrates,  in  another  place,  refers  to  a  matter  of  some  importance 
in  its  bearings  on  the  duration  of  pregnancy.  He  states  that  his  own 
father  knew  not  his  mother  for  two  years  before  his  birth  !  We  believe 
that  the  Roman  law  was  somewhat  liberal  in  cases  of  ])rotracted  gestation, 
"but  the  Greeks  must  have  had  some  very  peculiar  notions  on  the  subject, 
if  theyi  rauked  the  birth  of  this  reputed  18th  lineal  descendant  of^Escul- 
apius"  (the  latter,  son  of  Apollo,)  among  the  legitimate  ! — [  Western 
Lancet. 


Rev.  Sidney  Smith  on  Hag  Fever. — In  a  letter  to  Dr.  Holland,  the 
eccentric  Dean  of  St.  Paul,  thus  gives  his  personal  experience  in  this 
complaint : 

k>  I  am  suffering  from  my  old  complaint,  the  hay  fever  (as  it  is  called.) 
My  fear  is,  perishing  by  deliquescence ;  I  melt  away  in  nasal  and  lachry- 
mal prorluvia.  My  remedies  are  warm  pediluvium,  cathartics,  topical 
applications  of  a  watery  solution  of  opium  to  the  eyes,  ears,  and  the  in- 
terior of  the  nostrils.  The  membrane  is  so  irritable  that  light,  dust,  con- 
tradiction and  absurd  remark,  the  sight  of  a  Dissenter — anything — sets 
me  sneezing ;  and  if  I  begin  sneezing  at  twelve,  I  don't  leave  off  till  two 
o'clock,  and  am  heard  distinctly  in  Taunton,  when  the  wind  sets  that 
-way — a  distance  of  six  miles.  Turn  your  mind  to  the  little  curse.  If 
consumption  is  too  powerful  for  physicians,  at  least  they  should  not  suf- 
fer themselves  to  be  outwitted  by  such  little  upstart  disorders  as  the  hay 
fever;—  [Ibid. 

Anaisthesis  by  "  Projection? — To  avoid  the  accidents  due  to  excessive 
inhalation  of  the  anesthetic  agent,  and  especially  to  insure  that  the  ma- 
terial should  be  mixed  with  the  requisite  amount  of  air,  Dr.  Heurteloup, 
known  in  surgery  for  the  invention  of  Lithotripsy,  has  contrived  an  ap- 
paratus for  this  end,  (having  in  hi>  experiments  made  use  of  chloroform). 
The  apparatus  is  like  a  syringe  with  a  small  bellows  for  throwing  in  air 
in  place  of  the  piston,  and  having  a  gauze  partition  on  which  the  chloro- 
form is  poured.  The  working  of  the  bellows  throws  a  steam  out  of  the 
small  end  in  a  jet,  which  contains  more  or  less  chloroform,  according  as 
the  discharging  tube  is  brought  more  or  less  near  to  the  bellows.  The 
jet  is  established  only  on  working  the  bellows,  and  there  is  no  waste  of 
chloroform  during  the  operation. — [American  Jour,  of  Sci.  and  Arts. 

Incontinence  of  Urine. — M.  Trousseau  seems  to  have  most  unboun- 
ded confidence  in  the  efficacy  of  Belladonna  in  the  treatment  of  incon- 
tinence of  urine.     A  girl  ast.  19,  entered  the  hospital,  who  voided  her 


1858.]  - .  ' 

urine  two  or  three  times  during  the  night.  He  commenced  with  1  cen- 
tigramme (gr.  .1543  Troy)  of  the  extract,  and  in  the  course  of  a  few 
weeks,  increased  the  dose  to  18  centigrammes.  He  insists  upon  the 
continued  use  of  the  medicine  for  several  months  after  the  incontinence 
had  ceased,  as  a  return  of  the  difficulty  may  otherwise  be  anticipated. 

[  Western  Lancet. 

A  New  Property  of  Camomile. — Camomile  {anthemis  nobilis)  is  de- 
scribed in  all  treatises  of  materia  medica  as  emollient  digestive,  fortify- 
ing. <fcc  but  none  point  out  a  most  precious  virtue,  just  announced  as 
pertaining  to  it  by  M.  Ozanam,  whose  paper  on  the  subject  was  presented 
to  the  Academy  of  Sciences  at  its  last  sitting  by  M.  Cloquet.  This  vir- 
tue consists  in  preventing  suppuration  when  the  local  disease  is  not  too 
far  advanced,  and  in  gradually  stopping  it  when  it  has  existed  for  a  long 
time.  For  this  purpose  it  is  administered  in  powerful  doses  of  five,  ten* 
and  even  thirty  grammes  of  the  flower  in  a  litre  of  water,  the  infusion 
to  be  drunk  in  the  course  of  the  day,  and  to  be  continued  until  the  cure- 
be  effected.  Compresses  moistened  with  the  infusion  may  be  locally 
applied ;  they  aid  in  the  cure,  but  are  not  necessary — the  infusion  alone 
taken  internally,  being  quite  sufficient.  In  support  of  his  assertion,  M. 
Ozanam  quotes  a  number  of  cases  in  which  this  mode  of  treatment  was 
successful. — [London  Times. 

On  the  use  of  Manganate  of  Potass  as  a  Caustic  in  Cancer.  B7 
TVeedox  Cooke. — Mr.  Weedon  Cooke  speaks  highly  of  manganic  acid. 
in  combination  with  potassa  as  a  base,  as  the  caustic  in  the  treatment  of 
cancer.  It  produces,  he  says,  much  less  pain  than  any  other  caustic,  and 
no  ill-consequences  of  any  kind.  It  is  a  dark-green  powder,  which  may 
be  dredged  on  the  ulcerated  surface  by  means  of  a  pepper-castor. 

[Lancet. 


Duration  of  Cancer. — A  case  of  some  interest  presented  itself  at  the 
Cancer  Hospital,  on  the  25th  of  August,  in  the  person  of  a  female,  aged 
seventy-four  years,  the  subject  of  cancer  of  the  left  breast  for  twelve 
years.  She  had  been  a  patient  at  this  hospital  since  its  foundation,  with 
this  exception  of  the  last  three  years,  during  which  time  she  had  been  in 
good  health.  She  came  to  show  an  ulcerated  tuberculous  mass  in  the 
same  breast,  the  size  of  a  small  pear,  otherwise  the  disease  has  dried  up 
and  disappeared.     She  still  looking  a  hale  and  hearty  old  woman. — [lb. 

MedicalJoumals  in  the  United  States. — We  think  there  is  a  crrowin<r 
disposition  to  lessen  the  number  of  our  medical  journals — to  improve 
their  quality — and  a  decreasing  disposition  to  publish  them  for  nothing:  ! 
lianiiest  improvement  in  the  tone  and  character  of  almost 
all  our  exchanges,  and  we  notice  that  several  have  already  raised  their 
price:  we  think  these  features  in  our  journalism  are  pioper  and  com- 
mendable. Medical  periodicals,  if  published  at  all,  must  be  paid  for  in 
some  way — and  if  afforded  to  subscribers  at  a  price  actually  less  than 
the  paper  and  printing  cost,  somebody  roust  make  up  the  deficit, 
this  can  very  readily  be  afforded  sometimes,  by  parties  who  have  special 


218  Miscellaneous. 

interests  to  advance,  just  on  the  same  principle  that  we  get  a  flood  of 
almanacs  annually  thrust  under  our  doors  gratis,  for  the  sake  of  calling 
our  attention  to  their  author's  individual  skill,  or  wonderful  nostrums; 
but  we  doubt  if  the  true  interests  of  legitimate  medicine  are  to  be  ad- 
vanced by  the  publishing  of  our  journals  on  such  principles. 

[Cincinnati  Lancet  and  Observer. 


Artesian  Wells  in  Sahara.  (Athen.,  No.  15G2.) — The  Moniteur  Al- 
gerien  brings  an  interesting  report  on  the  newly-bored  Artesian  wells  in 
the  Sahara^Desert,  in  the  province  of  Constantine.  The  first  well  was 
bored  in  the  Oasis  of  Oued-Rir,  near  Tamerna,  by  a  detachment  of  the 
Foreign  Legion,  conducted  by  the  engineer,  M.  Jus.  The  works  were 
begun  in  May,  1856,  and,  on  the  19th  of  June,  a  quantity  of  water  of 
4,010  litres  per  minute,  and  of  a  temperature  of  21°  Reaumur,  rushed 
forth  from  the  bowels  of  the  earth.  The  joy  of  the  natives  was  unbound- 
ed ;  the  news  of  the  event  spread  towards  the  South  with  unexampled 
rapidity.  People  came  from  long  distances  in  order  to  see  the  miracle  ; 
the  Marabouts,  with  great  solemnity,  consecrated  the  newly-created  well, 
and  gave  it  the  name  of  "the  well  of  peace."  The  second  well,  in  Te- 
makin,  yielded  35  litres,  of  21°  temperature,  per  minute,  and  from 
a  depth  of  85  metres ;  this  well  was  called  "  the  well  of  bliss."  A  third 
experiment,  not  far  from  the  scene  of  the  second,  in  the  Oasis  of  Tamelhat, 
was  crowned  with  the  result  of  1 20  litres  of  water  per  minute.  The  Mara- 
bouts, after  having  thanked  the  soldiers  in  the  presence  of  the  whole 
population,  gave  them  a  banquet,  and  escorted  them  in  solemn  procession 
to  the  frontier  of  the  Oasis.  In  another  Oasis,  that  of  Sidi-Nached,  which 
had  been  completely  ruined  by  the  drought,  the  digging  of  "  the  well  of 
gratitude"  was  accompanied  by  touching  scenes.  As  soon  as  the  re- 
ioicino:  outcries  of  the  soldiers  had  announced  the  rushino-  forth  of  the 
water,  the  natives  drew  near  in  crowds,  plunged  themselves  into  the 
blessed  waves,  and  the  mothers  bathed  their  children  therein.  The  old 
Emir  could  not  master  his  feelings ;  tears  in  his  eyes,  he  fell  down  upon 
his  knees,  and  lifted  his  trembling  hands,  in  order  to  thank  God  and  the 
French.  This  well  yields  not  less  than  4,300  litres  per  minute,  from  a 
depth  of  54  metres.  A  fifth  well  has  been  dug  at  Oum  Thior,  yielding 
108  litres  per  minnte.  Here  a  part  of  the  tribes  of  the  neighborhood 
commenced  at  once  the  establishment  of  a  village,  planting  at  the  same 
time  hundreds  of  date-palms,  and  thus  giving  up  their  former  nomadic 
life.  The  last  well  is  that  of  Shegga,  where  soon  an  important  agricul- 
tural centre  will  spring  up.  There  is  no  doubt  but  that  these  wells  will 
work  in  these  parts  a  great  social  revolution.  The  tribes*  which,  after 
the  primeval  custom  of  their  ancestors,  kept  wandering  from  one  place  to 
another,  will  gather  round  those  fertilizing  springs,  will  exchange  the 
herdsman's  staff  for  the  plough  of  the  farmer,  and  thus  take'the  first  steps 
towards  a  civilization,  which,  no  doubt,  will  make  rapid  progress  in  Nor  th- 
em Africa. — [American  Jour,  of  Science  and  Arts. 


The  Boston  Transcript  says,  the  following  by  Oliver  W.  Holmes,  is 
the  finest  simile  ever  written :  "  The  mind  of  a  bigot  is  like  the  pupil  of 
the  eye ;  the  more  light  you  throw  upon  it,  the  more  it  contracts." 


SOUTHERN 

MEDICAL  AID  STJBGICAL  JOUMAL. 

(NEW  SERIES.) 

Vol.  XIV.]  AUGUSTA,  GEORGIA,  APRIL,  1858.  [No.  4. 

ORIGINAL  AND  ECLECTIC. 

ARTICLE    IX. 

A  Lecture  upon  Hemorrhoidal  Affections.  By  L.  A.  DuGAS,  M.D., 
Professor  of  Surgery  in  the  Medical  College  of  Georgia. — 
Taken  down  by  J.  F.  B.,  medical  student. 

Gentlemen  : 

I  will  direct  your  attention  to-day  to  the  subject  of  Hemor- 
rhoids, commonly  called  the  Piles.  And  in  order  that  you  may 
understand  the  anatomical  relations  of  the  parts  implicated,  I 
have  brought  before  you  these  very  handsome  models  of  dissec- 
tions of  the  rectum,  exhibiting  its  blood-vessels,  nerves,  muscles, 
&c.  It  is  not  my  intention  to  enter  upon  a  minute  description 
of  these  structures,  but  I  merely  desire  that  you  may  keep  your 
eye  upon  these  models,  in  order  that  you  may  understand  more 
readily  what  I  have  to  say  upon  the  disease  under  considera- 
tion. 

Hemorrhoidal  affections  show  themselves  in  different  forms. 
In  some  the  disease  consists  essentially  in  a  varicose  condition 
of  the  hemorrhoidal  veins,  with  or  without  a  similar  amplifica- 
tion of  the  capillaries  and  arterial  radicles,  and  is  entirely  con- 
fined to  parts  above  the  verge  of  the  anus.  This,  therefore, 
constitutes  what  is  commonly  called  internal  Piles,  in  contra- 
distinction of  another  variety  called  external  Piles,  in  which,  as 
the  term  indicates,  there  are  external  manifestations  of  the  disease 
in  the  form  of  one  or  more  small  globular  tumors  of  a  deep  red 
or  bluish  hue,  situated  at  the  verge  of  the  anus.     These  two 

K.S. — VOL.  XIV.    NO.  IV.  10 


220  Dugas.     Lecture  on  Hemorrhoidal  Affections.      [April, 

forms  of  the  disease  are  attended  with  a  very  considerable  de- 
gree of  vascularity  in  the  mucous  membrane  of  the  lower  end  of 
the  re&um,  and,  not  unfrequently,  with  a  relaxation  of  this 
membrane,  more  or  less  marked,  which  may  in  some  cases  allow 
it  to  protrude  during  the  expulsory  efforts  of  defecation. 

The  hemorrhoidal  tumors  to  which  we  have  referred,  may  be 
formed  either  by  an  extraordinary  dilatation  of  the  veins,  or, 
what  is-more  common,  by  an  exudation  of  blood  into  the  subcu- 
taneous cellular  tissue.  If  the  opening  from  which  the  blood 
has  issued  be  sufficiently  free,  the  blood  contained  in  the  little 
sac  or  tumor  may  remain  fluid ;  but  if,  on  the  contrary,  the 
blood  has  been  derived  from  mere  capillaries,  it  may  coagulate. 
Hence  it  is  that,  upon  opening  these  tumors,  we  sometimes  find 
them  filled  with  a  coagulum,  whereas  in  other  instances  nothing 
issues  but  liquid  blood.  It  is  thus,  also,  that  we  may  account  for 
the  fact  that  while  in  some  cases  these  tumors  may  be  dissipated 
by  pressure,  in  others  they  do  not  diminish  in  size  by  this  means. 
When  the  extravasated  blood  has  become  thus  coagulated,  it  op- 
erates somewhat  like  a  foreign  body,  and  provokes  more  or  less 
inflammatory  action  of  a  very  painful  character.  In  general, 
however,  after  the  painful  stage  of  the  disease,  occasioned  by  the 
distention  of  the  tissues,  has  ceased,  the  coagulum  dissolves  and 
is  gradually  removed  by  absorption,  with  the  exception  of  small 
fibrinous  concretions,  which  remain  in  the  form  of  slight  indur- 
ations, sometimes  projecting  beyond  the  general  level  of  the  parts 
These  little  indurated  teats  will  sometimes  become  chafed  and 
exquisitely  sensitive,  giving  the  patient  a  great  deal  of  annoy- 
ance long  after  the  subsidence  of  the  acute  symptoms. 

You  have  all  heard  of  persons  said  to  be  affected  with  blind 
Piles,  and  others  with  bleeding  Piles.  The  term  blind  Piles  is 
applied  simply  to  those  hemorrhoidal  affections  which  do  not 
bleed — whereas  the  bleeding  Piles  are  those  in  which  the  con- 
gested blood-vessels  relieve  themselves  by  an  issue  of  blood 
during  defecation,  and  occasionally  at  other  times.  Now  this 
issue  of  blood  usually  occurs  from  the  mucous  membrane  just 
within  the  sphincters,  although  it  may  sometimes  flow  from 
the  verge  of  the  anus.  When  it  occurs  during  defecation,  it 
is  manifestly  induced  by  the  expulsory  efforts,  which  very 
materially  increase  the  turgescence  of  the  mucous  surface.     It 


1858.]       Dugas.     Lecture  on  Hemorrhoidal  Affections.  221 

is  therefore  important,  in  such  cases,  that  these  efforts  be  not 
prolonged  unnecessarily,  in  order  that  the  hemorrhage  may  not 
be  excessive,  and  by  its  daily  repetition  seriously  impair  the 
patient's  health,  as  is  too  often  the  case.  In  the  cases  in  which 
the  bleeding  does  not  coincide  with  defecation,  it  is  most  apt  to 
take  place  when  the  patient  is  standing  or  walking,  and  conse- 
quently when  the  vessels  are  exposed  to  the  gravitating  influence 
of  the  superimposed  column  of  blood.  It  will  therefore  very 
rarely  occur  when  the  patient  is  in  the  horizontal  position.  In 
some  very  rare  instances  the  hemorrhage  proceeds  from  above 
the  sphincter  ani,  and  may  accumulate  in  the  rectum  until  it 
produces  a  desire  to  stool,  when  the  patient  may  pass  off  a  large 
quantity  of  blood  in  a  state  of  semi-coagulation.  And  this  may 
be  repeated  at  intervals  so  short  as  to  become  alarming.  I  have 
seen  two  cases  of  the  kind  which  proved  very  troublesome.  In 
general,  however,  the  flow  of  blood  shows  itself  externally,  and 
it  may  sometimes  be  felt  trickling  down  the  thighs  of  the  patient 
as  he  walks  along. 

Hemorrhoidal  affections  are  often  complicated  with  prolapsus 
ani,  or  a  ^disposition  on  the  part  of  the  lower  end  of  the  rectum 
to  protrude  during  defecation,  or  whenever  the  patient  remains 
long  in  the  erect  position.  This  adds  very  much  to  the  annoy- 
ance of  the  disease,  as  well  as  to  the  difficulty  of  its  manage- 
ment. 

I  have  now  given  you  the  leading  features  of  this  disease,  and 
you  may  perhaps  expect  me  to  say  something  of  its  causes,  or 
rather  of  its  remote  causes.  I  may  as  well  tell  you  at  once  that 
\  do  not  know  them ;  and  yet,  hemorrhoidal  affections  are  sup- 
posed by  some  to  be  induced  by  hepatic  disease  obstructing  the 
portal  circulation,  and  consequently  inducing  a  congestion  of 
the  veins  constituting  the  origin  of  the  vena  portarum.  We  are 
not  told,  however,  by  the  advocates  of  this  theory,  why  it  is  that 
the  blood-vessels  of  the  rectum  suffer  more  under  such  circum- 
stances than  those  of  the  other  portions  of  the  alimentary  canal. 
Moreover,  we  know  that  a  very  large  majority  of  those  affected 
with  hemorrhoids  furnish  us  no  evidence  whatever  of  hepatic 
derangement.  Hemorrhoidal  affections  are  also  attributed  to 
constipation _and  to  sedentary  habits;  whereas  every  practi- 
tioner of  observation  is  aware  that  they  very  often  occur  in 


222  DuGAS.     Lecture  on  Hemorrhoidal  Affections.      [April, 

persons  whose  bowels  are  perfectly  regular — that  they  not  un- 
frequently  occur  during  a  relaxed  condition  of  the  bowels,  and 
that  they  affect  the  active  as  well  as  the  sedentary.  The  fact  is, 
Gentlemen,  that  this  is  a  very  common  disease,  at  least  in  this 
part  of  the  world ;  and  I  do  not  think  it  an  exaggeration  to  say 
that  eight  persons  out  of  ten,  between  the  ages  of  twenty-five 
and  fifty,  suffer  more  or  less  with  this  infirmity.  I  should  have 
said  white  persons ;  for  it  is  a  remarkable  fact,  that  our  negroes 
are  so  rarely  affected  with  this  disease  that  I  do  not  recollect  to 
have  seen  more  than  two  or  three  of  them  suffering  with  it,  in  a 
practice  of  five  and  twenty  years,  although  one  half  of  our  popu- 
lation consists  of  this  class  of  people.  Whether  this  exemption 
of  the  negro  race  can  be  traced  to  any  anatomical  peculiarity  or 
not  would  be  a  subject  of  interesting  inquiry. 

You  must  have  observed,  that  I  restricted  the  liability  to  this 
disease  to  the  period  of  life  extending  from  the  twenty-fifth  to 
the  fiftieth  year.  I  did  so,  because  it  very  rarely  shows  itself 
before  twenty-five  years  of  age,  and  that  it  usually  declines 
and  ceases  to  be  troublesome  at  about  fifty  years  of  age.  We 
know,  that  with  the  advance  of  age  the  rectum,  and  especially 
its  lower  extremity,  diminishes  in  capacity  and  in  relaxation, 
often  to  such  a  degree  as  to  render  the  act  of  defecation  more 
or  less  difficult,  and  even  to  make  it  a  source  of  real  annoy- 
ance to  the  very  aged.  This  species  of  atrophy  may  perhaps 
account  for  the  cessation  of  hemorrhoidal  troubles  with  ad- 
vancing age. 

With  regard  to  the  treatment  of  this  disease  you  will  find 
quite  a  diversity  of  opinion  in  the  profession,  and  no  lack  of 
specifics  in  the  newspapers  of  the  day.  I  need  not  detain  you 
with  a  critical  appreciation  of  the  various  plans  suggested,  but 
will  at  once  proceed  to  give  you  the  course  I  usually  pursue  in 
the  management  of  these  affections.  This  must  necessarily  vary 
according  to  the  circumstances  of  the  case.  At  the  commence- 
ment of  the  disease,  it  usually  shows  itself  in  the  form  of  attacks 
more  or  less  acute,  which,  after  having  continued  a  few  weeks, 
will  gradually  subside,  leaving  the  patient  under  the  impression 
that  he  is  cured,  and  will  not  have  any  return  of  the  affection. 
It  is  then  that  he  is  willing  to  certify  to  the  efficacy  of  the  last 
remedy  used,  especially  if  he  has  procured  it  from  a  Charlatan 


1858.]       DuGAS.     Lecture  on  Hemorrhoidal  Affections.  223 

or  nostrum  vender.  But  the  occurrence  of  one  attack  is  almost 
invariably  the  precursor  of  others,  after  the  lapse  of  months  or 
even  years.  A  knowledge  of  this  fact  should  make  you  ex- 
ceedingly cautious  in  your  prognosis,  and  you  will  always  be 
on  the  safe  side  if  you  will  honestly  state  to  your  patient  that 
although  you  may  relieve  him,  you  cannot  promise  a  radical 
cure,  or  an  immunity  from  subsequent  attacks,  unless  the  patient 
be  near  the  age  at  which  the  disease  will  probably  cease  spon- 
taneously. 

These  acute  attacks  are  generally  attended  with  the  formation 
of  one  or  more  hemorrhoidal  tumors  at  the  verge  of  the  anus, 
intensely  painful  during  the  act  of  defecation.  The  pain  con- 
tinues after  defecation,  and  the  patient  complains  of  a  sense  of 
burning  and  throbbing  in  the  part  affected,  which  is  increased 
by  the  erect  position,  but  may  even  continue  to  annoy  him 
when  in  bed,  to  such  a  degree  as  to  prevent  any  quiet  sleep 
during  the  night.  We  have  here  the  usual  manifestations  of 
inflammatory  action,  set  up  by  the  effusion  of  blood  in  the  sub- 
cutaneous cellular  tissue  and  the  influence  of  distension.  It  is 
under  such  circumstances  that  we  find  the  patients  resorting  to 
the  various  pile  ointments  heralded  by  the  newspapers,  or  using 
some  similar  application  under  the  direction  of  their  medical 
adviser.  These  ointments  usually  consist  of  a  combination,  in 
various  proportions,  of  opium  or  some  of  its  preparations,  with 
finely  pulverized  gall-nuts  or  other  vegetable  astringents  and 
sugar  of  lead  or  alum,  rubbed  up  with  lard  or  simple  cerate.  *  I 
must  confess  that  I  have  never  derived  any  advantage  from 
these  applications,  and  that  I  believe  that  the  popular  error  in 
regard  to  their  efficacy  is  the  result,  as  already  intimated,  of 
their  use  at  the  period  at  which  the  disease  is  about  to  subside 
of  itself.  The  same  may  be  said  of  the  use  of  rhubarb  lozenges, 
sulphur,  cream  of  tartar,  and  other  remedies  in  popular  favor. 
During  the  intensity  of  the  disease  the  application  of  leeches  is 
highly  recommended  by  some,  and  may  afford  temporary  relief, 
but  the  leech  bites  will  sometimes  rather  increase  than  lessen 
the  pain.  I  am  in  the  habit  of  directing,  in  such  cases,  that  the 
patient  shall  remain  in  bed — that  the  bowels  be  emptied  by  a 
full  dose  of  rhubarb,  and  then  kept  quiet  for  several  days  by  the 
use  of  small  doses  of  opium.     The  preference  is  given  to  rhu- 


224  Dugas.     Lecture  on  Hemorrhoidal  Affections.     [April, 

barb  over  other  cathartics,  and  especially  over  saline  cathartics, 
because  the  discharges  it  occasions  are  less  excoriating.     Under 
the  effects  of  a  dose  of  salts  the  dejections  are  as  painful  as 
though  the  patient  were  passing  boiling  water  over  the  affected 
part.     Poultices  of  corn -meal,  or  of  bread  and  milk,  should  be 
hept  constantly  applied  to  the  anus,  either  hot  or  cold,  accord- 
ing to  the  preference  of  the  patient.     It  is  somewhat  singular, 
that  while  some  patients  derive  most  relief  from  hot  applications, 
others,  on  the  contrary,  find  them  intolerable  and  are  materially 
benefitted  by  the  cold.     Certain  poultices  are  supposed  by  some 
to  be  peculiarly  beneficial,  and  I  have  known  cases  relieved  by 
the  application  of  the  leaves  of  plantain,  rue,  or  wormwood, 
bruised  in  the  form  of  a  poultice,  after  other  applications  had 
failed.     Poultices  made  with  infusion  of  red  oak  bark  will  also 
be  found  sometimes  advantageous  in  the  latter  stages  of  the 
attack.     If  there  be  any  protrusion  of  the  intestine,  this  should 
be  anointed  with  a  little  sweet  oil,  or  sperm  oil,  (which  is  less 
apt  to  be  rancid,)  and  gently  forced  up  by  the  patient  with  his 
fingers  as  often  as  it  may  occur.     This  procc-ss,  which  is  some- 
times very  painful,  will  be  very  much  facilitated  if  the  patient 
will  place  himself  upon  his  knees  and  breast  so  that  his  pelvis 
may  be  elevated  and  allow  the  rectum  to  gravitate  towards  the 
abdomen.     I  have  already  advised  that  the  bowels  be  kept  quiet 
after  having  been  emptied,  but  when  this  is  no  longer  compati- 
ble with  the  comfort  of  the  patient,  the  rectum  may  be  washed 
out  with  cold  water ;  or,  if  he  cannot  tolerate  the  introduction 
of  the  canula,  he  should  take  a  smaller  and  merely  laxative  dose 
of  rhubarb,  to  be  followed,  as  before,  by  the  opiates.     My  object, 
you  perceive,  is  to  avoid  as  much  as  possible  the  disturbing  and 
irritating  influence  of  defecation.     The  patient  should  therefore 
use  animal  food,  which  leaves  less  fecal  matter  than  vegetable 
substances.     Under  these  directions  the  attack  will  usually  run 
its  course  with  as  little  suffering  as  possible ;  but  you  will  now 
and  then  find  cases  in  which  the  unmitigated  pain  may  warrant 
a  trial  of  other  means,  such  as  sitting  over  boiling  water,  or  steam 
generated  by  pouring  water  upon  a  hot  brick.     This  will  some- 
times give  considerable  relief,  and  may  be  repeated  as  often 
as  the  patient's   inclination   may   direct.      I   have   sometimes 
known  the  so-called  u  Pain-killers "  to  act  advantageously  in 


1858.]       Dugas.     Lecture  on  Hemorrhoidal  Affections.  225 

subduing  the  morbid  sensibility  of  the  parts.  These  nostrums, 
you  know,  consist  of  a  concentrated  tincture  of  capsicum  and 
morphine,  or  of  capsicum  and  morphine  mixed  with  lard.  The 
liquid  is  the  better  preparation  of  the  two.  When  applied,  it 
occasions  intense  smarting  for  a-while,  which  gradually  sub- 
sides and  may  leave  the  patient  considerably  relieved. 

In  the  acute  attacks,  attended  with  bleeding,  there  may  or 
not  be  any  protruding  tumors,  and  the  hemorrhage  usually  pro- 
ceeds from  the  mucous  surface  above  the  verge  of  the  anus.  In 
these  cases  the  act  of  defecation  is  more  or  less  painful,  and  there 
is  a  disposition  on  the  part  of  the  patient  to  make  strong  expul- 
sory  efforts,  not  unlike  those  provoked  by  a  mild  attack  of  dys- 
entery. And  it  is  then  that  the  blood  issues  either  in  a  distinct 
jet  or  stream,  which  will  cease  with  the  act  of  defecation.  The 
lower  end  of  the  rectum  and  the  verge  of  the  anus  may  become 
very  sore,  as  though  chafed  by  the  contact  of  the  feces. 

In  treating  acute  attacks  of  this  kind,  I  would  adopt  the  same 
plan  as  above  indicated,  with  the  exception  of  the  poultices,  in 
lieu  of  which  I  would  advise  ablutions  with  cold  water,  or  sitting 
a  few  minutes  in  cold  water  three  or  four  times  each  day. 

"We  now  come  to  the  consideration  of  the  treatment  of  the 
disease  when  chronic,  and  of  the  rules  to  be  observed  between 
the  acute  attacks.  In  the  first  place,  let  the  patient  be  fully  im- 
pressed with  the  importance  of  keeping  his  bowels  perfectly 
regular,  that  is  to  say,  of  having  one  stool  every  day :  nothing 
will  conduce  more  to  bring  about  this  state  of  things  than  the 
observance  of  a  stated  hour  at  which  he  will  invariably  go  to 
stool,  whether  he  feels  any  desire  to  do  so  or  not.  If  he  finds 
that  he  cannot  have  an  evacuation  naturally,  or  that  he  is  com- 
pelled to  make  strong  expulsory  efforts  to  accomplish  his  pur- 
pose, he  should  throw  up  a  small  quantity  of  cold  water  into  the 
rectum,  ten  or  fifteen  minutes  before  the  appointed  hour.  By 
so  doing,  he  will  find  that  the  bowels  will  gradually  acquire  the 
desired  habit  of  punctuality.  The  patient  should  bear  in  mind 
that  nothing  is  more  injurious  to  those  subject  to  Piles,  than 
long  sitting  and  protracted  efforts  at  stool.  He  should  therefore 
not  remain  more  than  a  few  minutes,  and  make  but  slight  ex- 
pulsory efforts,  and  if  he  cannot  thus  promptly  and  readily  emp- 
ty the  rectum,  he  should  desist  and  wait  until  the  next  day, 


226  Dugas.     Lecture  on  Hemorrhoidal  Affections.      [April, 

being  careful  not  to  allow  this  to  interfere  with  his  regularly 
appointed  hours. 

The  selection  of  the  hour  is  not  a  matter  of  indifference,  for 
if  this  be  fixed  in  the  early  part  of  the  day  the  injurious  effects 
of  defecation  will  continue  to  be  felt,  or  even  become  aggravated 
by  the  erect  position  and  exercise  during  the  remainder  of  the 
day.  If,  on  the  contrary,  this  act  be  performed  at  night,  or  just 
before  retiring  to  bed,  the  horizontal  position  will  favor  the  sub- 
sidence of  the  congestion,  and  the  restoration  of  the  parts  to 
their  normal  condition.  Without  a  due  observance  of  these 
little  matters  of  detail,  especially  in  cases  attended  with  a  dispo- 
sition to  protrusion,  all  your  other  directions  will  often  fail  to 
give  relief.  Again,  the  patient  should  use  cold  water  ablutions 
on  rising  from  bed,  and  on  retiring  at  night;  and  if  the  case 
be  troublesome,  this  should  also  be  done  at  noon,  especially 
during  the  summer. 

You  will  sometimes  be  consulted  for  cases  of  long  standing, 
in  which  the  protrusion  of  hemorrhoidal  tumors  or  of  folds  of 
the  intestine  will  have  become  almost  habitual,  at  least  when  the 
patient  is  in  the  erect  position.  In  these  cases,  if  the  patient  is 
compelled  to  attend  to  his  business,  it  may  become  necessary  to 
resort  to  mechanical  means  of  support.  The  patient  should 
wear  during  the  day,  and  sometimes  even  during  the  night,  an 
anal  supporter,  which  may  be  made  as  follows  :— Let  a  belt  be 
carried  around  the  body  so  as  to  rest  upon  the  hips,  and  buckle 
in  front ;  attach  to  the  back  part  of  this,  a  strap,  which  is  to  pass 
down  to  the  perineum  and  here  bifurcate,  so  that  one  end  will 
pass  on  each  side  of  the  scrotum,  and  be  buckled  to  the  belt  in 
front.  To  that  portion  of  the  perineal  strap  which  corresponds 
to  the  anus,  the  anal  supporter  should  be  fixed.  This  may  con- 
sist of  a  ball  of  cotton  thread  about  an  inch  and  a  half  in  diame- 
ter, and  covered  with  oiled  silk  for  the  purpose  of  cleanliness ; 
or  it  may  be  made  of  wood,  well  polished,  and  of  the  shape  of  a 
half  globe,  the  convexity  being  towards  the  anus.  This  maybe 
oiled  and  easily  kept  clean.  By  applying  this  bandage  with 
sufficient  firmness,  the  patient  may  attend  to  his  business  with 
very  little  inconvenience,  until  the  means  above  recommended 
shall  have  had  time  to  improve  the  condition  of  the  parts. 

You  perceive,  Gentlemen,  that  I  have  thus  far  recommended 


1858.]         Felder,  on  the  Uses  of  Chlorate  of  Potash.  227 

no  surgical  operation  in  the  management  of  these  affections ; 
but  you  will  recollect  that  I  have  repeatedly  endeavored  to  in- 
culcate the  doctrine  that  the  duty  of  the  surgeon  is  not  so  much 
to  perform  operations  as  it  is  to  avoid  their  necessity.  And  yet 
there  are  several  surgical  procedures  recommended  in  the  differ- 
ent stages  of  this  affection.  For  instance,  it  is  advised  by  some 
to  lay  open,  to  excise,  or  to  ligate  the  hemorrhoidal  tumors.  I 
have  never  had  occasion  to  resort  to  either  of  these  expedients, 
except  in  those  cases  in  which  small  indurated  teats  continue  to 
fret  the  patient.  I  then  clip  them  off  with  a  pair  of  scissors. 
The  use  of  ligatures  is  unjustifiable  in  any  event,  as  being  more 
painful  and  hazardous  than  cutting  instruments.  You  will  find 
it  recommended  by  high  authorities  to  excise  the  protruding 
portion  of  the  mucous  membrane,  or  to  apply  to  these,  concen- 
trated nitric  acid,  and  even  to  destroy  them  with  the  actual 
cautery.  "While  these  practices  may  perhaps  be  justifiable  in 
hospital  practice,  where  the  hygienic  observances  I  have  advised 
cannot  be  enforced,  I  have  never  been  compelled  to  have  re- 
course to  them,  nor  do  I  think  it  probable  that  you1  will  be  less 
fortunate,  if  you  should  think  proper  to  adopt  my  views. 


ARTICLE    X. 


Remarks  on  the  4Uses  of  Chlorate  of  Potash.     By  W.  L.  Feeder, 
M.  D.,  of  Augusta.  Ga. 

[We  are  much  pleased  to  find  that  the  casual  reference  to  our 
friend's  name,  in  connection  with  the  above  subject,  in  our  last 
number,  has  resulted  in  so  valuable  a  report  of  his  personal  ex- 
perience in  the  therapeutical  applications  of  Chlorate  of  Potash. 
We  may  really  feel  encouraged  to  try  the  same  device  on  some 
other  occasion. — Edts.] 

Messrs.  Editors — In  your  issue  of  the  March  number  of  the 
Southern  Medical  and  Surgical  Journal,  I  find  my  name  men- 
tioned in  connection  with  an  article,  or  a  few  remarks  of  yours, 
upon  the  subject  and  use  of  the  Chlorate  of  Potash.  I  do  not 
complain  of  your  having  done  so,  but  if  I  had  known  of 
your  intentions,  or  had  thought  for  a  moment  that  you  were 


228  Felder,  on  the  Uses  of  Chlorate  of  Potash.       [April, 

acquainted  with  the  fact  of  my  having  long  since  used  the 
medicine,  I  would  certainly  have  given  you  all  the  information 
in  my  power  upon  the  subject  of  its  use,  and  my  experience 
with  the  remedy,  and  thus  have  saved  the  necessity  of  intruding 
myself  upon  your  notice,  or  of  appearing  upon  the  pages  of  your 
Journal.  In  as  much,  however,  as  you  have  thought  proper 
(from  some  source  of  information,  which  I  can  readily  imagine) 
to  advert  to  my  use  of  the  article  in  a  limited  and  imperfect 
manner,  I  would  beg  leave  to  exercise  the  privilege  of  being 
correctly  reported,  as  to  the  quantity  used  and  the  diseases  for 
which  I  have  administered  it. 

Chlorate  of  Potash  has  long  since  been  a  favorite  remedy  with 
me  in  the  treatment  of  almost  every  form  of  fever,  and  especial- 
ly in  those  periodical  fevers  denominated  remittent,  or,  as  they 
are  called  in  some  places,  "  Country  fevers"  or  "  Santee  fevers." 

My  attention  was  drawn  to  the  remedy,  specially,  in  August, 
I  think,  eighteen  hundred  and  thirty- two,  in  the  Case  of  a  youth, 
then,  by  the  name  of  Gr*****  L***,  who  was  under  treatment  for 
remittent  fever  by  Dr.  H.  I  was  requested  to  visit  the  patient 
with  the  attending  physician.  I  thought  that  the  Chlorate  of  Pot- 
ash would  admirably  suit  the  case,  and  fill  all  the  purposes  then 
indicated ;  accordingly,  I  gave  it  in  the  following  manner : — 
R .  Chlorate  of  Potash,  2  drachms ;  Infusion  of  Serpen taria  Yir- 
giniana,  8  ounces.  Of  this,  a  tablespoonful  was  given  every  two 
or  three  hours,  until  its  discontinuance  should  be  ordered.  It 
had  a  "fine  effect,  and  in  three  or  four  days  he  was  in  a  situation 
to  take  quinine  and  brandy  also,  and  he  speedily  recovered.  I 
have  used  it  also  in  typhoid  fevers,  (symptomatic,  for  I  do  not 
believe  in  the  idiopathic  forms  of  typhoid,)  with  the  finest  re- 
sults, and  believe  that  under  some  circumstances,  it  constitutes  in 
the  list  of  remedial  agents  one  of  the  very  best  remedies,  and 
exerts  an  influence  in  low  forms  of  fever  that  no  other  remedy 
possesses. 

In  these  low  forms  of  fever  it  is  used  as  recommended  above, 
although  I  find  it  necessary  sometimes  to  combine  with  it  a  little 
tinct.  opii.  acetat.  The  dose  for  an  adult  is  a  tablespoonful  eve- 
ry two  or  three  hours:  less  to  younger  persons — about  the 
quantity  you  represent  in  your  article  at  my  hands. 

I  have  used  the  remedy  repeatedly  in  Scarlet  fever,  and  espe- 


1858.]         Felder:  on  the  Uses  of  Chlorate  of  Potash.  229 

cially  in  the  malignant  forms,  both  internally  and  as  a  gargle  for 
the  ulcers  about  the  mouth  and  throat  I  consider  its  use  im- 
portant, however,  in  any  of  the  varieties  of  Scarlet  fever,  and 
when  properly  administered,  will  produce  its  full  share  of  benefit. 
It  is  used  as  above  advised  in  these  affections,  when  taken  in- 
ternally ;  but  when  used  as  a  gargle,  I  make  it  much  stronger, 
and  use  it  with  Sage  tea,  if  convenient,  in  preference  to  the 
Snake-root  tea, — it  is  a  matter  of  very  little  consequence,  how- 
ever, whether  used  with  either — a  little  cold  water  will  answer 
every  purpose  to  dissolve  it.  As  a  cleanser  of  ulcers,  especially 
after  the  use  of  the  Xit.  silver,  it  has  no  superior.  From  three 
to  four  drachms  of  the  potash  with  eight  ounces  of  pure  water, 
or  with  either  of  the  teas,  is  the  usual  strength  in  which  I  have 
used  it.  I  would  not  hesitate,  however,  to  use  it  much  stronger^ 
either  externally  or  internally.  I  have  applied  it  to  indolent 
ulcers  of  the  legs,  and  in  one  instance  to  a  chronic  ulcer  of  long 
standing,  with  much  benefit,  in  the  form  of  powder.  I  have 
likewise  used  it  in  obstinate  cases  of  salivation  from  mercury 
with  decided  benefit,  and  in  one  case,  especially,  that  seemed  to 
baffle  every  other  remedy,  and  threaten  the  life  ef  a  very  inter- 
esting child,  who  had  been  worse  salivated  than  I  ever  saw  one, 
before  or  since ;  it  relieved  and  healed  the  ulcers  kindly,  and  I 
believe  was  the  only  remedy,  out  of  many,  that  saved  her  life. 
The  case,  however,  resulted  in  very  great  deformity,  and  has 
been  a  source  of  great  unhappiness  to  the  individual  who  ad- 
ministered the  calomel.  He  was  unacquainted  with  the  action 
of  mercury  and  "did  not  know  that  it  would  make  the  mouth 
sore,  much  less  produce  sloughing,"  and  thereby  permanently 
entail  miserable  deformity. 

In  the  various  vaginal  irritations  and  ulcerations  of  the  os  and 
cervix  uteri,  it  will  exert  a  very  happy  influence,  and  may  be 
relied  upon,  if  perseveringly  used,  in  counteracting  leucorrhceal 
discharges  produced  from  irritations,  and  very  often  heal  such 
ulcers  promptly. 

In  a  case  of  ulceration  of  the  os  and  cervix,  in  which  I  tried  it 
for  a  very  long  time  in  this  city,  its  effects  were  accompanied 
with  results  highly  flattering,  and  the  patient  seemed  to  be  ra- 
pidly recovering,  until  neglect  of  her  person,  growing  out  of  the 
fact  that  she  was  not  able  to  have  the  care  and  attention  that 


230  Musgrove.     Cases  of  Poisoning.  [April, 

such  cases  require,  and  consequently  the  local  affection  became 
aggravated,  her  constitution  failed,  and  the  case  terminated  in 
death.  I  was  not  in  attendance  at  the  time  of  her  death,  nor 
had  I  been  for  many  months  previously,  consequently  can 
say  nothing  upon  the  subject  of  her  condition  at  the  time  of  her 
death. 

I  have  said  all  that  I  conceive  to  be  prudent  and  proper  in 
an  article  of  this  sort ;  however,  I  could  mention  much  more 
concerning  its  effects  in  that  scorbutic  or  spongy  condition  of 
the  gums,  accompanied  with  hemorrhage,  in  typhoid  fever. 

I  am  now  treating  a  child  with  ulcerous  sore  mouth,  with  this 
salt  of  potash,  and  as  soon  as  I  satisfy  myself  fully  of  its  use  in 
gangrenous  ulcerations  about  the  mouth  as  well  as  the  aph- 
thous conditions  not  only  of  the  mouth,  but  extending  to  the 
pharynx  and  along  the  oesophagus  to  the  stomach  and  bowels, 
I  may  trouble  you  at  some  future  time,  with  a  publication 
setting  forth  my  views  of  the  utility  of  this  salt  in  the  two  last 
mentioned  conditions,  &c. 

By  reference  to  an  article  of  mine  upon  Yellow  fever,  pub- 
lished in  the  Southern  Medical  and  Surgical  Journal,  for  1855, 
October  number,  the  use  of  Chlorate  of  Potash  in  the  treatment 
of  that  disease  will  be  seen. 


(  ARTICLE  XI. 

Poisoning  by  Phytolacca}  Radix  (Poke  Root)— -four  cases.     Re- 
ported by  ~W.  C.  Musgrove,  M.D.,  of  Midville,  Ga. 

Messrs.  Editors, — I  have  been  intending,  for  some  time,  to 
write  an  article  for  the  Journal,  but  want  of  time  has  been  the 
chief  cause  of  delay  in  my  so  doing ;  and,  even  now,  I  shall 
wish  it  considered  a  u  resume"  of  my  practice  for  the  month  of 
January — a  generality  rather  than  a  speciality. 

The  month  of  January  has  been  a  peculiar  one  with  us — 
spring-like — very  wet,  and  but  few  cold  days.  By  reference  to 
my  weather  register,  we  have  had — 

Rain,  Cloudy,  Fair,  Variable, 

7  days.    11  days.    11  days.    2  days. 


1858.]  MrsGROTE.     Cases  of  Poisoning.  231 

The  diseases  usual  to  the  season  have  been  wanting :  it  is  true, 
we  have  had  catarrhs,  but  as  yet  I  have  seen  but  three  cases  of 
pneumonia,  two  of  which  were  typhoid.  The  cases  which  have 
been  under  treatment  for  the  month,  may  be  classified  thus : — 

Apoplexy 1  Chronic  Gastritis 1 

General  Nervous  Irritability 1  Delivery  of  Placenta 2 


Miscarriage  (3  months) 1 

Midwifery 7 

Do.       Twins,  (male  and  female). .  1 

Reducing  Luxation  Humerus 1 

Erysipelas 1 

Typhoid  Fever ...  1 

Pneumonia 3 


Puerperal  Fever 

Dj-srnenorrhoea 

Asthma 

Convulsions 

Congestion  of  the  Brain 

Phytolacca  Radix,  Poisoning  by 3 

Fraeture  Right  Ramus  of  Pubis. 1 


The  detail  of  some  of  these  cases  would  be  not  altogether  un- 
interesting. I  send  you  now,  however,  only  the  case  of  poison- 
ing by  the  Phytolacca^  Radix  (Poke  Root) : 

January  SO.  Visited  four  negro  children,  belonging  to  Mr. 
J.  S.  J.;  found  three  of  them  extended  on  a  blanket  before  the 
fire,  almost  cold  and  pulseless,  narcotized',  the  pupil  contracted ; 
the  muscles  greatly  relaxed,  as  in  a  very  drunken  man ;  the 
breathing  slow,  and  scarcely  any  motion  in  respiration  percept- 
ible. About  1  o'clock,  P.M.,  the  little  negroes  were  taken  with 
vomiting,  which  continued,  at  intervals,  until  I  saw  them,  at  6 
P.M.  They  were  aged  10  years,  8  years,  4  years,  and  16 
months.  The  eldest  was  relieved  by  the  emesis,  and  the  young- 
est was  severely  hypercaihar sized. 

Prescription. — Boiled  milk,  cold,  in  small  quantities ;  as  soon 
as  the  stomach  was  quieted  to  give  a  dose  of  oil  and  turpentine, 
and  stimulate  with  beef-broth  and  brandy.  "  Rubbing  the  cold 
surfaces  with  dry  mustard,  and  if  re-action  was  not  induced,  to 
use  spts.  turpentine,  mustard  cataplasm  for  the  youngest,  and 
carb.  ammonia. 

January  31.  Found  10,  8  and  4,  convalescing  finely,  but 
the  15  months  child  sinking — dying  about  10  A.M. 

The  children  had  been  eating  the  Poke  Root,  mistaking  it 
for  the  Artichoke.  There  was  no  convulsive  action  in  these 
cases. 

[As  the  Poke  Root  is  an  abundant  product  of  our  Southern 
States,  and  the  liability  to  poisoning  by  it  very  great,  we  regard 
Dr.  Musgrove's  brief  report  as  quite  important  to  practitioners 
in  these  regions. — Edts.] 


232  Lecture  on  Influenza.  [April, 


Clinical  Lecture  on  Influenza.  By  W.  T.  Gairdner,  M.  D. 
Physician  to  the  Eoyal  Infirmary,  and  Lecturer  on  Clinical 
Medicine,  Edinburgh. 

I  invite  your  attention  to-day  to  a  subject  of  great  importance, 
and  very  directly  suggested,  not  perhaps  by  any  one  case  now  in 
the  wards,  but  by  a  combination  of  circumstances  which  you 
have  witnessed  during  the  last  fortnight.  It  is  to  the  prevalence 
of  certain  diseases  in  our  hospital  wards,  which,  taken  collective- 
ly, amount  to  the  proof  of  an  epidemic  morbid  tendency ;  that  is' 
to  say,  which  show,  by  the  extent  and  manner  of  their  diffusion, 
the  existence  of  a  morbid  influence  operating  temporarily  upon 
the  population  at  large.  I  cannot,  indeed,  show  you  in  the  wards 
a  single  typical  case  of  this  epidemic  disorder,  as  it  is  seen  so  fre- 
quently outside,  unless  it  be  that  of  the  woman  just  admitted  into 
the  fever  ward.  But,  although  I  cannot  place  before  you  the 
ordinary  forms  of  the  epidemic  (because  these  are  commonly  too 
mild  to  be  admitted  into  hospital,)  I  can  show  you  its  accidents 
and  complications  in  sufficient  number  to  furnish  a  text  for  some 
remarks  on  its  nature  and  prevalence. 

You  may  recollect  that,  at  the  beginning  of  the  month,  we  had 
very  few  acute  cases  of  disease,  though  there  were  many  interest- 
ing chronic  cases,  chiefly  of  abdominal  affections,  and  almost 
all  of  organic  diseases.  The  few  acute  cases  that  we  had  were 
fevers,  and  these  almost  all  of  one  kind,  viz.,  enteric  typhus,  about 
which  I  may  have  more  to  say  at  another  time.  Now,  on  the 
other  hand,  the  wards  are  crowded  with  more  or  less  acute  cases 
of  disease ;  and  most  of  these  diseases  are  of  the  chest.  Let  me 
enumerate  a  few  of  them. 

There  is  the  case  of  the  woman  already  noticed  as  having  been 
admitted  to  the  fever  ward.  She  is  a  healthy -looking  young 
woman,  who  has  been  occupied  as  a  domestic  servant.  She  was 
seized,  a  few  days  ago,  with  shivering,  succeeded  by  headache, 
pains  in  the  limbs,  sickness.  Along  with  these  there  was  a  cer- 
tain amount  of  catarrh,  which  has  now  settled  (not  very  severely 
however)  upon  the  chest.  The  fever  is  now  intense,  and  very 
much  out  of  proportion  to  the  severity  of  the  catarrh.  Headache 
persists,  the  skin  is  hot,  the  tongue  loaded,  the  color  dingy,  and 
the  general  aspect  of  the  patient  certainly  goes  far  to  justify  her 
being  sent  to  a  fever  ward.  Nevertheless,  I  believe  it  will  turn 
out  not  to  be  a  case  of  fever,  in  the  ordinary  acceptation  of  the 
term ;  but  of  the  current  epidemic — which  I  will  take  the  liberty 
of  calling,  if  it  has  not  already  been  called — Influenza. 

Had  this  been  the  first  case  of  influenza  presented  to  my  notice, 
it  might  have  passed  for  one  of  continued  fever  or  typhus.  But 
even  then  I  should  have  remarked  its  singularly  abrupt  invasion, 


1858.]  Lecture  on  Influenza.  233 

the  great  amount  of  prostration  in  this  early  stage,  the  extreme 
severity  of  the  headache  and  articular  pains,  as  being  rather  out 
of  character  in  any  fever  to  which  we  have  lately  been  accustom- 
ed. Knowing  what  I  do  of  other  cases,  I  have  no  doubt  these 
symptoms  are  owing  to  influenza.  The  only  question  is.  whether 
this  woman  may  have  influenza  and  fever  combined.  This  ques- 
tion must  remain  open  for  the  present. 

Now,  by  considering  this  case  of  catarrhal  fever,  or  of  feverish 
cold  (if  you  like  to  call  it  so,)  in  relation  with  the  other  facts  to 
which  I  shall  allude  presently,  you  will  draw  for  yourselves  the 
picture  of  the  epidemic,  as  we  have  it. 

The  first  indication  we  had  of  anything  out  of  the  usual  course 
was,  perhaps,  that  downward  tendency  of  several  of  our  cases  of 
phthisis,  which,  you  will  recollect,  I  remarked  to  you  more  than  a 
fortnight  ago.  It  does  not  always  happen  that  cases  of  phthisis 
are  the  first  to  show  a  tendency  to  influenza,  and  in  this  instance, 
it  may  have  been  a  coincidence ;  but  it  is  a  curious  coincidence, 
that,  when  we  had  picked  out  four  cases  of  phthisis  as  fit  subjects 
for  trying  the  new  remedies — the  hypophosphites  of  lime  and 
soda — and  had  noted  them  carefully  for  that  object,  three  out  of 
the  four  should  have  been  seized  with  acute  symptoms,  within  a 
short  period  of  our  commencing  the  novel  treatment.  I  told  you 
at  the  time,  that  I  had  no  reason  to  blame  the  remedy  for  this 
result,  and  that  it  was  probably  a  mere  coincidence ;  I  am  now 
disposed  to  believe  that  it  was  one  of  the  first  manifestations  of 
the  morbid  influence  of  which  we  have  since  seen  so  much. 

[Two  of  these  patients  have  since  died  ;  one  went  out  relieved  ; 
another  survives,  considerably  enfeebled,  but  without  acute  symp- 
toms.] 

On  the  11th  ol  November,  we  saw  together  a  casein  the 
female  general  ward,  of  very  old-standing  chest  disease,  apparently 
emphysema  of  the  lungs,  in  which  acute  symptoms  had  super- 
vened, and  the  patient  appared  to  be  in  extreme  danger  from  res- 
piratory oppression,  with  feverishness  and  bronchitis.  Under  a 
very  simple  treatment,  this  woman  is  now  improving;  but  her 
case  is,  no  doubt,  one  of  the  epidemic  in  a  debilitated  subject. 

Shortly  before  this  case  was  admitted,  a  bov  was  brought  to 
the  waiting-room  screaming  with  pain,  which  he  referred  to  his 
left  side.  He  was  also  very  feverish.  He  had  not  much  catarrh, 
but  auscultation  left  us  in  no  doubt  that  there  was  a  degree  of  dry 
pleurisy  on  the  left  side,  and  also  a  friction  sound,  not  so  well 
marked,  over  the  pericardium.  Under  moderate  leeching  and 
opiates,  he  was  soon  convalescent;  but  the  respiratory  friction 
sound  continued  loud  and  characteristic,  and  we  have  detained 
him  in  the  ward  mainly  for  your  benefit.  I  had  some  doubts,  at 
first,  whether  this  boy  had  not  suffered  perforation  of  the  lung ; 
but  it  was  not  so.  I  do  not  say  it  was  a  well-marked  case  of  in- 
fluenza, but  I  mention  it  by  the  way. 


234  Lecture  on  Influenza.  [April, 

The  next  case  was  that  of  a  boy  from  the  Industrial  School, 
who  had  gone  through  a  distinct  attack  of  feverish  catarrh  before 
we  saw  him.  The  traces  remained  in  the  form  of  bronchitis  of  the 
smaller  tubes,  or  rather,  I  suspect,  a  tubercular  condition  of  the 
lung,  with  bronchitic  signs.  This  boy  has  probably  had  an  un- 
sound chest  for  some  time.  He  is  better,  however;  indeed  nearly 
well. 

About  this  time,  I  thought  it  right  to  pay  a  visit  to  the  Indus- 
trial School,  as  I  had  seen  several  cases  of  feverish  disorders  from 
thence,  which  the  head-master  sent  up  for  my  inspection.  I 
found  thirteen  or  fourteen  boys  smartly  ill  with  cold  of  the  head 
or  chest,  and  several  of  them  plainly  very  feverish.  Coughs  re- 
sounded on  every  side ;  and  squill  mixture,  with  paregoric  and 
ipecacuanha,  were  greatly  in  demand.  None  of  the  cases  were, 
however,  dangerous. 

On  November  14th,  I  directed  your  attention  to  a  very  acute 
case  of  bronchitis,  or  broncho-pneumonia,  admitted  two  days  be- 
fore. The  fever  was  very  intense  on  admission,  but  had  quite 
subsided,  before  you  saw  the  patient,  under  the  treatment  by  con- 
siderable doses  of  tartar  emetic,  employed  by  Dr.  Yellowlees  from 
the  commencement.  The  patient,  a  young  girl  of  seemingly  sound 
constitution,  recovered  rapidly — the  large  doses  of  tartar  emetic 
being  replaced  by  a  simple  cough  mixture,  with  small  doses  of 
antimonial  wine,  after  the  lapse  of  about  48  hours;  as  soon,  indeed, 
as  the  fever  shows  signs  of  retreating.  No  other  medicine  was 
required  in  this  case. 

Very  different  was  the  result  of  treatment,  or  rather  of  the 
neglect  of  treatment,  in  another  case  in  the  same  ward.  A  young 
woman,  the  mother  of  a  family,  was  seized  with  acute  bronchitis, 
and  lay  many  days  neglected.  She  was  then  seen  by  Dr.  Watson, 
who  after  blistering  the  chest  and  administering  some  internal 
remedies,  sent  her  into  the  hospital.  In  this  case,  seen  by  us 
only  at  an  advanced  stage,  the  fever  had  assumed  a  hectic  char- 
acter. Occasional  flushes  overspread  the  face ;  there  was  marked 
dyspnoea  and  lividity ;  sweating  was  very  severe  every  night, 
and  sometimes  in  the  day ;  and  prostration  very  considerable. 
She  has  since  had  acidulous  drinks,  antispasmodics  and  opiates, 
and  is  better;  but  her  convalescence  is  very  slow,  fever  is  not 
subdued,  and  I  greatly  fear  that  the  seeds  of  tubercular  disease 
have  been  laid  in  this  case.  She  flushes  whenever  she  is  spoken 
to,  and  is  very  nervous.  [This  patient  was  lately  dismissed,  as 
she  felt  it  necessary  to  go  home  to  her  family ;  but  she  is  very 
unfit  for  household  duties,  and  will  probably  be  so  for  some  time.] 

Two  other  cases  of  chronic  catarrh,  with  acute  exacerbation, 
were  admitted  into  the  male  ward,  and  were  seen  by  you  on 
November  18th.  Both  of  these  were  street-porters,  and  men 
above  60  years  of  age — by  no  means  temperate  in  their  habits. 
I  will  not,  however,  dwell  upon  them. 


1858.]  Lecture  on  Influenza.  235 

The  same  day,  November  18th,  brought  under  your  notice,  for 
the  first  time,  two  extremely  interesting  cases  of  acute  disease, 
having  the  imprint  of  the  epidemic  tendency. 

One  of  these  was  a  case  of  acute  pneumonia,  or  pleuro-pneu- 
monia,  in  a  previously  healthy  man  of  28  years  of  age.  The  dis- 
ease had  run  a  course  of  many  days  previous  to  admission,  having 
begun  in  symptoms  altogether  like  simple  influenza,  succeeded, 
at  the  end  of  a  week,  by  pain  in  the  right  side  of  the  chest  and 
difficulty  of  breathing,  with  shivering  fits.  We  found  the  whole 
lower  lobe  on  the  right  side  more  or  less  consolidated,  the  sputum 
rusty,  and  the  fever  considerable.  The  night  of  admission,  before 
treatment  had  been  well  begun,  pain  occurred  on  the  opposite 
(left)  side,  at  the  lower  part ;  and  this  aggravation  was  attended 
with  a  pulse  of  nearly  140  in  the  minute,  at  one  period,  and  with 
respirations  between  50  and  60  in  the  minute.  So  soon,  however, 
as  the  tartar  emetic  began  to  take  effect,  these  symptoms  subsi- 
ded ;  and  next  day  we  noticed  the  pulse  at  78,  and  the  respira- 
tions at  32,  the  skin  cool  and  moist,  and  the  general  state  quite 
satisfactory ;  though  a  certain  amount  of  dull  percussion,  with 
some  consonating  rale,  existed  at  the  lower  part  of  the  left  lung, 
and  the  physical  signs  on  the  right  side  were  unchanged.  In 
another  day,  the  line  of  dull  percussion  in  the  right  lateral  region 
was  lower  by  an  inch  and  three  quarters,  and  from  this  period 
the  convalescence  may  be  said  to  have  begun.  The  operation 
of  the  grain-doses  of  tartar  emetic  here  was  most  prompt  and  sat- 
isfactory ;  and  as  the  fever  and  dyspnoea  have  entirely  subsided, 
the  pulse  being  72  and  the  respirations  26  in  the  minute,  I  am  of 
opinion  that  we  may  now  suspend  the  remedy,  and  leave  the  cure 
to  be  completed  by  nature.  [The  convalescence  was  uninterrupt- 
ed.    The  patient  left  on  2d  December,  perfectly  well] 

The  other  case  which  we  saw  for  the  first  time  on  the  18th, 
was  that  of  a  woman  in  the  fever  ward.  This  patient,  a  domes- 
tic servant,  aged  28,  of  rather  corpulent  habit,  always  enjoyed 
good  health  till  a  fortnight  ago.  At  that  time  she  was  seized 
with  pains  in  the  head,  back,  and  limbs,  with  a  feeling  of  lassitude 
and  exhaustion,  which  confined  her  to  bed  for  three  or  four  days  ; 
but  at  the  end  of  that  time  she  was  somewhat  better,  and  tried  to 
resume  her  ordinary  work — to  very  little  purpose,  as  in  a  day  or 
two  more  she  took  to  bed  again,  and  has  been  feverish  ever  since. 

I  believe  that  this  case  is  one  of  enteric  typhus,  or  typhoid 
fever  as  it  is  often  called.  I  make  this  diagnosis,  however,  chief- 
ly on  the  ground  that  certain  rose-colored  spots,  which  you  saw 
me  mark  on  the  skin  yesterday,  bear  a  strong  resemblance  to  the 
characteristic  eruption  of  that  fever.  Should  these  spots  contin- 
ue to  appear,  we  shall  feel  sure  of  our  diagnosis ;  although  there 
is  at  present  not  a  trace  of  abdominal  complication,  and  all  the 
more  prominent  symptoms  are  thoracic,  so  that  there  is  little  doubt 
10* 


236  Lecture  on  Influenza.  [April, 

the  epidemic  tendency  is  showing  itself  strongly  in  this  woman. 
There  are,  in  fact,  the  following  very  formidable  symptoms  : — 
great  acceleration  of  the  respiration ;  dingy  lividity  of  counten- 
ance, with  flushed  cheeks ;  small  and  very  frequent  pulse ;  con- 
siderable pain  in  the  chest,  not  localized ;  some  delirium ;  and  I 
have  little  doubt  that  some  peculiar  form  of  broncho-pneumonia 
is  present,  as  there  is  a  scanty  sputum,  deeply  tinged  with  purple 
blood,  and  we  find,  on  examination,  limited  dullness  on  percussion, 
together  with  consonating  respiration  and  rale  in  both  backs,  at 
the  lower  part  of  the  lungs.  It  is  easy  to  see  in  this  case  enteric 
fever,  complicated  writh  influenza,  and  with  very  serious,  though 
ill-defined,  acute  diseases  of  the  lungs — a  very  ominous  conjunc- 
tion, and  all  the  more  so  as  the  debility  of  the  patient  forbids  the 
employment  of  active  remedies,  and  we  must  confine  the  treat- 
ment to  regulated  stimulation.  I  must  say,  that  the  state  of  this 
woman  appears  to  me  perilous  in  the  extreme. 

[The  sequel  of  this  case  justified  our  fears.  On  the  21st  she 
was  visited,  on  account  of  my  unavoidable  absence  from  town,  by 
Dr.  W.  Begbie,  who  marked  out  additional  rose-spots,  thus  re- 
moving all  doubts  as  to  the  diagnosis.  The  chest  symptoms, 
however,  still  predominated  ;  there  had  only  been  one  stool,  and 
that  a  natural  one,  since  admission  ;  and  there  was  no  pain  or 
tenderness  of  the  abdomen  to  any  appreciable  extent.  On  the 
night  of  the  21st  a  very  loose  stool  was  passed  containing  blood. 
Another  followed  next  day,  and  another  the  succeeding  night, 
the  blood  being  in  large  quantity,  notwithstanding  the  application 
of  ice  to  the  abdomen,  and  the  administration  of  acetate  of  lead, 
writh  opium,  internally.  On  the  23d,  at  visit,  she  was  manifestly 
sinking.  She  had  been  very  restless  and  delirious,  and  had  three 
other  stools,  largely  composed  of  blood.  The  tongue  was  dry 
and  brown,  and  the  pulse  almost  imperceptible.  There  was  no 
additional  embarrassment  of  breathing,  and  I  did  not  examine 
the  back ;  but  over  the  right  front  there  was  marked  dulness  on 
percussion,  with  feeble  tubular  respiration  and  consonating  rale. 
She  died  on  the  morning  of  the  24th. 

Post-mortem  examination  showed  numerous  enlarged  and  con- 
gested patches  of  Peyer  in  the  ileum,  in  a  state  of  ulceration  and 
sloughing;  with  enlarged,  congested  and  softened  mesenteric 
glands.  The  lungs  were  in  an  extremely  curious  and  almost  in- 
describable condition  ;  the  right  lung  almost  entirely  devoid  of 
air,  flaccid,  evidently  collapsed,  but  showing  throughout,  on  sec- 
tion, much  congestion,  and  here  and  there  patches  of  haemorrha- 
gic  condensation  ;  the  bronchi  loaded  with  mucus  deeply  stained 
with  blood.  In  the  left  lung  there  was  a  good  deal  of  collapse  at 
the  base  and  root ;  but  on  the  whole,  not  much  disease.  In 
neither  lung  was  there  anything  like  ordinary  hepatization,  and 
the  pleurae  were  quite  smooth,  and  free  from  exudation.  The  spleen, 
as  usual,  was  large  and  soft. 


1858.]  Lecture  on  Influenza.  237 

It  is  worth  noticing,  that  the  nurse  of  the  ward,  a  most  careful 
and  attentive  person,  was  under  the  impression  that  this  patient 
was  menstruating  two  or  three  days  before  death,  and  that  the 
patient  herself  had  a  similar  impression.  The  examination  of  the 
uterus  and  ovaries  showed  that  this  impression  was  erroneous. 
The  mucous  membrane  was  pale  throughout ;  a  gelatinous  mass 
of  mucus  occupied  the  cervix  uteri,  and  there  was  no  recent  cor- 
pus luteum.  It  is  evident  that  the  stains  of  blood  from  the  bowels 
had  led  to  a  mistake  in  this  particular.] 

The  only  other  case  worth  mentioning  in  illustration  of  the 
epidemic  tendency,  is  that  of  a  little  girl,  admitted  on  the  19th,  as 
she  had  been  several  times  before,  on  account  of  disease  of  the 
heart.  She  has,  I  think,  a  contracted  mitral  orifice ;  and  with 
this  there  is  associated,  at  present,  a  great  deal  of  lividity,  with 
feverishness,  and  marked  prostration  of  strength  ;  the  consequen- 
ces, no  doubt,  of  influenza  acting  upon  organs  predisposed  to  dis- 
ease. I  should  think  badly  of  this  case  if  I  had  not  seen  it  before  ; 
but  this  girl  has  repeatedly  got  over  attacks  considerably  worse 
than  the  present  in  a  very  short  time.  She  had  all  that  elasticity 
of  constitution  which  appears  to  be  the  exclusive  endowment  of 
youth ;  and  she  is  in  every  respect  a  very  good  and  hopeful  little 
patient.     [She  recovered  in  a  few  days.] 

Let  me  now  review  these  facts.  Here,  within  the  space  of  less 
than  a  fortnight,  you  have  seen  admitted  into  our  wards  (with  an 
average  population  under  40)  no  fewer  than  11  cases  of  febrile 
disease,  associated  with  pulmonary  symptoms  of  one  kind  or  other. 
Most  of  these,  no  doubt,  were  complicated  cases,  and  only  one  of 
them  could  be  called  simple  influenza.  But  this  is  because  simple 
influenza  is  usually  too  rapid  and  too  mild  a  disease  to  be  admit- 
ted to  an  hospital.  We  see  here,  not  the  disease,  but  the  conse- 
quences and  complications  of  the  disease. j  In  private  and  in  dis- 
pensary practice  we  see  the  disease  itself. 

[Of  these  11  cases  of  chest  affection, 
1  was  double  pleuro-pneumonia ; 

1  was  pleurisy  and  pericarditis  ; 

2  were  very  acute  bronchitis,  or  broncho-pneumonia,  in  one 

with  a  probable  tubercular  complication ; 
1  was  sub-acute  bronchitis,  certainly  with  tubercular  ante- 
cedents ; 

3  were  sub-acute  bronchitis,  supervening  an  old  emphysema 
of  the  lungs ; 

1  was  sub-acute  bronchitis,  supervening  upon  old  valvular 
disease  of  the  heart ; 

1  was  enteric  typhus,  with  very  acute  pulmonary  complica- 
tion; and 

1  was  influenza,  pure  and  simple.] 
While  we  have  been    watching   these  cases  together,  I  have 


238  Lecture  on  Influenza.  [April, 

seen  many  and  heard  of  many  more,  cases  of  the  simple  and  ordin- 
ary form  of  the  disease.  Not  a  few  of  yourselves  have  had  it, 
and  two  or  three  have  been  seriously  ill.  Most  of  the  cases  that 
I  have  seen,  however,  have  been  remarkable  for  the  sharpness  and 
suddenness  of  the  attack,  and  not  less  so  for  the  rapidity  of  the 
passage  from  a  state  of  feverish  prostration  to  convalescence.  I 
have  found  a  man  with  a  pulse  of  130  at  night  and  next  day  he 
has  been  up  and  about.  This,  of  course,  only  happens  with  sound 
constitutions.  In  one  or  two  instances,  it  has  appeared  to  me 
that  an  emetic,  given  in  time,  has  anticipated  or  cut  short  the 
attack.  Certainly  it  has  been  followed  by  great  relief.  For  the 
rest,  the  bed,  or,  in  mild  cases,  the  sofa,  restricted  diet,  laxatives 
where  required,  and  liberal  doses  of  opium  where  there  is  much 
restlessness  and  exhaustion,  seem  to  me  to  comprise  all  the  neces- 
sary treatment  of  ordinary  cases  of  influenza,  even  when  severe. 
In  the  complicated  cases  no  rule  can  be  laid  down.  Some  are 
very  amenable  to  remedies,  others  run  their  course  in  spite  of 
treatment.  You  have  seen  illustrations  of  both  kinds  in  these 
wards. 

The  most  characteristic  symptoms  of  influenza  are  intense 
feverishness,  usually  with  great  tendency  to  chilliness  or  shiver- 
ing, until  the  patient  takes  to  bed,  and  reaction  is  fairly  establish- 
ed. Then  come  racking  headache,  with  pains  in  the  back  and 
limbs,  which  sometimes  constitute  the  principal  source  of  suffer- 
ing; extreme  sensation  of  debility;  total  prostration  of  appetite, 
with  less  of  thirst  than  is  usual  in  fever  ;  and  with  these,  coryza 
or  mild  catarrh,  bronchitis,  broncho-pneumonia,  as  the  case  may 
be.  But  though  catarrh  is  frequent,  and  may  be  severe,  the 
disease  is  essentially  a  fever,  not  a  catarrh.  Nay,  the  catarrh  may 
be  absent,  or  insignificant ;  not  infrequently  it  is  so.  In  one  of 
the  cases  I  saw  among  yourselves,  there  was  absolutely  no  ca- 
tarrh ;  in  another  it  was  very  slight.  And  I  saw  two  very 
curious  cases  a  few  days  since,  which  enable  me  to  put  this  point 
yet  more  strongly.  The  catarrh  may,  in  fact,  be  absent  in  the 
very  case  in  which  you  would  a  priori,  expect  its  occurrence.  A 
gentleman,  who  has  been  long  afflicted  with  spasmodic  asthma, 
with  intervals,  however,  of  fair  good  health,  and  with  no  appreci- 
able organic  disease  of  the  chest,  came  to  me  after  he  had  been 
struggling  for  several  days  with  debility  and  prostration,  with  chil- 
liness and  feverish  sensations.  These  were  with  him  the  only 
manifestations  of  influenza.  [He  afterward,  at  an  interval  often 
days,  had  a  slight  cold  in  the  head,  without  fever ;  in  the  mean- 
time his  whole  family  sickened  with  feverish  colds,  some  of  them 
with  chest  affection,  from  which  he  himself  remained  exempt 
throughout.]  In  another  case,  a  gentleman,  who  also  suffers 
from  habitual  asthma  and  bronchitis,  and  in  whom  I  suspect  a 
morbidly  enfeebled  heart,  sent  for  me  in  a  great  hurry  on  account 


1858.]  Lecture  on  Influenza.  239 

of  the  alarming  prostration,  produced  by  this  strange  and  inex- 
plicable "influence."  He  was,  however,  more  friqhtened  than 
hurt ;  in  a  couple  of  days  he  was  convalescent,  and  the  amount 
of  bronchitis  in  his  case  never  gave  me  the  slightest  uneasiness. 

Even  the  complications  in  influenza  are  not  always  of  a  catarr- 
hal kind,  nor  even  confined  to  the  chest.  Ten  years  ago,  in  con- 
nection with  a  great  and  general  epidemic  of  influenza,  I  witness- 
ed in  this  hospital  a  succession  of  cases  such  as  I  have  never  seen 
since  that  time.  In  the  course  of  a  few  weeks  there  occurred,  I 
forget  exactly  how  many,  but  upward  of  half  a  dozen  cases  of  in- 
flammation of  all  the  great  serous  membranes  conjointly — double 
pleurisy,  pericarditis, peritonitis.  Most  of  them  were  fatal ;  indeed, 
they  seemed  to  come  into  the  house  only  to  die ;  so  rapid,  so  in- 
controllable  were  the  symptoms,  that  no  time  was  given  for  the 
application  of  remedies,  even  had  remedies  been  clearly  indica- 
ted. 

It  is  somewhat  remarkable,  that  the  great  epidemic  influenza 
of  1847-8  began  at  the  same  time  of  the  year  with  the  present 
one,  almost  to  a  week.  You  will  find  an  account  of  it  in  the 
excellent  monography  of  Dr.  Peacock,  of  London.*  That  epidem- 
ic however,  came  upon  a  population  wasted  by  typhus  and  other 
forms  of  fever,  and  not  yet  recovered  from  the  famine  and  desti- 
tution caused  by  the  blight  of  the  potato,  and  the  high  price  of 
grain  in  1845-6.  Scurvy,  dysentery,  and  fever,  preceded  the 
influenza  on  that  occasion,  and  cholera  followed  not  very  long 
after.  Notwithstanding  the  recent  money-crisis,  and  the  distress 
likely  to  follow  among  certain  classes  of  the  working  population, 
we  may  hope  that  we  are  at  present  more  favorably  situated  than 
we  were  ten  years  ago.  A  short  time  will  show  whether  the 
present  epidemic  is  to  bear  comparison  with  the  last  or  not.  Hith- 
erto it  has  been  of  a  very  mild  character,  comparatively  speaking. 
I  have  myself  seen  only  one  fatal  case — a  man  who  had  been  for 
some  time  in  poor  health,  and  who  died  of  a  chest  complication, 
not  very  unlike  that  of  our  case  of  enteric  fever.  I  do  not  know, 
indeed,  that  this  can  fairly  be  called  a  death  from  influenza,  though 
I  believe  influenza  to  have  been  mixed  up  with  the  fatal  result. 


{From  a  Clinical  Lecture  on  Friday,  November  27th,  1857.) 

Since  I  spoke  to  you  about  influenza  a  week  ago,  there  have 
been  only  two  additions  to  the  list  of  acute  diseases  which  appear 
to  have  had  their  origin  in  it — one  a  case  of  pleuro-pneumonia, 
admitted  only  two  days  ago,  treated  both  before  and  after  admis- 
sion by  calomel  and  opium,  and  already  in  process  of  resolution ; 
the  other  a  case  of  genuine  influenza,  with  all  the  usual  symp- 

*  On  the  Inflnenza,  or  Epidemic  Catarrhal  Feyer,  of  1847-8.     London   1848. 


240  Lecture  on  Influenza.  [April, 

toms,  and  which  like  the  former  one,  was  sent  up  to  the  fever 
ward,  as  lying  under  suspicion.  I  have  directed  her  to  be  put  in 
the  closet,  apart  from  the  other  patients ;  and  we  shall  make  a 
point  of  parting  with  her  as  soon  as  possible.  So  far  as  the 
wards  are  concerned,  the  epidemic  does  not  appear  to  have  made 
rapid  progress  this  week. 

I  have  received  the  Kegistrar-General's  report  of  mortality  in 
London  for  the  week  ending  November  21st.  It  is  worth  while 
to  compare  the  indications  in  this  report  with  those  derived  from 
our  own  observation  as  regards  Edinburgh.  For  this  purpose,  I 
have  drawn  up  a  table  of  those  diseases  whose  mortality  appears 
to  be  notably  above  the  average  of  the  season,  and  have  calcula- 
ted the  existing  mortality  as  against  the  corrected  average  of  ten 
years.  The  correction  I  speak  of  is  made  thus : — The  Registrar's 
table  gives  the  mortality  of  each  disease  during  the  forty-seventh 
week  of  the  present  year,  and  during  the  corresponding  week  of 
ten  previous  years ;  from  these  he  deduces  an  average,  which 
occupies  a  separate  column.  But  before  you  can  use  this  aver- 
age as  against  the  number  of  the  present  year,  you  must  in  every 
case  raise  it  by  one  tenth,  to  make  allowance  for  the  increase  of 
population,  which,  it  is  calculated,  increases  by  one  tenth  in  five 
years. 

Now,  the  past  week  has  in  London  been  one  of  unusual  mor- 
tality for  the  season ;  seeing  that  the  corrected  average  for  ten 
years  makes  the  total  mortality  of  the  forty-seventh  week  of  the 
year  1211 ;  while  during  the  past  week  it  has  been  1382.  This 
very  considerable  extra  mortality  appears  to  be  due  chiefly  to 
bronchitis,  pneumonia,  and  phthisis,  to  which  may  be  added 
whooping  cough.  All  of  these  are  20  or  more  in  excess  of  the 
average  mortality  of  the  season ;  and  bronchitis  is  in  excess  by 
the  very  large  number  of  123,  showing  a  mortality  much  more 
than  double  the  corrected  average  of  the  ten  years.  These  four 
diseases  together  have  a  mortality  188  in  excess  of  the  average  ; 
while  the  entire  excess  of  deaths  for  the  week  is  only  171 ;  the 
difference  being,  of  course,  made  by  diseases  which  are  below  the 
average,  especially  typhus,  scarlatina,  and  smallpox,  which  have 
at  present  a  low  mortality.  The  other  diseases  which,  though  to 
a  smaller  extent,  have  contributed  notably  to  raise  the  mortality 
of  the  past  week  above  the  corrected  average,  are — croup  (with 
which  I  have  included  laryngitis,)  scrofula  (the  disease  of  the 
young,)  and  apoplexy,  with  paralysis,  the  diseases  of  the  aged  ;  to 
which  we  may  add  that  somewhat  vague  condition  called  atrophy 
(mostly  infantile,)  and  that  still  more  vague  cause  of  death  called 
age.  Both  of  these  are  considerably  in  excess ;  and  these  with 
the  other  causes  stated,  go  to  show  that  the  mortality  of  the  past 
week  in  London  has  fallen  heavily  on  the  two  extremes  of  life. 
This  indeed  is  always  the  case  with  influenza. 


1858.] 


Lecture  on  Influenza. 


241 


But  are  we  justified  in  assuming  the  existence  of  influenza  as 
a  cause  of  death  in  these  cases,  especially  when  we  look  to  the 
fact,  that  not  more  than  9  deaths  are  recorded  in  all  London  du- 
ring the  past  week.,  as  having  occurred  from  influenza  ?  I  think 
we  are ;  because  we  may  be  sure  that  an  epidemic  condition 
which  raises  the  whole  mortality  by  one  seventh,  which  more 
than  doubles  the  deaths  from  bronchitis,  and  largely  increases 
those  from  other  acute  diseases  of  the  chest,  while  the  aged  and 
the  young,  the  apoplectic,  paralytic,  and  consumptive,  suffer  out 
of  proportion  to  the  rest  of  the  population — such  an  epidemic  con- 
dition, I  say,  has  essentially  the  characters  attributed  to  influenza, 
bv  whatever  name  it  may  be  called.  The  small  number  of  deaths 
under  the  special  head  of  influenza,  therefore,  is  only  one  proof 
out  of  many  that  the  Registrar-General  need  not  have  been  at  the 
trouble  of  making  a  separate  class  of  what  he  calls  zymotic  or 
epidemic  diseases.  The  epidemic  tendencies  of  a  given  period 
must  be  sought,  not  in  any  particular  class,  but  in  an  intelligent 
consideration  of  the  whole  mortality  list.  Medical  men  are  slow 
to  report  a  death  from  influenza  when  it  can  be  properly  placed 
under  any  other  title.  It  is,  however,  the  fact  (as  1  know  from 
other  sources,)  that  influenza  has  been  unusually  prevalent  in 
London. 

Table  deduced  from  the  Registrar-General's  Returns  (London) 
for  the  week  ending  November  21,  1857  ;  showing  the  rate  of 
mortality  in  the  forty-seventh  week  of  the  year  1S57.  in  regard 
to  those  diseases  which  are  above  the  corrected  average  of  the 
same  week  for  ten  years  : 


Whooping  cough 

Croup  and  Laryngitis. 

Influenza 

Scrofula 

Phthisis 

Apoplexy 

Paralysis , 

Bronchitis 

Pleurisy , 

Pneumonia. 

Atrophy 

Age...'. 

All  Causes , 


Average 
Mortality. 

Actual 
Mortalita. 

Excess 

Excess 
percent. 

33.5 

53 

20 

58 

13.4 

26 

13 

94 

3 

9 

6 

— 

6.5 

13 

7 

— 

137.6 

159 

21 

15 

25.6 

33 

1 

29 

22.7 

31 

8 

36 

103.6 

227 

123 

118 

2.6 

7 

4 

— 

104.2 

127 

23 

22 

30.6 

38 

7 

24 

49.6 

57 

7 

15 

1211.4 

1382 

171 

14 

Additional  Remarks,  Dec.  19th. — The  epidemic  mortality  in 
London  appears  to  have  attained  its  culminating  point,  in  the 
week  ending  December  6.  in  which  the  mortality  from  all  causes 
was  1428;  from  bronchitis  242,  from  pneumonia  129,  and  from 
phthisis  168.  Considered  with  reference  to  the  season,  however, 
this  mortality  is  by  no  means  so  much  in  excess  as  that  indicated 


242  Lecture  on  Influenza.  [April, 

in  the  above  table  ;  and  we  may  therefore  possibly  conclude,  that 
the  epidemic  has  passed  its  maximum  in  London.  The  next  week 
shows  a  considerable  decline.  It  is  worthy  of  remark,  that  all 
the  gentle  hints  and  solicitations  of  the  Registrar-General  in  the 
Weekly  Reports,  have  not  succeeded  in  raising  the  cypher  of  in- 
fluenza above  22.  In  the  year  1847,  the  stated  deaths  from  influ- 
enza for  the  corresponding  week  were  198,  those  from  bronchitis 
343,  from  pneumonia  306,  and  from  all  causes  2454.  The  epi- 
demic of  1847-8  was,  therefore,  immensely  more  fatal  than  the 
present  one,  so  far,  at  least,  as  we  have  hitherto  gone. 

It  appears  from  the  returns  of  the  Registrar-General  (London) 
for  the  quarter  ending  September,  1857,  that  the  mortality  from 
acute  diseases  of  the  chest  was  considearbly  below  the  average 
during  the  past  autumn.  It  began  to  exceed  the  decennial  aver- 
age, however,  in  the  month  of  October ;  and  during  the  latter 
week  of  that  month  and  the  beginning  of  November,  the  increase 
was  considerable,  although  not  such  as  to  give  a  decidedly  epidem- 
ic character  to  the  mortality.  It  was  only  in  the  second  week  of 
November  that  the  total  mortality  began  to  be  decidedly  in  excess 
of  the  decennial  average. 

In  Scotland,  the  Registrar-General's  returns  show  a  very  large 
advance  on  the  mortality  from  pulmonary  diseases  during  the 
month  of  November,  1857,  as  compared  with  the  preceding  month. 
Thus,  in  October,  the  deaths  from  bronchitis  in  the  eight  princi- 
pal towns  of  Scotland  were  only  76,  while  in  November  they  were 
151,  or  almost  exactly  double.  Pneumonia  in  the  same  period  in- 
creased from  53  to  76  ;  while  phthisis  has  only  advanced  from  212 
to  228.  The  increase,  as  regards  brnnchitis,  is  most  marked  in 
Aberdeen,  next  in  Greenock,  next  in  Dundee,  next  in  Glasgow, 
and  next  in  Edinburgh.  Influenza  scarcely  appears  in  the  returns, 
numbering  only  3  in  October,  and  7  in  November. 

The  weather  was,  on  the  whole,  fine  in  November,  and  not 
very  dissimilar  from  that  of  the  preceding  month.  The  barome- 
tric pressure  was  somewhat  higher  than  in  October,  viz.,  30.143 
inches  against  29.817  inches.  The  mean  temperature  was  nearly 
six  degrees  less,  viz.,  45°. 1  against  51°. 0,  The  rainfall  was  some- 
what greater,  and  there  was  somewhat  more  of  easterly  winds. 
It  is  worthy  of  remark,  that  the  mean  developement  of  ozone,  as 
tested  at  Greenock,  was  decidedly  less  in  November  than  in  Octo- 
ber. 

It  would  be  interesting  to  know  to  what  extent  the  inland  dis- 
tricts of  Scotland  have  been  affected  with  influenza,  and  whether 
its  manifestations  have  been  simultaneous  with  those  in  the  cities 
or  not.  From  circumstances  which  have  incidentally  come  to 
my  knowledge,  I  am  inclined  to  believe,  that  in  some  places  in 
the  neighborhood  of  Edinburgh  the  appearance  of  influenza,  in  an 
epidemic  form,  was  considerably  later  than  in  the  city  itself. 

[Edinburgh  Med.  Jour.     Boston  Med.  and  Surg.  Jour. 


1858.]  Report  on  Practical  Medicine.  243 

PRACTICAL   MEDICINE. 

[Professor  Austin  Flint  has  prepared  for  the  North  American 
Medico-Chirurgical  Keview,  the  following  report  of  selections 
from  various  Journals.  The  six  following  papers  are  some  of 
those  which  refer  to  Fevers,  and  we  transfer  them  to  our  pages 
for  the  benefit  of  our  readers. 

No  man  in  this  country  has  contributed  more,  in  the  way  of 
faithful  statistical  observation  to  the  department  of  Fevers,  and 
no  one,  in  our  opinion  is  better  prepared,  than  Dr.  Flint  to  re- 
cord what  is  truly  valuable  on  the  subject,  for  the  consideration 
and  guidance  of  others. 

"  The  purpose  of  this  report,"  says  Dr.  Flint,  "is  to  notice  the 
more  important  of  the  contributions  to  practical  medicine,  con- 
tained in  the  medical  literature  during  the  past  year,"  1857. 

Fever  articles  are  ever  acceptable  to  practitioners  in  a  Fever 
region,  and  we,  therefore,  make  no  further  apology  for  our  se- 
lections below. — Edts.] 

Report  on  Practical  Medicine  for  the  year  1857.  By  Austin  Flint, 
M.  D.,  Professor  of  Clinical  Medicine  and  Medical  Pathology 
in  the  University  of  Buffalo. 

Remitting  Fever  of  Children. — In  a  paper  read  at  a  meeting 
of  the  Society  of  Statistical  Medicine,  in  the  city  of  New  York, 
Dr.  J.  Lewis  Smith  presents  some  considerations  in  reference 
to  the  nature  of  the  disease  denominated  infantile  remitting  fever, 
and  to  the  proper  mode  of  treatment. 

The  most  eminent  European  writers  (Barthez,  Billiet,  and 
West)  describe,  under  this  title,  a  form  of  disease  which  they 
deem  identical  with  the  continued  fever  of  adults.  Drs.  Stewart 
and  Condie,  of  this  country,  authors  of  works  on  the  diseases  of 
children,  which  are  extensively  read,  regard  the  affection  as 
symptomatic  of  intestinal  irritation  or  inflammation.  Dr.  Smith 
has  treated  many  cases  both  in  private  and  dispensary  practice, 
and  has  been  led  to  form  an  opinion  of  the  pathology  of  the  dis- 
ease differing  from  the  views  of  the  writers  just  referred  to.  The 
cases  which  he  has  studied  occurred  in  the  upper  wards  of  the 
city  of  New  York,  which,  as  he  states,  are  in  an  eminently  mala- 
rious situation.  He  regards  the  disease  as  in  a  large  proportion 
of  cases  miasmatic.  He  gives  the  following  facts  in  support  of 
this  opinion : — 

"  1.  The  disease  is  very  prevalent  in  spring  and  autumn,  and 
rare  in  mid-summer  and  mid-winter,  like  malarious  affections. 

K.  8. — VOL.  XIV.   NO.  IV.  1 1 


244  Report  on  Practical  Medicine.  [April, 

There  are  certain  streets  where  I  have  known  it  to  prevail 
almost  like  an  epidemic  in  the  vernal  and  autumnal  months.  If 
the  disease  were,  as  Dr.  Condie  states,  'in  every  instance,  either 
a  gastro-enteritis,  an  ileitis,  or  an  entero-colitis,'  how  can  this 
influence  of  the  seasons  be  explained? 

"  2.  Often,  not  always,  the  remissions  are  more  marked  than 
would  be  likely  to  occur  in  a  symptomatic  fever.  The  child 
may  appear  almost  well  in  the  morning,  but  in  the  afternoon 
and  evening  exhibit  such  intensity  of  symptoms  as  to  cause  the 
greater  anxiety  on  the  part  of  the  friends. 

"3..  The  symptoms  are  not  altogether  such  as  we  should  ex- 
pect to  find  in  a  purely  local  affection.  The  patient  will,  it  is 
true,  when  asked  where  he  feels  the  pain,  sometimes  place  his 
hand  on  the  abdomen,  and  pressure  upon  the  abdominal  parietes 
not  unfrequently  produces  great  distress.  Dr.  Condie  alludes 
to  this  tenderness,  evidently  believing  it  to  be  a  symptom  of 
inflammation.  But  I  have  always  been  satisfied  that  it  was 
neuralgic,  from  the  fact  that  pressure  on  the  lumber  vertebrae, 
and  frequently  on  the  chest  and  limbs,  caused  as  much  suffering 
as  when  it  was  made  on  the  abdominal  walls.  The  patient,  if 
old  enough,  will  complain,  too,  of  aching  in  the  head,  back,  and 
limbs,  which  is  more  the  symptom  of  an  independent  fever  than 
of  inflammation. 

"  Again,  constipation  is  ordinarily  present,  unless  in  the  last 
stages  of  the  disease.  Intestinal  irritation  or  inflammation,  suf- 
ficient to  cause  so  intense  and  protracted  a  fever  as  is  often 
present,  would  be  more  likely  to  cause  diarrhoea. 

"  4.  Children,  even  nursing  infants,  take  intermittent  fever ; 
why,  then,  may  they  not  take  remittent  fever,  from  malaria? 
In  my  class  at  the  dispensary,  children  with  these  diseases  are 
frequently  brought  in  together. 

"5.  I  have  found  that  measures  directed'  to  the  alimentary 
canal,  beyond  simple  purgation,  do  more  harm  than  good.  They 
fail  to  ameliorate  symptoms ;  they  awaken  and  distress  the  child. 
Moreover,  when  remissions  occur,  quinine  will  materially 
abridge  the  disease. 

"  6.  Death  seldom  occurs  from  this  affection.  In  one  or  two 
fatal  cases  which  have  fallen  under  my  observation,  this  result 
followed  convulsions  and  coma;  and  Dr.  Stewart  remarks,  '  Dis- 
sections have  furnished  but  little  light  on  the  morbid  condition 
of  the  system  in  remittent  fever;  for  on  a  fatal  termination,  the 
transmission  to  the  brain  is  the  ordinary  course  of  the  disease.' 
The  mode  of  death,  then,  and  the  post-mortem  appearances,  do 
not  comport  with  the  doctrine  that  the  intestines  are  the  seat  of 
the  morbid  process. 

"Dr.  Condie  does  not  agree  with  Dr.  Stewart,  but  attributes 
death  to  inflammation  of  the  intestines.     I  do  not  think  that  the 


1858.]  Report  on  Practical  Medicine.  245 

remittent  fever  which  I  have  treated,  if  uncomplicated,  ever  ter- 
minates in  this  way,  for  I  have  never  seen  a  case  in  which  ab- 
dominal symptoms  did  not  yield  to  simple  measures. 

"  7.  Continued  fever  of  the  adult  is  of  rare,  and  infantile  re- 
mittent of  frequent  occurrence  in  the  locality  of  my  practice. 
The  latter  is  not  then  identical  with  the  former,  as  it  appears  to 
be  in  London  and  Paris,  from  the  descriptions  given  by  Rilliet, 
Barthez,  and  West. 

"The  above  facts  appear  to  me  conclusive  that  the  form  of 
infantile  remittent  fever,  which  it  has  been  my  lot  to  treat,  has 
been  generally  of  a  miasmatic  character. 

"  It  is  very  important  to  understand  the  nature  of  this  affection, 
as  the  treatment  will  vary  according  to  the  theory  we  adopt.  If 
living  in  a  malarious  region,  we  embrace  the  Broussian  views 
of  the  American  authors  whom  I  have  cited,  and  treat  the  fever 
as  a  local  disease,  we  shall  fail  to  ameliorate  the  symptoms,  and 
be  mortified  and  discouraged  by  the  result,  if  I  may  judge  from 
my  own  experience.  My  reliance  at  present  is  mainly  on  ex- 
pectant measures,  till  remissions  occur,  and  then  on  the  exhibi- 
tion of  quinine.  In  cases  thus  managed,  convalescence  has  been 
more  speedy  and  certain  than  when  opium,  calomel,  and  counter- 
irritation  have  been  employed  to  remove  intestinal  irritation  or 
inflammation. 

"  At  the  risk  of  appearing  presumptuous,  I  have  thus  present- 
ed a  theory  of  infantile  remittent  fever  not,  indeed,  novel, — for 
Taylor  attributes  one  variety  of  it  to  miasm,  but  different  from 
that  contained  in  any  American  and  most  European  treatises  on 
diseases  of  children.  I  am  the  more  anxious  that  the  true  nature 
of  the  disease  should  be  understood,  because  I  believe  that  the 
accepted  doctrine  is  exceedingly  pernicious  to  practitioners  in 
malarious  regions,  and  especially  to  the  younger  members  of  the 
profession  who  rely  more  on  books  than  experience  for  guidance. 
The  fact,  too,  that  remittent  fever  has  been  in  my  practice  the 
most  frequent  affection  of  early  life,  in  the  vernal  and  autumnal 
seasons,  gives  additional  interest  to  the  subject." — [New  York 
Jour,  of  Medicine,  Jan.  1857,  p.  106. 


On  the  Different  Methods  of  Treating  Intermittent  Fever,  with  the 
Results  of  Treatment  in  Sixty-nine  Cases.  By  Austin  W. 
Nichols,  M.  D.,  of  Buffalo. 

The  object  in  this  paper  is  to  study  the  effect  of  treating  cases 
of  intermittent  fever  without  resorting  to  the  preparatory  treat- 
ment by  emetics,  cathartics,  etc.,  which  are  still  deemed  impor- 
tant by  many  practitioners ;  and  also  to  institute  a  comparison 
as  regards  relapses  and  the  duration  of  the  disease,  between  a 


246  Report  on  Practical  Medicine.  [April, 

section  of  country  where  the  disease  prevails  to  a  great  extent 
every  year,  and  a  region  not  malarious. 

Of  the  69  cases,  46  were  treated  in  a  malarious  section,  and 
23  in  a  region  not  malarious. 

Of  the  46  cases  occurring  in  a  malarious  section,  17  were  treat- 
ed at  once  with  quinia,  in  doses  sufficient  to  arrest  speedily  the 
paroxysms,  and  29  received  preparatory  treatment — viz.  ipecac- 
uanha and  calomel,  or  calomel  combined  with  either  rhubarb  or 
jalap.  Relapses  were  observed  in  14  of  the  latter  and  in  4  of 
the  former  cases,  the  ratio  being  as  1  to  4|  in  the  cases  which 
did  not  receive,  and  1  to  2^  in  the  cases  which  received  the 
preparatory  treatment.  The  average  duration  of  the  disease, 
dating  from  the  commencement  of  the  use  of  quinia,  was  found 
to  be  less  in  the  cases  which  did  not  receive  preparatory  treat- 
ment, being  a  fraction  over  six  days;  while  in  the  cases  which 
received  preparatory  treatment,  the  average  duration  was  a  frac- 
tion under  eight  days.  Adding  the  period  occupied  by  the 
preparatory  treatment,  the  r^tio  is  as  6£  to  8£  days. 

Of  the  23  cases  occurring  in  a  region  not  malarious,  all  had 
no  preparatory  treatment.  Of  these  cases,  in  ten,  previous  at- 
tacks had  occurred.  In  the  latter,  the  average  duration  of  the 
disease,  after  treatment  was  commenced,  was  3|  days.  In  ten  of 
the  recent  cases,  the  average  duration  was  2£  days.  Of  the 
latter,  relapses  were  observed  in  two  cases ;  of  the  former  in 
three  cases. 

Comparing  the  results  as  regards  duration  and  relapses  in  the 
cases  occurring  in  the  malarious  section  and  not  receiving  pre- 
paratory treatment,  and  in  the  cases  occurring  in  the  region  not 
malarious,  the  contrast  is  striking :  the  average  duration  in  the 
former  being  6j  days,  and  the  average  of  relapses  1  in  4± ;  in 
the  latter,  2} J  days,  and  the  average  of  relapses  1  in  3|  cases. 
These  results  are  greatly  in  favor  of  the  region  not  malarious. 

The  reporter  analyses  his  collection  of  cases  with  reference  to 
the  types  of  the  disease ;  the  number  of  paroxysms  in  each  type ; 
the  number  of  relapses  and  the  duration  in  each  type.  He  also 
analyses  separately  the  cases  of  tertian  type. 

The  following  summary  embodies  the  practical  conclusions 
which  he  deduces  from  the  results  of  his  analytical  investiga- 
tion : — 

"From  the  foregoing  analysis  it  will  be  seen  that  in  cases  of 
first  attack  the  duration  is  somewhat  less,  and  the  number  of 
cases  relapsing  about  one-half  that  in  cases  having  had  one  or 
more  prior  attacks.  In  a  section  of  country  where  this  fever 
is  prevalent  to  a  great  degree  every  year,  or  in  a  malarious  region, 
the  duration  is  nearly  three  times  that  in  a  country  not  malari- 
ous, and  the  relapsing  cases  occur  as  frequently  even  under  the 
same  plan  of  treatment.     It  will  be  found  that  in  a  malarious 


1858.]  Report  on  Practical  Medicine.  247 

region  the  treatment  of  patients  by  quinia  alone  not  only  dimin- 
ishes the  number  of  paroxysms  and  abridges  the  duration  of  the 
disease,  but  that  fewer  relapsing  cases  occur  than  where  a  pre- 
paratory course  of  treatment  has  been  adopted.  Even  in  the 
analysis  of  40  tertian  cases,  although  the  duration  of  the  number 
of  paroxysms  is  nearly  the  same  under  the  two  different  methods 
of  treatment  employed,  yet  the  cases  of  relapse  are  found  to  be 
nearly  twice  as  numerous  where  the  preparatory  plan  was  adopt- 
ed"—{Buffalo  Med.  Journal  and  Month1  y  Review  of  Medical  and 
Surgical  Science,  January,  p.  460.) 


Treatment  of  Remittent  Fever.     By  Jxo.  Herbert  Clairboxe, 
A.  M.,  M.  D.,  Petersburg,  Virginia. 

The  practice  of  Dr.  Clairbone,  in  cases  of  remittent  fever,  is 
embraced  in  the  following  quotations  from  an  article  entitled 
"  Periodic  vs  Typhoid  Fever." 

"  It  is  in  the  treatment  of  these  cases  the  '  triple  base'  of  Mail- 
lot so  accurately  expresses  the  indications  to  be  fulfilled— r-viz. 
1  To  combat  the  visceral  lesions ;  to  oppose  the  return  of  the 
paroxysms;  to  prevent  the  occurrence  of  relapses.'  To  carry 
out  the  first,  it  may  be  only  necessary,  if  the  patient  be  seen  in 
the  paroxysm,  to  administer  six  or  eight  grains  of  the  mild 
chloride  of  mercury,  with  as  many  of  Dover's  powder,  and  one 
or  two  of  ipecac,  applying  a  dozen  or  two  leeches  to  the  head  or 
stomach,  according  to  the  force  of  the  reaction  and  its  concen- 
tration at  either  point.  The  early  occurrence  of  the  remission 
will  afford  opportunity  to  exhibit  the  anti-periodic,  which  will 
effectually  meet  the  two  latter.  Fifteen  or  twenty  grains  of  the 
sulphate  of  quinine  given  in  one  dose  at  this  time,  or  in  two 
doses  of  a  few  hours'  interval,  will  usually  cut  short  an  attack. 
Indeed,  I  have  seen  it  succeed,  in  summarily  effecting  this  end, 
after  the  disease  had  already  continued  unabated  for  more  than 
a  week,  and  when  a  dry  tongue,  nervous  tremors,  and  incohe- 
rency  of  language  had  apparently  ushered  in  the  typhoid  stage. 
After  two  or  three  days  of  treatment,  if  the  fever  still  continue, 
which  is  sometimes  the  case,  we  have  found  smaller  doses  of 
quinine,  five  or  six  grains,  exhibited  in  the  remission,  to  answer 
a  very  good  effect — gradually  neutralizing  the  poison  of  the 
disease,  and  hastening  convalescence,  without  inducing  any  of 
the  disagreeable  symptoms  of  cinchonism.  We  sometimes  com- 
bine the  quinine  with  calomel,  ipecac,  and  opium,  at  its  first 
administration ;  and  where  there  is  much  visceral  engorgement, 
the  antiperiodic  is  often  thus  more  effectual. 

"Cases  subjected  to  this  treatment  in  their  early  stages  have 
not  generally,  in  our  experience,  { run  into  typhoid  fever.'     Of 


248  Report  on  Practical  Medicine.  [April, 

nineteen  cases,  not  selected,  but  transcribed  from  our  note-book 
of  last  September,  the  average  duration  of  treatment  was  six 
days.  Six  more  days  would  cover  the  average  period  of  con- 
valescence. *  *  *  *  * 

"  When  the  fever  has  persisted  for  one  or  two  weeks,  in  spite 
of  the  treatment  adopted,  and  the  tongue  begins  to  be  dry,  and 
brown,  and  fissured,  and  the  bowels  are  irritable,  we  usually 
recommend,  about  once  in  twenty-four  hours,  four  or  five  grains 
of  Dover's  powder,  with  as  much  of  hyd.  c.  creta,  if  there  should 
be  a  necessity  for  the  latter  in  the  condition  of  the  secretions, 
and  apply  at  the  same  time  a  mild  visicatory  over  the  abdomen. 
We  continue  the  use  of  the  antiperiodic,  however,  exhibiting 
three  grains  of  quinine  or  an  ounce  of  the  infusion  of  cinchona 
and  serpentaria  every  six  hours,  alternating  sometimes  with 
fifteen  or  twenty  drops  of  oil  of  turpentine. 

"  With  regard  to  the  use  of  purgatives.  We  have  found  them 
generally  not  only  unnecessary,  but  positively  prejudicial  at  any 
stage  of  the  disease,  and  evincing,  even  the  mildest  of  them, 
aptness  to  induce  irritation  of  the  bowels." 


Treatment  of  Scarlatina.    By  James  D.  Harper,  M.  D.,  Minden, 
Louisiana. 

After  describing  briefly  the  characters  of  an  epidemic  of  scar- 
latina which  prevailed  in  Minden  in  May,  1856,  Dr.  Harper 
gives  the  following  account  of  his  method  of  treatment,  and  the 
results. 

"Of  the  40  cases  under  my  care  during  the  epidemic,  there 
were  19  of  simplex,  12  of  mild  anginosa,  and  9  aggravated  cases 
of  anginosa,  some  of  which  threatened  to  assume  the  malignant 
form.  In  some  of  the  cases,  seldom  anything  was  employed 
beyond  a  saline  laxative,  repeated  from  time  to  time,  as  circum- 
stances demanded.  When  the  arterial  excitement  was  very  high, 
cold  water  to  the  head  and  throat,  cooling  drinks,  and  gargles  of 
flaxseed  and  vinegar,  constituted  the  treatment  in  a  majority  of 
the  simple  cases ;  in  others,  the  chlorate  of  potash  was  added  to 
the  treatment,  as  recommended  by  Dr.  Watson,  with  the  hap- 
piest effect.  The  twelve  mild  cases  of  anginosa  yielded  pretty 
much  to  the  same  treatment  as  those  of  the  simple  form, — the 
more  lavish  use  of  cold  water,  and  the  occasional  application  of 
nitrate  of  silver  or  sulphate  of  copper,  with  the  probang,  con- 
stituting the  essential  difference  in  the  treatment  of  these  two 
forms  of  scarlatina.  The  troublesome  itching  of  the  skin,  which 
is  apt  to  supervene  upon  the  appearance  of  the  eruption,  can  be 
relieved  to  some  extent  by  sponging  the  surface  with  cold  water, 
which  does  away  with  the  intolerable  heat ;  brans  of  different 


1858.]  Beport  on  Practical  Medicine.  249 

kinds  may  be  rubbed  upon  the  body,  and  thrown  into  the  bed 
of  the  patient,  which  soothes  for  a  time. 

41  The  nine  cases,  alarming  in  their  character,  underwent  in  the 
early  stages,  to  a  certain  extent,  the  same  treatment  as  those  of 
the  mild  form ;  but  as  they  advanced,  the  more  threatening  be- 
come the  symptoms,  such  as  great  difficulty  of  breathing,  from 
glandular  enlargement,  combined  with  a  viscid  and  tenacious 
secretion,  choking  up  the  larynx ;  a  more  frequent  pulse ;  ex- 
treme restlessness  and  jactitation,  doubtless  arising  from  obstruc- 
tion in  the  air-passages,  with  some  disposition  to  diarrhoea,  and 
evident  tendency  to  congestion  of  the  brain ;  in  some,  these 
symptoms  were  recognized  at  an  early  period ;  in  others,  were 
deferred  until  desquamation  had  commenced.  The  head  and 
throat  trouble  was  the  distinguishing  feature  in  these  cases;  pulse 
ranged  from  125  to  180,  with  more  than  usual  heat  about  the 
head,  attended  at  times  also  by  slight  incoherency,  and  nervous 
twitchings  of  the  fingers  and  eyelids.  There  is  but  little  doubt 
that  in  most  of  these  cases  the  excitement  of  the  brain  evidently 
arose  from  the  condition  of  the  throat;  these  symptoms  were, 
however,  promptly  met,  not  by  sponging,  but  by  pouring  cold 
water  out  of  a  pitcher,  or  some  other  convenient  vessel,  upon  the 
head,  giving  the  water  a  fall  of  from  4  to  12  inches  ;  this  was 
continued  from  15  to  40  minutes  at  a  time,  or  until  the  pulse 
was  reduced  20  or  30  beats  in  a  minute,  and  the  head  became 
cool.  At  this  crisis,  the  patient  would  more  frequently  than 
otherwise  go  off  in  a  refreshing  sleep,  lasting  half  an  hour,  more 
or  less.  Reaction  manifested  itself  by  the  same  restlessness,  in- 
coherency, and  hurried  respiration,  but  which  would  always  give 
way  to  the  impression  of  the  water,  thereby  placing  the  patient 
in  a  condition  highly  favorable  for  recovery,  other  things  being 
equal.  In  some  of  the  cases  chlorine  was  used  as  a  stimulant 
and  antiseptic  with  good  effect. 

"There  was  a  condition  of  the  throat  which  gave  rise  to  much 
trouble,  even  after  desquamation  had  in  some  instances  almost 
subsided,  and  the  patient  otherwise  convalescing;  it  was  where 
the  ulcer  was  so  low  as  to  be  beyond  the  reach  of  the  probang, 
and  the  little  patient,  not  knowing  the  importance  of  raising  the 
foul  secretions,  swallowed  them,  whereby  the  s}'stem  became 
thoroughly  inoculated  with  the  animal  poison,  generating  that 
condition  of  system  well  known  as  typhoid,  and  in  one  instance 
producing,  as  I  am  well  convinced,  that  characteristic  feature  of 
the  diseased  state  of  the  glands  of  Peyer,  similar  to  that  which 
accompanies  genuine  enteric  fever,  with  a  pulse  from  125  to  180, 
a  tympanitic  abdomen,  and  considerable  excitement  about  the 
brain.  Cases  of  this  character  were  treated  pretty  much  as  those 
of  enteric  fever,  at  the  stage  where  similar  symptoms  were 
present,  with  the  addition  of  cauterizing  the  ulcer  of  the  throat, 


250  Report  on  Practical  Medicine.  [April, 

if  accessible,  which  is  most  certainly  the  source  of  the  mischief. 
A  nourishing  diet  was  given,  also  brandy  or  port  wine,  with  a 
free  use  of  chlorine,  to  rid,  as  much  as  possible,  the  secretions  of 
their  obnoxious  properties.  When  the  respiration  became  em- 
barrassed or  hurried,  from  flatulency,  turpentine  was  adminis- 
tered ;  if  any  threatening  of  brain  disease  appeared,  the  patient 
was  subjected  to  the  cold  water,  and  continued  until  such  symp- 
toms were  allayed. 

"  This  condition  of  things  lasted  from  six  to  ten  days.  The 
motions  from  the  bowels  consisted  mostly  of  secretions  from  the- 
throat,  occasionally  tinged  with  faecal  matter ;  but  so  long  as  the 
throat  remained  in  an  ulcerated  state,  diarrhoea  was  invariably 
present;  it  could  only  be  temporarily  checked,  as  the  source  of 
the  malady  had  to  be  reached  before  any  permanent  benefit 
could  be  realized,  proving  that  the  diseased  throat  and  enteric 
symptoms  bore  the  relation  of  cause  and  effect. 

"The  sequelae  of  '  scarlet  fever'  are  generally  a  source  of  much 
interest  and  uneasiness  to  the  physician.  Indeed,  there  is  no 
one  disease  which  presents  a  longer  catalogue  of  secondary  affec- 
tions than  scarlatina.  Of  the  various  diseases  which  are  likely 
to  follow  scarlet  fever,  dropsy  in  some  form  is,  according  to  my 
observation,  the  most  frequent.  Of  the  various  forms  of  dropsy, 
anasarca  is  probably  the  one  generally  met  with;  it  ordinarily 
makes  its  appearance  from  the  last  stages  of  desquamation  to 
the  third  or  fourth  week  following.  Medical  opinion  is  yet  un- 
settled as  to  the  form  of  scarlatina  most  apt  to  be  succeeded  by 
dropsy.  Of  the  fifty-six  cases  enumerated,  there  were  eight 
cases  of  anasarca,  all  of  which  supervened  upon  mild  cases  of 
scarlet  fever,  not  one  severe  case  of  scarlatina  resulting  in  dropsy 
of  any  kind.  In  the  dropsies  following  this  eruptive  fever  there 
is  an  almost  total  inaction  of  the  kidneys,  an  inertness  which 
seldom  attends  the  disease  originating  from  a  different  cause ; 
it  readily  yields  to  active  hydragogue  cathartics  and  diuretics 
— the  one  to  produce  copious  watery  evacuations  from  the 
bowels,  while  the  other  incites  the  kidneys  to  increased  action. 
An  exclusive  milk  diet  should  be  rigidly  adhered  to  throughout 
the  complaint.  When  the  lower  extremities  are  swollen  to  any 
great  extent,  a  bandage  applied,  beginning  at  the  toes  and  ter- 
minating at  the  knee,  or  high  up  the  thigh,  if  preferred,  has  been 
found  highly  useful  in  reducing  the  effusion.  After  the  effusion 
has  been  in  a  great  measure  removed,  if  the  patient  is  perceived 
to  be  in  an  anaemic  condition,  some  one  of  the  mineral  acids,  or 
ferruginous  preparations,  should  be  immediately  resorted  to. 
A  varied  and  nutritious  diet,  in  this  state  of  the  system,  is  ad- 
missible. 

"  It  is  stated  that  the  dropsies  which  follow  scarlatina  are  some- 
times dependent  upon,  or  associated  with,  that  peculiar  uraemic 


1858.]  Report  on  Practical  Medicine.  251 

state  known  as  'Bright's  Disease;'  if  so,  then  a  case  thus  de- 
pendent on,  or  associated  with  '  Bright's  Disease,'  would  be 
found  more  difficult  of  cure  than  those  which  came  under  my 
notice. 

"Various  speculations  have  been  indulged  in  regard  to  the 
prophylactic  virtues  of  atropa  belladonna  in  scarlatina.  There 
are  few  who  place  implicit  reliance  in  its  preventive  properties ; 
others,  again,  firmly  believe  that  it  has  the  unmistakable  power 
of  modifying,  if  not  preventing,  an  attack ;  while  others,  whose 
statements  are  equally  reliable,  denounce  its  virtue  in  prevent- 
ing or  modifying  the  disease,  and,  in  this  respect,  as  worthy 
only  of  the  source  from  which  it  emanated. 

"  I  gave  belladonna,  during  the  epidemic  of  1856,  to  20  child- 
ren ;  19  of  them  took  it  as  directed,  and  one  irregularly.  Of  the 
20  children,  the  one  only  who  neglected  to  take  the  medicine 
as  directed  had  the  disease ;  most  of  the  19  who  escaped  were 
not  only  exposed  to  the  epidemic  influence,  but  to  direct  conta- 
gion. 

11  With  this  experience,  I  have  ranked  myself  with  that  class 
of  the  profession  who,  without  relying  implicitly  on  the  preven- 
tive powers  of  belladonna,  yet  deem  it  highly  useful  in  modify- 
ing and  arresting,  to  some  extent,  the  dreadful  ravages  of  scar- 
latina."— {New  Orleans  Medical  and  Surgical  Journal,  May,  1857, 
pp.  743—746.)* 


Hospital  Treatment  of  Yellow  Fever  in  New  Orleans.     By  E.  D. 
Powell,  M.  D.,  Brunswick  Co.,  Ya. 

Dr.  Powell  states  that,  having  been  a  resident  of  the  Charity 
Hospital  in  New  Orleans  in  1855,  he  had  an  opportunity  of 
comparing  different  methods  of  treating  yellow  fever,  and  the 
plan  which  appeared  to  him  most  successful  was  the  following : 
A  hot  mustard  foot-bath  was  promptly  employed.  Next,  the 
infusion  of  orange-leaves  given  freely  as  a  drink,  and  continued 
during  the  attack.  As  a  purgative,  castor  oil  combined  with  a 
few  drops  of  laudanum.  This  was  administered  soon  after  the 
admission  of  the  patient.  Ice  applied  to  the  head  to  relieve  cere- 
bral symptoms,  if  the  later  supervened ;  also,  local  blood-letting, 
by  cupping  or  leeching. — (  Virginia  Medical  Journal,  June,  1857, 
p.  470.) 


*  An  interesting  article  by  Dr.  Lutton,  of  Aurora,  Indiana,  on  the  diversity  of 
symptoms  in  scarlatina  maligna  having  already  appeared  in  the  pages  of  this 
journal,  (North  American  Medico-Chirurg.  Review,)  No.  for  Nov.,  p.  912,  is  not 
here  introduced. 


252  Report  on  Practical  Medicine.  [April, 

Epidemic  Fever  characterized  by  mild  Erythematic  Pharyngitis. 

During  the  months  of  January,  February,  and  March,  1857, 
there  prevailed,  in  the  city  of  Buffalo  and  its  vicinity,  a  form  of 
fever  accompanied  by  mild  pharyngitis,  having  a  career  of  from 
three  to  five  days,  and  generally,  if  not  invariably,  ending  in 
convalescence.  In  a  report  made  to  the  Buffalo  Medical  Asso- 
ciation by  the  reviewer,  the  results  of  an  analysis  of  twenty-three 
recorded  cases  coming  under  his  own  observation  were  given, 
and  the  question  of  the  identity  of  the  disease  with  scarlatina, 
discussed.  From  the  results  of  the  analysis,  the  following  de- 
ductions were  drawn  by  the  reporter: — "The  disease  was  an 
epidemic  fever,  characterized  by  mild  erythematic  inflammation 
of  the  fauces  as  a  constant  local  complication.  Its  character  as 
esentially  a  fever  is  established  by  the  febrile  movement  being 
in  so  marked  a  degree  out  of  proportion  to  the  local  affection ; 
in  other  words,  evidently  not  being  symptomatic  of  the  latter, 
and  by  its  running  a  definite  although  a  brief  career.  It  is  a 
fever  of  from  three  to  seven  days'  duration.  Its  epidemic  char- 
acter is  sufficiently  apparent.  It  has  prevailed  more  or  less  ex- 
tensively in  the  city  for  about  two  months,  reaching  its  acme 
gradually,  declining  gradually,  and  at  length  disappearing,  af- 
fecting both  sexes  and  different  ages  without  notable  discrimi- 
nation. As  an  epidemic  fever  its  symptomatic  features  were 
very  uniform.  The  erythematous  affection  of  the  fauces  consti- 
tutes the  only  positive  character,  aside  from  the  brief  duration 
of  the  febrile  career.  The  other  symptoms  uniformly  present 
were  only  those  incident  to  febrile  movement ;  and  the  symp- 
toms observed  in  a  few  cases — viz.  the  convulsions  in  one  case, 
the  retraction  of  the  head  in  one  case,  etc.,  were  only  incidental 
events,  not  intrinsic  elements  of  the  disease.  The  small  patches 
of  white  exudation  observed  in  some  of  the  cases  do  not  suffice 
to  establish  any  relation  of  the  local  affection  to  that  called  diph- 
theritic by  Brettonneau  and  others.  The  occurrence  of  several 
cases  repeatedly  in  the  same  family  does  not  suffice  to  prove 
that  the  disease  was  propagated  by  contagion,  since  this  fact  is 
explicable  on  the  supposition  of  the  patients  being  equally  ex- 
posed to  an  epidemic  influence,  and  there  being  a  marked  dis- 
crepancy in  the  intervals  separating  the  cases  necessarily  occur- 
ring in  the  same  family. 

The  disease  was  considered  as  a  species  of  fever  distinct  from 
scarlatina,  on  the  following  grounds :  1.  The  uniform  absence 
of  the  scarlatinous  eruption  on  the  exterior  surface.  2.  The 
uniform  absence  of  any  connection  with  well-marked  cases  of 
scarlatina,  occurring  either  previously  or  subsequently.  In  no 
instance  was  the  disease  preceded  or  followed  by  scarlatina  in 
the  same  family.     3.  Several  of  the  persons  affected  being  adults 


1853.]  Liability  of  Xegroes  to  Epidemic  Diseases.  253 

and  persons  beyond  middle  life.  4.  Medicine  was  in  no  in- 
stance followed  by  the  sequels  of  scarlatina — viz.  rheumatism, 
serous  inflammation,  and  especially  dropsy.  5.  In  several  in- 
stances the  persons  affected  had  had  scarlatina. 

Professor  Eochester  at  the  same  time  made  a  report  on  the 
same  subject.  Between  January  6th  and  April  4th  he  had  noted 
thirty-seven  cases.  In  many  instances  he  had  been  led  to  ob- 
serve irregular  intimacy  in  the  febrile  movement.  The  subjects 
in  ten  cases  were  of  all  ages  and  conditions.  He  regards  the 
communicability  of  the  disease  as  probable.  If  communicable, 
the  period  of  incubation  is  short,  the  disease  manifesting  itself 
in  some  instances  within  twenty-four  hours  after  exposure.  In 
many  of  his  cases  the  patients  had  had  scarlatina.  Two  children 
who  were  very  ill  with  scarlatina  had  this  form  of  fever  a  month 
after  their  recovery. — (Buffalo  Med.  Journal,  May,  p.  718.) 


Liability  of  Xegroes  to  the  Epidemic  Diseases  of  the  Soutli. 

The  fact  is  so  glaring,  and  so  universally  admitted,  that  I  am 
really  at  a  loss  to  select  evidence  to  show  that  there  is  no  accli- 
mation against  the  endemic  fevers  of  our  rural  districts.  Is  it 
not  the  constant  theme  of  the  population  of  the  South,  how  they 
can  preserve  health  ?  and  do  not  all  prudent  persons,  who  can 
afford  to  do  so,  remove  in  the  summer  to  some  salubrious  local- 
ity, in  the  pine-lands  or  the  mountains  ?  Those  of  the  tenth 
generation  are  just  as  solicitous  on  the  subject  as  those  of  the 
first.  Books  written  at  the  Xorth  talk  much  about  acclimation 
at  the  South ;  but  we  here  never  hear  it  alluded  to  out  of  the 
yellow-fever  cities.  On  the  contrary,  we  know  that  those  who 
live  from  generation  to  generation  in  malarious  districts  become 
thoroughly  poisoned,  and  exhibit  the  thousand  Protean  forms  of 
disease  which  spring  from  this  insidious  poison. 

I  have  been  the  examining  physician  to  several  life-insurance 
companies  for  many  years,  and  one  of  the  questions  now  asked 
in  many  of  the  policies  is,  uIs  the  party  acclimated?"  If  the 
subject  lives  in  one  of  our  southern  seaports,  where  yellow  fever 
prevails,  and  has  been  born  and  reared  there,  or  has  had  an  at- 
tack of  yellow  fever,  I  answer,  ''  Yes."  If,  on  the  other  hand, 
he  lives  in  the  country,  I  answer,  *'No;"  because  there  is  no  ac- 
climation against  intermittent  and  bilious  fevers,  and  other 
marsh  diseases.  Now,  I  ask  if  there  is  an  experienced  and  ob- 
serving physician  at  the  South  who  will  answer  differently  ?  An 
attack  of  yellow  fever  does  not  protect  against  marsh  fevers,  nor 
vice  versa. 

The  acclimation  of  negroes,  even,  according  to  my  observa- 


264  Substitute  for  Human  Milk.  [April, 

tion,  has  been  put  in  too  strong  a  light.  Being  originally  natives 
of  hot  climates,  they  require  no  acclimation  to  temperature,  are 
less  liable  to  the  more  inflammatory  forms  of  malarial  fevers,  and 
suffer  infinitely  less  than  whites  from  yellow  fever :  they  never, 
however,  as  far  as  my  observation  extends,  become  proof  against 
intermittents  and  their  sequelae.  The  cotton  planters  throughout 
the  South  will  bear  witness,  that,  wherever  the  whites  are  at- 
tacked with  intermittents,  the  blacks  are  also  susceptible,  though 
not  in  so  great  a  degree.  My  observations  apply  to  the  region 
of  country  removed  from  the  rice  country.  We  shall  see,  fur- 
ther on,  that  the  negroes  of  the  rice-field  region  do  undergo  a 
higher  degree  of  acclimation  than  those  of  the  hilly  lands  of  the 
interior.  I  know  many  plantations  in  the  interior  of  Alabama, 
South  Carolina,  Georgia,  Mississippi,  and  Louisiana,  on  which 
negroes  of  the  second  and  third  generation  continue  to  suffer 
from  these  malarial  diseases,  and  where  gangs  of  negroes  do  not 
increase.     (P.  376.) 

And  again :  Certainly,  negroes  do  suffer  greatly  on  many 
cotton  plantations  in  the  middle  belt  of  the  Southern  States ; 
and  I  have  seen  no  evidence  to  prove  that  negroes  can,  in  this 
region,  become  accustomed  to  the  marsh  poison ;  and  my  obser- 
vation has  been  extensive  in  four  States.  A  question  here 
arises :  Is  there  any  difference  in  types  of  those  malarial  fevers 
which  originate  in  the  flat  tide-water  rice-ilands,  and  those  of 
the  clay- hills,  or  marsh  fevers  of  the  interior?  I  am  inclined  to 
think  there  is. — Indigenous  Races,  p.  376;  Art.  "Acclimation," 
etc.  By  J.  C.  Nott,  M.  D.,  of  Mobile,  Ala. — [North  American 
Medico-  Chir.  Review. 


On  a  Substitute  for  Human  Milk.    Bv  William  H  Cummixg 
M.D. 

[The  following,  on  a  most  important  department  of  Hygiene, 
is  from  the  pen  of  one,  in  whom  we  are  gratified  to  recognize 
one  of  the  alumni  of  the  Medical  College  of  Georgia.  Dr.  C. 
has  devoted  much  attention  to  the  subject  of  which  he  treats, 
and  his  views  are  reliable,  for  they  are  the  result  of  the  most 
intelligent  personal  observation  and  diligent  experiment.] 

Artificial  lactation  is  the  subject  of  this  paper.  In  order  to 
prepare  our  minds  for  its  proper  consideration,  it  will  be  well  to 
examine  the  natural  function  in  its  normal  state. 

Lactation  exists  as  a  function  only  among  the  Mammalia. 
These  derive  their  title  as  a  class  from  the  existence  of  the  organs 


1858.]  Substitute  for  Human  Milk.  255 

of  this  function.  "Whether  they  spend  their  lives  in  the  water 
or  on  the  land,  whether  they  swim  or  creep,  or  walk  or  climb, 
or  fly,  they  all  have  milk-producing  organs;  they  all  suckle 
their  young. 

And  yet  there  are  foreshadowings  of  lactation  far  down  the 
scale  of  being.  The  bees  and  wasps  and  ants  prepare  a  supply 
of  food  for  their  young,  and  the  larva  on  his  emergence  from  the 
egg,  finds  this  provision  near  at  hand  and  amply  sufficient  for 
his  wants. 

Many  birds  bring  insects  and  worms  to  their  yet  unfledged 
young.  The  swallow  and  the  wren  are  familiar  examples  of 
this.  Nothing  can  exceed  the  diligence  and  assiduity  with 
which  they  devote  themselves  to  this  important  work  of  artifi- 
cial lactation.  The  pigeon  comes  still  nearer  to  the  mammalia 
in  this  matter,  for  it  supplies  to  its  young  an  abundance  of  part- 
ly digested  food.  The  fact  has  not  escaped  notice,  and  "pigeon- 
milk  "  is  the  name  of  this  article  of  diet. 

The  truth  is,  that  most  animals  leave  the  egg  or  the  womb  in 
a  state  of  development  in  which  they  are  unable  to  obtain  and 
use  the  ordinary  food  of  their  kind.  In  most  cases  their  or- 
gans of  locomotion  do  not  enable  them  to  obtain  this  food.  The 
larva  of  the  bee  cannot  fly,  the  puppy  cannot  walk,  the  monkey 
cannot  climb,  the  beaver  cannot  swim.  Nor  can  they  in  most 
cases  masticate  and  digest  such  food  as  their  parents  use.  The 
teeth  are  ordinarily  still  within  the  gum,  and  do  not  appear  for 
some  time  after  birth.  Most  of  these  animals  therefore  abso- 
lutely require  for  their  sustenance  and  growth  a  peculiar  food 
suited  to  their  actual  condition. 

What  then  is  lactation  ?  It  is  the  secreting  from  their  own  blood, 
in  organs  then,  and  then  only  active,  and  the  furnishing  to  their 
newborn  young,  a  liquid  food  suited  to  the  various  degees  of 
their  development  at  birth,  and  the  continuing  to  furnish  the 
supply,  until  the  young  animal  has  become  able  to  use  the  ordi- 
nary food  of  his  race. 

This  secretion  is  continued  much  longer  in  some  animals  than 
in  others.  The  young  are  not  born  in  the  same  state  of  develop- 
ment. The  young  of  the  Marsupials  leave  the  womb  while  yet 
in  an  embryotic  state.  The  ruminants  stand  at  the  other  ex- 
treme. Between  these  the  other  orders  range  themselves.  In 
order  to  fix  this  fact  in  our  minds,  let  us  compare  those  animals 
with  which  we  are  most  familiar.  Compare  the  rat,  tlie  puppy, 
the  kitten,  with  the  colt,  the  lamb,  the  calf.  Blindness,  weak- 
ness and  deformity  mark  the  former ;  while  the  latter  are  able 
to  see  and  hear  and  walk.  How  soon  do  the  young  ruminants 
follow  their  dams,  skipping  and  running  as  they  go.  The  states 
of  development  at  birth  are  thus  seen  to  vary  greatly. 

The  nature  of  the  future  food  of  the  young  animal  has  an  im- 


256  Substitute  for  Human  Milk.  [April, 

portant  connection  with  the  length  of  lactation.  The  digestion 
of  grass  and  grain  and  roots  requires  more  gastric  energy  than 
that  of  worms  and  insects  and  flesh.  In  conformity  with  this, 
is  the  fact,  that  the  graminivorous  animals  furnish  milk  to  their 
young  until  the  latter  are  very  much  more  developed  than  the 
carnivora  are  when  they  are  weaned. 

We  have  used  the  word  Milk.  What  is  Milk  ?  It  is  a  gen- 
eral term  for  the  various  products  of  the  mammary  glands  of 
different  animals.  It  is  the  name  for  the  food  furnished  by  these 
mothers  to  their  young.  Milk  is  a  white,  obaque,  oily  liquid, 
its  color  is  not  pure  white,  but  verging  on  yellow.  In  some 
animals  it  is  sweet,  containing  notable  quantities  of  sugar.  But 
in  all  it  contains  three  great  constituents — butter,  cheese  and 
water. 

We  have  said  that  milk  is  suited  to  the  wants  of  the  young 
animal.  It  consists  universally  of  two  classes  of  food;  oily 
materials  containing  no  azote,  and  caseous  substances  holding 
in  combination  mineral  salts,  and  admirably  adapted  to  the 
growth  of  the  body. 

It  is  suited  to  the  wants  of  the  young  animal.  What  is  the 
first  want  of  a  new-born  animal  of  this  class?  Warmth.  He 
has  been,  during  the  previous  stages  of  his  existence,  surround- 
ed by  tissues  of  the  temperature  of  100°.  He  is  now  out  in 
the  open  airf  or  in  still  colder  water,  the  heat  of  his  body  rapidly 
radiated  or  conducted  into  these  cooler  media.  This  loss  of  heat 
does  not  lower  his  temperature,  for  there  is  an  internal  supply. 
At  the  moment  of  his  birth,  respiration  commenced,  and  the 
oxygen  of  the  air  combining  with  the  oil  of  his  body,  evolves 
heat  sufficient  to  replace  that  which  is  lost.  But  this  consump- 
tion of  oil  cannot  be  long  continued,  unless  the  supply  be  re- 
newed. The  body  will  be  soon  reduced  to  a  state  of  extreme 
emaciation,  and  death  from  cold  must  follow. 

A  supply  of  oil  is  then  the  first  want  of  the  young  animal. 
The  lamp  of  life  must  be  fed,  or  it  will  speedily  go  out.  The 
milk  contains  oil  in  proper  proportion  for  this  purpose.  This 
oil  is  butter. 

But  not  only  must  the  vital  heat  be  maintained,  the  tissues  of 
the  child  must  grow.  The  materials  for  the  growth  of  the  tissue 
are  supplied  by  the  casein  or  albuminous  portion  of  the  milk. 
The  name  casein  is  applied  to  a  group  of  substances  having  an 
almost  identical  chemical  composition.  Indeed  it  has  until  re- 
cently been  supposed  to  be  identical.  But  it  has  been  ascertain- 
ed by  Quevenne,  that  while  their  organic  composition  seems  the 
same,  they  hold  in  combination  different  proportions  of  mineral 
insoluble  salts.  Thus,  phosphate  of  lime  (the  bone  earth)  exists 
in  different  proportions  in  suspended  casein,  in  dissolved  casein, 
in  albumen,  and  albuminose.     These  four  substances  also  differ 


1858.]  Substitute  for  Human  Milk.  257 

in  the  effects  produced  upon  them  by  different  agents.  Thus, 
while  suspended  casein  is  coagulated  by  a  small  quantity  of  ren- 
net, the  dissolved  casein,  the  albumen,  and  the  albuminose  are 
unaffected  by  it.  Thus,  while  the  albumen  is  coagulated  by 
ebullition  of  the  milk,  the  other  three  constituents  of  the  casein 
are  unaffected.  Xitric  acid  produces  the  same  effect  without 
the  agency  of  heat. 

-In  the  present  state  of  our  knowledge  on  this  subject,  we  can 
only  say  that  these  four  substances,  by  the  action  of  the  gastric 
juice,  seem  to  be  all  converted  into  albuminose,  and  to  be  in  this 
form  absorbed  into  the  system. 

Thus  constituted,  having  both  azotised  andunazotised  elements 
the  milk  is  suited  to  supply  the  wants  of  the  animal,  and  to  pro- 
mote his  growth  and  development. 

These  general  statements  concerning  lactation  are  applicable 
to  the  function  as  existing  in  the  woman.  An  element  which 
is  not  universally  but  very  generally  found  in  milk,  exists  in 
human  milk  in  the  proportion  of  0.075,  we  refer  to  the  sugar. 
Of  the  uses  of  the  sugar  we  are  not  so  well  informed.  There  is 
reason  to  believe  that  it  contributes  principally  to  the  mainte- 
nance of  the  heat  of  the  body. 

AVe  come  now  to  the  subject  of  artificial  lactation.  Some- 
times by  the  death  of  the  mother,  more  frequently  by  her  fail- 
ure to  secrete  enough  milk,  the  child  is  deprived  of  the  needed 
supply.  Something  must  be  done  for  the  famishing  infant.  In 
a  few  cases,  we  may  have  recourse  to  another  woman  for  the 
needed  food.  Few  good  nurses,  however,  can  be  found.  In 
the  cities,  there  are  by  no  means  enough  to  supply  the  demand 
for  human  milk ;  in  the  country,  they  can  scarcely  ever  be  ob- 
tained. In  this  country  we  can  find  no  permanent,  reliable  sup- 
ply of  milk,  except  that  furnished  by  the  cow.  The  question 
is, — Can  artificial  lactation  be  successfully  performed  by  means  of 
the  milk  of  the  cow?  This  is  a  question  of  great  interest  to 
medical  practitioners,  as  well  as  to  parents. 

In  using  cow's  milk  as  a  substitute  for  the  natural  food  of  in- 
fants, great  difficulties  are  found.  These  arise  from  the  differ- 
ence of  composition  of  the  two  kinds  of  milk — thus : 

{Butter,  38.59  C  Butter,  20.76 

Casein,  40.75  While  Hwnan  Milk  is  J  Casein,  14.34 

Sugar,  53.97  composed  af               1  Sugar,  75.02 

Water,  866.69  ^  Water,  889.88 

If  we  so  dilute  cow's  milk  as  to  reduce  the  butter  to  20.76,  we 
shall  have  21.92  of  casein,  or  50  per  cent,  more  than  in  human 
milk.  This  excess  of  casein  leads  to  serious  indigestion,  with 
consequent  gastric  and  intestinal  disorders. 

If,  on  the  other  hand,  we  reduce  by  still  farther  dilution  the 
casein  to  14.34,  we  shall  have  only  13.58  of  butter,  or  less  than 


258  Substitute  for  Human  Milk.  [April, 

two-thirds  of  the  proper  proportion.  This  deficiency  of  butter 
does  not  produce  such  immediate  disturbance  as  we  have  stated 
to  follow  the  excess  of  casein,  but  its  permanent  influence  is 
most  injurious. 

First,  because  there  is  a  deficiency  of  the  material  needed  for 
the  production  of  heat.  If  the  temperature  of  the  body  be 
lowered,  all  the  functions  languish,  and  the  child  is  unable  to 
resist  the  hurtful  influence  of  atmospheric  changes. 

Secondly,  this  deficiency  of  butter  implies  a  corresponding 
deficiency  of  the  phosphureted  oil  (lecithine)  of  the  milk,  the 
proper  and  peculiar  nutriment  of  the  nervous  system,  which  ex- 
ists in  butter  in  the  proportion  of  8  per  cent,  or  one-twelfth.  If 
there  be  a  deficiency  of  one- third  of  the  butter,  there  will  be  of 
necessity,  a  corresponding  deficiency  of  one-third  of  this  phos- 
phureted oil.  As  the  child,  during  the  first  year  of  his  life, 
should  take  from  1,000  to  1,400  lbs.  of  milk  containing  from  20. 
76  to  29.06  lbs.  of  butter,  the  annual  deficiency  of  this  phosphu- 
reted oil  would  be  from  0.5536  to  0.7749  lb.;  that  is,  from  nine 
to  twelve  ounces.  The  natural  consequence  of  this  deficiency  of 
nerve  food  is  failure  of  nervous  energy,  and  imperfect  performance 
of  nerve  functions.  The  various  processes  languish,  and  calori- 
fication, circulation,  absorption,  digestion  and  secretion  all  feel 
the  depression. 

The  proper  remedy  for  these  evils,  is  to  provide  a  milk  much 
richer  in  butter  than  the  ordinary  milk  of  the  cow.  If  we  leave 
a  quantity  of  cow's  milk  at  rest  for  four  or  five  hours,  and  then 
carefully  remove  and  examine  the  upper  third,  we  find  that  it 
contains  about  50  per  cent,  more  butter  than  at  first.  In  round 
numbers,  the  butter  is  to  the  casein  as  57  to  40,  or  as  100  to  70. 
Now  this  is  the  relation  between  these  two  substances  in  human 
milk.  If  we  then  so  dilute  this  new  milk  as  to  reduce  the  casein 
to  14.34  thousandths,  we  shall  have  20.76  thousandths  of  butter. 
This  is  just  what  we  need  (with  the  addition  of  sugar)  as  an 
accurate  imitation  of  human  milk,  and,  therefore,  a  good  substi- 
tute for  it. 

Take,  then,  ordinary  cow's  milk  and  let  it  stand  for  four  or 
five  hours.  For  a  child  three  months  old,  2  \  quarts  will  be 
needed.  Take  the  upper  third,  (l£  pints,)  and  add  to  it  2 \  pints 
of  water;  sweeten  it  with  the  best  sugar,  of  which  2|  ounces 
will  be  required.  It  should  be  made  somewhat  sweeter  to  the 
taste  than  ordinary  cow's  milk. 

A  child  three  month  old  will  take  from  48  to  60  fluid  ounces, 
daily,  in  six  or  seven  doses  of  a  half  pint  each. 

It  should  be  given  from  a  bottle — suction  being  the  only  proper 
mode  of  feeding  for  a  young  child. 

Its  temperature  should  be  from  100°  to  104°.  It  should  be 
warmed  again  if  it  becomes  cool  while  the  child  is  taking  it. 


1853.]  Substitute  for  Human  Milk.  259 

The  child  should  be  early  trained  to  pass  6  or  8  hours  at  night 
without  feeding. 

The  kind  of  bottle,  which  for  cheapness  and  convenience  is 
most  advantageous,  is  a  plain  8  ounce  vial,  of  an  elliptical  form. 
The  artificial  nipple  is  best  made  by  rolling  a  quill  in  soft  mus- 
lin and  forcing  this  into  the  neck  of  the  vial,  leaving  about  three 
fourths  of  an  inch  projecting  from  the  neck.  The  ease  with 
which  the  muslin  may  be  unrolled  and  thoroughly  washed,  gives 
this  arrangement  a  superiority  over  every  other,  especially  in 
warm  weather.     The  quill  also  may  be  readily  cleaned. 

The  child  should  be  fed  at  intervals  of  three  or  three  and  a 
half  hours.     [Regularity  in  this  respect  is  very  advantageous. 

During  the  first  month,  the  child  needs  food  of  different  com- 
position. There  should  be  more  butter  in  proportion  to  the 
casein.  In  order  to  obtain  this  increased  proportion  of  butter, 
let  the  upper  eighth  of  the  milk  be  taken  instead  of  the  upper 
third.  This  milk  contains  from  70  to  80  thousandths  of  butter. 
It  should  be  diluted  with  2.6  parts  of  water. 


For  a 

child  from  3  to  10  days 

old. 

Milk  1000 

Water  2643 

Sugar 

243 

" 

•* 

10  to  30 

<< 

" 

<( 

2500 

(< 

225 

u 

<< 

1  month  old. 

" 

" 

2250 

" 

204 

it 

<t 

2 

K 

" 

1850 

" 

172 

tl 

<« 

3 

it 

tt 

1500 

<« 

144 

<< 

" 

4 

it 

it 

1250 

ti 

124 

It 

tl 

i. 

5 
6 

tl 

a 

1000 
875 

it 

104 
94 

II 

" 

7 

tl 

" 

750 

" 

84 

II 

" 

9 

tt 

it 

675 

f 

78 

If 

n 

11 

tl 

" 

625 

tt 

73 

if 

tt 

14 
18 

it 

tt 
it 

550 
500 

ti 

67 
63 

By  thus  gradually  diminishing  the  proportion  of  water,  we 
furnish  the  child  a  milk  containing  an  ever-increasing  propor- 
tion of  nutritive  matter. 

How  long  should  artificial  lactation  be  continued  ?  The  only 
answer  to  this  is,  "  until  the  child  has  become  able  to  use  ordina- 
ry human  food."  The  child  should  be  fed  with  milk  until  his 
organs  of  mastication  and  his  powers  of  digestion  render  it  best 
for  him  to  have  other  food.  And  at  what  age  does  this  condi- 
tion exist  ?  Children  vary  so  much  in  the  rate  of  their  devel- 
opement,  that  no  answer  can  be  given  applicable  to  all  cases. 
In  a  vigorous  child  the  first  dentition  is  usually  completed  at 
two  years  of  age.  Sometimes  this  appearance  of  the  full  com- 
plement of  teeth  takes  place  six  months  earlier,  and  sometimes 
six  months  later.  Whenever  this  first  dentition  is  completed, 
the  child  has  the  full  masticating  apparatus  of  childhood,  and 
may  receive  other  food  than  milk.  In  many  cases,  lactation 
must  be  continued  until  the  age  of  three  years.  And  it  may  be 
safely  presumed,  that  no  food  will  be  found  so  suitable  for  the 
11* 


260  Substitute  for  Human  Milk.  [April, 

tardily-developed  child  as  that  which  divine  wisdom  has  prepar- 
ed for  the  purpose  of  promoting  this  development.  As  an 
article  of  food  for  adults,  milk  is  of  great  value.  Entire  races 
of  men  rely  upon  it,  and  it  seems,  when  thus  largely  and  per- 
manently used,  to  promote  strength  and  vigor.  For  the  forma- 
tion of  teeth  and  bones,  its  phosphate  of  lime  is  indispensable, 
and  no  other  food  suited  to  a  feeble  child  contains  so  much  in 
intimate  union  with  organic  elements. 

Nothing  has  been  said  of  any  other  mode  of  artificial  lacta- 
tion. This  omission  is  not  accidental.  The  truth  is,  that  milk 
is  the  only  material  that  inspires  or  even  warrants  any  hope  of 
real  success.  But  this  is  not  meant  to  say  that  all  children  reared 
otherwise  die,  but  that  good,  physiologically  good  results  do 
not  follow  the  use  of  any  other  food.  Children  may  survive 
months  of  arrow-root  or  other  farinaceous  food,  but  a  normal, 
healthy,  happy,  vigorous,  steady,  ever-advancing  development 
was  never  yet  attained  in  this  way.  The  human  stomach  has 
no  creative  power.  The  materials  must  be  furnished,  or  the 
building  cannot  rise.  Lecithine  must  be  given,  or  the  nervous 
energy  declines.  Without  phosphate  of  lime,  how  shall  the 
teeth  and  bones  be  made  ? 

If  we  examine  the  constitution  of  the  blood,  we  shall  find 
what  materials  go  to  make  the  human  body.  What  are  these  ? 
Oxygen,  hydrogen,  carbon,  azote,  chlorine,  fluorine,  iodine, 
sulphur,  phosphorus,  silicon,  potassium,  sodium,  calcium,  mag- 
nesium, iron  and  manganes.  Of  these  sixteen  substances,  all 
are  found  in  milk.  And  not  only  so,  but  they  exist  in  the  milk 
in  the  same  combinations  as  in  the  blood.  Not  only  have  we 
chlorine  and  sodium,  but  we  have  chloride  of  sodium ;  not 
merely  phosphorus  and  calcium,  but  phosphate  of  lime  already 
prepared  for  use.  Not  only  have  we  oxygen  and  hydrogen  and 
carbon,  but  we  have  ten  different  oils  already  existing  in  the 
milk.  We  have  four  different  protein  compounds,  each  holding 
in  combination  a  definite  proportion  of  phosphate  of  lime.  Thus, 
and  in  all  probability  thus  only,  can  this  invaluable,  but  inso- 
luble salt  be  introduced  into  the  tissues,  and  give  strength  and 
firmness  to  the  frame.  Why,  then,  with  this  evident  adaptation 
of  milk  to  the  development  of  the  body,  should  we  look  for 
other  articles  of  food?  Among  all  the  substances  now  used, 
none  can  make  any  such  claim.  Indeed,  it  may  be  safely  said, 
that  milk  is  an  article  standing  alone,  prepared  expressly  for 
this  one  purpose,  and  challenging  all  competition. 

If  the  attempt  made  in  this  paper  to  show  that  the  milk  of  the 
cow  may  be  so  modified  as  to  suit  the  peculiar  wants  and  condi- 
tion of  the  infant,  has  been  at  all  successful,  there  is  ground  for 
hope  that  much'suffering  may  be  relieved,  and  many  lives  saved. 
The  subject  is  one  of  great  importance,  and  demands  the  earnest 


1858.]  Empyema  Treated  by  Injections.  261 

consideration  of  the  medical  profession.  To  them  the  eyes  of 
anxious  and  sorrowful  parents  are  turned  for  help ;  if  aid  can 
be  given,  let  it  not  be  withheld. — [American  Med.  Monthly. 


Empyema   Treated  by  Injections.     By  David  PsiNCK,  M.  D.,  of 

Jacksonville,  111. 

[The  following  case  presents  some  analogy  to  the  one  reported 
in  our  last  number,  by  Dr.  Sternes  DeWitt,  of  Baker  county, 
Georgia.  Dr.  DeTTitt  reports  a  definite  and  very  large  quanti- 
ty of  pus.     In  this  case  the  amount  is  not  designated. 

Dr.  De  Witt  treated  his  case  successfully,  by  large  injections  of 
cold  water  into  the  cavity  of  the  pleura,  which  we  would  much 
prefer  to  the  use  of  Iodine  injections,  recommended  in  the  fol- 
lowing report : — Edts.] 

The  perusal  of  Dr.  Brainard's  case  of  cure  of  empyema  of  the 
pleural  cavity  by  injections  of  iodine  (A.  II".  M.  and  S.  Jour,  for 
November),  has  induced  me  to  record  a  case  of  mv  own  in  your 
valuable  Journal. 

Little  Henry  Lurton,  aged  four  years,  the  third  child  of  heal- 
thy parents,  and  of  healthy  constitution  himself,  had  an  attack 
of  pleuritis  of  the  right  side,  and  was  left  entirely  to  the  aid  of 
the  vis  medicatrix  nature?,  under  the  guise  of  infinitesimal  doses 
for  about  six  weeks,  when,  on  the  2Sth  of  J;<nuarv,  1856,  I  was 
called  upon  for  surgical  interference. 

At  this  time  the  enlargement  of  the  right  side  was  very  obvi- 
ous to  the  eye,  and  the  sound  was  dull  on  percussion. 

Frequent  and  quick  pulse  and  daily  fever  and  nightly  sweats 
were  present,  while  the  little  patient  could  breathe  only  in  the 
sitting  posture,  and  his  sleep  was  in  the  rocking  chair. 

A  considerable  quantity  of  pus  was  discharged  through  the 
canula  left  in  the  orifice  made  by  the  trochar,  giving  immediate 
and  inexpressible  relief. 

Feb.  9th. — The  puncture  had  not  been  kept  open,  and  the 
demand  for  a  second  puncture  became  urgent.  The  amount  dis- 
charged was  somewhat  smaller  than  before.  The  opening  was 
from  this  time  prevented  from  closing  by  the  daily  introduction 
of  a  tent,  upon  the  withdrawing  of  which,  a  considerable  quan- 
tity of  ill-conditioned  pus  would  be  discharged. 

As  nature  seemed  not  to  be  making  good  progress  with  the 
case,  it  was  resolved  to  see  if  the  behaviour  of  iodine  would  be 
as  good  here  as  in  other  cavities.  On  the  25th  of  March,  two 
drachms  (  3ij)  of  strong  tincture  of  iodine  were  thrown  in  by  a 


262  On  the  Escharotic  Treatment  of  Cancer.  [April 

small  glass  syringe.  This  was  done  after  the  tent  had  been  with- 
drawn, and  the  pus  collected  during  the  preceding  twenty-four 
hours  had  pretty  well  escaped ;  the  tent  was  again  introduced  as 
usual,  to  be  daily  withdrawn  as  before. 

The  injection  was  repeated  at  intervals  of  about  a  week,  for 
five  times,  when  the  discharge  had  pretty  much  ceased.  The 
respiratory  murmur  could  be  heard  throughout  the  whole  ex- 
tent of  the  lung ;  all  sign  of  disease  has  disappeared,  and  by  the 
middle  of  May  the  boy  was  at  play  with  his  top. — [Chicago  Med. 
Journal. 


On  the  Escharotic  Treatment  of  Cancer.    By  Professor  Syme. 

After  some  sour  comments  upon  Dr.  Fell's  mode  of  treating 
cancer,  and  upon  the  conduct  of  the  surgeons  of  the  Middlesex 
Hospital,  in  allowing  so  irregular  an  experiment  to  take  place 
under  their  auspices,  Mr.  Syme  proceeds  to  state  his  own  opin- 
ion upon  the  escharotic  treatment  of  cancer  and  to  offer  certain 
practical  rules  upon  the  treatment  of  cancer  generally. 

"If,"  he  says,  "caustic  is  ever  used  for  destroying  malignant 
textures,  it  should,  therefore,  be  of  such  power  and  so  employed 
as  to  strike  at  once  to  the  root  of  the  evil,  and  I  am  able  to  sug- 
gest efficient  means  for  this  purpose. 

"Mons.  Yelpeau,  in  speaking  of  the  caustic  made  by  mixing 
sulphuric  acid  with  saffron,  expresses  his  persuasion  that  it  would 
be  the  best  of  all  escharotics  except  for  its  expense  and  the  diffi- 
culty of  confining  its  action  within  certain  limits.  It  occurred 
to  me  that  sawdust  would  supply  the  place  of  saffron,  and  my 
assistants  at  the  hospital  ingeniously  devised  the  following  ef- 
fectual means  of  restraining  the  extent4  of  action.  A  solution 
of  gutta  percha  in  chloroform  is  applied  to  the  skin  for  some 
distance  around  the  part  to  be  attacked ;  then  a  thick  piece  of  the 
same  material,  with  an  aperture  cut  in  it  of  the  requisite  size, 
and  softened  by  exposure  to  heat,  is  pressed  firmly  so  as  to  ad- 
here everywhere  to  the  surface  thus  prepared ;  a  thin  piece  is 
next  glued  round  the  edge  of  the  opening,  so  that,  when  support- 
ed by  a  stuffing  of  lint,  it  may  form  a  wall  enclosing  the  diseased 
part.  Concentrated  sulphuric  acid,  with  about  an  equal  weight 
of  sawdust  stirred  into  it,  until  the  admixture  assumes  a  homo- 
geneoes  consistence  equal  to  that  of  thin  porridge,  is  lastly  ap- 
plied, in  quantity  proportioned  to  the  extent  of  thickness  con- 
cerned. In  the  first  instance,  as  the  pain  is  acute,  opiates  or 
chloroform  may  be  used ;  but  after  a  short  while,  so  little  uneasi- 
ness is  felt  that  the  patient  can  easily  allow  the  caustic  to  remain 
for  ten  or  twelve  hours,  when  it  will  be  found  that  the  whole 
diseased  mass,  though  covered  with  skin  and  several  inches  in 


1858.]  Syrup  of  the  Superphosphate  of  Iron.  263 

depth,  has  been  reduced  to  a  cinder,  presenting  the  appearance 
of  strongly  compressed  tow.  Under  poultices,  the  slough  sepa- 
rates in  the  course  of  days  or  weeks,  according  to  its  depth,  and 
the  sore  then  heals  without  any  trouble.  If,  therefore,  patients, 
from  an  unconquerable  dread  of  cutting,  should  prefer  the 
escharotic  treatment,  or  if  the  circumstances,  on  any  other  ac- 
count, should  seem  to  render  this  method  eligible,  the  procedure 
just  described  may  be  found  useful. 

11  In  conclusion,  I  beg  to  offer  the  following  principles  or  prac- 
tical rules  for  the  treatment  of  cancer : — 

"1.  The  treatment  of  cancer  may  be  divided  into  curative  and 
palliative. 

11 2.  The  curative  treatment  should  not  be  undertaken  when 
the  local  disease  is  so  seated  or  connected  as  to  prevent  its  com- 
plete removal ;  when  the  lymphatic  glands  are  affected ;  and 
when  the  patient's  general  health  is  deranged. 

"3.  Removal  may  be  accomplished  by  means  of  the  knife, 
escharotics,  and  ligatures. 

"  4.  Of  these  means,  in  general,  the  knife  is  best,  and  ligatures 
the  worst. 

"4.  Escharotics  may  be  used  with  most  advantage  when  the 
disease  is  superficial. 

"  6.  Escharotics,  employed  with  a  curative  view,  should  al- 
ways destroy  the  whole  morbid  part  by  one  application. 

" 7.  The  palliative  treatment  is  generally  best  accomplished 
by  means  of  soothing  applications  and  attention  to  the  general 
health. 

11 8.  When  the  local  disease  is  very  troublesome,  it  may  some- 
times be  relieved  for  a  time  by  destruction  of  the  morbid  growth. 

"9.  The  best  agent  for  this  purpose,  and  also  with  a  curative 
view,  is  concentrated  sulphuric  acid  properly  applied." — [Edin- 
burgh Med.  Jour.,  and  Banking's  Abstract. 


Syrup  of  the  Superphosphate  of  Iron.    By  Alexander  Cush- 

MAN. 

The  very  favorably  mention  made  in  the  European  Medical 
Journals,  of  this  new  remedy  induced  some  of  our  physicians  to 
send  out  during  the  past  year,  and  obtain  a  supply  for  the  pur- 
pose of  testing  its  effects. 

The  result  was  so  far  satisfactory  that  many  others  wished  to 
introduce  it  in  their  practice,  and  the  English  supply  being  ex- 
hausted, I  found  it  necessary  to  prepare  it  myself,  which  I  did 
according  to  the  formula  of  Mr.  Greenish,  of  London,  as  specified 
in  the  U.  S.  Dispensatory,  under  the  article  on  Ferri  Phosphati. 
A  paper  in  the  American  Medical  Gazette  for  January,  also 


264  Syrup  of  the  Superphosphate  of  Iron.  [April, 

brought  it  more  generally  before  the  profession  here,  and  it  ap- 
pears to  be  attracting  much  attention  wherever  it  is  heard  of. 
Hitherto  the  precipitated  phosphate  of  iron  has  been  but  little 
employed  owing  to  its  repulsive  color,  but  when  as  at  present 
it  is  dissolved  in  an  excess  of  phosphoric  acid,  and  formed  with 
sugar  into  a  clear  white  syrup,  as  inviting  to  the  eye  as  agreea- 
ble to  the  taste,  there  is  reason  to  anticipate  that  its  use  will 
become  very  popular. 

A  careful  and  somewhat  troublesome  manipulation  is  requisite 
in  the  preparation  of  this  syrup,  in  order  to  produce  a  perfect 
result.  There  is  a  strong  tendency  to  reaction  between  the  sugar, 
and  the  acid,  which  will  sometimes  cause  a  precipitation  of  the 
iron,  sometimes  a  granulation  of  the  sugar,  and  sometimes  a 
partial  decomposition  of  the  latter,  resulting  in  a  reddish  or 
brown  color,  more  or  less  dark.  Experience  and  care  in  regula- 
ting the  heat  only  will  prevent  these  accidents.  When  however, 
once  perfectly  formed,  there  is  no  tendency  to  decomposition,  as 
it  is  not  affected  by  the  atmosphere  or  by  light,  nor  does  it  show 
any  disposition  to  ferment.  The  variable  quality  of  the  phos- 
phoric acid  of  the  shops,  is  also  a  fact  to  be  guarded  against. 
Out  of  twenty-three  parcels  which  I  have  examined,  only  four 
have  proved  to  be  of  standard  strength.  That  this  is  no  unusual 
case,  may  be  seen  by  comparing  the  following  analyses,  showing 
the  proportions  of  Anhydrous  acid  and  water  in  the  specimens 
examined  by  four  different  authors. 

Kose.  Peligat.  Dulong.        Berthol. 

P.O.  92-7—90-52  ....  8745  ....  82-92  ....  75 
H.O.  7-3  —  948  ....  12-55  ....  17-08  ....  25 
If  the  acid  used  is  not  of  sufficient  strength  to  dissolve  the 
phosphate  of  iron  immediately,  it  forms  an  insoluble  white  com- 
pound, probably  the  tribasic  phosphate  which  cannot  be  made 
use  of.  On  the  other  hand,  an  over  excess  of  acid  renders  the 
resulting  syrup  disagreeably  sour,  and  of  course  gives  an  uncer- 
tainty to  the  preparation  which  should  not  exist,  besides  increas- 
ing the  likelihood  of  decomposition  in  the  sugar.  Each  new 
parcel  of  acid  should  therefore  be  tested  before  use,  to  determine 
the  exact  amount  required  to  neutralize  a  given  quantity  of  the 
precipitate  phosphate,  before  proceeding  to  make  up  any  large 
amount. 

It  may  not  be  amiss  in  this  connection,  to  quote  a  few  of  the 
cases  given  under  the  authority  of  Greenish  as  showing  the  pe- 
culiar class  of  diseases  in  which  the  superphosphate  of  iron  has 
been  successfully  administered  in  England. 

"  Case  1. — A  University  Student,  very  weak,  emaciated  with 
loss  of  appetite,  diarrhoea  followed  by  obstinate  constipation  of 
frequent   occurrence,   palpitation  of  the  heart,  loss  of  memory, 


1858.]  Syrup  of  the  Superphosphate  of  Iron.  265 

countenance  sallow,  frequent  headache,  which  would  continue 
for  hours,  and  quite  incapacitate  him  from  mental  exertion.  The 
syrup  of  the  superphosphate  of  iron  was  prescribed  three  times 
a  day.  In  about  ten  days  he  expressed  himself  to  be  an  altered 
man;  the  headache  had  not  recurred,  his  apetite  improved,  his 
strength  was  greatly  increased — indeed,  in  about  a  month  he 
was  perfectly  well,  and  was  enabled  to  compete,  and  successful- 
ly so,  for  several  prizes  which  in  his  former  state  would  have 
been  quite  impossible.     He  has  continued  well  ever  since. 

"  Case  2. — A  young  lady  had  for  some  time  suffered  greatly 
from  painful  and  defective  menstruation ;  her  general  aspect  was 
palid,  with  a  marked  green  tinge.  There  was  great  pain  and  a 
sensation  of  sinking  in  the  back  with  copious  leucorrheal  dis- 
charge, great  headache,  especially  in  the  erect  position  or  walk- 
ing. For  these  reasons,  she  was  unwilling  to  exert  herself;  she 
complained  much  of  languor,  and  it  was  said  by  those  acquaint- 
ed with  her,  that  of  late  she  had  become  very  dull  of  apprehen- 
sion ;  she  had  no  appetite,  could  not  take  animal  food,  and  what 
she  did  take  always  laid  heavy  on  her  stomach ;  constipation 
was  always  more  or  less  present,  except  when  she  took  power- 
ful purgatives,  which  very  much  weakened  her.  The  syrup 
was  prescribed  in  doses  of  a  teaspoonful  three  times  a  day.  In 
about  a  week  she  was  much  improved,  and  by  the  end  of  a 
month  the  menses  recurred  without  pain,  and  in  larger  quantity 
than  she  had  seen  for  weeks.  From  that  time  all  her  disagreea- 
ble symptoms  had  disappeared,  and  she  has  continued  well  ever 
since. 

"  Case  3. — A  young  man,  suffering  from  carious  softening  of 
one  of  the  bones  of  the  wrist,  and  who  had  been  long  under  med- 
ical treatment,  as  a  last  resource  was  recommended  to  take  the 
syrup  of  superphosphate  of  iron.  He  did  so  with  the  greatest 
success.  The  wrist  was  subsequently  injured  a  second  time  in 
playing  cricket,  and  the  disease  recurred  ;  he  was  again  ordered 
to  take  the  syrup  of  the  superphosphate  of  iron,  and  the  disease 
was  again  arrested,  and  the  use  of  the  wrist  completely  restored 
in  a  short  time. 

"  Case  4. — A  child  two  years  of  age,  was  affected  with  weak 
ankles,  and  to  such  an  extent,  that  his  walking  powers  were 
materially  interfered  with ;  his  feet  turned  in  and  upon  them- 
selves continually.  The  syrup  was  suggested  and  tried,  and  in 
the  course  of  a  very  short  time,  the  ancles  appeared  to  have  ac- 
quired much  power,  the  child  being  enabled  to  walk  perfectly, 
uprightly,  and  firmly,  upon  them ;  the  case  indeed  progressed 
to  a  perfect  cure  in  about  a  month." 


266  Syrup  of  ilie  Superphosphate  of  Iron.  [April, 

These  cases  tend  to  establish  the  truth  of  the  theory,  that  the 
waste  of  nervous  energy  and  mental  power  occurring  in  many 
diseased  states  of  the  system,  arises  from  a  deficiency  of  phospho- 
rus and  iron  in  the  tissues  of  the  brain  and  nerves,  which  this 
preparation  is  calculated  to  supply  most  promptly  and  adequate- 
ly, presenting  those  substances,  as  it  does,  in  a  state  of  chemical 
combination  most  easily  assimilated  by  the  blood. 

It  is  certainly  known  that  iron  and  phosphorus  are  among 
the  most  important  constituents  of  the  body. 

"  The  brain  consists  essentially  of  phosphoric  acid  and  oil,  and 
a  due  proportion  of  the  first  is  necessary  to  the  integrity  of  the  • 
mental  functions.  Iron  exists  in  the  blood  as  a  phosphate,  but 
the  digestive  powers  are  sometimes  so  weakened  that  they  cannot  as- 
similate other  preparations  of  iron,  and  convert  them  into  the  phos- 
phate required.11  "  In  some  cases  of  weakness  the  amount  of  the 
phosphates  excreted,  is  so  much  greater  than  that  contained  in 
the  food  taken,  that  the  phosphates  of  the  living  tissues  are  preyed 
upon  for  a  supply ',  especially  the  brain,  the  richest  in  phosphorus 
of  all  the  organs.  Hence  madness,  loss  of  memory  1  and  various 
other  disorders  of  the  mental  organization." 

u  As  in  tubercular  disease  the  fatty  tissues  are  preyed  upon, 
and  cod-liver  oil,  and  other  highly  carbonized  substances,  have 
proved  useful  in  supplying  the  waste,  so  there  are  cases  where 
the  superphosphate  of  iron  may  act  in  a  similar  manner,  by  giv- 
ing directly  to  the  system  the  amount  of  phosphorus  and  iron 
necessary  to  prevent  any  injurious  overdrain,  and  allowing  time 
for  recuperation  by  the  natural  forces." 

The  proportions  of  the  syrup  used  in  the  above  case,  as  of 
that  prepared  by  myself,  are  forty  grains  of  the  phosphate  of 
iron  to  each  fluid  ounce  of  syrup.  This  gives  the  full  dose  of 
five  grains  of  phosphate  to  the  teaspoonful,  or  fluid  drachm.  Its 
effects,  as  I  have  been  informed  by  several  of  the  physicians  who 
have  already  tried  it,  are  remarkably  prompt  in  this  dose.  For 
children  it  is  sometimes  diluted  with  two  or  three  times  its  bulk 
of  simple  syrup  flavored  with  orange  flower  water,  or  with  gin- 
ger or  some  agreeable  fruit  syrup.  All  the  bitter  and  astringent 
tinctures  and  infusions  unite  with  it  without  decomposition,  so 
far  as  I  have  tried  them,  so  that  tincture  of  cinchona,  rhatany, 
&c,  may  be  prescribed  with  it  in  any  desired  proportion.  Add 
to  these  facts  that  it  does  not  injure  the  teeth  or  blacken  the 
stools,  and  it  presents  advantages  simply  as  an  eligible  mode  so 
administering  iron,  apart  from  the  theoretical  claims  adduced 
above,  which  must  give  it  a  high  place. — [Am.  Druggists1  Circular. 

[We  feel  much  inclined  to  say  here  to  our  readers — "Bead 
this  again."  It  certainly  presents  matters  of  weighty  importance 
for  our  consideration. — Edts.] 


1858.]  Abdominal  Typhus  of  Children.  267 


On  the  Abdominal  Typhus  of  Children.    By  Dr.  Edmund  Fried- 
rich,  of  Dresden. 

The  following  analysis  of  Dr.  Freidrich's  work  on  "Der 
Abdominal  Typhus  der  Kinder,"  is  from  the  pen  of  Dr.  E. 
Noeggerath. 

u The  author,"  writes  the  reviewer,  "having  been  for  some 
years  house-physician  in  the  hospital  for  sick  children  of  Dres- 
den, Saxony,  has  made  a  collection  of  observations  relating  to 
typhus  fever  in  children,  which  were  taken  partly  from  personal 
experience,  partly  from  notes  recorded  in  the  day-books  of  the 
hospital.  It  comprises  an  analysis  of  275  cases  of  typhus  fever, 
occurring  during  twenty -one  years,  in  a  number  of  14,868  chil- 
dren, which  makes  1  out  of  54,  and  speaks  sufficiently  for  the 
importance  of  the  disease  in  this  age  of  life. 

"  In  the  historical  portion  of  the  work,  the  author  points  out 
the  fact,  that  an  accurate  knowledge  of  this  affection  was  first 
derived  from  German  and  French  physicians,  while  there  exist- 
ed, even  now,  pretty  incorrect  notions  of  this  disease  among 
English  authors,  with  the  exception  of  Dr.  Underwood. 

"  The  following  sections  comprise  very  interesting  and  thor- 
oughly elaborated  articles,  in  regard  to  statistics,  etiology,  symp- 
tomatology, course,  complications,  diagnosis,  prognosis,  and 
treatment  of  the  disease.  In  all  these  particulars,  we  find  the 
author  has  fulfilled  everything  that  could  be  expected  of  a  man 
of  his  diligence  and  skill.  In  order  to  give  the  reader  a  correct 
idea  of  the  work,  we  will  endeavor  to  present'  a  condensed  state- 
ment of  its  contents,  and  the  conclusions  to  which  it  leads. 

"  1.  Abdominal  typhus  is  by  no  means  a  rare  disease  among 
children,  and  is  observed  among  them  in  a  sporadic,  as  well  as 
in  an  epidemical  form. 

"2.  It  more  often  attacks  male  than  female  children. 

"3.  The  number  of  fatally  ending  cases  is  smaller  among 
children  than  among  grown  people ;  and,  again,  greater  among 
female  than  male  patients. 

u  4.  In  the  very  first  years  of  life  the  disease  is  rare ;  becomes 
more  frequent  from  the  second  year,  and  reaches  its  greatest  ex- 
tent from  the  sixth  to  the  eleventh  year.  From  that  it  decreases 
again  up  to  the  time  of  puberty ;  mortality  is  greatest  from  the 
first  to  the  fourth  year. 

"5.  Boys  generally  die  sooner  from  the  disease  than  girls, 
because  the  fever  commonly  has  a  more  rapid  development 
among  the  first. 

"  6.  Abdominal  typhus  and  scarlet  fever  exclude  one  another, 
so  that  while  one  of  these  epidemics  is  raging,  the  other  disap- 
pears, or  is  seen  only  in  isolated  cases. 

k.  s.— vol.  xrv.  no.  rv.  12 


268  Abdominal  Typhus  of  Children.  [April, 

"7.  Typhus  epidemics  have  been  observed  in  small  circuits, 
which  seized  exclusively  upon  children,  while  grown  persons 
were  not  taken  at  all,  or  only  in  some  isolated  instances. 

"8.  The  pathological  lesions  among  children  are  about  the 
same  as  in  grown  persons,  especially  in  regard  to  enlargement 
of  the  spleen.  But  in  children  there  is  very  rarely  found  a  de- 
posite  of  material  in  the  intestinal  tube,  or  genuine  typhus  ulcers. 
There  are  generally  found  only  a  few  single  infiltrated  follicles 
in  the  glandular  placques,  which  return  to  the  normal  condi- 
tion, without  even  leaving  a  cicatrix,  by  a  resorption  of  the 
infiltrated  matter,  or,  more  often,  by  rupture  of  the  follicle  open- 
ing into  the  intestinal  tube.  The  rupture  and  discharge  into 
the  intestinal  canal  is  generally  observed  only  to  a  small  extent. 
Moreover,  the  formation  of  ulcers  in  the  mucous  membrane  of 
the  pharynx,  oesophagus,  trachea,  &c,  is  of  rare  occurrence 
among  children. 

"  9.  As  decided  causes  of  the  disease,  we  have  to  consider 
poverty,  uncleanliness,  improper  food,  and,  above  all,  impure 
air,  and  a  damp,  dark  abode.  Moreover,  acclimatization,  sud- 
den change  of  the  former  mode  of  living,  entrance  into  new 
conditions  of  life,  have  their  influence  upon  the  origin  of  the 
disease.  Still,  the  most  important  point  is  the  character  of  the 
epidemical  constitution.  Scrofula  seems  to  be  not  favorable  for 
the  development  of  typhus  fever  among  children. 

"  10.  The  most  reliable  symptoms  are  the  tumor  of  the  spleen, 
diarrhoea,  meteorismus,  and  the  abdominal  gurgle.  Fever,  ac- 
celerated respiration,  and  catarrh  of  the  bronchial  tubes  are 
equally  constant  symptoms.  The  scarce  and  trifling  intestinal 
hemorrhages  at  the  beginning  of  the  disease  establish  the  fact, 
that  the  local  disease  is  unaccompanied  by  a  severe  congestion. 
Seldom  does  the  typhus  fever  of  children  invade  with  chills,  as 
is  the  case  with  grown  people.  Delirium  and  drowsiness  are 
generally  present,  but  not  very  intense.  Koseola  is  often  ob- 
served, not  so  much  a  papulous  eruption,  and  at  a  later  period, 
sometimes  miliaria  are  seen.  The  extent  of  the  exanthema  does 
not  seem  to  depend  upon  the  intensity  of  the  disease. 

"  11.  Abdominal  typhus  generally  appears  in  a  milder  form 
among  children,  its  duration  being  from  sixteen  days  to  several 
months. 

"12.  Its  complications  with  parotitis,  phlebitis,  and  hemor- 
rhages, are  far  more  seldom  odserved  in  children  than  in  grown 
persons.  During  recovery,  measles,  smallpox,  and  other  erup- 
tions may  be  developed, 

"13.  The  most  common  termination  is  recovery,  which  gen- 
erally proceeds  very  fast,  while  tuberculous,  gangrene,  intestinal 
ulceration,  abscess,  or  atrophy  of  the  mesenteric  glands  are 
of  rare  occurrence  among  children.    Tubercles,  if  present  in 


1858.]  Acute  Internal  Inflammation.  269 

small  quantities,  seem  to  be  liable  to  calcination  during  typhus 
fever. 

"  14.  The  most  important  points  in  diagnosis  are  the  enlarge- 
ment of  the  spleen,  the  roseola,  the  increased  temperature  of  the 
skin,  the  diarrhoea,  the  meteorismus,  the  painfulness  about  the 
abdomen,  the  coecal  gurgle,  the  bronchial  catarrh,  the  symptoms 
of  cerebral  disturbance,  and  the  prevailing  epidemic. 

"15.  The  following  symptoms  are  of  the  greatest  importance 
in  prognosis,  which  is  generally  favorable :  the  character  of  the 
epidemic,  the  external  conditions  of  life,  age,  and  sex.  Compli- 
cations and  remaining  diseases  prove  often  more  dangerous  than 
the  fever  itself  in  its  greatest  intensity. 

"16.  Experience  has  taught  that  the  expectant  treatment  is 
the  best  that  can  be  pursued.  It  is  impossible  to  cut  short  ty- 
phus fever ;  still,  medium-sized  doses  of  calomel,  given  from  the 
fifth  to  the  eighth  day  of  the  disease,  have  a  decidedly  good 
effect  upon  its  course.  Under  all  circumstances,  we  must  spare 
the  strength  of  the  children,  and  let  them  have  nutritious  food 
in  good  season." — [N.  Y.  Jour,  of  Med.,  and  Banking's  Abstract. 


Remarks  upon  the  Treatment  of  Acute  Internal  Inflammations.  By 
R  B.  Todd,  M.  D.,  F.  R.  S.,  Physician  to  the  King's  College 
Hospital. 

The  case  of  Jane  Cook,  aged  twenty- two,  affords  a  good  illus- 
tration of  the  phenomena  of  disease  in  its  most  acute  form.  She 
has  had  pericarditis  in  connection  with  rheumatic  fever,  some 
degree  of  endocarditis,  and  pneumonia  with  consolidation  of 
about  a  fourth  of  the  posterior  part  of  each  lung. 

This  patient  is  rapidly  recovering,  and,  indeed,  in  an  illness 
of  unusual  severity,  she  has  had  no  serious  drawback.  On  the 
2nd  of  July  rheumatic  symptoms  first  showed  themselves  in  pains 
and  swelling  of  the  lower  joints.  On  the  6th  of  July  a  pericar- 
dial friction  sound  was  first  heard  over  the  base  of  the  heart, 
which  soon  became  distinctly  audible  over  its  whole  anterior 
surface.  On  the  7th  bronchial  breathing  was  heard  at  the  pos- 
terior part  of  the  lower  third  of  the  left  lung,  and  on  the  10th 
the  right  lung  was  similarly  affected  and  to  an  equal  extent. 
On  the  12th  vesicular  breathing  began  to  be  audible  in  both 
lungs,  and  the  bronchial  breathing  to  disappear. 

Now  this  patient  was  treated  in  the  manner  in  which  (with 
but  slight  modification)  I  have  been  for  some  years  in  the  habit 
of  dealing  with  similar  internal  inflammations,  especially  those 
of  the  lungs  and  heart.  Although  my  practice  in  such  cases  is 
now  pretty  well  known,  and  I  am  proud  to  think  is  practised  by 


270  Acute  Internal  Inflammation.  [April, 

very  many  of  my  pupils  in  various  parts  of  this  city  and  of  the 
country,  it  may  be  useful  if  I  take  this  opportunity  of  explaining 
to  you  the  principles  upon  which  it  is  based. 

On  admission,  while  yet  it  was  uncertain  how  far  the  rheuma- 
tic symptoms  would  extend,  she  was  treated  with  alkalies  and 
mild  saline  purgatives.  Bicarbonate  of  potass  in  doses  of  from 
twenty  to  thirty  grains  were  given  every  four  or  six  hours,  and 
very  soon  opium  was  freely  given,  when  the  cardiac  affection 
manifested  itself.  As  much  as  one  grain  of  opium  was  given 
every  fourth  hour.  Care  was  taken  to  keep  the  bowels  open  by 
giving  an  aperient  draught  daily  of  sulphate  and  carbonate  of 
magnesia.  Counter  irritation  was  employ d  over  the  situation 
of  the  inflamed  lungs  by  means  of  stupes  of  flannel  soaked  in 
turpentine ;  these  were  applied  twice  or  thrice  a  day,  and  the 
region  of  the  heart  was  freely  blistered. 

A  principal  and  very  important  part  of  the  treatment  to 
which,  as  most  of  you  know,  I  pay  very  special  attention,  is  that 
which  I  may  call  the  dietetic  portion.  The  object  of  this  is  to 
support  the  vital  powers  of  the  patient  and  to  promote  general 
nutrition,  during  the  time  when  those  changes  are  taking  place 
in  the  frame  which  tend  to  check  or  to  alter  the  morbid  process, 
and  to  convert  it  into  a  healing  process. 

When  a  patient  suffers  from  pneumonia,  the  tendency  is  for 
the  lung  to  become  solid,  then  for  pus  to  be  generated,  and  at 
last  for  the  pus-infiltrated  lung-structure  to  be  broken  down  and 
dissolved.  Such  are  the  changes  when  matters  take  an  unfavor- 
able course.  On  the  other  hand,  recovery  takes  place,  either 
through  the  non-completion  of  the  solidifying  process,  or  by  the 
rapid  removal,  either  through  absorption,  or  a  process  of  solution 
and  discharge  of  the  new  material,  which  has  made  the  lung 
solid. 

It  will  scarcely  be  affirmed,  even  by  the  most  ardent  believer 
in  the  powers  of  the  Therapeutic  art,  that  any  of  the  measures 
which  are  ordinarily  within  our  reach,  such  as  the  administra- 
tion of  certain  drugs,  or  the  abstraction  of  blood,  or  the  applica- 
tion of  blisters,  exercise  a  direct  influence  in  effecting  these 
changes.  Save  in  the  case  of  antidotes,  which  directly  antago- 
nise the  proximate  cause  of  the  morbid  state,  medicines  promote 
the  cure  of  acute  disease  by  assisting  and  quickening  some  natu- 
ral curative  process.  And  he  is  the  wisest  practitioner,  and  will 
be  the  most  successful  therapeutist,  who  watches  carefully  the 
natural  processes  of  cure — in  other  words,  who  studies  the  phe- 
nomena, both  anatomical  and  physiological,  which  accompany 
them,  and  of  which,  indeed,  they  consist. 

Let  me  therefore,  exhort  you  to  look  very  carefully  to  this  as 
a  part  of  your  clinical  study.  If  you  will  be  on  the  look-out,  you 
may  often  meet  with  cases  of  acute  disease  which  recover  with 


Acute  Internal  Inflammation.  271 

little  or  no  medical  treatment,  and  von  may  observe  and  note 
the  clinical  phenomena  which  they  exhibit. 

Allow  me  to  anticipate  your  observation  on  this  point,  and  to 
point  out  what  you  may  look  for  in  cases  of  pneumonia,  and 
what  you  will  certainly  find  in  almost  every  instance. 

First,  the  hot,  often  burning  skin,  which  is  so  generally  pre- 
sent in  the  first  stages  of  pneumonia,  will  be  exchanged  for  one 
bedewed  with  moisture,  generally  to  the  extent  of  free  sweating. 

Secondly,  along  with  this  sweating  process  there  will  be  one 
of  increased  flow  of  urine,  and  very  often  a  free  precipitate  of 
brick-dust  sediment,  lithate  of  soda,  more  or  less  deeply  colored. 

Thirdly,  not  unfrequently  expectoration  becomes  freer,  the 
sputa  are  more  easily  discharged,  they  lose  their  characteristic 
reddish,  rusty  color,  and  often  they  become  very  profuse  and 
even  purulent.  Now  and  then  the  purulent  sputa  are  so  abun- 
dant that  it  is  difficult  to  imagine  that  they  can  have  come  from 
any  other  source  than  an  abse 

Fourthly,  the  chemical  characters  of  the  pneumonic  sputa  ex- 
hibit an  interesting  contrast  with  those  of  the  urine.  In  the 
heights  of  the  inflammatory  state,  the  sputa  contain  common 
salt  (chloride  of  sodium)  in  abundance,  andthe  urine  is  entirely 
devoid  of  it.  As  the  inflammation  becomes  resolved  the  salt 
returns  to  the  urine  and  leaves  the  sputa. 

Lastly,  while  all  these  changes  are  going  on,  the  physiological 
functions  which  have  been  disturbed  by  the  local  malady,  grad- 
ually approach  their  normal  state.  The  quickened  breathing, 
the  accelerated  pulse,  the  unnatural  general  generation  of  heat 
gradually  subside.  As  all  these  admit  of  being  measured  by 
numbers,  you  should  tabulate  them  in  your  records  of  cases, 
and  you  will  find  on  each  succeeding  day  (under  such  circum- 
stances as  I  am  now  referring  to)  the  figure  assignable  to  each 
function  gradually  become  lower  until  you  arrive  at  the  normal. 

Xow  is  it  not  plain  from  all  this  that  the  process  of  resolution 
of  pneumonia  is  a  distinct  natural  process,  afiected  by  the  vari- 
ous physical  agencies  which  are  concerned  in  the  nutrition  of 
the  lung  ?  A  material  with  clogs  the  air  cells  and  minute  tubes 
is  removed,  chemical  changes  of  the  most  marked  and  obvious 
kind  accompany  the  deposition  and  the  removal  of  this  material, 
and  certain  functions  of  excretion  become  strikingly  augmented, 
as  if  for  the  purpose  of  getting  rid  of  some  noxious  matter  out 
of  the  circulation.  A  more  exact  and  minute  analytic  chemis- 
try than  we  have  at  present  will,  at  some  future  time,  beyond 
doubt,  detect  more  minute  changes  in  the  blood,  and  determine 
the  exact  nature  of  the  discharged  matters. 

One  other  remark  I  must  make  in  connection  with  this  sub- 
ject. These  acute  internal  inflammations  are  very  often — I  sus- 
pect always — connected  with  the  undue  prominence  of  some 


272  Treatment  of  Phagedenic  Ulcers.  [April, 

peculiar  diathesis — the  gouty  or  the  rheumatic,  for  instance — 
sometimes  the  scrofulous.  Of  these  diatheses  the  main  charac- 
teristic is  the  generation  of  some  peculiar  morbid  matter  which, 
when  accumulated  in  undue  quantity  in  this  or  that  organ,  gives 
rise  to  inflammation  in  it.  And  the  determination  of  the  mor- 
bid matter  to  the  lung,  or  the  pleura,  to  a  joint  or  a  muscle,  will 
often  depend  on  the  direct  influence  of  cold,  or  of  an  unwanted 
amount  of  exercise,  or  of  some  mechanical  injury.  The  evil  is 
to  be  remedied  by  the  diminution  of  the  intensity  of  the  diathe- 
sis. This  is  done  naturally,  and  is  to  be  imitated  artificially,  by 
the  elimination  of  the  morbid  element  through  the  channels  of 
augmented  excretions,  such  as  the  sweat,  the  urine,  and  the  se- 
cretions of  the  alimentary  canal. 

You  will  perceive,  then,  that  my  argument  may  be  thus 
summed  up.  Internal  inflammations  are  cured,  not  by  the  in- 
gesta  administered,  nor  by  the  egesta  promoted  by  the  drugs  of 
the  physician,  but  by  a  natural  process  as  distinct  and  definite 
as  that  process  itself  of  abnormal  nutrition  to  which  we  give  the 
name  of  inflammation.  What  we  may  do  by  our  interference 
may  either  aid,  promote,  and  even  accelerate  this  natural  ten- 
dency to  get  well ;  or  it  may  very  seriously  impair  and  retard, 
and  even  altogether  stop,  that  salutary  process. 

If,  then,  this  view  of  the  nature  of  the  means  by  which  inflam- 
mation is  resolved  in  internal  organs  be  correct,  it  is  not  unrea- 
sonable to  assume  that  a  very  depressed  state  of  vital  power  is 
unfavorable  to  the  healing  process.  Indeed,  if  you  watch  those 
cases  in  which  nothing  at  all  has  been  done,  or  in  which  noth- 
ing has  been  done  to  lower  the  vital  powers,  you  will  find  that 
the  mere  inflammatory  process  itself,  especially  in  an  organ  so 
important  as  the  lung,  depresses  the  strength  of  the  patient  each 
day  more  and  more. — [Archives  of  Med.,  and  Amer.  Med.  Monthly. 


On  the  Treatment  of  Phagedenic  Ulcers  by  Irrigation.  By  Dr.  J. 
Sutherland,  Surgeon  to  the  8th  Kegiment  of  Native  In- 
fantry. 

When  Dr.  Sutherland  was  putting  this  mode  of  treatment  in 
practice  in  the  regimental  hospital  at  Dinapore,  he  was  not  aware 
that  a  similar  mode  of  treatment  had  been  adopted  by  Mr.  Cock 
at  Guy's  Hospital  (v.  "  Abstract,"  XXIY.  p.  120).  Dr.  Suther- 
land was  led  to  adopt  this  plan  of  treatment  by  an  observation 
of  the  case  first  in  order. 

Cases. — A  young  soldier,  a  Seikh,  had  been  under  treatment 
for  intermittent  fever  with  enlarged  spleen,  and  was  taking 
iodide  of  iron  and  quinine ;  at  this  time  a  slight  sore  situated 
over  the  spleen  took  on  a  phagedenic  character,  spread  rapidly, 


1858.]  Treatment  of  Phagedenic  Ulcers.  273 

and  threatened  to  involve  a  large  portion  of  the  abdominal  pa- 
rietes ;  the  usual  treatment,  constitutional  and  local,  was  adopted, 
with  little  effect  in  arresting  the  spread  of  the  ulceration ;  there 
was  considerable  fever  and  great  pain  in  the  dark  and  inflamed 
ring  around  the  sore,  nitric  acid  had  been  applied  without  effect, 
and  the  patient  was  very  importunate  for  relief;  morphia  was 
given  at  bed- time  to  allay  pain  and  procure  sleep ;  under  these 
circumstances  it  occurred  to  me  that  benefit  might  be  derived 
from  a  continuous  washing  away  of  the  morbid  discharge  as  it 
was  formed,  and  that  water,  made  slightly  warm,  would  be  a 
bland  application  to  the  extremely  irritable  sore;  accordingly  I 
decided  on  having  a  continued  dripping  of  tepid  water  over  the 
foul  ulcerated  surface ;  [this  was  effected  by  allowing  the  water 
to  flow  along  a  skein  of  thread,  one  end  being  placed  in  a  vessel 
of  water  above  the  level  of  the  bed,  another  end  of  the  thread 
(or,  what  answers  the  purpose  nearly  as  well,  a  strip  of  calico) 
being  placed  over  the  sore. 

The  result  of  this  treatment  surprised  me ;  an  almost  immedi- 
ate arrest  of  the  phagedenic  ulceration  took  place,  and  pain  and 
irritative  fever  quickly  abated ;  from  this  time  the  cure  was  ra- 
pid, the  sore  granulated  kindly,  and  in  about  ten  days  a  large 
ulcerated  space  was  filled  up  with  healthy  granulations. 

The  second  case  in  which  the  remedy  was  used  was  equally 
satisfactory ;  the  patient,  a  weak  young  man  of  a  strumous  dia- 
thesis and  a  constitution  tainted  with  syphilis,  had  a  bubo  in  the 
left  groin,  extensive  sinuses  (in  the  groin),  had  been  laid  open 
and  the  sore  was  healing  favorably  when  it  suddenly  took  on  a 
phagedenic  character  and  spread  in  all  dir  actions,  forming  an 
extensive  sore,  which,  extending  upwards,  threatened  to  pene- 
trate the  abdomen ;  having  observed  the  satisfactory  result  of  a 
continuous  dripping  of  water  over  an  ulcerated  surface  in  the 
case  above  detailed,  I  was  led  to  subject  this  patient  to  the  same 
treatment;  the  result  was  equally  gratifying,  an  immediate  arrest 
to  the  spread  of  the  ulceration  took  place  and  the  sore  healed 
rapidly ;  quinine,  ammonia,  with  tinctura  opii,  which  had  been 
given  some  days  previous,  were  continued  for  a  short  time,  but 
no  other  local  remedy  was  used  to  complete  the  cure. 

The  third  case  was  that  of  a  sepoy  of  the 1ST.  I.;  this  man 

was  admitted  into  the  station  hospital  with  an  extensive  ulcer 
on  the  right  hip  of  eighteen  months'  standing ;  according  to  the 
statement  of  the  patient,  he  had  been  fourteen  months  under 
treatment  in  his  regimental  hospital,  and,  all  applications  hav- 
ing failed  to  heal  the  sore,  he  got  leave  to  visit  his  home  that 
change  of  air  might  do  him  good ;  the  sore  becoming  worse,  he 
applied  for  admission  into  the  station  hospital  in  this  place ;  the 
ulcer  was  superficial,  with  jagged  edges  and  unhealthy  flabby 
granulations ;  there  were  several  small,  deep,  foul  ulcers  around 


274  Treatment  of  Cicatrices  from  Burns.  [April, 

the  large  ulcer,  at  distances  varying  from  one  to  five  inches ;  the 
patient  was,  at  first,  very  unwilling  to  submit  to  the  treatment 
(as  it  required  him  to  lie  in  a  constrained  position),  asserting, 
with  much  appearance  of  truth,  that  he  had  not  benefited  by  all 
that  had  been  done  for  him  before ;  he  has  been  under  treat- 
ment since  the  third  instant,  and  the  large  sore  has  completely 
healed  under  the  irrigating  system,  all  the  smaller  ulcers  have 
also  healed,  with  the  exception  of  two  that  could  not  be  subject- 
ed to  the  treatment,  owing  to  their  position. 

I  think  it  probable,  from  the  nature  of  the  ulcers,  that  the  ad- 
dition of  sulphas  zinci  or  nitras  argenti  to  the  water  would  have 
expedited  the  cure,  but  I  was  unwilling  to  make  the  addition, 
as  I  wished  to  try  the  action  of  pure  water  alone  on  the  sores. 
[Indian  An.  of  Med.  Science,  and  Ranking\s  Abstract. 


On  the  Treatment  of  Cicatrices  from  Burns.     By  Mr.  Skey,  Sur- 
geon to  St.  Bartholomew's  Hospital. 

On  a  recent  occasion,  we  had  an  opportunity  of  seeing  the 
plan  adopted  by  Mr.  Skey,  at  St.  Bartholomew's  Hospital,  for 
removing  the  contraction  of  tissues  consequent  upon  a  burn. 

The  patient  was  a  little  girl  (Emma  B ,  set.  6  years),  the 

front  of  whose  neck  had  been  burnt  some  years  before,  and  had 
so  contracted  as  to  produce  a  number  of  distinct  bands,  running 
from  above  downwards,  without  very  great  deformity.  The 
contraction  resulting  from  the  burn  was  treated,  whilst  the  girl 
was  under  the  influence  of  chloroform,  by  making  a  number  of 
short  transverse  incisions  in  various  parts  of  the  cicatrized  tis- 
sues, which  gaped  as  they  were  made.  This  plan  Mr.  Skey  has 
found  very  efficacious  in  some  eight  cases,  all  of  which  have 
done  very  well.  It  has  certainly  the  advantage  over  dissecting 
up  portions  of  cicatrized  skin,  in  that  there  is  no  danger  nor  risk 
of  sloughing — an  accident  which  not  unfrequently  makes  a  case 
worse  than  if  nothing  whatever  had  been  attempted. 

On  a  subsequent  visit,  we  found  these  transverse  healing  well, 
without  any  appearance  of  contraction  of  the  cicatrix.  She  lay 
upon  a  flat  bed,  with  her  head  considerably  lower  than  the 
shoulders,  and  the  wounds  are  dressed  with  narrow  pieces  of 
strapping,  so  as  to  approximate  the  ends  of  a  cut  to  each  other — 
not  the  sides — and  lengthen  out  the  old  cicatrix  as  much  as  pos- 
sible.— [Lancet,  and  Ibid. 


Diphtheritic,  or  Malignant  Sore  Throat. 

Benjamin  Godfrey  reports  four  cases  of  this  disease,  and  be- 
lieves the  order,  in  which  its  symptoms  generally  occur,  to  be 
this:  Shivering;  intense  depression;   dryness  and  tingling  of 


15»:-5  "       P"-'-  :  •"  ."""-  :~  v>i  -.',-■:::'. .:/'.■■.",:■'::  :~  m^m:.m;  _"' 

fli^*  l^EKMfcl^  nares  alio!  <f^rs : 

whitish  spot  on  die  manual  membmneof 

deepening  in  color  bb  Ike 

dLstkse  appears  to  u?.  Godfrey  no 

membrane,  neither  iimdiing  lac 

tore.    The  glandular  enllargemondi  is 

tk».    Its  dsagsftosfae  diffiaeoce  from 

L  Tne  absence  of  all  ferer,  i  Absence  of  ill  not,  S.  PapOba 

c:me   :;::-    m;   :^::0   ~   >\   iesmmmmm  ::'  me  :m__e 

me:  me  m>v;.m  ....fires  :zi     m  mmmme   v.z.: — imf  me  ms:m:f 

:;m_f  7.-:mm  me":mml  mi  ':  mm  :i>  ~m  :m   : ::  -_r_  .mmm.:- 

-r~'::^r.  mi  if  ;mmm  so.mr:.:  mm  :07mm  r  Im  m- 
:re:m  mi  :m.i  iem-ess;:::  if  .mm  mm_ec  :~  me  :e;:ef:mm  :: 

r-  •■* :-r~  •■"'  sdrl-:  mrer.  ::me  :oi-mse  ::'  -L^...l. 'm     mm 

:,:-:::  mm  i.:C  mmmm  :.:  mo  mm.  :.i:::^:i  mi  iimmi 
aspn jnria.  The  mam  point  in  the  treatment  k  to  aajupiMt  Ac 
:..^.i-'i  10-mrs,  :t  rmmmmif  ,::  :::::^  mi  :.:  meoi:  mf 
mrmi  :f:m  mmme  m  :m  immmmm    ::   :m    5r;::  romeom 

;mi:m:'s  pmu-eos  is  :m  mmm:  mm  ii_r  i;.-f-;mm  mi  me  if- 
l-:esmm.~7«mm  ,:o;m:  ioime  me  l-r^v_£ :=■*.  mm:;  resm; 
mm:  -o:  mmi  :01m;  mmmmm  ,c;v,:C  "1  _mmmm  ;:  me  mi- 
m"_s  emmoi  .is  1  mmjmi  s-mm.m  m  erem  mm  _  :.  momej 
believes  die  tinctnre  of  a^nkMoride  of  iron  die  best  remedy. 


Onf^e  Pr&xaJs^^^  By  Pm£ 

Dbsoubaix 


Professor  Beraobaix,  Suigeon  to  d»  St  Jea%  BraoBel^ 

iiims  1  series  ;:   imors  ';:•::   mis  si  mo;   "-mi.  me   :':'_:vz: 

1.  ItktodnfrofasaigeQmtoaeehv  ty  the  hmpranremart  of 

m  memm.-e  mm :im<.  :.;  :"m.me  me  mms"  m:me-is  :•:' 
memmim  me  eiiem::  ;.;  mooveo  me  zem  ::  irmemim  :: 
me  s-:::rv  .mi: i mm  ~'i:.:z  me  im  rmre  imoemm  is  smi 
imme  imjormism  immieo  1;  im  imis. 

2.  Ooold  the  great  amgical  opemtMins  be  rendered  fern  dan- 
gerens  in  diomadfo^   ■■  inserrentLoa  c*  szr^rr  womb]  b? 
much,  more  deudy  and  more  fiwjnenisi'T  m&sstec  i£ 
tbe  praetiao^ex  now  often  is  obfrgnd  to  remain  a 
:m  ;:'  i:-;:-ier<  v.-r.m  imij  m-me  :m 

S.  Tke  dajager  of  great  ©perij^^ 
sanaces  concerned,  bat  to  the  nnmber  and  Tomine  of  the 


276  Prevention  of  the  Ill-consequences  of  Operations.     [April, 

4.  When  the  division  of  veins  proves  mischievous,  it  does  so 
by  giving  rise,  through  a  mechanism  the  nature  of  which  it  is 
not  always  easy  to  appreciate,  to  the  production  of  purulent  in 
fection,  one  of  the  most  fearful  consequences  of  traumatic  lesions. 
The  great  danger  and  extreme  frequency  of  this  complication 
justify  the  efforts  made  for  its  prevention  or  removal. 

5.  There  are  two  directions,  both  perhaps  equally  good,  by 
following  which  we  may  succeed  in  rendering  pyaemia  of  much 
less  frequent  occurrence.  The  first  of  these  consist  in  improving 
and  rendering  less  uncertain  the  process  of  healing  by  the  first 
intention  ;  and  the  second  in  so  modifying  the  divided  surfaces 
as  to  convert  them  into  a  lesion  of  continuity  of  far  less  danger- 
ous character. 

6.  Metallic  caustics,  at  least  in  the  immense  majority  of  cases, 
do  not  give  rise  to  purulent  infection ;  but  they  are  not  applica- 
ble to  certain  operations — as,  e.g.,  amputations. 

7.  It  is  rational,  then,  when  seeking  for  substitutive  or  modi- 
ficatory means  for  the  prevention  of  pyaemia,  to  resort  to  such 
as  most  resemble  caustics  in  their  mode  of  action,  and  yet  are 
exempt  from  the  disadvantages  of  these  therapeutical  agents. 

8.  The  tincture  of  iodine  would  seem  to  possess  properties  en- 
abling it  to  fulfil  these  indications,  seeing  the  deep-seated  modi- 
fication it  impresses  on  the  tissues,  and  the  plastic  effects  it  gives 
rise  to.  It  does  not  act  upon  the  ligatures,  and  therefore  does 
not  give  rise  to  the  danger  of  secondary  hemorrhage.  When  it 
is  applied  to  bleeding  surfaces  after  an  operation,  it  induces  a 
general  hyposthenic  effect  of  short  duration,  and  a  local  hypos- 
thenic  effect,  which  imparts  peculiar  characteristics  to  the  gran- 
ulations and  cicatrization. 

9.  The  most  remarkable  results  of  this  hyposthenization  are, 
the  much  less  indolence  of  the  wound,  the  slight  amount  of 
suppuration,  the  notable  diminution  of  the  general  reaction,  and 
the  maintenance  of  a  condition  approaching  that  of  health. 
These  phenomena  offer  no  impediment  to  rapid  cicatrization. 

10.  The  discharge  from  the  surface  of  the  wound  is  consider- 
ably diminished  as  a  consequence  of  the  application  of  the  tinc- 
ture ;  but  this  does  not  prevent  artificial  hemorrhage,  or  the  loss 
of  blood  from  the  large  veins. 

11.  The  putridity  of  the  wound  becomes  evidently  diminish- 
ed ;  and  when  the  tincture  is  applied  to  the  divided  extremities 
of  the  veins,  these  become  corrugated  and  narrowed,  and  then 
agglutinated.  If  phlebitis  arises,  it  is  obliterative  and  adhesive, 
not  suppurating. 

12.  The  application  of  the  tincture  to  the  sawn  surface  of  the 
bones  does  not  lead  to  necrosis. 

13.  The  tincture  imparts  no  preservative  power  against  pyae- 
mia when  an  open  venous  orifice,  through  which  pus  may  be 


1858.]  Treatment  of  Ununited  Fracture.  277 

easily,  so  to  say,  mechanically  introduced,  exists  at  any  point  of 
the  surface. 

14.  In  ordinary  cases,  even  the  tincture  is  no  certain  prevent- 
ive of  purulent  infection.  When,  after  it  has  been  applied,  we 
find  the  vicinity  of  the  wound  remaining  very  painful,  we 
should  suspect  a  commencement  of  phlebitis,  and  the  course  of 
the  pain  should  be  carefully  inquired  into. 

15.  It  should  be  remarked,  that  as  the  general  hypostheniza- 
tion  which  results  from  the  application  of  the  tincture  exhibits 
itself  in  symptoms,  comparable  to  a  certain  point  to  those  pro- 
duced by  chloroform,  prudence  is  required  in  the  simultaneous 
or  successive  employment  of  the  two  substances.  Perhaps  this 
is  the  principal  defect  of  the  iodine. 

16.  The  injection  of  the  tincture  into  the  veins  is  immediately 
fatal.  It  induces  an  entirely  peculiar  coagulation  of  the  blood, 
incapable  of  being  confounded  with  any  other  pathological  or 
spontaneous  coagulation. 

17.  Nevertheless,  this  medical  substance  cannot,  when  applied 
to  a  bleeding  surface,  be  carried  in  substance  into  the  current  of 
the  circulation,  unless,  indeed,  venous  orifices  be  maintained 
open  by  adhesions.  It  is  absorbed  in  the  state  of  an  alkaline 
iodide,  and  may  be  found  in  such  a  state  of  combination  in  the 
blood  and  urine.  The  amount  ordinarily  absorbed  exerts  no 
ill-effect  upon  the  economy. — [Presse  Med.  "Beige,  Med.  Chir.  Bev. 
and  Banking's  Abstract. 


On  the  Treatment  of  Ununited  Fracture.     By  Mr.  Syjie,  Professor 
of  Clinical  Surgery  in  the  University  of  Edinburgh. 

"  When  there  is  merely  a  slight  degree  of  mobility  at  the  seat 
of  injury,  so  that,  although  quite  sufficient  to  prevent  any  useful 
exercise  of  the  limb,  it  may  require  some  care  for  its  detection, 
there  will  be  a  favorable  prospect  of  success,  even  after  the  ex- 
piry of  several  months,  through  the  employment  of  means  for 
the  complete  prevention  of  motion ;  and  I  have  put  upon  record 
cases  in  which  even  the  thigh-bone  was  rendered  perfectly  rigid 
by  this  simple  expedient,  in  circumstances  of  apparently  a  very 
hopeless  character,  from  the  long  duration  of  flexibility.  But 
when  the  extremities  of  the  bone  remain  quite  separate,  or  even 
overlap  each  other,  and  are  surrounded  by  a  sort  of  fibrous  cap- 
sule with  cellular  interstices,  so  that  they  admit  of  hardly  less 
free  motion  than  if  there  really  were  a  joint  between  them,  it  is 
evident  that  merely  preventing  motion  could  not  possibly  prove 
sufficient  for  the  production  of  an  osseous  union.  It  has  been 
supposed,  that  the  difficulty  thus  presented  might  be  overcome 
by  rubbing  the  ends  of  the  bones  together ;  by  stirring  up  the 
texture  connecting  them  through  the  agency  of  needles  or  teno- 


278  Treatment  of  Ununited  Fracture.  [April, 

tomy  knives ;  by  passing  setons  through  the  flexible  medium  of 
union ;  and  by  inserting  pegs  of  ivory  into  the  respective  osse- 
ous surfaces.  But,  so  far  as  I  am  able  to  form  an  opinion  on 
the  subject,  all  of  these  means  are  absolutely  useless,  and  owe 
any  share  of  credit  that  they  may  have  acquired  to  the  preven- 
tion of  mobility  which  is  conjoined  with  their  employment.  In 
short,  I  believe  that  the  procedures  in  question  cannot  accom- 
plish recovery  in  any  case  not  remediable  by  the  enforcement 
of  rest,  and  that  they  consequently,  must  always  be  useless,  if 
not  injurious.  There  is  still  another  mode  of  treatment,  which 
consists  in  cutting  off  the  ends  of  the  bone,  so  as  to  obtain  two 
fresh  osseous  surfaces,  and  place  the  limb  in  a  condition  simi- 
lar to  that  of  a  compound  fracture  recently  inflected;  and 
this,  I  feel  persuaded,  affords  the  only  reasonable  ground  for 
expecting  success  in  cases  not  amenable  to  the  influence  of  im- 
mobility. It  is  true  that  the  experience  of  this  method  has  not 
hitherto  been  at  all  satisfactory,  through  want  of  due  attention 
to  some  circumstances  in  the  mode  of  procedure,  which  must  in 
a  great  measure  determine  the  result.  Of  these  may  be  special- 
ly mentioned  an  imperfect  removal  of  the  ends  of  the  bone,  and 
a  want  of  complete  immobility  after  the  operation.  The  follow- 
ing case  will,  I  hope,  tend  to  illustrate  the  importance  of  attend- 
ing to  these  points. 

Case. — "  J.  H ,  aet.  34,  a  private  of  the Foot,  while 

discharging  some  duty  in  the  Kedan,  on  the  8th  of  December, 
1855,  after  the  occupation  of  Sebastopol,  was  blown  up  by  a 
Eussian  mine,  which  had  escaped  detection,  and,  in  addition  to 
some  slighter  injuries;,  sustained  a  fracture  of  the  left  arm  be- 
tween two  and  three  inches  above  the  elbow.  He  walked  up 
to  his  regimental  hospital,  where  splints  were  applied,  and  re- 
tained for  a  month,  when,  there  being  no  signs  of  union,  the 
ends  of  the  bone  were  rubbed  together,  and  supported  by  a 
starched  bandage.  He  left  the  Crimea  on  the  3d  of  February, 
and  was  sent  to  the  hospital  at  Eenkioi,  where  a  seton  was 
passed  through  the  seat  of  fracture,  and  retained  for  five  weeks 
without  any  benefit.  On  the  20th  of  May  he  proceeded  home- 
wards, and,  after  a  long  voyage  of  nearly  two  months,  arrived 
at  Portsmouth,  whence  he  was  transferred  to  Chatham  on  the 
17th  of  July.  No  attempt  to  restore  rigidity  was  made  there, 
and  at  the  end  of  two  months  he  was  dismissed  the  service,  with 
a  pension  of  one  shilling  per  day,  in  consideration  of  his  disabil- 
ity, which  was  regarded  as  equal  to  the  loss  of  a  limb. 

"In  the  hope  that  relief  might  still  be  afforded,  he  applied  to 
me  on  the  22nd  of  January  last,  nearly  fourteen  months  from 
the  date  of  the  injury ;  and  finding  that  the  arm  was  entirely 
useless  through  the  extreme  mobility  of  the  ends  of  the  bone, 
which  overlapped  each  other  to  the  extent  of  more  than  an  inch, 


1858.]      Reproduction  of  Bones  and  Joints  in  Whitlow.  279 

I  resolved  to  adopt  the  only  procedure  that,  in  my  opinion, 
afforded  any  reasonable  prospect  of  remedy  under  such  circum- 
stances, which  was  to  remove  the  ends  of  the  bone,  and  after- 
wards maintain  the  most  perfect  rest.  In  preventing  the  motion 
of  a  joint,  it  is  a  most  important  principle,  never  to  be  forgotterj, 
that  as  most  of  the  muscles  pass  over  two  articulations,  it  is  im- 
possible to  keep  any  one  perfectly  quiet  without  placing  the 
whole  limb  under  restraint.  Proceeding  under  this  impression, 
my  first  step  was  to  have  the  arm  put  in  an  easy  position,  with 
the  elbow  bent  at  a  right  angle,  and  then  covered  from  beyond 
the  shoulder  to  the  tips  of  the  fingers  with  pasteboard  and 
starched  bandages,  so  as  to  form  a  case,  which,  when  it  became 
dry,  effectually  prevented  the  slightest  movement  in  any  of  the 
joints.  This  case  was  next  cut  up  on  one  side  from  end  to  end, 
so  as  to  allow  the  arm  to  be  taken  out  of  it,  and  undergo  the 
requisite  operation,  which  was  performed  under  chloroform. 
An  incision  having  been  made  along  the  outer  edge  of  the  tri- 
ceps, I  exposed  the  upper  end  of  the  bone,  and  sawed  off  a 
portion  of  it  sufficient  for  obtaining  a  complete  osseous  surface. 
The  lower  end,  lying  anterior  to  the  shaft  in  a  sort  of  capsule, 
could  not  be  subjected  to  the  saw,  but  was  removed,  to  the  ex- 
tent of  more  than  an  inch,  by  cutting  pliers.  The  arm  was 
then  supported  by  a  couple  of  splints,  and  the  patient  lay  quietly 
in  bed  for  a  fortnight,  when  the  limb  was  placed  in  its  paste- 
board case,  in  which  an  aperture  had  been  made  over  the  wound 
then  nearly  healed,  and  discharging  a  very  little  matter,  that 
soon  ceased  entirely.  The  patient,  feeling  that  the  slightest 
motion  was  impossible,  even  if  he  had  wished  it,  was  relieved 
from  any  further  restraint,  and  no  longer  remained  in  bed.  At 
the  end  of  a  month,  or  altogether  six  weeks  from  the  date  of  the 
operation,  which  was  performed  on  the  30th  Jannary,  the  limb 
was  examined,  and  found  to  be  quite  straight,  with  a  firm  osse- 
ous union ;  so  that  the  patient  was  able  to  leave  the  hospital, 
not  only  with  his  comfortable  pension,  but  also  with  a  perfectly 
useful  arm." — [Edinburgh  Med.  Jour.,  and  Ibid. 


Reproduction  of  Bones  and  Joints  after  their  Removal  in  cases  of 
Whitlow. 

Some  time  ago  Dr.  Toland,  of  California,  claimed  the  discove" 
ry  of  this  important  fact  in  surgery.  In  the  February  number* 
1858,  of  the  Buffalo  Medical  Journal,  we  find,  however,  that  to 
Professor  Dudley,  of  Lexington,  Kentncky,  is  due  the  credit  of 
having  made  the  discovery,  and  to  Professor  Hamilton,  of  Buf- 
falo, N.  Y.,  is  due  the  credit  of  having  first  promulgated  the  idea 
through  the  medium  of  the  medical  journals.  Doubtless  we 
shall  soon  have  some  more  discoverers  in  the  field.  But  this  is 
all  right.    We  say,  "  honor  to  whom  honor  is  due." 


280  Case  of  Transfusion.  [April, 

During  five  years  practice  in  the  country,  it  was  our  lot  to 
encounter  a  great  number  of  these  cases  of  paronychia  among 
the  plantation  negroes.  Indeed,  strange  as  the  idea  may  seem 
to  some,  we  are  sure  of  having  witnessed  the  disease  once  in  an 
epidemic  form.  Throughout  an  entire  neighborhood  the  disease 
was  strictly  prevalent,  and  we  can  now  call  to  mind  several  ne- 
groes who  lost  the  first  phalanx  of  two  or  more  fingers  in  one 
season.  Of  course  the  vast  majority  of  the  cases  lost  the  first 
phalanx,  as  every  overseer  and  old  woman  in  the  country  ima- 
gine themselves  fully  competent  to  treat,  or  rather  cure  whitlow 
or  bone  felon.  When  the  doctor  is  called  in,  the  bone  is  loosen- 
ed from  its  attachments,  and  he  has  no  alternative  but  to  remove 
it.  When  we  first  encountered  the  cases,  such  was  the  degree 
of  the  disease  of  the  surrounding  tissues,  we  amputated  the  end 
of  the  finger ;  but  observation  soon  taught  us  that  this  proce- 
dure materially  diminished  the  value  of  the  cotton-picker,  as  the 
finger  was  not  only  considerably  shortened,  but  the  stump,  un- 
protected by  the  nail,  was  continually  subject  to  injury.  We 
then  resorted  to  the  plan  of  picking  out  the  dead  bone,  and  the 
only  deterioration  the  hand  suffered  was  comparatively  slight 
shortening  of  the  finger.  In  no  instance  have  we  ever  seen  any 
thing  approaching  reproduction  of  the  bone — and  this  notwith- 
standing we  have  carefully  supported  the  finger  by  means  of 
splints  and  bandages. — \N.  Orleans  Med.  News  and  Hosp.  Gaz. 


On  a  Case  of  Transfusion,     By  John  Wheatcroft,  Esq.,  M.  R. 
C.  S,  L  .S.  A.,  Cannock. 

In  the  Lancet  of  October,  there  appeared  a  case  of  transfusion 
of  blood,  which  operation  I  again  performed  successfully  on  the 
25th  inst.     The  following  are  the  particulars  : — 

I  was  summoned  to  see  Mrs. ,  aged  thirty-two,  on  the  24th 

instant.  I  found  her  in  an  almost  exsanguined  condition.  A  ter- 
rible gush  of  blood  per  vaginam  had  suddenly  occurred,  followed 
by  coagula  two  or  three  pounds  in  weight.  Her  neighbors  with 
difficulty  got  her  up  stairs,  and  again  haemorrhage  set  in  frightful- 
ly. I  found  her  lying  on  the  bed  in  a  state  of  great  exhaustion ; 
face  white  and  anxious  ;  lips  blanched  ;  skin  and  extremities  cold ; 
pulse  small,  very  feeble,  and  rapid,  120  per  minute. 

I  immediately  plugged  the  vagina,  administered  the  yolk  of 
egg  with  a  little  brandy,  enjoining  upon  the  attendant  strict  at- 
tention to  the  ordinary  methods  adopted  in  uterine  haemorrhage. 
On  visiting  the  case  four  hours  afterwards,  I  found  the  plug  right, 
and  the  bleeding  had  been  arrested ;  a  little  more  colour  in  the 
lips;  the  pulse  100,  but  small  and  thready;  complained  much  of 
giddiness  and  severe  uterine  pain:  she  was  three  months  ad  van- 


1858.]  Pulmonary  and  Bronchial  Tuberculosis.  281 

ced  in  pregnancy.  I  then  gave  her  small  doses  of  tincture  of 
opium,  but  vomiting  having  supervened,  every  dose,  together 
with  the  egg,  was  rejected.  Small  doses  of  sulphuric  ether  arrest- 
ed the  sickness.  I  left  her,  apparently  going  on  favorably,  but  in 
four  hours  was  again  hastily  summoned.  She  had  complained  of 
severe  expulsive  pain,  violent  retching  accompanied  it,  and  ex- 
pelled the  plug,  together  with  a  large  coagulum ;  the  flooding  re- 
commenced, and  I  found  her  lying  in  a  large  pool  of  blood.  I 
could  detect  no  foetus  either  in  the  bed  or  the  vigina  ;  the  os  uteri 
was  too  high  to  be  reached ;  the  skin  and  extremities  had  again 
become  cold,  the  surface  of  the  body  as  white  as  snow ;  pulse 
almost  imperceptible  ;  the  breathing  gasping ;  face  very  anxious  ; 
great  restlessness  ;  loss  of  vision  ;  eyes  sunk  and  leaden. 

Ably  assisted  by  J.  Blackford,  Esq.,  and  Mr.  Samuel  Wheat- 
croft,  I  transmitted  about  two  pounds  of  blood  from  the  husband. 
The  change  was  immediate  (I  had  previously  replugged  the  va- 
gina;) the  colour  returned  to  her  lips,  the  eye  became  brilliant, 
the  pulse  distinct  and  firm,  the  restlessness  vanished,  the  breathing 
became  normal,  and  she  now  looks,  with  the  exception  of  her 
whitened  skin,  as  well  as  I  ever  saw  her.  Although  complaining 
of  giddiness  and  tightness  across  the  brow,  she  is  quite  cheerful. 
The  fetus  has  not  been  expelled.  I  have  removed  the  plug,  and 
there  is  not  a  drop  of  blood  to  be  seen.  The  plug  here  was  as 
valuable  as  the  transfusion. 

Permit  me  to  suggest  the  trial  of  this  operation  in  the  last  stage 
of  low  typhus  and  the  colapse  of  Asiatic  cholera  when  every  other 
means  have  failed. — [London  Lancet. 


Pulmonary  and  Bronchial  Tuberculosis. 

Every  physician  acquainted  with  the  methods  of  physical 
exploration — and  we  readily  believe  every  one  is  now-a-days — 
ought  to  know,  that  tuberculosis  is  not  at  all  uncommon  in  chil- 
dren. The  symptoms  are  generally  known  ;  the  prognosis  not 
so  unfavorable  as  in  adults.  This  statement  is  affirmed  by  Dr. 
J.  Schwartz,  of  Berlin,  who  reports  to  have  repeatedly  succeed- 
ed, by  careful  regulations  as  to  their  diet,  and  some  well-adapted 
pharmaceutical  remedies,  in  restoring  to  health  children  of  from 
two  to  five  years,  who  were  already  considerably  emaciated, 
and  subject  to  hectic  fever.  Against  the  attack  of  hectic  fever 
he  warmly  recommended,  as  Skoda  did  before  him,  the  sulphate 
of  quinine,  with  small  doses  of  Dover's  powder.  Besides,  he 
gives  cod-liver  oil  and  armara,  which  he  says  are  too  little  thought 
of  in  our  time,  and  have  been  too  readily  forgotten. — [Journal 
fur  Kinderkrankheiten)  and  N.  Y.  Jour,  of  Med. 


282  Editorial.  [April, 


EDITORIAL  AND  MISCELLANEOUS. 

Medical  College  of  Georgia — Appointment  of  Professor  Joseph 
Jones. — The  Chair  of  Chemistry  and  Pharmacy  in  the  Medical  College 
of  Georgia,  recently  vacated  by  the  resignation  of  Professor  Means,  has 
been  promptly  filled  by  the  unanimous  election  of  Dr.  Joseph  Jones, 
Professor  of  Chemistry  and  Physics  in  the  University  of  Georgia, 
and  formerly,  Professor  of  Medical  Chemistry  in  Savannah  Medical 
College. 

Dr.  Jones  has  for  years,  most  ardently  devoted  himself  to  original  Che- 
mical and  Physiological  Investigations.  His  labors  have  been  crowned 
with  such  brilliant  success,  that  to  praise  them,  on  the  present  occasion, 
could  not  certainly  add  to  their  universally  acknowledged  merit.  His 
contributions  to  Chemical  and  Physiological  Science  have  been  present- 
ed to  the  Profession  in  papers  bearing  the  following  titles : 

1st.  Abs+ract  of  Experiments  upon  the  Physical  Influences  exerted  by 
Living,  organic  and  inorganic,  Membranes  upon  Chemical  Sub- 
stances passing  through  them  by  Endosmose.  Read  before  the 
Academy  of  Natural  Sciences,  Philadelphia,  October  25th,  1854. 
[Accompanied  by  lithographic  illustrations  from  original  drawings 
by  the  author,  from  appearances  under  the  microscope.] 

2nd.  Observations  upon  the  Kidney  and  its  Excretions  in  different  ani- 
mals. Published  April,  1855,  in  the  American  Journal  of  Medical 
Sciences.     [With  twenty  wood  cut  illustrations.]     Pp.  42,  8vo. 

3rd.  The  Digestion  of  Albumen  and  Flesh,  and  the  Comparative  Anato- 
my and  Physiology  of  the  Pancreas.  Published  in  the  Medical 
Examiner,  Philadelphia,  May,  1856.     Pp.  20,  8vo. 

4th.  Physical,  Chemical,  and  Physiological  Investigations  upon  the  Vital 
Phenomena,  Structure  and  Offices  of  the  Solids  and  Fluids  of  Ani- 
mals. Published  in  the  American  Journal  of  Medical  Sciences, 
Philadelphia,  July,  1856.     Pp.  64,  8vo. 

5th.  Investigations  Chemical  and  Physiological,  relative  to  certain  Amer- 
ican Vertebrata.  Referred  by  the  Smithsonian  Institute  to  Profes- 
sor Samuel  Jackson,  Professor  Joseph  Leidy,  and  Professor  Jeffries 
Wyman,  with  Professor  Joseph  Henry,  Secretary  of  the  Institute, 
as  Commissioners ;  accepted  by  them  March,  1856,  and  subse- 
quently published  by  the  Smithsonian  Institute.  4to.,  pp.  137. 
[This  work  is  embellished  with  27  wood  cut  illustrations.  It  was 
published  and  distributed  at  the  expense  of  the  Institute.] 

Prof.  Jones  is  a  native  of  Liberty  county,  Georgia.  He  relinquishes 
his  chair  in  Athens,  where  his  relations  have  been  of  the  most  agreeable 


1858.]  Editorial  283 

and  encouraging  character,  for  the  sole  purposes,  as  he  states,  of  devoting 
himself  more  entirely,  than  he  can  at  present,  to  Medical  Science  in  its 
Chemical  and  Physiological  departments,  and  with  the  view  of  assisting 
in  elevating  the  standard  of  Medical  attainment  at  the  South.  He  will 
make  Augusta  his  place  of  residence,  and  his  course  will  be  eminently 
practical  and  instructive,  especially  in  the  important  departments  of 
Medical,  Physiological  and  Pathological  Chemistry. 

In  the  next  number  of  this  Journal,  we  shall  present  to  our  readers 
an  elaborate  and  most  valuable  contribution  from  his  pen,  on  the 
subject  of  the  Chemical  and  Physiological  Relations  of  the  Blood  to 
Diabetes.  As  Editors,  we  congratulate  our  readers  and  ourselves,  on  so 
valuable  an  accession  to  our  corps  of  contributors. 


American  Medical  Association. — The  eleventh  Annual  Meeting  of 
the  American  Medical  Association,  will  be  held  in  Washington  City,  on 
Tuesday,  the  4th  day  of  May,  1858. 

The  American  Medical  Association  has,  for  years,  ceased  to  be  an  ex- 
periment ;  its  wise  deliberations,  its  judicious  suggestions  for  the  advance- 
ment of  medical  science,  and  for  the  improvement  of  medical  education 
and  medical  ethics,  have  fully  vindicated  its  right  to  be  considered,  the 
highest  and  most  authoritative  tribunal,  in  the  medical  sciences,  in  the 
land.  The  time  is  past,  when  it  may  be  doubted  that  its  efforts  have 
wrought  an  improvement  in  the  status  of  the  profession ;  there  are  too 
many  evidences  of  the  diligent  investigation  and  research,  of  independent 
experimentation,  directly  growing  out  of  the  spirit  which  this  body  has 
infused,  for  it  to  be  longer  doubted,  that  it  has  done  much  good.  No 
one  will  hesitate  to  admit,  that  since  its  establishment,  American  medi- 
cine has  assumed  a  form,  and  presents  a  character  of  its  own  and  a  spirit 
of  its  own,  highly  progressive,  energetic — indeed,  American.  Not  only  is 
this  change  witnessed  at  home,  but  is  observed  elsewhere.  The  valuable 
Transactions  of  this  Association  are  distributed  everywhere,  and  may  be 
now  found  in  the  Libraries  of  the  Scientific  Institutions,  throughout 
Europe.  It  is  important  then,  that  this  body  should,  in  its  present 
dignified  position,  use  great  care  and  judgment  in  its  deliberations. 
There  are  many  important  questions  to  come  up  before  them  at 
Washington — some  of  these  are  vitally  connected  with  the  interests 
of  the  Profession.  We  have  not  time  nor  space  at  present,  however, 
to  present  any  of  these  subjects  properly,  and  therefore  close  our 
remarks  with  the  confident  hope  that  all  questions  will  be  discussed 
and  determined  in  the  best  and  wisest  manner  for  the  general  good  of 
the  Profession. 

•  11* 


284 


Editorial. 


[April, 


Medical  College  of  Georgia — Annual  Commencement. — The  un- 
diminished prosperity  of  the  Medical  College  of  Georgia,  even  under 
the  multiplication  of  institutions  throughout  the  country,  we  are  sure, 
must  be  a  subject  of  great  satisfaction  to  its  many  friends  and  alumni, 
and  also  to  those  engaged  in  a  liberal  competition  in  the  same  field.  At 
the  last  Commencement,  the  degree  of  Doctor  of  Medicine  was  conferred 
on  sixty-one  candidates,  whose  names  we  take  pleasure  in  here  recording : 


Toliver  Dillard, 

of 

Georgia. 

J.  H.  Ruddell, 

oi 

'  Georgia. 

Henry  Kinnebrew, 

u 

tt 

L.  C.  Wisdom, 

tt 

tt 

J.  J.  Denson, 

it 

tt 

Wm.  Hadden, 

tt 

tt 

A.  G.  V.  Doney, 

u 

tt 

R.  B.  McRee, 

tt 

tt 

A.  H.  Mathers, 

a 

Florida. 

W.  A.  Childress, 

tt 

u 

R.  J.  Healey, 

<t 

Alabama. 

J.  Y.  Bradfield, 

tt 

tt 

S.  M.  Simmons, 

u 

Georgia. 

P.  L.  Blakely, 

tt 

S.Carolina. 

Wm.  J.  Colley, 

ft 

tt 

G.  W.  Chisholm, 

tt 

Georgia. 

J.  W.  Lowman, 

ft 

S.  Carolina. 

G.  W.  Pitts, 

tt 

tt 

A.  H.  Read, 

u 

Alabama. 

H.  W.  Culver, 

it 

Alabama. 

R.  C.  Johnson, 

tt 

Georgia. 

E.  G.  Scruggs, 

tt 

Georgia. 

A.  J.  Speer, 

tt 

S.  Carolina. 

R.  M.  Hitch, 

tt 

tt 

J.  L.  Rucker, 

it 

Georgia. 

J.  B.  Harvley, 

u 

S.Carolina. 

A.  J.  Flowers, 

it 

tt 

J.  R.  McAfee, 

tt 

Georgia. 

"W.  R.  Armor, 

ii 

tt 

J.  F.  Donehoo, 

tt 

tt 

T.  A.  Raines, 

(i 

tt 

H.  C.  Edmunds, 

N 

S.Carolina. 

J.  T.  Sego, 

ii 

tt 

J.  H.  Gibson, 

it 

Florida. 

A.  A.  Delaigle, 

ii 

tt 

E.  G.  Kirkland, 

ft 

Georgia. 

S.  B.  Mills, 

ii 

tt 

B.  S.  Hudson, 

ii 

tt 

J.  W.  Rhodes, 

u 

tt 

J.  F.  Martin, 

if 

tt 

A.  T.  Jenkins, 

ii 

tt 

John  Herren, 

it 

Alabama. 

B.  F.  Stanley, 

ii' 

tt 

J.  M.  Howell, 

ii 

Georgia. 

S.  W.  Gardner. 

a 

Mississippi. 

J.  S.  Smith, 

it 

S.Carolina. 

Wensley  Hobby, 

it 

Georgia. 

J.  W.  Traylor, 

it 

tt 

J.  S.  W.  Johnson, 

it 

tt 

Solomon  Newson, 

ii 

Georgia. 

J.  R.  Cox, 

ii 

tt 

M.  R.  Cassaday, 

it 

Alabama. 

T.  A.  Power, 

it 

S.Carolina. 

T.  0.  Powell, 

ii 

Georgia. 

G.  W.  Coxwell, 

it 

Alabama. 

S.  A.  Tomkins, 

it 

S.Carolina. 

Patrick  Todd, 

it 

S.  Carolina. 

F.  A.  Driver, 

ti 

Alabama. 

W.  B.  Reynolds, 

it 

Georgia. 

J.  D.  Patten, 

ii 

S.Carolina. 

J.  S.  Johnson, 

tt 

Alabama. 

R.  M.  Tindall,  M.D.,  of  Mississippi,  a  graduate  of  Memphis  Medical 
College,  was  also  admitted  adeundem  gradum  by  the  Board  of  Trustees. 


Savannah  Journal  of  Medicine. — We  have  just  received  the  Pros- 
pectus of  the  above  new  Journal.  It  will  be  published  bi-monthly,  in 
Savannah,  and  Edited  by  Juriah  Harriss,  M.  D.,  Professor  of  Physiology 
in  Savannah  Medical  College,  and  J.  S.  Sullivan,  M.  D. — with  R.  D.  Ar- 
nold, M.D.,  Professor  of  Principles  and  Practice  of  Medicine  in  Savannah 


1858.]  Editorial  285 

Medical  College,  as  associate  Editor.  We  wish  for  this  Journal  in  pros- 
pectu,  a  safe  and  speedy  birth,  and  from  the  character  and  ability  of  its 
Editorial  corps  we  may  hope  for  it  a  successful  career.  We  will  present 
our  readers  with  a  more  extended  notice  when  we  have  seen  the  first 
number,  and  we  will  be  happy  to  place  it  upon  our  exchange  list. 


A  Syllabus  of  Lectures  on  Materia  Medica  :  delivered  at  Atlanta  Medical 
College,  by  J.  G.  Westmoreland,  M.  D.,  Professor  of  Materia  Medica, 
&c,  in  that  Institution. 

We  have  received,  through  the  courtesy  of  the  author,  the  above  vol- 
ume. It  is  creditably  gotten  up,  and  presents  a  compendious  resume  of 
the  author's  Lectures,  and  will  doubtless  be  found  of  much  assistance  to 
those  attending  Lectures  in  the  Atlanta  Medical  College. 


Medical  Society  of  the  State  op  Georgia. — The  next  annual 
meeting  of  our  State  Medical  Society  will  be  held  at  Madison,  on  the 
second  Wednesday  in  April. 

We  quote  the  following  from  the  minutes  of  the  last  meeting,  held  in 
this  place,  in  order  to  remind  the  several  Essayists  of  their  respective  ap- 
pointments : — 

"The  Committee  on  Essays,  made  the  following  report  of  Subjects  and 
Essayists  for  the  next  meeting — which  was  received  and  adopted. 

Dr.  J.  G.  Howard,  of  Savannah — On  Uterine  Disease. 

Dr.  E.  J.  Roach,  of  Pulaski — On  the  Propriety  of  Surgical  Operations 
about  the  Joints. 

Dr.  H.  F.  Campbell,  of  Augusta — On  the  Rectal  Administration  of  Medi- 
cine. 

Dr.  J.  M.  Green — On  the  Value  of  Escharotics  in  the  Treatment  of  Cancer. 

Dr.  R.  D.  Arnold,  of  Savannah — On  the  Pathology  and  Treatment  of  Yel- 
low Fever. 

Dr.  Ira  E.  Dupree,  of  Twiggs — On  the  Treatment  of  Prolapsus. 

Dr.  Eben.  Hillyer,  of  Atlanta — On  the  Physiology  of  Menstruation. 

Dr.  V.  H.  Taliaferro,  of  Atlanta — On  Obstetrical  Surgery. 

Dr.  X.  F.  Powers,  of  Thomson — On  Diseases  of  the  Skin. 

Dr.  W.  S.  Meire,  of  Madison — On  the  Use  of  Alcohol  in  Typhoid  Fever. 

Dr.  R.  Campbell,  of  Augusta — On  Wounds  of  the  Abdomen. 

Dr.  I.  P.  Garvin,  of  Augusta — On  Nervous  Irritation  of  the  Stomach. 

Voluntary  Communications  from  any  member  of  the  Society  are  earn- 
estly requested,  and  will  be  gratefully  received." 

We  sincerely  hope  there  will  be  a  full  attendance,  and  that  the  con- 
tributions, both  by  appointment  and  voluntary,  will  exceed  those  of  any 
previous  meeting. 


286  Editorial  [April, 

Our  Exchanges. — Editorial  Changes,  Fusions,  Enlargements,  &c, 
<fec. — We  are  much  gratified  to  see  that  there  has  been  great  improve- 
ment in  the  character,  style  and  spirit  of  our  exchanges  generally, 
American  Medical  journalizing,  we  may  indeed  feel  proud  of.  There  is 
manifested  on  the  part  of  contributors,  much  improvement  in  the  way  of 
research  and  independent  investigation ;  and  also  on  the  part  of  Editors, 
great  industry,  discrimination  and  courtesy ;  each  to  a  degree,  we  think 
we  may  safely  say,  with  few  exceptions,  unsurpassed  by  any  period  during 
the  last  ten  years.  We  sincerely  regret,  that  the  suggestion  made  some 
years  ago  by  our  able  predecessor,  Prof.  L.  A.  Dugas,  of  some  periodical 
work  annually  or  semi-annually,  embodying  the  contributions  of  American 
Physicians,  has  not  been  more  fully  carried  out.  A  work  entirely  and 
strictly  devoted  to  this  object  would  be  of  great  value  to  the  readers  and 
writers  of  this  country,  and  would  greatly  enhance  the  credit  and  repu- 
tation of  American  writers  among  their  brethren  in  Europe.  The  Ameri- 
can Journal  of  the  Medical  Sciences  (of  which  we  present  no  distinct 
notice  at  this  time),  has  for  years,  with  great  fairness,  presented  a  careful 
abstract  of  all  American  contributions  which  the  editors  deemed  worthy 
of  record ;  but  we  conceive  that  the  republication  of  entire  articles,  which 
could  only  be  done  in  a  work  devoted  to  the  purpose,  would  better  com- 
pass the  above  object,  than  any  other  plan  which  could  be  adopted. 

The  North  American  Medico-Chirurgical  Review. — This  excellent 
Bi-monthly  comes  to  us  in  an  improved  dress.  The  January  number, 
which  contains  over  two  hundred  pages,  presents  many  valuable  Reviews, 
Criticisms  and  Analyses  of  works,  besides  much  valuable  original  matter. 
In  the  Report  of  their  able  collaborator,  Prof.  S.  Weir  Mitchell,  on  the 
Progress  of  Physiology  and  Anatomy,  we  find  that  a  new  feature  is  intro- 
duced, which  will  enhance  the  value  of  the  journal.  "  It  is  proposed," 
says  the  reporter,  "  in  future,  to  present  once  a  year,  a  complete  analyti- 
cal Review  of  the  general  progress  of  Physiology  and  Anatomy.  At  the 
same  time,  and  as  an  essential  part  of  this  task,  we  shall  endeavor  to 
point  out  with  care  whatever  advances  in  these  sciences  are  due  to  the 
annually  increasing  labors  of  our  own  countrymen."  We  have  been 
not  a  little  surprised,  that  so  discriminating  a  reporter  as  Dr.  Mitchell 
should  have  been  content  with  only  a  frequent  reference,  to  the  articles 
of  Professor  Joseph  Jones,  of  Georgia,  and  that  he  did  not  embody  a 
full  abstract  of  his  views  and  results ;  for  his,  have  certainly  been  the 
most  elaborate,  thorough  and  creditable  experimental  investigations 
into  the  chemical  changes  of  the  blood  and  other  fluids  of  animals,  which 
have  ever  been  presented,  so  far  as  we  are  aware  of,  by  any  American 
Physiologist.     It  may  be  said,  however,  that  it  is  probable  that  their 


1858.]  Editorial.  287 

great  bulk  and  the  permanent  form  in  which  these  have  been  published 
by  the  Smithsonian  Institute,  rendered  their  presentation  in  the  present 
report,  a  matter  both  of  great  labor  and  at  the  same  time  a  work  of 
super  errogati  on. 

We  are  much  gratified  at  the  favorable  notice  taken  of  Dr.  W.  A. 
Hammond's  laborious  and  almost  self-immolating  investigations  on  the 
"  Nutritive  Value  and  Physiological  Effects  of  Starch,  Gum  and  Albu- 
men," as  presented  in  his  Prize  Essay  before  the  last  meeting  of  the 
American  Medical  Association.  And  lastly,  we  may  be  here  allowed  also 
to  express  our  gratification  at  the  manner  in  which  he  has  been  pleased 
to  allude  to  our  own  humble  labors. 

We  take  great  pleasure  in  commending  the  above  Bi-monthly  Review 
to  the  favorable  consideration  of  our  readers,  for  its  able  review  articles, 
for  its  analyses,  and  for  other  valuable  matter,  more  particularly  suited 
to  this  more  permanent  form  of  periodical  medical  literature. 

The  Charleston  Medical  Journal  and  Review. — This  valued  ex- 
change, has  recently  passed  from  the  hands  of  its  former  able  Editor, 
Dr.  C.  Hapholdt,  and  will  hereafter  be  edited  by  J.  Dickson  Brims, 
M.  D.  Dr.  Bruns  is  most  favorably  known  to  the  Profession  as  the  au- 
thor of  a  most  interesting  and  able  pamphlet,  entitled,  "  Life  ;  its  Rela- 
tions, Animal  and  Mental."  We  congratulate  the  readers  of  this  Journal 
upon  his  accession  to  the  chair  Editorial.     It  is  published  by-monthly. 

The  Nashville  Journal  of  Medicine  and  Surgery. — Professor  Paul 
F.  Eve  has  retired,  and  Professor  W.  K.  Bowling  has  associated  with  him 
in  the  Editorial  conduct  of  this  valuable  work,  Drs.  R.  C.  Foster  and 
George  S.  Blackie,  as  assistants.  WTe  heartily  wish  our  friend,  Dr.  Eve, 
all  the  otium  cum  dignitate  of  retirement,  and  welcome  the  other  dis- 
tinguished gentlemen  most  cordially  into  the  body  Editorial.  We  con- 
gratulate Dr.  Bowling  that  he. still  finds  pleasure  and  satisfaction  in  his 
literary  labors,  and  ourselves,  that  we  still  find  him  among  our  confreres. 

The  American  Medical  Monthly,  published  in  New  York,  and  The 
American  Medical  Gazette,  also  published  in  New  York,  have,  like  our 
own  Journal,  been  benefitted  by  an  addition  to  the  number  of  their  pages, 
without  any  change  of  Editors. 

The  Cincinnati  Medical  Observer  and  The  Western  Lancet  have 
united  under  the  title  of  "  Cincinnati  Lancet  and  Observer."  The  present 
work  will  be  edited  by  Prof.  George  Mendenhall,  John  A.  Murphy,  M.  D., 
and  Edward  B.  Stephens,  M.  D.  Drs.  Blackmail  and  Lawson,  both  able 
journalists,  have  withdrawn,  but  there  can  be  no  doubt,  that  the  present 
work  will  be  ably  sustained  by  their  successors. 


288  Editorial  [April, 

The  Peninsular  Journal  of  Medicine  and  The  Medical  Independ- 
ent, both  published  at  Detroit,  Michigan,  have  effected  a  happy  union. 
The  Independent  was  sustained  for  one  year  by  our  friends,  Prof.  Moses 
Gunn  and  L.  G.  Robinson,  M.  D.,  and  now  becomes  amicably  incorpora- 
ted with  its  competitor,  under  the  comprehensive  title  of  "  The  Peninsu- 
lar and  Independent  Medical  Journal.'1''  May  this  friendly  adjustment 
of  their  mutual  difficulties  serve  to  inspire  the  Peninsular,  with  a  spirit 
of  amiability  and  liberality  towards  its  more  distant  confreres,  and  may 
the  ink  "spilt"  in  the  former  contests  of  these  two  journals,  serve,  like 
the  blood  of  Patriots,  to  cement  more  firmly  their  present  union.  This 
is  but  "  the  expression  of  a  pious  wish."  We  regret  that  Professor  Zina 
Pitcher,  the  late  distinguished  President  of  the  American  Medical  Asso- 
ciation, is  no  longer  in  this  corps  of  editors ;  we  hope  that  his  retirement 
may  be  as  happy,  as  his  editorial  life  has  been  courteous,  dignified  and 
useful. 

The  New  Orleans  Medical  News  and  Hospital  Gazette,  one  of  our 
most  valuable  exchanges,  has  undergone  a  change  of  Editors,  and  is  now 
under  the  management  of  Profs.  D.  Warren  Brickell  and  E.  D.  Fenner. 
This  journal,  from  its  commencement,  has  been  most  ably  conducted, 
and  the  recent  association  of  our  excellent  friend,  the  veteran  Fenner,  in 
its  Editorial  conduct,  augurs  well  for  its  future  success.  Dr.  Fenner  has 
the  credit  of  having  been  the  first  to  establish  a  Medical  Periodical  in 
New  Orleans.  The  several  volumes  of  his  "  Southern  Medical  Reports," 
are  most  useful  contributions  to  Medical  Science,  as  well  as  enduring 
monuments  of  the  pel  severing  industry  and  great  ability  of  their  author. 

The  New  Orleans  Medical  and  Surgical  Journal. — This  excellent 
Bi-monthly  Journal  and  Review  still  maintains  its  high  position  in  the 
comparative  estimation  of  our  exchanges.  The  work  has  passed  into 
the  hands  of  Drs.  W.  Stone,  J.  Jones,  and  S.  Chaille,  who  have  also  be- 
come assistant  Editors,  while  Dr.  Bennett  Dowler  still  retains  the  posi- 
tion of  Editor-in-chief. 

The  Memphis  Medical  Recorder. — We  have  on  a  former  occasion 
noticed  the  resignation  of  Prof.  A.  P.  Merrill  from  the  Editorship  of  this 
journal,  and  also  at  that  time  signified  our  great  satisfaction  with  the 
appointment  of  our  friend,  Professor  Daniel  F.  Wright,  to  that  position. 
Whatever  may  be  the  future  changes  and  improvements  in  this  highly 
useful  and  creditable  work,  we  here  earnestly  express  the  wish  that  he 
may  still  wield  a  pen  for  its  pages,  and  long  remain  as  now,  our  valued 
and  courteous  confrere; 


1858.]  Editorial  and  Miscellaneous.  289 

The  Southern-  Journal  of  the  Medical  and  Physical  Sciences. — 
The  Editor  of  this  Journal,  Professor  EL  0.  Curiy,  of  Knoxville,  Term., 
who  has  ably  sustained  the  work  for  several  years,  suggests  certain 
changes  in  its  arrangement  and  management,  which  will  be  doubtless 
beneficial  to  himself  and  to  the  journal.  As  the  work  has  as  yet  under- 
gone no  change,  we  defer,  till  some  other  number,  a  more  extended 
notice  of  it. 

The  Medical  and  Surgical  Reporter. — TTe  have  just  seen,  in  the 
Boston  Medical  and  Surgical  Journal  of  March  25th,  that  "  the  Reporter 
is  about  to  be  removed  from  Burlington,  X.  J.,  to  Philadelphia,  and  that 
Dr.  "William  B.  Atkinson,  of  the  latter  city,  who  has  for  some  time  past 
been  a  regular  contributor  to  its  pages,  will  be  associated  with  Dr.  Butler 
in  its  editorial  management."  We  think,  too,  that  Philadelphia  presents 
a  good  opening  for  a  monthly  journal.  The  Reporter  has  ever  been  an 
agreeable  visitor  with  us,  and  whether  it  comes  from  Burlington  or  from 
Philadelphia,  we  shall  greet  it  with  the  same  welcome. 

There  have  occurred  doubtless  other  changes  in  our  exchanges,  which 
we  at  present  omit  from  their  having  escaped  our  notice — as  thev  occur 
to  us,  we  will  take  great  pleasure  in  recording  them. 


Forensic  Medicine. — M.  Collongues,  in  a  note  presented  to  the  Acade- 
miedes  Sciences  {Comptes  Rendus,  21st  Dec.  1857,  p.  1048),  points  out 
the  usefulness  of  knowing  whether  there  is  a  peculiar  sound  or  not  to  be 
found  if  death  exists.  He  has  already  announced  that  during  life  there 
is  in  all  the  parts  of  the  body  a  peculiar  sound,  which  may  be  heard 
easily  by  the  application  of  the  ear,  or  with  the  help  of  averv  small 
stethoscope.  This  sound  disappears  after  death,  but  not  immediatelv. 
It  may  last  five,  ten,  and  even  fifteen  hours  after  the  last  beating  of  the 
heart.  It  disappears  gradually,  and  according  to  the  author,  its  com- 
plete absence  from  all  the  superficial  parts  of  the  body,  is  a  positive  si^n 
of  death.  In  an  amputated  limb  it  persists  a  few  minutes. — [Nem  York 
Journal  of  Medicine. 


Fistula  in  Ano  in  Relation  to  Pulmonary  Tuberculosis.  Bv  P.  H. 
Strong,  M.  D. — Dr.  Strong  embodies  in  the  following  formula  the  doc- 
trine generally  held  with  regard  to  this  subject : 

M  The  relations  of  fistula  in  ano  to  pulmonary  tuberculosis  are  such, 
that  its  presence,  either  as  antecedent  to  or  coexistent  with  the  latter,  is 
a  desideratum,  and  to  be  sedulously  cherished,  having  reference  to  its 
(pulmonary  tuberculosis)  prevention  in  the  one  case,  and  to  its  cure  or 
favorable  modification  in  the  other." 

Dr.  Strong  argues  against  the  correctness  of  this  doctrine,  first,  that  it 
is  based  mainly  on  the  belief  of  a  revellant  influence  being  exerted  by 
the  fistula,  while  an  enlightened  pathology  and  clinical  observation  teach 


290  Miscellaneous. 

that  such  an  influence  is  of  little  or  no  value  in  preventing:  or  retarding 
the  progress  of  pulmonary  tuberculosis ;  second,  other  and  "kindred  affec- 
tions,  scirrhus  aud  melanosis,  depending  alike  on  a  blood  dyscracy,  are 
not  affected  generally  by  revellent  or  derivant  discharges ;  third,  the 
doctrine  originated  when  erroneous  views  prevailed  respecting  the  causes, 
nature,  and  management  of  tubercular  affections. 

Conceding  that  tubercular  matter  is  discharged,  as  it  were  vicariously, 
by  means  of  the  fistula,  he  contends  that  the  proper  object  for  therapeu- 
tics in  this  affection  is  not  to  eliminate  the  material,  but  to  remedy  the 
dyscrasy,  by  removing  the  condition  on  which  it  depends. — [Buffalo 
Med.  Journal. 


Discovery  of  the  Tomb  of  Hippocrates. — The  JEsperance  of  Athens 
states,  that  near  the  village  of  Arnaoutli,  not  far  from  Pharsalia,  a  tomb 
has  just  been  discovered,  which  has  been  ascertained  to  be  that  of  Hip- 
pocrates, the  great  Physician,  an  inscription  clearly  enunciating  the  fact. 
In  the  tomb  a  gold  ring  was  found,  representing  a  serpent — the  symbol 
of  medical  art  in  antiquity — as  well  as  a  small  gold  chain  attached  to  a 
thin  piece  of  gold,  having  the  appearance  of  a  band  for  the  head.  There 
was  also  lying  with  these  articles  a  bronze  bust,  supposed  to  be  that  of 
Hippocrates  himself.  These  objects,  as  well  as  the  stone  which  bears 
the  inscription,  were  delivered  up  to  Housin  Pasha,  governor  of  Thessaly, 
who  at  once  forwarded  them  to  Constantinople. — [Late  Foreign  paper. 



A  Compliment  to  the  Doctors. — Dr.  Jackson,  the  elder,  of  Boston, 
meeting  his  old  friend  Josiah  Quincy,  (both  past  eighty  years  of  age,) 
on  the  side-walk,  accosted  him  with,  "  Well,  Mr.  Quincy,  how  much  lon- 
ger do  you  intend  to  live?"  "Till  I  send  for  a  doctor,"  was  the  quick 
reply.  "And  when  rid  you  send  for  one,  last?"  inquired  Dr.  J.  "Just 
eighty-six  years  ago !'-'  answered  Mr.  Quincy,  adding  the  precise  date  of 
his  birth. 


A  young  man  in  Georgetown,  D.  C,  who  last  week  took  four  grains  of 
Strychnine  for  the  purpose  of  committing  suicide,  was  saved  by  the  inha- 
lation of  an  ounce  and  a  half  of  Chloroform.  Either  of  the  doses  would 
have  killed  him  separately — between  them  both,  he  lived. — [Druggist's 
Circular. 


Glycerine. — Dr.  Cotton,  of  Brompton  Hospital,  has  employed  this  ar- 
ticle exclusively,  and  testifies  against  its  efficiency  in  phthisis,  pronouncing 
it  greatly  inferior  to  cod-liver  oil. — [American  Med.  Gazette. 

Sup>ra-renal  Capsules. — The  cogenital  absence  of  these  organs  has 
been  found  in  a  man,  who  always  had  a  white  skin,  lived  up  to  40  years, 
and  died  of  a  malady  of  the  chest.  He  worked  as  a  joiner,  was  married, 
and  had  three  sons.     (See  Glasgow  Med.  Journal  for  July  last.) — Ibid. 

Value  of  a  Young  Lady's  Teeth. — The  Paris  courts  value  a  young 
lady's  teeth  at  8,000  francs.  An  English  governess  was  recently  knock- 
ed down  by  a  carriage,  and  lost  by  the  accident  all  her  teeth.  She 
brought  on  an  action  of  damages,  and  the  tribunal  awarded  that  amount. 


SOUTHERN 

MEDICAL  AND  SURGICAL  JOUMAL. 

(NEW  SERIES.) 

Vol.  XIV.]  AUGUSTA,  GEORGIA,  MAT,  1S58.  [No.  f. 

ORIGINAL  AND  ECLECTIC. 

ARTICLE  XII. 

Case  of  Diabetes  Mellitus.  Treated  by  Joseph  Jones,  A.M.,  M.D., 
Professor  of  Physics  and  Natural  Theology  in  the  University 
of  Georgia,  Athens ;  Professor  of  Chemistry  and  Pharmacy  in 
the  Medical  College  of  Georgia,  Augusta ;  formerly  Professor 
of  Medical  Chemistry  in  the  Medical  College  of  Savannah. 

Irish  laborer,  entered  the  Savannah  Marine  Hospital  and  Poor 
House,  July  17th,  1857 :  age  24  ;  height  5  feet  7  inches ;  light 
hair,  blue  eyes,  scanty  reddish  yellow  whiskers ;  greatly  ema- 
ciated— arms  and  legs  resemble  those  of  a  skeleton;  ankles 
cedematous.  Weight,  in  health,  140  lbs. ;  now,  it  cannot  be 
more  than  90  lbs. 

Complained  of  continued  pain  in  his  head  and  bones,  loss  of 
strength,  a  voracious  appetite,  insatiable  thirst,  disordered  diges- 
tion and  a  continued  and  exhausting  diarrhoea. 

Had  no  fever  and  no  enlargement  of  liver  or  spleen.  Upon 
physical  exploration  the  action  of  the  heart  and  lungs  appeared 
to  be  normal. 

The  attempt  was  made  to  arrest  the  diarrhoea.  Hope's  mix- 
ture produced  a  temporary  effect,  but  did  not  arrest  the  waste  of 
tissue.  Opium,  chalk  mixture,  and  the  usual  remedies  for  diar- 
rhoea were  administered.  They  checked  the  diarrhoea  tempora- 
rily, but  did  not  arrest  the  waste  of  tissue  and  loss  of  muscular 
and  nervous  force. 

His  diet  was  strictly  guarded.  It  was  found  that  the  greater, 
portion  of  the  meat  which  he  ate,  passed  entirely  through  the  ali- 

N.  6. VOL.  XIV.    NO.  V.  13 


292  Jones,  on  Diabetes  Mellitus.  U&&J, 

mentary  canal,  and  was  voided  in  the  form  of  fetid  undigested 
masses. 

The  patient  was  placed  upon  farinaceous  diet — arrow -root, 
rice,  and  boiled  milk  and  rice.  Under  this  regimen,  the  stools 
became  less  numerous,  and  improved  in  appearance,  but  the 
destruction  of  tissue  and  loss  of  power  was  not  arrested. 

External  applications  had  no  effect  whatever  upon  the  pain 
in  his  head  and  limbs.  Strychnia,  in  small  doses,  failed  to 
strengthen  his  digestive  apparatus  and  nervous  system. 

This  treatment  was  continued  for  three  weeks,  and  during  this 
time  his  progress  was  steadily  downwards.  His  tissues  continu- 
ed to  waste  away,  and  his  strength  every  day  grew  less. 

August  7th.    Pulse  70. )  Temperature  of  Atmosphere,  81°F. 
V  "  "  Hand,  96J° 

Kespiration    19. )  "      under  Tongue,        100° 

August  8th.    Pulse  64. )  Temperature  of  Atmosphere,  81°F. 
I  "  "  Hand,  97  i° 

Eespiration     18.)  "     under  Tongue,         100° 

Examination  of  Urine. — Keaction  slightly  acid. 
Specific  gravity  1040. 
Of  a  light  straw  color,  clear  limpid,  resembling  the  urine  of 
a  female  suffering  with  hysteria.  The  resemblance  extended 
only  to  the  color  and  amount  passed,  The  high  specific 
gravity  of  the  urine  of  this  patient,  at  once  distinguished  it  from 
the  abundant  light  colored  urine  often  passed  by  hysterical 
females.  The  amount  of  urine  passed  by  this  patient  during  the 
24  hours  varied  from  one  to  one  and  a  half  gallons — an  enor- 
mous quantity,  considering  his  reduced  state,  and  the  large 
amount  of  solid  matters  held  in  solution  in  the  urine. 

Trommer's,  Moore's,  and  the  fermentation  tests  and  the  rapid 
formation  of  the  Torula  Cerevisiae,  gave  unequivocal  evidence 
of  the  presence  of  grape  sugar  in  large  amount. 

Chemical  analysis  showed  that  the  specific  gravity  of  the  urine 
was  due,  in  great  measure,  to  the  large  amount  of  grape  sugar 
which  it  held  in  solution. 

Examination  of  Blood. — Specific  gravity  of  Blood,    .  .  1043*2 
Specific  gravity  of  Serum,    .  .  1022#2 
Coagulation  of  the  blood  commenced  in  a  few  minutes  after  it 
was  drawn,  and  the  clot  was  firm. 


1858.] 


Jones,  on  Diabetes  Hellitus. 


293 


Under  the  microscope,  the  colored  corpuscles  were  normal  in 
color  and  form.  They  had  a  great  tendency  to  stick  together 
and  form  rolls,  as  in  the  blood  of  inflammation,  and  in  the  blood 
of  the  horse. 

This  phenomenon  resembled,  in  all  respects,  that  which  oc- 
curs in  well  marked  cases  of  inflammation. 

The  colorless  corpuscles  appeared  to  be  deficient  in  numbers. 

Serum  of  a  light  straw  color.  When  the  serum  was  mixed 
with  an  equal  quantity  of  water,  and  treated  with  a  few  drops  of 
hydrochloric  acid,  sufficient  to  neutralize  its  alkaline  reaction, 
no  coagulation  took  place,  even  after  prolonged  boiling. 

Nitric  acid  produced  prompt  coagulation  of  the  albumen  of 
the  serum. 


WATER 

In  1000  parts  of  Blood,  838*510 
"      "       "      "  Serum,  922-341 
(l)u      "       "      "  Liquor 

Sanguinis,     -     -     919*039 
(2)"  1000  parts  of  Liquor 

Sanguinis,     -     -     887*339 


SOLID  MATTERS 
In  1000  parts  of  Blood,  161*490 
"     "         "     "  Serum,     77*659 
(1)"     "         "     "  Liquor 

Sanguinis,     -     -       80*961 
(2)"  1000  parts  of  Liquor 

Sanguinis,     -     -     112*661 


FIXED  SALINE  CONSTITUENTS 

In  1000  parts  of  Blood, 9*061 

u      «         u      »  Serum, 5*319 

(1}  "      "         "      "  Liquor  Sanguinis, 5*325 

(2)  "      "         "      "  Liquor  Sanguinis, 7*181 

"  Blood  Corpuscles  of  1000  parts  of  Blood, 4*443 

"  1000  parts  of  Dried  Blood  Corpuscles, 47*916 

"      "         "      "  Moist  Blood  Corpuscles, 11*981 

"      "         "      "  Dried  Residue  of  Blood,    ------  56*108 

"      "         "      "     "             "        "  Serum,  -<----  68*488 

(1)  "      "         "      "     "             "        "  Liquor  Sanguinis,      -     -  68*493 

(2)  "      "         "      "     "              «        «  Liquor  Sanguinis,      -     -  63*739 
"  Solid  Matters  of  Serum  of  1000  parts  of  Blood,     -     -     -  4*519 

1000  Parts  of  Blood  Contained 

Water, 838*510 

Dried  Blood  Corpuscles,  92*702  i  !?riecJ  °W**  **»*  §    '  8^9 

1                           )  b l.xed  Saline  Constituents,  -  4*443 

Fibrin, -_....  2*806 

Albumen 40  539  1  Dlied  0r£anil-  Matters,      -  48*157 

j  Fixed  Saline  Constituents,  -  1*382 

Extractive  Matters,-     -     16-003  1  ^P1?™''  "£■*      "  1J«J! 

[  Fixed  Saline  Constituents,  -  3*137 


294  Jones,  on  Diabetes  Mellitus.  [May, 

1000  Paets  of  Blood  Contained 

.)  Water 278-106 

Moist  Blood  Corpuscles,  370-808  V  Dried  Organic  Residue,      -  88-259 

)  Fixed  Saline  Constituents,  -  4-443 

^  Water,  -     -     -     - 560-404 

Ait             )  Dried  Organic  Residue,  -     -  48*157 

Liquor                   I       DUmen'  j  Fixed  Saline  Constituents,    -  1-382 

Sanguinis,  629-192  f    Extractive  and   )  Dried  Organic  Matters,  12-866 

Coloring  Matt'rs,  j  Fixed  Saline  Constituents     3-137 

Fibrin, 2-606 

1000  Parts  of  Moist  Blood  Corpuscles  Contained 

Water, 750-001 

Dried  Organic  Matters,     --- 238-018 

Fixed  Saline  Constituents, 11-981 

(1)  1000  Parts  of  Liquor  Sanguinis  Contained 

Water, - 919-039 

Albumen       ....     59-737  l  Organic  Residue,     -    -    -  58-110 

'                                        )  Fixed  Saline  Constituents,  -  1-620 

Extractive  and  Coloring                 )  Organic  Residue,     -    -    -  13-670 

Matters,     -     -     -     -    17-345  j  Fixed  Saline  Constituents,  -  3-682 

Fibrin, 3*302 

(2)  1000  Parts  of  Liquor  Sanguinis  Contained 

Water, 886-740 

ah,  ho  ^00  )  Organic  Residue,     -    -    -       76*537 

Albumen,      .    -    -    -     78- ,33  J-  Fixsed  Saline  Con^ituents> .        2-196 

Extractive  and  Coloring  )  Organic  Residue,     -     -    -       24*484 

Matters,    -     -     -     -     29*469  )  Fixed  Saline  Constituents,  -         4*985 

Fibrin, 4-459 

The  method  of  analysis  employed  in  these  investigations  has 
been  described  by  the  author  (')  in  his  Inaugural  Dissertation  for 
the  degree  of  M.  D.  in  the  University  of  Pennsylvania,  and  in 
his  Chemical  (2)  and  Physiological  Investigations,  published  by 
the  Smithsonian  Institution,  and  is  similar  in  many  respects  to 
that  employed  by  MM.  Becquerel  (3)  and  Eodier,  Bowman,  (4) 
and  others.  (5) 

(1)  Physical,  Chemical  and  Physiological  Investigations,  upon  the  Vital  Phe- 
nomena, Structure,  and  Offices  of  the  Solids  and  Fluids  of  Animals.  By  Joseph 
Jones.     (American  Journal  of  Medical  Sciences,  July,  185G,  p.  46. 

(2)  Investigations,  Chemical  and  Physiological,  relative  to  certain  American 
Vertebrata.    By  Jos.  Jones.    Smithsonian  Contributions  to  Knowledge.     1856. 

(S)  Pathological  Chemistry,  by  MM.  Becquerel  and  Rodier.  Translated  by 
S.  T.  Speer,  M.  D.     London :  1857,  p.  19,  et.  sq. 

(4)  Bowman's  Medical  Chemistry,  pp.  145-194.     Philadelphia :  1850. 

(5)  Simons  Chemistry  of  Man,  p.  142.  Philadelphia:  1846.  Lehmann's  Physi- 
ological Chemistry.  Translated  by  G.  E.  Day.  Cavendish  Society  pub.  vol.  ii., 
pp.  153-280.  London.  1851-1854.  See  also  American  ed.,  edited  by  Prof. 
Rogers,  vol.  1,  pp.  541-648.  Manuals  of  Blood  and  Urine.  By  Griffith  Reese 
andMarwick.     Philadelphia:  1848. 


1858.]  Jones,  on  Diabetes  Mellitus.  295 

All  physiological  chemists  have  failed  to  ascertain  with  abso- 
lute accuracy  the  amount  of  solid  matter  in  the  serum  of  1000 
parts  of  blood. 

The  proportion  by  which  this  is  determined,  although  the 
closest  approximation  to  the  truth  that  can  be  made  in  the  pre- 
sent state  of  science,  is  founded  upon  the  erroneous  assumption 
that  all  the  water  of  the  blood  exists  in  the  liquor  sanguinis. 
C.  Schmidt  has  shown  that  three-fourths  of  the  colored  blood 
corpuscles  are  composed  of  water.  Hence,  to  obtain  the  relation 
of  the  moist  blood  corpuscles  to  the  liquor  sanguinis,  we  must 
multiply  the  dried  residue  of  the  corpuscles  by  4. 

Physiological  chemists  possess  no  method  by  which  the  blood 
corpuscles  can  be  determined  with  absolute  accuracy. 

It  is  evident,  from  these  facts,  that  when  we  attempt  to  calcu- 
late the  moist  blood  corpuscles  and  liquor  sanguinis  of  1000 
parts  of  blood,  whatever  error  entered  into  the  calculation  of  the 
solid  matters  of  the  blood  corpuscles,  will  be  increased  four  fold, 
whilst  the  error  in  the  calculation  of  the  constituents  of  the 
liquor  sanguinis  will  increase,  not  only  in  a  direct  ratio  to  the 
errors  in  the  calculation  of  the  blood  corpuscles  and  solid  mat- 
ters of  the  serum  of  1000  parts  of  blood,  but  also  in  a  definite 
ratio  to  the  actual  increase  or  decrease  in  the  1000  parts  of  moist 
blood  corpuscles.  That  error  exists  in  this  method  of  analysis 
is  rendered  evident  when  we  calculate  the  constituents  of  1000 
parts  of  liquor  sanguinis,  from  the  data  obtained  by  subtract- 
ing the  moist  blood  corpuscles  from  1000  parts  of  blood,  and 
considering  the  remainder  liquor  sanguinis. 

The  results  thus  obtained  do  not  correspond  with  those 
obtained  from  the  actual  analysis  of  1000  parts  of  liquor  san- 
guinis. 

To  render  this  error  evident  in  the  present  method  of  analysis, 
I  have  in  this  and  subsequeut  analyses,  stated  the  actual  an- 
alysis of  1000  parts  of  liquor  sanguinis,  and  that  calculated 
from  the  constitution  of  the  liquor  sanguinis  determined  in  1000 
parts  of  blood,  by  the  subtraction  of  the  moist  blood  corpus- 
cles. 

The  former,  by  actual  experiment,  is  always  marked  (1) ;  the 
latter,  by  calculation,  is  always  marked  (2). 

We  will  now  compare  this  analysis  of  the  blood  of  our  diabetic 


296 


Jones,  on  Diabetes  Mellitus. 


[May, 


patient  with — 1st,  analyses  of  normal  blood,   and  2nd,  with 
analyses  of  abnormal  blood. 

The  following  is  given  by  Lehmann,(6)  as  the  standard  con- 
stitution of  healthy  human  blood. 


1000  Parts  of  Moist  Blood  Cor- 
puscles contain 

Water, 688-000 

Solid  Constituents,    -     -     312-000 
Specific  Gravity,  -     -     -1088-5 

Haematin, 16-750 

Globulin  &  Cell  Membrane,  282-220 

Fat, 2-310 

Extractive  Matters,  -     -         2-600 
Mineral  Substances  with- 
out Iron,     -    -    -    -         8-120 


1000  Parts  of  Liquor  Sanguinis 

contain 
Water,-     -----     902-900 

Solid  Constituents,    -     -       97-100 
Specific  Gravity,  -    -     -  1028- 

4-050 
78-840 
1-720 
3-940 
8-550 


Fibrin, 

Albumen,  -     -    -     - 

Fat, 

Extractive  Matters,  - 
Mineral  Substances,  - 


The  following  are  the  physiological  limits  of  the  variations  of 
the  constituents  of  the  blood,  as  established  by  the  researches  of 
MM.  Becquerel  (7)  and  Kodier. 


In  1000  F 

'arts 

OF 

Blood, 

The  Water  may  vary      -    -    - 

from 

760-000  to 

800-000 

"     Specific  Gravity  of  the  Blood 
"     Globules 

may  vary 

"     1055- 

1063- 

u 

u 

u 

120-000  " 

150-000 

"     Fibrin  - 

u 

u 

u 

2-000  " 

3-500 

"     Solid  Matters  of  the  Serum 

u 

u 

u 

90-000  " 

105  000 

"     Cholesterine  - 

u 

u 

u 

0-075  " 

0-150 

"     Animal  Soap, 

u 

a 

u 

1-000  " 

2-000 

"     Serolin          - 

<i 

M 

u 

0-010  " 

0-030 

"     Chloride  of  Sodium 

u 

U 

u 

2-000  " 

5-000 

"     Soluble  Salts 

a 

u 

a 

1-500  " 

4-000 

"    Phosphates    - 

a 

u 

u 

0-500  " 

1-000 

In  1000  Parts 

OF 

Serum, 

The  Specific  Gravity  of  the  Serum 

may  var) 

'  from  1027-        to 

1032- 

"  Water  of  the  Serum  - 

M 

u 

u 

880-000   " 

900-000 

"   Solid  Matters     - 

U 

u 

u 

100-000    " 

120-000 

Albumen  - 


70-000 


90-000 


The  following  is  the  typical  formula  of  the  constitution  of  the 
blood  in  health,  adopted  by  MM.  Becquerel(8)  and  Kodier: 


(6)  Lehmann's  Physiological  Chemistry,  English  ed.,  p.  160,  vol.  ii.     American 
ed.,  p.  546,  vol.  i. 

(7)  Pathological  Chemistry  of  MM.  Becquerel  and  Kodier,  English  ed.,  p.  90. 

(8)  Pathological  Chemistry,  by  MM.  Becquerel  aud  Rodier.     Eng.  ed.,  p.  81. 


1858.] 


Jones,  on  Diabetes  Mellitus. 


297 


Analysis  of  1000  Parts  of  Serum. 

Specific  Gravity  of  Se- 
rum,       1028-000 

Water, 908*000 

Albumen,      -     -     -     -  80-000 

Extractive  Matters  and 

Free  Salts,      -     -     -  12-000 


Analysis  of  1000  Parts  of  Blood. 
Specific   Gravity   of  the 

Blood, 1060-000 

Water, 781-600 

Globules, 135-000 

Albumen, 70-000 

Fibrin,  - 2-500 

Fatty  Matters,  Extractive 

Matters  &  Free  Salts,  -  10-000 
Phosphates,  -  -  -  -  0*550 
Iron, 0-350 


If  we  carefully  compare  the  analysis  of  the  blood  of  our  pa- 
tient with  these  analyses  of  normal  blood^we  will  find — 

1.  The  specific  gravities  of  the  blood  and  serum  are  much 
lower  than  the  normal  standard. 

2.  The  colored  corpuscles  are  diminished  in  numbers,  the 
dried  corpuscles  being  only  92*702,  and  the  moist  blood  corpus- 
cles 370*808,  whilst  in  health  the  dried  corpuscles  generally 
average  135*000  and  the  moist  corpuscles  540*000. 

3.  The  albumen  of  the  liquor  sanguinis  is  much  less  than 
normal,  being  only  49*539  in  the  1000  parts  of  blood,  whilst » 
in  health,  it  ranges  from  70  to  90. 

4.  The  extractive  and  coloring  matters  are  12*866,  and  are 
greater  in  amount  than  normal.  When  we  compare  the  ex- 
tractive matters  with  the  diminished  albumen  and  blood  corpus- 
cles, it  is  evident  that  they  are  far  more  abundant  than  normal. 

5.  The  fixed  saline  constituents  are  normal  in  amount  as 
compared  with  normal  blood,  but  increased  when  compared 
with  the  diminished  albumen  and  blood  corpuscles. 

It  is  important  that  we  should,  in  the  next  place,  compare  the 
blood  of  this  patient,  reduced  in  flesh  and  strength  to  the  last 
degree,  with  the  blood  of  individuals  whose  blood  has  been 
depraved,  and  forces  exhausted  by  other  diseases. 

The  following  examples,  are  selected  from  numerous  analyses 
of  the  blood  of  patients  suffering  with  malarial  fever,  which  I 
conducted  in  the  Savannah  Marine  Hospital  and  Poor  House, 
during  the  last  summer  and  fall : — 

Case  I.  Intermittent  Fever,  neglected. — Irish  laborer,  entered 
the  Savannah  Poor  House  Sept.  23rd :  age  22 ;  height  5  feet  8 
inches.    Had  been  working  in  the  marshes  along  the  Savannah 


298 


Jones,  on  Diabetes  Mellitus. 


[May, 


river,  and  suffered  with  chill  and  fever  for  two  months,  during 
which  time  he  had  no  medical  attendance.  Complexion  sallow ; 
tongue,  lips  and  gums  pale;  digestion  impaired.  Complains  of 
great  weakness.  Flesh  not  much  redtfced,  but  feels  soft  and 
unnatural. 

Examination  of  Blood. — Blood  watery  in  appearance — coagu- 
lated slowly  in  30  minutes.  Eeaction  decidedly  alkaline.  In 
the  specific-gravity-bottle  filled  with  blood,  the  colored  corpus- 
cles gravitated  towards  the  bottom  and  left  above  a  light  yellow 
transparent  clot.  After  standing  20  hours,  the  clot  had  con- 
tracted but  little,  and  its  consistency  was  very  weak.  Serum, 
of  a  light  yellow  color. 

Specific  Gravity  of  Blood,     -     -    -     -    1030*5 
Specific  Gravity  of  Serum,    ....     1021-3 


WATER 

In  1000  parts  of  Blood,  877-553 
"     «       "     «  Serum,  927-757 

(1)  «     »       «     «  Liquor 

Sanguinis,    -     -     925-725 

(2)  "1000  parts  of  Liquor 

Sanguinis,  -     -     911-124 


SOLID  MATTERS 
In  1000  parts  of  Blood,  122-447 
"     "       "      "Serum,    72-243 
(1)"     "       «     "Liquor 

Sanguinis,    -     -       74*275 
(2)  "4000  parts  of  Liquor 


Sanguinis, 
"  in  Serum  of  1000 
parts  of  Blood    - 


88-876 
68-435 


(1) 
(2) 


(1) 
(2) 


FIXED  SALINE  CONSTITUENTS 
In  1000  parts  of  Blood,  .... 
"         "      "  Serum, 
"         "      "  Liquor  Sanguinis,  - 
»         "      "  Liquor  Sanguinis,  - 
Serum  of  1000  parts  of  Blood,     - 
1000  parts  of  the  Solid  Matters  of  Blood, 
"         "  Serum, 
"         "  Blood  Corpuscles, 
"         "  Liquor  Sanguinis, 
"         "  Liquor  Sauguinis, 
"  Blood  Corpuscles  of  1000  parts  of  Blood, 
"  1000  parts  of  Moist  Blood  Corpuscles, 


N      <i 

U      U 


3 
3 
3 

3 
27 
45 

3 
44 
44 

0 

0 


1000  Parts  of  Blood  Contained 
Water, 

Dried  Blood  Corpuscles,       51  987 


Fibrin, 

Albumen  and  Extractive 
and  Coloring  Matters, 


68-335 


877- 
Dried  Organic  Residue,  51- 
Fixed  Saline  Constituents,     0' 

I- 
Dried  Organic  Residue,  65* 
Fixed  Saline  Constituents,      3' 


316 
326 
328 
965 
141 
083 
901 
240 
779 
612 
175 
841 


553 
812 
175 
925 
194 
141 


1858.]  Jones,  on  Diabetes  Mellitiis.  299 

1000  Parts  of  Blood  Contained 

\  Water,    ...  155  861 

Moist  Blood  Corpuscles,     207  948  V  Organic  Residue,      -  51-612 

)  Fixed  Saline  Constituents,      0-175 

1  Water,    -        -         -         721-692 
|  Albumen  and  Extractive 
Liquor  Sanguinis,     -         792-052  \      and  Coloring  Matters,       65-194 

I  Fixed  Saline  Constituents,      3-141 
J  Fibrin,     -         -         -  1-925 

1000  Parts  of  Moist  Blood  Corpuscles  Contained 
Water,         --.-----.         749-51S 

Dried  Organic  Matters,         - 249-154 

Fixed  Saline  Constituents, 0-841 

(1)  1000  Parts  of  Liquor  Sanguinis  Contained 

WTater, 925-725 

Albumen,  Extractive  and  Coloring  Matters,     -         -         •  68-817 

Fibrin,         -.-------  2-032 

Fixed  Saline  Constituents,     -         -         •         -         -         -  3-326 

(2)  1000  Parts  of  Liquor  Sanguinis  Contained. 
Water,         .-----.--         911-167 
Albumen,  Extractive  and  Coloring  Matters,     -         -         -  82-312 

Fibrin,         ..-..•-.•  3-965 

Fixed  Saline  Constituents,     ------  2-430 

The  urine  of  the  patient  was  of  low  specific  gravity,  dimin- 
ished in  amount,  and  contained  no  grape  sugar. 

Case  II.  Intermittent  Fever,  neglected — terminating  in  Bilious 
Remittent  Fever,  and  complete  alteration  of  the  Chemical  Constitu- 
tion of  the  Blood  and  Tissues. 

German  Butcher,  entered  the  Savannah  Poor  House  Sept. 
25th :  age  23 ;  height  5  feet  10  inches ;  weight,  in  health, 
180  lbs. 

His  present  weight  cannot  be  more  than  110  lbs.  Has  been 
suffering  with  chill  and  fever  for  two  months,  and  has  had  no 
medical  attendance.  Sallow,  anaemic  complexion;  flesh  and 
strength  greatly  reduced;  nervous  and  muscular  forces  very 
feeble.     Was  brought  into  the  Hospital  in  a  comatose  state. 

Stimulants,  sinapisms,  cut  cups  to  the  temples  and  back  of 
neck,  and  blisters  to  the  epigastrium  and  back  of  neck,  aroused 
him  from  this  comatose  condition. 

A  few  days  after  his  entrance  into  the  hospital,  a  large  abscess 


300  Jones,  on  Diabetes  Mellilus.  [^aj, 

formed  upon  the  side  of  his  head,  in  -  the  region  of  the  ear,  and 
joint  and  angle  of  the  inferior  maxillary  bone. 

Notwithstanding  that  this  abscess  was  lanced,  the  pus  formed 
an  entrance  into  the  external  meatus  auditorius. 

Large  masses  of  the  cellular  tissue  and  muscles  sloughed 
away,  and  the  angle  and  superior  portion  of  the  inferior  maxil- 
lary bone  were  almost  completely  stripped  of  flesh.  The  abscess 
compelled  him  to  lie  upon  the  opposite  side  of  his  body,  and 
the  arm  upon  which  the  weight  of  the  body  rested  swelled  enor- 
mously, until  it  appeared  to  be  ready  to  burst,  and  finally  the 
skin  over  the  biceps  muscle  changed  to  a  black  color,  and 
sloughed  off  in  a  single  night,  leaving  the  red  quivering  mus- 
cles entirely  exposed. 

The  biceps  muscle  sloughed  entirely  off  from  its  lower  attach- 
ment.    Large  ulcers  appeared  in  various  parts  of  his  body. 

The  patient  lingered,  supported  by  tonics,  nutritive  diet  and 
stimulants,  for  three  weeks. 

After  death,  his  liver  presented  a  color  a  shade  lighter  than 
the  slate  color  of  the  malarial  fever  liver,  and  in  many  parts  it 
was  regaining  its  normal  hue.  The  spleen  was  enlarged  and  in 
many  parts  completely  degenerated  in  structure,  being  convert- 
ed into  pus  and  a  substance  resembling  cheese.  The  surface  of 
the  spleen  was  covered  with  effused  coagulable  lymph,  and 
bound  to  the  liver  by  bands  of  coagulable  lymph.  The  border 
next  to  the  liver  contained  an  abscess  about  the  size  of  a  wall- 
nut,  filled  with  pus.  The  whole  substance  of  the  spleen  was 
consolidated,  and  those  portions  which  were  not  degenerated, 
resembled,  when  cut,  the  liver  of  malarial  fever.  The  stomach 
showed  the  marks  of  chronic  inflammation. 

The  glands  of  Peyer,  in  the  lower  portion  of  the  intestinal 
canal,  were  enlarged,  but  pale,  and  not  more  congested  with 
blood  than  usual. 

Examination  of  the  Blood  of  this  patient  four  days  after  his  en- 
trance into  the  Hospital. — Blood  coagulated  slowly.  In  one  spe- 
cimen, the  coagulation  was  remarkably  slow,  and  the  blood 
corpuscles  gravitated  towards  the  bottom  of  the  vessel  and  left 
above  a  clear,  golden  colored  clot.  This  transparent  portion  of 
the  clot  was  about  I  of  an  inch  in  thickness. 

Serum,  of  a  deep  golden  color.    Eeaction  of  serum,  alkaline. 


1858.] 


Joxes,  o/i  Diabetes  Mtllitus. 


301 


Specific  Gravity  of  Blood, 
Specific  Gravity  of  Serum, 


1036-6 
1023-6 


WATER 
In  1000  parts  of  Blood,  B40-511 
"     "       "      »•  Serum,  913  950 
(1)"     "       ■«      "Liquor 

Sanguinis,    -     -     912  665 
(2)  "  1000  parts  of  Liquor 


Sanguinis, 


882-723 


SOLID  MATTERS 
In  1000  parts  of  Blood,   159*489 
"     "       "      "  Serum,    86-050 
(1)"     "       M      "Liquor 


;anguinis,    -     - 


86-973 


(2)"  1000  parts  of  Liquor 

Sanguinis,    •     -     117  '27 7 
Solid  Matters  of  Serum  of 

1000  parts  of  Blood,     79-135 


(1) 
(2) 


(1) 
(2) 


FIXED  SALINE  CONSTITUENTS 

In  1000  parts  of  Blood,  - 
*     "  Serum,  - 
u     "  Liquor  Sanguinis,   - 
"     "  Liquor  Sanguinis,  - 
'     "  Solid  .Matters  of  Blood, 
'     "      M  "         ■•  Serum, 

"     "      "  "         "  Liquor  Sanguinis, 

I  "      "  "         ••  Liquor  Sanguinis, 

II  "      M  M  "  Blood  Corpuscles, 
"     "  Moist  Blood  Corpuscles,  - 

Blood  Corpuscles  of  1000  parts  of  Blood, 
"  Serum  of  1000  parts  of  Blood,     - 


5-796 

2-647 

2-653 

3-493 

36-341 

30-178 

30-205 

29-850 

42-914 

10-723 

3-409 

2-357 


1000  Parts  of  Blood  Co>-tai:ved 
Water,     --.------. 

-rv  ■  j  t»i     jp  i        ~c\  A*>-t  )  Dried  Organic  Residue,     • 

Dried  Blood  Corpuscles,    79-43/  >  „.      ,  ^  ?.      n      ...      ' 

r  $  rixed  Valine  Constituents, 

Fibrin - 

Albumen,  Extractive  and  >  Dried  Organic  Residue,     - 

Coloring  Matters,    -     79-096  V  Fixed  Saline  Constituents, 


840-511 

76-023 

3-409 

0-877 

76-703 

2-387 


1000  Parts  of  Blood  Contained 
Moist  Blood  Corpuscles,  317-748 


}  Water, 

18  V  Dried  ( 

)  Fixed  \ 


Organic  Residue,  - 
Saline  Constituents, 


1  Water,  - 
Dried  Organic  Residue,  - 
Fixed  Saline  Constituents, 
Fibrin,  - 


238-271 

76-028 

3.409 

602-240 

76-708 

2-387 

0  677 


1000  Parts  of  Moist  Blood  Corpuscles  Cotalxed 
Water,        .---•-..-.         749-873 
Dried  Organic  Residue,         ......         239-284 

Fixed  Saline  Constituents,     ..-.-.  10-728 


302 


Jones,  on  Diabetes  Mellitus. 


[May, 


(1)    1000  Parts  of  Liquor  Sanguinis  Contained 
Water,         -...--.-.         913-022 
Albumen,  Extractive  and  Coloring  Matters,     .         -         -  83-303 

Fixed  Saline  Constituents,     -         i         -         -         -         -  2-647 

Fibrin,         -  -  0-928 


(2)    1000  Parts  of  Liquor  Sanguinis  Contained 
Water,         ...---.--         882-723 
Albumen,  Extractive  and  Coloring  Matters,     -         -         -         112-433 
Fixed  Saline  Constituents,     ------  3-498 

Fibrin,         .--.---..  1-285 

Case  III.  Bilious  Remittent  Fever. — American  Seaman,  na- 
tive of  Boston,  entered  the  Savannah  Marine  Hospital  Sept. 
26th :  age  21 ;  weight  150  lbs. ;  height  5  feet  10  inches.  Mus- 
cular system  moderately  well  developed. 

This  is  his  first  trip  to  Savannah.  Has  been  sleeping  at  night, 
on  the  deck  of  the  ship  in  the  open  air.  The  captain  compelled 
all  his  men  to  sleep  on  board  the  ship,  which  was  lying  along 
the  low  marshy  shore  below  the  city. 

This  patient  was  brought  in  comatose,  and  has  been  passing 
his  urine  and  feces  in  bed. 

Sept.  29th.  Jjies  in  a  stupor ;  complexion  sallow ;  teeth  coat- 
ed with  sordes;  tongue  perfectly  dry  and  as  rough  to  the  feeling 
as  the  surface  of  a  newly  sawed  board.  Pulse  120 ;  Eespira- 
tion  22. 

Examination  of  Blood. — Blood  coagulated  slowly.  Serum,  of 
a  deep  golden  color. 

Nitric  acid  showed  that  this  color  was  due  to  the  presence  of 
bile. 

Eeaction  of  serum,  alkaline. 


Specific  Gravity  of  Blood, 
Specific  Gravity  of  Serum, 


1040 
1022 


WATER 

In  1000  parts  of  Blood,  833-449 
"     «       ii      c<  Serum,  912-386 
(1)"     «       «      "Liquor 

Sanguinis,    -     -     910-798 
(2)"  1000  parts  of  Liquor 

Sanguinis,    -     -     875-813 


SOLID  MATTERS 

In  1000  parts  of  Blood,   166-551 
u     u       u      «( gerum,    87-614 

(1)  "     «       «      "  Liquor 

Sanguinis,    -     -       89-203 

(2)  "1000  parts  of  Liquor 

Sanguinis,    -     -     124-187 
"Serum  of  1000  parts 

of  Blood,       -     -       80-033 


1858.] 


JONES,  on  Diabetes  Melliius. 


303 


FIXED  SALINE  CONSTITUENTS 

In  1000  parts  of  Blood, 
"  Serum, 

"  Liquor  Sanguinis, 
M  Liquor  Sanguinis, 
"  Dried  Blood  Corpuscles, 
"  Moist  Blood  Corpuscles, 
"  Dried  Residue  of  Blood, 
"       "      «       "  M  w  Serum, 

Serum  of  1000  parts  of  Blood,  - 


U 

u 

(i 

(1) 

II 

H 

tl 

(2) 

m 

H 

M 

m 

M 

N 

u 

II 

II 

u 

II 

II 

6-314 
6*620 
6-630 
8-759 
6-595 
1-646 
37-909 
75-558 
5-747 


1000  Parts  of  Blood  Contained 

Water,         .........  S33-449 

Tk  •  j  oi     j  n           i        o-  nco  ^  Dried  Organic  Residue,     -  84-400 

Dr.ed  Blood  Corpuscles,   8o.968  {  Fixed  £^  ConstitueMs,  0-567 

Fibrin,        •         .         .         .         ...         .         .         .  1-450 

Albumen,  Extractive  and  )  Dried  Organic  Residue,     -     74-1S6 

Coloring  Matters,     -    80-033  ]  Fixed  Saline  Constituents,  .       5-747 

1000  Parts  of  Blood  Contained 

}  Water,     ....  258-804 
Moist  Blood  Corpuscles,  343-872  V  Dried  Organic  Residue,     -     84-400 

}  Fixed  Saline  Constituents,  -       0-567 
^  Water,     -  574-646 

|  Albumen,   Extractive  and 
Liquor  Sanguinis,  -     -  656*128  J-      Coloring  Matters,  -         -     74-185 

|  Fixed  Saline  Constituents,  -       5-747 
J  Fibrin,     ....       1-450 

1000  Parts  of  Moist  Blood  Corpuscles  Contained 
Water,      .-.-------  752-646 

Dried  Organic  Residue,     -------  245-239 

Fixed  Saline  Constituents,  ---...       1-648 

(1)  1000  Parts  of  Liquor  Sanguinis  Contained 
WTater,     .......  910-797 

Albumen,  Extractive  and  Coloring  Matters,    .     -         -         -     80-996 
Fixed  Saline  Constituents,  ------       1-587 

Fibrin,     -  6-620 

(2)  1000  Parts  of  Liquor  Sanguinis  Contained 

Water, -  875-813 

Albumen,  Extractive  and  Coloring  Matters,  -  -  -  113-064 
Fixed  Saline  Constituents,  ..-.--  8-758 
Fibrin, -  2-209 


Lender  the  use  of  stimulants,  sulphate  of  quinia,  and  nutri- 
tious diet,  this  patient  recovered,  slowly.  He  was  confined  to 
his  bed   three  weeks,  and  at  the  end  of  this  time,  exhibited 


304  Jones,  on  Diabetes  Mellitus.  [May, 

the  effects  of  the  bilious  remittent  fever,  in  his  pale,  sallow, 
anaemic  countenance,  pale  lips  and  gums,  and  tottering  gate. 

The  violent  nature  of  the  malarial  fever,  contracted  by  sleep- 
ing in  the  open  air  in  the  low  marshy  land  bordering  our  fresh 
water  rivers,  is  forcibly  illustrated  by  the  subsequent  history  of 
the  crew  to  which  this  patient  belonged. 

A  few  days  after  his  admission  into  the  hospital,  the  captain 
weighed  anchor  and  sailed  for  New  York.  Before  getting  well 
out  to  sea,  himself  and  the  whole  of  his  crew  were  taken  sick. 
There  was  not  a  man  with  strength  to  work  a  pump  or  furl  a 
sail.  Fortunately  a  small  vessel  perceived  their  signals  of  dis- 
tress, and  towed  them  into  Darien.  Before  reaching  this  port 
the  captain  and  five  out  of  seven  of  the  crew  had  died.  There 
were  but  two  remaining  out  of  eight,  and  these  were  extreme- 
ly  ill. 

If  we  compare  the  blood  of  these  cases  with  that  of  health, 
and  with  the  blood  of  the  patient  suffering  with  diabetes  melli- 
tus, we  will  observe  the  following  points  of  agreement  and 
disagreement : 

1.  The  colored  blood  corpuscles  are  diminished  greatly  and 
rapidly  in  malarial  fever.  This  destruction  of  the  colored  blood 
corpuscles  is  far  more  rapid  in  malarial  fever  than  in  diabetes 
mellitus. 

2.  The  salts  of  the  colored  blood  corpuscles  are  diminished 
to  a  remarkable  extent  in  malarial  fever — whilst  they  are  normal 
in  amount  in  the  blood  of  diabetes  mellitus. 

3.  The  blood  coagulates  slowly,  and  the  clot  is  soft,  in  mala- 
rial fever — whilst  the  reverse  was  the  case  in  this  specimen  of 
diabetic  blood. 

4.  The  fibrin  is  often  diminished  in  malarial  fever,  and  the 
serum  presents  a  golden  color — whilst  in  this  case  of  diabetes 
mellitus  the  fibrin  was  slightly  increased  and  the  color  of  the 
the  serum  was  normal. 

That  the  poison  of  malarial  fever  induces  profound  changes 
in  the  colored  blood  corpuscles,  and  other  constituents  of  the 
blood,  I  have  demonstrated  by  the  following  facts : 

(a).  The  urine  of  patients  suffering  with  malarial  fever  con- 
tains an  increased  quantity  of  iron.  The  increase  of  the  iron 
in  the  urine  is  subsequent  to  the  destruction  of  the  colored  cor- 
puscles in  the  blood. 


1858.]  JoXES,  on  DiuLetes  Mellitus.  305 

(b).  In  examinations  of  the  organs  after  death,  from  all  the 
forms  of  malarial  fever — intermittent,  remittent  and  congestive — 
I  have  observed  that  the  dark  blood  of  the  spleen  and  liver  do 
not  change  to  the  arterial  hue  when  exposed  to  the  action  of  the 
oxygen  of  the  atmosphere. 

After  death  from  phthisis,  cirrhosis  of  the  liver,  organic  dis- 
ease of  the  circulatory  apparatus,  and  apoplexy,  and  mechanical 
injuries,  as  far  as  my  observations  extend,  the  blood  of  the 
spleen  and  liver  always  change  to  the  arterial  hue  when  ex- 
posed to  the  action  of  the  oxygen  of  the  atmosphere. 

(c).  Animal  starch  accumulates  in  the  malarial-fever  liver — 
whilst  grape  sugar,  as  far  as  my  observations  extend,  is  absent. 
I  have  tested  the  livers  of  malarial  fever  for  grape  sugar  and 
starch.  An  abundance  of  starch  (9)  was  obtained,  without  a 
trace  of  grape  sugar. 

The  livers  were  set  aside,  and  examined  after  intervals  of 
twelve  hours.  The  last  examination  was  made  thirty-six  hours 
hours  after  the  first.  At  every  examination  the  result  was  the 
same — an  abundance  of  animal  starch,  and  no  grape  sugar. 

These  facts  are  important,  not  only  in  their  bearing  upon 
malarial  fever,  but  also  in  their  bearing  upon  diabetes  mellitus. 
M.  CI.  Bernard  (!  °)  has  demonstrated  that  the  transformation 
glycogenic  hepatic  matter  (animal  starch)  formed  by  the  liver, 
into  glucose,  is  the  result  of  the  action  of  a  special  ferment, 
which  is  formed  and  exists  in  the  blood,  independent  of  the 
liver. 

From  the  facts  which  we  have  previously  stated,  it  is  evident 
that  in  malarial  fever,  this  ferment  is  destroyed,  whilst  the  liver 
still  possesses  the  power  of  transforming  the  nitrogenized  and 
non-nitrogenized  elements  into  animal  starch. 

We  have  now  facts  sufficient,  to  draw  important  distinctions 
between  malarial  fever  and  diabetes  mellitus. 

(9)  So  abundant  is  this  animal  starch  in  the  malarial  fever  liver,  that  if  a  small 
particle  of  the  substance  of  the  liver  be  mashed  upon  a  glass  slide,  treated  -with 
a  saturated  solution  of  iodine  in  alcohol,  and  viewed  under  the  microscope,  nu- 
merous beautiful  blue  masses  ot  this  animal  starch,  colored  by  the  iodine,  will  be 
seen.  If  the  fibrous  capsule  be  torn  off  from  the  surface  of  the  liver,  spread  upon 
a  glass  slide,  and  treated  with  tincture  of  iodine,  these  blue  masses  will  be  seen 
scattered  amongst  the  meshes  of  the  fibrous  tissue.  With  reference  to  the  dis- 
covery of  animal  starch,  see  Ameriean  Journal  of  Medical  Sciences,  Oct.  1857, 
p.  549. 

(10)  Moniteur  de  Hopitaux,  April  14,  1857  ;  also,  American  Journal  of  Medical 
Sciences,  July,  1857,  p.  208 


306 


JONES,  on  Diabetes  Mellitus 


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1858.]  Joxes,  on  Diabetes  Meltitus.  307 


~\Ve  have  now  all  the  necessary  facts  for  the  intelligent  treat- 
ment of  this  case. 

The  indications  in  the  treatment  of  this  case  of  diabetes  melli- 
tus  are — 

(1).  To  strengthen  digestion. 

His  stomach  fails  to  digest  the  nitrogenized  elements — the 
very  substances  which  he  needs,  to  supply  the  rapid  waste  of  his 
tissues. 

(2).  To  afford  the  organic  and  inorganic  materials  of  structure. 

(3).  To  quiet  and  strengthen  the  nervous  system. 

(■i).  To  arrest  the  destruction  and  transformation  of  the  ele- 
ments of  the  blood,  tissues  and  food,  into  animal  starch  and 
grape  sugar. 

(1).  To  strengthen  Digestion. — Meat  passed  entirely  through  the 
alimentary  canal,  without  being  digested.  This  is  clear  evi- 
dence that  the  gastric  and  pancreatic  juices  do  not  perform  their 
offices.  The  active  and  essential  principle  of  the  gastric  j  uice 
being  pepsine.  this  must  first  be  supplied.  If  pepsine  and  an  acid 
be  supplied,  digestion  will  take  place  in  a  weak,  diseased  stom- 
ach, as  well  as  in  the  healthy  stomach.  The  truth  of  this  asser- 
tion has  been  established  by  the  experiments  of  Dr.  L.  Corvisart 
of  Paris,  (T  l)  to  whom  the  profession  is  indebted  for  the  intro- 
duction of  pepsine  into  the  practice  of  medicine. 

Andral,  Longer,  (12)  Billet,  Barthez,  (13)  Grisole,  Herard, 
Togel,  Schiff,  Josi,  Lecointe,  (,4)  Ballard,  (15)  Bertholet,  (16) 

(11)  "Dyspepsie  et  Consomption — usage  de  la  Pepsine,"  by  Dr.  L.  Corvisart. 
Paris,  IS 54. 

"  Recherches  ayant  pour  but,  d'administrer  aux  malades  qui  ne  digerent  point 
des  aliments  tours  diffires  par  le  sue  gastrique  des  animaux/'  Comptes  Rendus, 
Aug.  16th,  1S52— Sept.  6th,  1S52. 

Etudes  sur  les  Aliments  et  Nutriments — Xouvelle  Methode  pour  le  traitement 
des  malades  dont  l'estomac  ne  digere  point." — L'Union  Medicale,  1854,  p.  17. 

(12)  In  typhoid  fever. — Bulletin  Gen.  de  Therap.  t  xlvil  p.  320. 

(13)  Sur  Tapepsie  (on  absence  de  digestion)  chez  lezenfans.  et  sur  le  traitement 
de  cette  maladie  par  la  pepsine. — L'Union  Medicale,  Jan.  12th,  1S56. 

(14)  Observation  d'un  cas  de  consomption  ultime,  traitee  par  la  Poudre  Xutri- 
mentive, — Bulletin  Gen  de  Therap.  L  xlix.  p.  268. 

(15)  Artificial  Digestion  as  a  Remedy  in  Dyspepsia,  Apepsia,  and  their  resulta. 
By  Edward  Ballard,  M.D.,  London,  1857.  This  valuable  work  contains  the  me- 
thod of  preparing  the  pepsine.  and  also  the  report  of  numerous  cases  of  disordered 
digestion,  successfully  treated  with  pepsine,  by  Dr.  Ballard  and  other  practitionere 
of  medicine. 

(16)  In  Dyspepsia  of  a  year's  duration. 

13* 


308  Jones,  on  Diabetes  Mellitus.  [May, 

Cahagnet,  ('  7)  Parise,  (l  8)  Huet,  ('  9)  Chambers,(2  °)  Nelson  (2  *) 
and  others,  (2  2)  have  testified  to  the  efficacy  and  value  of  pepsine 
in  various  diseases. 

The  fourth  stomach  of  ruminants  (rennet  bag)  is  generally 
recommended  as  a  source  of  pepsine.  In  hospital  practice,  how- 
ever, I  preferred  to  employ  the  stomach  of  the  pig,  for  two 
reasons : 

The  pig  is  an  omniverous  animal.  Its  food  and  digestive 
process  resembles  more  nearly  that  of  man,  and  consequently 
its  gastric  juice  must  be  better  adapted  to  his  wants. 

For  hospital  purposes,  the  stomach  of  the  pig  can  be  much 
more  readily  obtained  and  prepared,  than  that  of  the  cow  or 
sheep. 

When  pepsine  can  be  obtained  pure  from  the  apothecaries,  or 
when  the  physician  has  time  to  prepare  it  himself,  the  Poudres 
Nutrimentives  (2  3)  of  Corvisart  is  by  far  the  most  elegant  and 
portable  preparation. 

(1*7)  In  Dyspepsia  and  Vomitings  of  several  years'  duration. 

(18)  In  Dyspepsia  of  early  Pregnancy. 

(19)  Gastralgia  after  food  of  several  years'  duration. 

(20)  Practical  Lectures  on  the  Management  of  Digestion  in  Disease,  by  T.  K. 
Chambers,  M.D.— London  Lancet,  Aug.,  1857,  p.  101— Sept.  1857,  p.  180,  Am.  Ed. 

(21)  On  Mellitic  Diabetes  in  reference  to  its  Treatment  by  Rennet  or  Liquor 
Pepticus  Prsep.,  by  David  Nelson,  M.D. — London  Lancet,  Aug.  1857,  p.  118,  Am.. 
Edition. 

(22)  Rennet  in  Diabetes  Mellitus,  by  Dr.  James  Gray. — Glasgow  Med.  Journal, 
Oct.  1856.     See  also  American  Journal  of  Medical  Sciences,  Jan.   1857,  p.  2  5. 

(23)  The  following  are  the  directions,  given  by  M.  Boudalt,  for  the  preparation 
of  the  medicine  : — "Take  a  sufficient  number  of  rennet  bags  (the  fourth  stomach 
of  the  ruminants),  open  and  reverse  them,  and  wash  them  under  a  thin  stream  of 
cold  water ;  scrape  off  the  mucous  membrane,  reduce  it  to  a  pulp,  and  macerate  it 
in  distilled  water  for  twelve  hours ;  filter ;  add  to  the  liquor  a  sufficient  quantity 
of  acetate  of  lead,  and  after  separating  the  precipitate,  pass  through  it  a  current 
of  sulphuretted  hydrogen ;  filter  again  ;  evaporate  at  a  low  temperature  to  the 
consistence  of  a  syrup,  which  is  mixed  intimately  with  starch  pulverized,  and 
dried  at  a  temperature  of  100°  centig.  In  this  state  the  gentle  application  of  heat 
will  reduce  it  to  a  dry  mass  re'adily  reducible  to  a  powder  of  uniform  efficacy. " 

The  power  of  the  pepsine  thus  obtained,  varies,  and  before  the  use  of  a  speci- 
men, we  should  first  test  its  transforming  power.  The  standard  dose  is  that  quan- 
tity of  the  powder,  which  when  acidulated  with  three  drops  of  lactic  acid  and 
added  to  15  grammes  (225  grains)  of  water,  would  transfer  6  grammes  (90  grs.) 
of  fresh  fibrin  finely  cut  up,  and  kept  in  a  bottle,  at  a  temperature  of  40°  centig.  r 
for  twelve  hours,  with  occasional  shaking.  The  average  dose  of  the  "Poudre 
Kutrimentive"  is  15  grains.  It  may  be  taken  dry  or  in  solution,  in  unfermented 
bread,  or  in  a  spoonful  of  soup,  or  in  sweetened  water.  It  should  always  be  ta- 
ken with,  or  at  the  commencement  of  the  meal  on  which  it  is  to  act. — Ballard  on 
Artificial  Digestion,  p.  10.  See  also,  Memoire  sur  le  principe  digestif,  les  prepa- 
rations nutrimentives,  et  les  moyens  propres  a  reconnaitre  et  a  mesurer  leur  ac^ 
tion. — Acad.  Imp.  de  Med.,  Seance  du  14  Fevrier,  1854,  et  Moniteur  des  Hopitaux, 
16  Fevrier,  1854. 


1858.]  Jones,  on  Diabetes  Mellitus.  309 

*$.  Cut  a  pig's  stomach  into  thin  slices,  and  pour  upon  it 
one  pint  of  vinegar,  and  preserve  from  decomposition  (if  the 
weather  be  warm),  by  surrounding  with  ice. 

The  pepsine  and  vinegar  will  reduce  the  tissues  of  the  stom- 
ach to  a  uniform  mass,  or  rather,  fluid.  Dose,  f  5j.  three  times 
a  day,  mixed  with  cold  mutton  or  beef  soup. 

This  preparation  is  useful  for  hospital  purposes,  because  it  is 
easily  prepared,  and  at  the  same  time  is  more  efficacious  than 
the  pepsine  ordinarily  sold  in  the  shops. 

Chambers^4)  and  other  (25)  have  shown  that  much  of  the 
pepsine  now  sold,  possesses  but  feeble  transforming  powers. 

Pepsine  is  not  the  only  substance  concerned  in  the  digestion 
of  albumenoid  substances. 

The  connective  tissues  and  muscular  fibres  are  disintegrated 
and  softened,  but  never  completely  dissolved  by  the  gastric  juice. 

The  ultimate  fibrilla3  of  muscles  which  have  escaped  the  ac- 
tion of  the  gastric  juice  pass  into  the  small  intestines,  and  are 
there  digested  by  the  pancreatic  juice. 

M.  L.  Corvisant(2  6)  communicated  to  the  Imperial  Academy 
of  Sciences,  April  6th,  1857,  a  Memoir  on  the  Power  of  the 
Pancreas  to  Digest  Azotized  Food,  in  which  he  confirmed  the 
assertion  of  Purkinge  and  Pappenheim,  that  the  secretion  of  the 
pancreas  is  endowed,  like  the  gastric  juice,  with  the  property  of 

The  following  is  the  mode  adopted  and  recommended  by  Dr.  James  Gray  of 
preparing  the  rennet: 

"  The  stomach  of  a  calf  (and  the  younger  it  is  the  better,)  is  gently  washed 
with  water,  taking  care  not  to  injure  the  mucous  membrane;  it  is  then  salted, 
tied  up  and  allowed  to  dry.  After  this,  it  is  cut  into  small  pieces,  macerated  in 
a  pint  and  a  half,  or  two  pints  of  water,  according  to  the  size  of  the  stomach,  for 
four  days  or  longer  in  winter,  shaking  it  at  intervals ;  the  fluid  is  then  poured  off 
and  bottled,  and  to  test  its  power,  a  spoonful  may  be  added  to  a  pint  of  warm 
milk,  which,  if  it  curdles,  it  is  now  fit  for  use.  A  little  spirits,  or  decoction  of 
sparrow-grass,  may  be  added  to  make  it  keep.  The  dose  of  rennet  thus  prepared 
is  a  tablespoonful,  three,  four,  or  six  times  a  day,  about  half  an  hour  after  each 
meal,  and  during  the  process  of  digestion,  followed  shortly  after  by  an  alkali,  to 
neutralize  the  lactic  acid  formed.  That  which  I  recommend  is  the  alkaline  tri- 
basic  phosphate  of  soda;  but  the  carbonate  of  potash  will  answer  very  well, 
either  alone  or  combined  with  the  tincture  of  nux  vomica,  in  five  or  ten  drop 
doses." — Glasgow  Medical  Journal,  Oct.  1856.  See  abstract  of  paper  in  Amer. 
Jour,  of  Medical  Sciences,  Jan.  1857,  p.  215. 

(24)  Experiments  upon  Artificial  Digestion,  by  T.  K.  Chambers,  M.  D.  London 
Lancet,  Aug.  1857,  p.  133,  Am.  ed. 

(25)  Experiments  upon  the  Action  of  Pepsine,  by  Edward  H.  Sieveking.  Med. 
Times  and  Gazette,  April  4,  1857.  See,  also,  American  Journal  of  Med.  Sciences, 
26  July,  1857,  p.  212. 

Monitenr  des  Hopitaux,  April  21st,  1857.  See,  also,  American  Journal  of  Med. 
Science*,  July,  1857,  p.  206, 


310  Jones,  on  Diabetes  Mellitus.  [May, 

dissolving  azotized  food,  and  demonstrated  that  the  pancreatic 
juice  in  disintegrating  albumenoid  elements,  effects  in  them  a 
transformation  identical  or  analogous  to  that  which  the  stomach 
produces. 

The  pancreatic  juice  acts  only  on  those  portions  of  the  food 
which  have  escaped  the  action  of  the  gastric  juice,  and  at  the 
same  time  it  has  no  effect  upon  the  digested  products  of  the 
stomach. 

When  separated,  the  pancreatic  and  gastric  fluids  exercise 
their  functions  in  full,  and  when  mingled  in  their  pure  state, 
the  two  digestions  are  arrested.  The  two  ferments,  pepsine  and 
pancreatine,  destroy  each  other. 

In  the  alimentary  canal,  this  is  prevented.  1st,  by  the  pylor- 
ous  which  separates  the  two  ferments.  2nd,  by  the  gastric 
digestion  during  which  the  pepsine  is  destroyed.  3rd,  by  the 
bile  which  destroys  in  its  course  the  activity  of  the  pancreatine. 

It  is  evident,  therefore,  that  the  pancreatine,  or  the  pancreatic 
juice,  so  far  from  assisting  digestion,  would  retard  it.  M.  S. 
Corvisart  states  that  he  had  failed  to  receive  any  benefit  from 
the  administration  of  pancreatine  for  the  relief  of  derangement 
of  the  digestion  in  the  intestinal  canal. 

In  this  case  of  diabetes  mellitus,  I  employed  a  preparation  of 
the  pancreas  of  the  pig,  prepared  in  the  same  manner  with 
the  stomach.  No  beneficial  results  were  produced,  and  it  was 
abandoned  and  the  pepsine  retained. 

(2.)  To  afford  the  organic  and  inorganic  materials  of  structure. 

As  usual  in  the  treatment  of  diabetes  mellitus,  the  patient  was 
furnished  principally  with  animal  food — eggs,  mutton,  beef,  &c. 

Bread  and  rice  were  allowed  more  frequently,  however,  than 
in  the  practice  laid  down  in  the  books. 
$     Phospate  of  Iron,  .  . 
"        a  Lime, .  . 
"  Soda,  .  . 
"         "  Potassa,   .     "    iv. 
Mix  and  administer  three  times  during  the  day,  in  the  soup 
containing  the  pepsine.     These  salts  were  given  because  they 
form  important  constituents  of  the  blood  corpuscles,  muscles  and 
brain,  and  nervous  system. 

$     Cod-liver  oil,  tablespoonful  three  times  a  day. 


grs. 

1> 

u 

iv. 

u 

vi. 

1858.]  Jones,  on  Diabetes  Mellitus.  311 

Cod-liver  oil  is  indicated  in  the  treatment  of  diabetes  mellitus 
for  two  reasons : 

To  supply  the  fatty  matters  which  have  been  consumed. 

There  is  a  close  connection  between  phthisis  and  diabetes. 

Writers  upon  this  disease  state  that,  in  the  majority  of  cases, 
phthisis  makes  its  appearance  before  death. 

(3.)  To  strengthen  and  quiet  the  nervous  system. 
The  depressed  spirits,  fretful,  peevish  temper,  impaired  mem- 
ory and  intelligence,   loss  of  sexual  propensity,  and  complete 
exhaustion  of  nervous  power,  call  for  those  remedies  which  will 
act  both  as  tonics  and  sedatives  to  the  nervous  system. 

To  accomplish  these  objects,  opium  and  strychnia  should  be 
given  simultaneously. 

$     Strychnia, grs.  ij. 

Extract  of  Gentian,  .  .  .    "     3 ij. 

Mix  and  divide  into  100  pills;  one  pill  three  times  a  day,  to  be 
gradually  increased,  according  to  the  strength  of  the  patient 
and  effects  upon  the  nervous  system. 

Strychnia  not  only  exerts  a  tonic  influence  upon  the  digestive 
organs,  and  muscular  and  nervous  systems,  but  also  exerts  a 
direct  influence  in  diminishing  the  amount  of  sugar  formed. 

#  One  grain  of  opium  at  bed-time,  and  one  grain  in  the 
morning,  at  9  o'clock. 

Opium  quiets  the  nervous  irritability  of  the  patient,  and  con- 
trols the  diuretic  influence  of  the  sugar  in  the  blood.  It  checks 
the  excessive  discharge,  but  does  not  prevent  the  production  of 
sugar.  Nevertheless,  its  action  upon  the  nervous  system  ren- 
ders it  one  of  the  most  valuable  of  the  secondary  means. 

As  a  stimulant  and  tonic  to  the  digestive  organs,  f  I  ij.  of  bran- 
dy were  administered,  three  times  a  day,  in  a  cup  of  the  officinal 
infusion  of  quassia  and  soda. 

Aug.  10th. — Pulse,  74.     Temperature  of  Atmosphere,  88°  F. 

"  under  Tongue,   98° 

Aug.  11th. — Pulse,  78.  Temperature  of  Atmosphere,  81°  F. 
Eespiration,  16,        "  under  Tougue,   99 J° 

August  12th. — Slight  improvement  of  digestion.  Bowels  are 
not  moved  so  frequently.  He  is  exceedingly  weak,  and  com- 
plains of  pain  in  his  head  and  bones. 


812  Jones,  on  Diabetes  Mellitus.  [May, 

August  19th. — Complains  of  great  weakness  and  thirst;  is  in 
a  profuse  perspiration ;  says  that  his  digestion  improves,  but  his 
strength  does  not  increase.  The  brandy  causes  him  to  sleep 
and  perspire  too  freely,  and  is  probably  the  cause  of  the  increas- 
ed flow  of  urine  and  loss  of  strength. 

The  experiments  of  George  Harley,  M.D.,  (2  6)  and  M.  Ber- 
nard, (2  7)  have  demonstrated  that  alcohol,  ether,  chloroform, 
methylated  spirit,  and  ammonia,  introduced  into  the  duodenum, 
or  injected  directly  into  the  portal  vein,  will  excite  an  increased 
secretion  of  sugar.  Healthy  animals  thus  operated  on  were 
rendered  for  a  time  diabetic.  This  fact  is  important,  not  only 
in  the  treatment,  but  also  in  its  bearing  upon  the  causes  of  dia- 
betes mellitus. 

Drunkards  are  said  to  be  peculiarly  liable  to  this  disease. 

Pulse  84,  Eespiration  17,  Temperature  of  Atmosphere,  90°  F. 

"  under  Tongue,  104° 

The  acceleration  of  the  pulse  may  be  due  to  the  action  of  the 
alcoholic  stimulants.  "We  will  discontinue  the  brandy  and  sub- 
stitute 10  grains  of  carbonate  of  ammonia,  three  times  a  day,  in 
a  cup  of  the  infusion  of  quassia  and  soda. 

The  carbonate  of  ammonia  is  administered,  first,  as  a  stimu- 
lant, and  second,  as  a  means  of  diminishing  the  amount  of  grape 
sugar. 

Some  chemists  (2  8)  have  supposed  that  the  occurrence  of  alka- 
line carbonates  is  necessary  for  the  decomposition  of  sugar  in 
the  animal  economy,  and  that  in  diabetes  the  passage  of  glucose 
into  the  urine  is  due  to  a  want  of  alkalinity  in  the  blood. 

(26)  "  Contributions  to  the  Physiology  of  Saccharine  Urine.  On  the  Origin  and 
Destruction  of  Sugar  in  the  Animal  Economy,  by  George  Harley,  M.D." — British 
and  Foreign  Medico-Chir.  Review,  July,  1857,  p.  144. 

(27)  Gazette  Medicale  de  Paris,  Mai  10,  No.  19,  1856,  and  Schmidt's  Jahrb.,  vol. 
xciii.  p.  24,  1857. 

(28)  Chimie  applique  a'la  Physiologie  et  a  la  Therapeutique,  Par  M.  le  Docteur 
Mialhe,  Pharmacien  d'  l'Empereur. — Paris,  1856. 

In  this  work,  Mialhe,  after  examining  the  various  hypotheses  which  have  been 
proposed  to  explain  the  nature  of  diabetes  mellitus,  comes  to  the  conclusion  that 
its  true  cause  is  a  deficiency  of  alkali  in  the  blood.  To  the  objection  that  the 
blood  of  diabetic  patients  is  never  either  neutral  or  acid,  but  always  alkaline  in 
its  reaction,  Mialhe  answers  that  it  is  difficult  to  determine  the  amount  of  the 
alkalinity  of  the  blood;  and  again,  that  part  of  the  alkaline  reaction  of  this 
fluid  is  derived  from  the  presence  of  alkaline  phosphates  which  possess  no  power 
of  decomposing  glucose.  He  is  inclined  to  consider  that  the  alkaline  carbonates 
are  deficient  or  absent,  the  phosphates  remaining  intact,  thus  preventing  the 
fluid  from  exhibiting  anything  but  an  alkaline  reaction. 

In  the  treatment  of  diabetes  he  acts  strictly  u^on  these  indications,  and  pre- 


1858.]  Jones,  on  Diabetes  Mellitus.  313 

Direct  experiment  does  not  supp*::;  this  theory,  for  the  re- 
searches of  C.  G.  Lehmanri,  (39)  Bouchardat  and  Bernard,  (30) 
have  proved  on  the  contrary,  that  the  blood  of  diabetic  persons 
preserves  its  alkalinity,  and  that  the  alkalies  of  the  blood  do  not 
promote  the  oxidization  of  sugar  to  the  extent  asserted. 

Direct  experiment  and  clinical  facts,  on  the  other  hand,  have 
shown  that,  in  certain  derangements  of  the  nervous  and  circu- 
latory systems  and  of  the  constituents  of  the  blood,  the  produc- 
tion of  grape  sugar  is  increased  and  it  passes  into  the  urine ; 
and  farther,  that  the  alkaline  carbonates  diminish  the  proportion 
of  sugar  in  the  urine  of  diabetic  patients. 

We  may  then  employ  the  alkaline  carbonates  in  the  treatment 
of  diabetes  mellitus,  although  their  action  upon  glucose  in  the 
animal  economy  is  not  well  understood,  and  probably  differs 
both  in  degree  and  kind  from  that  asserted  by  Mialhe. 

August  20th. — Feels  very  weak,  and  complains  of  a  pain  in 
the  region  of  his  liver.     Bowels  are  still  irregular,  but  improving. 
Pulse,  ...  72.      Temperature  of  Atmosphere,   83°  F. 
Inspiration,  14  "  "  Hand,    ....  97° 

"  under  Tongue,  100±° 

August  26th. — Improving  in  strength  and  spirits.  Digestive 
function  restored.  Slowly  gains  flesh.  Digests  large  quantities 
of  meat  with  ease. 

$.     Cane  sugar  ixij.  during  the  24  hours. 

scribes  lime  water,  magnesia,  vichey  water,  bicarbonate  of  soda,  alkaline  and 
vapor  baths,  flannel,  friction,  exercise,  animal  diet^  and  sometimes  sudorifics. 
M.  Mialhe  relates  the  case  of  an  Italian  professor  of  music,  afflicted  with  diabetes 
mellitus.  Under  the  alkaline  treatment  the  sugar  rapidly  diminished  and  the 
patient  recovered. 

(29)  Prof.  C.  G.  Lehmann  injected  a  solution  of  grape  sugar,  prepared  from 
starch,  into  the  veins  of  37  dogs  and  rabbits,  and  in  every  instance  grape  sugar 
appeared  in  the  urine;  and  the  reaction  of  the  urine  was  acid.  The  sugar  pass- 
ed so  rapidly  into  the  urine,  that  it  was  frequentlj*  detected  five  minutes  after  its 
injection,  and  then  when  only  O'l  of  a  gramme  was  injected. 

Caustic,  alkalies,  and  their  carbonates,  associated  with  grape  sugar,  were  also 
injected  into  the  veins  of  rabbits. 

Notwithstanding  the  caustic,  alkalies  and  the  carbonates,  the  urine  not  only- 
contained  grape  sugar,  but  also  exhibited  an  acid  reaction. 

Prof.  Lehmann  also  injected  dilute  solutions  of  tartaric  and  citric  acids  into  the 
stomachs  of  rabbits  and  dogs,  fed  on  food  poor  in  alkalies.  Although  the  blood 
was  thus  rendered  poor  in  alkalies,  while  at  the  same  time  vegetable  acids  were 
introduced,  still  not  a  trace  of  sugar  appeared  in  the  urine. — Physiological  Chem- 
i.-try,  by  Prof.  C.  G.  Lehmann.  English  Ed.,  voL  hi.,  p.  233.  American  Ed., 
vol.  ii.,  p.  357. 

These  experiments  have  been  repeated  by  Uhle,  with  similar  results. — Dis. 
Iuaug.  Med.  Lips.,  1852.  p.  19. 

(30)Moniteur  des  Hopitaux,  May  14,  1857. 


314  Jones,  on  Diabetes  Mellitus.  [May, 

Hoppe's(3 1)  Investigations  upon  the  action  of  cane  sugar  upon 
the  animal  economy  have  established  the  following  facts : 

1.  No  trace  of  grape  sugar  was  found  in  the  urine  or  feces 
during  continued  feeding  with  cane  sugar. 

2.  When  sugar  and  meat  were  given  together,  the  weight  of 
the  animal  increased  much  more  rapidly  than  when  meat  alone 
was  given. 

3.  When  sugar  and  meat  were  consumed,  urea  was  excreted 
in  smaller  quantity  than  when  meat  alone  was  taken. 

4.  By  exclusive  sugar  diet,  the  excretion  of  urea  was  de- 
pressed to  its  lowest  amount. 

5.  By  the  presence  of  much  sugar  in  the  blood,  the  albumin- 
ous substances  are  preserved  from  oxidization. 

The  albumen  thus  stored  up  appears  to  be  decomposed  during 
the  development  of  fat.  In  this  manner  sugar  produces  fatten- 
ing, only  when,  at  the  same  time,  albuminous  substances  are 
liberally  supplied. 

6.  The  temperature  of  the  body  was  not  increased,  by  the 
addition  of  sugar  to  the  allowance  of  meat. 

7.  The  health  of  the  animals  experimented  on,  was  in  no  way 
injured  by  feeding  on  large  quantities  of  cane  sugar,  in  addi- 
tion to  a  liberal  supply  of  meat. 

September  23rd.  Has  continued  steadily  to  improve  in  health 
and  strength,  and  is  now  able  to  walk  about  the  hospital  grounds 
and  assist  in  nursing  the  patients. 

The  amount  of  urine  voided  daily  has  diminished. 

October  20th.  His  muscular  and  nervous  forces  have  increased 
greatly.  His  face  and  limbs  have  filled  out.  His  spirits  are  ex- 
cellent; and  he  says  that  he  is  now  as  fleshy  as  in  health. 

He  is  able  to  act  as  assistant  nurse,  and  often  sits  up  all  night 
with  those  patients  who  require  his  services. 

The  amount  of  urine  excreted  daily  has  greatly  diminished, 
and  ranges  from  seventy  to  ninety  fluid  ounces. 

The  grape  sugar  has  diminished  greatly  in  amount,  but  has 
not  entirely  disappeared. 

At  this  date  I  resigned  the  charge  of  the  Savannah  Marine 
Hospital  and  Poor  House. 

(31)  F.  Hoppe,  on  the  Influence  of  Cane  Sugar  in  Digestion  and  Nutrition. — 
Virchow's  Archiv.,  vol.  x.,  pp.  144,  S.  S.,  1856. 


1858.]  DuGAS.     New  Principle  of  Diagnosis.  315 

It  is  evident,  that  sufficient  time  had  not  elapsed  to  warrant 
the  assertion  that  this  case  was  cured ;  nevertheless,  the  reme- 
dies used  produced  decided  beneficial  effects,  and  were  the 
means,  in  Providence,  of  arresting  the  disease,  when  the  patient 
appeared  to  be  in  the  last  stages  of  diabetes  mellitus,  and  upon 
the  borders  of  the  grave. 

I  have  endeavored  to  give  a  simple  statement  of  the  facts  ob- 
served in  this  case,  the  plan  of  treatment  pursued,  and  the  reasons 
which  led  me  to  the  adoption  of  this  mode  of  treatment. 

Although  this  is  but  a  single  case,  the  treatment  of  which  was 
not  even  conducted  to  its  termination  in  complete  health,  or 
death,  still,  I  am  persuaded  that,  in  the  present  state  of  Medical 
Science,  every  successful  effort  to  arrest  so  formidable  a  disease 
as  Diabetes,  even  for  a  few  months,  will  be  considered  worthy 
of  an  examination  by  Practitioners  of  Medicine. 


AETICLE    XIII. 


A  Xew  Principle  of  Diagnosis  in  Dislocations  of  the  Shoulder-joint. 
E y  L.  A.  Dcgas,  M.  D.,  Professor  of  Surgery,  in  the  Medical 
College  of  Georgia.* 

Having  for  a  number  of  years  inculcated  in  my  lectures  the 
principles  contained  in  this  paper,  I  was  requested  to  reduce 
my  views  to  writing,  for  the  benefit  of  our  classes,  and  according- 
ly published  an  article  on  the  subject  in  the  March  number,  for 
1856,  of  the  Sout/iern  Medical  and  Surgical  Journal,  p.  131. 
The  object  of  this  communication  is  to  present  the  American 
Medical  Association  with  a  brief  expose  of  this  interesting  sub- 
ject, and  to  accompany  my  remarks  with  pictorial  illustrations, 
calculated  to  impress  the  eye  as  well  as  the  understanding  of  the 
reader. 

The  principle  of  diagnosis  to  which  I  refer  may  be  enuncia- 
ted in  the  following  language :  If  the  fingers  of  the  injured  limb 
can  be  placed  by  the  patient  or  by  the  surgeon  upon  the  sound 
shoulder,  while  the  elbow  touches  the  thorax,  there  can  be  no  dis- 
location; aud  if  this  cannot  be  done,  there  must  be  a  dislocation. 
In  other  >vords,  it  is  physically  impossible  to  bring  the  elbow  in 

*  The  above  Report  was  read  before  the  American  Medical  Association,  and 
printed  in  the  loth  Volume  of  the  Transactions. 
K.s. — vol.  xrv.  no.  v.  14 


816 


DUGAS.     New  Principle  of  Diagnosis. 


[May, 


contact  with  the  sternum  or  front  of  the  thorax  if  there  be  a  dis- 
location ;  and  the  inability  to  do  this  is  proof  positive  of  the  ex- 
istence of  dislocation,  inasmuch  as  no  other  injury  of  the  shoul- 
der-joint can  induce  this  inability. 

In  order  to  make  these  propositions  apparent,  I  beg  leave  to 
present  drawings  taken  from  the  skeleton,  showing  the  relative 
position  of  the  bones  in  the  natural  state,  and  in  the  several  dis- 
locations of  the  shoulder.  The  evidence  thus  obtained  in  sup- 
port of  my  principle,  would  be  still  stronger  if  the  bones  were 
invested  with  their  normal  coverings  and  attachments. 

Let  us  then  look  at  Fig.  1,  and  we  may  observe,  that  while 
the  head  of  the  humerus  occupies  the  glenoid  cavity,  and  the  fin- 
gers rest  upon  the  other  shoulder,  the  elbow  and  lower  end  of 
the  humerus  lie  upon  the  thorax  without  difficulty,  because  of 
the  circumstance  that  the  head  of  the  humerus,  when  in  its  natu- 
ral position,  is  removed  several  inches  from  the  ribs.  In  con- 
sequence of  the  rotundity  of  the  thoracic  walls  it  is  physically 
impossible  that  both  ends  of  the  humerus  should  at  the  same 
time  come  in  contact  with  the  chest.     We  see,  therefore,  in  Fig. 

Fig.  1. 


1,  that  in  the  absence  of  any  dislocation,  the  upper  half  of  the 
bone  does  not  touch  the  thorax,  and  that  the  lower  half  does  so 
without  the  least  difficulty. 


1853.]  Dug  AS.     New  Principle  of  Diagnosis.  317 


Fig.  2. 


By  now  referring  to  Fig.  2,  which  represents  a  dislocation  into 
the  axilla,  we  find  that,  the  fingers  being  placed  upon  the  oppo- 
site shoulder,  the  elbow  is  forced  so  far  forwards  that  it  cannot 
touch  the  thorax.  In  this  state  of  things,  the  upper  end  of  the 
humerus  alone  touches  the  ribs,  while  the  lower  end  is  propor- 
tionately removed  from  the  chest.  Any  attempt  to  force  the 
elbow  against  the  thorax  must  be  fruitless,  unless  at  the  expense 
of  a  disruption  of  all  the  soft  parts  by  which  the  head  of  the  hu- 
merus is  held  down  ;  for,  as  I  have  already  stated,  it  is  physical- 
ly impossible  for  both  ends  of  the  humerus  to  touch  the  thoracic 
walls  at  the  same  time. 

We  have  represented,  in  Fig.  3,  a  dislocation  forwards  or  be- 
low the  clavicle ;  and  here  again  we  find  the  upper  end  of  the 
humerus  resting  upon  the  ribs — the  elbow  being  consequently 
removed  from  the  chest.  The  upper  half  of  the  humerus  touches 
the  thorax,  and  so  long  as  this  is  the  case,  it  is  physically  impos- 
sible for  the  lower  portion  of  the  humerus  also  to  do  it.  In  dislo- 
cations of  this  kind,  it  is  very  difficult  to  carry  the  fingers  upon 
the  opposite  shoulder,  even  though  the  elbow  be  allowed  to  pro- 
ject forward,  because  of  the  resistance  offered  by  the  strong  mus- 
cles which  pull  back  the  humerus.  I  have,  however,  represen- 
ted the  bones  of  the  skeleton  in  this  position,  for  the  purpose  of 


318 


DuGAS.     New  Principle  of  Diagn 


osis. 


[May, 


showing  the  effect,  in  case  it  could  be  assumed,  in  the  living 
subject. 

Fig.  3. 


Dislocations  of  the  humerus  upon  the  dorsum  of  the  scapula, 
although  very  rare,  should  still  be  carefully  studied.  I  have, 
therefore,  represented  this  accident  in  Fig.  4,  by  which  it  may 

Fig.  4. 


be  seen  that  the  same  principles  are  applicable  also  to  it.    Here, 


1858.]  Dugas.     New  Principle  of  Diagnosis.  319 

as  well  as  in  the  other  instances,  it  is  only  the  upper  end  of  the 
humerus  that  touches  the  thorax,  and  the  elbow  projects  strong- 
ly forwards.  In  this  dislocation,  it  might  be  possible  to  bring 
the  elbow  against  the  side  of  the  trunk,  by  carrying  the  hume- 
rus down  parallel  with  the  axis  of  the  body ;  but  any  contact 
of  the  elbow  with  the  chest  is  impossible,  if  the  fingers  be  directed 
towards,  or  placed  upon  the  sound  shoulder,  for  then  the  form 
of  the  thorax  would  offer  an  insuperable  obstacle. 

Having  now,  I  trust,  sufficiently  demonstrated  the  truth  of 
the  proposition  that  it  is  physically  impossible  to  bring  the  elbow 
against  the  front  of  the  thorax  in  dislocation  of  the  shoulder,  I 
would  simply  add,  that  it  is  equally  true,  that  no  other  injury 
of  the  shoulder-joint  than  a  dislocation  can  induce  this  physical 
impossibility.  It  is  obvious,  that  a  mere  contusion  of  the  soft 
parts  may  render  motion  of  the  joints  so  painful  as  to  deter  the 
patient  from  the  effort  necessary  to  carry  the  fingers  upon  the 
other  shoulder.  But  there  can  be  no  difficulty  on  the  part  of 
the  surgeon  in  placing  the  limb  in  this  position,  and  an  anaesthe- 
tic might  be  used,  if  desirable,  so  as  to  render  manipulation  pain- 
less. The  same  may  be  said  of  fractures  of  the  upper  end  of  the 
humerus,  of  the  acromion,  of  the  coracoid  process,  and  of  the 
neck  of  the  scapula.  In  neither  of  these  accidents  can  there  be 
any  physical  impediment  in  the  way  of  bringing  the  elbow  in 
contact  with  the  front  of  the  chest,  for  in  neither  of  them  can 
the  upper  end  of  the  humerus  be  so  fixed  against  the  ribs  as  to 
make  it  impossible  for  the  lower  end  to  touch  the  chest.  Nothing, 
therefore,  but  a  dislocation  can  prevent  the  limb  from  being 
placed  in  the  position  indicated. 

If  it  be  justly  esteemed  a  matter  of  great  importance  to  be  in 
possession  of  correct  principles  of  diagnosis  in  occult  diseases,  it 
is  certainly  not  the  less  so  with  regard  to  surgical  accidents,  es- 
pecially when  these  demand  prompt  interference.  Our  profes- 
sional records  unfortunately  establish  too  conclusively  the  im- 
perfection of  our  diagnostic  resources  in  injuries  of  the  joints,  to 
permit  any  indifference  on  the  subject.  If,  therefore,  the  views 
here  presented  may  facilitate,  in  the  least  degree,  the  detection 
of  injuries  confessedly  more  or  less  obscure,  my  object  will  have 
been  attained. 


320  Supra-renal  Capsules  and  Bronzed  Skin.  [May, 

Supra-renal  Capsules  and  Bronzed  Skin.     By  George  Harley, 
M.  D.,  F.  R.  C.  S.  London. 

[The  following  condensed  analysis  of  the  above  paper  published 
in  the  British  and  Foreign  Med.  Chir.  Review,  presents  a  compre- 
hensive resume  of  the  various  opinions  and  experimental  results 
upon  the  subject.  It  is  by  Dr.  Austin  Flint,  Jr.,  and  is  transfer- 
red from  the  Buffalo  Journal. — Edts.] 

The  Supra-Renal  Capsules.  By  Austin  Flint,  Jr. — Medical 
practitioners  have  always  occasionally  met  with  a  disease  affect- 
ing the  color  of  the  skin  and  accompanied  by  extreme  emacia- 
tion, of  the  pathology  of  which  they  were  utterly  ignorant.  We 
ourselves  had  an  opportunity  of  seeing  such  a  case  in  the  wards 
of  Prof.  Flint,  at  the  Buffalo  Hospital  of  the  Sisters  of  Charity. 
In  this  case,  as  far  as  our  memory  serves  us,  the  patient  was  ex- 
ceedingly emaciated  ;  had  cough  and  extensive  pulmonary  disease, 
and  was  affected  with  a  brown  discoloration  of  the  skin,  which 
was  general,  with  the  exception  of  spots  over  the  body  of  dazzling 
whiteness,  which  were  of  irregular  shape,  and  varied  in  size  from 
that  of  a  sixpence  to  a  dollar,  or  in  a  few  places  were  even  lar- 
ger. The  patient  died  a  few  days  after  his  admission  into  the 
wards,  but  no  autopsy  was  made. 

A  short  time  after  this,  we  saw  a  notice  of  a  monograph  by  Dr. 
Addison,  on  "  The  supra-renal  capsules  and  iheir  connection  with 
Bronzed  Skin."  Dr.  Addison  has  made  a  number  of  post-mortem 
examinations  of  patients  who  where  affected  with  this  peculiar 
discoloration  of  the  integument,  which  he  denominated  "  Bronzed 
Skin"  and  invariably  found  associated  with  it  a  disease  or  disor- 
ganization of  the  supra-renal  capsules,  by  which  their  function 
was  entirely  abolished.  As  Addison  was  the  first  to  point  out 
any  connection  between  bronzed  skin  and  disease  of  these  organs, 
it  has  been  proposed  that  the  disease  shall  be  called  "Addison's 
Disease,"  as  albuminuria  connected  with  organic  diseases  of  the 
kidneys  was  named  after  its  distinguished  discoverer,  Dr.  Bright. 
Physiologists,  as  is  well  known,  have  never  been  able  to  deter- 
mine definitely  the  function  of  the  ductless  glands  or  the  blood 
glands,  as  they  are  sometimes  called ;  which  are  the  spleen,  thy- 
noid  and  thymus  glands,  mesenteric  glands  and  the  supra-renal 
capsules.  These  organs  have  all  the  anatomical  characteristics 
of  ordinary  glands,  with  the  exception  of  ducts ;  and,  as  owing  to 
this,  their  secretion,  if  they  have  any,  cannot  be  subjected  to 
analysis,  their  role  in  the  economy  has  remained  almost  unknown. 
In  none  of  these,  however,  has  the  obscurity  been  so  great  as  in 
the  case  of  the  supra-renal  capsules.  The  brilliant  experiments 
of  Bernard  in  regard  to  the   Glucogenic   function  of  the  liver, 


1858.]  Supra-renal  Capsules  and  Bronzed  Shin.  321 

which  so  surprised  and  delighted  the  scientific  world,  and  which 
made  such  an  advance  into  the  pathology  of  that  hitherto  unac- 
countable disease,  diabetes  mellitus ;  gave  a  new  impulse  to  the 
study  of  the  ductless  or  blood  glands;  as  by  these  experiments 
Bernard  has  shown  that  the  liver,  in  addition  to  its  office  as  a 
bile  secreting  organ,  formed  sugar  within  its  substance,  which 
was  given  up  immediately  to  the  mass  of  blood  without  the  inter- 
vention of  an  excretory  duct :  since  this  was  discovered,  it  has 
been  shown  that  the  liver  also  produces  fat  de  novo,  though  as 
much  is  not  known  about  this  function  as  about  the  production  of 
sugar.  Thus  the  liver,  in  addition  to  being  an  ordinary  gland, 
possessed  of  an  excretory  duct,  is  in  reality  a  blood  gland  like  the 
spleen,  or  supra-renal  capsules. 

A  great  proportion  of  the  energy  of  the  investigations  into  the 
functions  of  the  ductless  glands  hasbeen  directed  towards  the  spleen, 
and  it  is  now  supposed,  and  on  pretty  good  foundation,  that  the 
spleen  and  mesenteric  glands  have  an  important  office  in  the  for- 
mation of  blood  globules.  The  physiology  of  the  supra-renal  cap- 
sules, however,  had  still  remained  buried  in  its  original  obscurity. 

Upon  the  appearance  of  the  excellent  monograph  by  Dr.  Addi- 
son, observers  in  all  parts  of  the  world  set  themselves  to  work  upon 
the  physiology  of  the  supra-renal  capsules  ;  the  paper  of  Addison 
having  thrown  some  light  on  the  subject,  and  seeming  indeed  to 
establish  some  connexion  between  these  organs  and  the  formation 
of  pigment,  or  the  regulation  of  its  deposition.  The  Physiologists 
who  have  made  known  to  the  world  the  results  of  their  experi- 
ments, are  Gratiolet,  Brown  Sequard,  Philipeaux,  and  Dr.  Harley, 
of  University  College,  London.  The  experiments  of  these  gen- 
tlemen, whose  names  our  readers  will  recognise  as  belonging  to 
men  eminent  in  this  department,  have  led  them  to  somewhat  dif- 
ferent results  :  we  had  the  pleasure  of  listening  to  lectures  by  Dr. 
Brown  Sequard  on  this  subject  a  year  ago,  when  he  seemed  to 
prove  that  the  supra-renal  capsules  were  essential  in  the  highest 
degree  to  life,  even  more  so  than  the  kidneys  themselves ;  as  an 
animal  survived  for  two  or  three  days  after  the  extirpation  of  the 
kidneys,  but  it  lived  for  a  few  hours  only  after  the  removal  of  the 
supra-renal  capsules.  Brown  Sequard  also  showed  that  animals 
from  whom  these  organs  had  been  removed,  were  convulsed  and 
affected  with  that  peculiar  nervous  phenomenon  which  is  known 
as  "  turning,"  this  turning  always  being  in  the  same  direction. 
He  also  asserts  that  death  supervenes  too  rapidly  to  be  due  to 
inflammation  of  the  peritoneum,  and  indeed,  on  examining  this 
membrane  after  death,  no  evidences  of  inflammation  are  observed. 
Brown  Sequard  performed  experiments  in  the  presence  of  his 
audience,  and  we  had  an  opportunity  of  witnessing  the  phenome- 
na which  he  described. 

The  most  elaborate  and  satisfactory  paper  on  this  subject  which 


322  Supra-renal  Capsules  and  Bronzed  Skin.  [May, 

we  have  yet  seen,  is  from  the  pen  of  Dr.  Harley,  and  appeared 
in  the  last  number  of  the  British  and  Foreign  Medico-Chirurgi- 
cal  Review.  Thk  article  we  have  carefully  perused,  and  it  was 
this  which  led  us  to  make  the  preceding  observations.  Think- 
ing this  subject  to  be  of  great  importance  to  us  as  Physiologists 
and  Pathologists,  we  have  been  thus  extended  in  our  remarks,  and 
will  give  a  brief  recapitulation  of  the  more  important  results  at 
which  Dr.  Harley  has  arrived ;  this  we  deem  the  more  appropri- 
ate, as  it  is  probable  that  many  of  our  readers  do  not  have  an 
opportunity  of  seeing  the  above  mentioned  periodical. 

In  anatomical  structure,  these  organs  present  no  very  striking 
points  of  difference  from  some  of  the  ordinary  secreting  glands  of 
the  economy ;  they  are  formed  of  a  medullary  and  cortical  sub- 
stance like  the  kidneys.  There  is  a  peculiarity  however  in  their 
chemical  constitution.  "  In  the  beginning  of  the  last  year,  M. 
Vulpian  communicated  to  the  Societie  de  Biologie  the  discovery 
a  very  peculiar  reaction  possessed  by  the  super-renal  capsules  of 
vertebrated  animals.  He  found  that  an  aqueous  solution  of  iodine 
brought  in  contact  with  the  medullary  substance  gave  rise  to  a 
beautiful  rose  color.  And  further,  that  the  greater  portion  of 
oxidizing  agents  acted  like  the  iodine  solution,  although  in  a 
minor  degree.  Even  the  oxygen  of  the  air,  under  the  influence 
of  light,  produced  the  same  effect.  I  have  repeated  M.  Vulpian's 
experiment  on  the  medullary  substance  of  the  supra-renal  capsules 
of  sheep  with  success ;  but  am  equally  at  a  loss  with  the  author 
to  form  an  opinion  as  to  the  nature  of  the  substance  which  pos- 
sesses the  strange  property  alluded  to.  We  as  yet  know  so  little 
regarding  the  nature  of  color  and  coloring  matter,  that  it  would 
be  futile  to  attempt  to  draw  any  conclusions  with  regard  to  the 
import  of  the  rose  colored  reaction  above  spoken  of." 

"  Not  being  able  to  separate  the  coloring  matter,  M.  Vulpian, 
in  concert  with  M.  Cloez,  proceeded  to  extract  the  "  immediate 
principles"  of  the  supra-renal  bodies;  and  these  gentlemen  have 
recently  communicated  to  the  Institute  de  France  as  the  result  of 
their  united  labors,  the  discovery  of  hip-puric  and  tanrocholic 
acids  in  the  supra-renal  capsules  of  herbiverous  animals.  But  as 
these  substances  have  been  abundantly  found  in  different  parts  of 
the  animal  body,  their  discovery  in  the  latter  organs,  although  in- 
teresting, unfortunately  throws  no  light  upon  the  nature  of  their 
functions." 

Dr.  Harley  has  since  seen  a  communication  from  Prof.  Vir- 
chow,  in  which  he  confirms  the  observation  of  M.  Vulpian  with 
regard  to  the  rose  colored  reaction,  and  also  mentions  that  he  has 
found  senecine  in  the  medullary  substance. 

The  question  arises  whether  the  supra-renal  capsules  are  or- 
gans peculiarly  essential  to  foetal  existence  and  developement. 
It  was  formerly  supposed    that  this  was  the  case,  and  the   argu- 


1858.]  Supra-renal  Capsules  and  Bronzed  Skin.  323 

ments  in  favor  of  this  idea,  were  the  great  relative  size  of  these 
bodies  in  the  foetus,  and  their  small  size  in  adults.  Meckel  states 
that  at  the  third  month,  the  supra-renal*capsules  and  kidneys  are 
of  equal  size,  at  the  sixth  month  as  2  to  5.  at  birth  as  1  to  8,  and 
in  adult  life  as  1  to  28.  Later  observations,  however,  by  the 
author,  Brown  Sequard,  and  others,  show  a  different  result  in  the 
case  of  some  of  the  mammalia.  Dr.  Harley  has  been  confined  in 
his  observations  to  the  cat,  having  examined  thirteen  foetal  and 
six  adult  capsules.  Without  giving  the  figures  and  calculations, 
we  will  give  the  results  at  which  Dr.  Harley  has  arrived  and  in 
which  he  confirms  Ecker,  Frey,  and  others:  "The  weight  of 
the  supra-renal  capsule  in  the  kitten  at  birth  is  to  that  of  the  kid- 
ney as  1  to  57.3 ;  and  in  the  adult  as  1  to  54.8.  But  as  so  few 
adult  capsules  and  kidneys  were  employed,  it  may  be  perhaps 
better  to  take  the  average  of  the  whole  six  that  were  examined, 
which  would  then  give  us  the  relative  weight  of  three  organs  in 
the  full  grown  animal  as  1  to  46.49. 

"  We  shall  find  by  a  very  simple  calculation  that  the  kidney 
was  after  birth  increased  12.35  times  in  weight,  while  the  supra- 
renal capsule  at  the  same  time  has  increased  14.87  times  in  weight. 
What  conclusion  are  we  to  draw  from  this  fact  ?  We  here  see 
that  the  supra-renal  capsules  increase  in  size,  as  age  advances,  at 
a  greater  rate  than  the  kidneys.  I  must  here  speak  with  caution 
however.  Small  statistics  are  dangerous  data  to  draw  conclusions 
from,  and  perhaps  a  larger  number  of  observations  might  furnish 
us  with  different  results." 

Thus  our  readers  will  see  that  Ecker,  Frey.  and  Brown  Sequard, 
whose  observations  are  here  confirmed  by  Harley,  have  develop- 
ed an  exceedingly  important  fact  in  relation  to  the  probable  com- 
parative activity  of  the  function  of  the  supra-renal  capsule,  what- 
ever it  may  be,  in  foetal  and  adult  life:  conecting  the  doctrines 
promulgated  by  Meckel,  that  these  organs  in  the  mammalia  dimin- 
ish after  birth,  both  in  relative  size  and  activity  of  function. 

We  now  come  to  experiments,  bearing^directly  on  the  function 
of  the  supra-renal  capsules.  The  first  experiment  was  on  an 
adult  cat,  from  which  the  right  capsule  was  removed.  The  ani- 
mal survived  nine  days  after  the  operation,  and  on  post  mortem 
examination,  no  cause  of  death  could  be  discovered. 

Another  experiment  was  made  on  a  white  cat,  from  which  the 
capsules  were  removed.  This  died  in  twenty-four  hours,  and  on 
examination  there  were  found  all  the  indications  of  peritonitis. 

Another  experiment  was  made  on  a  small  white  coach  dog, 
from  which  the  left  capsule  was  removed.  It  died  on  the  twelfth 
day,  and  on  examination,  signs  of  peritonitis  were  discovered. 

An  experiment  was  then  made  on  two  Guinea  pigs,  in  one  of 
which  the  abdomen  was  opened,  and  the  amount  of  injury 
which  the   parts  would  suffer   by  the  removal  of  the  supra-renal 


321  Supra-renal  Capsules  and  Bronzed  Skin.  [^ay, 

capsules,  was  inflicted,  the  wound  sewed  up,  and  the  capsules  al- 
lowed to  remain;  the  fellow,  which  was  of  the  same  age,  sex,  and 
development,  was  then  deprived  of  the  capsule  on  the  correspond- 
ing side.  Both  these  animals  died  within  twenty-four  hours  after 
the  operation.  The  same  experiment  was  then  repeated  on  two 
cats.  The  cat  from  which  the  supra-renal  capsule  (the  right,) 
was  removed,  lived  two  days;  the  other  died  during  the  third 
night.  In  the  abdomens  of  both,  signs  of  peritonitis  were  dis- 
tinctly visible. 

The  next  experiment  was  made  on  a  bull  terrier  dog,  by  re- 
moving one  of  the  capsules  without  applying  a  ligature  to  the 
vessels,  the  body  being  enucleated  with  the  fingers.  The  dog 
remained  in  the  author's  possession  for  five  months,  and  did  not 
suffer  from  a  day's  illness. 

The  next  experiment  was  of  exceeding  interest :  it  was  on  a 
large  torn  cat,  in  which,  on  opening  the  abdomen,  the  right  cap- 
sule was  rough  and  hard  as  a  stone :  it  was  enucleated  with  the 
greatest  facility.  The  same  operation  was  repeated  on  the  other 
side  with  a  similar  result.  On  making  a  section  of  the  capsules, 
it  was  found  that  a  considerable  portion  of  the  medullary,  as  well 
as  of  the  cortical  substance,  had  become  replaced  by  a  calcareous 
deposit,  consisting  chiefly  of  carbonate  of  lime.  The  remaining 
portion  of  the  gland  contained  so  much  fibrous  tissue,  that  the 
normal  structure  might  be  said  to  have  entirely  disappeared.  iVs 
the  operation  on  this  animal  had  been  performed  with  the  utmost 
facility,  and  there  had  been  no  haemorrhage,  or  any  apparent  in- 
jury done  to  the  surrounding  parts,  except  the  tearing  through  the 
vessels  and  nerves,  the  author  felt  sanguine  of  success.  His  as- 
tonishment was  great  therefore  when,  arriving  at  the  college  next 
morning,  he  found  the  cat  dead.  The  post  mortem  examination 
revealed  nothing,  though  the  blood  was  searched  for  signs  of 
phlebitis,  examined  for  crystals,  and  for  the  flakes  of  pigment  des- 
cribed by  Brown  Sequard.  As  it  has  been  found  by  Ludwig  and 
HafFer,  that  section  of  the  splanchnic  nerves  will  kill  animals  in 
one  or  two  days,  and  according  to  Brown  Sequard,  mere 
pricking  or  cutting  of  the  semi-lunar  ganglion  proves  fatal  to  rab- 
bits in  thirty  hours,  while  division  of  the  sympathetic  in  the 
neighborhood  of  the  kidneys  causes  death  in  twenty-three  hours : 
in  absence  of  other  proof  of  death,  it  is  probable  that  it  resulted 
from  injury  done,  in  tearing  out  the  capsules,  to  the  ganglionic 
system  of  nerves. 

The  extirpation  of  the  right  is  more  fatal  than  the  removal  of 
the  left  capsule,  as  it  proved  by  experiments  which  the  author  has 
cited,  but  which  it  is  unnecessary  for  us  to  state.  M.  Gratiolet 
thought  that  this  fact  was  to  be  explained  by  the  proximity  of  the 
liver,  and  the  occurrence  of  hepatitis;  at  first  Dr.  Harley  was 
of  this  opinion,  but  he  now  very  justly  concludes  that  it  is  due  to 


1858.]         Supra-renal  Capsules  and  Bronzed  Skin,  325 

another  cause.  The  right  semi-lunar  ganglion,  which  is  much 
larger  than  the  left,  lies  (in  the  dog  and  cat)  directly  beneath  the 
supra-renal  capsule;  while  the  smaller  left  semi-lunar  ganglion  is 
placed  on  the  left  cms  of  the  diaphragm,  and  internal  to  the  supra- 
renal body.  Thus  it  will  be  immediately  seen  that  a  removal  of 
the  right  capsule  will  do  more  mischief  to  this  ganglion,  and  this 
injury  has  been  shown  by  Ludwig,  H after  and  Brown  Sequard 
to  be  sufficient  to  produce  death  in  a  short  time. 

As  it  is  generally  the  case  in  the  removal  of  double  organs,  that 
if  one  be  left  it  becomes  hypertrophied  from  being  compelled  to 
perform  a  double  function.  Dr.  Harley  was  anxious  to  observe 
if  this  was  the  case  as  respects  the  supra-renal  capsules.  He 
accordingly  removed  the  right  capsule  from  a  cat,  which  had 
made  an  excellent  recovery  from  the  operation  of  removing  the 
left  about  a  month  before.  Nothing  unusual,  however,  was 
observed :  on  the  morning  of  the  third  day  it  died,  and  on  open- 
ing the  abdomen,  two  of  the  lumbar  lymphatic  glands  were  ob- 
served very  much  enlarged,  and  presenting  a  peculiarly  beautiful, 
semi-transparent,  lobular  appearance. 

Dr.  Harley  performed  another  experiment  on  a  piebald  rat, 
with  reference  to  the  same  point.  The  right  supra-renal  cap- 
sule was  removed,  and  the  animal  made  a  rapid  recovery,  being 
in  excellent  condition  at  the  end  of  six  weeks.  The  left  cap- 
sule was  then  removed,  and  compared  with  others  taken  from 
animals  of  the  same  species  and  age,  in  order  to  ascertain  if  it 
had  become  hypertrophied.  But  in  this,  as  in  the  case  of  the  cat, 
there  was  no  very  marked  difference  in  either  its  size  or  appear- 
ance. From  the  effects  of  the  latter  operation  the  animal  speed- 
ily recovered,  and  ultimately  became  very  fat  and  healthy 
looking. 

An  experiment  was  made  on  a  white  rat,  in  order  to  observe 
if  any  change  would  take  place  in  the  color  of  the  hair  and  skin. 
Both  capsules  were  removed  at  an  interval  of  nine  days.  The 
animal  lived  sixteen  days  after  the  last  operation,  and  during  that 
time  the  color  of  the  hair  and  skin  was  carefully  watched,  with- 
out discovering  any  alteration,  excepting  that  the  neck  became 
denuded  of  hair,  was  covered  with  a  luxuriant  crop  of  young  hair, 
about  an  eighth  of  an  inch  long. 

The  foregoing  experiments,  which  we  have  presented  in  as  con- 
densed a  form  as  was  consistent,  cannot  fail  to  strike  every  one 
as  extremely  interesting,  and  leading  to  some  very  important 
conclusions.  Brown  Sequard  has  maintained  that  it  is  impossi- 
ble for  an  animal  to  live  for  more  than  forty-eight  hours  at  the 
farthest,  after  it  has  been  deprived  of  its  supra-renal  capsules. 
The  experiment  of  Dr.  Harley  fully  controvert  this  statement, 
and  in  addition,  M.  Philipeaux,  of  Paris,  has  removed  the  spleen, 
supra-renal  capsules,  and  the  thyroid  body  from  the  same  animal, 


326  Apoplexy  and  Hemiplegia.  pJay, 

which  afterwards  recovered.-  Dr.  Harley  brought  with  him  from 
Paris  a  young  rat,  the  offspring  of  a  mother  which  had  been  de- 
prived of  spleen  and  supra-renal  capsules.  Brown  Sequard  is  also 
probably  in  the  wrong  in  supposing  that  the  convulsions  and  turn- 
ing which  followed  his  experiments,  were  due  to  the  removal  of 
the  supra-renal  capsules ;  as  Dr.  Harley  has  not  observed  it  in 
his  experiments,  and  is  confirmed  by  a  private  letter  from  Profes- 
sor Virchow,  who  has  also  failed  to  notice  this  phenomenon. 

We  had  the  pleasure,  from  the  politeness  of  Dr.  Brown  Sequard, 
of  examining  certain  microscopic  crystals,  which  he  invariably 
found  in  the  blood  of  animals  from  which  he  had  removed  the 
supra-renal  capsules.  These  crystals  wTere  unlike  the  ordinary 
blood  crystals,  being  pale  and  needle  shaped.  Dr.  Harley  makes 
no  allusion  to  this  occurrence. 

Finally  we  present  the  conclusions  drawn  by  Dr.  Harley  from 
the  results  of  his  experiments. 

1st.     The  supra-renal  capsules  are  not  solely  fetal  organs. 

2d.     The  supra-renal  capsules  are  not  absolutely  essential  to  life. 

3d.  The  removal  of  the  right  is  generally  more  fatal  than  remo- 
val of  the  left  capsule. 

4th.  That  convulsions  do  not  necessarily  folloiu  the  removal  of 
the  capsule. 

5th.  That  the  absence  of  this  function  (in  rats),  is  attended 
neither  by  great  emaciation  nor  debility. 

6th.  That  when  death  follows  upon  the  extirpation  of  the  supra- 
renal bodies,  it  is  in  most  cases  in  consequence  of  the  injury  done  to 
the  neighboring  tissues  ;  perhaps  most  frequently  the  mutilation  of 
the  ganglionic  system  of  nerves. 

7th.  Absence  of  the  function  of  the  supra-renal  bodies,  is  not 
proved  to  have  any  special  effect  in  arresting  the  transformation  of 
hcematin,  or  in  increasing  the  formation  of  blood  crystals. 

8th.  The  suppression  of  the  supra-renal  capsular  function  is 
not  attended  by  any  increased  depjosit  of  pigment  in  the  shin  in  its 
appendages  (in  rats). 

9th.  The  problem  of  the  connection  of  b?*onzed  skin  and  supra- 
renal capsular  disease  is  more  likely  to  be  solved  in  the  dead  house 
than  in  the  physiological  laboratory. 


To  lohat  Degree  are  the  Intellectual  Faculties  affected  in  cases  of 
Apoplexy  and  Hemiplegia  f  By  Benjamin  W.  M'Ceeedy, 
M.  D.,  Physician  to  Bellevue  Hospital. 

This  inquiry,  irrespective  of  its  medico-legal  relations,  is  of 
interest  and  importance  to  the  medical  practitioner.  Dr. 
M'Creedy  brings   to  bear  upon  it  the  results  of  an  analysis   of 


1858.]  Apoplexy  and  Hemiplegia.  327 

cases  collected  from  different  authors,  as  well  as  instances  falling 
under  his  own  observation,  and  communicated  to  him  by  medi- 
cal friends.  From  an  examination  of  "  a  collection  of  cases  of 
apoplexy,"  by  Mr.  Copeman,  of  London,  published  in  1845,  he 
arrived  at  the  following  conclusions :  "  In  all,  out  of  a  record  of 
two  hundred  and  fifty  cases,  fifty  cases  have  been  taken  in  which 
the  patient  had  recovered  from  the  first  effects  produced  W  the 
apoplectic  stroke.  They  are  all  the  cases  contained  in  the  book 
in  which  such  recovery  had  taken  place,  and  in  which  the  cases 
were  clearly  of  an  apoplectic  character.  Yet  in  no  one  of  the 
cases  is  there  the  slightest  indication  that  the  patient  was  left 
with  a  mind,  I  will  not  say  reduced  to  a  state  of  imbecility,  but 
impaired  in  any  marked  degree.  They  all  as  far  as  the  mind  is 
concerned,  with  the  exceptions  to  be  mentioned,  recovered ;  re- 
covered perfectly ;  were  restored  to  their  usual  state ;  returned 
to  their  previous  occupations.  In  two  instances  the  faculty  of 
speech  was  either  deranged  or  lost,  and  in  those  instances  their 
physicians  assert  that  the  faculty  of  language,  not  reason,  was 
deranged.  In  the  third^rn stance  the  patient  is  stated  to  have 
recovered  with  an  impaired  memory,  and  with  some  confusion 
of  thought ;  but  a  merchant,  seventy-three  years  of  age,  who 
after  partial  recovery  from  a  severe  apoplectic  seizure,  is  enabled 
to  labor  for  his  support  by  writing  for  the  weekly  papers,  may 
be  esteemed  to  have  still  possessed  a  fair  share  of  intellect  and 
energy.  The  second  attack  left  him  yet  more  prostrate,  very 
much  weakened  in  body,  and  unable  to  do  anything  for  the 
support  of  his  family.  From  the  third  attack  he  never  recover- 
ed ;  still  there  is  nothing  like  imbecility :  he  lies  for  months  in 
a  feverish  condition,  alternating  between  coma  and  delirium,  and 
even  a  few  days  before  his  death  he  partially  recovered  and 
talked  in  a  rational  manner  with  his  wife." 

The  foregoing  conclusions  are  corroborated  by  the  results  of 
an  examination  of  a  series  of  cases  contained  in  Andral's  Clin- 
ique  Medicale,  and  in  the  Anatomie  Pathologique  of  Cruveilhier. 
These  cases,  like  the  preceding,  are  quoted  in  brief  detail  by  the 
writer.  In  expressing  the  results  of  this  examination,  the  writer 
says:  "Here  then,  are  sixteen  cases  in  which  the  condition  of 
the  intellect  before  the  attack  was  obscured,  in  which  the  nature 
of  the  disease  was  verified  by  post-mortem  examination — being 
all  that  are  contained  in  the  Clinique  Medicale  of  Andral,  and  the 
Anatomie  Pathologique  o£ Cruveilheir,  and  reported  by  men  whom 
every  one  will  allow  were  competent,  careful,  and  conscientious 
observers — in  which  the  hemorrhage  was  situated  in  almost 
every  part  of  the  brain,  presenting  every  degree  of  severity  com- 
patible with  the  continuance  of  life,  many  of  them  liviDg  for 
years  after  the  occurrence  of  the  apoplectic  seizure,  and  yet  in 
only  two  of  these  was  there  any  decided  improvement  of  the 
mind  noticed." 


828  Apoplexy  and  Hemiplegia.  [May, 

The  writer  adds :  "  Perfectly  in  accordance  with  this  have 
been  the  results  of  my  own  observations.  At  Bellevue,  the 
great  pauper  hospital  of  the  city,  there  are  always  a  number  of 
hemiplegiacs ;  but  since  my  attention  has  been  directed  to  the 
subject,  I  have  seen  no  case  in  which  hemiplegia  has  been  the 
consequence  of  a  well-marked  apoplectic  seizure,  in  which  I 
have  found  the  intellect  seriously  impaired.  In  some  of  these 
cases  the  first  impression  of  the  observer  is  wholly  unfavorable 
to  -  the  intelligence  of  the  patients;  the  distorted  countenance, 
the  impaired  speech,  and  the  motionless  tears  or  laughter,  give 
them  an  appearance  of  utter  imbecility ;  yet  a  patient  examina- 
tion will  commonly  discover  an  amount  of  intelligence  en- 
tirely unexpected."  *  *  *  -  "  From  the  facts  given  above, 
no  other  conclusions  can  be  drawn  than  that  any  impairment  of 
mind,  as  a  direct  consequence  of  apoplexy,  after  the  patient  has 
recovered  from  its  primary  effects,  must  be  an  exceptional  occur- 
rence. That  the  apoplectic  seizure  may  hasten  the  approach  of 
senile  atrophy  of  the  brain  is,  as  before  stated,  probable ;  when 
atrophy  has  already  commenced,  an  apoplectic  attack  may  un- 
doubtedly quicken  its  progress,  and,  in  such  a  case,  the  friends 
of  the  patient  would  naturally  attribute  the  rapid  decay  of  the 
mind  wholly  to  the  apoplectic  seizure.  This,  I  think,  I  have 
myself  seen ;  and  as  apoplexy  becomes  more  common  as  life 
advances,  such  cases  may  not  be  unfrequent.  The  confusion  of 
mind,  the  difficulty  in  pursuing  a  train  of  thought,  of  which 
apoplectics  are  apt  to  complain,  is  to  a  great  extent  the  mere 
result  of  diminished  nervous  energy.  They  comprehend  well, 
and  judge  correctly,  but,  before  their  general  health  is  confirm- 
ed, they  can  no  more  think  continuously  than  they  can  take  a 
long  walk,  or  perform  any  other  act  demanding  a  considerable 
expenditure  of  nervous  force.  It  is  not  the  brain  specially  that 
is  affected — it  is  the  system  at  large.  Of  all  the  faculties,  memory, 
either  special  or  general,  is  most  apt  to  be  impaired,  and  this 
impairment  patients  are  always  ready  to  admit  and  complain  of. 
As  the  patient  recovers,  the  memory  commonly  improves ;  and 
if  no  new  attack  supervene,  this  improvement  is  progressive  for 
years."  *  *  *  "Whence,  then,  arises  the  number  of  imbeciles 
who  are  to  be  found  in  every  almshouse?  Partly,  doubtless, 
from  the  cases  already  mentioned,  in  which  senile  atrophy  is 
prematurely  caused,  or  its  progress  hastened  by  the  occurrence 
of  apoplexy.  And  let  us  recollect  the  state  of  isolation  and 
neglect  from  which  such  persons  frequently,  often  necessarily, 
suffer,  is  in  itself  a  main  cause  of  a  weakened  intellect:  the  mind 
rusts  out  for  want  of  exercise." 

The  writer  details  a  series  of  cases  in  which,  while  the  hear- 
ing remained  unaffected,  the  patient's  consciousness  entire  and 
no  delirium,  the  faculty  of  speech  was  either  lost  or  perverted. 


1858.]  Apoplexy  and  Hemiplegia.  329 

He  remarks  on  these  cases  as  follows: — "  Here,  it  will  be  seen, 
are  eleven  well-marked  cases  of  hemiplegia,  three  of  them  com- 
plicated with  epileptic  convulsions,  and  all  of  them  with  loss  or 
perversion  of  the  faculty  of  speech.  Besides  the  cases  here  re- 
corded, three  more  have  come  to  ray  knowledge  the  subjects  of 
which,  I  believe,  are  still  living.  This  shows  conclusively  the 
loss  of  speech,  as  an  accompaiment  of  hemiplegia,  to  be  no  very 
rare  occurrence.  Of  the  whole  fourteen  cases,  two  have  perfect- 
ly recovered  the  use  of  speech;  two  have  recovered  it  to  a  par- 
tial and  limited  extent ;  the  others  still,  I  believe,  remain  speech- 
less. From  the  cases  recorded  in  the  journals  to  which  I  have 
access,  I  believe  that  recovery  from  perversion  of  the  faculty  of 
speech  is  more  common  and  perfect  than  when  the  power  of  ar- 
ticulation is  either  wholly  lost  or  confined  to  a  few  monosyllables. 
Direct  medication,  except  in  so  far  as  it  improves  the  general 
health  of  the  patient,  seems  to  have  no  effect  on  the  lost  faculty  ; 
more  is  to  be  hoped  for  from  careful,  long  continued,  and  well- 
directed  exercise  of  the  local  organs  by  the  patient  himself." 

The  foregoing  conclusions  are  certainly  at  variance  with  the 
views  inculcated  by  medical  writers  and  commonly  held  by  prac- 
titioners. The  general  belief  is,  that  after  an  apoplectic  seizure, 
as  a  rule,  the  mind  is  more  or  less  impaired,  and  in  severe  cases 
the  patient  is  apt  to  fall  into  a  condition  of  partial  or  complete 
imbecility.  Epilepsy  is  also  supposed  to  tend  intrinsically  to 
induce  deterioration  of  the  mental  faculties  in  proportion  to  the 
frequency  and  severity  of  the  paroxysms.  Assuming  that  the 
writer's  conclusions  are  correct,  it  is  in  a  great  measure  owing  to 
the  pervailing  error  on  the  subject  that  the  faculties  of  the  mind 
are  in  a  certain  proportion  of  instances,  permanently  damaged ; 
and  it  becomes  a  very  important  point  in  practice  to  enjoin,  un- 
der judicious  restrictions,  that  degree  of  exercise  of  the  mental 
faculties  which  shall  secure  their  healthful  if  not  vigorous  activi- 
ty. This  practical  point  is  especially  applicable  to  the  manage- 
ment in  cases  of  epilepsy.  The  reviewer  has  long  entertained 
the  opinion  that,  in  this  affection,  the  mental  deterioration  which 
is  frequently  observed  is  not  due  so  much  to  an  intrinsic  tenden- 
cy of  the  malady  as  to  the  isolation  and  inactivity  incident  to  it. 
With  reference  to  epilepsy,  the  author  of  the  highly  interesting 
paper  which  we  have  reviewed,  states  that  he  has  ''repeatedly 
seen  and  prescribed  for  a  person  who  has  had  epilepsy  for  thirty- 
three  years,  occurring  several  times  in  every  month,  and  some- 
times eight  and  ten  times  a  day  ;  in  whom,  though  there  is  obvi- 
ous enlargement  of  one  side  of  the  head,  and  much  headache, 
and  the  tongue  bears  the  marks  of  countless  lacerations,  yet  it 
is  impossible  to  discover  in  this  person  the  least  change  in  her 
mental  condition."  He  adds,  that  "both  the  medical  profys- 
eion  and  the  judicial  bench  of  the  city  can  each  furnish  at  least 


330  On  the  Medicinal  Hypophosphites.  [May, 

one  illustration  of  the  distinction  and  usefulness  to  which 
persons  who  have  been,  or  still  are,  subject  to  epilepsy,  may 
attain." — [New  York  Jour,  of  Medicine. 


Remarks  on  the  Medicinal  Ilypophosphites*     By  William  Proc- 
tor, Jr. 

[In  our  last  number,  we  presented  to  our  readers,  a  striking 
article  from  Dr.  Churchill,  on  the  use  of  the  Hypophosphites,  in 
the  treatment  of  Tuberculosis.  We  here  transfer  to  our  pages  a 
paper  in  which  these  several  salts  and  their  mode  of  preparation 
are  described. — Edts.] 

The  recent  researches  of  Dr.  Churchill  into  the  therapeutic 
character  and  value  of  the  hypophosphites  in  tuberculosis,  some 
account  of  which  will  be  found  at  page  143  of  this  number,  have 
attracted  much  attention  from  physicians,  and  many  inquiries 
have  been  made  after  these  salts ;  and  it  is  believed  that  a  notice 
of  the  processes  for  preparing  them,  and  some  formulas  for  their 
prescription,  will  be  acceptable  to  the  readers  of  the  Journal,  es- 
pecially, as  from  their  hitherto  unimportant  position  among  phar- 
maceutical chemicals,  no  mention  is  made  of  them  in  works  most 
accessible.  The  salts  which  have  been  used  are  those  of  lime, 
soda,  potassa  and  ammonia.  In  the  sequel  a  notice  is  given  of 
these,  of  the  hypophosphite  of  sesquioxide  of  iron,  and  of  hypo- 
phosphorus  acid. 

The  hypophosphites,  according  to  Gmelin,  are  mostly  crystal- 
lizable.  They  cannot  exist  without  a  certain  proportion  of  water, 
which  is  equally  true  of  the  acid  itself,  which  in  its  most  concen- 
trated form  contains  three  equivalents  of  water,  one  of  which  is 
replacable  by  bases.  When  heated  till  decomposed,  these  salts 
emit  phosphuretted  hydrogen.  They  are  permanent  in  the  air  as 
regards  oxidation ;  but  when  heated  in  solution,  especially  if  free 
alkali  is  present,  they  are  decomposed  into  phosphates  and  hydro- 
gen gas.  They  are  nearly  all  soluble  in  water,  and  several  of 
them  in  alcohol,  and  readily  reduce  the  soluble  salts  of  silver  and 

Sold 

Hypophosphite  of  Lime  is  the  most  important  of  these  salts,  as  it 

not  only,  by  oxidation  in  the  economy,  will  afford  phosphate  of 
lime  in  a  nascent  state,  if  needed,  but  its  reaction  with  the  carbo- 
nates of  the  alkalies  give  a  ready  means  of  obtaining  the  alkaline 
hypophosphites.     When  phosphorus  is  boiled  with  milk  of  lime  it 

*  The  Hypophosphites  are  manufactured  in  quantity  by  Hennell  Stevens,  of 
Philadelphia,  who  is  successfully  directing  his  attention  to  the  supply  of  new 
chemicals  for  medicinal  use,  and  fine  chemicals  in  general. 


1858.]  On  the  Medicinal  Uypophosphites.  331 

gradually  disappears,  with  evolution  of  spontaneously  inflamma- 
ble phosphuretted  hydrogen,  which  explodes  as  it  reaches  the  at- 
mosphere with  the  formation  of  water  and  phosphoric  acid.  When 
the  strong  odor  of  phosphuretted  hydrogen  ceases  to  be  given  off, 
the  liquid  contains,  besides  the  excess  of  lime,  nearly  half  of  the 
phosphorus  as  phosphate  of  lime,  and  the  remainder,  deducting 
the  considerable  portion  which  has  escaped  into  the  air  as  phos- 
phuretted hydrogen,  as  hypophosphite  of  lime.  According  to 
Wurtz,  more  than  one  equivalent  of  water  is  decomposed,  and 
the  phosphuretted  hydrogen  is  accompanied  by  free  hydrogen. 
If  this  be  true,  the  source  of  the  super  oxidation  of  so  much  of  the 
phosphorus  is  traceable  to  the  resulting  oxygen;  but  Rose  is  of  the 
opinion  that  this  oxygen  is  derived  from  the  atmospheric  air  in 
contact  with  the  boiling  liquid.  When  the  process  is  conducted 
in  a  flask,  it  requires  a  constant  ebullition  of  the  liquid  to  prevent 
the  explosion  consequent  upon  the  entrance  of  the  atmospheric 
air.  To  avoid  this  result,  it  has  been  found  safer  to  employ  a 
deep,  open  vessel.  The  constant  evolution  of  gas  and  vapor, 
which  keeps  a  froth  on  the  surface,  excludes  the  atmosphere  in  a 
great  degree,  so  that  the  yield  is  not  much  diminished,  whilst  the 
safety  and  easiness  of  the  process  is  greatly  increased.  The  pro- 
cess should  be  conducted  under  a  hood  with  a  strong  draught,  or 
in  the  open  air,  to  avo  id  the  disagreeable  fumes  which  are  evolv- 
ed. 

Take  of  Lime  recently  burned 4  lbs.  av. 

Phosphorus 1  lb.     " 

Water, 5  gals. 

Slake  the  lime  with  a  gallon  of  water,  put  the  remainder  in  a 
deep  boiler,  and  as  soon  as  it  boils  add  the  slaked  lime,  and  mix  to 
a  uniform  milk.  The  phosphorus  is  now  added,  and  the  boiling 
is  kept  up  constantly,  adding  hot  water  from  time  to  time,  so  as 
to  preserve  the  measure  as  nearly  as  may  be,  until  it  is  all  oxidi- 
zed and  combined,  and  the  strong  odor  of  the  gas  has  disappeared. 
The  mixture  froths  much,  and  but  little  of  the  phosphorus  reaches 
the  surface.  Then  filter  the  solution  through  close  muslin,  wash 
out  that  portion  retained  by  the  calcareous  residue  with  water, 
and  evaporate  the  filtrate  till  reduced  to  six  pints.  The  concen- 
trated liquor  should  now  be  re-filtered  to  remove  a  portion  of  car- 
bonate of  lime  which  has  resulted  from  the  action  of  the  air  on 
the  lime  in  solution,  and  again  evaporated  till  a  pellicle  forms, 
when  it  may  be  crystalized  by  standing  in  the  drying  room,  or 
the  heat  may  be  continued  with  stirring  till  the  salt  granulates, 
when  it  should  be  introduced  into  bottles. 

Hypophosphite  of  lime  is  a  white  salt  with  a  pearly  margarin- 
like  lustre,  and  crystalizes  in  flattened  prisms.     Its  composition, 
according  to  Wurtz,  is  CaO  ,-|-2HO,PO,  the  water  being  essen- 
tial to  the  salt.     It  is  soluble  in  six  parts  of  cold  water,  and  in  not 
14* 


832  On  the  Medicinal  Hypophosphites.  [May, 

much  less  of  boiling  water ;  it  is  soluble  slightly  in  diluted  alco- 
hol, but  insoluble  in  alcohol  sp.  gr.  .835. 

Ilypophosphate  of  Soda  is  prepared  by  double  decomposition 
between  hypophosphite  of  lime  and  crystalized  carbonate  of  soda. 

Take  of  Hypophosphite  of  lime 6  oz. 

Crystalized  carbonate  of  soda    -     -     -     -  10  " 
Water,  a  sufficient  quantity. 

Dissolve  the  hypophosphite  in  four  pints  of  water,  and  the  car- 
bonate in  a  pint  and  a  half,  mix  the  solutious,  pour  the  mixture 
on  a  filter,  and  lixiviate  the  precipitate  of  carbonate  of  lime,  after 
draining,  with  water,  till  the  filtrate  measures  six  pints.  Evapo- 
rate this  liquid  carefully  till  a  pellicle  forms,  and  then  stir  con- 
stantly, continuing  the  heat  till  it  granulates.  In  this  state  the 
salt  is  pure  enough  for  medical  use;  but  if  desired  in  crystals, 
treat  the  granulated  salt  with  alcohol  sp.  gr.  .835,  evaporate  the 
solution  till  syrupy,  and  set  it  by  in  a  warm  place  to  crystalize. 

Hypophosphite  of  soda  crystalizes  in  rectangular  tables  with 
a  pearly  lustre,  is  quite  soluble  in  water  and  in  ordinary  alcohol, 
and  deliquesces  when  exposed  to  the  air.  Its  composition  is  NO 
-|-2HO,PO. 

Hypophosphate  of  Potassa  is  prepared  by  the  same  process  as 
that  given  above  for  the  soda  salt,  substituting  5|  ounces  of  gran- 
ulated carbonate  of  potassa,  in  place  of  10  ounces  of  crystalized 
carbonate  of  soda,  and  using  half  a  pint  instead  of  a  pint  and  a 
half  of  water  to  dissolve  it. 

Hypophosphite  of  potassa  is  a  white,  opaque,  deliquescent  salt,- 
very  soluble  in  water  and  alcohol.  Its  greater  tendency  to  absorb 
moisture  renders  it  less  eligible  for  prescription  than  the  soda  salt. 
Its  composition  is  KO-|-2HO,PO. 

Hypophosphate  of  Ammonia  is  prepared  from  hypophosphite  of 
lime  and  sulphate  or  carbonate  of  ammonia. 

Take  of  Hypophosphite  of  lime -       6  oz. 

Sesqui-carbonate  of  ammonia  (translucent)  7.23  oz. 
Water,  a  sufficient  quantity. 

Dissolve  the  lime  salt  in  four  pints  of  water,  and  the  ammonia 
salt  in  two  pints  of  water,  mix  the  solutions,  drain  the  resulting 
carbonate  of  lime,  and  wash  out  the  retained  solution  with  water. 
The  filtrate  should  then  be  evaporated  carefully  to  dryness,  then 
dissolved  in  alcohol,  filered,  evaporated  and  crystalized. 

This  salt  is  deliquescent  in  the  air,  very  soluble  in  alcohol  and 
water,  and  when  carefully  heated  evolves  ammonia,  and  leaves 
hyd rated  hypophosphorus  acid.  The  composition  of  this  salt  is 
NH3-|-2HO,PO. 

Hypophosphite  of  Sesquioxide  of  Iron. — This  salt  may  be  obtain- 
ed in  the  form  of  a  white  gelatinous  hydrate,  by  precipitating  a 
solution  of  hypophosphite  of  soda  or  ammonia  with  one  of  sesqui- 
sulphate   of  iron.     The  precipitate  should   be  well  washed   with 


1858.]  On  the  Medicinal  Hypophosphites.  333 

water  and  dried  at  a  moderate  temperature.  It  is  necessary  to 
avoid  using  a  hypophosphite  containing  any  alkaline  carbonate 
or  the  precipitate  will  be  contaminated  with  free  sesquioxide. 
Thus  prepared,  this  salt  is  a  white,  amorphous,  tasteless  powder, 
like  the  pyrophosphate,  soluble  in  hydrochloric  acid,  and  in  free 
hypophosphorus  acid. 

Hypophosphorus  Acid, — So  far  as  we  are  aware,  this  acid  has 
not  been  employed,  in  a  free  state,  by  Dr.  Churchill,  but  it  is  high- 
ly probable  that  it  may  come  into  use,  should  the  favorable  results 
claimed  for  its  salts  be  substantiated  by  new  observations.  Any 
claims  which  phosphoric  acid  may  possess  as  an  agent  to  supply 
the  waste  of  phosphorus  and  phosphates  in  the  human  economy, 
will  be  more  than  equalled  by  this  acid.  Hypophosphate  of  bary- 
ta is  the  salt  which  is  most  eligible  for  the  preparation  of  this  acid, 
but  it  is  more  convenient  to  prepare  it  from  the  lime  salts 
viz: — 

Take  of  Hypophophite  of  lime      -     -     -     -      480  grains. 
Crystal ized  Oxalic  acid  -     -     -     -      350  grains. 

Distilled  water 9  fluid  oz. 

Dissolve  the  hypophosphite  of  lime  in  six  ounces  of  the  water  and 
the  acid  in  the  remainder,  with  the  aid  of  heat,  mix  the  solutions, 
pour  the  mixture  on  a  white  paper  filter,  and  when  the  liquid  has 
passed  add  distilled  water  carefully,  till  it  measures  ten  fluid 
ounces,  and  evaporate  this  to  8^  fluid  ounces 

The  solution  thus  prepared  contains  about  ten  per  cent,  of  terhy- 
drated  hypophosphorus  acid  (HO-|-2HO,PO)  a  teaspoonful 
representing  6  grains  of  the  acid,  which  contains  2|  grains  of 
phosphorus.  The  dose  of  this  acid  solution  will  probably  vary 
from  ten  minims  to  a  teaspoonful. 

It  is  proposed  to  give  several  forms  in  which  the  hypophosphites 
may  be  conveniently  administered,  and  a  few  hints  to  the  physi- 
cian in  reference  to  prescribing  them. 

The  soluble  salts  of  mercury  and  silver  are  reduced  by  contact 
with  the  hypophosphites.  All  soluble  sulphates  and  carbo- 
nates are  incompatible  with  the  lime  salt,  and  should  not  be  asso- 
ciated with  it  in  prescriptions,  if  phosphate  of  lime  is  indicated  in 
the  case.  The  iron  salt  when  dissolved  by  excess  of  acid  is  col- 
ored black  by  gallotannic  acid  and  drugs  containing  it,  but  is  not 
blackened  by  the  tannin  of  cinchona,  catechu  and  krameria; 
hence  any  preparation  containing  it  may  be  associated  with  Pe- 
ruvian bark.  The  hypophosphites  of  soda,  potassa  and  ammonia, 
are  more  or  less  deliquescent,  and  when  prescribed  in  powder  it 
should  be  with  proper  precautions  to  avoid  moisture,  as  by  asso- 
ciation with  a  considerable  excess  of  sugar  of  milk.  The  lime 
salt  may  be  mixed  with  either  this  sugar  or  ordinary  sugar.  None 
of  these  salts  are  soluble  in  cod-liver  oil ;  and  if  given  with  it,  they 
should   be  dissolved  in  syrup,  and  mixed   by  agitation.     Where 


334  On  the  Medicinal  Eypophosphites.  [May, 

lactin  and  glycerin  are  indicated  in  the  treatment  of  phthisis  or 
dyspepsia,  any  of  these  salts  may  be  very  elegantly  associated  in 
the  form  of  syrup. 

Syrup  of  Hypophosphite  of  Lime. 

Take  of  Hypophosphite  of  lime,  an  ounce. 

Water,  nine  and  a  half  fluid  ounces. 
White  sugar,  twelve  ounces. 
Fluid  extract  of  vanilla,  half  a  fluid  ounce. 
Dissolve  the  salts  in  the  water,  filter,  add  the  sugar,  dissolve  by 
aid  of  heat  and  add  the  vanilla.     The  dose  is  from  a  tea-spoonful 
(3  J  grs.)  to  a  table-spoonful  (14.,)  according  to  the  circumstances 
of  the  case,  three  times  a  day. 

Compound  Syrup  of  Hypophosphite. — The  following  formula 
has  been  made  in  view  of  the  double  purpose  to  which  these  salts 
are  directed  by  Dr.  Churchill,  viz :  the  increase  of  nerve  force,  and 
the  elevation  of  the  tone  of  the  several  functions  concerned  in 
alimentation  and  nutrition ;  and  will  afford  an  agreeable  means 
of  testing  practically  their  merit.  The  iron  salt  is  presented  in 
a  form  well  adapted  for  entering  the  circulation,  whilst  the  acid, 
besides  exerting  its  solvent  power,  adds  to  the  agreeable  taste  of 
the  preparation. 

Take  of  Hypophosphite  of  lime,  256  grains. 

Hypophosphite  of  soda,  192      " 

Hypophospite  of  potassa,  128      " 

Hypophosphite  of  iron*  (recently  precipitated)  96      " 
Hypophosphorus  acid  solution,  q.  s.  or    240      " 

White  sugar,  12  ounces. 

Extract  of  vanilla,  \  ounce. 

Water,  a  sufficient  quantity. 
Dissolve  the  salts  of  lime,  soda  and  potassa  in  six  ounces  of 
water;  put  the  iron  salt  in  a  mortar,  and  gradually  add  solution 
of  hyphosphorus  acid  till  it  is  dissolved ;  to  this  add  the  solution 
of  the  other  salts,  after  it  has  been  rendered  slightly  acidulous 
with  the  same  acid,  and  then  water,  till  the  whole  measures  9  fluid 
ounces.  Dissolve  in  this  the  sugar,  with  heat,  and  flavor  with 
the  vanilla.  Without  flavoring,  this  syrup  is  not  unpleasant,  being 
slightly  saline,  and  not  at  all  furruginous.  Any  other  flavoring 
may  be  used,  as  orange  peel,  orange  flower  or  ginger.  It  is  also 
suggested  to  physicians  that  glycerine  may  be  used,  wholly  or 
partially,  in  sugar  when  indicated,  six  ounces  and  a  half  of  gly- 
cerine being  substituted  for  twelve  ounces  of  sugar.  The  object 
of  acidulating  the  saline   solution  is  to   decompose  any  alkaline 

*/This  quantity  96  grains,  of  hypophosphite  of  iron  is  obtained  when  128  grains 
of  hypophosphite  of  soda  dissolved  in  2  ounces  of  water  is  decomposed  with  a 
slight  excess  of  solution  of  persulphate  of  iron,  and  the  white  precipitate  will 
wash  on  a  filter  with  water. 


1858.]  Diphtherite  or  Malignant  Sore  Throat.  335 

carbonates  which  may  be  present  and  which  have  been  noticed 
by  the  writer  in  some  of  the  commercial  soda  salt.  The  dose  of 
this  preparation  is  a  teaspoonful  three  or  four  times  a  dav.  A 
teaspoonful  contains  2  grains  of  the  lime  salt,  1|  of  the  soda  salt, 
1  of  the  potassa  salt,  and  £  of  a  grain  of  the  iron  salt,  besides  a 
little  hvpophosphorus  acid. — [American  Jour,  of  Pharmacy. 


Reports  of  Cases  of  Diphtherite,  or  Malignant  Sore-throat.     By 
Benjamin  Godfrey,  M.  D.,  M.RC.S.L. 

Case  1.     J.  B ,  a  little  boy,  aged  two  years.     He  had  been 

healthy  and  strong  through  life,  with  the  exception  of  the  tri- 
vial ailments  incident  to  childhood.  Five  months  ago  he 
suffered  from  discharge  of  pus  from  the  ear,  with  occasional 
epistaxis.  These  ailments  soon  passed  away,  and  he  continued 
pretty  well  until  the  present  attack. 

Oct.  17th. — The  child  complained  of  cold  in  the  head;  dis- 
charge of  yellow  mucoid  matter  from  the  nose,  with  occasional 
haemorrhage,  dyspnoea,  and  dysphagia;  great  drowsiness  and 
extreme  languor.  The  tongue  was  slightly  coated,  but  not  in- 
jected; the  skin  was  moist  and  comfortable ;  the  pulse  quick 
and  feeble,  120 ;  pupils  dilated.  On  examino.tion  of  the  throat, 
a  small,  whitish  spot  was  observed  on  the  mucous  membrane  of 
the  right  tonsil,  about  the  size  of  a  pea ;  bowels  constipated. 
Ordered  the  sixteenth  of  a  grain  of  extract  of  belladona,  with 
one  grain  of  carbonate  of  ammonia,  every  three  hours;  a  rhu- 
barb and  jalap  powder  at  bedtime. 

18th. — The  patient  is  much  weaker ;  dyspnoea  greater,  but 
dysphagia  less.  The  spot  has  become  of  an  ashy  hue,  extending 
over  the  right  tonsil,  and  slowly  creeping  ov»;r  the  uvula.  Pulse 
130.     Kepeat  the  mixture. 

19th  and  20th.— The  discharge  from  the  i?Dse  and  mouth  has 
-increased — very  acrid,  and  of  a  highly  offensive  odor;  the 
throat  externally  is  much  swollen  ;  the  parotid  and  sub- maxil- 
lary glands  are  much  enlarged  ;  both  tonsils  are  coated  with  the 
ulcerative  process;  pulse  130;  tongue  coated,  white;  bowels 
nicely  relieved,  but  great  exhaustion  and  prostration  is  apparent. 
Ordered  carbonate  of  ammonia  and  tartrate  of  iron  every  three 
hours;  port- wine  and  beef- tea  in  abundance. 

21st. — Still  getting  weaker;  almost  pulseless;  extremities 
cold;  face  palid  and  anaemic;  throat  very  much  swollen  exter- 
nally. Ordered  warm  fomentations;  milk,  wine,  and  beef-tea, 
and  ten  minims  of  the  tincture  of  sesquichloride  of  iron  every 
three  hours. 

22nd. — Less  swelling  of  the  throat  externally.  The  black 
gangrenous  mass  is  sloughing  away,  and  a  line  of  demarcation 


336  Diphtherite  or  Malignant  Sore  Throat.  [May, 

is  visible,  of  healthy  granulations  springing  up  to  throw  off  the 
dead  foetid  mass,  and  to  restore  health  to  the  diseased  part. 
Dyspnoea  less ;  dysphagia  now  but  slight.  Eepeat  the  medicine 
and  nourishment. 

23rd  and  24th. — Very  much  better.  Several  pieces  of  highly 
offensive  dead  material  have  passed  away.  Pulse  stronger; 
tongue  nearly  clean;  bowels  relieved;  pupils  less  dilated,  but 
still  drowsy  and  very  weak. 

Day  by  day  the  little  sufferer  improved,  and  gathered  strength 
each  day.  The  only  drawback  to  his  recovery  was  an  occasion- 
al attack  of  epistaxis,  which  blanched  the  restored  color  of  the 
cheeks  and  enfeebled  the  returning  powers.  Iron  and  quinine 
with  strong  beef-tea  and  wine,  were  freely  given,  but  exhaustion 
soon  set  in,  and  he  died  on  the  3rd  of  November,  a  fortnight 
after  the  attack,  anaemiated  and  exhausted. 

Case  2.     B.  B ,  residing  in  the  same  house.     He  was  a 

strong,  well-built  boy,  of  excitable  temperament,  and  affection- 
ate disposition.  He  was  taken  ill  on  the  22nd  of  October.  He 
complained  of  great  languor,  chilliness,  stiffness  of  the  neck,  dys- 
phagia, and  headache.  The  tongue  was  white,  but  the  papillae 
were  not  more-  prominent  than  they  are  in  irritation  of  the 
stomach.  The  throat  was  much  swollen  externally,  and  on  the 
tonsil  a  small  ashy  spot  was  seen.  No  heat  of  skin  ;  no  dryness, 
but  the  palms  of  the  hands  were  moist  aud  comfortably  warm; 
pul ;  3  quick  and  weak,  130.  Ordered  the  belladonna  and  ammo- 
nia fixture  ev^ry  three  hours. 

Oct.  23rd. — Bowels  freely  moved;  throat  much  worse;  spot 
very  much  extended,  and  the  breath  extremely  foetid ;  discharge 
from  the  nose  great ;  pupils  much  dilated ;  urine  free  and  nor- 
mal. Ordered  to  gargle  well  with  warm  water,  alternating  with 
the  chloride-of-zinc  gargle.  Wine  and  beef- tea  to  be  freely  taken, 
and  ten  drops  of  the  tincture  of  muriate  of  iron  every  three  hours. 

24th. — Throat  more  swollen ;  dysphagia  greater,  and  dpspncea 
also  increased.  Applied  nitrate  of  silver  solution,  ten  grains  to 
the  ounce,  to  the  throat  with  a  sponge  probang.  Small  pieces 
of  black  disintegrated  mucous  membrane  came  away.  Com- 
plains of  the  wine  and  beef-tea  burning  his  throat,  and  causing 
his  ears  to  tingle. 

25th. — The  throat  is  one  black  gangrenous  mass,  the  odour 
of  which  is  very  disagreeable.  His  powers  are  fast  failing. 
Takes  half  a  pint  of  port  wine  a  day,  with  beef-tea,  &c.  Milk 
also  in  abundance. 

26th. — Fast  sinking.  Throat  exceedingly  swollen  ;  dyspnoea 
greater  than  dysphagia;  pupils  much  dilated;  extreme  drowsi- 
ness, yet  perfectly  sensible  when  aroused.  He  continued  failing 
till  the  27th,  when  he  expired. 


1858.]  Diphtherite  or  Malignant  Sore  Throat  337 

Case  3.     J.  B. ,  aged  seven  years,  brother  of  the  patient 

before  mentioned.  lie  was  attacked  with  the  same  disease,  with 
precisely  the  same  order  of  symptoms.  He  was  treated  with 
chlorate  of  potash  and  cascarilla  the  former  part  of  the  illness, 
and  nitro-muriaticacid  and  gentian  the  latter  part;  but  in  seven 
days  from  the  time  he  was  attacked  he  also  died. 

Case  4.  In  the  same  house  was  a  young  lady  who  had 
watched  over  the  before-mentioned  children,  and  on  the  28th 
she  was  also  taken  ill.  The  first  symptoms  were, — Shivering, 
and  intense  prostration,  so  powerless  that  she  could  not  stand; 
tingling  of  the  throat,  back  of  the  nares,  and  in  the  ears;  the 
throat  became  dry,  and  deglutition  became  difficult.  On  exam- 
ining the  throat,  there  was  the  plague-striken  spot  on  the  left 
tonsil.  Ordered  four  ounces  of  port  wine  and  strong  beef-tea, 
with  the  nitro-muriatic  acid  and  cascarilla  mixture. 

Oct.  29th. — The  spot  is  much  increased,  extending  over  the 
uvula.  Powers  en febled ;  pulse  120,  very  feeble;  tongue  white 
eand  furred;  skin  cool  and  moist;  bowels  regular;  urine  scanty, 
but  natural.  She  can  scarcely  breathe  through  her  nose.  The 
discharge  is  increased  from  the  mouth  and  nose,  and  the  breath 
is  become  foetid.  Ordered  the  chloride-of-zinc  gargle,  and 
thirty  drops  of  the  tincture  of  the  sesquichloride  of  iron  in  infu- 
sion of  Columbia  root.  Strong  hydrochloric  acid  was  applied 
with  a  glass  rod  to  the  ulcerated  surface.  Several  large  pieces 
sloughed  away. 

30th. — Pulse  very  feeble,  and  bodily  power  failing.  The 
whole  of  the  soft  palate  and  back  of  the  throat  is  covered  with 
the  sloughing  mass.  The  ears  and  Eustachian  tubes  are  very 
tender  and  painful.  Deglutition  is  performed  with  great  effort 
and  pain.  The  nares  are  extremely  painful,  and  the  discharge 
acrid  and  disagreeable.  Applied  again  the  muriatic  acid.  Or- 
dered half  a  pint  of  port  wine  a  day,  with  eggs  and  beef-tea,  and 
to  continue  the  medicine. 

31st. — Still  getting  weaker.  Pulse  130,  irritable;  skin  cold 
and  clammy;  the  wine  passes  down  her  threat  like  liquid  fire, 
giving  great  pain.  Ordered  wine  and  beef-tea  ad  libitum ;  the 
iron  to  be  increased  in  quantity,  three  drachms  of  the  tincture 
to  be  taken  every  day. 

Nov.  1st. — Better;  throat  less  swollen,  and  dysphagia  less; 
bowels  well  moved;  dyspnoea  less.  At  every  gargle,  pieces  of 
dead  material  came  away.  Steaming  her  nose  and  throat  over 
hot  water  has  relieved  her  much.  Skin  beautifully  warm  and 
moist. 

2nd  and  3rd. — The  throat  is  granulating  quickly;  several 
large  pieces  have  been  thrown  off;  fcetor  less,  and  appetite  im- 
proving ;  pulse  120,  fuller  and  more  regular. 


338  Diphtherite  or  Malignant  Sore  Throat.  [May, 

From  this  time  she  began  gradually  to  improve;  each  day 
pieces  of  morbid  material  were  brought  away.  The  throat  healed 
up  in  the  course  of  a  week  or  two  perfectly,  and  day  by  day  her 
powers  improved,  and  she  left  my  care  on  November  15th,  quite 
recovered. 

Remarks — The  disease  appears  to  me  to  be  confined  to  the 
mucous  membrane,  neither  touching  the  muscular  nor  glandu- 
lar structure.  The  glandular  enlargement  is  due  to  sympathetic 
irritation,  the  same  as  we  see  often  in  other  parts  of  the  body ; 
thus  a  wound  in  a  leg  producing  an  enlarged  gland  in  the  groin. 
The  question  has  been  asked — "  Is  it  scarlet  fever  without  the 
rash!"  This,  I  think,  is  answered — 1st,  by  absence  of  all  fever ; 
2ndly,  absence  of  all  rash ;  3rdly,  papilae  of  the  tongue  not  en- 
larged; and  4thly,  no  desquamation  of  the  cuticle  after  the 
disease  passes  off.  Yet,  on  the  other  hand,  scarlet  fever  existed 
in  the  adjoining  house.  It  differs  also  materially  from  cynanche 
tonsillaris.  In  that  disease  the  abscess  forms  within  the  tonsil, 
and  bursts  its  way  out.  But  in  diphtherite,  the  morbid  change 
commences  on  the  surface  of  the  mucous  membrane,  and  is  con- 
fined solely  to  that  covering.  The  extreme  and  rapid  depression 
is  only  equalled  by  the  depression  of  malignant  scarlet  fever,  or 
the  collapse  of  Asiatic  cholera.  Each  patient  that  died  appeared 
to  sink  from  exhaustion  and  partial  asphyxia. 

Treatment. — The  main  point  to  keep  in  view  is  to  support  the 
patient's  powers,  and  check  as  far  as  possible  the  inroad  of  the 
disease.  The  former  by  stimulants  and  tonics  ;  the  latter  by 
the  application  of  the  strong  mineral  acids.  The  question  may 
arise,  might  not  tracheotomy  have  been  successfully  employed 
to  relieve  the  dyspnoea.  My  reply  is,  that  the  depression  of  the 
patient's  powers  was  far  greater  than  the  dj^spncea,  so  that  the 
operation  would  have  been  unsafe.  That  depression  did  not 
result  from  the  blood  being  imperfectly  aerated  is  shown  by  the 
depression  appearing  before  the  dyspnoea.  The  dilatation  of 
the  pupil  did  not  depend  upon  the  belladonna  given,  for  it  exist- 
ed as  a  marked  symptom  in  every  case.  As  regards  remedies, 
I  believe  the  tincture  of  sesquichloride  of  iron  the  best.  The 
essentials  of  the  disease,  or  the  symptoms  in  the  order  they  occur, 
are  these : — Shivering,  intense  depression  ;  dryness  and  tingling  of 
the  throat,  nares,  and  ears;  external  swelling  of  the  glands;  a 
whitish  spot  on  the  mucous  membrane  of  the  tonsil,  gradually  deepen- 
ing in  colour  as  the  disease  progresses ;  dysphagia  and  dyspnoza ; 
dilated  pupil;  impending  asphyxia,  and  death. 

[London  Lancet. 


1858.]  Case  of  Tetanus.  839 


Report  of  a  Case  of  Tetanus  occurring  in  Bellevue  Hospital  under 
the  care  of  Dr.  Jas.  R.  Woodj  Visiting  /Surgeon.  By  J.  J. 
Campbell,  M.D.,  House  Surgeon. 

Eebecca  H.,  aged  38,  pretty  good  constitution,  but  of  intem- 
perate habits,  was  admitted  into  Bellevue  Hospital,  at  4  P.  M., 
February  7th,  1858,  with  severe  burns  of  both  lower  extremi- 
ties, caused  the  evening  before  by  getting  her  clothes  on  fire. 
When  admitted,  she  was  suffering  a  great  deal  of  pain,  and  her 
stomach  was  so  irritable  that  she  could  scarcely  retain  any  of  the 
nourishment  and  stimulants  that  were  given  her.  Her  pulse 
was  frequent  and  feeble,  and  she  had  slept  none  the  night  pre- 
vious. Stimulants  and  anodynes  were  given  freelv,  and  her 
limbs  were  ordered  to  be  dressed  with  cotton  soake*  in  equal 
parts  of  linseed  oil  and  lime  water. 

Feb.  8th.  Did  not  sleep  any  last  night,  although  she  had 
taken  the  eighth  of  a  grain  of  morphine  every  hour  since  her 
admission ;  her  stomach  still  remains  irritable ;  her  pulse  con- 
tinues frequent  and  weak,  and  her  limbs  feel  easier.  Sub-nitrate 
of  bismuth,  opium,  and  a  small  quantity  of  carbonate  of  ammo- 
nia, ordered  in  pills,  to  be  given  with  the  view  of  allaying  the 
irritability  of  her  stomach.  Beef  tea  and  rare  boiled  eggs  direct- 
ed to  be  taken  in  small  quantities  at  a  time.  Stimulants  and 
anodynes  to  be  continued  as  before.  This  course  of  treatment 
was  persevered  in,  but  she  did  not  improve  much  until  February 
11th,  when  she  was  able  to  retain  all  the  nourishment  that  was 
given  to  her.  Her  pulse  still  remained  frequent,  although  it 
was  stronger  than  when  she  came  into  the  hospital.  She  rested 
better  at  night,  and  continued  doing  well  in  every  other  respect 
from  this  time  until  the  morning  of  February  15th,  when  she  was 
attacked  with  the  symptoms  of  trismus,  that  I  first  noticed  by 
directing  her  to  put  out  her  tongue,  which  she  could  not  do  to 
any  extent,  as  she  could  not  separate  her  jaws  more  than  three 
quarters  of  an  inch.  On  inquiry,  I  ascertained  that  she  had 
some  stiffness  in  the  muscles  of  the  back  of  the  neck.  I  then 
desired  her  to  swallow  a  little  beef  tea,  which  she  did  with  great 
difficulty  and  a  feeling  of  choking.  Morphine,  in  half-grain 
doses  every  two  hours,  was  ordered  to  be  given,  and  her  allow- 
ance of  stimulants  increased. 

At  11.30  A.  M.  she  was  seen  by  Dr.  Wood,  who  directed  that 
she  should  be  put  upon  a  stimulant,  anodyne  and  anti-spasmo- 
dic course  of  treatment.  Twenty  ounces  of  brandy  and  a  pint 
of  madeira  wine  were  ordered  to  be  given  in  the  twenty-four 
hours.  The  morphine  was  given  pretty  freely  by  the  mouth ; 
but  as  she  could  not  swallow  as  much  of  the  stimulants  as  was 
directed,  they  had  to  be  in  part  injected  into  the  rectum  with  two 

».s. — vol.  xrv.  ko.  v.  15 


340  Case  of  Tetanus.  [May- 

ounces  of  lac  assafoetida  and  one  drachm  of  tincture  of  opium 
every  two  hours.  She  was  also  directed  to  be  kept  as  quiet  as 
possible.  *Her  pulse  at  this  time  was  128,  quick  and  moderate- 
ly fall,  and  her  respiration  a  little  more  frequent  than  it  had 
been  for  a  few  days  past.  There  was  not  much  increase  in  the 
severity  of  the  symptoms  up  to  10  P.  M.  At  11  P.  M.  she  com- 
menced sleeping,  and  continued  doing  so  until  2  A.  M.,  after 
which  she  remained  wakeful. 

9  A.  M.,  February  16 — pulse  128,  quick  and  moderately  full ; 
respiration  24;  cannot  separate  her  jaws  more  than  one-third 
of  an  inch ;  has  great  difficulty  in  deglutition ;  muscles  of  the 
neck  quite  rigid ;  head  drawn  back,  and  does  not  appear  to 
suffer  much  when  undisturbed.  She  has  had  no  spasms  except 
of  the  muscles  of  the  back  of  the  neck.  Same  treatment  contin- 
ued. 

6  P.  M.  With  the  exception  of  a  little  more  difficulty  in  swal- 
lowing, is  in  much  the  same  condition  that  she  was  this  morn- 
ing. 

Feb.  17th,  9  A.  M.  Slumbered  a  little  during  the  night ; 
pulse  132,  quick  and  weak ;  respiration  34 ;  rigid  spasm  of  all 
the  muscles  about  the  jaws  and  neck,  and  cannot  drink  from 
the  feeding  cup ;  and  all  the  fluid  she  swallows  has  to  be  inject- 
ed into  her  mouth  with  a  small  syringe.  Her  face  assumes  a 
livid  hue  during  each  attempt  at  deglutition.  Has  to  lay  on  her 
side,  owing  to  the  strong  contraction  of  the  muscles  on  the  back 
of  her  neck.  Loud  rales,  produced  by  the  air  passing  through 
the  secretions  in  the  mouth,  can  be  heard  while  standing  by  her 
bedside.  Her  bowels  moved  during  the  night  for  the  first  time 
since  the  14th.  At  1.45  P.  M.,  was  seized  with  a  convulsion 
that  affected  the  whole  body,  but  more  especially  the  muscles  of 
the  back  and  neck.-  Well-marked  opisthotonos  remains.  Her 
jaws  are  rigidly  closed,  and  she  cannot  swallow  anything.  At 
3.40  P.  M.,  has  had  another  general  convulsion  that  lasted  for 
about  a  minute.  At  4.45  P.  M.,  has  had  another  convulsion  like 
the  two  former.  Pulse  120,  and  weak ;  respiration  45,  and  is 
perspiring  quite  freely.  Chloroform  was  tried,  and  the  muscles 
closing,  the  jaws  relaxed  a  little.  From  this  time  until  twenty 
minutes  of  six,  when  she  died,  she  had  a  great  many  convul- 
sions. Just  as  she  was  breathing  her  last,  all  her  muscles  became 
quite  flaccid.  During  the  two  hours  preceding  her  death,  one 
ounce  of  the  tincture  of  opium  with  very  near  a  pint  of  brandy 
and  wine  were  injected  into  her  rectum.  She  remained  rational 
until  the  last  moment  of  her  life. 

Her  burns  looked  healthy  all  the  time. 

Post  mortem  39  hours  after  death.  Slight  rigor  mortis.  Some 
venous  congestion  of  the  vessels  of  the  brain  aud  spinal  cord. 
About  two  ounces  of  serum  escaped  on  opening  into  the  dura 


1858.]  Tetanus  relieved  by  Amputation.  3-il 

mater  of  the  brain  and  cord.  No  other  condition  noticed  in 
these  parts.  The  right  side  of  the  heart,  especially  the  right 
auricle,  was  distended  with  black,  clotted  blood,  while  the  left 
side  contained  but  very  little.  This  organ  felt  normal.  No  ul- 
ceration could  be  detected  in  either  the  stomach  or  duodenum. 
The  colon  contained  a  great  deal  of  scybalae.  The  bladder  was 
empty  and  contracted. — [American  Med.  Monthly. 


A  Case  of  Tetanus  Relieved  by  Amputation.     By  W.  W.  ANDER- 
SON, M.D.,  ofStateburg,  S.  C. 

Chavis,  a  strong,  athletic  negro  man,  in  the  prime  of  life,  the 
property  of  Col.  Richard  Singleton,  in  the  month  of  January, 
18-io,  was  lifting  a  long,  heavy  inch  plank,  with  a  ten-penny  nail 
driven  to  the  head  through  one  end  of  it.  The  plank  acciden- 
tally slipped  out  of  his  hands  and  fell  on  his  foot.  The  nail 
penetrated  his  great  toe  near  the  joint,  and  between  the  joint 
and  toe-nail.  The  next  day  he  went  to  his  work  as  usual ;  but 
a  day  or  two  afterwards  his  master,  passing  by,  found  him  sitting 
by  the  road-side,  and  learning  the  cause  of  his  leaving  his  work, 
ordered  him  to  go  home  and  poultice  his  foot.  He  did  so,  but 
continued  to  suffer  considerable  pain  and  uneasiness  until  the 
loth  of  the  same  month,  when  I  was  called  to  see  him,  about 
five  days  after  the  accident.  I  found  him  in  pain,  with  symp- 
toms of  approaching  tetanus.  An  incision  was  made  in  the 
course  of  the  wound,  and  spirits  of  turpentine  applied.  The 
usual  remedies,  such  as  mercurial  purgatives,  blisters,  the  free 
administration  of  opiates,  etc.,  were  followed  up  actively,  but  to 
no  purpose.  Violent  spasms  came  on,  accompanied  with  pain 
in  the  back  of  his  neck,  and  constriction  of  his  chest  and  abdo- 
men. The  spasms  increased  in  violence  and  frequency  every- 
day, until  the  opisthotonos  was  so  great  that  his  head  and  heels 
were  brought  nearly  into  contact  with  each  other  during  the 
spasms,  and  he  was  unable  to  swallow  in  the  intervals  of  the 
paroxysms.  So  great  were  the  debility  and  exhaustion,  that  I 
considered  the  case  hopeless,  and  expressed  this  opinion  to  Col. 
Singleton,  but  said  I  wished  to  try  the  effects  of  amputation,  as  a 
last  resort,  to  which  he  readily  consented.  Having  only  a 
pocket-case  of  instruments  at  hand,  I  rode  to  a  carpenter's  shop 
not  far  off,  and  borrowed  a  fine  tenon  saw,  and  immediately  on 
my  return  began  the  operation.  With  a  bistoury  I  made  an 
incision  around  the  toe,  through  the  skin,  and  immediately  over 
the  joint,  dissected  up  the  integument,  and  turned  it  back;  then 
completed  the  incision  to  the  bone,  and  sawed  it  off  between 
the  joints,  tied  the  artery,  drew  down  the  skin,  and  secured  it 
with  adhesive  plaster,    A  soft  compress  over  the  stump,  and 


342         Researches  on  the  general  Paralysis  of  the  Insane.      [May, 

bandage,  completed  the  operation.  After  a  little  rest,  he  swal- 
lowed a  large  dose  of  laudanum,  and  was  ordered  to  be  kept  as 
quiet  as  possible.  I  now  dissected  the  toe,  and  following  the 
course  of  the  wound,  found  at  the  bottom  of  it,  imbedded  in  the 
cartilage  near  the  joint,  what  I  at  first  supposed  to  be  the  point 
of  the  nail ;  but  on  further  examination,  it  proved  to  be  a  hard 
piece  of  black  leather,  which  had  been  punched  from  the  man's 
shoe  by  the  blunt  nail,  and  deposited  there.  No  inflammation 
was  apparent  in  the  cartilage ;  but  there  is  little  room  to  doubt 
that  this  minute  piece  of  hard  leather  was  the  cause  of  all  the 
mischief.  In  a  short  time  after  the  operation  the  spasms  began 
to  abate,  and  in  a  day  or  two  ceased  altogether.  The  patient 
was  now  convalescent.  The  toe  healed  kindly,  and  the  man 
recovered  his  usual  health.  I  saw  him  from  time  to  time  after- 
wards, for  several  years,  a  strong  healthy  negro. 

[Charleston  Med.  Journal. 


New  Researches  on  the  general  Paralysis  of  the  Insane. 

This  affection,  which  has  been,  for  the  first  time,  well  described 
by  some  French  physicians,  among  whom  particularly  Bayle  and 
Calmeil,  has  lately  been  the  object  of  a  very  remarkable  inaug- 
ural dissertation  by  M.  Linas.  One  of  the  principal  questions 
examined  by  this  young  physician,  concerns  the  nature  of  this 
disease.  Is  it  the  effect  of  an  inflammation  of  the  encephalon  or 
of  its  membranes,  as  Bayle,  Delaye,  Calmeil,  Parchappe  and 
others  admitted,  or  is  it  a  purely  nervous  affection  of  the  brain, 
as  Lelut  and  others  have  maintained  ? 

Already  Bayle  had  opened  one  hundred  corpses  of  paralytic 
insane,  and  Calmeil  forty-seven.  They  had  found  the  meninges 
of  the  convexity  of  the  cerebal  lobes  opaque,  injected,  hardened, 
infiltrated  with  serosity,  and  offering  frequently  granulations  or 
false  membranes.  M.  Linas  has  opened  one  hundred  and  four- 
teen bodies  of  paralytic  insane.  In  twelve  cases  he  has  found 
the  pia-mater  excessively  injected.  The  cerebral  substance  was 
quite  full  of  blood,  the  grey  matter  being  from  an  intense  red  to 
a  dark  violet.  In  twenty -eight  cases,  besides  the  preceding  al- 
terations, there  were  adhesions  between  the  convolutions  and 
the  meninges.  In  seventy-four  cases,  the  meninges  were  infil- 
trated, opaqe,  and  as  tough  as  a  fibrous  membrane ;  the  cortical 
substance  of  the  brain,  sometimes  violet,  sometimes  yellowish, 
according  to  the  degree  of  the  paralysis,  always  softened,  less 
thick  than  in  normal  brains;  the  white  substance  injected,  and 
sometimes  infiltrated ;  the  convolutions  me.igre,  and  the  whole 
mass  of  the  brain  more  or  less  atrophied. 

In  thirteen  cases,  besides  the  preceding  alterations,  there  was 


1858.]  Transfusion  of  Blood.  843 

one  or  many  small  circumscribed  places  where  the  encephalitis 
had  been  more  violent  than  elsewhere.  In  eight  cases  there 
were  also  effusions  of  blood. 

From  these  facts,  it  results  positively  that  the  paralysis  of  the 
insane  depends  upon  a  chronic  inflammation  of  the  brain  and  its 
meninges.  Whether  the  disease  begins  in  the  membranes,  as 
Bayle  had  said,  or  in  the  brain  itself;  as  M.  Calmeil  maintains, 
is  a  question  of  comparatively  little  importance.  The  great  point 
is,  that  the  brain  is  always  inflamed.  M.  Calmeil  has  ascertain- 
ed with  the  microscope,  that  in  doubtful  cases,  when  the  brain 
did  not  seem  to  be  much  altered  with  the  naked  eye,  there  were, 
nevertheless,  all  the  microscopical  appearances  of  inflammation. 
M.  Linas  relates  cases  to  prove,  that  an  acute  encephalitis  may 
cause  the  paralysis  of  the  insane. 

As  regards  the  first  symptoms  of  this  affection,  M.  Linas  de- 
clares, that  sometimes  intellectual  disorders  first  appear,  and  in 
other  cases,  muscular  paralysis  and  insanity  appear  at  the  same 
time.  It  has  been  said  that  there  was  always  what  is  called  by 
the  French,  ambitious  delirium.  But  Parchappe,  Trelat,  Lasegue, 
have  shown  that  there  are  exceptions  to  this  rule,  and  that,  there- 
fore, there  is  nothing  specific  or  essential  in  this  symptom.  M. 
Linas  goes  farther,  and  he  calls  this  opinion  a  paradox.  Ac- 
cording to  him,  the  delirium  of  paralytic  insane  has  sometimes 
the  monomaniac  form,  sometimes  the  hypomaniac,  and  in  other 
-  the  maniac;  but  he  acknowledges  that  ambitious  ideas  are 
extremely  common. — [New  York  Jour,  of  J. 


ion  of  Blood. 

I  have  communicated  several  papers  on  this  subject  to  the 
rices  (see  Cbmptei  li  Not.  185 7,  p. 

925),  to  the  Societede  Biologie,  and  to  the  CercU  ,ces. 

It  is  known  that  Blundell  had  found  that  a  dog,  bled  almost 
to  death,  can  recover,  even  if  blood  of  a  mammal  of  another  spe- 
cies, be  transfused  into  its  veins;  but  that  after  a  few  days  death 
always  comes ;  while  the  blood  of  another  dog  being  employed 
for  the  transfusion,  may  reproduce  a  lasting  life. 

Messrs.  Prevost  and  Dumas  declare  also  that  mammals  cannot 
be  recalled  permanently  to  life  after  a  great  loss  of  blood,  if  trans- 
fusion be  made  with  blood  of  mammals  of  a  species  different 
from  theirs.  They  state  also,  that  the  blood  of  animals  transfused 
in  the  veins  of  birds,  and  vice  verso,  produces  almost  immediate 
death,  after  having  caused  violent  convulsions.  M.  Eayer  af- 
firms, also,  that  the  blood  of  man  kills  rabbits,  after  having 
produced  convulsions.  DiefTenbach  has  sometimes  seen  animals 
recover  after  transfusion  of  blood  of  animals  of  other  species,  but 


844  Transfusion  of  Blood.  [May, 

never  when  they  were  in  a  state  of  apparent  death  after  a  con- 
siderable loss  of  blood.  Bischoff  also  has  never  succeeded  in 
restoring  to  life  mammals  that  had  lost  a  great  deal  of  blood,  in 
transfusing  blood  of  birds  in  their  veins. 

An  important  fact,  found  by  Bischoff,  should,  however,  have 
opened  the  way  to  more  successful  results  in  transfusion.  He 
ascertained  that  the  arterial  blood  of  mammals  can  be  injected  in 
the  veins  of  birds,  without  killing  them,  while  the  venous  blood 
causes  rapid  death.  I  have  found  that  venous  and  arterial 
blood  do  not  differ  one  from  the  other,  except  on  account  of  the 
different  quantities  of  carbonic  acid  and  oxygen  they  contain. 
Both  may  kill,  if  they  are  rich  in  carbonic  acid ;  both  may  not 
have  any  injurious  influence  if  they  contain  a  great  quantity  of 
oxygen.  Numerous  experiments  have  led  me  to  the  following 
conclusions : 

1st.  That  arterial  or  venous  blood  from  an  animal  of  any  one 
of  the  four  classes  of  vertebrata,  containg  oxygen  in  a  sufficient 
quantity  to  be  scarlet,  may  be  injected,  without  danger,  into  the 
veins  of  a  vertebrated  animal  of  any  one  of  the  four  classes, 
provided  that  the  amount  of  injected  blood  be  not  too  consid- 
erable. 

2nd.  That  arterial  and  venous  blood  of  any  vertebrated  ani- 
mal, being  sufficiently  rich  in  carbonic  acid  to  be  almost  black, 
cannot  be  injected  into  the  veins  of  a  warm-blooded  animal, 
without  producing  phenomena  of  asphyxia,  and  most  frequent- 
ly death,  after  violent  convulsions,  provided  that  the  quantity 
of  injected  blood  be  not  below  one -five-hundredth  of  the  weight 
of  the  animal,  and  also  that  the  injection  be  not  made  too  slowly. 

The  reasons  for  which  Blundell,  Bischoff,  and  others  have 
failed  to  restore  a  lasting  life  after  the  transfusion  of  blood  of  an 
animal  of  a  species  different  from  that  of  the  transfused  one,  are: 
1st,  That  the  blood  employed  was  not  fresh ;  2nd,  that  it  was  in 
too  large  a  quantity ;  3rd,  that  it  was  injected  too  quickly  ;  4th, 
that  it  was  too  rich  in  carbonic  acid,  and  too  poor  in  oxygen. 
The  greatest  causes  of  failure  were  this  last  one,  and  after  it  the 
quantity  of  blood. 

From  my  experiments  I  have  arrived  at  the  conclusion,  that 
there  is  no  danger  in  employing  the  blood  of  dogs,  cats,  or  other 
mammals  in  transfusion  in  man.  Besides,  I  have  ascertained, 
after  Dieffenbach  and  others,  that  defibrinated  blood  is  as  good 
as  blood  containing  fibrin.  As  regards  the  quantity  of  blood,  I 
think  that  four  or  five  ounces  would  be  as  much  as  can  be  need- 
ed for  an  adult  man  or  woman.  It  is  not  necessary  to  warm  the 
blood,  but  it  may  be  useful  to  do  it  in  some  cases.  The  blood 
to  be  transfused,  either  that  of  man  or  of  mammal,  should  be 
received  in  a  large  open  vase,  and  whipped  at  once,  then  passed 
through  a  thick  cloth.     If  it  is  not  injected  at  once,  it  must  be 


1858.]  Indications  and  Treatment  of  Croup.  345 

either  whipped  again,  or,  at  least  agitated  to  be  charged  with 
oxygen  just  before  transfusion,  wh:ch  can  be  performed  with 
any  kind  of  syringe.  The  injection  must  be  extremely  slow, 
and  if  after  the  injection  of  two  or  three  ounces,  there  is 
increase  in  the  respiratory  movements,  it  is  well  to  stop  for  ten 
or  fifteen  minutes  before  finishing  the  transfusion. — [New  York 
Journal  of  Medicine. 


On  Indications  and  Treatment  of  Croup. 

According  to  Luszinsky,  of  Vienna,  there  are  four  indications 
to  be  followed  in  croup,  which  are — 1st,  to  alter  the  peculiar 
crasis  of  the  blood.  This  indication  requires  anaplastics,  of 
which  hepar  sulphuris,  sulphate  of  copper,  and  tartar  emetic  are 
either  too  uncertain,  or  too  dangerous,  because  repeated  vomit- 
ing would  be  injurious  by  congestion  of  the  brain,  and  mercury, 
which  readily  injures  by  producing  diarrhoea,  salivation  and 
general  mercurialisrn.  Better  than  all  of  them,  are  alkalies, 
which  Luszinsky  seems  to  have  recommended  prior  to  Lemaire 
and  Marechal,  of  Paris.  The  hydrate  of  potash  or  soda  is  most 
antiplastic,  but  they  are  not  easily  tolerated;  the  bicarbonate  is 
the  most  digestible,  but  the  abundance  of  carbonic  acid  in  the 
chemical  composition  of  the  bicarbonate  of  potash  or  soda  dimin- 
ishes the  medicinal  effects  of  the  alkalies;  therefore  he  gives  the 
carbonate  of  potash  or  soda,  from  one  half  of  a  drachm  to  two 
drachms  every  day.  2nd — To  prevent  the  localization  of  the 
inflammation  in  the  larynx.  This  indication  requires  no  bleed- 
ing, nor  leeches,  but  in  the  first  stages  of  the  disease,  cold  ap- 
plied to  the  laaynx,  and  large  blistering  plasters,  kept  in  suppu- 
ration for  some  days.  3rd — To  remove  the  spasm  of  the  larynx 
by  narcotics.  4th — To  destroy  or  remove  the  pseudo-membranes 
which  have  been  formed.  The  best  caustic  in  these  cases  is  a 
solution  of  from  four  to  eight  grains  of  nitrate  of  silver  in  an 
ounce  of  water,  which  is  to  be  applied  by  a  brush.  Emetics  are 
necessary,  where  pseudo-membranes  are  loose,  or  beginning  to 
loosen,  in  the  larynx  or  bronchi. — {Journal  fur  Kinderkrank- 
heiten,  and  Ibid. 


On  the  Abuse  of  Irritating  Applications  in  certain  Forms  of  Oph- 
thalmia.   By  Mr.  Ceitciiett. 

There  was  recently  a  case  under  Mr.  Critchett's  care,  in  the 
Royal  Ophthalmic  Hospital,  in  which  the  greatest  benefit  has 
been  derived  from  desisting  from  the  measure  which  had  pre- 
viously been  employed.  The  patient  is  a  lad  of  eighteen,  to 
whose  eyes,  for  four  years  past,  stimulating  drops  had  been  daily 


346  Epilepsy  treated  by  Ligation  of  Artery.  P^&y, 


applied,  on  account  of  chronic  inflammation  and  thickening  of 
the  conjunctiva.  His  eyes  had  been  kept  in  a  state  of  constant 
irritation,  and  when  admitted  his  vision  was  very  imperfect,  on 
account  of  superficial  vascularity  of  the  cornea.  He  had  been 
sent  up  from  a  considerable  distance  in  the  country.  Mr. 
Critchett  directed  the  eyes  to  be  left  quite  alone,  a  single  seton 
thread  being  introduced  in  each  temple.  The  improvement 
was  extremely  rapid,  and  within  a  week  the  greater  part  of  the 
vascularity  had  cleared  away.  No  doubt  the  seton  has  had 
some  good  influence ;  but,  looking  at  the  rapidity  of  the  cure,  it 
seems  certain  that  the  chief  agent  has  been  the  rest  from  injuri- 
ous applications.  Cases  more  or  less  similar  are  constantly  pre- 
senting themselves,  in  which,  with  a  perverseness  worthy  of  a 
better  cause,  irritating  collyria  have  been  employed  for  periods 
far  too  long. — \Med.  Times  and  Gaz.,  and  Banking's  Abstract. 


Epilepsy  treated  by  Ligation  of  the  Common  Carotid  Artery.     By 
C.  Angell,  M.  H.,  of  Pittsburg,  Indiana. 

Dr.  AngRl  has  resorted  to  ligation  of  the  common  carotid 
artery  on  one  side  in  two  cases  of  epilepsy.  The  first  operation 
was  performed  in  July,  1857.  The  patient,  a  male,  was  twenty 
years  of  age,  about  five  feet  in  height,  large  head,  short  neck, 
sanguine  temperament,  and  of  full  habit.  Epilepsy  had  existed 
for  three  or  four  years,  the  fits  progressively  becoming  more  fre- 
quent and  severe.  He  had  become  partially  idiotic.  He  had 
from  fifteen  to  twenty  fits  during  the  forenoon  of  the  day  on 
which  the  operation  was  performed.  The  day  after  the  opera- 
tion he  complained  of  difficulty  in  swallowing,  and  the  left  side 
became  incompletely  paralyzed.  The  paralysis  continued,  with 
difficulty  of  articulation  and  swallowing,  till  the  next  day,  when 
he  died  in  a  comatose  condition.  The  epileptic  paroxysms  did 
not  recur  after  the  operation. 

The  second  operation  occurred  a  few  days  after  the  first. 
The  patient,  a  male,  was  forty  years  of  age,  of  a  full  habit  and 
sanguine  temperament.  Epilepsy  had  existed  for  seven  years. 
For  the  last  three  years  the  paroxysms  had  recurred  almost  daily. 
The  mind  was  much  affected.  He  recovered  from  the  operation 
satisfactorily,  and  had  no  return  of  the  epilepsy  for  twenty- two 
days.  At  the  end  of  that  time  he  had  a  paroxysm  on  two  suc- 
cessive days.  Seventeen  days  after  this  a  third  paroxysm  occur- 
red, and  about  a  month  afterwards  a  fourth.  These  four  parox- 
ysms were  all  that  had  taken  place  up  to  the  time  of  writing 
the  report,  a  period  of  a  little  more  than  two  months.  The 
paroxysms  after  the  operation  differed  from  those  which  occur- 
red previously  as  regards  premonitions.    Prior  to  the  operation, 


1858.]  Removal  of  a  Large  Uterine  Polypus.  347 

lie  had  no  warning  of  their  approach;  but  after  the  operation, 
a  sensation  of  dizziness  preceded  the  attacks  for  several  minutes, 
giving  him  time  to  provide  against  falling. 

The  patient  declared  that  he  felt  better  than  at  any  time 
during  the  three  years ;  some  of  his  friends  thought  that  there 
was  a  decided  improvement  in  his  general  appearance  and  men- 
tal condition. 

The  report  is  made  too  recently  after  the  operation  to  warrant 
any  conclusion  as  to  its  permanent  value  in  this  instance. 

[Xorth-  Western  Med.  and  Surg.  Journal. 


A  Large  Uterine  Polypus  removed  by  the  Curved  Ecraseur  vriih 
Double  Action. 

A  woman  fifty  years  of  age,  who  had  been  suffering  from 
frequent  uterine  haemorrhage  during  the  last  two  years,  was  ad- 
mitted into  the  Samaritan  Hospital  ten  days  ago,  under  Dr. 
Savage's  care.  Many  examinations  had  been  made  elsewhere 
previously  by  various  surgeons ;  but  a  polypus,  if  suspected, 
until  the  day  before  her  admission,  was  probably  quite  out  of 
reach.  A  swelling  could  even  now  be  scarcely  made  out  by  the 
finger  introduced  far  into  the  os  uteri.  Sponge  tents  were  intro- 
duced daily.  On  the  third  day  the  tumour  became  more  distinct, 
and  then  rapidly  distended  through  the  dilated  os  into  the  vagi- 
na. On  the  fourth  day  it  could  be  felt  in  size  and  shape  like  a 
large  jargonel  pear  (its  neck  not  much  less  than  its  body,)  extend- 
ing into  the  uterus  to  be  attached  somewhere  towards  its  back 
part.  On  the  fifth  day  the  polypus  was  lain  hold  of  by  a  pair 
of  ring  forceps,  the  loop  chain  of  the  ecraseur  being  passed  over 
the  handle  of  the  forceps,  slipped  up,  and  was  drawn  tight,  pre- 
cisely as  the  cord  in  the  ordinary  operation  by  ligature,  and  the 
tumour  was  brought  away  without  pain  or  haemorrhage.  Dr. 
Savage  observed  that  the  unwieldly  look  of  the  instrument  was 
suggestive  of  much  pain  and  difficulty ;  but  its  curve  fell  into  the 
hollow  of  the  sacrum  with  the  utmost  facility,  and  its  point  as 
readily  passed  into  the  uterus  as  high  as  he  thought  necessary. 
As  the  chain  is  flexible  only  on  one  side,  much  careful  manipu- 
lation was  required  before  it  could  be  got  where  he  thought  it 
ought  to  be.  Before  working  the  handle  which  tightened  the 
chain,  the  single  fore- finger  readily  ascertained  that  nothing 
improper  was  included.  The  handle  was  worked  at  half-minute 
intervals  as  soon  as  decided  resistence  showed  that  contraction 
had  commenced.  The  tumour  came  away  in  six  minutes. 
From  first  to  last  the  patient  said  she  felt  no  pain  whatever. 
The  haemorrhage  has  not  appeared.  Dr.  Savage  said  he  had 
heard  of  two  cases  of  polypus  thus  treated  in  this  country,  but 


348  On  the  Functions  of  the  Thyroid  Body,  [May, 

believed  they  had  not  been  recorded.  He  had  several  times  seen 
M.  Chassaignac  remove  parts  highly  vascular  with  his  ecraseur 
without  the  least  hemorrhage,  and  thought  as  the  plan  he  had 
adopted  in  this  case  was  equally  safe  as  the  ligature,  without  any 
of  its  obvious  annoyances,  he  would  add  his  testimony  to  its 
value  through  the  Medical  Society.  Dr.  Savage  strongly  recom- 
mended an  instrument  with  the  double  action,  the  finishing 
improvement  of  the  inventor,  M.  Matthieu. — [London  Lancet. 


On  the  Functions  of  the  Thyroid  Body.     By  Dr.  P.  Martyn. 

Dr.  Peter  Martyn  has  communicated  to  the  Koyal  Society 
some  very  ingenious  speculations  as  to  the  use  of  this  remarka- 
ble body.  He  first  called  attention  to  the  necessity  of  rigidity 
in  all  round  instructions.  This  is  accomplished,  he  thinks,  by 
the  thyroid  gland,  which,  being  pressed  upon  by  the  muscles, 
during  the  act  of  speaking,  becomes  gorged  with  blood,  and 
presses  upon  the  larynx,  rendering  it  tense.  Furthermore,  he 
believes  this  so-called  gland  acts  as  a  loader.  In  musical  instru- 
ments, loaders  are  used  to  render  the  vibrations  slower  and  long- 
er, and  the  tone  in  consequence  fuller,  louder  and  deeper.  They 
thus  give  to  the  voicing  part  of  a  small  instrument  the  power 
and  quality  of  a  large  one.  The  human  organ  of  voice  is  only 
three  inches  long,  and  yet  "  has  the  same  power  as,  and  better 
quality  of  tone  than,  the  instrument  which  more  nearly  ap- 
proaches it — the  French  horn — which  is  nine  feet,  or  the  'vox 
humana'  pipe  of  a  moderate-sized  organ,  which  is  from  four  to 
eight  feet  long.  This  economy  of  size  in  the  human  organ  has 
always  been  wondered  at,  but  never,  that  I  know,  explained." 
Finally,  the  author  of  the  paper  believes  that  by  the  varying 
shape,  bulk,  destiny  and  pressure  of  this  body,  it  aids  materially 
in  producing  the  qualities  of  modulation  and  expression  belong- 
ing to  the  human  voice. — [Amer.  Jour,  of  Med.  Science. 


Treatment  of  Intermittent  Fever. 

There  is  a  means  of  treatment  of  fever  and  ague,  which  is  by 
far  too  much  neglected.  It  consists  in  applications  of  the  cold 
shower-bath  a  little  before  fever  sets  in.  Although  we  do  not 
admit,  as  it  might  be  concluded  from  a  paper  of  M.  L.  Fleury, 
that  every  case  will  be  cured  by  this  mode  of  treatment,  we 
think  that  the  facts  mentioned  by  this  able  physician  are  worthy 
of  attention.  He  states  that  he  has  treated,  during  the  last  ten 
years,  one  hundred  and  fourteen  patients,  and  that  they  all  have 
been  cured,  only  by  cold  shower  baths,  and  that  there  has  not 
been  a  single  return  of  the  disease.     Forty-three  were  recent 


1858.]  Uterine  Haemorrhage.  349 

cases,  having  existed  from  two  days  to  three  months;  seventy- 
one  were  old  and  rebellions  cases.  In  all  these  last  cases  there 
was  an  enlargement  of  the  spleen,  or  of  the  liver,  or  both ;  there 
was  anaemia  or  even  a  cachectic  state. 

One  single  shower-bath  has  often  been  enough  to  effect  the 
cure.  It  has  never  been  necessary  to  give  more  than  five  show- 
er-baths. Not  only  is  periodical  fever  cured  by  this  means,  but 
all  kinds  of  periodical  affections  may  also  be  cured  in  the  same 
way. 

When  the  periodical  attacks  are  stopped,  there  are  irregular 
ones,  in  most  of  the  cases,  as  long  as  the  engaged  viscera  have 
not  been  brought  down  to  their  normal  volume.  In  these  cases 
local  douches  have  been  applied  twice  a  day,  on  the  hepatic  or 
splenic  regions. — [Comptes  Rendus  de  V  Acad,  des  Sciences,  and 
New  York  Journal  of  Medicine. 


Injection  of  Liquor-Ferri  Sesquichlorati  in  Uterine  Hemorrhages. 

Dr.  Breslau's  case  of  injection  of  liquor-ferri  sesquichlorati 
shows  the  efficacy  of  this  treatment  in  certain  cases  of  excessive 
uterine  haemorrhage.  A  woman,  45  years  old,  had  worn  a  pes- 
sary for  a  long  time,  which  she  had  given  up  on  account  of  pain 
and  hemorrhages.  Examined,  there  were  found  five  grape- 
shaped  polypi  around  the  os  uteri,  with  ulceration.  These  were 
removed  by  Siebold's  scissors,  and  potassa  fusa  applied  to  the 
ulcerations.  The  haemorrages  remitted  somewhat.  The  uterus 
was,  however,  entirely  bent  upon  itself,  and  the  menses  returned 
in  great  excess.  The  cavity  of  the  uterus  was  somewhat  enlarg- 
ed. The  return  of  the  menorrhagia  reduced  the  patient  to  an 
extreme  degree  of  anaemia.  Ergot  of  rye  failed  to  effect  any 
contraction  of  uterus  or  arrest  of  flooding.  Two  possible  condi- 
tions presented  themselves  to  Dr.  Breslau:  1st,  The  five  polypi 
attached  to  the  cervix  favored  the  presumption  that  there  exist- 
ed a  similar  warty  hypertrophy  of  the  lining  membrane  of  the 
uterus ;  2d,  There  might  be  a  destructive  ulcerative  process  of  a 
malignant  character  going  on  in  the  same  structure.  In  the 
first  case,  the  currette  of  Recamier  seemed  indicated,  in  order  to 
scrape  the  uterine  membrane  clean  from  the  presumed  excrescen- 
ces. In  the  second  case,  it  seemed  necessary  to  bring  a  caus- 
tic and  styptic  agent  in  direct  contact  with  the  diseased  mem- 
brane. To  answer  this  latter  indication,  he  selected  the  liquor- 
ferri  sesquichlorati  of  the  Bavarian  Pharmacopoeia.  Having 
first  straightened  the  retroflected  uterus  by  the  sound,  and  in- 
serted an  elastic  catheter  as  far  as  the  fundus,  he  injected  one 
ounce  and  a  half  of  the  liquor-ferri,  diluted  with  an  equal  quan- 
tity of  water.  The  injected  fluid  was  retained  in  the  uterine 
cavity  for  a  minute  and  a  half  by  the  pressure  of  the  fingers  at 


350  Statistics  of  Coiling  of  the  Funis.  [^ay» 

the  os  around  the  catheter.  During  the  operation,  the  patient 
felt  a  dull  labourlike  pain  which  lasted  for  two  hours.  The  hae- 
morrhage, which  had  hitherto  been  unintermitting,  now  sudden- 
ly stopped,  and  was  not  renewed.  After  some  days,  brown, 
crumbling  clots  were  discharged,  but  no  fluid  blood.  Seven 
months  afterwards  there  had  been  no  return  of  menorrhagia. 
The  patient  menstruated  regularly  every  twenty-one  to  twenty- 
four  days;  and  through  internal  administration  of  steel  and 
quinine,  recovered  robust  health.' — [British  and  Foreign  Medico- 
Chirurgical  Review.     New  Orleans  Med.  News  and  Gazette. 


Statistics  of  Coiling  of  the  Funis.     By  Dr.  Weidemann. 

Dr.  Weidemann  states  that  among  28,430  deliveries  the  funis 
has  been  found  coiled  around  the  child  in  3,379  instances.  In 
3,230  of  these  it  was  coiled  around  the  neck,  and  in  149  around 
other  parts  of  the  body.  Of  the  3,230  cases,  2,546  consisted  in 
a  simple  coil,  and  in  684  there  were  severe  coils.  In  relation  to 
the  causes  of  this  occurrence,  it  is  interesting  to  notice  that  of 
1,788  cases  occurring  at  the  Marburg  Midwifery  Institution,  the 
funis  was  in  80  (1:22.2)  under  15  inches,  and  in  183  above  25 
inches  (1:9.71)  in  length  ;  that  in  54  (1.33)  there  were  very  little 
liquor  amnii,  and  in  41  (1:43.6)  there  was  very  much;  in  165 
(1:10.8)  the  child  was  under  5  pounds  weight,  and  in  28  (1:61.7) 
it  was  8  pounds.  Therefore,  among  the  favoring  causes  of  the 
occurrences  may  be  mentioned  a  long  funis,  abundance  of  liquor 
amnii,  and  a  small  child. 

Among  2,930  infants  born  at  Marburg,  182  (1:16.09)  were 
dead,  251  (1:12.41)  were  still-born.  Of  725  born  with  coiled  funis, 
45  (1:16.11)  were  dead,  and  72  (1:10.%)  were  still-born.  Of  the 
45  dead-born,  in  18  only  could  the  death  be  referred  to  this  alone, 
i.  e.,  only  1:40.2  in  the  725  examples  of  coiling.  From  an  ex- 
amination of  the  figures  derived  from  the  midwifery  institutions 
at  Dresden,  Gottingen,  Wiirsburg,  Berlin,  and  Marburg,  it  re- 
sults that  of  13,720  new-born  infants,  902  (1:15.21)  were  born 
dead ;  while  in  the  1,217  instances  of  coiling  of  the  funis,  31 
children  were  born  dead,  whose  death  could  be  attributed  to  that 
circumstance,  giving  a  proportion  of  1:39  to  the  coilings,  and 
1:19  to  the  number  born  dead. 

Thus,  as  (1)  the  16th  child  among  new-born  children  in 
general,  as  well  as  among  those  in  which  coiling  has  taken  place, 
is  born  dead ;  as  (2)  the  12th  child  among  the  new-born  in  gen- 
eral, and  the  10th  among  those  around  whom  the  funis  is  coiled 
is  born  still-born ;  and  as  (3)  in  one  child  in  40  only  can  this 
coiling  be  regarded  as  really  the  cause  of  death,  it  is  evident  that 
this  accident  does  not  occupy  a  very  prominent  place. — [Monatsch. 
fur  Geburtskunde,  and  Med.  Times  and  Gaz. 


1858.]  Case  of  Diabetes  Traumaticus.  351 

Case  of  Diabetes   Traumaticus.     Translated  for  the  Charleston 
Med.  Jour,  and  Review. 

Dr.  Herman  Itzigsohn  reports  the  following  case  in  Virchmtts 

Archiv,  for  April  1857:  A  Mechanic,  aged  thirty-eight  years, 
unmarried,  previously  in  good  health,  received  a  year  ago,  a 
blow  from  the  blade  of  a  hatchet  on  the  top  of  the  head,  a  little 
to  the  left  of  the  median  line.  He  immediately  suffered  from 
incontinence  of  urine ;  but  he  could  void  it  copiously  on  making 
a  strenuous  effort.  Gradually  diabetes  manifested  itself.  Inor- 
dinate thirst  supervened,  the  patient  drinking  sixteen  quarts  of 
fluid  daily,  which  naturally  produced  a  corresponding  flow  of 
urine.  He  dieted  himelf  on  bacon,  which  he  craved  more  than 
any  other  kind  of  food.  At  this  time  yellow  discoloration  of 
the  conjunctivas  announced  disorder  of  the  liver,  which  condi- 
tion was  further  indicated  by  swelling  and  uneasiness  in  the 
hepatic  region. 

This  case  is  in  two  respects  worthy  of  notice :  firstly,  for  its 
traumatic  origin  ;  secondly,  for  the  tardy  appearance  of  the  liver 
affection.  In  accordance  with  Bernard's  theory,  it  may  be  sup- 
posed that  a  splinter  of  bone  was  driven  into  the  fourth  ventricle, 
or  that  an  extra vasated  clot  occurred  there ;  although  it  is  not 
probable,  as  there  was  not  the  slightest  appearance  of  the  brain 
being  injured,  either  by  shaking  of  the  head,  or  any  other 
irregular  movement ;  neither  was  there  vertigo  nor  headache  at 
any  time.  It  remains  yet  to  be  proved  whether  diabetes  is  to 
be  traced  primarily  to  a  diseased  brain,  and  secondarily  to  the 
liver,  or  not.  The  expression  of  opinion  is  desirable  on  so  im- 
portant a  question. 


Condition  of  the  Nerves  in  Degenerated  Tissues.     Translated  for 
the  Charleston  Med.  Jour  and  Review. 

In  Yischow's  Archiv,  Band  XL,  Heft  2,  p.  200,  we  find  the 
following  summary  of  the  researches  of  Fred.  Marfels.  The 
author  examined  the  condition  of  the  nervus  vagus  in  four 
human  subjects,  the  victims  of  pulmonary  phthisis  and  maras- 
mus. He  ascertained  that  the  fatty  degeneration  does  not  attack 
the  nerves  immediately;  but  that  the  metamorphosis  begins 
in  developement  of  cells,  which  in  the  nerve  fibres  itself  should 
normally  proceed.  He  describes  the  same  as  nucleus-holding 
cells  of  the  size  of  the  small  colorless  blood  corpuscles,  which  lie 
in  the  midst  of  the  fibres,  for  the  most  part  without  any  interven- 
ing granular  substance ;  and,  strange  to  relate,  he  finds  that 
neither  potash,  ether,  nor  iodine  decompose  them.  Once  when 
examining  the  ischratic  nerve,  he  found  these  cells  even  inside 


352  Calcareous  Salts  in  the  Treatment  of  Rickets.         [May, 

the  axis  cylinders,  which  observation  corresponds  with  the  dis- 
covery made  in  some  of  the  lower  animals  of  the  existence  of 
cells  in  the  nerves,  partly  granulated  and  non-nucleated,  and 
partly  transparent,  clear  and  nucleated,  strung  together  in  the 
central  cord  of  the  nerves.  The  author  did  not  find  nuclei  in 
the  sheath  of  the  primitive  nerve-fibres  in  man ;  but  in  animals 
he  thinks  he  saw  them,  where  the  nerve-sheaths  appear  to  be 
filled  by  these  fibres.  Twice  he  observed  the  escape  of  the  nerve 
contents  from  the  sheath,  when  at  the  same  time  he  saw  the 
above  alluded  to  cells. 


Calcareous  Salts  in  the  Treatment  of  Rickets. 

Dr.  W.  Budd,  of  the  Bristol  Koyal  Infirmary,  states  (British 
Medical  Journal,  Jane,  1857,  p.  514)  that  he  has  derived  better 
results,  in  the  treatment  of  rickets,  from  the  compounds  of  lime, 
than  from  any  other  remedial  means.  In  cases  short  of  rickets, 
too,  where  children  with  large  heads,  tumid  bellies,  and  pasty 
complexion,  whose  spines  are  too  weak  to  support  their  bodies, 
who  are  slow  in  intellect,  and  backward  in  teething,  and  have 
reached  the  age  of  eighteen  months  or  more,  without  showing 
any  desire  to  take  to  their  feet,  the  beneficial  influence  of  calca- 
reous compounds  is  equally  manifest.  In  such  cases,  Dr.  Budd 
gives  five  or  ten  grains  of  phosphate  of  lime,  in  chalk  mixture, 
thrice  daily,  adding  a  simple  chalybeate  if  anosmia  is  palpably 
present.  At  the  end  of  a  fortnight,  the  improvement  of  the 
patient  is  generally  conspicuous.  Dr.  Budd  believes  that  the 
deterioration  in  the  teeth  of  the  rising  generation  is  due  to  the 
insufficient  supply  of  the  inorganic  constituents  of  these  organs 
in  the  food  of  children,  and  suggests  that  children  in  cities 
should  be  fed,  in  part,  during  dentition,  on  biscuits  containing 
a  proportion  of  salts  of  lime. — [Virginia  Med.  Journal. 


On  Lead  Colic.    By  M.  Briquet. 

Avery  interesting  communication  has  been  made  to  the  Aca- 
demie  de  Medicine,  by  M.  Briquet,  physician  of  the  Cbarite 
hospital.  The  object  of  the  paper  is  the  nature  and  treatment 
of  lead  colic.  What  is  the  seat  of  the  violent  pain  which  then 
exists  f  Is  it  the  digestive  canal — the  muscles  of  the  abdomen — 
the  diaphragm  ?  Is  the  spinal  cord  affected,  as  Laennec  and 
Barbier  admitted?  Is  the  pain  purely  neuralgic,  as  maintained 
by  Andral  and  Grisolle?  M.  Briquet  affirms,  from  researches 
made  on  forty-four  patients,  that  the  pain  is  in  the  muscles  of 
the  abdomen,  sometimes  in  one,  sometimes  in  many.  He  says 
also,  that  there  is  in  some  cases  a  real  hyperesthesia  of  the  skin 


1858.]  Editorial  and  Miscellaneous.  353 

in  the  neighborhood  of  the  painful  muscles.  In  some  patients, 
however,  the  reverse  exists :  the  skin  is  anaesthetic.  He  affirms 
that  constipation  has  no  influence  whatever  on  the  abdominal 
pain.  He  proposes  in  another  paper  to  relate  cases  to  prove  that 
the  application  of  galvanism  to  the  painful  muscles  usually  takes 
away  the  pain  at  once.  We  can  assert  that  it  is  perfectly  true 
that  the  pain  may  disappear  immediately  in  cases  of  lead  colic, 
after  one  application  of  an  electro-magnetic  current. — [Ibid. 


EDITORIAL  AND  MISCELLANEOUS. 

Editorial. — On  account  of  the  space  occupied  this  month  by  an  un- 
usual amount  of  original  matter,  and  the  space  given  to  the  minutes  of 
the  State  Society,  our  Editorial  matter  must  be  deferred  for  the  next 
month. 


Minutes  or  the  Annual  Meeting  of  the  State  Medical  Society. 

Madison,  April  14th,  1858. 

The  Society  assembled  at  10  o'clock,  in  the  Town  Hall,  in  Madison, 
and  was  called  to  order  by  the  1st  Vice-President,  Dr.  H.  F.  Campbell, 
of  Augusta. 

The  following  regular  members  were  present : — Drs.  J.  G.  Westmore- 
land, M.  H.  Oliver,  John  W.  Jones,  T.  C.  H.  Wilson,  Thos.  S.  Powell, 
W.  T.  Hollingsworth,  W.  S.  Meiere,  Jos.  P.  Logan,  A.  Means,  V.  H. 
Taliaferro,  G.  L.  McCleskey,  Henry  F.  Campbell,  Eben.  Hillyer,  J.  K 
Simmons,  Juriah  Harriss,  E.  E.  Jones,  DeSaussure  Ford,  S.  G.Anderson, 
Win.  Louis  Jones. 

The  minutes  of  the  last  annual  meeting,  held  in  Augusta,  April  8th, 
1857,  were  read  and  approved. 

The  rules  were  suspended,  and  upon  written  application,  the  following 
gentlemen  were  duly  elected  members  of  the  Society : 

R.  T.  Pulliam,  A.  J.  Shaffer,  J.  N.  Coe,  L.  J.  Green,  A.  M.  Parker, 
Isham  'H.  Ragan,  J.  H.  Conaly,  F.  S.  Colley,  S.  J.  Saffold,  L.  T.  P.  Har- 
well, L.  G.  Anderson,  J.  M.  Boring,  R.  J.  Stewart,  S.  H.  Dean,  S.  H. 
Smith,  L.  S.  Means,  A.  M.  Boyd,  W.  F.  Westmoreland,  H.  W.  Brown, 
B.  M.  Smith,  H.  J.  Walker,  Wm.  H.  Philpot,  Wm.  B.  Crawford,  Gasby 
Night. 

The  election  of  officers  being  next  in  order,  a  ballot  was  ordered,  and 
the  following  gentlemen  were  elected  for  the  ensuing  year : 

Dr.  J.  P.  Logan,  of  Atlanta,  President ;  Dr.  H.  J.  Ogleby,  of  Madison, 


354:  Miscellaneous.  [May, 

1st  Vice-President;  Dr.  John  T.  Banks,  of  Zebulon  (Pike  county),  2nd 
Vice-President ;  Dr.  Eben  Hillyer,  of  Rome,  Treasurer  and  Secretary. 

On  motion,  a  committee  of  two  were  appointed  to  conduct  the  Presi- 
dent elect,  Dr.  Joseph  P.  Logan,  to  the  chair ;  which  being  done,  he 
returned  his  thanks  to  the  Society,  in  a  few  appropriate  remarks,  for  the 
honor  conferred  upon  him. 

Dr.  E.  H.  W.  Hunter,  of  Louisville,  was,  by  ballot,  elected  to  deliver 
the  Oration  at  the  next  annual  meeting.  Dr.  G.  L.  McCleskey,  of  Mad- 
ison, as  his  alternate. 

The  selection  of  delegates  to  the  American  Medical  Association  being 
next  in  order,  a  committee  of  five,  consisting  of  the  following  gentlemen, 
were  appointed  to  nominate  them,  and  report  at  their  earliest  conven- 
ience :— Dr.  Ford,  Dr.  Harriss,  Dr.  W.  F.  Westmoreland,  Dr.  Simmons 
and  Dr.  Boyd. 

Society  then  adjourned  until  2  o'clock  P.  M. 

AFTERNOON    SESSION. 

Society  called  to  order  by  the  President. 

Dr.  Hillyer,  by  appointment,  read  an  essay  upon  the  Physiology  of 
Menstruation. 

The  committee  to  appoint  delegates  to  the  American  Medical  Asso- 
ciation, reported  the  names  of  the  following  gentlemen : — Juriah  Harriss, 
of  Savannah ;  W.  T.  Hollingsworth,  of  Morgan ;  F.  S.  Colley,  of  Wal- 
ton ;  W.  G.  Bulloch,  of  Savannah ;  H.  F.  Campbell,  of  Augusta ;  H.  M. 
Boyd,  of  Cave  Spring ;  Eben.  Hillyer,  of  Rome ;  B.  M.  Smith,  of  Atlanta ; 
C.  B.  Nottingham,  of  Macon ;  R.  Q.  Dickinson,  of  Albany ;  E.  M.  Pen- 
dleton, of  Sparta ;   James  Green,  of  Macon  ;  J.  F.  Banks,  of  Zebulou. 

The  essay  of  Dr.  Meiere  being  called  for,  he  responded  in  a  very  inter- 
esting article  upon  the  use  of  Alcohol  in  Typhoid  Fever. 

Society  adjourned  till  7  o'clock  P.  M. 

Society  met,  pursuant  to  adjournment. 

Dr.  W.  F.  Westmoreland  moved,  that  the  mode  of  appointing  Essay- 
ists and  subjects  be  changed.  That  each  gentleman  appointed  be  allow- 
ed to  write  upon  any  subject  of  his  own  selection. 

Upon  motion,  Drs.  Campbell,  E.  Jones  Oliver,  W.  F.  Westmoreland, 
and  Dean,  wrere  appointed  a  committee  to  nominate  Essayists  for  the  next 
meeting. 

The  report  of  the  late  Treasurer,  Dr.  Nottingham,  for  the  years  1856- 
185V,  were  received  and  adopted. 

A  ballot  was  ordered,  to  determine  upon  a  point  for  the  next  annual 
meeting,  which  resulted  in  the  selection  of  Atlanta. 


1858.]  Miscellaneous.  355 

Dr.  J.  G.  Westmoreland  moved,  that  two  hundred  copies  of  the  Con- 
stitution, By-Laws,  Roll  of  Members,  (fee.,  be  ordered  to  be  published  in 
pamphlet  form,  for  distribution  among  the  members  of  the  Society. 

Dr.  Meiere  moved,  as  a  substitute,  that  all  the  medical  journals  in  the 
State  be  requested  to  publish  the  Constitution,  &c,  in  their  columns — 
which  substitute  was  carried. 

The  Committee  on  Essays  reported  the  names  of  the  following  gentle- 
men, as  Essayists  for  the  next  annual  session  of  the  Society : 

Dr.  H.  W.  D.  Ford,  Dr.  H.  F.  Campbell,  Dr.  Robert  Campbell,  Dr. 
Smith  of  Griffin,  Dr.  E.  Hillyer,  Dr.  Stewart  of  Pike  county,  Dr.  G.  B. 
Night,  Dr.  S.  H.  Dean,  Dr.  W.  F.  Westmoreland,  Dr.  W.  H.  Doughty 
of  Augusta,  Dr.  Juriah  Harriss,  Dr.  J.  G.  Howard,  Dr.  R.  D.  Arnold, 
Dr.  V.  EL  Taliaferro,  Dr.  Joseph  A.  Eve,  Dr.  A.  M.  Boyd,  Dr.  Joseph  P. 
Logan,  Dr.  H.  W.  Brown,  Dr.  J.  M.  Green,  Dr.  T.  B.  Ford,  Dr.  G.  L. 
McCleskey. 

On  motion  of  Dr.  Means,  it  was  passed,  that  the  report  of  any  inter- 
esting case,  or  other  communication,  would  be  gladly  received  from  any 
gentleman  by  the  Society. 

The  following  report  was  received  from  Drs.  Bulloch,  and  Arnold,  a 
committee  appointed  by  the  Savannah  Medical  College,  to  solicit  the 
co-operation  of  the  Society  in  procuring  the  legalization  of  dissections,  for 
medical  and  surgical  purposes,  and  the  modification  or  repeal  of  the  laws 
now  in  force  against  it : 

To  the  President  and  Members  of  the  Medical  Society  of  the  State  of 
Georgia : 

Gentlemen — We,  the  undersigned  committee,  have  been  appointed 
by  the  Faculty  of  the  Savannah  Medical  College,  and  instructed  to  con- 
fer with  you,  asking  your  concurrence  in  a  movement  having  for  its 
object  the  passage  of  a  law  by  the  Legislature  of  Georgia,  legalizing  dis- 
section for  the  purposes  of  medical  and  surgical  study. 

To  effect  this  great  object,  we  would  most  respectfully  solicit  the  So- 
ciety to  unite  wTith  us  in  a  petition  to  the  Legislature,  at  their  next  session, 
to  pass  an  Act  rendering  it  lawful  for  the  Professors  and  Teachers  in 
Medical  Colleges  and  Schools  in  this  State,  to  receive  for  Anatomical 
study  the  unclaimed  bodies  of  persons  dying  at  public  hospitals  and  other 
kindred  institutions.     Such  a  law  is  in  force  in  other  States. 

Accompanying  this,  will  be  found  a  copy  of  the  Statute  enacted  by  the 
Legislative  Assembly  of  the  State  of  New  York. 

The  New  York  law  concedes,  as  you  will  observe,  very  little  else  than 
the  single  point  of  legalizing  dissection.  Even  this  may  be  of  immense 
practical  service,  by  ridding  us  of  the  annoyance  to  which  we  may  be  at 
any  time  exposed,  whilst  the  possession  of  a  dead  body,  even  for  scientific 
purposes,  is,  according  to  the  existing  law,  equivalent  to  a  crime  to  which, 
evil  disposed  persons  might  at  any  time  call  public  attention. 

Is  it  not  the  bounden  duty  of  the  State  to  see  that  the  Medical  Profess- 
15* 


356  Miscellaneous.  [^a7» 

ion  of  the  land,  who  are  the  true  missionaries  to  suffering  humanity,  lack 
nothing  needful  for  their  efficiency  and  usefulness,  without  the  necessity 
of  going  out  of  the  State  to  obtain  this  knowledge — not  forgetting  that 
it  is  this  profession  alone  that  can  be  brought  to  bear  on  the  waste  of 
human  life. 

The  public  demands  that  the  medical  institutions  shall  furnish  it  with 
good  and  accomplished  physicians  and  surgeons,  yet  it  has  set  its  face 
against  the  only  means  of  obtaining  them.  But  at  the  present  time,  un- 
der its  present  prosperity  and  attainment,  there  is  that  advancement  made 
in  other  branches  of  learning  and  science — there  is  that  enlightened  poli- 
cy in  legislation  upon  all  matters  of  general  interest  and  improvement, 
that  we  have  a  right  now  to  expect  and  to  ask  for  some  measure,  some 
means,  whereby  we  can  procure  material  for  dissection  in  some  legitimate 
manner,  that  we  may  be  enabled  to  make  that  progress  and  advancement 
in  our  profession  that  will  raise  it  to  that  rank  and  standard  it  so  nobly 
bears  in  other  sections  of  our  land. 

We  wish  to  be  relieved  from  this  false  and  dangerous  position  that 
affixes  upon  us  the  stigma  of  felons,  in  the  acquisition  of  anatomical 
knowledge,  and  all  these  difficulties  and  excessive  annoyances  under 
which  we  are  laboring,  and  which  we  are  now  obliged  to  encounter  and 
overcome,  to  make  that  progress  and  advancement  in  our  profession  that 
operates  only  to  favor  our  more  faithful  discharge  of  duty.  This  is  not 
for  the  exclusive  advantage  of  me  medical  man  :  it  seeks  no  other  benefit 
than  that  which  it  wishes  all  others  to  enjoy :  it  is  for  the  common  good. 
Every  intelligent  man,  whether  professional  or  non-professional,  cannot 
but  admit  that  the  interests  of  society  imperatively  demand  the  study  of 
practical  anatomy.  Then  why  should  not  the  State  make  a  suitable 
arrangement  by  law.  Is  there  any  reason  why  we  should  stand  in  this 
matter  behind  New  York,  Massachusetts,  Michigan,  and  many  other 
states,  in  an  enlightened  policy.  Considering  the  rights  of  the  medical 
profession,  in  the  just  and  proper  estimate  of  its  value,  and  in  comparison 
with  the  privileges  that  are  extended  to  it  in  other  states,  let  there  be 
removed  from  our  Statute  books  those  laws  repressing  the  study  of  Sci- 
ence— laws  that  should  exist  only  in  darker  ages — that  now  put  a  barrier 
in  the  way  almost  ruinous  to  the  pursuit  of  anatomical  investigation,  and 
continually  threatens  and  exposes  us  to  a  most  disgraceful  and  ignomini- 
ous punishment ! 

We  would  prefer  securing  the  passage  of  a  more  liberal  law  than  that 
of  the  New  York  Act,  so  that  if  our  views  on  this  subject  accord,  any 
petition  your  honorable  body  may  think  proper  to  make,  calculated  to 
facilitate  the  passage  of  a  bill,  through  the  Legislature,  would  meet  our 
hearty  concurrence. 

WM.  G.BULLOCH,  M.D. 
R.  D.ARNOLD,  M.D. 

The  following  was  passed,  offered  by  Dr.  Taliaferro,  of  Atlanta : 

Resolved,  That  the  thanks  of  this  Society  be  tendered  to  Col.  C.  R. 
Hanleiter,  editor  of  the  National  American,  for  his  presence  on  this  occa- 
sion, and  for  the  interest  he  manifests  in  the  elevation  of  Medical  Science, 
by  the  exclusion  from  the  columns  of  his  paper,  the  advertisement  of  all 


1858.]  Miscellaneous.  357 

quack  medicines,  secret  remedies  and  criminal  drugs,  which  too  frequent- 
ly pollute  the  public  press. 

The  following,  passed,  offered  by  Dr.  Dean  : 

Resolved,  That  the  thanks  of  this  Society  be  tendered  to  the  town 
authorities  of  Madison,  for  the  use  of  their  Hall — to  the  Trustees  of  the 
Presbyterian  Church  for  the  use  of  their  Church  building — to  the  Physi- 
cians and  citizens,  for  their  courtesy  and  attention  to  the  members  of  this 
Society. 

The  following  letter,  to  the  Society,  from  Dr.  Arnold,  was  presented 
and  read  by  Dr.  Harriss : 

Savannah,  April  11, 1858. 
To  the  Officers  and  Members  of  the  Med.  Society  of  the  State  of  Georgia : 

Gentlemen — My  engagements  with  Savannah  Medical  Journal  have 
prevented,  and  will  prevent  me  from  fulfilling  the  appointment  of  the 
Society,  in  writing  an  article  on  the  Pathology  and  Treatment  of  Yellow 
Fever.  I  think  I  can  do  the  subject  more  justice,  in  carrying  out  the 
plan  I  have  formed,  of  giving  in  successive  numbers  of  the  Journal  a  full 
history  of  our  terrible  epidemic  of  1854,  for  which  my  notes  taken  at  the 
time  are  ample. 

I  respectfully  request  to  be  discharged  from  the  further  consideration 
of  the  subject. 

Respectfully  yours, 

R.  D.ARNOLD. 
The  request  of  Dr.  Arnold  was  granted. 
On  motion,  the  following  was  passed : 

Resolved,  That  this  Society  do  now  adjourn,  to  reassemble  in  the  city 
of  Atlanta,  on  the  second  Wednesday  of  April,  1859. 

EBEN.  HHLYER,M.D., 

Secretary. 


New  Febrifuge.  Azderach  Bark. — Dr.  W.  R.  Cornish,  of  the  Bengal  ar- 
my, (Indian  Annals  of  Med.  Science,  Oct.  1856,)  states  that  the  Margosa 
or  Neem  tree  has  long  enjoyed  a  considerable  reputation  in  India  as  a 
febrifuge,  and  that  it  belongs  to  the  natural  order  Meliaceae  and  genius 
"  Azadirachta."  It  is  probably  the  Melia  Azederach  of  our  Pharmaco- 
poeia, and  which  under  the  name  of  Pride  of  India  is  so  extensively  em- 
ployed as  a  shade  and  ornamental  tree  in  the  Southern  States.  Here  the 
bark  is  used  as  a  vermifuge.  Dr.  C.  describes  the  bark  as  being  nearly 
white  internally  and  purple  externally.  When  chewed,  in  its  recent 
state,  its  taste  is  at  first  sweetish,  followed  quickly  by  a  powerful  and 
lasting  bitter.  Dr.  C.  employed  the  bark  during  six  months  with  nearly 
all  the  fever  patients  that  came  under  his  care,  in  the  form  of  decoction, 
(the  strength  of  which  is  not  given,)  from  one  to  two  wine-glassfuls  being 
administered  repeatedly  before  the  accession  of  the  paroxysm.  Dr.  Cor- 
nish considers  that  the  active  principal  resides  more  especially  in  the  light 
colored  inner  bark,  the  dark  exterior  being  highly  astringent,  owing  to  a 
tannin  analogous  to  that  in  catechu. — [American  Jour,  of  Pharmacy. 


858  Miscellaneous.  P^ay> 

Ampelopsis  Quinquefolia,  or  Virginia  Creeper. — The  common  Am- 
pelopsis, or  Virginia  Creeper,  so  ornamental  as  a  deciduous  climbing  plant 
in  our  woods  and  on  many;  walls  in  this  city,  is  recommended  by  Dr.  J. 
McCall  as  a  remedy  in  dropsy.  The  bark  of  the  vine  is  the  part  employed, 
and  it  should  be  gathered  late  in  the  Autumn,  wThen  the  berries  are  fully 
ripe  and  the  leaves  begin  to  turn  red  and  fall.  It  should  be  dried  in  the 
shade  and  preserved  carefully  from  moisture.  The  Ampelopsis  is  readi- 
ly known  by  the  quinate  division  of  the  leaf.  Its  creeping  character  and 
frequent  occurrence  on  the  same  tree  with  Rhus  radicans,  or  poison  vine, 
should  lead  the  collector  to  avoid  substituting  the  latter,  which  has  a 
three-lobed  leaf. 

In  its  physiological  effects  it  appears  to  "  stimulate  absorption  and  the 
elimination  of  matter  through  all  of  the  outlets  of  the  system  rather  than 
to  act  on  any  particular  secretion,  though  by  some  it  is  stated  to  be  ac- 
tively diuretic." 

Dr.  McC.  esteems  the  Ampelopsis  a  valuable  addition  to  the  materia 
medica ;  it  is  not  unpleasant  to  take,  though  in  taste  it  is  acrid  and 
persistent.  Its  infusion  and  decoction  are  quite  mucilaginous. — [Mem- 
phis Jour,  of  Medicine. 


Cancer  in  a  Woman  aged  Eighty  Years.  Soap  and  Lead  Plaster  in 
Schirrus. — The  same  day  that  we  saw  the  foregoing  cases,  wre  observed 
a  woman,  eighty  years  of  age,  at  the  Cancer  Hospital,  with  well-marked 
scirrhus  of  the  left  breast,  which  appeared  about  a  year  ag*o.  Notwith- 
standing her  great  age,  she  had  the  blooming,  healthy  cheeks  of  a  country 
girl  of  eighteen  ;  her  general  health  was  perfect,  and  under  the  use  of 
tonic  remedies,  and  soap  and-lead  plaster  spread  on  leather,  with  a  little 
camphor,  the  cancer  has  diminished  in  size,  and  its  progress  is  complete- 
ly arrested  for  the  piesent.  This  is  by  no  means  an  exceptional  case  of 
the  arrest  of  the  progress  of  cancer  at  this  hospital ;  for  we  have  observed 
several  in  whom  the  disease  has  been  kept  stationary  for  years,  with  no 
other  inconvenience  than  the  presence  of  the  tumour  in  the  breast,  and 
the  knowledge  on  the  part  of  the  patient  that  it  was  still  there.  The 
soap-and-lead  plaster  is  one  of  the  principal  agents  in  effecting  this  desi- 
rable object ;  the  lead  appears  to  possess  some  peculiar  influence  in  the 
disease. — [London  Lancet. 

Powdered  Chlorate  of  Potash  as  an  Application  to  Ulcers,  etc. — For 
some  time  past,  at  the  Metropolitan  Free  Hospital,  Mr.  Hutchinson  has 
employed  the  powdered  chlorate  of  potash  as  an  application  to  cachectic 
ulcers.  In  most  cases  it  appears  to  exert  a  very  beneficial  influence, 
speedily  inducing  cicatrization ;  and  it  is  very  convenient  of  use.  The 
cases  in  which  it  has  best  suited  have  been  some  of  ulcers  of  the  leg, 
open  buboes,  simple  sores  on  the  skin  of  the  penis,  and  cracked  nipples. 
In  the  latter  it  answers  admirably.  The  salt  should  be  powdered  very 
fine  and  dusted  into  the  sore  with  the  finger.  It  produces  sharp  smarting 
for  a  short  time,  but  the  pain  soon  subdues.  In  most  cases  suitable  for 
its  use  it  is  also  desirable  to  prescribe  its  internal  administration;  but 
with  a  view  to  making  the  experiments  more  conclusive,  in  the  cases 
upon  which  Mr.  Hutchinson  founded  his  opinion  of  its  efficacy,  no  other 
treatment  was  adopted. — [lb. 


1858.]  Miscellaneous.  359 


Ulcerated  Larynx  in  Typhoid  Fever,  Producing  General  Emphyse- 
ma.— It  was  thought  to  exemplify  an  occasional  complication  of  ty- 
phoid fever.  The  ease  was  one  of  a  boy  who  lately  died  under  Dr.  Ad- 
dison's care,  at  Guy's  Hospital.  About  the  twelfth  day  of  his  illness  his 
neck  was  observed*  to  be  emphysematous,  and  in  a  few  hours  the  face, 
arms,  chest,  &c,  were  in  a  like  condition.  This  continued  for  ten  davs, 
when  he  died.  Besides  the  usual  affection  of  the  ileum,  there  was  found 
at  the  back  part  of  the  larynx  a  sloughing  ulcer,  which  communicated 
with  a  space  between  the  oesophagus  and  trachea.  Through  this  line 
the  air  had  penetrated  into  the  mediastinum,  and  so  to  the  general  sub- 
cutaneous tissue  of  the  body.  Considering  the  rarity  of  emphysema  from 
such  a  cause,  the  case  might  be  thought  to  be  unique  or  accidental,  but 
(Dr.  Wilkes  believed)  for  various  reasons,  it  was  probably  not  so.  In  the 
first  place,  emphysema  had  been  alluded  to  by  various  writers  as  an  occa- 
sional occurrence  in  typhoid  fever,  though  the  cause  was  unknown  ;  and 
secondly,  a  peculiar  disease  of  the  larynx  had  been  described  by  various 
pathologists  as  a  part  of  typhoid  fever.  In  all  probability,  then,  these 
two  affections  stood  in  the  relation  of  effect  and  cause,  and,  therefore, 
although  this  was  the  first  case  of  the  kind  he  had  witnessed,  it  afforded, 
in  all  likelihood,  an  explanation  of  an  occurrence  which  rarely,  though 
sometimes,  happens  in  the  course  of  typhoid  fever. — [lb. 

A  Venereal  Badge. — M.  Renaud  states  the  following  fact  in  a  feuille- 
ton  of  the  Gazette  des  Hopitaux : — In  Servia,  a  woman  who  is  found  to 
be  suffering  from  syphilis,  can  claim  admission  into  an  hospital,  or  has 
the  privilege  of  being  treated  at  home  by  any  medical  man  she  chooses 
to  call  in.  When  she  is  attended  at  her  own  residence,  she  is  obliged  to 
wear  a  necklace  fastened  in  front  with  a  seal,  which  must  be  broken  be- 
fore the  necklace  can  be  removed.  The  clandestine  breaking  of  this 
seal  is  severely  punished  ;  and  any  one  coming  in  contact  with  the  woman 
thus  marked,  must  plainly  see  in  what  state  of  health  she  is.  It  is  to  be 
regretted  that  like  measures  are  not  in  force  in  other  parts  of  the  East, 
where  prostitution  is  carried  on  without  any  control. — [lb. 

Case  of  Congenital  Hypertrophy  of  the  Tongue,  and  Amputation. — 
This  case  was  reported  by  Dr.  Morrogh,  of  New  Brunswick,  X.  J.,  and 
occurred  in  a  girl  seven  years  old.  At  birth  the  hypertrophy  was  moder- 
ate, but  it  had  increased  more  or  less  rapidly  till  reaching  its  present 
dimensions ;  the  tongue  was  found  protruding  two  inches  outside  the 
jaws.  It  measured  two  inches  across  the  teeth,  and  was  of  a  corres- 
ponding thickness.  The  papilla?  of  the  protruded  portion  were  enlarged, 
and  the  mucous  membrane  was  thickened  and  indurated.  On  the  under 
surface  was  a  ragged,  hard  ulcer,  produced  by  the  pressure  of  the  teeth. 
These  were  pressed  forward  considerably  out  of  their  natural  position. 
The  horizontal  rami  of  the  inferior  maxilla  were  curved  downwards  so 
that,  when  the  molar  teeth  came  in  contact,  a  space  of  about  one  inch 
remained  between  the  upper  and  lower  incisors.  By  this  the  girl  was 
enabled  to  masticate  and  swallow  without  difficulty.  After  theexample 
of  Dr.  Harris,  of  Philadelphia,  who,  after  endeavoring  to  amputate  in  a 
similar  case  by  ligature,  in  1829,  performed  the  same  operation,  in  1835 
by  a  double  flap  incision,  checking  the  hemorrhage  by  ligature,  Dr.  Mor- 


360  Miscellaneous.  [May, 

rough  operated  by  removing  a  V  shaped  portion  from  the  anterior  mid- 
dle part  of  the  tongue,  and  ligating  the  ranine  artery.  Although  copious 
hemorrhages  followed,  the  patient  went  home  well,  on  the  sixth  day  after 
the  operation. — [Medical  and  Surgical  Reporter. 


Transcendental  Medicine;  the  Divine  Unconscious. — It  is  not  man 
who  cures  disease  by  means  of  his  conscious  spirit ;  but  it  is  the  divine 
Unconscious  in  man.  The  same  power  which  fashions  his  organism,  and 
daily  recreates  it  in  depths  of  mystery,  is  alone  that  which  brings  him 
back  from  sickness  to  health ;  and  all  that  man's  inventive  mind  has 
learnt  in  the  healing  art,  for  long  centuries,  limits  himself  to  providing 
means  to  facilitate,  to  further,  and  in  general,  perhaps,  to  render  possible, 
the  task  of  this  divine  Unconscious.  . .  We  cannot,  by  an  immediate  ex- 
ercise of  skill,  cure  the  most  trivial  cut  of  the  finger ;  the  healing  of  even 
such  a  wound  as  this  depends  on  a  formation  of  new  organic  substance, 
of  which  formation  the  divine  Unconscious  is  alone  capable;  at  most  we 
can  either  hinder  or  further  this  process,  and  in  the  accomplishment  of 
the  latter  aim  lies  the  essence  of  the  surgical  art. — [Dr.  C.  G.  Carus  : 
Ueber  Lebanmagnetismus.     London  Lancet. 


Slitting  up  the  Lachrymal  Canals. — The  practice  of  slitting  up  the 
lachrymal  canals  and  their  orifices,  originally  introduced  by  Mr.  Bow- 
man, for  the  treatment  of  certain  cases  of  epiphora,  still  continues  to  be 
extensively  employed  at  the  Moorfields  Ophthalmic  Hospital.  It  is  adapt- 
ed to  all  cases  in  which  either  the  punctum  is  narrowed  or  displaced 
outwards,  and  these  constitute  a  very  numerous  class.  In  almost  all 
cases  of  long-continued  tinea  tarsi,  in  which,  by  degrees,  the  thickening 
of  the  lower  Jid  has  everted  its  edge,  this  simple  procedure  relieves  the 
patient  of  his  most  troublesome  symptom.  Mr.  Critchett  has  recently 
had  made  some  grooved  steel  probes  for  this  operation,  which  materially 
facilitate  its  performance.  The  silver  ones  formerly  employed  being 
necessarily  very  small,  were  unsteady  as  guides  to  the  point  of  the  knife. 
The  steel  ones,  on  the  contrary,  give  it  good  support,  and  their  groove 
is  of  great  advantage  in  securing  that  it  shall  glide  easily  in  the  right 
direction.  To  secure  smoothness  of  surface,  and  prevent  rusting,  the 
steel  probes  are  gilt.  A  Beer's  knife  is  the  best,  and  with  these  instru- 
ments the  operation  is  one  of  extreme  ease. — [Med.  Times  and  Gazette. 

Rules  Respecting  the  Treatment  of  Primary  Syphilis. — It  seems  to  be 
now  pretty  generally  acknowledged,  in  hospital  practice,  that  mercury 
should  be  given  only  in  those  cases  in  which  the  chancre  presents  marked 
induration,  and  that  in  all  others  secondary  symptoms  should  be  waited 
for  before  having  recourse  to  specific  treatment.  In  a  large  majority  of 
sores  not  attended  by  induration,  no  constitutional  phenomena  will  follow ; 
and  to  discriminate'between  those  likely  to  be  so  followed  and  the  harm- 
less class,  is  admitted  to  be  impossible.  There  is,  therefore,  no  altera- 
tive, except  we  would  give  mercury  very  often  unnecessarily,  but  to  wait 
in  these  cases  until  the  real  nature  of  the  affection  shall  have  been  made 
manifest.  In  the  non-indurated  class,  local  stimulants,  as  sulphate  of 
copper,  lunar  caustic,  or  the  acid  nitrate  of  mercury,  are  the  oldand 
«ttll  favorite  remedies.     If  the  chancre  be  seen  within  a  week  of  its  origin, 


1858.]  Miscellaneous.  361 

whether  induration  have  already  commenced  or  not,  vre  believe  most  sur- 
geons would  destroy  it  freely  either  by  nitric  acid  or  some  other  caustic. 

[Med.  Times  an:!  Gazette. 


New  Antiperiodic. — Dr.  R.  S.  Cauthorn,  of  Richmond,  Va.,  gives  an 
account  of  the  root  of  Apocynum  Cannabinum,  as  a  powerful  antiperio- 
dic. This  power  of  the  root  was  discovered  by  an  herb  doctor,  by  the 
name  of  Ragland,  and  the  medicine  is  called  "Dr.  Raglard's  Root  of 
Man"  by  the  people  who  had  used  it.  About  six  grains  of  the  root  is 
administered  in  the  form  of  powder  or  pills,  preceded  in  cases  of  ague 
by  a  dose  of  calomel.  Dr.  Cauthorn  expresses  much  confidence  in  the 
virtue  of  the  Apocynum  Cannabinum,  and  he  may  be  correct  in  his  infer- 
ences ;  but  as  his  own  observations  were  only  extended  to  six  cases  it  may 
be  well  to  get  further  information  before  admitting  it  to  the  rank  claimed 
for  it  by  Dr.  Cauthorn,  which  can  readily  be  effected,  as  the  plant  is 
found  all  over  the  Middle  States. — [Richmond  Stethoscope. 


Corrosive  Sublimate  and  Collodion  as  an  Escharotic. — Dr.  Macke  uses 
a  solution  of  a  drachm  of  corrosive  sublimate  in  an  ounce  of  collodion 
as  an  eschrrotic  to  remove  small  exerescences,  which  it  is  desirable  to  get 
rid  of  without  using  the  knife.  It  is  applied  by  means  of  a  camel's  hair 
brush.  When  the  inflammation  is  high,  it  may  be  abated  with  cold 
water  applications  without  interfering  with  the  action  of  the  caustic,  the 
eschar  is  then  thrown  off  in  from  three  to  six  days,  with  slight  pain,  and 
the  author  has  not  noticed  absorption  to  take  place  during  its  contact. 

[Hay's  Journal. 


Gelatinized  Chlorform. — Dr.  Massart  (Revue  de  Therapeutique)  gives 
the  following  process  for  making  chloroform  jelly  for  facilitating  its  use 
as  a  local  anaesthetic,  viz :  Take  equal  parts  of  white  of  egg  and  chloro- 
form, shake  the  mixture  and  let  it  stand  for  three  hours.  Or  take  one 
part  of  white  of  egg  and  four  parts  of  chloroform,  put  them  in  a  bottle, 
which  is  then  plunged  in  a  water  bath  of  the  temperature  of  from  120° 
to  140°  Fahr.,  when  gelatinization  occurs  in  four  minutes.  This  prepara- 
tion is  applied  by  rnbbing  the  painful  part,  and  its  power  of  affording  re- 
lief is  said  to  be  remarkable.  Dr.  Massart  prefers  the  cold  process.  If 
allowed  to  remain  long  in  contact  with  the  skin,  it  produces  incipient 
cauterization. — [Boston  Med.  Journal. 

Foul  Ulcers  of  the  Legs. — A  woman  at  St.  Mary's  Hospital,  whose 
entire  leg  had  been  in  a  state  of  ulceration  for  years,  with  islands  of  skin 
here  andthere,  has  had  it  effectually  healed  up,  by  Mr.  Coulson,  by  wrap- 
ping a  piece  of  linen  around  it  wet  with  a  lotion  of  the  sulphate  of  soda, 
and  a  bandage  over  all.  Mr.  Coulson  thinks  the  bandaging  and  rest  have 
proved  as  serviceable  as  anything  else  used. — [Ibid. 

Yeast  in  Scarlet  Fever. — Some  years  ago  my  attention  was  directed 
to  the  use  of  yeast  in  scarlet  fever,  by  an  article  in  your  Journal  from  the 
pen  of  Dr.  Smith,  of  Baltimore.  I  have  given  it  this  last  winter  in  fifty- 
three   cases,  and  all  have  recovered.     These  were   all  the  cases  in  my 


362  Miscellaneous, 

practice.     Together  with  the  yeast,  inunction  has  been  employed  in  two 
thirds  of  them. 

I  believe  that  the  free  use  of  yeast  may  prevent  a  bad  type  of  the  dis- 
ease. It  was  given,  at  the  outset,  every  two  or  three  hours,  in  doses  from 
a  teaspoonful  to  a  tablespoonful,  and  continued  until  desquamation. 

[A.  S.  McClean.  Boston  Med.  and  Surg.  Journal. 

Poison  Census. — The  Medical  Times  states,  that  in  the  four  years, 
from  1848  to  1851,  the  deaths  by  poisoning  ranged  from  444  to  447  each 
year.  In  the  three  subsequent  years,  52,  '53,  and  '54,  the  number  of 
deaths  by  poisoning  was  370,  409,  and  398.  This  decrease  is  attributed 
by  Dr.  Farr,  to  a  certain  extent,  to  the  effect  of  the  Legislative  restrictions 
from  the  "  Sale  of  Arsenic  Act." — [Druggists  Circular. 

Edinburgh  Celebrities  from  an  American  Point  of  View. — Dr.  Simp- 
son, a  short  thick  man,  with  what  General  Massey  calls  "body  of  Bac- 
chus and  the  head  of  Jove,"  really  a  very  fine  head,  covered  with  long 
black  curls,  seamed  with  gray,  a  round  Scotch  face,  high  cheek-bones, 
penetrating  mild  eyes  and  curious  prim  mouth,  deep  sunk  between  the 
nose  and  chin,  like  that  of  Cicero.  And  there  is  no  reason  why  it  should 
not,  for  the  doctor,  too,  is  eloquent  in  his  own  sphere.  He  persuades 
nervous  females  into  good  health,  and  amuses  all  by  his  genial  humour 
and  stories.  He  is  a  bold  experimenter,  and  has  hit  upon  other  things 
than  chloroform.  Many  tales  of  his  benevolence  are  told.  The  poor 
never  apply  to  him  in  vain.  Not  a  few  of  his  own  profession  envy  him, 
and  assail  his  reputation  for  the  love  of  novelties,  etc.;  while,  on  the  other 
hand,  the  disciples  of  mesmerism  and  the  water  cure  declare  he  could 
say  something  in  their  favor,  if  he  had  the  courage  and  the  good  will.— Pro- 
fessor Syme,  the  first  operator  alive,  is  a  clean  made,  gentlemanly  man, 
with  a  finely  formed,  baldish  head — a  most  concise,  decided  individual, 
sharp,  curt,  and  unceremonious  as  his  own  knife,  but  always  going  direct 
to  the  heart  of  the  matter,  never  wasting  a  drop  of  blood  or  a  drop  of  ink, 
or  a  single  word.  He  is  not  much  addicted  to  giving  drugs.  He  likes 
to  see  what  he  is  about,  and  has  no  fancy  for  poisoning  people  at  random 
with  the  preparation  of  chemistry. — A  colleague  of  these  two,  and  an 
opponent  of  the  former  in  reference  to  homoeopathy  warfare  in  Scotland, 
a  tall,  compact,  swarthy,  bushy-haired  man,  dexterous  at  controversy, 
and  capable  of  making  a  clear  extempore  statement,  in  a  style  that  many 
lawyers  would  envy. — [Scottish  American  Journal. 

Wendell  Holmes  on  Controversy. — "  If  a  fellow  attacked  my  opinions 
in  print  would  I  reply  ?  Not  I.  Do  you  think  I  don't  understand  what 
my  friend,  the  professor,  long  ago  called  the  hydrostatic  paradox  of  con- 
troversy? Don't  know  what  that  means?  Well,  I'll  tell  you.  You 
know  that  if  you  had  a  bent  tube,  one  arm  of  which  was  the  size  of  a  pipe 
stem,  and  the  other  big  enough  to  hold  the  ocean,  water  would  stand  at 
the  same  hight  in  one  as  in  the  other.  Controversy  equalizes  fools  and 
wise  men  in  the  same  way — and  the  fools  know  it." 

The  London  Lancet  says  "  that  Quacks  bear  the  same  relation  to  the 
Medical  Profession,  with  that  of  the  pediculus  to  the  human  being  on 
whom  it  preys." 


SOUTHERN 

MEDICAL  AND  SURGICAL  JOURNAL. 

(NEW  SERIES.) 


Vol.  XIV.]  AUGUSTA,  GEORGIA,  JUNE,  1858.  [No.  6. 

ORIGINAL  AND  ECLECTIC. 

ARTICLE  XIV. 

Observations  on  Malarial  Fever.  By  Joseph  Jones,  A.M.,  M.D., 
Professor  of  Physics  and  Natural  Theology  in  the  University 
of  Georgia,  Athens ;  Professor  of  Chemistry  and  Pharmacy  in 
the  Medical  College  of  Georgia,  Augusta ;  formerly  Professor 
of  Medical  Chemistry  in  the  Medical  College  of  Savannah. 

PRELIMINARY   OBSERVATIONS. 

In  the  present  state  of  Medical  Science,  the  complete  investigation 
of  all  the  effects  and  phenomena  of  'disease,  is  impossible. 

Imperfections  in  our  instruments ;  imperfections  in  our  methods 
of  analysis  and  the  complicated  nature  of  the  phenomena,  render 
physiological  and  pathological  investigations  difficult  and  uncer- 
tain. 

The  truth  of  this  assertion  may  be  established  by  an  examina- 
tion of  the  relations  of  animated  beings  to  exterior  inorganic 
bodies,  to  each  other,  and  to  the  physical  and  chemical  forces. 

Organized  animate  bodies  are  composed  of  inorganic  elements, 
and  are  governed  by  all  the  laws  and  phenomena  of  inorganic 
bodies,  and  are  absolutely  dependent,  for  their  existence,  upon 
inorganic  bodies.  They  have,  however,  a  new  set  of  phenome- 
na, dependent  upon  the  vital  force;  and  in  animals  we  have 
another  set  of  phenomena,  dependent  upon  the  existence  of  the 
nervous  system  and  intellectual  faculties;  and  in  man  we  have 
another  set  of  phenomena,  dependent  upon  the  combination  of 
the  intellectual  with  moral  faculties. 

K.  S. — VOL.  XIV.   KO.  VI.  16 


364  Jones,  on  Malarial  Fever.  [June, 

Inorganic  bodies,  with  their  properties,  form  the  necessary 
conditions  for  the  existence  of  plants  and  animals,  just  as  the 
properties  of  cohesion  nnd  gravitation  form  the  essential  condi- 
tions for  the  existence  of  the  universe,  in  its  present  arrange- 
ment. 

The  phenomena  of  living  beings,  plants  and  animals,  are 
therefore  more  complicated,  and  less  general,  than  those  of 
inorganic  inanimate  bodies. 

Without  entering  into  an  enumeration  of  all  the  distinctions,- 
between  inorganic  bodies  and  animated  beings,-  it  may  be  statedr 
that  inorganic  bodies  are  homogeneous  in  structure,  and  would 
remain  forever  at  rest,  and  unchanged,  physically  and  chemi- 
cally, unless  acted  upon  by  extraneous  forces ;  whilst,  on  the 
other  band,,  all  vegetables  from  the  simple  cell,  to  the  most  highly 
developed,  and  all  animals  from  the  simple  cell  animalcule,  to 
the  complicated  organism  of  man,  have  arisen  from  cells,  and 
are  composed  of  cells,  variously  developed,  and  grouped  so  as 
to  form  organs,  and  systems  of  organs,  and  apparatus,  capable 
of  accomplishing  definite  results,  when  moved  by  the  proper 
chemical  and  physical  forces. 

The  acts  of  development,  nutrition,  secretion,  excretion  and 
propagation  are  peculiar  to  plants  and  animals,  and  are  directed 
by  the  vital  force  which  is  incorporated  with,  and  presides  overr 
every  molecule  of  living  organized  matter,  directing  all  its 
physical  and  chemical  changes,  so  that  amidst  innumerable  and 
unceasing  changes  the  individuality  of  every  organ,  apparatus 
and  animal  is  preserved.  Physical  and  chemical  forces  exist 
independently  of  the  vital  force.  The  vital  force,  on  the  con- 
trary, cannot  exist  and  manifest  its  peculiar  effects,  without 
matter  and  the  physical  and  chemical  forces. 

The  germination  and  development  of  vegetables  and  animals1  and 
the  maintenance  of  their  life  actions,  depend  essentially  upon  the 
correlation  of  the  vital,  chemical  and  physical  forces. 

The  study  of  complicated,  highly  developed  plants,  and  animals, 
involves  the  consideration  of  their  origin,  development,  structure, 
and  relations  to  exterior  bodies — involves  the  consideration  of  the 
chemical  and  physical  properties  of  the  elements,  and  combination 
of  elements,  entering  into  their  constitution,  and  the  relations  of  the 
constituents  of  their  bodies  to  the  surrounding  medium — involves 


1858.]  JONES,  on  Malarial  Fever.  365 

the  consideration  of  the  relations  of  the  vital,  chemical  and  physical 
forces  and  intellectual  and  moral  faculties — involves  the  considera- 
tion of  die  relations  of  animated  bodies  to  the  forces  of  the  sun. 

These  phenomena  may  be  studied  with  a  greater  degree  of 
precision  in  the  lowest  orders  of  plants  and  animals,  whose 
structures  are  simple. 

As  we  rise  in  the  scale  of  vegetable  and  animal  existence  the  phe- 
nomena of  life  become  more  complex  and  less  general,  and  the 
conditions  of  existence  become  more  complicated  and  restricted.  The 
truth  of  this  proposition  is  illustrated  in  a  forcible  manner,  by 
the  relation  of  vegetable  and  animal  existence,  to  the  distribu- 
tion of  the  forces  of  the  sun  upon  the  surface  of  our  globe. 

Thus,  as  a  general  rule,  after  the  inorganic  elements  and 
moisture  have  been  supplied,  the  luxuriance  and  perfection  of 
plants  depend  upon  the  intensity  of  the  forces  of  the  sun.  The 
more  complicated  and  perfect  the  vegetable  structures,  the  closer  is 
their  dependence  upon  the  proper  supply  and  balance  of  the  physical 
forces.     The  converse  of  this  proposition  is  also  true. 

The  truth  of  this  proposition  is  established  by  a  reference  to 
the  distribution  of  plants  upon  the  surface  of  our  globe,  and  upon 
mountains  which  rise  to  a  great  height  in  tropical  countries. 

Whilst,  in  equinoctial  and  tropical  countries,  where  a  suffi- 
cient supply  of  moisture  combines  with  the  influence  of  heat  and 
light,  vegetation  appears  in  all  its  magnitude  and  glory ;  on  the 
other  hand,  in  polar  regions  and  upon  the  summits  of  lofty 
mountains,  all  the  more  complicated  forms  of  vegetable  existence 
disappear,  and  lichens  and  microscopic  plants  take  the  place  of 
the  majestic  forests  and  impenetrable  jungle. 

In  the  tropics,  the  lowest  orders  of  plants  are  comparatively 
rare,  whilst  in  the  polar  regions  and  upon  the  summits  of  moun- 
tains they  form  almost  the  entire  vegetation.  The  plants  which 
first  form  upon  barren  rocks  and  lava  streams,  and  coral  islands, 
are  those  of  the  most  simple  organization.  The  simply  organ- 
ized lichens  covering  the  bald-granite  rocks  are  familiar  to  every 
resident  of  a  primitive  region. 

Along  the  sides  of  Etna,  Ischia,  Vesuvius,  and  other  volca- 
noes, lava  streams  are  seen  stretching  in  all  directions,  which  have 
flowed  down  like  rivers.  These  lava  streams  are  of  different 
agea,  and  many  of  them  were  formed  within  the  memory  of 


366  Jones,  on  Malarial  Fever.  [June, 

man.  An  investigation  of  these  lava  streams  affords  an  oppor- 
tunity of  determining  the  gradual  distribution  of  vegetables. 
Some  are  still  naked — others  have  only  a  few  plants,  scattered 
here  and  there,  in  hollows  and  crevices,  and  in  others  the  de- 
caying plants  are  forming  a  soil. 

According  to  the  observations  of  Professor  J.  F.  Schouw,^) 
•the  plants  which  first  settle  upon  the  naked  lava,  and  form  a 
soil  for  the  more  complex,  are  especially  those  lower  and  simply 
organized  plants  called  lichens.  Certain  succulent  and  fleshy 
plants,  as  the  Indian  fig  (Opuntia  vulgaris),  which  are  nourished 
chiefly  by  the  carbonic  acid  and  aqueous  vapor  of  the  air  ab- 
sorbed by  the  stem  and  leaves,  are  also  amongst  the  earliest 
inhabitants  of  the  lava  streams.  Geology  also  teaches  that  the 
lower  orders  of  plants  appeared  first  upon  our  globe. 

As  the  luxuriance  and  perfection  of  plants  depend  upon  the  tem- 
perature of  the  surrounding  medium  and  the  intensity  of  the  forces 
of  the  sun,  so  also  the  perfection  of  the  nervous  system  ;  and  of  all  the 
organs  and  apparatus,  and  the  activity  and  intelligence  of  animals, 
correspond,  in  a  great  measure,  to  the  rapidity  of  the  physical  and 
chemical  changes  going  on  in  the  molecules  of  their  bodies,  and  to  the 
relations  of  the  physical  and  chemical  and  vital  forces,  and  to  the 
temperature  which  they  are  able  to  maintain,  regardless  of  that  of  the 
surrounding  medium. 

As  the  chemical  changes  become  feeble,  and  the  temperature  of 
animals  descends  and  becomes  dependent  upon,  that  of  the  surround- 
ing medium,  they  become  more  simple  in  their  organization  and  mode 
of  life,  the  conditions  of  their  existence  become  less  restricted,  and  they 
resemble  closely  the  simple  forms  of  vegetables,  and  in  the  twilight  of 
existence,  zve  can  scarcely  distinguish  between  the  lowest  forms  of 
plants  and  animals. 

If  we  examine  the  relations  of  the  physical  and  chemical 
agents  to  the  animal  kingdom,  we  will  find  that  the  most  sim- 
ply constructed  animals,  many  of  which  are  devoid  of  a  nervous 
system  and  special  organs  of  sense,  as  the  infusoria,  are,  as  in  the 
case  of  the  simply  organized  plants,  the  most  widely  distributed 
over  the  face  of  our  globe,  and  are  at  the  same  time  far  less 
dependent  for  their  existence  upon  the  temperature  of  the  sur- 
rounding medium. 

(1)  Schouw's  Earth  Plants  and  Man. — Bohn's  Scientific  Library. 


1858.]  Jones,  on  Malarial  Fever.  367 

Infusoria  occur  in  immense  numbers  in  every  situation :  in 
stagnant  pools,  in  marshes,  in  mud  of  rivers,  in  peat  earth, 
twenty  feet  below  the  surface ;  in  the  structures  and  fluids  of 
living  animals  and  vegetables,  in  putrifying  organic  matter,  in 
the  bed  and  waters  of  the  ocean,  in  snow,  in  ice,  and  in  boiling 
springs.  Sir  John  Eoss,  in  the  year  1840,  picked  up  some 
brash  ice,  of  a  brown  yellow  color,  in  the  Arctic  regions,  not 
far  from  Mount  Erebus,  which  was  supposed  to  contain  allu- 
minous  matter,  ejected  in  fine  ashes  from  the  volcano.  Speci- 
mens were  brought  home  in  sealed  glass  vessels,  and  forwarded 
to  M.  Ehrenberg.  This  microscopist  found  the  coloring  matter 
to  consist  of  myriads  of  infusoria,  almost  the  whole  of  which 
reachad  Berlin  in  1844,  in  a  living  state. 

Here  we  see  that  these  microscopical  animals,  after  having 
been  frozen  and  thawed  out,  lived  without  food  for  four  years. 

Certain  species  of  these  animalcules  have  been  found  living 
and  propagating  in  boiling  springs,  and  some  of  them  have  been 
observed  to  recover,  after  drying  in  vacuo  along  with  chloride 
of  calcium  and  sulphuric  acid  for  twenty -eight  days,  and  after 
exposure  to  a  heat  of  248°.  (2) 

The  infusorial  animals  were  created  at  an  early  geologic 
period,  and  a  large  number  of  the  fossil  species  which  compose 
the  Polirschiefer  and  semi-opal  of  Bilin,  are  found  at  the  pre- 
sent time  living  and  propagating  in  the  seas  and  oceans.  The 
infusoria  form  a  chain  connecting  (he  organic  life  of  distant  ages  of 
the  earth,  and  demonstrating,  conclusively  that  the  distribution  of 
animals,  and  the  power  to  survive  physical  changes,  depends  upon 
their  development. 

The  simpler  the  structures,  the  feebler  the  vital,  nervous  and 
physical  forces,  the  less  complicated  the  conditions  of  existence. 

The  gelatinous  medusas  (Gelly  fishes)  occur  in  such  vast  num- 
bers in  the  cold  Greenland  sea,  that  they  impart  an  olive-green 
color  to  the  sea,  rendering  the  water  dark  and  opaque  in  com- 
parison with  the  ordinary  cerulean  hue. 

(2)  See  experiments  of  Doyere,  in  Mem  sur  les  Tardigrades,  et  sur  leur  propriete 
derevenir  a'la  vie,  1842,  pp.  119,  129,  131, 133.  Also,  Ehrenberg's  Die  lufuSions- 
thierchen,  als  vollkomme  Organismem,  1838. 

(3)  See  Remarks  on  the  real  occurrence  of  Fossil  Infusoria,  and  their  extensive 
diffusion,  by  Prof.  Ehrenberg,  J.  C.  Poggendorffs  Annalen  der  Physik  and  Chimie, 
vol.  xxxviii.,  No.  5.  Taylor's  Scientific  Memoirs,  vol.  1,  1837,  pp.  400  to  413  ; 
also,  vol.  3,  1843,  pp.  219-376. 


868  Jones,  on  Malarial  Fever.  [June, 

The  space- allotted  to  this  article  will  not  allow  us  to  enter 
more  fully  into  the  consideration  of  the  distribution  and  relation 
to  the  physical  forces,  of  the  other  members  of  the  invertebrate 
kingdom. 

These  facts  are  sufficient  to  illustrate  for  this  class  of  animals, 
this  law,  which  has  an  immediate  bearing  upon  our  investiga- 
tions. 

Cold-blooded  vertebrate  animals,  although  more  highly  or- 
ganised than  invertebrate  animals,  still  show  remarkable  pow- 
ers of  enduring  extremes  of  heat  and  cold,  without  death.  Fish 
may  be  frozen  and  again  thawed  out  without  a  destruction  of 
life.  The  rapidity  with  ivhich  the  absence  of  heat  is  attended  with 
loss  of  sensibility  and  death,  is  directly  proportional  to  the  develop- 
ment and  perfection  of  vertebrate  animals. 

The  relations,  between  the  physical,  chemical  and  vital  forces, 
are  strikingly  exhibited  in  certain  cold  and  warm-blooded  ver- 
tebrated  animals,  which  become  torpid  or  hybernate  during 
the  winter  season.  In  this  state,  all  the  chemical  and  physical 
actions  are  of  the  most  sluggish  character.  The  heart  scarcely 
beats,  the  frequency  and  force  of  the  action  of  the  heart,  and 
flow  of  the  circulation,  is  greatly  diminished,  if  not  entirely 
stopped.  The  amount  of  carbonic  acid  thrown  off  from  the  lungs 
is  greatly  diminished,  and  all  the  chemical  and  physical  changes 
of  the  elements  of  the  tissues,  and  fluids  and  organs  of  these  an- 
imals, are  retarded. 

If  the  temperature  of  a  warm-blooded  animal  be  reduced  in 
like  manner,  all  its  physical,  chemical,  and  vital  actions  will  be 
depressed,  and  the  active  animal  will  be  reduced  to  the  condi- 
tion of  a  sluggish  cold-blooded  animal,  and  death  will  rapidly 
ensue.  There  is,  however,  this  great  difference  between  the 
cold  and  warm-blooded  animal — the  conditions  of  the  existence  of 
the  latter  are  far  more  restricted  than  those  of  the  former. 

The  chemical  changes  of  the  cold-blooded  animal  are  slow, 
and  it  can  exist  without  food  for  weeks  and  months,  whilst  a 
few  days  starvation  is  fatal  to  the  warm-blooded  animal. 

These  facts  demonstrate  conclusively  that  the  conditions  and  phe- 
nomena of  life  are  complicated  and  restricted,  in  exact  accordance 
with  the  development  and  perfection  of  the  organs  and  tissues  of  an- 
imals, and  the  rapidity  of  the  chemical  and  physical  changes  of  the 
molecules  of  their  bodies, 


1858.]  Jones,  on  Malarial  Fever.  369 

To  understand  the  bearing,  complication  and  imperfections  of  pa- 
thological investigations,  ice  must  take  a  general  view  of  the  most 
important  phenomena  and  relations  of  man.  Those  who  would  at- 
tempt to  investigate  pathological  and  physiological  phenomena,  must 
first  form  clear  concepAions  of  the  phenomena  to  he  investigated,  and 
the  perfection  of  the  methods  and  instruments  capable  of  being  em- 
ployed in  these  investigations. 

Man  is  composed  of  inorganic  elements,  prepared  and  grouped 
into  definite  compounds  in  the  vegetable  kingdom,  by  the  com- 
bined actions  of  the  vital  force,  and  the  physical  and  chemical 
forces  of  the  sun. 

Man  is  governed  by  all  the  laws  and  phenomena  of  inorganic 
bodies,  and  is  absolutely  dependent  for  his  existence  upon  the 
existence  and  mutual  relations  of  inorganic  bodies. 

As  all  the  motions,  in  the  various  forms  of  inorganic  matter  upon 
the  surface  of  our  globe,  are  excited  by  the  forces  of  the  sun,  in  like 
manner,  all  the  forces  of  man,  are  dependent  through  vegetables,  upon 
the  forces  of  the  sun.  As  there  can  be  no  creation  of  force  in  inor- 
ganic matter,  independent  of  the  Deity,  so  man,  although  an  active 
being,  cannot  create  any  force,  however  feeble,  any  more  than  he  can 
create  or  annihilate  a  particle  of  matter.  His  forces  are  the  result- 
ants of  the  chemical  changes  of  those  substances,  which,  in  the  veget- 
able kingdom,  have  been  elevated  into  a  state  of  force  by  the  action  of 
the  sun. 

The  mechanical  power  which  man,  or  any  animal,  is  able  to 
exercise,  is  exactly  proportional  to  the  amount  of  food  consum- 
ed, assimilated  and  chemically  altered  in  the  production  of  the 
nervous  and  muscular  forces.  The  power  of  a  well-constructed 
steam-engine,  is  exactly  proportional  to  the  amount  of  fuel  con- 
sumed, or,  in  other  words,  is  exactly  proportional  to  the  amount 
of  chemical  action.  The  amount  of  chemical  action  is  exactly  pro- 
portional to  the  amount  of  force  derived  from  the  sun,  and  expended 
in  grouping  the  molecules  of  matter,  in  such  a  manner,  as  to  be  capa- 
ble of  chemical  change  and  development  of  physical  force.  The 
power  of  falling  water  which  turns  the  water-wheel,  and  accom- 
plishes various  mechanical  operations,  is  the  resultant  of  the 
combined  actions  of  gravity,  and  the  heat  of  the  sun.  The  laws 
of  physics  apply  as  well  to  the  human  machine  in  action,  as  to  the 
changes  in  Oie  exterior  universe. 


370  Jones,  on  Malarial  Fever.  [June, 

Man  is  the  most  perfect  engine  that  has  ever  been  constructed 
for  the  same  amount  of  chemical  combinations  and  decomposi- 
tions, he  produces  a  much  greater  amount  of  work  than  the 
most  perfect  engine. 

Man  has  other  phenomena  besides  the  physical  and  chemical. 
He  is  a  machine  and  something  more.  The  generation,  devel- 
opment, constitution,  and  structure  of  man  is  similar  to  that  of 
all  vegetables  and  animals. 

Man,  in  common  with  vegetables  and  animals,  is  endowed 
with  vital  force,  and  like  them  is  dependent  for  his  existence 
and  action  upon  exterior  bodies,  and  the  physical  and  chemical 
forces. 

Man,  in  common  with  all  animals,  and  in  contra-distinction 
to  vegetables,  possesses  a  nervous  system,  endowed  with  special 
sensibilities. 

The  nervous  system  is  the  apparatus  which  relates  man  and 
animals  to  the  exterior  world,  and  also  relates  the  various  or- 
gans and  apparatus  to  each  other,  in  such  a  manner,  that  amidst 
an  innumerable  number  of  complex  actions,  unity  and  harmony 
result. 

Man  possesses  not  only  a  vital  force,  an  organism  composed  of  inor- 
ganic elements,  perfect  in  its  mechanical  structure,  and  material  arrange- 
ments of  its  parts,  and  a  nervous  system  endowed  with  special  sensibili- 
ties ;  but  he  also  possesses  an  intelligence  endowed  with  special  faculties, 
capable  of  receiving  impressions  from  the  motions  of  exterior  bodies,  and 
of  exciting  the  forces  by  which  it  is  surrounded,  and  a  moral  nature 
which  relates  him  in  a  peculiar  manner  to  the  universe. 

The  possession  of  moral  and  intellectual  faculties  combined, 
distinguishes  man  from  every  other  form  of  matter,  and  every 
other  being  upon  our  globe. 

The  immaterial,  intellectual,  moral  soul  of  man  has  no  direct 
communication  with  the  exterior  world.  The  mind  receives 
impressions,  transmits  its  volitions,  and  excites  the  mechanical 
structures  of  the  engine  by  which  it  is  environed,  through  the 
nervous  system  which  is  endowed  with  special  sensibility.  The 
impressions  of  exterior  bodies,  upon  the  nervous  system,  is  always 
attended  by  a  change  of  the  structure  of  the  nervous  system. 

All  the  organs  of  sense  are  excited  by  changes  of  matter. 
The  excitement  of  the  nervous  system  and  transmission  of  the 


1858.]  Jones,  on  Malarial  Fever.  371 

impressions  are  attended  by  a  change  of  matter.  Every  act  of 
the  mind  which  excites  the  nervous  sytem,  is  attended  by  a 
change  of  the  chemical  elements  of  the  nervous  system.  Every 
action  excited  in  the  mechanical  apparatus  by  the  nervous  system 
is  commenced  and  sustained  by  a  physical  and  chemical  change 
of  the  elements  of  the  muscular  system,  and  nutritive  fluids. 
The  intellectual  and  moral  faculties  of  man  work  only  through  and  by  the 
physical  and  chemical  forces  ;  they  are  distinct  from  matter,  they  excite 
matter  to  action,  they  direct  and  control  the  actions  of  matter. 

By  his  intellectual  moral  nature,  man  overcomes  all  the  barriers  and 
obstacles  of  nature,  not  by  a  suspension  or  alteration  of  her  immutable 
laws,  but  by  peculiar  applications  of  those  forces  and  laws. 

The  material  portion  of  man  is  composed  of  the  same  elements  as  the  ex- 
terior world.  It  is  governed  by  all  the  astronomical  and  chemical  and  phys- 
ical laws  of  inorganic  bodies,  and  comprehends  within  itself  all  organic 
nature.  The  size  of  his  organs,  the  strength  of  his  muscles  and 
bones,  and  the  vigor  of  his  forces,  have  all  been  constructed 
with  exact  reference  to  the  force  of  gravity,  the  size  of  our 
globe,  and  its  relations  with  the  sun,  and  all  other  worlds  in  the 
universe.  Man  revolves  with  the  earth  and  planets  around  the 
sun,  and  the  whole  system  moves  forward  in  space  at  the  annu- 
al rate  of  one  hundred  and  fifty  millions  of  miles,  around  a  dis- 
tant unknown  centre.  Like  plants  and  animals,  his  existence 
is  dependent  upon  the  length  of  the  day,  and  of  the  year,  which 
are  dependent  upon  the  adjustments  of  the  solar  system.  His 
existence,  through  plants,  is  absolutely  dependent  upon  the 
intensity  of  the  forces  of  the  sun.  If  the  distance  from  the 
earth  to  the  sun  be  increased  or  diminished,  the  structure  of 
many  inorganic  bodies  w^ould  be  changed,  the  conditions  of. ex- 
istence would  be  correspondingly  altered,  and  all  vegetable  and 
animal  life  would  be  destroyed. 

The  molecules  composing  the  structures  of  man,  like  the  im- 
mense masses  of  matter  which  are  scattered  through  space,  are 
in  a  state  of  unceasing  activity.  As  each  star  has  its  own  ap- 
propriate motions,  its  own  peculiar  offices  to  perform,  so  each 
molecule  of  matter,  each  organ  and  tissue  in  the  body  of  man, 
has  its  own  peculiar  motion,  its  appropriate  office  to  perform. 

A$  the  universe  is  governed  by  a  Being,  infinite  in  wisdom 
and  in  power,  who  constructed,  controls  and  directs  matter  and 


372  Jones,  on  Malarial  Fever.  [June, 

all  its  chemical  and  physical  actions,  so  the  material  part  of  man, 
this  little  world,  is  governed  by  an  intelligence  distinct  from 
matter,  which  works  by  and  through  matter,  and  moulds  exte- 
rior material  nature,  after  the  ideal  creations  of  its  own  interior 
immaterial  nature.  Man  then  is  a  type  of  the  universe.  It  is  evident, 
therefore,  that  to  understand  the  phenomena  of  man  in  health  and  disease, 
and  his  relations  to  the  universe,  we  must  comprehend  the  phenomena  and 
mutual  relations  of  all  animate  and  inanimate  bodies,  terrestrial  and 
celestial 

If  the  phenomena  of  man  in  health  be  thus  complicated,  how 
much  more  complicated  must  they  be  in  disease,  where  the  com- 
plex constitution  of  his  solids  and  fluids  may  be  altered  in  many 
ways,  and  the  relations  between  the  vital,  chemical  and  physical 
forces  deranged. 

Any  one  of  the  normal  constituents  of  his  body  may  be  deranged, 
and  occupy  different  relations  to  each  one  of  the  other  constituents. 
As  these  constituents  are  numerous,  the  resulting  derangements 
may  be  correspondingly  numerous.  The  forms  of  this  class  of 
diseases  may  be  as  numerous  as  the  different  positions  which  the 
elements  may  be  made  to  assume  towards  each  other. 

Any  one  of  the  elements  of  his  body  may  be  in  excess  or  deficiency,  and 
the  diseases  may  be  as  numerous  as  the  elements  themselves,  and  at  the 
same  time  totally  different  from  the  diseases  arising  from  an  alteration  in 
the  relative  positions  of  the  elements. 

Foreign  morbific  agents  may  be  introduced  into  the  fluids  and  solids, 
which  will  excite  abnormal  changes  in  the  elements  of  the  solids  and  fluids. 
The  number  of  diseases  of  this  class  will  correspond  to  the  num- 
ber of  distinct  morbific  agents.  Combinations  of  these  morbific  agents 
may  produce  still  more  numerous  and  complicated  diseases. 

The  Creator  has  associated  the  vital  force  with  a  definite  constitution  of 
matter.  Whatever  interferes  with  this  constitution,  interferes  with  the 
action  of  the  vital  force.  Whatever  interferes  with  the  vital  force,  neces- 
sarily disturbs  its  relations  with  the  physical  and  chemical  forces.  If 
the  balance  of  the  forces,  their  correlation  be  disturbed,  the  chemical  ac- 
tions between  the  elements  may  not  only  be  deranged  in  kind,  but  also  in 
degree,  and  the  generation  of  the  physical  forces  which  work  the  machine- 
ry, and  the  manifestation  of  the  intellectual  and  moral  phenomena  will 
be  correspondingly  altered. 

One  or  two,  or  all  of  these  causes  of  disease  may  act  atpnce, 
or  successively,  and  thus  render  the  results  still  more  complex. 


1858.]  JoXES,  on  Malarial  Fever.  373 

The  relative  intensity  of  the  effects  of  disease  will  depend  upon  the 
perfection  of  the  constitution  and  relations  of  the  organs,  tissues  and  ap- 
paratus, and  upon  the  power  and  correlation  of  the  vital,  chemical  and 
physical  forces.  As  no  two  human  countenances  are  exactly 
alike,  as  no  two  temperaments  are  exactly  alike,  as  the  chemical 
actions  and  forces  of  different  individuals  vary,  so  also  will  the 
effects  of  disease  vary. 

The  nervous  system  is  the  last  and  most  perfect  work  of  the 
vital  force,  and  thus  the  index  of  the  power  of  the  vital  force. 

The  nervous  system  not  only  forms  the  medium  of  communi- 
cation between  the  intellectual  faculties  and  the  exterior  world, 
but  it  also  forms  the  medium  of  communication  between  the 
organs  and  apparatus,  solids  and  fluids  of  the  economy.  That 
the  nervous  force  is  nothing  more  than  a  higher  development  of 
the  vital  force,  is  evident,  from  the  fact  that  plants,  and  the  sim- 
ply constructed  animals,  which  are  devoid  of  a  nervous  system, 
are  capable  of  carrying  on  the  offices  of  generation,  develop- 
ment, digestion,  assimilation,  nutrition,  secretion,  excretion,  and 
preserving  a  definite  form  amidst  unceasing  changes.  Many  of 
the  simply  organised  animals,  although  without  a  nervous  sys- 
tem, still  possess  sensation  and  voluntary  motion.  The  nervous 
system  appears  only  when  the  parts  of  the  machinery  are  com- 
plicated, and  need  a  special  means  of  communication. 

The  development  and  perfection  of  the  nervous  system  cor- 
responds exactly  to  the  development,  perfection  and  complica- 
tion of  the  organs  and  apparatus. 

This  fact  is  true  of  the  animal  kingdom  in  its  successive 
degrees  of  development,  and  also  of  the  successive  stages  of  the 
development  of  the  solids  and  fluids  of  each  individual  highly 
organized  animal.  Physical  and  chemical  actions  take  place  in 
a  similar  manner  in  all  animals,  simple  or  complex  ;  they  differ 
only  in  intensity.  The  higher  the  animal,  the  more  complicated 
its  parts,  the  more  rapid  the  chemical  changes  and  consequent 
generation  of  the  forces,  and  the  greater  is  the  necessity  for  some 
special  apparatus  endowed  with  a  high  vitality,  which  will  bring 
all  these  complex  organs  and  actions  into  relation.  Unless  the 
actions  of  different  organs  can  be  telegraphed  (so  to  speak)  to 
each  other,  confusion  in  a  complicated  organism  will  necessarily 
result.     Thus,  if  the  amount  of  blood  circulating  through  any 


374  Jones,  on  Malarial  Fever.  [June, 

organ,  and  the  chemical  actions,  are  too  great,  how  can  they  be 
regulated  without  some  medium  of  communication  with  the 
other  parts  of  the  system,  and  some  means  of  regulating  the 
chemical  and  physical  actions  ?  To  the  nervous  system  is  dele- 
gated this  property  of  regulating  the  actions  of  the  organs  and 
apparatus,  and  thus  regulating  the  amount  of  oxygen  and  blood 
supplied  to  the  organs  and  tissues  and  apparatus. 

The  blood  supplying  the  nutritive  elements  of  the  tissues 
and  organs,  and  the  materials  for  the  secretions  and  develop- 
ment of  the  forces,  and  oxygen  being  the  active  agent  in  all 
the  chemical  actions  of  the  bodies,  it  is  evident  that  whatever 
disturbs  the  constitution  of  the  nervous  system,  necessarily 
disturbs  the  functions  of  the  apparatus  and  organs  and  pro- 
duces corresponding  alterations  in  their  secretions  and  excre- 
tions. As  the  integrity  of  the  nervous  system  depends  upon 
the  integrity  of  the  blood,  in  like  manner,  whatever  alters 
the  constitution  of  that  fluid,  will  produce  aberrated  action  in 
the  nervous  system,  and  in  turn,  this  disturbance  may  extend 
itself  indefinitely. 

Disease  then,  whether  arising  in  the  organs,  or  in  the  blood,  or  origin- 
ally in  the  nervous  system,  will  always  be  attended  by  aberrated  nervous 
action.  The  most  prominent  symptoms  of  disease  therefore  will  be  con- 
nected with  the  nervous  system.  In  all  our  investigations  into  the 
causes  and  effects  of  disease,  we  should  always  remember,  that  the  origin 
of  the  disease  may  be  connected  with  derangements  in  the  constituents  of 
the  blood  and  all  the  organs,  independent  altogether  of  the  nervous  system. 
Thus  in  malarial  fever,  the  poison,  whatever  it  be,  is  rapidly 
destructive  of  the  colored  blood  corpuscles,  and  destroys  the 
ferment  in  the  blood,  which  converts  the  animal  starch  into 
grape  sugar,  it  also  produces  profound  alterations  in  the  struc- 
ture of  the  spleen  and  the  blood  which  it  contains.  Now, 
these  effects,  in  the  beginning,  may  take  place  entirely  indepen- 
dent of  any  alteration  in  the  nervous  system. 

The  nervous  system  will  be  secondarily  affected,  and  its  ac- 
tion seriously  disturbed,  and  this  disturbance  will  give  rise  to 
a  distinct  set  of  phenomena,  but  it  is  evident  that  the  cause  and 
origin  of  the  disease  lies  back  of  this  disturbance. 

In  the  investigation  of  the  origin,  causes,  effects  and  treatment  of 
disease,  the  constitution  of  all  the  fluids  and  solids  of  all  the  organs  and 


1858.]  Jones,  on  Malarial  Fever.  375 

tissues,  of  the  blood,  secretions  and  excretions,  should  be  carefully  as- 
certained and  compared  with  the  standard  of  health.  All  the  chemical 
and  physical  changes,  and  the  relations  of  the  vital  and  physical  forces, 
should  be  ascertained. 

The  temperature,  the  amount  of  chemical  change,  the  alterations  in 
every  organ  and  tissue  should  be  determined  How  can  these 
things  be  accomplished  when  physiologists  and  pathologists 
are  not  acquainted  with  many  chemical  changes  going  on  in 
the  body : — when  they  dispute  about  the  origin  and  offices  of 
some  of  the  most  important  constituents ;  and  know  little  about 
the  origin  and  offices  of  the  extractive  matters  of  the  blood  and 
urine:  when  they  are  ignorant  of  the  offices  of  the  spleen, 
supra-renal  capsules,  tlrymus  and  thyroid  glands :  when  they 
cannot  even  explain  the  mode  of  origin,  propagation  and  death 
of  the  solitary  gland  cells  of  the  blood,  which  elaborate  the 
materials  for  the  nervous  and  muscular  systems :  when  they 
possess  no  absolutely  accurate  method  of  analyzing  the  blood, 
or  of  determining  the  amount  of  the  products  thrown  off  from 
the  lungs  and  skin  ?  It  is  important  that  we  should  know  and 
acknowledge  our  ignorance  and  weakness. 

At  the  very  outstep,  I  acknowledge  that  these  physiological 
and  pathological  investigations,  which  I  hope  to  present  from  time 
to  time,  are  imperfect  in  many  respects.  They  could  not  be 
otherwise  in  the  present  state  of  science,  and  especially  when 
I  had  to  act  as  physician  and  surgeon  to  one  hundred  patients, 
and  at  the  same  time,  conduct  the  investigations. 

I  have  determined  to  present  them  in  their  imperfect  con- 
dition, because  they  were  instiuted  with  a  desire  to  discover 
the  truth,  and  with  the  hope  that  I  might  acquire  during  their 
prosecution,  sufficient  knowledge  to  point  out  to  the  young  mem- 
bers of  the  profession,  the  difficulties  and  methods  of  conducting 
such  investigations ;  and  because  they  were  conducted  at  a  sacri- 
fice of  much  time,  money,  and  health. 

"  Art  is  long  and  time  is  fleeting, 

And  our  heaits  though  stout  and  brave, 

Still  like  muffled  drums  are  beating 
Funeral  marches  to  the  grave." 

/  think  and  hope  that  they  will  at  least  demonstrate  the  impossibility  of 
the  successful  investigation,  of  all  the  phenomena  of  disease,  by  a  single 
individual,  and  lead  to  unity  and  concert  of  action  amongst  investigators. 


376  Jones,  on  Malarial  Fever.  [June, 

In  pathological  investigations,  we  need  in  this  country,  above  all  things, 
an  organised  corps,  who  would  make  a  division  of  labor.  We  should 
have  a  separate  investigator  for  the  careful  examination  of  each 
one  of  the  following  subjects : 

The  analysis  of  the  urine  (1);  blood  (2);  determination  of  animal 
temperature  (3) ;  functions  of  skin  and  lungs  (4);  record  of  symptoms 
and  treatment  (5) ;  meteorologic,  geologic*  and  topographical  investiga- 
tions, and  record  of  mortuary  statistics  (6)  ;  examinations  chemically  and 
microscopically  of  the  structure  and  alterations  in  the  nervous  system 
after  death  (7)  ;  and  of  the  liver  and  bile  (8)  ;  of  the  alimentary  canal 
with  its  secretions  and  excretions  (9);  and  of  the  kidneys  and  the  other 
organs  (10).     _ 

If  a  corps  of  intelligent,  generous-minded  observers  would  act 
with  zeal  and  unity,  the  results' for  medicine  would  be  of  the 
most  momentous  character.  It  would,  in  time,  rank  amongst 
the  exact  sciences,  and  the  physician  would  become  a  true  pro- 
phet ;  and  instead  of  the  frequent  disagreement  between  theory 
and  practice,  and  between  rival  schools,  we  would  have  harmo- 
ny; instead  of  distrust  in  the  public,  and  even  in  the  minds  of 
physicians,  themselves,  we  would  have  confidence. 

These  investigations  were  conducted  in  the  Savannah  Marine 
Hospital  and  Poor-house,  and  two  hundred  and  fifty  patients 
suffering  with  the  different  forms  of  malarial  fever,  came  under 
my  observation. 

I  would  here  acknowledge  my  obligations  to  my  friend  and 
former  colleague,  Dr.  Eichard  D.  Arnold,  Professor  of  the  The- 
ory and  Practice  of  Medicine  in  the  Savannah  Medical  College, 
for  his  kindness  in  resigning  into  my  hands,  the  charge  of  the 
Savannah  Marine  Hospital  and  Poor-house. 

I  would  also,  return  my  thanks  to  Theodore  McFarland,  M. 
D.,  and  Mr.  Eobert  Myers,  student  of  medicine,  in  the  Savan- 
nah Medical  College,  for  valuable  assistance  during  post-mor- 
tem examinations. 

The  medical  topography  of  Savannah  will  be  considered  more 
fully  hereafter.  The  following  brief  statement  will  give  a  gen- 
eral idea  of  the  medical  topography. 

Savannah  is  situated  on  the  Savannah  river,  eighteen  miles 
from  its  mouth,  upon  a  sandy  plain,  elevated  forty-two  feet 
above  half  tide.  On  the  north,  this  plain  is  terminated  abruptly 
by  the  Savannah  river,  a  turbid  stream,  pursuing  its  sluggish 


1868.]  Jones,  on  Malarial  Fever.  577 

course  through  the  low-grounds  and  rice-fields  of  South  Carol i- 
na  and  Georgia.  On  the  east  and  west,  the  city  is  flanked  by 
extensive  tide-swamps,  formerly  under  wet  culture,  at  the  pre- 
sent time  under  dry  culture.  The  sandy  plain  extends  for  sev- 
eral miles  beyond  the  city.  Savannah,  therefore,  is  surrounded 
on  all  sides,  except  the  south,  by  malarious  districts. 

Section  I. — Intermittent  Fever. 

Case  I. — Seaman,  entered  Savannah  Marine  Hospital  Sep- 
tember 29th,  1857;  native  of  New  York;  age  22;  height  5  feet 
4  inches;  weight  140  lbs. ;  black  hair,  and  florid  complexion; 
handsome,  intelligent  countenance;  sanguine  nervous  tempera- 
ment. Has  never  been  sick  before.  Has  been  in  Savannah 
two  weeks,  and  this  is  his  first  visit.  Slept  on  board  the  ship 
the  first  week,  and  the  last  week  slept  at  the  "Sailor's  Home,"" 
on  the  bay.  Says  that  he  was  taken  sick  four  days  ago,  with 
chill,  vomiting,  and  pains  in  all  his  bones,  and  has  had  a  chill 
every  day  since.,  commencing  regularly  at  12  o'clock  M.  Had  a 
chill  this  day,  commencing  a  few  minutes  after  12  o'clock  M. 
Says  that  he  took  three  blue  pills  and  castor  oil,  night  before 
last.     This  medicine  operated  twice. 

7  o'clock  P.  M.,  Sept,  29th.  Has  fever,  and  complains  of  pains 
in  his  joints.  Slight  tenderness  upon  pressure  of  epigastrium ; 
tongue  clean,  moist,  red  at  tip  and  edges;  papillae  enlarged  and 
of  a  bright  red  color.     Eeaction  of  saliva  decidedly  acid. 

Pulse  120.     Respiration  32,  full,  thoracic. 

Temperature  of  Atmosphere, 79°F. 

11  Hand, 103°33' 

11     under  Tongue, 106° 

$.  Calomel,  grs.  xij.;  sulphate  of  quinia,  grs.  vij.  Mix,  and 
administer  immediately,  and  follow  with  castor  oil  in  four  hours. 
As  soon  as  fever  remits,  give  sulphate  of  quinia,  grs.  v.,  every 
three  hours,  up  to  grs.  xxv.  During  fever,  give  soda  powders 
(pulveres  effervescents  tartarizati).     Diet,  gruel  and  flaxseed  tea. 

Sept.  30th,  1  o'clock  P.  M.  Medicine  operated  freely,  and 
says  that  he  is  much  better,  but  complains  of  weakness.  Tongue 
presents  the  same  appearance;  skin  cool  and  relaxed;  face  not 
so  much  flushed. 

Pulse  70,  regulafr.     Respiration  22,  regular  and  gentle. 

Temperature  of  Atmosphere ,     68°F. 

"  Hand, 92° 

"         under  Tongue, 99°  5' 

Amount  of  urine  passed  the  last  18  hours,  grains  23,220. 

Amount  of  urine  excreted  each  hour,  grains  1,290. 

Calculated  amount  of  urine  for  24  hours,  grains  30,952. 

Reaction  of  urine  decidedly  acid. 


378  Jones,  on  Malarial  Fever.  [June, 

This  is  characteristic  of  the  urine  df  fever ;  the  acidity  is  in  pro- 
portion  to  the  severity  of  the  attack.  The  acidity  is  more  intense  in 
remittent  than  in  intermittent  fever,  and  still  more  intense  in  conges- 
tive fever,  than  in  intermittent  and  remittent  fever. 

Color  of  urine,  light  orange.  Urine  passed  last  evening  and 
night  up  to  11  P.  M.,  specific  gravity  1011,  color  a  shade  higher 
than  that  passed  this  morning.  Specific  gravity  of  urine  passed 
from  11  o'clock  P.  M.,  last  night,  up  to  1  o'clock  P.  M.,  this  dav, 
1008. 

Uric  acid  in  whole  amount  of  urine  passed  in  18  hour,  (grs.  23,220).     grs.  1-0035 
"     "  calculated  "       "     "  "       "    24     "      (grs.  30,952).      "     1-3376 

Uric  acid  in  1000  parts  of  the  night  urine,  (sp.  gr.  1,011)     0-0494 
"     "     "         "      "     "  morning  "       (sp.  gr.  1,008)     0*0396 

Up  to  this  time,  1  o'clock  P.  M.,  has  taken  20  grains  of  sulph- 
ate of  quinia,  and  the  action  of  this  medicine  may  be  connected 
with  the  marked  diminution  of  the  uric  acid. 

The  urine  was  set  aside  and  examined  under  the  microscope 
after  successive  intervals.  After  standing  48  hours,  there  was  a 
small  light  yellow  deposit,  which,  under  the  microscope,  was 
found  to  consist  of  small  vegetable  cells  of  several  shapes — glo- 
bular, elliptical,  and  acicular.  When  viewed  under  a  low  mag- 
nifying power,  these  cells  resembled  a  collection  of  globular  and 
acicular  cystals  of  the  urates  of  ammonia. 

A  careful  examination  under  the  microscope,  with  the  appro- 
priate chemical  re-agents,  demonstrated  that  they  contained  no 
uric  acid  or  inorganic  salts,  but  were  of  vegetable  origin.  The 
size  of  the  cells  were  many  times  less  than  those  of  the  torula 
cerevisiae. 

5  o'clock  P.  M.  Half  an  hour  ago  was  taken  with  chill  and 
vomiting.  Now  the  chill  appears  to  be  subsiding,  the  shaking 
and  contraction  of  the  muscles  is  diminishing.  Extremities  cool, 
whilst  the  head  and  trunk  are  hot  and  pungent  to  the  hand. 

Pulse  108.     Kespiration  30,  labored,  thoracic. 

Temperature  of  Atmosphere, 74°  F. 

11  Hand, 91° 

"        under  Tongue, 105°5' 

Instead  of  a  reduction  of  temperature  in  the  trunk  and  head  dur- 
ing chill,  there  is  a  decided  elevation.  The  sense  of  cold  arises  from 
a  want  of  circulation  in  the  capillaries  of  the  extremities. 

The  patient  had  taken  20  grains  of  the  sulphate  of  quinia  be- 
fore the  chill  came  on.  This  did  not  arrest,  but  delayed  the  chill 
for  several  hours. 

3.  Spirits  of  Mindererus  f  I  iss.  in  sweetened  water. 

8i  o'clock  P.  M.     Says  that  he  is  more  comfortable. 

Pulse  108.  Eespiration  32,  not  so  thoracic  and  labored  as 
during  the  chill,  but  still  thoracic  and  labored. 


1858.]  Joxes;  on  Malarial  Fever.  379 

Temperature  of  Atmosphere, 73°F. 

"  Hand, 103.5° 

11        under  Tongue, 105° 

Slight  tenderness  upon  pressure  of  epigastrium.  Eeaction  of 
saliva  decidedly  acid.  Tongue  red  at  tip  and  edges;  papillae 
enlarged  and  red. 

Amount  of  urine  passed  from  1  P.M.,  (8  hours),  grs.  5,100. 
Calculated  amount  for  2-i  hours,  grs.  15,300. 
Amount  of  uric  acid  in   5,100  grs.  of  urine,  grs.  2. 
"        ii     ii     a     u  15^00    «     «     «        "    6. 

Uric  acid  in  1000  parts  of  urine,  0-3921. 

Specific  gravity  of  this  specimen  of  urine  excreted  during  the 
chill,  1020.     Color  normal.     Reaction  decidedly  acid. 

The  uric  acid  has  increased  in  amount  during  the  chill  and 
commencement  of  the  fever :  when  compared  with  the  former 
specimens  of  urine,  it  is,  however,  still  below  the  standard  of 
health.  If  the  diminution  of  the  amount  of  uric  acid  be  due  to 
the  action  of  the  sulphate  of  quinia,  it  shows  that  this  action  of 
this  remedy  pointed  out  by  Ranke, 3  is  not  necessarily  attended 
with  a  disappearance  of  the  chill. 

Amount  of  urine  excreted  hourly  during  last  24  hours,  grains 
1,180. 

Amount  of  urine  passed  in  the  last  24  hours,  ending  Sept. 
30th,  8  o'clock  P.  M..  grs.  28,320. 

Amount  of  uric  acid  in  grs.  28,320  of  urine,  grs.  3.0035. 

$.  As  soon  as  fever  remits,  give  sulphate  of  quinia,  grs.  v., 
every  three  hours,  up  to  grs.  xx.     Diet,  gruel. 

October  1st,  11  o'clock  A.  M.  Says  that  he  is  better,  and  has 
no  pain,  except  a  slight  headache,  and  was  in  a  perspiration  all 
night.     Fever  intermitted  at  12  P.  M. 

Skin  cool.     Pulse  76.     Respiration  23. 

Temperature  of  Atmosphere, 70° F. 

"         i    "  Hand, 95° 

"        under  Tongue, 98°5' 

Has  taken  15  grs.  of  sulphate  of  quinia  since  the  intermission 
of  the  fever. 

$ .  Continue  sulphate  of  quinia  up  to  grains  xxv. 

Diet,  mutton  soup,  gruel  and  tea. 

Reaction  of  saliva  slightly  acid.  Reaction  of  urine  decidedly 
acid.  Urine  clear,  no  deposit,  and  a  shade  higher  colored  than 
normal. 

Specific  gravity  of  the  urine  passed  during  the  first  half  of  the 
night,  1010. 

Specific  gravity  of  the  urine  passed  subsequent  to  12  M.,  last 
night,  1012. 

■   - —  ■  .        —• — » . — i* 

(3)  Medical  Times  and  Gazette,  May  30,  1857,  p.  54a 
n.b. — vol.  xrv.  no.  vi.  17 


380  Jones,  on  Malarial  Fever.  [June, 

Amount  of  urine  passed  during  the  last  15  hours,  grs.  19,209. 

Calculated  amount  of  urine  for  24  hours,  grs.  30,734. 

Amount  of  urine  excreted  each  hour,  grs.  1280. 

October  2nd,  11  o'clock,  A.M. — Says  that  he  feels  badly ;  had 
no  chill  yesterday  evening,  but  the  fever  came  on  at  7  o'clock, 
P.  M.  Suffered  with  headache,  and  was  restless,  without  sleep 
during  the  night.  Skin  soft  and  moist ;  slight  tenderness  upon 
pressure  of  epigastrium;  tongue  redder  and  dryer  than  yester- 
day, but  still  soft  and  moist ;  reaction  of  saliva,  acid ;  face  flushed. 

Pulse  84.     Respiration  32. 

Temperature  of  Atmosphere, 74°    R 

"  Hand, 100.  5' 

"  under  Tongue, 102 

The  fever  is  subsiding.  Urine  of  a  deep  orange  color  :  higher 
colored  than  yesterday ;  turbid,  with  slight  deposit.  Reaction, 
alkaline,  after  standing  20  hours;  it  was  acid  when  first  voided. 
The  deposit  is  due  to  the  precipitation  of  the  alkaline  and 
earthy  phosphates,  in  combination  with  the  ammonia,  generated 
during  the  decomposition  of  the  urea. 

As  far  as  my  experience  extends,  the  rapid  change  from  the  acid  to  al- 
kaline reaction  of  the  urine  is,  in  malarial  fever,  a  sign  of  convalescence. 

Every  specimen  of  urine  excreted  during  the  active  stages  of  malarial 
fever,  which  I  havd  examined,  gave  a  decided  acid  reaction,  and  the  in- 
tensity  of  this  reaction  corresponded  to  the  intensity  of  the  disease.  As 
the  disease  declined,  the  reaction  of  the  urine  oecame  less  acid,  and  the 
tendency  to  fermentation,  and  the  development  of  an  alkaline  reaction 
increased. 

Amount  of  urine  passed  during  the  last  24  hours,  grs.  15,810. 
"  of  uric  acid  in  15,810  grs.  of  urine,  grs.  9.300. 

Specific  gravity,  1020. 

Uric  acid  in  1000  parts  of  urine,  0.588. 

Amount  of  urine  excreted  hourly,  grs.  658. 

Has  not  had  a  movement  of  his  bowels  since  the  operation  of 
the  calomel. 

^  Calomel  grs.  vi;  sulphate  of  quinia  grs.  vi;  castor  oil  in 
four  hours.  After  the  action  of  the  calomel,  commence  with 
sulphate  of  quinia,  grs.  v,  every  three  hours  up  to  grs.  xv. 

October  3rd,  11  o'clock,  A.M. — Says  that  he  feels  much  better, 
and  has  "  no  pain,  except  a  slight  soreness  in  his  bones."  Tongue 
clean,  moist,  and  only  a  shade  redder  than  normal.  Papillae 
still  enlarged,  red  and  distinct.  Reaction  of  saliva,  acid.  No 
pain  upon  pressure  of  epigastrium.  The  fever  intermitted  yes- 
terday afternoon,  and  he  has  had  no  return. 

Pulse  62.     Respiration  20. 

Temperature  of  Atmosphere, 74°    F. 

"  Hand, 96° 

"  under  Tongue, 98°5' 


1858.]  JOXES,  on  Malarial  Fever.  381 

Color  of  -urine  a  shade  lighter  than  normal,  and  in  22  hours 
after  it  was  voided,  let  fall  a  copious  light  yellow  deposit  of  tri- 
ple phosphate  and  urate  of  soda.  20  hours  after  it  was  voided, 
its  reaction  was  decidedly  alkaline.  It  was  acid  when  first 
voided,  but  much  less  acid  than  during  fever.  The  urea  has 
also  undergone  decomposition  much  more  rapidly,  because  it 
has  become  decidedly  alkaline  in  the  same  time  in  which  the  fe- 
brile urine  remained  decidedly  acid.  When  first  passed,  the 
urine  was  clear,  devoid  of  sediment.  The  deposit  in  the  urine 
which  had  stood  over  night,  was  due  in  a  great  measure  to  the 
precipitation  of  the  phosphates,  by  their  union  with  the  ammo- 
nia generated  during  the  decomposition  of  the  urea. 

Amount  of  urine  passed  during  the  last  24  hours,  grs.  18,180. 
Specific  gravity  1010. 

Amount  of  urine  excreted  hourly,  grs.  757*5. 

Uric  acid  in  grs.  18,180,  of  urine,  grs.  8*100.  Uric  acid  in 
1000  parts  of  urine,  0"445. 

$.  Officinal  infusion  of  Virginia  snake-root,  fixviii. ;  sulph. 
of  quinia,  grs.  xv.  Mix.  Tablespoonful  every  three  hours. 
Diet,  mutton  soup  and  boiled  rice. 

October  4th,  11  o'clock  A.  M.  Much  better.  Has  had  no 
return  of  chill  and  fever.  Tongue  clean  and  papillae  not  so  dis- 
tinct and  red.     Bowels  opened  twice. 

Pulse  60.     Respiration  20. 

Temperature  of  Atmosphere, 72°5'F. 

"  Hand, 96° 

"        under  Tongue, 99°5' 

Reaction  of  urine  after  18  hours  strongly  alkaline.  It  emits 
ammonia.  "When  a  rod  dipped  in  hydrochloric  acid  is  held  over 
the  urine,  it  emits  heavy  fumes  of  hydrochlorate  of  ammonia. 
Heavy  light  yellow  deposit. 

Amount  of  urine  passed  during  the  last  24  hours,  grs.  20,520. 
"         "       "         "        hourly,     grs.  855. 

Specific  gravity,  1018. 

R.  Officinal  infusion  of  quassia  and  soda.  Continue  snake- 
root  tea. 

October  5th,  11  o'clock  A.  M.  Has  had  no  return  of  fever, 
and  complains  of  nothing  except  weakness.  Tongue  clean, 
moist  and  soft;  papillae  still  redder  and  more  enlarged  than 
normal ;  skin  soft  and  cool ;  reaction  of  saliva  acid. 

Pulse  62.     Respiration  21. 

Temperature  of  Atmosphere, 70DF. 

"  Hand, 96° 

"        under  Tongue, 99°33' 

Urine  normal  in  color.  Specific  gravity  1015.  Amount  of 
urine  excreted  hourly,  grs.  1268. 


3S2  Joxes,  on  Malarial  Fiver.  [June, 


Amount  of  urine  passed  in  last  24  hours,  grs.  30,450. 
"         "  Uric  acid  in  grs.  30,450  of  urine,  grs.  15,000. 

Uric  acid  in  1000  parts  of  urine,  0*492. 

After  standing  12  hours,  alkaline  reaction  and  a  light  yellow 
deposit. 

This  patient  continued  to  improve,  and  left  the  hospital  on  the 
following  day.  He  returned  to  the  same  locality  on  the  bay, 
and  was  exposed  to  the  damp  north-east  winds  blowing  over 
the  river  and  low  grounds  of  South  Carolina. 

He  returned  to  the  hospital  October  18th,  with  an  attack  of 
chill  and  fever,  of  the  same  type  as  the  one  we  have  just  describ- 
ed.    The  chill  came  on  every  day. 

The  annexed  Table  will  present  a  condensed  view  of  the  phe- 
nomena observed. 

In  this  case  there  was  a  close  relation  between  the  state  of  the  skin, 
pulse,  respiration  and  temperature  of  extremities  and  trunk. 

A  rapid  full  pulse,  hurried  thoracic  respiration,  and  dry  shin, 
was  attended  with  a  corresponding  elevation  of  temperature. 

If  the  functions  of  the  organs  and  apparatus  be  properly  per- 
formed, a  full  and  rapid  vigorous  circulation  and  respiration 
must  be  attended  by  the  rapid  absorption  of  oxygen,  and  exha- 
lation of  carbonic  acid  gas,  and  correspondingly  rapid  chemical 
changes,  and  development  of  heat. 

A  slow  pulse  and  respiration,  and  cool  moist  shin,  was  accompa- 
nied with  a  lovj  degree  of  heat. 

During  the  cold  stage  (chill)  there  was  a  rapid  feeble  pulse,  full 
thoracic  rapid  respiration,  and  a  hot  trunk  and  cold  extremities. 

During  the  rapid  thoracic  respiration,  oxygen  is  supplied  in 
abundance,  and  enters  into  the  blood,  which  is  confined  during 
the  cold  stage,  almost  entirely  to  the  trunk  and  large  organs. 
The  temperature  of  the  trunk  is  correspondingly  elevated.  This 
elevation  of  temperature  does  not  extend  to  the  extremities,  be- 
cause the  circulation  of  the  blood  in  the  blood-vessels  and  capil- 
laries is  feeble.  The  surface  of  the  extremities  look  bluish  dur- 
ing the  cold  stage,  because  the  supply  of  oxygen  being  withheld 
in  great  measure,  the  change  from  the  venous  to  arterial  hue 
does  not  take  place. 

We  hope  to  demonstrate  hereafter,  by  numerous  careful  ob- 
servations, that  the  determination  of  the  relations  of  the  circula- 
tion, respiration,  and  temperature  or  chemical  changes  in  mala- 
rial fever,  is  of  the  greatest  importance,  in  enabling  the  practi- 
tioner of  medicine  to  understand  the  nature  and  treatment  of  the 
different  forms  of  this  disease,  and  predict  with  a  great  degree  of 
certainty  its  course  and  termination.  Whenever,  as  in  congestive 
fever,  there  is  a  want  of  corresponaence  between  the  circulation,  respi- 
ration and  chemical  changes,  the  patient  is  alvjays  in  danger.  A 
patient  with  a  rapid  feeble  pulse,  and  rapid  thoracic  respiration  and 


1858.] 


Joxes,  on  Malarial  Fever. 


383 


Calculated  amount  of  Uric 
Acid  excreted  in  24  hrs. 


Calculated  amount  of  Urine 
excreted  in  24  Lours. 


Uric  Acid. 


§ 


Specific  Gravity. 


o  -< 

<N  .-I 
O  O 


O     oc  o 

©    o  © 


Hours. 


C-i 


Urine  excreted  in 


o  5 
o  o 

1-1    (M 


o  o  o 

00  cn  o 

00  o  o 

i-i  iM  CO 


Urine  excreted  hourly. 


XT-  IC  00 
VQ  U5  SO 
X>      00  <N 


Uric  Acid  excreted  in  24 
hours. 


o  •  o 
o  •  o 
,-i       .  o 


CO 

< 


Urine  excreted  in  24  hours,  grains. 


o  cs 
CM  o 

CO   CO 


oo 

CM  O 

©  o 

CM   CO 


Temperature  under  Tongue. 


o   o   o   o 

OS  iO  1O00 
O  O  O  OS 


»o     >o  CO 
o      o   o 

oo     oo 


Temperature  of  Hand. 


c    ■ 
o   o   o   o 

CN  .-I  C3  »0 

©  Cft  o  o> 


o   o 

SO    SO 
OB   C5 


Temperature  of  Atmosphere. , 


o   o   o   o 
x  —  :t  C 


W3 

o      o   o 

■«*      <M  O 


Respiration 


Pulse. 


2  S'O 

-5  a  a  s-s-s-i 


If* 


esi 


c3    cJ 

g    g 

O    O 


a 


■5  £    .-5 
S--H  >jt 

«   «*   £  ' '~    bC  ^ 
60  W>-    5.2    ^ 

ja  £3  g^ 

=  -  0  '>-=  £"3 
f2\S*o  boaa  an  "c 


O 


Hour  of  Day. 


00  .-H  i-i 


Day  of  Month. 


Month . 


384  Jones,  on  Malarial  Fever.  [June, 

low  temperature  {sluggish  chemical-  changes),  is  always  in  great 
danger.  A  full  rapid  pulse,  and  rapid  thoracic  respiration,  and 
correspondingly  high  temperature,  are  always  favorable  symptoms, 
provided  there  be  no  complication,  as  congestion  of  the  brain.  The 
severity  of  malarial  fever  is  by  no  means  proportional  to  the  height  ' 
of  the  fever  {animal  temperature).  Asa  general  rule,  the  higher  the 
fever  {temperature),  the  more  readily  does  the  attach  yield  to  treat- 
ment, and  the  less  serious  the  effects.  High  temperature  signifies 
active  chemical  changes,  and  an  effort  on  the  part  of  nature  to  break 
up  and  consume  the  poison,  and  a  power  of  resistance. 

It  is  the  want  of  a  high  temperature  which  is  the  most  dangerous 
symptom  in  malarial  fever. 

In  this  case,  the  amount  of  urine  excreted  corresponded  with 
its  specific  gravity,  or  degree  of  concentration.  Considering  the 
situation  and  diet  of  the  patient,  the  amount  of  urine  did  not 
differ  greatly  from  the  standard  of  health. 

The  urine  is  affected  by  so  many  varied  external  and  internal 
conditions,  that  the  amount  excreted  exhibits  great  fluctuations 
even  in  health. 

No  two  observers  agree  with  reference  to  the  amount  excreted 
in  definite  periods.  Thus,  Lecanu,  from  examinations  of  the 
urine  of  16  individuals,  living  upon  mixed  food,  estimated  that 
the  amount  of  urine  discharged  in  24  hours,  ranged  from  8085 
grains  to  84,973  grains. 

Becquerel  found  that  the  mean  daily  quantity  passed  by  four 
men,  was  19,511  grains,  and  that  by  four  women,  was  21,130 
grains. 

Lehmann,  from  experiments  instituted  upon  himself,  estimat- 
ed the  quantity  discharged  daily,  at  from  18,829  grains  to  22,299 
grains. 

According  to  the  valuable  experiments  of  Dr.  William  A. 
Hammond,  instituted  upon  himself,  the  amount  of  urine  excreted 
under  a  mixed  diet,  ranged  from  19,684  grains  to  22,756  grains, 
with  a  mean  of  20,898  grains;  under  a  diet  of  albumen,  from 
12,325  to  21,592,  with  a  mean  of  17,738  grains ;  under  a  diet  of 
starch,  from  14,339  to  23,352,  with  a  mean  of  18,427  grains ;  and 
under  a  diet  of  gum,  from  20,516  to  23,721  grains,  with  a  mean 
of  21,538  grains. 

The  only  accurate  method  of  determining  whether  or  not  the 
urine  be  increased  or  diminished,  is,  to  refer  it  to  the  standard 
of  health,  in  the  individual  examined.  In  hospital  practice  this 
is,  in  the  majory  of  cases,  impossible,  and  we  are  compelled  to 
be  content  with  approximate  results. 

In  this  case,  during  fever  and  under  the  action  of  sulphate  of 
quinia,  the  uric  acid  teas  greatly  diminished,  and  on  the  other  hand, 
when  the  fever  declined,  and  the  action  of  the  sulphate  of  quinia 
ceased,  the  amount  of  uric  acid  increased  beyond  the  normal  standard. 


1858.]  Jones,  on  Malarial  Fever.  385 

From  the  microscopical  and  chemical  examination  of  several 
hundred  specimens  of  urine  excreted  during  the  different  forms 
of  malarial  fever,  I  found  it,  as  a  general  rule,  to  be  true,  that 
in  the  mode  of  treatment  which  I  adopted,  the  uric  acid  appears 
in  much  larger  quantities  in  the  urine  of  convalescence,  than  in 
that  excreted  during  the  fever,  even  when  the  sulphate  of  qui- 
nia  had  been  withheld,  or  sparingly  administered  The  major- 
ity of  specimens  of  urine  excreted  during  fever,  which  were  set 
aside  and  examined,  under  the  microscope,  at  successive  inter- 
vals, gave  no  deposits  of  the  crystals  or  salts  of  uric  acid,  whilst 
specimens  of  the  urine  of  convalescence  very  soon  gave  evidence 
of  the  presence  of  uric  acid,  by  letting  fall  deposits  of  urate  of 
soda  and  ammonia. 

These  facts  explain  the  nature  of  the  so-called  critical  discharges 
of  malarial  fever.  The  urine  excreted  during  fever  is  generally  de- 
ficient in  uric  acid  and  the  earthy  salts,  whilst  its  acidity  is  increas- 
ed, and  it  will  remain  for  a  great  length  of  time  ivithout  undergoing 
decomposition.  flfe 

The  urine  of  convalescence,  on  tJte  other  hand,  is  rich  in  uric  acid 
and  the  earthy  and  alkaline  salts,  and  readily  undergoes  decomposi- 
tion. The  deposit  of  the  urates  of  soda  and  ammonia,  and  the  pre- 
cipitation of  the  triple  phosphate,  by  the  ammonia  generated  during 
decomposition  of  the  urea,  form  the  so-called  critical  discharges. 

As  a  general  rule,  the  urine  excreted  during  the  hot  stage  of 
intermittent  fever,  is  poorer  in  uric  acid  than  the  urine  of  remit- 
tent fever,  and  I  have  known  cases  in  which,  daring  fever,  the 
uric  acid  disappeared  almost  entirely. 

In  several  cases  of  congestive  fever,  the  urine  contained  only 
traces  of  uric  acid,  and  in  one  case,  which  terminated  fatally,  the 
disappearance  of  the  uric  acid  was  attended  with  the  disappear- 
ance of  the  urea. 

Dr.  Ranke  (4)  slates  in  Ms  article  vjpon  the  physiological  action  of 
sulphate  of  quinia,  that  according  to  all  observers,  there  is  in  ague  an  in- 
crease of  uric  acid.  My  observations  do  not  correspond  with  this  asser- 
tion, if  it  is  intended  to  apply  to  the  active  stages  of  intermittent,  remittent 
and  congestive  fevers.  The  fact  that  uric  acid  increases  during  conva- 
lescence from  malarial  fever,  demonstrates  conclusively  that  the  diminu- 
tion of  the  amount  of  uric  acid  by  sulphate  of  quinia  is  an  attending 
circumstance,  and  not  necessarily  one  of  the  beneficial,  remedial  modes  of 
the  action  of  this  medicine. 

Case  II. — Englishman  :  entered  the  Savannah  Marine  Hos- 
pital Oct  9th,  1857 ;  age  27.  Has  been  in  America  thirteen 
years.     Height  5  feet  10  inches ;  weight  145  lbs. ;  muscular  sys- 

(4)  Medical  Times  and  Gazette,  May  30,  1858,  p.  537. 


386 


Jones,  on  Malarial  Fever. 


[June, 


J 


tern  well  developed ;  sanguine  temperament.    Occupation,  stew- 
ard on  ship.     Has  been  in  Savannah  three  weeks. 

Says  that  he  was  taken  yesterday  at  12  o'clock  M.,  with  cold 
feelings  and  headache.  The  chilly  feelings  lasted  four  hours, 
and  were  succeeded  by  fever,  which  continued  until  4  o'clock 
A.  M.  this  morning.  Two  and  a  half  hours  after  the  subsidence 
of  the  fever  (8  J  o'clock  A.  M.),  he  shook  violently.  This  chill 
was  followed  by  fever. 

Now,  8  o'clock  P.  M.,  fever  is  subsiding. 

Pulse  98,  full  but  soft. 

Temperature  of  Atmosphere, 72°F. 

"  "  Hand, 102°5' 

"        under  Tongue, 103 

Tongue  moist ;  skin  in  a  profuse  perspiration. 

Says  that  he  took,  last  evening,  a  dose  of  salts  and  cream  of 
tartar,  which  operated  twice  this  morning. 

3.  When  fever  goes  off,  give  sulphate  of  quinia,  grs.  v.,  every 
three  hours,  up  to  grs.  xx. 

October  10th,  12  o'clock  M.  Vhere  was  a  complete  intermis- 
sion of  the  fever  about  2  o'clock  A.  M.  this  morning.  At  this 
time  the  sulphate  of  quinia  was  commenced,  and  he  has  taken 
grs.  xv. 

Amount  of  urine  passed  the  last  16  hours,  grs.  6,144. 
"     "  "     hourly,  grs.  321-5 

Calculated  amount  of  urine  for  24  hours,  grs.  9,216. 


analysis  i. 


In  grs.  6,144  of 
Urine  (16  hrs.) 


In  grs.  9,216,  cal- 
culated for  24  hrs. 


In  1000  parts  of 
urine, 


Urea, 

Uric  Acid, 

Fixed  Saline  Constituents, 


226-980 

0-600 

40-200 


340-470 

0-900 

60-100 


36-943 
0-097 
6-542 


Specific  gravity  of  urine  1024 — clear,  no  deposit,  light  red 
color.     Keaction  decidedly  acid. 

Microscopical  examination  of  urine. 

After  Standing  12  hours,  no  deposit. 

"  "         36      "       a  very  slight,  light  yellow  deposit. 

After  standing  60  hours,  the  surface  was  covered  with  a  pel- 
licle, which  under  a  magnifying  power,  of  210  diameters,  was 
found  to  consist  of  small  oval  cells,  about  the  size  of  the  human 
blood  corpuscle.  There  were  also  other  elongated  elliptical  cells, 
the  short  diameters  of  which  did  not  differ  from  those  of  the 
globular  cells.  Many  of  the  elongated  cells  had  a  vibratory 
motion.  The  deposit  at  the  bottom  consisted  of  these  globular 
elliptical  acicular  cells,  and  a  few  crystals  of  triple  phosphate. 

That  these  cells  were  organized  bodies,  was  demonstrated  by 


• 


1858.]  Jones,  on  Malarial  Fever.  387 

the  action  of  chemical  re-agents  under  the  microscope.  Not  a 
trace  of  uric  acid  was  found  in  the  pellicle  and  deposit.  The 
bottle  containing  the  urine  had  been  kept  closely  stopped. 

12i  o'clock,  P.M. — A  chill  is  just  coming  on.  The  thermo- 
meter, placed  in  his  hand,  indicated  91^°  F.  Simultaneously 
with  the  increase  of  the  chill,  it  commenced  to  descend,  and  in 
15  minutes  stood  at  87j°. 

In  15  minutes  his  hand  lost  4°  F.  He  feels  very  cold,  but 
does  not  shake.  The  extremities  feel  cold,  whilst  the  surface 
of  the  head  and  trunk  feel  hot  and  pungent.  When  the  bulb  of 
the  thermometer  was  simply  placed  between  the  skin  and  flannel 
shirt,  and  gently  pressed  against  the  surface  of  the  chest,  it 
commenced  to  rise  rapidly  and  in  a  few  moments  indicated 
103°  F.  i 

When  placed  in  the  arm-pit,  it  rose  rapidly  to  107°  F. 

Pulse  100 ;  not  so  full  as  during  fever,  but  small  and  threaded. 

Eespiration  26,  full  thoracic. 

Temperature  of  Atmosphere, 68°5'  F. 

11  Hand, 87°5; 

in  Axilla, 107 

Tongue  pointed,  but  moist,  and  not  much  redder  than  usual. 
Skin  dry,  with  a  purplish  mottled  appearance,  as  if  the  circula- 
tion in  the  capillaries  was  retarded.  Says  that  he  has  "  dull 
pains  wandering  around  his  loins  up  to  his  chest."  Complains  of 
great  thirst.  His  stomach  is  so  irritable  that  I  could  not  ascer- 
tain the  temperature  under  his  tongue.  I  made  seven  un- 
successful attempts.  At  every  trial  the  contact  of  the  bulb  of 
the  thermometer,  with  the  base  of  the  tongue,  excited  violent 
retching  and  vomiting.  I  applied  a  sinapism  over  the  region  of 
the  spinal  column,  18  inches  in  length,  and  3  inches  in  breadth, 
also,  one  over  the  epigastrium,  and  administered  brandy  and 
snake-root  tea,  f  5ij.  The  brandy  and  snake-root  tea  were  vo- 
mited up  in  a  few  moments.  In  half  an  hour  alter  their  appli- 
cation, the  mustards  aroused  the  capillary  circulation  in  the 
extremities. 

His  surface  does  not  present  the  mottled  appearance ;  the  heat 
has  in  a  great  measure  returned  to  his  extremities,  the  cold 
sensations  have  disappeared,  and  "he  feels  warm  all  over." 
The  temperature  of  his  hand  is  now  99°.  In  half  an  hour,  the 
temperature  of  his  extremities  has  risen  11°5'.  The  temperature 
under  the  arm  pit  is  still  107°. 

The  temperature  of  the  hand  does  not  correspond  fully  with 
that  of  the  trunk,  and  reaction  is  not  yet  fully  established. 

Has  just  passed  urine.  Clear,  limpid,  of  a  light  straw  color. 
Reaction  acid.  Specific  gravity  1003.  Amount  of  urine  void- 
ed, grains  7021. 


388                        Jones,  on 

Malarial  Fever. 

[June, 

ANALYSIS  II. 

7021  grains  of  Urine 
contained, 

lOOC 

parts  of  Urine 
contained, 

Urea, 

Uric  Acid, 

Fixed  Saline  Constituents, 

39-551 
0-420 
9-800 

5-650 
0-059 
1-395 

J 


Nitrate  of  urea  remarkably  silky  and  white. 

Microscopical  Examination. — The  urine  was  poured  into  a 
closely  stopped  bottle,  and  set  aside  for  60  hours.  At  the  end 
of  this  time  the  surface  had  a  pellicle,  and  there  was  a  small, 
light  yellow  deposit. 

The  pellicle  consisted  entirely  of  the  globular,  elliptical  and 
vibrating  cells,  observed  in  the  former  specimen.  The  deposit 
also  consisted  of  these  cells,  and  a  few,  beautifully  formed,  prys- 
matic  crystals  of  triple  phosphate. 

The  fact,  that  the  bottle  was  kept  closely  stopped,  does  not 
prove  that  the  germs  of  these  cells  originated  in  the  urine,  for 
the  bottle,  in  which  the  urine  was  first  deposited,  remained  open 
during  the  voiding  of  the  bladder,  and  the  germs  of  these  vegeta- 
ble bodies  were,  without  doubt,  then  received  from  the  atmos- 
phere. 

This  specimen  of  urine  is  interesting,  because  it  was  passed  at 
the  close  of  a  chill,  and  was  probably  excreted  by  the  kidneys, 
during  the  existence  of  the  cold  stage.  It  was  much  lighter  in 
color  than  that  passed  during  fever :  in  fact,  it  resembled  the 
urine  of  hysterical  women,  in  its  light  color  and  low  specific 
gravity.  The  urea  and  uric  acid  were  diminished,  whilst  the  fixed  sa- 
line constituents  were  relatively  increased. 

If  the  diminution  of  the  uric  acid  was  due  to  the  action  of  the  15  grains 
of  sulphate  of  quinia,  which  he  took  this  morning,  then  the  fact  is  demon- 
strated that  the  diminution  of  the  amount  of  uric  acid  oy  the  sulphate  of 
quinia,  has  nothing  to  do  with  the  cure  of  intermittent  fever. 
v  $.  During  fever,  give  soda  powders.     As  soon  as  fever  re- 

mits, give  sulphate  of  quinia,  grs.  v.,  every  three  hours,  up  to 
grs.  xxx.  Do  not  wait  for  the  complete  intermission  of  the  fever. 
Diet,  gruel  and  flaxseed  tea. 

7  o'clock  P.  M.  The  fever  is  abating,  and  his  skin  is  in  a 
slight  moisture.  The  circulation  is  fuller  and  more  regular,  and 
the  temperature  more  equally  distributed. 

Temperature  of  Atmosphere, 67°F. 

"  Hand, 102 

Amount  of  urine  passed  since  12|  P.  M.,  (6^  hours,)  grs.  5,075 ; 
high  colored,  resembling  new  madeira  wine.  Keaction  decided- 
ly acid. 

Specific  gravity  1015. 


1858.] 


Jones,  on  Malarial  Fever. 


389 


Nitrate  of  urea  white,  silvery. 

Amount  of  urine  excreted  hourly,  during  last  6}  hours,  grs. 
780. 

Calculated  amount  of  urine  for  24  hours,  grs.  20,300. 

Actual  amount  of  urine  excreted  during  the  last  24  hours, 
grs.  18,240. 

Amount  of  urine  excreted  hourly  during  the  last  24  hours,, 
grs.  760. 


ANALYSIS  IIL 


5075  grs.  of  Urine, 
passed  in  61-2  hrs. 
contained  grains. 


Urea,  .  .  . 
Uric  Acid,  . 
Fixed  Saline 
Constituents. 


99-425 
0-250 

28-500 


20,300  grs.  calculated 
amount  of  Urine  for 
24  hrs.  contain'd  grs. 


397-700 
1-000 

114-000 


1000  pts.  of 
Urine,  con 
tained  grs. 


18,240  grs  of  Urine, 
passed  during  last 
24  hrs.  cont'd  grs. 


19-586 
0-049 

5-615 


365-956 
1-270 

78-500 


Microscopical  examination  of  the  last  specimen  of  urine  ex- 
creted during  the  last  6}  hours,  up  to  7  o'clock  P.  M. 

After  standing  60  hours  a  slight  deposit  fell,  consisting  of  the 
vegetable  cells,  previously  described,  and  prismatic  crystals  of 
triple  phosphate. 

Chemical  reagents  failed  to  give  any  evidence  of  the  presence 
of  uric  acid  in  this  deposit.  His  fever  still  continues.  This 
specimen  of  urine  therefore  was  excreted  during  fever.  The 
patient  has  taken  no  sulphate  of  quinia  since  11  o'clock  A.  M., 
this  morning. 

It  is  important  to  note,  that,  in  this  case,  the  uric  acid  is  diminished, 
both  in  the  cold  and  hot  stages. 

October  11th,  10}  o'clock,  A.M. — Says  that  he  is  much  better. 
There  was  a  complete  intermission  of  the  fever  this  morning,  at 
5  o'clock,  A.M.  The  subsidence  of  the  febrile  excitement  was 
attended  with  a  profuse  perspiration,  which  continued  up  to  8 
o'clock,  A.M.  At  the  present  time  his  pulse  is  88,  and  respira- 
tion 22.  Tongue  moist  and  soft ;  skin  relaxed  and  soft ;  bowels 
were  moved  this  morning. 

Has  taken  20  grains  of  sulphate  of  quinia  since  the  intermis- 
sion of  the  fever. 

ty  Sulphate  of  quinia,  grains  v.  ty  Snake-root  tea  f  Sxviij, 
sulphate  of  quinia  grains  xv :  mix.  One  tablespoonful  every 
four  hours.     Half  diet:  beef  soup,  rice  and  tea. 

Amount  of  urine  passed  during  the  last  15}  hours,  grs.  9144. 

Specific  gravity,  1^16. 

Amount  of  urine  passed  hourly  during  the  last  15}  hours, 
grs.  590- 

Calculated  amount  of  urine  for  24  hours,  grs.  14630. 


390                         Jones,  on  Malarial  Fever. 

[June, 

ANALYSIS  IV. 

9144  grains  Urine 
excreted  during 
last  15>£  hours, 
contained,  grs. 

14620  grains  Urine 
calculated  for  24 
hours,    contain- 
ed, grains, 

1000  parts   Urine 
contained 

Urea, 

Uric  Acid, 

Fixed  Saline  Constituents, 

157-140 

3150 

40-500 

251-424 

5-040 

64-800 

17-185 
0-344 
4-429 

Chemical  and  microscopical  examination  of  the  urine  passed 
during  the  last  15£  hours.  Specific  gravity  1016.  Color,  deep 
orange  inclining  to  red,  with  a  heavy,  light-yellow  deposit. 
Eeaction  alkaline.  It  has  changed  rapidly  from  acid  to  alkaline 
since  it  was  voided.  This  is  characteristic  of  the  urine  excreted  dur- 
ing convalescence  from  intermittent  fever.  During  the  active  stages  of 
malarial f  ever,  the  urine  is  always  decidedly  acid,  and  retains  this  reac- 
tion for  many  hours,  and  in  severe  cases,  for  several  days,  even  in  the 
heat  of  summer.  When  the  fever  intermits  and  the  skin  is  moist  and  re- 
laxed, and  the  patient  is  convalescent,  the  urine  then  excreted,  rapidly 
undergoes  decomposition,  dnd  in  a  few  hours  the  reaction  changes  from 
acid  to  alkaline.  I  believe  this  to  be  one  of  the  most  certain 
signs  of  convalescence  in  malarial  fever. 

The  deposit  in  this  specimen  of  urine  was  found,  under  the 
microscope,  to  consist  of  well  formed,  prismatic  crystals  of  triple 
phosphate,  and  globular  acicular  crystals  of  urate  of  soda,  and 
the  globular  and  elliptical  cells  previously  described.  When 
the  deposit  was  treated  with  hydrochloric  and  acetic  acids,  un- 
der the  microscope,  an  abundant  crop  of  crystals  of  uric  acid 
appeared.  This  is  the  first  specimen  of  urine  in  which  the  de- 
posits have  contained  uric  acid. 

The  chemical  analysis  of  the  urine  also  shows  that  the  uric  acid  is  more 
abundant  than  in  the  urine  of  the  hot  and  cold  stages,  notwithstanding  that 
the  patient  was  under  the  influence  of  20  grains  of  sulphate  ofquinia. 

October  12th,  11  o'clock,  A.  M. — Continues  to  improve. 
Missed  the  chill,  but  had  a  slight  fever  in  the  evening. 

Pulse  84.  Eespiration  20.  Countenance,  complexion,  skin, 
and  temperature,  normal. 

$  Quassia  and  soda.     Continue  snake-root  tea  :  full  diet. 

The  urine  through  mistake  was  not  preserved  for  examination. 

1\  o'clock,  P.  M. — Pulse  92;  skin  moist  and  cool. 

Amount  of  urine  passed  during  the  last  9  hours,  grs.  15120. 

Specific  gravity  1008.     Orange  color. 

Amount  of  urine  passed  during  each  hour,  grs.  1680. 

Calculated  amount  of  urine  for  24  hours,  grs.  40219. 

October  13th,  10  o'clock,  A.  M. — Says  that  he  is  quite  well. 
Had  no  fever  last  night,  and  rested  well.  Tongue  and  skin 
normal  in  appearance ;  reaction  of  saliva  slightly  acid ;  during 
the  height  of  the  fever,  it  was  decidedly  acid. 


1858.] 


JoXES,  on  Malarial  Fever. 


391 


Respiration  16.     Pulse  68. 

Temperature  of  Atmosphere, 78°F. 

"Hand, 98 

"  under  Tongue, 99 

Amount  of  urine  excreted  during  last  14^  hours,  grs.  13662, 

Specific  gravity,  1012. 

Amount  of  urine  excreted  hourly,  grs.  942. 

Calculated  amount  of  urine  for  24  hours,  grs.  21859. 

Amount  of  urine  excreted  hourly  during  the  last  24  hours, 
grs.  1199. 

Actual  amount  of  urine  excreted  during  last  24  hours,  grs. 
28782. 


ANALYSIS  V. 

13662  grs.  of  Urine 
excreted  in  11% 
hours,  contain- 
grains, 

21859  grs.  of  Urine 
calculated  for  24 
hours,  contained 
grains. 

100  parts  of  Urine 
contained, 

Urea, 

Uric  Acid, 

Fixed  Saline  Constituents, 

101-850 

2-025 

29-700 

162-960 

3-240 

47-520 

7-188 
0-148 
2-173 

Reaction  of  the  urine  alkaline,  in  12  hours;  color  normal; 
light  yellow  deposit.  Under  the  microscope,  this  deposit  con- 
sisted of  a  few  prismatic  crystals  of  triple  phosphate,  globular 
crystals  of  urate  of  soda,  and  vegetable  cells. 

October  15th. — Dressed  up  and  walking  in  the  hospital  yard. 

Pulse  64.  Respiration  16.  Reaction  of  saliva,  slightly  alka- 
line. 

Amount  of  urine  passed  during  the  last  24  hours,  grs.  16320. 

Color  normal ;  no  deposit  in  18  hours.     Specific  gravity  1020. 

Reaction  acid.     Urine  excreted  hourly,  grs.  680. 


ANALYSIS  VI. 

Grains  16820  of  Urine  ex- 
creted   in  24  hours, 
contained,  grains, 

1000  parts  of  Urine  con- 
tained, 

Urea, 

Uric  Acid, 

Fixed  Saline  Constituents, 

488-880 

9-600 

115.200 

29-818 
0-588 
7-058 

The  patient  had  no  return  of  fever,  and  was  discharged  the    / 
next  day. 

The  following  table  will  present  a  condensed  view  of  the  re- 
sults obtained. 


't^UOJ^ 


cnto  ton 


TflUOJ^  JO  ^UQ 


<S  .O^ 


iC«(ijo.moH 


•axioiaapj 


o  o 


3  5 


a 


£-2-3  3 
o  o 


ga  3 


'King   50  3XVX§ 


eepj 


•uoi^Jidsay; 


• '  *  •gjgijdsouriy  jo  a.m^Jaduiaj, 


•pa^if  jo  aan^iadraajQ 


•anSuoj,  Japuti  eatvituadarex 


OS  CO  Ol  eo 
CO  (35  '-'  »-* 

toot  to^ 
O  to  o  ^ 


sanoi{  ^3  UT  Pa 

■^9.10X9  eui.ij}  jd^unotny 


-saq  f  g  tit  pa^9J0X9  usafi 


s.moq 

f g  ui  p9}9jox9  ppy  oi.ifl 


sanoq  t5  ui 

s^uatvji'isuoQ  atnjtfg  paxyj 


UI  p9;9.I0X9  9XIUX1 


w 
w 


"sanojj 


o  o  o  o 

O  K>  00  O 


o>  o 
o  to 
o  o» 


•^TABJf)  OUlDedg 


"B9JX1 


ppy  ouq 


oo  *»-  oo  to 
o  to  o  o 


to  tf*.  l-1 

H-"    O    rf»- 

oo  to  <3» 


S:  S 


'S^TOtVjpSUOQ  8UITB  g  p9XTj[ 


•^j.moq  p9^9aox9  anjjQ 


•  •  sanoq  t3  UT  paiiaaox© 
anufi  jo  ^utb  pg^popQ 


sxivao sanoq 

f%    J0J    pa:j«TllOTt?0      'B9J£l 


•skivhd 


sanoq  f  5 

ioj  p^BTnoj'eo  ppy  oij_q 


•ainoq  j>£  aoj  paiitf  jtiotbd 

Kin^tHriSUOQ  9Ul[1?g  P9XIJ 

■/  , .' ! 


1858.]  Jones,  on  Malarial  Fever.  393 

The  most  striking  phenomena  in  this  case  were  those  mani- 
fested during  the  cold  stage.  The  temperature  of  the  extremi- 
ties was  19^  degrees  below  that  of  the  trunk.  The  temperature 
of  the  trunk  was  elevated  8  degrees  above,  while  the  tempera 
ture  of  the  extremities  was  depressed  10 £  degrees  below  the 
normal  standard. 

Similar  phenomena  have  been  manifested  by  every  case  of 
intermittent  fever  which  I  have  examined  during  the  cold  stage. 

The  phenomena  of  the  cold  stage  will  be  illustrated  by  the 
following  cases,  which  were  carefully  examined,  just  as  they 
occurred  in  the  hospital,  without  any  selection. 

Case  III. — Seaman :  aged  55,  height  5  feet  4  inches,  small, 
spare  man.  Has  been  in  the  hospital  for  several  months,  suffer- 
ing with  an  affection  of  the  eyes. 

This  case  has  originated  in  the  hospital. 

Chill  came  on  one  hour  ago :  he  is  still  shaking  violently, 
and  his  lips  and  hands  look  blue.  Pulse  100.  Kespiration  36 
to  50,  varies  with  each  quarter  of  a  minute ;  irregular,  thoracic, 
labored. 

Temperature  of  Atmosphere, 71°5'  F. 

"  Hand, 92° 

'•'  under  Tongue, 104° 

Case  IV. — Seaman:  aged  38,  height  5  feet  8  inches,  light 
hair,  blue  eyes,  sallow  complexion.  Looks  as  if  his  liver  was 
out  of  order.  Says  that  he  "  has  had  chills  off  and  on  from  the 
16th  of  July  to  the  present  time,  October  12th."  His  first  attack 
of  intermittent  fever  was  contracted  in  the  swamps  of  the  Peedee 
River,  S.  C.  Tongue  clean  and  pale ;  lips  pale,  anaemic.  This 
patient  presents  the  true  malarial  hue,  and  his  blood  is  deficient 
in  colored  corpuscles.  In  the  present  attack  of  intermittent 
fever,  he  has  a  chill  every  day. 

October  12th. — This  morning  had  a  chill,  followed  by  hot 
fever.  During  the  febrile  excitement,  his  pulse  was  108  and  his 
respiration  32  to  the  minute.  As  soon  as  the  fever  remitted, 
xx  grs.  of  sulphate  of  quinia  were  administered.  The  sulphate 
of  quinia  delayed  the  chill ;  it  did  not  appear  at  the  regular  hour 
on  the  13th  inst.,  but  came  on  at  4  o'clock,  P.M.,  on  the  14th  inst. 

I  commenced  the  examination  about  15  minutes  after  the  com- 
mencement of  the  chill.  Lips  and  fingers  pale,  and  of  a  bluish 
color ;  extremities  cold,  whilst  the  trunk  is  hot  to  the  touch. 
Patient  is  shaking  all  over. 

Pulse  92,  feeble.     Respiration  32,  thoracic,  labored. 

Temperature  of  Atmosphere, 77°  5'  F. 

"  Hand, 91 

"        under  Tongue, 103 


Jones,  on  Malarial  Fever.  [June, 

A  small  amouut  of  urine  was  excreted  at  the  close  of  the  cold 
stage,  and  commencement  of  the  general  elevation  of  tempera- 
ture, (equalization  of  the  actions  of  the  general  and  capillary 
circulation,)  which  had  a  normal  color.  Specific  gravity  1023, 
and  decided  acid  reaction,  and  under  analysis  exhibited  a  large 
increase  of  uric  acid. 

Analysis  viii. — 1000  parts  of  urine  contained  Urea,  21-825 
— Uric  acid,  1*467 — Fixed  saline  constituents,  7436. 

This  specimen  of  urine  is  in  striking  contrast  with  that  ex- 
creted, under  precisely  similar  circumstances,  in  Case  ii.  During 
the  sweating  stage  the  reaction  of  his  skin  was  neutral.  As  a 
general  rule,  I  have  found  it  to  be  acid  in  the  various  forms  of 
malarial  fever.     Eeaction  of  saliva,  as  usual,  acid. 

October  15th.     Complete  intermission  of  fever. 

Pulse  80,  fuller.     Respiration  20,  regular. 

Temperature  of  Atmosphere, 71°5'F. 

"  Hand, 96 

"        under  Tongue, 98 

/ 

"1/         Case  V. — Frenchman,  aged  45 :  brown  hair  and  eyes ;  height 

5  feet  7  inches;  weight  130  lbs.     Thin,  spare  man.     Had  an 
attack  of  intermittent  fever,  commencing  Sept.  15th. 

This  case  was  treated  in  the  Savannah  Poor  House,  and  yield- 
ed to  the  ordinary  remedies,  and  the  patient  was  discharged  in 
the  course  of  ten  days.  He  returned  to  a  miasmatic  situation, 
on  the  Savannah  river,  and  was  attacked  again  with  intermit- 
tent fever.  He  entered  the  Hospital  and  Poor  House  Oct.  7th, 
and  stated  that  for  the  last  four  days,  he  had  had  ■'dumb  ague," 
which  came  on  every  day  at  the  same  hour,  (11  o'clock  A.  M.,) 
and  lasted  two  hours. 

A  purgative,  followed  by  xxv.  grains  of  sulphate  of  quinia, 
was  administered.  This  delayed  the  "dumb  ague"  until  Oct. 
9th,  3i  o'clock  P.  M.  (28  hours). 

Examination  commenced  half  an  hour  after  the  commence- 
ment of  the  "  dumb  ague."  Lips  and  fingers  purplish ;  extremities 
cold ;  head  and  trunk  warm.  Complains  greatly  of  the  sensa- 
tions of  cold,  but  shakes  far  less  than  in  the  former  cases 
recorded. 

Pulse  92,  so  feeble  that  it  is  with  difficulty  felt,  and  with  still 
greater  difficulty  counted.  The  vibrations  of  the  pulse  resemble 
those  of  a  fine  thread.     Respiration  accelerated  and  irregular. 

Temperature  of  Atmosphere, 75°  F. 

"  "  Hand, 83 

"        under  Tongue, 101°  5' 

6|  o'clock  P.  M.  Reaction  has  taken  place,  and  he  now  has 
fever. 

Pulse  96,  much  fuller  than  during  the  chill,  but  weaker  than 
in  a  frank  open  case. 


1858.]  Jones,  on  Malarial  Fever.  395 

Temperature  of  Atmosphere, 70°  F. 

"  "  Hand, 101°  75' 

under  Tongue,       .     . 102°  75' 

In  this  case,  which  was  far  more  serious  than  any  which  we 
have  yet  recorded,  the  urine  was  of  a  high  color  and  specific 
gravity,  and  correspondingly  rich  in  urea  and  extractive  mat- 
ters.    The  uric  acid  was  slightly  increased. 
Oct.  10th.     Intermission  of  fever. 

Temperature  of  Atmosphere, 70°  F. 

"  Hand, 97°  5' 

"        under  Tongue, 98°  5' 

Case  YI. — Irishman ;  black  hair,  black  eyes ;  height  5  feet 
10  inches ;  weight  150  lbs.     In  health,  florid  cAnplexion. 

Has  been  suffering  with  intermittent  fever  for  four  days. 
Chills  have  been  slight.     The  present  chill  (Sept.  23d)  is  slight. 

Temperature  of  Atmosphere, 79°F. 

"  "  Hand, 90 

"        under  Tongue, 102 

Case  VII. — Seaman — Englishman  :  brown  hair,  brown  eyes ; 
florid  complexion  in  health,  now  his  complexion  is  anaemic ; 
weight  146  lbs. ;  age  25  ;  height  5  feet  6  inches. 

Sept.  10th.  Entered  the  Savannah  Marine  Hospital,  with 
bilious  remittent  fever,  and  from  this  date  until  the  19th  inst. 
was  extremely  ill. 

This  patient  recovered  so  as  to  be  able  to  walk  about  the 
hospital  yard.  jSTotwithstanding  the  administration  of  tonics 
and  iron,  his  complexion  was  pale,  anaemic,  and  he  complained 
of  a  severe  and  continual  pain  in  his  head. 

Cut  cups,  external  applications  and  internal  remedies,  failed 
to  relieve  the  pain  in  his  head.  On  the  4th  of  October  he  was 
taken  with  a  severe  chill,  followed  by  high  fever.  This  returned 
every  day. 

Oct.  6th.  The  chill  has  been  on  him  one  hour,  and  the  hot 
stage  is  just  coming  on.  Pulse  110,  feebler  than  after  the  com- 
plete reaction,  but  stronger  than  during  the  lowest  depression 
of  the  cold  stage.  Kespiration  irregular,  thoracic,  panting — 
45-50.     Muscles  trembling  violently. 

Temperature  of  Atmosphere, 70°F. 

"  Hand, ,     ...     97 

"        under  Tongue, 104 

Case  VIII. — Irish  laborer :  stout,  well  formed  man  ;  sanguine 
temperament ;  light  hair,  blue  eyes,  florid  complexion  ;  height 
5  feet  9  inches ;  weight  190  lbs. 

This  is  his  second  attack  of  chill  and  fever  this  season. 

V.  B. — VOL.  XTV.    FO.  VI.  18 


396  Jones,  on  Malarial  Fever.  [June, 

Sept.  18th,  11  A.  M.  Chill  is  now  just  going  off.  Pulse  112. 
Respiration  28. 

Temperature  of  Atmosphere, 90°  5'  F. 

"  Hand, 100 

"        under  Tongue,    ..*.,...  104 
Sept.  19th,  2  P.  M.     Apyrexia  complete.     Pulse  68.     Respi- 
ration 24. 

Temperature  of  Atmosphere, 91°  F. 

"  Hand, 97°  5' 

"        under  Tongue, 99 

Recovered  from  this  attack — commenced  work  upon  a  steam 
Tug,  and  slept  on  board,  in  the  Savannah  river,  at  night.  Re- 
turned to  the  hospital  with  a  third  attack  of  intermittent  fever. 

October  2nd,^  P.  M.  Has  a  chill  and  is  shaking  violently. 
Pulse  120,  in  sitting  posture.     Respiration  22,  in  sitting  posture. 

Temperature  of  Atmosphere, 79°  F. 

"  Hand, 89 

"         under  Tongue, 102°  25' 

Oct.  3rd,  2  P.  M.  Has  high  fever.  Pulse  100.  Respiration 
26,  thoracic. 

Temperature  of  Atmosphere, 77a  5'  F. 

"  "  Hand, 105 

11         under  Tongue, 106 

Oct.  4th,  2  P.  M.  Apyrexia  complete.  Pulse  58.  Respira- 
tion 20. 

Temperature  of  Atmosphere,  .     .     .     .     .     .     .     .     76°  F. 

"  "  Hand, 96°  5' 

"         under  Tongue, 98°  5' 

From  these  and  many  other  examinations  of  the  phenomena 
of  intermittent  fever,  I  have  deduced  the  following  conclusions, 
the  importance  and  bearing  of  which  will  be  more  fully  pointed 
out  hereafter. 

(1).  The  higher  the  temperature  of  the  trunk,  during  the  cold  stage, 
the  more  rapid  will  he  the  equalization  of  the  circulation  and  temperature. 

(2).  The  higher  the  temperature  of  the  trunk,  during  the  cold  state,  and 
of  the  extremities  and  trunk  during  the  subsequent  hot  stage,  (stage  of 
equalization  of  the  circulation  and  chemical  action,)  the  milder  and  shorter 
will  be  the  attack.  A  high  temperature  in  imiermitteut  fever  is  then  a 
favorable  symptom. 

Whether  the  high  temperature  signifies  an  effort  on  the  part 
of  nature,  to  break  up,  chemically  alter,  destroy,  and  throw  off 
the  malarial  poison  ;  or  whether  the  high  temperature  be  signi- 
ficant of  nothing  more  than  vigorous,  vital,  nervous,  physical 
and  chemical  forces,  nevertheless  the  determination  of  the  cor- 
relation of  the  respiration,  circulation,  and  temperature  (chemi-  , 
cal  action),  affords  the  most  valuable  information  to  the  medical 
practitioner. 


1858.]  Jones,  on  Malarial  Fever.  397 

Having  already  extended  this  article  over  much  more  than 
the  space  allotted,  I  will  leave  the  discussion  of  these  subjects  to 
a  subsequent  article. 

Before  closing,  it  is  necessary  that  I  should  state  the  methods 
by  which  the  Temperature,  Pulse  and  Eespiration  were  deter- 
mined. 

The  pulse  and  respiration  in  these  and  subsequent  investiga- 
tions, were,  unless  stated  otherwise,  always  determined  in  the 
recumbent  posture. 

All  the  temperatures  recorded  in  these  and  subsequent  inves- 
tigations, were  determined  by  the  same  instrument.  This  ther- 
mometer was  compared  with  standard  instruments,  and  found  to 
be  accurate.  The  thermometer  was  always  allowed  to  remain 
under  the  tongue,  in  the  hand,  or  under  the  arm-pit,  for  some 
time  after  it  was  stationary,  and  all  the  observations  were  taken 
and  recorded  at  the  bed-side,  under  my  own  hand  and  eye. 

The  greatest  care  was  exercised  in  determining  the  tempera- 
ture ;  the  patients  were  in  all  cases,  unless  stated  otherwise, 
lying  quietly  in  bed,  and  protected  from  all  currents  of  air.  The 
importance  of  attending  to  these  circumstances,  are  strikingly 
illustrated  by  the  following  experiments,  which  I  performed 
upon  myself. 

Athens,  January  23rd,  6  o'clock  A.  M.  Lying  in  bed,  just 
after  waking  from  sleep.     Pulse  76.     Respiration  15. 

Temperature  of  Atmosphere  of  Chamber,      .     .     .     45°  F. 

11  "  Atmosphere 28 

11  Hand, 95 

in  Axilla, ;     .     .     98 

Dressed  myself  and  took  a  walk  of  two  miles,  over  several 
hills,  in  thirty  minutes.  The  ground  was  frozen  and  covered 
with  frost.  During  the  walk,  my  hands  were  bare  and  freely 
exposed  to  the  atmosphere.  At  first,  the  sensation  of  cold  was 
unpleasant,  but  towards  the  end  of  the  walk,  reaction  appeared 
to  take  place  and  they  felt  much  warmer. 
Pulse  90.     Respiration  20. 

Temperature  of  Atmosphere, 30°  F. 

"  Hand, 78 

"  in  Axilla, 98 

During  the  walk,  the  pulse  had  gained  14,  and  the  respiration 
5,  to  the  minute.  The  temperature  in  the  hand  had  fallen  17°, 
whilst  that  in  the  axilla  had  remained  stationary.  The  respira- 
tion, in  bed,  was  gentle  and  regular.  The  respiration,  after 
walking  in  the  cold,  was  accelerated,  full  and  vigorous. 

Here  we  see  that  a  diminution  of  the  temperature  upon  the 

'•'exterior  was  attended  by  a  corresponding  change  in  the  move- 

1  ments  of  the  circulatory  and  respiratory  systems.     They  became 


398  On  the  Use  of  Iron.  [June, 

more  active,  in  order  to  receive,  and  distribute  more  rapidly,  the 
oxygen,  and  remove,  with  corresponding  rapidity,  the  increased 
products  of  the  increased  chemical  changes. 

It  is  also  worthy  of  note,  that  the  increased  circulation  and 
respiration  was  not  attended  with  a  rise  of  temperature,  because 
the  radiation  of  heat  from  the  surface  of  the  body,  more  than 
balanced  the  increased  generation  of  heat,  consequent  upon  the 
increased  chemical  change. 

I  took  breakfeast,  and  then  walked  three  miles  over  several 
hills,  in  40  minutes.  My  hands  were  kept  in  the  over-coat 
pocket  during  the  walk. 

Pulse  88.     Eespiration  26. 

Temperature  of  Atmosphere, 45°  F. 

"  Hand, 97° 

of  Axilla, 98°5' 

January  24th,  4  o'clock,  P.M. — After  sitting  and  writing  for 
several  hours  in  a  cold  room,  without  fire,  my  right  hand,  which 
was  freely  exposed  moving  over  the  paper,  felt  very  cold  and 
stiff. 

Pulse  76.     Eespiration  16. 

Temperature  of  Atmosphere, 48°  F. 

"Eight  Hand, 75° 

"  in  Axilla, .     98°5' 

In  this  experiment  the  right  hand  lost  22°  in  the  course  of 
two  hours. 

These  experiments  demonstrated,  conclusively,  the  absolute 
necessity  of  adhering  rigidly  to  a  uniform  method  of  ascertaining 
the  pulse,  respiration,  and  temperature  in  health  and  disease. 

In  comparative  investigations,  the  truth  will  not  be  obtained 
without  the  most  scrupulous  and  unremitting  attention,  to  the 
position  and  state  of  the  patient,  and  all  the  surrounding  cir- 
cumstances. 

(To  be  continued) 


On  the   Use  of  Iron.     By   Isaac  Casselberry,  M.  D.,   Evans- 
ville,  Indiana. 

A  brief  notice  of  the  anatomy  and  physiology  of  the  blood  will 
make  its  morbid  changes  during  fever  more  evident. 

Anatomy. — The  blood  is  a  living  fluid  tissue,  which  is  formed 
and  matured  by  the  organizing  force  of  the  automatic  nervous 
system  out  of  the  organizable  constituents  of  the  maternal  blood 
during  embryotic  life. 

After  birth,  the  organizable  elements  of  the  blood  are  derived 
from  the  food,  which  is  decomposed  by  the  gastric  juice.     These 


1858.]  On  the  Use  of  Iron.  399 

elements  are  then  transformed  and  rearranged  by  the  organizing 
force  of  the  automatic  nervous  brandies  of  the  stomach,  and 
constitute  chyme. 

This  is  conveyed  into  the  duodenum,  in  which  additional  or- 
gnnizalJe  elements  are  received  from  the  liver  and  pancreas. 
The  whole  mass  is  then  transmuted  and  reformed  by  the  organ- 
izing force  of  the  automatic  nervous  branches  of  the  duodenum 
into  chyle. 

This  is  absorbed  by  the  lacteals,  in> which  it  undergoes  a  con- 
tinued series  of  molecular  changes  and  combinations,  until  it  is 
deposited  in  the  subclavian  vein. 

The  blood  consists  of  a  vast  number  of  cells,  which  are  the 
agents  the  automatic  nervous  system  employs  to  perform  its  func- 
tions in  the  human  organism.  These  differ  in  form,  size,  and 
functional  endowments,  according  to  the  varied  duties  they  are 
designed  to  fulfil. 

For  practical  purposes,  they  may  be  arranged  into  two  classes  ; 
one  of  nutrition  or  reproduction,  the  other  of  secretion  or  removal. 
When  the  human  organism  is  at  maturity  and  in  health,  these 
processes  should  maintain  a  relation  of  exact  equivalence. 

Physiology. — The  cells  of  nutrition  are  endowed  with  an  elec- 
tive force,  by  which  they  select  and  attract  the  nutritive  elements 
of  the  blood,  which  they  transform  and  rearrange  into  molecular 
combinations.  These  combinations  undergo  a  continued  series 
of  molecular  changes  and  recombinations,  until  they  attain  matu- 
rity, when  the  elements  they  have  elaborated  are  appropriated 
and  form  constituent  parts  ot  the  tissues,  with  which  they  possess 
identity  of  elementary  composition  and  arrangement. 

The  cells  of  secretion  are,  likewise,  endowed  with  an  elective 
force,  by  which  they  select  and  attract  the  effete  or  worn-out 
elements  which  they  transform  and  arrange  into  molecular  com- 
binations. These  combinations  undergo  a  continued  series  of 
mutations,  till  the  elements  they  possess  are  completely  elabora- 
ted in  the  capillaries  of  the  depuratory  glandular  systems,  in  which 
they  are  coalesced  and  removed  from  the  blood  as  secretory 
products.  The  form  of  force  by  which  they  are  coalesced  is  a 
specific  endowmenj  of  each  of  these  glandular  systems,  by  which 
this  important  change  is  produced.  One  depuratory  system  can- 
not, therefore,  compensate  for  deficient  function  in  another  only 
so  far  as  the  elements  conveyed  to  it  are  identical  with  those 
of  its  own  secretion. 

The  blood  gives  each  tissue  the  means  of  repairing  itself:  first, 
by  furnishing  it  with  material  of  new  growth  ;  secondly,  by  re- 
moving from  it  those  elements  of  its  composition  which  have 
become  worn  out  and  useless.  Were  this  the  whole  history  of 
the  blood,  its  investigation  in  disease  would  be  comparatively 
easy.     But  it  undergoes  progressive  changes  analogous  to  the 


400  On  the  Use  of  Iron.  [June,. 

growth  of  the  solid  tissues.  The  new  materials  it  obtains  from 
the  food  are  not  blood  at  the  time  of  their  addition;  they  are 
crude  immatuie  products  which  subsequently  mature. 

The  automatic  nervous  system  endows  the  blood  with  a  power 
to  resist  changes,  convert  crude  material  into  its  own  elements, 
and  perpetuate  its  own  elementary  composition  and  molecular 
arrangement.  Physiology  teaches  that  the  abundance  oi  cell 
developement  measures  the  activity  and  constancy  of  growth  ; 
and  that  this  developmental  activity  in  the  blood  is  infinitely 
greater  than  in  any  other  tissue.  Cell-germs  abound  in  the  fluid 
of  the  thoracic  duct.  But  they  attain  their  maturity  and  fulfil 
the  purpose  of  their  creation  only  when  received  into  the  blood. 

Not  only  does  the  blood  grow,  but  its  growth  must  precede 
that  of  every  other  tissue  in  the  organism.  It  grows,  then  the 
other  tissues  grow  at  its  expense. 

Its  functions  in  health  will  show  sufficiently  what  peculiar  dif- 
ficulties attend  any  investigation  of  its  changes  in  disease.  The 
extreme  rapidity  with  which  all  its  changes  transpire,  and  the 
minute  quantities  in  which  several  ingredients  exist,  oppose  great 
obstacles  to  the  research ;  but  these  are  greatly  enhanced  by  the 
physiological  fact  that  all  the  elements  of  the  blood  correspond 
to  different  periods  of  time,  to  different  degrees  of  developement, 
and  to  different  developemental  cells. 

Viewed  as  an  object  of  scientific  research,  human  life  exhibits 
itself  in  a  series  of  manifestations,  the  connection  and  recurrence 
of  which  are  determined  by  the  changes  which  the  food  and  the 
oxygen  absorbed  from  the  atmosphere  undergo  in  the  organism 
under  the  controlling  influence  of  the  automatic  nervous  system ; 
for  the  first  condition  of  life  is  the  assimilation  of  nutritive  mate- 
rial, and  the  second  is  that  of  a  continual  absorption  of  oxygen 
from  the  atmosphere.  The  intensity,  the  integrity,  the  quantity, 
and  the  quality  of  the  molecular  combinations  and  rearrange- 
ments of  the  elements  of  the  blood  depend  on  the  mutual  action 
of  the  oxygen  of  the  atmosphere  and  the  elementary  constituents 
of  the  food. 

The  most  convincing  experiments  have  proved  that  the  human 
organism  is  absolutely  incapable  of  producing  an  elementary  con- 
stituent, such  as  carbon  or  nitrogen,  out  of  substances  which  do 
not  contain  it;  therefore  it  follows  that  all  kinds  of  food,  to  pro- 
duce the  tissues  and  maintain  them  in  a  normal  relation  with 
each  other,  must  possess  the  elements  of  which  the  tissues  are 
composed.  Fibrine  and  albumen,  the  chief  ingredients  of  the 
blood  contain  seven  chemical  elements,  among  which  are  oxygen, 
carbon,  hydrogen,  nitrogen,  phosphorus,  and  sulphur.  The  se- 
rum retains  in  solution  sea  salt  and  the  salts  of  potassa  and  soda, 
in  which  the  acids  are  carbonic,  phosphoric,  and  sulphuric. 

The  globules  of  the  blood  contain  fibrin  and  albumen,  with  a 


1858.]  On  the  Use  of  Iron.  401 

red  coloring  matter  in  which  iron  is  a  constant  element.  They 
are  formed  out  of  the  elements  contained  in  the  serum;  because 
it  is  the  atmosphere,  and  supplies  the  material  for  cell  develope- 
ment,  which  is  constantly  taking  place  within  this  fluid.  Hence 
it  is  the  most  important  branch  of  hematology. 

The  chief  constituents  of  the  blood  are  compounds,  in  which, 
the  relative  proportions  are  invariable.  These  compounds  are 
the  nascent  state  of  the  tissues,  and  maintain  a  relation  of  mutual 
dependence  on  each  other.  The  blood  could  not  become  organ- 
ized, nor  could  it  promote  the  growth  of  tissues  without  the 
existence  of  albumen  in  the  serum;  because  the  globules  are  de- 
veloped in  this  fluid  at  the  expense  of  its  albumen,  and  they  carry 
the  oxygen  which  they  absorb  from  the  atmosphere  into  every 
tissue  of  tf:e  organism,  where  it  determines  the  changes  which 
may  transpire. 

Oxygen  is  necessary  to  the  growth  and  maturity  of  the  tissues  ; 
it  is  necessary  for  their  conservation  ;  and  it  is  necessary  for  their 
conversion  into  lifeless  compounds  ;  but  it  can  only  be  introduced 
by  the  agency  of  the  globules.  These  can  only  attain  a  condi- 
tion favorable  to  the  reception  and  conveyance  of  the  oxygen 
at  the  expense  of  the  primary  elements  of  the  blood,  which  are 
obtained  from  the  elementary  constituents  of  the  food. 

The  absorption  of  oxygen  and  the  secretion  of  carbonic  acid 
gas  constitute  the  visible  functions  of  respiration,  and  the  vast  ab- 
sorbent and  secretory  capacity  of  the  lungs  depends  on  the  im- 
mense expanse  of  absorbent  and  secretory  cells  brought  in  prox- 
imity to  the  oxygen  of  the  atmosphere  at  each  inspiration,  and  on 
the  quantity  and  quality  of  the  molecular  combinations  of  the 
elements  of  the  blood  which  are  developed  during  that  period. 

The  food  must  contain  and  supply  the  elements  of  which  the 
blood  is  composed  ;  they  must  undergo  normal  transformation  ; 
they  must  grow  and  mature  normally,  before  the  necessary  quan- 
tity of  oxygen  can  be  absorbed  to  consume  them  by  combination. 
For  a  more  enlarged  consideration  of  this  interesting  subject  the 
reader  is  invited  to  an  essay  in  the  American  Journal  of  the  Med- 
ical Sciences,  for  July,  1855,  on  the  Physiology  of  the  Automatic 
Nervous  System,  in  which  1  maintain  the  unity  and  mutual  con- 
vertibility of  all  the  different  forms  of  external  force  and  of  all  the 
different  forms  of  the  automatic  nervous  force,  and  to  another 
essay  in  the  same  Journal  for  April,  1856,  in  which  I  endeavored 
to  show  the  causes  of  fever,  and  explain  the  mode  in  which 
they  produce  diseased  transformation  of  the  tissues. 

Pathology. — From  these  physiological  facts,  it  is  evident  that 
fever  may  assume  a  vast  multiplicity  of  forms,  which  are  mani- 
fested by  characteristic  symptoms.  These  have  often  been  mis- 
taken for  the  disease  itself;  and  the  error  has  been  magnified  and 
perpetuated  by  giving  them  names  which  have  been  commemo- 


402  On  the  Use  of  Iron.  [June, 

rated  by  learned  authors.  Symptoms  are  like  sentinels  on  duty  ; 
they  guard  the  organism,  evince  the  existence  of  disease,  indicate 
the  avenues  of  its  approach,  and  the  degree  of  resistance  offered 
by  the  organism,  manifest  its  progress,  portray  its  pathology,  and 
proclaim  its  triumph  or  announce  its  extermination.  Clothed  in 
the  attire  of  fancy,  marshalled  by  the  mandates  of  theory,  mantled 
by  the  nomenclature  of  authors,  they  are  often  received  and  en- 
tertained in  the  mansion  of  affliction  instead  of  the  disease. 

Fever  is  a  diseased  transformation  of  all  the  tissues ,  but  the  fluid 
tissues  suffer  the  most,  because  the  solid  tissues  are  formed  in 
them  and  of  them.  The  blood  contains  not  only  -the  nutritive 
elements,  but  also  the  effete  constituents  of  the  transformed  solid 
tissues.  Both  the  nutritive  and  the  effete  elements  are  formed, 
matured,  and  appropriated  by  cellular  combinations. 

These  are  the  agents  of  the  automatic  nervons  force  acting  on 
the  organizable  constituents  of  the  food,  and  blood,  or  upon  the 
organizable  elements  of  the  transformed  tissues. 

The  activity,  the  quantity,  and  the  quality  of  the  molecular 
combinations  depend  on  the  intensity  and  integrity  of  this  force, 
manifested  as  nutritive  attraction,  molecular  affinity,  and  effete 
repulsion.  The  nascent  state  of  this  force  in  any  of  these  forms 
are  easily  transmuted ;  and  both  the  developmental  cells  and  the 
molecular  combinations,  to  the  formation  of  which  it  contributes, 
as  the  formative  or  organizing  force,  will  partake  of  the  abnormal 
mutation.  Hence  the  vast  number  of  symptoms  which  arise 
during  the  incipiency  and  course  of  fever.  The  cells  of  nutrition 
neither  grow  nor  mature  normally;  nor  are  their  constituents 
appropriated  to  the  nutrition  of  the  tissues  normally.  From  the 
diminished  quantity  and  feeble  intensity  of  the  organizing  force 
of  the  automatic  nervous  branches  of  the  digestive  and  assimila- 
tive organs,  the  organizable  elements  of  the  food  are  not  decom- 
posed, transformed,  rearranged,  and  absorbed  in  normal  quantity 
and  quality ;  only  a  small  amount  of  nutritive  material  is  receiv- 
ed by  the  lacteals  out  of  which  blood  may  be  formed  and  devel- 
oped ;  and  the  molecular  combinations  of  the  cells,  containing  this, 
are  so  imperfect,  that  they  cannot  undergo  mutations  with  normal 
force  and  celerity. 

Imperfectly  developed  by  molecular  combination,  the  nutritive 
constituents  of  the  blood  often  aggregate  in  some  of  the  capillaries, 
in  which  they  then  constitute  excessive  and  perverted  nutrition, 
or  inflammation.  This  is  of  frequent  occurrence  during  the 
progress  of  fever,  and  merits  the  anxious  and  careful  considera- 
tion of  the  physician. 

During  fever  the  secretory  cells  are  neither  formed,  developed, 
nor  matured  normally ;  nor  are  the  elements  which  they  should 
normally  aggregate  and  elaborate  depurated  from  the  blood;  be- 
cause the  nutritive  elements  neither  absorb  a  normal  quantity  of 


1858.]  On  the  Use  of  Iron.  403 

oxygen  from  the  atmosphere,  nor  does  that  which  is  received 
undergo  normal  molecular  combinations  on  account  of  their  im- 
perfect molecular  developement. 

The  imperfectly  combined  oxygen,  when  it  is  not  consumed 
by  molecular  combination  with  the  protein  elements  of  the  blood, 
acts  upon  those  elements  of  the  solid  tissues  exciting  the  sensa- 
tion of  pain,  when  it  consumes  branches  of  the  sensitive  nervous 
tissue,  producing  irregular  and  involuntary  muscularactions,  when 
it  consumes  those  of  the  excito-motory,  and  creating  the  sensa- 
tion of  thirst  oppression,  and  suffocation,  when  it  consumes  only 
those  of  the  automatic  nervous  system. 

During  the  incipiency  of  fever,  the  effete  elements  of  the  blood, 
therefore,  undergo  a  series  of  abnormal  transformations,  and  are 
chiefly  retained  in  the  blood ;  a  lesion  of  nutrition  and  secretion 
exists,  the  organizing  force  of  the  automatic  nervous  system,  which 
in  a  normal  state,  creates,  maintains,  and  governs  the  cellular 
formation  and  coalescence  of  the  elementary  constituents  of  the 
blood  is  increased,  decreased,  or  perverted ;  there  is  a  lesion  of 
capillary  circulation ;  the  blood  recedes  from  the  external  capil- 
laries and  accumulates  chiefly  in  the  portal  venous  system  ;  a 
diseased  transformation  of  all  the  tissues  is  present;  Fever  exists; 
it  is  manifested  by  symptoms;  these  assume  a  great  multiplicity 
of  appearances  and  forms,  according  to  the  pathological  condition 
of  the  tissues. 

There  is  no  longer  a  perfect  equilibrium  between  the  processes 
of  waste  and  repair ;  neither  a  normal  quantity  of  food  is  desired, 
nor  could  it  be  assimilated,  were  it  ingested;  every  tissue, 
therefore,  suffers  for  appropriate  nourishment. 

Those  more  immediately  concerned  in  the  processes  of  nutri- 
tion most  early  evince  the  requirements  of  food,  or  the  necessary 
elementary  constituents  for  the  repair  of  their  tissues. 

As  the  automatic  nervous  system  creates,  governs,  and  main- 
tains all  the  tissues  by  ils  organizing  force  acting  on  the  organi- 
zable  elements  of  the  food  and  blood,  it  is  the  first  tissue  to 
manifest  the  want  of  nourishment  by  lesion  of  the  different  forms 
of  its  force. 

Quinine  supplies  nutritive  elements  to  this  tissue,  and  by  this 
gives  its  different  forms  of  force  increased  intensity.  Its  phys- 
iological effects  on  the  organism  are  an  increase  of  the  develop- 
mental intensity  and  celerity  of  the  cells,  and  a  promotion  of  their 
molecular  combination  and  coalescence,  by  which  the  transfor- 
mation of  the  nutritive  cells  is  increased,  and  those  of  secretion 
augmented.  When  a  diseased  transformation  exists,  it  should, 
therefore,  be  carefully  administered,  and  its  effects  sedulously 
investigated. 

In  the  June  No.  of  the  Cincinnati  Medical  Observer  for  1857,  I 
have  given  my  views  of  the  use  of  quinine  in  fever;  and  in  the 


40 J:  On  the  Use  of  Iron.  [June, 

July  No.  of  the  American  Journal  of  the  Medical  Sciences  for  1857, 
I  have  discussed,  at  some  length,  the  use  of  water  in  fever. 

In  the  latter  essay  I  have  maintained  that  the  hydrogen  of  the 
water  combines  with  the  imperfectly  combined  oxygen  in  the 
blood,  forms  water,  and  is  removed  from  the  blood  in  the  form 
of  sweat  or  perspiration ;  while  the  oxygen  of  the  water  com- 
bines with  the  carbon  of  the  blood,  evolves  heat,  and  is  secreted 
in  the  form  of  carbonic  acid  gas. 

The  attention  of  the  reader  is  invited  to  each  of  these  essays. 

After  the  employment  of  appropriate  remedial  agents,  and  the 
removal  of  the  more  manifest  symptoms  of  fever,  there  often  re- 
mains an  impoverished  condition  of  the  blood,  which  is  a  fertile 
source  of  local  dependent  forms  of  disease,  especially  when,  during 
the  progress  of  fever,  a  chill  from  time  to  time  occurs.  The 
condition  of  the  blood  is  sensitively  evinced  by  lesion  of  nutrition, 
loss  of  nervous  energy,  want  of  appetite,  muscular  debility,  and 
more  or  less  perversion  of  secretion ;  and  it  is  caused  by  deficient 
developmental  intensity  of  the  molecular  combinations  of  the  elements 
of  the  blood. 

The  large  proportion  of  albumen  generally  found  in  this 
morbid  condition  of  the  blood,  is  the  result  of  defective  cell-growth  ; 
because  there  is  more  nutritive  material  in  the  serum  than  could 
have  remained  there,  if  the  normal  proportion  of  blood-cells  had 
been  developed  out  of  it.  The  evidence  is,  therefore,  almost 
conclusive,  that  the  albumen  which  exists  in  the  blood  does  not 
grow  and  mature  normally,  or  it  would  be  consumed  by  molecu- 
lar combination. 

The  causes  of  fever,  how  slight  soever  they  be,  retard  the 
developemental  intensity  and  activity  of  the  blood  cells;  and  if 
they  be  long  continued,  frequently  repeated,  or  of  great  disturb- 
ing force,  they  impair  the  normal  molecular  changes  of  the  blood, 
and  transmute  them,  with  more  or  less  celerity,  into  the  different 
forms  of  chemical  force,  when  life  may  soon  become  extinguish- 
ed. If  the  abnormal  mutations  be  arrested,  a  period  of  time 
must  transpire  before  the  different  forms  of  the  organizing  force 
of  the  automatic  nervous  system  can  attain  normal  tranquility 
and  intensity;  because  the  tissue  of  this  system  has  suffered  for 
normal  nutrition;  and  its  different  forms  of  force  have  been  so 
disturbed  and  so  transmuted,  that  time  is  required  for  them  to 
regain  normal  intensity  and  a  controlling  influence  over  the  mole- 
cular combinations  of  the  blood. 

When  this  is  obtained,  all  the  forms  of  the  organizing  force 
are  united  in  purpose,  harmonious  in  action,  and  conspire  to 
promote  the  conservation  and  well-being  of  the  organism.  But 
they  require  organizable  elements  to  elicit  their  action;  and  the 
lesion  of  nutrition  opposes  the  attainment  of  this  grand  object  by 
not  supplying  all  the  constituents  necessary  to  the  developmental 
intensity  of  the  blood-cells. 


1858.]  On  the  Use  of  Iron.  405 

Although  so  minute,  these  cells  always  act  harmoniously  ;  they 
elaborate  the  constituents  of  the  blood  in  a  continued  series  of 
succession ;  each  performs  a  definite  and  distinct  duty  ;  but  the 
blood  must  contain  all  the  elements,  of  which  the  tissues  are  com- 
posed, or  these  cells  cannot  be  normally  transformed  and  rearran- 
ged ;  they  cannot  grow  and  mature  normally,  because  the  absence 
of  a  single  organizable  element  would  disturb  the  unity  of  purpose 
and  the  concert  of  action  between  the  different  forms  of  the  organ- 
izing force,  and  thereby  impede  the  molecular  growth  and  develop- 
ment of  the  whole.  This  is  precisely  what  always  transpires 
during  the  incipiency  of  fever;  and  it  is  perpetuated  throughout 
its  course.  The  lesion  of  nutrition  may  be  slight,  but  it  is  suffi- 
cient to  produce  and  maintain  the  continued  absence  or  imma- 
ture condition  of  one  or  more  constituents  of  the  tissues. 

The  developement  of  the  blood  must,  therefore,  be  imperfect ; 
and  this  imperfection  will  always  be  commensurate  with  the  de- 
gree and  duration  of  the  nutritive  lesion. 

The  dependence  of  the  capillary  circulation  upon  the  normal 
molecular  combinations  of  the  elements  of  the  blood  always  pro- 
duces a  lesion  of  this  circulation  proportionate  to  the  abnormal 
mutations,  which  transpire  from  imperfect  developement  of  the 
globules. 

There  is,  therefore,  always  present  more  or  less  anaemia  in  fever; 
because  the  morbid  changes  of  the  molecular  combinations  of 
the  constituents  of  the  blood  prevent  its  introduction  into  the 
capillaries  in  normal  quantity  by  nutritive  attraction  ;  and  although 
the  arterial  system  may  be  bounding  and  throbbing,  these  vessels 
convey  an  absolutely  diminished  quantity  of  blood  to  the  capilla- 
ries. 

The  mechanical  force  of  the  muscular  action  of  the  heart  and 
arteries  is  derived  from  the  cellular  changes  of  the  elements  of 
the  blood  at  the  ultimate  termination  of  their  muscular  fibres  ;  so 
that  it  must  be  diminished  in  intensity  when  these  molecular 
mutations  do  not  take  place  with  normal  force  and  celerity  from 
deficient  developement  of  the  globules. 

Enfeebled  action  of  the  heart  and  arteries  is,  therefore,  always 
present  in  fever.  Their  mechanical  force  is  diminished;  they 
only  propel  a  quantity  of  blood  to  the  external  capillaries  equal  to 
their  propulsive  intensity ;  and  as  this  is  not  equal  to  the  whole 
quantity  of  the  blood,  a  certain  portion  must  regurgitate  from  the 
heart,  at  each  systole,  in  the  portal  venous  system. 

The  morbid  accumulation  of  blood  in  this  venous  syste^pro- 
duces  an  anaemic  state  of  the  external  capillaries. 

These  abnormal  states  of  the  circulation  perpetuate  fever,  be- 
cause only  a  small  quantity  of  nutritive  material  can  be  elabora- 
ted and  introduced  into  the  blood  on  account  of  the  capillary 
lesions ;  and  the  molecular  mutations  of  the  blood  in  the  depurato- 


406  On  the  Use  of  Iron.  [June, 

ry  glands  are,  consequently,  so  abnormal,  that  what  already  exists 
is  very  imperfectly  depurated. 

Only  a  limited  quantity  of  oxygen  is  absorbed  ;  but  that  which 
is  received  is  not  normally  consumed  by  combination.  Imper- 
fectly consumed  by  combination,  it  combines  with  the  solid  tis- 
sues, producing  their  death  and  decomposition  by  conversion  into 
lifeless  compounds. 

Fever,  attended  by  the  symptoms  which  arise  from  these  states 
of  the  solid  and  fluid  tissues,  is  called  typhus  or  typhoid.  It  is 
frequently  observed  in  the  southwestern  States  in  the  autumn, 
when  the  days  are  hot  and  the  nights  cool,  especially  if  fever 
with  intermittent  symptoms  prevailed  during  the  preceding  sum- 
mer. 

Throughout  the  southwestern  States,  fever,  with  chills  at  irreg- 
ular periods,  is  often  of  protracted  duration  ;  and,  during  its  course, 
the  spleen  is  liable  to  become  hypertrophied,  and  the  blood  poor 
and  attenuated.  When  the  spleen  is  greatly  hypertrophied,  and 
soft  and  yielding  upon  pressure,  large  granular  globules,  two  or 
three  times  the  size  of  the  natural  colourless  corpuscles,  may 
frequently  be  oberved  in  great  abundance  in  the  blood ;  and 
usually  the  ordinary  colorless  corpuscles  are  in  great  excess  in 
this  condition  of  the  spleen.  Southwestern  physicians,  who  have 
unfortunately  employed  bleeding  from  a  large  orifice  in  the  treat- 
ment of  inflammation  of  the  lungs,  when  the  spleen  is  in  this 
pathological  condition,  can  bear  witness  to  the  frequency  of  these 
appearances  of  the  blood. 

When  this  patholigical  state  of  the  blood  exists,  the  hepatic 
functions  are  always  more  or  less  disturbed  by  the  morbid  accu- 
mulation of  blood  altered  in  quality  in  the  hepatic  capillaries. 
This  disturbance,  when  it  is  of  long  duration,  is  usually  manifest- 
ed by  a  yellow  appearance  of  the  skin,  clay-colored  discharges 
from  the  bowels,  and  scant  high-colored  urine,  alternated  with 
green  fetid  evacuations  from  the  bowels,  and  large  quantities  of 
yellow  sedimentary  urine. 

A  serous  diarrhoea  sometimes  supervenes  upon  these  conditions, 
when  the  sufferer  is  rapidly  exhausted  by  the  continuous  drain  of 
serum.  Cruveilhier,  Becquerel  and  Rodier,  Andral  and  Gavaret, 
have  conclusively  shown  that  the  attenuation  of  the  blood  by 
bleeding  decreases  the  quantity  of  the  corpuscles,  while  the  other 
constituents  undergo  little  change  in  their  proportion  either  to 
each  other  or  to  the  entire  mass. 

Thp  same  law  prevails  in  respect  to  hemorrhage  and  many 
exhaustive  forms  of  disease.  The  attention  of  the  profession  is 
particularly  invited  to  monorrhagia,  as  it  affects  women  who 
reside  on  our  southwestern  alluvial  bottoms.  With  them  the  hem- 
orrhage often  alternates  with  serous  diarrhoea,  when  general  anae- 
mia is  soon  produced  and  pervades  every  tissue  of  her  organism. 


1858.]  On  the  Use  of  Iron.  407 

The  human  female  has  a  peculiar  law  of  blood-development. 
During  about  thirty  years  of  her  life  she  forms  biood  enough  for 
herself  and  an  infant.  If  she  be  pregnant  or  suckling,  this  redun- 
dant blood  formation  fulfils  its  purposes  by  nourishing  her  organ- 
ism and  that  of  her  infant;  but  if  she  be  neither  pregnant  nor 
suckling,  the  large  blood  formation,  which  is  normal  to  her  for 
these  purposes,  becomes  excessive  in  their  absence,  and  tends  to 
effect  its  own  cure  by  means  of  recurrent  hemorrhage  for  the  mu- 
cous membrane  of  the  uterus,  which  attends  the  discharge  of 
unfertilized  ova  from  the  Graafian  vesicles,  and  constitutes  men- 
struation when  it  is  normal,  and  menorrhagia  when  it  is  abnor- 
mal from  the  excessive  quantity  of  blood  discharged.  Lesions 
of  this  process  most  usually  occur  from  general  causes  affecting 
the  development  of  the  blood  ;  and  among  these,  in  the  south- 
western States,  the  most  universal  are  those  vicissitudes  of  the 
atmosphere  which  produce  fever.  The  morbid  influences  of  the 
climate  or  locality  impoverish  the  blood  and  produce  the  patho- 
logical conditions  which  arise  from  the  want  of  cell  development 
of  the  blood-corpuscles. 

The  anaemia  which  so  often  takes  place  about  the  period  of 
puberty  in  young  women  in  the  western  States,  consists  essential- 
ly in  deficient  growth  of  blood-cells  ;  and  it  is  of  much  more  fre- 
quent occurrence  than  is  generally  apprehended.  During  the 
autumn,  teething  children  often  suffer  of  a  serous  diarrhoea  of 
protracted  duration.  This  is  perpetuated  by  the  want  of  develop- 
mental activity  of  the  globules. 

The  plysiological  effects  of  iron  conclusively  evince,  that  it 
promotes  the  development  of  the  blood  cells  and  accelerates  their 
maturity.  This  is  in  accordance  with  a  general  law  of  the 
human  organism,  that  the  specific  stimulants  of  cell  growth  in 
every  tissue  are  elements  identical  with  the  natural  contents  of 
the  cells,  or  convertible  into  them. 

The  globules  of  the  blood  contain  increments  of  iron  obtained 
from  the  food  ;  and  from  the  physiological  facts  that  these  are 
always  present  in  normal  blood,  it  is  self-evident  that  iron  is 
absolutely  necessary  to  animal  life. 

From  the  physiological  fact  that  the  globules  do  not  contribute 
to  the  nutrition  of  the  tissues  until  they  have  attained  maturity ; 
that  they  will  not  mature  normally  without  certain  increments 
of  iron:  that  when  these  are  normally  present  they  greatly  pro- 
mote the  developmental  intensity  and  activity  of  the  blood-cells  ; 
that  they  increase  the  capacity  of  these  cells  for  the  absorption  of 
the  oxygen  of  the  atmosphere  and  for  the  secretion  of  carbonic 
acid  gas  from  the  blood,  by  which  the  gobules  assume  a  bright- 
red  colour ;  that  the  blood  in  this  manner  oxidized  is  conveyed 
and  introduced  into  the  capillaries,  in  which  its  elements  are 
transformed,  matured,  and   appropriated   to  the  nutrition   of  the 


408  On  the  Use  of  Iron.  [June, 

tissues,  evolves  animal  heat,  and  absorbs  the  effete  constituents 
of  the  transformed  tissues  ;  and  that  the  pathological  states  which 
are  produced  are  those  which  are  dependent  on  imperfect  mole- 
cular development  of  the  globules,  and  the  consequent  deficient 
oxidation  and  depuration  of  the  blood;  we  can  appreciate  the 
cause  of  the  perverted  condition  of  the  different  forms  of  the 
automatic  nervous  force,  the  abnormal  forms  this  force  assumes 
in  the  molecular  combinatian  of  the  elements  of  the  blood,  when 
all  development  is  deficient,  and  the  best  means  to  effect  its 
tranquility  and  early  restoration. 

Iron  is  the  most  efficient  agent  to  promote  the  normal  restora- 
tion of  these  lesions,  because  it  supplies  the  element  required  to 
promote  the  growth  and  maturity  of  the  protein  globules.  The 
effects  of  few  medicinal  substances  are  more  immediate  or  more 
remarkable  than  that  which  results  in  disease  from  deficient  cell 
development  from  the  exhibition  of  iron. 

Every  physician  has  observed  how  soon,  under  the  influence 
of  this  remedy,  patients  recover  their  normal  complexion.  A 
chemical  analysis  of  the  blood  explains  this  sufficiently.  F. 
Simon  relates  a  case  in  which,  after  a  few  weeks  of  treatment, 
the  proportion  of  blood  globules  rose  from  32  to  95  in  the  thou- 
sand ;  Herberger,  one  in  which  it  rose  from  38  to  98 ;  Andralr 
one  in  which  it  rose  from  46  to  95. 

Iron  is  seldom  administered  in  a  metallic  state.  It  is  usually 
oxidized,  and  combined  with  a  vegetable  or  mineral  acid.  The 
compounds  formed  by  combination  of  iron  with  the  vegetable 
acids  are  less  powerful  and  efficient  than  those  by  mineral  acids. 
The  citrate  and  tartrate  of  iron  are  mild  in  their  action,  and  they 
may,  therefore,  often  be  given  before  the  stronger  compounds. 
We  not  unfrequently  observe  that  the  stronger  compounds  of  iron, 
when  first  administered,  apparently  increase  all  the  anaemic 
symptoms,  especially  those  referable  to  the  stomach  and  head. 
The  potassio-tartrate  of  iron  may  be  given  along  with  the  bitar- 
trate  ofpotassa,  when  there  is  oedema  of  the  ankles,  or  of  the  cel- 
lular tissue  generally.  This  is  a  valuable  compound  of  iron  in 
the  anaemia  of  females,  when  there  is  local  effusion  in  the  cellu- 
lar tissue. 

Several  of  the  compounds  of  iron  are  often  given  in  larger 
doses  than  is  necesary  when  the  design  is  to  promote  the  absorp- 
tion of  the  iron  into  the  blood.  This  observation  applies  espe- 
cially to  the  carbonate,  sulphate,  and  mutriated  tincture.  The 
regeneration  of  the  globules,  when  much  diminished  in  quantity 
and  altered  in  quality,  must  require  considerable  time. 

That  the  efficacy  of  a  ferruginous  compound  is  not  in  propor- 
tion to  the  quantity  of  iron  it  contains  is  shown  by  the  fact  that 
many  mineral  waters  are  very  powerful,  though  they  contain  less 
than  a  grain  in  the  pint.     This  fact  clearly  evinces  the  necessi- 


1858.]  On  the  Use  of  hua.  -AU9 

ty  of  the  greatest  care  in  the  selection  of  the  compound  we  are 
about  to  employ  ;  because  the  efficacy  of  iron  often  depends  on 
the  compound  used  and  its  mode  of  administration.  Deficient 
cell-growth,  which  occasions  the  necessity  for  the  employment 
of  iron,  causes  a  vast  multiplicity  of  symptoms,  which  are  pro- 
duced by  the  functional  disturbance  of  the  visceral  glands.  The 
compound  of  iron  should,  as  nearly  as  possible,  be  adapted  to  the 
particular  state  of  the  digestive  organs,  that  it  maybe  readily 
absorbed  and  elaborated  with  the  nutritive  elements  of  the  blood  ; 
for  this  is  the  only  mode  by  which  iron  can  promote  the  growth 
and  maturity  of  the  blood.  Sir  James  Murray  first  recommended 
the  administration  of  iron  in  the  following  mode:  Dissolve  one 
drachm  of  the  bicarbonate  of  soda  in  four  ounces  of  water;  then 
add  to  this  one  drachm  of  the  muriated  tincture  of  iron.  The 
draught  should  be  taken  during  effervescence.  It  should  be  re- 
peated three  or  four  times  a  day.  Although  the  quantity  of  iron 
is  small,  yet  it  is  in  a  state  of  subdivision  so  minute  as  to  favour 
greally  the  absorption  of  each  increment.  The  double  decompo- 
sition which  takes  place  forms,  as  one  of  its  products,  muriate  of 
soda.  This  saline  is  most  congenial  to  the  development  of  the 
globules. 

During  the  protracted  continuance  of  fever,  diarrhoea,  dysente- 
ry, or  any  other  form  of  disease,  during  the  autumn  or  winter  in 
the  Southwest,  the  use  of  iron  according  to  this  suggestion  of  Sir 
James  Murray,  is  often  attended  with  the  greatest  efficacy,  espe- 
cially when  the  fever,  or  other  form  of  disease,  assumes  what  is 
usually  termed  a  typhoid  form.  The  iron  should  be  administered 
every  three  or  four  hours,  alternated  with  other  appropriate  reme- 
dies. The  minute  quantities  of  iron  and  muriate  of  soda  thus 
presented  to  the  digestive  and  absorbent  glands,  which  have  been 
so  long  deranged  and  weakened,  stimulate  and  promote  the 
growth  and  maturity  of  their  cells,  and  thereby  favor  the  diges- 
tion and  accelerate  the  absorption  of  any  nutritive  or  medicinal 
substance.  This  will  be  celarly  evinced  by  the  increased  secre- 
tion, which  will  take  place  in  a  day  or  two  from  the  beginning  of 
the  use  of  the  iron.  The  biliary,  uninary,  and  cutaneous  secre- 
tions will  be  greatly  augmented  ;  the  tongue  will  become  more 
moist,  the  thirst  less  urgent,  and  the  sleep  more  tranquil. 

When  inflammation  exists,  iron  should  be  used  cautiously  and 
carefully.  When  fever,  dysentery,  or  diarrhoea  assumes  what  is 
called  a  typhoid  state,  iron  is  of  the  greatest  efficacy,  because  it 
stimulates  and  promotes  the  growth  and  maturity  of  the  blood- 
cells.  The  matured  blood-cells  absorb  and  elaborate  more  oxy- 
gen from  the  atmosphere ;  an  increased  transformation  of  the 
elements  of  the  blood  ensue  ;  the  capillary  circulation  is  accelera- 
ted and  augmented,  and  increased  secretion  from  all  the  depura- 
torv  glandular  systems  takes  place. 


410  Treatment  of.  Menorrhagia  with  Ergot.  [June, 

When  a  typhoid  state  exists  in  any  form  of  disease,  western 
physicians  have  often  prescribed  for  several  days  without  observ- 
ing scarcely  any  effect  from  the  medicine  they  had  directed.  Let 
them  employ  iron,  as  here  directed,  and  in  a  day  or  two,  each 
medicinal  article  will  begin  to  manifest  its  characteristic  effects 
on  the  organism. 

Muriated  tincture  of  iron  is  a  very  efficacious  compound  in  the 
treatment  of  menorrhagia.  Its  use  should  be  continued  for  a 
considerable  time.  It  may  often  be  employed  with  the  greatest 
advantage  in  fever  with  typhoid  symptoms. 

Iodide  of  iron  is  a  preparation  which  combines  in  some  degree 
the  properties  of  iodine  with  those  of  iron,  though  the  latter  pre- 
dominate. It  seems  to  promote  the  secretions  more  than  any 
other  compound  of  iron.  When  it  is  not  too  stimulating  it  is 
one  of  the  best  tonics  in  the  anaemia  of  phthisis  and  scrofula; 
and  from  my  experience  of  its  effects  in  these  affections  in  this 
climate,  it  is  never  too  stimilating.  It  may  be  advantageously 
employed  in  all  cases  of  anaemia  combined  with  enlargement  of 
the  lymphatic  glands.  It  changes  the  molecular  condition  of  in- 
durated glands  and  promotes  their  absorption.  It  may  be  used 
advantageously  in  the  chronic  form  of  many  diseases,  in  which 
calomel  should  have  been  employed  during  the  acute  state. 

The  citrated  aromatic  wine  of  iron  possesses  the  most  agreea- 
ble odor  and  taste  of  any  medicinal  compound  of  iron.  It  is 
seldom  rejected  by  the  most  delicate  stomach.  I  have  directed 
it  for  children  and  young  persons  in  various  forms  of  disease  with 
debility,  and  I  never  found  it  disliked  or  rejected,  and  its  repeti- 
tion is  more  generally  desired. 

When  excessive  secretion  from  a  relaxed  state  of  the  mucous 
membrane  in  chronic  bronchitis  exists,  combined  with  wine  of 
ipecacuanha,  it  is  of  peculiar  efficacy.  In  all  diseases  which  arise 
from  deficient  developmental  activity  of  the  blood-cells,  it  is  a 
remedy  of  great  value.  There  are  many  other  compounds  of 
iron  of  peculiar  value  and  great  efficacy  ;  but  I  cannot  extend 
the  limits  of  this  paper  by  a  definite  notice  of  them. 

When  we  contemplate  the  effects  of  the  climate  of  the  alluvion 
districts  in  the  southwestern  States  in  the  production  of  an  im- 
poverished condition  of  the  blood,  the  frequency  with  which  this 
state  of  the  blood  is  met  with  in  these  localities,  and  its  injurious 
consequences  to  the  organism  when  allowed  to  continue,  the  value 
of  iron  in  the  promotion  of  the  growth  and  maturity  of  the  blood- 
cells,  and  the  consequent  removal  of  this  condition  of  the  blood, 
can  scarcely  be  sufficiently  appreciated. 


1858.]  On  Chorea  arid  Myelitis  of  die  Chord.  411 


Lecture  on  Chorea  and  Myelitis  of  the  Chord.    By  Thos.  Addisox, 
M.  D.,  F.  E.  C.  P.,  Senior  Physician  to  Gay's  Hospital. 

Gentlemen. — There  is  that  case  in  the  bed,  No.  15,  that  boy, 

J.  B ,  aged  11  years — a  delicate,  strumous  boy  that  moves 

about  like  a  frog  or  a  lizard  thrown  into  half  a  hundred  contor- 
tions, and  which  you  recognise  at  once  as  hemiplegic  chorea. 
There  is  that  poor  boy,  I  say,  so  curiously  afflicted ;  the  case  is 
one  of  great  interest.  You  observed,  no  doubt,  some  of  you, 
when  first  I  saw  him,  how  carefully  we  listened  to  the  action 
of  the  heart,  and  how  I  felt  the  skin.  I  will  explain  why  I  did 
so  as  we  go  along. 

Now,  whenever  I  see  a  young  subject  the  victim  of  chorea, 
I  always  suspect  that  it  had  its  origin  in  rheumatism.  I  felt 
this  boy's  skin  to  discover  if  he  had  that  sweaty  surface,  so 
characteristic  of  rheumatism.  I  listened  to  the  heart,  and  what 
did  I  find?  Loud  mitral  bruit.  And  what  do  we  learn  in  going 
over  the  previous  history,  as  noted  by  the  clinical  clerk?  "We 
find  that  about  three  years  ago  he  had  rheumatism ;  and  here 
I  may  tell  you>  that  you  will  often  find,  under  the  name  of 
severe  "growing  pains,"  that  you  have  had,  in  point  of  fact,  a 
veritable  attack  of  rheumatism.  Are  we  to  believe  this  mitral 
bruit  was  the  result  of  rheumatism,  or  not? 

Believe  me,  rheumatism  is  a  very  eccentric  disease ;  I  know 
none  more  so.  There  is  no  disease,  perhaps  of  which  we  know 
really  so  little  as  rheumatism  in  its  pathological  essence  and 
nature!  An  old  physician  of  considerable  experience  was 
asked  What  cure  is  for  rheumatism?  His  answer  was  laconic: 
"The  cure  for  rheumatism  is — six  weeks/"  In  other  words, 
rheumatism  must  be  let  cure  itself.  I  have  cut  rheumatism 
and  rheumatic  gout  short  in  less  than  half  the  time  with  colchi- 
cum  or  the  powdered  cormus  and  sulphate  of  magnesia,  and 
other  things;  but  I  am  not  so  certain  that  cutting  rheumatic 
gout  short  by  potent  measures  is  quite  the  same  thing  as  curing 
it.     Let  us,  however,  at  all  hazards  mind  the  heart  in  these  cases. 

Eheumatism  is  a  queer  or  eccentric  disease,  I  have  said. 
Now,  it  is  my  belief  that  rheumatic  disease,  whatever  it  is,  some- 
times attacks  the  skin  alone.  It  is  my  firm  belief  that  it  some- 
times attacks  the  heart  alone.  I  know  the  rheumatic  skin  well ; 
and  I  am  satisfied  also  about  the  ravages  committed  by  this 
so-called  rheumatic  inflammation  in  the  endocardium  and  peri- 
cardium, and  that,  too,  without  any  pain  to  attract  attention. 
I  see  the  rheumatic  skin ;  and  when  I  do,  I  almost  with  cer- 
tainty predict  rheumatism,  which  is  sure  to  supervene.  One 
may  sometimes  find  the  heart  inflamed,  by  itself,  but  you  will 
do  well  to  look  out  for  rheumatism  in  the  joints  and  their  syno- 

u.  8. — vol.  xiv.   vo.  vi.  19 


412  On  Chorea  and  Myelitis  of  the   Chord.  [June, 

vial  or  ligamentous  tissues.  This  pericarditis  is  of  a  marked 
kind,  with  no  pain  about  the  heart. 

But  you  say,  What  has  all  this  to  do  with  chorea?  Well, 
what  the  relations  are  is  not  clearly  made  out;  but  that  there 
is  a  connection  or  relation  is  perfectly  evident.  If  we  look  at  it 
in  this  way,  we  find,  for  instance,  in  acute  endocarditis,  the 
patient's  manner  is  often  very  remarkable,  more  so  than  *in 
pericarditis;  he  may  be  even  quite  delirious  or  laboring  under 
decided  cerebral  complications. 

Some  ability  and  ingenuity  are  shown  by  Dr.  Kirkes  and 
others  in  tracing  certain  clots  or  shreds  of  fibrinous  matter,  as 
washed  from  the  endocardium  into  the  brain,  causing  irritation 
there.  On  the  continent,  I  find  they  look  on  the  matter  in  a 
less  mechanical  way,  and  they  say  a  poison — say,  like  that  of 
some  other  serous  effusions — is  carried  to  the  brain  from  the 
rheumatic  deposit  in  the  endocardium.  I  am  afraid  we  have 
too  many  analogies  in  pyaemia  and  other  affections  to  give  stabil- 
ity to  this  hypothesis.* 

There  are  several  curious  associations,  I  have  said,  between 
the  brain  and  heart,  epilepsy,  for  instance,  affects  the  heart. 
Sometimes,  a  fit  of  epilepsy  extends  itself  in  a  violent  tumult  of 
the  heart.  I  was  consulted  some  time  ago  by  a  gentleman — a 
manufacturer  at  Huddersfield,  or  somewhere  down  there — for 
some  curious  functional  derangement  of  the  heart.  I  told  his 
family  doctor  it  was  epilepsy  of  the  heart ;  and  I  believe  my 
friend  thought  I  did  not  know  what  I  was  saying,  and  smiled  at 
me ;  but  the  epilepsy  of  the  heart,  with  those  curious  fits  of  un- 
consciousness he  could  not  understand;  and  how  puzzling  they 
are  you  will  find  when  you  get  into  private  practice ;  so  that 
you  cannot  give  too  much  attention  to  them.  Well!  these 
anomalous  fits  of  unconsciousness  and  tumultuous  palpitation 
ended,  nevertheless,  in  regular  fits  of  epilepsy — some  of  the 
most  marked,  perhaps  ever  seen.  I  do  not  pretend  to  explain 
how  this  is  brought  about;  I  only  know  the  practical  bedside 
fact.  The  relations  of  the  fit  in  epilepsy  itself  are  very  peculiar ; 
but  emotional  influences  will  produce  palpitation  of  the  heart; 
and,  I   suppose,  in   some  such  way,    epilepsy   produces  it   as  a 

*  Chorea  is  derived  from  the  word  choros,  a  dance.  During  the  middle  ages, 
we  learn  from  Hecker,  sundry  choreic  ravings  attacked  the  peasants  at  Kolbig, 
Erfurt,  and  Utrecht,  in  1374.  At  Aix-la-Chapella  the  sick  thus  seized  "appear- 
ed to  have  lost  the  control  over  their  senses,  and  were  only  relieved  by  swathing 
the  body,"  and  various  incantations  common  at  the  time.  These  choreic  ravings 
were  mixed  up  with  various  religious  ravings,  evidently  the  reflection  of  sundry 
broken  images,  as  from  the  broken  mirror  of  some  popular  impression  of  the  day. 
The  name  "St.  John's  Dance"  was  given  to  chorea,  as  it  was  at  one  time  thought 
chorea,  originated  in  the  revels  of  that  festival  and  St.  Vitus's  dance,  because  of 
the  cures  effected  at  the  celebrated  chapel  of  St,  Vitus.  This  disease  continued 
two  centuries.  Paracelsus  (no  very  reliable  authority)  give9  a  long  description 
of  the  epidemic,  and  the  Arabians  called  it  a  palsy. 


1858.]  On  Chorea  and  Myelitis  oftiu  413 

sort  of  first  of  three  warnings."  Emotional  influences  or  fright 
will  cause  chorea :  in  fact,  it  is  the  most  common  of  all  causes 
of  the  disease.  A  dog  runs  after  a  child  ;  a  ghost  story  is  told 
by  a  foolish  nurse;  a  house  takes  fire,  and  child  is  exposed  to 
danger;  the  child,  perhaps,  is  seized  with  chorea:  some  horri- 
ble agitation  *  is  set  up  in  the  emotional  (or  central)  parts  of 
the  brain,  and  chorea  tits  are  the  result.  The  complication  or 
connection  of  chorea  and  heart  diseases  is  so  common  that  I 
always  look  for  it.  See  in  that  case  of  gout,  on  the  other  hand, 
in  that  poor  woman  in  the  other  part  of  the  ward,  you  can 
scarcely  tell  it  from  rheumatism :  she  has  renal  disease,  with 
gout  in  her  foot;  but  her  heart  is  perfectly  free,  and,  in  all  pro- 
bability will  continue  free.     How  curious  these  peculiarities  are  ! 

Yet  gout  and  rheumatism  are  pathological  first  cousins;  but 
why  does  one  affect  the  heart,  the  other  not?  I  cannot  tell  you. 
Well,  we  gave  this  boy  a  mild  mercurial  first,  to  settle  all  right 
in  the  prim*  vice,  and  we  shall  follow  that  up  with  the  sulphate 
of  zinc,  in  which  I  have  great  faith  as  a  remedy  in  chorea.  At 
Guy's  at  least,  we  have  not  yet  hit  on  any  thing  equal  to  it. 

These  poor  patients  with  chorea  are  often  very  ludicrous,  but 
very  distressing  to  observe.  I  have  seen  four  or  five  deaths  from 
the  excessive  exaggeration  of  the  chorea  spmptoms ;  like  lizards 
or  eels,  such  patients  are  contorted  into  a  myriad  of  forms ;  they 
glide*  and  twist  and  tumble  about  the  floor  and  out  of  bed  or  into 
the  fire!  I  have  known  chorea  to  begin  with  pregnancy,  and 
go  on  increasing  as  the  poor  big-bellied  woman  got  bigger  and 
more  unwieldly,  and  only  yield  when  the  uterus  became  empty 
again  !  Dr.  Hamilton  once  thought  purgatives  cured  chorea : 
but  I  do  not  believe  this  is  invariably  found.  Sulphate  of  zinc 
or  oxide  of  zinc  is  the  remedy  we  have  made  out  as  most  valua- 
ble at  Guy's.  I  have  known  a  patient  take  of  sulphate  of  zinc 
(not  oxide,  mind)  so  much  as  eighteen  grains  four  times  a  day. 
My  attention  was  once  drawn  by  the  late  Dr.  Chambers  to  a 
peculiar  cast  of  countenance  such  patients  acquire  who  are  taking 
these  very  large  doses  of  zinc  :  you  know,  of  course,  the  dark 
tint  or  tinge  produced  by  nitrate  of  silver,  the  dark  line  of  the 
gums  by  lead,  kc.  We  were  attending  a  patient  for  another 
disease  altogether,  and  though  Dr.  Chambers  could  not  describe 
what  it  was,  he  said,  to  one  in  the  apartment,  ;'Why  you  are 
taking  zinc,  are  you  not?''  and  it  turned  out  that  he  was.  The 
nearest  idea  I  can  give  you  of  the  zinc  complexion  of  the  face 
is.  that  it  is  destitute  of  the  freshness  and  cherry  redness  of  rude 
health,    and  the  skin  of  the  face  assumes  a  glossy  sameness  of 

*  It  was  recently  stated  that  a  young  man  dropped  dead  of  fright,  at  a  theatre, 
on  seeing  the  Ghost  in  'Hamlet'  stalk  forth  for  the  first  time  on  the  stage;  and 
a  similar  case  of  death  from  fright,  not  long  since  formed  the  subject  of  a  coroner's 
inquest. 


414  Causes  of  Pneumonia.  [June, 

tint  very  like  pewter;  in  fact,  Dr.  Chambers  knew  the  "pewter 
face"  very  well ;  it  requires  the  light  to  fall  in  a  particular 
direction,  and  then  you  will  see  it :  the  hint  may  be  of  use  to 
you.  We  will  now  say  a  few  words  about  the  patient  in  the 
bed  No.  20.  He  has  been  in  the  habit,  he  tells  us,  of  carrying 
heavy  loads  on  his  head  ;  this  I  need  not  say,  produces  a  strain 
on  the  muscles  about  the  neck,  and  pressure  on  the  veins.  Well, 
lie  has  had  fits  of  unconsciousness,  and  now  has  excessive  pain 
of  a  neuralgic  character  in  his  limbs.  We  had  a  man  not  long 
since  under  care,  you  recollect,  with  what  I  called,  "  ligamen- 
tous rheumatism."  I  have  seen  more  than  once  this  sort  of  liga- 
mentous rheumatism  attacking  the  delicate  ligaments,  the  odon- 
toid, and  others  of  the  articulation  of  the  axis  occipital  bone  and 
others  of  the  axis  and  atlas ;  in  one  case  of  a  boy  it  threatened 
to  end  in  universal  paralysis,  as  the  thickened  membranes  no 
doubt  pressed  on  the  medulla  oblongata,  producing  a  somewhat 
common  disease,  myelitis  of  the  medulla  oblongata  or  chord,  or 
perhaps  mechanical  pressure.  In  a  woman  with  the  same 
disease  I  verily  believe  we  saved  her  life  by  keeping  the  head, 
almost  in  splints,  perfectly  quiet.  We  will  adopt  the  same  plan 
in  this  poor  man  ;  we  shall  support  him  and  prescribe  cod-liver 
oil  and  tonics,  and  you  will  see  the  result. — [Medical  Circular. 


On  the  Causes  of  the  Pneumonia  which  supervenes  upon  Laryngo- 
tomy.     By  Professor  Schuh. 

All  surgeons  of  experience  are  aware  that  pneumonia  is  some- 
times observed  after  the  performance  of  laryngotomy  or  trach- 
eotomy :  but  observers  are  by  no  means  agreed  upon  the  causes 
of  this.  Most  persons,  however,  seem  of  opinion  that  the  opera- 
tion itself  does  not  bear  any  direct  casual  relation  to  this  occur- 
rence. Professor  Schuh  entirely  differs  from  them,  and  the  per- 
formance of  a  very  large  number  of  operations  upon  the  air-pas- 
sages, during  his  twenty-three  years'  attendance  at  the  Vienna 
Hospital,  enables  him  to  speak  with  authority  upon  the  subject. 
Although  a  great  advocate  for  these  operations  under  a  variety 
of  circumstanses,  he  is  convinced  that  the  altered  position  and 
amount  of  the  column  of  air  that  is  admitted  into  the  lungs  is 
not  unfrequently  the  sole  cause  of  the  supervening  pneumonia. 
The  following  are  the  grounds  for  this  opinion: — 

1.  The  air,  after  the  operation,  enters  the  lungs  by  a  shorter 
passage,  and  by  one  that  is  straight  in  place  of  being  curved,  as 
before ;  and  it  does  not  pass  through  an  aperture  which  is  alter- 
nately widened  and  contracted,  as  is  the  case  with  the  rimaglot- 
tidis.  The  column  of  air,  too,  which  passes  through  the  canula 
is  larger  than  that  which  traverses  the  glottis,  for  if  a  smaller 


1858.]  Causes  of  Pneumonia.  415 

canula  were  employed,  it  would  be  liable  to  dangerous  obstruc- 
tion. We  have  thus  two  important  changes  in  the  mechanical 
conditions  of  respiration  ;  and  the  lung  becomes  exposed  to  the 
pressure  and  impulse  of  a  large  column  of  air,  arriving  more 
rapidly  bv  a  shorter  passage.  This,  so  tender  and  vascular  an 
organ  will  not  always  support,  and  inflammation  may  be  easily 
excited,  just  as  it  may  when,  in  the  operation  of  paracentesis 
thoracis,  the  fluid  is  too  rapidly  drawn  off,  and  the  lung  is  too 
suddenly  exposed  to  the  pressure  of  the  air.  2.  Experience 
confirms  what  a  priori  might  have  been  expected.  Any  one 
who  has  very  frequently  performed  the  operation,  must  have 
met  with  cases  in  which  the  patient  has  complained  of  the 
admission  of  too  large  a  quantity  of  air,  and  has  only  felt  at  ease 
when  the  opening  of  the  canula  has  been  diminished  a  third  or 
a  half  by  sticking-plaster.  If  such  an  indication  of  an  intelli- 
gent and  observant  patient  be  neglected,  pneumonia  will  follow. 

3.  The  author  has  lost  several  patients  in  whom,  at  the  time  of 
its  performance,  no  signs  of  pneumonia  could  be  detected,  and 
who  seemed  to  be  going  on  very  well  to  the  tenth  or  even 
twenty-first  day.  ]S"ot  only  did  no  other  cause  for  the  devel- 
opment of  the  pneumonia  exist,  but  this  was  also  always  found 
on  the  right  side — this  being  on  account  of  the  greater  width 
and  shortness  of  the  right  bronchus  more  exposed  to  the  impulse 
of  the  air.  The  disease  does  no£  come  on  actively,  but  is  indi- 
cated by  some  -acceleration  of  respiration  and  slight  fever. 
Physical  examination,  however,  shows  that  very  considerable 
infiltration  has  taken  place;  and  the  neglecting  to  institute  this 
may  be  a  cause  that  many  pneumonias  have  been   overlooked. 

4.  Cases  of  cut-throat,  in  which  the  larynx  is  wholly  or  partially 
divided,  also  strikingly  exhibited  the  danger  of  opening  into  the 
air  passages,  such  patients  not  infrequently  perishing  in  a  few 
days  of  pneumonia,  this  ahvays  commenced  on  the  right  side, 
and  in  even  fatal  cases  being  usually  confined  to  that  side.  It 
may  also  spring  up  in  smaller  wounds  of  this  part,  if  these  be 
not  kept  carefully  closed  either  by  sutures  or  suitable  dressings 
and  bandages. 

To  the  question  whether  pneumonia  after  laryngotomy  can 
be  prevented,  the  answer  is,  that  it  can  in  many  cases,  but  not 
in  all.  For  this  purpose  no  wider  canula  should  be  employed 
than  is  necessary  to  maintain  uninterrupted  respiration  ;  and  as 
soon  as  the  patient  can  breathe  freely  enough  through  the  mouth, 
and  can  both  breathe  and  speak  when  its  orifice  is  closed,  it 
should  be  changed  for  a  smaller  one,  or  its  opening  should  be 
partly  closed  by  plaster.  When  the  breathing  continues  per- 
fectly easy,  the  canula  being  stopped,  before  this  is  entirely 
removed  it  should  be  allowed  to  remain  in,  completely  stopped, 
during  twentyfour  hours,  care  being  taken  that  it  should   not 


416  Causes  of  Pneumonia.  [June, 

project  inwardly,  so  as  to  narrow  the  normal  passage  for  the  air. 
The  temperature  of  the  room  should  never  be  allowed  to  sink 
below  66^  Fahr. 

It  is  often  exceedingly  difficult  to  determine  the  time  when 
the  canula  should  be  finally  removed.  After  such  removal,  the 
patient  may  continue  to  breathe  quite  easy  for  from  two  to 
eight  days,  when  the  difficulty  gradually  returns,  until  it  be- 
comes as  bad  as  ever.  If  even  a  couple  of  days  have  passed, 
the  re-introduction  of  the  canula  can  seldom  be  accomplished, 
and  then  only  by  first  passing  through  the  canula  a  conical  obtur- 
ator, which  can  better  overcome  the  elasticity  of  the  edges  of  the 
cartilage.  The  longer  the  canula  has  remained  prior  to  removal, 
the  more  readily  may  it  be  re-introduced.  The  recurrence  of 
dyspnoea  is  especially  to  be  apprehended  when  we  have  reason 
to  suspect  ulcer  of  or  around  the  rima,  open  abcesses,  and  sinuses 
beneath  the  mucous  membrane.  Tumefaction  rapidly  diminish- 
es, and  the  normal  permeability  is  soon  re-established;  but  on 
the  admission  of  the  stream  of  air  to  the  diseased  part  by  the 
withdrawal  of  the  canula,  the  former  difficulties  may  soon  be 
reproduced.  Hence,  when  the  diagnosis  can  be  established,  the 
canula  in  such  cases  should  be  retained  during  several  weeks, 
in  order  to  give  the  surfaces  time  for  healing.  According  to 
Professor  Schuh's  experience,  pneumonia  never  comes  on  after 
the  first  twenty-one  da}'s  are  passed,  and  the  canula  may  then 
be  worn  for  months  or  years  without  inj  ury.  On  the  other  hand, 
the  Professor  has  lost  cases  by  removing  the  canula  too  late, 
pneumonia  unexpectedly  appearing.  The  sensibility  of  the  lung 
to  the  unusual  arrival  of  air,  is  especially  great  when  the  difficul- 
ty of  breathing  that  has  given  rise  to  the  operation  has  been  of 
long  duration,  and  the  organ  has  become  enfeebled  by  venous 
congestion  and  a  diminution  of  the  contractile  powers  of  its  cells. 

In  a  case  in  which  Professor  Schuh  performed  laryngotomy 
in  order  to  facilitate  the  removal  of  a  large  pharyngeal  polypus, 
the  patient  who  had  suffered  for  months  from  a  difficulty  of 
breathing,  was  quite  well  on  the  day  of  the  operation.  The 
canula  having,  however,  been  left  in  during  twenty-four  hours, 
pneumonia  was  detected  by  auscultation  within  this  period. 

Thus,  it  results  from  what  has  been  said,  that  pneumonia  is 
sometimes  a  consequence  of  breathing  through  an  artificial 
opening ;  and  by  due  regulation  of  the  size  of  the  volume  of 
air,  the  temperature  of  the  room,  and  the  timely  removal  of  the 
canula,  it  may  usually  be  prevented.  This,  however  is  not 
always  the  case,  for  the  condition  of  the  patient  may  require  a 
long  retention  of  the  canula,  the  lung  may  be  excessively  sen- 
sible to  the  changed  mechanism,  and  art  has  as  yet  furnished 
no  apparatus  as  a  substitute  for  the  alternated  dilatation  and 
contraction  of  the  glottis. — [Wien  Wochensch.,  and  British  and 
Foreign  Med.  Chir.  Rev. 


1858.]  Editorial  and  Miscellaneous.  417 


EDITORIAL  AND  MISCELLANEOUS. 

THE  AMERICAN  MEDICAL  ASSOCIATION. 

This  National  Medical  Congress  of  our  Republic  held  its  eleventh 
annual  meeting  in  Washington,  (D.  C.,)  beginning  May  5th,  1858. 

The  Association  met  in  the  Lecture-room  of  the  Smithsonian  Insti- 
tute, and  was  called  to  order  at  a  quarter  past  11  o'clock  A.  M.,  by  Dr. 
Condie,  of  Philadelphia,  when  the  Chair  was  taken  by  the  President, 
Dr.  Paul  F.  Eve,  of  Nashville,  Tennessee.  Vice-Presidents,  Breckenridge 
of  Kentucky,  Reese  of  New  York,  and  Campbell  of  Georgia,  were  also  on 
the  platform ;  and  at  their  table  were  the  efficient  Secretaries,  Drs.  Fos- 
ter of  Tennessee  and  Semmes  of  this  city  [Washington].  Rev'd  Byron 
Sunderland,  D.  D.,  at  the  invitation  of  the  President,  offered  an  eloquent 
and  appropriate  prayer,  invoking  the  blessing  of  Almighty  God  upon  the 
Convention. 

The  meeting  was  then  addressed  by  Dr.  Harvey  Lindsley,  of  Washing- 
ton, Chairman  of  the  Committee  of  Arrangements.  His  welcome  was 
warm  and  open-hearted,  and  expressed  in  language  chaste,  beautiful  and 
appropriate;  and  was  indeed  but  the  earnest  of  that  abundant  hospitali- 
ty the  members  were  to  receive  during  their  sojourn  at  the  Capital. 

The  number. of  delegates  and  permanent  members  present  was  larger, 
we  think,  than  ever  assembled  on  any  similar  occasion,  excepting,  per- 
haps, the  meeting  in  1853,  held  in  the  city  of  New  York.  The  names 
amounted  to  over  four  hundred,  on  the  calling  of  the  roll  at  the  first 
session. 

On  the  calling  of  the  roll  by  the  Secretary,  State  by  State,  as  it  had 
been  made  out,  up  to  the  commencement  of  the  meeting,  the  following 
number  of  delegates  responded  : 

Maine  2,  New  Hampshire,  8,  Connecticut  18,  Vermont  1,  Massachu- 
setts 40,  Khode  Island  5,  New  York  *73,  New  Jersey  25,  Pennsylvania  66, 
Delaware  4,  Maryland  24,  District  of  Columbia  25,  Virginia  8,  North 
Carolina  8,  South  Carolina  10,  Georgia  12,  Alabama  1,  Kentucky  0, 
Tennessee  7,  Indiana  6,  Illinois  12,  Michigan  3,  Iowa  3,  Missouri  4,  Ohio 
14,  California  1,  American  Medical  Society  of  Paris  1,  U.  S.  Navy  2. 
[When  the  name  of  Dr  Harvey,  who  has  come  from  California  expressly 
to  attend  this  convention,  was  called,  there  was  a  loud  applause.]  Other 
members  were  announced  at  different  times  during  the  day,  and  when 
the  Association  adjourned  there  were  four  hundred  and  six  names  regis- 
tered. 

Dr.  David  M.  Reese,  of  New  York,  now  presented  and  read  a  written 
apology  for  having  recommended  for  a  position  in  Blockley  Hospitalr 


418  Editorial  and  Miscellaneous.  [June, 

Philadelphia,  Dr.  McClintock,  who  had  been  expelled  from  the  Associa- 
tion for  a  violation  of  the  ethics  and  the  etiquette  of  the  Profession,  by- 
lending  himself  to  the  quackery  of  Patent  Medicines. 

On  motion  of  Di;.  Condie,  of  Philadelphia,  the  apology  was  accepted, 
and  ordered  to  be  entered  upon  the  minutes. 

Dr.  Bryan,  of  Philadelphia,  who  had  also  recommended  Dr.  McClin- 
tock, made  a  verbal  adoption  of  Dr.  Reese's  apology,  the  reception  of 
which  was  warmly  debated.  Dr.  C.  C.  Cox,  of  Maryland,  opposed,  and 
Dr.  Condie  advocated  the  reception.  Dr.  A.  B.  Palmer,  of  Michigan, 
moved  the  previous  question  on  a  motion  to  refer  the  subject  to  a  com- 
mittee, which  was  lost.  The  apology  of  Dr.  Bryan  was  then  accepted. 
[It  was  rumored  in  the  hall  that  Dr.  McClintock  will  be  reinstated  during 
the  session  of  the  Association.] 

The  President,  Professor  Paul  F.  Eve,  of  Nashville,  Tennessee,  then 
delivered,  in  a  clear  voice  and  with  pleasing  oratorical  effect,  his  annual 
address  to  the  Association.  This  paper,  which  is  a  most  able  review  of 
the  history  of  the  Association  from  its  beginning  to  the  present  time, 
most  eloquently  and  conclusively  vindicates  that  body  from  the  charge 
of  having  accomplished  but  little,  and  is  eminently  calculated  to  inspire 
its  members  with  pride  in  view  of  what  they  have  accomplished  in  the 
past,  and  with  energy  and  determined  high  purpose  for  the  future.  It  is 
fortunate  that,  by  the  unanimous  action  of  the  Association,  such  a  paper 
is  to  be  recorded  in  the  next  volume  of  the  Transactions — and  every 
journal  should  record  it,  as  an  encouragement  and  a  stimulus  to  the 
American  Medical  Profession.  It  shall  be  presented  to  our  readers  in 
our  next  number,  as  a  separate  paper. 

Dr.  Grafton  Tyler,  of  Georgetown,  D.  C,  chairman  of  the  committee 
on  prize  essays,  reported  that  the  essays  received  were  three  in  number, 
each  of  which  had  been  examined  with  great  care ;  considering,  first, 
the  intrinsic  merits  of  each  essay,  and  then  their  merits  in  relation  to 
each  other.  The  first  prize  was  awarded  to  "  an  essay  on  the  clinical 
study  of  the  heart's  sounds,  in  health  and  disease,"  bearing  the  motto — 
"Clinica  clinice  demonstrandum."  The  second  prize  was  awarded  to 
"  an  essay  on  vision  and  some  of  the  anomalies  as  rendered  by  the  oph- 
thalmoscope," bearing  the  motto — "  Dux  kominum  medicus  est." 

Dr.  Tyler  then  proceeded  to  open  the  sealed  envelopes  bearing  the 
above-named  mottoes,  and  containing  the  names  of  the  writers  of  the 
essays.  The  first  was  written  by  Dr.  Austin  Flint,  of  Buffalo,  New  York ; 
and  the  second  by  Dr.  Montrose  A.  Pallen,  of  St.  Louis,  Missouri.  This 
is  the  second  time  Dr.  Flint  has  won  this  distinguished  honor,  and  the 
third  time  that  it  has  been  awarded  to  Buffalo  since  the  association  was 
organized,  eleven  years  ago. 


1858.]  Editorial  and  Miscellaneous.  419 

On  motion,  the  report  of  the  committee  was  accepted  and  adopted. 
Doctors  Flint  and  Pallen  were  then  invited  to  give  resumes  of  their 
essays,  which  they  did,  and  each  of  the  gentlemen  was  listened  to  with 
marked  attention  on  the  part  of  the  association. 

Among  other  gentlemen,  Dr.  Peter  Parker,  ex-commissioner  to  China, 
and  assistant-surgeon  Frederick  A.  Rose,  of  the  British  Navy,  were  unani- 
mously elected '*  members  by  invitation." 

The  latter  gentleman,  Dr.  F.  A.  Rose,  of  the  British  Navy,  who  so  no- 
bly volunteered  his  services  on  boafd  the  United  States  ship  Susquehan- 
na, at  Port  Royal,  and  who  came  in  her  to  New  York,  devoting  himself 
to  the  sick  crew,  was  unanimously  elected  a  "member  by  invitation," 
and  invited  to  take  a  seat  upon  the  platform.  [Applause.]  It  was  an- 
nounced that  Dr.  Rose  had  left  the  city. 

Dr.  Francis  G.  Smith,  of  Philadelphia,  chairman  of  the  committee  on 
publication,  made  his  report,  showing  the  expense  of  publishing  the  an- 
nual volume. 

Dr.  Caspar  Wistar,  of  Philadelphia,  presented  his  annual  report  of 
receipts  and  expenditures,  showing  a  balance  on  hand  of  $806.  Accom- 
panying the  Treasurer's  report  was  a  resolution  providing  that  the  back 
volumes  on  hand,  when  over  two  years  old,  shall  be  sold  at  two  dollars  a 
volume,  and  that  volumes  V,  VII,  VIII,  and  IX,  of  whieh  there  are  a 
surplus,  be  sold  at  $5  a  set  to  any  member. 

A  report  was  made  by  the  committee  on  nominations,  which  was  ac- 
cepted ;  and  the  association  then  elected  the  following  officers : 

President,  Dr.  Harvey  Lindsley,  of  Washington  City.  Vice-Presi- 
dents, Drs.  W.  L.  Sutton,  of  Kentucky ;  Thomas  0.  Edwards,  of  Iowa ; 
Josiah  Crosby,  of  New  Hampshire;  and  W.  C.  Warren,  of  North  Caroli- 
na. Secretary,  Dr.  A.  J.  Semmes,  of  Washington  City.  [The  other 
Secretary  will  be  elected  when  the  location  of  the  next  association  is 
selected.]     Treasurer,  Dr.  Caspar  Wistar,  of  Philadelphia. 

On  motion,  Drs.  Flint,  of  New  York,  Gross,  of  Pennsylvania,  and 
Gibbes,  of  South  Carolina,  were  appointed  a  committee  to  conduct  the 
President  elect  to  the  chair. 

Dr.  Lindsley,  having  been  introduced  to  the  association  by  the  retiring 
President,  Dr.  Eve,  made  a  few  pertinent  remarks,  acknowledging  the 
honor  as  the  highest  he  had  ever  been  called  upon  to  receive,  and  the 
highest  that  any  medical  man  in  America  can  receive.  [Applause.] 
Unaccustomed  to  preside  over  so  large  a  body,  and  having  had  but  little 
practice  in  presiding  over  smaller  assemblages,  he  must  throw  himself 
upon  the  forbearance  of  the  association,  and  look  to  the  members  for 
support  in  the  discharge  of  his  official  duties.     [Applause.] 

On  motion,  the  thanks  of  the  association  were  voted  to  the  retiring 
x.  8. — vol.  xiv.  yo.  vu  20 


420  Editorial  and  Miscellaneous.  [June, 

officers  for  the  able  and  impartial  manner  in  which  they  have  discharged 
the  duties  of  their  respective  offices.     [Applause.] 

On  motion,  the  ex-presidents  of  the  association  present  were  invited  to 
take  seats  on  the  platform. 

The  committee  on  medical  topography  and  epidemics  was  called  by 
States.  A  paper  from  the  member  from  Maine  stated  that  he  will  report 
next  year.  There  was  no  response  from  New  Hampshire,  Vermont, 
Rhode  Island,  Connecticut,  or  Massachusetts.  Dr.  Smith,  of  New  Jer- 
sey, read  an  able  report  on  New  Jersey,  and  the  association  then  ad- 
journed until  this  morning  at  nine  o'clock. 

Evening  Hospitalities. — At  eight  o'clock  in  the  evening  the  dele- 
gates and  the  ladies  who  have  accompanied  them  paid  a  visit  by  invita- 
tion to  the  Executive  Mansion.  The  East  Room,  with  the  adjacent  suite 
of  drawing  rooms,  were  brilliantly  lighted,  and  were  filled  by  about  five 
hundred  gentlemen,  representing  all  sections  of  the  country,  and  a  hun- 
dred or  more  ladies.  One  of  the  delegates  had  seen  upwards  of  four 
score  years — others  have  but  just  entered  upon  the  practice  of  their 
profession. 

The  President  received  his  guests,  as  they  were  successively  presented 
by  Dr.  Cornelius  Boyle,  chairman  of  the  committee  of  arrangements,  with 
his  accustomed  cordiality,  and  afterwards  moved  about  in  the  East  Room, 
engaging  in  conversation  with  the  gsoups  there  gathered.  The  entire 
cabinet  was  present,  with  J.  B.  Henry,  Esq.,  Marshal  Selden,  and  Com- 
missioner Blake. 

From  the  Executive  Mansion  the  delegates  generally  proceeded  to 
Georgetown,  where  they  were  hospitably  entertained  at  the  residences 
of  Dr.  Grafton  Tyler,  at  the  corner  of  Gay  and  Washington  streets,  and 
of  Dr.  Riley,  No.  91  Gay  street.  A  cordial  welcome  and  good  cheer 
awaited  them  at  the  houses  of  each  of  these  distinguished  practitioners. 

There  was  a  large  number  of  arrivals  at  the  different  hotels  last  even- 
ing, and  an  interesting  session  may  be  expected  to-day. 

SECOND  DAY. 

The  Association  was  called  to  order  by  the  President,  Dr.  Harvey 
Lindsley,  and  A.  J.  Semmes,  one  of  the  Secretaries,  read  the  minutes  of 
the  first  days  proceedings ;  which  were  adopted. 

On  motion  of  Dr.  Watson,  of  New  York,  Dr.  Delafield,  of  New  York, 
one  of  the  first  officers  of  the  association,  was  invited  to  take  a  seat  on 
the  platform. 

On  motion  of  Dr.  Atkinson,  of  Virginia,  an  amendment  to  the  consti- 
tution was  received,  providing  that  no  person  shall  be  recognized  as  a 
member  or  admitted  as  a  delegate  at  meetings  of  the  association  who 
has  been-  expelled  from  any  State  or  local  medical  association,  until  re- 
lieved by  action  of  such  State  or  local  association.     [Applause.] 


1858.]  Editorial  and  Miscellaneous.  421 

An  abstract  of  the  report  on  medical  literature  was  then  read  by  Dr. 
A.  B.  Palmer,  of  Michigan ;  which  report  was,  on  motion,  accepted  and 
referred  to  the  committee  of  publication. 

On  motion,  Dr.  N.  Bozeman,  of  Alabama,  was  elected  a  member  by- 
invitation. 

The  report  on  medical  education  was  now  presented  by  the  chairman, 
Dr.  James  R.  Wood,  of  New  York.  This  is  an  able  and  judicious 
paper,  of  which  we  can  at  present  only  give  a  summary,  hoping,  in  some 
future  number,  to  transfer  the  whole  of  it  to  our  pages.  Dr.  Wood,  in 
our  opinion,  acted  with  good  judgment,  in  referring  many  of  the  details 
of  medical  education  to  a  convention  of  professors  of  colleges.  This, 
certainly,  instead  of  disfranchising  the  schools,  as  was  apprehended 
might  be  attempted  at  the  present  meeting,  is  decidedly  a  step  taken 
the  other  way.  This  measure  is  the  more  to  be  appreciated,  coming  as 
it  does,  from  Dr.  Wood,  who,  though  not  connected  with  any  college, 
knows  well  how  to  estimate  the  exigencies  and  the  requirements  of  medical 
teaching,  in  our  country,  from  his  long  and  intimate  relation  to  this  de- 
partment, in  the  position  he  has  so  creditably  filled  in  Bellevne  Hospital. 

The  subjects  discussed  in  this  report  are  the  following: — 1st,  primary 
medical  schools ;  2nd,  the  number  of  professorships  in  medical  colleges ; 
3rd,  the  length  and  number  of  tenns  during  the  year ;  4th,  the  requisite 
qualifications  for  graduation ;  5th,  such  other  subjects  of  a  general  char- 
acter as  to  give  uniformity  to  our  medical  system.  Having  reviewed 
these  propositions  at  length,  the  committee  have  arrived  at  the  following 
conclusions : 

First.  Primary  medical  schools  should  be  encouraged ;  but,  as  office 
nstruction  will  continue  to  be  sought  by  students,  practitioners  should 
either  give  them  necessary  advantages  of  demonstrations,  illustrations, 
md  recitations,  or  if  not  prepared  to  do  so,  they  should  refer  them  to 
such  primary  schools,  or  medical  men,  as  will  give  them  proper  instruc- 
tion. 

Second.  The  number  of  professorships  should  not  be  less  than  seven — 
viz :  a  Professor  of  Anatomy  and  Microscopy,  Physiology  and  Pathology, 
Chemistry,  Surgery,  Practical  Medicine,  Obstetrics,  and  Materia  Medica. 

Third.  There  should  be  but  one  term  annually,  which  should  com- 
mence about  the  1st  of  October,  and  close  with  the  March  following,  thus 
lengthening  the  term  to  six  months.  The  commencement  of  the  term, 
in  October,  should  be  uniform  in  all  the  colleges  throughout  the  country. 
During  the  session  there  should  never  be  more  than  four  lectures  given 
daily. 

Fourth.  The  qualifications  for  graduation,  in  addition  to  those  now 
required  by  the  schools,  should  be  a  liberal  primary  education,  and  at- 
tendance upon  a  course  of  clinical  instruction  in  a  regularly  organized 
hospital. 

In  order  to  give  our  medical  colleges  an  opportunity  to  consider  the 


422  Editorial  and  Miscellaneous.  [June, 

recommendations  here  advanced,  and  that  this  body  may  have  the  ad- 
vantage of  their  wisdom  and  their  mature  views,  before  any  definite 
action  is  taken  upon  them,  your  committee  submit  to  the  association  the 
following  resolutions : 

Resolved,  That  the  several  medical  colleges  of  the  United  States  be 
requested  to  send  delegates  to  a  convention  to  be  held  at  on 

the         day  of  for  the  purpose  of  devising  a  uniform  system  of 

medical  education. 

Resolved,  That  the  present  report  af  the  special  committee  on  medical 
education  be  referred  to  such  convention  for  its  consideration. 

Resolved,  That  said  convention  of  delegates  from  the  several  colleges 
of  the  United  States  be  requested  to  submit  to  the  meeting  of  this  asso- 
ciation in  May,  1859,  the  result  of  their  deliberations. 

On  motion,  the  report  was  accepted  and  referred  to  the  committee  on 
publication,  the  accompanying  resolution  being  laid  on  the  table. 

The  committee  on  nominations  reported  Louisville,  Ky.,  as  the  place 
of  meeting  in  1859,  and  nominated  Dr.  S.  S.  Bemis,  of  that  city,  as  se- 
cond secretary.  They  also  nominated  the  following  standing  commit- 
tees: 

Committee  on  Publication — Dr.  F.  Gurney  Smith,  Pa.,  chairman ;  Drs, 
Caspar  Wistar,  Pa. ;  A.  J.  Semmes,  D.  0. ;  S.  M.  Bemis,  Ky. ;  S.  L.  Hol- 
linsworth,  Pa. ;  S.  Lewis,  Pa. ;  H.  F.  Askew,  Del. 

Committee  on  Medical  Literature — Dr.  John  Watson,  N.  Y.,  chairman; 
Drs.  L.  A.  Smith,  N.  J. ;  C.  G.  Comegys,  Ohio ;  R.  W.  Gibbes,  S.  C. ;  W. 
M.  McPheeters,  Mo. 

Committee  on  Prize  Essays — Dr.  J.  B.  Flint,  Kv.,  chairman ;  Drs. 
M.  Goldsmith,  N.  J.;  H.  Miller,  Ky.;  Calvin  "West,  Ind. 

Committee  on  Medical  Education — Dr.  G.  W.  Norris,  Pa.,  chairman ; 
Drs.  A.  H.  Luce,  111.;  E.  R.  Henderson,  S.C. ;  G.  R.  Grant,  Tenn.;  T.  S. 
Powell,  Ga. 

Committee  of  Arrangements — Dr.  R  J.  Breckenridge,Ky.,  chairman ; 
Drs.  G.  W.  Ronald,  B.  M.  Wible,  D.  W.  Goodall,  D.  D.  Thompson,  N. 
B.Marshall,  G.  W.  Burglass,  R.  C.  Hewett,  and  A.  B.  Cook,  all  of 
Kentucky. 

The  report  was  accepted,  the  nominations  were  confirmed,  and  the 
committee  received  permission  to  sit  again. 

After  considerable  discussion,  it  was  decided  that  the  meeting  go  into 
a  committee  of  the  whole,  to  reconsider  the  acceptance  of  the  apology 
presented  on  the  day  previous  by  Dr.  Reese. 

Dr.  T.  O.  Edwards,  of  Ohio,  now  took  the  chair. 

It  was  now  moved,  to  read  the  remonstrance  of  the  Philadelphia  Medi- 
cal Society,  in  which  all  the  circumstances  of  the  recommendation  of 
Dr.  McClintock  by  Dr.  Reese,  and  his  appointment  to  office  in  Blockley 
Hospital,  were  fully  set  forth. 

Dr.  Biddle,  of  Philadelphia,  protested  against  the  reading  of  the  re- 
monstrance, as  a  violation  of  plighted  faith. 


1858.]  Editorial  and  Miscellaneous.  423 

The  remonstrance  was  however  read.  It  was  a  long  document,  giving 
a  detailed  account  of  the  recommendation  by  Dr.  Reese  of  Dr.  McClin- 
tock  for  a  position  in  Blockley  Hospital,  after  the  last-named  gentleman 
had  been  guilty  of  selling  quack  nostrums,  and  had  thus  committed  an 
offence  against  the  ethics  of  the  profession. 

Dr.  Humphries  of  Indiana,  moved  that  each  member  of  the  commit- 
tee of  the  whole  be  restricted  to  five  minutes,  allowing  Dr.  Reese  what- 
ever time  he  wished  to  defend  himself  in. 

Dr.  Phelps  showed  that  a  ten-minutes  rule  was  now  in  force.  Dr.  Cox 
moved,  as  an  amendment,  to  make  the  time  fifteen  minutes ;  which 
amendment  was  lost,  and  the  original  motion  of  Dr.  Humphries  was  then 
carried. 

Dr.  Reese  then  ascended  the  platform,  and  made  a  statement  of  his 
position  from  the  commencement  of  the  controversy.  He  considered 
his  apology  of  the  day  previous  a  satisfactory  one,  but  was  willing  to 
make  it  more  so  if  it  was  objected  to.  He  had  not  brought  the  subject 
before  the  association ;  but  had  been  given  to  understand  that  if  he 
made  the  apology  which  he  had  made,  the  remonstrance  would  not  be 
offered.  During  his  remarks  there  was  a  demand  for  the  reading  of  the 
apology ;  which  was  read,  as  follows : 

To  the  Officers  and  Members  of  the  American  Medical  Association  : 
The  undersigned,  one  of  the  vice-presidents  of  the  American  Medical 
Association,  having  during  the  interval  since  our  last  annual  meeting, 
certified  to  the  professional  fitness  for  the  charge  of  the  Blockley  Hospi- 
tal, at  Philadelphia,  of  an  individnal  who  had  been  expelled  from  this 
body  for  a  violation  of  our  code  of  ethies,  after  consultation  with  the 
other  officers,  and  yielding  to  the  advice  of  other  personal  friends,  desires 
to  say  to  the  association  now  assembled — 

1st.  That  in  giving  said  certificate,  he  was  prompted  solely  by  motives 
of  sympathy  and  humanity  to  a  fallen  brother,  who  had  been  a  personal 
friend  prior  to  his  offence ;  and  that  he  did  not  realize,  acting  under  the 
impulse  of  the  moment,  that  hMs  individual  act  could  be  construed  by 
the  profession  as  indicating  hostility  to  his  brethren. 

2d.  That  while  his  own  mind  is  clear  that  his  certificate  contained 
only  the  truth,  and  that  under  his  peculiar  relations  to  the  party  con- 
cerned, he  could  not  withhold  his  certificate,  of  medical  qualification, 
consistent  with  conscience  and  duty,  yet  he  is  ready  to  concede  that 
he  had  no  abstract  right  to  relieve  the  party  from  the  censure  of  the 
association  until  this  body  had  restored  him  to  his  fellowship. 

3d.  That  so  far  from  intending  any  disrespect  to  the  association,  or 
to  its  act  of  discipline,  the  undersigned  had  publicly  sustained  and  de- 
fended both.     He  therefore  disclaims  the  inference  from  his  certificate 


424  Editorial  and  Miscellaneous.  [June, 

that  he  intended  to  recommend  to  a  high  professional  office  a  man  whom 
the  association  had  excluded,  and  thereby  nullify  the  action  of  this 
body. 

And,  finally,  with  these  statements  and  disclaimers,  the  undersigned, 
while  retaining  his  own  opinion  of  the  rectitude  of  his  motives,  and  of 
his  duty,  under  the  peculiar  circumstances  of  the  case,  is  nevertheless 
prepared  to  defer  to  the  judgment  of  those  whom  he  knows  to  be  his 
friends,  that  he  erred  in  doing  what  he  had  no  right  to  do,  in  view  of  his 
official  position  in  the  association,  and  is  hence  called  upon  to  offer  this 
explanation  and  apology  to  his  brethren. 

(Signed)  DAVID  M.  REESE. 

It  was  moved  to  refer  the  apology  and  remarks  of  Dr.  Reese  to  a  spe- 
cial committee  of  seven,  to  report  to-morrow  morning.  Dr.  Atlee,  of  Lan- 
caster, and  other  gentlemen  urged  delay. 

Dr.  Condie  hoped  that  a  committee  would  be  appointed  to  give  the 
subject  a  careful  consideration. 

Dr.  Cox,  of  Maryland,  after  complimenting  Dr.  Reese  as  an  able  prac- 
titioner and  an  experienced  editor,  whose  labors  have  been  of  great  value 
to  the  profession  and  to  the  country,  said  that  he  did  not  consider  the 
statement  full  and  satisfactory.  The  offence  was  not  an  unpardonable 
one,  but  the  violation  of  that  code  of  ethics  which  is  the  life  of  the  pro- 
fession should  be  properly  atoned  for.  [Applause.]  The  apology  was 
good  enough,  but  it  carried  as  its  sting  the  mental  reservation  which 
Dr.  Reese  persists  in.  Nay,  in  his  journal,  issued  simultaneously  with 
this  meeting,  and  circulated  here,  he  says :  "  Having  done  right  in  certi- 
fying to  the  labors  of  our  quandam  friend  McClintock,  we  resented  the 
unmerited  censures  of  our  Philadelphia  brethren."  This  completely  stul- 
tifies the  effect  of  the  apology. 

Dr.  La  Roche,  of  Philadelphia,  explained  his  action  and  that  of  the 
Philadelphia  county  society  in  the  matter. 

Dr.  Pain,  of  Vermont,  Dr.  Cox,  and  Dr.  Bond  made  some  rather  sharp 
remarks.  Dr.  Davis  of  Massachusetts,  thought  that  Dr.  Reese  had  but 
to  admit  that  he  had  done  wrong,  and  ask  pardon  without  any  mental 
reservation. 

Dr.  Reese  said  that  he  had  intended  to  make  a  satisfactory  apology. 
Such  was  his  earnest  wish  and  desire,  and  he  wished  to  frankly  state 
that  he  had  no  mental  reservation,  neither  did  he  attempt  to  conceal 
anything.  He  made  the  statement  which  had  been  read  without  reser- 
vation and  without  evasion.     [Applause.] 

Dr.  Conte  expressed  his  entire  satisfaction,  as  did  numerous  other  gen- 
tlemen, several  crossing  to  where  Dr.  Reese  was  sitting  and  shaking 
hands  with  him. 


1858.]  Editorial  and  Miscellaneous.  425 

The  committee  of  the  whole  then  rose,  and  the  chairman  reported  to 
the  president  that  the  committee  had  heard  and  discussed  the  apology  of 
Dr.  Reese,  and  that  they  considered  that  it  was  "ample,  full,  complete, 
and  satisfactory." 

On  motion,  the  report  of  the  committee  was  received  and  adopted. 

The  case  of  Dr.  Bryan  then  came  up,  when  it  was  suggested  that  his 
apology  should  be  in  writing,  he  expressing  a  willingness  to  make  one  as 
ample  as  was  that  of  Dr.  Reese.. 

Dr.  Reese  then  drafted  an  apology,  but  several  gentlemen  insisted 
that  he  should  insert  the  word  "  regret."  Dr.  Reese  declined,  stating 
that  no  gentleman  would  apologize  for  that  which  he  did  not  regret,  and 
that  he  would  never  be  dictated  to  by  any  gentleman,  even  if  the  prison- 
door  stood  open  on  his  right  hand,  and  the  stake  was  at  his  left  hand. 

Dr.  Wood  (who  was  greeted  with  loud  applause)  stated  that  he  had 
been  with  the  side  which  had  offered  the  apology,  but  he  did  not  con- 
sider the  apology  complete  without  the  insertion  of  the  word  "  regret." 

Drs.  Bonner,  Clark,  of  New  Jersey,  Hard,  of  Illinois,  Parker,  of  New 
York,  and  other  gentlemen  participated  in  an  exciting  debate  on  the 
necessity  of  having  the  word  "  regret"  inserted. 

Dr.  Reese  added  the  following  sentence,  "  and  regrets  that  he  has  in- 
curred the  displeasure  of  his  brethren."     This  was  not  favorably  received. 

Dr.  Boyle,  chairman  of  the  committee  of  arrangements,  here  announ- 
ced that  arrangements  had  been  made  by  which  delegates  who  had  pur- 
chased tickets  on  their  way  to  the  convention  over  the  following  roads 
could  return  free  by  exhibiting  their  cards  of  membership :  Pennsylva- 
nia, Wilmington  and  Manchester,  Illinois,  Central,  Northeastern  South 
Carolina,  and  Richmond  and  Petersburg. 

The  apology  of  Dr.  Reese  was  again  taken  up,  and  discussed  with 
spirit,  although  there  was  no  manifestation  of  bad  feeling  on  either  side. 
At  length  he  presented  the  following : 

"  The  undersigned  regrets  that  he  certified  to  the  professional  quali- 
fications for  Blockley  Hospital,  Philadelphia,  of  an  expelled  member  of 
this  body,  and  hereby  offers  this  apology  for  his  departure  from  the 
ethical  code." 

This  was  received  with  loud  applause,  and  on  motion  of  Dr.  White, 
accepted  as  an  ample  and  satisfactory  apology. 

Dr.  Bryan  submitted  a  similar  apology,  which  was  also  accepted,  and 
then  the  committee  adjourned  until  to-day  at  nine  o'clock,  A.  M.,  evidently 
well  pleased  that  this  question  was  finally  disposed  of. 

THIRD  DAY. 

The  President,  Dr.  Lindsley,  having  called  the  Association  to  order  at 
half-past  9  o'clock,  Dr.  Grant,  of  New  York,  asked  leave  to  present  a 


426  Editorial  and  Miscellaneous.  [June, 

complaint  against  the  New  York  Medical  College,  but  on  information  by 
Dr.  Edwards,  that  a  Committee  on  Ethics  would  be  recommended  by  the 
Nominating  Committee,  he  withdrew  the  request. 

The  appointment  during  last  year  of  Dr.  George  Hayward,  of  Boston^ 
as  a  delegate  to  represent  the  American  Medical  Association,  in  kindred 
societies  in  Europe,  was  announced  by  Dr.  Eve. 

Medical  Education. — Dr.  Hamilton,  from  the  Committee  of  Delegates 
from  medical  schools  and  colleges,  to  whom  was  referred  the  report  of 
the  Special  Committee  on  medical  colleges,  reported  the  following  pre- 
amble and  resolution: 

Fully  appreciating  the  value  and  importance  of  the  resolution  under 
which  they  were  appointed,  but  a  majority  of  the  gentlemen  constituting 
this  committee  not  being  authorized  by  the  medical  faculties  of  the  sev- 
eral colleges  with  which  we  are  connected  to  act  as  their  representatives 
in  this  matter,  and  therefore  regarding  it  quite  impossible  to  secure  a 
convention  of  delegates  in  the  interim  of  the  meetings  of  the  association  : 

Therefore,  Resolved,  That  we  recommend  to  all  the  medical  colleges 
entitled  to  a  representation  in  this  body,  that  they  appoint  delegates, 
especially  instructed  to  represent  them  in  a  meeting,  to  be  held  at  Louis- 
ville, on  Monday,  the  day  immediately  preceding  the  convention  of  the 
American  Medical  Association,  for  the  year  1859,  at  ten  o'clock,  at  such 
place  as  the  Committee  of  Arrangements  shall  designate. 

The  report  was  accepted,  and  the  preamble  and  resolution  were  pass- 
ed ;  after  which,  several  gentlemen  claimed  the  floor,  but  the  president 
decided  that  the  reports  of  special  committees  were  in  order,  the  reports 
of  committees  on  Medical  Topography  and  Epidemics  having  previously 
i)een  referred  to  the  Committee  on  Publication  without  reading. 

Dr.  Foster  Jenkins,  of  New  York,  read  a  report  on  the  Spontaneous 
Umbilical  Hemorrhage  of  the  newly  born ;  which  was  read  and  referred 
to  the  Committee  on  Publication. 

Marriages  of  Consanguinity. — Dr.  S.  .M,  Bemis,  of  Kentucky,  read 
an  able  and  learned  report  on  the  "  Influence  of  Marriages  of  Consan- 
guinity upon  Offspring. 

Stone  contributed  to  the  Washington  Monument. — Dr.  John  L. 
Atlee,  from  the  committee  appointed  at  the  annual  meeting  at  Richmond, 
in  May,  1852,  to  procure  a  stone  with  a  suitable  inscription  to  be  insert- 
ed in  the  Washington  National  Monument,  made  a  final  report.  It 
stated  that  Mr.  Haldy,  a  marble  mason  of  the  city  of  Lancaster,  Penn- 
sylvania, had  in  his  employment  a  young  man,  Mr.  J.  Augustus  Beck,  a 
native  of  Litiz,  Pennsylvania,  who  had  given  unmistakable  evidence  of 
genius  as  a  sculptor.  At  the  suggestion  of  the  late  lamented  Dr.  A.  L. 
Pierson,  of  Salem,  Massachusetts,  (made  at  the  meeting  in  New  York, 
just  ten  days  before  his  death,)  the  design  of  the  celebrated  painting  of 
Girodet  Tricoson,  representing  Hippocrates  refusing  the  presents  of  the 


1858.]  Editorial  and  Miscellaneous.  427 

Persian  king,  Artaxerxes,  and  his  invitation  to  leave  Greece,  and  reside 
and  practise  among  her  enemies,  was  selected.  This  was  sculptured 
upon  a  block  of  Vermont  marble,  with  the  motto,  "  Vincet  Amor 
Patrice"  and  the  stone  is  now  at  the  monument  grounds.  The  entire 
expense  was  $1,000,  of  which  one  half  was  paid  to  the  young  artist. 
The  amount  contributed  by  members  individually  was  8501.30;  the  bal- 
ance was  voted  from  the  treasury  of  the  society.  Accompanying  the 
report  was  a  letter  from  the  Secretary  of  the  Washington  National  Mo- 
nument Association,  and  a  resolution  of  thanks  to  the  railroad  compa- 
nies by  whose  liberality  the  stone  was  brought  from  Lancaster  to  Wash- 
ington, free  of  charge.     The  report  was  accepted,  and  the  resolution  was 


Dr.  Palmer,  of  Buffalo,  read  a  report,  made  by  Dr.  E.  Andrews,  of 
Chicago,  Illinois,  on  the  "  Functions  of  the  different  portions  of  the  Ce- 
rebellum." » 

Dr.  Campbell,  of  Georgia,  read  a  report  on  "  The  Nervous  System  in 
Febrile  Diseases,"  which  was  accepted,  and  referred  to  the  Committee 
on  Publication. 

Dr.  J.  Marion  Simms,  of  New  York  city,  read  an  abstract  of  his  report 
on  the  "Treatment  of  the  Results  of  Obstructed  Labor,"  illustrated 
with  a  series  of  magnified  illustrations. 

Committees  for  the  ensuing  year. — Dr.  Edwards,  from  the  Commit- 
tee of  Nomination,  offered  the  following  list  of  committees  for  the  ensu- 
ing year,  which  was  accepted,  and  the  committees  were  chosen : 

Special  Committee  on  the  Microscope. — Drs.  Holsten  of  Ohio,  Dal  ton 
of  New  York,  Hutchinson  of  Indiana,  Stout  of  California,  and  Ellis  of 
Massachusetts. 

Special  Committee  on  Medical  Jurisprudence. — Drs.  Smith  of  New 
York,  Hamilton  of  Buffalo,  Crosby  of  New  Hampshire,  Purple  of  New 
York,  and  Mulford  of  New  Jersey. 

Committee  on  Quarantine. — Drs.  Harris  of  New  York,  Moriarty  of 
Massachusetts,  La  Roche  of  Pennsylvania,  Wragg  of  South  Carolina,  and 
Fenner  of  St.  Louis. 

Committee  on  Surgical  Pathology. — Dr.  James  R.  Wood  of  New 
York,  chairman. 

Committee  on  Diseases  and  Mortality  of  Boarding  Schools. — Dr.  C. 
P.  Mallengly  of  Kentucky,  chairman. 

Committee  on  thevarions  Surgical  Operations  for  the  Relief  of  Defect- 
ive  Vision. — Dr.  Montrose  A.  Pallen  of  St.  Louis,  chairman. 

Committee  on  Milk  Sickness. — Dr.  Edward  A.  Murphy  of  Indiana, 
chairman. 

Committee  on  Medical  JEihics. — Drs.  John  Watson  of  New  York,  Dal- 
ton  of  Massachusetts,  Emerson  of  Pennsylvania,  Hamilton  of  New  York, 
and  Gaillard  of  South  Carolina. 

Dr.  Edwards  also  reported  from  the  Committee  of  Nomination,  the 
following  resolution,  in  reference  to  the  restoration  of  Dr.  Bailey : 


428  Editorial  and  Miscellaneous.  [June, 

Resolved,  That  a  committee  of  nine  be  appointed  by  the  chair  to  wait 
on  the  Hon.  Howell  Cobb,  Secretary  of  the  Treasury,  and  respectfully  to 
request  the  restoration  of  Dr.  M.  J.  Bailey,  as  inspector  of  drugs  and 
medicines  for  the  port  of  New  York. 

Dr.  Edwards  followed  his  resolution  by  an  elaborate  and  eloquent  ar- 
gument, giving  his  opinion  of  the  importance  of  the  office  of  inspector, 
and  urging  that  it  was  obligatory  on  the  association  to  insist  on  the  re- 
instatement of  Dr.  Bailey,  as  one  eminently  qualified  to  discharge  its 
duties. 

Dr.  Tyler,  of  Georgetown,  rose  to  reply  to  the  remarks  of  Dr.  Edwards, 
he  acknowledged  the  important  service  Dr.  Edwards  had  rendered  the  pro- 
fession in  procuring  in  Congress  the  passage  of  the  law  for  the  inspection 
of  drugs  and  medicines,  but  when  it  was  proposed  to  appoint  a  committee 
to  wait  upon  an  executive  officer  of  government,  and  dictate  to  him,  he  felt 
that  it  would  be  turning  aside  from  the  purpose  for  which  this  associa- 
tion was  organized. 

A  rather  protracted  argument  here  succeeded,  in  which  substitutes 
were  offered  for  the  first  resolution,  and  in  which  the  following  gentle- 
men engaged :  Dr.  Bolton  of  Virginia,  Dr.  Cox,  of  Maryland,  who  offered 
the  following  substitute : 

Resolved,  That  the  appointment  of  inspectors  of  drugs  and  medicines 
in  the  various  ports  of  the  United  States,  should,  in  the  opinion  of  this 
association,  have  regard  to  the  essential,  moral,  and  scientific  qualifica- 
tions of  the  candidates,  and  not  to  considerations  of  personal  favoritism 
or  political  bias. 

Dr.  Tyler,  of  Georgetown,  supported  the  resolution  of  Dr.  Cox  as  a 
fair  compromise.  He  believed  that  the  appointment  of  the  committee 
would  transform  the  association  into  a  mere  political  machine,  and  con- 
cluded by  strongly  urging  the  passage  of  the  resolution  offered  by  Dr. 
Cox.  Dr.  Dunbar,  of  Maryland,  strongly  opposed  the  resolution  of  the 
Nominating  Committee,  and  asked  if  it  was  the  duty  of  that  committee 
to  nominate  a  candidate  for  inspector-general  of  drugs  at  New  York. 
[Laughter.]  The  discussion  of  this  question  here  became  very  general, 
and  rather  noisy,  the  following  gentlemen  engaging — Dr.  Bachelder  of 
New  York,  Dr.  Parker  of  Virginia,  Dr.  Wilcox  of  Connecticut,  Dr.  Jew- 
ell of  Pennsylvania,  Dr.  Wood  of  New  York,  Dr.  Rodgers  of  New  York, 
and  Dr.  Sayer  of  New  York. 

The  resolution  as  amended  was  then  carried  by  a  vote  of  79  ayes  to 
52  noes. 

Resolved,  That  a  committee  of  nine  be  appointed  by  the  chair  to  wait 
on  the  Hon.  Howell  Cobb,  Secretary  of  the  Treasury,  and  respectfully  to 
request  the  restoration  of  Dr.  M.  J.  Bailey  as  inspector  of  drugs  and 
medicines  for  the  port  of  New  York — at  the  same  time  disclaiming  all 
political  considerations. 


1858.]  Editorial  and  Miscellaneous.  429 

Dr.  Gibbs,  of  South  Carolina,  moved  that  Professor  Henry  be  request- 
ed to  favor  the  association  with  his  views  on  Meteorology,  at  such  time 
during  the  session  as  he  may  select :  carried. 

Dr.  Campbell,  of  Georgia,  moved  that  the  Secretary  place  on  record 
an  expression  of  the  regret  with  which  this  association  has  learned  the 
death  of  Dr.  Marshall  Hall  of  London,  Dr.  Claiborn  R.  Walton  of  Au- 
gusta, Dr.  S.  W.  Granton,  Dr.  T.  Y.  Simmons  of  Charleston,  S.  C,  Dr.  J. 
K.  Mitchell  of  Philadelphia,  and  other  members  deceased,  since  the  last 
annual  session :  carried. 

Vote  of  Thanks. — On  motion  of  Dr.  Phelps,  the  following  resolutions 
were  passed  unanimously,  the  members  rising : 

Resolved,  That  the  thanks  of  this  association  are  eminently  due  to  the 
Regents  and  Professor  Henry,  of  the  Smithsonian  Institution,  for  the 
ample  and  convenient  accommodations  afforded  for  the  transaction  of 
business. 

Resolved,  That  the  Committee  of  Arrangements  are  entitled  to  our 
praise  and  highest  appreciation  of  their  exertions  to  promote  the  comfort 
of  the  members  and  best  interests  of  the  association. 

Resolved,  That  to  the  physicians  of  Washington  and  Georgetown  and 
the  faculty  of  Georgetown  College  we  accord  the  homage  of  our  sincerest 
thanks  for  their  elegant  hospitalities  extended  to  the  members  from 
abroad,  by  which  the  pleasure  of  their  sojourn  here  has  been  so  greatly 
enhanced. 

Resolved,  That  we  feel  assured  that  the  impressions  on  the  tablet  of 
memory  received  here,  in  our  national  metropolis,  in  this  the  first  year 
of  the  second  decade  of  the  association,  will  long  remain  an  evidence  of 
the  urbane  attentions  received,  not  only  from  the  Chief  Magistrate  and 
other  public  functionaries  of  our  glorious  Union,  but  of  private  citizens 
and  the  community  at  large. 

Resolved,  That  the  manifestations  of  union  of  heart  and  purpose  in  the 
action  of  this  session,  inaugurate  a  new  era,  and  call  for  devout  acknow- 
ledgement to  Divine  Providence,  and  presage,  as  we  trust,  not  only  a 
bright  future  for  the  association,  but  also  as  contributing  to  the  perpe- 
tuity and  prosperity  of  our  great  national  confederation. 

On  motion  of  Dr.  Anderson,  of  New  Jersey,  it  was  unanimously  re- 
solved that  the  thanks  of  the  medical  association  be  presented  to  Rev. 
Dr.  McGuire  and  his  faculty  of  the  College  of  Georgetown  for  their  very 
cordial  reception  and  entertainment  of  the  association  at  the  College 
yesterday. 

Dr.  Arnold,  of  Georgia,  then  exhibited  specimens  of  a  new  method  of 
medical  preparations  of  some  membrane  incomprehensible  to  the  report- 
er, but  which  was  evidently  very  interesting  to  the  association. 

On  motion  of  Dr.  Foster,  of  Tennessee,  it  was  resolved  that  after  1860, 
Dr.  Hamilton  have  the  privilege  of  using  his  report  on  H  Deformities  after 
Fractures,"  published  in  the  Transactions,  for  a  work  which  he  proposes 
to  publish. 


430  Editorial  and  Miscellaneous.  [June, 

Dr.  Campbell,  of  Georgia,  was  not  aware,  until  he  had  just  heard 
permission  granted  to  Dr.  Hamilton,  that  he  had  trangressed  in  repub- 
lishing in  a  work  a  report  which  he  had  contributed  to  the  Transactions 
of  the  association.  [Cries  of  "  regret  it,"  "  regret  it."]  He  did  regret  it, 
and  asked  the  sanction  of  the  society :  which  was  granted. 

Dr.  Dunbar  moved  to  reconsider  the  vote  appointing  a  committee  to 
request  the  reinstation  of  Dr.  Bailey,  and  Dr.  Morgan  seconded  it,  but 
as  Dr.  Parker  had  been  invited  upon  the  platform,  the  motion  was  ruled 
out  of  order. 

Dr.  Parker's  Chinese  Hospital. — Dr.  Peter  Parker,  ex-commission- 
er to  China,  was  then  introduced,  and  was  received  with  applause.  He 
exhibited  some  curious  specimens  of  calculi,  as  the  results  of  thirty-eight 
operations  upon  Chinese.  They  were  of  various  shapes  and  composition, 
and  weighed  from  a  few  drachms  up  to  three,  seven,  and  eight  ounces, 
his  description  of  the  operations  by  which  these  calculi  were  removed 
was  deeply  interesting,  and  it  was  gratifying  to  learn  that  out  of  the  thir- 
ty eight  patients  all  but  five  or  six  recovered  perfect  health. 

Dr.  Parker  proceeded  to  state  that  he  has  treated  in  China,  at  the  hos- 
pital under  his  charge,  fifty-three  thousand  cases.  Pictures  of  the  most 
curious  cases  he  had  brought  to  this  country,  and  they  were  on  exhibi- 
tion in  the  room  below.  At  no  very  distant  period  he  hopes  to  place  in 
a  permanent  form  the  results  of  his  labors,  with  illustrations.  [Applause.] 
Among  other  cases,  he  had  probably  performed  upwards  of  a  thousand 
operations  for  cataract.  On  one  day  he  operated  in  sixteen  cases,  the 
youngest  being  a  mere  child,  and  'the  oldest  on  old  lady  seventy-nine 
years  of  age.  She  came,  led  by  a  servant,  submitted  heroically  to  opera- 
tions on  both  eyes  the  same  day,  and  in  a  fortnight  had  her  sight  per- 
fectly restored.  [Applause.]  In  acknowledging  a  vote  of  thanks,  Dr. 
Parker  said  he  had  among  his  patients  all  classes,  from  members  of  the 
imperial  family  down  to  beggars.  His  greatest  difficulty  had  bee»  to 
persuade  his  patients  that  he  could  not  cure  all  diseases. 

Reconsideration  of  the  Dr.  Bailey  Resolution. — Dr.  Dunbar 
claimed  the  floor,  and  urged  the  reconsideration  of  the  vote  appointing 
a  committee  to  wait  on  the  Secretary  of  the  Treasury,  and  solicit  the 
reinstation  of  Dr.  Bailey. 

Dr.  Payne,  of  Virginia,  opposed  the  reconsideration. 

Dr.  Tyler  advocated  it,  and  asked  if  this  association  was  formed  to 
wait  on  executive  officers,  and  to  dictate  to  them  who  they  shall  remove, 
and  who  they  shall  appoint.  Many  gentlemen  around  him,  he  was  assur- 
ed, had  voted  for  the  resolution  without  due  reflection,  and  he  trusted 
with  confidence  in  their  sober  second  thought.  [Applause.]  The  press 
and  the  profession,  he  felt  confident,  would  denounce  this  association  if  it 


1858.]  Editorial  and  Miscellaneous.  431 

entered  into  the  wide  field  of  politics.  It  was  instituted  to  promote  the 
great  cause  of  science,  not  to  join  issue  with  government.     [Applause.] 

Dr.  Morgan  also  advocated  a  reconsideration.  He  was  not  a  partisan. 
Although  he  resides  in  Washington,  he  has  no  personal  acquaintance 
with  the  President  or  the  Secretary  of  the  Treasury,  but  he  was  confi- 
dent that  they  would  not  have  m^e  the  change  without  good  reason, 
and  it  was  not  the  mission  of  this  association  to  criticise  or  to  attempt 
to  change  their  views. 

Dr.  Palmer,  after  stating  how  little  regard  he  had  for  the  opinions  of 
the  press,  inquired  as  to  the  present  incumbent  of  the  office.  Is  he  capa- 
ble? 

Dr.  Watson,  of  New  York,  said  that  Dr.  Bailey  had  had  his  circulars 
out  since  his  "rotation,"  and  the  subject  had  been  twice  before  the 
Academy  of  Medicine,  who  have  ignored  it. 

Dr.  Burns  of  Brooklyn,  said  that  he  was  not  a  politician,  and  that  he 
was  a  personal  friend  of  Dr.  Bailey,  but  he  hoped  that  the  vote  would 
be  reconsidered. 

A  member  from  California  relates  his  experience  there  on  a  question 
as  to  the  superintendent  of  a  lunatic  asylum.  In  his  opinion  the  less 
the  association  had  to  do  with  politics,  or  with  expressions  of  opinion 
on  political  appointments,  the  better.     (Applause.) 

Dr.  McXulty,  of  New  York,  said  that  the  question  had  been  twice 
before  the  New  York  Academy  of  Medicine,  and  twice  been  voted  down. 
The  present  incumbent,  whom  it  is  sought  to  oust,  is  a  German  by  birth 
and  education.  He  can  read  the  invoices  in  whatever  European  language 
they  may  be  sent,  and  he  makes  his  own  analyses,  which  it  is  reported 
the  ex-inspector  did  not  do. 

After  some  il  parliamentary''  skirmishing,  it  was  decided  to  reconsi- 
der by  a  vote  of  51  ayes  to  32  noes.  And,  on  motion,  the  subject  was 
then  indefinitely  postponed. 

The  association  then  took  a  recess  of  two  hours,  for  dinner. 

Evening  and  Closing  Session. — The  association  was  called  to  order 
at  five  o'clock,  P.  M.,  by  Dr.  Sutton,  one  of  the  vice-presidents,  who  took 
the  chair. 

The  amendment  to  the  constitution,  proposed  at  the  annual  meeting 
at  Nashville,  had  been  made  the  "  special  order."     They  were 

1st.  Amend  the  third  article  of  the  constitution,  in  relation  to  meetings, 
by  inserting  after  the  words  "  first  Tuesday  in  May,"  the  words  kk  or  the 
first  Tuesday  in  June ;"  and  also  inserting  after  the  words  M  shall  be  de- 
termined," the  words  "  with  the  time  of  meeting."  2d.  In  article  2, 
omit  the  words  "medical  colleges,"  and  also  the  words  "the  faculty  of 
every  regular  constituted  medical  college,  or  chartered  school  of  medi- 
cine, shall  have  the  privilege  of  sending  two  delegates." 


432  Editorial  and  Miscellaneous.  [June, 

Each  amendment  was  separately  discussed,  and  each  was  lost  by  a 
large  vote.  An  amendment  proposed  at  Philadelphia  in  1856  providing 
for  ihe  establishment  of  a  permanent  secretaryship,  was  lost  by  a  vote  of 
53  ayes  to  84  noes. 

On  motion  of  Dr.  Foster,  of  Tennessee,  the  secretary  was  directed  to 
collect  all  the  by-laws,  and  have  the^i  printed  in  the  next  volume. 

An  attempt  was  made  to  introduce  a  motion  endorsing  the  accoustics 
and  ventilation  of  the  new  Capitol  extensions,  but  it  was  ridiculed  by  Dr. 
Sayer,  and  was  withdrawn. 

Various  additional  votes  of  thanks  were  passed,  and,  at  ten  minutes  of 
seven,  the  association  adjourned  sine  die. 

The  account  of  the  11th  aunual  meeting  presented  in  the  foregoing 
pages,  we  have  condensed  mainly  from  the  very  accurate  report  found 
in  the  Daily  Washington,  Union,  adding  such  passing  comments  as  the 
performance  of  the  hurried  task  would  allow.  Many  of  the  measures 
therein  developed,  receive  our  hearty  approval,  while  others,  did  we  have 
time  and  space,  would  have  received  from  us,  comments  conveying  a 
far  different  opinion. 

Whatever  may  be  our  opinion  of  the  deliberations  of  the  association, 
all  are  constrained  to  admit  that  it  has  vindicated  its  power  and  influ- 
ence in  the  profession  all  over  the  land,  and  the  opinion  which  we  ex- 
pressed some  months  ago,  that  "  to  trangress  its  wise  and  benevolent 
counsels  is  to  suffer  loss  of  position,"  could  not  have  been  more  fully 
verified,  than  by  the  results  of  the  session  just  closed  at  Washington. 


Books,  Journals,  and  Pamphlets  received. — "We  have  received  a  large  num- 
ber of  Books,  Pamphlets  and  Journals,  besides  communications  for  our  own  pages, 
the  notices  of  which,  together  with  almost  our  entire  miscellany,  have  been  ex- 
cluded by  the  space  devoted  to  the  minutes  of  the  annual  meeting  of  the  Ameri- 
can Medical  Association.  We  shall  endeavor  to  do  justice  to  these  works  in  our 
next  issue. 


Coffee  and  Lemon  Juice  in  Ague. — M.  Von.  Holsbeek  draws  attention 
to  a  mode  of  treatment  he  has  found  useful.  Infuse  an  ounce  of  well- 
roasted  coffee  in  three  ounces  of  boiling  water,  and  having  strained  the 
fluid,  acidulate  it  with  lemon-juice.  The  whole  is  given  at  once,  five 
hours  before  the  paroxysm. — '  Presse  Beige,1  and  Med.  Times  and  Gaz. 


Local  Application  in  Eczema  of  the  Face  in  Children. — Dr.  Behrend 
in  a  note  on  the  treatment  of  eczema,  recommends  the  employment  of 
the  following  combination  as  a  remedy  for  the  numerous  scales  which 
frequently  cover  the  face  of  children : — Cod-liver  oil,  half  an  ounce ;  car- 
bonate of  soda,  half  a  drachm.  Mix. — Gaz.  Hop,  and  Dublin  Hospital 
Gazette. 


1858.]  Editorial  and  Miscellaneous.  433 

A  New  Anaesthetic. — The  subject  of  the  following  letter  we  deem  of  such  deep 
interest,  in  a  surgical  point  of  view,  that  we  have  inserted  it,  although  we  have 
not  space  for  those  comments  which  its  great  importance  evidently  demands. 
Should  electricity  take  the  place  of  chloroform  and  amylene,  in  Surgery,  how 
incalculable  will  be  the  result  of  the  experiments  here  detailed. 

Electricity  in  Extracting  Teeth.     By  D.  S.  Cuase,  M.D.,  D.D.S.,  of  Augusta,  Ga. 

To  the  Editors  of  the  Southern  Medical  and  Surgical  Journal : 

Gentlemen, — HaviDg  been  experimenting  with  electricity  in  some  of  the  more 
painful  operations  of  Dental  Surgery,  and  believing  the  subject  to  be  new  to 
most  of  your  readers,  I  send  you,  in  a  few  lines,  the  result  of  my  observations 
made  in  extracting  more  than  fifty  teeth,  for  different  persons,  within  the  last 
two  weeks. 

The  Eirst  Case  in  which  I  tried  it,  I  removed  seven  teeth,  all  firmly  set — five 
molars  and  two  cuspidati  or  eye  teeth.  In  extracting  the  first  tooth,  too  much 
electricity  was  applied,  and  the  patient  complained  of  pain  from  the  shock,  but 
not  from  the  removal  of  the  tooth.  In  the  second  tooth  too  little  was  applied, 
and  the  tooth  itself  gave  pain.  After  this,  we  were  able  to  regulate  the  quanti- 
ty, so  that  neither  the  electricity  nor  the  extraction  of  the  tooth  gave  much  pain. 
Patient  not  at  all  nervous,  and  frequently  expressed  herself  highly  pleased  with 
the  operation.  The  feeling  experienced  during  the  extraction  of  the  teeth,  as 
she  expressed  it,  was  a  benumbing  sensation  about  the  tooth,  which  appeared  to 
be  attached  only  to  the  gum. 

Second  Case. — Extracted  six  teeth.  Patient  somewhat  debilitated  from  previ- 
ous suffering  with  her  teeth,  and  quite  nervous.  Suffered  considerable  pain 
during  the  operation,  but  would  not  allow  one  to  be  extracted  without  electricity. 

Third  Case. — Extracted  four  teeth.     Patient  suffered  but  little  pain. 

Fourth'' Case. — Extracted  a  molar  tooth,  that  had  been  previously  broken,  for  a 
highly  intelligent  gentleman  from  a  neighboring  village.  He  was  much  pleased 
witli  the  operation,  and  was  very  enthusiastic  in  his  praises  of  electricity  as 
applied  to  Dental  Surgery. 

Fifth  and  last  Case,  that  I  will  report  at  present — Extracted  ten  teeth  for  an 
elderly  lady.  Expressed  no  fear  during  the  operation,  and  seemed  to  treat  the 
affair  as  a  mere  trifle,  which  might  be  attended  to  any  morning,  without  much 
inconvenience. 

The  general  expression  by  those  who  have  tried  it,  seems  to  be  in  favor  of 
electricity  in  extracting  teeth. 

In  some  of  the  cases  mentioned  above,  the  gums  were  lanced  by  the  same  pro- 
cess, by  connecting  one  pole  of  the  battery  with  the  handle  of  the  lancet,  while 
the  patient  held  the  other — the  hand  of  the  operator  being  protected  by  a  silk 
glove. 

I  would  here  suggest  that  electricity  may  prove  a  valuable  agent  in  the  hands 
of  the  sprgeon,  in  mitigating  the  pain  of  surgical  operations.     Who  will  try  it? 

The  machine  in  use  by  myself,  at  the  present  time,  is  the  compound  magneto- 
electric  machine,  the  same  as  used  by  physicians  for  medical  purposes ;  but  I 
have  no  doubt  that  voltaic  or  galvanic  electricity  will  answer  the  purposes  of  the 
surgeon,  better  than  the  magneto-electric  current,  as  the  shocks  of  the  former 
follow  each  other  in  such  rapid  succession,  as  to  appear  like  one  continuous 
current,  while  the  latter  is  more  or  less  interrupted,  causing  some  trembling,  and 
jerking  of  the  muscles. 


434  Editorial  and  Miscellaneous. 

How  to  keep  Rooms  cool  in  Summer. — Lord  Rosse  has  denied  the 
absurd  prediction,  that  the  approaching  summer  will  be  an  extraordina- 
ry hot  one.  Still,  it  may  be  well  that  medical  men  should  be  forearmed 
with  the  means  of  cooling  their  own  and  their  patients'  rooms.  A  flat 
vessel  rilled  with  water,  and  on  which  are  floated  branches  of  trees 
covered  with  green  leaves,  is  a  very  pleasant  and  efficacious  means,  and 
is  much  employed  in  Germany.  The  suspension  of  Indian  matting, 
previously  damped,  at  the  open  window,  tends  much  to  diminish  the 
heat.     The  matting  may  be  imitated  by  any  kind  of  plaited  glass. 

London  Lancet. 


Pressure  in  Phlegmasia  Dolens. — In  relating  the  case  of  a  young  woman 
who  had  suffered  from  phlegmasia  dolens,  and  in  whom  the  superficial 
veins  continued  much  swollen,  M.  Trousseau  cautioned  his  pupils  against 
applying  in  similar  cases  firm  bandages.  The  deep-seated  veins  being 
obliterated,  this  enlargement  of  the  superficial  ones  is  a  necessary  conse- 
quence, and  compressing  them  by  a  firm  bandage  would  completely  in- 
terrupt the  circulation  of  the  limb.  A  moderate  degree  of  pressure, 
however,  is  admissable,  as  giving  support  to  the  walls  of  the  superficial 
vessels,  and  preventing  their  becoming  varicose. — Ibid,  and  Med.  Times 
■and  Gazette. 


Death  of  Dr.  R.  Q.  Dickenson. — We  deeply  regret  that  it  becomes 
our  duty  to  record  the  death  of  our  worthy  and  now  lamented  friend, 
Dr.  R.  Q.  Dickenson,  of  Albany.  The  following  notice,  we  (for  want  of 
space  and  on  account  of  its  late  arrival)  have  been  obliged  to  condense 
from  a  well  written  sketch  prepared  by  one,  who,  like  ourselves,  knew 
him  well  and  loved  him  well. 

Obituary. — Died,  recently,  in  Albany,  Baker  county,  Dr.  Roger  Q. 
Dickenson,  aged  61  years. 

Dr.  Dickenson  was  born  in  Spottsylvania,  Virginia,  and  was  a  graduate  of  the 
University  of  Pennsylvania  of  the  year  1826.  He  was  one  of  the  oldest  and  most 
successful  practitioners  in  our  State,  having  been  for  more  than  thirty  years  en- 
gaged in  the  humane  and  benevolent  ministrations  of  our  Profession.  Some  five 
years  ago  he  was  elected  President  of  the  Medical  Society  of  the  State  of  Georgia, 
the  duties  of  which  post  he  discharged  with  dignity  and  honor.  None  enjoyed 
the  annual  meetings  more  than  he  did,  for  his  heart  and  soul  were  fully  enlisted 
in  every  measure  which  could  advance  and  elevate  the  Medical  Profession.  The 
medical  men  of  his  own  community  will  feel,  sensibly,  his  loss  : — there,  he  was 
personally  and  intimately  known.  Being  the  oldest  physician  in  the  community, 
he  was  revered  and  honored  by  them  all ;  his  kind  and  gentle  manners  won  their 
hearts,  and  they  must  feel  that,  in  the  death  of  their  elder  brother,  each  has  lost 
an  able  counsellor — a  kind  and  warm  hearted  friend. 

Albany,  Dougherty  Co..  Oa.,  May  20th,  1868.  S.  S.  C ,  M.D. 


SOUTHERN 

MEDICAL  AND  SURGICAL  JOURNAL. 

(NEW  SERIES.) 

Vol.  XIV.]  AUGUSTA,  GEORGIA,  JULY,  1868.  [No.  7. 

* 

ORIGINAL  AND  ECLECTIC. 

ARTICLE  XV. 

Observations  on  Malarial  Fever.  By  Joseph  Jones,  A.M.,  M.D., 
Professor  of  Physics  and  Natural  Theology  in  the  University 
of  Georgia,  Athens ;  Professor  of  Chemistry  and  Pharmacy  in 
the  Medical  College  of  Georgia,  Augusta ;  formerly  Professor 
of  Medical  Chemistry  in  the  Medical  College  of  Savannah. 

[Continued  from  p.  398  of  June  No.  1848.] 

In  the  preceding  article  we  stated  briefly,  some  of  the  difficul- 
ties attending  pathological' and  physiological  investigations,  and 
acknowledged  the  imperfections  of  the  present  researches.  We 
are  about  to  present  numerous  analyses  of  the  urine ;  and  before 
doing  this,  we  would  candidly  acknowledge  the  sources  of  error 
in  attempting  to  determine  the  amount  of  urine  excreted  during 
any  stated  period,  as  24  hours.  When  the  bowels  are  frequently 
moved,  it  is  almost  impossible  to  ascertain,  even  approximately, 
the  amount  of  urine  excreted. 

When  the  patient  is  delirious,  and  passes  his  urine  and  feces 
in  the  bed,  it  is  impossible  to  ascertain  either  the  amount  or 
character  of  the  urine.  Even  when  the  bowels  are  not  moved, 
and  the  patient  retains  his  faculties  and  a  considerable  amount 
of  strength,  it  often  happens  that,  during  the  night,  the  nurse 
will  neglect  to  attend  to  the  passage,  and  preservation  of  the 
excretions  in  the  proper  vessels. 

It  often  happens,  from  a  combination  of  such  circumstances, 
that  the  urine  of  the  most  fatal,  important  and  interesting  cases 
escapes  our  examination. 

These  difficulties,  in  hospital  investigations,  cannot  readily  be 
overcome,  and  will  often  invalidate  the  conclusions  drawn  from 
individual  cases.  Our  duty,  then,  is  to  obtain  as  wide  an  induc- 
tion of  facts  as  possible,  and  thus  eliminate  or  equalize,  as  far  as 

N.  8. VOL.  XIV.     NO.  VII.  21 


436  Jones,  on  Malarial  Fever.  [Jutyj 

possible,  the  errors,  and  draw  our  conclusions,  not  so  much 
from  individual  cases  as  from  the  whole  assemblage  of  facts. 
From  our  copious  notes  on  "more  than  two  hundred  cases  of 
malarial  fever,  we  have  determined  to  present  a  condensed 
statement  of  those  which  presented  points  of  interest  to  the 
physiologist,  pathologist  and  practitioner  of  medicine. 

Our  limits  will  not  permit  us  to  enter  into  a  minute  account 
of  the  method  of  analyzing  the  urine.  In  view  of  the  numerous 
excellent  treatises  upon  this  subject,  accessible  to  all,  this  would 
involve  an  unnecessary  consumption  of  space  and  time.  We 
will  simply  state  the  method,  with  full  references  to  the  appro- 
priate authors. 

The  urea  was  separated  in  the  form  of  the  nitrate,^)  and 

(1)  Lehmann's  Physiological  Chemistry,  Eng.  Ed.,  vol.  i.,  p.  159.  Amer.  Ed., 
vol.  i.,  p.  149. 

Mitscherlich  in  Annalen  derPhysik  und  Chemie,  Von  Poggendorff,  Bd.  31,  S.  303. 

Kidneys  and  Urine,  by  J.  J.  Berzelius.  Translated  by  Boyle  &  Learning,  M.D. 
Philadelphia,  1843,  pp.  66-83. 

Hand  Book  of  Chemistry,  by  Leopold  Gmelin.  Translated  by  H.  Watts,  Cav. 
Soc.  pub.     London,  1852.     Vol.  vii.,  p.  363. 

Simons  Chemistry  of  Man.     Philadelphia,  1846,  p.  39*7. 

Becquerel's  &  Rodier's  Pathological  Chemistry.    Trans,  by  Speer.   Lond.  185*7. 

The  student  of  medicine  desirous  of  entering  into  similar  investigations  upon  the 
urine  and  blood,  will  find  not  only  all  the  details  of  anatysis,  but  also  invaluable 
information  in  the  following  works  and  articles: — Anleitung  zur  Qualitativen 
und  Quantitativen  Zoochemischen  Analyse,  Von  E.  Von  Gorup  Besanez.  Nurn- 
berg,  1854.  Anleitung  zur  Qualitativen  und  Quantitativen,  Analyse  des  Harns, 
Von  Carl  Neubauer.  Wiesbaden,  1854.  Heintz:  Lehrbuck  der  Zoochemie.  Ber- 
lin, 1853.  Schlossberger :  Lehrbuch  der  Organischen  Chemie  mit  besonderer, 
Rucksicht,  auf  Physiologie  und  Pathologic  Stuttgart,  1854.  Robin  et  Verdeil : 
Traite  de  Chimie  Anatomique  et  Physiologique,  ou  des  Principes  immeditas  Nor- 
maux  et  Morbides  que  constituent  le  Corps  de  l'Homme  et  de  Mammiferes.  3  vols. 
Paris,  1853.  "  A  Course  of  Practical  Chemistry,"  arranged  for  the  use  of  Medical 
Students,  by  Wm.  Ordling,  M.  D..  London,  1854.  Bird,  on  Urinary  Deposits. 
Philad.  1854.     Bowman's  Medical  Chemistry.    Philad.  1855. 

For  Leibig's  valuable  memoir  "  On  Certain  Urea  Compounds,  and  a  new  me- 
thod of  determining  the  Chloride  of  Sodium,  and  the  Urea  in  the  Urine,"  see 
Ann.  der  Chem.  und  Pharm.,  vol.  lxxxv.,  pp.  289-328.  See  translation  of  this 
memoir  in  vol.  vi.  of  the  Quarterly  Journal  of  the  Chemical  Society.  Limpricht, 
on  the  Influence  of  Allantoin  on  the  determination  of  Urea  by  the  method  of 
Liebig.    Ann.  der  Chem.  und  Pharm.,  vol.  lxxxvii.,  p.  99. 

Kletzinsky,  "  On  the  Comparison  of  the  Values  of  the  Different  Methods  of 
Determining  the  Quantity  of  Urea."  Heller's  Archiv.  fur  Chem.  und  Mikrosk., 
p.  252.    Jahrgang,  1853. 

"  A  New  Method  of  Determining  the  Amount  of  Urea,  by  Dr.  E.  Davy."  Phil. 
Mag.,  June,  1854.  Medico-Chir.  Rev.,  Oct.  1854.  "The  Detection  and  Estima- 
tion of  Urea,  by  Ragsky."  Ranking's  Abstract  of  Med.  Sciences,  1845.  Part  II, 
p.  90.  Beitrage  zur  Kenntniss  der  Urinabsonderung  bei  gesunden.  Inaugural 
Abhandlung.  Von  Aug.  Winter.  Giessen,  1852.  Beitrage  zur  Kenntniss  der 
Urinabsonderung  bei  Gesunden  schwangern  und  kranken  Personen.  Inaugural 
Abhandlung.  Von  Friedr.  Mosler.  Giessen,  1853.  Klinische  Untersuchungen 
uber  den  Stoffwechsel,  bei  gesunden  und  kranken  menschen  uberhaupt  und  den 
durch  den  Urin  insbesondere.  Von  Prof.  J.  Vogel.  Gottingen,  1853.  Studien 
zur  Urologie.  Von  Dr.  F.  Fr.  Beneke.  (Archiv.  des  Vereins  fur  gemeinschaft- 
liche  Arbeiten.     Band  i.,  Hefte  3  and  4.)     Gottingen,  1853. 


1858.]  Jones,  on  Malarial  Fever.  437 

every  care  was  taken  to  secure  accuracy  in  the  results.  The 
amounts  of  the  constituents  in  all  these  analyses,  from  the  causes 
previously  stated,  will  be  under-rated,  and  never  over-rated. 

The  urine  was  always  analyzed  a  short  time  after  its  passage. 
This  precaution  is  necessary  in  a  warm,  moist  climate,  like  that 
of  Savannah.  In  the  heat  of  summer  the  urea  is  often,  espe- 
cially in  the  urine  of  convalescence,  rapidly  decomposed  into 
carbonate  of  ammonia.  In  one  case  of  malarial  fever,  where 
the  patient  was  suffering  with  a  stricture  and  irritation  of  the 
bladder,  every  trace  of  urea  disappeared  from  the  urine  in 
twelve  hours. 

I  have  endeavored,  scrupulously,  to  exclude  from  these  pa- 
pers, every  analysis  the  result  of  which  was  influenced  by 
changes,  in  the  urine,  subsequent  to  its  excretion  by  the  kidneys. 
Uric  acid  was  determined  in  the  usual  manner,  by  precipitation 
with  hydrochloric  acid. 

The  inorganic  matters  of  the  urine  were  determined  accord- 
ing to  the  simple  and  accurate  method  of  M.  Lecanu.  The 
amount  of  the  coloring  and  extractive  matters  was  obtained  by 
substracting  the  weights  of  the  urea,  uric  acid  and  inorganic 
matters,  from  the  solid  matter  of  the  urine,  carefully  and  accu- 
rately determined. 

The  analyses  of  the  blood  were  conducted  according  to  the 
method  previously  described  by  the  author. 

Case  IX. — October  9th,  8  o'clock,  P.M.  Seaman :  age  40, 
height  5  feet  10^  inches,  weight  170  lbs.  Auburn  hair,  blue 
eyes,  florid  complexion ;  sanguine  temperament ;  well  developed 
muscular  man.  Native  of  Sweden.  Has  been  in  New  Orleans, 
Panama,  and  other  southern  ports,  but  has  never  been  sick  be- 
fore. 

This  is  his  first  trip  to  Savannah  ;  has  been  sleeping  on  the 
bay;  was  taken  with  chill  and  fever  two  days  ago,  and  has 
suffered  much  with  painsin  his  head.  Yesterday  vomited  bile. 
Tongue  slightly  coated  with  white  fur.  Now  his  skin  is  in  a 
good  perspiration.  Twenty  minutes  ago,  his  skin  felt  very  hot 
and  dry  to  the  touch.  Supposing  that  his  temperature  was 
several  degrees  above  the  normal  standard,  I  hastened  to  the  la- 
boratory to  obtain  my  thermometer ;  I  was  detained  twenty 
minutes,  and  when  I  returned,  to  my  surprise,  his  skin  felt  moist 
and  cool  under  the  hand,  in  comparison  with  the  previous  ob- 
servation. 


438  Jones,  on  Malarial  Fever.  [July, 

Pulse 86  )  Temperature  of  Atmosphere, 72°     F. 

[■  "  "  Hand 100 

Respiration.  ..23  )  "  under  Tongue 101°75' 

The  rise  of  the  thermometer  in  his  hand  (the  hand  as  usual  was  kept  carefully- 
closed  around  the  bulb,)  was  irregular.  It  rose  to  100°,  and  at  this  point  was 
stationary  for  several  minutes :  it  then  fell  gradually  to  98°,  and  again  rose  gra- 
dually to  100°.  In  this  case  we  see  that  the  reduction  of  temperature  was 
simultaneous  with  the  relaxation  of  the  skin  and  flow  of  perspiration. 

Is  the  remission  of  the  fever  due  to  the  restoration  of  the 
functions  of  the  sudoriparous  glands,  which  collectively  expose 
a  surface  of  tubing  1,570,000  inches,  or  nearly  28  miles  in 
length?  Is  the  morbific  agent,  or  agents,  which  have  disturbed 
the  chemical  actions  and  correlation  of  the  forces  eliminated  by 
these  glands? 

If  the  intermission  is  due  to  the  restoration  of  the  functions  of 
the  sudoriparous  glands,  what  excited  them  to  action  ?  Is  the 
phenomena  connected  with  the  nervous  system  alone,  or  with 
chemical  and  physical  changes  in  the  structure  of  the  morbific 
agents,  and  of  the  blood  and  secretions  and  excretions  ?  If  the 
reduction  of  temperature  be  not  dependent  upon  the  restoration 
of  the  functions  of  the  sudoriparous  glands,  what  retarded  the 
chemical  actions  by  which  the  physical  forces  are  generated? 
If  the  chemical  actions  developing  an  unusual  amount  of  heat 
were  excited  by  the  introduction  of  foreign  elements,  may  not 
the  foreign  elements  themselves  have  entered  into  these  chemi- 
cal actions,  and  been  so  altered,  that  they  have  been  for  a  time 
rendered  inert? 

That  a  special  end  is  accomplished,  in  malarial  fever,  by  an 
elevation  of  temperature  is  proved  by  the  fact  that  the  cases 
which  manifest  the  highest  temperatures,  are  as  a  general  rule 
attended  with  little  or  no  danger,  whilst  in  those  cases,  as  con- 
gestive fever,  where  there  is  a  depression  of  temperature,  the 
danger  is  always  imminent. 

It  is  true  that  the  sudoriparous  glands  have  much  to  do  with 
the  regulation  of  the  temperature  for  the  water  which  they  elim- 
inate from  the  blood  during  its  evaporation,  abstracts  one  thou- 
sand degrees  of  heat  from  the  surface  of  the  body  and  the 
surrounding  atmosphere.  This  heat  is  expended  in  the  mecha- 
nical action  of  keeping  asunder  the  particles  of  water,  and  is 
hence  insensible  to  the  thermometer. 

The  experiments  of  Dr.  South  wood  Smith,  (2)  at  the  Phoenix 
Gas  Works,  and  of  MM.  Berger,  Delaroche,  (3)  Fordice,  Blag- 
den,  (4)  and  others,  (5)  have  shown  that  when  animals  and  man 

(2)  "Philosophy  of  Health,"  vol.  II.  pp.  391—396. 

(3)  "  Experiences  sur  les  Effets  qu'une  forte  Chaleur  produit  sur  l'Economie." 
Paris,  1805,  and  Journal  de  Physique,  tomes  lxxiii.,  lxxi.,  et  lxxvii. 

(4)  "Philosophical  Transactions."     1775.  . 

(5)  Magendie's  Experiments  upon  the  Influence  of  Hot  air  on  Animal  Life. — 
Ana.  Jour.  Med.  Sciences,  January  1845,  p.  183. 

M.  Constantine  James,  on  the   effects  of  the  hot  moist  air  of  the  baths,  or 


1858.]  Jones,  on  Malarial  Fever.  439 

were  subjected  to  great  external  degrees  of  heat,  the  tempera- 
ture of  the  body  was  regulated  by  the  evaporation  from  the 
surface  of  the  skin  and  lungs.  When  the  air  was  dry,  individ- 
uals were  able  to  endure,  for  a  considerable  length  of  time,  a 
temperature  of  from  250  to  350  degrees,  without  injurious  ef- 
fects, and  without  any  great  elevation  of  temperature.  The 
loss  of  water  from  the  surface  of  the  body  was  correspondingly 
great,  and  by  its  evaporation  maintained  the  temperature  of  the 
interior  at  the  normal  standard.  If,  however,  this  evaporation 
be  interfered  with,  by  saturating  the  air  with  aqueous  vapor,  the 
temperature  rose  rapidly,  and  the  individuals  died  in  a  short 
time. 

The  rapidity  and  force  of  the  circulation  and  respiration  also, 
have  much  to  do  with  the  increase  or  diminution  of  temperature 
in  the  active  stages  and  in  the  intermission  of  malarial  fever.  This 
will  be  established  in  future  by  numerous  examples. 

Examination  of  Urine  passed  one  hour  after  these  observations,  when  the  sweat- 
ing stage  was  fully  established.  Reddish  orange  color,  scant.  Reaction  acid. 
Specific  gravity,  1028. 

1000  parts  of  Urine  contained: 

UnVAcid\\\\\\\\\\\\\\\\'20^6U^e  imo"nt  °*  lr.on  Weired  to  be 
Fixed  Saline  Constituents.  .16-245  )  shShtly  lnci>eased- 

Microscopical  Examination. — After  18  hours,  no  deposit,  reaction  still  acid. 
After  60  hours,  a  light  yellow  deposit  of  a  few  prismatic  crystals  of  triple  phos- 
phate, and  numerous  globular  acicular  crystals  of  urate  of  ammonia,  and  small 
globular  and  elongated  vegetable  cells  and  vibrones. 

When  this  deposit  was  treated  with  hydrochloric  acid,  numerous  crystals  of 
uric  acid  appeared  under  the  microscope. 

Has  no  pain  upon  pressure  of  epigastrium,  but  has  a  tendency  to  vomit. 

fy  Apply  sinapism  to  epigastrium.  Calomel  grs.  xij.,  sulphate  of  quinia  grs. 
vi.,  mix  ;  administer  and  follow  with  castor  oil  in  four  hours.  As  soon  as  fever 
intermits,  give  sulph.  of  quinia  grs.  v.  every  three  hours,  up  to  grs.  xx. 

October  10th,  1  o'clock,  P.M.  Medicine  operated  well ;  much 
better,  sitting  up;  skin  and  tongue  normal;  pulse  64;  respira- 
tion 24.     Has  taken  20  grains  of  sulphate  of  quinia. 

I>  Quassia  and  soda.     Full  diet. 

8  o'clock,  P.M.     Had  a  chill  one  hour  ago,  which  lasted  thir. 

stoves,  of  Nero,  at  Pozzuoli,  Gazette  Medicale,  27th  Avril,  1844.     "W.  F.  Edwards 

on  Animal  Heat.     Cyclopedia  of  Anatomy  and  Physioloy,  vol.  ii.  pp.  649 684. 

John  Davy,  on  Animal  Temperature.  Philosophical  Transactions,  1814.  Edin- 
burgh Philosophical  Journal,  Jan.  1826.  See  also,  Researches  Physiological  and 
Anatomical,  by  Dr.  John  Davy,  London,  1839,  vol.  i.  pp.  141 — 248.  Experi- 
ments of  Tillet  and  Duhamel. -experiments  on  the  servants  of  a  baker  at  Roche- 
foucault  in  Angoumois.  Mem.  Acad.  Scien.  pour  1764,  p.  186,  et  seq.  Experi- 
ments of  Dobson  at  Liverpool ;  Phil.  Trans,  for  1775,  p.  463,  et  seq.  Observations 
on  the  effects  of  High  Temperatures,  by  Bell  of  Manchester.  Manchester  Mem. 
vol.  i.  p.  1,  et  seq.  Currie  on  application  of  Water  at  different  Temperatures. 
Phil.  Trans,  for  1792,  p.  199,  et  seq.  Experiments  of  Delaroehc,  Jour.  Phys.  t. 
lxiii.  p.  207.  Nicholson's  Journ.,  vol.  xvii.  p.  142.  215.  Jour.  Phys.,  t.  lxxi.'p. 
289,  and  t.  lxxvii.  1.  Lavoisier  on  Transpiration,  Mem.  Acad.,  pour  1790.  John 
Reid  on  Respiration,  Cycloped.  of  Anatomy  and  Physiology,  vol.  iv.  pp.  325 368. 


440 


Jones,  on  Malarial  Fever. 


[July, 


ty  minutes.  His  extremities  are  just  recovering  their  normal 
temperature,  $  As  soon  as  fever  remits,  give  sulph.  of  quinia 
up  to  grs.  xx.  Urine  light  orange  color,  scant  and  concentrat- 
ed. The  amount  was  not  determined  on  account  of  the  action 
of  the  medicine. 

October  11th,  11  o'clock,  A.  M.  Had  fever  all  night,  and 
vomited  three  times.  Fever  intermitted  this  morning,  at  4 
o'clock,  A.M.  Suffered  greatly  with  pain  in  his  head  during 
the  fever.  This  moderated  greatly  after  the  subsidence  of  the 
fever.  No  tenderness  of  epigastrium;  tongue  clear  and  a  little 
redder  at  its  tip  and  edges  than  normal. 

Pulse  70.  Respiration  20.  Has  taken  10  grains  of  sulph.  of  quinia  this  morn- 
ing.    ~fy  Continue  sulph.  of  quinia  up  to  grs.  xxv.     Diet,  beef  soup  and  tea. 

Urine  passed  during  fever,  of  a  deep  orange  color.  Specific  Gravity  1020. 
Reaction  decidedly  acid. 

Amount  of  Urine  passed  during  the  last  15  hours,  10200  grains. 

"             «             «        hourly       "         "         "  680       " 

Calculated  amount  of  Urine  for  24  hours, 16320      " 


Urine  excreted  in 
15  hours,  grs.  10200 
contained,  grs. 


ANALYSIS  IX. 


Calculated  am't  of  Ui  ine 
for  24  hours,  grs.  16320, 
contained  grs. 


1000  parts  of 
Urine  contain- 
ed, 


Uric  Acid,. . . 

Fixed  Saline 

stituents. . , 


Con- 


0-800 
9*7-000 


1-280 
155-200 


0-078 
9.509 


We  see  that,  notwithstanding  the  diminution  of  the  uric  acid 
under  the  action  of  the  sulphate  of  quinia,  the  chill  and  fever 
returned. 

After  standing  40  hours,  the  urine  let  fall  a  moderately  heavy 
deposit  of  triple  phosphate  and  vegetable  cells. 

Oct.  12th,  11  o'clock  A.  M.  Says  that  yesterday  afternoon, 
between  the  hours  of  3  and  6  o'clock  P.  M.,  he  "had  cold  chills 
running  over  his  body,  which  did  not,  however,  amount  to  a 
regular  shaking  chill."  These  chilly  feelings  were  not  followed 
by  fever,  but  by  a  profuse  sweat. 

Pulse  76.     Respiration  20,  soft  and  gentle.     Tongue  clean ;  skin  moist  and  cool. 
fy.  Quassia  and  soda.     Snake-root  tea.     Full  diet. 

Urine  passed  during  the  last  24  hours  of  a  deep  orange  color,  with  a  heavy 
light-yellow  deposit  of  triple  phosphate  and  vegetable  cells.     Sp.  Gr.  1020. 
Amount  passed  during  the  last  24  hours,     grains  12,240 


(I                it 

hourly,                                    " 

510 

ANALYSIS  X. 

Urine  excreted  in  24  hours, 
grs.  12,240  contained  grs. 

1000  parts  of  Urine 
contained 

Uric  Acid, 

1-200 
48-000 

0-098 

Fixed  Saline  Constituents, . . 

3-921 

The  uric  acid  is  still  far  below  the  normal  standard. 

8  o'clock  P.  M.  Has  no  fever ;  skin  moist  and  cool ;  pulse 
regular.     Urine  orange  colored,  and  of  high  specific  gravity. 

Oct.  13th,  11  o'clock,  A.  M.  Up  and  dressed.  Says  that  he 
"had  no  fever  last  night,  but  did  not  rest  well ;  his  dreams  trou- 
bled him.     After  rising  this  morning  suffered  with  vertigo,  and 


1858.]  Jones,  on  Malarial  Fever.  441 

vomited  mucus."     Tongue  normal ;  skin  cool ;  pulse  60  ;  respi- 
ration 16. 

Amount  of  Urine  passed  during  the  last  15  hours,  grains  4136.    J  Orange  color'd. 

Calculated  amount  for  24  hours, "      6617.    >-  Specific   gravi- 

Amount  of  Urine  excreted  hourly, •'        275.7  )  ty  1034. 

Reaction,  after  standing  15  hours,  decidedly  alkaline.  N05  and  Hcl.  produced 
a  powerful  effervescence  by  the  liberation  of  the  carbonic  acid  from  the  carbon- 
ate of  ammonia  resulting  from  the  decomposition  of  the  urea.  Up  to  this  time 
the  reaction  of  the  urine,  after  standing  the  same  length  of  time,  has  been  acid. 

Uric  acid  in  urine  of  15  hours,  (grs.  4136) 0'800 

"         "     Calculated  amount  of  urine  for  24  hours,  (grs.  6617)  1.280 
"     1000  parts  of  urine, 0193 

A  few  hours  after  its  deposition  the  urine  let  fall  a  heavy  light-yellow  deposit 
of  penniform  and  prysmatic  crystals  of  triple  phosphate  and  globular  and  elonga- 
ted vegetable  cells.  The  weather  has  been  damp  and  cloudy  for  two  weeks,  and 
the  wards  of  the  hospital  are  crowded  with  patients,  and  this  will  account  for  the 
rapid  propagation  of  these  vegetable  organisms.  This  patient  left  the  hospital 
on  the  succeeding  day. 

Case  X. — October  5th,  11  o'clock  A.M.  American  seaman, 
age  16 ;  weight  125  lbs. ;  light  brown  hair,  blue  eyes,  florid 
complexion  ;  sanguine  temperament.  From  cutter  Taney,  which 
has  been  lying  at  the  ship-yard  in  the  low  lands  east  of  the  city. 
Four  nights  ago  he  slept  on  the  Savannah  river  in  an  open  boat. 
Has  not  felt  well  since,  and  thinks  that  this  was  the  cause  of  his 
sickness.  The  next  morning  he  felt  badly ;  had  pains  in  his 
bones  and  back,  but  no  chill.  These  uncomfortable  feelings 
were  followed  by  fever,  which  intermitted  yesterday  morning. 
This  morning  he  had  a  slight  chill,  followed  by  fever. 

Has  high  fever  now.  Xo  tenderness  upon  pressure  of  epigastrium,  Pulse  120. 
Respiration  40. 

Temperature  of  Atmosphere,       72°     F.  )      Skin  hot,  dry  and  pungent  to  the 

"  "  Hand, 105°75'    >  hand;  lips  parched  and  dry  ;  tongue 

"         under  Tongue,. .. .  106°         )  red,  dry,   and  rough  to  the  feeling. 
Reaction  of  saliva  acid. 

Here  is  a  bounding,  rapid  pulse — full,  heaving,  rapid  respira- 
tion, and  a  correspondingly  high  temperature.  These  symp- 
toms, together  with  the  hot,  pungent  skin — dry,  parched  lips — 
red  tongue,  and  flushed  face,  although  striking,  as  a  general 
rule,  should  never  alarm  the  practitioner,  as  long  as  they  are 
not  complicated  with  obstinate  vomiting,  or  cerebral  symptoms. 

In  cases  of  malignant  (congestive)  malarial  fever,  on  the  other 
hand,  there  is,  as  far  as  my  observations  extend,  a  want  of  co- 
ordination between  the  actions  of  the  circulatory  and  respiratory 
systems,  and  the  rapidity  and  character  of  the  chemical  changes. 
The  heart  attempts  to  propel  the  blood — it  beats  rapidly,  (flut- 
ters 140  to  160  times  in  a  minute,)  but  the  blood  does  not  flow 
readily  through  the  capillaries,  because  the  chemical  changes  are 
in  a  great  measure  arrested,  and  in  many  cases  perverted.  In  the 
present  case,  on  the  other  hand,  there  is  a  correspondence  in  all 
the  actions,  the  rapid  circulation  and  respiration  are  attended  with 
correspondingly  rapid  -chemical  changes  and  high  temperature. 


442 


Jones,  on  Malarial  Fever. 


[July, 


R;  Calomel  grs.  viij.,  castor  oil  in  4 
hours,  fy  Bicarbonate  of  potassa,  3iv. 
Citric  acid  3ij.,  water  ffxxiv.,  mix  and 
drink  ad  libitum  during  fever.  Diet — 
Gruel  and  flaxseed  tea. 

$:  As  soon  as  fever  remits,  give  sulp. 
of  quinia  grs.  v.  every  three  hours,  up 
to  grs.  xx. 

October  6th,  1-J-  o'clock,  P.  M.  Says, 
that  he  is  much  better,  feels  very  well, 
and  has  no  pain  anywhere.  Medicine 
operated  twice,  freely.  No  tenderness 
upon  pressure  of  epigastrium.  The  fe- 
ver intermitted  last  night,  and  he  rested 
well.  Tongue  moist,  soft,  and  clean; 
papillae  slightly  enlarged  and  distinct; 
skin  moist  and  relaxed.  Pulse  64.  Res- 
piration 20. 

Temperature  of  Atmosphere,    73°  F. 

"  Hand 94°5' 

"     under  Tongue 99° 

Urine  light  orange  color.  Sp.  Gr.  1022. 
Reaction  of  saliva  acid.  Has  taken  15 
grs.  Sulph.  of  quinia. 

R;  Sulph.  of  quinia  grs.  v. 

October  7th,  1£  o'clock,  P.  M.  Deci- 
dedly better,  up  and  dressed.  Tongue 
clean  and  normal.  Pulse  62.  Respira- 
tion 20. 

Temperature  of  Atmosphere,  72°    F. 

"  "  Hand 94°75' 

"     under  Tongue 99°20' 

fy  Snakeroot  tea,  tablespoonful  every 
four  hours. 

ty  Quassia  and  soda.     Full  diet. 

Amount  of  urine  passed  during  the 
last  24  hours,  grs.  8240.  Sp.  Gr.  1030. 
Am't  of  urine  passed  hourly  grs.  343-3. 
Reaction  acid  when  first  voided.  In  16 
hours  the  reaction  changed  to  alkaline, 
and  a  heavy  light  yellow  deposit  was 
thrown  down. 

Octr.  8th,  2  o'clock,  P.M.     Continues 
to  improve.     Tongue  and  skin  normal. 
Pulse  52.     Respiration  24. 

Temperature  of  Atmosphere,  73°   F. 

"  "  Hand 98°2' 

"     under  Tongue 99°5' 

Ri  Continue  quassia  and  soda. 

Amount  of  urine  passed  in  the  last  24 
hours,  grs.  8721.  Sp.  Gr.  1026.  Amount 
of  urine  passed  hourly,  grs.  363.3.  Re- 
action changed  from  acid  to  alkaline  in 
14  hours .  The  patient  states  that  he 
ordinarily  drinks  but  a  small  quantity 
of  water,  and  hence  the  concentrated 
state  of  his  urine. 


Spec.  Gravity 
of  Urine.. . 


Urine  excret- 
ed hourlv . . 


Urine  excret- 
ed in 
24  hours. . . 


to  ■* 

o  o 


ec  eo 
«o  <£> 
co  eo 


JT-  OS 

oo  »o 


Temperature 
under 
Tongue. . . . 


Temperature 
of 
Hand 


O  O 


1Q    1Q 

o   o 

os  cs 

OS  Ci 


O     O 

OO  CO 
OS  OS 


Temperature 

of 
Atmosphere. . 


Respiration . . 


o     o     o 

CO       <N       CO  CO 
£-      .C-      £-  £- 


Pulse 


o     « 


Hour  of  Day . 


wo 
5j5 


Sb&D 

°  °  2  * 

IM53  8. 

i — '    "■    c    -^  : 

— 'do — ' — 


(L,        2 


Day#of  Month      g      £ 


Month. 


1858.]  Jones,  on  Malarial  Fever.  443 

October  9th,  12  o'clock,  M.  Has  been  walking  about  the 
Hospital  grounds.     Pulse  t  -piration  24. 

Amount  of  urine  passed  during  the  last  24  hours,  grs 15912 

"      hourly "   663'8 

Reaction  alkaline  in  10  hours.  In  16  hours  threw  down  «  heavy  light  yellow- 
deposit     Sp.  Gr.   1024. 

The  foregoing  table  (Case  X.,  Table  3,)  will  give  a  condensed 
view  of  the  phenomena. 

Case  XI. — American  seamaq,  native  of  Maine;  weight  140 
lbs.  height  5  feet  8  inches;  age  19;  light  hair  and  blue  eves; 
fair  complexion.  Has  been  in  Savannah  for  three  weeks.  Was 
taken  with  chill,  followed  by  fever,  yesterday  at  12  M.  Had 
another  chill  this  morning  at  4  o'clock  A.  M. 

October  10th,  11  o'clock  A.  M.  Has  a  high  fever  now,  and 
complains  of  pain  in  his  head  and  bones.  Skin  Very  hot,  but 
moist.  Pulse  112  ;  respiration  thoracic,  labored ;  tongue  slight- 
ly coated  with  fur. 

fy.  Calomel  grs.  x,  Sulph.  of  quinia  grs.  vi.  Mix,  and  administer  immediately, 
and  follow  with  castor  oil  in  four  hours,     fy.  Soda  powders. 

7  o'clock  P.  M.  The  fever  still  continues  unabated.  Pulse 
and  respiration  still  greatly  excited.  Urine  clear  orange  color- 
ed. The  urine  excreted  during  the  febrile  excitement  of  the 
milder  forms  of  malarial  fever,  is  generally  of  a  lighter  color  than 
that  of  the  intermission,  or  of  remittent  fever.  Specific  gravity 
1022.  Xitrate  of  urea  clear,  silvery.  Eeaction  of  urine  decided- 
ly acid. 

Amount  of  urine  excreted  during  the  last  10  hours,     grains    9198. 

Calculated  amount  for  24  hours, '*       22075. 

Hourly  amount  of  urine  excreted, "  919. 


ANALYSIS  XL 

Urine  excreted  in 
10  hours,  grs.  9198 
contained  grains 

Calculated  amount  of 

urine  for  24  hours,  grs. 

contained  grains 

1000  parts 
of  urine  con- 
tained 

Urea, 

222-520 

3-960 

87-300 

534-C4S 

9-504 

209-520 

24-843 

Uric  Acid, 

0*430 

Fixed  Saline  Constituents, 

9-492 

Microscopical  examination  of  this  urine  which  was  excreted  during  high  fever. 
After  standing  72  hours  the  urine  still  retained  its  acid  reaction.  After  standing 
72  hours,  there  was  a  small  cloudy,  mucus-like  deposit.  Under  the  microscope, 
this  consisted  of  nothing  but  vegetable  cells. 

October  11th,  1  o'clock  P.  M.  Medicine  operated  freely.  Com- 
plains of  great  weakness.  Still  has  pain  in  his  head.  Tongue 
moist,  soft,  and  slightly  coated  with  white  fur.  Papilla?  red,  en- 
larged and  distinct.  Skin  cool  and  moist.  Pulse  74.  Respira- 
tion 26.     Has  taken  10  grains  of  the  sulph.  of  quinia. 

fy.  Continue  sulph.  of  quinia  up  to  gr&  xx.  Diet,  beef  soup,  gruel  and  tea. 
On  account  of  the  action  of  the  medicine,  the  whole  amount  of  urine  was  not  pre- 
served. Specific  gravity  1027.  After  standing  36  hours,  its  reaction  changed 
from_acid  to  alkaline,  and  a  moderately  heavy  deposit  of  vegetable  cells,  with  a 


444 


Jones,  on  Malarial  Fever. 


[July, 


few  crystals  of  triple  phosphate  and  urate  of  soda,  were  thrown  down.  Hydro- 
chloric acid  showed  the  presence  of  uric  acid  in  the  deposit.  It  is  probable  that 
these  vegetable  cells,  in  many  cases,  have  much  to  do  with  the  fermentation  of 
the  urine,  for  this  change  takes  place  most  rapidly  in  damp  warm  weather,  which 
is  favorable  to  the  growth  of  these  cells. 
Color  of  urine  orange. 

{1000  parts  of  urine  contained: 
Uric  Acid 0'194 
Fixed  Saline  Constituents 16*508 

October  12th,  11  o'clock,  A.M.  Much  better,  has  no  pain  in 
his  head ;  still  complains  of  weakness.  Skin  cool  and  moist. 
Pulse  72,  regular.     Respiration"  20. 

l$c  Quassia  and  soda.     Snakeroot  tea.     Full  diet. 

Amount  of  urine  passed  during  the  last  7  hours,  grs.  3580      [    g      ^r    1023 

"         "         "         "      hourly "      511*4  J       ^' 

Reddish  orange  color.  Reaction  acid.  After  48  hours  the  reaction  was  still 
acid,  and  it  was  without  deposit. 

Calculated  amount  of  urine  for  24  hours,  grs.  12177. 


ANALYSIS  XIII. 

Urine  excreted  in  7 
hours,  grs.  3580,  con- 
tained, grains, 

Calculated  am't  urine 
for  24  hours,  grs.  12177 
contained,  grains, 

1000  parts  of 
urine    contain- 
ed, 

Urea 

132-068 
1-750 

21-700 

452-729 
5*999 

74-387 

39-207 

Uric  Acid 

0*488 

Fixed  Saline  Con-  ) 
stituents [ 

6*060 

8  o'clock,  P.  M.  Continues  to  improve.  Skin  soft  and  nor- 
mal. Pulse  64,  normal.  Respiration,  normal.  Urine,  straw- 
colored.     Specific  Gravity,  1020. 

Amount  passed  in  the  last  9  hours grs.  5100 

666.6 
5120 
8192 
341*3 
10220 
.425-8 


hourly. 


Oct.  13,  11  o'clock,  A.M. 


Am't  of  urine  passed  in  the  last  15  hours,  grs. 

Calculated  amount  for  24  hours. . ." " 

Urine  excreted  hourly " 

Am't  of  urine  excreted  in  the  last  24  hours,  " 
hourly 


Sp.  Gr.  1024.     Color  normal.     After  24  hours  no  deposit.     Reaction  acid. 


ANALYSIS  XIV. 


Urine  excreted  in  ]  5 
hours,  grs.  5120,  con- 
tained, grains, 


Calculated  am't  urine 
for  24  hours,  grs.  10220 
contained,  grains, 


1000  parts  of 
urine  contain- 


Uric  Acid 

Fixed  Saline  Con- 
stituents  


2-750 
46-000 


4-400 
73-600 


0-637 
8-984 


In  this  case,  considering  the  conditions  of  perfect  rest,  and 
almost  entire  deprivation  of  food,  the  urea  was  increased  in 
quantity,  during  both  the  fever  and  the  intermission.  The 
amount  of  uric  acid  was  diminished  under  the  action  of  the 
sulphate  of  quinia. 

Case  XII. — Irish  laborer;  stout,  well  made  man,  remarkably 
large  chest;  brown  hair;  florid  complexion;  weight  192  lbs. ; 
height  5  feet  8 £  inches.     Has  been  in  America  five  years.     Re- 


1858.] 


JONES,  on  Malarial  Fever. 


445 


sided  in  New  York  city  four  years ;  and  during  the  last  twelve 
months  has  resided  in  Savannah.  During  the  summer  has  been 
working  along  shore,  and  running  up  and  down  the  Savannah 
river  in  a  flat. 

August  27th,  1857.  Entered  the  hospital  with  a  quotidian. 
For  several  hours  after  his  entrance,  was  stupid — could  not  an- 
swer coherently.  Pulse  104;  respiratiou  24,  labored,  thoracic. 
Tenderness  upon  pressure  of  epigastrium.  Tongue  slightly 
furred,  but  normal  in  color  and  moist.  The  warm  bath,  cut 
cups  to  the  epigastrium  and  a  purgative,  aroused  him  from  his 
stupor.  On  the  next  day,  his  pulse  was  104 ;  respiration  38  ; 
temperature  of  hand  102,  and  skin  hot,  but  moist.  Sulphate  of 
quinia  was  freely  administered  during  the  intermission  of  the 
fever.  Had  no  retnrn,  and  left  the  hospital  in  a  few  days.  Ke- 
turned  to  the  same  miasmatic  situation  on  the  Savannah  river. 

Entered  the  hospital  again  Sept.  17th,  1  o'clock  P.  M.,  with 
high  fever,  which  had  been  preceded  by  a  chill  last  evening. 
Twelve  grains  of  calomel  and  six  grains  of  sulph.  of  quinia  were 
administered.  The  fever  intermitted  during  the  night,  and 
twenty  grains  of  sulphate  of  quinia  was  administered,  in  five 
grain  doses,  at  intervals  of  three  hours.  This  did  not  arrest  the 
chill,  which  came  on  the  next  day,  Sept.  18th,  at  11  o'clock  A.M. 
2  o'clock  P.M.     Chill  is  just  going  off. 

(  Temperature  of  Atmosphere, 90°5'  F* 

Pulse  112.     Respiration  28.  \  "  "   Hand, 100 

(  "      under  Tongue, 104 

~fy.  Soda  powders.  As  soon  as  fever  remits  give  sulphate  of  quinia  grains  v, 
every  three  hours,  up  to  grains  xx. 

September  19th,  2  o'clock  P.  M.  Complete  intermission  of 
fever.  During  the  last  38  hours  has  taken  46  grains  of  the 
sulphate  quinia. 

{Temperature  of  Atmosphere, 91°  F. 
"  Hand, 97°5' 
"     under  Tongue, 99 

Amount  of  Urine  passed  during  the  last  24  hours,    grains  18,144 

"      •'  "         hourly "  756 

Reaction  acid.     Sp.  Gr.  1008,  clear,  limpid — color  a  shade  higher  than  normal. 


ANALYSIS  XV. 

Urine  excreted  in  24  hours, 
grs.  18144  contained  grains, 

1000  parts  of  Urine 
contained, 

Water, 

17626-878 

517-122 

226-980 

2-880 

231406 

53856 

971497 

Solid  Matters, 

28-503 

Urea, 

12-584 

Uric  Acid, 

0-158 

Extractive  and  coloring  matters. 
Fixed  Saline  Constituents, 

12290 
2-969 

There  was  no  return  of  fever,  and  the  patient  was  discharged. 
He  obtained  employment  upon  a  steam -tug,  which  plied  up  and 
down  the  river,  and  slept  on  board  at  night.  Was  taken  with 
a  chill,  followed  by  high  fever,  on  September  29th. 


446  Jones,  on  Malarial  Fever.  [July, 

October  2nd.  Has  just  entered  the  Hospital,  2  o'clock,  P.M., 
and  is  shaking  with  a  chill.  Pulse  120  in  the  sitting  posture. 
Kespiration  22  in  the  sitting  posture,  labored,  thoracic. 

Temperature  of  Atmosphere. . .  .79°  F.  \      Lips  and  hands  purplish,  he  is  shiv- 

"  "  Hand 89°        >•  ering  violently:  hands  feel  very  cold. 

"       under  Tongue 102°25'  )     The  intermissions  between  the  chills 

have  been  about  16  hours.  $  Mustards  to  extremities.  Ifc  Spts.  of  Mindererus 
and  brandy  and  snakeroot  tea,  of  each  a  tablespoonful  every  half  hour  until  re- 
action is  established.  Ifc  Calomel  grs.  xii.,  sulph.  of  quinia  grs.  vii.,  mix  and 
administer  as  soon  as  reaction  is  established,  and  follow  with  castor  oil  in  four 
hours,  fy  Sulph.  of  quinia  grs.  v.  every  three  hours,  up  to  grs.  xxv.,  commence 
as  sdon  as  there  is  the  slightest  tendency  to  a  remission. 

October  3rd,  2\  o'clock,  P.M.  Mustards  and  stimulants  cut 
short  the  chill,  and  hastened  the  febrile  action.  Medicine  oper- 
ated well,  and  he  feels  much  better.  Has  taken  22  grains  of 
sulphate  of  quinia.  Complains  of  ringing  and  pain  in  his  head. 
Pulse  100,  full.     Eespiration  26,  thoracic,  labored. 

Temperature  of  Atmosphere . . .  .77°6'F.  )      Tongue  red  at  tip,  but  moist  and 

"  Hand 105°        [-soft.      Reaction  of  saliva,   slightly 

"        under  Tongue 106°        )  acid.     Skin  dry. 

fy  Stop  sulph.  quinia  until  the  fever  intermits.     ^  Soda  powders.    Diet,  gruel. 

October  4th,  2  o'clock,  P.M.  Has  no  fever:  feels  much  bet- 
ter.    Pulse  58.     Eespiration  20,  regular  and  gentle. 

Temperature  of  Atmosphere. . .  .76°  F.  )      Urine  of  a  deep  orange  color,  and 

"  "  Hand 96°5'     >•  decided  acid  reaction.     Am't  passed 

"         under  Tongue 98°5'     )  in  the  last  24  hours,  grs.  14112.    Am't 

passed  hourly,  grs.  588.     Sp.  Gr.  1008. 

Says  that  during  the  night  he  was  in  a  profuse  perspiration. 
Has  taken  15  grains  of  the  sulphate  of  quinia  this  morning. 
October  5th.     Has  had  no  chill. 

R;  Quassia  and  Soda.     Urine  reddish  orange  color.     Sp.  Gr.  1016. 

Amount  of  urine  passed  in  the  last  24  hours grs.  15290 

hourly "         635 

Eecovered  sufficiently  to  act  as  nurse  and  servant  about  the 
Hospital.  Although  apparently  well  and  capable  of  much  mus- 
cular exertion,  this  patient  complained  of  a  continual  pain  in 
his  head. 

October  14th,  2  o'clock,  P.M.  Chill  came  on  at  11  o'clock, 
this  morning.  Now  has  high  fever.  Pulse  and  respiration 
much  accelerated,  and  skin  hot. 

fy  Calomel  grs.  xii.,  sulph.  of  quinia  grs.  vi.,  castor  oil  in  four  hours. 
#  Citrate  of  potassa  mixture  during  fever. 

October  15th,  2  o'clock,  P.M.  Apyrexia  complete.  Skin 
relaxed  and  cool.  Pulse  and  respiration  near  the  normal  stand- 
ard. 

Urine  excreted  during  the  febrile  excitement,  normal  in  color. 
Specific  gravity  1002.  Amount  of  this  urine  voided  during  the 
last  twelve  hours,  grains  35,070.   Says  that  "  during  the  nightfhe 


1858.]  Jones,  on  Malarial  Fever.  447 

drank  large  quantities  of  water,  and  felt  a  constant  desire  to 
urinate." 


ANALYSIS  XVI. 

Grains  35070  of  Urine  excreted  during  12 
hrs.  of  febrile  excitement,  contained  grs. 

1000  pte  ofU- 
rine  contained 

Urea, 

166-005 
A  trace — few  small  crystals. 
58-360 

4-743 

Uric  Acid, 

A  trace. 

Fixed  Saline  Constituents, 

1-696 

This  attack  also  yielded  readily  to  the  sulphate  of  quinia,  and 
up  to  the  time  that  I  resigned  the  charge  of  the  Savannah  Ma- 
rine Hospital  and  Poor  House  (October  20th),  this  patient  had 
had  no  return  of  fever. 

This  case  presents  several  points  of  interest.  The  phenomena 
of  the  cold  stage  have  been  noticed  and  compared  with  similar 
phenomena  in  a  former  article.  (See  page  396.)  At  the  pre- 
sent time  we  will  call  attention  to  the  fact,  that  during  the  fe- 
brile excitement  the  uric  acid  diminished  greatly  in  amount, 
with  and  without  the  action  of  the  sulphate  of  quinia,  and  in  the 
last  analysis  (xvi.)  disappeared  almost  entirely,  notwithstanding 
that  only  vi.  grains  of  sulph.  of  quinia  had  been  administered, 
and  that  in  conjunction  with  an  active  purgative.  The  follow- 
ing cases  will  show  that  the  uric  acid  is  frequently  diminished 
during  the  febrile  excitement  of  intermittent  fever,  independent- 
ly of  the  action  of  the  sulphate  of  quinia. 

•  Case  XIII. — Irish  laborer,  age  40 ;  height  5  feet  8  inches ; 
weight  145  lbs ;  brown  hair ;  grey  eyes ;  sallow  complexion ; 
occasionally  indulges  too  freely  in  ardent  spirits.  Was  in  the 
hospital  ten  days  ago  with  intermittent  fever.  After  leaving 
the  hospital,  he  obtained  work  along  the  river,  at  Fort  Pulaski, 
and  was  much  exposed  to  the*  sun.  "Was  taken  with  pains  in  his 
head  and  back,  and  fever,  yesterday  afternoon  at  4  o'clock  P.  M. 
Now,  Aug.  17th,  12  o'clock  M.,  there  is  an  intermission.  Pulse 
66:  respiration  20,  skin  moist  and  cool,  tongue  slightjx  furred. 
$.  Castor  oil. 

Aug.  18th.  Complains  of  great  thirst,  and  pains  in  his  head 
and  back.  Tongue  coated  in  the  middle  with  yellowish  fur, 
pointed  and  red  at  the  sides  and  tip ;  skin  hot  and  dry. 

(  Temperature  of  Atmosphere 90°  F. 

Pulse  100.     Respiration  36. -j  "  "Hand, 106 

(  "     under  Tongue 106  • 

fy.  Calomel  grs.  vi,  Tartrate  of  Antimony  gr.  i,  Xitrate  of  Potassa  grs.  xxx. 
Mix,  and  divide  into  six  powders — one  powder  every  three  hours.  8  o'clock  P.M. 
Skin  hot,  but  softer,  with  a  tendency  to  moisture.  Pulse  104 ;  respiration  still 
thoracic  and  labored. 

Aug.  19th.  Fever  intermitted  this  morning  about  2  o'clock 
A.  M.  Now,  12  o'clock  M.,  pulse  70  to  minute,  soft  and  nor- 
mal.    Respiration  22,  normal. 


448  Jones,  on  Malarial   Fever.  [Juty* 

Temperature  of  Atmosphere,  90°  F.  j  Tongue  normal  in  size,  papillae  not 
"     under  Tongue, .. .     98  (enlarged,  covered  with  yellowish  fur. 

Urine  passed  last  evening  and  night,  during  the  fever,  clear,  of  a  light  yellow 
color,  resembling  the  urine  of  hysterical  females.  This  resemblance  extended 
also  to  its  densit}T.  Specific  gravity  1005.  Amount  passed  during  six  hours  of 
febrile  action,  grains  7035.  When  one  thousand  grains  were  carefully  tested  for 
uric  acid,  only  a  small  trace,  just  evident  to  the  eye,  but  inappreciable  in  weight, 
was  exhibited,  after  the  most  careful  manipulation. 

Urine  passed  this  morning,  after  complete  subsidence  of  febrile  action,  orange 
colored.  Sp.  Gr.  1014.  When  concentrated,  it  exhibited  the  extractive  matter 
in  much  larger  amount  than  in  the  urine  of  fever. 

As  a  general  rule,  the  extractive  and  coloring  matters  are  less 
abundant  during  the  active  stage  of  intermittent  fever,  than 
during  the  intermission.  They  appear  to  be  consumed  during 
the  active  chemical  changes  of  fever.  The  nitrate  of  urea  form- 
ed from  the  urine  excreted  during  the  active  stages  of  intermit- 
tent fever,  is  silvery  white.  The  nitrate  of  urea  formed  from 
the  urine  excreted  during  the  intermission  is  dark,  discolored 
with  coloring  matter,  and  the  crystals  are  not  so  well  formed. 
The  former  kind  of  urine,  when  evaporated  and  concentrated, 
generally  has  a  yellowish  or  brownish  color,  whilst  the  concen- 
trated urine  of  the  intermission,  assumes  the  color  of  a  very 
strong  decoction  of  over-parched  coffee. 

Amount  of  urine  passed  during  7  hours  of  the  intermission,  grs.  6084 
Uric  Acid  in  "         "  "  "  "  "  "  0.48 

Uric  Acid  in  1000  parts  of  urine,  0.08 
The  microscopical  examination  of  these  specimens  of  urine  resembled  in  most 
respects,  the  examinations  of  urine  excreted  under  similar  circumstances. 
&  Sulph.  of  quinia  and  snakeroot  tea.     $  Cut  cups  to  small  of  back. 

August  20th.  Complains  of  pain  in  his  back,  and  restless- 
ness. Skin  moist,  tongue  slightly  coated  with  white  fur,  flat, 
papillae  not  enlarged.     Pulse  86.     Eespiration  27. 

(  Temperature  of  Atmosphere.  .87°F. 

Urine  high  colored,  Sp.  Gr.  1017.     -J  "  "Hand 100 

(  "         under  Tongue. . .  101 

Amount  of  urine  passed  during  the  last  24  hours, grs.  14120 

"      Uric  Acid  excreted  "         "       "       "    "  5.600 

"  #  "        "    in  1000  parts  urine  0.400 

August  21st.     Much  better.     Pulse  72.     Eespiration  17}. 

Urine  normal  in  color.  Sp.  Gr.  1009  (  Temperature  of  Atmosphere.  .80°F. 

Amount  passed  during  the  last  <  "  "Hand 96 

24  hours grs.  14126  (  "         under  Tongue 98 

Heavy  deposit  of  prismatic  crystals  of  triple  phosphate.  When  held  in  the 
sun-light,  the  urine  appeared  to  be  glittering  with  thousand  particles  of  bright 
shining  silver. 

August  22nd.  Skin,  pulse,  tongue,  respiration,  and  circula- 
tion, normal.     Urine  normal  in  color.     Specific  Gravity  1011. 

Amount  excreted  during  the  last  24  hours grs.  11132 

Uric  Acid       "  "  "         "       "     "  6.500 

"       "  in  1000  parts  of  urine "  0.500 

Concentrated  urine  of  a  dark,  almost  black  color. 


1858.]  Jones,  on  Malarial  Fever.  449 

Case  XIV. — American  seaman,  age  40  ;  weight  160;  height 
5  feet  9  inches ;  florid  complexion  ;  light  hair ;  sanguine  nervous 
temperament.  Has  been  in  the  Hospital  for  two  months,  with 
stricture  of  the  urethra.  There  were  several  strictures,  and  the 
passage  of  the  catheter  painful  and  difficult. 

The  urethra  and  bladder  were  so  irritable,  and  the  sufferings 
of  the  patient  so  great,  that  the  catheter  could  be  passed  only  at 
intervals  of  several  da}rs.  The  passage  of  the  catheter  was  al- 
ways followed  by  an  attack  of  chill  and  fever.  During  the  last 
two  months,  this  patient  was  treated  for  five  attacks  of  intermit- 
tent fever,  each  one  of  which  succeeded,  and  appeared  to  have 
been  excited  by  the  irritation  of  the  bladder  and  urethra. 

The  Savannah  Marine  Hospital  and  Poor-house  is  situated  in 
a  malarious  district.  Three  hundred  yards  to  the  southeast 
opens  a  large  sewer  from  the  city,  and  a  short  distance  beyond, 
where  this  sewer  discharges  its  contents,  is  a  body  of  low, 
swampy  land.  The  situation  of  the  Hospital  is  also  lower  than 
that  of  a  portion  of  the  city,  and  during  a  hard  rain,  a  large 
body  of  water  flows  down  and  accumulates  in  the  street  between 
the  hospital  and  the  park.  This  statement  is  farther  sustained, 
by  the  fact,  that  nearly  all  the  inmates  of  the  hospital  suffering 
with  other  diseases,  even  the  consumptives,  were  attacked  during 
this  season  with  malarial  fever.  Although  this  patient  was  not 
acclimated,  still,  in  health,  the  dose  of  malaria  was  not  sufficient 
to  produce  general  disturbance  of  the  chemical  actions  and 
physical  and  nervous  forces.  Whenever  his  system  was  excited 
and  enfeebled  by  the  irritation  of  the  urethra  and  bladder,  then 
the  characteristic  phenomena  of  the  action  of  the  malarial  poison 
were  manifested. 

October  11th.  This  patient  left  the  hospital  several  days  ago, 
became  intoxicated,  and  slept  all  night  in  the  open  air.  He  was 
taken  to  the  guard-house  by  the  mounted  police,  and  remained 
there  until  this  morning,  when  he  was  sent  to  the  hospital  in  a 
state  of  great  febrile  excitement.  Says  that  he  "  had  a  severe 
chill  this  morning  at  9  A.  M.,  which  lasted  four  hours,  and  was 
attended  with  vomiting.  Pulse  140,  full,  bounding.  Inspira- 
tion 32,  thoracic,  panting.  Skin  hot,  pungent;  face  flushed. 
The  temperature  was  not  determined,  but  it  must  have  been  at 
least  107°  under  the  tongue.  Urinary  secretion  abundant,  and 
orange  colored  during  the  febrile  action.  Specific  gravity  1008. 
After  careful  manipulation,  with  more  than  1000  grains  of  urine, 
only  a  trace  of  uric  acid  was  discovered. 

The  decomposition  of  the  urea  was  far  more  rapid  in  this  case, 
than  in  any  other  which  I  have  thus  far  examined.  Every 
trace  of  urea  disappeared  in  24  hours.  This  rapid  change  was 
due  to  the  catalytic  actions  of  the  perverted  secretions  of  the 
urethra  and  bladder. 

[To  be  continued] 


450  McDaxiel.     Tapping  in  Ovarian  Dropsy.         [July, 


ARTICLE    XVI. 

Tapping   in    Ovarian    Dropsy.     By  E.    McDaniel,    M.  D.,  of 

Laurens  District,  So.  Ca. 

Mrs.  B.,  34  years  of  age :  of  strong  constitution — the  mother 
of  seven  children — was  attacked  with  ovarian  dropsy  in  1841 ; 
died  the  4th  of  January,  1858,  making  sixteen  years  from  the 
commencement  of  her  disease  to  the  termination. 

Mrs.  B.  was  treated  by  several  experienced  physicians,  for 
upwards  of  two  years.  The  accumulation,  still  increasing,  and 
the  disease  becoming  more  alarming,  a  consultation  was  called 
November  10th,  1843,  and  the  operation  of  tapping  was  per- 
formed, for  the  first  time,  by  Dr.  E.  C,  with  the  evacuation  of 
thirteen  quarts  of  water.  From  that  time  to  the  termination 
of  the  case,  she  was  tapped  two  hundred  and  nineteen  times, 
with  the  evacuation  of  four  hundred  and  ninety  five  gallons  of 
water. 

Dr.  E.  C.  continued  to  perform  the  operation  of  tapping,  for 
a  number  of  times,  when  the  instrument  was  given  up  to  the 
Eev.  Mr.  B.,  her  husband,  a  very  intelligent  man,  who  perform- 
ed the  operations  up  to  the  time  of  her  death,  and  who  kept  a 
correct  statement  of  the  number  of  times  that  she  was  tapped, 
and  the  amount  of  fluid  evacuated  at  each  operation. 

Mrs.  B.  gave  birth  to  two  daughters  during  her  illness — the 
first  one,  March  22nd,  1843,  which  lived  and  did  well ;  the  se- 
cond, was  born  June  19th,  1845,  which  lived  a  few  hours,  and 
expired;  the  operation  being  performed  twelve  times  up  to  this 
date. 

Four  years  previous  to  her  death  a  tumour  made  its  descent 
into  the  vagina,  filling  the  whole  vagina,  which  interfered  very 
much  with  the  convenience  of  the  patient  in  a  sitting  position. 
A  physician  was  called  in — the  tumour,  or  sack,  was  pierced, 
with  the  evacuation  of  eight  quarts  of  water,  to  the  great  alle- 
viation of  the  patient.  During  her  illness,  she  was  tapped 
twenty-nine  times,  per  vaginam,  yielding  from  five  to  twelve 
quarts  of  water  at  an  operation. 

For  the  last  few  years,  being  the  family  physician,  and  being 
called  to  see  Mrs.  B.,  who  suffered  much  in  the  latter  period  of 
her  disease,  I  found  that,  after  the  operation  of  tapping,  inflam- 


1858.]  Green.     Case  of  Malformation.  451 

mation  of  the  sack  had  ensued  several  times,  but  was  combated, 
successfully,  by  a  strict  antiphlogistic  treatment — inflammation 
ensuing  again  after  the  two  hundred  and  eighteenth  operation, 
proved  rapidly  fatal. 

At  the  earnest  solicitation  of  the  patient,  she  was  tapped  a  few 
hours  before  she  expired. 

I  report  this  case  to  the  Profession,  on  account  of  the  frequent 
number  of  tappings,  and  the  aggregate  amount  of  water  that  was 
evacuated.  As  far  as  my  knowledge  extends,  such  a  case  is 
rare,  if  it  does  not  exceed  any  on  record. 


ARTICLE  XVII. 

Remarkable  Case  of  Malformation.    Reported  by  Wm.  A.  Green, 
M.  D.,  ofStarkville,  Ga. 

Was  called  to  Mrs  L ,  Monday,  January  5th,  1858.     Had 

been  in  labour  with  her  second  child.  Nothing  unusual  occur- 
red during  gestation  or  parturition.  She  gave  birth  to  a  child, 
over  the  average  size,  which  cried  lustily,  seeming  to  indicate 
every  function  was  regularly  and  properly  performed.  Upon  a 
close  examination,  the  following  deformities  were  found  to 
exist : 

The  spine  began  a  curvature  at  the  superior  third  of  the  cer- 
vical vertebra?,  in  a  direction  towards  the  right  h}<pochondrium, 
to  the  top  of  the  sacrum.  The  concavity  of  this  curvature  was 
filled  with  two  or  three  sac-like  appendages,  containing,  appa- 
rently, a  fluid  and  gas,  movable  and  compressible.  "A  want  of 
the  spinous  processes  of  three  or  four  contiguous  vertebras,  is 
not  a  very  uncommon  species  of  monstrosity."  "This  consti- 
tutes spina  bifida."  "There is,  usually  a  soft,  fluctuating  tumour 
in  the  situation  of  the  malformed  bones,  caused  by  water,  con- 
tained within  the  sheath  of  the  spinal  marrow." — Vide  Rams- 
bothams  Obstetrics.  (Keating.)  Appendix  M.  p.  622.  Below, 
upon  each  side  of  the  sacrum,  were  two  appendages,  resembling 
the  mammae  of  woman.  In  front,  between  the  point  where  the 
umbilicus  was  attached,  and  the  symphisis  pubis,  was  a  protru- 
sion of  intestines,  within  the  peritoneal  sac,  reducible  by  pres- 
sure, but  returning  when  removed.     Immediately  under  this 

V.  S. VOL.  XIV.     NO.  VII.  22 


452  Acclimation,  &c.  [July, 

hernia,  the  urine  trickled,  continuously,  from  two  or  three  small 
openings,  which  could  not  be  entered  by  the  smallest  probe. 
Below  this,  and  hanging  pendent  from  the  middle  of  the  symphi- 
sis pubis,  were  the  testicles,  perfectly  formed.  There  was  no 
trace,  nor  any  portion  of  the  penis.  Behind  the  symphisis  pubis, 
in  juxta-contact,  and  at  the  extreme  anterior  portion  of  the 
perinaeum,  was  an  anus,  well  formed,  through  which  the  fasces 
passed.  About  an  inch  and  a  half  behind  this,  at  the  point  of 
the  os  coxcygis,  was  another  anus,  that,  upon  examination, 
proved  to  be  imperforate — a  cul  de  sac. 

The  face  of  the  infant,  when  first  born,  was  perfectly  black, 
but  is  changing  to  a  mulberry  hue.  Numerous  marks  are  upon 
itsbodyr  such  as  are  frequently  seen  upon  children.  Every 
other  portion  of  the  child  seems  perfectly  and  symmetrically  de- 
veloped. Its  bowels  are  regular;  it  is  healthy,  and  rapidly 
growing.  The  complete,  entire,  absence  of  the  penis,  or  any 
portion  of  it — the  unusual,  unheard-of  positions  of  the  anus,  tes- 
ticles and  anomalous  passage  of  the  urine,  are  extremely  remark- 
able and  interesting.  The  bladder  has  no  urethra,  through 
which  to  pass  its  urine,  so  these  apertures  must  come  in  direct 
contact  withy  and  even  enter  the  fundus  of  the  bladder. 


Acclimation ;  and  the  Liability  of  Negroes  to  the  Endemic  Fevers 
of  the  South.  By  E.  D.  Fenner,  M.  D.,  Professor  of  Theory 
and  Practice  of  Medicine,  N.  O.  School  of  Medicine. 

In  the  last  {March)  number  of  that  influential  and  widely-cir- 
culated journal,  the  North  American  Medico-  Chirurgical  Review, 
we  find  an  extract  from  the  work  of  Nott  and  Gliddon,  on 
the  Indigenous  Races  of  Mankinds  expressing  observations  and 
opinions  on  the  above  subjects  so  entirely  different  from  our  own, 
and  as  we  believe,  so  wide  of  the  truth,  that  we  have  concluded 
to  invite  the  special  attention  of  Southern  physicians  to  them, 
with  the  view  of  ascertaining,  if  possible,  to  what  extent  such 
opinions  prevail.  We  do  this  in  no  captious  spirit  towards  our 
talented  and  esteemed  friend,  Dr.  Nott ;  but  solely  for  the  pur- 
pose of  eliciting  truth  on  a  subject  of  vital  importance.  ^  Constitu- 
ted as  men  are,  they  cannot  be  brought  to  see  things  in  the  same 
light,  nor  to  reason  alike  from  given  premises ;  yet  there  must 
be  truth  on  one  side  or  the  other  in  all  such  discussions,  and 
when  it  cannot  be  satisfactorily  demonstrated,  we  have  to  receive 


1858.]  Acclimation,  Ac.  •  453 

as  truth  the  concurrent  observations  and  conclusions  of  the 
largest  number  of  equally  competent  observers  and  thinkers. 
The  following  is  the  extract  alluded  to : 

"  The  fact  is  so  glafing,  and  so  universally  admitted,  that  I  am 
reallv  at  a  loss  to  select  evidence  to  show  that  there  is  no  acclima- 
tion against  the  endemic  fevers  of  our  rural  districts.  Is  it  not 
the  constant  theme  of  the  population  of  the  South,  how  they  can 
preserve  health  ?  and  do  not  all  prudent  persons,  who  can  afford 
to  do  so,  remove  in  the  summer  to  some  salubrious  locality,  in 
the  pine-lands  or  the  mountains  ?  Those  of  the  tenth  generation 
are  just  as  solicitous  on  the  subject  as  those  of  the  first.  Books 
written  at  the  North  talk  much  about  acclimation  at  the  South; 
but  we  here  never  hear  it  alluded  to  out  of  the  yellow-fever  cities. 
On  the  contrary,  we  know  that  those  who  live  from  generation 
to  generation  in  malarial  districts  become  thoroughly  poisoned, 
and  exhibit  the  thousand  Protean  forms  of  disease  which  spring 
from  this  insidious  poison. 

"I  have  been  the  examining  physician  to  several  life-insurance 
companies  for  many  years,  and  one  of  the  questions  now  asked 
in  many  of  the  policies  is,  l  Is  the  party  acclimated?'  If  the  sub- 
ject lives  in  one  of  our  Southern  seaports,  where  yellow  fever 
prevails,  and  has  been  born  and  reared  there,  or  has  had  an  attack 
of  yellow  fever,  I  answer,  '  Yes.1  If,  on  the  other  hand,  he  lives 
in  the  country.  I  answer.  'No;'  because  there  is  no  acclimation 
against  intermittent  and  bilious  fevers,  and  other  ma&h  diseases. 
Now,  I  ask  if  there  is  an  experienced  and  observing  rMysician  at 
the  South  who  will  answer  differently  ?"* 

Dr.  Nott  here  proclaims  that  "there  is  no  acclimation  against 
the  endemic  fevers  of  our  rural  districts?  and  boldly  asks  M  if  there 
is  an  experienced  and  observing  physician  at  the  South  who  will 
answer  differently  ?" 

With  all  due  deference  we  feel  bound  to  reply  that  there  is  at 
least  one,  and  we  believe  thousands,  not  only  of  physicians,  but 
planters,  too,  who  differ  with  him  on  this  question.  We  were 
born  and  raised  in  the  South,  and  have  practiced  medicine  in  the 
country,  in  villages,  and  in  the  city  of  New  Orleans.  We  have 
been  a  planter  also,  and  have  had  no  ordinary  opportunities  to 
observe  the  effects  of  acclimation,  not  only  on  the  white  and 
black  races  of  men,  but  also  on  the  lower  animals,  and  we  must 
express  the  opinion,  that,  but  for  the  attainment  of  a  greater  or  less 
degree  of  acclimation,  the  extensive  malarious  region  of  the  South- 
ern and  Southwestern  States  never  could  have  reached  its  present 
state  of  population  and  improvement.  So  far  from  the  fact  bein^ 
"glaring  and  universally  admitted  that  there  is  no  acclimation 
against  the  endemic  fevers  of  our  rural  districts,"  as  is  maintain- 
ed by  Dr.  Nott,  we  contend  that  exactly  the  converse  opinion 
obtains;  hence  the  additional  value  attached  by  all  practical  men 


454:  •   Acclimation,  &c.  [July, 

in  these  parts,  both  country  and  city,  to  the  acclimated  negro, 
horse,  ox  and  milch  cow.  Perhaps  it  would  not  be  going  too  far 
to  say  that  even  the  dogs,  turkeys  and  chickens  have  to  undergo 
acclimation  before  they  can  do  well  here,  i 

We  thought  the  fact  was  universally  admitted  that  all  immi- 
grants from  more  Northern  regions  to  the  South  were  very  liable 
to  suffer  from  the  endemic  fevers,  for  the  first  two  or  three  years 
of  their  residence,  but  that  after  that  period  they  obtain  compara- 
tive immunity,  and  in  the  course  of  time  may  enjoy  as  good 
health  here  as  they  did  where  they  came  from,  and  some  of  them 
much  better.  They  become  habituated  to  the  climate  and  its  dis- 
eases, and  may  live  as  long  as  the  Creoles,  or  natives,  who  certain- 
ly make  no  contemptible  display  of  longevity  in  the  mortuary 
statistics  of  the  country. 

There  appears  to  be  a  slight  inconsistency  in  some  of  the  re- 
marks of  Dr.  Nott  respecting  the  acclimation  of  negroes  and  their 
liability  to  the  endemic  fevers  of  the  South.  In  one  place  he  says 
negroes  are  "  comparatively  exempt  from  all  the  endemic  diseases 
of  the  South."  In  another — "The  acclimation  of  negroes,  even 
according  to  my  (his)  observation,  has  been  put  in  too  strong  a 
light."  *  *  *  *  "They  never  become  proof  against  inter- 
mittents  and  their  sequelae."  #  #  *  *  "  Whenever  the 
whites  are  attacked  with  intermittents,  the  blacks  are  also  suscep- 
tible, though  not  in  so  great  a  degree."  And  again  :  "Certainly 
negroes  do  suffer  greatly  on  many  cotton  plantations  in  the  mid- 
dle belt  of* the  Southern  States ;  and  I  have  seen  no  evidence  to 
prove  that  they  can,  in  this  region,  become  accustomed  to  the 
marsh  poison."  Dr.  Nott  applies  these  observations  to  the  region 
of  country  removed  from  the  rice  country,  and  adds :  "  We  shall 
see  further  on  that  the  negroes  of  the  rice-field  region  do  under- 
go a  higher  degree  of  acclimation  than  those  of  the  hilly  lands  of 
the  interior."  Upon  this  he  throws  out  the  suggestion  that  there 
may  be  "difference  in  the  types  of  those  malarial  fevers  which 
originate  in  the  flat  tide-water  rice-lands,  and  those  of  the  clay 
hills,  or  marsh  fevers  of  the  interior." 

Dr.  Nott  says  in  a  note  :  "  A  medical  friend,  (Dr.  Gordon,)  who 
has  had  much  experience  in  the  diseases  of  the  interior  of  Alabama, 
South  Carolina  and  Louisiana,  has  been  so  kind  as  to  look  over 
these  sheets  for  me,  and  assures  me  that  I  have  used  language 
much  too  strong  with  regard  to  the  exemption  of  negroes.  He 
says  they  are  quite  as  liable  as  the  whites,  according  to  his  obser- 
vation, to  intermittents  and  dysentery."  On  a  closer  examination 
of  the  different  remarks  of  Dr.  Nott,  above  quoted,  we  confess 
ourselves  somewhat  at  a  loss  to  decide  which  side  of  the  question 
he  has  raised,  they  tend  chiefly  to  support.  First  comes  the  gen- 
eral remark  that  "  there  is  no  acclimation  against  the  endemic 
fevers  of  our  rural  districts ;"  then,  "  negroes  are  comparatively 


1858.]  Acclimation^  &c.  455 

exempt  from  all  the  endemic  diseases  of  the  South  ;"  again,  "  ne- 
groes do  suffer  greatly  on  many  cotton  plantations  in  the  middle 
belt  of  the  Southern  States,  and  he  has  seen  no  evidence  to  prove 
that  they  can,  in  this  region,  become  accustomed  to  the  marsh 
poison;"  and  finally,  "that  the  negroes  of  the  rice-field  region  do 
undergo  a  higher  degree  of  acclimation  than  those  of  the  hilly 
lands  of  the  interior." 

A  reviewer  of  Dr.  Xott,  in  the  Southern  Medical  and  Surgical 
Journal  for  January,  1858,  says  at  page  22 :  "  We  must  differ 
from  the  learned  author  when  he  affirms  that  negroes  are  compar- 
atively exempt  from  all  the  endemic  diseases  of  the  South.  Such 
is  certainly  not  the  case  in  this  section  of  Georgia,  (Augusta,)  and 
in  the  adjacent  portions  of  South  Carolina  and  Alabama,  where 
every  planter  knows  that  his  negroes  suffer,  equally  with  the 
whites,  annual  attacks  of  intermittent  and  remittent  fevers,  dys- 
entery, malarial  pneumonia,  etc.  This  writer  then  goes  on  to 
*' out-Herod  Herod"  in  his  opposition  to  malarial  acclimation, 
reaching  the  ne  plus  ultra  when  he  says  :  "We  may  safely  affirm 
the  liability  to  our  fevers  is  in  a  direct  ratio  with  the  length 
of  time  the  individual  has  resided  in  the  malaria  district,  and  that 
natives  are  the  most  susceptible."  *  *  *  *  "  Negroes  born 
and  reared  upon  the  plantations  of  Georgia  and  South  Carolina 
are  fully  as  liable  to  fever  as  new  comers,  and  we  think  much 
more  so."  But  finally,  he  concurs  with  Dr.  JSTott,  that  in  the 
most  malarious  portions  of  the  whole  malarious  region,  the  low 
country,  "negroes  do  become  acclimated  and  comparatively 
exempt  from  fevers."  From  this  he  infers  also  with  Dr.  Nott, 
"  that  the  low-country  fever,  like  yellow  fever,  must  then  be  essen- 
tially different  from  any  form  of  fever  in  the  upper  sections  of  the 
Southern  States." 

Now,  to  our  apprehension,  the  attainment  of  more  perfect  ac- 
climation in  the  latter  region  is  more  justly  attributed  to  the 
steady  continuance  than  to  any  peculiarity  of  the  febrific  cause  ; 
for  we  find  no  material  difference  in  the  types  of  fever  prevailing 
here  and  the  uplands. 

There  are  malarious  seasons  as  well  as  malarious  regio?is,  and  it 
appears  to  us  that  in  those  climates  and  localities  where  the 
operation  of  the  morbific  cause  is  most  continuous,  the  effects 
should  be  most  durable.  Thus,  by  the  inherent  conservative 
powers  of  the  animal  constitution,  it  is  capable,  in  the  course  of 
time,  of  habituating  itself  to  the  deleterious  influence  of  deadly 
poisons,  as  is  actually  witnessed  in  the  use  of  opium,  strychnine, 
-arsenic  and  corrosove  sublimate.  The  following  quotations  from 
respectable  authorities  will  serve  to  show  how  widely  different 
from  the  commonly  received  opinion  on  the  subject  of  acclima- 
tion are  the  positions  held  by  both  Dr.  Nott  and  his  reviewer. 

Dr.  E.  M.   Pendleton  of  Sparta,   Georgia,   in   an   interesting 


456  Acclimation,  &c,  [July? 

paper  "  on  the  susceptibility  of  the  Caucasian  and  African  races  to 
the  different  classes  of  disease,"  published  in  the  Southern  Medical 
and  Surgical  Journal  for  November,  1849,  after  showing  the 
greater  liability  of  children  than  adults  to  idiopathic  fevers,  re- 
marks: "But  why  the  adult  should  be  less  liable  than  young 
persons  is  not  so  easily  determined,  unless  young  people  in  mias- 
matic districts  have  to  undergo  a  kind  of  acclimation,  as  foreign- 
ers, and  afterwards  become  less  subject.  I  have  observed  that 
parents  seldom  have  fever  where  they  have  lived  a  long  time  in 
unhealthy  sections,  while  their  children  are  frequently  every  one 
prostrated  at  once.  Inquire  of  them,  however,  and  you  will  find 
that  in  former  years  they  were  equally  as  subject  to  it  as  their 
children  seem  to  be  in  later  days," 

From  Dr.  LaRoche's  valuable  work  "  on  Pneumonia  and  Ma- 
laria" we  take  the  following :  Speaking  of  the  protection  afford- 
ed by  acclimatization,  he  says :  "  That  such  a  protection  is  thus 
obtained,  to  a.  greater  or  less  extent,  in  regard  to  all  malarial  and 
some  other  forms  of  fever,  no  one  who  has  examined  the  subject 
with  attention  will  feel  disposed  to  deny.  By  long  habituation  to 
infectious  localities,  and  to  the  high  temperature  of  hot  regions, 
the  system  becomes  acclimatized,  and  thereby  acquires  the  power 
of  tolerating  perfectly  and  permanently  the  poison,  or  of  elimina- 
ting it  as  soon  as  received,  without  succeeding  reaction.  The 
observation  is  of  old  standing.  Pliny,  nearly  twenty  centuries 
ago,  called  attention  to  the  fact,  that  they  who  are  seasoyxed  can 
live  amid  pestilential  diseases"  and  the  statement  has  been  con- 
firmed by  all  subsequent  observations."     P.  403. 

Dr.  La  Roche  goes  on  to  show  correctly  that  ';  the  dangers  of 
infection  to  strangers  is  in  proportion  to  the  coldness  of  their 
native  land — that  the  protective  influence  of  acclimatization  is  lost 
by  a  prolonged  residence  in  cold  climates — that  the  children  of 
the  natives  and  acclimatized  do  not  enjoy  the  same  advantage 
in  regard  to  protection  as  their  parents,  but  acquire  them  rapidly 
as  they  advance  in  age,  etc  ;"  the  most  of  which  he  also  shows  to 
be  equally  true  of  yellow  fever.     P.  404-5. 

Dr.  Nott  says:  "An  attack  of  yellow  fever  does  not  protect 
against  marsh  fevers,  nor  vice  versa!'  This  is«very  true,  but  we 
go  further  still.  We  maintain  that  a  mere  attack  of  yellow  fever 
does  not  protect  completely  against  the  same  disease.  To  effect 
this  purpose  there  must  be  a  good  strong  attack — one  that  is  capa- 
ble of  modifying  the  system  and  leaving  a  permanent  impression. 
So,  likewise,  with  malarious  or  country  fevers.  It  requires  longer 
exposure  and  often  numerous  attacks  before  the  human  system 
becomes  seasoned  to  the  deleterious  influence  of  malaria.  Yet 
La  Roche  demonstrates  the  fact  by  voluminous  testimony,  and  it 
fully  accords  with  our  observation,  that  persons  who  have  lived 
long  in  Southern  malarious  districts  suffer  much  less  from  yellow 


1858.]  Acclimation,  &c.  457 

fever,  when  first  exposed  to  it,  than  those  from  the  North  who  have 
not  been  thus  seasoned.  What  does  this  prove,  if  not  that  there 
exists  a  consanguinity  between  the  types  of  fever? 

The  following  extract,  from  Watson's  Lectures,  present  this 
subject  in  its  proper  light : 

"  Another  tact  worthy  of  notice,  in  respect  to  the  agency  of  the 
malaria  upon  the  human  frame,  is  that  it  affects  strangers  much 
more  readily  and  decidedly  than  the  natives  of  the  place.  In 
other  words,  habit  mitigates  the  injurious  effects  of  the  poison. 
Persons  become  seasoned  to  it.  At  Walcheren,  though  almost 
every  adult  among  the  lower  classes  had  labored,  in  the  course  of 
his  life,  under  the  endemic  intermittent,  yet  they  were  infinitely 
less  subject  to  it  than  strangers:  and  they  will  not  believe  that 
their  beloved  birthplace  is  unhealthy.  Sir  Gilbert  Blane  says 
that  persons  of  education,  and  even  medical  men,  denied  indig- 
nantly that  this  country  was  less  healthy  than  any  other;  and 
attributed  the  sickness  which  raged  among  our  troops  to  some 
trivial  circumstance  of  diet  or  habits,  and  not  to  any  insalubrity 
of  the  air.  This  is  a  curious  moral  feature,  but  a  very  general 
one.  In  the  pestilential  plains  of  Estremadura  the  superstitious 
natives,  unable  or  unwilling  to  account  for  a  disease  of  a  type  so 
uncommon,  among  the  soldiers,  from  any  unwholesomeness  of  the 
air,  declared  that  they  had  all  been  poisoned  by  eating  mushroons. 
It  was  found,  also,  at  Walcheren,  that  the  strangers  who  survived 
the  first  attacks  became  thereafter  much  less  liable  to  the  endemic 
fevers.  The  French  general,  Monnet,  who  had  held  the  command 
at  Flushing  for  several  years,  had  acquired  a  knowledge  of  this 
fact,  and  endeavored  to  turn  it  to  practical  account.  He  recom- 
mended that  troops  should  not  be  frequently  changed ;  for  when 
it  was  the  custom  to  send  batallions  from  Bergen-op-Zoom  every 
fourth  night  in  succession,  to  work  on  the  lines  of  Flushing,  these 
men  never  failed,  upon  their  return,  to  be  taken  ill  in  great  num- 
bers. General  Monnet  therefore  advised,  however  displeasing  it 
might  be  to  the  officers,  that  a  stationary  garrison  should  be  re- 
tained at  Walcheren,  in  order  that  the  men  might  be  habituated 
or  seasoned  to  the  air,  {acclimates)  and  he  adduced  the  instance 
of  a  French  regiment  which  suffered  in  the  second  years  of  its 
being  stationed  there  only  one-half  the  sickness  and  mortalitv 
which  it  suffered  during  the  first  year,  and  hardly  suffered  at  all 
in  the  third  year."     P.  446. 

Dr.  Watson  then  speaks  of  the  generally  injurious  effects  of 
malaria,  besides  the  violent  and  distinct  forms  of  fever  it  produ- 
ces in  new  comers,  and  gives  the  following  testimony  in  respect 
to  the  exemption  of  negroes  : 

"One  remarkable  exception  is  mentioned  by  Dr.  Ferguson. 
From  some  peculiarity  or  idiosyncrasy  (which  he  conjectures 
may  be  somehow  connected  with  the  texture  of  the  skin)  the  negro 


458  Acclimation,  <&c.  [Ju^7» 

appears  to  be  proof  against  endemic  fevers.  To  him  marsh 
miasmata  are  in  fact  no  poison,-  and  hence  his  incalculable  value 
as  a  soldier,  for  field  service,  in  the  West  Indies.  The  warm, 
moist,  low  and  leeward  situations  where  these  pernicious  exhala- 
tions are  generated  and  concentrated,  prove  to  him  congenial. 
He  delights  in  them,  for  there  he  enjoys  life  and  health,  as  much 
as  his  feelings  are  abhorrent  to  the  currents  of  wind  that  sweep 
the  mountain-tops,  where  alone  the  whites  find  security  against 
endemic  fevers." 

There  is  doubtless  much  truth  in  the  remarks  of  Dr.  Ferguson, 
but  his  assertions  are  altogether  too  strong  for  our  temperate  re- 
gion. Malaria  is  certainly  &  poison  to  the  negro  as  well  as  the 
white,  but  it  is  less  deleterious  to  the  former,  and  he  more  readily 
becomes  seasoned  to  it. 

It  would  seem  that  those  types  of  idiopathic  fever  which,  ac- 
cording to  Dr.  Campbell's  plausible  theory,  depends  chiefly  on 
disorder  of  the  cerebrospinal  system  of  nerves,  as  all  the  well- 
marked  paroxysmal  fevers  are  more  subject  to  recurrence  and 
require  a  longer  period  for  acclimation  than  those  of  the  continued 
types,  as  yellow  typhoid,  typhus  and  the  eruptive  fevers,  measles, 
scarlatina,  variola,  varicella,  etc.  Quotations  on  this  subject 
might  readily  be  multiplied  to  any  extent,  but,  perhaps,  to  little 
purpose.  The  testimony  would  be  found  to  be  very  conflicting, 
and  difference  in  opinion  would  still  remain. 

To  show  that  we  have  not  penned  these  remarks  in  a  spirit  of 
captious  criticism,  but  only  for  the  purpose  of  eliciting  the  expres- 
sion of  opinion  by  others  on  the  subject,  we  will  now  give  our 
own  views  in  regard  to  acclimation,  published  in  our  first  volume 
of  Southern  Medical  Reports,  (1849.)  Nearly  ten  years  of  addi- 
tional observation  has  only  served  to  strengthen  the  opinions  here 
expressed : 

"In  connection,  it  may  be  expected  of  us  to  say  something  in 
regard  to  what  is  termed  '  acclimation.1  This  term  is  in  very 
common  use,  and  is  well  understood  to  mean  the  habituation  of  a 
person  to  a  special  climate. 

"  It  is  but  reasonable  to  suppose,  that  man,  '  the  master-piece 
of  his  Creator,'  and  '  the  inheritor  of  the  earth,'  was  designed  to 
live  in  every  portion  of  the  globe  which  is  supplied  by  the  hand  of 
nature  with  the  means  of  subsistence,  or  accessible  to  commerce 
and  tMe  arts.  Yet,  so  great  is  the  difference  of  soil,  climate  and 
attendant  circumstances,  in  the  various  regions  between  the 
tropics  and  the  poles,  that  no  race  of  animals  is  capable,  at  once, 
of  enjoying  equal  health  in  them  all.  There  is  required  a  certain 
adaptation  of  the  constitution  to  each,  which  can  only  be  attain- 
ed through  the  gradual  changes  effected  by  time  and  exposure. 
Independent  of  the  peculiarities  of  climate,  soil,  water,  etc.,  to  be 
found  indifferent  regions,  it  is  presumable  that  there  exist  in  the 


1858.]  Acclimation,  &c.  459 

atmosphere  over  certain  localities,  deleterious  gasses,  effluvia,  or 
emanations  from  the  earth,  which  exert  their  most  powerful 
effects  upon  the  living  system  when  it  is  first  exposed  to  their  in- 
fluence; but  to  which  the  system  may  become  gradually  inured 
in  the  process  of  time.  To  become  accustomed  to  these  peculi- 
arities of  soil,  climate  and  noxious  effluvia,  is  what  we  term  being 
seasoned  or  acclimated;  and  it  is  wonderful  to  witness  the  capa- 
bilities of  the  human  system  in  this  respect.  There  are  but  few 
individuals  who  can  make  a  great  change  of  residence  with  per- 
fect impunity.  With  the  great  majority  of  people,  it  is  done  at 
the  peril  of  their  lives;  but  the  effects  are  very  different  upon  dif- 
ferent constitutions.  Some  do  not  become  seasoned  until  they 
have  suffered  the  severest  form  of  endemic  fever  belonging  to  the 
climate  and  locality ;  others  become  gradually  and  thoroughly 
acclimated  without  even  suffering  an  open  or  severe  attack. 
There  are  persons  who  have  resided  in  New  Orleans  twenty  years 
without  ever  having  had  yellow  fever,  whilst  others  have  had  it 
two  or  three  times.  Strong  attacks  of  the  severest  forms  of  our 
remittent,  bilious  and  yellow  fever  seems  to  cause  a  modification 
of  the  system,  which  secures  to  the  individual  a  greater  or  less 
immunity  from  subsequent  attacks.  Attacks  of  the  milder  forms, 
as  ordinary  intermittents,  effect  no  such  immunity  ;  but.  on  the 
contrary,  when  frequent,  lead  to  permanent  engorgement  of  the 
spleen,  and  cause  an  increased  liability  to  the  complaint.  The 
term  acclimation  is  just  as  familiar  to  the  inhabitants  of  all  the 
Southern  portions  of  the  Mississippi  valley,  as  it  is  to  the  citizens 
oi  New  Orleans,  and  is  used  to  express  the  same  idea,  viz :  that 
persons  coming  from  a  Northern  climate  and  settling  there  are 
very  liable  to  have  attacks  of  fever  during  the  first  two  or  three 
years,  but  afterwards  become  quite  exempt.  This  fact  is  so  well 
known  as  to  cause  a  considerable  difference  in  the  valuation  of 
negroes,  and  even  horses  and  cattle.  An  acclimated  negro,  horse, 
or  milch  cow,  commands  a  higher  price  than  an  unacclimated 
one.  We  shall  not,  at  this  time,  attempt  to  explain  the  nature  of 
the  change  effected  by  acclimation,  nor  the  manner  in  which  it  is 
brought  about;  but  it  is  a  fact  confirmed  by  long  experience  and 
common  observation. 

"  Believing,  as  we  do,  that  yellow  fever  is  only  one  of  the  forms 
or  types  of  endemic,  malarious  fever,  witnessed  almost  annually 
in  this  city,  and  less  frequently  at  many  other  places  in  the  South, 
we  may  stare  the  fact,  that  those  who  have  suffered  severe  attacks 
of  it,  or  even  mild  attacks,  during  severe  epidemic  seasons,  cer- 
tainly remain  quite  secure  from  subsequent  attacks;  especially  if 
they  continue  to  dwell  in  the  same  locality.  But  that  they  are 
equally  as  secure  as  those  who  have  had  small-pox,  measles  or 
hooping-cough,  as  is  maintained  by  some  physicians,  we  cannot 
for  a   moment   admit.     Our  own  observation,    if  we  have  seen 


460  Syphilitic  Inflammation  of  the  Retina.  [July? 

aright,  is  at  variance  with  this  position.  It  is  a  common  remark 
among  persons  who  thought  themselves  acclimated,  when  attacked 
by  fever  again,  during  a  sickly  season,  to  say,  that  '  if  they  were 
not  certain  of  having  once  had  yellow  fever,  they  would  think  they 
had  it  again.'  The  truth  is,  they  did  have  it  again;*  and  if,  by 
neglect  or  malpratice,  the  disease  had  run  on  to  a  dangerous  stage, 
or  to  death,  all  doubt  would  have  been  removed.  But,  fortunate- 
ly, the  partial  acclimation  attained  so  fortifies  the  system  against 
the  malign  influence  of  the  morbific  cause,  that  the  tendency  to 
death  is  not  near  so  strong  as  in  unacclimated  subjects  ;  therefore, 
most  generally,  they  are  easily  relieved,  and  come  to  the  conclu- 
sion they  have  not  had  yellow  fever  a  second  time. 

"  It  is  a  common  belief,  both  in  the  profession  and  out  of  it,  'that 
the  Creoles,  or  natives  of  New  Orleans,  do  not  have  yellow  fever 
at  all ;  but  in  our  accounts  of  the  epidemics  of  1847  and  1848,  we 
have  given  the  testimony  of  some  of  the  most  respectable  physi- 
cians to  the  contrary.f 

"  From  the  foregoing  remarks  it  follows,  then — 

"  1.  That  persons  coming  from  more  northern  latitudes  to  this 
have  to  undergo  an  acclimation  or  seasoning,  before  they  become 
secured  in  the  enjoyment  of  good  health. 

"2.  That  this  acclimation  may  be  attained  without  sickness; 
but  that,  most  generally,  it  requires  the  endurance  of  one  or  more 
spells  of  the  customary  endemic  fevers. 

"  3.  That  an  attack  of  the  endemic  yellow  fever  effects  greater 
security  against  subsequent  attacks,  than  any  form  of  fever  seen 
in  the  country ;  but  the  remark  is  applicable,  in  some  degree,  to 
all  of  them,  excepting  the  ordinary  mild  intermittents. 

"  4.  That  persons  may  have  yellow  fever  more  than  once, 
though  it  is  evident  that  those  who  have  had  one  plain  attack, 
usually  have  little  or  nothing  to  dread  from  subsequent  attacks. 

"  5.  That  Creoles  or  natives  of  New  Orleans,  may  have  yellow 
fever — though  generally  they  have  it  in  a  very  mild  form. 

"  So  much  for  our  present  views  of  acclimation.  The  subject 
is  full  of  interest,  and  we  shall  probably  recur  to  it,  from  year  to 
year,  as  our  .experience  is  enlarged." — [New  Orleans  Med.  News. 


Syphilitic  Inflammation  of  the  Retina. 

The  revelations  of  the  ophthalmoscope  bid  fair  to  add  a  pecu- 
liar form  of  retinitis  to  the  acknowledged  role  of  symptoms  due 
to  constitutional  syphilis.  A  fortnight  ago  we  noticed  a  very 
interesting  case,  in  which  lymph  had  been  seen  deposited  on  the 
retina  of  an  infant,  the  subject  of  hereditary  syphilis.     A  few 

*  Dr.  Harrison  says  he  had  known  persons  to  have  yellow  fever  two  or  three 
times,  but  he  never  knew  such  eases  to  terminate  fatally. 

f  Xew  Orleans  Medical  and  Surgical  Journal,  1848  and  1849. 


1858.]  Errors  in  Relation  to  Hysi  4.61 

days  afterwards  Mr.  Critchett  admitted  a  second  case,  in  which 
a  girl,  whose  history  and  appearance  led  to  the  belief  that  she 
was  the  subject  of  the  same  kind  of  taint,  was  losing  sight  in 
both  eyes,  from  the  punctate  effusion  of  lymph  on  the  retina. 
Two  other  cases  are  attending  Mr.  Critchett's  clinique,  in  which, 
in  connection  with  acquired  syphilis,  retinitis  with  effusion 
has  occurred.  In  one  the  effusion  is  in  the  form  of  isolated 
white  dots;  but  in  the  other  the  whole  visible  extent  of  retina 
is  cloudy  and  opaque,  the  optic  nerve  itself  being  but  dimly 
seen.  It  is  worthy  of  note,  that  in  neither  of  these  cases  has 
there  been  any  iritis  or  affection  of  the  anterior  parts  of  the 
globe. — \Omodei  Annali  Universalis  and  Med.  limes  and  Gaz. 


On  some  of  the  prevalent  Errors  in  relation  to  the  Predisposition  to 
Hysteria.     By  M.  Briquet. 

M.  Briquet  believes  that  most  writers  have  been  indebted 
more  to  their  imaginations  than  to  the  observation  of  facts  for 
the  pictures  they  have  drawn  of  this  disease.  It  has  been  attrib- 
uted by  most  of  them  either  to  unsatisfied  sexual  desires,  or  to 
excessive  excitement  of  the  uterus  and  its  appendages,  and  a 
fanciful  etiology  to  correspond  has  been  invented.  The  object 
of  this  paper  is  to  show  that  these  and  other  preconceived  ideas 
have  no  solid  foundation  in  fact. 

1.  The  hysterical  constitution,  about  which  so  many  positive 
assertions  have  been  made,  has  in  fact  no  existence — the  affec- 
tion occurring  in  women  having  the  most  opposite  external  ap- 
pearances. The  author  examined  425  cases  of  hysteria  in  this 
point  of  view;  of  these,  as  regards  height,  127  were  tall,  168 
medium  size,  and  106  short;  as  to  strength,  99  were  strong,  36 
medium,  and  26  weak  ;  as  to  flesh,  194  were  stout,  106  medium, 
and  92  thin  and  spare ;  as  to  color,  220  were  fair,  and  164  dark, 
27  haviag  the  hair  light,  39  black,  177  light  chestnut,  and  188 
deep  chestnut.  In  168  the  face  was  pale  or  'brownish,  and  in 
174  fresh  colored.  Thus  it  will  be  seen  these  were  the  ordinary 
varieties  met  wTith  amoug  women  in  general. 

2.  The  temperament  is  also  various  enough.  The  following  is 
the  classification  M.  Briquet  made  of  383  cases.  In  143  it  was 
lymphatico-sanguineous,  in  125  lymphatic,  in  91  nervous  or 
lymphatico-nervous,  in  12  bilious,  and  in  11  sanguineous.  These 
are  evidently  very  much  the  proportions  that  are  found  in  fe- 
males of  15  to  30,  part  inhabitants  of  the  country,  and  part  of 
the  towns,  as  was  the  case  with  these.  At  all  events,  there  is 
no  temperament  that  can  properly  be  called  hysterical. 

3.  Moral  disposition. — That  which  is  not  discoverable  in  the 
physical  constitution  of  hysterical  females  is,  however,  very  evi- 


462  Errors  in  Relation  to  Hysteria.  [July, 

dent  in  their  moral  disposition.  So  much  is  this  the  case,  that 
of  430  cases  occurring  to  the  author,  not  more  than  20  at  the 
utmost  have  not  manifested  it.  The  characteristic  of  this  is 
marked  impressionability,  foreshadowed  in  childhood  by  great 
timidity,  excessive  susceptibility  to  blame,  and  a  disposition  to 
shed  tears  easily. 

4.  Mode  of  life. — Another  of  the  axioms  that  have  been  laid 
down  as  undoubted,  is,  that  hysteria  is  the  prerogative  of  the 
wealthy  and  luxurious,  and  that  poverty  is  a  security  against  its 
occurrence.  It  is  a  complete  error ;  the  common  people  being 
the  subjects  of  hysteria  in  almost  a  double  proportion  to  the 
other  classes.  At  a  particular  epoch  M .  Briquet  visited  all  the 
female  patients  in  the  medical  and  surgical  wards  of  La  Charite, 
with  the  exception  of  those  suffering  from  epilepsy,  apoplexy, 
insanity  or  delirium.  The  number  amounted  to  203,  and  of 
these  65  were  hysterical  (38  with  convulsive  paroxysms),  49 
were  impressionable,  and  89  only  were  neither  hysterical  nor 
impressionable.  Thus,  among  the  common  people  there  was  1 
woman  in  5  who  had  hysterical  paroxysms,  and  3  out  of  every 
8  were  the  subjects  of  hysteria.  So  far  from  being  exaggerated 
the  statement  is  rather  below  the  truth.  But  where  is  the  prac- 
titioner who  meets  with  3  cases  of  hysteria  among  8  of  his  pri- 
vate patients?  According  to  the  experience  of  many  M.  Bri- 
quet has  consulted  upon  the  subject,  there  is  about  1  in  8  or  10 
in  the  easy  classes  of  society,  not  alluding  to  the  very  highest. 
The  charms  and  simplicity  of  a  country  life,  too,  have  been  suf- 
ficiently praised,  and  nervous  diseases  have  been  said  to  be  the 
almost  exclusive  afflictions  of  civic  life.  M.  Forget,  in  1847, 
somewhat  startled  this  belief  by  showing  how  frequently  hyste- 
ria occurs  among  the  simple  Alsatian  peasantry.  M.  Briquet 
has  obtained  cognizance  of  the  place  of  abode  and  of  early  edu- 
cation in  324  cases  of  hysteria,  and  of  these  168  were  town  born 
and  bred,  and  156  from  the  country — the  majority  of  these  lat- 
ter having  in  childhood  labored  in  the  fields.  In  the  case  of  42 
of  these  country  girls  their  mothers  had  been  hj^sterical,  29  suf- 
fering from  paroxysmal  attacks.  Professor  Lebert,  of  Zurich, 
also  assures  the  author  that  hysteria  is  just  as  often  seen  in  the 
poverty-stricken  cantons  of  Switzerland  as  in  the  most  flourish- 
ing ones.  A  too  tender  and  luxurious  education  has  been  as- 
signed as  a  predisposing  cause;  but  of  81  cases  of  hysteria 
occurring  before  the  age  of  puberty,  in  21  the  harsh  treatment 
they  had  been  subjected  to  was  the  principal  cause  of  the  dis- 
ease. A  third  portion  of  the  author's  collection  of  cases  had 
been  submitted  to  ill-treatment  or  privation  during  childhood. 
In  place  of  a  tender  education  being  assigned  as  a  predisposing 
cause,  it  would  be  more  just  to  stigmatize  a  harsh  one. 

5.  Continence  has  been  stated  by  many  authors  as  an  unnatu- 


1858.]  Errors  in  Relation  to  Hysteria.  463 

ral  condition,  predisposing  to  hysteria;  but  when  it  is  remem- 
bered that  the  majority  of  cases  occur  between  12  and  20,  we 
naturally  ask  at  what  age  it  becomes  unnatural,  as  also  for  the 
explanation  of  the  occurrence  of  the  disease  in  86  children  under 
12  years  of  age.  Various  authors  since  the  time  of"  Galen  have 
deplored  the  fate  of  widows,  as  the  necessary  victims  of  hysteria  ; 
but  in  point  of  fact  their  solicitude  has  been  little  needed,  inas- 
much as  among  375  cases  collected  by  Landovzy,  only  12  of  the 
subjects  were  widows,  as  were  only  14  in  the  author's  own  -430 
cases,  i.e.,  26  in  800  cases,  or  1  in  30.  Of  the  authors  14  cases, 
fcoo,  in  6  the  hysteria  appeared  on  the  day  of  the  husband's 
death,  and  in  4  during  the  first  month  after  it,  and  should  sure- 
ly with  more  probability  be  referred  to  moral  emotion.  Hyste- 
ria has  been  said  to  be,  on  the  one  hand,  common  among  nuns, 
and,  on  the  other,  rare  among  women  who  give  free  vent  to 
their  sexual  desire.  But  in  point  of  fact  it  is  rare  in  convents, 
and  is  chiefly  found  in  those  in  which  there  is  great  fasting  and 
maceration.  The  reverse  position  so  strongly  maintained  by 
authors  may  also  be  disposed  of.  Thus,  of  300  hysterical  fe- 
males above  the  age  of  15,  139  were  married  or  kept  women, 
and  among  them  had  367  children,  not  counting  miscarriages. 
Among  the  161  remaining,  very  few  resigned  themselves  to 
continence.  At  the  Lourcine,  where  syphilitic  workwomen  and 
servants  repair,  among  424  patients,  169  were  hysterical.  As  to 
prostitutes,  of  197  applying  to  St.  Lazare  on  account  of  syphilis, 
106  were  hysterical,  28  xevy  impressionable,  and  65  neither 
hysterical  nor  impressionable.  It  results  from  all  this  that  con- 
tinent women  are  rarely  hysterical,  those  who  do  not  observe 
continence  are  frequently  the  subjects  of  hysteria,  while  those 
who  pursue  the  extreme  of  incontinence  are  the  most  liable  of 
all.  The  reason  is  obvious.  Among  these  different  classes  of 
women,  the  first  lead  peaceable  lives,  the  second  have  much  to 
go  through,  while  the  last  are  a  prey  to  frequent  and  violent 
emotions.  Next  we  may  consider  the  effects  of  marriage  on 
hysterical  women,  which,  to  judge  from  the  statements  made, 
have  been  truly  remarkable.  But  among  M.  Landovzy 's  and 
the  author's  800  cases,  in  only  29  instances  did  decided  advant- 
age follow  marriage,  notwithstanding  the  complex  character  of 
the  modifications  ensuing  upon  this  state. 

6.  Menstruation  and  affections  of  the  uterus. — This  class  of  in- 
fluences has  been  raised  to  the  highest  rank  by  those  writers 
who  are  determined  at  placing  the  seat  of  hysteria  in  the  uterus. 
1.  This  has  been  supported  by  the  supposed  effects  of  normal  or 
abnormal  conditions  of  the  menstruation.  From  the  author's 
observations,  however,  made  on  411  hysterical  women,  in  but 
136  had  there  been  any  derangement  of  the  menses.  Of  237 
deliveries  of  hysterical  women,  in  but  12  were  there  any  convul- 


464  Alarming  Head  Symptoms  relieved  by  Quinine.       [July, 

.sive  paroxysms,  some  of  which  too  might  have  been  examples 
of  eclampsia,  2.  According  to  authors,  it  is  common  to  observe 
hysteria  in  affections  of  the  uterus.  JNTow  these  diseases  are  ex- 
ceedingly common,  and  the  connection  ought  to  be  easily  de- 
monstrable. But  this  is  not  the  case,  for  Landovzy  and  other 
partisans  of  the  opinion  are  able  to  collect  but  some  40  cases  of 
the  affections  of  the  genital  organs  giving  rise  to  hysteria — few 
enough  as  compared  with  the  thousands  of  cases  daily  occurring. 
Practitioners,  moreover,  having  much  to  do  with  the  various 
female  diseases  entirely  deny  such  connection. 

[U  Union  Medicate,  and  Med.  Times  &  Gazette. 


Alarming  Head  Symptoms  relieved  by   Quinine.     By  Mr.  R.  L. 
Bowles,  of  Folkstone. 

Case. — H.W.  B ,  a  medical  man,  stout,  strong,  and  healthy, 

set.  28,  and  married,  was  attacked  on  the  evening  of  July  6th, 
on  his  way  home  from  the  cricket-field,  with  most  severe  head- 
ache. He  had  walked,  in  the  course  of  the  day,  about  sixteen 
miles,  besides  having  played  for  two  hours  at  cricket.  The  day 
was  hot  and  sultry.  On  arriving  at  home,  he  went  to  bed,  but 
the  severity  of  the  pain  in  his  head  prevented  his  sleeping.  He 
had  also  great  intolerance  of  light.  During  the  next  two  days 
he  continued  much  in  the  same  state,  with  the  addition  of  occa- 
sional delirium.  It  was  at  this  time  I  was  called  in,  and  found 
my  patient  complaining  of  severe  splitting  pain  in  the  forehead, 
which  was  much  increased  by  talking  or  moving.  He  earnestly 
requested  me  to  leech  or  bleed  him,  having  a  conviction  that  he 
was  suffering  from  congestion  of  the  brain.  The  pulse  was  from 
46  to  48  in  a  minute,  soft,  and  occasionally  intermitting;  the 
skin  cool  and  moist;  the  tongue  cedematous  and  pale,  with  a 
soft  white  fur  on  its  surface ;  the  face,  which  was  occasionally 
flushed  (though  without  a  corresponding  heat  of  skin),  wore  a 
singularly  indifferent  and  solemn  expression ;  the  ocular  con- 
junctiva was  healthy  in  appearance.  He  had  become  restless 
and  irritable,  and  was  constantly  throwing  himself  about  in  bed. 
His  bowels  had  been  acted  upon  by  a  seidlitz  draught.  A  mix- 
ture of  ammonia,  sulphuric  ether,  and  camphor  julep,  was  now 
prescribed  to  be  taken  every  four  hours,  and  a  full  dose  of  liquor 
opii  at  bedtime. 

July  9th,  8,  A.M.  The  patient  had  passed  a  comfortable 
night,  and  appeared  much  relieved,  his  countenance  wearing  a 
more  natural  expression.  In  the  afternoon,  however,  the  symp- 
toms retufned  in  all  their  severity.  The  opiate  was  omitted  at 
bedtime.     A  blister  was  applied  to  the  neck. 

July  10th.     In  the  morning  I  found  that  he  had  been  deliri- 


1858.]  Ttsts  for  Saccharine  Urine,  dr.  465 

ous,  and  had  passed  a  restless  night;  the  pain  and  intolerance  of 
light  were  quite  as  distressing;  and  he  was  unwilling  to  take 
nourishment  of  any  kind.  The  bowels  were  confined,  and  the 
tongue  had  now  a  "brownish  coat  on  the  back  part.  The  blister 
had  risen  well.  A  physician,  a  friend  of  my  patient,  called  to 
see  him ;  and,  believing  the  case  to  be  of  the  nature  of  sun- 
stroke, advised  eight  leeches  to  the  temples,  which  were  accord- 
ingly applied,  but  with  no  relief  to  the  symptoms.  He  was  now 
a  good  deal  depressed. 

July  11th.  He  passed  a  restless  night.  The  bowels  were 
freely  relieved  by  a  pill  of  calomel  and  colocynth,  but  each  ac- 
tion of  the  bowels  appeared  rather  to  aggravate  the  headache. 
The  opiate  was  given  at  bedtime,  and  a  mixture  of  sulphuric 
ether,  valerian  and  camphor ;  with  beef-tea  ad  libitum.  This 
treatment  afforded  considerable  relief,  and  gave  him  a  comforta- 
ble night. 

July  13th.  Severe  symptoms  again  returned,  which  were 
partially  relieved  by  repeated  doses  of  the  stimulating  mixture. 
Mr.  Eoscow  (who  now  saw  the  case  with  me)  advised  disulphate 
of  quinine,  in  three-grain  doses,  to  be  taken  at  intervals  of  two 
or  three  hours ;  care  being  taken  to  give  the  first  dose  of  quinine 
when  the  headache  was  at  its  minimum.  The  effect  was  ma- 
gical. The  first  dose  prevented  the  paroxysmal  return  of  head- 
ache, and,  with  its  continuance,  a  rapid  general  improvement 
took  place. 

_  July  16th.     My  patient  was  convalescent,  the  pulse  having 
risen  to  its  normal  standard. 

Twelve  months  ago  my  patient  was  living  in  the  island  of 
Greneda,  and  for  nearly  two  months  he  suffered  severely  from 
repeated  attacks  of  intermittent  fever,  for  which  he  had  taken 
large  doses  of  quinine  with  great  advantage. — [British  Medical 
Journal,  and  Banking's  Abstract. 


On  the  various  Tests  for  Saccharine  Urine,  and  on  the   Varieties 
of  Diabetes.     By  Dr.  A.  Becquerel. 

Dr.  Becquerel  draws  attention  to  certain  fallacies  that  may 
arise  in  the  employment  of  the  potassio-cupric  liquid  of  Barres- 
wil,  the  solution  ofTrommers,  or  caustic  potash,  as  tests  for 
sugar  in  the  urine.  The  following,  method,  he  states,  prevents 
all  fallacy : — To  a  measured  quantity  of  urine — say  thirty  parts 
add  a  similar  quantity  of  solid  acetate  of  lead  in  crystals — say 
two  parts;  heat  being  applied,  a  dirty-white  precipitate  is  at  once 
obtained ;  this  liquid  is  to  be  filtered,  and  the  filtrate  treated  with 
the  sulphate  of  soda  in  excess — say  four  parts.  The  second 
mixture  is  to  be  again  heated ;  the  sulphate  of  lead  is  precipita- 


466  Tests  for  Saccharine  Urine,  &c.  [July, 

ted,  and  a  clear,  transparent  liquid  remains,  which  contains  the 
sugar,  if  any  was  present,  the  urea,  and  some  saline  matter.  The 
potassio-cupric  solution  is  not  reduced,  nor  liquor  potassas  turned 
brown,  unless  sugar  is  present  in  this  liquid.  If  albumen  is 
present  in  the  urine,  the  acetate  of  lead  carries  it  down  with  the 
other  organic  matter  contained. 

After  various  remarks  on  the  purely  chemical  aspects  of  the 
question,  Dr.  Becquerel  passes  to  the  consideration  of  diabetes; 
which  he  regards  either  as  idiopathic  or  symptomatic.  The 
former  is  characterized  by  the  presence  of  a  notable  amount  of 
sugar  in  the  urine,  which  is  increased  in  quantity  ;  there  is  ex- 
cessive thirst  and  hunger,  with  other  morbid  phenomena.  In 
the  latter  the  presence  of  some  sugar  in  the  urine  is  an  accessory 
symptom,  following  upon  other  diseased  conditions;  like  albu- 
minuria, it  is  associated  with  a  great  variety  of  diseases.  In 
these  cases  the  sugar  is  never  very  considerable,  though  it  may 
amount  to  as  much  as  25  or  26  per  1000 ;  while  in  idiopathic 
diabetes  it  rises  to  60  and  even  80  per  1000.  In  symptomatic 
diabetes  neither  the  quantity  nor  the  density  of  the  urine  is 
materially  increased. 

Dr.  Becquerel  divides  the  conditions  with  which  symptoma- 
tic diabetes  may  be  associated  into  five  categories : — 1.  Diseases 
of  the  brain  and  cord.  2.  Diseases  of  the  liver.  3.  Diseases 
accompanied  by  dyspnoea.  4.  The  presence  of  lactation.  5. 
Various  diseases. 

Among  nearly  two  thousand  patients,  whose  urine  the  author 
has  caused  to  be  examined  at  the  Hopital  de  la  Pitie,  he  has 
found  five  cases  belonging  to  the  first  category ;  they  were  res- 
pectively,— 1.  A  case  of  myelitis  in  a  woman,  aged  thirty-seven, 
who  died  tetanic,  and  had  sugar  constantly  in  her  urine.  2.  A 
case  of  general  paralysis  in  a  woman,  aged  fifty-four,  with  tem- 
porary convulsive  affections,  during  which  the  urine  was  sac- 
charine. 3.  Amaurotic  amblyopia,  with  a  paralytic  condition 
of  the  lower  extremities,  in  a  man,  aged  fifty-one;  urine  perma- 
nently saccharine.  4.  A  man,  aged  sixty-two,  closely  resemb- 
ling the  last  case.  5.  A  young  woman,  aged  twenty-two,  with 
meningo-cephalitis,  during  which  there  were  8  to  12  grammes 
of  sugar  per  1000  in  the  urine.  Eecovery :  five  weeks  later, 
return  of  the  same  symptoms,  when  there  was  no  sugar  or  albu- 
men in  the  "urine.  Death  ensued,  and  the  diagnosis  was  con- 
firmed by  the  autopsy. 

Dr.  Becqueral  reports  three  cases  of  liver  disease  accompa- 
nied by  diabetes.  1.  A  man,  aged  fifty-three,  with  chronic  gas- 
tritis and  chronic  hepatic  congestions,  had  20  to  28  grammes  of 
sugar  per  1000.  2.  A  man,  aged  fifty-four,  with  pulmonary 
emphysema,  and  consecutive  chronic  congestion  of  the  liver  i 
the  sugar  was  detected  for  six  months,  and  then  disappeared. 


1858.]  Fatal  Disease  of  Appendix  Yermiformis.  467 

3.  A  young  man  aged  nineteen,  with  slight  enteritis  and  blen- 
norrhagia  (there  is  no  further  statement  about  hepatic  disease :) 
being  a  sugar-refiner,  he  consumed  nearly  a  kilogramme  of 
sugar  (about  l^lb.)  daily.  Sugar  was  found  in  his  urine  during 
the  whole  time  of  his  stay  in  the  hospital. 

Dr.  Becquerel  expected  to  find  sugar  frequently  in  diseases 
accompanied  by  embarrassed  breathing,  but  failed  to  do  so  en- 
tirely. 

He  found  sugar  in  the  urine  of  nine  women  recently  deliver- 
ed, in  whom  the  lacteal  secretion  was  established.  It  was  also 
met  with  in  the  two  following  cases,  which  do  not  come  under 
any  of  the  preceding  heads : — 

1.  Female,  aged  thirty-five,  affected  with  cancer  of  the  neck 
of  the  womb,  not  ulcerated.  2.  A  man  aged  fifty-four,  affected 
with  extreme  anaemia,  the  result  of  poverty. — [Z'  Union  Medicate, 
and  British  and  Foreign  Med.  Chir.  Rev. 


Fatal  Disease  of  the  Appendix  Yermiformis.  Dr.  Caspar  Wister 
read  the  following  paper  before  the  College  of  Physicians  of 
Philadelphia  : — 

The  appendix  vermiformis  exists  only  in  man  and  two  supe- 
rior species  of  the  quadrumana,  the  orang  and  the  ape.  It  is  the 
type  of  the  prolonged  caecum  common  to  all  other  mammiferous 
animals.  During  fetal  life  it  is  continuous  with  the  caecum,  and 
of  the  same  size,  and  is  developed  from  the  cul  de-sac  of  the  latter. 
Bishoff  admits  that  the  earliest  recognition  of  its  origin  wras  by 
Meckel,  in  a  foetus  seven  lines  in  length. 

The  appendix  is  ordinarily  three  inches  long,  with  a  diameter 
of  two  lines,  but  is  subject  to  great  variety  of  size  as  well  as 
position.  Occasionally  it  is  entirely  absent,  while  Welga  has 
seen  it  nine  inches  long,  with  many  convolutions,  and  Autenrieth 
four,  and  as  large  as  the  colon. 

It  is  entirely  enveloped  by  the  peritoneum,  which  forms  for  it 
also  a  true  mesentery,  holding  it  loosely  in  position.  The  muscu- 
lar coat  is  not  in  bands,  as  in  the  colon,  but  surrounds  it  as  in  the 
rectum.  The  lining  membrane  is  continuous  with  that  of  the 
caecum,  and  forms  a  valve  at  the  entrance,  the  falciform  edge  of 
which  looks  towards  the  right  and  downwards.  This  valve,  in 
most  instances,  prevents  the  introduction  of  foreign  bodies, 
but  permits  free  exit  to  mucus,  of  which  in  adults  there  is  a  large 
supply,  with  rarely  any  admixture  of  alimentary  matter  ;  in  infants, 
on  the  contrary,  it  is  filled  with  meconium.  The  glands  within 
are  very  numerous,  and  of  the  solitary  variety.  The  extremity 
of  the  appendix  is  found  at  times  in  the  pelvis,  more  commonly 
1  posterior  to  the  colon ;  its  position  is  entirely  uncertain. 

N.  8. VOL.  XIV.     NO.  VII.  23 


468  Fatal  Disease  of  Appendix  Vermiformis.  [July, 

The  function  of  this  body  is  supposed  to  be  similar  to  that  of 
a  gland ;  it  furnishes  an  acid  secretion  which  causes  the  chyme 
in  the  caecum  suddenly  to  acquire  the  property  of  reddening  lit- 
mus paper. 

The  subject  of  the  following  notice  was  a  boy  of  five  years  of 
age,  fair  skin,  light  eyes  and  hair,  and  delicate  physical  develop- 
ment, the  son  of  a  father  lately  dead  with  phthisis. 

This  child  was  visited  professionally  on  the  first  of  November ; 
he  was  at  that  time  out  of  bed  and  in  his  ordinary  dress.  His  ex- 
pression was  languid;  he  had  much  fever,  with  a  pulse  of  130; 
his  tongue  was  covered  with  a  slight- white  deposit,  through  which 
the  papillae  were  projecting,  the  tip  and  edges  being  unusually  red. 
He  complained  of  pain  in  the  abdomen,  describing  it  vaguely  as 
"stomach  ache,"  without  giving  it  any  locality.  This  pain  was 
spasmodic,  recurring  at  short  intervals ;  sharp  and  griping,  but 
followed  by  complete  relief.  At  this  time  there  was  no  pain  upon 
pressure,  or  soreness  over  the  abdomen.  On  the  afternoon  of  the 
day  but  one  preceding,  an  ordinary  walk  had  been  followed  by 
complaints  of  much  weariness,  and  in  the  course  of  the  night  by 
the  first  expression  of  pain,  and  this  without  any  chill.  Through- 
out the  following  day  there  had  been  some  fever  and  pain,  but 
this  was  not  thought  of  sufficient  gravity  to  require  medical  in- 
terposition. There  had  been  no  motion  of  the  bowels  during  the 
forty-eight  hours  immediately  preceding  the  first  professional  visit ; 
and  at  that,  time  the  case  had  the  aspect  of  an  ordinary  slight 
attack  of  colic,  with  the  sympathetic  fever  natural  to  a  child  of 
sensitive  organization,  teeming  with  sympathies  ready  to  respond 
to  any  slight  disturbance  of  the  economy.  A  mercurial  purgative 
wasdirected,  and  a  febrifuge  at  intervals.  There  had  been  no 
unusual  article  of  diet  taken,  except  a  moderate  quantity  of  chest- 
nuts. The  night  was  much  disturbed,  with  an  increase  of  both 
fever  and  pain;  the  latter  still  in  paroxysms. 

The  morning  of  the  2d,  in  consequence  of  the  purgative  not 
having  operated,  a  copious  enema  was  administered,  which  pro- 
duced a  large  fecal  discharge,  none  of  it  of  a  dry  or  impacted  des- 
cription, but  contained  distinct  evidence  of  the  operation  of  the 
mercurial.  The  child  expressed  a  sense  of  relief;  and,  after  a 
dose  of  oil  and  a  fomentation  adjusted  over  the  seat  of  pain,  he 
was  confined  to  bed. 

The  following  morning  Nov.  3d,  there  was  a  spontaneous 
motion  of  the  bowels,  without  any  improvement;  there  was  now 
tenderness  over  the  abdomen  although  during  the  paroxysmal  pain, 
pressure  with  the  hand  was  grateful.  This  pain  continued  the 
chief  subject  of  complaint,  engrossing  the  child's  mind,  and  pro- 
voking constant  expression  of  distress.  We  commenced  frequent 
doses  of  small  quantities  of  calomel,  with  full  proportions  of 
ipecacuanha  and  opium,  and  employed  gum  in  solution  largely  as 
a  diet. 


1858.]  Fatal  Disease  of  Appendix  Vermiformis.  469 

On  the  4th,  the  symptoms  were  more  grave,  greater  pain  upon 
pressure,  some  tympanitis,  and  soreness  attending  all  motion  of 
the  person  ;  the  spasmodic  pain  still,  however,  caused  most  com- 
plaint, and  recurred  at  short  intervals.  Leeches  were  now  applied 
over  the  entire  abdomen,  all  other  treatment  being  continued 
except  the  use  of  ipecacuanha  ;  this  was  withdrawn  in  consequence 
of  slight  vomiting.  After  leeching  there  was  less  complaint  of 
pain  upon  pressure,  and  soreness  and  nausea  disappeared,  while 
stimulation  was  found  necessary. 

On  the  morning  of  Nov.  5th,  he  presented  excessive  tympani- 
tis, constantly  recurring  paroxysms  of  pain,  great  restlessness, 
sunken  features,  some  tenderness  upon  pressure,  and  a  pulse  of 
140.  The  child  was,  after  consultation  with  Dr.  Wood,  placed 
under  the  full  effect  of  opium,  with  an  increase  of  the  mercurial, 
and  a  blister  over  the  abdomen.  The  rectum  was  relieved  of  a 
large  accumulation  of  gas  by  the  introduction  of  a  catheter,  but 
all  motion  of  the  bowels  was  in  vain  solicited.  Under  the  full 
effect  of  the  opiate  there  was  less  exhibition  of  pain  and  restless- 
ness, without  any  arrest  of  disease:  tympanitis  greatly  increased, 
and  compressing  the  stomach  caused  regurgitation  of  fluid,  and 
much  depressed  the  vitality  of  the  entire  organism. 

Nov.  6.  Small  quantities  of  oil  of  turpentine,  with  full  doses  of 
the  officinal  solution  of  morphia,  were  administered,  accompanied 
by  further  stimulation.  Gradual  sinking  under  the  unchecked 
march  of  disease,  aided  by  the  accumulation  of  gas,  terminated 
in  death  on  the  7th  of  the  month,  seven  days  after  the  commence- 
ment of  treatment;  this  being  the  result  of  a  disease  deficient  in 
symptoms  sufficiently  distinct  for  satisfactory  diagnosis,  and  only 
decided  in  the  steadiness  with  which  it  resisted  treatment. 

After  death  the  abdominal  cavity  was  found  dry,  with  indica- 
tions of  peritoneal  inflammation,  consisting  most  conclusively  in 
a  few  patches  of  pasty  lymph  upon  the  intestinal  surfaces.  There 
was  an  engorgement  of  the  vessels  of  the  intestines,  but  being  in 
longitudinal  bars  from  the  diaphragm  to  the  pubis  over  the  entire 
mass,  there  was  some  doubt  as  to  the  time  of  its  occurrence,  par- 
ticularly as  signs  of  incipient  decomposition  existed  elsewhere. 
The  intestines,  from  the  pyloric  orifice  of  the  stomach  to  the  sig- 
moid flexure  of  the  colon,  were  greatly  distended  with  gas,  and 
contained,  besides,  a  large  amount  of  fluid  fecal  matter.  The 
stomach  was  empty  and  much  contracted,  the  accumulation  of 
gas  having  pressed  it  against  the  diaphragm,  and  in  so  doing 
caused  the  latter  to  encroach  upon  the  thoracic  viscera,  thus  ren- 
dering the  last  hours  of  life  a  most  painful  exhibition.  The  lining 
membrane  of  the  intestinal  canal  was  healthy  throughout,  and  the 
cause  of  death  was  not  manifest  until  the  appendix  vermiformis 
was  examined.  This  was  perforated  at  the  lower  extremity  ;  the 
opening  being  large,  with  ragged  edges,  indicating  ulceration,  and 


470  Fatal  Disease  of  Appendix  Vermiformis.  [July, 


partially  filled  by  a  plug  of  concrete  matter  of  the  size  and  much 
the  shape  of  a  date-stone,  composed  of  small  seeds,  many  of  these, 
from  figs,  associated  with  concrete  matter  deposited  in  layers,  and 
arranged  in  concentric  circles. 

In  this  instance,  the  extremity  of  the  appendix  rested  in  the 
pelvis  upon  the  rectum,  immediately  over  the  fundus  of  the  blad- 
der; here  an  effusion  of  the  contents  of  the  intestines  had  occur- 
red, but  in  small  quantity,  owing  to  the  plug  having  filled  the 
ulceration  it  had  caused  in  the  appendix. 

The  matter  effused  had  given  rise  to  excessive  inflammation 
and  the  formation  of  much  lymph,  an  attempt  having  been  made 
to  form  an  abscess  and  inclose  the  offending  fluid.  This  deposit 
of  lymph  extended  over  a  surface  of  three  inches  in  diameter,  was 
dark  in  hue,  passing  into  gangrene;  and,  although  adhering 
strongly  to  the  intestinal  surfaces,  left  them,  when  removed, 
healthy  in  appearance.  Those  surfaces  of  the  sigmoid  flexure  of 
the  rectum  facing  each  other  in  the  natural  position  were  strong- 
ly adherent  for  a  distance  of  three  inches,  and  consequently  pre- 
vented peristaltic  motion  at  this  point.  This  explained  the  reten- 
tion of  gas  after  the  peritoneal  symptoms  became  decidedly 
marked,  although  there  had  been  a  free  passage  of  fecal  matter  in 
an  early  stage  of  the  disease. 

Again,  the  son  of  a  very  distinguished  physician  of  this  city, 
twenty-two  years  of  age,  passed  Sunday  evening  in  the  society  of 
his  family  and  a  small  collection  of  his  father's  friends;  he  was 
gay  and  apparently  in  good  health. 

A  few  days  previously  he  had  complained  of  vague  pains  in  the 
abdomen,  not  however  of  a  degree  to  attract  particular  attention. 

He  retired  on  the  evening  above  mentioned  without  any 
unusual  sensations,  but  awoke  before  daylight  with  intense  colic. 
This  increasing,  his  father  sent  for  a  medical  friend,  after  exhaust- 
ing his  own  resources  and  failing  to  procure  relief.  Throughout 
Monday  the  symptoms  of  colic  continued  without  abatement,  and 
as  the  day  wore  on  only  presented  indications  of  peritoneal  com- 
plication. There  was  a  large,  though  not  excessive  accumulation 
of  gas,  the  most  prominent  feature  of  the  case  being  excruciating 
pain  from  which  only  partial  relief  was  procured  by  complete  nar- 
cotism. The  bowels  resisted  every  attempt  to  procure  evacuation 
of  their  contents  after  the  earliest  stage  of  the  disease. 

On  Monday  night  and  Tuesday  morning  the  agony  of  the 
patient  began  to  abate,  but  only  to  be  followed  by  collapse,  with 
cold  damp  surface  and  failing  pulse ;  he  gradually  sank,  and  died 
in  the  course  of  the  morning,  after  an  illness  of  thirty  hours. 

The  abdomen  was  found  after  death  much  distended  by  gas, 
free  from  effusion,  and  not  affording  any  evidence  of  excessive 
peritoneal  inflammation.  The  effect  of  disease  in  this  case  could 
be  traced  with  much  confidence,  as  the  examination  was  made  on 


1858.]  Fatal  Disease  of  Appendix  Yermiforrnis.  471 

Tuesday  afternoon,  a  few  hours  after  death,  and  but  a  short  time 
was  allowed  for  decomposition  to  embarrass  investigation. 

The  appendix  was  much  distended  at  its  lower  extremity  by  a 
concrete  mass  composed  largely  of  raisin  seeds.  Its  walls  had 
not  been  perforated,  and  contained,  with  the  foreign  matter,  an 
accumulation  of  pus,  the  whole  forming  a  mass  the  size  of  a  wal- 
nut. The  appendix  partially  embraced  the  illium,  adhering  to  it 
strongly,  and  completely  strangulated  the  small  intestines ;  which 
were,"  for  a  distance  of  six  feet  above,  of  a  dark  mahogany  colour 
and  passing  into  gangrene.  At  the  point  of  strangulation  there 
had  been  much  inflammation  with  large  effuion  of  lymph  ;  the 
walls  of  the  tumor  were  thin,  bursting  under  pressure  of  the  fingers  ; 
but,  having  retained  its  contents  during  life,  there  was  no  dis- 
charge of  foreign  matter  into  the  peritoneal  cavity  giving  rise  to 
peritonitis  and  masking  the  earlier  symptoms  of  colic,  as  in  the 
case  just  described. 

Moreau  cites  a  case  identical  with  this,  the  ilium  having  been 
strangulated  by  adhesion  of  the  appendix  to  the  mesentery  ;  while 
Marteau  has  seen  the  jejunum,  and  Scarpa  the  colon,  embraced 
in  the  same  manner  and  with  a  like  effect. 

Klockhof  reports  a  case  in  which  the  appendix  adhered  to  the 
colon  by  its  extremity,  thus  forming  a  loop  through  which  the 
small  intestines  had  passed,  producing  strangulation. 

Merling,  in  examining  a  subject,  found  the  appendix  adherent 
to  the  colon  by  the  lower  extremity,  and  forming  a  free  commu- 
nication between  different  sections  of  the  intestine,  but  was 
unable  to  learn  anything  of  the  previous  history  of  the  individual, 
or  under  what  train  of  symptoms  this  union  occurred,  evidently 
followed  by  entire  recovery. 

Again,  the  appendix  is  at  times  metamorphosed  into  a  hydro- 
pic capsule,  as  reported  by  Rokitansky,  from  the  presence  of  a 
concretion  in  the  tube  closing  the  canal  and  preventing  escape  of 
the  mucous  secretion.  This  causes  the  extremity  to  become 
dilated,  and  the  mucus  to  pass  into  the  condition  of  a  serous 
membrane  secreting  an  albuminous  fluid. 

Besides  the  foreign  matter  collecting  in  the  appendix  mechan- 
ically, tuberculous  and  typhoid  deposits  are  laid  down  at  times  in 
its  walls,  giving  rise  to  ulceration.  When,  in  addition  to  these 
varieties  of  disease,  we  consider  the  fact,  that  a  long  time  may 
be  required  to  establish  the  existence  of  serious  symptoms,  since 
it  is  asserted  that  a  concretion  may  exist  and  only  give  rise  to 
blennorrhcea,  a  correct  diagnosis  is  only  equalled  in  difficulty  bv 
its  importance.  Ulceration  of  the*  appendix  is  not  necessarily 
fatal,  but  forms  abscesses  at  times  pointing  in  various  directions, 
according  to  the  variety  of  directions  assumed  by  the  appendix; 
and  it  is  of  great  moment  that  these  should  be  anticipated  and  dis- 
charged at  the  earliest  period  possible,  and  the  risk  of  an  infernal 


472         Inflammatory  Diseases  of  the  Respiratory  Organs.     [July, 

rupture  of  their  walls  diminished.  In  the  cases  cited  above,  the 
earliest  symptoms  were  of  colic,  excepting  the  obstinate  con- 
stipation, the  bowels  having  been  freely  evacuated  without  relief. 
In  both,  the  earlier  symptoms  were  overlaid  by  peritonitis  ;  while 
in  one  there  was  an  attempt  to  form  an  abscess,  the  constitution 
failing  before  it  was  accomplished. — [Transactions  of  the  College 
of  Physicians. 


Treatment  of  Inflammatory  Diseases  of  the  Respiratory  Organs. 

Dr.  Semple  read  before  the  Medical  Society  of  London  (Janu- 
ary 16th,  1858)  a  paper  on  this  subject.  He  commenced  by 
observing  that  the  treatment  of  pneumonia  was  formerly  sup- 
posed to  consist  almost  solely  and  essentially  in  the  abstraction 
of  blood  from  the  arm ;  but  that  in  the  present  day,  not  only  in 
this,  but  in  other  inflammatory  diseases,  the  use  of  the  lancet 
was  but  seldom  resorted  to,  and  by  many  practitioners  it  was 
abandoned  altogether.  It  became  a  question  whether  this  great 
alteration  in  treatment  was  due  to  the  varying  fashion  of  the  day, 
or  to  the  fact  that  disease  had,  in  fact,  altered  its  type,  and 
therefore  required  very  different  treatment  from  that  formerly 
adopted.  He  (Dr.  Semple)  was  inclined  to  believe  that  disease 
had  really  altered  its  type,  for  he  and  others  had,  at  the  com- 
mencement of  their  professional  career,  bled  patients  very  con- 
stantly, and  certainly  with  good  results,  but  at  present  the 
operation  of  venesection  was  not  so  much  required.  He  had 
been  for  the  last  three  years  connected  with  the  Northern  Dis- 
pensary, where  all  the  usual  forms  of  disease  presented  themselves 
to  his  notice,  and  he  had  recommended  bleeding  only  once 
during  the  whole  of  that  period  in  that  institution.  The  fact 
appeared  to  be,  that  the  sthenic  inflammatory  diseases  were 
dying  out  amongst  us,  and  that  asthenic  complaints  were  taking 
their  place.  The  cholera  which  visited  this  country  in  1832, 
was  certainly  a  disease  of  depression,  and  this  was  immediately 
followed  by  the  influenza,  a  disease  of  the  same  depressing  c! ass, 
and,  like  it,  requiring  a  tonic  plan  of  treatment.  Since  the  date 
referred  to,  neuralgia,  also  a  disease  of  depression,  had  become 
almost  epidemic;  carbuncles  and  carbuncular  boils  were  at  pre- 
sent decidedly  so ;  and  Bright's  disease,  the  disease  of  the  supra- 
renal capsules  giving  rise  to  the  bronzed  skin,  and  the  disorders 
classed  under  the  head  of  fatty  degeneration,  were  all  much 
more  prevalent  than  formerly,  even  if  we  do  not  admit  them  to 
be  new  diseases.  In  fact,  it  now  became  a  question  whether 
bleeding  should  ever  be  practised  at  all,  and  he  (Dr.  Semple) 
was  as  cautious  in  ordering  a  patient  to  be  bled  as  a  surgeon 
would  be  in  deciding  upon  the  amputation  of  a  limb.     Never- 


1858.]     Inflammatory  Diseases  of  the  Respiratory  Organs.        473 

theless,  although  the  cases  which  were  met  with  in  practice 
required  in  general  the  adoption  of  tonic  and  stimulating  treat- 
ment, it  was  by  no  means  proved  that  all  forms  of  disease  were 
characterized  by  depression;  for  cases  of  a  sthenic  type  still 
presented  themselves,  and  demanded  the  application  of  antiphlo- 
gistic measures.  The  remarks  made  upon  the  treatment  of 
inflammatory  diseases  in  general  were  particularly  applicable  to 
those  of  the  respiratory  organs,  which  are  essential  to  life,  and 
the  inflammations  of  which  require  the  most  prompt  and  judi- 
cial medication ;  still  it  was  impossible  that  any  stereotyped 
rules  could  be  laid  down  for  the  treatment  of  these  affections, 
which  may  present  the  most  opposite  therapeutical  indications. 

The  author  then  related  the  case  of  a  lady  in  whom  the  treat- 
ment by  bleeding,  calomel,  and  tartrate  of  antimony  was  adopt- 
ed for  an  acute  inflammation  of  the  larynx  and  trachea,  extending 
to  the  bronchial  tubes,  substance  of  the  lungs  and  pleurae.  This 
treatment  not  having  at  first  produced  a  well-marked  effect,  the 
antiphlogistic  plan  was  changed  for  a  stimulating  one,  and  car- 
bonate of  ammonia  and  brandy  were  employed  while  the  acute 
symptoms  still  continued.  The  result  was,  that  the  patient  be- 
came decidedly  worse,  and  appeared  to  be  on  the  point  of  death 
by  suffocation;  Luton  again  changing  the  plan,  and  resorting  to 
bleeding,  low  diet,  and  tartrate  of  antimony,  the  disease  gradu- 
ally subsided,  and  the  patient,  who  is  now  alive  and  well,  was 
restored  to  perfect  health,  without  any  trace  whatever  of  the 
previous  illness. 

Dr.  Semple  wished  that  it  should  be  understood  that  he  had 
no  dogmatic  views  to  offer  upon  the  treatment  of  the  inflamma- 
tory diseases  of  the  respiratory  organs.  He  could  not  advocate 
indiscriminately  large  bleedings,  profuse  mercurialization,  and 
repeated  doses  of  tartar-emetic;  nor,  on  the  other  hand,  could 
he  approve  of  the  universal  adoption  of  the  plan  of  stimulating 
such  cases  by  brandy  and  carbonate  of  ammonia;  and  it  was 
difficult  to  determine  which  would  be  the  greater  error  of  the 
two.  He  believed  that  many  cases  of  pure  sthenic  inflammation 
still  presented  themselves  in  practice,  although  they  were  by  no 
means  so  common  as  they  formerly  were;  and  in  such  instances 
the  abstraction  of  blood,  and  the  administration  of  mercury,  of 
the  alkalies  and  tartar-emetic,  will  effect  a  cure.  But  there  are 
in  the  present  day  a  great  number  of  epidemics,  contagious,  and 
diathetic  forms  of  disease,  which  are,  it  is  true,  accompanied  by 
inflammation,  but  of  a  low  or  asthenic  character,  and  these  re- 
quire tonics,  alteratives  and  stimulants.  Undue  depletion  ought 
to  be  avoided  in  persons  who  are  the  subjects  of  the  gouty,  the 
venereal,  or  the  scrofulous  diatheses ;  and  whenever  an  v  of  these 
affections  co-exist  with,  or  precede  inflammation,  the  disease 
ought  not  to  be  considered  as  of  a  sthenic  character,  and  the  cure 


474  Foreign  Body  in  the  Nasal  Passage.  [July? 

should  be  sought  rather  by  correcting  the  prevailing  morbid 
taint  in  the  system  than  in  indiscriminate  depletion;  and  some 
of  these  constitutional  maladies,  especially  scrofula,  required 
cod-liver  oil,  iodine,  iron,  meat,  wine,  and  beer. 

The  paper  concluded  with  a  sketch  of  the  treatment  of  pneu- 
monia as  it  presented  itself  in  children,  in  vigorous  adults,  in  the 
inhabitants  of  towns  and  cities,  in  persons  labouring  under  fever, 
in  its  typhoid  form,  and  in  its  complication  with  tubercular 
phthisis,  in  each  of  which  cases,  although  the  name  of  the  disease 
was  the  same,  yet  the  treatment  required  was  very  different, 
owing  to  the  peculiar  features  which  the  malady  assumed. 

In  the  discussion  which  ensued,  Dr.  Eouth,  Dr.  Camps,  Dr. 
Webster,  Dr.  Cotton,  Dr.  Chowne,  and  Dr.  Stocker  took  part. 
The  debate  elicited  nothing  very  striking  or  novel ;  but  it  was 
remarkable  that  none  of  the  speakers  spoke  in  favour  of  the 
stimulating  plan  of  treatment  in  inflammatory  diseases  of  the 
chest. 

Dr.  Semple,  in  reply,  feared  that  the  nature  of  his  remarks 
had  been  misunderstood  by  some  of  the  speakers.  So  far  from 
advocating  the  indiscriminate  use  of  bloodletting,  his  paper  had 
just  the  contrary  tendency  ;  and  he  believed  that  a  medical  man 
was  bound  to  dispossess  himself  of  all  dogmatic  opinions,  and 
to  treat  his  patients  in  such  a  manner  as  would  most  rapidly 
restore  them  to  health.  This  could  only  be  done  by  studying 
the  peculiarities  of  every  case,  and  paying  strict  attention  to  all 
modifying  circumstances.  However  valuable  statistics  might  be, 
he  thought  that  they  did  not  throw  much  light  upon  practice ; 
and  as  to  the  number  of  cases  which,  it  was  said,  recovered  from 
pneumonia  in  the  Vienna  hospital  without  any  treatment  at  all, 
it  was  not  stated  what  the  peculiar  forms  of  the  disease  were,  or 
what  were  their  complications,  and  the  results  might  be  quoted 
to  support  any  doctrine  whatever.  He  thought  that  the  subject 
of  the  modern  treatment  of  the  inflammatory  diseases  of  the  res- 
piratory organs,  and  of  innaVnmatory  diseases  generally,  was  a 
very  proper  one  for  debate  in  medical  societies;  and  as  the  ar- 
guments were  not  by  any  means  yet  exhausted,  he  hoped  that 
others  would  continue  the  discussion  upon  some  future  occa- 
sion.— [Amer.  Jour,  of  the  Med.  Sciences. 


Foreign  Body   retained  upwards   of  Tiuenty  Years  in   the  Nasal 
Passage. 

Dr.  Hays  states  that  the  interesting  case  communicated  to  the 
College  at  its  previous  meeting  by  the  president,  in  which  a 
foreign  body  had  remained  four  years  in  the  lungs,  recalled  to 
his  mind  a  case  in  which  a  foreign  body  had  remained  in   the 


1858.]  Treatment  of  Plturo- Pneumonia.  475 

nose  for,  probably,  upwards  of  twenty  years,  and  a  brief  notice 
of  which  might  interest  the  Fellows. 

Some  years  since  I  was  consulted  by  a  lady  of  between  twenty- 
five  and  thirty  years  of  age  on  account  of  oza?na,  with  which 
she  had  been  troubled  ever  since  childhood.  The  disease  resist- 
ed various  means  of  treatment,  and  I  discontinued  my  visits  and 
lost  sight  of  the  case. 

About  four  years  subsequently,  a  Fellow  of  the  College,  Dr. 
Wm.  Darrach,  inquired  of  me  if  I  recollected  the  case,  and  stated 
that  the  patient  had  afterwards  fallen  under  his  care,  and  that 
finding  it  very  intractable,  he  had  determined  to  examine  into 
the  condition  of  the  bones  of  the  nose.  With  this  object  he  in- 
troduced a  probe  through  the  nose  into  the  nasal  fossae,  and 
while  moving  this  instrument  about  there,  he  accidentally  dis- 
lodged a  mass  which  dropped  into  the  opening  of  the  nostril, 
and  by  an  effort  on  the  part  of  the  patient  was  expelled.  On 
examination,  it  proved  to  be  an  old-fashioned  glass  button  with 
a  brass  wire  eye. 

The  mother  of  the  lady  stated  she  remembered  distinctly  that 
one  of  her  sons,  when  a  child,  had  had  a  coat  with  similar  but- 
tons. 

Dr.  D.  supposed  that  the  lady,  when  a  child,  had  been  play- 
ing with  one  of  these  buttons,  had  placed  it  in  her  mouth,  whence 
it  had  slipped  into  her  throat  and  produced  strangling,  and  that 
in  the  effort  to  expel  the  button  it  had  been  forced  up  through 
the  posterior  nares  and  lodged  in  the  nose.  Here  as  a  foreign 
body  it  had  become  a  source  of  irritation,  and  produced  the  dis- 
ease for  which  we  had  been  consulted. — [Transactions  of  the 
College  of  Physicians. 


Treatment  of  Pie  uro- Pneumonia. 

Dr.  S.  0.  Habershon,  Ass.  Phys.  to  Guy's  Hospital,  draws  the 
following  inferences  from  certain  cases  he  has  observed  and  re- 
corded. 

1.  That  active  mercurial,  antimonial  and  opiate  medicines  are 
not  necessary  in  many  cases  of  pneumonia,  even  without  de- 
pression, and  when  seen  at  an  early  stage. 

2.  That  convalescence  rapidly  takes  place  in  many  instances 
under  the  saline  plan  of  treatment,  as  bicarbonate  of  potash,  as 
shown  by  Dr.  Hughes  Bennett  and  others. 

3.  That  while  some  cases  of  pleuro-pneumonia,  especially  in 
young  subjects,  as  several  af  the  cases  related  were,  may  recov- 
er, even  without  any  medical  treatment,  that  salines  appear  to 
be  of  some  value,  perhaps  by  increasing  the  action  of  the  secret- 
ing organs,  modifying  the  character  of  the  blood,  and  hastening 
the  absorption  of  the  effused  product. 


476         Principles  of  Treatment  in  Chronic  Rheumatism.      [July, 

4.  That  in  other  instances,  mercury  appears  to  be  of  consid- 
erable value,  as  in  cases  where  there  is  considerable  pleuritic 
effusion. 

5.  That,  in  some,  especially  where  there  is  much  bronchitis, 
with  great  febrile  excitement,  without  prostration  or  struma, 
antimony  also  is  of  much  service;  but  that  the  indiscriminate 
use  of  calomel  and  antimony  in  very  many  cases  retards  conva- 
lescence, interferes  with  the  return  to  healthy  nutritive  action, 
and  should  be  avoided. 

6.  That  opium  alone,  or  as  its  alkaloid  morphia,  is  also  a  val- 
uable remedy  in  pneumonia,  either  combined  with  ipecacuanha, 
as  in  Dover's  powder,  or  with  antimony,  when  that  is  admissi- 
ble; that  it  acts  possibly  by  diminishing  the  frequency  of  the 
respiratory  act,  by  its  action  on  the  nervous  system,  increasing 
diaphoresis,  when  combined  as  just  mentioned;  quieting  the 
nervous  system,  relieving  pain,  and  diminishing  the  excitability 
of  the  nervous  system,  and  diminishing  the  excitability  of  the 
bronchial  tubes. 

7.  That  while,  in  some  cases,  general  or  local  bleeding  may  be 
called  for,  such  are  exceptional  cases  now ;  and  that  many  in- 
stances, on  the  contrarjr,  require  the  liberal  administration  of 
nourishing  diet,  and  in  some  cases  stimulants. 

8.  That  each  case  must  be  judged  by  its  own  peculiarities; 
and  whilst  many,  from  their  age  and  other  circumstances,  will 
probably  recover  under  most  varied  treatment,  other  cases,  of 
which  I  might  adduce  many  instances,  almost  invariably  die, 
as  those  arising  in  very  intemperate  habits,  or  where  it  follows 
in  the  course  of  pyasmia  and  allied  conditions.  We  have 
thus  sought  by  these  instances  to  show  that,  whilst  calomel  and 
antimony  are  sometimes  of  value,  much  more  frequently  they 
may  be  dispensed  with  altogether  in  cases  of  pleuro-pneumonia, 
rapidly  advancing  to  consolidation  of  the  lung,  where  a  com- 
paratively short  time  ago  these  remedies  would  have  been  pre- 
scribed.— [Med.  Times  and  Gazette. 


Principles  of  Treatment  in  Chronic  Rheumatism. 

Dr.  Inman  read  an  instructive  paper  on  this  subject,  before 
the  Liverpool  Medical  Society.  He  adverted  to  the  frequency 
of  the  occurrence  of  chronic  rheumatism,  and  the  multiplicity 
of  the  plans  of  treatment  employed  for  it ;  remarking  that  they 
all,  however,  possessed  something  in  common.  Difficulty  as  to 
diagnosis,  and  confusion  as  to  treatment,  he  thought  had  arisen 
from  the  practice  of  classing  all  sorts  of  aching  pains  under  one 
head,  as  rheumatic.  The  uneasy  sensation  experienced  before 
the  access  of  eruptive  fevers,  and  during  the  course  of  malignant 
disease,   or  felt  by  those  exposed  to  the  action  of  mercury  or 


1858.]     Principles  of  Treatment  in  Chronic  Rheumatism.   '      17T 

lead,  and  by  those  suffering  from  gout,  gonorrhoea,  or  syphilis, 
and  in  cases  where  it  was  evident  that  bile  or  urea  was  mixed 
with  the  blood,  and  by  children  affected  with  struma — had  all 
been  set  down  as  rheumatic,  though  due  to  most  varied  causes. 
The  term  "Chronic  rheumatism,"  he  believed  strictly  applica- 
ble to  cases  in  which  there  is  dull  pain,  usually  coming  on  during 
the  night,  referred  to  the  tendinous  expansions  of  the  muscles, 
the  pulse  not  quickened,  the  skin  warm,  excepting  over  the  seat 
•of  pain,  where  the  temperature  is  usually  low  ;  the  pain  remit- 
ting about  4  P.  M.,  and  not  recurring  till  some  time  during  the 
night.  There  is  usually  no  error  of  secretion,  nothing  visible  at 
the  seat  of  pain.  The  duration  may  be  from  one  or  two  days 
to  six  weeks.  Deposits  in  the  joints  rarely  take  place ;  and  that 
form  which  causes  gradual  contraction  of  joints,  and  crippling 
of  limbs  is  rare.  The  rheumatic  pain  is  usually  symmetrical ;  its 
chief  seats  those  parts  least  protected  by  fat  and  integuments. 
Loss  of  motor  power  accompanies  the  pain,  which,  is  increased 
by  action,  and  relieved  by  relaxation  of  the  affected  parts. 
Rheumatism  is  not  occasioned  by  dry  and  intense  cold,  but  by 
the  more  moderate  degrees  of  cold,  especially  if  the  air  be  moist. 
The  experience  of  Arctic  navigators,  and  of  the  army  before 
Sebastopol,  as  well  as  the  comparative  rarity  of  rheumatism 
among  carmen,  carters,  and  bricklayers,  confirm  this  point. 
Firemen  of  ocean-going  steamers  appear  particularly  liable  to 
it.  Persons  of  feeble  constitution  and  languid  circulation  are 
more  obnoxious  to  it,  than  those  with  good  circulation.  It  is 
not  common  in  women,  except  at  advanced  ages.  The  vigor- 
ous action  of  the  heart  helps  to  remove  the  pain,  as  is  evidenced 
by  the  improvement  which  generally  occurs  after  dinner.  In  a 
case  where  there  was  great  pain  and  stiffness  in  the  arms,  hands 
and  deltoid  muscles,  the  immersion  of  the  arms  in  very  warm 
water  removed  the  pain  for  the  time.  Many  rheumatic  patients 
feel  quite  well  in  a  warm  bath ;  though  often  worse  after  it, 
from  increased  susceptibility.  The  influence  of  temperature  on 
the  local  circulation  has  much  power  over  rheumatism.  Patients 
take  cold  often  through  sitting  near  cold  walls,  &c  The  cause 
of  the  pain  is  probably,  primarily,  the  contraction  of  the  pale 
muscular  fibres  of  the  skin,  the  stagnation  of  blood  in  their 
capillaries;  the  hot  aching  pain  which  succeeds^  being  due  to 
reaction  and  dilatation  of  the  vessels:  the  one  efficient  cause  of 
rheumatic  pain  in  general,  being  deficient  flow  of  blood  through 
the  affected  parts.  With  regard  to  treatment,  the  author  thought 
that  no  satisfactory  results  could  be  ascribed  to  colchicum,  in 
large  or  small  doses.  "Warm  baths  are  useful  in  some  cases. 
Nitrate  of  potash  had  proved  useful  in  the  hands  of  some,  but 
he  thought  the  iodide  of  potassium  had  a  stronger  claim  to  effi- 
ciency.    Guaiacum,  aconite,  opium,  steel,  and  cod-liver  oil,  all 


478  Lactate  of  Zinc  in  Epilepsy.  [July, 

prove  useful  in  some  cases ;  and  the  local  application  of  heat  by 
packing  in  wet  sheets,  blisters,  sinapisms,  heated  irons,  red  flan- 
nel, and  red  merino,  also.  The  indication  appears  to  be,  to 
restore  the  strength  of  the  individual,  and  the  vigour  of  his  cir- 
culation. In  the  most  troublesome  form,  pain  in  the  plantar 
fascia,  was  removed  by  perfect  rest  and  galvanism. — [Liverpool 
Medico-  Chirurgical  Journal. 


Lactate  of  Zinc  in  Epilepsy. 

Dr.  Herpin's  name  is  familiar  to  the  medical  profession  on 
account  of  his  urgent  advocacy  of  the  employment  of  oxide  of 
zinc  in  the  treatment  of  epilepsy.  He  now  abandons  this  pre- 
paration entirely  in  favor  of  the  lactate  of  zinc.  The  greater 
solubility  and  digestibility  of  the  latter  would  a  priori  engage 
our  sympathies  in  its  favour.  The  following  is  one  of  the  cases 
which  have  decided  the  author's  preference,  and  deserves  to  be 
recorded  on  account  of  the  success  obtained  in  fcpite  of  the  un- 
favourable prognosis  which  the  case  would  have  justified  in  the 
first  instance. 

Miss  E.,  aged  eleven  and  a  half,  consulted  Dr.  Herpin,  Februa- 
ry 1st,  1854.  She  was  well  made,  intelligent  and  pleasing.  Her 
paternal  grandfather  had  died  epileptic  at  forty-nine  years  of  age ; 
her  maternal  grandfather  at  seventy-six,  after  being  insane  for 
six  years,  and  in  a  state  of  melancholy  for  forty  years.  No  pre- 
disposing or  exciting  cause  was  traceable  in  the  patient,  except- 
ing perhaps  the  fright  caused  by  a  fire  two  months  previous  to 
the  first  attack.  She  enjoyed  excellent  health  till  six  years  of 
age,  when  she  had  typhoid  fever,  having  on  the  right  side  a 
tendency  to  slight  and  evanescent  deafness.  Three  months  be- 
fore the  first  seizure  she  was  attacked  with  frequent  headache, 
generally  commencing  in  the  morning,  and  lasting  till  evening. 
The  headache  ceased  in  December,  1853.  The  first  fit  occurred 
on  August  15,  1853,  the  second  on  September  5,  the  third  on 
September  26 ;  six  then  followed  at  variable  intervals,  making 
altogether  nine  in  less  than  five  months ;  they  always  took  place 
during  the  first  hour  of  sleep,  and  the  evening  before  the  attack 
she  was  observed  to  be  somewhat  excited.  The  symptoms, 
which,  are  detailed,  leave  no  doubt  as  to  the  attacks  having  been 
those  of  genuine  epilepsy.  The  oxide  of  zinc  had  been  pre- 
scribed for  the  patient  from  September  to  the  following  July, 
but  she  was  unable  to  bear  the  doses  which  Dr.  Herpin  thinks 
necessary  in  order  to  make  a  proper  impression  upon  the  patient. 
He  was  once  able  to  reach  a  dose  of  six  grammes  (ninety  grains) 
per  week,  but  he  was  obliged  to  diminish  it.  Still  the  attacks 
ceased,  from  January  the  8th  to  July  the  18th;  but  a  return  on 
that  day,  brought  on  by  a  tepid  bath,  induced  M.  Herpin  to  have 


1858.]  Observations  on  Diabetes  Mellitus.  479 

recourse  to  the  lactate  of  zinc,  which  he  gave  for  above  six 
month,  during  which  time  the  patient  swallowed  306  grammes 
(4600  grains).  The  tolerance  of  the  remedy  was  complete,  and 
when  she  left  off  taking  it,  she  was  in  perfect  health.  There 
was  one  recurrence  of  epilepsy  two  months  after  commencing 
the  lactate.  Three  years  have  since  elapsed,  and  the  lady's 
health  continues  sound. — [&  Union  Medicate,  and  British  and 
Foreign  Med.  Chir.  Rev. 


Observations  on  Diabetes  Mellitus,  especially  with  regard  to  Hie 
Changes  of  Temperature  occurring  in  this  Disease.  By  Dr. 
Lo^initz. 

On  twenty-one  successive  days,  24th  October  to  13th  Novem- 
ber, 1856,  Dr.  Lomnitz  carefully  examined  the  temperature  of 
three  diabetic  patients  in  the  hospital  at  Gottingen,  by  introdu- 
cing the  bulb  of  a  thermometer  into  the  arm-pit  and  into  the 
mouth.  The  observations  were  taken  morning  and  evening, 
and  each  time  the  frequency  of  the  pulse  and  respiration,  as 
well  as  the  amount  of  urine  passed  in  twenty-four  hours,  and  its 
specific  gravity,  were  noted.  Two  of  the  patients  were  females, 
and  respectively  thirty  and  thirty-six  years  of  age ;  the  third,  a 
young  man,  was  nineteen  years  old.  On  comparing  the  aver- 
age of  his  results  with  the  temperature  of  healthy  individuals  as 
determined  by  Barensprung,  he  finds  that  the  diabetic  patients 
suffer  an  average  reduction  of  1'07°  Reaumur  (2*4°  Fahrenheit) 
in  the  arm-pit,  and  of  0'39°  Reaumur  (0;8°  Fahrenheit)  in  the 
mouth.  The  author  sums  up  his  observations  thus: — 1.  The 
temperature  of  a  person  suffering  from  diabetes  mellitus  is  lower 
than  that  of  a  healthy  individual.  2.  The  diminution  of  tem- 
perature is  not  progressive,  but  persists  at  a  definite  point,  acqui- 
red at  a  stage  of  the  disease  which  has  not  yet  been  determined. 
3.  There  is  no  relation  between  the  loss  of  temperature  and  the 
alterations  in  the  pulse. — [Henle  und  Pfeuffer's  Zeitschrift,  and 
Brit,  and  For.  Med.  Chir.  Review. 


On   the    Treatment  of  Menorrhagia   with   Ergot.     By  J.  McF. 
G-astox,  M.  D.,  Columbia. 

The  author  of  this  paper,  after  giving  to  Dr.  Churchill  the 
merit  of  having  first  pointed  out  the  'value  of  ergot  in  menor- 
rhagia,  relates  his  own  experience  upon  the  subject.  He  tried 
it  at  first  (1846)  in  the  case  of  a  young  lady  who  had  suffered 
from  profuse  flow  of  the  menses  for  a  considerable  period,  and 
under  the  use  of  the  remedy  she  completely  recovered,  married, 
and  had  a  family.  The  ergot  was  given  with  carbonate  of  iron, 
in  doses  of  five  grains  of  each,  three  times  a  day.     Dr.  Gaston 


480      Sulph.  Acid  and  Sulphate  of  Zinc  as  a  Caustic  Agent.  [ July, 

has  found  the  use  of  the  ergot  followed  by  beneficial  results  in 
every  subsequent  case  of  menorrhagia  in  which  he  has  prescri- 
bed it.  He  has  latterly  given  it  in  infusion,  combined  with  the 
tincture  of  the  sesquichloride  of  iron,  which  he  thinks  a  prefera- 
ble form  of  administration.  When  much  nervousness  was  ex- 
cited valerian  was  combined  with  the  ergot ;  and  when  there 
was  great  pain,  opium  was  added  with  advantage.  A  discharge 
somewhat  similar  to  menorrhagia  occasionally  occurs  within 
the  second  month  after  delivery,  which,  if  continued,  may  en- 
feeble the  patient ;  and  in  such  cases  Dr.  Gaston  has  employed 
the  ergot  and  iron  with  excellent  effect.  The  ergot  is  of  course 
contra-indicated  in  pregnancy,  unless  it  should  be  desirable  to 
dislodge  the  foetus.  In  a  case  of  haemorrhage,  about  the  fifth 
month  of  pregnane}7,  which  threatened  to  prostrate  the  patient, 
Dr.  Gaston  gave  the  ergot  in  doses  of  five  grains,  with  one  grain 
of  opium,  every  two  hours,  and  only  three  doses  were  taken 
when  the  child  was  expelled  and  the  hemorrhage  ceased. 

[Charleston  Med.  Jour,  and  Review. 


Sulphuric  Acid  and  Sulphate  of  Zinc  as  a  Caustic  Agent. 

There  is  an  important  chemical  principle  involved  in  the  ap- 
plication of  sulphuric  acid  for  the  destruction  of  living  tissues, 
which  is  that  the  acid  mainly  acts  upon  organized  matters,  by 
its  powerfuj  tendency  to  combine  with  the  elements  of  water 
contained  in  them,  so  that  the  carbon  is  left  free,  forming  the 
black  charcoal-like  mass  with  which  we  are  familiar  as  the  result 
of  its  action  upon  all  such  tissues.  Now,  the  more  concentrated 
is  the  acid,  in  its  liquid  form,  the  greater  is  its  power  to  decom- 
pose animal  or  vegetable  tissues  by  abstracting  the  elements  of 
water.  It  is  desirable,  therefore,  in  adding  material  to  the  acid 
for  the  purpose  of  giving  it  the  form  of  paste,  that  the  substance 
employed  should  not  be  an  organized  matter  capable  of  furnish- 
ing water  to  the  acid,  and  so  weakening  its  caustic  power,  but  a 
substance  which  should  add  fresh  caustic  power,  so  as  to  pro- 
duce a  combination  possessing  the  greatest  possible  degree  of 
caustic  force.  The  dried  sulphate  of  zinc  suggested  itself  to  Mr. 
Henry  Thompson  as  such  a  material ;  and  upon  trial  it  has  fully 
answered  his  expectations.     He  prepares  it  as  follows  : 

"  The  ordinary  sulphate  of  zinc  is  to  be  dried  in  an  oven  or 
sand-bath,  so  that  the  water  of  crystallization  is  driven  off,  and 
a  whitish  powder  remains.  Enough  of  this  is  to  be  added  to 
some  strong  sulphuric  acid,  in  order  to  make  a  semi-fluid  mass 
of  consistence  sufficient  to  prevent  its  running  beyond  the  spot 
on  which  it  is  placed.  The  mixture  should  be  kept  in  a  stopper- 
ed bottle,  and  be  applied  with  a  small  glass  spatula  or  rod.  Be- 
fore using  it,  the  surrounding  parts  should  be  protected  by  a 


1858.]  On  Obstinate  Vomiting.  48  L 

thick  layer  of  cerate  or  firm  ointment,  so  as  to  form  an  embank- 
ment limiting  the  surface  to  be  destroyed,  and  a  layer  of  the 
caustic  may  be  made  upon  this  of  about  the  eighth  or  tenth  of  an 
inch  in  thickness.  This  is  allowed  to  remain.  As  in  the  case 
of  other  caustics,  I  believe,  the  pain  is  less  in  the  superficial  than 
in  the  deeper  diseased  tissues." 

One  advantage  of  this  combination  consists  in  the  ease  with 
which  it  is  prepared,  and  the  facility  with  which  its  constituents 
may  be  obtained. — [Lancet 

On  Obstinate  Vomiting. 

Various  means  have  been  proposed  against  vomiting  during 
pregnancy,  in  hysteria  and  other  circumstances.  Several  French 
physicians  have  lately  tried  with  success,  in  many  cases,  some 
remedies  either  too  neglected  or  quite  new.  During  pregnancy 
vomiting  has  been  stopped  by  the  use  of  a  portion  of  tincture  of 
iodine  (10  drops),  iodide  of  potassium  (10  grains),  and  120  gram- 
mes (4  ounces)  of  water  and  syrup.  This  prescription  has  been 
employed  by  M.  Becquerel.  A  physician  of  the  south  of  France, 
M.  Bacarisse,  has  made  use  of  iodide  of  potassium  alone,  which 
he  thinks  to  be  more  successful  than  tincture  of  iodine.  Profes- 
sor Buisson,  of  Montpelier,  has  tried  three  remedies  :  tincture  of 
iodine  with  alcohol  (a  remedy  much  spoken  of  in  Germany) ; 
iodide  of  potassium  alone,  and  with  tincture  of  iodine.  With 
the  first  of  these  three  medicines  he  has  seen  an  increase  of  the 
vomiting;  with  the  second,  vomiting  has  hardly  diminished; 
with  the  third  it  has  completely  ceased.  He  has  made  this  trial 
three  times.  Dr.  Martin  Magron,  of  Paris,  has  employed  suc- 
cessfully dry  cupping  on  the  spine,  and  in  a  case  of  obstinate 
hysterical  vomiting,  he  has  succeeded  at  every  fit  in  stopping 
the  vomiting  by  this  mode  of  treatment.  In  a  case  of  paraple- 
gia, with  convulsive  fits  and  vomiting,  he  has  succeeded  a  great 
many  times,  in  stopping  at  the  same  time  the  vomiting  and  the 
fit,  by  cupping  applied  on  the  spine  and  slight  bleeding. — [Vir- 
ginia Med.  Journal. 

On  the  Use  of  Chloroform  in  Certain  forms  of  Paralysis.     By  M. 
Laxdry. 

M.  Landry  terminates  a  long  series  of  papers  with  the  follow- 
ing conclusions : — 1.  There  exists  a  group  of  paralyses  of  the 
motor  powers,  offering  the  following  general  characters.  There 
is  preservation  of  muscular  irritability  and  of  the  excitability  of 
the  nervous  trunks,  integrity  of  muscular  nutrition,  and  absence 
of  reflex  motion,  of  spontaneous  convulsive  movements,  of  con- 
tractions, of  fibrillary  contractions,  and  of  trembling  in  parts 
actually  deprived  of  voluntary  motion.     2.  In  this  group  may 


482  lite  Doctrine  of  Elimination.  [July, 

especially  be  ranged  hysterical  paralysis  and  sympathetic  par- 
alysis, generally  confounded  together  under  the  common  de- 
nomination hysterical.  3.  Some  of  these  paralyses  disappear 
during  sleep,  and  immediately  yield  to  the  action  of  chloroform 
(probably  also  of  ether)  and  narcotics.  Others  undergo  no  modi- 
fication under  such  influences.  4.  The  former  appear  to  belong 
to  the  category  of  sympathetic  paralyses ;  the  latter  to  that  of 
hysterical  paralysis,  properly  so  called.  5.  These  phenomena 
constitute  a  means  of  diagnosis  of  true  hysterical  paralysis.  6. 
They  serve  to  distinguish  in  all  cases  the  paralyses  in  which 
they  are  observed  from  those  which  are  dependent  upon  organic, 
nervous  or  muscular  lesion.  7.  Narcotic  and  anaesthetic  agents 
may  be  employed  in  the  treatment  of  paralysis,  whether  as  cura- 
tive agents,  palliatives,  or  simple  auxiliaries. — \_Mon,  des  Hop., 
and  Med.  Times  and  Gaz. 


The  Doctrine  of  Elimination,  as  propounded  bg  recent  Authors. 

Dr.  Thomas  Inman  has  published  {Liverpool  Medico-  Chirurgi- 
cal  Journal,  July,  1857),  a  very  interesting  paper  on  this  subject, 
in  which  he  inquires :  1st.  What  the  doctrine  of  elimination  is. 
2nd.  The  arguments  in  its  favour.  3rd.  The  plan  of  treatment 
it  leads  to.     And  he  endeavours  to  show — 

"  1.  That  the  processes  by  which  poisons  are  expelled  from 
the  body  are  passive,  rather  than  active. 

"2.  That  evacuations,  emanations,  or  eliminations,  are  not  to 
be  considered  as  '  salutary  efforts  of  nature  to  cure,'  but  as  symp- 
toms of  the  normal  nutrition  being  modified  by  a  new  force. 

"3.  That  it  is  dangerous  in  diseases  of  a  humoral  origin,  to 
act  upon  an  eliminant  plan  of  treatment  principally. 

"4.  That  the  mode  of  treating  diseases,  depending  on  the 
presence  of  poison,  is  to  enable  the  system  in  general,  or  any 
organ  in  particular,  to  resist  its  action  or  tolerate  its  presence. 

"5.  That  anything  which  depresses  the  vital  powers,  makes 
an  individual  more  susceptible  of  foreign  influences. 

"It  is  not  simply  a  pure  condition  of  the  blood  that  is  neces- 
sary to  health  ;  for  man  may  have  the  most  healthy  blood  pos- 
sible, and  yet  die  of  cold ;  while  those  whose  blood  is  vitiated 
by  tuberculosis,  cancer,  the  paludal  or  gouty  poison,  may  appear 
to  enjoy  perfect  health,  for  a  lengthened  period,  if  not  for  the 
ordinary  duration  of  life.  No  medicine,  therefore,  whose  sole 
aim  is  to  purify  the  blood,  and  no  plan  of  treatment  simply 
eliminative,  can  be  expected  to  have  more  than  temporary,  or 
accidental  success. 

"  There  is,  however,  one  plan  for  the  elimination  of  all  poi- 
sons, with  which  we  feel  bound  to  concur.     It  is  that  which 


1858.]  Perchloride  of  Iron  in  Erysipelas.  483 

places  the  patient  in  the  midst  of  pure  air  and  lovely  scenery; 
which  takes  him  from  the  turmoil  and  wearing  activity  of  busi- 
ness, and  gives  him  mental  repose ;  which  supplies  him  with 
nutritious  diet,  and  abundance  of  the  finest  water;  which  pro- 
cures sound  rest  at  night,  without  any  other  opiate  than  health- 
ful exercise ;  and  which  does  not  scour  out  the  bowels  by  a  daily 
purge. 

"In this  way,  we  believe  health  maybe  regained,  and  poison 
be  expelled  ;  for  there  is  in  every  living  being  a  necessity  for  a 
constant  renovation;  old  materials  are  daily  being  replaced  by 
new;  and  when  the  increments  are  all  healthy,  and  all  old  ma- 
terials are  being  expelled,  it  is  a  necessary  consequence  that  the 
body  should  have  as  sound  a  constitution  as  it  is  possible  to  at- 
tain."— [American  Jour,  of  die  Med.  Sciences. 


Perchloride  of  Iron  in  the  Treatment  of  Erysipelas. 

The  use  of  perchloride  of  iron  in  the  treatment  of  erysipelas 
has  lately  been  brought  again  into  notice  by  the  publication  of 
a  thesis  by  M.  Louis  Mathey,  and  by  some  observations  made 
by  M.  Aran,  physician  of  the  Hopital  St.  Antoine  in  Paris.  M. 
Mathey  relates  ten  cases  of  erysipelas  treated  with  this  medicine, 
and  his  conclusions  are  contained  in  the  following  remarks: 

The  action  of  perchloride  of  iron  on  erysipelas  is  evident,  and 
the  course  of  the  disease  is  modified  a  short  time  after  its  admin- 
istration. In  fact,  on  the  second  day,  and  sometimes  even  on 
the  first,  M.  Mathey  has  seen  the  disease  become  limited  and 
circumscribed,  and  its  further  progress  arrested.  As  to  the  du- 
ration of  the  disease,  the  effect  of  the  perchloride  is  still  very 
remarkable :  not  only  is  the  progress  of  the  erysipelas  sensibly 
modified  from  the  first  few  hours  which  follow  the  administra- 
tion of  the  medicine,  but  it  is  completely  arrested ;  the  radical 
cure  of  the  disease  is  obtained  in  a  very  short  time.  It  was 
observed  that  in  ten  rather  severe  cases  of  erysipelas  treated  by 
the  internal  use  of  perchloride  of  iron,  three  were  cured  in  two 
days,  three  were  cured  in  three  days,  two  were  cured  in  four 
days,  one  in  five  days,  and  one  in  seven  days.  It  cannot  there- 
fore be  denied  that  erysipelas  is  advantageously  modified  by  the 
internal  use  of  chloride  of  iron  ;  that  the  cessation  of  the  symp- 
toms proper  to  erysipelas  is  sometimes  very  rapid  after  the  ad- 
ministration of  this  medicine ;  that  in  a  series  often  observations 
made  upon  varied  cases,  this  treatment  never  failed;  that  even 
where  its  efficacy  may  be  doubted  it  has  never  given  rise  to  any 
bad  symptom ;  and  that  when  administered  in  the  dose  of  30  drops 
to  a  healthy  subject,  it  has  never  given  rise  to  any  painful  sensa- 
tion, and  has  never  produced  any  notable  functional  disturbance. 

M.  Aran  agrees  with  M.  Mathey  in   never  having  observed 

k.  s. — vol.  xiv.   jro.  vn.  24 


484  Perchloride  of  Iron  in  Erysipelas.  [July* 

any  unfortunate  result  from  the  administration  of  the  perchloride 
of  iron  in  larger  doses  than  those  employed  by  M.  Mathey — 
namely,  thirty,  fifty,  sixty,  and  one  hundred  drops  a  day,  in 
certain  exceptional  cases.  But  a  wider  and  more  extensive 
experience  of  the  employment  of  the  perchloride  has  shown  him 
that  there  are  particular  circumstances  which  favour  the  action 
of  the  medicine.  M.  Aran  believes  that  it  would  be  vain  to 
expect  advantageous  results  from  the  administration  of  per- 
chloride of  iron  in  all  cases  of  erysipelas.  He  is  convinced  that 
some  cases  of  erysipelas  will  not  yield  to  this  remedy ;  as,  for 
instance,  the  cases  which  occur  in  young,  strong,  and  robust 
subjects  of  a  sanguine  temperament,  and  which  are  accompa- 
nied by  a  well-marked  imflammatory  action.  On  the  other 
hand,  the  cases  of  erysipelas  which  are  developed  in  feeble,  deli- 
cate subjects,  of  a  well-marked  lymphatic  or  scrofulous  tempera- 
ment; in  individuals  already  weakened  by  previous  disease; 
the  cases  especially  which  exhibit  with  well-marked  tendency 
to  spread,  the  cedematous  form ;  and  in  which,  even  with  a 
marked  acceleration  of  the  pulse,  the  arterial  throbs  are  weak 
and  easily  depressed,  or  when  fever  is  completely  wanting,  as 
happens  sometimes  in  old  persons;  these  cases  are  remarkably 
modified  and  often  arrested  in  twenty-four,  thirty-six,  or  forty- 
eighth  hours,  by  the  administration  of  the  perchloride.  The 
erysipelas,  which  is  still  more  atonic,  and  which  supervenes  in 
the  course  of  serious  diseases,  around  punctures,  abrasions,  or 
lacerations  of  the  skin,  at  other  times  even  without  appreciable 
causes,  are  amenable  to  the  perchloride  of  iron.  Lastly,  the  cases 
which,  even  when  they  show  themselves  in  strong  and  robust 
subjects,  after  having  been  reduced  by  various  and  appropriate 
treatment,  still  linger  on  and  pass  from  one  part  to  another, 
throwing  out  unexpectedly  its  eruptions  in  places  where  the 
disease  appeared  to  have  been  long  extinguished;  such  cases 
are  often  terminated  in  24  hours  by  the  perchloride  of  iron. 

Another  point  connected  with  this  subject  is  the  propriety  of 
administering  the  perchloride  as  a  prophylactic.  "  There  are 
certain  epochs  and  years,"  says  M.  Mathey,  "when  cases  of 
erysipelas  of  a  traumatic  origin  are  multiplied  to  infinity,  and 
show  themselves  in  such  great  number,  that  the  disease  is  truly 
epidemic.  The  application  of  a  seton,  a  moxa,  or  a  blister,  is 
followed  by  erysipelatous  inflammation ;  and  a  fortiori,  the  great 
wounds  united  by  sutures  and  bandages  of  diachylon  are  almost 
infallibly  attacked  with  the  disease.  The  surgeon  who  operates 
under  these  circumstances  is  pretty  sure  to  see  erysipelas  among 
his  patients.  It  would  perhaps  be  proper  to  postpone  the  opera- 
tion, but  sometimes  the  case  is  urgent,  and  the  surgeon  would 
think  himself  fortunate  and  could  act  with  more  confidence  if 
he  could  hope  to  put  his  patient  beyond  the  reach  of  a  trouble- 


1858.]  Antidote  to  the  Poison  of  the  Rattlesnake.  485 

some  complication ;  might  we  not,  for  the  first  few  days  which 
follow  a  delicate  operation,  and  during  which  inflammation  is 
to  be  feared,  unite  with  soothing  beverages  some  drops  of  per- 
chloride  of  iron,  because  it  is  fully  established  that  its  use  in 
moderate  doses  is  not  followed  by  any  bad  effect?" — [Bull.  Gen. 
de  Therap.  and  Brit,  and  For.  Med.  Chirurg.  Rev. 


Experiments  with  Bibron's  Antidote  to  the  Poison  of  the  Rattle- 
snake, &c.  By  William  A.  Hammond,  M.  D.,  Assistant 
Surgeon  U.  S.  Army. 

Some  four  years  since,  Prince  Paul,  of  Wurtemberg,  the  cele- 
brated naturalist,  communicated  to  my  friend,  Mr.  De  Vesey, 
the  results  of  some  experiments  performed  before  the  French 
Academy  of  Sciences,  by  Professor  Bibron,  relative  to  an  anti- 
dote to  the  poison  of  the  rattlesnake.  According  to  Prince  Paul, 
Professor  Bibron  allowed  a  rattlesnake  to  bite  him  in  the  lips, 
cheeks,  etc.,  and  by  taking  the  antidote  discovered  by  him,  pre- 
vented ail  alarming  symptoms,  and  in  fact  suffered  no  incon- 
venience therefrom. 

The  antidote  in  question,  as  stated  by  Prince  Paul,  is  prepar- 
ed according  to  the  following  recipe: 

ty.  Potassi  iodidi,  gr.  iv. ;  hydrarg.  chloridi  corros.,  gr.  ij.; 
bromini,  3  v.  M.  Ten  drops  of  this  mixture,  diluted  with  a 
tablespoonful  or  two  of  wine  or  brandy,  constitutes  a  dose,  to 
be  repeated  if  necessary.  It  must  be  kept  in  glass-stoppered 
vials,  well  secured. 

Prince  Paul  forwarded  a  small  quantity  of  the  above  mixture 
to  Mr.  De  Yesey,  who  used  it  successfully  in  the  cases  of  two 
men  bitten  by  rattlesnakes  near  his  residence  in  Iowa. 

During  a  recent  expedition  to  the  Eocky  Mountains,  I  had 
several  opportunities  of  testing  its  efficacy,  and,  since  my  return, 
have  performed  additional  experiments  with  it.  The  results 
have  been,  upon  the  whole,  exceedingly  satisfactory,  and  I  think 
that,  when  taken  in  time,  it  may  be  entirely  depended  upon  in 
the  poisonous  wounds  of  the  rattlesnake,  and  perhaps  also  in 
those  of  other  venomous  serpents. 

First  Experiment — Heinrich  Brandt,  acting  hospital  steward, 
was  bitten  on  the  2nd  of  July,  1857,  in  the  index  finger  of  the 
right  hand  by  a  large  rattlesnake  (crotalus  confluentus),  which 
he  was  in  the  act  of  putting  into  a  jar  for  preservation.  The 
snake  inflicted  a  very  deep  wound,  and  hung  by  his  fangs  to  the 
finger  for  a  second  or  two  before  it  could  be  detached.  About 
four  minutes  after  the  bite,  and  before  much  pain  or  swelling 
had  ensued,  I  administered  one  dose  of  Bibron's  antidote.  The 
symptoms  almost  immediately  disappeared.  Forty  minutes  after 
giving  the  first  dose  the  pain  and  swelling  returned,  attended 


486  Influence  of  Atmospherical  Changes,  &c.  [July, 

with  considerable  throbbing.  I  repeated  the  medicine,  and  in 
less  than  five  minutes  the  finger  had  regained  its  natural  ap- 
pearance, and  all  pain  and  swelling  had  vanished.  He  remain- 
ed perfectly  well,  and  resumed  his  duties  in  an  hour  from  the 
reception  of  the  injury. — [American  Jour.  Med.  Sciences. 


Influence  of  Atmospherical  Changes  in  Determining  the  Recurrence 
of  Paroxysms  of  Asthma. 

Dr.  A.  W.  Nichols  has  presented,  in  a  tabular  form,  the  suc- 
cessive paroxysms  of  asthma  occurring  in  a  case  under  observa- 
tion at  the  Buffalo  Hospital  of  the  Sisters  of  Charity,  in  the 
service  of  Dr.  Flint,  from  December  3rd  to  February  17th. 
During  this  period  seventeen  paroxysms  occurred.  The  date  of 
each  paroxysm — the  time  of  the  day  when  it  took  place — the 
degree  of  severity,  duration,  remedies  employed,  and  the  appa- 
rent effect,  as  well  as  the  state  of  the  weather,  are  noted  in  the 
table  referred  to.  The  paroxysms  generally  came  on  during 
the  night  or  early  in  the  morning.  They  did  not  observe  any 
rule  of  periodicity.  They  were  variable  as  regards  intensity, 
and  were  usually  much  more  severe  after  any  decided  change  in 
the  atmosphere.  Almost  all  of  the  variations  in  the  weather 
were  from  a  cold  and  dry  to  a  warmer  and  moister  atmosphere. 
It  is  also  to  be  noticed  that  no  paroxysms  occurred  after  or 
during  certain  decided  atmospheric  changes,  as  great  as  those 
which,  at  other  times,  were  followed  or  aocompanied  by  asthma- 
tic attacks.  The  paroxysms,  even  when  most  severe,  and  when 
not  influenced  by  remedial  agents,  did  not  continue  longer  than 
twenty  hours.  The  inhalation  of  chloroform  produced  more 
marked  relief  than  any  other  measure  employed.  The  parox- 
ysms were  apparently  abridged  by  it;  the  difficulty  of  breathing 
was  diminished ;  the  patient  was  able  to  assume  the  recumbent 
posture,  and  natural  sleep  soon  succeeded.  This  was  the  result 
in  six  paroxysms  in  which  it  was  tried.  The  dry  bronchial  rales 
were  diminished  in  a  few  minutes  after  breathing  chloroform. 
[Buffalo  Med.  Jour,  and  North  American  Med.  Chir  Rev. 


Rules  Respecting  the  Treatment  of  Primary  Syphilis. 

It  seems  to  be  now  pretty  generally  acknwledged,  in  hospital 
practice,  that  mercury  should  be  given  only  in  those  cases  in 
which  the  chancre  presents  marked  induration,  and  that  in  all 
others  secondary  symptoms  should  be  waited  for  before  having 
recourse  to  specific  treatment.  In  a  large  majority  of  sores  not 
attended  by  induration,  no  constitutional  phenomena  will  fol- 
low ;  and  to  discriminate  between  those  likely  to  be  so  followed 


1858.]  Influence  of  Pregnancg  on  Development  of  Tubercles.      487 

and  the  harmless  class  is  admitted  to  be  impossible.  There  is, 
therefore,  no  alternative,  except  we  would  give  mercury  very 
often  unnecessarily,  but  to  wait  in  these  cases  until  the  real  na- 
ture of  the  affection  shall  have  been  made  manifest.  In  the 
non-indurated  class  local  stimulants,  as  sulphate  of  copper,  lunar 
caustic,  or  the  acid  nitrate  of  mercury,  are  the  old  and  still  fa- 
vorite remedies.  If  the  chancre  be  seen  within  a  week  of  its 
origin,  whether  induration  have  already  commenced  or  not,  we 
believe  most  surgeons  would  destroy  it  freely  either  by  nitric 
acid  or  some  other  caustic. — [Omodei  Annali  Universal^  and 
Med.  Times  and  Gazette. 


Influence  of  Pregnancy  on   the   Development   of  Tubercles.     By 
Edward  Warrex,  M.  D.,  of  Edenton,  North  Carolina. 

This  subject  is  discussed  by  Dr.  Warren  in  an  essay  to  which 
was  awarded  the  Fiske  fund  prize,  June,  1856.  The  essay  was 
published  by  request  of  the  Khode  Island  Medical  Society. 
The  author  divides  the  investigation  into  three  heads,  thus — 1. 
A  consideration  of  the  tubercular  diathesis.  2.  An  inquiry 
into  the  nature  of  the  tubercle.  3.  An  application  of  rules  res- 
pecting disease  already  established.  In  view  of  the  length  of 
the  essay,  and  the  limits  to  which  this  review  must  be  restrict- 
ed, we  can  only  present  a  summary  of  the  several  points  of  the 
argument  by  which  the  author  endeavors  to  prove  that  pregnan- 
cy prevents  the  progress  of  phthisis  even  when  fully  developed. 

"(1.)  There  is  an  inequality  in  the  relations  which  men  and 
women  sustain  to  phthisis;  the  former  being  less  liable  to  it 
than  the  latter. 

"(2.)  This  inequality  depends  upon  certain  differences  of 
conformation,  etc.,  which  are  plain,  palpable,  and  conspicuous. 

''(3.)  An  examination  of  phthisical  statistics  should  show  that 
more  women  fall  victims  than  men,  and  that  the  difference  in 
the  relative  mortality  of  the  two  is  as  plain,  payable,  and  con- 
spicuous, as  their  original  dissimilarity  of  constitution  and  pre- 
disposition. 

"(4.)  An  examination  of  statistics  proves,  that  it  is  not  a  set- 
tled fact  that  more  females  are  destroyed  by  this  malady,  and 
that  there  is  a  positive  approximation  toward  equality  in  the 
effects  of  phthisis  upon  the  two  sexes. 

"(5.)  This  'approximation  toward  equality'  shows  the  opera- 
tion of  some  great  equalizing  cause,  by  which  a  certain  amount 
of  protection  is  secured  to  the  female  system  that  makes  up  for 
its  greater  original  susceptibility,  and  affects  the  general  result 
in  the  manner  alluded  to  above. 

u  (6.)  Pregnancy  complies  with  all  the  conditions  which  this 


488  After  Treatment  of  Surgical  Operations.  [July, 

cause  demands  for  its  operation,  and  it  is  fair  to  attribute  this 
protecting,  preventing,  and  equalizing  effect  to  its  influence 
upon  the  female  system." — [American  Jour,  of  Med.  Sciences,  and 
North  American  Med.  Ghir.  Review. 


After  Treatment  of  Surgical  Operations. 

Dr.  Broadbent,  in  a  paper  read  before  the  Liverpool  Medical 
Society,  session  1855-56,  referred  to  the  object  sought — that  of 
union  by  the  first  intention.  He  believed  one  most  common 
obstacle  to  this  union  to  be  the  occurrence  of  hemorrhage,  one 
or  two  hours  after  the  operation  ;  not  to  such  an  extent  as  to 
require  the  removal  of  the  dressings,  but  sufficiently  to  form  a 
coagulum  of  such  a  size  as  to  seriously  interfere  with  the  union 
of  the  wound — acting,  in  fact,  as  a  foreign  body.  The  cause  of 
this  appeared  to  be,  that  in  amputations,  &c,  when  the  surfaces 
were  brought  together  immediately  after  the  completion  of  the 
operation,  the  vessels  were  tied  while  the  patient  was  still  suffer- 
ing from  the  shock  of  the  operation,  or  it  might  be,  was  some- 
what depressed  by  the  after-effect  of  chloroform,  whilst  the  more 
minute  vessels  were  prevented  from  oozing,  by  their  exposure 
to  the  air,  and  that  when  reaction  took  place,  the  hemorrhage 
came  on.  The  author  thought  that  those  cases  in  which  this 
occurred  to  such  an  extent  as  to  necessitate  the  re-opening  of 
the  wound,  usually  terminate  more  favorably  than  others.  He 
therefore  advocated  the  plan  of  postponing  the  dressing  until  all 
oozing  had  ceased,  and  the  cut  surfaces  had  glazed  over.  The 
unnecessary  removal  of  dressings,  he  believed  to  be  another 
frequent  cause  of  non-union.  He  thought  that  the  sutures  hav- 
ing been  removed,  the  bandages,  &c,  should  remain  untouched 
till  the  third  or  fourth  day,  and  should  then  be  carefully  cut  off. 
The  inability  of  the  patieut  to  maintain  the  required  position, 
acted  in  the  same  way,  and  to  obviate  this,  it  was  suggested 
that  the  patient  should,  before  the  operation,  be  habituated  to 
the  position  in  which  he  would  have  to  lie  after  it.  In  the 
maintenance  of  the  position  of  the  parts,  by  means  of  pressure, 
the  author  believed  that  small  air-cushions  might  be  advantage- 
ously used,  instead  of  pads  of  lint. — [Liverpool  Medico- Chirurg. 
Journal. 


Diagnosis  between  Cancer  and  Condylomata. 

A  young  married  woman  is  now  under  Mr.  Lloyd's  treatment 
in  St.  Bartholomew's,  whose  case  well  exemplifies  the  need  for 
great  care  in  expressing  opinions  as  to  the  nature  of  growths 
which  have  the   slightest  resemblance   to   cancer.     She   was 


1858.]  Editorial  489 

originally  admitted  about  nine  months  ago  for  some  small  in- 
durated tubercles  on  one  labium,  not  at  all  dissimilar  from  con- 
dylomata, of  more  than  usual  hardness.  There  were  three,  and 
they  were  quite  distinct  from  each  other.  This  fact  together 
with  the  patients  age  and  good  state  of  health,  induced  many  to 
believe  them  of  syphilitic  origin.  Mr.  Lloyd,  however,  held  a 
contrary  opinion,  and  determined  to  excise  them.  This  was 
done,  and  on  microscopic  inspection  the  elements  of  epithelial 
cancer  was  detected  in  abundance.  The  woman  left  the  hospi- 
well,  but  she  has  now  returned,  with  a  recurrence  of  undoubted 
cancerous  ulceration  in  the  same  site.  The  glands  in  the  groin, 
being  enlarged,  have  been  excised. — [Med.  Times  and  Gazette. 


EDITORIAL  AND  MISCELLANEOUS. 

Professional  Correspondence. — We  are  sometimes  called  upon  to 
write  letters  of  advice,  and  to  present  our  views  in  relation  to  certain 
diseases,  where  an  amount  of  reflection  and  consideration  is  required, 
almost  equal  to  that  which  would  be  necessary  to  prepare  a  regular 
essay  upon  the  subject  in  question.  As  these  letters  often  occupy  the 
time  which  should  be  appropriated  to  our  Editorial  department,  we 
have  deemed  it  but  fair  to  answer  some  of  them  editorially.  As  they 
generally  refer  to  subjects  of  immediate  and  daily  interest  to  the  practi- 
tioner, their  occasional  appearance  in  these  pages  may  be  found  accept- 
able to  the  profession,  more  especially  to  our  friends,  the  younger 
members,  notwithstanding  the  informal  and  often  imperfect  manner  in 
which  the  views  and  suggestions  may  be  presented.  Most  of  these  letters 
will  be  written  in  answer  to  queries  propounded  by  recent  graduates  of 
the  Medical  College  of  Georgia ;  if,  therefore,  they  sometimes  assume  a 
didactic  tone,  other  readers  will  remember  that  they  are  then,  but  the 
words  of  the  teacher  to  those  who  were  but  recently  his  esteemed  and 
attentive  pupils. — [Edts. 

Dr.  R.  Campbell, 

Dear  Sir, — You  remember  sometime  last  winter,  I  requested  you  to 
give  me  your  treatment  for  Typhoid  Fever,  I  suppose  it  has  escaped 
your  memory.  \Yhen  I  subscribed  for  the  Medical  Journal,  I  mentioned 
it  to  your  brother  (Prof.  Henry  Campbell) ;  he  said  I  would  find  it  in  the 
Journal,  but  I  have  failed  to  do  so,  unless  it  was  in  the  April  number, 
which  I  did  not  receive. 

This  is  undoubtedly  the  worst  country  for  typhoid  fever  I  ever  heard 


490  Editorial  [July, 

of.     Every  case  of  sickness  I  hear  of,  the  doctors  pronounce  it  typhoid 
fever.     Hoping  that  you  will  comply  as  soon  as  you  conveniently  can, 
I  remain,  your  obedient  servant,  *  *  * 


Augusta,  Ga.,  June  15th,  1858. 

Dear  Sir, — Your  request  for  my  Treatment  of  Typhoid  Fever,  is 
before  me.  The  requirements  of  the  case  will  not  permit  me  to  be  very 
brief;  yet,  on  the  other  hand,  there  being  some  limit  to  an  epistolary 
communication,  space  may  not  allow  me  to  particularize  with  absolute 
definiteness,  so  that  what  I  may  hereinafter  say,  you  will  please  regard 
as  a  basis  of  hints,  rather  than  a  complete  and  thorough  detail  of  man- 
agement for  this  disease. 

First :  you  must  understand  that  this  disease  is  of  long  continuance, 
and  is  also  self-limited  in  duration.  That  is — start  out  to  deal  with  it, 
under  the  firm  and  full  conviction,  that  you  cannot  cure  it ;  and  this 
conviction,  if  honestly  maintained,  will  save  the  life  of  many  a  patient. 
Let  the  patient  and  the  disease  alone,  so  long  as  they  appear  to  agree 
together  very  well,  without  the  latter  taking  advantage  of  the  former  by 
attacking  him  at  any  particular  vital  point,  and  you  will  find  that 
generally,  the  patient  will  outlive  the  fever,  unless  he  started  out  to  die. 

Secondly :  should  the  disease  attack  with  violence  a  vital  organ,  as 
brain,  lungs  or  bowels ;  or  to  speak  more  properly,  should  these  organs 
not  possess  sufficient  force  of  vitality  to  resist  the  enervating  and  disor- 
ganizing influence  of  this  condition,  it  will  become  necessary  to  fortify 
them  by  remedial  means  directed  thereto,  also  by  supporting  the  gene- 
ral strength,  and  thus  assist  the  recuperative  powers  of  the  system. 

Then,  should  the  brain  become  the  seat  of  congestion,  you  may  drive 
it  out,  and  keep  it  out,  at  the  same  time  giving  tone  to  the  vessels,  by 
the  frequent,  though  not  too  severe,  application  of  the  cold  douche  to  the 
head.  Should  the  parenchyma  of  the  lungs  be  the  seat  of  engorgement, 
sufficient  to  embarrass  their  function,  as  manifested  by  partial  or  com- 
plete occupation  of  the  air  passages  with  mucus — as  shown  by  ausculta- 
tion and  percussion,  as  well  as  by  the  extreme  frequency  of  the  respira- 
tion— treat  the  case  according  to  Behier's  plan,  (see  March  No.  of  South- 
ern Med.  and  Surg.  Journal,)  viz.,  with  extensive  and  repeated  dry  cupping 
to  the  chest,  and  use  turpentine  to  give  tone  to  the  mucous  tissue  of  the 
lungs,  and  prevent  or  suppress  inordinate  secretion  or  exudation.  Should 
the  mucous  membrane  of  the  small  intestines  give  way,  at,  or  in  the 
vicinity  of  Peyer's  glands,  which  sometimes  happens,  though  not  invari- 
ably (as  is  supposed  by  some),  give  turpentine  as  the  best  known  means 
of  arresting  the  disorganization  of  this  tissue,  and  to  stimulate  its  recu- 


1858.]  Editorial  491 

perative  energy.     This  can  be  materially  assisted  by  keeping  a  small 
blister — the  size  of  the  hand — open,  upon  the  right  iliac  region. 

But  if  you  have  not  the  forbearance  and  firmness  to  stand  by  a  case 
of  typhoid  fever,  which  is  running  its  course  harmlessly,  without  inter- 
fering to  diminish  the  patient's  strength,  and  with  it,  his  chance  of 
recovery,  you  had  better  forego  all  the  reputation  you  may  expect  to 
gain  by  your  professional  enterprise  in  this  quarter. 

Is  typhoid  fever,  then,  a  disease  not  requiring  the  regular  attendance 
of  the  physician  ?  Far  from  it.  It  is  one  above  most  of  diseases,  de- 
manding his  especial  supervision  and  untiring  watchfulness. 

1st.  He  must  guard  the  patient,  that  he  does  nothing  himself,  and 
that  nothing  be  done  for  him  or  with  him,  by  others,  to  jeopard  his 
chance  of  recovery. 

2nd.  He  must  see  that  he  is  placed  and  kept  in  the  most  favorable 
circumstances  as  regards  bodily  comfort,  temperature,  ventilation,  <fec; 
bodily  wants — as  diet  properly  and  judiciously  ordered,  limited  and 
adapted  to  the  stages  of  the  disease ;  also,  as  regards  the  application  of 
stimulants  and  when  to  be  used. 

3rd.  He  is  to  watch  and  listen  with  a  sentinel's  eye  and  ear  the  distant 
approach  of  those  insidious  complications,  to  which  we  have  referred, 
and  which  are  sometimes  the  result  of  this  disease,  in  one  or  more  of 
the  vital  organs ;  and  begin  early  to  assist  the  patient's  constitution  to 
withstand  or  overcome  them. 

The  patient  with  typhoid  fever  seems  to  me  to  be  poised  with  fearful 
precision  between  life  and  death.  If  he  maintains  his  ticklish  position 
through  this  protracted  crisis,  he  is  safe ;  but  how  awful  it  is,  to  see 
what  a  little  influence  may  jostle  him  from  it.  He  may  not  drop  off 
suddenly,  but  that  little  influence,  even  one  injudicious  dose  of  active 
medicine,  in  the  beginning  of  the  attack,  may  prove  the  source  of  his 
gradual,  but  inevitable  decline  and  final  fall. 

Therefore,  beware  of  treating  this  disease  actively,  even  in  the  begin- 
ning. Especially  exclude  purgative  medicines,  which  are  detrimental  in 
various  ways. 

One  of  the  first  and  the  most  prominent  symptom  throughout  the 
disease,  is  weakness,  or  loss  of  vital  energy.  The  vitality  of  the  fluids, 
as  well  as  of  the  solids,  is  below  par.  Depletion  increases  the  impover- 
ishment of  the  fluids  and  the  approach  to  necraeinia ;  and  from  this 
condition  of  the  blood,  probably,  results  the  extreme  loss  of  nervous 
power  in  this  disease.  The  patient  seems  completely  enervated  :  very 
slight  muscular  effort  seems,  often,  entirely  to  overcome  him,  so  that 
rising  up  in  bed  quickens  the  pulse,  and  if  frequently  repeated,  will 
often  seriously  damage  the  prospects  of  the  case.     Therefore,  the  mere 


492  Editorial  [July, 

effort  to  get  up  to  stool,  frequently,  should  be  avoided,  and  purgatives 
withheld  for  this  reason,  if  other  more  valid  objections  did  not  obtain. 
I  have  seen  a  convalescent  relapse  for  two  weeks,  from  walking  across 
the  floor  to  change  his  bed. 

Purgatives  given  early  in  typhoid  fever  are  apt  to  determine  to  the 
bowels,  in  the  latter  stages,  by  deranging  them  and  rendering  them  en- 
feebled and  more  susceptible  to  the  influences  which  manifest  themselves 
in  this  portion  of  the  organism,  as  the  most  common  form  of  complica- 
tion or  organic  implication,  occurring  in  this  disease.  And  who  can 
say,  but  that  the  bowel  affection  is  in  many  instances  determined  by 
this  treatment  in  the  incipiency  of  the  attack.  If  the  alimentary  canal 
requires  clearing  out,  a  simple  dose  of  castor  oil  would  probably  accom- 
plish it  without  irritation  or  depletion.  But  I  would  express  here,  my 
unfeigned  disapprobation  of  the  abominable  plan  of  purging  every  pa- 
tient, in  every  disease,  as  a  necessary  preliminary  to  any  other  treatment. 
In  typhoid  fever,  it  is  productive  of  positive  mischief,  by  precipitating  the 
result  of  an  existing  predisposition,  viz. — to  intestinal  disease :  whereas, 
in  paroxysmal  fever,  often,  valuable  time  is  lost  in  waiting  for  the  opera- 
tion of  active  medicines,  to  the  delaying,  or  entire  exclusion  of  the  only 
important  element  of  treatment. 

Thus,  you  perceive,  that  as  for  the  treatment  of  typhoid  fever,  it  is  a 
disease  that  requires  more  watching  than  active  interference.  But  if 
there  is  one  remedy  in  the  catalogue  of  the  Materia  Medica,  which 
seems  to  be  adapted  to  this  condition  more  than  another — if  there  is 
anything  which  seems  calculated  to  relieve  the  complications  which 
generally  arise  in  this  disease,  or  to  prevent  them  ere  they  make  their 
appearance — it  does  seem  that  that  agent  is  Turpentine. 

Dr.  Thomas  Smith,  of  London,  wrote  ninety  pages  upon  the  good 
effects  of  turpentine,  and  some  were  disposed  to  smile  at  his  credulity  ; 
but  I  rather  think  he  was  right. 

The  turpentine  treatment  of  typhoid  fever  has  been  long  in  vogue. 
The  name  of  Professor  Wood,  of  Philadelphia,  is  particularly  associated 
with  this  treatment,  inasmuch  as  he  recommends  it  highly,  and  advo- 
cates strongly  its  advantages  above  all  others  in  certain  stages. 

I  have  used  this  treatment  for  six  or  eight  years,  and  whether  from 
its  positive  advantages,  or  from  the  benefit  derived  from  the  exclusion  of 
all  other  medication,  there  has  certainly  been  the  greatest  improvement 
in  the  success  of  my  practice  upon  this  disease  during  that  period. 

It  sometimes  happens  that  typhoid  fever,  in  its  incipiency,  is  mixed 
up  with  paroxysmal  fever.  These  cases  require  quinine  to  rid  them  of 
this  paroxysmal  complication — which  it  does — leaving  the  continued 
fever  to  pursue  the  even  tenor  of  its  way.     I  sometimes  give  quinine  in 


1858.]  Editorial.  493 

moderate  doses,  three  times  a  day,  and  continue  its  use  for  a  length  of 
time,  varying  the  quantity  with  the  degree  of  necessity  for  its  continu- 
ance— in  those  cases  which  have  a  tendency  to  congestion,  or  to  passive 
hemorrhages — because  I  believe  that  quinine  acts  upon  the  vascular 
tissue,  to  give  it  tone  or  contractility ;  and  I  have  seen  many  good  re- 
sults from  the  continued  administration  of  considerable  doses  of  quinine 
under  such  circumstances. 

The  mode  in  which  I  have  found  it  convenient  to  administer  turpen- 
tine in  typhoid  fever,  is  by  the  following  emulsion : 


Be  Turpentine, £ss. 

Loaf  Sugar, 

Gum  Arabic, 

Com  p.  Spts.  Lavender,  .  . 

Bi  Carb.  Soda, 

Camphor  Water, .  q.  s. 

To  make  an  8  ounce  Emulsion. 


aa  I). 


Dose — For  an  adult,  1  tablespoonful  three  times  a  day  (well  shaken), 
and  so  continue. 

To  begin  with  the  turpentine  early  in  the  attack,  seems  to  lessen  the 
danger  to  the  bowels,  and  also  to  the  lungs. 

I  have  often  seen  the  bowels,  discharging  large  watery  stools  before 
the  use  of  this  emulsion,  become  even  constipated  under  its  use,  by  re- 
lieving the  local  affection.  I  have  continued  the  emulsion  in  many 
cases  from  my  first  visit  to  a  patient,  until  he  was  discharged. 

If  there  should  be  much  diarrhcea,  and  the  emulsion  does  not  check 
it,  I  give  5  grains  sub.  nit.  bismuth  in  a  spoonful  of  water,  after  each 
passage.  The  most  convenient  mode  of  administering  the  bismuth,  I 
find  is  in  an  aqueous  mixture,  viz : 

R     Sub  Nit  Bismuth,  ....  grs.  80 

Water, gij. 

Mix  in  two  ounce  phial. 

Shake  until  well  mixed  at  each  dose,  and  give  one  teaspoonful  after 
each  passage. 

If  this  does  not  have  the  desired  effect,  I  add  a  small  quantity  of 
laudanum — from  10  to  20  drops.  I  dislike  the  too  free  use  of  opiates 
in  typhoid  fever :  I  think"  they  are  calculated  to  bring  about  coma  or 
delirium  in  the  latter  stages. 

The  bismuth,  in  connection  with  the  turpentine  treatment,  will  gene- 
rally check  the  bowels  as  promptly,  or  even  more  speedily  than  opiates. 
When  there  is  diarrhcea,  I  invariably  put  a  small  blister  over  the  right 
iliac  region,  and  keep  it  open  if  possible,  until  this  symptom  disappears. 
I  always  examine  this  region,  whether  there  is  diarrhoea  or  not,  and  if  I 


494  Editorial  [July, 

find  tenderness  upon  deep  pressure  with  the  hand,  or  meteorism,  I  take 
it  for  granted  that  the  diarrhoea  is  not  far  off,  and  apply  the  blister  and 
put  the  patient  upon  the  treatment  above  mentioned. 

You  will  generally  find  that  the  comp.  spts.  lavender,  in  the  emulsion, 
will  prevent  subsultus  tendinum  in  a  great  measure ;  but  if  this  pheno- 
menon should  appear,  add  to  the  course,  a  teaspoonful  of  the  tincture  of 
valerian  (for  an  adult,)  every  three  or  four  hours,  until  relieved,  and  re- 
peat pro  re  nata. 

I  give  this  tincture  also,  to  quiet  restlessness,  sleeplessness,  and  slight 
delirium,  in  these  cases.  Sometimes  a  Dover's  powder  (10  grains,)  at 
night  is  necessary  to  induce  sleep. 

In  the  earlier  stages,  when  the  skin  is  very  dry  and  hot,  great  benefit 
may  be  derived  from  the  thorough  application  of  lard  ("bacon-rind") 
to  the  surface  of  the  patient's  body  and  limbs.  It  has  a  very  cooling 
and  soothing  effect.  This  valuable  fact  I  gained  from  my  friend,  Dr.  P. 
D'L.  Baker  of  Alabama.  The  patient  may  be  greased  all  over,  once  or 
twice  a  day ;  or,  whenever  his  skin  becomes  very  hot  and  dry,  or  he 
seems  very  restless ;  that  is,  if  it  can  be  done  without  giving  him  the 
least  fatigue,  or  causing  the  least  muscular  effort :  for,  recollect,  that 
nothing  should  be  done  that  requires  the  patient  to  rise  up  or  to  move. 
I  have  a  patient  now,  who  got  his  pulse  up  very  high  the  other  day,  by 
simply  fanning  the  flies  off  of  himself,  for  a  little  while.  I  mention  this 
forcible  example  to  show  you,  how  little  muscular  effort  it  would  take, 
either  by  getting  up  to  stool  often,  or  otherwise,  to  kill  a  patient  with 
this  disease.  Thus,  a  patient  with  typhoid  fever,  should  never  be  allow- 
ed even  to  get  up  to  stool,  if  it  could  be  avoided ;  and  there  exist  the 
best  of  reasons  for  this,  but  time  and  space  forbid  my  entering  upon  the 
pathology  here.  I  will,  therefore,  cite  you  to  my  brother's  contributions 
upon  this  subject,  in  his  volume  entitled  "Essays  on  the  Secretory  and 
Excito-Secretory  System,"  article,  "  Typhoid  Fever." 

If  the  bowels  should  remain  constipated  for  too  long  a  time,  they 
should  be  relieved  by  warm-water  enemata. 

At  a  variable  length  of  time  from  the  beginning  of  the  attack,  some- 
times ten  days,  or  two  or  three  weeks,  the  skin  will  become  cool,  or 
even  sometimes  alarmingly  cold.  It  is  sometimes  proper  to  give  stimu- 
lants before  this  stage  comes  on,  when,  for  instance,  the  adynamic  char- 
acter of  the  disease  is  very  apparent  in  the  first  stage,  or  if  accompanied 
with  passive  hemorrhage — i.e.  brandy  with  quinine :  but  stimulants  are 
generally  imperatively  demanded,  when  the  cold  stage  has  set  in.  Some 
cases  only  require  port  wine,  with  which  I  often  combine  comp.  tincture 
of  cinchona,  three  times  a  day,  in  doses  of  from  one  to  two  ounces  of 
the  former,  to  two  to  four  drachms  of  the  latter  for  an  adult,  diminishing 


1858.]  Editorial  495 

in  proportion  to  the  age  of  younger  subjects.  Other  extreme  cases  re- 
quire brandy  almost  without  limit.  It  is  astonishing  sometimes  to  see 
what  immense  quantities  of  brandy  may  be  poured  down  a  patient  in 
this  very  low  condition,  without  his  system  appearing  to  recognize  that 
it  is  a  stimulant. 

The  dietetic  and  regi menial  conduct  of  a  case  of  typhoid  fever  Lb 
important,  and  I  believe,  even  more  so,  than  the  medicinal  course.  In 
the  earlier  stages  the  patient  does  not  desire  much  nourishment — does 
not  require  much ;  and  probably  it  would  do  him  an  injury  to  force  him 
with  much.  Some  light  food,  such  as  very  fresh  milk,  well  boiled  with 
rice  or  arrow-root ;  grated  cracker  and  hyson  tea,  <fec,  is  as  much  as  he 
will  generally  require ;  and  care  should  be  taken  that  he  does  not  take 
too  much  even  of  these  at  a  time. 

In  the  latter  stages,  it  is  necessary  not  only  to  use  stimulants,  but  a 
nourishing  diet  is  demanded,  both  by  the  patient's  improved  appetite, 
and  by  his  debilitated  general  condition.  Sometimes  the  appetite  is 
ravenous,  and  craving  the  most  indigestible  and  injurious  articles,  the 
patient  being  often  difficult  to  control,  and  this  is  a  dangerous  season  on 
that  account.  The  best  form  of  nourishment  under  these  circumstances 
is  beef  essence,  and  in  the  absence  of  this,  chicken  soup  made  with  rice, 
seasoned  with  pepper.  The  patient  should  be  allowed  the  free  use  of 
cold  water — ice  water,  if  practicable — but  not  to  take  too  large  a 
draught  at  a  time.  Sponging  the  body  with  cold  water  in  the  earlier 
stages,  often  affords  great  relief  and  improves  the  condition  of  the  pa- 
tient. He  should  never  be  allowed  to  lie  upon  the  floor,  or  in  an  ob- 
scure corner  of  the  room,  inconvenient  to  be  got  at;  but  should  always 
be  supplied  with  a  bedstead,  placed  in  the  most  accessible  part  of  the 
room — that  he  may  be  examined  critically,  in  a  good  light,  at  pleasure, 
and  without  the  disadvantages  of  a  constrained  position,  or  other  embar- 
rassments to  the  physician.  He  should  be  on  a  comfortable,  soft  bed, 
and  should  be  turned  over  occasionally,  or  else  he  will  have  bed-sores — 
one  of  the  most  serious  inconveniences  attendant  upon  this  protracted 
disease. 

Above  all  things,  he  should  be  in  a  well  ventilated  room,  and  not 
near  a  fire,  either  in  winter  or  summer.  I  believe  many  negroes  die  of 
this  disease,  from  being  kept  in  too  close  quarters,  and  exposed  to  the 
heat  and  smoke  of  a  cooking-fire.  The  temperature  of  their  apartments 
should  be  uniform  and  moderate. 

When  the  patient  is  convalescent,  do  not  allow  him  to  indulge  in  any- 
excess  of  diet,  or  exercise,  for  some  time  after  his  attack.  I  have  been 
thus  particular  in  dwelling  upon  these  minutiw,  because  in  attention  to 


496  Editorial.  [July, 

these  things,  which  are  ordinarily  considered  minor  points,  the  treat- 
ment of  typhoid  fever  principally  consists. 

Hoping  that  the  hints  which  I  have  thus,  so  hastily  and  unsystemati- 
cally,  thrown  together  here,  may  be  of  convenience  to  yourself  and  ben- 
efit to  your  patients,  I  have  the  pleasure  to  remain, 
Very  truly,  your  friend, 

ROBERT  CAMPBELL. 


Oglethorpe  Medical  and  Surgical  Journal. — In  a  recent  number, 
we  called  attention  to  the  prospectus  of  the  Savannah  Journal  of  Medi- 
cine ;  we  have  since  received  this  new  work,  and  find  that  it  fully  answers 
our  expectations,  both  in  the  character  of  its  productions,  and  the  style 
of  its  typographical  execution.  We  have  now  to  acknowledge  the 
receipt  of  the  first  number  of  the  Oglethorpe  Medical  and  Surgical 
Journal,  which  is  to  be  published  bi-monthly,  in  Savannah,  under  the 
editorship  of  Drs.  H.  L.  Byrd  and  Holmes  Steele,  Professors  in  the  Ogle- 
thorpe .Medical  College.  The  number  before  us  presents  a  handsome 
appearance,  both  in  the  variety  of  its  contents,  and  typographically.  It 
contains  64  pages,  and  will  be  published  every  two  months.  We  take 
pleasure  in  placing  both  the  above  journals  upon  our  exchange  list. 


Medical  College  of  the  State  of  South  Carolina.  Resignations 
and  Appointments. — "  It  is  with  extreme  regret  that  we  find  ourselves 
compelled  to  announce  the  resignation  of  Prof.  Geddings  from  the  chair 
of  Surgery,  in  the  Medical  College  of  the  State  of  South  Carolina.  We 
understand,  however,  that  the  resignation  has  been  proffered,  and  that 
the  Faculty  will,  with  whatever  reluctance,  feel  themselves  constrained 
to  accept  it. 

"  For  twenty-one  years  Dr.  Geddings  has  been  associated  with  the 
above  mentioned  institution ;  a  College  which  numbered  him  amongst 
the  very  first  of  its  graduates,  which  showed  its  high  estimate  of  his 
worth  and  abilities  by  unanimously  offering  him  one  of  its  earliest  va- 
cant chairs,  and  which  has  since  owed  a  large  measure  of  its  popularity 
and  influence  to  his  labors  and  name." 

In  the  words  of  the  Charleston  Medical  Journal  and  Review,  "  we 
heartily  wish  him  in  his  voluntary  retirement  from  the  labors  of  the 
desk,  length  of  years,  which  cannot  fail  to  bring  with  them  coequal  use- 
fulness and  honor." 

The  simultaneous  retirement  of  Prof.  S.  H.  Dickson,  from  the  chair  of 
Practice,  constitutes  a  double  loss  to  the  College  of  two  most  able  and 
popular  teachers.  Prof.  Dickson  has  accepted  the  appointment  to  the 
chair  of  Principles  and  Practice  of  Medicine  in  the  Jefferson  Medical 


1858.]  Editorial  and  Miscellaneous.  497 

College  at  Philadelphia,  vacated  by  the  death  of  the  lamented  Dr.  J.  K. 
Mitchell.  This  is  the  second  time  that  Dr.  Dickson  has  been  called  to 
and  accepted  a  chair  in  a  Northern  school ;  we  cordially  wish  hira  even 
more  satisfaction  and  success  in  Philadelphia  than  he  found  in  New  York. 
Appointments. — The  Charleston  Mercury  reports,  that  at  a  meeting 
of  the  Trustees  and  Faculty  of  the  Medical  College  of  the  State  of  South 
Carolina,  held  on  the  19th  of  May,  Dr.  P.  C.  Gaillard  was  elected  to  the 
chair  of  the  Institutes  and  Practice  of  Medicine  in  this  institution,  ren- 
dered vacant  by  the  resignation  of  Prof.  Dickson  ;  and  Dr.  J.  J.  Chisolm 
to  the  chair  of  Surgery,  made  vacant  by  the  resignation  of  Prof.  Ged- 
dings.     Both  these  gentlemen  are  favorably  known  to  the  profession. 


University  of  Louisiana  :  Professorial  change. — Professor  J.  C. 
Nott  has  resigned  the  Chair  of  Anatomy  in  this  Institution,  and  Dr.  T. 
G.  Richardson,  recently  Professor  of  Anatomy  in  the  Medical  Depart- 
ment of  Pennsylvania  College,  has  accepted  the  chair  thus  made  vacant. 
Professor  Richardson  is  well  known  to  the  profession,  as  one  of  the  able 
editors  of  the  North  American  Medico-Chirurgical  Renew,  and  also  as 
the  author  of  a  valuable  work  entitled  "Elements  of  Human  Anatomy  ; 
General,  Descriptive  and  Practical."  We  wish  our  confrere  every  hap- 
ness  in  his  Southern  home,  and  should  we  miss  him  from  the  North 
American,  we  hope  he  may  greet  us  some  where  else,  still  our  prized 
and  valued  co-laborer  in  medical  journalism. 


Books  received. — We  have  received  the  following  works  for  review  : 

From  Blanchard  &  Lea,  Philadelphia — 

Graham's  Elements  of  Inorganic  Chemisiry. 

Miller's  System  of  Obstetrics. 

Peaslee's  Human  Histology. 

Plates  to  Wilson  on  the  Skin. 

From  Lindsay  and  Blakiston,  Philadelphia — 

Meigs  on  Diseases  of  Children. 

Carnochan's  Contributions  to  Operative  Surgery  and  Surgical  Pa- 
thology. 

From  the  author — 

Paine's  Institutes  of  Medicine. 

Paine's  Medical  and  Physiological  Commentaries. 

Dr.  Paine's  Essays  on  Vitality  and  Remedial  Agents. 

From  S.  G.  Courtenay  <fe  Co.,  Charleston — 

Geddings'  Lectures  on  Surgery,  by  Drs.  Logan  and  Waring. 

Besides  many  valuable  pamphlets  and  minor  communications,  all  of 
which  shall  receive  due  attention. 


498  Editorial  and  Miscellaneous.         •  [July, 

Dr.  Eve's  Address. — We  have  already  expressed  our  high  apprecia- 
tion of  the  following  address,  in  our  summary  of  the  proceedings  of  the 
last  meeting  of  the  Association ;  we  now  vindicate  that  opinion  by  pre- 
senting it  entire  thus  prominently  to  our  readers.  We  here  copy  from 
the  Nashville  Journal  of  Medicine  and  Surgery : 

Gentlemen  of  the  American  Medical  Association : 

We  meet  under  most  auspicious  circumstances,  and  have  been 
welcomed  to  the  most  favorable  position  ever  occupied  by  our  profession 
on  this  continent.  The  very  ground  on  which  we  stand  may  be  con- 
sidered sacred ;  has  been  set  apart  from  a  common  to  a  special  purpose, 
and  is  national.  Invited  as  we  have  been  to  this  magnificent  temple, 
furnished  and  dedicated  by  a  generous  foreigner  to  science ;  in  the 
presence  of  that  towering  monument,  designed  to  commemorate  the 
worth  of  him  ever  enshrined  first  in  the  hearts  of  his  countrymen ;  sur- 
rounded by  the  glorious  recollections  constantly  associated  with  this 
government ;  and  before  the  great  men  and  assembled  wisdom  of  the 
nation ;  it  becomes  us  to  discharge  the  important  duties  which  have 
called  us  together,  with  honor  to  ourselves  and  benefit  to  our  profession. 
Inspired  by  its  benevolent  spirit,  and  invoking  the  aid  of  an  ever  present 
and  omnipotent  God  to  preside  over  our  deliberations ;  we  may  here 
renew  our  professional  obligations,  learn  to  love  each  other  better,  and 
resolve  henceforth  to  be  more  faithful  to  our  high  vocation,  that  its 
dignity  may  be  maintained  and  its  usefulness  extended. 

Knowing  as  I  do  full  well  the  value  of  time  in  our  short  sessions,  and 
how  much  is  expected  from  this  meeting,  the  half  hour  set  apart  for 
this  customary  address  will  be  restricted  to  subjects  appropriate  to  the 
occasion.  From  this  stand-point  in  the  history  of  our  meetings,  it  is 
proper  to  recall  what  has  already  been  achieved,  that  we  may  be  better 
prepared  profitably  to  engage  in  the  labor  now  awaiting  our  deliberations. 
This  summary  of  our  transactions  is  the  more  necessary,  since  by  a 
disastrous  fire  in  1851,  the  first  four  volumes  of  our  proceedings  have 
been  destroyed,  and  are  of  course  inaccessable  to  all  new  members :  the 
last  report  of  the  committee  on  publication  having  announced  the  fact 
that  not  one  complete  set  of  them  was  now  on  sale. 

The  grand  object  of  a  convention  of  the  physicians  of  the  United 
States,  held  the  previous  year  in  the  city  of  New  York,  was  carried  into 
effect  in  Philadelphia,  May  184  7,  by  organizing  this  Association;  and 
just  ten  years  ago,  the  first  general  assembly  met  in  Baltimore.  Since 
then  annual  meetings  have  been  convened  in  our  large  cities  for  the 
transaction  of  business  and  the  proceedings  regularly  published  each 
year.  Ten  large  octavo  volumes  now  comprise  the  Transactions  of  the 
American  Medical  Association,  being  the  contributions  of  its  two  thous- 
and members  delegated  to  represent  the  medical  institutions  of  thirty 
States  and  Territories. 

As  set  forth  in  convention,  the  ultimate  purposes  of  this  body  are  to 
cultivate  and  advance  medical  knowledge ;  to  elevate  the  standard  of 
medical  education ;  to  promote  the  usefulness,  honor,  and  interests  of  the 


1858.]  Miscellaneous.  499 

medical  profession ;  and  collaterally  to  enlighten  and  direct  public  opin- 
ion in  regard  to  the  duties,  responsibilities  and  requirements  of  medical 
men ;  to  excite  and  encourage  emulation  and  concert  of  action  in  the 
profession  and  to  facilitate  and  foster  friendly  intercourse  between  those 
engaged  in  it. 

In  carrying  forward  these  desirable  changes,  embracing  as  they  do 
medical  science,  medical  education,  and  medical  ethies,  no  one  believes 
that  we  have  done  every  thing  demanded  for  the  good  of  the  profession 
or  that  all  our  great  designs  could  have  been  attained  in  the  brief  space 
often  years.  The  work  assumed  by  the  Association,  it  was  well  known, 
would  take  time,  labor,  and  united  efforts.  It  comprehended  higher 
requisitions  for  admission  into  a  learned  profession  ;  prescribed  the  course 
of  instruction ;  demanded  a  separation  in  the  teaching  and  licensing 
power ;  proposed  a  code  to  regulate  the  intercourse  between  physicians, 
their  patients  and  the  public ;  and  claimed  that  every  one  within  its 
pale  should  assiduously  cultivate  the  science  of  medicine  and  promote  its 
best  #terests.  And  however  extensive  or  radical  may  have  been  these, 
contemplated  plans,  still  on  the  whole  it  can  safely  be  assumed  that  the 
American  Medical  Association  has  been  no  failure. 

It  has  advanced  medical  knowledge,  and  promoted  the  usefulness  of 
the  medical  profession.  There  will  be  found  in  the  ten  volumes  of  its 
printed  transactions,  the  results  of  the  meetings  held  in  Baltimore,  Boston, 
Cincinnati,  Charleston,  Richmond,  New  York,  St.  Louis,  Philadelphia, 
Detroit  and  Xashville,  that  no  less  than  three  hundred  pages  are  devo- 
ted to  medical  education;  over  five  hundred  to  hygiene,  including  the 
sanitary  condition  of  many  of  our  large  cities ;  six  hundred  to  botany  and 
indigenous  plants ;  one  hundred  and  fifty  to  obstetrics ;  four  hundred  to 
medical  literature ;  seven  hundred  and  fifty  to  medical  science  proper ; 
more  than  a  thousand  to  surgery ;  and  two  thousand  to  practical  medi- 
cine, including  the  epidemics  and  prevalent  diseases  of  nearly  every 
State  in  the  Union. 

Special  reports  have  been  made  from  committees  appointed  for  the 
purpose,  on  the  effects  of  anesthetic  agents,  ether  and  chloroform ;  on 
the  influence  of  tea  and  coffee  on  the  diet  of  children  and  the  laboring 
classes ;  on  the  supposed  influence  of  the  cerebellum  over  the  sexual  pro- 
pensities ;  the  results  of  operations  for  the  cure  of  cancer ;  the  introduc- 
tion oi  water  and  gas  into  cities ;  two  reports  on  the  blending  and  con- 
version of  types  of  fever ;  the  action  of  water  on  lead  pipes  and  the 
diseases  proceeding  from  it ;  reflection  of  the  uterus ;  a  nomenclature  of 
diseases  adapted  to  the  United  States,  having  reference  to  a  general 
registration  of  deaths ;  the  sources  of  typhus  fever  and  the  means  for 
their  extinction ;  the  permanent  cure  of  reducible  hernia ;  the  topical 
use  of  water  in  surgery ;  the  agency  of  refrigeration  by  radiation  of  heat 
as  a  cause  of  disease ;  the  results  of  surgical  operations  in  malignant 
diseases ;  the  acute  and  chronic  diseases  of  the  neck  of  the  uterus ;  the 
nature  of  typhoid  fever ;  coxalgia  or  hip-joint  disease ;  the  treatment  of 
morbid  growths  within  the  larynx ;  the  sympathetic  nerve  in  reflex 
phenomena ;  the  medical  and  toxicological  properties  of  the  cryptoga- 
mic  plants  of  the  United  States ;  erysipelas ;  the  influence  of  the  hy- 
grometrical  state  of  the  atmosphere  on  health ;  the  diet  of  the  sick ; 
pathology,  causes,  symptoms  and  treatment  of  scrofula ;  the  preservation 

N.S. — VOL.  XIV.    KO.  VII.  25 


500  Miscellaneous.  [July, 

of  milk ;  tlie  effects  of  alcoholic  liquors  in  health  and  diseases ;  hydro- 
phobia ;  the  changes  in  milk  produced  by  menstruation  and  pregnancy ; 
the  sanitary  police  of  cities;  treatment  of  cholera  infantum;  use  and 
effects  of  nitrate  of  silver  applied  to  the  throat ;  strychnine;  infant  mor- 
tality in  large  cities,  the  sources  of  its  increase  and  means  of  its  diminu- 
tion ;  medico-legal  duties  of  coroners ;  new  principle  of  diagnosis  in  dis- 
location at  the  shoulder-joint ;  the  flora,  fauna  and  medical  topography 
of  Washington  Territory;  the  nervous  system  in  febrile  diseases  ;  etc., 
etc. 

Prizes  have  been  awarded  by  the  Association  to  the  authors  of  the  fol- 
lowing essays,  viz :  On  the  Corpus  Luteum  of  menstruation  and  pregnan- 
cy, for  1851. 

On  the  variation  of  Pitch  in  percussion  and  respiratory  sounds  in 
physical  diagnosis,  for  1852. 

On  the  Cell,  its  physiology,  pathology  and  philosophy. 

And  on  the  Surgical  Treatment  of  certain  fibrous  tumors  of  the  uterus, 
heretofore  considered  beyond  the  resources  of  art,  for  ]  853.  * 

On  a  new  method  of  treating  ununited  Fractures  and  certain  Deformi- 
ties of  the  osseous  system,  for  1854. 

On  the  Statistics  of  Placenta  Prsevia,  for  1858. 

On  the  Physiology  and  chief  Pathological  Relations  of  the  ArteriaJ 
Circulation,  for  1856. 

On  the  Excito-secretory  System  of  Nerves,  in  relations  to  physiology 
and  pathology. 

And  on  Experimental  Researches  in  relation  to  the  nutritive  value  and 
physiological  effects  of  Albumen,  Starch  and  Gum,  when  singly  and  ex- 
clusively used  as  food,  for  1857. 

Carefully  prepared  reports  have  been  published  by  the  Association  of 
the  various  epidemics  and  diseases  which  have  prevailed  during  the  past 
ten  years  throughout  our  widely  extended  country,  and  the  mortuary 
statististics  and  public  health  of  our  large  cities  minutely  ascertained. 
Charts,  maps,  diagrams,  tables  and  plates  have  been  freely  employed  to 
illustrate  these  subjects,  so  important  to  the  general  welfare  of  the  people. 
Every  State  and  Territory,  every  large  city  and  sick  community,  with 
scarcely  an  exception,  has  had  its  hygienic  condition  explored  by  this 
body;  and  dysentery  and  cholera,  typhoid  and  yellow  fevers  have 
specially  claimed  the  attention  of  our  members.  The  communications 
on  deformities  after  fractures,  found  in  our  eighth,  ninth  and  '  tenth 
volumes,  constitute  the  basis  of  the  best  monograph  ever  issued  from  the 
press.  This  work  it  may  be  predicted,  will  do  more  than  all  others  to 
check  the  reckless  and  speculative  spirit  of  suits  for  mal  practice  against 
medical  men ;  for  in  addition  to  teaching  a  useful  lessen  to  the  profes- 
sion in  the  prognosis  of  fractures,  its  testimony  is  so  conclusive  in  refer- 
ence to  the  usual  results  of  these  accidents,  that  judicial  decisions  must 
hereafter  be  regulated  by  it. 

Besides  these  contributions  to  medical  knowledge,  this  Association  has 
taken  action  to  prevent  the  importation  into  our  country  "  of  worthless, 
adulterated  and  misnamed  drugs,  medicines  and  chemical  preparations," 
for  which  a  member  of  the  United  States  Senate  has  publicly  declared 
that  if  we  had  accomplished  nothing  else,  this  alone  should  have  entitled 
us  to  the  gratitude  of  the  nation  ;  it  recommended  to  the  different  States 


1858.]  Miscellaneous.  501 

the  adoption  of  a  regular  system  of  registration  of  births,  marriages  and 
deaths;  memoralized  Congress  to  secure  steerage  passengers  in  our 
emigrant  vessels  medical  attention,  and  due  amount  of  space  between 
decks ;  appointed  a  committee  to  ascertain  the  best  means  of  preventing 
the  introduction  of  disease  by  emigrants  into  our  large  cities ;  and  con- 
sidered many  interesting  individual  ca-    . 

This  is  a  mere  index  to  what  the  American  Medical  Association  has 
done  for  medicine  during  the  first  ten  years  of  its  existence.  A  simple 
reference  to  the  professional  facts  spread  out  upon  its  pages,  is  abundant 
and  satisfactory  proof  how  extensive,  varied  and  valuable  are  its  contribu- 
tions to  medical  science,  and  its  ten  volumes  an  overwhelming  and  con- 
gratulatory answer  to  the  taunting  proclamation  of  the  Edingurgh 
Review  of  1820, — "What  does  the  world  yet  owe  to  American  physi- 
cians and  surgeons?"  In  September,  1854,  the  editors  of  the  Associa- 
tion Medical  Journal  of  Great  Britian  published  our  code,  and  declared 
that  this  body  of  physicians  was  the  most  enlightened  representatives  of 
the  greatest  medical  constituency  in  the  world,  of  which  it  would  be 
presumptuous  in  them  to  speak  in  terms  of  praise.  They  said  of  the 
volumes  of  the  Transactions  already  published,  that  the  duties  of  the 
standing  committees  have  been  ably  and  thoroughly  performed ;  that 
the  progress  of  medical  science  as  a  whole,  its  prominent  divisions  into 
practical  medicine,  surgery  and  obstertics,  carefully  and  accurately  traced 
in  a  series  of  reports  worthy  of  the  highest  praise,  had  been  reported  in 
a  clear,  concise  and  comprehensive  manner,  reflecting  the  highest  credit 
upon  the  committees,  and  also  upon  the  Asssciation  in  selecting  them 
for  their  respective  duties :  and  in  regard  to  what  has  been  done  in  the 
laborious  investigation  of  the  indigenous  medical  flora  of  the  Union ; 
examination  into  and  reports  upon  the  adulteration  of  drugs ;  the  sanita- 
ry condition  of  the  various  States,  and  difference  between  them  in  the 
public  health ;  the  study  of  epidemies  and  of  special  scientific  subjects ; 
the  committees,  continue  these  European  medical  authors,  have  collected 
and  published  a  vast  amount  of  highly  valuable  information.  They 
moreover  assert  their  belief  that  our  success,  especially  in  ethical  reform, 
depends  solely  in  the  moral  power  inseparable  from  a  constitution  based 
upon  the  principle  of  equal  representation,  which  they  affirm  they  not 
only  greatly  admire,  but  can  scarcely  refrain  from  envying. 

Here,  then,  is  a  reply  to  the  above  invective  pronounced  against  the 
medical  profession  of  America,  voluntarily  called  forth  from  the  country- 
men of  its  authors,  and  before  he  had  been  in  his  grave  ten  years,  *  by 
the  contributions  of  this  body  to  medical  science  within  seven  years  of 
its  organization.  Upon  such  disinterested  evidence,  such  full,  free  and 
candid  confessions,  and  from  such  a  source,  may  rest  the  claims  of  the 
American  Medical  Association  for  proof  of  the  benefits  it  has  conferred 
on  medicine.  A  most  active  and  poweiful  agent  in  dissemminating 
useful  medical  knowledge  on  this  continent,  it  is  highly  probable  that  no 
similar  institution  has  ever  been  more  successful  in  carrying  out  its  chief 
object — the  promotion  of  science — than  the  one  now  assembled  in  this 
hall. 

It  has  done  something,  perhaps  all  it  could  under  the  circumstances, 


*Sidoev  Smith  died  in  1S54. 


502  Miscellaneous.  [July, 

to  elevate  the  standard  of  medical  education.     An   influential   motive 
calling  forth  this  organisation,  was  the  proposed  attempt  to  correct  the 
defects  in   the  plan  of  instruction  and   conferring  the  degree  then   gen- 
erally adopted  in  our  medical  colleges ;  and  one  of  the  first  resolutions 
passed,  even  when  the  profession  had  assembled  in  convention,  was  the 
creation  of  a  committee  to  report  at  an  early  day  on  these  exciting  sub- 
jects.    Improvement  in  the  system  of  teaching  medicine,  and  a  change 
in  the  power  granting  the  diploma,  if  not  reformation  in  the   schools, 
have  ever  since  agitated  the  profession,  and  consumed  a  considerable 
portion   of  the   time  of  our  sessions.     The  only   power   to  control  the 
economy  of  the  colleges  which  this  body  possesses  is  exclusively  moral, 
advisory  or  recommendatory,  and  not  legislative  or  legal ;  and  while  it 
may  be  true  that  no  set  of  resolutions  presented  by  the  several  commit- 
tees have  been  fully  carried  into  effect,  still  it  cannot  be  denied  that  im- 
portant changes  calculated  to  advance  medical  education  have  neverthe- 
less been  made.     At  least  seven  professors  now  compose  the  Faculty  in 
all  our  schools,  the  one  or  two  exceptions  to  this  being  in  those  in  which 
the  science  is  taught  nine  consecutive  months.     Xot  less  than  a  period  of 
four   full  months'  instruction   now  constitute  a  course  of  lectures,  and 
even  this  is  exceeded  in  most  of  the  institutions.     But  one  annual  course 
is  now  delivered  with  scarce  an  exception,  and  an  interval  is  thus  allowed 
for  reading  or  private  instruction.     The  Association  has  clearly  defined 
what  shall  be  taught.     It  has  inquired  into  the  practical  operations   of 
all  the  colleges  in  the  land;  scrutinized  the  general  condition  of  medical 
teaching  in  every  State ;  compared  it  with  that  of  the  most  enlightened 
nations ;  called  attention  to  preliminary  education  and  declared  what  it 
ought  to  be ;  advised  higher  requisitions  and  a  more  rigid  examination 
for  obtaining  the  degree ;  and  has,  by  its  free  discussions  and  oft  reitera- 
ted expressions  in  regard  to  the  business  of  teaching  and  regulating  the 
schools,  undoubtedly  prevented  greater  abuses.     It  has  never  ceased  to 
urge  at  every  meeting  the  pressing  necessity  for  a  more  thorough  prepar- 
ation and  greater  attainments  in  candidates  for  the  honors  of  the  profes- 
sion. 

This  subject,  gentlemen,  is  one  upon  which  you  will  be  called  to  take 
action.  A  committee  chosen  at  Nashville  is  to  report  here  on  medical 
education.  It  is  composed  of  gentlemen  from  different  sections,  who, 
while  familiar  with  the  systems  of  teaching  medicine  in  our  country,  are 
yet  disconnected  from  all  the  colleges.  It  would  seem  to  be  a  desirable 
object  to  settle  at  this  meeting  the  future  relation  of  the  schools  to  this 
Association.  Our  sessions  then  might  become  less  educational  in  charac- 
ter, and  hereafter  more  scientific.  And  at  the  present  stagje  of  our  pro- 
ceedings, after  all  that  has  been  said  and  done  on  this  subject,  the  time 
has  surely  arrived  for  a  decision.^  I  cannot  believe  the  colleges  have  any 
interested  motives  before  this  body;  they  of  all  others  should  be  the  last 
to  oppose  a  more  thorough  cultivation  of  medicine,  and  ought  by  such  a 
course  to  become  unworthy  of  their  trust,  and  unwelcome  members  of  a 
great  national  congress  of  physicians,  whose  grand  design  is  to  promote 
medical  science.  We  have  now  reached  a  period  in  our  history  when 
this  voluntary  Association  is  to  determine  what  medical  organizations, 
be  they  State,  county  or  city  societies ;  hospitals,  boards  or  schools,  are 
entitled  to  be  represented  in  its  meetings.     It  alone,  can,  of  course,  pre- 


1858.]  Miscellaneous.  503 

scribe  the  requisitions  for  its  own  delegates.  If  created  to  improve  and 
advance  medical  education,  (and  this  is  in  accordance  with  its  own  ex- 
pressed declarations,)  then  it  is  quite  certain  the  schools  must  be  con- 
trolled. It  has  but  to  speak  on  this  point  and  it  will  be  obeyed  :  for  it 
is  now  too  late  for  any  physician  to  oppose,  or  any  medical  college  to  set 
at  defiance  the  moral  power  of  this  body. 

As  to  the  first  object  of  an  ethical  nature  over  which  the  Association 
designed  to  exert  its  influence,  that  of  enlightening  and  directing  public 
opinion   in  respect   to  the   duties,  responsibilities  and   requirements   of 
medical  men,  we  are  free  to  confess  little  or  nothing  has  been  done. 
Nor  is  there  much  probability  that  any  great  change  will  soon  if  ever, 
be  effected.     The  work   itself,  in  the   very  nature  of  things,  is  Utopian. 
How  is  it  possible  to  enlighten  or  direct  the  public  mind  on  the  economy 
of  a  science  which  it  practically  denies  to  exist  I     We  ought  to  recollect 
that  the  time  has  not  long  passed  since  grave  professors  in  our  colleges 
signed  certificates  recommending  nostrums;  or  what  was  done  even  last- 
year  in  London  at  Middlesex  Hospital,  by  its  regular  surgical  staff:  these 
rerainiscenses,  however  unpleasant,  may  serve  somewhat  to  moderate 
our  indignation  against  those  who  would  insult  the  profession,  or  who 
entertain  a  very  low  estimate  of  the  scientific  acquirements  of  physicians 
even  at  the  present  day.     The  profession  must  first  fully  comprehend 
its  duties  and  responsibilities,    and  the  proper  and  special  qualifications 
for  the  practice  of  medicine,  before  any  attempt  can  succeed  to  get  the 
public  to  appreciate  what  these  are,  or  acknowledge  the  ethical  impro- 
priety of  employing  secret  remedies.     If  we  make  no  distinction  between 
the  regular  and  irregular  practitioner,  between  the  physician  and  the 
proprietor  of  a  nostrum,  we  are  alone  censurable  that  two  such  opposite 
characters  are  so  generally  confounded  by  the  community.     Until  we 
are  more  honest,  more  united,  truer  to  ourselves  and  our  calling,  and 
cultivate  a  proper  esprit  du  corps,  in  vain  is  it  to  expect  a  change  in  pub- 
lic opinion  regarding  medical  science.     To  prevent  disease  or  relieve  the 
sick  is  a^nost  benevolent  and  honorable  vocation,  and  when  one  con- 
ceals for  selfish  ends  a  valuable  medicine,  he  ceases  to  be  honest  and  is 
void  of  philanthropy ;  for  by  attempting  to  place  a  monied  valuation 
upon  pain  and  life,  he  becomes  a  trader  in  human  physical  sufferings ; 
he   estimates  in    dollars   and  cents  the  groans  and   tears  of  his  fellow- 
creatures.     He  may  profess  what  he  pleases,  but  his  piety  is  not  of  the 
Bible,  and  has  not  a  jot  or  tittle  of  Christianity  about  it,  for  that  teaches 
us  to  love  our  neighbors  as  ourselves.     Eschewing  politics,  and  seeking 
no  aid  from  State  or  Church,  we  should  become  a  law  unto  ourselves, 
or  rather  act  above  all  law  save  the  Dfvine,  since  it  is  quite  certain  we 
alone  must   protect  the   honor  of  the   medical  profession.     And   thank 
God,  standing  this  day,  the  proudest  of  my  life,  before  this  good: 
sembly,  and  at  the  capital  of  our  common  country,  I  can  announce  that 
here,  to  the  American  >.  it  may  with  a 

confided.  By  its  recent  acts,  proclaimed  throughout  the  length  and 
breadth  of  this  wide  domain,  this  body  has  denounced  all  fellowship 
with  irregular  pra  I  erected  a  barrier  impassable  to  honor  and 

.•ct  ability. 
Having  learned  wisdom  from  a  more  careful  examination  of  the  statis- 


50-1  Miscellaneous.  [July, 

tics  and  results  of  deformities  after  fractures,  the  question  occurs  if  we 
have  not  ourselves  unwittingly  made  patients  expect  too  much  from 
remedical  agents.  Disease  in  itself  is  a  destructive  process,  which  we 
can  only  prevent  or  relieve,  and  as  of  course,  we  can  not  create  or  restore, 
should  we  not  therefore  be  more  chary  of  the  little  word,  "  cure  ?"  The 
monument  erected  to  Ambrose  Pare,  the  father  of  surgery,  bears  the 
modest  inscription,  in  reference  to  the  wounds  he  treated,  *  "  Je  les  pan- 
sey  et  Dieu  les  guarit."  Empirics  may  boast  that  they  cure,  and  doctors 
of  divinity  may  sustain  them ;  but  the  physician  knows  it  is  God  who 
healeth  all  our  diseases. 

On  that  branch  of  ethics  which  relates  to  ourselves,  that  of  encour- 
aging emulation  and  concert  of  action  among  physicians,  and  fostering 
friendly  intercourse  in  the  profession,  the  Association  has  been  eminent- 
ly successful.  It  has  far  exceeded  the  most  sanguine  expectations  in 
overcoming  all  opposition ;  in  creating  an  admirable  code  now  adopted 
everywhere ;  in  organizing  State,  county  and  city  societies ;  in  bringing 
together  physicians  from  the  remotest  parts  of  our  immense  territory ;  in 
awaking  the  whole  profession  to  its  true  interests;  and  in  blending 
us  into  a  common  harmonious  fraternity.  Without  law  or  authority, 
but  by  moral  suasion  have  we  been  united  as  one  man,  and  possess  this 
day  the  power  to  be  felt  over  this  entire  continent.  There  never  has 
been  a  more  propitious  period  for  medicine  in  America ;  never  greater 
evidence  of  vitality  and  extended  usefulness  in  our  ancient  and  benevo- 
lent calling ;  never  better  feeling  or  more  confidence  of  success  than  now, 
by  our  united  effort  to  do  good  in  the  great  cause  of  suffering  humanity. 

We  have  seen,  gentlemen,  how  much  this  Association  has  achieved  in 
its  infancy  to  elevate  honorable  medicine.  A  wide  field  for  scientific  in- 
vestigation is  before  us ;  much  territory  still  remains  to  be  redeemed  ; 
the  wilderness  is  yet  to  blossom  as  the  rose ;  and  the  leaves  to  be  gath- 
ered for  the  healing  of  nations.  The  hygienic  condition  of  the  nation, 
of  such  immense  interest  to  our  people ;  that  first,  all-important  ques- 
tion, ever  before  the  profession — the  prevention  of  disease — isjto  be  im- 
proved. We  are  to  search  after  truth,  and  when  found  it  is  to  be  gener- 
ously applied  for  the  good  of  mankind.  The  work  is  a  self-sacrificing 
and  benevolent  one,  but  it  is  grand  and  sublime,  even  God-like;  for  it 
has  to  do  with  pain  and  disease,  life  and  death.  And  we  rejoice  to  know 
that  whenever  or  wherever  called  upon,  the  members  of  our  profession 
and  of  this  Association  have  never  failed  in  any  duty,  and  have  been 
faithful  to  the  end.  Yea,  many  of  them  have  stood  alone  between  the 
living  and  the  dead,  and  cheerfully  laid  down  their  lives  to  stay  the  pes- 
tilence and  destroyer. 

The  very  waters  at  our  feet,  as  they  sweep  onward  to  the  ocean,  pass 
in  sight  of  a  city  where  three  years  ago  no  less  than  four-fifths  of  our 
profession  in  that  community,  swelled  too  as  their  ranks  had  been  by 
volunteers  from  this  body,  fell  manfully  contending  with  disease  and 
death  :  and  on  a  late  occasion,  when  one  of  our  steam-packets  having 
been  injured  by  a  collision,  went  down  in  an  instant,  carrying  every  soul 

*  Ancient  French, 


1858.]  Miscellaneous.  505 

onboard  into  the  depths  of  the  ocean,  among  the  passengers  was  a  mem- 
ber of  this  Association.  To  the  inquiry  where  was  be  during  the  heart- 
rending scenes  of  a  sinking  ship,  freighted  with  human  lives,  promptly 
came  the  affecting  and  sublime  eulogy  from  one  who  knew  him  well,  that 
so  long  as  a  woman  or  child  remained  unprovided  for.  he*  never  left  the 
ill-fated  Arctic.  How  near  akin  was  his  gallant  spirit  to  that  of  him, 
who  during  a  subsequent  and  similar  occurrence,  after  seeing  every 
woman  and  child  committed  to  his  care  safely  rescued  from  his  founder- 
ing bark,  after  sending  the  last  parting  message  to  his  family,  and  dis- 
charging every  duty  without  one  lingering  ray  of  hope,  calmly  assumed 
his  commanding  position  on  the  deck  of  his  vessel,  and  as  she  glided  from 
under  him  into  the  yawning  billows,  instinctively  uncovered  to  meet  his 
fate  and  his  God.  While  the  wild  waves  are  sighing  a  requiem  over 
the  unseen  burying  places  of  these  illustrious  dead,  the  benedictions  of  a 
grateful  people  are  continually  ascending  over  the  forty  graves  of  the 
martyred  heroes  of  Xorfolk.  These  were  our  companions,  who  died  in 
the  noble  service  of  that  calling,  to  promote  the  best  interests  of  which 
has  assembled  us  together. 

Gentlemen  of  the  American  Medical  Association,  we  have  convened 
for  important  purposes ;  great  events  ai  _  before  us ;  the  interests  of 
humanity  are  here ;  the  hopes  of  the  profession  are  in  this  meeting; 
the  eyes  of  the  medical  world  are  upon  us.  May  we  then  so  act  in  view 
of  surrounding  circumstances,  that  "The  skill  of  the  physician  shall  lift 
up  his  head ;  and  in  the  sight  of  great  men  he  shall  be  in  admiration." 

Puerperal  Convulsions. — Dr.  James  M.  Xewman  presented  a  report 
on  this  subject  to  the  Buffalo  Medical  Association,  at  a  late  meeting, 
which  is  published  in  full  in  the  Buffalo  Medical  Journal,  comprising 
some  accounts  of  33  cases  collected  from  various  sources.  Of  these  17 
were  priimparae,  9  multiparas,  7  not  stated.  Recovered,  24 ;  died,  9. 
Described  as  anasarcous,  7.  The  urine  was  albuminous  in  12  cases;  not 
albuminous  in  2 ;  dark  colored  in  2 ;  no  secretion  of  urine  in  2  ;  and 
condition  not  noted  in  19.  Ether  or  chloroform  was  employed  after 
bloodletting  in  19  cases — and  of  these,  16  recovered  and  3  died;  em- 
ployed without  bloodletting,  9 — and  of  these,  6  recovered  and  3  died.  Con- 
vulsive movements  modified  and  controlled  by  anesthetics,  in  23  cases  ; 
convulsions  not  diminished  by  them,  in  6  cases.  Two  cases  proved  fatal 
in  which  chloroform  was  administered  without  previous  treatment  being 
indicated. — [Boston  Med.  and  Surg.  Journal. 

Platinized  Charcoal. — The  power  of  charcoal  in  inducing  chemical 
combination  is  greatly  increased  by  combination  with  minutely  divided 
platinum.  In  this  manner  a  combination  may  be  produced  possessing 
the  absorbent  power  of  charcoal  (which  is  much  greater  than  that  of 
spongy  platinum,)  and  nearly  equal,  as  a  promoter  of  chemical  combi- 
nation, to  spongy  platinum  itself.  In  order  to  platinize  charcoal,  nothing 
more  is  necessary  than  to  boil  it,  either  in  coarse  powder  or  in  large 
pieces,  in  a  solution  of  bichloride  of  platinum,  and,  when  thoroughly 
impregnated,  which  seldom  requires  more  than  ten  minutes,  or  a  quar- 

*  Pro£  Carter  P.  Johnson,  of  Richmond,  Ya. 


506  Miscellaneous. 

ter  of  an  hour,  to  heat  it  to  redness  in  a  close  vessel,  a  capacious  platinum 
crucible  being  well  adapted  for  the  purpose.  ******  Platinized 
charcoal  seems  likely  to  admit  of  various  useful  applications;  one  of  the 
most  obvious  of  these  is  its  excellent  adaptability  to  air-filters  and  respi- 
rators. From  its  powerful  oxidizing  properties,  it  may  also  prove  a 
highly  useful  application  to  malignant  ulcers  and  similar  sores,  on  which 
it  will  act  as  a  mild  but  effective  caustic. — [Ibid. 


On  the  Discrimination  of  Albumen. — The  detection  of  albumen  in 
urine  is  very  simple.  A  small  quantity  of  the  urine  is  to  be  heated  until 
it  boils,  in  a  test-tube,  over  the  flame  of  a  spirit-lamp.  As  soon  as  the 
temperature  of  the  liquid  becomes  raised  over  170°  Fahr.,  the  albumen 
will  become  coagulated  ;  and  if  the  test-tube  be  set  aside  for  a  time,  it 
will  become  deposited,  when  it  may  be  collected,  dried,  affd  weighed. 
The  precipitate  albumen  is  soluble  in  solution  of  potash,  but  insoluble 
in  nitric  acid. — [Dr.  HasseVs  Lectures.     Ibid. 


Increase  of  Insanity  in  England. — It  would  appear,  by  the  following 
statement  from  the  London  Lancet,  that  the  United  States  is  not  the 
only  country  in  which  insanity  has  been  on  the  increase  during  the  last 
few  years. 

"There  are  1000  patients  in  Hanwell  Asylum  ;  the  house  is  to  be  en- 
larged so  as  to  accommodate  2000.  There  are  1200  pauper  lunatics  in 
the  house  at  Colney  Hatch.  Yet  there  are  still  1100  pauper  lunatics  in 
Middlesex  unprovided  for.  'A  few  years  ago  lunatics  were  in  the  pro- 
portion of  one  to  rather  more  than  800  of  the  population,  while  now 
they  are  in  the  rate  of  one  to  700 — an  increase  of  one  eighth  to  an  in- 
creased population.' " — [Ibid. 


Death  of  Dr.  Hare. — We  find  in  the  American  Medical  Gazette,  the 
following  notice  of  the  departure  of  a  distinguished  man :  indeed,  one  of 
the  fathers  of  American  science.  Let  us  remember  him,  not  as  the  star 
whose  brightness  was  dimmed,  as  it  sank,  behind  the  horizon,  but  ra- 
ther as  when  in  the  ascendant,  or  at  his  meridian,  he  shed  a  glory  and 
a  resplendence  upon  American  Medicine. 

Died,  in  Philadelphia,  May  16th,  1858,  Dr.  Robert  Hare,  in  the 
seventy-seventh  year  of  his  age.  He  was  for  a  series  of  years  Professor 
of  Chemistry  in  the  University  of  Pennsylvania,  and  by  his  discoveries 
and  improvements  acquired  high  distinction  at  home  and  abroad,  rank- 
ing justly  among  the  first  chemists  of  the  age.  The  latter  years  of  his 
life  have  been  beclouded  by  mental  infirmities,  terminating  in  senile  im- 
becility, under  the  influence  of  which  he  was  ensnared  by  the  vagaries 
t>f  clairvoyance,  and  thus  led  into  the  mysticism  of  the  modern  spiritual- 
ists, endorsing  by  his  high  name  the  wildest  of  their  speculations.  Hu- 
manum  est  errare. 


SOUTHERN 

MEDICAL  AND  SURGICAL  JOURNAL. 


(NEW  SERIES.) 


Vol.  XIV.]  AUGUSTA,  GEORGIA,  AUGUST,  1858.  [No.  8. 


ORIGINAL  AXD  ECLECTIC. 

AKTICLEJ.VIIL 

Observations  on  Malarial  Fever.  By  Joseph  Jones,  A.M.,  MD., 
Professor  of  Physics  and  Natural  Theology  in  the  University 
of  Georgia,  Athens ;  Professor  of  Chemistry  and  Pharmacy  in 
the  Medical  College  of  Georgia,  Augusta ;  formerly  Professor 
of  Medical  Chemistry  in  the  Medical  College  of  Savannah. 

[Continued  from  p.  449  of  July  Xo.,  1858.] 

Case  XV. — Irishman,  age  18 ;  brown  hair,  brown  eyes ; 
height  5  feet  6  inches ;  weight  125  lbs. ;  well  developed  chest. 
Occupation  bar-keeper  in  a  sailor's  boarding-house  on  the  bay. 
Five  days  ago,  attended  a  boat  race  at  Thunderbolt,  and  slept 
for  two  nights  in  an  open  boat.  The  second  morning,  after 
waking,  felt  very  badly,  and  vomited. 

Sept.  11th,  8  o'clock  P.M.  Tongue  slightly  furred,  not  redder 
than  normal.     No  tenderness  upon  pressure  of  epigastrium. 

(  Temperature  of  Atmosphere, ....     80°  F. 
Pulse  116.     Respiration,  30  thoracic. -j  "  "Hand, 102°5' 

(  "      under  Tongue, 103 

#.  Calomel,  grs.  xii.  Castor  oil  in  four  hours,  ty.  Soda  powders,  Flaxseed 
tea.  Diet,  grueL  fy.  As  soon  as  fever  remits,  give  sulphate  of  quinia  grs.  v. 
every  three  hours,  up  to  grs,  xx. 

Sept.  12th,  12  o'clock  M.  Says  that  he  feels  much  better; 
medicine  acted  four  times.  Skin  cool;  tongue  very  slightly 
coated  with  white  fur;  papillae  not  enlarged;  pulse  84,  soft  and 
regular ;  respiration  24,  gentle.  Says  that  the  fever  went  off 
about  1  o'clock  this  morning. 

n.s. — VOL.  XIV.  NO.  VIII.  26 


508 


Jones,  on  Malarial  Fever. 


[August, 


Temperature  of  Atmosphere,    83°  F.  (-,-,,  ,  .        ,. ,,        n  i    ■      e 

"  "  Hand  98°5'    ■)  s  ta^en  ten  grains  °*  t"e  sulphate  of 

«    under  Tongue,'.'.'.'.    99         (  <luinia-     &•  Continue  up  to  grs.  xx. 
Amount  of  Urine  collected  during  the  last  16  hours,. . . .  grains    7,126 

"  "       "      calculated  for  24  hours, "       10,689 

"  "      "      collected  during  each  hour, "  445 

Without  doubt,  some  urine  was  lost  during  the  action  of  the  medicine. 
Specific  gravity  1018.     High  colored.     Reaction  decidedly  acid.     After  stand- 
48  hours,  there  was  only  a  slight  deposit  of  vegetable  cells. 


Calculated  am't  of  urine| 
for  24  hours,  grs.  10689 
contained  grs. 


ANALYSIS  XVII. 


Water, 

Solid  Matters, 

Urea, 

Uric  Acid, 

Extractive  <fe  col.  matters. 
Fix'd  Saline  Constituents. 


Urine  collected  dur- 
ing 16  hrs.,  grs.  7126 
contained  grs. 


6766-102 

359-898 

203-700 

A  trace. 

110-397 

45-801 


10149153 
539-847 
305-550 

A  trace. 
165-596 
68-701 


1000  pts- 
of  urine* 
contain'd 


949-495 
50-505 
28-585 

A  trace. 

15-512 

6-408 


The  disappearance  of  the  uric  acid  could  not  have  been  due 
to  the  action  of  the  sulphate  of  quinia,  for  the  greatest  portion 
of  the  urine  had  been  passed  before  the  administration  of  the 
sulphate  of  quinia.  8  J  o'clolk  P.  M.  Pulse  100,  fuller.  Inspi- 
ration 24. 

Temperature  of  Atmosphere,    82°  F. )    Tongue  slightly  furred.  Urine  clear, 

"  "  Hand, 102  12'  >  high  colored— a  shade  lighter  than  that 

"     under  Tongue 103    9' )  passed  this  morning.    Sp.  Gr.  1022. 

Amount  of  urine  excreted  during  the  last  8  hours, ....  grains    6138 

"  "      "    calculated  for  24  hours, "       18414 

"         "      "    excreted  hourly, «  767 

Sept.  13th,  11  o'clock  A.  M.  Did  not  rest  well  during  the 
night.  Tongue  moist  and  slightly  coated  with  fur.  Pulse  98. 
Eespiration  26.  Eespiration  irregular,  every  half  minute  draws 
a  long,  full  inspiration. 

Temperature  of  Atmosphere,      82°    F. )  fy    Citrate  of  Potassa,    -    -    gss. 

"Hand, 102°  25'  [•         Water, f^xvi. 

"        under  Tongue,. . . .  103°        )  Dose,  wineglassful  every  three  hours. 
#  As  soon  as  fever  remits,  give  sulph.  of  quinia  grs.  xx. 

Amount  of  urine  excreted  during  the  last  15  hours,    grains    7154. 

"  "        calculated  for  24  hours, "       1 1446. 

Amount  of  urine  excreted  hourly, "  477. 

High  colored,  clear.     Specific  Gravity  1020. 

5£  o'clock,  P.  M.  Pulse  90.  Eespiration  28.  Urine  high 
colored. 

(  Temperature  of  Atmosphere, 85°  F. 

Specific  Gravity  1022.  \  "  "  Hand, 101 

(  "     under  Tongue, 102°9' 

Amount  of  Urine  passed  during  the  last  7  hours, . . .  .grains  4092 

Calculated  amount  of  Urine  for  24  hours, "    14029 

Amount  excreted  hourly "        584*5 

September  14th,  1  o'clock,  P.M.  Tongue  slightly  coated  with 
white  fur,  moist  and  natural  in  appearance.  Skin  moist  and 
cool.  Pulse  65}  regular  and  soft.  Eespiration  24,  regular. 
Color  of  urine  much  lighter. 


1858.] 


Joxes,  on  Malarial  Fever. 


509 


{Temperature  of  Atmosphere, 85°  F. 
"  Hand, 96 
"     under  Tongue, 98 

Amount  of  Urine  passed  during  the  last  20  hours,  grains  10210 


10210     ) 

12252     [ 

510-5  ) 


Jfc    Quassia 
and  soda. 


Calculated  amount  for  24  hour; 
Amount  of  Urine  excreted  hourly, 

September  loth,  10  o'clock,  A.M.  Much  better;  dressed  and 
walking  about  the  Hospital  grounds.  Pulse,  skin,  respiration, 
and  tongue,  normal.  Urine  orange  colored,  much  lighter  than 
the  former  specimens  passed  subsequent  to  the  first  stage  of  fe- 
brile action.  Specific  Gravity  1019-7.  Eeaction  after  twelve 
hours,  alkaline.  Heavy  light  yellow  deposit  of  urate  of  soda, 
and  prismatic  crytals  of  triple  phosphate.  The  crystal  of  triple 
phosphate  numerous  and  beautiful.  Up  to  the  present  time,  the 
reaction  of  the  urine  has  been  very  acidr  and  it  has  remained 
without  deposit  for  many  hours. 

Amount  of  urine  collected  during  last  20  hours,  grains  11726 
Calculated  amount  of  urine  for  24  hours,  "       14071 

Amount  of  urine  excreted  hourly,        -        -        -     "  586*3 


ANALYSIS  XYIII. 

Grs.  11726  of  urine  1  Grs.  14071.8  of  urine 
excreted  during  20  calculated  for  24  hrs 
hrs.,  contain'd  grs.  |  contained,  grains, 

1000  parts  of 
urine    contain- 
ed, 

Water, 

11291*844 

435-206 

161-047 

8-624 

204-291 

60-644 

13550-613 
521-247 
200-016 

10-350 
237.109 

72-772 

962-887 

Solid  Matters, 

37-113 

Urea, 

13-792 

Uric  Acid, 

0-735 

Extractive  and  coloring  matters. 
Fixed  Saline  Constituents, 

17-332 
5154 

The  patient  left  the  Hospital  a  few  hours  after  these  observa- 
tions. He  entered  the  Hospital  again  on  the  18th  of  October, 
with  a  severe  attack  of  remittent  fever. 

Case  XVI. — Irish  seaman :  black  hair,  black  eyes,  and  florid 
complexion  ;  height  5  feet  11  inches ;  weight  175  lbs.  Has  been 
staying  on  board  the  light  ship  and  running  up  and  down  the 
Savannah  River,  at  all  hours  of  the  day  and  night.  Says  that 
he  resided  six  years  at  Panama,  but  was  never  sick.  Was 
taken  with  chill  and  fever  two  days  ago,  and  the  captain  of  the 
light  ship  gave  him  several  doses  of  drastic  medicine. 

September  5th,  7  o'clock,  P.M.  Has  fever.  $  James'  pow- 
der, grs.  xviij.,  nitrate  of  potassa,  grs.  xxx. — Mix  and  divide 
into  six  powders,  one  powder  every  three  hours. 

September  6th,  1  o'clock,  P.M.  Has  just  had  a  chill,  which 
in  fact  is  not  yet  entirely  off.  He  is  still  shaking.  Tongue 
coated  with  light  yellow  fur,  pale  at  its  edges.  Complains  of 
pain  in  his  head.  "Epigastrium  tender  upon  pressure ;  extremi- 
ties cool ;  head  and  trunk  warm.  Pulse  118.  Respiration  va- 
ries from  20  to  32. 


510 


Jones,  on  Malarial  Fever. 


[August, 


ft  Three  cut  cups  to  epi-  i  Temperature  of  Atmosphere, 85°  F. 

gastrium.      ft  Spts.  Mindere-  •<  "  "  Hand, 96 

rus  grs.  §ss.  every  half  hour.     (  "    under  Tongue, 101°5' 

6  o'clock,  P.M.  Cupping  relieved  the  tendency  to  vomit. 
Skin  hot,  although  moist.  Pulse  120.  $  Soda  powders.  $ 
Sulph.  of  Quinia,  grs.  xv. 

September  7th,  10  o'clock,  A.M.  Did  not  rest  well;  "bow- 
els are  quite  loose."  Has  taken  ten  grains  of  sulph.  of  quinia. 
Pulse  98.  Eespiration  28.  Urine  clear,  high  colored.  Speci- 
fic Gravity  1021. 

Temperature  of  Atmosphere ..  80°F.  )      ft  Opium,  gr.  1. 

"  Hand 100       V 

"        under  Tongue. . .  104       )      Diet,  arrowroot  and  flaxseed  tea. 

The  whole  amount  of  urine  passed  was  not  collected,  on  ac- 
count of  the  affection  of  his  bowels.  After  standing  36  hours, 
there  was  a  small  deposit  of  crystals  of  triple  phosphate  and 
urate  of  soda. 

1000  parts  of  Urine  contained 

Water, 936'047 

Soliid  Matters, 63-953 

\         Urea, 34-995 

Uric  Acid, 0-705 

Extractive  and  Coloring  Matters, 21  •  277 

Fixed  Saline  Constituents, 6  •  976 

Sept.  7th,  7  o'clock  P.  M.  Skin  warm  and  moist ;  tongue 
slightly  coated ;  no  pain  upon  pressure  of  epigastrium.  Has  ta- 
ken 15  grs.  of  quinine  and  2  grs.  of  opium  this  morning.  Bowels 
have  not  been  moved  since  this  morning.  Pulse  108 ;  respira- 
tion 24. 

Temperature  of  Atmosphere. ...    82°  F.  }      Urine  clear,  high  colored.     After 

"  "   Hand 103°7  5' >•  standing  39  hours,  there  was  a  small 

"        under  Tongue 105°       )  deposit  of  the  urate  of  soda.     Spe- 
cific Gravity  1020'8. 

Amount  of  urine  passed  during  the  last  9  hours grs.  2552* 

Calculated  amount  of  urine  for  24  hours, "     6803* 

Amount  of  urine  excreted  hourly, "       283'6 


ANALYSIS  XIX. 


ANALYSIS  XX. 

Urine  excreted  in 
9  hours,  grs.  2552 
contained  grains 

Calculated  amount  of 
urine  for  24  hours,  grs. 
6803  contained  grains 

1000  parts 
of  urine  con- 
tained 

"Water, 

2402-683 

149-317 

81-660 

1-000 

54422 

12-235 

6405-664 

397-968 

217-705 

2-666 

144-986 

32-611 

941-490 

Solid  Matters, 

58*510 

Urea, 

31-976 

0391 

Ext.  and  coloring  matters, 
Fixed  Saline  Constituents, 

21-356 
4-787 

Sept.  8th,  9  o'clock  A.  M.  Says  that  he  feels  much  better. 
Rested  well  during  the  night.  Bowels  have  been  moved  twice. 
Tongue  clean  at  tip  and  edges,  superior  portion  slightly  coated 
with  fur ;  color  of  tongue  paler  than  normal ;  skin  cool,  moist 
and  relaxed.    Pulse  78 ;  respiration  18. 


1858.] 


Jones,  on  Malarial  Fever. 


511 


Temperature  of  Atmosphere ... .  75°  V.)      Urine  high  colored-     Sp.  Gravity 

"  Hand 98°5'    V 1C18-7.     After   standing   26  hours, 

"       under  Tongue 100°5'    )  urate  of  soda  and  prismatic  crystals 

of  triple  phosphate  were  deposited. 

Amount  of  urine  passed  during  the  last  14  hours, grs.  12224 

hourly     "       "     "       "  "         873 

Calculated  amount  of  urine  for  24  hours, "     20903 

Actual  amount  of  urine  excreted  during  the  last  24  hours,  "     14776 
"      «  "    hourly,     "     "      u      M       "         615 


ANALYSIS  XXI. 


Water, 

Solid  Matters, 

Urea 

Uric  Acid, 

Extractive  and  co- 
loring matters, 

Fixed  Saline  Con- 
stituents, 


Grs.  12224  of 
Urine  passed 
during  last  14 
hrs.,  contain- 
ed grains 


11613-180 

616-220 

279-360 

3-240 

272-388 
56-232 


Grs.  20903  of  U- 
rine,  calculated 
for  24  hrs.,  con- 
tained graius 


19856-093 

1047-631 

477*705 

5-540 

466-885 
96-157 


Grs.  14776  ofU- 
rine,  actual  am't 
excreted  in  24 
hours,  contained 

grains 


14015-863 

760-537 

361-020 

4-240 

326-810 
68.467 


1000  pts.  of 
Urine  con- 
tained 


950-000 

50-000 

22-852 

0*265 

22*283 
4-600 


12  o'clock,  M.  Has  just  exhibited  a  rising  upon  the  buttock 
When  lanced,  f  sii,  of  fetid  black  matter  flowed.  #  Sulph.  of 
quinia,  grs.  v.     Diet,  beef  soup  and  tea. 

6  o'clock,  P.M.  Complains  of  great  weakness.  Pulse  88. 
Eespiration  18.  Extremities  are  much  colder  than  the  head 
and  trunk.  The  phenomena  resemble  those  of  chill.  He  does 
not,  however,  complain  on  any  chilly  sensation. 

Temperature  of  Atmosphere. ..  .76°  F.  )      Urine  high  colored.    After  twenty- 

"  "  Hand 93°        >  four  hours,  a  heavy  deposit  of  urate 

"      under  Tongue 104°5'    )  of  soda  and  triple  phosphate. 

Amount  of  urine  excreted  during  the  last  9  hours,  grs 6127 

"         "         "  hourly "   680.7 

"         "        "        "  during  the  last  24  hours,    "  18351 

■         "        "        "  hourly        "       "         "       "  764.4 

Calculated  amount  of  urine  for  "         "       "  16335 

Hourly "   680 

Specific  Gravity  1021  -2. 


ANALYSIS  XXIL 


Water 

Solid  Matters, 

Urea, 

Uric  Acid, 

Extractive  and  co-  ) 

loriLg  matters,  j 
"Fixed  Saline  Con-  ) 

stituents,  f 


Grs,  6127  of 
Urine,  passed 
during  last  9 
hrs.,  contain- 
ed grains 


5830-238 

286962 

113-490 

4320 

126-498 
42-654 


Grains  16335  ofj 
Urine  calculat'd  1000  parts   of'U 
for  24  hrs.,  con-  urine  contain 
tained  grains       ed 


15570-075 

765-040 

302-564 

11-517 

337-244 
113-715 


953165 

46-835 

18-521 

0-705 

20-647 
6-962 


Gre.  18351  of 
rineexcret'd 
during  last  24 
hrs.,  contain- 
ed grains 


17453-472 

898128 

392-850 

7-560 

398-886 
98-886 


512 


Jones,  on  Malarial  Fever. 


[August, 


September  9th,  10  o'clock,  A.M.  Continues  to  improve,  but 
complains  of  great  weakness.  Pulse  76.  Eespiration  20.  Skin 
cool  and  moist;  bowels  regular;  urine  high  colored;  deposit  of 
urate  of  soda  and  triple  phosphate,  after  standing  a  few  hours, 
and  acid  reaction  changed  to  the  alkaline. 

C  Temperature  of  Atmosphere.  .75°  F. 

Specific  Gravity  1018' 2  ■{  "  "Hand 97°75' 

(  "         under  Tongue 99°  5' 

Amount  of  Urine  passed  during  the  last  16  hours,  grains 9163 

"      "         "         hourly, "   572.6 

Calculated  amount  of  urine  for  24  hours "   13745 

Actual  "  "  "  "    "   15291 

hourly      "    "   628.7 


ANALYSIS  XXIII. 

Grs.    9163   of 
Urine    passed 
during  iast  16 
hrs.,    contain- 
ed grains 

Grs.   13745  of 
Urine  calcula- 
ted for  24  hrs. 
contained 
grains 

1000  parts 
of  Urine  con- 
tained 

Grs.  15291  of  U- 
rine,  actual  am't 
excreted    in   24 
hours,  contained 

grains 

Water, 

8677-223 

486-567 

237-456 

0-720 

215*955 
32-436 

13015-850 

729-850 

356-084 

1-080 

324-032 
4S-654 

946-903 

53-097 

25-912 

0-078 

23-568 
3-539 

14517-471 

Solid  Matters, 

Urea, 

773-529 
351-946 

Uric  Acid, 

5-040 

Extractive  and  co-  ) 
loring  matters,    ) 

Fixed  Saline  Con-  ) 
stituents,              ) 

341-453 
75-090 

September  9th,  6  o'clock,  P.  M.  Tongue  and  skin  normal. 
Pulse  76.  Eespiration  22.  Urine  orange  colored.  Specific 
Gravity  1022.  Slight  deposit  in  15  hours  of  urate  of  soda  and 
triple  phosphate. 

Temperature  of  Atmosphere 87°  F. 

"Hand 97°5' 

"         underTongue 99°8' 

Amount  of  urine  passed  during  the  last  8  hours,  grains 6135 

"       hourly          "  "  "     766' 8 

Calculated  amount  of  urine  for  24  hours "     18405 

Actual  amount  passed  during  the  last  24  hours. .     "     15298 

Hourly  amount  of  urine  passed  during  the  last  24  hours,  grs 637.4 


ANALYSIS  XXIV. 

Grs.    6135    of 
Urine  excret- 
ed during  last 
8  hrs.  contain- 
ed grains 

Grs.    1S405  of 
Urine  calcula- 
ted for  24  hrs. 
contained  grs. 

1000  parts 
of  Urine  con- 
tained 

Grs.   15298   of 
Urine,   excreted 
during  last    24 
hrs.,   contained, 
grains 

Urea, 

113.490 
4.440 

340  470 
13-320 

18.498 
0-723 

350*948 

Uric  Acid, 

5-160 

September  10th,  10|  o'clock,  A.  M.  Pulse  68.  Eespiration 
19.  Color  of  urine  only  a  shade  higher  than  normal.  After 
twelve  hours  a  slight  deposit  of  urate  of  soda  and  triple  phos- 
phate. 


1858.] 


JOXES,  on  Malarial  Fever. 


513 


(  Temperature  of  Atmosphere 79°  F. 

Specific  Gravity 1021'5-j  "  "Hand 96°5' 

(  "        under  Tongue 98 

Amount  of  urine  passed  during  the  last  16  hours,  grains 5107 

"     hourly         "         *         "         "     319 

Calculated  amount  for  24  hours "     7661 

Actual  amount  of  urine  passed  during  last  24  hours,  "     11242 

Amount  passed  hourly "     468*4 


ANALYSIS  XXV. 

Grs.    5107    of 
Urine    passed 
during  last  16 
hrs.,   contain- 
ed grains 

Grs.  7661  of 
Urine  calcula- 
ted for  24  hrs. 
contained  grs. 

1000  parts 
of  Urine  con- 
tained 

Grs,  11240  of 
Urine    excreted 
during    last    24 
hours,  grains 

Urea, 

63-050 
1-000 

94-575 
1-500 

12-362 
0.196 

176540 

Uric  Acid, 

5-400 

The  diminution  of  the  frequency  of  the  action  of  the  respira- 
tory and  circulatory  systems,  and  the  reduction  of  the  tempera- 
ture, have  been  attended  by  a  diminution  in  the  amount  of 
urine  excreted,  and  also  of  its  constituents. 

7  o'clock,  P.M.  Dressed  himself  and  walked  in  the  Hospital 
yard.  Still  feels  weak ;  is  now  in  a  profuse  perspiration.  Pulse 
68.     Inspiration  20. 

Temperature  of  Atmosphere, .  .80°  F.  )      Sp.  Gr.  of  urine  10204.     Deposit  in 

"  "  Hand 97°       >  12  hours  of  urate  of  soda  and  prismatic 

"         under  Tongue 98°9'    )  crystals   of  triple  phosphate.      When 

held  in  the  sun,  the  whole  mass  sparkled  with  the  crystals  of  triple  phosphate. 

Amount  of  Urine  passed  during  the  last  24  hours,  grains 10209 

"  "         hourly  "  "  "     425 '3 

during  "       9     "  "     5102 

•'  "  "         hourly  "  "  "     566.8 

Calculated  amount  for  24  hours "     13601 


ANALYSIS  XXYL 


Urea 

Uric  Acid- . 


Grs.  5102  of| 
Urine  passed 
during  last  9 
hrs.  contained 
grains 


63-040 
2  300 


Grs.  13601  of 
Urine  calcula- 
ted for  24  hrs. 
contained  grs. 


169-091 
6131 


1000  parts 
of  Urine  con- 
tained 


12-352 
0-450 


Grs.  10209  of 
Urine  excreted 
during  last  24 
hours  contained 
grains 


126100 
3-300 


"Sept.  11th,  11  o'clock  A.  M.     Pulse  74  ;  respiration  18. 

Temperature  of  Atmosphere,    82°  F.  1     Color  of  urine  a  shade  higher  than  nor- 
"     Hand,  97         >mal.    Specific  Gravity  1021-2.    In  12  hrs. 

"         under  Tongue,      98  2'     )  a  small  deposit  of  urate  of  soda  and  triple 
phosphate. 

Amount  of  Urine  passed  during  the  last  16  hours, grs.  7148. 

•i      »  «        hourly  "      "    "      "  »      446.7 

Calculated  amount  of  Urine  for  24  hours, "10722. 

Amount  of  Urine  passed  during  the  last  24  hours, "  12250. 

u      «      «  u    hourly    "      "    "      "  «•'      510.4 


514 


Jones,  on  Malarial   Fever. 


[August, 


ANALYSIS  XXVII 


Urea, 

Uric  Acid, 

Fixed  Saline  Constit. 


Grs.  7148  of  U-| 
rine  passsd  du 
ring  the  last  16 
hours  contained 
grains 


137-095 

4200 

41195 


Grs.  10722  cal- 
culated for  24 
hours,  contain- 
ed grains 


205-642 

6  300 

61-792 


1000  parts 
Urine  con- 
tained 


19  490 
0  587 
5037 


Grs.  12250  pas- 
sed in  24  hours 
contained  grs. 


200145 
6500 


6J  o'clock  P.  M.  Has  been  walking  in  the  Hospital  yard. 
Pulse  67 ;  respiration  22.  Urine  normal  in  color.  Sp.  Gravity 
1026*5.  Fermentation  proceeded  so  rapidly,  that  in  the  course 
of  24  hours,  the  whole  of  the  urea  was  converted  into  the  car- 
bonate of  ammonia.  Deposit  consisted  of  prismatic,  stellated 
and  plumose  crystals  of  triple  phosphate,  and  globular  and  aci- 
cular  crystals  of  urate  of  soda. 

Temperature  of  Atmosphere, 78°75'  F. 

"  "    Hand, 97  83 

"        under  Tongue, 99 

Amount  of  Urine  passed  during  the  last  1\  hours, grs.    4106 

«      «  «    hourly,    "      "    "       "  "        534 

Calculated  amount  of  Urine  for  24  hours, "     13139 

Amount  of  Urine  passed  during  the  last  24  hours, »M     11254 

«      "  «    hourly,    "      "    "        "  "        4689 

Uric  acid  in  grains  41 06  of  Urine.  (7£  hours) grs.    4-720 

"      "      "      "     13139"      "    calculated  for  24  hours, "     15.104 

"      "     "  1000  parts  of  Urine, «      1149 

"      "      "  grs.  11254  "      "    excreted  in  24  hours, «      8-920 

Sept.  12th,  12  o'clock  M.  Pulse  60',  respiration  20.  Sp. 
Gravity  of  urine  1022*15.  Heavy  deposit  of  urate  of  soda,  and 
prismatic  and  plumose  crystals  of  triple  phosphate. 

Temperature  of  Atmosphere, 83°  F. 

"  "    Hand, 97 

"        under  Tongue, 98°8' 

Amount  of  Urine  passed  during  the  last  17  hours, grs.  4088. 

i«         «       k        «      hourly,     "      "     "      «  "      2405 

Calculated  amount  for  24  hours. "    5768. 

Amount  of  Urine  passed  during  the  last  24  hours, . .  .grs.  8194, 
«         «        "        "    hourly,      "    "      "      "  "      341.4 

Uric  acid  in  grs.  4088  of  Urine  passed  during  1 7  hours, grs.  5.400 

«      «     n    u    5768"      "       calculated  for  24     "  "    7.619 

"      "      "  1000  parts  of  Urine, "    1.320 

"      "     «    «    8194  "        "    passed  during  24  hours, "10.120 

Fixed  Saline  Constituents  in  grs.  4088  of  Urine,  (17  hours) grs.  40.880 

«  «  «  "    M    5768  "      u    (collected  in  29  hrs.)      "    57.688 

"  m  *  "     1000  parts  of  Urine, "    10.000 

«  «  «  "grs.  8194      "        "    (24  hours) '«    10.120 

Sept.  13th,  11  o'clock  A.  M. 

Amount  of  Urine  passed  during  the  last  24  hours,  grs.  16.962.    Sp.  Gr.  1025. 
k        (.      «  ««    hourly    "     *     "      «■  "        706.7 


1858.] 


Jones,  on  Malarial  Fever. 


515 


Sept.  14th,  4  o'clock  P.  M. 

Amount  of  Urine  passed  during  the  last  30  hours,  grs.  31.669.    Sp.  Gr.  1021-6 

ii        u      n  K  u        u      it    24      "        "  25.335 

it        «      «  ii     hourly,   "      "      "      "        M  1.055 


,  ANALYSIS  XXVIII. 

Water, 

Solid  Matters. 

Urea, 

Extractive,  Col'g    Mat-  ) 

ters,  and  Uric  Acid,     ) 

Fixed  Saline  Constituents 


Grs.  31669  of  Urine, 
passed  during  30hrs. 
contained  grs. 

Grs.  25335  ot  Urine, 
passed  duri  ng  24  hrs. 
contained  grs. 

10U0  parts 
of     Urine, 
contained 

29965  178 

1703-822 

630  470 

690  510 

382-842 

23971  943 

1363  057 

504-376 

552-406 

306  275 

945  455 
54-545 
19  940 

22-484 

12121 

In  this  case  the  uric  acid  was  diminished  during  the  active 
stages  of  the  malarial  fever,  and  increased  during  convalescence. 
The  temperature  of  the  body  was  slightly  depressed  below  the 
normal  standard,  during  convalescence,  and  this  depression  was 
attended  by  a  corresponding  diminution  of  all  the  urinary  con- 
stituents, except  the  uric  acid. 

The  phenomena,  during  the  cold  stage,  resembled  in  all  res- 
pects, those  previously  described.  The  consideration  of  many 
other  points  of  interest  is  deferred  until  we  institute  a  general 
comparison  of  all  the  various  forms  of  malarial  fever. 

The  annexed  Table  No.  IV.  (on  pages  516-17),  will  present 
a  view  of  the  foregoing  results. 

Case  XVIII. — Frenchman:  age  45;  weight  130  lbs.;  thin 
and  spare  ;  nervous  temperament;  complexion  pale.  Has  been 
in  Savannah  three  weeks.  Has  been  acting  as  nurse  in  the 
Hospital  for  the  last  two  weeks.  Occupation,  nurse  in  an  in- 
sane asylum. 

September  15th,  12  o'clock,  M.  Was  taken  with  a  chill  this 
morning,  at  8  o'clock,  A.M.,  which  was  attended  with  vomiting 
and  followed  by  high  fever.  Urine  passed  during  the  height 
and  decline  of  the  fever,  orange  colored,  and  diminished  in 
amount. 

September  16th,  12  o'clock,  M.  Apyrexia.  Amount  of  urine 
passed  during  the  last  24  hours,  grains  4086.  Sp.  Gr.  1021*5. 
Amount  of  uric  acid  passed  during  the  height  and  commence- 
ment of  the  intermission  of  the  fever  (24  hours),  grains  0'400. 

1000  parts  of  urine  contained — 

Urea, 20-425 

Uric  Acid, 0097 


516 


Jones,  on  Malarial  Fever. 


[August, 


TABLE  IV. 


3ept'r, 


1    P.M. 

6  " 

10  A.M. 

7  P.M 
9  A.M. 
6  P.M. 

10  A.M. 

6  P.M. 
lO.^A.M. 

7  P.M. 

11  A.  M. 
61  P.M. 

12"  M. 
13ill    A.M. 

14    4  p.m. 


US 


80° 

82 

75 

76 

75 

87 

79 

80 

82 

78«75' 


100 
103°75 
98-5' 
93 

97J75 
97^5' 
96u5 
97 
97 

97-~83 
97 


101c5' 


104° 
105 
100  5: 
104^5' 

99-5' 

99c8' 

98 

98°9' 

9802' 

99 

9S°8' 


14776 
18351 
15291 
15298 
11240 
10209 
12250 
11254 
8194 


637 


341 
706 
(885-1055 


14015 
17453 
14517 


23971 


1363 


4.24 
7.56 
5.04 
350  5.160 
176  5.400 


200 


504 


6.500 
8.920 
10.120 


o  a 


GRS.  GRS. 


326  6S.0 
398  98.8 
341  75.0 


552 


2552 
12224  14 
6I27i  9 
916316 
6135  8 
510716 
5102  9 
714816 
41067* 
408S|17 


1020.8 

1018.7 

1021.2 

1018.2 

1022 

1021.5 

1020.4 

1021.2 

1026.5 

1022.15 


1021.6 


ANALYSIS  XXIX. 
Sept.  17th. 


Urea,     -     -     -     -     - 

Uric  Acid,  -  -  -  - 
Specific  Gravity,  -  - 
Ara't  excreted  hourly, 


Grs.  6641  of  Urine,  excreted 
during  24  hours,  contained 


252-200 

2-275 

1021-700 

276-800 


1000  parts  of  Urine 
contained 


38-001 
0-342 


ANALYSIS  XXX. 

Sept.  18th. 


Urea, 

Uric  Acid,  -  -  -  - 
Specific  Gravity,  -  - 
Am't  excreted  hourly, 


Grs.  6640  of  Urine   passed 
during  24  hrs.  contained 


136-188 
13-845 

1023-000 
277-000 


1000  parts  of  Urine 
contained 


20-470 
2-082 


Sept.  18th.  Temperature  of  Atmosphere,  88°.  Temp,  of  Hand,  93°5'. 
Temp,  under  Tongue,  99°. 

Sept.  19th.  Amount  of  Urine  in  24  hours,  grs.  7530.  Amounnt  hour- 
ly, grs.  314.  Temp,  of  Atmosphere,  89°5'.  Temp,  of  Hand,  96°5'. 
Temp,  under  Tongue,98°. 

Continued  to  improve,  and  was  discharged  from  the  hospital 
Sept.  23rd. 

October  7th,  3|  o'clock  P.  M.  Has  returned.  Says  he  has 
been  "keeping  bar"  on  the  bay,  and  was  taken  with  a  "dumb 


1858.] 


JoXES,  on  Malarial  Fever. 


517 


TABLE   IV. 


c 

a 

P 

— < 

> 
> 

13 
X 

3     p 
2       g 

r  " 

Q 

- 
M 

— 

g 

Q 

c 
= 

X 

O 
p. 
o 

?     & 
->      p 

-      - 

8    | 

■x       a 

:       e 

0 
-      ^ 

rl 

3        c 
•       E 

0 

p 

[»      ^ 

?      J 

— 

*■      c 

O 

p_ 

g    S 

-     - 

f    e 
?    I 

o 
>      = 

-.     & 

5 

"~     e 

Calculated    amount 
Saline  Constltue 

houra 

Calculated  amount  < 
tive  and  Color 
ters  for  21  hour 

4 
p 

© 

© 
6 

cc 

0 

;   0 
.   "- 

\   s 

:  1 

d 
■ 

0 
§ 

p 

5 

0 

G 

> 
0 

© 

0 
0 

M 
H 

=   1 
1  s 

—  ? 
2       = 

-  — 

7      0 

0      1 

i  * 
s  i 

cc 

5 

0 

B 

=■  = 
O  ■* 
E  c 

fd 

:  5" 
;  • 

•    n 

:  x 

•       E" 

C 
■ 

ST 

o 

c       O 

o 

:x    c 

■    =  ~-  ■    B  o 

o 

:  « 

d 

?  ff 

:      e 

'.      <*■ 

-       ? 

j        C 
E" 

• 

cc 

:      c 
•     s 

■     c 

•         r. 

:  -  -  :  °  * 
■   79   :    £=. 

d 

•      "5 

.       OB 

;    c 

5 

S 

0 

d 

'.      O. 

GRS. 

GRS. 

GRS. 

GRS. 

GRS. 

GRS. 

GRS. 

GRS. 

GRS. 

GRS.    1    GRS. 

s 

© 

© 

GRS. 



!".**!! 

"""""! 



'936  63 '9 
941  5S.5 

*34.9 
31.9 

0.705 
0.391 

21/27' 
21.35 

*6!976 

4.78 

81  6 

1.00 

54.4  12.235 

6S03 

6405    397.9 

217.7 

2.666 

144.9    32.61 

2S3 

279  3 

3.24 

272.3  50.2 

20903    19S56 

1047. 

477. 

5.54 

466.      96.15 

950 

50. 

0.265  22.2$ 

4.600 

566 

113  4 

4.32 

126.4  42. 6 

163:351  15570 

765. 

302.5 

11.507 

837.    113.7 

953 

46. S 

I8.fi 

0.705  20.6 

6.962 

6^0 

887  4 

0.72 

215.9  32.4 

13745 

13015 

729. 

306. 

1.05 

324.      48. 6 

946 

53.0 

25.9 

0.078  23.5 

3.539 

572 

113.4 
63.0 
63.0 

137.0 

4.440 
1.000 
2.300 
4.200 

1S405 

7661 

13601 

10722 

340. 

13.32 

18.4 

12.3 
12.3 
19.49 

0.723 
0.196 

766 
468 
566 
446 

94.5     1.50 



169.0 
205.6 

6.131 
6.300 

0.450 

0.5>7 

41.19 

61.792 

5.087 

4.720 
5.400 

13139 

15.104 
7.619 



1.149 
1.320 

534 
240 
706 
1055 

576S 

680. 

690.0 

945 

54.5 

19.9 

22.4 

12.1 

ague''  on  the  5th  inst.,  which  lasted  two  hours.  The  "dumb 
ague:'  has  returned  at  the  same  hour,  11  o'clock  A.M.,  on  the 
succeeding  and  this  day.  Now  has  fever,  with  pain  in  all  his 
limbs,  and  vomiting.  Calomel,  grs.  xii.,  sulph.  of  quinia,  grs.  v. 
were  administered,  and  followed  by  castor  oil.  20  grs.  of  the 
sulphate  of  quinia  were  also  administered.  This  delayed  the 
chill  until  Oct.  9th,  3^  o'clock,  (27j  hours.) 

The  following  tables  will  present  the  most  important  phe- 
nomena observed: 

October  9th,  31  o'clock  P.  M. — Phenomena  of  Cold  Stage. 


Pulse  92,  very  feeble,  resembles 
the  vibration  of  a  fine  thread — with 
difficulty  counted.  Respiration  ac- 
celerated and  irregular. 

Lips  and  fingers  blue. 


Temp,  of  Atmosphere,  .  .     75°  F. 

u       "     Hand, 83 

"     under  Tongue,    .  .  .  101  5' 
R.  Mustard  to  extremities.     Bran- 

dv  &  snake-root  tea,  until  reaction. 


61  o'clock  P.  M 

. — Hot  Stage. 

Pulse  96  ;  much  fuller  than  dur- 
ing the  chill.     Respiration  fuller. 
Pulse  not  so  full  as  in  milder  cas- 
es. 

Temp,  of  Atmosphere,  .  .     70°  F. 

"     Hand, 101    8' 

"     under  Tongue,    .  .  .  102    8' 
R.  Citrate  of  Potassa  mixture. 

Oct.  10th,  11  A.  M.     Febrile  excitement  has  almost  entirely  subsided. 
BL.  Sulph  of  quinia,  grs.  xxv. 


518 


Jones,  on  Malarial  Fever. 


[August, 


5  o'clock  P.  M. — Apyrexia. 


Pulse  and  respiration  near  the 
normal  standard. 


Temp,  of  Atmosphere, 
"       "     Hand,  .  .  . 
"     under  Tongue,    ...     98 
Oct.  12th,  3  P.M.     Pulse,  respiration,  skin  and  tongue,  normal. 


70°  F. 
9V  5' 
at 


ANALYSIS  XXXI. 
Oct.  10th,  11  AM. 


Urea,  -  -  -  - 
Uric  Acid,  -  -  - 
Fixed  Saline  Contit' 


Am't  of  Urine  excreted  dur- 
ing 15  hours  of  febrile  ex- 
citement, grs.  8687.  Sp.  Gr. 
1022.  Am't  excreted  hour- 
ly, grs.  579.     Grains 


342*167 

5-950 

28-050 


Grs.  13899  calcu- 
lated for  twenty- 
four  hours,  con- 
tained grains 


547-388 

9-520 

44-880 


1000  pts.  of 
Urine  con- 
tained 


39-388 

0-684 

43-228 


ANALYSIS  XXXII. 
Oct,  12th,  3  o'c.  P.M. 


Urea,     -     -     -     - 

Uric  Acid,  -     -     - 
Fixed  Saline  Conslit'* 


Amount  of  Urine  passed  during  the  last  24 
hours  of  Apyrexia,  grs.  15330.  Sp.  Gravity 
1022.     Am't  passed  hourly,  grs.  638.     Grs. 


349-200 
11-250 
76-500 


1000  pts.  of 
Urine  con- 
tained 


22-678 
0-733 
4-990 


Urine  was  high  colored,  like  new  Madeira  wine.  The  appro- 
priate tests  exhibit  the  presence  of  iron  in  abnormal  amount. 
The  coloring  matters  were  in  such  abundance  that  hydrochloric 
acid  changed  the  color  of  the  urine  into  a  purplish  black.  When 
evaporated  to  the  consistence  of  a  syrup,  the  urine  assumed  a 
dark  brown,  almost  black  color.  After  standing  50  hours,  pris- 
matic crystals  of  triple  phosphate,  vegetable  cells,  urate  of  soda, 
and  carbonate  of  lime  were  deposited. 

This  patient  had  no  return  of  fever,  but  suffered  for  some  time 
with  great  weakness,  and  exhibited  in  his  pale  lips,  pale  gums, 
and  sallow  complexion,  the  effects  of  the  malarial  poison  on  the 
colored  blood  corpuscles. 

In  this  case  the  uric  acid  was  not  diminished  during  the  hot 
stage. 

If  we  compare  the  first  with  the  second  attack,  it  is  evident 
that  the  urea  was  more  abundant  in  the  second,  than  the  first. 
The  first  attack  of  intermittent  fever  was  slight,  while  the  se- 
cond was  severe.  When  we  consider  the  weight  and  condition 
of  rest,  and  almost  complete  starvation  of  this  patient,  it  is  evi- 
dent that  the  urea  was  greatly  increased. 


Case  XIX.- 


-English 


seaman 


age  25;  weight  160  lbs.; 
height  5  feet  6  inches ;  black  hair ;  florid  complexion  ;  muscu- 
lar system  well  developed ;  powerful  chest ;  short  stout  neck. 
Has  just  returned  from  Jacksonville,  Fla.  Has  been  sick  one 
week. 


1858.]  Joxes,  on  Malarial  Fever.  519 

August  18th,  11  o'clock,  A.M.  Skin  hot  and  dry ;  face  very 
red ;  pulse  106 ;  respiration  thoracic ;  temperature  of  atmosphere 
88°  ;  temperature  of  hand  105°.  Complains  of  pain  in  his  head. 
Urine  high  colored.  Specific  gravity  1021.  $  Bloodletting  in 
the  standing  posture  to  produce  relaxation  of  the  system. 

2  o'clock,  P.M.  Preparations  were  made  for  blood-letting. 
The  patient  appeared  to  be  alarmed  by  the  preparations ;  and 
when  I  appeared  with  the  specific  gravity  bottles,  beaker  glasses 
and  capsules,  to  receive  the  blood,  he  fell  back  into  the  arms  of 
the  assistant,  and  in  a  few  moments  before  the  lancet  was  ap- 
plied, the  perspiration  stood  in  large  drops  upon  his  face  and 
hands.  During  the  bleeding,  he  perspired  freely,  and  fainted 
before  f  $  x,  were  abstracted.  The  pulse  and  respiration  were 
diminished  in  frequency  and  force,  and  the  patient  fell  into  a 
profound  slumber,  during  which  his  clothes  were  completely 
saturated  with  a  profuse  perspiration. 

Examination  of  Blood. — Blood  of  a  dark,  almost  black  color, 
commenced  to  coagulate  in  about  ten  minutes.  After  remain- 
ing for  two  hours  exposed  to  the  atmosphere,  the  surface  of  the 
blood  exposed,  changed  to  a  bright  red  arterial  hue. 

Specific  gravity  of  blood,  1042  ;  Specific  gravity  of  serum,  1018. 
Serum  of  a  light  golden  color.  The  color  was  not  so  deep  as 
in  severer  cases  of  malarial  fever. 

ANALYSIS  OF  BLOOD,  I. 


Water, 

In  1000  parts  of  Blood,  830-509 

"         "     Serum,    -  929-287 

(1)  "         "     Liq.  Sang.  927-194 

(2)  "         "     Liq.  Sang.  887-328 


Solid  Matters, 

In  1000  parts  of  Blood,  169*491 

"         "     Serum,    -  70-713 

(1)  "         "     Liq.  Sang.  72-806 

(2)  "         "  _  Liq.  Sang.  112-672 
Sol.  Matters  in  Serum  of 

1000  parts  of  Blood,  64*158 


Fixed  Saline  Constituents. 

In  1000  parts  of  Blood, 7-532 

"         "         Serum,     -                  5*000 

(1)  "         "         Liq.  SaDguinis, 5*332 

(2)  "         "         Liq.  Sanguinis, 8'245 

"         "         Solid  Matters  of  Blood,       ....  44.439 

"         "             "         "         "  Serum,      ....  77*931 

"         "             "         "         "  Liq.  Sanguinis,  -        -         -  73*345 

"         "  Blood  Corpuscles,      -         -  28*500 

"         "         Moist  Blood  Corpucles,       -  7*258 

In  Blood  Corpuscles  of  1000  parts  of  Blood,         ...  3.002 

In  Serum  of  1000  parts  of  Blood, 4.530 


o20  Jones,  on  Malarial  Fever.  [August, 

1000  parts  of  Blood  contained, 

Water, 830-509 

tv  •  a  x>\     j  n           i                       1no  ,oo  )  Organic  Matters,  100-431 

Dried  Blood  Corpuscles,     -         -  103-433  J-  M£eral        «      '  3.002 

Fibrin, -  1-900 

Albumen           -                                   ^4-1 86  1 0rSanic  Matters,  54-426 

Albumen,                                           °4  186  [  Mineral        "  2*760 

Extractive  and  Coloring  Matters,        8972  [  jg™  M^>  ™°* 

1000  parts  of  Blood  contained, 

J  Water,          -         -         -  310-219 

Moist  Blood  Corpuscles,    413-732  V  Organic  Matters,  -         -  100-431 

)  Mineral         "       -         -  3-002 

Water,         ...         -  520-210 

A11                  )  Organic  Matters,  51*426 

Albumen,       Kt*L™i         „  0.7An 


Liquor  Sanguinis,    586-268 


Mineral         "  2-760 


Extractive 


j  *  n  i    >    f  Organic  Matters,      r6-902 
and  Colore  V  ,rb      ,         «  « n^n 

Matters,      gj  Mineral  2-070 

Fibrin,  ....  1-900 

1000  parts  of  Moist  Blood  Corpuscles  contained, 

Water,     ----------     749-996 

Organic  Matters,        -         -         -        -  .       -         -         -         -     242*746 

Mineral  Matters, 7.258 

(1)  1000  parts  Liquor  Sanguinis  contained, 

Water, 927-194 

A1,  e_  onn  )  Organic  Matters,       56-762 

Albumen,  ....     59*809^^         u  3.Q47 

Fibrin, 2-093 

Extractive  and  Coloring  Matters,      10*904  !•  «.=      ,         u     '         0.005 

(2)  1000  parts  of  Liquor  Sanguinis  contained, 

Water, 887*328 

.„  nn  AnA  )  Organic  Matters,       87*717 

Albumen,  ....     92*424^^         u  ^ 

Fibrin, 3*242 

Extractive  and  Coloring  Matters,      15*310  !• «.°      ,         u     '        3.538 

8  o'clock,  P.  M.  Much  better;  pain  in  his  head  has  disap- 
peared ;  in  a  profuse  perspiration ;  skin  much  cooler.  Pulse  96 
to  the  minute,  soft  and  natural.  Kespiration  regular  and  nor- 
mal. 

August  19th,  10  o'clock,  P.M.  Skin  moist;  urine  high  co- 
lored ;  Pulse  82 ;  Kespiration  2-i.     Temperature  of  Atmosphere 


1858.]]  JONES,  on  Malarial  Fever.  521 

89°F.  Temperature  of  Hand  100°.  Temperature  under  Tongue 
102°25'. 

August  20th,  12  o'clock,  M.  Skin  and  tongue  normal; 
urine  high  colored.  Specific  gravity,  1015.  Pulse  80;  Respira- 
tion  21.  Temperature  of  Atmosphere  85°F.  Temperature 
under  Tongue  101°. 

August  21st.  Pulse  80 ;  Respiration  20.  Temperature  of 
Atmosphere  80°     Temperature  under  Tongue  98°8/. 

This  case  yielded  readily  to  the  action  of  sulphate  of  quinia, 
and  the  patient  was  discharged  on  the  23d.  This  has  been  a  mild 
attack  of  malarial  fever,  and  the  blood  corpuscles  were  but 
slightly  diminished. 

At  first  sight  this  case  would  seem  to  prove  the  efficacy  of 
blood-letting  in  malarial  fever.  The  fact  that  the  mere  prepar- 
ations for  bleeding,  caused  the  patient  "  to  break  out  into  a 
profuse  perspiration,"  demonstrated  that  the  sweating  stage  was 
nigh  at  hand  and  the  bleeding  was  the  occasion  and  not  the 
cause  of  its  appearance. 

It  is  probable  that  this  patient  would  have  done  just  as  well, 
without,  as  with  this  bleeding.  The  next  patient  suffering  with 
malarial  fever,  which  I  bled,  was  a  stout  German,  with  high 
fever,  scarlet  face,  and  M  distracting  pain  in  his  head,"  presenting 
similar  only  severer  symptoms.  This  case  terminated  fatally. 
I  have  used  local  blood-letting  (cut  cups)  in  scores  of  cases  of 
malarial  fever,  and  always  with  apparent  benefit.  Over  the 
epigastrium  it  often  arrests  obstinate  vomiting,  and  over  the 
temples  and  back  of  neck,  and  over  the  spine,  it  often  relieves 
distressing  pain.  Local  differs  from  general  blood-letting,  in  two 
essential  degrees.  First,  the  quantity  of  blood  abstracted  is  much 
less,  and  second,  the  number  of  colored  blood  corpuscles  is  less 
in  proportion  to  the  amount  of  blood  abstracted,  in  local  than 
in  general  blood-letting.  The  colored  blood  corpuscles  rush 
along  principally  in  the  centre  of  the  streams,  and  in  general 
blood-letting  they  are  lost,  more  rapidly  than  the  other  elements 
of  the  blood.  The  malarial  poison,  whatever  it  be,  destroys 
rapidly  the  colored  blood  corpuscles.  Whatever  therefore 
diminishes  the  colored  blood  corpuscles  acts  in  concert  with  the 
malarial  poison.  The  malarial  poison  reduces  rapidly  the  forces. 
General  blood-letting  reduces  rapidly  the  forces.  The  two,  in 
this  particular,  again  act  in  concert.  These  views  will  be  sub- 
stantiated by  facts,  and  more  fully  discussed  hereafter. 

Case  XX.  Frenchman,  laborer;'  height  5  feet 8  inches; 
weight,  110  lbs.,  in  health,  140  lbs.  Has  been  in  America,  ten 
years,  and  in  Savannah,  six  months.  Has  been  living  and 
working  in  a  low   miasmatic  situation  on  Thunderboldt  road, 


522  Jones,  on  Malarial  Fever.  [August, 

one  mile  from  Savannah.  Has  been  sick  with  chill  and  fever 
five  weeks,  and  has  had  no  medical  attendance.  He  is  much 
reduced  in  flesh  and  strength.  Complexion  sallow,  anaemic. 
Lips  and  gums  pale — the  effects  of  miasmatic  fever  are  well 
marked. 

August  19th.  Pulse  72 ;  Eespiration  24.  .Temp,  of  Atmos- 
phere, 90°F. ;  Temp,  under  Tongue,  98°.  Complains  of  great 
weakness,  and  constant  pain  in  his  head. 

August  22nd.  Examination  of  Blood. — The  blood  coagulated 
in  the  usual  time,  and  the  clot  was  firm.  After  standing  four 
days  in  a  stoppered  bottle,  in  the  heat  of  summer,  the  clot  ap- 
peared firm,  un  decomposed,  and  the  serum  was  clear.  The 
blood  of  a  patient  who  was  suffering  from  the  effects  of  remit- 
tent fever,  and  severe  salivation,  placed  by  the  side  of  this,  in 
the  same  time,  and  under  the  same  circumstances,  had  its  clot 
completely  disintegrated,  and  commenced  to  putrefy. 

ANALYSIS  OF  BLOOD  II. 
Specific  gravity  of  Blood,         -        -         -         1034 


"Water, 
In  1000  parts  of  Blood,       850.888 
"         "       Serum,        920-820 

(1)  "         "       Liq.  Sang.,  918-072 

(2)  "         "       Liq.  Sang.,  892-859 


Solid  Matters, 
In  1000  parts  of  Blood,      149-112 
"         "       Serum,         79-180 

(1)  "         "       Liq.  Sang.,  81-928 

(2)  "         "       Liq.  Sang.,1 07-424 
In  Serum  of  1000  parts  of 

Blood,-        -        -       73.167 


Fixed  Saline  Constituents, 

In  1000  parts  of  Blood, 7*692 

"         Serum, -  5-119 

(1)  "         "         Liquor  Sanguinis, 5-120 

(2)  "         "         Liquor  Sanguinis, 6'696 

"         "         Solid  Matters  of  Blood,     -        -        -        -  51-586 

«         "             "         "         "  Serum,    -  64-648 

"         "             "         "         "  Liquor  Sanguinis,     -        -  62-493 

"         "             "         "         «  Blood  Corpuscles,     -         -  40-351 

"         "        Moist  Blood  Corpuscles,    -         -         -         -  10-087 

In  Blood  Corpuscles  of  1000  parts  of  Blood,       -        -         -  2-962 

In  Serum  of  1000  parts  of  Blood, 4-730 

1000  parts  of  Blood  contained, 

Water, 850-888 

Dried  Blood  Corpuscles,-        -      73-405  [  gSJ™  Mat|T'  7™* 

Fibrin,                                        :  2-540 

Albumen,  Extractive  and  Coloring              )  Organic  Matters,  68-405 

Matters,  -                                 73-167  f  Mineral        "  4-730 


1858.]  Jones,  on  Malarial  Fever.  528 

1000  parts  of  Blood  contained, 

)  Water,     -         -  220-215 

Moist  Blood  Corpuscles,    -         -    2 9 3*G 2 0  V  Organic  Matters,  70-411 

)  Mineral         "  2-962 

•    Water,     -         -  630-705 

T.          c         .   .                               h~Q  OOA     Organic  Matters,  68'405 

Liquor  Sanguinis,     -         -         -    Y°6,380  f  Mineral         «  4-730 

Fibrin,     -         -  2540 

(1)  1000  parts  of  Liquor  Sanguinis  contained, 

Water, 918-072 

Albumen  and  Extractive  Matters,       -  74*050 

Mineral  Matters, 5'120 

Fibrin, 2'748 

(2)  1000  parts  of  Liquor  Sanguinis  contained, 

Water, 892*859 

Albumen  and  Extractive  Matters, 96-838 

Mineral  Matters, 6-696 

Fibrin, 3-890 

1000  parts  of  Moist  Blood  Corpuscles  contained, 

Water, 750-000 

Organic  Residue, 239-803 

Fixed  Saline  Constituents, 10-087 

This  analysis  confirms  the  statement,  that  the  malarial  poison 
(either  directly  or  indirectly)  destroys  the  colored  blood  corpus- 
cles. They  are  diminished  one  half,  the  dried  corpuscles  being 
only  73*405,  and  the  moist  corpuscles  293*620,  whilst  in  health 
the  dried  corpuscles  generally  average  135'000,  and  the  moist 
corpuscles  540*000. 

This  patient  improved  very  slowly  under  the  action  of  sul- 
phate of  quinia,  chalybeates,  and  alteratives,  and  on  the  2nd  of 
September  had  a  return  of  chill  and  fever. 

September  3rd,  12|  o'clock,  P.M.  Chill  has  just  commenced; 
he  is  shaking  violently.  Pulse  96,  very  feeble,  can  scarcely  be 
felt.  Eespiration  82^0,  irregular,  spasmodic.  Extremities 
cold;  trunk  warm.  Temp,  of  atmosphere  83°;  temp,  of  hand 
93°75' ;  temp,  under  tongue  100°5'. 

3£  o'clock,  P.M.  Skin  hot  and  dry;  pulse  108;  respiration 
28 ;  temp,  of  atmosphere  85°F.;  temp,  of  hand  104°  ;  temp,  un- 
der tongue  105°. 

7  o'clock,  P.M.  Fever  is  subsiding;  pulse  90;  respiration 
26;  temp,  of  atmosphere  78°F.;  temp,  of  hand  101°5' ;  temp, 
under  tongue  103°. 

September  4th.     Apyrexia. 

September  5th.    No  return  of  fever. 

y.  s. — you  xiv.   no.  vhi.  27 


524 


Jones,  on  Malarial  Fever. 


[August, 


September  6th.  Pulse  76 ;  respiration  20 ;  temp,  of  atmos- 
phere 80°F.;  temp,  of  hand  98° ;  temp,  under  tongue  100°. 

Examination  of  Urine  passed  during  the  febrile  excitement 
and  the  intermission,  Sept.  3rd. 


ANALYSIS  XXXIII. 


Urea,  -     - 
Uric  Acid,  - 


Grs.  7084  of  Urine  passed  j 
during  16  hrs.  Sp.  Crav. 
1012-4.  Am't  pass'd  hour- 
ly, grs.  442  7.    Grains 


151-077 
2-243 


Grs.  10613,  calculated 
for  24  hours,  contain 
ed  grains 


226-616 
3-365 


1000  parts 
of  Urine, 
contained 

21-08& 
0-326 


Case  XXI.  Irish  laborer ;  light  brown  hair,  brown  eyes ; 
has  been  in  America  seven  years,  and  in  Savannah  three  years ; 
age  22,  medium  height.  Has  been  living  and  making  bricks  in 
a  low  miasmatic  situation.  Says  that  he  has  suffered  with  chill 
and  fever  for  six  weeks.  Complexion  sallow  and  anaemic;  lips, 
gums,  and  tongue  pale.  He  is  exhausted  by  slight  exertions, 
and  complains  of  great  weakness. 

Sept.  16th,  12|  o'clock  P.M.  Pulse  88,  respiration  24.  Tem- 
perature of  atmosphere,  87°5'F. ;  Temp,  of  hand,  100°5' ;  Temp, 
under  tongue,  101°25'. 

Sept.  17th,  Hi  o'clock  P.  M.  Pulse  72,  respiration  20.  Has 
just  awoke  from  sleep,  in  a  profuse  perspiration.  Temperature 
of  atmosphere,  86°  F. ;  Temp,  of  hand,  90° ;  Temp,  under 
tongue,  98° 


ANALYSIS  XXXIV. 


Water, 

Solid  Matters,    '•*    -    - 

Urea, 

Uric  Acid,     -     -     -     - 
Extractive  and  Color- ) 
ing  Matters,  j 

Fix'd  Saline  Constituents 


Grs.  16027  ot  Urine  excreted  in  24  hours. 
Sp.  Gr.  1001-7.  Clear,  limpid.  Amount 
excreted  hourly  667-7.    Grains 


15958-568 

68432 

42'680 

1-280 

18-776 

5696 


1000  parts 
of  Urine, 
contained 


995-730 
4-270 
2-664 
0-079 

1-171 

0-356 


The  reduction  of  the  nervous  and  physical  forces  was  attend- 
ed by  a  reduction  in  the  amounts  of  the  solid  constituents  of  the 
urine.  $.  Snake-root  tea,  1  pint;  brandy,  flvi. ;  sulph.  of 
quinia,  grs.  xv.  Mix.  Take  a  wine-glassful  six  times  a  day. 
$.  Citrate  of  Iron,  grs.  iv.  three  times  a  day. 

Sept.  17th,  12  M.  Pulse  72,  respiration  20.  Temp,  of  atmos- 
phere. 88°  F.;  Temp,  of  hand,  98°5';  Temp,  under  tougue,  99°5'. 
Amount  of  urine  excreted  during  last  24  hours,  grs.  14645.  A- 
mount  excreted  hourly,  grs.  610.  Sp.  Gr.  1010.  Urea  in  grs. 
146459  of  urine,  196.910;  Uric  acid  in  grs.  146459  of  urine, 


1858.] 


Jones,  on  Malarial  Fever, 


525 


7.975;  Urea  in  1000  parts  of  urine,  12.445;  Uric  acid  in  1000 
parts  of  urine,  0.544 

The  snake-root  tea  and  sulph.  of  quinia  and  citrate  of  iron, 
have  produced  an  increase  of  the  solid  constituents  of  the  urine. 

Sept.  19th,  2  o'clock  P.  M.  Pulse  76,  respiration  24.  Temp, 
of  atmosphere,  89°  F. ;  Temp,  of  hand,  98°  ;  Temp,  under  tongue, 
99°.  Sp.  Gr.  of  urine,  1012 ;  Urea  in  1000  parts,  10.270 ;  Uric 
acid  in  1000  parts,  0.247. 

Sept.  20th.  Pulse  96,  respiration  24.  Temp,  of  atmosphere, 
83°  F.;  Temp,  of  hand,  100°;  Temp,  under  tongue,  102°.  A- 
mount  of  urine  passed  during  last  24  hours,  grs.  20400.  Specific 
Gravity  1010. 


Examination  of  Blood,  No.  II — Blood  watery  in  appearance, 
and  coagulated  slowly.  Reaction  decidedly  alkaline.  After 
standing  twenty  hours,  the  clot  contracted  but  little,  and  it  was 
soft,  possessing  but  little  consistency. 

In  the  specific  gravity  bottle,  the  colored  blood  corpuscles 
gravitated  towards  the  bottom,  and  left  above  a  light  yellow, 
transparent  clot.  Serum  of  a  light  yellow  color.  Specific  gra- 
vity of  blood  10305 ;  specific  gravity  of  serum  1021*3 


Water 
In  1000  parts  of  Blood,       877-553 
"       "      Serum,         927-757 

(1)  "       "      Liq.  Sang.   925725 

(2)  "       «      Liq.  Sang.   911-124 


Solid  Matters. 

In  1000  parts  of  Blood,       122-447 
"       "     Serum,     -       72-243 

(1)  "       "     Liq.  Sang.       74-275 

(2)  "       "     Liq.  Sang.      88-876 
Serum  of  1000  pts.  Blood,   68-435 


Fixed  Saline  Constituents. 
In  1000  parts  of  Blood, 
"         "     Serum      - 

(1)  "         "     Liquor  Sanguinis,     • 

(2)  "         "     Liquor  Sanguinis,     - 
In  Serum  of  1000  parts  of  Blood,  • 
"    1000  parts  of  the  Solid  Matters  of  Blood, 
u       «  «       u         a         n         «.  Serum 

<<  u  a  («  4<  u  (< 


•         "         "        t"  Liquor  Sanguinis, 
u       "         "         "         '"  Blood  Corpuscles, 
Blood  Corpuscles  of  1000  parts  of  Blood,     - 
1000  parts  of  Moist  Blood  Corpuscles, 


3316 

3-326 

3-328 

3  965 

3141 

27083 

45-901 

44-790 

3-240 

0175 

0  841 


1000  Parts  of  Blood  Contained, 

Water,         -------..         877-553 

t^  •  j  m     j  m           i          ci  no7  )  Dried  Organic  Residue,  51»812 

Dried  Blood  Coipuscles,     51-987  >  r.     ,  ^  &     „      ..        [  _  ,** 

^                             )  Fixed  Saline  Constituents,  0175 

Fibrin,         .........  1-925 

Albumen,  Extractive    and  Color-  )  Dried  Organic  Residue,  65*194 

ing  Matters,   -         -         68-335  \  Fixed  Saline  Constituents,  3-141 


52ft  Jones,  on  Malarial  Fever.  [August, 

1000  Parts  of  Blood  Contained, 

)  Water,    -         -         -         155861 
Morgt  Blood  Corpuscles,    207*948  V  Organic  Residue,     -  51-812 

3  Fixed  Saline  Constituents,     0175 

Water,     ....  721-692 

Albumen,  Extractive  &  Co*  >  65-194 

loring  Matters,  $ 

Fixed  Saline  Constituents,  3*141 

Fibrin,      -  1-925 


Liquor  Sanguinis,  792*052 


J000  Parts  of  Moist  Blood  Corpuscles  Contained, 
Water,        --......-         749*519 

Dried  Organic  Matters,         ......         249*154 

Fixed  Saline  Constitueuts,    ......  0-841 

(1)  1000  Parts  of  Liquor  Sanguinis  Contained, 
Water,        .........         925*725 

Albumen,  Extractive  and  Coloring  Matters,    -         -         .  68*817 

Fibrin,         -...-....  2*032 

Fixed  Saline  Constituents,     •         -         -         -         -         •  3  326 

(2)  1000  Parts  of  Liquor  Sanguinis  Contained, 
Water,        .........         911*167 

Albumen,  Extractive  and  Coloring  Matters,    -         -         -  823 1 2 

Fibrin,        .........  3  965 

Fixed  Saline  Constituents, 2*430 

This  analysis  shows  that  the  continued  action  of  the  malarial 
poison  has  reduced  the  colored  blood  corpuscles  to  51.987  dried, 
or  207.948  moist,  which  is  a  little  more  than  one-third  of  the 
normal  standard. 

The  fixed  saline  constituents  of  the  colored  blood  corpuscles 
are  also,  not  only  correspondingly,  but  absolutely  diminished 
in  amount.  I  have  derived  much  benefit  in  the  treatment  of 
the  effects  of  malarial  fever,  from  the  phosphates  of  iron,  lime, 
soda,  and  potassa.  It  is  probable  that  they  act  beneficially  by 
supplying  those  salts  which  are  deficient.  If  the  hypophos- 
phites  of  lime,  soda,  potassa  and  ammonia,  act  with  as  much 
power  and  in  the  manner  asserted  by  Dr.  Churchill,*  they  will 

?rove  valuable  remedies  in  the  latter  stages  of  malarial  fever, 
have  employed  them  upon  myself,  this  winter,  after  an  attack 
of  intermittent  fever,  with  apparent  benefit. 

*  "  On  the  Proximate  Cause  and  Specific  Remedy  of  Tuberculosis,"  by  Dr. 
John  Francis  Churchill.  Dublin  Hospital  Gazette,  Aug.  15th,  1857.  Ranking's 
Abstract,  No.  26,  July  to  Dec,  1857,  p.  47.  Dr.  Churchill  has  employed  the 
hypophosphites,  in  the  treatment  of  tuberculosis,  with  success,  and  asserts  that 
they  increase  nervous  force,  and  are  infinitely  superior  to  all  other  medicines  as 
bsematogens. 


1858.] 


Jones,  on  Malarial  Fever. 


527 


Case  XXII. — German  laborer,  age  30 ;  height  5  feet  5  inches ; 
weight,  in  health,  112  lbs.;  light  hair,  blue  eyes;  small,  delicate 
man.  Has  been  in  the  United  States  three  years  and  in  Savan- 
nah three  months.  Has  been  "keeping  store"  on  the  river, 
near  the  rice  mill.  Was  taken  sick  with  chill  and  fever  two 
months  ago.  Complexion  anaemic.  Complains  of  great  weak- 
ness. Lips,  gums  and  tongue  pale ;  tongue  coated  with  white 
fur. 

Sept.  10th,  11  o'clock  A.  M.  Says  that  he  had  his  chill  yes- 
terday. $.  Sulph.  of  quinia  grs.  v.  every  three  hours,  up  to 
grs.  xv. 

Sept.  11th,  12  o'clock,  M.  Skin  cool;  in  a  profuse  perspira* 
tion.     Pulse  76 ;  respiration  19. 

Temperature  of  Atmosphere, 85°  F. 

"     Hand, 94 

"         under  Tongue, 98 

Amount  of  Urine  excreted  during  last  17  hours,  grs.  5072 

u  ..       u  u       hourly     "      "       "  "        298-9 

Calculated  amount  for  24  hours,  "     7157 

Specific  gravity  1014*5.     Color  a  shade  higher  than  normaL 


Grs.  5072  ot  Urine, 

Grs.  7157  calculated 

1000  parts  of 

ANALYSIS  XXXV. 

excreted  in  17  brs., 

for  24  hours,  con- 

Urine contain- 

contained grains, 

tained  grains,"- 

ed, 

Water,     -    -    -    - 

4886-160 

6895-783 

963-462 

Solid  Matters,     -    - 

185-340 

261-514 

36538 

Urea, 

65-475 

92-385 

12-907 

Uric  Acid,    -     -     - 

2-750 

3-880 

0-552 

Extractive  &  Color- ) 
ing  Matters,          j 

102-485 

144-607 

20-225 

Fixed  Saline  Constit's, 

14-631 

20-642 

2-884 

In  this  case,  as  in  the  preceding,  we  see  that  the  depressed 
state  of  the  forces,  consequent  upon  the  continued  action  of  the 
malarial  poison,  was  attended  by  a  marked  diminution  of  the 
solid  constituents  of  the  urine. 

Sept.  12th,  12i  o'clock,  P.M.  Pulse  72;  respiration  19. 
Skin  cool. 

Temperature  of  Atmosphere,         .         .         .         64°  F. 
44  "    Hand,         .         .         .         .         97  25' 

"         under  Tongue,     ....         99     9 

Amount  of  Urine  excreted  during  the  last  24  hours,  .     grs.  13652 

"         "       "  "         hourly    "      "     "       "     .  .      ■  568-8 

Specific  gravity  1011-3.  After  16  hours,  a  copious  deposit  of  urate  ef 
eoda  and  triple  phosphate. 


528  Jones,  on  Malarial  Fever.  [August, 


ANALYSIS  XXXVI. 

Grs.  13652  ot  Urine,  excre- 
ted in  24  hours,  contained 
grains, 

1000  parts  of  Urine 
contained, 

Water, 

Solid  Matters, 

Urea, 

Uric  Acid, 

Extractive  and  Col'g  Matters, 
Fixed  Saline  Constituents,    - 

13242-437 
409-563 
209-520 

19-710 
158-485 

20-265 

970-000 
30-000 
15-316 

1-443 
11-676 

1-567 

Under  the  action  of  the  sulphate  of  quinia,  the  urea,  uric  acid 
and  extractive  and  coloring  matters,  have  been  increased  in 
amount. 

Sept.  13th,  12  M.  Much  better.  Amount  of  urine  passed 
in  last  24  hours,  grs.  10,100.  Amount  of  urine  passed  hourly, 
grs.  420*8.  Sp.  Grav.  1010.  fy.  Quassia  and  soda,  and  snake- 
root  tea. 

Sept.  14th.  Amount  of  urine  passed  in  24  hours,  grs.  14084. 
Amount  of  urine  passed  hourly,  grs.  587.     Sp.  Gr.  1006. 

Sept.  15th.  Pulse  64 ;  respiration  18.  Temp,  of  atmosphere, 
85°  F.;  Temp,  of  hand,  98°;  Temp,  under  tongue,  99°.  Spe- 
cific gravity  of  urine  1007*1.  Grs.  13631  of  urine  contained,  urea 
96*400;  uric  acid  6*151.  1000  parts  of  urine  contained,  urea 
6*003;  uric  acid  0*446.  Urine  excreted  in  24  hours,  grs.  13631 ; 
urine  excreted  hourly,  grs.  568. 

Case  XXIII.  Irishman  ;  height  6  ft ;  black  hair,  black  eyes. 
This  patient  had  been  in  the  Savannah  Poor  House  for  three 
months,  suffering  with  phthisis  pulmonalis  in  its  advanced  stages. 
For  the  last  two  months  he  had  been  confined  to  the  ward  and 
recently  he  had  been  confined  to  his  bed. 

August  23d.  During  the  night,  was  taken  with  chill,  follow- 
ed by  fever.  Had  chill  and  fever  four  nights  in  succession,  until 
the  paroxysm  yielded  to  the  action  of  the  sulphate  of  quinia. 
The  chill  and  fever  returned  several  times  after  this.  Under 
the  combined  actions  of  pulmonary  consumption  and  intermit- 
tent fever,  the  patient  lost  strength  rapidly,  and  died  Sept.  4th. 

(1.)    Autopsy  12    houks  after  death. 

Exterior. — Body  much  emaciated,  universal  sallow  color, 
marked  cadaverous  rigidity. 

Head. — "When  the  skull  cap  was  removed,  about  f  §  iss.  of 
serum  and  blood  escaped  from  the  base  of  the  brain.  Dura- 
mater  normal.  Arachnoid  membrane  slightly  opalescent  in 
several  spots,  especially  in  the  neighborhood  of  the  larger  blood 
vessels.  The  greatest  part  of  this  membrane,  however,  was  trans- 
parent and  normal.in  appearance.  Subarachnoid  fluid  appeared 
to  be  more  abundant  than  usual.  Bloodvessels  of  pia  mater 
filled  with  blood.     The  venticles  of  the  brain  contained  small 


1858.]  JONES,  on  Malarial  Fever.  529 

quantities  of  serum.  The  cortical  and  medullary  substances, 
the  cerebellum,  pons  varolii,  the  medulla  oblongata,  and  the 
spinal  marrow,  appeared  natural  to  the  naked  eye. 

Chest. — Tubercles  of  various  sizes,  in  various  stages  of  devel- 
opment and  disintegration,  were  deposited  throughout  the  sub- 
stance of  both  lungs.  Many  of  the  largest  were  broken  down 
into  a  pus-like  matter,  mingled  with  portions  of  the  cheesy  tuber- 
culous substance. 

Heart  normal  in  size;  weight  grains,  6557.  Portions  of  the 
right  heart  showed  the  commencement  of  fatty  degeneration. 
The  right  auricle  was  filled  by  a  large  light  yellow  clot,  which 
was  attached  to  the  tricuspid  valves  and  cordae  tendinae,  and 
sent  a  large  cylindrical  branch  down  the  vena  cava.  The  surface 
and  whole  structure  of  this  clot  was  of  a  light  yellow  color  and 
appeared  to  be  entirely  free  from  colored  blood  corpuscles.  In 
the  right  auricle  and  venticle  were  several  other  smaller  clots, 
which  resembled  ordinary  coagulated  blood,  and  must  have  been 
formed  posterior  to  the  light  yellow  fibrinous  clot.  The  lower 
portion  of  the  vena  cava  contained  coagulated  blood.  No  clots 
were  found  in  the  left  auricle  and  ventricle.  The  carotid  arte- 
ries contained  flattened  cylindroid,  light  yellow  clots,  which 
sent  off  branches  to  the  smaller  arteries.  These  clots  appear  to 
have  been  formed  before  death,  when  the  circulation  was  greatly 
diminished  in  force. 

Abdomen. — Stomach  small,  contracted;  small  intestines  and 
colon  inflated  with  air.  Mucous  membrane  of  stomach  of  a  pur- 
plish red  color,  in  spots,  presenting  a  mottled  appearance.  Blood- 
vessels upon  the  exterior  filled  with  blood.  The  small  intestines 
contained  fecal  matters  colored  by  bile.  Internal  surface  of  a 
dark  purplish  and  reddish  yellow  hue.  Blood  vessels  upon  the 
exterior  and  through  the  structures  of  the  intestines  were  filled 
with  dark  blood.  Glands  of  Peyer,  normal,  not  enlarged. 
Brunner's  glands  did  not  attract  attention. 

Liver. — The  form  of  the  liver  was  abnormal;  it  had  no  left 
lobe,  and  in  its  general  shape  resembled  a  spleen.  The  color 
was  purplish  red.  The  structure  was  unusually  firm.  It  required 
considerable  force  to  tear  it  asunder.  It  cut  toughly  under  the 
knife,  and  the  lobules  started  out  from  the  cut  surface,  as  if  they 
had  been  bound  down.  The  fibrous  capsule  surrounding  the 
exterior  of  the  liver,  forming  a  sheath  for  the  large  vessels  lying 
in  the  portal  canals,  was  thickened.  The  individual  lobules  of 
the  liver  were  surrounded  with  fibrous  tissue.  The  lobules  of 
the  liver  have  been  described  by  Malpighi,  (')  Kiernan,  (2)  Mul- 

(1)  Malpighi.     De  Yiscerum  Structura  Bologna.     London:   1699. 

(2)  The  Anatomy  and  Physiology  of  the  Liver,  by  Francis  Kiernan.  Philoso- 
phical Transactions  of  the  Royal  Society  of  London.     1833.     P.  714. 


630  Jones,  on  Malarial  Fever.  [August, 

ler,  (3)  Leidy,  (4)  and  others  as  isolated  from  each  other,  and 
each  invested  with  a  layer  of  areolar  or  fibrous  tissue.  In  the 
pig,  in  which  these  lobules  were  first  noticed,  and  in  the  Polar 
bear  according  to  Muller,  and  in  the  octodon  cummingii,  accor- 
ding to  Hyrtl,  (5)  the  lobules  are  invested  by  fibrous  tissue,  but 
in  the  liver  of  the  human  subject,  and  in  that  of  vertebrate  ani- 
mals generally,  the  lobules  are  not  separated  from  each  other 
by  a  fibrous  partition,  and  there  is  no  areolar  or  fibrous  tissue 
or  prolongation  of  Glisson's  capsule  between  them  or  in  their 
interior.  Yogel,  Henle,  (6)  Bowman,  (7)  and  Beale,  (8)  have 
failed  to  detect  any  fibrous  tissue  in  the  interlobular  fissures  of 
the  normal  human  liver. 

In  cirrhosis  of  the  liver,  on  the  other  hand,  there  is  a  remark- 
able development  of  fibrous  tissue  in  the  parenchyma  of  the 
liver,  and  the  individual  secreting  segments  become  prominent, 
or  even  form  isolated  lobules.  The  increase  of  fibrous  tissue  in 
the  liver  of  this  subject,  was  manifest  to  the  eye,  and  especially 
when  the  liver  was  subjected  to  the  action  of  a  stream  of  water, 
and  gently  mashed  between  the  fingers.  The  softer  parts  were 
washed  out,  and  the  fibrous  tissue  remained.  The  character  of 
this  was  determined  by  microscopical  examination.  The  portions 
of  the  liver  surrounded  by  the  indurated  fibrous  tissue  appeared 
to  be  but  little  altered  and  could  be  readily  scraped  away. 

The  cirrhosed  condition  of  the  liver  was  not  the  result  of 
malarial  fever,  for  the  microscopical  examination  showed  that 
the  fibrous  tissue  was  abundant  and  well  formed.  The  whole 
structure  of  the  liver  could  not  have  been  pervaded  by  fibrous 
tissue  in  the  course  of  a  few  days.  It  is  reasonable  to  conclude 
with  Dr.  Budd,  (9)  that  the  remarkable  changes  in  cirrhosis,  are 
mainly  the  consequence  of  adhesive  inflammation  in  the  areolar 
tissue  about  the  small  twigs  of  the  portal  vein,  and  in  the  areolar 
tissue  of  the  portal  canals,  by  which  serous  fluid  and  coagulable 
lymph  are  poured  out.  In  this  stage/the  liver  may  be  enlarged. 
The  serous  part  of  the  effusion  is  next  absorbed,  the  lymph 
contracts,  becomes  converted  into  dense  fibrous  tissue,  which 
divides  the  lobular  substance  of  the  liver  into  well-defined 
masses,  and  gives  great  density  and  toughness  to  the  organ. 

(3)  Muller.  De  Glandularum  Seceinent  Struct.  Penit,  Berlin.  1830.  Ele- 
ments of  Physiology,  by  J.  Muller,  M.D.  Translated  by  Wm.  Baly,  M.D.  Lond., 
1840.  Vol.  1,  p.  493. 

(4.)  Researches  into  the  Comparative  Structure  of  the  Liver,  by  Joseph  Leidy, 
M.D.     American  Journal  of  the  Medical  Sciences,  new  series,  vol.  xv.,  1848,  p.  18. 

(5)  Hyrtl.     Lehrbuch  der  Anatomie  des  Menchen.     1850. 

(6)  Huf eland's  Journal.     1838.     P.  8. 

(7)  Article,  "  Mucous  Membrane,"  in  Todd's  Cyclopaedia  of  Anatomy  and  Physi- 
ology, by  W.  Bowman.  Vol.  iii.,  p.  497.  The  Physiological  Anatomy  and 
Physiology  of  Man,  by  Todd  <fe  Bowman.     Philadelphia:  1857,  p.  773. 

(8)  On  Some  Points  in  the  Anatomy  of  the  Liver  of  Man  and  Vertebrated  Ani- 
mals, by  Lionels.  Beale,  M.D.     London:  1856,  pp.  13,  16,  19,  72. 

(9)  On  the  Diseases  of  the  Liver,  by  George  Budd,  M.D.    London:  1857,  p.  143. 


1858.]  Jones,  on  Malarial  Fever.  531 

Finally,  this  fibrous  tissue,  compresses  the  small  twigs  of  the 
portal  vein  and  the  small  gall  ducts,  and  thus  impeding  the  es- 
cape of  the  bile  and  the  flow  of  blood,  induces  great  atrophy  of 
the  original  hepatic  tissue,  and  causes  by  a  deprivation  of  blood 
and  the  admixture  of  this  dirty  white  fibrous  tissue,  marked 
changes  in  the  color  of  the  liver.  If  these  views  of  Dr.  Budd  be 
correct,  it  is  evident  that  this  condition  of  the  liver  could  not 
have  resulted  from  an  attack  of  malarial  fever,  which  had  com- 
menced only  twelve  days  before  death.  The  weight  of  this  liver 
was  22968,  troy  grains,  or  52^  ounces  avoirdupois.  According 
to  the  researches  of  Dr.  John  Keid,  (l  °)  the  liver  weighed  in  43 
cases,  out  of  82,  between  48  and  58  ounces  in  the  adult  male; 
and  in  17  cases,  out  of  36,  its  weight  in  the  adult  female  ranged 
between  40  and  50  ounces.  It  may  then,  in  general  terms  be 
stated  that  the  weight  of  %lq  liver  in  health  varies  from  3  to  4 
pounds,  according  to  the  quantity  of  blood  which  it  may  contain 
at  the  time  it  is  examined.  The  weight  of  this  liver  therefore, 
was  normal.  It  was  however  far  more  engorged  with  blood  than 
is  usual  in  cirrhosis.  If  this  patient  had  died  from  tuberculosis 
and  not  from  malarial  fever,  it  is  probable  that  the  liver  would 
have  weighed  less  than  in  health. 

This  patient  was  an  Irish  laborer.  This  class  are  addicted  to 
the  free  use  of  ardent  spirits,  and  the  true  cause  of  this  cirrhos- 
ed  condition  of  the  liver,  was  the  action  of  the  alcohol  in  the 
portal  blood,  absorbed  directly  from  the  stomach  and  intestines, 
upon  the  bloodvessels  and  secreting  apparatus  of  the  liver.  We 
know  that  this  form  of  disease  is  most  frequent  in  large  manu- 
factoring  towns,  among  the  poorer  classes  who  drink  large  quan- 
tities of  ardent  spirits.  All  the  cirrhosed  livers  which  I  have 
had  an  opportunity  of  examining,  have  been  taken  from  the 
bodies  of  those  who  have  been  accustomed  to  the  free  use  of 
spirits.  So  common,  and  well  known  is  this  cause,  that  cirrho- 
sis is  familiarly  termed  by  the  English  practitioners,  gin-drink- 
ers' liver. 

The  color  of  the  liver  of  this  patient  was  very  different  from 
that  generally  presented  in  cirrhosis.  Upon  the  inferior  surface 
of  the  liver,  there  was  a  small  portion  of  a  dark  slate  inclining 
to  bronze  color,  resembling  the  color  of  the  malarial  fever  liver, 
and  forming  a  striking  contrast  with  the  surrounding  purplish 
red  color.  In  cirrhosis,  owing  to  the  admixture  of  fibrous  tissue 
and  the  impediment  to  the  circulation  of  the  blood,  and  the  pas- 
sage of  the  bile,  and  the  compression  of  the  capillaries  and  secre- 
ting apparatus,  the  normal  dull-reddish  brown  color  of  the  liver 

(10)  London  and  Edinburgh  Monthly  Journal  of  Med.  Science,  April,  1843, 
See  also  Comparative  Weights  of  the  Liver  of  Animals,  by  Joseph  Jones,  M.D. 
Smithsonian  Contributions  to  Knowledge.     1856,  p.  113. 


532  Jones,  on  Malarial  Fever.  [August, 

is  altered  sometimes  to  a  bright  canary  yellow,  sometimes  to  a 
brownish  or  greenish,  and  occasionally  to  a  reddish  color.  A 
section  of  the  liver  upon  a  general  view  presents  the  greyish 
and  yellow  color  of  impure  bees- wax. 

The  researches  of  Dr.  Thomas  Stewardson,  (l !)  in  the  Phila- 
delphia Hospitals,  confirmed  by  those  of  Dr.  Wm.  T.  How- 
ard, (12)  in  the  Baltimore  Alms  House,  of  Dr.  Swett,  (J  3)  in 
the  New  York  Hospital,  ofDrs.  Anderson,  (1 4)  and  Frickin  the 
Baltimore  Almshouse  and  Infirmary,  and  of  Dr.  Kichard  D. 
Arnold,  (* 5)  in  the  Savannah  Marine  Hospital  and  Poor  House, 
have  shown  that  the  color  of  the  liver  in  malarial  fever,  is 
changed  from  the  normal  reddish  brown,  to  a  slaty  or  bronze,  or 
mixture  of  bronze  and  olive.  The  observations  of  the  author, 
which  we  hope  to  present  in  subsequent  numbers  of  this  journal, 
confirm  the  statements  of  these  observers. 

In  this  case,  owing  to  the  pathological  conditions  of  cirrhosis, 
the  admixture  of  fibrous  tissue,  impediment  of  the  circulation 
of  the  blood,  and  flow  of  bile  and  the  compression  of  the 
capillaries  and  secretory  apparatus,  the  color  of  the  liver  was 
not  so  marked  as  in  those  cases  of  malarial  fever,  in  which  the 
liver  was  normal  before  the  introduction  of  the  malarial  poison. 
Allowing  due  weight  to  the  pathological  changes  of  cirrhosis,  it 
is  evident  that  the  change  in  the  color  of  the  liver,  was  similar 
in  all  respects  to  the  slate  or  bronze  color  of  livers  which  were 
normal  before  the  onset  of  the  malarial  fever.  This  change  in 
the  color  of  the  liver  in  malarial  fever  is  due  to  changes  in  the 
amount,  and  physical  and  chemical  constitution  of  the  blood  in 
the  capillaries  of  the  liver,  and  to  physical  and  chemical  changes 
in  the  bile  and  the  contents  of  the  secretory  apparatus.  The 
blood  which  issued  from  the  cut  surface  of  the  liver,  remained 
of  a  dark  purplish  color,  and  did  not  change  to  the  arterial  hue 
upon  exposure  to  the  oxygen  of  the  atmosphere.  The  loss  of 
this  power  to  change  from  the  venous  to  the  arterial  hue  is  sig- 
nificant of  profound  changes  in  the  constitution  of  the  colored 
blood  corpuscles. 

In  this,  and  many  other  cases  of  malarial  fever,  I  have  obser- 
ved the  bile  to  be  of  high  specific  gravity — thick,  concentrated, 
and  of  a  greenish  black  color  when  seen  in  mass,  and  of  a  gam- 
boge yellow,  when  spread  in  thin  layers.     I  have  always  found 

(11)  Stewardson,  on  Remittent  Fever.  American  Jour.  Med.  Sciences,  April, 
1841,  new  series,  vol.  i.,  p.  289.  Elliotson's  and  Stewardson's  Practice  of  Medi- 
cine, p.  338. 

(12)  Communicated  by  Dr.  Stewardson.     Am.  Jour.  Med.  Sciences,  Jan.  1845. 

(13)  Swett,  on  Pathol,  of  Remit.  Fever. 

(14)  Published  by  Dr.  Alfred  Stille.  "         "         "  "       April,  1846. 

(15)  "  An  Essay  upon  the  Relation  of  Bilious  and  Yellow  Fever,  prepared  at 
the  request  of,  and  read  before  the  Medical  Society  of -Georgia,  April,  1856,"  by 
RJphard  D.  Arnold,  M.D. — Southern  Med.  and  Surg.  Journal,  vol.  xii.,  p.  515. 


1858.]  Jones,  on  Malarial  Fever.  533 

the  filtered  decoction  of  malarial  fever  livers,  to  be  of  a  brownish 
yellow  color,  whilst  the  decoction  of  normal  livers  is  of  a  light 
yellow,  whilst  that  of  yellow  fever  livers  is  of  a  bright  golden 
yellow.  The  color  alone,  would  seem  to  point  to  pathological 
changes  in  malarial  and  yellow  fevers,  differing  in  each  disease. 
The  amount  of  blood  contained  in  the  capillaries  of  the  malarial 
liver  has  always  appeared  to  be  greater  than  normal.  The 
combination  of  these  three  causes  will  account  for  the  peculiar 
color  of  the  liver  in  malarial  fever. 

The  liver  of  yellow  fever  on  the  other  hand,  as  far  as  my  obser- 
vations extend,  is  of  a  bright  yellow  color,  (readily  extracted 
by  water  and  alcohol,)  firm  texture,  and  contains  much  less  blood 
than  the  malarial  liver.  The  yellow  fever,  liver  although  resem- 
bling fatty  degeneration  in  color,  as  far  as  my  observations  ex- 
tend, gives  no  evidence  of  such  a  change  under  the  action  of 
chemical  re-agents.  A  solution  of  liquor  potassa  readily  dis- 
solves the  liver  of  malarial  fever,  but  acts  very  slowly  upon  the 
3Tcllow  fever  liver. 

These  facts  are  sufficient  to  show  that  the  patholigical  changes 
are  widely  different  in  the  two  diseases.  The  liver  of  this  patient 
who  had  died  with  phthisis  pulmonalis  and  intermittent  fever,  was 
carefully  tested  for  grape  sugar,  with  Moore's  and  Trommer's  tests. 
Not  a  trace  of  grape  sugar  was  obtained.  The  absence  of  the 
grape  sugar  was  not  due  to  the  cirrhosed  condition  of  the  organ, 
for  I  have  detected  grape  sugar  in  the  cirrhosed  livers  of  patients 
who  had  died  from  other  causes  than  malarial  fever.  Diabetes 
mellitus,  has  existed  when  much  of  the  lobular  substance  of  the 
liver  had  been  destroyed  by  cirrhosis,  and  the  secretion  of  the 
bile  defective  and  the  passage  of  the  blood  through  the  liver 
much  impeded.  Such  a  case  occurred  in  King's  College  Hospi- 
tal, under  the  care  of  Dr.  George  Budd.(16)  From  numerous 
chemical  examinations  of  the  livers  of  patients  who  had  died 
with  the  different  forms  of  malarial  fever,  I  am  convinced  that 
the  absence  of  grape  sugar  is  due  to  the  action  of  the  malarial 
poison  upon  the  special  ferment  of  the  blood. 

When  tested  for  glycogenic  hepatic  matter  (animal  starch), 
after  the  method  of  Bernard,  an  abundant  precipitate  was 
obtained.  When  the  fibrous  capsule  of  the  liver  was  torn  off, 
spread  upon  a  glass  slide,  partially  dried  and  treated  with  tinc- 
ture of  iodine,  the  cellular  tissue  was  not  altered  by  the  tincture 
of  Iodine,  but  wherever  a  particle  of  liver  adhered  to  the  fi- 
brous tissue,  there  a  purple  and  blue  color  was  produced.  Under 
the  microscope  the  fibrous  tissue  of  the  liver  generally,  and  of 
the  portal  canals,  were  found  to  be  completely  infiltrated  with 
this  animal  starch.     Under  the  microscope  the  liver  cells  appear- 

(16)  "On  the  Diseases  of  the  Liver,"  by  George  Budd.M.D.     London:  1857. 


534:  Jones,  on  Malarial  Fever.  [August^ 

ed  to  be  paler  and  have  fewer  oil  globules  and  granules  than 
usual,  but  otherwise,  they  were  normal.  When  single  cells 
were  treated  with  tincture  of  iodine  under  the  microscope,  I  was 
not  able  to  demonstrate  satisfactorily  whether  they  contained 
animal  starch.  When,  however,  a  number  of  them,  in  mass,  were 
treated  with  tincture  of  iodine,  the  characteristic  blue  color  was 
produced. 

In  this  case  of  intermittent  fever,  the  special  ferment  in  the 
blood  which  transforms  animal  starch  into  glucose,  had  been 
destroyed,  whilst  the  power  to  manufacture  starch  from  both 
nitrogen ized  and  non-nitrogenized  materials,  was  exercised  by 
the  liver,  and  hence  the  absence  of  glucose  and  the  accumulation 
of  glycogene.  From  chemical  examinations  of  the  livers  of  the 
different  forms  of  malarial  fever,  from  the  summer  of  1856  to  the 
present  time.  I  have  obtained  similar  results — an  abundance 
of  animal  starch,  without  a  trace  of  grape  sugar.  Livers  were 
set  aside  and  examined  after  intervals  of  12  hours.  The  last 
examination  was  made  36  hours  after  the  first.  At  every  exami- 
nation the  result  was  the  same — an  abundance  of  animal  starch, 
without  a  trace  of  grape  sugar. 

The  mere  presence  of  starch  in  the  liver  is  not  peculiar  to 
malarial  fever — it  is  not  a  pathological  condition.  In  the  month 
of  September  1856,  I  had  an  opportunity  of  examining  chemi- 
cally the  liver  of  a  patient  who  had  been  under  the  care  of  my 
friend  and  former  colleague  Dr.  J.  B.  Kead.  This  patient  had 
black  vomit,  and  all  the  symptoms  of  yellow  fever,  and  the 
liver  presented  the  yellow  box-wood  color  peculiar  to  this  dis- 
ease. Drs.  Eead  and  Arnold,  who  have  had  extensive  expe- 
rience in  the  treatment  of  yellow  fever,  pronounced  it  a  genuine 
case  of  yellow  fever.  (17)  Chemical  examination  gave  decided 
evidence  of  the  presence  of  animal  starch  in  the  structure  of  the 
liver.  The  liver  of  a  yellow  fever  patient  brought  from  Nor- 
folk by  Dr.  J.  B.  Kead,  (*  8)  presented  a  similar  appearance,  and 
also  yielded  animal  starch. 

I  have  detected  this  substance  in  the  human  liver,  in  normal 
condition  after  sudden  death,  from  diseases  of  the  circulatory 
apparatus,  and  appoplexy,  and  phthisis,  and  in  abnormal  states, 
as  cirrhosis,  fatty  degeneration,  and  cirrhosis  and  fatty  degener- 
ation combined.  I  have  examined  the  livers  of  numerous  ver- 
tebrate and  invertebrate  animals,  injected  and  uninfected,  and 
in  every  instance  animal  starch  has  been  found.  Whether  the 
elaboration  of  this  product  is  confined  specially  to  any  one  of 

(17)  For  report  of  this  case,  see  Addendum  to  Dr.  Richard  D.  Arnold's  Essay- 
on  Bilious  and  Yellow  Fever,  p.  3. 

(18)  Chief  Physician  of  the  Savannah  Volunteers,  who  went  on  to  Norfolk  in 
1866,  and  rendered  medical  service  during  the  terrible  epidemic  of  yellow  lever. 


1858.]  JoNES,  on  Malarial  Fever.  535 

the  anatomical  elements  of  the  liver,  I  have  not  as  yet  been  able 
to  determine  with  certainty,  for  it  has  been  found  in  the  fibrous 
tissue  of  the  portal  canals,  in  the  hepatic  ducts  and  in  the  secre- 
ting cells.  ~\Ve  would  naturally  infer  that  it  was  formed  in  and 
by  the  secreting  cells  of  the  liver,  and  was  deposited  in  other 
positions  by  endosmosis.  The  exact  point  at  which  it  is  conver- 
ted into  grape  sugar,  is  also  unknown.  Bernard  has  shown  that 
this  change  is  due  to  the  action  of  a  special  ferment  contained 
in  the  blood.  Experiments  have  shown  that  the  liver  cells  con- 
tain  grape  sugar  as  well  as  the  hepatic  veins.  If  the  starch  is 
formed  in  the  secreting  cells,  and  grape  sugar  is  formed  in  them 
also,  then  the  special  ferment  of  the  blood  must  be  absorbed  by 
the  secreting  cells.  A  portion  of  the  animal  starch  may  be  ab- 
sorbed by  the  hepatic  veins,  and  be  acted  upon  by  the  ferment, 
partially,  if  in  large  quantities,  and  finally  be  deposited  in  the 
organs  and  tissues.  This  view  is  sustained  by  the  fact  that  this 
substance  is  not  confined  to  the  liver.  I  have  found  it  in  con- 
siderable abundance  in  the  malarial  fever  spleens,  and  in  normal 
spleens  taken  from  patients  who  had  died  from  cirrhosis  and 
fatty  degeneration  of  the  liver  combined,  and  in  one  case  where 
the  patient  (an  aged  negro  man)  had  died  suddenly  from  apo- 
plexy. 

A  carbo-hydrate,  similar  in  its  composition  and  properties  to 
vegetable  cellulose,  has  been  found  in  some  of  the  lower  classes 
of  animals.  C.  Schmidt,  (* 9)  discovered  cellulose  in  the  mantle 
of  phallusia  mammillaris  (one  of  the  mollusca,)  and  Lowig  (2  °) 
and  Kolliker,  have  discovered  it  in  the  outer  tube  of  salpae,  in 
the  leathery  mantle  of  the  cynthiae,  and  in  the  cartilaginous  cap- 
sule of  the  simple  ascidiae.  The  researches  of  Odier,  (21)  Las- 
saigne,  (aa)  Payen,  a  3)  Children,  (2  4)  and  Danniel,  and  especial- 
ly of  C.  Schmidt,  (25)  have  shown  that  a  body  closely  resemb- 
ling cellulose,  (vegetable  fibre,  which  C.  Schmidt,  regards  as 
composed  of  a  carbo-hydrate  and  of  a  nitrogenous  body  having 
the  composition  of  the  muscular  fibre  of  insects,)  forms  the  true 
skeleton  of  all  insects  and  Crustacea.  This  substance,  called 
chitin,  constitutes  not  only  the  external  skeleton,  the  scales  and 
hairs  of  insects,  but  it  also  forms  their  trachae,  and  even  one  of 
the  layers  of  the  intestinal  canal.     Cellulose  or  animal  starch 

(19)Zu  Vergl.  Physiol,  der  Wirbellosen  Thiere.  1845,  S.  62.  See  also 
"Contributions  to  the  Comparative  Physiology  of  the  Invertebrate  Animals,  be- 
ing a  Physiologieo-Chemical  Investigation,"  by  Dr.  Carl  Schmidt.  Taylor's 
Scientific  Memoirs,  vol.  v.,  part  xviii.     1852,  p.  34. 

(20)  Ann.  de  Scienc.  Nat.,  3d  series,  T.  5,  pp.  193-232. 

(21)  Memoire  de  la  Societe  d'Historie  Naturelle,  torn.  1,  p.  29,  et.  sq. 

(22)  Comptes  Rendus,  torn,  xvi.,  p.  1087     Journ.  de  Chim.  Med.  1—9.  p.  379. 

(23)  Comptes  Rendns,  torn,  xvii.,  p  227. 

(24)  Todv's  Cyclopaedia  of  Anatomy  and  Physiology,  vol.  ii.,  p.  882. 

(25)  Zur  Vergleichend,  Physiol,  der  Wirbellosen.  Thiere.  1845.  S.  32—69. 
Trans,  in  Taylor's  Sci.  Memoirs,  vol.  v.  1852.  pp.  14-28. 


636  Jones,  on  Malarial  Fever.  [August, 

has  been  discovered  by  Kudolph  Virchow,  (2  6)  in  the  brain 
and  in  some  of  the  higher  nerves  of  sense.  These  observations 
were  subsequently  confirmed  by  those  of  George  Busk.  (2  7) 
In  1853,  Yirchow(28)  announced  the  discovery  of  corpuscles 
presenting  the  same  reaction  as  the  corpora  amylacea  of  the  brain, 
in  the  malpighian  corpuscles  of  diseased  human  spleens — in  the 
condition  termed  waxy  spleen.  Virchow,  Bennet  and  Carter 
have  also  pointed  out  the  existence  of  a  peculiar  amyloid  sub- 
stance in  the  liver,  in  some  chronic  forms  of  disease,  as  waxy 
or  fatty  degeneration. 

Notwithstanding  that  much  time  and  labor  were  expended 
upon  the  microscopical  and  chemical  examinations  of  the  liver 
in  this  case,  and  in  many  others  which  we  hope  to  record  in 
future,  and  notwithstanding  that  several  facts  of  value  to  pathol- 
ogy have  been  discovered,  still  the  whole  subject  is  open  for 
investigation  and  presents  an  inviting  and  untrodden  field  to 
the  investigator.  These  imperfect  results  are  presented  with 
the  hope  that  others  may  be  excited  to  enter  the  same  field,  and 
not  only  prove  their  truth  or  falsity;  but  also  remove  the  uncer- 
tainty and  obscurity,  and  establish  a  clear  knowledge  of  the 
pathology  of  malarial  and  yellow  fevers.  Those  who  enter  upon 
this  field  of  investigation  will  soon  be  convinced,  that  chemical 
and  microscopical  examinations  of  the  liver  are  tedious,  and  to 
a  great  extent  uncertain  and  vague,  on  account  of  the  complex- 
ity and  delicacy  of  the  structures,  and  secretions. 

The  accuracy  and  value  of  pathological  investigations,  depend 
upon  the  state  of  anatomy  and  physiology.  If  anatomists  and 
physiologists  are  not  agreed  with  reference  to  the  minute  anato- 
my of  the  liver,  and  the  mode  of  formation,  and  offices  of  its 
secretions,  how  can  the  pathologist  arrive  at  accurate  and  defi- 
nite conclusions,  when  he  has  to  investigate  not  only  the  com- 
plex anatomical  structures  and  secretions,  but  also  examine  the 
morbid  physical  and  chemical  alterations,  and  if  possible,  dis- 
cover the  character  and  mode  of  action  of  the  morbific  agent  or 
agents  ?  The  difficulty  of  correct  microscopical  examination  of 
the  liver  is  strikingly  shown  by  the  differences  of  opinion 
amongst  the  most  distinguished  anatomists,  with  reference  to 
the  connexion  of  the  liver  cells,  with  the  hepatic  ducts.  Kier- 
man,  (29)  Schroder  Vander  Kolk,  (30)   Krukenberg,  (31)  We- 

(26)  Virchow's  Archiv.  b.  vii.,  h.  1,  p.  135. 

(27)  Journal  of  Microscopical  Science,  No.  vi ,  p.  101. 

(28)  Comptes  Rendus,  No.  23.    December  2,  1853. 

(29)  The  Anatomy  and  Physiology  of  the  Liver,  by  Francis  Kiernan.    Philo- 
sophical Transactions.    1833. 

(30)  In  Backer's  Essay.    De  Structura  Subtilori  Hepatis  Sani  et  Morbose. 

(31)  Untersuchungen  ueber  den  feineren    Bau  der  Menschichen  Leber,  in 
Mull.  Archiv.,  St.  3l8. 


1858.]  Jones,  on  Malarial  Fever.  537 

ber,  (33)  Retzius,  (33)  Theile,  (34)  Backer,  (35)  Leidy,  (36)and 
Beale,  (37)  have  advocated  the  existence  of  a  tubular  basement 
membrane,  continuous  with  the  ducts,  within  which  lie  the 
liver  cells.  Kolliker,  (3  8)  describes  the  hepatic  cells  as  so  arran- 
ged in  the  lobules,  as  to  form  a  net  work,  by  the  simple  apposi- 
tion of  their  flat  surfaces,  Avithout  the  assistance  of  any  foreign 
connecting  intermediate  or  investing  coat.  Not  a  trace  of  bilia- 
ry ducts  is  to  be  observed  in  this  net-work,  and  it  is  impossible 
to  make  out  any  connection  between  the  biliary  ducts  and  he- 
patic cell  net-work,  which  is  undoubtedly  the  secreting  portion 
of  the  liver.  Dr.  Handheld  Jones,  (39)  asserts  that  the  ducts 
terminate  in  blind  extremities,  on  reaching  the  lobule,  instead  of 
forming  a  plexus  within  it,  and  that  the  chief  agents  in  the  secre- 
tion of  bile,  and  the  cells  lining  these  ducts,  and  not  the  cells  in 
the  lobular  substance.  These  facts,  show  the  necessity  for  care- 
ful and  laborious  research,  and  the  importance  of  having  a  large 
number  of  careful  investigators  engaged  in  this  field.  (4  °) 

Spleen. — Color  of  spleen,  dark  slate,  resembling  in  all  respects 
that  common  to  the  severer  forms  of  malarial  fever.  Weight, 
grains,  6343.  According  to  the  observations  of  Dr.  John  Eeid, 
the  weight  of  normal  spleens  ranges  from  2187  to  3062  grains. 
This  organ  then  was  enlarged.  It  was  partially  disorganized; 
its  fibrous  capsule  was  torn  upon  the  slightest  pressure,  and  the 
cellular  framework  was  readily  ruptured  when  the  substance  of 
the  spleen  was  pressed  between  the  fingers.  The  pulp  (mud)  of 
the  splen  was  of  a  dark  reddish  brown  color,  and  changed  very 
slowly  and  slightly,  when  exposed  to  the  atmosphere.  After  12 
hours  exposure  to  the  atmosphere,  although  the  color  became  a 

(32)  Annot.  Anat.  et  Physiolog.,  Prol.  vi.,  vii.,  viii.  Lips.  Zusatze  zu  seineD 
Untersuchungen  uber  den  Ban  der  Leber,  in  Berichte  der  K.  Sachs.  Ger.  (L 
Wissench,  zu  Leipzig,  St.  151.    Programmatar  Collecta,  Fasc.  11.  Lips. 

(33)  Uber  den  Bau der  Leber,  Mull.  Archiv.  It.  p.  141. 

(34)  Art.  Leber,  in  R.  Wagner's  Handw.  der  Phys.  11,  St.  308. 

(35)  De  Structura  Subtiliori  Hepatis  Sani  et  Morbose,  Diss  Inaug.  Trajecti  ad 
Rhenum. 

(36)  Researches  into  the  Comparative  Structure  of  the  Liver.  American  Jour, 
of  the  Medtcal  Sciences,  Jannary  1848,  p.  18. 

(37)  "On  some  points  in  the  Anatomy  of  the  Liver  of  Man  and  Vertebrate 
Animals,"  by  Lionel  S.  Beale,  M.D.     London  :  1856. 

(33)  Manual  of  Human  Microscopical  Anatomy,  bv  A.  Kolliker.  Translated 
by  G.  Busk  and  T.  Huxley.    Philadelphia:  1854,  p.  532,  el.  seq. 

(39)  C.  Hanfield  Jones,  on  the  Secretory  Apparatus  of  the  Liver.  Philosophi- 
cal Transactions,  1846,  p.  473.    On  the  Structure  and  Development  of  the  Liver. 


Phil.  Trans.  1849.  1.  p.  109.    Further  inquiries  as  to  the  Structure,  Development 
is  of  the  Liver.    Phil.  Trans.  1853,  Part  i.  p.  1-29. 
(40)  Of  all  anatomists,  Dr.  Lionel  S.  Beale  appears  to  have  examined  the  liver 


with  the  greatest  care,  and  to  have  arrived  at  the  most  accurate  results,  and  I 
would  recommend  his  recent  work  "On  some  points  in  the  Anatomy  of  the  Liver 
of  Man  and  Vertebrated  Animals.  Lopdon :  1856,"  to  the  young  members  of 
the  medical  profession  who  may  enter  upon  similar  investigations.  This  work 
contains  minute  and  valuable  directions  for  the  injection  and  preparation  of  the 
liver  for  microscopical  examination. 


538  Batty,  on  Emulsions,  [August, 

little  lighter  and  redder,  still  it  by  no  means  assumed  an  arterial 
hue,  as  is  usual  with  normal  spleens.  This  spleen  was  not  how- 
ever as  much  enlarged  and  disorganized,  as  in  severer  cases  of 
malarial  fever.  When  the  fibrous  capsule  was  torn  off,  spread 
upon  a  glass  slide,  and  treated  with  tincture  of  iodic  e,  the  fibrous 
tissue  was  simply  colored  red  by  the  iodine,  whilst  in  the  meshes 
of  the  fibres  were  seen  irregular  blue  and  purple  masses,  resem- 
bling in  all  respects  the  animal  starch  of  the  liver.  When  the 
spleen  was  subjected  to  a  stream  of  water,  and  the  pulp  washed 
out  of  the  cells,  and  the  cellular  frame-work  and  bloodvessels 
thus  cleansed,  spread  upon  a  glass  slide,  and  treated  with  a  solu- 
tion of  iodine,  numerous  small  irregular  blue  and  purple  masses 
were  seen  in  the  meshes  of  the  fibrous  tissue  of  the  frame-work, 
and  also  of  the  blood-vessels. 

Kidneys — normal   in  appearance.     Bloodvessel    filled    with 
blood.     Weight,  grains  4156. 

Bladder — contracted,  contained  no  urine. 

(To  be  continued.) 


ARTICLE    XIX. 

Emulsions.    By  Robert  Batty,  M.  D.,  of  Rome,  Georgia. 

[The  following  excellent  suggestions  on  Emulsions,  received 
some  months  since,  have  not  appeared  hitherto,  for  the  want  of 
space.     We  gladly  find  a  place  for  them  in  the  present  number. 

The  writer,  it  seems,  has  paid  considerable  attention  to 
pharmaceutical  combinations,  and  lays  great  stress  upon  the 
neatness  and  beauty  which  those  compounds  should  present. 
He  gives  some  good  hints  as  to  the  mode  of  preparation  by 
which  these  desirable  qualities  may  be  secured. 

As  regards  his  reference  to  our  Formula  for  Dysentery,  pub- 
lished some  months  ago,  we  would  simply  say,  that  we  gave  it 
to  the  Profession  in  the  exact  form  in  which  it  occurred  to  us, 
and  in  which  it  gained  our  confidence  by  its  marked  effects,  and 
just  as  it  has  been  used  ever  since,  not  only  by  ourselves,  but 
by  many  others,  with  the  most  gratifying  results.  We  would 
prefer,  therefore,  to  retain  the  amount  of  each  ingredient  intact, 
rather  than  to  sacrifice,  in  any  degree,  the  success  of  the  treat- 
ment to  pharmaceutical  neatness,  or  agreeableness  of  taste. 

We  see  that  The  London  Lancet,  a  most  critical  and  fastidi- 


1558.]  Batty,  on  Emulsions.  539 

ous  Journal,  in  transferring  this  formula  to  its  pages,  did  not  see 
fit  to  suggest  an  alteration. — Edts.] 

There  is,  perhaps,  no  class  of  preparations  in  the  dispensing 
practice  of  country  physicians,  so  badly  done  up  as  emulsions. 
A  few  practical  suggestions,  from  one  who  has  spent  some  years 
in  the  drudgery  of  a  dispensing  shop,  will,  I  trust,  not  be  devoid 
of  interest  to  those  who  desire  to  furnish  their  patients  with 
nauseous  remedies  in  this  most  eligible  form. 

An  emulsion  may  be  defined  to  be  a  combination  of  oil,  fat, 
or  resin,  with  water,  through  the  intervention  of  an  alkali,  gum, 
albumen,  or  casein.  It  is,  in  other  words,  an  artificial  milk,  of 
which  nature  has  given  us  a  perfect  type  in  the  milk  of  animals, 
the  juices  of  the  garden  lettuce,  the  poppy,  the  asclepias  syriaca, 
the  ferula  assafcetida,  and  a  large  number  of  both  indigenous 
and  foreign  plants,  are  samples  or  copies  furnished  us  for  our 
study  and  imitation. 

In  attempting  to  arrive  at  the  points  of  a  good  emulsion,  we 
cannot  do  better,  perhaps,  than  take  cow's  milk  as  our  standard 
of  comparison;  and  first,  we  notice  that  it  is,  when  fresh,  an 
opaque,  homogeneous  liquid — such  should  be  the  character  of 
the  well-formed  emulsion.  The  milk,  upon  standing  for  a  time, 
throws  up  its  cream  to  the  surface — the  emulsion,  by  age,  will 
do  the  same;  but  as  we  do  not  find  masses. of  butter  upon  the 
milk,  neither  should  we  have  globules  of  free  oil  on  the  top  of 
he  emulsion — the  latter,  like  the  former,  should  admit  of  free 
dilution  with  water,  without  any  separation  or  decomposition. 
Like  milk,  while  it  should  not  be  too  thin  and  watery,  it  is  by 
no  means  thick  and  viscid;  in  color,  pure  white,  if  possible — 
if  tinted,  let  it  be  cleanly  and  agreeable  to  the  eye;  in  odor  and 
taste,  as  little  repugnant  as  the  nature  of  the  remedy  will  per- 
mit. 

Let  us  now  inquire  how  these  indications  are  to  be  carried 
out  in  practice.  We  will  take,  for  illustration,  the  recipe  upon 
page  163  of  this  Journal — a  recipe  medicinally  admirable,  but 
pharmaceutical!}7  bad.  We  have  here,  of  oils  2^  ounces,  solid 
materials  3  ounces,  tincture  1  ounce,  and  water  3£  ounces — a 
preparation  entirely  too  concentrated,  thick  and  viscid — a  tea- 
spoonful  of  which  forms  a  more  nauseating  dose  than  four  times 
v.b. — vol.  rrv.  vo.  vin.  28 


5i0  Batty,  on  Emulsions.  [August, 

the  quantity  of  a  well  made  milky  emulsion.  When  diluted 
with  an  equal  bulk  of  water,  it  separates  into  three  distinct  lay- 
ers— a  dirty  looking  fluid,  with  a  curdled  precipitate  at  the 
bottom  and  an  oily  fayer  upon  the  top :  in  both  respects,  then, 
most  unlike  its  prototype — milk.  In  this  case,  the  quantity  of 
water  has  been  insufficient  to  prevent  the  curdling  action  of  the 
lavender  upon  the  mucilage;  it  should  therefore  be  increased ; 
and  this  may  best  be  done  by  using  a  portion  of  aqua  menth. 
pip.  as  a  corrigent,  and  also  to  conceal  the  flavor  of  the  turpen- 
tine. The  quantity  of  soda,  upon  the  other  hand,  is  excessive, 
its  saponifying  properties  being  tin-necessary— so  much  only 
should  be  used  as  is  medicinally  requisite. 

Salts  should  enter  into  emulsions  only  when  clearly  indicated 
in  the  case,  and  then  in  small  quantity;  for,  with  the  exception 
of  the  alkaline  salts,  they  impair  the  permanence  of  the  prepa- 
ration— while  the  alkaline  salts,  themselves,  in  large  quantity,, 
offend  the  palate  and  stomach.  The  use  of  ordinary  spts.  tur- 
pentine should  be  avoided  if  possible — fresh  camphine  or  pine 
oil  is  preferable;  and  when  this  cannot  be  obtained,  the  spts. 
turpentine  may  be  put  in  a  retort  or  flask,  writh  a  little  water, 
and  one  half  of  it  distilled  off  for  medicinal  purposes:  as  pre- 
pared in  this  manner,  it  is  so  nearly  free  of  taste  and  odor,  as  to 
be  scarcely  recognizable  in  the  emulsion.  The  castor  oil  should 
be  clear  and  limpid,  and  wholly  soluble  in  alcohol ;  and  the 
powdered  gum  arabic,  when  rubbed  upon  a  pill  tile,  with  a  little 
water,  should  form  a  bright  and  clear  mucilage,  free  of  color. 

Upon  remodeling  the  formula,  in  accordance  with  the  views 
above  indicated,  we  have  a  handsome  preparation,  as  little  re- 
pugnant to  the  taste  as  the  remedies  will  admit,  and  the  recipe 
will  read  somewhat  as  follows : 


01.  Ricini  Opt. 


Terebinth,  Recentis.  .  .  f  Sss. 

Sodas  Bi  Carb.        .        .  .  3ij. 
Pal.  Acacia  Opt.     . 

"  Sacch.  Alb.        .         .  .  aa  l'\. 

Sps.  Lavendul  Comp.      .  .  f§i. 
Aquae  Camph. 

"       Menthar  Pip.          .  .  aaf^vj. 

M.     Ft.  Emulsio,  Sig.  a  tablespoonful  to  be  taken  every  two 
hours. 


fiij. 


1858. J  Batty,  on  Emulsions.  5-il 

It  is  not  sufficient,  however,  that  we  have  a  well  devised  for- 
mula :  skillful  manipulation  in  combining  the  ingredients  is  also 
of  prime  importance,  if  we  would  have  a  handsome  product. 
The  simple  mixture  of  the  materials  in  a  bottle,  gives  us  a  hete- 
rogeneous mass,  utterly  devoid  of  form  and  comeliness;  and 
even  when  well  begun,  a  single  false  step  in  the  process  will 
often  wholly  defeat  the  end  proposed.  Yet  the  process,  when 
once  understood,  is  by  no  means  a  complicated  or  difficult  one. 
In  compounding  the  above  formula,  the  first  step  is  to  weigh 
the  dry  materials — soda,  gum  and  sugar — and  combine  them  in 
a  suitable  mortar,  capable  of  containing  a  pint — then  add  of  the 
camphor  water  sufficient  to  form  a  thick  mucilage,  which  gives 
a  crackling  sound  under  the  pestle.  Mix  well  the  turpentine 
and  oil  in  a  graduate,  and  add  it  in  successive  portions  of  5  or 
10  drops,  triturating  thoroughly  after  each  addition,  until  about 
one-fourth  has  been  thus  combined  with  the  mucilage,  which 
will  be  found  to  have  thickened  in  the  process.  It  will  now  be 
necessary  to  add  a  few  drams  of  the  camphor  water  to  attenuate 
the  mixture  to  its  former  consistence,  when  it  will  be  proper  to 
add  the  remainder  of  the  oils,  slowly,  as  before,  and  with  con- 
stant trituration.  The  camphor  water  may  now  go  in,  dram  by 
dram,  followed  by  the  mint  water;  and  lastly,  the  sps.  laven- 
der, which  should  be  added  cautiously,  drop  by  drop,  continu- 
ing the  trituration  constantly  throughout  the  process. 

I  have  been  accustomed  in  past  years  to  compound  an  emul- 
sion of  Copaiba,  extensively  and  favorably  known  to  the  Pro- 
fession here  as  "No.  310."  The  recipe,  obtained  from  Prof. 
Miller,  of  the  Augusta  College,  is  as  follows: 

$.  Copaibae, 

Tinct,  Cubeba?, 
*Syr.  Uva  Ursi,     .     .     aa  f!ij. 
Pul.  Acacice  Opt.     .     .       lij. 
Aquas  Cinnam.    .     .     .     fsxvj. 
M.     Ft.  Emulsio.  Sig.     Dose,  a  tablespoonful  three  times  daily. 

I  use,  in  my  own  practice,  a  formula,  as  I  think  it  somewhat 
more  elegant  than  the  above — 

*  Syrup  Uva  Ursi  contains  the  active  matter  of  four  ounces  of  the  leaves  in 
each  pint  of  ayrujx 


642  Batty,  on  Emulsions.  [August, 

$.  Copaibae,  .         .        .        .        fgss. 

fExt,  Dios.  Fl.  Comp.         .        f  3iv. 

01.  Menth.  Yir.  .        .      gtt.  viij 

Pul.  Acaciae  Opt.       .        .  I  ss. 

Aquae  Font.       .        .        .         f  I  v. 

M.     Ft.  Emulsio.  Sig.     Tablespoonful  three  times  daily. 

In  comparing  the  two  recipes,  three  points  are  worthy  of  no- 
tice :  First,  the  use  of  mentha  virida  to  couch  the  taste  and  odor 
of  the  copaiba,  as  being  much  better  fitted  for  this  purpose  than 
the  cinnamon  ;  secondly,  the  use  of  ol.  menth  virida,  in  place 
of  aq.  menth  vir.,  saving  the  unnecessary  trouble  of  preparing 
the  latter  for  the  purpose ;  thirdly,  the  use  of  fluid  ext.  of  buchu, 
in  place  of  the  tr.  cubebs  and  syrup  uva  ursi.  The  buchu  con- 
tains a  notable  quantity  of  sp.  nitre,  oil  cubebs  and  oil  juniper, 
and  is  altogether  a  more  eligible  preparation  for  this  use. 

In  typhoid  fever,  and  indeed  all  febrile  cases  where  I  have  a 
dry,  parched  tongue  to  contend  with,  I  use  the  following  for- 
mula: 


3.  01.  Terebinth  Eecini, 


f3ij. 
3J. 


Sodas  Bi  Carb. 
Pul.  Acaciae  Opt. 

"     Sacch.  Alb aa    5ss. 

Sp.  Lavendul.  Comp.     .        .        .        f  5ss. 

Aquae  Camph f!iv. 

"      Menth.  Pip.  .        .        .        fjiij. 

M.     Ft.  Emulsio.  Sig.     Tablespoonful  every  two  hours. 

To  this,  tinct.  opii.  or  tinct.  verat.  viride  may  be  added,  if 
indicated. 

In  digesting  a  formula  the  following  suggestions  will  be  found 
useful : 

1st.  The  quantity  of  the  active  ingredient  must,  of  course,  be 
governed  by  the  case.  For  one  pint  of  emulsion,  two  to  four 
ounces  of  castor  oil — one  half  to  one  ounce  of  oil  turpentine,  and 
one  to  two  ounces  of  copaiba,  will  usually  be  found  desirable 
limits. 

2nd.  The  quantity  of  gum  used  may  be  one  ounce  for  four 
of  castor  oil,  two  of  copaiba,  and  one  of  oil  turpentine — unless 
it  should  be  desirable,  as  in  the  case  of  copaiba,  to  render  the 


\  Each  pint  represents,  of  Buchu  2£  ounces ;  Sp.  Nit  Ether  2£  ounees ;  Oil  Cu- 
beba  and  Oil  Juniper,  of  each,  21  drops. 


1858.]  Clinical  Lecture  on  Dyspepsia.  543 

preparation  more  mucilaginous.  When  sugar  is  used,  the  gum 
may  be  a  little  curtailed,  if  desired. 

3rd.  Syrups  may  be  added  freely,  if  iudicated ;  but  with  tinc- 
tures and  spirits  it  is  advisable  that  the  quantity  do  not  exceed 
an  ounce  in  the  pint 

4th.  No  insoluble  powders  should  be  added  to  an  emulsion  ; 
nor  should  soluble  salts  be  used  in  large  quantity. 

The  rules  for  the  preparation  of  emulsions  may  be  briefly 
summed  up  in  the  order  in  which  the  materials  are  to  be  used. 

1st  All  dry  materials. 

2nd.  Watery  menstruum  to  a  crackling  mucilage. 

3rd.  The  oils,  until  the  mucilage  thickens. 

4th.  Watery  menstruum  to  attenuate. 

5th.  Eemainder  of  the  oils. 

6th.         u  "  watery  menstruum. 

7th.  Simple  or  fluid  extracts,  if  any. 

8th.  Tinctures,  or  spirits. 


Clinical  Lecture  on  Dyspepsia.     Delivered  at  the  Hotel  Dieu,  by 
M.  Trousseau. 

Of  the  patients  at  present  in  the  wards  of  our  service,  you  may 
every  day  see  some  who  complain  of  disordered  digestion.  You 
have  seen  me  give  trial  to  various  therapeutic  means,  and  per- 
haps an  accusation  of  empiricism  has  planted  its  germ  in  your 
minds-  but  do  not  deceive  yourselves.  I  have,  it  is  true,  been 
groping  my  way;  but  if  to  some  I  have  prescribed  bicarbo- 
nate of  soda,  carbonate  of  magnesia,  carbonate  of  lime,  and  selt- 
zer water;  to  others  cinchona  wine,  infusion  of  quassia,  or  of 
nux"  vomica;  and  to  others  again,  opium  or  hydrochloric  acid, 
it  is  because  I  would  ascertain  in  what  cases  one  or  other  of 
these  medicines  is  more  particularly  indicated,  and  more  espe- 
cially useful.  This  premised,  let  me  now  enter  into  some  details, 
for  dyspepsia  is  a  question  on  which  it  will  be  worth  while  to 
bestow  some  pains. 

There  are  circumstances  in  which  the  physician,  furnished 
with  therapeutic  agents,  may  bring  his  patients  into  particular 
conditions  of  adjustment,  and  impress,  for  instance,  on  the 
stomach  a  co-adaptation  necessary  to  the  regularity  of  its  actions. 
The  organism  readily  accommodates  itself  to  a  new  impression. 
Man  certainly  was  not  born  under  the  50th  degree  of  latitude ; 


544  Clinical  Lecture  on  Dyspepsia.  [August, 

his  body  which  is  protected  neither  by  hair  nor  by  feathers, 
unlike  the  bodies  of  other  animals,  shows  clearly  that  it  was 
placed  at  first  by  its  Creator  under  a  sky  so  mild  as  to  render 
unnecessary  that  clothing  which,  in  oar  climate,  is  indispensable 
to  the  preservation  of  life.  When  the  earth  became  too  narrow 
for  him,  man  directed  his  steps  towards  other  regions,  and  thanks 
to  the  wonderful  aptitude  he  possesses,  after  turning  his  back 
on  equatorial  countries,  he  now  lives  under  the  pole.  As  with 
these  climatic  variations,  so  it  has  been  with  his  food ;  from  a 
regimen  the  most  elementary,  consisting  with  the  Hindoos  of 
scanty  rations  of  rice,  milk,  and  water,  man  has  at  last  arrived 
at  the  copious  table  of  the  nations  of  the  north.  Now,  what  we 
have  said  of  individuals  is  just  as  applicable  to  the  organs. 

What  is  seen  occurring  in  the  animal  on  which  there  has  been 
practised  stomachic  fistula  ?  It  is  only  necessary,  you  know, 
to  introduce  into  the  stomach  a  glass  tube  in  order  to  excite  the 
mucous  membrane  of  that  bag,  and  produce  an  abundant  flow 
of  gastric  juice.  Under  the  influence  of  such  irritation — of  this 
impression,  which  the  nerves  transmit  to  the  ganglionic  nervous 
centres — there  is  produced  an  extra  physiological  secretion  of  a 
perfectly  normal  fl  uid.  Carry  the  excitement  to  a  higher  degree, 
produce  inflammation,  and  there  is  no  longer  any  flow  of  gas- 
tric juice:  the  fistula  now  gives  exit  only  to  mucus.  But  such 
perturbations  manifest  themselves  independently  of  mechanical 
irritation.  Let  a  man  have  fever,  and  let  the  fibrile  state  be 
accompanied  with  a  certain  modification  of  the  innervation,  and 
you  have  suspension  of  the  gastric  secretion.  M.  CI.  Bernard 
has  repeated  the  experiment  a  thousand  times,  by  exciting,  in 
his  way,  fever  in  animals.  Let  the  stomach  be  no  longer  in  con- 
cert with  the  cerebral  nerves  and  brain,  let  the  pneumograstric 
nerve  be  divided,  and  the  same  instant  the  glands  of  Lieberkuhn 
become  powerless  and  inert.  If,  on  the  other  hand,  you  touch 
the  ganglia  of  the  trisplanchnicsj^stem,  that  furnish  nervous  fila- 
ments to  the  stomach,  a  phenomenon  of  another  order  arises: 
the  gastric  secretion  becomes  more  abundant.  The  results,  there- 
fore, are  thus  essentially  different  as  the  disturbance  produced  in 
the  nervous  system  has  its  seat  in  the  encephalorachidian  system, 
or  in  the  ganglionic  system. 

We  see  eveiy  day  exemplified  in  man  the  influence  which 
moral  emotions  have,  if  considerable,  after  a  repast;  indigestion 
supervenes  just  as  it  would  do  had  the  pneumogastric  nerve  been 
divided.  Long  continued  mental  affections  may  greatly  change 
the  functions  of  the  stomach;  hence  dyspepsia  is  frequently  oc- 
casioned by  sadness.  Keep  these  etiological  details  in  remem- 
brance :  they  may  be  singularly  useful  to  you  in  the  treatment 
of  an  affection  sometimes  so  obstinate,  and  which  will  form  the 
subject  of  several  of  our  conferences. 


1858.]  Clinical  Lecture  on  Dyspepsia.  545 

The  stomach  secretion  is  modified  also  by  local  pain  and  neu- 
ralgia. As  neuralgia  of  the  eye  augments,  ophthalmic  conges- 
tion increases  the  temperature  of  the  organ,  and  causes  an  over- 
flow of  tears,  so  neuralgia  of  the  stomach  brings  with  it  analog- 
ous effects,  and  exaggerates  the  acid  secretions  to  such  a  degree 
that  they  occur  not  only  during  digestion,  but  also  when  diges- 
tion is  at  an  end. 

Dyspepsia  is  observed  in  rsons  who  experience  difficul- 

ty in  evacuating  the  bowels.  Is  constipation  a  cause  or  an  ef- 
fect of  dyspepsia?  This  question  to  me  does  not  seem  of  easy 
determination  ;  for  you  may  just  as  readily  suppose  an  individu- 
al may  become  constipated  because  his  food  is  too  sparing,  as 
that  he  is  constipated  because  he  is  dyspeptic 

When  you  irritate  the  lower  extremity  of  the  large  intestine 
you  bring  on  a  diarrhoea  that  has  its  source  in  the  ileum.  The 
anal  impression  thus  communicates  itself  to  the  small  inte-- 
A  very  evident  proof  of  the  sympathy  which  connects  the  rec- 
tum with  the  other  parts  of  the  intestinal  tube  may  be  seen  in 
fact  that  an  enema  administered  after  a  meal  gives  rise  to  indiges- 
tion. A  suppository,  which  is  never  introduced  beyond  four 
or  five  centimetres,  very  often  produces  results  identical  with 
those  caused  by  the  enema.  This  at  least  is  sufficient  to  provoke 
alvine  evacuation,  at  first  of  the  form  of  the  large  intestine,  then 
demi-liquid,  and  containing  matters  in  part  from  the  ccecum  or 
last  portions  of  the  small  gut.  There  is  then  a  participation  of 
action,  a  synergia,  by  which  the  whole  muscular  apparatus  of 
the  alimentary  canal  is  preserved  in  harmony  with  the  large 
intestine.  These  considerations  conduct  you  to  an  explanation 
of  the  fact  that  constipation  may  cause  dyspepsia;  the  muscular 
apparatus  of  the  rectum,  when  this  gut  is  indolent,  contracts 
feebly,  the  movements  of  the  rest  of  the  tube  are  weakened,  and 
digestion  becomes  more  difficult.  It  is  the  reverse  of  what  takes 
place  in  diarrhoea;  so  much  is  this  the  course  of  things,  that 
with  some  patients  it  is  only  necessary  to  procure  regular  eva- 
cuations, whether  by  enemeta  or  ascending  douches,  so  as  to 
awaken  harmonious  intestinal  action,  in  order  to  cure  the  dys- 
pepsia. 

There  is  a  multitude  of  circumstances  in  which  colic  pains  are 
taken  for  stomachic.  The  transverse  colon  lies,  in  fact,  in  the 
epigastric  region,  and  is  found  in  contiguous  relation  with  the 
stomach.  To  that  organ  the  patient  invariably  refers  the  pains 
he  feels  in  this  situation — an  error  into  which  the  physician  too, 
it  must  be  remarked,  often  falls.  Of  pains  in  the  hypochondria 
the  same  thing  may  be  said ;  whether  they  affect  the  ascending 
or  the  descending  colon,  on  account  of  their  proximity  to  the 
liver  and  spleen,  they  are  confounded  with  hepatic  and  splenic 
•  mptoms, 


546  Clinical  Lecture  on  Dyspepsia.  [August, 

In  constipated  individuals,  accumulation  of  fecal  matters 
occurs  in  the  transverse  colon,  giving  rise  to  a  feeling  in  that 
part,  of  fullness  and  distension,  which  the  patient  never  fails  to 
refer  to  the  stomach,  though  innocent  of  the  evil.  It  will  not 
be  long  ere  voa  are  convinced,  if  you  interrogate  carefully,  that 
the  pains  complained  of  are  not  coincident  with  the  first  diges- 
tion, but  rather  with  the  time  when  it  is  all  but  accomplished. 
When  you  pursue  your  examination  actively,  you  discover  that 
such  individuals  are  liable  to  obstinate  constipation,  followed 
often  by  diarrhoea,  with  a  more  or  less  abundant  excretion  of 
mucus,  to  be  recognized  by  small  whitish  bands,  sometimes 
mistaken  for  fragments  of  tape-worm.  Such  persons,  in  the 
end,  have  attaeks  of  colitis,  and  of  intestinal  neuralgia,  and  are 
yet  supposed  to  suffer  from  affections  of  the  stomach — dyspep- 
sia— but,  in  its  more  general  sense,  dyspepsia  in  such  has  no 
existence.  Nevertheless,  the  attacks  of  colitis  may  give  rise 
consecutively  to  that  affection. 

Morbid  states  of  the  liver  occasion  painful  dyspepsia.  The 
hepatic  gland  has  with  the  stomach  a  relation  so  intimate,  and 
the  physiological  part  it  plays  is  of  so  great  importance  to  diges- 
tion, ihat  it  is  easy  to  see  how  disease  of  the  liver  may  influence 
the  gastric  apparatus,  and  disturb  the  course  of  its  action.  He- 
patic pains,  on  the  other  hand,  are  sometimes  mistaken  for  gas- 
tralgic  phenomena;  but  the  diagnosis  is  not  difficult.  The 
Patient  refers  all  his  sufferings  to  the  region  of  the  stomach,  but 
medical  investigations  show  that  they  extend  to  the  entire  right 
hypochondrium. 

The  uterus  exerts  on  the  stomach  an  influence  not  less  remark- 
able; and  you  know  what  perturbations  are  often  excited  in 
the  stomach  by  pregnancy,  an  ordinary  symptom  of  which  is 
vomit  ng,  in  some  cases  quite  incorrigible.  If  you  admit  the 
action  of  the  uterus,  physiologically  modified,  on  the  alimenta- 
ry canal,  you  must  also  admit  that  the  organ  of  gestation  may 
act  in  the  same  manner  when  it  is  the  subject  of  pathological 
lesions;  hence  the  dyspepsias  that  arise  in  the  course  of  leucor- 
rhcea  and  the  leading  diseases  of  the  generative  system.  The 
same,  moreover,  may  be  said  of  diseases  of  the  kidneys,  and  of 
other  organs. 

I  thought  it  would  be  interesting  to  speak  to  you  of  those  dys- 
peptic states  that  depend  upon  distinct  functional  disorders,  and 
organic  lesions.  These  dyspeptic  difficulties  always  recur  with 
increased  or  diminished  activity  of  the  movements  and  secretions 
of  the  stomach  ;  and  it  is  essential  to  establish  the  differential 
characters  that  distinguish  symptomatic  or  sympathetic  affections 
from  such  as  are  idiopathic.  For  the  latter,  address  yourselves 
to  the  stomach;  for  the  former,  }^ou  will  be  obliged  to  have  re- 
course, not  only  to  the  distant  cause,  but  also  to  the  momentary 


1858.]  Clinical  Lecture  on  Dyspepsia.  547 

morbid  phenomena,  and  the   organic  lesions.     Unless  you  do 
this,  you  will  find  therapeutics  impossible. 

At  the  beginning  of  the  present  century  gastritis  came  to 
overturn  all  our  received  notions  in  pathology.  The  celebrated 
chief  of  physiological  medicine,  exaggerating  the  facts  he  had 
observed,  and  in  his  march  retrogading  back  to  Van  Helmont, 
whose  archeeus  sat  enthroned  in  the  centre  of  the  epigastrium, 
pretended  to  establish  an  etiological  relation  between  the  mucous 
membrane  of  the  stomach  and  diseases  the  most  dissimilar  and 
discrepant,  and  would  have  inflammation  of  that  tunic  to  be  the 
source  of  almost  all  the  phlegmasia?.  You  have  no  doubt  heard 
of  the  scientific  combats  that  were  carried  on  at  that  time,  and 
the  struggles  which  that  doctrine  had  to  sustain.  Broussais, 
doubtless,  went  too  far ;  but  it  must  be  said,  also,  that  physicians 
of  the  present  day  allow  themselves  to  be  led  away  by  a  contra- 
ry exaggeration  when  they  deny  to  the  mucous  membrane  of 
the  stomach  a  capability  01  becoming  inflamed.  "Why,  then,  do 
they  admit  that  inflammation  may  attack  the  mucous  linings 
of  the  nostrils,  pharynx,  trachea,  bronchi,  uterus,  vagina,  and 
even  that  of  the  intestines?  Why,  because  Broussais  abused 
the  subject  of  gastritis.  Would  they  have  the  internal  coat  of  the 
stomach  alone  exempt?  This  is  just,  in  fact,  what  we  always 
do;  from  one  evil  we  fall  into  a  greater. 

In  vitiura  dacit  culpae  fuga  si  caret  arte. 

Gastrits,  then,  has  an  existence,  and  there  are  satisfactory- 
reasons  why  it  should.  As  the  chronic  states  is  that  in  which 
it  is  most  frequently  seen,  so  also  is  it  sometimes  masked:  but 
still  it  is  there,  and  excites  serious  disturbance  in  the  process  of 
digestion.  Under  the  influence  of  this  inflammation,  the  move- 
ments of  the  muscular  fibres  of  the  stomach  become  irregular, 
and  the  secretions  no  longer  take  place,  but  in  an  abnormal 
manner.  Hence  you  see  dyspepsia  accompanied  by  inappe- 
tency,  and  the  tongue  covered  with  a  salivarial  coating;  the 
patient  finds  his  food  taste  bitter,  nausea  occurs  after  meals, 
and  so  do  inodorous  eructations,  retchings,  and  vomiting.  Com- 
mence your  inquiries  into  the  etiology  of  this  form  of  dyspep- 
sia, and  it  will  not  be  long  ere  you  discover  that  the  origin  of  the 
disease,  its  symptoms,  and  physical  signs,  are  all  referable  to 
some  permanent  irritation;  to  chronic  grastritis.  There  is  a 
variety  of  dyspepsia,  in  which. bulimia  takes  the  place  of  inap- 
petency.  The  patient  experiences  in  his  stomach  a  constant 
feeling  of  emptiness.  Scarcely  has  he  finished  eating  ere  appe- 
tite returns  with  imperious  craving,  compelling  attention  to  its 
factitious  wants :  eructation,  flatulence,  and  constipation  are,  in 
such  cases,  exceptional  phenomena ;  but  diarrhoea  is  frequent. 
The  reason  of  this  you  will  soon  comprehend.    In  order  that 


5-iS  Clinical  Lecture  on  Dyspepsia*  [August, 

digestion  take  place  physiologically,  each  of  its  phases  must  be 
accomplished  in  a  given  time;  but  should  the  stomach  contract 
with  too  much  energy,  the  alimentary  mass  is  protruded  with 
undue  celerity  into  the  duodenum,  and  before  it  has  acquired  a 
state  of  elaboration  sufficient  for  fitting  it  for  the  second  digestion. 
The  intestine  thus  brought  into  contact  with  a  foreign  body — if 
I  may  use  the  expression — hastens  its  expulsion,  exciting  an 
abnormal  state  of  activity,  both  in  its  secretion  and  contractions. 
Hence  the  diarrhoea,  and  often,  also,  dysentery. 

Let  us  go  on  to  another  form  of  dyspepsia.  You  will  often 
be  consulted  by  individuals  whose  stomach,  after  meals,  become 
distended  with  air  to  such  an  extent  that  the  patient  has  to  undo 
his  clothes.  You  are  told  that  this  phenomenon  is  due  to  the 
rapid  fermentation  of  amylaceous  food,  or  else  to  an  abundant 
production  of  carbonic  acid,  the  result  of  fermentation  going  on 
in  the  stomachic  bag,  analogous  to  that  of  wine  in  a  vat.  But 
sucli  is  not  the  way  the  thing  occurs.  As  Graves  has  well  re- 
marked, if  you  substitute  meat  for  amylaceous  food,  the  patient 
taking  animal  food  almost  exclusively,  gas  nevertheless  appears, 
and  with  the  same  importunity.  Now,  would  you  say  in  this 
case,  that  the  gas  is  a  product  of  fermentation?  There  is  here 
a  peculiar  secretion  that  has  nothing  to  do  with  digestion  of  the 
food.  In  hysterical  women,  tympanitis  sometimes  shows  itself 
in  less  than  ten  minutes;  the  abdomen  may  be  felt  enlarging 
under  the  hand.  Assuredly  fermentation  will  not  suffice  for  the 
explanation  of  such  a  phenomenon.  Under  the  influence  of 
nervous  disorders  there  occurs  an  exaggerated  gaseous  secretion, 
which  recalls  those  other  secretions,  the  lachrymal,  salivary, 
renal,  &c,  the  quantity  of  which  is  often  extraordinary. 

These  facts  are  not  without  their  importance.  In  fact,  if  you 
reason  as  the  chemists  do,  and  consider  the  stomach  a  sort  of 
crucible,  the  excess  of  carbonic  acid  which  comes  from  the  pre- 
tended fermentation  you  must  combat  by  every  sort  of  means 
that  chemistry  affords.  Well,  I  can  tell  you  beforehand,  that, 
if  you  thus  proceed,  you  will  accomplish  nothing  to  the  purpose. 
But,  on  the  other  hand,  if  you  pursue  the  path  of  the  true  prac- 
titioner, if  you  prescribe  baths,  effusions,  a  few  drops  of  ether, 
or  any  other  means  in  which  experience  has  taught  you  to  con- 
fide, you  will  succeed  in  mastering  the  symptoms.  But  on  this 
we  shall  say  more  when  we  come  to  the  treatment. 

In  certain  cases  the  acids  of  the  stomach  are  in  quantity  enor- 
mous, and  the  patient  has  scarcely  finished  a  meal  before  he  is 
assailed  by  eructations  in  great  number,  and  so  acid  as  to  set  the 
teeth  on  edge.  There  was  lately  in  the  Salle  St.  Bernard,  ISTo. 
27,  a  young  woman,  a  prey  to  sufferings  of  this  kind.  When 
taken  with  vomiting — it  was  frequent — and  using  a  copper 
basin,  as  they  do  in  all  the  hospitals,  lactate  of  copper  was  im- 


1858.]  Clinical  Lecture  on  Dyspepsia.  549 

mediately  produced,  easily  recognized  by  its  green  color.  The 
chemists" have  not  been  behind  hand  in  endeavoring  to  find  out 
the  cause  of  this  acidity.  Ii  is  a  transformation,  say  they ,  of 
glyclose  into  alcohol,  and  of  alcohol  into  vinegar.  Unfortu- 
nately, the  explanation  falls  to  the  ground  before  the  fact  that 
the  production  of  acid  is  often  more  abundant  when  animal 
food  is  exclusively  used.  The  contrary,  no  doubt,  takes  place 
in  many  case3,  but  can  this  weaken  in  any  measure,  the  former 
results?  No;  the  acids  of  the  stomach  are  not  produced  by  a 
chymic  operation,  but  are  due  to  a  particular  secretion.  Graves 
said  in  1823,  and  Berzelius  repeated  in  1830,  that  this  acidity 
consists  principally  of  lactic  acid,  which  may  be  formed  in  no 
inconsiderable  quantities  under  the  influence  of  nervous  action 
and  excitation  peculiar  to  the  mucous  membrane  of  the  stomach. 

I  have  now  passed  in  review  with  you  various  forms  of  dys- 
pepsia. But  can  it  be  said  that  in  practice  you  will  be  able, 
with  as  much  precision,  to  seize  on  all  the  various  shades  of  the 
disease?  That  is  often  impossible.  In  order  to  convey  my 
thoughts  I  am  obliged  to  reassemble  facts,  give  form  to  state- 
ments, and  describe  genera  and  sub-genera,  but  I  express  nothing 
that  is  absolute.  Classification  is  in  natural  history  a  very  sim- 
ple thing,  and  to  take  only  an  example  from  botany,  vegetable 
spices  are  distinguished  by  well  marked  differential  characters. 
But  the  case  is  by  no  means  the  same  in  nosology.  Diseases  in 
general,  and  the  dyspepsias  in  particular,  are  far  from  being 
always  identical  with  themselves.  In  their  manifestations  there 
is  confusion  ;  they  are  crossed  one  with  another,  and  rest  on  data 
too  shifting  and  unstable  for  one  to  attempt  here  to  lay  the  foun- 
dations of  a  sure  classification.  Take  warning  then  ;  and  when, 
in  the  treatment  of  some  obstinate  case,  your  minds  are  left  to 
their  own  resources,  be  not  too  ready  to  accuse  therapeutics 
should  success  not  promptly  follow*  your  efforts ;  for  so  you 
might  soon  be  brought  to  deny  medicine  altogether,  the  worst 
evil  that  could  befall  you  in  the  practice  of  your  art.  If  on  the 
contrary,  you  bear  in  mind  this  form  of  dyspepsia  may  usurp 
the  attributes  of  another,  and  that  both  may  occur  simultaneous- 
ly, then  you  will  not  delay  having  recourse  to  the  mixed  treat- 
ment I  shall  presently  point  out  to  you.  Discouragement  will 
no  longer  then  have  any  hold  on  you. 

Dyspepsia  causes  its  influence  to  be  felt  throughout  the  whole 
system  :  a  fact  to  which  M.  Bean  was  the  first  to  direct  the  atten- 
tion of  practitioners.  He  has  shown  that  there  are  very  gener- 
ally in  dyspepsia  anaesthetic  conditions  analogous  to  those  seen 
in  many  cases  of  hysteria,  insensibility  taking  possession  of  an 
arm,  or  a  hand,  or  the  face.  Of  our  experiments  in  confirmation 
of  this  you  have  yourselves  been  witnesses;  and  you  have  seen 
me  pinch,  prick,  and  make   holes  with  a  needle  in  certain  part3 


■550  Lecture  on  Pulmonary  Hemorrhage.  [August, 

of  the  skiu,  without  the  patient  being  at  all  aware  of  what  had 
been  done,  while  the  other  parts  of  the  body  were  perfectly  sen- 
sible. Nor  do  the  moral  and  intellectual  faculties  escape  its 
influence.  The  difficulties  of  the  stomach,  moreover,  become  a 
clog  upon  labor,  interfere  with  the  exercise  of  thought,  and  pre- 
pare the  way  for  hypochondriasis.  The  various  influences  which 
dyspepsia  exerts  on  the  general  health  are  attended  with  the 
most  serious  consequences.  Thus,  disorders  of  digestion  are  a 
cause  of  imperfect  nutrition;  and  the  almost  perfect  inanition, 
which  results  from  this  state,  changes  the  composition  of  the 
blood,  and  plunges  the  patient  into  a  state  of  physiological 
wretchedness. — [Medical  Circular,  American  Med.  Monthly. 


Clinical  Lecture  on  Pulmonary  Hemorrhage.     By  Jame3  Alder- 
son,  M.D.,  Senior  Physician  to  St.  Mary's  Hospital. 

Gentlemen — There  are  at  this  time  a  number  of  cases  in  the 
wards,  which  form  a  group,  displaying  all  the  same  formidable 
symptom  of  hemorrhage  from  the  lungs.  Separately  examined, 
these  cases  will  also  afford  so  many  subjects  for  tracing  the  vari- 
ous causes  whence  that  formidable  symptom  may  arise.  I  shall 
preface  what  I  have  to  say  by  a  few  general  remarks  on  medical 
study  which  I  conceive  to  bear  especially  on  the  interesting  sub- 
ject before  us. 

There  are  two  methods  by  which  we  may  study  disease :  one 
to  consider  the  pathological  condition  of  the  organ  in  fault,  and 
having  fully  understood  it,  then  to  observe  the  various  symptoms 
consequent  on  the  pathological  change ;  the  other  is  to  bestow 
your  primary  attention  on  the  symptoms  of  the  case,  and  after- 
wards to  investigate  the  several  morbid  conditions  which  may 
give  rise  to  them.  The  first  is  a  safe  course  of  study,  in  which, 
as  diligent  pupils,  you  can  scarcely  lose  your  way.  The  second 
is  a  course  still  more  needed  for  perfect  information,  but  many 
students  fail  to  gather  the  full  reward  of  their  industry  by  becom- 
ing unduly  absorbed  in  the  contemplation  of  symptoms  ;  thus,  by 
neglecting  to  seek  for  the  original  causes,  they  will  fail  to  learn 
that  there  may  be  many  for  the  same  phenonenon.  The  danger 
of  falling  into  this  error  is  increased  by  the  mode  of  pursuing 
medical  science  continually  coming  more  in  vogue — viz.,  the  sub- 
division of  medical  labour,  leading  to  what  are  called  specialities. 
It  is  obvious  that  the  eye  long  exercised  on  given  subjects  may 
perceive  those  points  more  clearly  than  a  less  diligent  direct  organ, 
but  it  is  a  psychological  fact,  that  the  mind,-  too  much  absorbed 
in  one  limited  field  of  investigation,  becomes  narrowed  in  per- 
ception, and  incapable  of  wider  trains  of  reasoning.  Now,  we 
know   that  natural  science   is  linked  together  by  primary  laws, 


1858.]  Lecture  on  Pulmonary  Hemorrhage.  551 

some  known,  some  yet  to  be  discovered.  It  is  plain,  therefore, 
that  comprehensive  views  of  phenomena  and  their  causes  are 
needed  in  order  to  make  any  advance  towards  realizing  truth. 
In  practice,  I  would  not  deprecate  undivided  close  attention  to 
the  nature  and  treatment  of  such  organs  as  the  eye  and  ear. 
because  their  special  knowledge  and  special  manipulation  are 
required;  but  in  the  vast  subject  of  internal  disease,  the  habit  of 
taking  a  wide  view  of  all  the  distinctive  features,  and  reasoning 
on  them  as  a  whole,  cannot  safely  be  surrendered  to  the  narrower 
course  of  choosing  some  essential  but  limited  train  of  symptoms 
for  favourite  contemplation.  The  progress  of  fashion  is  unfortu- 
nately dividing  every  organ,  and  even  some  particular  derange- 
ment of  the  particular  functions  of  every  organ,  into  a  separate 
subject  for  exclusive  study.  By  this  process,  secondary  symptoms 
are  being  continually  exalted  into  primary  diseases,  tending  in 
many  cases,  to  the  neglect  of  vital  phenomena,  and  in  all  to  the 
obscuration  of  much  pathological  truth.  The  practical  result  is, 
the  adoption  and  laudation  of  specifics. 

The  second  course  of  study  which  I  have  alluded  to,  and  which 
has  given  rise  to  these  remarks  on  specialities,  is,  however,  that 
which  strictly  belongs  to  clinical  teaching.  We  will  therefore 
pursue  it,  endeavoring  to  avoid  the  error  of  classing  diseases  too 
much  by  symptoms,  and  too  little  by  the  causes. 

The  popular  view7  of  hemorrhage  from  the  lungs  refers  it  to  the 
rupture  of  a  bloodvessel ;  it  is  also  the  common  belief  that  such 
hemorrhage  is  the  beginning  of  consumption.  Now,  it  is  not 
always  the  breaking  of  a  bloodvessel ;  and  whether  it  is  or  is  not 
so,  consumption  does  not  always  follow.  It  is  not  denied,  as  we 
shall  see  hereafter,  that  hemorrage  may  take  place  from  a  ruptur- 
ed or  ulcerated  vessel  in  the  lungs,  but  this  form  of  haemoptysis  is 
the  exception  to  the  general  rule. 

Hemorrhage  from  the  lungs  most  frequently  occurs  by  means 
of  exudation  through  membranes  or  the  coats  of  vessels.  Exuda- 
tion of  blood  may  also  result  from  a  constitutional  derangement, 
of  which  I  shall  presently  describe  an  instance  in  one  of  the  cases 
before  us.  They  are  also  exceptional  cases,  the  cause  of  which  I 
shall  presently  refer  to ;  but  by  far  the  greater  number  are  to  be 
referred  to  the  existence  of  tuberculous  deposit.  It  is  not  difficult 
to  understand  how  the  presence  of  tuberculous  matter  will  cause 
blood  to  be  exuded  from  the  vessels.  As  all  the  blood  of  the 
body  has  to  pass  through  the  lungs,  for  the  purpose  of  purifica- 
tion before  being  again  transmitted  to  the  system,  it  is  plain  that 
the  presence  of  any  foreign  body  in  the  lungs  must  offer  obstruc- 
tion to  the  free  transmission  of  the  blood,  and  cause  delay  and 
congestion.  The  greater  the  quantity  of  blood  present  in  the 
lungs,  the  greater  must  be  the  necessity  of  the  presence  of  air  to 
purify  it ;  and  the   forced   accumulation   of  both  occasions   the 


552  Lecture  on  Pulmonary  Hemorrhage.  [August, 

blood  to  exude  from  the  surface  of  the  membranes  and  vessels. 
Hence  we  account,  not  only  for  the  symptom  before  us,  but  also 
for  the  dyspnoea,  or  difficulty  of  breathing.  It  must  also  be  borne 
in  mind  that  the  structures  and  vessels  are  altogether  impaired 
in  tubercular  constitutions,  and  therefore  admit  more  easily  of 
transudation. 

In  the  latter  stages  of  pulmonary  consumption,  the  hemorrhage 
results  not  only  from  exudation,  but  from  ulceration  of  smaller 
vessels  in  the  immediate  neighborhood  of  softened  tubercles.  In 
the  progress  of  the  disease  this  hemorrhage  is  small  in  quantity, 
though  frequently  repeated;  but  in  advance  cases  of  a  particular 
class  it  is  profuse  and  generally  fatal,  having  resulted  from  the 
ulceration  of  a  large  vessel.  This  lesion  is  still  essentially  differ- 
ent from  what  is  termed  the  breaking  of  a  bloodvessel,  as,  for  in- 
stance, in  the  brain  or  its  membranes,  whether  as  in  apoplexy,  or 
as  the  result  of  an  injury. 

If  we  now  briefly  review  the  general  character  of  spitting  of 
blood,  we  shall  find  that  it  occurs  under  two  forms — the  one 
severe,  the  other  slight.  In  the  first,  several  ounces  of  blood  will 
be  brought  up  at  once — six  or  seven  or  more  ounces  at  a  time. 
In  the  other,  only  specks  or  streaks  may  be  seen  in  the  expecto- 
ration ;  both  forms  being  referable  to  exudation  from  obstruction  ; 
and  although  it  is  only  the  larger  quantity  which  terrifies  the 
patient,  both  forms  equally  reveal  to  the  physician  the  existence 
of  a  diseased  condition  of  the  lungs, 

When  profuse,  the  blood  is  usually  of  a  florid  colour,  frothy 
from  the  admixture  of  air,  and  clots  of  dark  blood  will  be  occa- 
sionally spit  up,  or  sometimes  apparently  vomited,  when  a  sort  of 
convulsive  action  of  the  diaphragm  accompanies  the  expectora- 
tion of  the  blood.  A  difficulty  of  breathing  almost  universally  at- 
tends it,  as  well  as  pain,  which  is  usually  referred  to  the  sternum, 
though  sometimes  to  the  side  affected. 

You  will  now  follow  me  through  the  case  of  J.  F ,  in  Albert 

ward.  He  was  received  into  the  hospital  having  a  severe  attack 
of  spitting  of  blood,  which  had  come  on  suddenly  to  such  an  ex- 
tent, that  in  a  few  hours  he  had  expectorated  six  or  eight  ounces. 
He  was  not  in  the  slightest  degree  emaciated,  the  arms  and  chest 
being  well  covered  with  flesh ;  though  he  admitted  that  he  had 
some  slight  difficulty  of  breathing,  and  a  little  cough,  there  had  not 
been  sufficient  distress  before  the  hemorrhage  began  to  warn  him 
that  there  was  anything  wrong  within  the  chest. 

The  patient  is  twenty-one  years  of  age,  and  by  trade  a  boot- 
maker ;  and  in  the  course  of  his  employment  he  had  to  use  strong 
exertion,  and  whilst  thus  at  work  the  spitting  of  blood  came  on. 
His  pulse  was  100  in  a  minute,  but  he  had  no  fever;  his  bowels 
were  confined.  On  examining  the  chest  we  perceived  that  he 
did  not  expand  the  right  side  as  well  as  the  left ;  on  "percussion, 


1358.]  Lecture  on  Pulmonary  Hemorrhage.  55o 

at  about  a  couple  of  inches  below  the  clavicle,  over  the  upper  lobe 
of  the  lung  anteriorly,  there  was  a  decided  dullness,  very  percepti- 
ble when  compared  with  the  sound  on  percussion  on  the  left  side  ; 
some  degree  of  dullness  was  also  found  posteriorly  by  percussion. 
By  the  stethoscope  the  respiratory  murmur  over  the  left  side  was 
clear  and  good  ;  over  the  right  side,  a  crepitation  or  crackling 
over  the  upper  lobe,  together  with  here  and  there  increased  re- 
sonance of  the  voice.  For  treatment,  he  was  immediately  ordered 
a  dose  of  calomel  and  colocynth,  followed  by  sulphate  of  mag- 
nesia in  infusion  of  senna;  he  was  also  ordered  acetate  of  lead 
with  morphia,  and  diluted  with  acetic  acid  at  intervals  ;  for  drink, 
lemonade;  enjoined  perfect  rest;  simple  diet,  to  be  taken  cold. 

The  use  of  the  dilute  acetic  acid  is  to  keep  the  lead  in  the  state 
of  superacetate.  The  aperient  treatment  had  for  its  object  to 
divert  the  flow  of  blood  to  the  bowels.  When  constipation 
exists,  the  active  treatment  of  this  symptom  is  of  great  value,  and 
is  often  found  of  itself  sufficient  to  stay  hemorrhage. 

I  have  the  following  notes  of  his  state  on  the  third  day  : — 
The  pulse  still  100  in  a  minute;  the  cough  not  troublesome, 
but  still  existing.  Great  relief  had  followed  the  action  of  the 
aperient.  His  expectoration  clear  and  frothy,  but  free  from  blood. 
On  examining  the  chest  by  the  stethoscope,  the  air  was  found  to 
enter  freely  and  rapidly  on  the  left  side,  but  a  hesitation  or  delay 
occurred  to  the  passage  of  air  into  the  cells  on  the  right  side, 
conveying  an  idea  of  some  obstruction  to  its  admission,  as  if  re- 
sisted by  some  foreign  body,  the  expiratory  murmur  being  longer 
than  the  inspiratory.  The  pulse  soon  after  this  fell  to  80,  but  in 
a  day  or  two  again  rose  to  100,  when  the  expectoration  again 
showed  a  few  specks  and  streaks  of  blood.  He  complained  of 
pain  and  weight  over  the  upper  part  of  the  right  lung  where  the 
breathing  was  a  little  tubular,  indicating  again  some  consolidation 
from  tubercular  deposit.  A  few  leeches  and  a  cupping  glass  were 
applied  ;  the  aperient  was  repeated,  and  for  the  lead  were  substi- 
tuted nitrate  of  potash  and  digitalis,  with  a  view  to  act  on  the* 
kidneys,  and  to  control  the  heart's  action  ;  and  the  opiate  was 
discontinued  to  avoid  confining  the  bowels. 

This  appears  to  be  a  case  of  tubercular  deposit  in  its  earliest 
stage,  the  deposit  being  confined  to  the  right  lung,  and  being  at 
present  so  limited  in  extent  as  not  to  have  set  up  alarm  in  the  con- 
stitution, the  processes  of  nutrition  not  having  as  yet  been  inter- 
fered with.  This  man  will  be  liable  to  returns  of  haemoptysis,  the 
severity  of  which  would  probably  be  heightened  by  any  violent 
or  unusual  exertion.  He  will,  sooner  or  later  be  the  subject  of 
pulmonary  consumption.  His  intervals  of  troubled  health  will 
be  regulated  by  the  favorable  or  unfavorable  circumstances  which 
may  attend  his  life,  and  in  a  great  measure  on  the  care  and  treat- 
ment of  symptoms  as  they  arise. 


o54  Lecture  on  Pulmonary  Hemorrhage.  [August, 

A  certain  degree  of  relief  for  a  time  from  his  alarming  symp- 
toms may  result  from  the  equilibrium  of  the  circulation  through 
the  lungs  being,  in  a  measure,  restored.  It  is  possible  that  the 
tubercular  deposit  has  taken  place  rapidly,  presenting  a  sudden 
obstacle  to  the  transmission  of  blood  through  the  lungs.  A  large 
withdrawal  of  the  functional  powers  of  a  vital  organ  may  be  com- 
patible with  continued  life,  when  the  change  takes  place  gradual- 
ly, and  the  system  has  time  and  power  to  accommodate  itself; 
but  sudden  interferences  of  a  much  slighter  character  will  destroy 
life  before  the  system  has  had  time  to  accommodate  itself  to  the 
change. 

I  shall  now  direct  your  attention  to  a  case  in  which  haemopty- 
sis occurred  in  a  later  stage  of  pulmonary  consumption — that  of 

S.  B ,  in  Carlisle  ward.     This  young  woman,  aged  nineteen, 

has  been  received  into  the  house  more  than  once  during  the  last 
year,  with  symptoms  of  phthisis  so  obviously  marked  that  "he 
may  run  that  readeth."  On  receiving  partial  relief  she  has  been 
discharged.  During  her  former  admissions  there  were  some  ap- 
pearance of  spitting  of  blood,  and  this  symptom  has  now  become 
more  grave  and  constant.  The  blood  she  spits  is  still  only  small 
in  quantity  at  a  time.  It  appears  in  specks  and  streaks,  mixed 
with  much  purulent  and  offensive  expectoration.  The  blood  is 
florid.  Her  cough  is  most  distressing,  loud,  and  frequent,  and 
she  suffers  from  the  constant  effort  to  vomit  during  the  paroxysms. 
The  case  last  considered  was  one  of  obstructed  circulation  through 
the  lungs,  and  consequent  exudation  of  blood  through  the  mem- 
branes ;•  in  this  case  the  blood  is  not  only  obstructed  by  tubercu- 
lar deposit,  but  also  escapes  from  the  vessels  in  the  immediate 
neighborhood  of  the  tubercles,  the  vessels  being  perforated  by 
means  of  the  ulceration  which  has  taken  place  in  the  process  of 
the  softening  of  the  tubercles  and  the  breaking  up  of  the  lung. 
The  chest  in  this  young  woman  is  nearly  immovable,  and  to  this 
circumstance  may,  perhaps,  be  attributed  the  slow  progress  of  the 
disease.  Adhesion  of  the  lungs  to  the  chest  controls  the  move- 
ment of  the  lungs  during  respiration,  keeps  the  organ  quieter,  and 
thus  avoids  irritation  of  diseased  surfaces.  The  vomiting  is  a 
usual  and  marked  symptom  of  pulmonary  consumption.  This 
may  be  referred  partly  to  the  expectoration  dwelling  about  the 
fauces,  but  arises  chiefly  through  the  medium  of  the  association, 
by  nervous  influence,  of  the  throat,  lungs,  and  stomach,  which  is 
effected  by  the  pneumogastric  nerve,  and  is  a  reflex  act. 

In  the  treatment  of  this  form  of  hemorrhage,  palliatives  are  the 
only  resource.  Opiates  to  allay  the  irritation,  and  occasional 
local  means  to  repress  the  attacks  of  pleuritic  pain  ;  a  single  leech 
to  relieve  the  action  set  up  at  points  where  tubercular  matter 
reaches  the  pulmonary  pleura,  exciting  and  giving  rise  to  adhe- 
sion ;  or  a  liniment  of  chloroform  and  opium  may  also  be  used  to 


1858.]  Lecture  on  Arthritis.  555 

subdue  the  pain  till  adhesion  takes  place.  To  restrain  the  hemor- 
rhage, and  to  prevent  as  much  as  possible  the  offensive  charac- 
ter of  the  expectoration,  alum  is  excellent.  Creasote  is  also  found 
useful :  it  seems  especially  indicated  in  these  cases.  It  is  not  only 
a  deodorizing  agent,  but  stays  sickness,  and  seems  generally  to 
paliate  symptoms.  If  one  searches  for  a  reason  for  this  palliation, 
I  should  give  the  following :  The  lung  having  lost  its  power  from 
want  of  space  to  throw  off  the  carbon  of  the  blood,  the  oxygen 
present  during  respiration  remains  free  to  damage  the  structure  ; 
creasote.  therefore,  being  chiefly  carbon,  is  offered  to  the  oxygen, 
neutralizing  the  bad  effects  of  the  latter.  Creasote  is,  in  another 
form,  the  old  tar  water  of  the  last  century,  which  had  a  fashion 
without  an  explanation.  Many  remedies  are  taken  up  from  good 
experience,  but  laid  down  because  they  are  not  explained.  I  only 
deprecate  the  present  fashionable  quackeries,  as  cod-liver  oil,  &c, 
because  they  can  be  explained,  and  the  reason  has  been  found 
insufficient. — [Lancet. 


Clinical  Lecture  on  the  Diagnosis  of  Idiopathic  from  Rheumatic 
Arthritis,  and  the  Pathology  of  these  Diseases.  By  E.  A.  Lloyd, 
Esq.,  F.  R.  C.  S.,  Surgeon  to  St.  Bartholomew's  Hospital. 

Gentlemen — The  subject  on  which  I  wish  to  treat  to-day  in  a 
"  Clinical  Lecture,"  so  called,  is  one  on  which  a  good  deal  of 
obscurity  seems  to  hang,  yet  one  on  which  you  may  be  asked  to 
give  an  opinion  very  often. 

The  great  object  of  clinical  lectures  I  believe  to  be  to  teach 
practical  therapeutics  and  diagnosis ;  some  say  to  teach  general 
surgical  principles ;  but  these  you  will  receive  in  your  lectures  on 
"Surgery,"  and  the  less  of  sameness  and  repetition  we  have  in  a 
school  like  this  the  better.  The  subject  of  treatment — that  is  the 
corner-stone  of  all  the  edifice.  I  never  knew  a  surgeon  to  get 
on  properly  in  after-life  who  was  not  aufait  as  to  the  little  details 
of  therapeutics  and  good  general  treatment.  The  great  secret 
of  success  is  to  put  yourself  in  the  patient's  place,  and  to  treat  all 
cases  well. 

How  often  do  I  find  old  pupils  of  St.  Bartholomew's  regretting 
that  they  neglected  therapeutics  ?  Students  are,  by  the  present 
Examination  Boards,  encouraged  to  go  to  "grinders;"  encoura- 
ged, indirectly,  to  make  themselves  u  up"  on  fixed  questions  of 
delicate  anatomy  or  histology — of  no  conceivable  importance. 
But  therapeutics !  how  to  order  the  commonest  mixture  or  lotion, 
or  what  lotion  or  mixture  is  valuable  in  a  specific  surgical  case, 
is  thought  infra  dig.  It  is  when  you  have  "  passed"  the  College 
you  will  find  this.  "Clinical"  lectures  are  a  step  in  the  right 
direction ;  but,  then,  they  are  only  another  name  for  lectures  on 
v.s. — vol.  uv.  no.  vin.  29 


556  Lecture  on  Arthritis,  [August, 

therapeutics  and  diagnosis.  As  such  also  you  should  not  neglect 
them  if  you  wish  to  get  on  in  practice. 

The  case  I  propose  to  speak  of  to-day  is  one  of  what  was  called 
"Rheumatic  Arthritis,"  but  where  we  have  now  reason  to  see 
the  diagnosis  was  confused  and  uncertain  for  a  long  time — at 
least,  out  of  hospital.  The  poor  man  told  us  the  disease  commen- 
ced with  a  dull,  heavy  pain  of  the  joint,  which  led  his  surgeon  in 
the  country  to  pronounce  it  "rheumatic  ;"  a  dull,  heavy  pain  that 
prevented  him  going  about  his  work;  he  could  tell  us  very  little 
else  about  it.  About  the  end  of  August,  you  remember,  I  left 
town,  and  the  patient  was  then  under  Dr.  McWhinnie's  care. 
The  patient  was  sixty-eight  years  of  age,  and  the  disease  had  ex- 
isted fifteen  months  prior  to  admission  ;  it  was  called  rheumatism. 
An  abscess  formed  under  the  knee-joint,  which  was  discharging 
pus  profusely,  the  joint  was  swollen,  and  some  sinuses  were  observ- 
ed around  it ;  on  passing  a  probe,  I  found  necrosis  of  the  tibia — 
in  fact,  there  was  a  hole  in  the  tibia,  with  a  piece  of  loose  necros- 
ed bone.  It  was,  therefore,  very  clearly  not  rheumatic  arthri- 
tis, but  a  case,  probably,  of  idiopathic  disease  of  the  tibia.  The 
patient's  health  was  not  suffering  much,  there  was  very  little  pain. 
When  I  again  saw  him,  pus  had  got  into  the  cavity  of  the  joint, 
and  very  foetid  matter  was  let  out,  which  is  always  an  indication 
of  loose  or  diseased  bones.  How  the  case  was  mistaken  for 
rheumatism  before  it  came  to  us,  I  am  not  in  a  position  to  say. 

Well,  after  this  the  knee-joint  increased  again  in  size,  and  now 
severe  pain  also  came  on,  with  signs  of  a  new  attack  of  inflamma- 
tion. I  was  obliged  to  allow  exit  to  more  matter ;  the  man  then 
rallied,  the  fever  diminished,  but  subsequently  he  had  tedious  sup- 
puration again,  and  he  sunk.  I  dwell  on  this  case  to-day,  as  you 
all  had  excellent  opportunities  of  watching  it  from  the  time  of  its 
admission.  We  often  learn  a  good  deal  also  that  is  retained  in 
the  mind  from  errors  of  diagnosis  rather  than  from  plain  sailing. 

I  now  show  you  the  diseased  parts — and  this  is  what  I  call 
practical  diagnosis  of  cases.  The  man  died  a  few  days  ago,  and 
we  have  the  knee-joint  here  well  preserved,  and  full  of  instruc- 
tion. There  is  a  cavity  posteriorly  communicating  with  that  of 
the  knee-joint ;  the  cancellous  structure  of  the  head  of  the  lower 
bone  is  engaged,  and  even  in  the  medullary  cavity  wTe  see  here 
fragments  of  diseased  bone  ;  there  is  a  large  cavity,  in  fact,  in  the 
head  of  the  tibia ;  the  articulating  surfaces  are  destroyed,  but  the 
condyles  of  the  femur  have  escaped.  Now  this  is  a  state,  I  need 
not  tell  you,  that  we  do  not  find  in  rheumatism  ;  it  explains  the 
great  tediousness  and  intractableness  of  the  case.  Some  might 
say,  why  not  try  resections,  &c.  ?  But  mind  you.  the  man  was 
sixty-eight  years  of  age,  and  worn  down  by  suffering. 

Now,  the  diagnosis  of  rheumatic  diseases  of  joints  is  sometimes 
very  difficult.     We  have  had  some  cases  sent  into  our  surgical 


1858.]  Lecture  on  Arthritis.  557 

wards  from  medical  wards  over  the  way.  The  fever  in  these 
cases  was  so  great  that  they  misled  the  physicians;  but  they  were 
cases  of  acute  synovitis  of  the  hip-joint,  and  immediate  relief  was 
obtained  by  opening  the  joint — Mr.  Gay's  method  over  a  case  of 
a  woman.  She  went  out  of  hospital  improved,  and  entirely 
altered  for  the  better  after  this  operation.  It  is  of  course,  a  very 
formidable  proceeding,  and  not  to  be  undertaken  too  lightly;  but 
in  some  cases  the  relief  afforded  is  something  wonderful 

In  a  private  case,  not  long  ago,  treated  by  one  physician,  and 
then  by  another,  for  articular  rheumatism — for  I  do  not  know 
how  long — I  was  sent  for,  and  I  found  it  common  synovitis  with 
purulent  deposit  in  the  joint.  This  case  took  two  years,  but 
ultimately  got  well  with  stiff  joint,  better  perhaps  than  so-called 
resections  or  amputations,  and  death.  I  saw  at  once  it  had 
nothing,  in  fact,  to  do  with  rheumatism ;  it  puzzled  ihe  two 
physicians  exceedingly.  If  treated  properly  at  first,  all  such  cases 
are  rendered  more  amenable  to  professional  skill ;  this  is  what  I 
call  proper  diagnosis,  for  it  is  obvious  to  every  one  if  we  form  a 
wrong  diagnosis,  and  use  wrong  therapeutical  agents  early,  we 
only  confuse  the  case;  and  many  of  these  cases,  as  they  reach  us 
in  hospital,  are  sadly  confused.  In  a  case  at  present  in  "  Colston" 
ward,  sent  to  me  also  as  rheumatism,  the  disease  was  thickened 
periosteum  over  the  os  calcis.  I  divided  this,  and  the  patient  has 
gone  on  well.  Now  the  treatment  of  the  two  diseases  is  not  at 
all  the  same  ;  so  you  will  do  well  to  take  a  note  of  the  differences. 

The  question  you  are  all  this  while  asking  yourselves  is,  how 
is  rheumatic  to  be  diagnosed  from  common  or  idiopathic  disease 
of  articulations?  In  rheumatism  it  is  very  rare  to  find  pain  in 
one  single  joint;  there  is  also  some  history,  more  or  less  obscure, 
of  previous  rheumatism  of  various  joints,  pericaiditis,  &c,  or  of 
some  affection  probably  yielding  to  rheumatism  medicines. 
Again — rheumatism  is  very  seldom,  if  ever,  complicated  with 
suppuration  in  or  about  joints.  Rheumatism  is  also  a  very  com- 
mon disease. 

Now,  the  disease  we  are  speaking  of  is  a  very  rare  and  very 
tedious  disease.  In  diseased  bone  there  is  dull,  heavy,  protracted 
pain,  without  effusion  at  first,  but  soon  we  get  effusion  of  pus. 
Now,  I  never  saw  suppuration  in  rheumatic  disease  ;  on  the  con- 
trary, the  slightest  amount  of  idiopathic  synovitis  leads  very  often 
to  suppuration.  Again,  in  pyaemia  you  may  find  rapid  suppuration 
into  joints  and  in  internal  parts,  but  you  can  scarcely  call  them 
abscesses.  In  acute  idiopathic  inflammation,  the  cases  are  not 
so  tedious  in  their  previous  history,  as  this  form  of  disease  goes 
through  its  stages  more  quickly  than  chronic  rheumatism.  If  you 
find  "  rigors"  have  set  in,  you  may  be  almost  sure  there  is  sup- 
puration going  on,  and  that  it  is  not  rheumatism  you  have  to  deal 
with.     Anchylosis  is  very  rare,  or  entirely  unknown  in  rheuma- 


558  Case  of  Hematuria.  [August, 

tism ;  joints  get  stiff,  but  there  is  no  true  bony  anchylosis.  In 
chronic  rheumatism  of  joints,  too,  the  fibrous  and  synovial  tissues 
are  thickened,  nay,  the  cartilage  may  be  removed,  but  the  ends 
of  the  bones  do  not  anchylose — they  become  polished.  How  dif- 
ferent all  this  is  from  strumous  disease  of  joints  with  anchylosis, 
so  easily  brought  about,  I  need  not  to-day  stop  to  describe. 

I  believe  that  opening  a  diseased  knee-joint  with  pus  in  it,  is  not 
at  all  the  same  thing,  or  so  formidable  as  opening  a  healthy  knee- 
joint.  I  have  now  done  it  very  often.  I  believe  it  a  good  opera- 
tion.    A  great  deal  consists  in  a  good  diagnosis  of^the  case. 

There  are  other  forms  of  disease  that  may  be  confounded  with 
this  "Rheumatic  Arthritis;''"  I  mean  malignant  disease  of  joints. 
Here  we  have  the  well  known  cachexia,  attended  with  quick  pulse 
and  pains  at  night,  as  well  as  other  diagnostic  points  to  lead  us — 
which  time  will  not  permit  me  to  enter  into  at  any  length.  Nor 
must  we  forget  syphilitic  and  gonorrhoeal  diseases  of  joints  ;  in 
the  former,  mercury  sometimes  does  good,  but  I  think  it  does 
harm  in  other  forms  of  joint  disease.  You  will  merely  make  the 
mistake  of  confounding  these  diseases  with  idiopathic  forms  of 
inflammation;  but  you  will  do  well  to  take  care  of  "splitting  on 
the  rock"  in  your  way — rheumatic  as  compared  with  idiopathic 
'disease  of  bones  and  joints. — [Medical  Circular. 


Case  of  Hematuria,  Successful  Treatment  with  Sulphate  of  Quinia. 
Translated  from  the  April  Number  of  the  Revista  Medica  de 
lalsla  deCuba.  By  J.  F.  Grall,  M.D.,  Demonstrator  of  Anato- 
my, NewT  Orleans  School  of  Medicine. 

Being,  in  the  month  of  September  last,  in  the  district  of  San 
Anton  de  la  Negada,  a  hurried  call,  to  render  professional  assist- 
ance to  the  wife  of  an  old  acquaintance,  occasioned  the  following 
observation,  very  important  in  a  practical  point  of  view,  particu- 
larly to  physicians  practising  in  a  swampy  locality;  and  since  it 
is  a  phenomenon  only  mentioned  in  a  vague  way  by  authors,  even 
the  most  modern,  when  they  speak  of  local  affections  sustained 
by  a  miasmatic,  or  better  said,  malaric  cause,  I  shall  try  to  give 
a  clear  idea  of  the  case. 

The  patient  was  a  woman  about  thirty  years  of  age,  of  bilious 
temperament,  and  already  mother  of  five  children.  She  com- 
plained of  severe  pains  in  the  hypogastric,  lumbar  and  inguinal 
regions,  and  in  the  posterior  part  of  the  thighs.  These  pains 
were  not  continuous,  but  observed,  marked  intermissions,  which 
circumstance,  united  with  a  cessation  of  her  menstruation  for  two 
months,  made  me  suspect  a  commencing  abortion  ;  but  I  was  not 
able  to  verify  my  suspicion  by  a  vaginal  examination,  on  account 
of  the   repugnance,   sometimes   invincible,  which    most   women 


1858.]  Case  of  Hoematuria.  659 

evince  against  that  kind  of  exploration.  This  hypothesis  estab- 
lished, my  remedial  means  were  naturally  directed  towards  an 
arrestation  of  the  abortion.  I  recommended,  therefore,  absolute 
rest  in  the  horizontal  position,  evacuated  the  rectum  by  an  emol- 
lient injection,  followed  by  a  demilavement  with  ten  drops  of 
laudanum,  and  give  her  a  u  portion  calmente,"  consisting  of  aqua 
laurocerasi,  aqua  florum  aurant,  and  infusum  tilia?.  Jn  conse- 
quence of  this  treatment  the  pains  were  somewhat  relieved  ;  some- 
times they  returned  with  the  same  intensity  as  before,  to  disappear 
after  the  administration  of  the  medicine.  She  remained  in  this 
state  for  about  four  days,  when,  the  urine  which  up  to  this  time 
had  been  clear  and  normal,  began  to  have  a  turbid  aspect,  and  I 
noticed  floating  in  it  particles  of  mucus,  and  a  few  drops  of  blood, 
which  latter  gradually  increased,  so  that  three  days  afterwards  she 
discharged  almost  as  much  blood  as  urine.  Under  such  alarming 
symptoms,  I  considered  a  rigorous  examination  of  the  bladder  uf 
absolute  necessity,  to  which  the  patient  readily  submitted,  com- 
prehending the  critical  state  in  which  she  found  herself.  A  ca- 
theter introduced  found  no  obstacle,  either  in  the  urethra,  neck 
of  the  bladder,  nor  the  bladder  itself.  Although  I  endeavored  to 
arrest  this  hemorrhage  by  employing  the  different  local  and  gen- 
eral remedies  recommended  by  the  majority  of  authors,  I  produced 
only  a  palliative  effect;  from  time  to  time  the  urine  presented  a 
sanguinolent  aspect,  accompanied  by  the  inseparable  sequitus  of 
pains  above  mentioned. 

Twenty  days  had  already  passed,  and  my  patient  remained  in 
the  same  state,  with  more  or  less  prolonged  interruptions,  when 
I  decided  to  call  in  consultation  Ldo.  D.  Jose  Manuel  Xunez, 
who  has  already  practiced  twelve  years,  with  excellent  success, 
in  that  neighborhood.  I  related  to  him  the  past  and  what  I  had 
done,  to  which  he  answered,  that  in  his  long  practice,  which 
brought  him  in  contact  particularly  with  diseases  of  an  intermit- 
tent character,  and  their  larved  (masked)  types,  he  had  observed 
four  cases  altogether  similar  to  the  one  I  presented  to  him  ;  that, 
full  of  doubts  at  the  beginning  of  his  career,  he  could  not  fail  to 
recognize  the  miasmatic  element,  after  he  had  observed,  that  all 
the  patients,  who  presented  themselves  with  this  affliction,  lived 
in  swampy  localities,  and  that  consequently  he  had  recourse  to 
quinine,  always  with  very  satisfactory  results. 

I,  in  consequence,  determined  to  administer  to  my  patient  the 
sulphate  of  quinia,  not  with  full  confidence,  although  I  relied  on 
the  good  faith,  and  the  great  knowledge  of  the  medical  topogra- 
phy of  the  county  of  Guamutas,  which  my  colleague  possesses  ;  and 
not  only  for  these  reasons  was  I  determined  to  give  the  quinine  a 
trial,  but  also,  because  I  considered  the  administration  of  some 
tonic  necessary,  to  reanimate  the  failing  strength  of  a  patient  who 
had  suffered  from  a  disease  of  a  haemorrhagic  nature  during  twenty 


5  GO  Case  of  Hhematuria.  [August, 

days.  I  confess  openly,  that  I  did  not  hope  for  the  result  I 
obtained  with  a  scruple  of  sulphate  of  quinia,  associated  with 
the  extract  ol  absynthium,  divided  in  twelve  pills,  which  were 
taken  in  twenty-four  hours.  I  took  good  care  not  to  divulge  to 
my  patient  the  conposition  of  these  pills,  because,  in  spite  of  my 
short  practice,  particularly  in  this  island,  I  am  not  ignorant  of 
the  repugnance,  the  horror,  they  have  in  the  country  of  this  salt 
of  the  Peruvian  bark;  because  to  it  they  attribute  generally  the 
effect  or  consecutive  lesions  of  swamp  fevers,  which  terror  some- 
times goes  to  such  an  extent,  that  they  refuse  to  take  it  even  in 
the  most  urgent  cases,  as  they  consider  it  as  a  fire  (un  fuego) — to 
use  their  own  expression.  Unhappy  error,  that  has  conducted 
more  than  one  victim  to  the  grave! 

Two  days  after  the  administration  of  the  quinine,  I  saw  my 
patient,  and  what  was  my  surprise,  when  she  told  me  that  the 
sanguineous  fluid  had  ceased  from  the  moment  she  began  to  take 
the  pills ;  and  it  did  not  return  afterwards,  at  least  not  until  the 
month  of  December,  at  which  period  I  left  that  neighborhood. 

When  we  consider  on  the  one  hand,  the  habitation  of  our 
patient,  which  was  situated  close  to  a  swamp,  fed  by  the  over- 
flow of  a  ditch,  which  does  not  empty  itself  where  it  ought  to,  in 
consequence  of  the  embankment  of  the  railroad  of  Jucaro,  causing 
continuous  miasmatic  emanations  to  such  a  degree  that  few  per- 
sons inhabit  that  part  of  San  Anton  de  la  Negada,  without  suffer- 
ing from  some  form  of  intermittent  fever;  and,  on  the  other  hand, 
the  immediate  good  result  from  the  antiperiodic,  par  excellence, 
the  quinine — if  we  consider  these  facts,  there  remains  not  the 
least  doubt  that  the  haemorrhage,  which  might  have  carried  our 
patient  to  the  grave,  was  caused  and  sustained  by  the  malaric  or 
swampy  miasmata,  which  she  constantly  respired. 

We  believe  that  our  readers  will  find  this  observation  really 
and  trulyv  interesting,  because,  far  from  being  very  common,  I 
have  not  seen  this  occurrence  mentioned  by  any  author,  nor  even 
in  the  very  modern  work  of  Dr.  Wanderlich,  (Handbuck  der 
Pathologie  und  Therapie,  Vierter  Band  ziveite  Eadfte.  Stuttgart, 
1856.)  which  is  perhaps,  the  most  complete  treatise  on  pathology 
now  existing  in  the  field  of  science.  When  treating  of  haemor- 
rhages caused  by  intermittent  affections,  he  confines  himself  to  the 
following  words  :  "  Haemorrhages  are  very  frequent  in  malaric 
diseases.  In  more  than  half  the  cases  of  recent  intermittent 
fevers,  more  or  .less  abundant,  epistaxis  presents  itself,  and  is 
sometimes  repeated.  But  it  is  when  already  a  prolonged  cachexia 
exists,  that  with  more  certainty  these  haemorrhages  and  other  san- 
guineous extravasations  present  themselves." — [N.  0.  Med.  News. 

Dr.  Juan  C.  Oxamendi. 


1558.]  Remarks  upon  Rheumatism.  561 

Remarks  upon  Rheumatism.     By  O.  C.  Gibbs,  M.  D. 

In  the  Peninsular  and  Independent,  for  April,  Dr.  DuBois  pub- 
lishes an  interesting  and  able  Report  upon  Rheumatism,  which 
we  have  read  with  pleasure.  Its  reading  has  suggested  a  few 
thoughts,  which  we  wish  to  express,  and  that  too  in  no  spirit  of 
criticism,  influenced  only  by  the  consciousness  that  it  is  every 
man's  duty,  who  is  engaged  in  the  noble  work  of  mitigating  pain 
and  disease,  to  contribute  his  mite  to  enhance  the  efficiency  of  his 
art. 

In  regard  to  the  difference  to  be  noticed  between  rheumatic 
and  ordinary  inflammation,  Dr.  DuBois  says : 

'•  Throughout  all  this  febrile  disturbance,  there  is  no  coma,  no 
marked  trouble  of  the  stomach  or  of  the  bowels,  no  vomiting,  no 
diarrhoea,"  &c. :  "  which  it  is  fortunate  to  remember  in  some 
masked  cases  of  difficult  diagnosis." 

To  our  apprehension,  the  above  quotation  contains  an  error,  to 
which  we  are  the  more  anxious  to  call  attention,  as  Dr.  DuBois 
is  not  the  first  to  have  given  it  expression.  Vomiting  is  not  com- 
mon in  rheumatic  inflammation,  but  we  have  certainly  seen  un- 
mistakeable  cases,  in  which  vomiting  was  the  most  distressing 
symptom.  We  have  seen  vomiting  commence  almost  simultane- 
ously with  the  arthritic  inflammation,  before  any  remedies  had 
been  administered,  and  have  seen  this  symptom  persist,  in  spite 
of  treatment  for  many  days. 

Rheumatism  is  a  disease  of  such  frequent  occurrence,  so  dis- 
tressing in  its  symptoms,  so  protracted  in  its  course,  and  so  often 
fatal  in  its  consequences,  that  any  practical  remarks  in  regard  to 
its  treatment  cannot  be  deemed  ill-timed  or  out  of  place. 

In  regard  to  treatment  in  this  disease,  we  have  never  bled, 
have  never  given  emetics,  or  antimony  as  an  antiphlogistic,  and 
in  no  inconsiderable  experience,  have  never  had  reason  to  regret 
this  neglect.  Purging  with  neutral  salts  is  an  important  therapeu- 
tic measure,  but,  as  an  antiphlogistic  in  this  peculiar  form  of  in- 
flammation, we  know  of  no  compound  to  be  compared  with  calo- 
mel, opium,  and  colchicum ;  the  first  in  rather  small,  the  other 
two  in  full  doses.  These  of  course,  are  to  be  used  conjointly 
with,  or  succeeded  by,  such  other  means  as  the  peculiar  circum- 
stances of  the  case  may  demand.  Contrary  to  the  teachings  of 
some  of  our  highest  authorities,  we  have  no  hesitation  in  saying 
that  the  earlier  the  calomel  is  used  in  this  combination  the  sooner 
will  the  cure  be  effected,  and  the  less  will  be  the  liability  to  heart 
complications.  In  our  own  practice,  we  are  confident  that  endo- 
and  pericardic  complications  have  not  averaged  one  in  fifty. 

Rheumatic  inflammation  occurs  in  such  a  diversity  of  con- 
stitutions, and  of  such  varying  grades  of  intensity,  that  no  uniform 
plan  of  treatment  can  be  adopted.     We  have  certainly  seen  cases, 


562  On  Urethral  Intermittent  Fever.  [August, 

to  the  cure  of  which  quinine  and  opium  was  better  adapted,  in 
our  judgment,  than  any  other  known  combination.  In  Rheuma- 
tism, as  in  all  other  diseases,  for  their  successful  treatment,  a 
goodly  share  of  common  sense,  and  a  thorough  and  appreciative 
knowledge  of  the  principles  of  medicine  are  more  indispensible  to 
the  practitioner  than  the  best  set  formula  that  was  ever  devised. 

There  is  one  article  of  medicine  that  Dr.  DuBois  has  not  seen 
fit  to  mention,  that  in  some  forms  of  Rheumatism  is  certainly 
worthy  of  consideration.  In  chronic  forms  of  this  disease,  or  even 
in  the  acute  forms  when  convalescence  has  commenced,  the  tinc- 
ture of  cimicifuga,  combined  with  the  iodide  of  potassium  (the 
former  in  teaspoonful,  the  latter  in  from  four  to  six  grain  doses)  is 
certainly  a  remedy  of  great  efficacy.  The  good  effect  of  this 
combination  will  be  materially  enhanced  by  the  conjoint  action 
of  quinine  in  the  debilitated,  and  the  veratrum  viride  in  the  ple- 
thoric. Dr.  Davis,  of  Chicago,  Dr.  Johnson  of  New  York,  and 
others,  have  recommended  the  tincture  of  cimicifuga  even  in  the 
early  stages  of  Acute  Rheumatism  :  we  have  but  little  acquaint- 
ance with  the  remedy  as  recommended  by  them,  but,  in  circum- 
stances as  above,  we  speak  from  a  reasonable  amount  of  experi- 
ence. 

In  that  troublesome  form  of  rheumatic  disease,  denominated 
Sciatica,  we  have  succeeded  in  effecting  a  cure  with  strychnine, 
after  the  failure  of  almost  every  other  known  means. 

For  a  fuller  expression  of  our  views  of  the  pathology  and  treat- 
ment of  inflammatory  Rheumatism,  we  beg  leave  to  refer  the 
reader  to  the  American  Medical  Monthly,  for  1854,  Vol.  II.,  page 
412. — [Peninsular  Med.  Jour. 


On  Urethral  Intermittent  Fever.     By  M.  Chassaignac 

This  is  the  name  M.  de  Chassaignac  attaches  to  the  febrile 
attack  which  all  surgeons  have  observed  as  a  consequence  of 
catheterism,  and  which,  if  it  were  desired  to  indicate  the  cause 
giving  rise  to  it,  might  be  termed  cathartic  fever.  It  is  a  curious 
point  to  determine,  whether  the  contact  of  the  instrument  with 
the  entire  length  of  the  urethra  is  necessary  for  the  production 
of  the  paroxysmal  attacks,  or  whether  it  is  sufficient  for  one 
portion  of  the  canal  to  have  undergone  such  contact,  and  in  that 
case,  which  portion.  Judging  from  the  facts  known  to  him 
before  the  case  which  gave  rise  to  these  observations  came  under 
his  notice,  M.  Chassaignac  was  disposed  to  believe  that  neither 
the  membranous  nor  the  prostatic  portion  of  the  urethra  was  in 
the  portion  in  question.  Thus  he  never  met  with  an  instance  of 
such  febrile  paroxysm  being  produced  after  catheterism  in  the 
female,  nor  is  he  aware  of  any  one  who  has  ever  met  with  one. 


1858.]  Case  of  Mole,  or  False  Conception.  563 

A  natural  inference  would  be  that  it  is  not  observed  in  woman, 
because  the  paroxysm  arises  from  the  contact  of  the  instrument 
with  a  portion  of  the  urethra  which  does  not  exist  in  her.  An 
opportunity  offered  itself  for  confirming  this  conjecture,  by  the 
counter-proof  of  the  induction  of  the  paroxysm  by  the  exclusive 
catheterism  of  the  portion  of  the  uretha  which  is  proper  to  man. 
This  occurred  in  the  case  of  a  patient  suffering  from  multiple 
urinary  fistula?.  The  catheter  being  passed  from  one  of  these  to 
the  meatus,  and  back  again  from  the  meatus  to  the  fistula,  no 
difficulty  or  pain  occurring,  an  intense  intermittent  paroxysm  was 
produced.  The  patient  had  had  the  catheter  passed  before,  and 
had  borne  one  fixed  in  the  urethra  without  such  effects  having 
been  produced.  It  was  quite  certain  that  on  this  occasion  the 
instrument  had  not  come  in  contact  with  either  the  membranous  or 
prostatic  portion  of  the  urethra,  or  with  the  neck  of  the  bladder; 
and  until  further  information  upon  the  subject,  M.  Chassaignac 
feels  justified  in  localizing  in  the  bulbous  or  anterior  portion  of  the 
urethra  the  physiologico-pathological  process  which  gives  rise  to 
the  production  of  the  paroxysm  in  these  cases. — [Moniteur  des 
Hopitaux.     New  Orleans  Med.  News. 


Case  of  a  Mole,  or  False  Conception  retained  in  Utero.    By  Samuel 
B.  Clark,  M.D.,  of  Brothersville,  Geo. 

[As  cases  of  false  conception  are  very  rare  in  this  region  of 
country,  we  select  the  following  case  from  the  Nashville  Journal 
of  Medicine  and  Surgery.  The  subject  is  an- interesting  one  and 
should  elicit  more  attention  from  the  profession — as  a  more 
thorough  inquisition  into  the  nature  of  these  abnormal  bodies 
would  in  time,  doubtless  lead  to  a  detection  of  their  cause. — - 
Edts.]  t 

I  delivered  Mrs.  J.  B.,  of  a  female  child  on  the  18th  of  October, 
1857,  with  nothing  peculiar  about  the  labor,  except  perhaps  a 
little  more  difficulty  in  delivering  the  placenta  than  usual. 
Some  ten  days  afterwards  I  was  called  to  see  her,  and  learned 
that  the  lochial  discharge  had  become  pale,  as  usually  happens, 
but  that  without  any  appreciable  cause  she  had  a  return  of 
hemorrhage  again,  with  very  little  pain.  Gave  ergot  and  other 
astringents,  which  nearly  checked  the  hemorrhage,  but  in  a  few 
days  she  complained  of  heat  low  down  in  the  abdomen.  I  then 
made  an  examination  per  vag.,  and  found  a  substance  engaged 
in  the  os  uteri.  Introducing  the  fingers  still  higher  up,  I  found 
the  attachment  to  the  inside  of  the  uterus  so  slight  that  I  easily 
separated  it  and  brought  it  away.  On  examination  I  found  it 
jr.  s. — vol.  nv.   ko.  viii.  80 


564  Treatment  of  Aphonia  by  Electricity.  [August, 

to  be  a  mole  or  false  conception,  of  a  conical  or  pyriform  shape, 
about  three  inches  long  and  two  in  thickness.  It  was  smaller 
at  the  neck,  where  it  was  attached  to  the  uterus,  and  rather  more 
consistent  than  a  placenta,  with  no  regular  organization.  The 
hemorrhage  stopped,  and  she  got  well  under  the  use  of  quinine, 
iron,  etc. 

How  long  do  these  substances  remain  in  utero  usually  ?  This 
must  have  remained  nine  months  or  more,  unless  it  was  a  case 
of  superfcetation.  According  to  my  experience  they  usually 
remain  from  two  to  four  months.  It  may  not  be  amiss  to  remark 
that  this  lady  had  twins  at  her  first  confinement,  and  that  all  of 
her  sisters  who  have  had  children  have  had  twins,  so  far  as  I 
have  been  informed.  In  my  limited  library  I  cannot  find  a 
very  full  history  of  these  substances.  In  the  8th  volume  and 
467th  page  of  the  Nashville  Journal  of  Medicine  and  Surgery, 
Br.  T.  Lipscomb  gives  an  account  of  two  cases,  and  requests- 
other  physicians  to  make  inquiries  respecting  them.  His 
theory  is  that  the  continuance  of  lactation  after  conception  has 
taken  place,  will  blight  the  conception  by  abstracting  the  neces- 
sary stimuli  from  it  to  the  mammary  glands,  and  thereby  pro- 
duce a  false  conception.  In  the  case  of  Mrs.  B.,  I  do  not  think 
she  nursed  her  former  infant  until  after  conception  took  place,, 
as  it  was  eighteen  months  old  when  conception  took  place. 


Treatment  of  Aphonia  hy  Electricity. — A  case  of  aphonia  was  observ- 
ed at  the  Samaritan  Hospital,  under  the  care  of  Dr.  Savage.  A  woman, 
aged  21,  lost  her  voice  a  month  ago ;  she  thought  it  was  brought  on  by 
her  having  caught  a  cold.  The  movements  of  the  tongue  were  not  in 
the  least  impaired.  There  were  no  signs  of  inflammation  nor  of  ulcera- 
tion of  the  larynx  ;  very  little  cough,  and  some  little  pain  in  the  larynx, 
as  well  as  in  the  chest.  No  tubercular  deposits  in  the  lungs.  She  has 
always  been  regular.  Purposely^o  medicine  was  given,  but  Dr.  Savage 
asked  Dr.  Althaus  to  try  what  Faradization  might  do  for  her.  Dr.  Al- 
thaus  applied  the  current  of  the  first  order  of  his  apparatus  of  induction 
by  means  of  solid  metallic  excitors  covered  with  wet  fingers  of  gloves, 
localizing  the  electric  stimulus  in  the  inferior  laryngeal  nerve,  which 
animates  all  the  muscles  of  the  larynx  concurring  to  the  formation  of  the 
voice.  The  day  after  the  first  sitting,  which  only  lasted  two  minutes, 
the  speech  seemed  to  be  not  materially  improvd ;  but  in  the  course  of 
whispering,  sometimes  the  normal  sound  of  voice  returned.  After  the 
second  sitting  of  the  same  duration  as  above,  the  improvement  was 
striking ;  the  day  after  the  third  seance  the  patient  spoke  almost  quite 
naturally,  and  the  treatment  was  discontinued  after  another  sitting,  as 
now  the  speech  is  going  on  perfectly  well.  We  know  of  no  other  case 
of  aphonia  in  which  the  effect  of  the  electric  treatment  was  so  quick  and 
manifest,  without  having  been  connected  with  any  inconvenience  what- 
ever.   Professor  Sedillot  applied  electricity  in  a  ease  of  aphonia,  one  pole 


1858.]  Editorial  565 

being  placed  alternately  on  different  parts  of  the  tongue,  and  the  other 
one  on  the  mastoid  bone,  the  posterior  and  superior  part  of  the  neck  and 
various  points  of  the  face.  The  application  was  useful,  but  could  not  be 
repeated  until  one  week  afterwards,  owing  to  severe  headache,  which  had 
followed  the  application  of  electricity.  By  localizing  the  electric  stimu- 
lus in  the  inferior  laryngeal  nerve  no  such  inconveniences  were  produc- 
ed.— [Med.  Times  and  Gaz. 


EDITORIAL  AND  MISCELLANEOUS. 

The  Principles  and  Practice  of  Obstetrics.  Including  the  Treatment  of 
Chronic  Inflammation  of  the  Uterus,  considered  as  a  frequent  cause  of 
Abortion.  By  Henry  Miller,  M.D.,  Professor  of  Obstetric  Medicine 
in  the  Medical  Department  of  the  University  of  Louisville.  With  Il- 
lustrations on  wood.  Philadelphia :  Blanchard  &  Lea.  1858.  8vo. 
pp.  624. 

A  systematic  book  on  Obstetrics,  or  any  department  of  medicine, 
must  necessarily  be,  to  a  considerable  extent,  a  republication  of  matter 
already  in  print,  but  the  present  work  is  less  obnoxious  to  this  objection 
than  any  that  has  appeared  for  a  long  time.  Dr.  Miller  has  very  properly, 
not  deemed  it  incumbent  on  him  to  relate  every  thing  his  predecessors 
have  thought,  done  or  written.  He  quotes  when  requisite,  for  illustra- 
tion and  elucidation,  and  no  more.  He  tells  what  he  has  seen  and  done 
himself — what  others  will  meet  in  practice — the  services  they  will  be 
required  to  render — the  operations  they  will  be  called  on  to  perform. 
He  records  his  own  experience  and  practice. 

Some  treatises  are  more  extensive  and  comprehensive,  consequently 
in  some  respects  preferable  as  books  of  reference,  perhaps  as  text  books 
for  students ;  but  as  a  practical  work  very  few  are  equal  to  it,  and  none 
possess  higher  claims  to  originality.  The  author  is  an  original  and  in- 
dependent thinker — a  bold  and  able  practitioner. 

We  would  not  be  over-fastidious  or  severe,  but  we  must  acknowledge, 
we  admire  his  sound  logic,  his  plain  common-sense  instruction,  more 
than  his  occasional  sallies  of  wit  and  humor.  His  style  would  be  suffi- 
ciently interesting,  were  he  in  another  edition,  which  we  predict  will 
soon  be  demanded,  to  expunge  everything  like  a  jest,  pun,  or  other  wit- 
ticism :  his  subject  is  too  serious,  too  delicate,  and  too  important  to  ad- 
mit of  anything  ludicrous,  such  as  the  serio-comic  delivery  of  an  unfor- 
tunate half-born  baby,  by  three  persons  holding  on  to  each  other  and 
the  feet  of  the  infant,  and  "  taking  a  long  pull,  a  strong  pull,  and  a  pull 
altogether." 


566  Editorial  [August, 

He  asks  us  to  excuse  a  pun  on  his  own  name ;  we  have  to©  much  re- 
spect for  that  name  to  have  it  treated  so  lightly  :  for,  besides  the  honor 
which  his  own  well  earned  fame  has  cast  about  it,  there  are  too  many- 
tender  recollections  embalming  it,  for  it,  ever,  to  form  the  element  of  a 
jest ;  the  word  is  dear  to  us,  as  the  name  of  a  loved  and  respected  col- 
league ;  with  us  also,  it  is  hallowed,  nay  almost  sacred,  because  it  calls 
up  in  solemn  remembrance  the  lamented  image  of  one  of  Georgia's  most 
cherished  sons,  "  The  Woman's  Friend"  in  the  councils  of  our  State ; 
and  with  all  the  world,  it  must  forever  waken  painful  and  loving  remem- 
brances, as  it  reminds  us  of  the  melancholy  fate  of  one  of  Scotland's 
brightest  jewels,  her  mechanic-philosopher,  the  gifted  "  Stone-mason  of 
Cromarty,"  who 

"  Quarried  truth  all  rough-hewn  from  the  earth 
And  chiselled  it  into  a  perfect  gem." 

If  time  would  permit,  it  would  afford  us  much  pleasure  to  analyze  the 
entire  work,  and  give  the  author's  views  on  many  subjects  which,  with 
very  rare  exceptions,  we  most  cordially  approve.  His  highest  claims  to 
originality  are  based  on  his  5th  and  6th  chapters,  in  which  he  treats  of 
abortion  and  haemorrhage ;  each  of  which  published  alone  would  con- 
stitute a  valuable  monograph. 

Dr.  Miller's  method  of  treating  the  subject  of  abortion  is  novel  and 
interesting,  and  founded  on  the  most  rational  and  scientific  principles. 
We  would  not  assert  that  his  opinions  and  views  are  all  original :  they 
have  generally  been  entertained  and  expressed  by  others,  but  to  him  the 
credit  is  due  of  having  collated  them  in  such  a  manner,  from  various 
sources,  as  to  constitute  an  original  and  valuable  treatise. 

Dr.  Miller  considers  the  principal  cause  of  abortion  to  be  disease  of 
the  cervix,  which  he  believes  extends  from  the  cervical  canal  into  the 
cavity  of  the  body,  much  more  frequently  than  Dr.  Bennett  supposes, 
which  opinion  we  have  long  since  entertained  and  expressed.  In  his 
preface  he  says : 

"lam  not  aware  that  modern  improvements  in  uterine  pathology, 
resulting  chiefly  from  the  employment  of  the  speculum  uteri,  and  the 
more  rational  and  successful  treatment  of  uterine  diseases,  which  have 
followed  in  their  train,  have  hitherto  received  the  full  recognition  which 
they  deserve,  by  any  author  of  a  treatise  on  obstetrics.  Appreciating 
so  highly  as  I  do  these  advances  in  the  right  direction,  and  having  en- 
joyed such  abundant  opportunities  of  testing  their  value,  I  have  thought 
it  incumbent  on  me  to  give  them  their  rightful  place  in  this  volume,  and 
this  was  found  in  discussing  the  subject  of  abortion.  There  is  no  fact  in 
pathology,  of  which  I  am  more  thoroughly  convinced,  than  the  frequen- 
cy of  inflammation  and  ulceration  of  the  neck  and  body  of  the  uterus 
during  pregnancy,  and  I  am  as  well  persuaded  that  such  a  morbid  con- 


1858.]  Editorial  567 

dition  of  the  gestative  organ  is  among  the  most  frequent  causes  of  abor- 
tion. I  could  not,  therefore,  hesitate  to  give  to  specular  treatment  of 
the  disease  a  prominent  place  in  the  prophylaxis  of  abortion." 

Dr.  Miller  makes  the  following  very  judicious  and  practical  division 
of  the  treatment  of  abortion  : 

"The  treatment  of  abortion  may  be  divided  into  the  resistive,  ike  pal- 
liative, and  the  prophylactic — meaning  by  the  first  such  measures  as 
may  be  taken  to  avert  the  disaster  when  it  is  threatened  ;  by  the  second, 
the  conducting  of  it  to  as  favorable  an  issue  as  possible,  when  miscarriage 
is  inevitable ;  and  by  the  latter,  the  prevention  of  it  by  the  cure  of  any 
diseased  state,  which  would  be  likely  to  occasion  it  or  has  already  pro- 
duced it  in  the  previous  pregnancies  of  the  patient." 

Professor  Miller  considers  that  the  prophylactic  is  the  most  import- 
ant part  of  the  treatment,  and  that  this  consists  principally  in  treating 
the  uterine  disease,  which  is  the  most  frequent  cause.  Under  this  head 
he  gives  the  appropriate  treatment  of  inflammation  of  the  cervix,  and 
its  extension  into  the  cavity  of  the  body.  His  favorite  remedy  is  nitrate 
of  silver,  although  he  does  not  by  any  means  neglect  or  ignore  others, 
either  general  or  topical. 

In  the  treatment  of  chronic  endo-uteritis,  in  place  of  injections,  of  the 
danger  of  which  he  entertains  very  just  apprehensions,  he  proposes  to 
insert  a  strip  of  lint,  wet  with  a  saturated  solution  of  nitrate  of  silver, 
through  the  cervical  canal  into  the  cavity  of  the  body.  In  reference  to 
the  alarming  symptoms  that  frequently  follow  uterine  injections,  Dr. 
Miller  remarks : 

"  Considering  the  subject  in  all  its  bearings,  it  occurred  to  me  that  such 
sudden  and  violent  symptoms  must  be  owing  more  to  the  mode  in  which 
the  remedies  were  applied  than  to  actual  intolerance  of  the  internal  sur- 
face of  the  uterus.  Acting  upon  this  view,  instead  of  abandoning  the 
use  of  topical  remedies  altogether,  I  began  to  introduce  them  upon  strips 
of  lint,  pushed  into  the  uterine  cavity  with  a  probe  or  sound.  I  first 
applied  the  nitrate  of  silver  in  this  way,  notwithstanding  that  experience 
had  taught  me  that  a  weak  solution  of  it — two  grains  to  the  ounce  of 
water — injected  into  the  uterus,  might  be  followed  by  the  alarming 
symptoms  that  have  been  detailed.  I  used  it,  commencing  a  very  weak 
solution,  carefully  prepared  by  the  apothecary^and  finding  that  it  caused 
no  more  pain  than  an  ordinary  cauterization %i  the  os  uteri,  1  was  em- 
boldened to  make  it  stronger  and  stronger,  until  I  ceased  to  have  it  pre- 
pared by  weight  and  measure,  but  took  a  strip  of  lint,  wet  it  thoroughly 
with  water,  and  passed  the  stick  of  caustic  overit  till  it  was  imbued  with, 
as  I  judged,  a  saturated  solution.  I  have  cauterized  the  internal  surface 
of  the  womb  in  this  manner,  in  quite  a  considerable  number  of  cases, 
without  any  of  the  alarming  consequences  incident  to  intra-uterine  in- 
jection. No  practitioner  hesitates,  in  cervicitis,  to  push  the  nitrate 
crayon  into  the  neck  to  cauterize  the  whole  extent  of  its  internal  surface. 


668  Editorial.  [August, 

Experience  warrants  me  to  declare  that  we  may,  with  as  little  hesitation, 
treat  the  internal  surface  of  the  body  in  the  same  manner,  only  a  satura- 
ted solution  is  preferable  to  the  stick,  on  account  of  its  liability  to  break 
and  be  retained  in  the  cavity — -an  accident  which  sometimes  happens  in 
the  neck." 

This  is  a  valuable  suggestion  :  it  will  doubtless  be  found  an  excellent 
practice  when  that  patulous  state  of  the  os  and  cervix,  which  always 
obtains  to  some  extent  in  cases  of  endo-uteritis,  is  very  much  exagger- 
ated ;  but  I  cannot  conceive  that  it  can  possess  any  advantage  over  the 
introduction  of  the  solid  nitrate  through  the  os  internum  into  the  cavity 
of  the  body,  where  it  may  be  held  long  enough  for  some  of  the  caustic 
to  dissolve  and  diffuse  itself. 

Our  experience  differs  a  little  from  that  of  Dr.  Miller :  first,  in  that 
no  practitioner  hesitates  to  thrust  the  nitrate  crayon  into  the  cervical 
canal  in  cervicitis :  we  have  met  with  a  number  of  cases  in  which  the 
external  cervical  inflammation  had  been  successfully  treated,  while  its 
extension  into  the  cervical  canal  had  been  altogether  neglected,  from 
the  physician,  formerly  in  attendance,  hesitating  to  introduce  the  caustic 
freely  into  that  canal.  Secondly,  according  to  my  observation,  the 
caustic  crayon  when  sufficiently  large  is  not  liable  to  break  in  the  cer- 
vical canal,  and  when  it  does,  from  the  contractile  powers  of  that  canal 
it  is  promptly  expelled. 

Dr.  Miller's  remarks  on  haemorrhage  in  general  are  excellent ;  but  he 
proposes  a  new  method  of  treating  the  unavoidable,  which  if  found  on 
fair  experiment  by  other  practitioners  to  be  as  successful,  as  it  has 
proved  hitherto  in  his  own  practice,  will  be  one  of  thcgreatest  improve- 
ments in  modern  midwifery,  and  ought  to  render  his  name  illustrious. 
At  present  we  regard  it  very  favorably,  as  every  proposed  improvement 
ought  to  be,  in  a  practice,  to  say  the  least,  heretofore  very  unsatisfactory, 
but  we  are  not  prepared  to  adopt  it  to  the  full  extent  advised  by  Dr. 
Miller. 

Properly  executed  it  might  perhaps  answer  admirably  in  every  case, 
if  the  practitioner  had  charge  of  it  from  the  commencement;  but  cases 
occasionally  occur  in  which  the  labor  is  far  advanced  and  the  patient  in 
extreme  exhaustion,  wheAfirst  seen  by  the  practitioner,  in  which  I  do 
not  think  anything  can  prove  a  substitute  for  version ;  therefore,  I  can 
not  yet  confine  turning  exclusively  to  the  correction  of  malformations ; 
although  I  fully  concur  with  Dr.  Miller  that  as  an  obstetric  operation  it 
has  been  grossly  abused,  and  ought  to  be  very  much  limited  in  practice. 

Dr.  Miller  describes  his  new  method  in  the  following  extracts : 

"The  substitute  for  turning,  which  I  will  venture  to  propose,  is  a 
modification  of  the  method  of  M.  Puzos,  and  consists  in  originating  ex- 


1858.]  »  Editorial  569 

pulsive  contraction  of  the  uterus  by  the  tampon  or  plug  and  then  punc- 
turing the  membranes,  relying  on  the  tampon  to  control  the  flooding  until 
the  liquor  amnii  is  evacuated.  This  is  the  only  method  of  treatment,  of 
which  I  have  any  experience,  and  I  have  employed  it  with  uniform  suc- 
cess, so  far  as  the  mother  is  concerned.  This  is  strong  testimony,  but  it 
must  be  mollified  by  the  confession  that  my  experience,  in  placenta 
pra?via  cases,  has  not  been  large  :  yet  I  have  encountered  them  sufficient- 
ly often  to  have  acquired  some  acquaintanceship. 

'•  To  expound  this  method  of  treatment  and  at  the  same  time  vindicate 
it,  it  must  be  observed  that  the  tampon  is  preferable  to  manual  dilatation, 
as  an  oxytocic,  in  placental  presentations,  because  forced  dilation  could 
not  be  practised  without  necessarily  siill  furthur  detaching  the  placenta, 
giving  rise  to  additional  hemorrhage,  all  the  more  profuse  on  account  of 
the  non-parturient  state  of  the  uterus.  Then,  again,  such  manipulations 
would  be  objectionable  because  of  the  greatly  more  vascular  and  sensi- 
tive condition  of  the  portion  of  the  uterus  contiguous  to  the  os,  which  has 
already  been  mentioned  as  a  reason  why  delivery  by  turning  ought  to 
be  refrained  from. 

u  In  arousing  the  uterus  to  expulsive  contraction,  the  tampon  acts,  I  sup- 
pose, through  the  channel  that  has  been  more  than  once  indicated  in  the 
previous  pages  of  this  work,  viz  :  irritation  of  the  incident  nerves  of  the 
cervix,  leading  to  reflex  action  of  the  fibres  of  the  fundus  and  body.  Ex- 
plain as  we  will,  however,  the  fact  is  generally  admitted  that  the  tampon 
is  competent  to  excite  uterine  contraction  and  being  on  labor.  Should 
it  fail  (and  what  may  not  \ )  it  may  be  reinforced  by  the  puncture  of  the 
placenta,  as  recommended  by  If.  Gendrin,  which,  considered  merely  as 
a  means  of  bringing  on  labor,  is  excellent  and  wholly  unexceptionable, 
and  it  will  be  observed  that  I  am  not,  just  now.  speaking  of  the  restrain- 
ment  of  hemorrhage  but  of  the  excitement  of  labor.  No  case  can  occur, 
I  think,  in  which  the  tampon,  aided,  if  necessary,  by  puncture  of  the 
placenta,  will  fail  to  bring  on  labor,  in  a  longer  or  shorter  time,  and 
where  the  tampon  alone  is  sufficient,  and  labor  is  regularly  established  by 
its  instrumentality,  either  the  placenta  must  be  punctured  to  evacuate 
the  liquor  amnii,  or  the  finger  must  be  pushed  up  beyond  its  margin  to 
rupture  the  membranes  during  a  uterine  pain.  I  have  myself  usually 
practised  the  latter  alternative,  and  always  felt  that  my  patient  was  safe, 
when  advanced  thus  far  on  the  ft>ad  to  recovery. 

'•The  supervention  of  labor — the  evacuation  of  the  liquor  amnii — these, 
in  their  order,  are  the  great  bulwarks  of  a  flooding  woman,  no  matter 
where  the  placenta  is  implanted.  It  is  a  maxim  in  obsteterics  that  a  con- 
tracted uterus  cannot  bleed  ;  it  might,  I  think,  be  amended  and  enlarg- 
ed, by  adding  that  neither  can  a  contracting  uterus  bleed  when  it  is 
emptied  of  its  waters,  or  at  any  rate,  if  it  bleed,  the  hemorrhage  is  no 
longer  dangerous." 

In  conclusion,  we  can  only  express  our  regret  that  we  cannot  do  full 
justice  to  this  excellent  book,  by  presenting  larger  extracts,  in  an  ex- 
tended review.  We  can  only  now  say  that,  we  have  derived  much 
pleasure  and  benefit  from  its  perusal,  and  that  we  cordially  recommend 
it  to  the  profession,  both  to  practitioners  and  to  pupils.  J.  A.  E. 


570  Editorial  [August, 

The  Institutes  of  Medicine.  By  Martyn  Paine,  A.M.,  M.  D.,  L.  L.  D., 
Professor  of  Institutes  of  Medicine  and  Materia  Medica  in  the  Univer- 
sity of  the  City  of  New  York,  &c,  &c.  4th  Edition,  pp.  1095.  Harper 
&  Brothers:  New  York,  1858. 

The  above  work,  together  with  the  volumes  of  the  Medical  and  Physio- 
logical Commentaries,  and  a  pamphlet  of  Essays  on  Vitality  and  Remedial 
Agents,  was  acknowledged  in  the  last  number  of  this  Journal,  as  sent  us 
by  their  distinguished  author.  We  wish  to  notice  briefly,  at  present, 
the  "  Institutes  of  Medicine,"  regretting,  that  in  our  monthly  journal 
space  is  allowed  only  for  a  bibliographical  notice,  rather  than  for  a  re- 
view, which  the  character  of  the  work  richly  merits. 

Of  all  American  writers,  no  one  has  been  more  indefatigable  and 
laborious  than  Professor  Paine,  and  the  works  of  but  few,  either  in  this 
country  or  in  Europe,  display  a  greater  amount  of  learning  than  we  find 
enriching  both  the  Institutes  and  Commentaries  of  this  perhaps  most 
recondite  of  American  authors.  On  opening  any  of  his  works,  we  may 
be  said  to  be,  at  once  "  lost  in  a  sea  of  erudition,"  and  his  copious  refer- 
ences to  the  authors  of  every  country  and  every  language,  attest  his 
familiarity  with  the  general  literature  of  the  science  to  an  extent  rarely 
evinced  by  cis-Atlantic  writers.  Although,  in  the  beginning,  we  must 
affirm  our  thorough  dissent  from  both  the  tenor  and  the  tendency  of 
Professor  Paine's  peculiar  physiological  tenets,  we  cannot  justly  withhold 
our  cordial  recommendation  of  the  work  before  us,  as  one  presenting  a 
most  valuable  collection  of  physiological  and  medical  facts,  accompanied, 
in  many  instances,  with  very  just  commentaries  upon  the  phenomena  of 
life ;  but  we  must  say,  that  his  reflections  have  not  always  led  their  author 
to  such  principles  of  practice,  as  we  can  wholly  approve  :  for  instance — 
he  quotes,  with  approval,  a  number  of  authors  who  strongly  recommend 
profuse  bloodletting  in  typhoid  diseases,  and  endorses  Dr.  Parry  as  hav- 
ing "introduced  the  only  successful  or  philosophical  treatment,  that  of 
bloodletting,  in  purpura  hemorrhagica*  This  treatment  may  have  been 
applicable  in  some  particular  form  of  purpura,  and  in  some  peculiar 
epidemic ;  but  our  own  experience,  and  that  of  most  practitioners  of  the 
present  day,  will  attest  the  virtue  of  an  opposite  course,  and  the  extreme 
hazard  of  depletion. 

From  our  examination  of  the  work,  we  receive  the  impression  that  its 
pervading  spirit  will  be  found  expressed  in  the  first  line  of  the  initial 
page ;  "  Solidism  and  vitalism  will  form  the  basis  of  these  Institutes," 
says  our  author,  and  we  find,  upon  every  page,  that  it  is  most  uncompro- 
misingly carried  out.  Vitalism  is  for  Dr.  Paine,  the  Procrustean  bed 
upon  which  every  fact,  every  phenomenon,  and  every  medical  theory  are 
placed,  and  with  his  determined  hand  laid  upon  them,  they  are  length- 


1858.]  Editorial  DTI 

ened  or  shortened  into  a  consistency  which  is  often  almost  unanswerable. 
For  this  vitalism,  he  contends  with  the  most  unyielding  pertinacity,  and 
the  chief  objects  of  his  horror,  appear  to  be,  the  chemical  and  humoral 
doctrines,  in  whatever  form  they  may  be  presented.  To  the  humoral 
pathology  he  specially  devotes  but  a  small  number  of  pages  (about  35) 
of  the  present  work,  but  he  maintains  a  sharp  skirmishing  warfare  with 
this  class  of  medical  philosophers,  from  his  very  first  to  his  very  last 
page. 

This  vitalism,  which  in  earlier  times,  and  even  as  late  as  the  days  of 
Boerhaave  and  Cullen,  was  a  wonderful  advance  upon  the  unsettled  no- 
tions about  physiological  action,  has  become,  in  these  later  days,  when 
all  our  discussions  of  the  phenomena  of  organic  action  are  conditioned, 
by  a  definite  understanding  of  the  nature  of  the  elements  with  which  we 
deal,  too  vague  a  principle  to  "form  the  basis"  of  our  physiological  and 
pathological  reasonings.  Vitalism,  in  its  technical  sense,  has  ever  ap- 
peared to  us,  to  sustain  the  same  relation  to  medicine,  that  the  searchings 
after  the  nature  of  the  soul  do  to  theology.  The  existence  of  both  is 
evident — indeed  undeniable,  and  must  be  admitted  as  being  in  close  rela- 
tion, the  one  with  all  our  moral  and  intellectual,  and  the  other  with  all 
our  physiological  and  organic  acts,  but  still  neither  of  them,  when  we 
attempt  to  seize  upon  and  define  it,  can  be  made  the  basis  of  satisfactory 
and  conclusive  argument.  As  in  theology,  it  has  scarcely  ever  yielded 
a"hy  thing  to  investigate  the  ultimate  nature  of  the  soul,  so  in  medicine, 
beyond  the  full  admission  of  the  vital  principle  and  its  acceptance  as  a 
dominant  influence  in  all  our  organic  acts,  nothing  has  been  gained  by 
the  most  elaborate  investigation  into  the  exact  nature  of  the  force  by 
which  these  organic  acts  are  accomplished. 

Physiology,  like  all  the  other  inductive  sciences,  has  for  its  basis,  a  bun- 
dle of  facts — indeed,  in  the  present  day,  it  has  become  an  ocean  of  facts. 
These  facts,  are  of  no  one  kind  :  many,  it  is  true',  relate  to  the  nervous 
system,  and  indicate  its  sway  over  all  our  vital  acts,  but  then  others  as 
fully  shew  that  humoral,  chemical  and  atmospheric  influences  are  at 
work  in  modifying,  supplying  and  controlling  the  power  exercised  by  the 
nervous  system,  and  so  intimately  blended  here,  are  cause  and  effect, 
that  when  we  would  attempt  to  say  of  any  one  of  them,  "  here  is  the 
beginning,"  we  become  involved  in  labyrinths  interminable,  and  are 
forced  to  look  back,  to  that  Beginning  of  all  beginnings,  that  source  of 
all  power,  the  Creator  of  man  and  the  universe. 

Notwithstanding  we  have  thus  candidly  considered  those  parts  of 
Prof.  Paine's  work  which  have  appeared,  to  ws,  objectionable,  we  repeat, 
that  we  can  still  cordially  recommend  it  as  a  valuable  addition  to  the 
medical   literature  of  our  country.     In  an  age  when   Humoralism  and 


572  Editorial  [August, 

Organic  Chemistry  are  threatening  to  displace  all  other  views  of  physiolo- 
gical and  pathological  action,  this  work,  because  it  is  ultra  in  its  vitalism 
and  solidism,  must  exert  a  most  salutary  influence  upon  the  history  of  the 
medical  opinion  of  the  present,  and  the  rising  generation.  It  requires  no 
half-way  assertion  of  the  power  of  nervous  action  to  gain  its  admission  ; 
but  he  who  would  advocate  its  unmodified  sway,  as  Dr.  Paine  does, 
must  be  as  firm  and  as  uncompromising  even  as  he  has  been,  throughout 
the  comprehensive  work  before  us. 

The  present  edition  has  been  prepared,  apparently  with  great  care, 
and,  with  a  few  marring  exceptions,  the  typographical  execution  very 
well  sustains  the  reputation  of  the  Harpers.  A  most  copious  analytical 
index  much  enhances  the  value  of  the  volume,  and  attests  well,  the  per- 
severance and  industry  of  the  author. 

In  regard  to  what  may  be  called,  par  excellence,  the  controversial  por- 
tion of  this  work,  viz.,  "The  Rights  of  Authors"  in  the  appendix,  we  do 
not  intend  to  make  any  extended  remark :  For  although  some  of  Dr. 
Paine's  reclamations,  strangely  enough,  appear  to  refer  pointedly  to  the 
labors  of  one  of  the  editors  of  this  journal,  still,  printed  beside  them — on 
the  same  page,  is  the  unanswerable  decision  of  Dr.  Marshall  Hall,  the 
acknowledged  Father  of  the  great  principle  of  Reflex  action,  awarding 
the  merit  on  the  other  side,  and  declaring  that ."  the  field  is  indisputably 
His  Own."  With  his  originality  thus  asserted,  he  may  well  be  content 
to  add,  not  even  a  single  word,  for  himself,  no  matter  from  what  source 
the  denial  may  come. 

Under  these  circumstances,  we  do  not  feel  called  upon  to  select  this 
one,  from  the  thirty-nine  !  distinct  claims  recorded  in  this  appendix,  in  or- 
der to  make  it  the  subject  of  particular  discussion. 


PROFESSORIAL  CHANGES,  HOSPITALS,  COLLEGES,  &c. 
In  our  last  number,  we  recorded  several  changes  in  various  Faculties 
of  Medical  Colleges  throughout  the  United  States.     Our  exchanges  sup- 
ply us  with  the  following  in  addition : 

Professor  Daniel  F.  Wright,  the  former  able  Professor  of  Physi- 
ology and  Pathology  in  the  Memphis  Medical  College,  has  been  elected 
to  the  same  Chair  in  the  Shelby  Medical  College.  Professor  W.  is  also 
editor  of  the  Memphis  Medical  Recorder,  one  of  our  ablest  and  most 
valuable  exchanges.  We  sincerely  hope  that  his  change  of  residence 
will  not  deprive  us  of  our  valued  confrere. 

Dr.  J.  H.  B.  McClellan  of  this  city,  (Philadelphia,)  has  been  elected 
to  fill  the  vacancy  in  the  Medical  Department  of  Pennsylvania  College, 


1558.]  Editorial  573 

caused  by  the  removal  of  Dr.  T.  G.  Richardson  to  New  Orleans. — Medi- 
cal and  Surgical  Reporter. 

Dr.  Richardson  held  the  Chair  of  Anatomy  in  the  above  College. 

"Professor  S.  G.  Armor,"  says  the  K.  0.  Med.  News  and  Hos-pital 
Gazette,  u  requests  us  to  announce  his  resignation  of  the  chair  of  Path- 
ology and  Clinical  Medicine  in  the  Missouri  Medical  College  of  St. 
Louis.  Dr.  B.  L.  Jones  lias  been  appointed  to  the  vacant  chair  of  Che- 
mistry in  the  Oglethorpe  Medical  College." 

The  New  Orleans  Medical  News  and  Hospital  Gazette,  thus  re- 
gretfully refers  to  the  resignation  of  Dr.  Thomas  Peniston  from  the  chair 
of  Clinical  Medicine  in  the  X.  0.  School  of  Medicine :  "  We  are  record- 
ing an  event  which  only  gives  us  pain,  and  we  shall  do  it  in  as  few  words 
as  possible.  Impaired  health  has  forced  our  worthy  and  most  highly 
esteemed  colleague  to  tender  his  resignation,  and  he  has  gone  across 
the  water  to  seek  repose  from  his  labors,  and  that  restoration  for  which 
he  shall  have  our  heartfelt  prayers." 

Professor  Austin  Flint,  the  distinguished  author  of  Clinical  Reports 
on  Typhoid  Fever,  the  most  accurate  and  reliable  since  those  of  Louis, 
has  been  elected  to  fill  the  chair  vacated  by  the  resignation  of  Dr.  Penis- 
ton..  As  Philadelphia  has  recently  been  making  inroads  into  a  Southern 
Faculty  by  calling  Prof.  Dickson  from  Charleston,  it  seems  but  fair  that 
New  Orleans  should  make  reprisals  on  the  North  ;  this  has  been  done 
by  the  New  Orleans  School  of  Medicine  securing  Dr.  Flint  from  Buffalo, 
and  the  University,  Dr.  Richardson  from  Philadelphia.  Also,  Dr.  J.  F. 
Grail  has  been  appointed  Demonstrator  of  Anatomy  in  the  New  Orleans 
School  of  Medicine. 

L'niyersity  of  Louisville. — This  excellent  Institution  which  a  year 
ago  had  the  misfortune  to  lose  its  edifice  by  fire,  with  an  energy  truly 
surprising  and  highly  commendable  in  its  Faculty,  was  able  to  gather 
the  same  season,  quite  a  large  class.  The  following  changes  have  oc- 
curred in  its  Faculty :  Prof.  Benjamin  R.  Palmer  has  been  transferred 
from  the  chair  of  Anatomy,  so  long  and  so  ably  filled  by  him,  to  that  of 
the  Principles  and  Practice  of  Surgery ;  and  Prof.  J.  B.  Flint,  the  form- 
er Professor  of  Surgery,  occupies  the  newly  created  chair  of  Clinical 
Surgery,  while  the  chair  of  Anatomy  thus  vacated  is  filled  by  the  elec- 
tion of  Dr.  J.  W.  Benson.  Prof.  Henry  Miller  having  resigned  the  chair 
of  Obstetrics,  his  place  has  been  judiciously  supplied  by  the  election  of 
Dr.  Llewellen  Powell. 

Dr.  S.  M.  Bemis,  favorably  known  to  the  profession  by  his  contribu- 


574  Editorial  [August, 

tions  to  the  American  Medical  Association,  has  been  elected  to  the  chair 
of  Clinical  Medicine. 

The  other  members  of  the  Faculty  occupy  their  old  positions,  viz., 
Prof.  T.  S.  Bell,  Theory  and  Practice;  Prof.  L.  P.  Yandell,  Physiology 
and  Pathological  Anatomy ;  Prof.  Robert  J.  Breckenridge,  Therapeutics 
and  Materia  Medica;  and  Prof.  J.  L.  Smith,  Chemistry  and  Toxicology. 
With  the  above  excellent  organization,  the  University  may  reasonably 
expect  the  same  distinguished  success  in  her  new  edifice,  which  marked 
her  progress  in  the  old. 

Shelby  Medical  College. — The  unprecedented  success  of  the  Uni- 
versity of  Nashville,  has  encouraged  others  to  establish  a  second  Medical 
Institution  at  this  point.  The  following  gentlemen  have  been  elected  to 
fill  the  respective  Chairs : 

J.  F.  May,  M.  D.,  Principles  and  Operations  of  Surgery ;  E.  B. 
Haskins,  M.  D.,  Theory  and  Practice  of  Medicine ;  J.  P.  Ford,  M.  D., 
Obstetrics  and  Diseases  of  Women  and  Children ;  T.  L.  Maddin,  M.  D., 
Descriptive,  Histological  and  Surgical  Anatomy ;  J.  H.  Chandler,  M.  D., 
Materia  Medica  and  Therapeutics ;  R.  0.  Currey,  M.  D.,  Chemistry  and 
Medical  Jurisprudence ;  Daniel  F.  Wright,  M.  D.,  Physiology  and  Pa- 
thology ;  H.  M.  Compton,  M.  D.,  Demonstrator. 

The  circular  of  the  new  college  evinces  a  conciliatory  spirit,  and  de- 
precates strongly  any  suspicion  of  unworthy  rivalry  or  desire  to  cripple 
the  valuable  organization  already  existing  in  Nashville.  "  Its  success  is 
a  source  of  gratification  to  all  who  take  pride  in  the  public  institutions 
of  the  city  and  the  state,  and,  without  affectation,  they  desire  it  to  con- 
tinue." 

Recognizing  the  names  of  several  of  our  valued  friends  in  the  above 
Faculty,  we  can  cordially  wish  them  success;  but  with  friends  equally 
prized  by  us,  in  the  University,  that  success  could  be  no  longer  gratifying 
to  us,  should  it  be  secured  at  the  expense  of  that  noble  and  liberal  Insti- 
tution. 

Nashville  Medical  Society. — The  Physicians  of  Nashville,  Teun., 
have  recently  organised  themselves  into  a  society,  adopted  a  constitu- 
tion and  chosen  officers  for  the  current  year.  Meetings  are  appointed 
to  be  held  monthly.  Dr.  A.  H.  Buchanan  is  President,  Dr.  S.  S.  May- 
field,  Vice-President,  and  Dr.  G.  S.  Blackie,  Secretary  and  Treasurer. — 
[Boston  Med.  and  Surg.  Journal. 

Ohio  Medical  and  Surgical  Journal. — Professor  J.  M.  Hamilton  has 
become  associated  with  Prof.  John  Dawson  as  joint  editor  and  proprie- 


1858.]  Editorial  575 

tor  of  the  Ohio  Medical  and  Surgical  Journal,  published  at  Columbus  in 
that  State.— [Ibid. 

"  We  have  room  merely  to  announce,"  says  the  Medical  and  Surgical 
Reporter,  "  that  Dr.  R.  K.  Smith  has  been  re-elected  Chief  Resident 
Physician  to  the  Philadelphia  Hospital,  Blockley — thus  effectually  re- 
deeming that  Institution  from  the  disgraceful  position  which  it  has  for 
some  time  occupied."  We  learn  also  from  the  Reporter,  that  a  new- 
college  hospital  has  been  established  at  Brooklin. 


NEW  JOURNALS. 

Journal  de  Physiologie  de  l'Homme  et  des  Animaux. — We  have 
the  pleasure  of  acknowledging  the  first  number  of  this  valuable  Journal 
whose  existence  is  due  to  the  energy  and  zeal  of  the  distinguished  ex- 
perimental physiologist,  Dr.  E.  Brown-Sequard,  so  well  known  in  this 
country,  as  well  as  in  Europe.  We  believe  that  this  is  the  first,  and  at 
present  the  only  periodical  exclusively  devoted  to  that  most  interesting 
and  progressive  branch  of  Medical  Science — Physiology.  The  "  Annals 
of  Anatomy  and  Physiology,"  published  in  Edinburgh,  by  John  Goodsir, 
was  of  a  different  character,  and  so  far  as  we  know,  did  not  reach  its 
third  number.  Dr.  Brown-Sequard  is  assisted  in  his  editorial  labors  by 
Drs.  Ch.  Robin,  Ch.  Rouget,  and  Tholozan,  and  he  has  the  promise  of 
original  communications  from  many  distinguished  contributors  in 
America,  England  and  Germany. 

Besides  Physiology  proper,  the  journal  will  treat  of — 

"1.  Organic  Chemistry,  hygiene,  toxicology,  and  legal  medicine,  in 
their  relations  to  physiology. 

u  2.  Descriptive  anatomy,  comparative  anatomy,  teratology,  and  nor- 
mal and  pathological  histology,  so  far  as  they  may  be  connected  with 
physiology. 

"  3.  The  application  of  physiology  to  the  practice  of  medicine,  surgery, 
and  obstetrics. 

"The  numbers  will  be  issued  four  times  a  year — on  the  first  day  of 
January,  April,  July,  and  October — each  number  containing  about  200 
pages. 

"The  contents  will  be  classified  in  the  following  manner : — 

"1.  Original  communications,  forming  more  than  one-half  of  each 
number. 

"  2.  Articles  published  abroad,  entire  or  in  part. 

"  3.  Critical  analyses  of  books  published  in  France  and  other  countries. 

"  4.  Accounts  of  the  progress  of  physiology  in  France  and  other  coun- 
tries. 

"The  subscription  price  in  this  eountry'will  be  twenty-five  francs,  or 
$5  per  year." 


576  Editoriul  and  Miscellaneous.  [AugustT 

American  correspondents  will  please  address,  post  paid,  Mons.  J.  B. 
Baillaire,  et  fils,  or  Dr.  Brown-Sequard,  Rue  de  Dragon,  16  a  Paris. 

We  place  the  above  journal,  with  pleasure,  on  our  exchange  list,  and 
hope  to  make  it  valuable  both  to  ourselves  and  to  our  readers. 

The  Maine  Medical  and  Surgical  Reporter. — We  have  received 
both  the  first  and  second  numbers  of  the  above  promising  new  journal. 
It  is  edited  by  W.  R.  Richardson,  M.  D.  and  R.  W.  Cummings,  M.  D., 
who  are  also  the  proprietors.  It  is  published  monthly,  at  Portland,  by 
Sanborn  &  Carter.  Both  numbers  are  filled  with  valuable  matter,  ori- 
ginal and  selected,  and  the  typographical  execution  and  style  of  the 
journal  does  credit  to  both  the  editors  and  the  publishers.  We  welcome 
the  new  comer  to  our  sanctum,  and  with  pleasure  place  it  among  our 
exchanges. 


Symmetrical  Morbid  Action. — We  copy  the  following  from  the  Buf- 
falo Medical  Journal.  The  fact  is  certainly  worthy  of  record,  however 
darkly  hidden  may  be  the  explanation. 

Lockport,  May  31st,  1856. 
Prof.  Hamilton  : 

Dear  Sir, — I  send  you  the  following  report  of  a  case  that  occurred  in 
my  practice,  and  which  may  possess  interest  enough  to  entitle  it  to  a 
more  extended  publicity.     You  are  at  liberty  to  do  with  it  as  you  see  fit : 

In  the  summer  of  1853,  Mr.  Monroe  Levally,  wagon-maker,  age  46, 
called  at  my  office  and  requested  me  to  examine  his  arm.  I  did  so,  and 
found  immediately  over  the  point  of  the  olecoron  process  an  encysted 
tumor  of  the  size  of  a  robin's  egg,  and  which  made  its  appearance  a  few 
days  previous.  I  made  a  few  incisions  in  the  sack  with  an  abscess  lancet, 
and  obtained  about  3iii.  of  a  thick  fluid.  Introduced  into  the  sack  a 
pledgit  of  lint,  and  in  a  few  days  a  perfect  cure  was  effected. 

But  the  next  week  I  was  not  a  little  surprised,  when  he  returned,  with 
another  tumor  on  the  other  arm,  an  exact  counterpart  of  the  previous 
one  in  every  particular.  It  made  its  appearance  in  the  same  manner ; 
in  locality  it  was  the  same,  (except  on  the  other  arm,)  of  the  same  size 
and  form.     I  treated  in  the  same  manner,  and  the  result  was  the  same. 

How  far  this  goes  to  prove  the  existence  of  a  sympathetic  action  be- 
tween the  corresponding  points  of  the  human  system,  we  leave  for  others 
to  decide ;  but  it  does  certainly  go  far  to  prove  that,  under  certain  cir- 
cumstances, one  elbow  at  least  has  some  sympathy  with  the  other. 

Yours,  ever,  A.  M.  Leonard. 

Dr.  Elint, — "Symmetrical  diseases"  are  known  to  occur  often  in 
eruptive  affections,  and  occasionally  in  rheumatic  and  syphilitic  affections, 
but  this  is  the  only  example  which  I  have  known  where  an  encysted 
tumor,  or  a  true  tumor  of  any  kind,  has  illustrated  this  curious  law  of 
affinities  between  opposite  portions  of  the  body. 

Yours,  F.  H.  Hamilton. 


1858.]  Miscellaneous.  577 

Pertussal  Glucosuria. — In  the  }Tear  1855,  the  fact  was  first  pointed 
out  by  Dr.  Gibb,  that  the  urine  in  almost  every  case  of  hooping-cough  is 
saccharine,  the  quantity  of  sugar  varying,  generally  but  small,  and  some- 
times a  trace  only  being  present.  A  considerable  quantity  he  has,  how- 
ever, found  on  several  occasions,  the  specific  gravity  being  at  the  same 
time  high,  and  in  general  characters  the  urine  has  been  similar  to  that 
of  diabetes.  A  case  of  pertussis,  with  urine  in  this  last  condition,  was 
recently  under  Dr.  Gibb's  care,  at  the  St.  Pancras  Royal  Dispensary,  in 
a  child  of  six  years,  who  had  reached  the  spasmodic  stage  of  the  com- 
plaint, without  any  complication,  unless  the  glucosuria  be  considered  as 
such.  The  remarkable  feature  of  this  case  was  the  rapidity  with  which 
the  quantity  of  sugar  diminished  under  the  usual  plan  of  treatment  re- 
commended by  Dr.  Gibb  in  this  disease — namely,  nitric  acid  in  large 
doses.  The  specific  gravity  of  the  urine  became  lower,  the  quantity  of 
sugar  diminished,  and,  as  a  cure  was  established  within  three  weeks,  not 
a  trace  of  it  was  to  be  found.  It  is  an  interesting  fact,  that  nitric  acid 
should  so  rapidly  diminish  the  glucosuria.  This  may  be  effected  in  one 
of  two  ways — either  by  its  curing  the  purtussis,  and  a  condition  with  it, 
which  must  hereafter  be  looked  upon  as  symptomatic  of  it;  or  else  the 
assimilation  of  the  acid  prevents  the  formation  of  the  sugar.  To  the  last 
view  Dr.  Gibb  inclines,  but  he  says  large  doses  only  will  produce  this, 
as  experience  has  proved  in  his  hands.  This  condition  of  the  urine  in 
hooping-cough  is  well  worthy  of  record.  We  shall  refer  at  a  future  time 
to  the  explanation  given  of  its  appearance,  but  we  take  this  opportunity  of 
throwing  out  the  suggestions  of  a  trial  of  the  influence  of  nitric  acid  in 
cases  of  diabetes  mellitus. — [Lancet. 


New  Method  of  Amputation. — M.  Maisonneuve  read  lately  a  paper 
before  the  Academy  of  Sciences  of  Paris,  on  a  new  method  of  amputa- 
tion, which  he  calls  the  diaclastic  method.  It  consists  of  a  contrivance 
for  fracturing  the  bone  at  the  precise  point  required  ;  after  which  the 
muscles  are  strongly  compressed  by  mechanical  means,  so  as  to  reduce 
them  to  small  diameter.  They  are  divided,  and  the  member  separated 
from  the  trunk.  In  consequence  of  the  compression,  all  hemorrhage  is 
effectually  prevented.  M.  Maisonneuve  quoted  six  cases  of  amputation 
by  this  astonishing  procedure — five  of  the  leg,  and  one  of  the  arm  ;  in 
all  of  which  complete  cures  were  effected.  No  unsuccessful  cases,  he 
says,  have  occurred  to  him. — [Lancet. 


"The  Sands  of  Life11  "Played  Out."— Under  this  caption  the  New 
York  Times  gives  an  account  of  the  legal  means  lately  adopted  in  that 
city  to  put  a  stop  to  the  disgraceful  system  of  quackery  for  some  years 
carried  on  by  a  reckless  swindler  representing  himself,  in  his  advertise- 
ments, as  a  physician  "  whose  sands  of  life  have  nearly  run  out."  It 
seems  that  he,  with  other  quacks  of  the  same  sort,  have  been  arrested, 
and  the  letters  which  are  daily  flowing  into  them  by  mail  are  sent  on  to 
the  Dead  Letter  Office  at  Washington,  whence  the  money  contained  in 
them  will  be  returned  to  the  deluded  victims  of  this  last  and  boldest  of 
the  medical  humbugs. — [Boston  Med.  and  Surg.  Journal. 


578  Miscellaneous. 

Glycerine  with  Alum  and  White  Precipitate. — Dr.  Anciaux  recom- 
mends the  following  formula  in  the  local  treatment  of  erysipelas,  obstinate 
eczemas  and  atonic  ulcers  :  alum,  in  impalpable  powder,  30  parts;  white 
precipitate,  1  part.  Triturate  them  well  together,  put  them  in  a  phial 
and  add  glycerine,  90  to  100  parts.  Shake  the  phial,  until  the  mixture 
assumes  the  consistence  of  cream,  each  time  it  is  applied. — [Ibid. 


Painless  Caustic. — M.  Piedagnel,  after  various  trials,  has  succeeded  in 
producing  a  caustic  that  may  be  employed,  causing  little  or  no  pain.  It 
is  formed  of  three  parts  of  the  Vienna  caustic  in  powder  and  one  part  of 
hydrochlorate  of  morphia,  intimately  mixed  together,  and  then  made 
into  a  thick  paste  by  means  of  chloroform,  alcohol,  or  water.  It  is  ap- 
plied to  the  skin  on  diachylon.  A  black  eschar  is  produced  in  fifteen 
minutes,  increasing  in  thickness  with  the  duration  of  the  application. 
The  morphia  mixed  in  the  same  proportion  with  powdered  cantharides, 
prevents  pain  during  the  rising  of  a  blister.  M.  Piedagnel,  who  at  present 
has  only  used  this  means  for  the  production  of  issue  and  blisters,  states 
that  the  action  of  the  morphia  is  merely  local. — [Druggists''  Circular. 


A  Specific  for  Scabies. — At  the  last  meeting  of  the  Academy  of  Scien- 
ces, Paris,  M.  Bonnet  ofEpinal,  sent  in  a  paper  announcing  that  benzine 
is  a  specific  for  the  itch.  The  author  of  the  paper  states  that  if  benzine 
be  rubbed  on  the  parts  affected,  and  also  very  slightly  on  the  other  parts 
of  the  body,  a  cure  will  be  effected  in  the  course  of  five  minutes,  after 
which  time  the  patient  may  take  a  warm  bath  for  half  an  hour.  Never- 
theless, in  cases  where  the  itch  is  accompanied  with  a  secondary  eruption, 
the  latter  will  require  a  separate  treatment. — [Ibid. 

Hydrocele  treated  by  Electricity. — Rodolfi  of  Milan,  has  applied  elec- 
tricity for  the  cure  of  hydrocele  in  four  cases,  and  reports  very  favorably 
concerning  its  effects,  not  only  the  fluid  disappearing  in  all,  but  its  re- 
production being  prevented  in  three  of  the  cases.  Bunsen's  or  better 
still,  Daniel's*  pile  should  be  employed. — [Ibid. 

New  local  application  in  Erysipelas. — M.  Anciaux  speaks  in  high 
terms  of  the  following  application  for  erysipelas  and  some  other  cutane- 
ous affections.  Alum  reduced  to  impalpable  powder,  30  parts ;  white 
precipitate,  1  part.  Rub  up  well  together,  and  place  the  powder  in  a 
bottle,  and  then  add  from  90  to  100  parts  of  glycerine.  Shake  the  bottle 
until  the  mixture  assumes  a  creamy  consistence,  and  repeat  the  shaking 
whenever  the  application  is  about  to  be  employed. — [Ibid. 

Infants  found  dead  in  bed,  are  not  generally  killed  by  being  laid  on 
by  their  mothers,  but  by  being  suffocated  under  the  bedclothes,  with 
carbonic  acid  gas  exhaled  from  their  own  lungs  and  re-inspired.  They 
die  without  pain,  in  a  profound  sleep.  Mothers,  give  your  babes  more 
air.  Let  them  sleep  with  their  heads  uncovered.  Do  not  let  them  go  to 
sleep  on  or  under  your  arm,  for  when  you  cover  yourselves,  in  the  half 
unconciousness  of  partial  sleep,  you  will  cover  your  darlings'  heads  also, 
and  in  the  morning  may  find  them  still  in  sleep — a  sleep  from  which 
your  caresses  cannot  awake  them. — [Pacific  Med.  and  Surg.  Journal. 


SOUTHERN 

MEDICAL  AND  SURGICAL  JOURNAL 


(NEW  SERIES.) 


Vol.  XIV.]  AUGUSTA,  GEORGIA,  SEPTEMBER,  1858.  [No.  9. 

ORIGINAL  AND  ECLECTIC. 

ARTICLE    XXX. 

Observations  on  Malarial  Fever.  By  Joseph  Jones,  A.M.,  M.D., 
Professor  of  Physics  and  Natural  Theology  in  the  University 
of  Georgia,  Athens;  Professor  of  Chemistry  and  Pharmacy  in 
the  Medical  College  of  Georgia,  Augusta ;  formerly  Professor 
of  Medical  Chemistry  in  the  Medical  College  of  Savannah. 

[Continued  from  page  538  of  August  No.  1858.] 

Section  II.— Remittent  Fever. 

In  the  preceding  articles  upon  Intermittent  fever,  but  few 
comparisons  were  made — but  few  conclusions  drawn.  A  simple 
statement  of  the  phenomena  was  made,  and  they  were  placed 
in  a  situation  for  future  analysis  and  comparison. 

A  similar  course  will  be  pursued,  with  Remittent  and  Con- 
gestive fevers. 

When  we  have  examined  the  phenomena  of  the  varieties  of 
Malarial  fever,  then  analysis  and  comparison  will  be  instituted: 
then  the  similar  will  be  combined,  and  the  dissimilar  separated; 
and  thus  we  will  endeavor  to  establish  the  relations,  or  laws,  of 
the  phenomena  of  Malarial  fever. 

Our  knowledge  of  Malarial  fever,  and  in  fact,  of  all  fevers,  is 
imperfect*.  Many  phenomena  have  never  been  analyzed,  and 
it  is  probable  that  there  are  many  which  have  escaped  observa- 
tion entirely.  It  is  necessary,  therefore,  that  we  should  proceed 
upon  the  strict  principles  of  induction. 

We  must  establish  a  true  knowledge  of  Malarial  fever,  in  the 

X.  8. VOL.  XIV.    NO.  IX.  31 


580  Jones,  on  Malarial  Fever.  [September, 


same  manner  that  all  sciences  have  been  constructed.  By  ob- 
servation, experiment  and  reason,  facts  must  be  observed,  re- 
corded, accumulated,  compared :  complex  phenomena  observed, 
recorded,  analyzed,  decomposed,  and  their  component  elements, 
arranged  and  compared:  the  errors  of  the  senses  corrected, 
and  thus  fundamental  laws  or  relations  established. 

By  analyzing  phenomena,  and  connecting  them  by  the  natural 
relations  of  succession  and  resemblance,  fixed  laws  or  relations 
are  discovered. 

The  end  of  knowledge  is  fore-sight,  fore-knowledge;  and 
when  perfected,  it  will  enable  us  to  predict  with  absolute  cer- 
tainty the  future  course  of  events. 

Thus  the  great  object  of  the  Astronomer  is  to  determine  the 
fixed  relations  or  laws  of  the  universe,  so  that  the  precise  condi- 
tion of  the  heavenly  bodies,  at  any  future  time,  may  be  deter- ., 
mined  with  absolute  certainty. 

The  great  object  of  the  Physician,  should  be  to  determine  the 
fixed  relations  or  laws  of  the  animal  economy,  and  the  definite 
action,  constitution,  and  relations  of  morbific  and  remedial 
agents,  so  that  he  may  be  able  to  predict  the  results  of  the  ac- 
tions of  these  agents,  and  also  to  control  and  direct  their  action. 

This  is  our  object  and  this  our  method.  But  our  instruments 
and  means  of  investigation  have  been  imperfect.  The  pheno- 
mena themselves  were  obscure,  and  it  is  probable  that  many,  of 
great  importance,  entirely  escaped  our  observation. 

Imperfections  of  the  senses,  imperfections  of  the  mental  facul- 
ties, imperfections  in  our  materials  and  instruments,  of  experi- 
ment and  analysis,  will  necessarily  render  the  results  imperfect. 

My  object  is  to  assist  in  the  establishment  of  the  truth,  and  it 
is  my  fervent  hope,  that  whatever  results,  relations,  or  laws,  I 
may  deduce  from  these  observations,  will  be  tested,  and  weighed 
by  careful,  conscientious  observers.  Thus,  we  hope,  that  in 
time,  the  errors  will  be  eliminated,  the  imperfections  removed, 
the  results  enlarged,  and  the  truth  established. 

Case  XXIII. — English  seaman :  age  25,  weight  140,  height 
5  feet  6  inches ;  black  hair ;  florid  complexion.  Sailed  from  New 
York  to  Darien,  Georgia.  Eemained  in  Darien  five  days ;  dur- 
ing which  time,  he  slept  on  board  the  vessel,  lying  in  the  Alta- 
maha  river.    Sailed  from  Darien,   and  arrived  in  Savannah 


1858.] 


Jones,  on  Malarial  Fever. 


581 


twelve  days  ago.  During  the  day  has  been  running  on  a  steam 
tug,  up  and  down  the  Savannah  river,  from  its  mouth  to  the 
city,  and  has  slept,  during  the  night,  on  the  bay.  Was  taken 
with  a  chill,  September  6th,  10  o'clock  A.  M. 

September  10th,  7  o'clock  P.  M.  Took  salts  and  senna,  this 
morning.  This  operated  five  times.  Has  taken  no  other  medi- 
cine. Pulse  90,  full;  respiration  48,  panting,  thoracic.  Tem- 
perature of  atmosphere,  80°  F. ;  Temp,  of  hand,  103° ;  Temp, 
under  tongue,  105°.  Tongue  pointed  and  red  at  tip  and  edges, 
superior  portion  coated  with  black  fur;  skin  dry.  Complains 
of  great  thirst  and  pain  in  his  head.     Face  flushed. 

September  11th,  11  o'clock  A.  M.  Pulse  88;'  respiration  la- 
bored, thoracic,  panting,  irregular,  varying  from  34  to  40.  Tem- 
perature of  atmosphere,  82°  F. ;  Temp,  of  hand,  103°25';  Temp, 
under  tongue,  105°.  Says  that  he  did  not  rest  well  last  night, 
and  complains  of  great  pain  in  his  head.  Intellect  clear.  Has 
been  vomiting  yellow  and  green  matters.  Bowels  have  not  been 
moved  during  the  night.  Skin  dry  and  harsh  to  the  feeling. 
Tongue  red,  dry  and  glazed.  To  the  finger  the  tongue  feels  as 
dry  as  the  skin.  The  state  of  the  tongue  would  lead  us  to  sus- 
pect tenderness  of  the  epigastrium,  but  there  is  none.  Complains 
of  great  thirst ;  says  that  he  felt  very  cold  and  weak  this  morn- 
ing at  5  o'clock.  The  nurse  states  that  at  this  time  his  pulse 
was  65,  and  his  skin  cool.  $.  Sulphate  of  quinia,  grs.  v.  every 
three  hours,  up  to  grs.  xxxv. 

If  the  stomach  rejects  the  sulphate  of  quinia,  administer  the 
following  injection: — $.  Sulphate  of  quinia,  grs.  xx.;  Starch, 
f^ij.;  Tincture  of  opium,  n\  x.  Mix.  Eepeat  in  three  hours. 
$.  5  cut  cups  to  epigastrium.  $.  Soda  powders.  Diet,  gruel 
and  flax  seed  tea. 


grams, 


8160 

12240 

510 


Amount  of  Urine  passed  during  the  last  16  hours, 
"         "       "     calculated  for  24     " 

"         "       "     excreted  hourly,         - 

Urine  clear,  high  colored,  like  new  Madeira  wine.  Specific 
gravity  1020.  Reaction  decidedly  acid.  After  standing  40 
hours,  threw  down  a  small  deposit  of  regular  prismatic  crystals 
of  triple  phosphate  and  vegetable  cells. 


Calculated  am't  of  Urine 
for  24  hours,  grs.  12240, 
contained  grains, 


ANALYSIS  XXXVII. 


Water 

Solid  matters, 

Urea, 

Uric  Acid, 

Extractive  <fe  coloring 

matters, 
Fixed  saline  constituents 


Urine  excreted  in 
16  brs.,  grs.  8160, 
contained  erains, 


7618-696 

54U3C4 

349*200 

3-200 

168-533 

20-160 


11428-044 

811-956 

523-800 

4-800 

252-805 

30-240 


1000  pta. 
contained 


933-664 

66-336 

42-593 

0-393 

20-673 

2  475 


582 


Jones,  on  Malarial  Fever. 


[September, 


Sept.  11th,  7  o'clock  P.  M.  Patient  is  not  so  restless — has  an 
inclination  to  sleep,  and  his  intellect  acts  more  slowly  than  nor- 
mal. Tongue  moister  than  this  morning,  but  still  much  dryer 
than  normal ;  free  extremity  of  the  tongue  clean  for  one  inch 
from  the  tip ;  this  portion  is  as  red  as  scarlet;  the  remainder  of 
the  tongue  is  coated  with  dark  fur.  The  nurse  states  thatr 
"  after  the  application  of  the  cut  cups,  his  skin  began  to  moist- 
en— he  became  much  more  quiet,  and  went  to  sleep."  Skin 
moist,  but  hot;  slight  tenderness  upon  pressure  of  epigastrium; 
lips  dry,  and  coated  at  the  edges  with  yellow  matter.  Pulse  90; 
respiration  40  to  44,  panting,  thoracic,  irregular — every  15  or  20 
respirations,  he  draws  a  long  sigh,  inflating  his  chest  to  its  ut- 
most capacity.  Temperature  of  atmosphere,  81°  F. ;  Temp,  of 
hand,  104°  ;  Temp,  under  tongue,  104°  8'. 

Bowels  have  not  been  moved.     Has  taken  20  grains  of  the 
sulphate  of  quinia. 

ty.  Stop  sulphate  of  quinia,  and  give  soda  powders, 
as  fever  remits,  commence  with  sulph.  of  quinia,  grs 
three  hours,  up  to  grs.  xv. 

Urine  high  colored,  clear;  reaction  decidedly  acid, 
gravity  1019*6.     After  standing  30  hours,  let  fall  a  small  depos- 
it of  vegetable  cells,   and  prismatic  crystals  of  triple  phosphate 
and  globulo-acicular  crystals  of  urate  of  soda. 

Amount  of  Urine  excreted  in  8  hours,      -        -  grains, 
Calculated  amount,     "        "  24     "          -  " 

Amount  "        "  hourly,         -  " 

Amount  of  Urine  excreted  in  the  last  24  hours,  " 

"         "       "  "     hourly,      "     "      "     -  " 


As  soon 
v.  every 

Specific 


5098. 
15294. 

637.2 
13258. 

552.4 


ANALYSIS  XXXVIII. 

Urine  excret- 
ed in  8  hours 
grs.  5098  con- 
tained, grains 

Calculated 
am't  Urine  for 
24  hours,  grs. 
15294  cont'nd 
grains 

1000  parts 
of  Urine 
contained 

Urine   excret" 
ed  in  the  last 
24  hours,  grs. 
13258  cont'nd 
grains 

Water 

4764-865 

333*135 

223-000 

1-450 

90210 

18*325 

14294-595 

999*405 

669-000 

4-350 

270-630 

54*975 

934-652 

65-348 

43-722 

0-284 

17-707 

3-595 

12383-561 

Solid  Matters 

874*439 

Urea , 

572-30O 

Uric  Acid 

4-650 

Ext.  and  Col'ing Matters. 
Fixed  Saline  Constituents 

258-743 
38-485 

A  comparison  of  this  analysis  with  the  preceding  one,  shows 
that  the  uric  acid  was  below  the  standard  of  health,  when  the 
patient  was  entirely  free  from  medicine,  and  that  under  the  ac- 
tion of  the  sulphate  of  quinia  (grs.  xxv.),  the  uric  acid  was  very 
slightly  diminished  in  amount,  only  T\\  of  a  grain  during  24 
hours. 

If  we  compare  these  analyses  (xxxvii.  and  xxxviii.)  with  the 
analyses  of  the  urine  in  intermittent  fever,  (see  pages  386-391 


1858.] 


Joxes,  on  Malarial  Fever. 


583 


and  438-450  of  this  journal,)  it  is  evident  that  the  urea  has 
.greatly  increased  in  amount.  The  increase  has  been  propor- 
tional to  the  increase  of  the  severity  of  the  disease.  When  we 
consider  the  state  of  rest,  and  the  almost  complete  starvation  of 
the  patient,  it  is  evident  that  the  urea  has  increased  to  more  than 
■double  the  normal  quantity.  These  facts  will  be  noticed  more 
fully  hereafter. 

September  12th,  12  o'clock  M.  Complains  of  weakness  and 
headache.  Was  not  so  restless  last  night  as  on  the  previous 
nights.  Fever  commenced  to  remit  at  10  A-  M.,  this  morning. 
Bowels  have  not  been  moved  since  his  entrance  into  the  hospi- 
tal. Some  tenderness  upon  pressure  of  epigastrium.  Tongue 
not  so  red,  cleaner  and  moister — the  dark  fur  about  the  root  has, 
in  a  great  measure,  cleaned  off — tip  and  edges  still  much  redder 
than  normal.  Pulse  70;  respiration  26-36,  thoracic,  irregular, 
varying  with  each  quarter — every  12  or  15  respirations,  draws 
a  long  sigh,  inflating  his  thorax  to  its  utmost  capacity.  After 
this,  his  respiration  ceases  for  a  few  moments.  The  respiration 
is  indicative  of  oppression.  Temperature  of  atmosphere,  83°  F. ; 
Temp,  of  hand,  100°  75' ;  Temp,  under  tongue,  102°  50'.  Has 
taken  10  grs.  sulphate  of  quinia  during  the  night. 

$.  Continue  sulphate  of  quinia,  grs.  v.  every  three  hours,  up 
to  grs.  xl.  Complains  of  uneasiness  in  his  bowels.  Has  a  dis- 
position to  visit  the  stool,  frequently,  without  the  ability  to 
evacuate  the  bowels.  #.  Calomel,  grs.  xii.,  followed  by  castor 
oil  in  four  hours.  Continue  the  sulphate  of  quinia,  regardless  of 
the  action  of  the  medicine.  Urine,  high  colored,  brownish-red, 
limpid,  without  deposit.  Sp.  gr.  1019  ;  reaction  decidedly  acid. 
After  40  hours,  a  small  deposit  of  vegetable  cells,  urate  of  soda 
and  triple  phosphate. 


ANALYSIS  XXXIX. 

Urine   excret- 
ed in  17  hours 
grains   15285, 
contained  grs. 

Calculated 
ara't  Urine  for 
24  hrs.,  grains 
21567  cont'nd 
grains 

1000  parts 
Urine    con- 
tained 

Urine  excret- 
ed during  the 
last  24  hours, 
grs.  20383  con- 
tained grains 

Water 

14476*810 

809-190 
567-450 

s-ooo 

95-050 
140-280 

20435*283 
1181*767 

800-671 

8-466 

134-115 

197-935 

947  059 

52-941 

37-124 

0-392 

5*182 

9-243 

19240-675 

Solid  Matters 

1142-325 

Urea 

790-450 

7'450 

Ext  and  Col'ing  Matters, 
fixed  Saline  Constituents, 

185*260 
158-605 

Amount  of  Urine  excreted  during  the  last  17  hours,  grains,  15285 

u         u       u  a       hourly,     "     '•      tt       "  "  899 

Calculated  amount  of  Urine  for  24  hours,     -  215G7 

Actual  amount  of  Urine  excreted  during  last  24  hrs.,     " 


hourly, 


20383 
849 


9  o'clock,  P.  ^L     Complains  of  some  pain  in  his  head,  and 


584  Jones,  on  Malarial  Fever.  [September, 

in  the  region  of  the  liver;  intellect  is  clear  and  he  is  not  so  rest- 
less; tongue  moist,  still  redder  than  normal ;  skin  moist  and  re- 
laxed. Pulse  70,  regular  and  soft ;  respiration  53,  irregular  and 
thoracic.  Temp,  of  atmosphere,  83°F. ;  Temp,  of  hand,  99°16; 
Temp,  under  tongue,  101°5.  Urine  high  colored,  reaction  de- 
cidedly acid.  Sp.  gr.  1020.  Medicine  has  operated  several 
times,  and  much  urine  was  passed  during  the  operations.  3. 
Sulphate  of  Quinia,  grs.  xv. ;  Snake-root  tea,  f  §xvi.  Table- 
spoonful  every  four  hours. 

Sept.  13th,  11  o'clock  A.  M.  Eested  well  during  the  night, 
feels  better,  but  very  weak ;  bowels  moved  three  times  during 
the  night;  tongue  moist,  rather  pointed,  red  at  tip  and  edges  ; 
tip  clean,  base  coated  with  light  yellow  fur,  slight  tenderness 
upon  pressure  of  epigastrium.  Pulse  52  regular,  respiration 
48,  more  regular  and  gentle  than  on  the  previous  day.  Temp, 
of  atmosphere,  85°F.;  Temp,  of  hand,  97°  ;  Temp,  under  tongue, 
100°.  The  calomel  has  evidently  been  productive  of  good. 
The  patient  however  appears  to  be  very  weak.  The  urine  has 
changed  greatly  in  color  since  }^esterday.  It  is  now  orange 
colored  and  turbid.  Sp.  gr.  1024;  reaction  after  15  hours 
alkaline,  ty.  Sulphate  of  Quinia,  grs.  xv. ;  Snake-root  tea, 
f  I  viij. ;  brandy,  f  5  viij.  Mix.  Dose,  a  tablespoonful  every  two 
hours.  If  the  pulse  rises  and  the  heat  increases,  discontinue  the 
brandy. 

6  o'clock  P.  M.  Tongue  moist,  not  so  red  at  tip  and  edges, 
slightly  coated  with  white  fur.  Pulse  60,  respiration  26  to  32, 
more  regular,  and  not  so  thoracic  as  formerly,  but  still  irregular, 
varying  with  each  quarter  of  a  minute ;  at  one  quarter  indicating 
45  to  the  minute,  and  perhaps  at  the  next  quarter  it  will  indi- 
cate only  20.  $.  Continue  Sulphate  of  Quinia,  Brandy,  and 
Snake-root  tea;  tablespoonful  every  three  hours ;  urine  orange 
colored.  Sp.  gr.  1022 ;  reaction  alkaline  after  standing  15 
hours. 

Sept.  14th,  1  o'clock,  P.  M.  Much  better.  Bowels  were 
moved  three  times  during  the  night.  Pulse  58,  respiration  28  ; 
no  tenderness  upon  pressure  of  epigastrium  ;  tongue  normal,  no 
tenderness  upon  pressure  of  the  epigastrium.  Temp,  of  atmos- 
phere, 87°F. ;  Temp,  of  hand,  99°. ;  Temp,  under  tongue,  102° ; 
urine  orange  colored ;  reaction  alkaline  in  12  hours ;  in  24  hours 
bad  thrown  down  a  copious  deposit  of  crystals  of  triple  phos- 
phate, and  urate  of  soda.  The  deposit  of  urate  of  soda,  greatly 
exceeded  in  amount  that  of  the  triple  phosphate.     Sp.  gr.  1025. 

Amount  of  Urine  excreted  during  the  last  19  hours,  grains,  15375 

"         u       a  u       hourly,    "     "      "       "  "  809 

Calculated  amount  of  Urine  for  24  hours,  "         19418 


1858.] 


Jones,  on  Malarial  Fever. 


585 


ANALYSIS  XL. 

Grs.  15375  Urine  ex- 
creted during  19  hrs. 
contained  grains 

Grs.  19418  calculat'd 
for  24  hours  contain- 
ed grains 

1000  parts 
Urine     con- 
tained 

Urea 

Uric  Acid 

538-350 

8-550 

35-840 

679-926 
10-798 
45-288 

35-054 
0-556 

Fixed  Saline  Constituents 

2-390 

September  loth,  10  o'clock  A.  M.  Continues  to  improve; 
tongue  moist,  and  normal  in  appearance;  skin  cool,  relaxed  and 
moist.  Pulse  50,  full  and  regular;  respiration  24,  regular  and 
gentle.  Temperature  of  atmosphere,  84°  F. ;  Temp  of  hand, 
94°  5';  Temp,  under  tongue,  99°.  3.  Quassia  and  soda.  Con- 
tinue snake-root  tea  and  sulph.  of  quinia,  table-spoonful  every 
four  hours.  Urine,  deep  orange  color — after  standing  20  hours, 
let  fall  a  deposit  of  urate  of  soda  and  triple  phosphate.  Specitic 
gravity  101 6*5. 

Amount  of  Urine  passed  during  the  last  20  hours,     grains,      6607 
u         u       u         u     hourly,      "      "     "       "  "  330 

Calculated  amount  of  Urine  for  24  hours,  "  8038 


ANALYSIS  XXL 

Grs.  6607  Urine  ex- 
creted during  20  hrs. 
contained  grains 

Grs,  8038  Urine  cal- 
culated for  24  hours, 
contained  grains 

1000  parts 
Urine     con- 
tained 

Water 

Solid  Matters 

6230*091 

376-909 

222-658 

4-225 

123-322 

26  504 

8585.710 

452-290 

267-189 

5-070 

147-986 

31-805 

942-953 
57*047 

Urea 

38*169 

Uric  Acid 

0*639 

Ext.  and  Col'ing  Matters. 
Fixed  Saline  Constituents, 

14-100 
4-027 

When  this  analysis  is  compared  with  the  former  analyses,  it 
is  evident  that  the  reduction  of  the  force  and  frequency  of  the 
circulation  aud  respiration,  the  reduction  of  the  temperature, 
and  the  relaxation  of  the  skin,  was  attended  by  a  diminution  of 
the  urea. 

7  o'clock  P.  M.  Pulse  47 ;  respiration  27.  Temperature  of 
atmosphere,  87°  F. ;  Temp,  of  hand,  96° ;  Temp,  under  tongue, 
99°.  Skin  moist,  relaxed,  cool,  perspiration.  Urine,  orange 
colored ;  sp.  gr.  1018-2 ;  after  standing  15  hours,  let  fall  a  heavy 
light-yellow  deposit  of  urate  of  soda  and  ammonia,  and  numer- 
ous well  formed  prismatic  crystals  of  triple  phosphate- 
Amount  of  Urine  passed  during  the  last  9  hours,  grains,  5121 
"       '•         "       hourly,     -  "  569 

Calculated  amount  for  24  hours,    -  "  13652 


ANALYSIS  XLIL 

Grs.  5121  Urine  ex- 
creted during  9  hrs., 
containedgrains 

Grs.  13652  Urine  cal- 
culate for  24  hours, 
contained  grains 

1C00  part* 
Urine     con- 
tained 

Water 

4946*350 

174650 

52-622 

6-250 

94-750 

20-815 

13186-384 
465-616 
140-291 

16*662 
252-035 

55  492 

965*854 

Solid  Matters. 

34146 

Urea 

10-277 

Uric  Acid 

1-220 

Ext.  and  Col'ing  Matters . 
Fixed  Saline  Constituents, 

18-484 
4-065 

586 


Jones,  on  Malarial  Fever, 


[September, 


September  16th,  12  o'clock  M.  Pulse  46 ;  respiration  20  to 
26,  irregular.  Urine,  orange  colored ;  specific  gravity  1022#2. 
Temperature  of  atmosphere,  87°  F. ;  Temp,  of  hand,  97° ;  Temp. 


under  tongue, 


After  standing  12  hours,  let  fall  a  light- 


yellow  deposit  of  octohedral  crystals  of  the  oxalate  of  lime, 
globular  crystals  of  the  urate  of  soda,  and  a  few  prismatic  crys- 
tals of  triple  phosphate. 

Amount  of  Urine  excreted  during  the  last  17  hours,  grains,  4599 

"         <.       u           a       hourly,     «     "     "       "             "  270 

Calculated  amount  of  Urine  for  24  hours,                         "  6490 

Actual  amount  of  Urine  excreted  during  the  last  24  hrs.  9720 

«         «          u     «             u     hourly     «      «     «     «  405 


ANALYSIS  XLIIL 


Water 

Solid  Matters 

Urea 

Uric  Acid 

Ext.  and  Col'ing  Matters, 
Fixed  Saline  Constituents, 


Grs.  4599  of 
Urine  excret- 
ed during  17 
hrs.  contained 
grains 


4292-402 

306*598 

150-592 

2-700 

120-000 

32-994 


Grs.  6490  of 
Urine  calcula- 
ted for  24  hrs. 
contained  grs. 


6057-391 

432-609 

212-4S6 

3-798 

169-200 

46-554 


1000 

parts 

Urine 

con- 

tained 

933 

334 

66 

666 

32-744 

0-537 

26-075 

7 

160 

Grs.  9720  of 
Urioe  excret- 
ed during  last 
24  hours  con- 
tained grains 
9238-752 
481-248 
203-214 
8-950 
214-750 
53-809 


8  o'clock  P.  M.     Pulse  47 ;  respiration  28.     Temperature  of 

atmosphere,  87°  5' F.;    Temp,  of  hand,    95°  9';    Temp,  under 

tongue,  99°. 

Amount  of  Urine  passed  during  last  8  hours,     -         grains,     4080 
u         «      u  «      hourly    u   u      u         .  «  510 

Calculated  amount  of  Urine  for  24  hours,  -  "        12240 

After  standing  12.  hours,  the  urine  threw  down  a  heavy  light- 
yellow  deposit  of  urate  of  soda  and  triple  phosphate. 

September  17th,  11  o'clock  A.  M.  Pulse  44;  respiration  24. 
Temperature  of  atmosphere,  84°  5'  F. ;  Temp,  of  hand,  96° ; 
Temp,  under  tongue,  99°.  Color  of  urine,  a  shade  higher  than 
normal.  Sp.  gr.  1018.  Eeaction  alkaline  in  10  hours.  Light 
yellow  deposit  of  urate  of  soda  and  triple  phosphate. 

Amount  of  Urine  excreted  in  the  last  15  hours,  grains,     8712 

"         u      u  u     hourly,     "      "      "  "  514 

Calculated  amount  of  Urine  for  15  hours,  "       13940 


Grs.  8712  Urine  ex- 
creted during  15  hrs. 
contained  grains 


ANALYSIS  XLIY. 


Water 

Solid  Matters 

Urea 

Uric  Acid 

Ext.  and  Col'ing  Matters, 
Fixed  Saline  Constituents, 


8139-466 
572-534 
123-675 
5-695 
281-067 
161-797 


Grs.  13940  Urine  cal- 
culated for  24  hours, 
contained  grains 


13023-945 
916*055 
197-880 
9-112 
449-707 
258-876 


1000  parts 
Urine  con- 
tained 


934-286 
65-714 
14-200 
0-653 
32-224 
18-571 


1858.] 


Jones,  on  Malarial  Fever. 


587 


September  18th,  12  o'clock  M.  Pulse  44;  respiration  24. 
Temperature  of  atmosphere,  86°  F. ;  Temp,  of  hand,  96°  25' ; 
Temp,  under  tongue,  99°. 

Amount  of  Urine  passed  during  the  last  24  hours,      grains,  15903 
u  ..       ..         u     hourly,"    M       "     "       "  "  u  662 

Uric  acid  in  grs.  15903  of  Urine  of  24  hours,  grains,  35*650 
Uric  acid  in  1000  parts  of  Urine,  u         2-241 

Urine,  normal  in  color.  After  standing  8  hours,  reaction 
alkaline,  with  a  heavy  deposit  of  urate  of  soda  and  triple  phos- 
phate. The  increase  of  the  uric  acid  has  attended  the  conva- 
lescence. This  fact  proves  that  the  action  of  the  sulphate  of 
quinia,  in  arresting  intermittent  fever,  is  not  due  to  its  power  of 
diminishing  the  amount  of  uric  acid. 

September  19th,  12  o'clock  M.  Pulse  44 ;  respiration  24. 
Urine,  normal  in  color;  deposit,  after  standing,  triple  phosphate. 
Temperature  of  atmosphere,  88°  5' F.;  Temp,  of  hand,  97°; 
Temp,  under  tongue,  99°. 

Amount  of  Urine  excreted  duriDg  the  last  24  hours,  grains,  24240 
"         "       "  "     hourly,         ...»  1010 

September  20th,  12  M.     Specific  gravity  1010. 

Amount  of  Urine  passed  during  the  last  24  hours,      grains,  32320 
"         "       "         "     hourly      "      "     "       "  "  1346 


September  22nd.     Specific  gravity  1008. 


grains,  23300 
"  929 


Amount  of  Urine  passed  during  the  last  24  hours, 

U  u         u  U      hourly^     U         U       U         U 

Pulse  44 ;  Eespiration  22.  Temperature  of  atmosphere,  84°F. ; 
Temp,  of  hand,  97°  8' ;  Temp,  under  tongue,  99°  12'. 

This  patient  is  now  able  to  walk  about  the  hospital  yard,  but 
is  pale,  anaemic,  and  very  weak. 


Examination  of  Blood,  No.  IY. — Blood  coagulated  slowly ; 
clot  firm.  During  coagulation  the  blood-corpuscles  settled,  and 
left  above  a  transparent  clot,  about  l-8th  of  an  inch  in  depth, 
and  of  a  light-yellow  color.  Color  of  the  serum,  light  yellow. 
Sp.  gr.  of  blood  1042.     Sp.  gr.  of  serum  1022-5. 


Water, 

In  1000  parts  of  Blood,  831-294 

"         "     Serum,  927-853 

(1)  "         "     Liq.  Sang.  924664 

(2)  *        *      *        *  887-265 


Solid  Matters. 
In  1000  parts  of  Blood, 
M     Serum, 

(1)  ■         "     Liq.  Sang. 

(2)  "         u       "       " 
Serum  of  1000  pts.  Blood, 


168-706 
72-147 
75-336 

112-735 
64-464 


588  Jones,  on  Malarial  Fever.  [September, 

Fixed  Saline  Constituents. 

In  1000  parts  of  Blood, 4-370 

"       "     Serum, 3*288 

(1)  "       "     Liquor  Sanguinis, 3-299 

(2)  "       "         "              " 4-885 

"       "     Solid  Matters  of  Blood, 25-906 

"       "         "         "         "  Serum, 45*576 

(2)    "       "         "         "         "  Liq.  Sanguinis,        -         -         -  37-390 

"       "         "         "         "  Blood  Corpuscles,    -         -         -  14-047 

"       "     Moist  Blood  Corpuscles, 3-511 

In  Blood  Corpuscles  of  1000  parts  of  Blood,          -         -         -  1*432 

"  Serum  of  1000  parts  of  Blood, 2-938 

1000  Parts  of  Blood  Contained, 

Water,           -         -         -         - 831*294 

Dried  Blood  Cornuscles       101*941  1  Dlied  0rganic  Residue,  100*409 
uned  tflooa  Corpuscles,      lUl  941  |  Fked  galine  ConstituentS)       VV62 

Fibrin, 2*301 

Albumen,  Extractive  and  Coloring  )  Dried  Organic  Residue,  61*500 
Matters,           -         -         64-464  (  Fixed  Saline  Constituents,       2-938 

1000  Parts  of  Blood  Contained, 

)  Water,          -         -         -  306-823 

Moist  Blood  Corpuscles,  407.764  V  Dried  Organic  Residue,  100-409 

)  Fixed  Saline  Constituents,  1-432 

1  Water,          -         -         -  525*471 

Dried  Organic  Residue,  61*500 

Fixed  Saline  Constituents,  2*301 

Fibrin,          -         -         -  2-938 

1000  Parts  of  Moist  Blood  Corpuscles  Contained, 

Water, r  750-000 

Dried  Organic  Residue, 246*468 

Fixed  Saline  Constituents,       -        ~         -         -         -         -  3*511 

(1)  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 924;664 

Albumen,  Extractive  and  Coloring  Matters,       -  68*858 

Fixed  Saline  Constituents,       --         -         -.       -         -  3-289 

Fibrin, -        -        -  3*189 

(2")  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 887-265 

Albumen,  Extractive  and  Coloring  Matters,       -  v               -  103880 

Fixed  Saline  Constituents, 3-885 

Fibrin,            - 4-945 


This  analysis  shows  that  the  dried  organic  residue,  and 
especially  the  fixed  saline  constituents,  of  the  colored  blood 
corpuscles,  have  diminished.  The  moist  blood  corpuscles  are 
less  than  normal  by  100  parts  in  the  1000  parts  of  blood.  The 
fixed  saline  constituents  are  less  than  one-half  the  normal 
amount. 


1858.]  Joxes,  on  Malarial  Fever.  589 

The  patient  recovered  sufficient  strength  to  walk  about  the 
hospital  grounds.  His  complexion  continued  anaemic  and  his 
forces  were  feeble  and  did  not  increase,  notwithstanding  the 
administration  of  tonics  and  iron.  He  complained  continually 
of  a  severe  pain  in  his  head.  Cut  cups  over  the  temples  and 
back  of  the  neck ;  cold  applications  and  internal  remedies  failed 
to  afford  any  relief. 

On  the  4th  of  October,  he  was  taken  with  a  chill  followed  by 
high  fever.  The  chill  came  on  at  1  o'clock  M.,  and  has  returned 
daily  at  this  hour. 

October  6th,  12  o'clock  M.  The  chill  has  been  on  one  hour, 
and  the  circulation  of  the  capillaries  is  becoming  equalized  and 
the  temperature  of  the  extremities  is  rising.  Pulse  110,  feebler 
than  after  complete  reaction,  but  stronger  than  during  the  lowest 
depression  of  the  cold  stage.  Respiration  rapid,  thoracic  pan- 
ting, 45-50 ;  muscles  trembling  violently.  It  was  with  the 
greatest  difficulty  that  the  bulb  of  the  thermometer  could  be  held 
under  the  tongue  with  the  lips  closed  around,  on  account  of  the 
violence  of  the  inspirations  and  expirations.  The  air  was  drawn 
into  the  lungs  and  expelled  with  great  violence. 

The  patient  resembled  an  over-heated  man  after  violent  exer- 
tion in  hot  weather,  panting  for  breath.  Temp,  of  atmosphere, 
70°F.;  Temp,  of  hand,  97°.;  Temp,  under  tongue,  104°.  The 
bulb  of  the  thermometer  under  the  tongue  excited  vomiting. 
After  vomiting  the  shaking  of  the  muscles  ceased,  and  the 
violent  respiration  became  calmer  and  more  regular.  This  at- 
tack yielded  to  sulphate  of  quinia,  and  the  recurrence  of  the 
chill  was  prevented  by  the  administration  of  arsenic. 

The  occurrence  of  intermittent  fever  after  an  attack  of  remit- 
tent fever,  was  due  in  this  case  to  one  or  both  of  two  causes. 
The  malarial  poison  may  not  have  been  completely  broken  up 
and  removed  during  the  attack  of  remittent  fever,  or  a  fresh 
dose  of  the  malarial  poison  may  have  been  received  subsequent- 
ly to  the  complete  elimination  of  the  disturbing  element. 

Both  these  causes  may  have  acted  simultaneously.  The  hos- 
pital is  situated  in  a  malarious  district,  and  a  dose  of  the  poison 
might  have  been  received  at  any  time. 

The  annexed  table  will  give  a  condensed  view  of  the  most 
important  phenomena.     (See  next  page.) 

A  comparison  of  the  phenomena  of  this  case  of  remittent  fever, 
with  those  of  health  and  intermittent  fever,  establish  the  follow- 
ing conclusions: 

(1).  The  secretions  of  the  mouth  are  more  completely  checked, 
and  the  tongue  is  dryer,  redder,  and  rougher  to  the  feeling  in 
remittent,  than  in  intermittent  fever. 

(2).  The  glowing  tongue  of  remittent  fever,  is  not  an  index  of 
iifflammation.     It  indicates  a  want  of  circulation  in  the  capilla- 


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1858.]  Jones,  on  Malarial  Fever.  591 

ries  of  the  superficial  parts  of  the  tongue.  The  secretions  of  the 
mucous  membrane  have  been^checked ;  the  moisture  is  evapora- 
ted by  the  elevated  temperature;  the  circulation  in  the  superfi- 
cial capillaries,  is  thus  retarded,  and  they  become  filled  with 
colored  blood  corpuscles,  which  give  the  bright  color  to  the 
tongue. 

The  question  arises,  what  checked  the  secretions  of  the  mucous 
membrane  of  the  mouth  ? 

The  consideration  of  the  chemical  alterations  of  many  elements 
and  secretions  enter  into  the  solution  of  this  question.  We  will 
mention  only  five  and  acknowledge  that  this  is  nothing  but  a 
statement  of  the  manner  in  which  the  changes  may  take  place, 
and  not  a  direct  absolute  answer  to  the  question. 

1.  Theftells  of  the  mucous  membrane.  2.  The  capilliaries  of 
the  mucous  membrane.  8.  The  serum  of  the  blood.  4.  The 
blood  corpuscles.  5.  The  nervous  system  presiding  over  the 
elaboration  of  the  blood,  the  circulation  of  the  blood  in  the 
capillaries,  and  the  formation  of  the  secretions. 

We  have  before  demonstrated  that  the  malarial  poison,  pro- 
duces profound  chemical  and  physical  alterations  in  the  colored 
blood  corpuscles,  destroying  many,  and  in  all  inducing  chemical 
changes  which  result  in  a  great  diminution  of  the  fixed  saline 
constituents. 

The  blood  corpuscles,  collectively  form  an  immense  gland, 
which  elaborates  the  materials  of  the  serum  into  compounds  for 
the  nervous  and  muscular  system,  and  probably  for  the  various 
secretions.  Whatever  therefore  destroys  or  alters  the  chemical 
changes  of  the  colored  blood  corpuscles,  must  produce  corres- 
ponding changes,  in  the  secretions  and  excretions,  and  in  the 
structure  and  action  of  the  nervous  system. 

There  is  a  portion  of  the  nervous  system  which  presides  over 
the  circulation  and  chemical  changes  in  the  capillaries  and  thus 
over  the  secretions.  The  malarial  poison  may  act  upon  the 
nervous  system  directly,  or  indirectly,  by  the  changes  induced  in 
the  blood  corpuscles  and  the  constituents  of  the  serum,  or  it  may 
act  upon  the  nervous  system  in  both  ways  combined  at  the  same 
time.  Whatever  acts  directly  or  indirectly  upon  the  nervous 
system,  will  produce  corresponding  changes  in  the  secretions, 
excretions  and  nutrition. 

3.  In  this  case  we  cast  aside  the  advice  of  many  of  the  older 
writers  and  administered  the  sulphate  of  quinia  freely  in  the 
outset  of  the  disease,  regardless  of  the  glowing  parched  tongue, 
tenderness  upon  presure  of  the  epigastrium,  and  severe  headache 
and  high  fever,  and  rapid  bounding  pulse,  thoracic  respiration, 
and  hot  dry  skin.  Under  the  action  of  the  sulphate  of  quinia, 
the  dry  red  tongue  became  moist,  clear  and  pale ;  the  circulation 
and  respiration  abated  in  force  and  frequency,  the  dry  harsh 


692  Jones,  on  Malarial  Fever.  [September, 

skin  was  covered  with  perspiration,  and  all  the  symptoms  sub- 
sided. The  advantage  of  this  mode  of  treatment  will  be  illus- 
trated subsequently. 

4.  The  increase  of  the  action  of  the  pulse  and  respiration  was 
attended  by  an  elevation  of  the  temperature.  The  elevation  of 
the  temperature  corresponded  more  accurately  with  the  increas- 
ed action  of  the  circulatory  and  respiratory  systems  in  intermit- 
tent fever,  than  in  this  case  of  remittent  fever.  That  is.,  the 
pulse  and  respiration  were  more  accelerated  in  remittent  fever, 
whilst  the  temperature  did  not  rise  higher  than  that  of  intermit- 
tent fever. 

5.  The  urea  was  increased  during  the  active  stages  of  the  fever, 
not  only  above  the  normal  standard  during  rest  and  a  depriva- 
tion of  food,  but  also  above  the  standard  of  intermittent  fever. 

6.  The  increased  temperature  and  correspondiugly  increased 
chemical  changes,  were  attended  by  an  increase  of  the  urea. 
When  the  temperature  fell  below  the  normal  standard,  in  both 
intermittent  and  remittent  fever,  the  urea  was  decreased  in 
amount. 

7.  The  uric  acid  was  diminished  in  the  active  stages  of  inter- 
mittent and  remittent  fevers,and  increased  as  the  diseases  subsi- 
ded. 

8.  The  changes  in  the  acidity  of  the  urine  in  this  case,  resem- 
bled in  all  respects,  those  during  intermittent  fever. 

9.  The  coloring  and  extractive  matters,  were  diminished 
during  the  active  stages,  and  increased  during  the  subsidence  of 
the  fever. 

Case  XXV.  Irish  seaman :  aged  21;  height  5  feet  4  inches; 
weight  125  lbs;  brown  hair,  brown  eyes,  sallow  complexion. 
Has  been  in  Savannah  three  weeks,  and  has  been  sick  three  days. 
This  is  his  first  trip  to  Savannah,  during  the  summer  season. 

October  12th,  12  M.  Complains  of  great  weakness  and  pain 
in  his  back  and  bones ;  says  that  he  has  had  no  chill  and  no  fever 
during  the  three  days  of  indisposition,  previous  to  his  entrance 
into  the  hospital.  Pulse  80,  full.  ty.  Sulph.  of  quinia  grs.  v., 
every  three  hours,  up  to  grs.  xv. 

October  13tb,  12  M.  Did  not  rest  well  last  night;  complains 
of  pain  in  his  head  and  bones.  Had  a  chill  two  hours  ago. 
Tongue  clean,  red,  dry,  and  rough ;  papillae  enlarged.  Some 
tenderness  of  epigastrium.  Skin  hot  and  dry.  Pulse  118  ;  res- 
piration 24-26,  irregular,  thoracic.  $.  Calomel,  grs.  x.,  castor 
oil  in  four  hours.  $.  Soda  powders  during  fever,  ty.  After 
fever  remits,  give  sulphate  of  quinia,  grs.  v.,  every  three  hours, 
up  to  grs.  xx. 

October  14th,  12  M.  Medicine  acted  twice;  tongue  clean  and 
very  red ;  patient  is  not  so  restless ;  complains  of  great  weakness. 


1858.] 


Jones,  on  Malarial  Fever. 


593 


Has  taken  xx  grs.  of  sulphate  of  quinia  ;  temperature  of  skin 
normal.  $.  Brandy,  Oviij.;  sulph.  of  quinia,  grs.  xv.;  snake- 
root  tea,  f^viij.     Mix.  Tablespoonful  every  four  hours. 

October  15th,  12  M.  Had  an  increase  of  fever  yesterday  after- 
noon, which  was  accompanied  with  severe  pain  in  his  head  and 
bones.  Now  he  is  restless  and  nervous;  countenance  uneasyy 
anxious.  All  his  motions  are  indicative  of  restless,  uneasy, 
anxious,  feeling;  complains  of  great  thirst;  tongue  as  red  as 
scarlet.  At  9  o'clock  A.  M.,  this  morning,  it  was  dry  and 
glazed;  at  the  present  time,  (three  hours  afterwards),  it  is  a  little 
moister  and  softer ;  lips  dry,  red  and  rough.  Epigastrium  very 
tender  upon  pressure;  trunk  and  head  very  hot,  extremities  only 
moderately  warm.  Complains  of  pain  in  the  small  of  the  back, 
and  in  the  knees  and  bones  of  his  legs.  Pulse  106,  feeble;  res- 
piration 30-40,  irregular,  labored,  thoracic,  panting.  Temp,  of 
atmosphere,  74°  F ;  Temp,  of  hand  101° ;  Temp,  in  axilla,  105°. 
The  temperature  under  the  tongue  could  not  be  taken  on  account 
of  his  restlessness.  Eeaction  of  saliva  acid.  There  is  a  great 
want  of  co-ordination  between  the  circulation,  respiration,  and 
temperature  of  the  extremities.  The  capillary  circulation  and 
chemical  changes  are  impeded.  ^,  4  cut  cups  to  epigastrium; 
4  cut  cups  over  the  lumbar  regions  and  spine.  $.  Mustard  to 
extremities.  $.  Soda  powders.  Urine  high  colored,  of  a  deep 
brownish  red  color.     Sp.  Gr.  1028 ;  reaction  decidedly  acid. 

Amount  of  Urine  passed  during  the  last  30  hours,    grains,     15430 
u  a       u         u  u    l     u     u     94     u  "  12344 

u         u       u         u     hourly,     "     "      "      "  "  514 


ANALYSIS  XLV. 

Grs.  15430  of  Urine 
passed  during  30  hrs. 
contained  grains 

Grs-  12344  of  Urine 
passed  during  24  hrs. 
contained  grains 

1000  parts- 
Urine     con- 
tained 

Urea 

727-500 

9-300 

75-000 

582-000 

7-440 

60-000 

47*178 

Uric  Acid 

0-60& 

Fixed  Saline  Constituents, 

4-863 

7^  o'clock,  P.  M.  Lies  in  a  stupor,  muttering  to  himself,  and 
is  with  great  difficulty  aroused.  When  aroused,  answers  inco- 
herently, and  says  that  he  feels  very  well.  Temperature  of  ex- 
tremities below  the  normal  standard — cool ;  temperature  of  head 
and  trunk  normal;  tongue  of  a  bright  red  color ;  great  tender- 
ness of  epigastrium,  pressure  here  arouses  him  more  quickly 
than  violent  shaking;  pulse  100,  feeble;  respiration  32.  ty. 
Two  cut  cups  to  each  temple.  $.  Apply  a  blister  over  the 
epigastrium  6  inches  by  4  inches,  and  another  to  the  back  of  the 
neck  4  inches  by  5.  R.  Apply  mustard  to  extremities.  #, 
brandy  and  snake-root  tea,  and  spirits  of  mindererus,  f  5ss.  of 
each  alternately  every  half  hour,  until  reaction  is  established. 
$.  Sulphate  of  quinia,  grs.  v.,  every  three  hours  up  to  grs.  xly. 


594 


Jones,  on  Malarial  Fever. 


[September, 


Amount  of  Urine  passed  during  the  last  7  J  hours,      grains,     4072 
u       «         u     hourly,     •'      "     «       "  "  543 

Calculated  amount  of  Urine  for  24  hours,  "         13030 

Urine  high  colored  and  strongly  acid  in  reaction.  After  stand- 
ing 50  hours  there  was  no  deposit,  and  the  reaction  was  still 
decidedly  acid.   Sp.  gr.  1018. 


ANALYSIS  XLVI. 

Grs.  4072  of  Urine 
passed  during  7 -J-  hrs. 
contained  grains 

Grs.  13030  Urine  cal- 
culated for  24  hours, 
contained  grains 

1000  parts 
Urine     con- 
tained 

Urea 

151*320 
1-888 

483-224 
6-036 

37-161 

Uric  Acid 

0*461 

October  16th,  9  A.  M.  Much  better,  intellect  clear.  The 
cups,  blisters,  and  stimulants,  and  sulphate  of  quinia  have  re- 
stored the  capilliary  circulation  to  its  normal  state. 

12 1  o'clock  P.  M.  Continues  to  improve.  Urine  high  colored, 
of  a  deep  orange  red  ;  reaction  strongly  acid,  after  standing  15 
hours,  a  slight  deposit  of  mucous  corpuscles,  and  after  100  hours 
a  small  light  yellow  deposit  of  mucous  corpuscles,  urate  of  am- 
monia and  vegetable  cells.  The  presence  of  the  mucous  corpus- 
cles in  the  urine  is  due  to  the  absorption  and  action  of  the  can- 
tharidin  upon  the  mucous  membrane  of  the  genito-urinary 
apparatus.  In  several  severe  cases  of  remittent  fever,  I  have 
discovered  after  the  action  of  blisters,  numerous  spermatozoa  in 
the  urine.     Sp.  gr.  of  urine,  1021. 


Grs.  11231   of 

Grs.    16746  of 

Grs.   15303  of 

Urine   passed 

Urine  calcula- 

1000 parts 

Urine  excret- 

ANALYSIS XLVIL 

during  last  16 

ted  for  24  hrs. 

Urine   con- 

ed during  24 

hrs.  containedj contained  grs. 

tained 

hrs.     contain- 

grains 

ed  grains 

Urea 

357-445 

5-500 

53-900 

535  667 

8-250 

80-850 

31-826 
0*489 
4-799 

508*760 

Uric  Acid. 

7*380 

Fixed  Saline  Constituents, 

64-680 

Amount  of  Urine  passed  during  the  last  16  hours,  grains,  11231 

"         "      "         "      hourly,     "      "     "       "            "  702 

Calculated  amount  of  Urine  for  24  hours,                     "  16746 

Actual  am't  of  Urine  excreted  during  the  last  24  hrs.,  "  15303 

"        "      "      "           "     hourly,      "     "     "     "      "  637 

3  o'clock,  P.  M.  Skin  dry  but  soft.  Has  taken  xlv  grs.  of 
sulphate  of  quinia.  This  has  not  as  yet  exerted  its  character- 
istic effects  upon  the  skin ;  tongue  red,  but  moist  and  soft;  blis- 
ters have  drawn  well — serum  from  blistered  surfaces  of  a  golden 
color ;  patient  complains  of  difficulty  in  passing  his  urine.  This 
is  due  to  the  absorption  and  action  upon  the  mucous  membrane 
of  the  bladder  and  urethra,  of  the  cantharadin  absorbed  from 
the  blistered  surfaces.  Pulse  84 ;  respiration  16 ;  Temp,  of  at- 
mosphere, 69°5'F. ;  Temp,  of  hand,  99° ;  Temp,  under  tongue, 


1858.]  Jones,  on  Malarial  Fever.  595 

99°5'.  $.  Sulphate  of  quinia,  grs.  v.,  every  three  hours  up  to 
grs.  xv.  fy.  Continue  spirit  of  mindererus  and  brandy,  and 
snake-root  tea,  f  I  ss  of  each  alternately,  every  two  hours.  Diet, 
mutton  soup  and  arrow  root. 

October  17th,  12  ML  Continues  to  improve;  tongue  red,  but 
clean  and  soft.  Pulse  70 ;  respiration  16.  Temperature  of  atmos- 
phere, 67°F.;  Temp,  of  hand,  97°33;  Temp,  under  tongue,  98°5. 
Color  of  urine  deep  red,  reaction  decidedly  acid.  Sp.  gr.  1022. 
Eeaction  of  saliva  strongly  acid. 

Amount  of  Urine  passed  during  the  last  24  hours,      grains,     8176 
"         "       "         "     hourly,     -  "  382 


ANALYSIS  XLYIIL 


Urea 

Uric  Acid 

Fixed  Saline  Constituents 


Grs.  8176  of  Urine  excreted 
during  24  hrs.  cont'nd  grs. 


185-240 

4*400 

40*000 


1000  parts  of  Urine  con- 
tained 


22-578 
0*538 
4-892 


The  reduction  of  the  temperature  and  of  the  action  of  the  res- 
piratory and  circulatory  system,  has  been  attended  by  a  corres- 
ponding diminution  of  the  constituents  of  the  urine. 

October  18th.  Continues  to  improve,  "feels  quite  well,  with 
the  exception  of  great  weakness".  His  appetite  has  returned; 
tongue  clean,  moist  and  soft,  and  not  so  red.  Pulse  72  ;  respira- 
tion 18.  $.  Continue  brandy  and  snake-root  tea.  Color  of 
urine  orange,  much  lighter;  reaction  in  20  hours  decidedly  al- 
kaline. Sp.  gr.  1020.  Heavy  light  yellow  deposit  after  stand- 
ing 20  hours. 

Amount  of  Urine  passed  during  the  last  24  hours,      grains,  20400 
"         "       "         "     hourly,     "      "     "       "  "  850 

Diet,  soft  boiled  eggs,  milk  punch,  arrow-root,  and  mutton  soup. 

October  19th,  12  M.  Skin,  pulse  and  respiration  normal. 
Urine  orange  colored.  Sp.  gr.  1020 ;  reaction  alkaline  in  12 
hours ;  heavy  light  yellow  deposit  in  20  hours. 

Amount  of  Urine  excreted  during  the  last  24  hours,  grains,  15300 
u         u       u  u     hourly,      "      "     "       "  "  637 

October  20th. 

Amount  of  Urine  passed  during  the  last  24  hours,      grains,  17374 
"       "     excreted  hourly,     -  "  724 


1000  parts  of  Urine  con- 


ANALYSIS  XLIX. 


Grs.  17374  of  Urine  passed 
during  24  hrs.  cont'nd  grs. 


Uric  Acid 

Fixed  Saline  Constituents, 


11-730 
93-500 


tained 


0-675 
5-381 


Specific  gravity  of  urine  1022 ;  reaction  alkaline  in  12  hours — 
orange  color.  After  standing  24  hours,  a  light  yellow  deposit 
of  triple  phosphate  and  urate  of  soda  was  thrown  down. 

N.8. — vol.  xrv.  no.  ix.  32 


596 


Jones,  on  Malarial  Fever. 


[September, 


October  21st,  9  A.  M.  The  patient  is  dressed  and  has  been 
walking  about  the  hospital  grounds.  His  pale  sallow  complex- 
ion and  feeble  gait,  show  the  effects  of  malarial  fever.  Urine  of 
a  light  orange  color,  only  a  shade  darker  than  normal.  Sp.  gr. 
1024.  Keaction  just  after  its  deposition,  acid — in  10  hours  after- 
wards alkaline.  This  change  gave  evidence  of  the  formation 
of  ammonia,  and  was  attended  by  the  formation  of  crystals, 
presenting,  when  the  urine  was  held  in  the  sun,  a  sparkling 
appearance,  like  particles  of  silver.  Under  the  microscope, 
these  crystals  were  found  to  be  well  formed  prismatic  crystals 
of  triple  phosphate.  The  microscope  also  revealed  a  few  crys- 
tals of  the  urates  of  soda  and  ammonia. 


ANALYSIS  L. 

Grs,  9234  Urine  ex- 
creted during  12  hrs. 
contained  grains 

Grs.  18468  Urine  cal- 
culated for  24  hours, 
contained  grains 

1000  parts 
Urine     con- 
tained 

Urea 

229-599 

7-740 

91-800 

458-198 

15*480 

183-600 

25-128 

Uric  Acid 

0'935 

Fixed  Saline  Constituents, 

9-941 

AmouDt  of  Urine  passed  during  12  hours,      -       -    grains,     9234 

"         "       "         "     hourly, «  769 

Calculated  amount  of  Urine  for  24  hours,  "       18468 

This  case  confirms  all  the  conclusions  which  were  drawn  from 
the  preceding  case  of  remittent  fever. 

Case  XXVI.  Irish  seaman,  aged  38 ;  weight  160  lbs ;  height 
5  feet  6  inches ;  stout  muscular  man :  first  trip  to  Savannah,  Has 
been  in  Savannah  10  days,  during  which  time  he  has  worked 
on  a  ship  lying  along  the  shore  of  the  river,  and  has  slept  on 
Bay-street  at  night. 

October  14th,  2  P.  M.  Was  taken  sick  four  days  ago  with 
pain  in  his  head  and  in  all  his  bones,  accompanied  with  fever, 
which  has  continued  unabated  up  to  the  present  time.  Has  had 
no  chill.  Took  a  dose  of  calomel  three  days  ago,  which  acted 
freely.  Now  his  face  is  much  flushed ;  skin  hot  and  dry ;  head 
very  hot ;  complains  greatly  of  pain  in  his  head ;  eyes  look  heavy 
and  stupid;  tongue  bright-red  and  dry;  voice  hoarse  and  gut- 
teral ;  says  that  he  has  been  vomiting,  and  can  retain  nothing 
upon  his  stomach.  $.  Cut  cups  to  each  temple,  and  two  to 
back  of  neck,  and  four  over  the  region  of  the  stomach. 

If  the  cut  cups  do  not  relieve  the  vomiting,  administer  a  table- 
spoonful  of  equal  parts  of  milk,  lime  water,  and  the  aqueous 
solution  of  the  acetate  of  morphia. 

October  loth,  11  A.  M.  Says  that  he  feels  better;  the  cut 
cups  over  the  temples  and  back  of  neck  relieved  the  pain  in  his 
head,  and  the  cut  cups  over  the  region  of  the  stomach  checked 
the  vomiting.    Face  is  not  so  much  flushed ;  tongue  still  very 


1858.]  Jones,  on  Malarial  Fever.  597 

red,  dry  and  rough;  no  tenderness  upon  pressure  of  epigastrium, 
although  the  state  of  his  tongue  would  lead  us  to  look  for  it ; 
skin  soft  and  not  so  hot.  This  morning  at  3  A.  M.,  the  fever 
remitted  with  a  perspiration.  Pulse  76 ;  respiration  20.  Has 
taken  xxvi  grs.  of  sulphate  of  quinia.  $.  Neutral  mixture; 
drink  ad-Ubitum. 

8  o'clock  P.  M.  Has  been  vomiting  this  evening.  This  was 
arrested  by  milk  and  lime-water,  and  acetate  of  morphia.  Tip 
of  tongue  for  three-fourths  of  an  inch,  clean,  dry,  glazed,  and  of 
a  brilliant  red  color — the  remainder  of  the  tongue  is  coated  with 
brownish-yellow  fur,  which  is  dr\r  and  harsh  to  the  feeling; 
face  flushed  and  hot ;  skin,  upon  all  parts  of  the  body,  hot,  pun- 
gent and  dry;  no  tenderness  upon  pressure  of  epigastrium. 
The  calomel  has  acted  several  times,  and  is  still  acting.  Pulse 
94;  respiration  26.  $.  Soda  powders.  Urine,  high  colored, 
like  new  Madeira  wine. 

October  16th,  1  o'clock  P.  M.  Did  not  rest  during  the  night; 
was  tossing  about,  and  getting  up  out  of  the  bed  every  few  mo- 
ments, and  was  and  is  now  tormented  by  unquenchable  thirst; 
appears  to  be  completely  exhausted.  Tip  of  tongue  clean,  dry, 
scarlet-colored,  glazed,  shining — posterior  portion  (base)  of 
tongue  coated  with  brown  and  black  fur,  dry,  harsh,  and  as 
rough  as  sand-paper.  The  under  surface  of  the  tongue  is  dry, 
glazed  and  shining.  There  is  no  more  moisture  in  his  tongue, 
and  in  the  walls  of  the  mouth,  than  if  they  were  made  of  glass. 
Skin  hot,  dry,  and  harsh  to  the  feeling. 

The  temperature  under  the  tongue,  cannot  be  taken,  on  ac- 
count of  the  dry  condition  of  the  lips  and  tongue.  Bowels  are 
loose — stools  watery  and  yellow ;  no  pain  upon  pressure  of  epi- 
gastrium. Complains  of  no  pain  anywhere.  There  is  a  great 
tendency  to  stupor. 

Although  his  tongue  is  glowing  red,  and  his  face  is  flushed, 
and  there  is  an  inclination  to  stupor,  still  I  will  administer  sul- 
phate of  quinia  and  stimulants,  because  he  is  exhausted,  and  the 
appearance  of  the  mucous  membrane  of  his  mouth  and  tongue 
is  indicative,  not  of  inflammation,  but  of  derangement  of  the 
capillary  circulation,  and  of  alterations  in  the  structure  of  the 
nervous  system  and  blood. 

$.  Brandy,  f  3  viij.;  Snake-root  tea,  f  3  viij.;  Sulphate  of  qui- 
nia, grs.  xv.  Mix.  f  5J.  every  hour.  $.  Spirit  of  mindererus, 
f  3 j.  every  hour.  3.  Mustards  to  extremities.  $.  Sulphate  of 
quinia,  grs.  v.;  Camphor,  grs.  ij.  Mix.  Every  three  hours. 
%.  Soda  powders. 

Amount  of  Urine  passed  during  the  last  IV  hours,      grains,  10210 
"         k-     hourly,     "  ■  600 

■  Calculated  amount  of  Urine  for  24  hours,     -         -         u         14406 

Sp.  gr.  1020 ;  reaction  decidedly  acid ;  urine  high  colored,  like 


598 


Jones,  on  Malarial  Fever. 


[September, 


new  Madeira  wine.  No  deposit  after  30  hours ;  after  60  hours, 
a  slight  deposit  of  mucous  corpuscles  and  triple  phosphate. 
Crystals  of  nitrate  of  urea,  silvery  and  well  formed.  Hydro- 
chloric acid  showed  the  presence  of  coloring  matters  in  large 
amount 


ANALYSIS  LI. 

Grs.  10210  Urine  ex- 
creted during  17  hrs. 
contained  grains 

Grs.  14406  Urine  cal- 
culated for  24  hours, 
contained  grains 

10C0  parts 
Urine     con- 
tained 

Urea 

320-980 
0-200 

30-000 

452-581 

0-382 

40-330 

32*305 

Uric  Acid 

0-019 

Fixed  Saline  Constituents, 

2-938 

Oct.  17th,  11  o'clock  A.  M.  Much  better.  Tip  of  tongue 
clean — superior  portion  coated  with  fur;  tongue  moister,  softer, 
and  not  so  red  as  on  yesterday ;  face  much  less  flushed ;  the 
burning  thirst  has  almost  entirely  disappeared;  has  no  pain 
anywhere,  and  says  that  he  has  an  appetite ;  no  tenderness  of 
epigastrium.  Has  taken  grs.  xxx.  of  the  sulphate  of  quinia 
since  1  o'clock  P.  M.,  October  16th.  Pulse  68;  respiration  18. 
.Pulse  much  fuller — respiration  more  regular  and  soft.  Tem- 
perature of  atmosphere,  68°  F. ;  Temp,  of  hand,  98° ;  Temp,  un- 
der tongue,  99°  5'. 

Here  we  see,  that  under  the  action  of  the  sulphate  of  quinia 
and  stimulants,  his  respiration  has  become  regular ;  his  pulse 
slower  and  fuller ;  his  burning  thirst  diminished;  his  glowing 
tongue  and  flushed  face,  paler ;  his  parched  mouth,  moister ; 
his  intellect  brighter ;  his  exhausted  forces  more  active  ;  and  all 
the  secretions  and  functions  more  regular.  Urine,  high  color- 
ed. Decided  acid  reaction.  Sp.  gr.  1022.  No  deposit  after 
standing  30  hours.  After  80  hours,  a  small  light-yellow  depo- 
sit of  triple  phosphate  and  urate  of  soda. 

Amount  of  Urine  excreted  during  the  last  24  hours,  grains,  12264 
"         "       "  "     hourly,      "      "     "       "  "  .511 


ANALYSIS  LII. 

Grs.  12264  Urine  passed 
during  24  hrs.  cont'nd  grs. 

1000  parts  of  Urine  con- 
tained 

Urea 

315  250 

5  200 

34-800 

30  846 

Uric  Acid 

0-440 

Fixed  Saline  Constituents. 

2-84G 

$.  Continue  camphor  and  sulphate  of  quinia,  and  brandy  and 
snake-root  tea.  Diet,  milk  punch,  wine  whey,  arrow-root,  and 
mutton  soup. 

October  18th,  12  o'clock  M.  Eested  well  during  the  night — 
had  no  fever,  and  his  skin  was  in  a  good  perspiration.  The 
great  thirst  has  entirely  disappeared.  Tongue  still  redder  than 
normal,  but  moist  and  soft,  and  the  yellow  fur  coating  the  pos- 
terior portion  is  breaking  up  and  cleaning  off;  skin  moist,  and 
normal  in  temperature  and  feeling.     Pulse  and  respiration  nor- 


1868.]  Joxes,  on  Malarial  Fever.  599 

mal.     Dressed  himself,    and  has   been  walking  in   the   ward. 
Urine  of  a  deep  orange  color,  several  shades  lighter  than  that 
voided  yesterday.     Sp.  gr.  1019.     Reaction  slightly  acid. 
Amount  of  Urine  passed  during  the  last  24  hours,      grains,  12737 
«       "         "     hourly,     "      "     u       u  "  614 

R.  Continue  brandy  and  snake-root  tea,  table-spoonful  every 
three  hours.  Diet,  soft  boiled  eggs,  milk  punch,  mutton  soup, 
arrow-root  and  rice. 

October  19th.     Dressed,  and  walked  about  the  ward. 

October  20th.  Walked  about  one  mile  into  town,  says  that 
he  feels  well;  urine  orange  color.  Sp.  gr.  1020.  After  stand- 
ing 12  hours,  a  heavy  light  yellow  deposit  of  triple  phosphate 
and  urate  of  soda.  1000  parts  of  urine  contained  uric  acid,0-607. 
Fixed  saline  constituents,  3*529. 

October  2 1st.  Says  that  he  took  a  slight  cold  yesterday 
during  the  walk  into  the  city  ;  urine  orange  color.    Sp.  gr.  1019. 

Amount  of  Urine  passed  during  the  last  17  hours,     grains,  13247 

M         u       u         u     hourly,      "     "     u       u  "  770 

Calculated  amount  of  Urine  for  24  hours,  *         19495 


ANALYSIS  LIU. 

Grs    13247  Urine  ex- 
creted during  17  hrs. 
contained  grs. 

Grs.  19595  Urine  cal- 
culated lor  24  hours, 
contained  grains 

1000  parts 
of  Uri  ne 
contained 

Urea 

181  5GS 

6  110 

96  900 

290-5H8 

9  770 

154  040 

12  992 

Uric  Acid 

0461 

Fixed  Saline  Constituents. 

7- 199 

This  patient  had  no  return  of  fever  and  was  discharged  a  few 
days  subsequently.  This  case  sustains  not  only  the  conclusions, 
but  also  the  treatment  of  the  two  preceding  cases  of  remittent 
fever. 

Case  XXVII.  Seaman,  native  of  Scotland;  age  21;  height 
5  feet,  5  inches ;  weight  lo4  lbs.  This  is  his  first  trip  to  Savan- 
nah. Has  been  in  this  port  three  weeks,  and  during  this  time, 
has  slept  on  board  ship  in  the  river.  Two  of  the  crew  from  the 
same  ship  are  now  in  the  hospital  with  remittent  fever. 

October  13th,  12  M.  Was  taken  three  days  ago  with  a  chill 
and  pain  in  his  back,  head  and  all  the  bones.  This  was  followed 
by  fever.  Has  fever  now.  Skin  hot  and  dry ;  pulse  108  full ; 
respiration  38,  thoracic;  tongue  pointed,  red  at  tip  and  edges; 
coated  with  brownish  yellow  fur — dry  and  harsh,  rough  to  the 
feeling;  no  tenderness  of  epigastrium.  $.  Calomel  grs.  x.; 
sulphate  of  quinia,  grs.  v.  Mix.  Administer,  and  follow  by 
castor  oil  in  four  hours.  The  patient  must  be  closely  watched 
during  the  action  of  the  medicine,  and  if  he  appears  to  be  undu- 
ly exhausted,  apply  sinapism  and  administer  stimulants. 

9  P.  M.     Appears  stupid,  is  aroused  with  difficulty.     Tongue 


600  Jones,  on  Malarial  Fever.  [September, 

dry  and  rough;  face  flushed;  skin  hot  and  dry  ;  pulse  100.  R. 
Brandy  and  snake-root  tea,  tablespoonful  every  hour.  R.  Sul- 
phate of  quinia,  grs.  v.  every  three  hours,  up  to  grs.  xxx. 

October  14th,  12  M.  Much  better ;  medicine  operated  freely ; 
tongue  soft  and  moist;  pulse  not  so  frequent;  skin  soft  and 
much  cooler;  no  tenderness  upon  pressure  of  epigastrium.  Com- 
plains of  pain  in  back,  in  the  region  of  the  lumbar  vertebrae  and 
cannot  bear  the  slightest  touch  over  the  seat  of  the  pain.  R. 
Four  cut  cups  over  the  region  of  the  pain  in  the  back.  R.  Con- 
tinue brandy  and  snake-root  tea,  and  sulphate  of  quinia,  table- 
spoonful  every  four  hours. 

October  15th,  12  M.  Cut  cups  relieved  the  pain  in  the  back. 
Apex  of  tongue,  for  about  half  of  an  inch,  clean,  red  and  dry; 
the  remainder  of  the  tongue  is  coated  with  rough,  dry,  brown- 
ish black  and  yellow  fur.  No  tenderness  of  epigastrium ;  skin 
hot,  dry  and  pungent ;  pulse  90 ;  respiration  30.  Temperature 
of  atmosphere  74°  F. ;  Temp,  of  hand,  105° ;  Temp,  under 
tongue,  106°.     Eeaction  of  saliva  decidedly  acid. 

8  o'clock  P.M.  Face  still  flushed,  and  expression  of  coun- 
tenance stupid ;  intellect  dull  and  heavy ;  skin  in  a  slight  moist- 
ure ;  tongue  presents  the  same  appearance,  only  a  little  moister. 
The  head  and  trunk  are  hot,  but  not  pungent.  Temperature  of 
extremities  above  the  normal  standard,  but  cooler  and  not  so 
pungent  as  at  12  o'clock.  Pulse  90 ;  respiration  22-26,  irregular. 
R.  Sulphate  of  quinia,  grs.  v.,  every  three  hours,  up  to  grs.  xx. 
Soda  powders. 

Amount  of  Urine  excreted  during  the  last  8  hours, 

"         "       «  "     hourly,       "      "    "      " 

Calculated  amount  of  Urine  for  24  hours,     -     '   - 


grains, 
U 

5610 
101 

u 

16830 

ANALYSIS  LIV. 

Grs.  5610  Urine  ex- 
creted during  8  hours 
contained  grains 

Grs.  16830  Urine  cal- 
culated for  24  hours, 
contained  grains 

1000  parts 
of   Urine 
contained 

Urea 

125-372 

4  675 

29-150 

376  047 
14  025 
87-450 

22  147 

Uric  Acid 

Fixed  Saline  Constituents. 

0  833 
5-196 

This  urine,  which  was  excreted  during  fever,  and  under  the 
action  of  sulphate  of  quinia,  differs  from  the  former  specimens, 
excreted  under  similar  circumstances,  in  that  the  uric  acid  was 
greatly  increased.  Sp.  gr.  of  urine  1020.  Orange  colored  nitrate 
of  urea,  silky,  silvery.  No  deposit  after  30  hours ;  at  the  expi- 
ration of  this  time  the  reaction  was  still  acid. 

October  16th,  12  o'clock  M.  Toogue  dry  and  rough ;  com- 
plains of  pain  in  his  legs  and  left  side.  Countenance  is  more 
easy.  Urine,  high  colored,  red.  Sp.  gr.  1020.  Eeaction  acid. 
After  standing  15  hours,  a  light  yellow  deposit  of  triple  phos- 
phate, and  urates  of  soda  and  ammonia. 


1858.] 


Jones,  on  Malarial  Fever. 


601 


Amount  of  Urine  passed  during  the  last  16  hours,     grains,  11220 

u         u       u         u       hourly     "      "     "       "              "  101 

Calculated  amount  of  Urine  for  24  hours,                        "  1G830 

Actual  amount  of  Urine  passed  during  the  last  24  hrs.  "  16830 

"          "         "       »         "     hourly,     "      "     "     "     u  701 


ANALYSIS  LV. 

Grs.  11220  ot 
Urine  excret- 
ed during  1G 
hrs  contained 
grains 

Grs.  16830  or 
Urine    calcu- 
lated   for    21 
hrs.,  contain- 
ed grains 

Grs.  16830  ol 
Urine  excret- 
ed during  24 
hrs.,  contain- 
ed grains 

1000  parts 
Urine  con- 
tained 

Urea 

341440 
4-400 

512- 160 
6-600 

466  812 
9  070 

30  906 

Uric  Acid 

0  392 

ft.  Brandy  and  snake-root  tea,  and  spirit  of  raindererus,  f  5j.  of 
each,  alternately,  every  two  hours,  ft.  Sulph.  of  quinia,  grs.  v., 
every  three  hours,  up  to  grs.  xxxv. 

3  o'clock  P.  M.  Tongue  moister  and  softer,  tip  and  edges  not 
so  red — posterior  portion  still  coated  with  brownish-yellow  fur. 
Slight  tenderness  upon  pressure  of  epigastrium.  Pulse  75; 
respiration  20.  Temperature  of  atmosphere,  70°  F. ;  Temp,  of 
hand,  101°33';  Temp,  under  tongue,  101°5\  R.  Continue 
brandy  and  snake-root  tea,  spirit  of  mindererus  and  sulph.  of 
quinia. 

October  17th,  12  M.  Much  better ;  has  been  dressed  and 
about  the  ward  this  morning ;  tongue  soft,  moist ;  the  yellow 
fur  is  soft  and  rapidly  disappearing ;  reaction  of  saliva  decided- 
ly acid;  pulse  54;  respiration  18;  Temp,  of  atmosphere,  68°F.; 
Temp,  of  hand,  96°  ;  Temp,  under  tongue,  99°.  Urine  much 
lighter  in  color,  only  a  shade  higher  than  normal.     Sp.  gr.  1020. 

1000  parts  of  Urine  contained, 

Urea,         -         -         -  -  20783 

Uric  Acid,          -         -  -  A  trace — a  few  small  crystals. 

Fixed  Saline  Constituents,  -  2156 

The  disappearance  of  the  uric  acid  is,  without  doubt,  due  to  the 
action  of  the  sulphate  of  quinia.  This  patient  continued  to 
improve  and  was  discharged  on  the  following  day.  This  case 
illustrates,  in  a  striking  manner,  the  beneficial  effects  of  stimu- 
lants and  large  doses  of  sulphate  of  quinia  in  remittent  fever. 
The  prompt  administration  of  sulphate  of  quinia  and  stimulants, 
not  only  cuts  short  the  disease,  but  also  supports  the  strength 
of  the  patient,  and  he  comes  through  a  severe  attack  with  com- 
paratively unimpaired  forces. 

(To  be  continued.) 


602  Doughty.    Report  of  Hospital  Cases.    [September, 


ARTICLE   XXI. 

Report  of  Cases  in  the  City  Hospital.     By  W.  H.  Doughty,  M.D., 
Augusta,  Ga. 

INTERMITTENT   FEVER,    ATTENDED  WITH  A  SWELLING  OF  THE 

TESTICLES. 

J.  0.,  was  admitted  March  10th,  for  injuries  (fractured  ribs) 
which  he  had  received  by  a  fall  upon  the  deck  of  a  steamboat. 
When  examined,  it  was  found  that  he  also  suffered  from  a 
swelling  of  the  testicles.  He  was  not  sensible  of  any  injury 
having  been  inflicted  upon  them,  but  thinks  that  no  violence 
has  been  done  them  by  the  fall,  since  he  is  subject,  upon  expo- 
sure, to  this  peculiar  malady.  The  ordinary  mode  of  manage- 
ment of  fractured  ribs  was  pursued,  attention  being  also  paid  to 
the  swollen  organs.  In  due  time,  these  latter  were  restored  to 
their  natural  size,  and  his  condition,  otherwise,  so  much  im- 
proved that  he  was  permitted  to  leave  the  hospital  for  a  short 
time.  He  became  intoxicated  soon  after  his  departure,  and  lay 
out  that  night  in  the  street,  exposed  to  a  very  damp  atmosphere 
and  an  exceedingly  heavy  dew. 

April  6th.  Keturned  at  7  o'clock  A.  M.  Was  taken  with  a 
chill  at  10  A.  M.,  which  lasted  about  four  hours,  and  during  the 
continuance  of  which  his  testicles  became  enormously  swollen. 
Having  been  interrogated  concerning  his  liability  to  intermit- 
tent fever,  and  whether  or  not  this  glandular  swelling  was  a 
common  attendant,  he  replied,  that  whenever  he  had  a  chill  or 
was  much  exposed  to  cold  and  damp,  his  testicles  almost  invari- 
ably swelled,  the  engorgement,  at  such  times,  producing  excru- 
ciating pain.  He  was  visited  during  the  chill;  and  being  struck 
with  this  unusual  feature  in  ague  and  fever,  the  testicular  en- 
gorgement was  closely  watched,  in  order  to  ascertain  whether 
or  not  it  would  subside  with  the  termination  of  the  paroxysm. 

Treatment. —  ty.  Spts.  camphor  gtt.  xxv. ;  Chloric  ether  3j.; 
Tr.  opii.  gtt.  x. — to  be  given  occasionally  during  the  cold  stage ; 
also,  mustard  to  spine  and  extremities. 

April  7th.  Patient  in  a  profuse  perspiration  ;  bowels  confined ; 
testicles  swollen  and  painful ;  tongue  furred,  yellow. 


1858.]  Intermittent  Fever,  &c.  603 

Treatment. — Mercurial  cathartic  immediately ;  quinine,  3  grs. 
every  three  hours ;  cold  applications  to  testicles. 

April  8th.  Patient  better ;  no  chill ;  swelling  of  the  testicles 
diminished. 

Treatment — Same  as  yesterday. 

April  9th.  Swelling  of  the  testicles  disappeared ;  patient  up, 
moving  about.     Discharged  10th. 

Eemarks. — Perhaps  no  principle  in  pathology  is  more  univer- 
sally received  by  the  practical  part  of  the  profession,  than  that 
of  a  congestion  of  the  organs,  which  repose  in  the  three  great 
splanchnic  cavities  of  the  body,  during  the  cold  stage  of  an  inter- 
mittent. Indeed,  whilst  they  differ  widely  among  themselves, 
as  to  its  determining  cause  or  causes — some  attributing  it  to  a 
state  of  poisoning  of  the  blood,  and  others  to  primary  lesion  of 
the  nervous  system,  yet  they  agree,  that  this  cold  stage  is 
the  result  of  a  sudden  retreat  of  the  blood  from  the  surface  to 
the  internal  organs  and  structures.  No  exception  to  this  fact  is 
recognized,  for  we  never  read  or  hear  of  a  congestive  deter- 
mination, to  either  of  the  four  extremities,  unless  we  regard 
as  such,  the  rare  instances  upon  record  of  a  concomitant  con- 
gestion of  the  genital  organs.  How  far  the  occasional,  perhaps 
accidental,  determination  of  the  vital  fluid  to  these  organs, 
constitutes  it  an  example  of  an  external  or  peripheral  ten- 
dency, we  are  not  prepared  to  say,  since,  like  the  arms  and 
legs,  in  the  language  of  Hunter,  they  "are  not  necessary  for 
the  existence  or  support  of  the  individual,  but  have  a  reference 
to  something  else."  The  exceeding  great  rarity  of  these  cases, 
entitles  them  to  peculiar  interest,  if  for  no  other  reason,  than 
the  opportunity  which  they  present  of  beholding  an  organ 
under  the  congestive  influence  of  an  intermittent.  The  penis, 
in  this  case,  was  unaffected,  being  entirely  relaxed,  notwith- 
standing the  violent  congestive  determination  in  its  immedi- 
ate vicinity.  All  of  the  cases,  affecting  the  genital  apparatus, 
that  have  come  within  the  scope  of  ray  study,  have  been 
confined  entirely  to  the  penis.  The, following  is  from  Dr.  Dick- 
son *  of  Charleston.  "  We  had  in  our  museum,  a  long  while, 
sthough  now  lost,  the  preparation  of  a  penis,   which  suffered 


*  Dickson's  Elements  of  Medicine,  page  214. 
K.  8. VOL.  XIV.    SO.  IX.  .33 


604:  Doughty.     Report  of  Hospital  Cases.    [September, 

during  a  protracted  attack  of  intermittent,  the  same,  or  analo- 
gous, engorgement,  enlargement  and  induration  which  usually 
derange  the  spleen  in  ague,  being  obviously  the  seat  of  the 
congestive  determination,  familiarly  taking  place  in  that  vis- 
cus.  They  possess  an  erectile  structure  in  common.  The  case 
occurred  in  our  almshouse,  and  was  witnessed  by  a  large 
number  of  physicians,  none  of  whom,  I  belive,  entertained  any 
doubt  of  its  nature."  Further  on,  he  states,  that  a  similar  case 
had  been  reported  to  him,  as  having  occurred  in  the  state  of 
New  York,  "in  which  the  same  organ  was  attacked  with  con- 
gestive or  vascular  turgescence,  during  the  paroxysms."  No- 
thing is  said  concerning  the  adjoining  organs  (testicles)  in  these 
cases,  but  we  are  justified  in  the  belief,  that  the  determination 
was  confined  entirely  to  the  penis.  In  the  case  reported,  it  will 
be  observed,  that  the  patient  had  just  recovered  from  an  attack 
of  orchitis, f  and  doubtless  the  predisposition  to  a  recurrence  still 
remained.  The  history  of  this  case  might  justify  us  in  laying 
stress  upon  secondary  influences,  in  producing  such  a  deter- 
mination ;  but  in  regard  to  those  quoted,  we  cannot  say,  since 
nothing  is  mentioned  as  to  their  previous  condition,  whether 
diseased  or  not.  A  point  of  dissimilarity  between  the  reported 
case  and  those  quoted,  exists  in  the  fact,  that  the  state  of 
priapism  of  the  latter,  is  said  to  have  existed,  "during  the 
paroxysm,"  whilst  the  testicles  in  the  former,  remained  swollen 
for  several  days,  and  were  subjected  to  treatment.  This  dis- 
similarity becomes  reconciled  at  once,  we  conceive,  by  a  refer- 
ence to  the  difference  in  the  anatomical  structure  of  the  two 
organs  and  their  physiological  functions. 

PHTHISIS    PULMONALIS. 

R  N.,  has  been  an  inmate  of  this  institution  since  Feb.  8 — 
is  about  45  years  of  age — has  been  subjected  to  great  hardships, 
and  undergone  the  numerous  privations  of  poverty :  is  also  ad- 
dicted to  drunkenness  and  its  associate  vices.  Has  been  labor- 
ing under  this  disease  since  1854.  During  this  time,  has  had 
numerous  hemorrhages,  not,  however,  very  profuse.  At  present, 
she  evinces  all  the  common  symptoms  of  consumption — viz., 
cough,  purulent  expectoration,  hectic  fever,  diarrhoea,  etc.     The 

f  There  was  no  venereal  infection. 


1858.]  Phthisis  Puhnonalis.  605 

most  distressing  symptom  seems  to  be  a  difficulty  of  breathing, 
apparently  asthmatic  in  character  and  referred  to  the  right  side. 

Physical  Examination  of  the  Chest.  Heart. — The  action  and 
sounds  of  this  organ  are  natural  in  their  evolutions. 

Auscultation  of  Right  Lung. — Broncho- vesicular  respiration 
established  throughout  the  king — is  everywhere  prominent,  but 
most  so  in  the  infra- scapular  and  scapular  regions.  Inspiration 
high  in  pitch — tubular  and  blowing  in  quality — intense  and 
shortened  in  duration ;  also,  a  sound,  as  of  dry  crackling,  dis- 
covered at  the  end  of  inspiration  in  the  scapular  region  and  at 
its  apex.  Expiration  high  in  pitch,  being  remarkably  loud, 
bronchial  in  quality,  and  longer  than  the  act  of  inspiration. 
The  natural  rhythm  of  the  respiratory  acts  destroyed,  being 
very  irregular. 

Left  Lung. — A  modified  (broncho-vesicular)  respiration  exists 
only  in  the  apex  of  this  lung:  the  vesicular  respiration  in  the 
middle  and  lower  lobes  seems  to  be  simply  exaggerated,  without 
noted  deviations  as  to  quality. 

Auscultation  of  the  Voice.  Right  Lung. — Bronchophony  very 
prominent  at  the  point  of  the  scapula,  and  radiating  in  a  more 
or  less  marked  degree,  all  over  the  right  side,  even  to  the  apex. 

Auscultation  of  the  Voice.  Left  Lung. — The  normal  vocal  re- 
sonance slightly  modified  in  the  apex. 

Auscultation  of  the  Speech.  Right  Lung. — Perfect  pectoriloquy 
at  the  point  of  the  scapula — not  discoverable  at  any  other  por- 
tion. • 

Auscultation  of  the  Speech.  Left  Lung. — No  departure  appre- 
ciable. 

Percussion  of  Right  Lung. — Marked  dulness  over  the  entire 
lung — more  tympanitic  than  otherwise,  in  quality,  about  the 
point  of  the  scapula,  denoting,  with  its  correlative  signs,  the 
presence  of  a  cavity. 

Percussion  of  Left  Lung. — Appreciable  dulness  over  the  apex 
ofthe  left,  with  tenderness. 

Treatment. — Blisters,  from  time  to  time ;  syrup  superphosphate 
ferri,  3iij.  three  times  daily. 

Remarks. — The  principal  treatment  of  the  above  case  con- 
sisted in  the  use  of  the  syrup  superphosp.  ferri.  Indeed,  having 
noticed  at  that  time,  frequent  allusions,  in  the  various  medical 


606  Doughty.    Report  of  Hospital  Cases.    [September 

journals,  to  the  treatment  of  consumption  with  phosphorus,  this 
course  was  adopted  with  an  experimental  view.  It  was  given 
in  such  a  manner,  that  from  5  to  10  grs.  of  the  salt  (superphos- 
phate ferri)  were  taken  daily — it  was  continued  up  to  the  time 
of  the  death  of  the  patient  (May  12th).  She  would  frequently 
express  herself  benefitted  by  it,  but  no  beneficial  effect  could  be 
perceived  by  myself.  The  only  good  which  it  possibly  accom- 
plished, was  an  exhilaration  of  the  system,  which  but  increased 
the  fatal  delusion  of  the  sufferer,  that  she  was  better  physically. 
The  preparations  of  phosphorus  recommended  by  Dr.  Churchill, 
the  hypo-phosphites  of  soda  or  lime,  could  not  be  obtained,  and 
this  being  at  hand  was  substituted.  Of  courser  no  inference 
would  be  safe,  much  less  conclusive,  in  regard  to  the  use  of  this 
therapeutical  agent,  from  a  single  case  of  phthisis,,  but,  as  far  as 
this  case  goes,  it  at  least  serves  to  negative,  to  some  degree,  that 
recent  special  pathology  of  consumption,  which  ascribes  it  to  a 
deficiency  of  phosphorus  in  the  system.  It  would  be  considered, 
neither  unwise  nor  unnatural  to  suppose,  that  a  deficiency  of 
this  chemical  element  did  exist,  amidst  the  outspread  and  almost 
illimitable  devastations  of  this  disease  ;  but  such  a  conditition, 
if  it  exists,  should  be  regarded  in  the  light  of  a  consequence  or 
coincidence,  rather  than  the  cause.  I  am  not  aware,  that  this 
ideal  pathology  is  supported  by  the  chemical  proof  of  a  material 
diminution,  not  to  say  absence,  of  this  element  of  the  numerous 
salts,  excreted  by  the  various  emunctories  of  the  body..  Molli- 
ties  ossium  is  a  disease,  attributed  to  a  deficiency  of  a  salt,  one 
element  of  which  is  phosphorus.  Would  not  persons,  subjects 
of  this  disease  oftentimes  for  years,  present  more  or  less  of  this 
condition,  as  an  ultimate  symptom,  if  this  pathology  be  true? 
More  than  this :  organic  chemistry  teaches,  that  the  brain  and 
osseous  system  contain  the  greater  part  of  the  phosphorus  of  the 
system.  Physiologists  also  state,  that  "the  quantity  of  phos- 
phorus which  may  be  found  in  the  nervous  matter  varies  con- 
siderably at  different  periods  of  life,  and  is  very  small  in  idiocy-." 
"  The  minimum  of  this  element  is  found  in  infancy,  in  old  age 
and  idiocy."  Now,  this  being  true,  intellectual  development 
would  seem  to  keep  pace  with  it,  increasing  with  its  increase, 
and  declining  with  its  decline.  Should  we  not,  with  consistency 
look  for  a  decided  failure  of  the  intellectual  man,  coextensive 
with  the  diminution  of  this  substance  in  the  .progress  .of _the  dis- 


1858.]  Bronchial  Phthisis,  &c,        '  607 

ease  ?  Does  the  practical  history  of  the  consumptive  teach  this  ? 
There  is  no  evidence  upon  record,  to  the  end,  that  consumption 
produces  greater  prostration  of  the  mental  energies,  than  any 
other  cachectic  disease.  On  the  contrary,  examples  are  not 
wanting  in  history,  showing  the  highest  mental  abilities,  in  con- 
sumptives, some  of  whom  have  distinguished  themselves  and 
left  their  mark  upon  the  age  in  which  they  lived.  To  deny  any  • 
benefit  to  alkaline  phosphates  or  those  tonic  in  their  combina- 
tion, in  phthisis,  would  bespeak  ignorance ;  but  we  think,  that 
time  and  experience  will  prove  that  they  are  not  curative,  and 
will  determine  the  circumstances  under  which  they  are  to  be 
used.  In  the  above  case,  it  produced  no  effect,  other  than  an 
increased  buoyancy  of  spirits,  with  a  commensurate  cheerful- 
ness. Seasoning  from  its  physiological  importance  to  the  sys- 
tem and  its  therapeutical  action,  as  far  as  is  understood,  it  is 
perhaps  better  adapted  to  the  condition  of  certain  dyspeptics. 

BRONCHIAL  PHTHISIS,  WITH  DISEASE   OF  THE  HEART.    • 

Edward  M.  was  admitted  March  14th,  for  cough:  is  about 26 
years  of  age ;  dark  hair  and  eyes — states  that  he  has  had  a  cough 
for  five  months ;  has  never  spit  blood  ;  is  not  hereditarily  pre- 
disposed to  consumption,  but  thinks  that  a  brother  of  his  died 
with  disease  of  the  heart. 

Symptoms. — A  violent,  convulsive  cough ;  scanty  and  frothy 
expectoration  during  the  day,  but  consists,  early  in  the  morning, 
of  pus  and  hardened  mucus;  shortness  of  breath,  confined  to  the 
left  side  of  the  chest ;  frequent  palpitation  of  the  heart;  the  least 
exercise  readily  excites  the  attacks  of  palpitation  ;  cannot  lie 
upon  the  left  side,  from  the  violence  of  the  cough,  which  is  ex- 
cited thereby;  no  pain  in  the  chest;  is  not  subject  to  headache; 
left  cheek  flushed;  pulse  natural  in  frequency,  but  rather  full; 
bowels  regular,  and  appetite  and  digestion  good. 

Physical  Examination  of  the  Lungs. — The  respiratory  murmur 
on  the  right  side,  normal  in  its  various  features ;  on  the  left,  the 
vesicular  murmur  is  somewhat  exaggerated  in  the  upper  lobe, 
whilst  a  broncho- vesicular  respiration  is  observed  in  the  other 
lobe — an  expiratory  murmur,  however,  only  occasionally  per- 
ceptible. 

Auscultatum-of Voice  and  Speech.—No  variation. 


608  Doughty.    Report  of  Hospital  Cases,    [September, 

Percussion. — Normal  vesicular  resonance  observed  throughout 
the  chest. 

Physical  Examination  of  the  Heart — In  the  supine  posture,  its 
impulse  is.  very  strong,  being  felt  and  heard  everywhere  on  the 
lower  part  of  the  left  side,  in  front,  and  in  the  infra-clavicular 
region  of  the  right;  in  the  erect,  in  the  supra-scapular  region  of 
the  left,  also.  The  sounds  appear  to  have  a  muffled  quality  or 
tone,  and  with  the  impulse,  are  distinctly  audible  in  the  supra- 
scapular and  tapper  inter-scapular  region  of  the  left  side.  In  no 
other  part  of  the  superficies  of  the  chest,  can  the  sounds  be  heard, 
than  in  the  immediate  vicinity  of  the  heart  and  in  this  particu- 
lar region. 

Percussion — shows  a  larger  area  ef  dulness  over  the  cardiac 
region,  than  is  usually  found  in  healthy  persons. 

Treatment. — Blister  2£  by  6  inches  to  chest,  (leftside),  running 
obliquely  towards  the  spine;  alkaline  cough  mixture. 

March  19th.  Patient  somewhat  improved ;  cough  less  fre- 
quent and  violent — since  the  drawing  of  the  blister,  has  lost  its 
convulsive  character;  expectoration  more  loose.  Treatment 
continued. 

March  23rd.  His  condition  the  same,  except  that  the  cough 
has  regained  its  convulsive  character,  since  the  drying  up  of  the 
vesication. 

Treatment. — Blister  renewed ;  ext.  belladonna?,  in  suitable 
doses,  added  to  the  alkaline  cough  mixture. 

March  29th.  Cough  less  frequent — expectoration  still  contains 
pus  early  in  the  morning. 

Treatment. — Cod-liver  oil,  Iss.  three  times  daily,  in  conjunc- 
tion with  the  above  remedies. 

March  30th.  Physical  Examination  of  the  Chest. — Broncho- 
vesicular  respiration  more  general  in  the  left  lung — sonorous 
rkonchus  sometimes  observed  in  the  same ;  the  other  characters, 
the  same  as  were  noted  at  the  first  examination. 

Percussion  over  the  left  lung  shows  an  appreciable  dulness  in 
the  infra-scapular  region. 

A  close  examination  of  the  heart  was  prevented  by  the  recent 
vesication :  so  far  as  was  observed,  the  result  confirmed  the  pre- 
vious one. 

April  20th.  Patient  is  decidedly  better — coughs  but  little,  and 
only  when  he  first  awakes ;  general  health  improved— can  walk 


1858.]  Bronchial  Phthisis,  &c.  609 

up  and  down  stairs,  without  being  distressed  by  palpitation;  is 
gaining  flesh;  still  expectorates  pus.     Treatment,  same. 

May  10th.  This  patient  was  so  much  improved,  that  he  left 
the  hospital  for  New  York. 

We  regret,  not  having  had  another  opportunity  of  examining 
him  physically,  which  was  prevented  by  his  sudden  determina- 
tion to  return  to  the  north. 

Remarks. — In  the  differential  diagnosis  of  diseases  of  the 
chest,  from  a  frequent  association  of  disease  of  the  different  or- 
gans, contained  in  the  cavity,  it  is  exceedingly  difficult,  if  not 
impossible,  always  to  distinguish  the  one  primarily  affected ;  for 
they  all  present  such  a  community  of  symptoms  as  to  require 
the  nicest  tact  and  the  most  accurate  judgment  to  determine,  une- 
quivocally, the  order  of  the  diseased  actions.  In  the  case  above 
the  patient  had  entered  the  institution  to  be  treated  for  a  cough 
which,  as  is  usual  among  the  unprofessional,  when  protracted 
he  considered  as  an  evidence  of  consumption.  Happily,  physi 
cal  exploration,  by  the  absence  of  certain  landmarks,  when  associ 
ated  with  the  history  of  the  individual,  as  to  predisposition  and 
the  previous  occurrence  of  haemoptysis,  was  sufficient  to  decide 
in  favor  of  a  bronchial  affection,  without  tubercular  complica- 
tion. Having  determined  this  point,  another  presented  itself, 
viz:  With  the  heart  and  the  bronchiae,  both  diseased — which  is 
the  primary  lesion?  This,  to  the  patient,  became  a  question  of 
great  moment;  for,  if  the  lung  be  primarily  diseased,  with  its 
cure,  which  might  reasonably  be  expected,  the  sympathetic  af- 
fection of  the  heart,  now  assuming  an  organic  nature,  might 
also  be  expected  to  retire.  But  if  the  heart  be  the  primarily 
diseased  organ,  notwithstanding  the  bronchial  affection  yield  to 
treatment,  yet,  to  say  the  least,  recovery  would  be  more  than 
doubtful,  such  condition  of  the  organ,  as  we  suppose  this 
to  have  been,  seldom,  or  never,  proving  amenable  to  treat- 
ment.  Without  mentioning,  in  detail,  the  reasons  which  im- 
pelled us  to  the  conclusion,  we  are  satisfied,  that  the  heart  was 
primarily  diseased,  and  that  the  bronchial  affection  was  second- 
ary, being  kept  up  by  its  proximity  to  the  former,  its  increased 
action  and  the  want  of  proper  treatment.  What  the  particular 
diseased  condition  was,  we  have  not  stated,  and  is  still  a  matter 
of  doubt,  but  we  suppose  it  to  have  been,  one  of  hypertrophy, 


610  Doughty.    Report  of  Hospital  Cases.    [September, 

with,  perhaps,  dilatation  of  its  cavities — its  various  signs  and 
symptoms  pointing  more  particularly  to  this.    The  most  remark- 
able feature  presented  by  the  case,  and  the  one  which  induced 
its  publication,  was  that  of  a  distinct  appreciation  of  the  impulse 
and  sounds  of  the  organ,  without  solidification  of  the  pulmonary 
tissue,  at  the  supra-scapular  and  upper  part  of  the  inter-scapular 
region  of  the  left  side  of  the  chest.     In  healthy  persons,  this 
latter  phenomenon  is  not  observable  at  any  point  on  the  poste- 
rior aspect  of  the  chest,  but  is  confined  to  an  extent  of  surface 
between  the  right  infraclavicular  region  and  the  anterior  aspect 
of  the  left  side  of  the  chest.     The  only  conditions  of  the  thoracic 
viscera  which  have  been  proposed  for  the  interpretation  of  this 
phenomenon,  are  an  increased  conducting  capacity  of  the  pul- 
monary structure  from  solidification,  as  in  pneumonia,  carcino- 
ma, pulmonary  apoplexy,   compressions  of  pleuritic  effusions, 
and  tuberculous  deposits ;  also,  in  cases  of  emphysema,  where 
the  conduction  of  sounds  seems  to  be  abnormal  in  one  lung 
from  the  diminished  capacity  of  the  other.     In  this  case,  no 
evidence  of  a  consolidated  condition  of  the  lung  was  observed ; 
on  the  contrary,  the  normal  vesicular  resonance  was  unmodified 
beyond  that  which  occurs  in  ordinary  cases  of  bronchial  disease. 
No  materially  increased  conductibility  of  sound  could  be  attri- 
buted to  this  organ  under  this  condition  of  things.     It  could  not 
have  been  produced  by  emphysema  of  the  right,  since  no  evi- 
dence to  this  effect  existed,  and,  moreover,  the  left  was  the  dis- 
eased one.     How,  then,  are  we  to  explain  its  production?     We 
have  no  satisfactory  answer  to  the  query,  unless  it  be,  that  under 
the  increased  action  of  the  heart,  the  enlarged  extent  of  its  sur- 
face, which  came  in  contact  with  the  chest,  the  thoracic  parietes 
became  the  instruments  of  this  greater  transmission  of  its  sounds. 
On  the  other  hand,  if  this  be  so,  would  not  every  case  of  hyper- 
trophy, with  dilatation,  even  unassociated  with  diseased  lungs, 
be  characterized  by  the  same  observation  ? 

In  connection  with  the  production  of  this  phenomenon,  it 
may  not  be  amiss,  to  present  the  following  quotation  :* 

"  Dr.  Walshe  states,  that  in  a  case  of  intense  emphysema  of 
the  left  lung  in  which  the  disease  was  limited,  and  especially 
marked  at  the  posterior  aspect  of  the  chest,  he  found  the  heart 

*  See  Flint,  on  the  Respiratary  Organs,  p.  291. 


1858.]  Bronchial  Phthisis,  &c.  611 

sounds  considerably  more  distinct  posteriorly  on  the  right,  than 
on  the  left  side,  there  being  no  evidence  of  induration  of  the 
right  lung  to  intensify  the  sounds  on  that  side.  The  disparity 
here  was  attributed  to  an  abnormal  diminution  of  the  transmis- 
sion of  the  sound  to  the  posterior  surface  of  the  left  chest,  the 
right  remaining  in  a  normal  condition  in  this  respect.  AVithout 
knowledge  of  the  fact  that  the  transmission  may  thus  be  abnor- 
mally diminished,  a  normal  intensity  may  be  mistaken  for  a 
marked  sign." 

An  obvious  inference  from  this  quotation  is,  that  this  trans- 
mission of  the  sounds  of  the  heart  to  the  posterior  of  the  chest, 
may  take  place  even  in  health ;  but  so  far  as  our  reading  and 
observation  extend,  it  is  at  variance  with  other  authors,  for  the 
vesicular  structure  of  the  lungs  produces  such  a  diffusion  of  the 
sonorous  vibrations,  as  effectually  to  prevent  such  a  perfect 
transmission,  as  will  be  appreciated  by  audition.  Being  analo- 
gous to  the  production  of  the  physical  sign,  pectoroloquy,  it 
necessarily  requires  a  more  solid  conducting  medium,  than  the 
porous,  vesicular  tissue  of  the  lungs.  It  will  be  remarked,  that 
the  phenomenon  was  only  distinguishable  at  a  particular  part 
(the  supra-scapular  and  upper  inter-scapular  region  of  the  left 
side):  if  it  had  been  owing  to  a  natural  transmissibility  by  the 
lung,  it  would  not  have  been  so  circumscribed. 

The  only  alternative,  to  which  we  may  resort,  by  which  to 
account  for  the  morbid  sign,  viz.,  transmission  by  the  thoracic 
walls,  is,  when  we  examine  strictly  the  circumstances  of  the  case, 
perhaps  ful]y  adequate  to  its  accomplishment.  In  health,  dur- 
ing the  alternate  contraction  and  dilatation  of  the  heart,  no  part 
of  the  organ  touches  the  thoracic  walls,  except  its  apex,  and 
that  only  during  the  contraction  of  the  ventricles.  The  im- 
pulse, the  result  of  this  action,  is  most  distintly  felt  between  the 
5th  and  6th  ribs.  Again,  those  parts,  the  various  valves,  which 
are  the  agents  in  the  production  of  the  two  sounds,  occupy  a 
position  in  this  organ  higher  up,  being  situated  beneath  the  3rd 
'and  4th  ribs,  whose  spinal  attachments  are  in  the  supra-scapular 
and  upper  inter-scapular  regions.  Now,  when  the  heart  is  of 
its  natural  size,  it  is  entirely  separate  from  these  ribs  (3  and  4), 
therefore,  whatever  of  sound  is  transmitted  by  them,  must  be 
derived  indirectly  from  the  impulse  below,  through  the  muscu- 
lar septum  of  the  intercostal  spaces.    Now,  if  the  heart  be  en- 


612  On  Headache.  [September, 

larged,  and  at  the  same  time  dilated,  it  has  a  greater  extent  of 
surface  in  contact  with  the  parietes  of  the  chest,  increasing  the 
space  over  which  the  impulse  may  be  felt,  and  favoring  a  more 
direct  transmission  of  the  valvular  sounds  by  the  same,  to  dis- 
tant parts.  Bearing  in  mind  the  spinal  attachments  of  the  3rd 
and  4th  ribs,  and  their  relation  at  their  sternal  extremities  to 
that  portion  of  the  heart  which  contains  the  valves  in  conjunc- 
tion with  the  increased  action  of  this  organ,  producing  greater 
intensity  of  sound,  may  we  not  find  in  their  direction  the  key 
to  the  solution  of  the  problem  under  discussion.  Their  firm, 
dense  structure,  receiving  direct  impressions,  render  them  better 
conductors  of  sounds,  and  perhaps  point  to  a  reason  why  the 
sounds  were  not  heard  in  other  directions  of  the  same  side. 

Perhaps  the  worthy  editors  of  this  journal  can  give  some 
additional  reflections,  valuable  to  its  readers,  upon  the  point 
involved. 


On  Headache.     By  John  Addington  Symonds,  M.  D.,  F.R.S.E., 
Consulting  Physician  to  the  Bristol  General  Hospital,  etc. 

It  is  an  interesting  but  a  difficult  investigation  to  ascertain  the 
mode  of  production  of  some  of  these  sympathetic  pains  in  the 
head.  Here,  for  instance,  is  a  question.  What  is  the  cause  of  a 
so-called  bilious  or  sick  headache  in  a  person  who  suffers  such 
an  attack  once  in  a  year  or  so?  In  him  there  cannot  be  any 
great  susceptibility  on  the  part  of  the  cerebral  nerves,  or  it  would 
occur  oftener.  But  what  is  the  course  of  events  when  it  does 
occur?  We  need  not  stop  to  ask  whether  it  is  some  imperfectly 
chymified  substance  in  the  duodenum,  or  some  depraved  secretion 
which  begins  the  mischief.  We  will  assume  it  to  be  some  dis- 
turbing impression  on  the  nerves  of  the  alimentary  tube. 

This  impression  may  or  may  not.  produce  a  sensation  of  indi- 
gestion before  the  headache.  If  it  does,  we  might  suppose  that 
the  impression  has  passed  by  extension  from  the  parts  of  the  sen- 
sorium  in  relation  with  the  nerves  of  the  stomach  to  that  which 
is  in  relation  with  the  nerves  of  the  head,  and  that  the  pain  is,  so 
to  speak,  reflected  on  the  latter  nerves.  If  this  is  the  course,  I 
think  it  must  be  presumed  that  there  must  have  been  some  pre- 
vious disposition  in  the  centres  related  with  the  nerves  of  the 
brain  to  be  so  affected. 

I  doubt  if  this  hypothesis  is  so  tenable  as  the  supposition  that 
the  impression  is  communicated  along  the  sympathetic  chain  to 
the  nerves  of  the  brain,  and  there  excites  the  disturbance. 


1858.]  On  Headache.  G13 

Whatever  may  be  the  function  of  the  sympathetic  nerves  as  to 
sensation,  motion,  and  reflex  action,  it  is  impossible  to  observe 
their  intricate  nexus,  as  well  as  their  distribution,  without  suspect- 
ing that  one  part  of  their  duty  must  be  internuncial  between  the 
viscera,  and  that  they  must  be  the  agents  of  that  consentaneous 
operation  without  which  the  functions  of  organic  life  could  not 
long  continue. 

Order  in  time  must  be  as  necessary  in  the  human  microcosm 
as  in  the  macrocosm  of  the  universe.  Were  the  processes  of 
digestion,  sanguifaction,  respiration  and  circulation,  to  go  on  in- 
dependently, the  vital  machinery  would  soon  come  to  a  stop. 
The  heart  beats  at  definite  intervals,  the  respiration  keeps  a  pro- 
portionate time,  food  should  enter,  and  its  residue  leaves  the  sys- 
tem at  regular  periods.  But  the  rates  are  perpetually  changing, 
from  the  variations  of  daily  or  even  hourly  life,  and  the  changes 
must  be  announced  from  one  part  to  another,  in  order  that  the 
requisite  adjustments  may  take  place.  Without  entering,  however, 
more  minutely  into  speculations  as  to  the  final  cause  of  the  inti- 
mate nervous  connexions  of  the  viscera,  we  may  content  our- 
selves with  pursuing  the  way  of  exclusion.  The  cerebro-spinal 
nerves  mixed  up  with  the  ganglionic  nerves  account  for  as  much 
of  sensation  and  emotional  influence  and  reflex  action,  as  we 
meet  with  in  the  viscera.  The  contractions  of  the  muscular 
fibres  of  organic  life,  probably  have  special  relations  with  true 
ganglionic  fibres  and  ganglionic  centres,  uni-pular,  bi-polar,  etc. 
Still  there  are  a  large  number  of  plexuses  and  nerves,  entering 
and  departing  from  those  plexuses,  whose  function  is  scarcely 
accounted  for,  unless  we  infer  that  their  office  is  to  keep  up  a  con- 
nexion of  some  sort  between  the  viscera. 

A  general  survey  of  the  ganglionic  system  and  the  connecting 
nerves,  impresses  us  with  the  unity  of  the  whole  system.  But 
without  the  a  priori  assumption  that  organs  so  connected  must 
work  together,  we  have  strong  a  'posteriori  evidence  of  the  con- 
nexion in  the  events  of  disease.  One  organ,  the  variations  of 
whose  actions  may  be  considered  typical  of  the  rest,  is  more  easily 
observed  than  the  others.  I  need  not  say  that  J  allude  to  the 
heart.  Much  has  of  late  years  been  done  to  prove  the  dependence 
of  its  rhythmical  action  on  ganglionic  centres.  Since  these  re- 
searches, I  think  we  can  no  more  definitely  understand  than  ever 
we  could  understand  before,  the  readiness  with  which  the  rate  of 
the  cardiac  pulsations  is  affected  by  disorders  of  anv  organs  within 
the  ganglionic  chain.  The  intermittent  pulse  of  indigestion,  the 
alarming  rapidity  of  the  heart's  action  from  inflammation  of  the 
peritonaeum,  or  the  depression  of  its  action  from  injuries  without 
loss  of  blood  or  severe  pain — show  that  this  regulating  central 
power  of  the  circulation,  not  only  receives  tidings  of  distant 
organs  with  great  quickness,  but  also  that  it  is  seriously  perturbed 


614  On  Headache.  [September, 

by  them.  There  is  every  reason  from  analogy  to  infer,  that, 
although  we  have  not  such  ready  means  of  noting  the  influence 
of  other  ganglionically  connected  organs  on  each  other  as  in  the 
case  of  the  heart  and  the  other  viscera,  yet  that  communications 
are  continually  going  on  in  health,  and  that  the  same  links  of  com- 
munication produce  the  association  of  morbid  phenomena.  That 
the  connexion  in  health  is  quite  irrespective  of  sensation  is  obvious, 
from  the  fact  that  in  perfect  health  individuals  may  live  for  long 
periods  of  time  unconcious  of  internal  viscera,  and,  therefore,  that 
their  harmonious  action  had  not  been  indebted  to  sensation.  The 
sensory  nerves  of  the  viscera  seems  to  have  no  other  function 
than  that  of  denoting  unusual  states  of  the  organs.  But  if  this 
be  the  function,  the  question  arises,  What  possible  good  can 
accrue  from  the  transference  of  the  sensation  from  the  sick  organ 
to  one  that  is  well,  or  comparatively  so? — a  common  enough 
occurrence  in  sympathetic  disorders.  The  good  would  certainly 
appear  to  be  beyond  our  discovery ;  but  we  may  endeavor  to 
learn  the  course  of  transmission.  Do  the  sensory  fibres  convey 
the  impression  direct  to  the  sensorium  ?  and,  before  its  conver- 
sion into  a  sensation,  is  the  impression  transferred  to  another  part 
of  the  sensorium,  related  with  sensory  ganglial  fibres  from  some 
other  viscus  ?  Is  the  impression  which  has  been  made  on  the 
gastric  nerves  by  a  lump  of  ice,  allowed  to  pass  over  the  ence- 
phalic cells  related  with  those  nerves  without  being  converted  into 
a  sensation,  while  on  reaching  the  cells  related  with  the  sensory 
fibres  of  the  first  branch  of  the  fifth  nerve,  it  causes  a  state  which 
is  felt  in  this  nerve  as  neuralgia?  Is  this  the, probable  route?  or 
is  there  not  another  equally  probable  ?  If  we  admit  that  impres- 
sions are  exchanged  between  the  different  ganglia,  may  we  not 
conjecture  that  the  impression  made  by  the  ice  on  the  gastric 
nerves,  instead  of  running  along  the  nearest  rami  communicantes 
to  the  spinal  ganglia,  and  thence  up  the  sensory  tracks  (whatever 
they  are)  to  the  sensorium,  or,  if  you  please,  by  the  more  direct 
course  of  the  vagus;  instead  of  either  of  these  courses  ;  I  say, 
may  we  not  conjecture  that  the  impression  takes  its  route  up  the 
chain  of  sympathetic  ganglia,  making  no  disturbance  till  it  reaches 
the  ophthalmic  ganglion,  which  being  in  a  susceptible  state,  un- 
dergoes a  certain  change,  which  change,  on  being  imparted  to  its 
sensory  nerves,  excites  a  sensation  of  pain  referred  to  the  parts 
over  which  the  sensory  nerves  of  that  ganglion  are  disturbed  ? 
In  this  hypothesis  I  assume  the  ophthalmic  ganglion  to  be  predis- 
posed to  disorder,  because  an  organ  sympathetically  affected  with 
disease,  implies  a  readiness  for  disease  in  some  part  of  its  struc- 
ture. A  sympathetic  disorder  is.  so  to  speak,  not  forced  on  the 
sympathizing  organ — it  is  invited  by  the  readiness  of  the  latter  to 
take  offence. 

Let  us   endeavor   to  apply   some  of  these  considerations   to 


1858.]  On  Headache.  615 

another  particular  instance  bearing  on  our  immediate  subject. 
A  gentleman  had  for  many  years  been  liable  to  attacks  of  head- 
ache on  the  slightest  provocation.  Long-continued  intellectual 
exertion,  the  excitement  of  an  agreeable  party,  a  journey,  any 
erro*  of  diet,  would  inevitably  lead  to  an  attack  of  headache. 
During  the  same  period  he  suffered  at  different  times  from  pain 
in  his  teeth,  which  decayed  rapidly,  and  at  last  were  removed, 
and  replaced  by  false  ones.  This  change  happened  more  than  a 
year  ago,  and  since  that  time  he  has  been  almost  exempt  from 
pain  of  the  head.  In  other  respects,  his  health  and  mode  of  life 
have  been  unaltered.  What  was  the  connexion  between  the 
diseased  teeth  and  the  headache  ?  The  morbid  impressions  on 
the  ganglionic  fibres  of  the  fifth  pair  might,  without  any  stretch 
of  hypothesis,  be  reasonably  presumed  to  induce  a  morbid  state  of 
the  Gasserian  ganglion,  whether  the  impressions  on  the  senory 
fibres  did  or  did  not  reach  the  sensorium,  and  induce  a  painful 
sensation  referred  to  the  teeth.  The  Gasserian  ganglion  is  con- 
nected by  marked  fibres  with  the  cephaiic  ganglion,  from  which  a 
large  number  of  nerves  pass  to  the  cerebral  arteries.  The  cepha- 
lic ganglion  probably  partook  of  the  morbid  condition  of  the  Gas- 
serian, and  hence  might  have  arisen  so  susceptible  a  state  of  the 
ganglionic  nerves  of  the  brain,  that  they  may  have  become  dispo- 
sed to  ache  under  the  influence  of  impressions  which,  without  the 
predisposition  in  the  nerves,  produced  in  the  manner  I  have  des- 
cribed, would  have  had  no  effect.  It  seems  to  me  that  if  this  ex- 
planation cannot  be  accepted,  there  is  no  alternate  but  the  sup- 
position that  morbid  impressions  on  the  dental  nerves  (not  crea- 
ting pain  in  those  parts)  arriving  at  the  central  extremities  of  the 
nerves,  are  passed  on  to  that  part  of  the  sensorium  which  is  rela- 
ted with  the  sensory  fibres  of  the  ganglionic  nerves  of  the  brain, 
and  maintain  in  that  part  of  the  sensorium  a  morbidly  susceptible 
condition  ;  and  that  this  condition  is  brought  into  such  action  as 
constitutes  pain,  whenever  the  said  part  ot  the  sensorium  receives 
impressions  transmitted  from  nerves  which  have  been  offended 
by  causes  acting  directly  upon  them  in  the  brain  itself,  (as  in  over- 
study  or  anxiety,)  or  when  it  has  received  like  disturbing  impres- 
sions from  the  nerves  of  other  parts  of  the  ganglionic  system. 

I  confess  that  the  first  of  these  views,  which  I  have  ventured  to 
propound,  is  the  one  that  seems  to  me  more  admissible.  The 
course  of  communication  traced  in  that  survey  is  more  direct, 
and  involves  less  complexity  of  causation. 

I  should  feel  myself  to  be  taking  an  unwarrantable  liberty, 
were  I  to  occupy  the  time  and  attention  of  such  an  audience  as 
that  which  I  have  the  honor  of  addressing,  with  hypothetical  sug- 
gestions if  the  case  would  admit  of  a  theory.  We  have  not  the 
means  of  subjecting  ganglia  and  their  nerves  to  satisfactory  exper- 
imental  observations    in   reference   to   sensation.      When   the 


616  On  Headache.  [September, 

vivisector  has  made  his  way  to  the  base  of  the  cranium,  external- 
ly and  internally,  though  he  might  obtain  satisfactory  information 
as  to  the  conduits  of  motor  influence,  I  know  not  how  it  would 
be  possible,  in  the  midst  of  such  tearing  and  severing  of  tissues, 
to  determine  degrees  of  sensation,  which  can  only  be  demonstra- 
ted by  cries  or  quiverings. 

Allow  me  to  try  the  hypothesis  by  another  example.  A  gen- 
tleman, after  playing  at  bowls  one  evening,  awoke  in  the  night 
with  slight  haemoptysis.  The  source  was  referred  by  his  own 
feelings  and  his  physician's  examination  to  the  upper  lobe  of  the 
right  lung.  Whether  or  not  a  tuberculous  nodule  was  the  nucleus 
of  the  disease,  there  was  evidence  for  a  short  time  of  a  portion  of 
the  lung  in  the  right  infra-clavicular  region,  and  in  the  same  part 
pain  was  felt  for  a  long  time  afterwards,  when  the  patient  laughed 
vehemently,  or  made  any  strong  muscular  exertion.  But  after 
awhile  he  observed  that  pain  would  occasionally  come  on  in  the 
same  part  whenever  his  stomach  was  at  all  deranged,  and  that  it 
would  subside  after  a  slight  eructation  of  wind.  What  was  the 
chain  of  events  in  the  production  of  this  obviously  sympathetic 
pain  ?  Was  the  morbid  impression,  which  had  been  made  by 
gas  in  the  stomach  on  the  gastric  nerves,  transmitted  by  sensory 
nerves  to  the  sensorium,  and  instead  of  being  transformed  into  a 
sensation  in  the  part  of  the  sensorium  related  with  the  gastric 
nerves,  passed  on  to  the  central  cells  related  with  the  sensory 
nerves  belonging  to  that  portion  of  lung  which  was  formerly  dis- 
eased? Or  is  it  not  more  probable  that  the  gastric  impression 
was  transmitted  by  ganglionic  nerves  to  the  pulmonary  plexus 
belonging  to  the  spot  of  lung  in  question,  and  that  the  impression, 
acting  on  the  morbid  susceptibility  left  in  that  plexus  by  old 
disease,  excited  in  it  another  impression,  which,  having  been 
transmitted  to  the  sensorium,  produced  a  sensation  referred  to  the 
lung  ? 

There  is,  however,  another  element  to  be  considered  in  that 
curious  process,  by  which,  when  impressions  are  being  made  on 
many  sensory  nerves,  some  in  particular  will  be  converted  into 
sensations,  and  which  may  easily  lead  to  a  fallacy.  It  is  a  famil- 
iar fact  that,  amid  the  din  of  confused  sounds  in  a  street,  or  at  a 
dinner  party,  the  only  auditory  impression  which  become  sensa- 
tions, that  is,  which  are  presented  to  the  consciousness,  may  be 
the  words  of  a  friend  in  colloquy.  The  cause  of  this  appears  to 
be  simply  the  predominance  given  to  one  cluster  of  impressions 
by  the  desire,  or  the  compulsion  of  the  will,  in  other  words,  the 
expectant  attention.  If  of  two  impressions,  starting  severally 
from  the  gastric  ganglionic  centre,  and  its  related  pulmonary 
centre,  one  is  more  intense  than  the  other,  it  will  become  the  sen- 
sation perceived  in  the  sensorium.  Or  supposing  the  intensity  to 
be  equal,  the  prevalence  may  be  determined  by  the  expectant 


1858.]  On  Headache.  617 

attention.  If.  for  example,  the  pulmonary  impression  has  been 
linked  with  apprehensions  as  to  the  nature  of  the  illness,  or  with 
previous  suffering,  it  will  be  perceived  to  the  exclusion  of  the 
gastric. 

This  subject  of  morbid  sympathy  as  to  sensation  may,  perhaps, 
be  still  further  elucidated,  if  we  consider  the  sympathy  between 
the  tegumentary  surface  and  the  internal  organs.  What,  for  in- 
stance, is  the  order  of  events  in  catching  cold,  in  the  common 
occurrence  of  a  catarrh?  A  person,  liable  to  such  attacks,  may 
have  been  standing  at  a  corner  of  a  street,  or  at  an  open  window,, 
conversing  with  a  friend.  According  to  the  degree  of  interest 
in  the  conversation,  he  may  or  may  not  feel  chilly  ;  but  in  twelve 
or  twenty-four  hours  he  has  the  symptoms  of  incipient  catarrh. 
What  has  happened  during  that  period  of  incubation?  What 
did  the  current  of  cold  air  do  to  him?  It  may  be  said  that  the 
insensible  perspiration  was  interfered  with,  and  that  matters  were 
thereby  retained  in  the  blood  which  ought  to  have  been  elimina- 
ted ;  and  that  the  blood,  thus  contaminated,  excites  disease  in  any 
predisposed  organ — the  Schneiderian  membrane,  for  instance. 
This  may  be  the  case ;  but  another  view  might  present  itself. 
It  might  be  inferred  that,  an  impression  has  been  made  on  the 
nerves  belonging  to  the  cutaneous  blood  vessels,  reaches  the  gan- 
glionic centres,  and  in  its  further  diffusion,  extends  to  the  grey 
ganglionic  nerves  belonging  to  the  blood-vessels  of  the  Schneider- 
ian membrane,  and,  through  them,  so  alters  the  circulation  and 
secretion  of  the  membrane,  as  to  produce  what  is  called  catarrh. 
The  one  view  seems  at  least  as  likely  as  the  other.  But  suppose 
the  cold  to  have  operated  on  some  limited  portion  of  the  body,  say 
the  scalp  ;  or  suppose  the  outward  cause  to  have  been  damp  ground 
operating  only  on  the  feet.  It  is  not  easy  to  presume,  in  this  case, 
a  general  defect  of  elimination.  The  more  probable  presumption 
is,  that  an  impression  is  made  on  the  nerves  belonging  to  the 
blood-vessels  in  the  skin,  and  that  they  transmit  the  impression  to 
the  visceral  ganglia,  and  disturb  such  parts  as  are  most  prone  to 
disorder. 

Or  we  may  take  another  case  for  investigation.  I  have  a 
patient  who  frequently  suffers  from  severe  attacks  of  headache, 
and  who  tells  me  that  one  of  the  most  frequent  causes  is  driving 
in  an  open  carriage  in  a  cold  wind.  She  has  no  general  chill,  for 
she  is  well  clothed,  but  some  morbific  impression  must  be  made 
on  the  face.  In  a  few  hours,  the  headache  comes  on.  There  is 
here  no  general  interference  with  elimination,  but  an  impression 
is  made  on  the  skin  of  the  face,  which  mav  be  transmitted  to  the 
Gasserian  ganglion,  and  thence  to  the  cephalic ;  or  it  may  travel 
by  the  route  of  the  arteries  to  the  nerves  of  the  brain.  But  the 
road  which  the  sympathy  travels  may  be  traced  in  the  reverse 
direction.     Thus  a  patient  is  the  subject  of  headache,  attended 


618  On  Headache.  [September, 

with  heat  of  the  scalp,  dilated  and  with  throbbing  temporal  arteries. 
Cold  is  applied  to  the  forehead  and  scalp,  and  the  pain  is  lessened 
or  removed.  How  is  it  thus  sedative  to  the  nerves  of  the  cerebral 
vessels?  Its  operation  on  the  vessels  of  the  scalp  is  to  cause  their 
contraction ;  and  I  presume  that  this  is  effected  by  its  operation 
on  the  vascular  nerves.  The  impression  on  them,  transmitted  to 
their  ganglion  and  plexus,  must  reach  the  nerves  of  the  brain.  We 
cannot  think  that  the  cold  penetrates  the  bony  case,  and  so  redu- 
ces the  vascular  disturbance  within  it;  or,  should  any  one  think 
that  this  is  not  impossible,  let  us  suppose  that  instead  of  cold  lotions, 
leeches  have  been  applied.  No  influence  is  in  this  way  transmit- 
ted through  the  cranium  ;  the  quantity  of  blood  lost  is  too  small  to 
affect  the  heart  or  the  general  circulation,  and  it  is  a  clear  case  of 
sympathy.  The  relief  is  afforded  here  unequivocally  through  the 
blood-vessels  and  their  nerves,  the  latter  nerves  being  the  only 
media  of  communication  between  the  vessels  of  the  scalp  and  the 
vessels  of  the  brain  and  pia  mater,  whatever  communication  may 
be  traced  between  those  of  the  scalp  and  the  cranium  and  dura 
mater.  An  analogous  train  of  argument  might  be  pursued,  as  to 
the  action  of  anodynes  applied  to  the  surface. 

The  phenomena  of  a  coup  de  soleil  also  illustrate  the  principle  ; 
for,  unless  it  be  thought  that  the  sudden  elevation  of  temperature 
in  the  scalp  is  extended  to  the  cranium,  and  thus  directly  irri- 
tates the  vessels  of  the  membranes  and  the  surface  of  the  hemis- 
pheres, there  seems  no  other  way  of  tracking  the  influence  than 
that  which  I  have  already  pursued,  along  the  nerves  of  the  exter- 
nal blood-vessels  to  those  of  the  corotidal  plexus. 

Cerebral  Circulation. — Having  thus  far  considered  the  relation 
which  painful  affections  of  the  head  bear  to  impressions  on  dis- 
tant nerves,  let  us  turn  our  attention  to  their  connexion  with  the 
cerebral  circulation. 

The  intimate  connexion  of  the  nerves  of  the  brain  with  its 
blood-vessels,  enables  one  to  account  for  the  difficulty  which  is 
often  presented  to  our  diagnosis — that  of  distinguishing  the  pain 
which  is  purely  nervous,  from  that  which  is  the  effect  of  vascular 
disorder.  The  peculiarity  of  the  intracranial  circulation  enhan- 
ces the  difficulty;  for  though  the  researches  of  Dr.  Burrows  have 
settled  the  question  as  to  whether  the  qnantity  of  blood  in  the  ves- 
sels can  vary,  having  proved  that  it  is  variable,  yet  the  nature  of 
the  outward  barrier  indicates  plainly  that  the  compression  of  the 
vessels,  and  consequently  of  the  nerves,  must  at  times  be  very  con- 
siderable. Suppose  the  nerves  be  in  a  normal  state,  the  pressure 
of  distended  vessels  may  occasion  pain,  as  in  the  inflammation  of 
the  pulp  of  the  tooth.  Or  suppose  the  nerves  to  be  hyper-aesthe- 
tic, very  slight  changes  in  the  force  and  the  volume  of  the  circu- 
lation will  distress  them.  The  aggravation  of  a  nervous  headache 
by  palpitation,  by  interruption  to  the  venous  circulation,  in  cough- 


1858.]  On  Headache.  619 

ing,  straining,  or  other  muscular  exertion,  must  be  familiar  to 
most  persons.  I  have  just  supposed  the  case  of  the  nerves  being 
in  a  normal  state,  and  then  distressed  by  the  hydrostatic  pressure  ; 
but,  on  consideration,  I  doubt  whether  pain  is  ever  due  to  simple 
vascular  distension,  unless  the  latter  has  been  extreme  and  long- 
continued. 

It  is  difficult  to  find  a  combination  of  circumstances  exactly 
like  that  of  the  vessels  and  nerves  of  the  brain.  Some  resemblance 
may  be  found  in  a  limb  compressed  by  an  article  of  dress,  as  a  foot 
by  a  tight  shoe,  which  in  the  evening,  under  the  influence  of  heat 
and  long  dependence,  begins  to  swell.  The  pressure  of  the  shoe 
makes  the  swelling  painful;  but  here,  again,  there  is  a  want  of 
strict  similarity.  For  the  pain  comes  from  the  superficial  nerves 
of  the  skin,  which  are  directly  compressed.  The  pain  is  not  like 
that  which  ensues  when  the  vascular  nerves  only  are  affected. 
That  mere  compression  of  healthy  nerves  by  their  distended  ves- 
sels should  occasion  pain,  is  rather  negatived  by  the  freedom  from 
pain  during  violent  muscular  exertions  and  strains,  which  put  the 
vessels  of  the  head  under  the  highest  degree  of  pressure.  And 
again  when  the  accumulation  of  blood  takes  place  in  the  other 
direction,  whether  attracted  into  the  capillaries  by  unusual  func- 
tional exercise,  or  injected  into  them  by  emotional  excitation  of 
the  heart,  or  by  the  more  composite  influence  of  alcohol,  there  is 
often  an  entire  exemption  from  pain,  and  in  the  latter  instance  a 
feeling  of  great  enjoyment.  I  think  it  may  be  inferred  that  when 
fulness  of  the  vessels  gives  rise  to  pain,  there  must  be  an  accom- 
panying or  preceding  unhealthy  state  of  the  nerves  of  the  part, 
or  that  the  congestion  must  have  been  long  continued  enough  to 
beget  such  textural  disorder  as  the  nerves  will  necessarily  partake 
of.  In  inflammation  the  nerves  are  for  the  time  injured  by  the 
changes  in  which  the  process  consists,  as  well  as  by  the  first  action 
of  the  exciting  cause. 

The  headache  which  follows  an  epileptic  paroxysm,  and  that 
which  attends  or  ensues  on  prolonged  dyspnoea,  or  violent  fits  of 
coughing,  might  seem  to  be  examples  of  pain  occasioned  by 
simple  disturbance  of  the  brain-circulation;  but  the  latter  cases 
are  exceptional;  that  is,  it  so  often  happens  that  both  long-contin- 
ued dyspnoea  and  cough  occur  without  producing  headache, 
that  we  cannot  but  infer  that  some  nervous  element  must  be  in- 
troduced into  those  cases  in  which  pain  attends  upon  difficult 
breathing  and  cough.  As  to  epilepsy,  though  we  have  much  to 
learn  respecting  its  pathology,  yet  a  paroxysm  presents  unambigu- 
ous evidence  that  the  vessels  are  enormously  strained  ;  and  the 
pain  after  the  attack  and  the  functional  disturbance  of  the  brain 
bear  a  direct  ratio  to  the  severity  and  frequency  of  the  attacks. 

It  was  while  I  was  considering  the  relation  of  headache  to  altered 
states  of  the  circulation  in  the  brain,  and  speculating  on  the  pos- 

n.s. — VOL.  XIV.   NO.  ix.  34 


620  On  Headache.  [September, 

sibility  that  the  duration  of  a  fit  of  headache  might  be  connected 
with  the  time  requisite  for  the  adjustment  of  the  disturbed  balance, 
and  especially  for  change  in  the  distribution  of  the  cerebrospinal 
fluid,  which  has  been  supposed  to  play  an  important  part  in  such 
adjustments — it  was  with  the  view  of  confirming  or  correcting 
this  supposition  that  I  determined  to  make  some  experiments  on 
animals.  In  the  performance  of  these  I  had  the  valuable  assist- 
ance of  my  friend,  Mr.  Michell  Clarke,  a  gentleman  well  versed 
in  anatomy,  and  expert  in  operating. 

If  the  cerebro-spinal  fluid  replaces  blood  withdrawn  from  the 
intracranial  vessels  by  gravitation,  or  if,  conversely,  the  recession 
of  the  fluid  makes  room  for  congestion  of  those  vessels,  it  appeared 
to  me  that  were  an  animal  kept  some  time  in  a  certain  position, 
the  cerebro-spinal  fluid  ought  to  be  found  accumulated  either  in 
the  cranial  or  in  the  vertebral  cavities;  if  erect,  in  the  ventricles 
and  subarachnoid  space  of  the  brain  ;  if  inverted,  in  the  theca 
vertebralis. 

Three  rabbits  were  selected.  One  was  suspended  by  its  ears 
and  fore-legs,  another  by  its  hind-legs,  a  third  was  kept  for  com- 
parison. 

The  two  suspended  rabbits  were  poisoned  with  prussic  acid  after 
about  half  an  hour,  their  position  having  been  strictly  maintained. 
The  post  mortem  examination  was  made  immediataly,  and  with 
the  bodies  kept  steadily  in  the  same  position. 

In  the  rabbit  inverted  during  suspension  the  eyes  were  very 
prominent,  and  the  membrana  nictitans  was  congested  (but  there 
had  been  no  manifestation  of  distress  during  life).  The  vertebral 
canal  was  first  laid  open.  All  the  tissues  in  the  lumbar  and  dor- 
sal regions  were  bloodless;  those  of  the  neck  and  cranium  were 
gorged  with  blood;  the  membranes  and  the  substance  of  the 
spinal  cord  in  the  lumbar  and  dorsal  regions  were  quite  pallid.  In 
the  cervical  portion  of  the  theca  there  appeared  a  slight  accumu- 
lation of  sanguinolent  serum.  On  opening  the  cranium,  the  bony 
tissue  was  full  of  blood ;  the  meninges  were  highly  congested, 
and  the  puncta  sanguinea  in  the  cerebral  substance  were  numer- 
ous and  strongly  marked.  There  was  no  serous  fluid  in  the  ven- 
tricles, and  none  external  to  the  convolutions. 

The  rabbit  which  had  been  suspended  by  its  ears  and  forelegs 
was  of  course  examined  in  an  erect  posture.  The  tissues  of  the 
head,  neck,  and  back  were  exsanguine  ;  but  those  of  the  lumbar 
region  were  in  an  opposite  condition.  When  the  cavities  were 
laid  open,  the  membranes  of  the  spinal  cord  in  the  same  region 
were  found  injected,  while  those  of  the  brain  and  the  vessels  of 
the  brain  substance  were  extremely  pallid.  Serous  fluid  was 
anxiously  and  carefully  looked  for  in  the  ventricles  and  between 
the  convolutions,  and  at  their  base,  but  none  was  found. 

The  third  rabbit  was  poisoned  with  prussic  acid,  and  examined 


1858.]  On  Headache.  621 

immediately  in  the  horizontal  position.  There  was  a  pretty  equal 
distribution  of  blood,  and  nothing  remarkable  was  observed,  ex- 
cepting the  absence  of  anything  like  cerebro-spinal  fluid,  either 
in  the  cranial  or  in  the  vertebral  cavity. 

These  experiments,  while  they  entirely  confirmed  the  observa- 
tions and  conclusions  of  Dr.  Burrows,  as  to  the  production  of  an 
increased  or  lessened  quantity  of  blood  in  the  brain  by  gravitation, 
were  negative  as  to  any  adjustment  affected  by  cerebro-spinal 
fluid. 

I  thought  it  well  therefore  to  repeat  the  experiment  on  two  full- 
grown  and  very  strong  rabbits.  They  were  suspended  for  an 
hour.  The  rabbit  which  hung  by  the  ears  and  forelegs  was 
found  dead.  The  other,  quite  vigorous,  was  poisoned  with  prus- 
sic  acid.  They  were  examined  with  the  same  results,  excepting 
that  in  the  inverted  animal  there  was  not  the  same  appearance 
of  sanguinolent  exudation  in  the  cervical  portion  of  the  theca 
vertebralis  which  had  been  found  in  the  first  case.  The  rabbit 
which  had  died  suspended  by  his  ears  and  fore-legs  was  examined 
with  particular  care  and  interest.  No  serous  fluid  was  discover- 
able in  the  ventricles,  and  none  beneath  the  pia  mater — none  in 
any  part  of  the  cranial  cavity.  But  the  membranes  and  brain- 
substances  were  absolutely  blanched.  The  appearances  corres- 
ponded with  the  plate  in  Dr.  Burrows'  work,  representing  those 
of  a  rabbit  bled  to  death. 

As  this  observation  was  interesting  in  proof  of  the  fatal  effects 
of  a  posture  which  diverted  blood  from  the  brain,  it  was  repeated 
on  two  other  rabbits.  One  was  suspended  by  the  ears  and  fore- 
legs, the  other  by  the  ears  only.  Death  occurred  a  few  minutes 
earlier  in  the  former  than  in  the  latter  case.  The  appearances 
within  the  cranium  were  similar  to  those  described  in  the  former 
instance. 

In  order  to  meet  the  supposition  that  the  animals  might  have 
been  distressed  by  the  weight  of  the  body,  and  the  strain  on  the 
ligaments  of  the  neck,  the  weight  had  been  taken  offby  a  support 
applied  to  the  haunches. 

Thinking  it  desirable  to  ascertain  whether  the  inverted  position 
would  occasion  death,  if  continued  longer  than  in  the  cases  of 
the  animals  suspended  in  that  posture,  a  strong  middle-sized  rab- 
bit was  hung  up  by  his  hind-legs  and  kept  in  that  situation  for 
more  than  four  hours.  After  being  cut  down,  he  looked  for  a 
moment  astounded,  then  gave  his  head  a  shake,  and  seemed  to 
have  recovered  his  self-possession.  He  was  in  fact  quite  well, 
and  began  to  feed  quite  heartily. 

Rabbits  are  known  to  hold  their  lives  on  a  slighter  tenure  than 
do  many  animals.  We  thought  it  right  therefore  to  try  the  effect 
of  the  erect  posture  in  one  of  another  order.  A  cat,  being  pro- 
verbially  tenacious  of  life,   was  selected.   'Mr.  Clarke   found   it 


622  On  Headache.  [September, 

difficult  to  keep  her  head  constantly  upright.  She  died  in  three 
hours  and  a  half.  The  brain  and  its  membranes  were  perfectly 
bloodless,  but  there  was  no  fluid  in  the  ventricles,  nor  under  the 
pia  mater,  nor  in  any  part  of  the  cranial  cavity.  Neither  could 
more  than  a  very  few  drops  be  discovered  in  the  vertebral  cavity, 

Whatever  may  be  the  physical  agency  by  which  the  brain 
deprived  of  its  blood  is  still  capable  of  filling  its  bony  case,  the 
proof  given  by  the  experiment  of  the  degree  to  which  blood  may 
be  drained  from  the  cerebral  vessels  by  posture  only,  has,  it  seems 
to  me,  some  considerable  value.  We  see  that,  independently  ol 
the  neutritive  relation  between  blood  and  neurine  for  the  perform- 
ances of  brain  function,  one  of  the  conditions  under  which  this 
function  is  performed  is  a  certain  amount  of  pressure,  a  greatei 
or  less  amount  of  which  may  produce  distressing  or  even  fatal  re- 
sults. In  the  rabbit  the  circulation  is  not  so  arranged  as  to  main- 
tain even  for  a  short  time  an  adequate  supply  to  the  brain  undei 
the  disadvantageous  circumstances  of  erect  posture.  While  the 
egress  of  blood  is  helped  by  gravitation,  the  afflux  is  to  be  kepi 
up  by  the  exertion  of  a  heart  not  vigorous  enough  to  overcome 
the  difficulty  presented  by  gravitation.  The  heart  soon  becomes 
further  weakened  by  the  reflected  influence  of  that  very  state  ol 
the  brain  which  its  own  incapacity  has  engendered,  and  fata) 
syncope  is  the  result. 

The  fact  teaches  us  also  how  important  to  man,  with  his  "os  sub- 
lime" is  a  sufficiency  of  strength  in  his  left  cardiac  ventricle.  Il 
may  be  that  in  him  there  is  a  larger  amount  of  cerebro-spinal  fluid 
normally  existent,  and  that  he  is  furnished  with  adjustments  for 
his  greater  variety  of  postures.  But  still  nothing  is  more  to  be 
apprehended  than  the  result  of  diminished  afflux  and  pressure, 
from  a  failure  of  the  cardiac  impulse.  And  the  observation  is,  ] 
think,  confirmed  by  all  clinical  and  pathological  experience. 

I  need  scarcely  say  that  in  these  experiments  it  was  a  surprise 
to  Mr.  Clarke  and  myself  that  no  appreciable  quantity  of  fluid 
should  have  been  found  corresponding  to  the  cerebro-spinal  fluid, 
though  it  was  carefully  looked  for.  Mr.  Clarke  was  at  the  pains 
of  examining  under  every  precaution  the  vertebral  and  cranial 
cavities  in  a  cat,  and  in  dogs  poisoned  with  prussic  acid,  but  with 
the  same  negative  results.  The  examination  of  a  dog  was  made 
in  the  presence  of  Mr.  Henry  Clark,  an  accomplished  anatomist, 
and  myself.  The  whole  quantity  of  fluid  collected  on  bibulous 
paper  from  the  theca  vertebralis,  the  ventricles  of  the  brain,  and 
the  cranial  cavity,  amounted  at  the  most  liberal  computation  to 
no  more  than  seven  drops. 

It  is  not  difficult  to  reconcile  these  negative  results  with  the 
fact  that  one  finds  more  or  less  serous  fluid  in  the  cranial  and 
spinal  cavities  of  the  human  subject,  because  the  latter  is  always 
examined  several  hours   after  death,  and  when   there  has   been 


1858.]  Conical  Cornea  and  its  Treatment,  &c.  623 

abundance  of  time  for  the  transudation  of  fluid  in  these  as  well 
as  in  other  serous  cavities.  And,  a  priori,  a  large  proportion 
might  be  expected  from  the  exceeding  vascularity  of  the  pia  mater, 
which  represents  sub-serous  cellular  tissue.  But  it  is  more  diffi- 
cult to  explain  the  absence  of  the  fluid  in  the  animals  examined 
by  us,  when  we  consider  it  in  relation  to  the  experiments  of 
Magendie,  Cruveilhier,  Ecker,  and  others,  on  the  living  animal. 
It  would  be  presumptuous,  as  it  is  unnecessary  to  question  the  ac- 
curacy of  such  practised  observers.  And  without  other  evidence 
I  shall  come  to  the  conclusion  that  the  presence  of  true  cerebro- 
spinal fluid  is  confined  to  the  living  animal,  and  that  when  the 
quantity  of  blood  in  the  vessels  is  diminished  by  death,  the  fluid 
passes  into  them  by  endosmotic  action. 

But  I  have  before  me  the  note  of  an  experiment  made  by  Mr. 
Clarke  on  a  living  dog,  previously  rendered  anaesthetic  by  chloro- 
form, which  fully  corroborated  those  of  Magendie  and  Cruveilhier. 
The  dog  was  of  smaller  size  than  that  which  was  examined  after 
death,  yet  nearly  sixty  drops  escaped  from  the  puncture  through 
the  occipito-atloid  ligament,  though  from  a  dead  animal  of  the 
same  size  the  sum  total  of  serous  fluid  obtained  from  venticles, 
cranium,  and  theca  vertebralis  amounted  at  the  outside  to  seven 
drops  only. 

I  have  already  said  that  it  also  remains  to  be  explained  how  the 
brain  all  but  emptied  of  blood,  still  fills  the  cranial  cavity.  Two 
cats  were  killed,  especially  with  a  view  to  this  point  The  brain 
was  drained  either  by  posture,  or  by  division  of  the  cervical  ves- 
sels, but  on  opening  the  cranium  the  dura  mater  was  found  as 
tense  as  if  the  vessels  had  been  full  of  blood,  and  yet  no  serous 
fluid  was  discoverable.  As  there  is  no  ground  for  attributing 
resilience  to  the  cerebral  substance,  we  are  forced  to  speculate 
upon  the  possibility  of  some  interstitial  fluid  or  serous  halitus.  As 
the  experiments  have  proved  that  the  cerebro-spinal  fluid  of  the 
living  animal  is  not  to  be  found,  after  death,  can  it  be  that  this 
fluid  instead  of  being  extra-membranous  becomes  interstitial  ?  Or 
is  there  some  aeriform  substance  in  the  vessels,  such  as  prevents 
the  coats  of  many  of  the  arteries  from  collapsing  after  death, 
though  they  no  longer  contain  blood  ?  I  have  already  suggested 
some  experiments  to  Mr.  Clarke  in  elucidation  of  this  subject, 
some  of  which  he  has  already  performed,  while  others  are  still  in 
progress. — [Xew  Orleans  Med.  News  and  Hosp.  Gaz. 


Clinical  Lecture — on  Conical  Cornea  and  its  Treatment,  and  on 
Gonorrheal  Iritis.  By  W.  Lawrence,  F.R.S.,  F.R.C.S.,  &c, 
Senior  Surgeon  to  St.  Bartholomew's  Hospital. 

Gentlemen, — We  have  had,  since  Summer  Session,  commen- 
ced various  instructive  "  eye"  cases  in  the  hospital,  to  which  I 


624  Conical  Cornea  and  its  Treatment,  &c.     [September, 

wish  to  direct  your  attention  to-day.  Several  severe  cases  of 
syphilitic  iritis,  with,  and,  I  may  say,  without  complications,  as 
also  a  most  unique  case  of  that  very  singular  disease  "conical 
cornea."  Iritis  is  a  very  ordinary  disease  in  practice,  so  that  your 
attention  cannot  be  drawn  to  it  too  early  in  the  session  ;  it  is  also 
01V3  seen  under  unexpected  circumstances.  The  first  case  of 
which  I  may  speak  is  that  patient  suffering  under 

INFLAMMATION  OF  THE  EYE  WITH  GONOERHCEA. 

You  will  remark,  I  say,  inflammation  of  the  eye  attended 
with  gonorhcea — not  gonorrhoea!  ophthalmia;  the  diseases,  in 
fact,  are  quite  different,  as  well  in  their  pathological  seat  and 
import  as  in  their  mode  of  treatment,  constitutional  or  otherwise. 

In  cases  of  gonorrhoeal  ophthalmia,  of  which  I  speak  hereafter, 
it  seems  as  if  a  patient  laboring  under  gonorrhoea  conveyed  much 
of  the  puriform  discharge  immediately  to  the  conjunctivitis,  of 
which,  no  doubt,  you  have  all  read  in  your  books;  but  in  this 
patient  now  under  our  notice,  with  a  gonorrhoeal  history  of  a 
somewhat  like  kind,  the  infection  from  some  constitutional  cause 
or  peculiarity,  probably  of  a  rheumatic  character,  extended  from 
the  conjunctiva  to  the  sclerotic  coats  of  the  eye:  from  thence 
even  to  the  iris,  causing  great  intolerance  of  light,  with  remark- 
able dullness  of  colour  in  the  iris  itself.  To  these  signs  of  this 
affection  were  added  profuse  lachrymation,  and  what  I  consider 
almost  as  pathognomonic  of  this  class  of  cases,  most  severe  supra- 
orbital pain — pain  of  a  most  remarkable  kind,  extending  round 
the  orbit,  and,  no  doubt,  in  some  measure  engaging  all  the 
fibrous  tissues  of  that  part.  Now  I  wish  you  to  remark  that 
both  these  diseases  arise  under  similar  circumstances ;  yet  this  is, 
you  see,  quite  a  different  thing  from  gonorrhoeal  conjunctivitis, 
or  a  conjunctivitis  of  any  kind,  properly  so  called. 

The  supra-orbital  pain  of  sclerotitis  is  absent  in  the  disease  oi 
the  conjunctiva.  The  appearance  of  the  patient  himself  is  also 
peculiar;  you  can,  in  fact,  scarcely  mistake  these  cases  when 
once  you  have  studied  them.  Fortunately,  this  serious  thing — 
gonorrhoeal  ophthalmia — is  not  very  often  seen  in  this  hospital ; 
but  if  any  cases  do  offer  themselves  I  shall  take  the  opportunity 
of  showing  them  to  you.* 

The  treatment  of  these  cases  differs,  also,  so  that  a  propel 
diagnosis  is  not  a  matter  of  idle  curiosity  or  ingenuity,  but  oi 
necessity.  In  this  patient  we  had  to  combat  the  inflammatory 
symptoms  in  the  sclerotic  coat  with  much  vigour.  Depletion 
and  cupping  on  the  temple  were  ordered  and  mercury  used 
night   and  morning:  calomel  and  opium,    not  for  any   specific 

*  Mr.  Wilde,  of  Dublin,  as  previously  stated  in  the  Circular,  has  recently  discov- 
ered that  simple  leucorrhoea  in  a  married  female  produced  as  marked  infection  in 
the  conjunctiva  a&  gonorrhoea. 


1858.]  Conical  Cornea  and  its  Treatment,  d*c.  625 

action,  so  much  as  to  stop  inflammation.  To  these  remedies  we 
added  a  blister  on  the  nape  of  the  neck ;  yet  all  did  not  answer, 
and  we  were  obliged  to  have  recourse  to  the  wine  of  colchicum 
— (  3  ss.,  sex  tis  horis).  This  affected  his  stomach  a  little,  as  col- 
chicum very  often  does,  so  that  it  is  a  drug  requiring  much 
caution  in  its  administration.  In  my  experience,  however,  I 
find  that  when  the  pain  and  sickness  are  induced,  the  action  of 
the  medicine  is  more  certain  and  specific  ;  still  great  caution  is 
also  necessary,  for  very  serious  results  have  followed  overdoses 
of  this  powerful  agent. 

If  the  colchicum*  be  used  without  due  caution,  even  fatal 
results  might  arise,  so  that  it  will  be  necessary  to  watch  its  action 
with  great  care.  I  am  not  going  now  to  enter  into  the  minute 
diagnosis  of  sclerotidis,  we  shall  see  it  as  we  go  through  the 
wards  during  the  summer,  and  it  will  be  better  to  point  it  out 
to  you  in  the  wards. 

the  next  case  I  wish  to  speak  more  in  detail  about,  is  a  patient 
suffering  under  what  is  termed, 

(TOXICAL  CORNEA. 

The   patient  is   E.  TV ,    a  poor  woman,  it  seems,    who 

has  been  led  about  the  streets  quite  blind.  She  is  a  comparative- 
ly young  woman,  only  aged  thirty  six  years;  she  has  occasion- 
al flashes  of  light,  she  says,  but  with  that  sole  exception  she  has 
been  now  thirteen  years  totally  without  vision  of  any  kind. 

This  is  a  most  singular  disease,  one  of  the  pathology  or  nature 
of  which  we  know  absolutely  nothing.  As  far  as  I  have  seen 
it  during  fifty  years'  experience  (if  possible  to  add  to  its  anoma- 
lous character)  it  usually  takes  place  in  young  and  healthy  sub- 
jects who  have  not  suffered  in  any  manner  irom  excessive  use 
of  the  eye,  like  watchmakers,  needlewomen,  printers,  &c.  This 
young  woman,  our  present  patient,  you  see,  is  perfectly  healthy ; 
she  tells  us  nothing  of  any  previous  disease  of  her  eyes ;  in  fact, 
it  is  a  gradual  change  occurring  over  a  long  space  of  time  in  a 
cornea  otherwise  healthy.  I  have  seen  the  cornea  in  this  state 
become  in  shape  quite  like  a  cone;  the  rays  of  light,  too,  present 
a  most  unusual  appearance  in  conical  cornea;  the  patient  does 
not  present  the  vacant,  dull  eye  of  the  amaurotic  patient,  who 
holds  his  head  towards  the  sky  whene'er  he  may  chance  to  catch 
a  glimmer — everything  dark,  dark, 

"  Amid  the  blaze  of  noon 
Irrecoverably  dark,  total  eclipse." 

*  It  may  be  prudent  to  observe  that  very  few  surgeons  share  Mr.  Lawrence's 
4read  of  the  use  of  colchicum,  at  least  in  Hospitals.     Mr.  Hancock,  uses  tiuct  of 
aconite  in  such  cases,  which  is  nearly  the  same  medieine,  and  probably  aconite, 
and  atropine  will,  ere  long,  supersede  all  the  routine  plans  of  calomel  and  opium, 
belladonna,  <fec,  <fcc 


626  Conical  Cornea  and  its  Treatment,  &c.     [September, 

There  is  nothing  of  this  dulness  or  opacity  of  the  eye  in  conical 
cornea,  but  no  doubt  you  have  observed  it  in  this  woman  ;  the 
eyes  here  have  an  unusual  bright  appearance,  sparkling  like 
diamonds  or  those  bits  of  cut  glass  that  sometimes  represent 
diamonds!  The  rays  of  light  passing  into  the  eye  in  conical 
cornea  are,  I  think,  reflected  (not  refracted,  mind  you)  before 
they  fall  on  the  retina,  and  are  thus  thrown  into  those  singular 
glittering  or  diamond-like  reflections  in  the  vitreous  humour 
and  lens  of  the  eye.  I  think  that  even  on  physical  principles 
the  blindness  of  the  eye  in  conical  cornea  is  to  be  explained; 
her  eyes  are  like  a  telescope  that  has  been  pulled  out  in  a  wrong 
manner,  or  fixed  at  half  cock.  But  neither  a  gun  or  a  telescope 
will  answer  if  fixed  firmly  at  half  the  measure  of  its  capacity. 
In  the  eye  it  must  also  very  seriously  impair  the  focus  of  vision, 
as  you  see  it  does  in  this  poor  woman.  She  says,  over  and  over 
again,  that  for  years  she  has  been  totally  blind,  led  about  like 
a  child ! 

Well,  on  examining  the  eye  with  some  care,  I  found  that, 
though  the  cornea  in  each  eye  is  in  a  very  marked  manner, 
bulged  into  a  cone- — from  what  cause  I  never  could  meet  any 
surgeon  who  could  exactly  say — yet  that  the  immediate  circum- 
ference of  the  cornea,  situated  next  the  sclerotic,  remained  un- 
changed ;  indeed,  few  persons  not  familiar  with  the  different 
varieties  of  blindness  would  detect  that  this  healthy  young 
woman,  with  what  the  story-books  would  call  "  brilliant  eyes," 
was  a  poor  creature  almost  totally  blind.  Any  one  accustomed 
to  eye  cases  will  at  once  distinguish  these  cases,  however,  from 
cases  of  photophobia,  amaurosis,  &c* 

Now,  on  the  admission  of  this  woman  with  conical  cornea  to  hos- 
pital, having  seen  some  similar  cases,  benefitted  by  the  only 
remedy  I  know  of  in  these  patients,  I  was  anxious  to  give  that 

*  In  these  times,  when  sanitary  science  shows  the  value  of  light,  it  is  very  in- 
teresting, with  the  additional  knowledge  imparted  by  modern  science,  to  study 
the  early  observations  of  Milton,  who,  "  in  the  latter  years  of  his  life  suffered 
severely  from  rheumatic  gout,  which,  attacking  his  eyes,  left  him  totally  blind" 
— so  severe  this  "  dim  suffusion"  which  veiled  his  sight !  Speaking  of  light  he 
exclaims — 

"  Thee  I  revisit  safe, 
And  feel  thy  sovereign  vital  lamp ;  but  thou 
Revisit'st  not  these  eyes  that  roll  in  vain 
To  find  thj-  piercing  ray." 
And  again  he  makes  the  blind  Sampson  say — 
"  Since  light  so  necessary  is  to  life 
And  almost  life  itself — 

Why  was  the  sight 
To  such  a  tender  ball  as  the  eye  confined." 
"Almost  life  itself  is  a  very  beautiful  idea!     Marshall  Hall  has  shown  that 
perhaps  the  first  link  in  the  long  chain  of  actions  ending  in  assimilation,  diges- 
tion, &c,  is  a  reflex  action  in  the  lenticular  ganglion,  and  eighth  pair  from  light 
exciting  the  retina. 


1858.]  Conical  Cornea  and  its  Treatment,  &c.  627 

remedy,  which  is  belladonna,  a  fall  trial.     I  will  now  read  some 
of  the  notes  of  the  case : 

May  5, — "  The  patient  has  had  the  belladonna  applied,"  (I 
read  in  the  notes  furnished  by  the  House-Surgeon,)  "since  when, 
greatly  to  our  astonishment,  she  begins  to  see  objects  all  around 
her,  and  on  bringing  a  book  close  to  her  face  she  sees  the  type 
and  recognises  the  larger  letters."  Exactly  so.  Now,  the  reason 
of  that  is  at  once  obvious :  1  have  already  remarked  that  the 
immediate  circumference  of  the  cornea,  next  to  the  sclerotic, 
remained  unchanged  ;  very  well,  now  comes  the  belladonna  or 
atropine,  and  dilates  the  pupil ;  more  light  is  thus  permitted  to 
pass,  and  through  a  healthy  portion  of  cornea  a  mere  line  or  so 
of  pupil  is  left,  and  on  bringing  a  book  up  to  the  face  she  can 
read  very  respectably  indeed.  It  is  remarkable  and  curious 
that  the  retina  retains  its  sensibility  for  a  very  long  period. 
Now,  the  conical  cornea  in  these  cases  is  subject  to  friction,  and 
becomes  roughened;  you  must  be  prepared  also  for  that,  but  I 
am  of  opinion  that  in  young  and  healthy  subjects  it  will  not 
give  much  trouble. 

An  elderly  gentleman,  a  clergyman,  quite  blind,  consulted 
me  some  time  ago ;  he  was  perfectly  well  in  all  other  respects, 
but  he  was  totally  blind,  and  had  this  singular  disease  of  the 
cornea.  A  change  had  occurred,  unfortunately,  in  this  case,  in 
the  apex  of  the  cone  due  to  friction,  it  appeared  quite  opaque. 
The  old  gentleman  was  very  far  advanced  in  life,  perhaps  about 
eighty — an  age,  of  which  one  is  not  fond  of  new  experiments 
or  new  theories.  It  has  been  suggested  now — by  the  new 
Ophthalmological  School,  if  I  mistake  not — to  make  an  artificial 
pupil  in  such  cases.  I  simply  ordered  the  atropine  drops,  from 
which  he  obtained  a  very  fair  amount  of  comfort ;  indeed,  he 
went  to  church,  he  rode  about  in  his  carriage,  took  exercise,  and, 
much  to  his  delight,  renewed  his  acquaintanceship  with  an  old 
friend,  the  'Times'  newspaper!  which  he  read,  holding  it  up 
close  to  his  nose  and  forehead.  I  cannot  say  that  I  am  favora- 
ble to  cutting  operations  in  these  cases;  the  palliative  plan  of 
atropine  answers  every  purpose. 

We  next  pass  on  to  a  different  order  of  cases,  but  one  which 
must  attract,  as  it  deserves  your  serious  attention.  The  next  is 
a  case  of 

SYPHILITIC  IRITIS. 

I  may  say,  in  the  beginning,  this  has  been  a  patient  a  little 
out  of  the  ordinary  hospital  routine  of  such  cases — a  respectable 
young  person  coming  to  us  in  perfect  health,  but  attacked  with 
iritis!  If  we  put  the  question  of  syphilitic  or  non-syphilitic  to 
herself  out  of  book,  I  should  be  disappointed  if  she  answered  it 
exactly  as  it  might  be  wished.     She  comes  to  us  from  the  coun- 


628  Conical  Cornea  and  its  Treatment,  &c.     [September, 

try ;  she  looks  something  like  a  quiet  governess  in  a  private 
family.  Now  governesses  may  go  wrong,  I  dare-  say,  for  all 
that  you  know,  as  well  as  those  over  whom  they  may  be  said 
to  govern.  It  is  very  probable  that  we  are  favored  with  this 
lady's  society  because  she  has  kept  the  thing  a  profound  secret 
up  to  the  present.  All  this  has  a  bearing  on  the  case,  however, 
and  if  we  make  any  hand  of  it,  it  will  be  by  going  slowly,  as 
there  is  such  a  thing  as  idiopathic  iritis,  rheumatic  iritis,  &c. 

She  admitted  that  she  had  taken  some  medicine,  but  it  was  all 
Epsom  salts,  certainly  nothing  else.  Well,  not  knowing  much 
of  what  are  now  termed,  in  the  phraseology  of  the  day,  this 
lady's  "antecedents,"  or  the  amount  of  moral  control  she  may 
or  may  not  have  practiced  as  a  governess  on  herself  by  way  of 

example  to  her  pupils,  Mr. ,  my  House  Surgeon,  commenced 

what  the  newspapers  call  a  "delicate  investigation."  She,  of 
course,  denied  point  blank  all  syphilitic  taint,  but  on  untying 
the  strings  of  her  bonnet — which  she  was  requested  to  do,  as 
you  saw  on  the  day  of  her  admission — there  were  some  copper- 
coloured  spots  under  the  ribbons,  not  as  inviting  as  one  would 
like;  yet  this  was  not  sufficient  for  our  purposes  of  a  diagnosis, 
though  it  left  no  doubt  on  my  own  mind  of  the  true  nature  of 
the  disease ;  but  we  further- made  out :  this  is  the  month  of  May, 
but  about  last  Christmas  she  had  a  discharge,  attended  by  swel- 
lings in  each  groin,  but  she  merely  took  small  doses  of  Epsom 
salts,  and  did  nothing  else.  She  would  not  for  the  world  have 
told  the  family  surgeon.  You  will  see  the  bearing  of  this 
'delicate  investigation'  presently:  she  took  her  salts,  and  rested 
contented  that  it  would  all  blow  over.  Now  let  us  retrace  our 
steps  with  this  new  light.  About  five  months  ago,  you  perceive, 
she  had  primary  syphilis:  it  may  have  been  very  slight;  she 
had  a  discharge  probably  from  an  abrasion  in  the  passage.  Two 
months  after  she  noticed  the  marks  under  the  ribbons  of  her 
bonnet — viz.,  a  scaly  eruption,  and  now  more  of  a  copper  colour, 
yet  she  very  probably  knew  of  no  bearing  of  one  of  these  things 
on  the  other. 

May  4. — Together  with  the  previous  history,  we  find  the  left 
eye  of  this  governess  has  been  bad  for  ten  days.  She  was 
ordered  strong  poppy  fomentation  and  gray  powder,  ter  in  die 
— eight  leeches  to  the  temple.  When  I  first  saw  the  muddy 
colour  of  the  iris,  and  perceived  that  she  complained  of  dimness 
of  vision,  that  the  pupil  was  contracted,  and  did  not  seem  to 
answer  to  the  stimulus  of  light,  I  had  no  doubt  in  my  own  mind 
of  its  being  syphilitic  iritis. 

13. — I  need  not  go  over  the  notes  of  treatment;  they  do  not 
present  anything  worthy  of  stopping  to  remark  on,  as  you  have 
seen  the  case  to-day;  but  here,  on  the  13th,  she  is  reported  as 
"nearly  well;"  the  leeches  and  gray  powder  have  answered 


1858.]      Effect  upon  the  Mother  of  Poisoning  the  Foetus.  629 

their  purpose;  the  iris  is  again  safe;  and  she  will  probably 
leave  the  hospital,  thus  rescued  from  further  temporising  mis- 
chief. 

Now,  gentlemen,  this  history  interests  us  all  as  surgeons. 
You  see  it  is  made  up  of  quiet,  confidential  demeanour  towards 
even  the  poorest  patient;  and  when  this  is  adopted  you  seldom 
fail  to  come  down  on  the  truth;  the  educated  surgeon  will  not 
go  astray,  and  then,  also,  it  teaches  you  a  great  tact,  as  I  take 
it  to  be,  in  the  natural  history  of  syphilis,  to  be  arrived  at  in  the 
same  manner,  that  you  may  most  undoubtedly  have  all  the 
phenomena  ofsj'philis,  even  in  syphilitic  iritis,  without  one 
grain  of  mercury  having  been  previously  administered.  Iritis 
is  said  especially  to  be  a  "mercurial  symptom."  Some  of  my 
colleagues  and  many  other  surgeons  express  themselves  strong- 
ly on  this  point  of  doctrine — a  doctrine  I  do  not  hold  at  all. 
This  young  woman,  as  Horace  says,  was  striving  to  drive  out 
Nature,  but  still  ii  would  ever  keep  returning — 

"]N~aturani  expellas  furca,"  <fec. 

She  took  no  mercury;  she  dosed  herself  soberly  with  salts;  but 
still  we  have  the  usual  course  of  natural  symptoms — an  abrasion 
or  an  ulcer,  probably  getting  Avell  by  cleanliness,  and  not  using 
any  irritating  washes ;  then  muco-purulent  discharge,  next  bu- 
boes, all  cured. for  the  time  by  salts  ;  then  the  inexorable  spots 
under  her  ribbons,  as  completely  copper  coloured  as  ever  I  saw, 
and  now  iritis;  but  all,  I  am  firmly  satisfied,  generated  without 
mercury ! 

You  probably  know  that  the  surgical  world  is  divided  into 
two  opposing,  if  not  hostile,  camps:  the  mercurial  and  non- 
mercurial  plan  of  treatment  having  each  its  ensign  flying,  and 
some  battle — some  Knights  arrayed  with  their  hosts  on  one 
side  or  the  other;  but  of  the  natural  progression  of  syphilitic 
symptoms,  even  as  far  as  iritis,  without  the  agency  of  mercury, 
I  have  had  no  doubt  whatever  ;  indeed,  this  single  case — every 
bit  of  which  is  now  coherent  and  simple — proves  it.  Do  not  be 
misled,  then,  by  the  supposition  that  diseases  of  the  iris  or 
periosteum  are  due  to  mercury  more  than  to  syphilis,  for  disease 
of  the  iris  brook  no  delay  if  you  wish  to  preserve  the  integrity 
of  vision  in  the  organ. — [Medical  Chronicle. 


An  Experimental  Inquiry  into  the  Effect  upon  the  Mother  of  Pois- 
oning the  Foetus.  By  W.  S.  Savory,  Demonstrator  of  Anato- 
my and  of  Operative  Surgery  at  St.  Bartholomew's  Hospital ; 
Surgeon  to  the  great  Northern  Hospital. 

The  structure  of  the  placenta  and  the  character  of  its  circula- 
tion— the  close  and  intimate  relation  which  exists  there  between 
the  fcetal  and  maternal  blood — is  naturally  appealed  to  in  ex- 


630       Effect  upon  the  Mother  of  Poisoning  the  Fcetus.  [September, 

planation  of  the  well-known  effects  produced  in  the  child  by 
various  morbid  and  other  peculiar  conditions  of  the  maternal 
system  occurring  during  pregnancy.  This  intimate  relation 
between  the  two  circulations  at  the  placenta  is  looked  to  for  an 
explanation,  not  only  of  the  transmission  of  obvious  and  fully 
developed  disease  from  the  mother  to  the  foetus,  as  variola 
and  syphilis,  but  also  of  those  more  subtile  and  obscure  changes 
which  are  likewise  understood  to  be  capable  of  affecting  the 
child. 

Although  the  influence  thus  exercised  by  the  mother  upon 
the  foetus  has  been  known  to  every  one  for  ages  past,  and  is  con- 
tinually illustrated  by  striking  examples,  it  is  only  compara- 
tively recently  that  the  converse  relation — the  influence  of  the 
foetus  upon  the  mother — has  received  any  attention. 

The  subject  has  been  most  ably  brought  before  the  profession, 
by  Dr.  Alexander  Harvey,  in  a  very  interesting  series  of  phil- 
osophical papers  "On  the  Foetus  in  Utero,  as  inoculating  the 
Maternal  with  the  Peculiarities  of  the  Paternal  Organism."*"  In 
these  well-known  essays,  he  advances  some  excellent  observa- 
tions, and  cites  many  cases  to  show  "  that  an  explanation  offered 
by  Mr.  M'Gillivray,  of  Huntly,  is  the  true  one — viz.,  that  while, 
as  all  allow,  a  portion  of  the  mother's  blood  is  continually  pas- 
sing by  absorption  (and  assimilation)  into  the  body  of  the  foetus, 
in  order  to  its  nutrition  and  development,  a  portion  of  the  blood 
of  the  foetus  is  as  constantly  passing,  in  like  manner,  into  the 
body  of  the  mother ;  that  as  this  commingles  there  with  the  gene- 
ral mass  of  the  mother's  own  blood,  it  inoculates  her  system  with 
the  constitutional  qualities  of  the  foetus;  and  that  as  these  quali- 
ties are  in  part  derived  to  the  foetus  from  its  male  progenitor, 
the  peculiarities  of  the  latter  are  thereby  so  engrafted  on  the  sys- 
tem of  the  female  as  to  be  communicable  by  her  to  any  offspring 
she  may  subsequently  have  by  other  males." 

Now,  although  we  are  in  possession  of  absolute  facts,  which 
furnish  clear  and  convincing  evidence  of  the  direct  transmission 
of  what  may  be  termed  accidental  matter  from  the  mother  to  the 
foetus,  not  only  of  certain  diseases,  but  also  of  foreign  substan- 
ces— as  camphor  and  oil  in  the  experiments  of  Magendie  and  D. 
Williams — yet  we  have  no  such  conclusive  facts  in  support  of 
the  converse  proposition.  However  strong  the  argument  from 
analogy  may  be,  supported  as  it  is  by  the  record  of  cases  of  ex- 
treme interest,  yet  demonstrative  evidence  is  wanting  of  the 
direct  absorption  of  foreign  matter  from  the  foetus  by  the  mother. 
Indeed,  the  only  experiments  in  reference  to  this  point  with 
which  I  am  acquainted  was  attended  by  a  negative  result. 

In  his  "  Compendium  of  Physiology,"  Magendie  briefly  says, 

*  Monthly  Journal  of  Medical  Science,  for  Oct  1849,  and  Sept.  1850, 


1858.]      Effect  upon  the  Mother  of  Poisoning  the  Foztus.  631 

"I  have  often  injected  very  active  poisons  into  the  vessels  of  the 
cord,  directing  them  towards  the  placenta;  but  I  have^never 
seen  the  mother  suffer  from  the  effects  of  them." 

And  this  negative  result  may  be  supposed  to  depend  upon 
the  fact  that  after  all  the  communication  between  the  maternal 
and  foetal  blood  is  only  an  indirect  one,  and  is  therefore  limited. 
It  may  reasonably  be  believed  to  be  one  office  of  the  cells  which 
intervene  between  the  fcetal  and  maternal  vessels  to  regulate 
or  control  such  transmission,  to  exercise  a  selecting  influence 
on  the  materials  absorbed,  as  some  other  cells  in  all  probability 
do.  It  is  commouly  supposed  that  the  office  of  these  cells  is 
solely  connected  with  the  transmission  of  materials  from  the 
mother  to  the  foetus,  one  set  selecting  and  separating,  and  the 
other  elaborating  and  absorbing  them.*  Therefore,  even  if  an 
interchange  to  the  certain'  extent  be  admitted,  there  is  still  no 
proof  that  poisons  or  other  morbid  materials,  whether  arising 
from  within  or  without,  must  necessarily  pass  from  the  foetus 
to  the  mother. 

But  in  whatever  way  the  argument  may  be  supported,  it  is 
certain  that  two  very  opposite  opinions  are  expressed  by  phys- 
iologists on  the  subject.  Dr.  Harvey,  after  quoting  this  sentence 
from  Mr.  M'Gillivray,  "I  am  quite  aware  that  many  physiolo- 
gists maintain  that,  in  the  highest  species  of  animals,  the  blood 
cannot  be  returned  by  the  foetus  to  the  mother  during  utero- 
gestation,"  endorses  it  with  the  following  statement: — "That 
this  opinion  is  very  generally  held  by  physiologists  in  this 
country  is  quite  certain.  Dr.  Alison,  for  instance,  after  obser- 
ving (on  the  authority  of  Magendie  and  of  Dr.  David  Williams, 
of  Liverpool)  that  camphor  and  oil  injected  into  the  blood  of 
pregnant  animals  are  soon  detected  in  the  blood  of  the  foetus ; 
but  that  poison  injected  into  the  umbilical  arteries,  although 
mixing  with  the  blood  on  its  way  from  the  foetus  to  the  placenta, 
does  not  affect  the  mother;  and  that  fatal  haemorrhage  in  the 
mother  does  not  apparently  diminish  the  fulness  of  the  vessels 
of  the  foetus — adds  '  so  that  it  would  seem  that  the  transmission 
of  fluids  is  almost  entirely  from  the  mother  to  the  foetus.7 
Again,  Dr.  Kirkes,  referring  to  Professor  Goodsir's  observations 
as  to  the  intervention  of  two  distinct  layers  of  cells  between  the 
fcetal  and  the  maternal  portions  of  the  placenta,  speaks  of  the 
one  being,  ( probably  designed  to  separate  from  the  blood  of  the 
parent  the  materials  destined  for  the  blood  of  the  foetus,'  while 
the  other  'probably  serves  for  the  absorption  of  the  material 
secreted  by  the  other  set  of  cells,  and  for  its  conveyance  into 
the  bloodvessels  of  the  foetus' — no  idea,  seemingly  being  enter- 

*  Kirkes'  Physiology,  3rd  edition,  p.  681.  Carpenter's  Manual  of  Physiology, 
3rd  edition,  pp.  154-5  and  526. 


632     Effects  upon  the  Mother  of  Poisoning  the  Foetus.  [September, 

tained  of  a  converse  process.*  Moreover,  the  view  taken  by 
most  physiologists  of  the  destination  of  that  portion  of  the  foetal 
blood  which  is  transmitted  to  the  placenta  appears  to  be  exclu- 
sively that  of  renovation  or  aeration,  by  coming  into  relation  with 
the  oxygenated  blood  of  the  mother,  nothing  being  said  as  to 
re-absorption  into  the  maternal  system."  In  a  note  he  adds,  "  In 
his  'History  of  Medicine,'  Dr.  Alison  expresses  himself  even 
more  strongly  on  the  subject:  'The  experiments  of  Magendie 
and  others  have  proved  that  any  substance  which  may  be  circu- 
lating in  the  blood  of  the  mother  finds  ready  access  to  that  of 
the  foetus,  but  that  there  is  little  or  no  transference  of  fluids  in 
the  opposite  direction.' "  Those  authors  who  express  a  contra- 
ry opinion,  cannot  refer  to  any  facts  in  support  of  it. 

As  the  question  at  present  stands,  then,  the  only  demonstra- 
tive evidence  is  that  yielded  by  the  experiments  of  Magendie, 
and  these  gave  a  negative  answer.  All  the  rest  of  the  evidence 
which  has  been  adduced  on  either  side  is  devoid  of  proof,  is  in- 
direct and  inconclusive. 

This  subject  was  brought  before  the  notice  of  the  Hunterian 
Society  by  Mr.  Jonathan  Hutchinson,  in  a  paper  on  the  "Com- 
munication of  Syphilis  from  the  Foetus  to  the  Mother,"  read  there 
in  the  latter  part  of  1856.f  Jt  was  followed  by  a  very  interest- 
ing discussion,  and  it  then  occurred  to  me  that  it  should  be 
brought  to  the  test  of  experiment.  I  could  find  no  such  evidence 
on  record,  excepting  the  experiments  of  Magendie  already  re- 
ferred to,  and  these  had  yielded  a  negative  result.  But  the 
nature  of  these  experiments  appeared  to  me  objectionable;  for 
it  seems  almost  impossible  to  open  the  vessels  of  the  cord  and 
inject  directly  into  them,  without  interfering  to  a  fatal  extent 
with  the  foetal  circulation. 

This  was  the  general  plan  of  my  experiments: — 

By  opening  the  abdomen  and  uterus  to  expose  and  isolate  a 
living  foetus.  Then  to  inject  into  it,  with  the  least  possible 
amount  of  violence,  some  substance  capable  of  ready  absorption, 

*  It  is  however,  only  fair  to  add  that  in  the  latter  editions  of  his  work,  Dr. 
Kirkes  in  a  note  expresses  the  following  strong  opinion : — "  Although  in  the  text 
mention  is  made  only  of  the  passage  of  materials  from  the  blood  of  the  mother 
into  that  of  the  foetus,  yet  there  can  be  no  doubt  of  the  existence  of  a  mutual  in- 
terchange of  materials  between  the  blood  of  both  foetus  and  parent,  the  latter 
supplying  the  former  with  nutriment,  and  in  turn  abstracting  from  it  materials 
which  require  to  be  removed."  The  most  recent  expression  of  Dr.  Carpenter's 
opinion  is  to  this  effect.  After  giving  the  common  account  of  the  function  of  the 
placenta  as  furnishing  materials  for  the  nutrition  of  the  embryo  and  as  a  respira- 
tory organ,  he  adds,  "  And  it  is  probable,  too,  that  the  placenta  is  to  be  regarded 
as  an  excreting  organ,  serving  for  the  removal,  through  the  maternal  blood,  of 
excrementitions  matter,  whose  continued  circulation  in  the  blood  of  the  foetus 
would  be  prejudicial  to  it." 

f  This  question  in  relation  to  the  transmission  of  syphilis  had  previously  been 
often  suggested  by  various  authors,  but  it  is  much  more  fully  discussed  by  Mr. 
Hutchinson. 


1858.]      Effects  upon  the  Mother  of  Poisoning  the  Foetus.  633 

and  the  operation  of  which  is  marked  by  obvious  and  unmis- 
takable effects.  To  be  sure  that  no  trace  of  the  substance  came 
into  direct  contact  with  the  maternal  tissues.  To  place  the 
foetus  thus  injected  in  a  condition  most  favorable  for  the  con- 
tinuance of  the  circulation,  and  then  to  watch  for  symptoms  of 
the  operation  of  the  poison  upon  the  mother. 

The  poison  I  selected  from  some  others  was  strychnia,  for 
these  reasons : — 

It  is  extremely  active  in  very  minute  doses. 

It  is  easily  dissolved,  and  therefore  readily  absorbed. 

Its  absorption  is  rapidly  followed  by  its  operation  on  the  sys- 
tem. 

The  symptoms  of  its  operation  are  striking  and  characteristic. 

Its  effects  are  not  materially  counteracted,  nor  its  symptoms 
marked,  by  the  influence  of  chloroform. 

After  some  experiments  with  strychnia  dissolved  in  various 
menstrua,  as  alcohol,  benzole,  &c.,  I  preferred  as  the  most  eligible 
a  solution  of  strychnia  in  diluted  acetic  acid.  In  this  way  I 
obtained  a  very  convenient  solution  of  the  acetate  of  strychnia, 
of  sufficient  strength. 

Twenty-four  grains  of  strychnia  were  dissolved  in  seven 
drachms  of  distilled  water  by  the  addition  of  one  drachm  of 
acetic  acid.  Twenty  minims  of  this  solution,  therefore,  contained 
one  grain  of  strychnia. 

A  certain  quantity  of  this  solution  was  introduced,  usually, 
into  the  abdominal  cavity,  through  the  parietes,  by  means  of 
AneFs  syringe.  This  little  instrument  is  very  convenient  for 
the  purpose.  The  abdominal  wall  can  be  easily  pierced  with 
its  fine  point  without  any  violence.  The  quantity  of  fluid  in- 
jected can  be  accurately  calculated,  and  when  withdrawn,  the 
minute  puncture  is  so  closed  by  the  natural  elasticity  of  the  tis- 
sues, when  the  foetus  is  far  advanced  in  development,  as  to  pre- 
vent the  escape  of  any  portion  of  the  solution. 

The  subjects  of  my  experiments  were  dogs,  cats  and  rabbits. 
Dogs,  from  their  size,  are  the  most  convenient,  and  furnish  the 
most  satisfactory  results. 

From  a  considerable  number  of  experiments,  I  select  the  fol- 
lowing ones  as  fair  examples: — 

Experiment  1. — A  pregnant  bitch,  a  common  smooth -haired 
terrier,  weighing  about  twelve  pounds,  was  rendered  insensible 
by  chloroform.  The  abdomen  was  opened  in  the  median  line, 
and  the  uterus  was  partially  drawn  out.  It  was  carefully  divi- 
ded over  a  foetus.  The  amnion  was  punctured,  and  the  foetus, 
ly  and  vigorous,  was  allowed  to  escape.  It  was  received 
upon  a  napkin,  and  remained  connected  with  the  mother  only 
by  the  cord.    The  foetus  was  carefully  supported,  so  as  to  avoid 


634      Effects  upon  the  Mother  of  Poisoning  the  Foetus.  [September, 

stretching  the  cord.  The  abdominal  wall  was  cautiously  punctur- 
ed with  the  point  of  the  syringe,  and  ten  minims  of  the  solution 
(half  a  grain  of  strychnia)  were  injected  into  the  cavity.  When 
the  syringe  was  withdrawn,  no  fluid  escaped.  The  puncture 
was  so  minute  that  nothing  exuded  even  upon  pressure.  The 
foetus,  which  struggled  slightly  after  the  operation,  and  then 
became  tetanic,  was  suffered  to  remain  where  it  lay,  not  in  con- 
tact with  the  mother. 

An  incision  was  then  made  in  another  part  of  the  uterus  over 
a  second  foetus,  which  was  only  partially  exposed,  and  not  drawn 
out.  The  side  of  the  chest  was  wiped  dry,  the  point  of  the 
syringe  was  inserted  between  the  lower  ribs,  and  about  the  same 
quantity  of  the  solution  was  injected  into  the  thorax.  The  pis- 
ton was  slightly  retracted  before  the  pipe  was  withdrawn,  and 
not  the  least  trace  of  moisture  appeared.  The  part  where  the 
puncture  was  made  was  carefully  watched  for  some  seconds  by 
Mr.  Crowfoot  and  myself,  and  we  both  were  fully  satisfied  on 
that  point.  That  portion  of  the  uterus  which  had  only  partially 
extruded,  was  now  carefully  replaced,  without  any  protrusion 
of  the  foetus,  then  the  rest  of  the  uterus,  and  lastly  the  foetus 
first  operated  on  was  returned  into  the  abdomen,  and  the  wound 
was  closed  by  sutures. 

The  bitch  lay  on  her  side  motionless,  and  breathing  tran- 
quilly for  eight  minutes  from  the  time  of  the  first  operation.  In 
about  nine  minutes  slight  spasms  appeared.  These  gradually 
increased  in  intensity,  and  continued,  with  scarcely  any  inter- 
mission, for  eighteen  minutes.  In  twenty-eight  minutes  from 
the  time  of  the  injection  the  dog  was  dead. 

Five  minutes  after  her  death,  the  abdomen  was  re-opened. 
There  were  two  other  foetuses  besides  those  two  which  had  been, 
injected — four  in  all.  While  the  two  which  had  received  the 
strychnia  revealed  no  signs  of  life,  the  other  two  were  still  alive 
and  vigorous.  They  lived  some  time  after  separation  from  the 
mother,  and  one  which  was  suffered  to  escape  from  its  mem- 
branes respired  and  otherwise  displayed  such  evident  signs  of 
full  development,  such  as  crying,  that  any  doubt  of  the  near 
approach  of  natural  labour  which  could  have  been  entertained 
after  a  mere  inspection  of  the  foetuses  were  completely  set  at 
rest.  The  parts  were  found  in  the  abdomen  as  they  had  been 
replaced,  and  the  foetus  which  was  operated  on  in  the  uterus 
still  remained  there. 

Now,  I  am  satisfied  that  in  these  experiments  none  of  the 
solution  escaped  from  the  foetus  through  the  puncture,  because 
I  ascertained  that,  if  proper  precaution  had  been  adopted  in  the 
injection,  none  escaped  upon  pressure.  Moreover,  I  had  learned, 
from  another  set  of  experiments,  that  when  the  solution  is  allow 
ed  to   come  into   direct  contact  with  the  maternal  tissues,   as 


1858.]       Effect  upon  the  Mother  of  Poisoning  the  Foetus.  635 

when  injected  into  the  uterine  or  peritoneal  cavity,  or  when 
allowed  to  escape  from  the  foetus,  its  symptoms  are  never  delay- 
ed for  a  period  at  all  approaching  the  length  of  time  which  elaps- 
ed between  the  closure  of  the  abdomen  and  their  manifestation 
in  these  experiments.  The  usual  period  is  two  minutes,  and 
this  is  rarely  extended  to  five.  The  animal  is  in  most  instances 
dead  before  that  period. 

But  that  this  source  of  fallacy  did  not  arise,  I  have  more  than 
once  unintentionally  obtained  still  better  evidence  in  another 
way.  Some  of  my  experiments,  the  earlier  ones  more  especial- 
ly, were  attended  with  a  negative  result.  Foetuses  were  inject- 
ed and  returned  into  the  mother,  but  no  visible  effects  on  her 
of  the  poison  followed.  Prolonged  exposure  and  rough  mani- 
pulation when  the  foetuses  were  small  and  feeble,  had  been  fatal 
to  their  circulation.  But  I  now  see  the  importance  of  the  nega- 
tive results  which  these  experiments  yielded.  The  solution 
could  not  have  escaped  from  them,  or  in  any  way  have  come 
into  contact  with  the  maternal  tissues. 

More  recently  I  have  performed  the  following  experiment: — 

Experiment  2. — I  removed  two  foetuses,  within  a  day  or  two 
of  their  full  term,  from  the  uterus  of  a  cat,  immediately  after  its 
death  from  chloroform,  having  previously  placed  ligatures  on 
the  foetal  portion  of  the  cords.  They  both  were  lively.  I  in- 
jected ten  minims  of  the  solution  into  the  abdominal  cavity  of 
each  by  perforating  the  walls  with  the  point  of  the  syringe  in  the 
usual  manner.  When  the  syringe  was  withdrawn,  the  punc- 
tures remained  dry,  and  the  spots  were  scarcely  .visible.  Xo 
fluid  exuded  upon  pressure.  Then,  without  in  any  way  se- 
curing those  punctures,  I  introduced  the  two  foetuses  alive  and 
tetanic  into  the  abdominal  cavity  of  another  cat  under  chloro- 
form, and  allowed  them  to  remain  there  for  more  than  twenty 
minutes.  Not  the  slightest  symptom  of  strychnia  was  produced 
in  the  cat. 

We  are  naturally  reminded  by  the  negative  result  of  these 
experiments  of  the  impunity  with  which  a  mother  may  carry  a 
dead  and  decomposing  foetus.  In  neither  case  is  there  any 
Onger  a  circulation. 

In  the  following  experiment  the  possibility  of  the  fallacy 
occurring,  which  has  just  been  alluded  to,  was  prevented: — 

Experimerit  3. — A  cat,  far  advanced  in  pregnancy,  was  render- 
3d  insensible  by  chloroform.  The  abdomen  wasopened  and  the 
iterus  exposed.  It  was  carefully  divided  at  a  part  to  which  a 
Dlacenta  was  not  attached,  and  a  vigorous  foetus  extracted  in  its 
nembranes,  which  were  removed  from  it.  It  was  carefullv 
supported  on  a  napkin,  and  into  the  abdominal  cavity  about  ten 
ninims  of  the  solution  were  ejected.  The  portion  of  integu- 
nent  around  the  puncture  was  then  carefully  pinched  up  and 

N.8. VOL.  XIV.    so.  IX.  35 


636      Effect  upon  the  Mother  of  Poisoning  the  Foetus.  [September, 

secured  by  a  ligature,  so  as  to  prevent  the  possibility  of  any 
escape  of  the  solution.  A  second  foetus  was  then  extractedy 
and  treated  exactly  in  the  same  manner.  Both,  with  the  por- 
tion of  the  uterus,  were  then  returned  into  the  abdomen,  which 
was  closed  with  sutures. 

For  ten  minutes  from  the  period  of  the  first  injection,  the  cat, 
lay  on  her  side  breathing  tranquilly.  Then  slight  spasms  en- 
sued in  the  hinder  extremities;  these  gradually  increased,  and 
at  length  passed  into  violent  and  general  ones.  In  seven 
minutes  more  the  cat  was  dead. 

The  abdomen  was  then  re-opened,  and  the  ligatures  placed 
upon  the  punctures  in  the  foetuses  were  found  still  perfectly 
secure.  Both  the  injected  foetuses  were  yet  alive.  Within  a 
few  minutes  after  they  were  injected,  they  exhibited  decided 
spasms,  and  these  continued  for  a  long  period  after  the  death  of 
the  mother  frequently  to  recur.  The  other  fcetues  were  not 
affected. 

In  the  next  experiment  the  foetuses,  after  being  injected,  were 
not  returned  into  the  abdomen. 

Experiment  4. — A  pregnant  rabbit,  within  a  day  or  two  of 
her  full  term,  was  rendered  insensible  by  chloroform,  and  the 
uterus  was  exposed  by  the  usual  longitudinal  incision,  and  pro- 
truded considerably.  It  was  carefully  divided  over  a  foetus, 
which  was  immediately  expelled,  and  received  on  a  napkin, 
remaining  connected  with  the  mother  only  by  the  cord.  The 
point  of  the  syringe  was  inserted  through  the  abdominal  wall, 
and  about  five  minims  of  the  solution  were  injected.  None  es- 
caped. Five  other  foetuses — all  but  one — were  removed  and 
injected  in  a  similar  way;  from  five  to  ten  minims  of  the  solu- 
tion being  thrown  into  each.  The  punctures  remained  dry.  In 
one  case  the  cord  gave  way.  The  foetuses  were  all  fully  develop- 
ed, and  very  vigorous.  Almost  immediately  after  the  injection, 
decided  tetanic  spasms  appeared  in  all,  but  each  survived  and 
moved  actively  for  some  time  after.  None  of  the  foetuses  were 
replaced  after  injection  ;  indeed,  it  would  have  been  impossible 
to  do  so  owing  to  their  size.  They  were  allowed  to  lie  outside 
the  mother,  and  remained  connected  with  her  only  by  the  um- 
bilical cords. 

At  the  end  of  fifteen  minutes  from  the  time  of  the  first  injec- 
tion decided  tetanic  spasms  appeared  in  the  mother,  and  aftei 
repeated  attacks  she  died  rigid  in  three  or  four  minutes  more, 
During  the  spasms  of  the  mother  two  or  three  of  the  placenta: 
became  detached. 

The  following  experiment  is  a  still  more  striking  one : — 

Experiment^. — A  large  bitch,  far  advanced  in  pregnancy,  was 
rendered  insensible  by  chloroform.  The  uterus  was  exposed 
and  opened  to  a  small  extent,  at  a  spot  as  far  as  possible  front 


1858.]      Effect  upon  the  Mother  of  Poisoning  t)ie  Foetus.  637 

the  attachment  of  a  placenta.  Through  this,  by  means  of  very 
gentle  pressure,  a  foetus  enclosed  in  its  membranes  was  readily 
expelled.  The  membranes  were  carefully  divided,  and  the  foetus 
now  only  connected  by  the  cord,  was  placed  in  a  large,  but 
shallow,  vessel  of  water,  conveniently  arranged,  the  temperature 
of  which  was  about  100° — that  is  as  nearly  as  possible,  the  tem- 
perature of  the  fluid  in  which  it  is  naturally  immersed.  Into  the 
abdominal  cavity  of  the  foetus,  which  was  kept  distant  from  the 
mother  the  entire  length  of  the  cord,  some  two  or  three  inches, 
twenty  minims  of  the  solution  (one  grain  of  strychnia)  were  in- 
jected, the  foetus  being  raised  from  the  water  for  that  purpose. 
In  about  two  minutes  the  foetus,  which  was  vigorous  and  lively, 
exhibited  decided  spasms,  and  these  continued  to  recur  at  fre- 
quent intervals. 

Another  foetus  removed  in  the  same  manner,  and  placed  in 
the  same  water,  was  similarly  treated  and  similarly  affected.  In 
about  five  or  six  minutes,  a  ligature  was  placed  on  each  cord, 
and  the  foetuses  were  separated,  by  dividing  the  cords  on  the  foetal 
side  of  the  ligature.  Little  or  no  blood  escaped  from  them. 
Three  other  foetuses  were  subjected  to  the  same  process,  and 
after  a  fq|f  minutes  likewise  removed.  The  quantity  of  the  so- 
lution injected  into  each  varied  from  twenty  to  twenty  five  or 
thirty  minims.  Into  one  nearly  forty  minims  were  thrown. 
They  all  exhibited  tetanic  spasms  which,  in  the  majority,  con- 
tinued, though  feebly,  after  division  of  the  cord.  The  protrud- 
ed portion  of  the  uterus,  which  still  contained  three  or  four 
foetuses,  and  such  portions  of  the  intestines  as  had  escaped, 
could  be  only  partially  replaced,  owing  to  the  contracted  state 
of  the  abdominal  muscles. 

The  mother  continued  to  breathe  placidly  under  the  influence 
of  chloroform  for  thirty  minutes  from  the  period  of  the  first  in- 
jection, and  for  fifteen  minutes  after  the  last  foetus  had  been 
removed.  At  the  end  of  that  time  very  slight  twitchings  were 
visible;  these  became  more  and  more  marked,  and  passed  at 
length  into  a  decided  spasm.  The  spasms,  preceded  by  twitch- 
ings, gradually  increased  in  intensity,  occurring  at  intervals  of 
about  two  minutes.  For  fifteen  minutes  I  watched  some  six  or 
seven,  to  remove  any  doubt  of  their  character,  and  then  as  the 
effects  of  the  chloroform  were  rapidly  subsiding,  I  did  not  choose 
to  prolong  the  experiment  further,  and  the  dog  was  killed. 

In  this  experiment,  all  direct  contact  between  the  injected 
foetuses  and  the  mother  was  prevented.  No  communication 
whatever  existed  between  the  injected  foetus  and  its  mother  ex- 
cept through  the  cord,  and  placenta.  It  cannot  be  doubted  that 
the  poison  passed  from  the  blood  of  the  foetus  to  the  blood  of  the 
mother  at  the  placenta. 

These  experiments,  more  especially  the  latter,  are  very  deli- 


638       Effect  upon  the  Mother  of  Poisoning  the  Foetus.    [September, 

cate  ones,  and  unless  certain  conditions  concur  they  are  very 
likely  to  fail.  When  foetuses  are  removed  from  the  uterus  and 
exposed,  they  soon  become  feeble;  the  circulation  very  rapidly 
declines;  and  of  course  they  perish  the  more  quickly  in  propor- 
tion as  they  are  young  and  small.  Therefore,  in  order  to  ensure 
success,  it  is  most  important  that  the  foetuses  be  well  developed, 
near  their  full  term,  large  and  vigorous.  It  is  more  difficult, 
but,  nevertheless,  quite  possible,  to  succeed  when  the  foetuses  are 
much  younger.  For  the  same  reason,  and  to  facilitate  the  neces- 
sary manipulation,  the  larger  the  mother  is  the  better.  In  di- 
viding the  uterus,  care  must  be  taken  not  to  wound  the  placen- 
ta. This  may  be  avoided  by  gently  raising  up  the  uterine  wall 
between  the  thumb  and  forefinger,  before  cutting  it;  in  this 
way  the  absence  of  placenta  can  be  ascertained.  It  is  also  as 
we'll  to  avoid,  if  possible,  dividing  the  larger  veins.  For  this 
and  for  other  reasons,  the  most  convenient  part  of  the  uterus 
for  division  is  towards  the  constricted  portion  between  two  ad- 
jacent foetuses  (as  the  placentas  are  circularly  attached  around 
the  dilated  portions  in  which  the  foetuses  are  contained),  and  at 
a  point  most  distant  from  its  attachment.  In  operating  on  the 
foetus,  traction  of  the  cord  must  be  most  rigidly  avdWed,  for, 
besides  interfering  with  its  circulation,  it  is  very  likely  to  tear  a 
portion  of  the  placenta  from  the  uterus. 

All  these  remarks  apply  with  increased  force  to  the  last  ex- 
periments, where  the  foetuses  remained  exposed,  for  when  they 
are  returned  in  a  feeble  condition  to  the  abdominal  cavity  the 
warmth  of  the  mother  often  greatly  restores  them.  In  the  latter 
experiments  the  more  foetuses  that  can  be  injected  the  better, 
and  in  a  few  minutes  after  the  injection  of  each,  it  is  as  well  to 
detach  it,  for  its  circulation  has  then  probably  almost  ceased, 
and  b}'  retaining  it  the  experiment  is  complicated  and  the  risk 
of  accidental  contact  of  the  foetus  with  some  part  of  the  mother 
or  separation  of  the  placenta  is  increased.  But  this  more  deli- 
cate and  difficult  experiment  is  doubtless  most  obviously  free 
from  objection. 

One  or  two  points  in  these  experiments  appear  worthy  of 
notice.  The  great  length  of  time  the  foetus  survives  after  the 
injection  of  strychnia  is  remarkable.  I  think  this  may  be  thus 
explained :  When  the  strychnia  kills  rapidly,  it  produces  death 
principally  by  aifecting  the  muscles  of  inspiration,  thus  fixing 
the  chest  and  so  suspending  respiration.  When  strychnia  kills 
quickly  it  kills  by  apncea.  This  kind  of  death  the  foetus  in  utero 
of  course  escapes,  and  in  it  death  is  probabty  produced  by  ex- 
haustion, as  in  ordinary  cases,  when  strychnia  kills  more  slowly. 

Again  in  my  experiments  after  the  mother  has  died  from  the 
effects  of  strychnia,  I  have  carefully  watched  for  any  appearance 
of  tetanus  in  those  foetuses  which  still  remain  untouched  in  the 


1858.]       Reminiscences  of  the  Treatment  of  Disease,  &c.  639 

uterus:  and  although  the  effect  of  strychnia  is  so  striking  in  the 
fcetus  when  directly  injected,  I  have  never  observed  any  of  its 
symptoms  in  those  which  I  had  not  poisoned.  This  fact  is  most 
interesting  in  relation  to  the  present  inquiry,  and  may  proba- 
bly be  explained  by  the  short  time  the  mother  survives  the 
effects. 

A  similar  remark  applies  to  chloroform.  Although  in  my 
experiments  the  mother  was  invariably  reduced  to  a  state  of 
profound  insensibility,  yet  the  foetuses,  when  exposed,  were 
always  active  and  lively. 

I  submit,  then,  that  proof  is  no  longer  wanting  of  the  direct  and 
rapid  transmission  of  matter  from  the  fcetus  to  the  mother 
through  the  blood  in  the  placenta. 

Although  it  has  hitherto  been  the  custom,  when  considering 
the  close  and  intimate  relation  between  the  fcetal  and  maternal 
blood,  to  speak  only,  or  especially,  of  the  effect  produced  on  the 
fcetus  by  morbid  materials  present  in,  or  other  unnatural  con- 
ditions of,  the  blood  of  the  mother,  to  say  the  least,  it  must  be 
admitted  that  there  is  an  equally  free  and  direct  transmission  of 
matter,  though  for  many  reasons  a  less  obvious  one,  from  the 
fcetal  to  the  maternal  blood. 

When  the  influence  which  the  foetus  in  utero  thus  exercises 
upon  the  mother  shall  be  fully  recognised,  it  will  soon  become 
more  clearly  understood.  At  present,  it  is  impossible  to  esti- 
mate the  importance  of  the  subject.  While  stauding  only  on 
the  very  threshold  of  the  inquiry,  enough  is  visible  to  tempt 
any  one  beyond.  Why  should  not  the  investigation  of  this 
question  lead  toresults  which,  although  moredfficult  to  obtain, 
are  perhaps  not  less  worthy  of  research  than  those  useful  and  ex- 
tensive ones  which  have  already  been  disclosed  by  the  study  of 
hereditary  transmission  of  disease  ? — [London  Lancet. 


Reminiscences  of  the  Treatment  of  Disease  without  the  use  of  Alco- 
holic Stimulants.  By  John  Higgln'BOTTOM,  Esq.,  F.E.S., 
Nottingham. 

Ox  Uterine  Hemorrhage. 

For  the  first  twenty-five  or  thirty  years  of  my  professional 
life,  I  had  a  very  extensive  midwifery  practice,  consequently 
many  cases  of  uterine  haemorrhage,  and  some  of  them  which 
caused  me  intense  anxiety  of  mind  for  the  safety  of  the  patient 
The  first  seventeen  years  of  my  practice,  I  was  in  the  habit  of 
Ifollowing  the  example  of  my  medical  brethren  in  giving,  as  a 
•medicine,  alcohol  in  the  form  of  port  wine  and  brandy,  and  the 
:  ;ure  of  opium.  The  tincture  of  opium — a  valuable  remedy 
— was  given  in  proper  doses;  but  the  wine  and  brandy  were 


640       Reminiscences  of  the  Treatment  of  Disease,  &c.  [September, 

administered  according  to  the  degree  of  haemorrhage  and  con- 
sequent depression,  often  with  little  attention,  to  either  the  qual- 
ity or  quantity  of  the  intoxicating  fluid,  depending  on  the  law 
of  tolerance  for  safety  in  such  cases. 

In  these  terrific  cases,  along  with  the  stimulants,  were  used 
every  local  application,  as  cold  water,  ice,  pressure  on  the  ute- 
rus, &c,  to  cause  contraction  of  the  organ.  Under  such  treat- 
ment the  patient  would  rally  a  little ;  but  very  soon  the  sinking 
pulse,  the  blanched  face  and  white  lips,  would  indicate  the  ne- 
cessity of  more  wine  or  brandy,  which  was  immediately  given, 
very  soon  to  be  followed  by  an  increased  flooding  and  conse- 
quent lowness.  This  alternate  state  of  reviving  and  sinking 
has  continued  for  several  hours,  when  the  stomach  has  become 
so  much  distended  and  irritated  by  the  stimulants  and  other 
fluids  given  as  to  produce  a  full  vomiting  of  the  contents  of  the 
stomach ;  after  this  the  haemorrhage  has  ceased,  the  patient  has 
gradually  recovered,  and  required  nothing  more  than  a  little 
gruel  or  tea.  This  happy  termination  by  vomiting  does  not 
always  take  place,  but  the  wine  and  brandy  have  been  given 
in  such  quantities  as  thoroughly  to  narcotize  the  patient;  she 
becomes  insensible  and  comatose,  and  cannot  be  roused,  and 
death  takes  place.  Alcohol  has  caused  her  death  ;  not  the  hae- 
morrhage.    The  following  is  a  case  in  point : 

In  June,  1823,  I  attended  Mrs.  M in  labour;  she  was 

of  a  stout,  plethoric  habit  of  body ;  she  had  after  delivery  a 
very  profuse  flooding.  The  usual  stimulants  of  wine  and  bran- 
dy, and  also  opium,  were  given  her,  and  the  customary  local 
applications  were  resorted  to  with  very  little  effect.  Her  friends 
became  alarmed  for  her  safety,  and  called  in  an  old  physician, 
without  my  knowledge,  who  immediately  was  dissatisfied  with 
the  brandy.  He  said  it  was  not  strong  enough,  it  having  been 
procured  from  a  neighboring  public-house.  More  brandy,  sup- 
posed to  be  of  a  better  quality,  was  procured  and  given  to  the 
patient.  The  quantity  administered  was  thought  quite  requisite 
to  keep  up  the  sinking  powers  of  the  patient;  insensibility  and 
coma  ensued,  breathing  became  heavy  and  laborious,  and  in 
about  two  hours  after  her  delivery  she  died.  The  stomach  in 
this  instance  unfortunately  retained  its  contents ;  her  only  safe- 
ty would  have  been  a  full  vomiting  of  the  contents  of  the  sto- 
mach. In  this  instance  I  have  always  been  of  opinion  that  she 
died  from  alcoholic  poisoning,  and  not  from  the  haemorrhage. 

The  following  case  will  show  the  value  of  vomiting  in  a  simi- 
lar case,  and  which  led  me  to  the  disuse  of  alcoholic  stimulants 
in  cases  of  flooding: 

Mrs.  C ,  a  delicate  female,  about  thirty  years  of  age.     ] 

had  attended  her  twice  in  labour  in  the  years  1821  and  1823 : 
each  time  she  had  severe  flooding  directly  after  the  separatior 


1858.]        Reminiscences  of  the  Treatment  of  Disease,  &c.  641 

of  the  placenta.  I  employed  the  usual  local  applications,  and 
administered  wine  and  brandy  and  tincture  of  opium.  These 
cases  were  attended  with  great  anxiety,  and  I  had  to  remain 
with  my  patient  several  hours  before  I  could  leave  her  with 
safety. 

On  her  third  labour,  in  the  year  1826, 1  was  afraid  she  would 
die,  after  having  used  all  my  remedies,  and  having  given  her  a 
pint  of  port  wine,  and  half  a  pint  of  brandy,  during  the  three 
hours  after  the  birth  of  the  child,  which  proved  of  no  avail:  it 
occurred  to  me  that  in  both  former  times  in  which  I  attended 
her,  when  I  had  used  similar  means  to  check  the  haemorrhage, 
that  there  was  no  amendment  until  she  had  ejected  the  con- 
tents of  the  stomach.  I  was  then  most  anxious  that  vomiting 
might  take  place  in  hope  of  relief,  as  she  was  rapidly  sinking. 
I  thought  as  vomiting  had  been  so  beneficial  to  her  in  the  form- 
er instances,  that  I  was  in  this  case  justified  in  procuring  it  by 
giving  an  emetic.  I  directly  gave  her  an  emetic  dose  of  ipecac- 
uanha; a  full  vomiting  soon  succeeded,  and  a  large  quantity  of 
fluid  was  ejected.  I  was  much,  struck  with  an  expression  of 
my  patient,  which  I  had  several  times  before  heard  in  similar 
cases  after  vomiting — "  Oh,  I'm  better;  I'm  better  now  !"  The 
haemorrhage  ceased  directly,  and  did  not  return,  the  symptoms 
of  sinking  abated,  and  the  patient  appeared  soon  in  her  usual 
state  of  body,  but  very  feeble ;  a  little  plain  gruel  was  all  the 
nutriment  given  her,  and  she  recovered  gradually  from  the 
weak  state. 

I  attended  the  same  patient  three  times  afterwards,  in  the 
years  1827,  1829,  and  1831,  and,  what  is  very  satisfactory  in 
favor  of  the  secale  cornutum,  which  was  about  that  time  com- 
ing into  use  in  this  locality,  I  gave  her  in  every  case  half  a 
drachm  of  the  powder  before  the  birth  of  the  child,  a  second 
dose  before  the  separation  of  the  placenta.  This  remedy  had 
the  desired  effect  of  preventing  the  haemorrhage,  so  that  I  had 
no  further  need  of  the  ipecacuanha,  or  indeed  any  other  remedy. 

I  have  attended  patients  since  that  time,  when  the  secale  had 
no  effect  in  checking  the  flooding,  both  in  my  own  practice  and 
in  consultation  ;  and  I  have  resorted  to  the  ipecacuanha  emetic, 
when  other  means  have  failed,  and  with  immediate  success. 

For  more  than  thirty  years  I  have  lost  all  confidence  in  the 
diffusible  stimulants,  such  as  wine,  brandy,  &c,  in  uterine 
haemorrhage,  from  &  conviction  that  they  increase  the  arterial 
circulation,  and  consequently  the  haemorrhage.  The  common 
practice  of  giving  the  patient  a  little  cold  water,  or  vinegar  and 
water,  to  drink,  and  keeping  the  body  in  a  cool  state  by  means 
of  a  well-ventilated,  cool  room,  are  more  likely  to  restrain  the 
haemorrhage,  and  thus  preserve  the  strength  of  the  patient. 

The  ipecacuanha  emetic,  in  half-drachm  doses,  I  consider  a 


642  Valuable  JRemedyfor  Dysmenorrhoea,  &c.    [September, 

perfectly  safe  remedy,  which  may  be  used  in  any  case  of  severe 
flooding,  but  I  have  hitherto  given  it  as  a  dernier  resort.  I  have 
found  the  secale  cornutum,  if  good,  to  answer  in  most  cases.  In 
other  cases,  I  have  given  a  drachm  of  the  tincture  of  opium 
with  decided  benefit;  if  not  fully  relieved  in  hajf  an  hour,  half 
a  drachm  more,  but  I  have  had  very  rarely  to  repeat  the  reme- 
dy a  third  time;  the  tincture  of  opium  has  the  effect  of  check- 
ing the  haemorrhage,  and  also  of  relieving  the  pain. — [Ibid. 


Valuable  Remedy  for  Dysmenorrhoea  and  consequent  Sterility. 

Professor  E.  D.  Fenner  presents  some  valuable  considerations 
on  the  subject  of  Dysmenorrhoea,  and  offers  his  experience  with 
a  new  formula.  '  We  select  the  following  from  the  Medical  News 
and  Hospital  Gazette: 

"Soon  after  I  commenced  the  practice  of  medicine,  I  received 
from  my  brother,  Dr.  Kobert  Fenner,  of  Jackson,  Tenn.,  a  recipe 
for  an  emeuagogue  which,  he  said,  was  not  to  be  found  in  any 
medical  book  of  the  day,  but  had  been  given  to  him  by  our  fa- 
ther, a  practitioner  of  forty  years  experience,  and  he  had  gotten 
it  out  of  an  old  English  work,  then  extinct,  written  by  a  Dr. 
Falk,  of  London.  1  was  told  that  it  was  an  excellent  emena- 
gogue,  more  especially  in  that  painful  form  of  obstructed  men- 
struation called  dysmenorrhea,  and  that  it  was  remarkable  for 
almost  invariably  causing  fruitfulness  in  the  cases  of  young 
married  women. 

The  following  is  the  original  recipe  and  directions: 
^.     Gum  guiac,    l'\. 

Balsam  canadens,    I  i. 

01.  sassafras,    3  ii. 

Merc,  corrosiv.  sublimat.,    9i. 

Eect.  spt.  vini  (alcohol),    1  viii. 
'Dissolve  the  guiac  and  balsam  in  one  half  the  spirit,  and  the 
corrosive  sublimate  in  the  other.     Let  the  guiac  and  balsam 
digest  for  several  days ;  then  pour  off  the  clear  liquor,  mix  with 
the  sublimate  and  add  the  oil.     Dose — Ten  or  twenty  drops  night 
and  morning  in  a  glass  of  wine  or  water,  pro  re  nataJ 
This  was  called  by  Dr.  Falk,    '  Tinctura  Antacrida.1 
I  have  continued  to  use  this  prescription .  for  dysmenorrhoea 
ever  since  I  first  received  it,  and  with  the  most  satisfactory  re- 
sults.    I  have  given  it  to  my  brother  practitioners  wherever  I 
have  lived,  and  they  have  all  pronounced  it  the  best  remedy 
they  ever  used  for  this  complaint.     It  is  only  very  recently  that 
I  accidentally  discovered  in  the  tenth  edition  of  Ellis'  Medical 
Formulary,  the  same  recipe,  though  not  exactly  the  same  direc- 


1858.]  Valuable  Remedy  for  Dysmenorrhea,  &c.  613 

tionsfor  preparing  it  (See  page  189  of  that  work).  It  is  there 
placed  amongst  his  alteratives,  with  the  commendation  of  Dr. 
Emerson  and  other  practitioners  of  Philadelphia,  in  lues  venera, 
etc.,  but  no  allusion  whatever  is  made  to  its  admirable  virtues 
'as  an  emenagogue.  Dr.  Falk  also  used  it  in  lues,  and  I  myself 
have  had  some  interesting  experience  of  its  virtues  in  that  dis- 
ease, but  I  shall  confine  my  remarks  at  present  to  its  effects  in 
dysmenorrhoea  and  sterility. 

Directions. — I  usually  direct  the  patient  to  begin  a  da}'  or  two 
before  the  expected  period  and  take  twenty -five  drops  in  an  in- 
fusion of  sage  or  sweetened  water,  night  and  morning,  until  the 
discharge  is  freely  established ;  then  cease  till  the  next  period. 
In  obstinate  and  severe  cases,  the  medicine  should  be  com- 
menced a  week  or  ten  days  before  the  period  ;  and  if  the  pain 
appears,  the  medicine  should  be  taken  every  four  or  six  hours 
till  relieved.  The  pain  usually  disappears  as  soon  as  the  dis- 
charge becomes  free ;  but  in  most  cases  the  discharge  comes  on 
without  pain  after  taking  a  few  doses.  I  have  known  immedi- 
ate relief  to  be  given  by  a  single  dose  taken  in  the  paroxysm; 
but  I  have  seen  cases  in  which  the  pain  was  excruciating,  caus- 
ing shrieks  and  even  violent  convulsions.  In  such  I  have  had 
to  resort  to  a  more  prompt  and  efficient  anaesthetic,  as  the  inha- 
lation of  chloroform,  or  the  following,  which  I  have  often  known 
to  act  like  a  charm  : 

#.     Spirit  Camphor,    3  iii. 

Chloroform,    3ii. 

Tinct.  opii.,  3i.  M. 
S.  A  teaspoonful  in  sweetened  water  once  an  hour  till  relieved. 
In  violent  hysterical  spasms  there  is  nothing  comparable  to 
to  the  inhalation  of  chloroform.  In  the  treatment  of  d}-smen- 
orrhcea,  it  is  important  to  obviate  costiveness  by  the  use  of 
aloetic  pills.  When  dysmenorrhea  is  relieved  by  this  treat- 
ment, conception  almost  invariably  soon  occurs  in  married  wo- 
men." 

After  giving  many  cases  illustrative  of  the  value  of  the  reme- 
dy, he  closes  with  the  following  incidents,  which  are  striking, 
both  for  their  significance  and  the  quiet  drollery  with  which 
they  are  related: 

"I  might  give  numerous  cases  of  newly  married  ladies  in 
which  I  was  consulted  for  dysmenorrhcea.  This  tincture  hardly 
ever  fails  to  restore  the  healthy  function  of  the  uterus,  and  'send 
them  on  their  way,'  but  not  always  'rejoicing,'  as  the  following 
incident  will  show.  A  gay,  sprightly  and  robust  married  lady, 
mother  of  three  or  four  children,  and  without  the  least  (Jesire 
for  more,  after  indulging  too  freely  in  the  fashionable  dissipa- 
tions of  the  '  gay  season '  in  Xew  Orleans,  began  to  have  symp- 


61-i  Valuable  Remedy  for  Dysmenorrhoea,  &c.    [September, 

toms  of  engorgement  of  the  uterus,  and  more  than  ordinary  pain 
at  her  monthly  period.  I  was  consulted,  and  gave  the  ordinary 
advice  in  such  cases ;  urging  upon  her  the  necessity  of  abstain- 
ing from  late  hours,  too  much  dancing,  and  rich  suppers.  She 
disregarded  my  advice,  got  worse,  and  sent  for  me  again.  She' 
was  now  a  plain  case  of  dysmenorrhoea,  and  I  knew  what  would 
soon  cure  her;  but  I  also  knew  that  if  aware  of  the  probable 
consequence,  she  would  not  take  the  medicine.  So  I  took  trie 
liberty  of  judging  for  her  what  was  best  to  be  done  under  the 
circumstances,  and  gave  her  the  tincture.  Her  next  period 
passed  free  and  easy ;  but  it  was  not  long  afterwards  that  she 
found,  to  her  horror,  that  she  was  pregnant.  She  has  since  borne 
two  fine  children,  but  I  have  never  ventured  to  reveal  to  her 
the  trick  that  was  played  on  this  occasion. 

In  several  instances  where  the  ladies  had  learned  from  experi- 
ence the  only  danger  of  the  medicine,  after  putting  it  off  until 
they  could  see  no  other  prospect  of  relief,  have  taken  the  medi- 
cine again,  and  were  soon  in  the  condition  they  expected. 

Only  a  few  months  since  I  was  consulted  byayoung  married 
man  about  the  case  of  his  wife,  who  was  suffering  greatly  with 
dysmenorrhoea.  They  had  been  married  about  twelve  months. 
The  young  wife  had  been  afflicted  with  this  complaint  during 
the  whole  time,  and  was  now  very  pale  and  feeble.  Getting  no 
relief  from  the  prescriptions  of  the  family  physician,  they  had 
been  induced  to  consult  a  Medical  Spiritualist,  one  of  the  vari- 
ous charlatans  who  practice  on  the  credulity  of  the  people  in 
this  city,  with  great  profit  to  themselves  alone.  He  said  the  spir- 
itualist told  him  '  his  wife  would  get  better  and  then  worse  again, 
and  thus  go  on  for  a  long  time,  but  finally  recover  her  health; 
and  that  there  was  no  medicine  that  would  do  her  much  good.' 
The  gentleman  permitted  her  to  go  on  this  way  for  several 
months,  but  finding  his  young  wife  continually  declining,  and 
her  monthly  pains  increasing  in  violence,  he  resolved  to  seek 
further  medical  advice.  About  this  time  he  happened  to  men- 
tion the  case  to  a  friend  whose  wife  had  suffered  in  a  similar  way, 
and  been  relieved  by  medicine  obtained  from  me.  Upon  this 
he  came  to  consult  me.  I  prescribed  this  tincture,  with  aloetic 
pills,  to  obviate  costiveness,  and  at  the  same  time  foretold  what 
would  be  the  probable  consequence,  which  did  not  seem  to  terrify 
either  of  them.  The  very  next  period  passed  off  free  and  easy, 
and  she  has  had  no  return.  Her  health  is  greatly  improved, 
and  they  are  now  rejoicing  in  prospect  of  an  heir. 

In  the  dysmenorrhoea  of  virgins,  a  complaint  by  no  means 
uncommon  among  our  delicate  young  ladies  of  the  South,  I 
have  known  this  tincture  to  produce  the  happiest  effects.  I 
have  prescribed  it  in  numerous  instances,  and  never  knew  it  fail 
to  give  relief  when  directions  were  properly  attended  to.    Some 


1858.]  The  Amaurosis  of  Laziness.  645 

of  the  most  severe  and  obstinate  cases  I  ever  met  with  were  in 
young  girls  from  the  age  of  fifteen  to  twenty  years.  As  in  mar- 
ried women,  these  unfortunates  sometimes  suffer  excruciating 
agony,  and  even  go  into  spasms.  In  this  emergency  I  usually 
prescribe  the  compound  tincture  of  chloroform  mentioned  in  the 
preceding  portion  of  this  paper." 


The  Amaurosis   of  Laziness.     (Under  the   care  of  Mr.  Ernest 
Hart.) 

Xo  other  affection  of  the  eye  comes  more  frequently  under 
care,  whether  in  private  or  in  hospital  practice,  than  scrofulous 
ophthalmia  attacking  all  the  various  tissues  of  the  eye  in  turn. 
Its  most  frequent,  and  usually  its  earliest,  seat  is  the  palpebral 
and  ocular  conjunctiva.  Out  of  the  total  number  of  cases  treat- 
ed by  him  at  this  Infirmary,  we  are  informed  by  Mr.  Hart  that 
at  least  two-thirds  are  either  confined  to  the  mucous  membrane, 
or  initiate  there  and  pass  on  to  the  other  structures.  The  cornea 
is  the  most  frequently  attacked  after  the  conjunctiva,  and  the 
ulceration  which  so  commonly  occurs  here — due  to  the  softness 
of  the  tissue — is  frequently  followed  by  opacity.  This  varies 
from  dense  leucoma  to  a  slight  want  of  polish  only.  It  is  stated 
by  Mr.  Hart  to  be  due  to  the  deposit  of  a  granular  lymph  be- 
tween the  lamellae  in  the  former  instance,  and  to  the  formation 
of  a  freshly  and  irregularly  developed  epithelial  layer  in  the 
latter.  He  has  two  cases  of  amaurosis  now  under  treatment — a 
result  of  leucoma  which  is  not  perhaps  so  unfrequent  as  it  may 
be  thought  to  be,  and  to  which  little  attention  is  commonly  di- 
rected, perhaps  because  its  origin  and  character  are  not  always 
clearly  perceived.  The  frequent  result  of  leucoma  is  amaurosis, 
as  in  these  cases ;  but  an  amaurosis  of  a  peculiar  character — the 
amaurosis  of  laziness.  The  opacity  of  the  cornea  renders  vision 
difficult  with  the  eye  affected,  and  hence  the  effort  necessary  is 
constantly  evaded.  The  whole  burden  of  vision  is  thrown  upon 
the  other  eye,  and  hence  it  is  overworked.  From  this  two  evils 
result :  a  confirmation  of  inefficiency  and  increased  amaurosis  in 
the  eye  which  is  dimmed  by  the  veil  of  opacity,  and  fatigue, 
weakness,  and  inflammation  of  the  overtaxed  organ.  Under 
these  circumstances,  the  attention  of  the  surgeon  is  not  to  be  led 
astray  and  fixed  upon  the  inflammatory  condition^  of  the  other- 
wise sound  eye.  Remedies  applied  to  this  are  perhaps  some- 
what worse  than  useless.  The  cure  is  to  be  effected  by  the  treat- 
ment he  adopted — that  of  compelling  its  leucomatous  fellow  to 
assume  a  share  of  work,  and  so  relieve  the  overstrain.  The 
sound  eye  should  be  bandaged,  and  the  necessary  effort  for  vis- 
ion with  the  other  should  thus  be  made  compulsory.  Vision 
rapidly  improves,  the  retina  adapting  itself  to  the  necessary  ef- 
fort with  considerable  facility. — [London  Lancet. 


64:6  Editorial  and  Miscellaneous.  [September, 

EDITORIAL  AND  MISCELLANEOUS. 

Practice  per  capita. — We  withhold  our  editorial  and  much  of  our 
miscellany  in  order  to  give  place  to  the  following  judicious  remarks  upon 
what  appears  to  be,  as  we  learn  from  many  sources,  a  great  evil  in  our 
profession,  in  certain  parts  of  the  country.  Although  we  may  not  be 
prepared  to  adopt  the  severity  of  tone  used  by  our  correspondent,  we  can 
yet  heartily  endorse  his  sentiments,  and  feel  very  much  like  commending 
even  his  indignation : 

Messrs  Editors : 

As  one  of  the  objects  of  a  medical  journal,  is,  to  expose  the  abuses  of 
the  Profession,  and  thereby  purge  it  of  all  corruption,  so  as  to  secure  a 
steady  course  of  improvement,  as  well  as  maintain  its  dignity  and  honor, 
we  propose,  at  this  time,  to  furnish  you  for  publication  an  exposition  of 
one  evil,  to  which  many  men,  calling  themselves  Doctors,  and  pretending 
to  practice  the  "  healing  art,"  have  resorted.  We  allude  to  the  taking 
of  families  per  capita,  or  by  the  head. 

We  regard  this  as  being  unprofessional,  unjust,  mean,  and  venal. 
There  is  such  a  practice  as  a  mule  or  a  hog-drover  paying  toll  over  a 
ferry  or  bridge  for  so  much  a  head.  Circus  companies  may  sometimes 
let  a  man  with  his  family,  or  his  negroes,  enter  for  so  much  a  head. 
Chicken  wagoners  may  sell  fowls  to  a  Hotel-keeper  for  so  much  a  head. 
Stock-raisers  may  furnish  the  flesh  market  for  so  much  a  head.  These 
are  all  right  and  proper,  and  in  keeping  with  the  business.  But  for  a 
man  to  practice  medicine — that  most  responsible,  time-honored,  and 
noblest  of  all  professions — which  has  for  its  high  object  the  preservation 
of  the  body  during  life's  temporal  existence — upon  which  so  much  is 
relied  in  the  hour  of  physical  suffering  and  despair — and  which  has  been 
distinguished  in  almost  all  ages  for  its  wise,  learned,  and  great  advocates, 
'for  so  much  a  head,  cannot  be  too  severely  censured,  and  ought  to  re- 
ceive the  condemnation  of  every  philanthropist. 

We  say  it  is  unprofessional,  because  its  tendency  is  to  bring  the  Pro- 
fession into  disrepute.  It  is  illegal,  because,  nowhere  in  all  the  past  his- 
tory of  the  Science  of  Medicine,  can  there  be  found  the  least  semblance 
of  authority  for  it — neither  is  it  tolerated  by  any  of  the  regular  schools 
of  the  present  day — nor  is  it  authorized  by  the  medical  board  of  the 
State :  hence  it  is  a  usurpation  of  privilege.  It  is  unjust,  because  it  robs 
many  of  patronage  which. their  superior  qualifications  and  honest  merits 
entitle  them  to.  It  is  mean,  because  it  is  beneath  the  dignity  of  the  Pro- 
fession. It  is  venal,  because  a  man  hires  himself  by  the  year,  as  he  would 
his  own  servant,  and  in  that  way  enslaves  himself. 


1858.]  Epitorial  and  Miscellaneous.  617 

The  practice  has  been  inaugurated,  and  is  still  pursued  by  a  few  Char- 
latans, who  care  nothing  for  the  dignity  and  honor  of  the  Profession,  and 
*are  forced  to  it  for  want  of  due  qualifications.  "We  have  come  to  this 
conclusion,  because  we  have  never  seen  a  man  that  was  really  qualified 
and  learned  in  the  science,  that  would  deign  to  do  such  a  thing, 
generally  true  is  this,  that  whenever  we  hear  of  a  man  guilty  of  it,  we 
mark  him  as  a  quack,  and  as  one  who  has  not  medical  learning  and  in- 
trinsic merit  enough  to  commend  him  to  the  favor  and  patronage  of  the 
people.  We  know  men  engaged  in  this  kind  of  practice,  who  are  just 
beginning  business,  and  we  must  confess  it  is  a  very  low  and  niggardly 
claim  for  a  young  man  to  set  up.  Our  advice  to  all  such,  is,  to  quit 
physic,  and  do  something  for  which  they  are  qualified.  Adopt  the  motto, 
that  if  you  can  be  of  no  honor  to  a  profession,  be  sure  that  you  are  of  no 
disgrace  to  it.  We  know  of  others,  who  have  been  practicing  for  years,  and 
have  amassed  wealth  by  a  combination  of  extraneous  influences,  and 
now,  that  young,  scientific,  and  skillful  physicians  have  set  up  in  opposi- 
tion to  them,  relying  entirely  upon  their  capacity,  and  contending  for  a 
just  and  full  remuneration  for  their  services — their  avarice  and  the  devil 
have  seduced  them  into  the  same  ignoble  practice  of  taking  families 
so  much  a  head,  seeming  to  care  nothing  for  the  interest  of  the  Profession 
after  they  have  made  a  "  speculation  "  out  of  it,  and  contending  with  the 
poor  young  physician,  upon  a  dishonorable  principle,  for  the  very  last 
dollar. 

We  further  deuounce  it  as  a  system  of  bribery.  For  it  is  a  voluntary 
inducement  offered,  to  obtain  that  which  rightly  belongs  to  another,  by 
virtue  of  his  superior  skill  and  qualifications.  Our  doctrine  is,  that 
every  thing  should  stand  upon  its  own  merits,  for  good  or  for  evil — for 
weal  or  for  woe.  It  is  the  same  glorious  doctrine  inculcated  in  Scripture, 
in  the  passage,  "  according  to  thy  works  shalt  thou  be  judged  " — evi- 
dently implying  the  just  reward  of  merit.  Every  man,  with  ordinary 
faculties  of  mind,  has  a  talent  for  something, — and  if  he  will  but  culti- 
vate it,  he  may  safely  calculate  on  success.  We  are  sorry  to  assert,  that 
there  are  many  persons  who  have  so  meagre  an  opinion  of  the  Science  of 
M  .icine,  and  depreciate  its  responsibilities  and  duties  so  far  as  to  ima- 
gine that  any  ordinary  mind  may  grasp  it  and  practice  it  successfullv. 
This  is  enough  to  verify  the  fallacy  and  incompetency  of  all  such,  when 
it  is  well  known  that  the  Science  of  Medicine  is  one  of  the  most  exten- 
sive and  recondite  in  all  nature.  It  is  not  only  difficult  to  comprehend, 
and  a  thorough  knowledge  acquired  by  a  course  of  hard  and  lengthened 
study  and  application,  but  demands  research  and  attention  at  every  step 
in  a  man's  life.  A  physician  should  be  a  student  of  medicine  as  long  as 
he  continues  to  practice  it. 


648  Editorial  and  Miscellaneous.  [September, 

We  come  now  to  the  causes  that  have  engendered  this  evil.  They 
are  two :  one  exists  in  the  so-called  Physician,  as  has  been  sufficiently 
indicated  in  the  above  remarks;  and  the  other  in  his  patrons.  This  is 
considered  a  fast  age — one  of  improvement — of  enterprise — and  of  pro- 
gress, which  would  naturally  suggest  the  idea  of  liberality.  But  such, 
in  the  main,  is  not  the  fact.  For  as  the  people  grow  richer,  their  hearts 
grow  more  callous,  contracted,  and  fixed  upon  the  idol — mammon. 
When  a  man  wants  to  buy  an  article  of  merchandize,  he  goes  to  the 
cheapest  store,  it  matters  not  whether  it  be  Dutch,  Jew  or  American. 
He  consults  his  purse,  and  nothing  else.  So,  when  he  wants  a  physi- 
cian, he  employs  the  cheapest — it  does'nt  matter  whether  he  has  ever 
heard  a  course  of  lectures  or  not — he  may  be  of  the  same  or  a  different 
creed.  He  will  employ  him  by  the  year,  at  a  small  sum,  and  if  he  loses 
half  his  family,  it  is  better  than  to  pay  a  learned  physician  double  the 
amount,  or  the  usual  rates,  and  save  all  his  family.  Well,  experience 
and  observation  have  taught  us,  that  cheap  things  are  of  little  value. 
Hence  we  conclude  that  cheap  Doctors,  like  cheap  goods,  are  of  little 
use. 

Many  people  are  ready  to  cry  out  against  the  Profession,  as  failing  to 
accomplish  the  object  of  its  institution,  and  impute  to  it  many  hard  and 
unkind  things.  But  we  ask,  in  all  candor,  how  can  they  expect  any  bet- 
ter, when  they  throw  all  their  patronage  and  influence  into  the  hands  of 
the  cheap  and  illiterate  Doctor,  while  the  educated,  intelligent,  and  skill- 
ful physician,  who  has  devoted  time,  money  and  labor,  for  the  acquire- 
ment of  a  thorough  knowledge  of  his  profession,  and  upholds  its  dignity 
by  contending  for  even  customary  rates,  and  refusing  to  condescend  to 
anything  uncourteous  and  unprofessional — is  forced  to  abandon  his  pro- 
fession, and  seek  other  means  of  support — or  plod  along  through  life  with 
a  mere  pittance  as  his  share  of  public  favor  and  patronage. 

This  is  certainly  a  deplorable  state  of  things,  and  is  tending  to  a  de- 
generacy of  the  Science  of  Medicine,  at  a  time  when  it  is  thought  to  be 
in  a  high  state  of  improvement  and  progression.  Let  this  evil  only  con- 
tinue a  few  years  longer,  and  we  predict  for  the  science  a  state  of  obscu- 
rity and  bigotry  exemplified  in  the  dark  ages  of  the  world.  The  succes- 
sive teachings  of  Hippocrates,  Stahl,  Boerhaave,  Cullen,  Brown,  Brous- 
sais,  Sydenham,  Harvey,  Jenner,  Rush,  Chapman,  and  many  other  great 
and  shining  lights  in  Medicine,  will  be  lost,  and  there  will  be  none  to 
succeed  and  revive  them.  Then,  instead  of  having  a  beautiful  Science, 
as  we  now  have,  which  harmonizes  with  the  laws  of  Chemistry  and  Na- 
tural Philosophy,  and  is  so  efficient  in  counteracting  and  subduing  the 
pathological  conditions  of  human  organism,  we  shall  have  a  mere  nom- 
inal system — an  insignificant  wrecked  skeleton  of  the  existing  mighty 


1858.]  Editorial  and  Miscellaneous.  649 

and  magnificent  ship.  What  a  great  calamity  it  would  be  to  deprive 
the  world  of  the  immense  amount  of  learning,  skill,  and  usefulness  that 
characterize  the  ranks  of  the  Medical  Profession,  when  it  can  be  so  easi- 
ly maintained  by  a  just  and  manly  reward  of  the  arduous  and  merito- 
rious labors  of  the  qualified  physician. 

Patron,  we  exhort  you  to  reflect  upon  this  subject :  for  the  evil  and 
its  remedy  are  both  in  your  hands.  If  the  science  ever  does  foil,  which 
seems  to  us  inevitable,  in  view  of  the  evil  which  we  have  been  dia 
ing,  the  dreadful  curse  of  the  sacrifice  must  rest  upon  your  own  heads. 
,  For,  as  long  as  you  continue  to  reward  medical  merit,  so  long  will  it  as- 
sume a  high  and  honorable  standard.  But  whenever  you  disregard  and 
ignore  it,  by  casting  all  your  influence  and  patronage  into  the  hands  of 
the  illiterate,  and  the  quack,  on  account  of  his  cheapness,  as  many  are 
now  doing,  you  at  once  consign  it  to  ruin,  decay,  and  oblivion. 

There  is  another  consideration  to  which  we  would  call  the  attention  of 
the  patron.  Suppose  one  of  your  family  gets  sick — are  you  not  bound, 
as  Father  or  Master,  as  the  case  may  be,  to  employ  the  best  medical 
skill  and  learning,  without  regard  to  price,  to  combat  the  disease,  and,  if 
possible,  restore  health  ]  But  suppose,  instead  of  doing  this,  you  employ 
one  of  those  cheap,  illiterate,  yearly  Doctors,  and  the  patient  dies,  as  is 
frequently  the  result,  then,  we  ask,  upon  whose  skirts  does  the  blood  of 
the  sacrifice  rest  \  Certainly  upon  yours.  Then,  if  you  want  good, 
skillful,  and  intelligent  physicians — such  as  are  worthy  of  the  appella- 
tion, and  such  as  you  can  repose  confidence  in,  in  the  hour  of  physical 
affliction  and  trial — when  all  your  earthly  hopes  are  at  stake — bestow 
your  patronage  upon  those  who  merit  it,  (even  if  your  bill  is  a  little 
larger,)  and  you  will  be  vastly  benefitted,  in  the. saving  of  life,  and  in  the 
discharge  of  you  duty  to  your  family,  and  the  satisfaction  that  will 
accrue  in  the  just  reward  of  merit.  But  when  you  wilfully  pursue  any 
other  course  than  this,  you  risk  life,  which  is  dearer  than  all  things  upon 
earth — subordinate  it  to  money,  barter  it  away  as  you  would  hides  and 
tallow,  and  thus  perpetrate  one  of  the  most  heinous  and  unpardonable 
offences  against  the  law  of  God  and  man. 

We  also  call  upon  the  Profession,  everywhere,  to  assist  in  expunging 
this  evil,  now  in  its  incipiency,  for  it  is  a  monstrous  one,  and  a  few  years 
will  develope  it,  when  it  cannot  be  eradicated.  If  there  be  found  any  in 
the  Profession  so  devoid  of  respect  for  its  dignity  and  honor,  as  to  resort 
to  this  abuse,  let  them  receive  the  condemnation  of  all  men,  both  in  and 
out  of  the  Profession.  Let  us  have  and  sustain  those  in  our  ranks  who 
are  worthy  and  well-qualified.  Let  us  contend  for  just  and  remunerating 
prices,  and  maintain  all  other  considerations  in  keeping  with  the  cause. 
Then  may  the  hopes  and  wants  of  the  afflicted  be  realized  in  the  timely, 


650  Editorial  and  Miscellaneous. 

skillful,  and  effectual  ministrations  of  the  genuine,  true,  and  enlightened 
physician.  Justitia. 


Sulphur  and  Nux  Vomica  in  Hemorrhoids. — M.  Van  Holsbeck  recom- 
mends the  following  formula  as  being  rapidly  beneficial : — ft.  Sulphur 
loti.  sacchar.  alb.  aa,  gj. ;  extr.  strych.  nuc.  vomic.  gr.  vj. ;  mucil.  gum. 
tragacanth.  sufficient  to  form  twenty-four  lozenges.  The  patient  is  to 
take  two  the  first  day,  increasing  the  dose  by  one  daily  until  six  a-day 
are  taken.  He  now  rests  a  few  days,  and  then  diminishes  the  dose  in 
the  same  proportion,  until  he  gets  to  the  two  again.  If  the  cure  is  not 
complete,  he  must  begin  again;  but  it  is  rare  to  find  the  treatment  re- 
quired for  more  than  a  week.  During  its  continuance  alcoholic  drinks 
and  a  too  stimulating  diet  are  interdicted.  The  treatment  is  applicable 
to  all  stages  of  uncomplicated  haemorrhoids. — [Druggist's  Circular. 

Wind  of  a  Shot. — The  following  extract  from  an  Indian  letter  con- 
firms the  doubts  entertained  as  to  deaths  attributed  to  the  "  wind  of  a 
shot:" — "Brigadier  Russell  is  also  about  to  leave  the  army,  under  the 
advice  of  a  medical  board.  Never,  perhaps,  in  all  the  chances  of  war 
has  there  been  such  an  escape  as  his.  A  cannon  ball  cut  the  gold  watch 
chain  at  the  back  of  his  neck  as  cleanly  as  if  it  had  been  a  pair  of  nip- 
pers, and  did  him  no  further  injury,  except  inflicting  a  shock  to  his 
nervous  system. — [Med.  Times  and  Gaz. 

Pennsylvania  Medical  College. — Dr.  T.  G.  Richardson  has  resigned  the 
Professorship  of  Anatomy  in  the  Medical  Department  of  Pennsylvania 
College,  and  Dr.  J.  H.  B.  McClellan  has  been  elected  to  the  vacant 
chair. — [Med.  News  and  Library. 


Augusta,  Ga.  the  Healthiest  City  in  the  Union. — We  are  pleased 
to  record  the  following  from  the  Constitutionalist  of  this  city  : 

"The  editor  of  the  Charleston  Mercury,  in  a  recent  article  on  the  mor- 
tality of  cities,  says  :  '  Looking  at  the  returns  of  Augusta,  Ga.,  we  find  it" 
to  be,  at  the  present  time,  the  healthiest  city  in  the  Union,  and  having 
less  deaths.' " 


Sir  Philip  Crampton's  Coffin — As  any  thing  which  relates  to  this 
great  Surgeon  must  be  interesting,  we  insert  the  following : 

"By  the  singular  directions  of  Sir  Philip  Crampton,  made  just  prior 
to  his  death,  the  body  was  placed  in  a  solid  Irish  oak  coffin  without  any 
lid ;  around  this  was  placed  a  thick  concrete  of  Roman  cement,  which 
was  made  to  fill  up  al!  the  spaces  in  the  interior  of  the  coffin  not  occu- 
pied by  the  body,  which  was  covered  over,  and  entirely  imbedded  in  the 
cement,  of  which  nearly  five  hundred  weight  was  used.  The  heavy  mass 
was  placed  wTithin  another  Irish  oak  coffin  of  great  strength,  which  was 
covered  with  fine  black  cloth,  on  the  lid  of  which  was  a  shield  bearing 
the  following  inscription  :  'Sir  Philip  Crampton,  Bart.,  died  June  10th, 
1858, aged  eighty-one  years.'" — [London paper. 


SOUTHERN 

MEDICAL  KM)  SURGICAL  JOURNAL. 


(NEW  SERIES.) 


Vol.  XIV.]  AUGUSTA,  GEORGIA,  OCTOBER,  1838.  [No.  10. 


ORIGINAL  AXD  ECLECTIC. 

ARTICLE    XXII. 

Observations  on  Malarial  Fever.  By  Joseph  Joxes,  A.M.,  M.D., 
Professor  of  Physics  and  Natural  Theology  in  the  University 
of  Georgia,  Athens;  Professor  of  Chemistry  and  Pharmacy  in 
the  Medical  College  of  Georgia,  Augusta;  formerly  Professor 
of  Medical  Chemistry  in  the  Medical  College  of  Savannah. 

[Continued  from  page  601  of  September  Xo.  1858.] 

Case  XXVIII. — Scotch  seaman  ;  age  14 ;  light  hair,  blue 
eyes,  florid  complexion;  height  5  feet  2  inches;  weight  95  lbs. 
From  light  ship,  lying  at  the  mouth  of  Savannah  river.  Was 
taken  sick  three  days  ago. 

September  16th,  7  o'clock  P.  M.  Face  as  red  as  scarlet;  skin 
in  a  profuse  perspiration,  which  has  saturated  his  thick  flannel 
shirt  and  wet  the  bed-clothes.  Pulse  100.  Eespiration  24 :  does 
not  correspond  with  the  flushed  appearance  of  his  face.  Tem- 
perature of  atmosphere,  88°  F. ;  temp,  of  hand,  102  ;  temp,  un- 
der tongue,  103.25.  Tip  and  middle  of  tongue  clean  and  of  a 
bright  red  color;  posterior  portion  (root)  of  tongue,  coated  with 
yellow  fur;  tongue  rough  and  perfectly  dry.  When  the  finger 
is  passed  over  the  tongue,  it  feels  as  dry  and  harsh  as  a  rough 
board.  Lies  in  a  stupor — it  is  almost  impossible  to  arouse  him. 
Great  tenderness  upon  pressure  of  epigastrium :  pressure  here 
causes  him  to  cry  out. 

$.  Blister,  6  by  6  inches,  over  the  epigastric  region.  Mus- 
tards to  extremities.  $.  Calomel,  grs.  x. ;  Sulphate  of  quinia, 
grs.  vij.  Mix.  Administer  immediately,  and  follow  with  castor 
oil  in  four  hours.  #.  As  soon  as  the  blister  and  mustards  have 
:aroused  the  patient,  administer  sulphate  of  quinia  grs.  v.  every 
three  hours,  up  to  grs.  xv. 

k;s. — vol.  xiv.  ko.  x.  36 


652 


Jones,  on  Malarial  Fever. 


[October, 


Sept.  17th,  It  o'clock  A.  M.  Restored  to  the  exercise  of  his 
intellectual  faculties,  and  says  that  he  is  much  better.  Mustards 
and  blister  acted  promptly,  and  aroused  the  patient.  The  calo- 
mel and  castor  oil  acted  six  times.  Rested  very  well  during 
the  night.  Skin  was  in  a  perspiration  during  the  night.  Tongue 
moist.  The  bright  red  color  and  dry  rough  state,  have  disap- 
peared. It  is  now  slightly  coated  with  yellow  fur.  Pulse  86; 
respiration  18,  regular  and  gentle.  Skin  moist  and  relaxed. 
Temperature  of  atmosphere.  87°  F. ;  temp,  of  hand,  100°  2 3  ; 
temp,  under  tougue,  I0ia.  lias  taken  xxij.  grains  of  sulphate 
of  quinia. 

$.  Sulphate  of  quinia,  grs.  xx.;  infusion  of  Virginia  snake- 
root,  f  I  xvi.  Tablespoonful  every  three  hours.  Diet,  gruel  and 
flaxseed  tea.  Urine  of  a  light  orange  color,  a  shade  higher  than 
normal.  Sp.  gr.  1008'2.  Amount,  of  urine  collected  during  the 
last  16  hoursr  grains  8065.  It  is  probable  that  much  urine  was 
lost  during  the  action  of  the  purgative. 


Grs.  8065  Urine  pass- 

Grs. 1 2098  Urfne  cal- 

If,00  parts 

ANALYSIS  LYL 

ed  during  16  hotirsr 

culated  for  24  hours, 

Urine     con- 

contained grains 

contained  grains- 

tained 

Water 

7880-128 

11745-892 

970-874 

Solid  Matters, ..... 

234-872 

352-108 

29-126 

Urea ,. 

83-100 

124-600* 

1C290 

Uric  Acid ,. 

01 60 

0-240 

0-019 

Ext.  and  Col'ing  Matters. 

118-216 

177-224 

4-077 

Fixed  Saline  Constituents, 

32-880 

49-200 

14-038 

Sept.  18th,  12  o'clock  M.  Took  a  change  for  tbe  worse  this 
morning — now  lies  in  a  stupor.  Tongue  coated  with  yellow 
fur,  much  drj^er  than  normal;:  reaction  of  saliva  acid.  Pulse 
9-3,  feeble;  respiration  32.  Temperature  of  atmosphere,  87° 5; 
temp,  of  hand,  103;  temp,  under  tongue,  104.  Has  taken  xxxv. 
grains  of  sulphate  of  quinia  during  the  last  30  hours. 

B.  A  cut  cup  to  each  temple,  and  two  to  back  of  neck.  Mus- 
tards to  extremities.  As  soon  as  fever  remits,  give  sulphate  of 
quinia,  grs.  v.,  every  three  hours,  up  to  grs.  xv.  Urine,  light 
straw  colored,  resembles  the  urine  of  Diabetes  Mellitus..  Sp. 
gravity  1010.  Amount  of  urea  in  1000  parts  of  urine,.  7.970; 
Amount  of  uric  acid  in  1000  parts  of  urine,  0.029^ 

8  o'clock  P.  M.  The  cut  cups  and  mustards  aroused  him,  and 
he  asked  for  something  to  eat.  The  change,  however,  was  only 
temporary,  and  he  relapsed  again  into  a  state  of  stupor.  Kow 
can  be  aroused  only  by  violent  shaking,  and  then  goes  into  a 
profound  sleep  in  a  few  moments.  Tongue,  bright  red  at  tip 
and  edges,  dry  and  harsh  to  the"  touch,  and  coated  at.  the  supe- 
rior portion  with  light  yellow  fur.  Pulse  90 ;  respiration  26. 
Temperature  of  atmosphere,   85°  F.;  temp,  of  hand,  102°  25; 


1858.]  Joxes,  on  Malarial  Fever.  653 

temp,  under  tongue,  103°  25.  Has  taken  x  grs.  of  the  sulphate 
of  quinia  during  the  last  eight  hours. 

H.  Blister  to  back  of  neck;  mustards  to  extremities.  Calo- 
mel, grs.  vi.;  castor  oil  in  four  hours.     Neutral  mixture. 

Sept.  19th,  11  o'clock  A.  M.  Appears  to  be  better.  Intel- 
lect more  active  than  last  night,  but  still  inclined  to  stupor.  Face 
still  much  flushed;  tongue  moist,  red  at  tip  and  edges  and  coat- 
ed with  white  fur;  papi Ike  enlarged.  Blister  upon  the  back  of 
the  neck  has  drawn.  Cathartics  acted  ten  times.  Skin  moist 
and  relaxed. 

R.  Brandy,  f  5  viij.;  Infusion  of  Virginia  snake-root,  f  I  viij.; 
-Sulphate  of  quinia,  grs.  xv.  Mix.  Tablespoonful  every  hour. 
Continue  neutral  mixture. 

Has  just  passed  5020  grains  of  light  orange  colored  urine. 
•Sp.  gr.  lOOi.  After  standing  50  hours,  a  very  slight  deposit  of 
triple  phosphate  and  urate  of  soda. 


ANALYSIS  LYII. 

Grains  5020  of  Urine  con- 
taiund   grains 

1000  parts   of  Urine  con- 
tained 

Water - 

4923*468 

96-537 
38*482 

0-200 

51-112 

6  435 

880*770 

Solid  Matters 

19*230 

Urea 

8-480 

Uric  Acid 

0-049 

Ext.  and  Coloring  Matters 
Fixed  Saline  Constituents, 

9-317 
1*282 

Sept.  20th,  12  o'clock  M.  Says  that  he  is  much  better.  The 
"brandy,  in  conjunction  with  the  infusion  of  snake-root,  and  sul- 
phate of  quinia,  appears  to  have  exerted  decided  beneficial  effects. 
Face  still  flushed;  tongue  relaxed,  moist,  and  slightly  coated 
with  white  fur;  papillas  enlarged,  and  prominent  over  the 
whole  surface  of  the  tongue.  Surface  of  blister  looks  health  v. 
Amount  of  urine  passed  during  the  last  24  hours,  grains  3030 ; 
sp.  gr>  100  L ;  reaction  slightly  acid ;  color,  very  light  yellow,  like 
•diabetic  urine. 

$.  Continue  brandy,  infusion  of  snake- root  and  sulphate  of 
quinia. 

Sept.  21st,  1  o'clock  P.M.  Continues  to  improve.  Countenance 
and  intellect  bright.  Tongue  has  altered  greatly  in  appearance — 
it  is  moist  and  pale,  and  very  slightly  coated  with  white  fur;  pa- 
pillae slightly  enlarged;  face  not  so  flushed.  Pulse66;  respiration 
18.  Temperature  of  atmosphere,  83°  F. ;  temp,  of  hand,  98°; 
temp,  under  tongue,  100°.  Skin  cool  and  relaxed.  Amount  of 
urine  passed  from  Sept.  20th,  1  o'clock  P.M.,  up  to  11  o'clock, 
(hours  10,)  grs.  13013  ;  light  yellow  color;  sp.  gr.  1001 ;  reaction 
alkaline  after  standing  15  hours.  Amount  of  urine  passed  from 
Sept.  20th,  11  o'clock  P.M.,  up  to  the  present  time,  grs.  5030: 
sp.  gr.  1006.    Deep  orange  color.    Amount  of  uric  acid  in  grs. 


654  Jones,  on  Malarial  Fever.  [October, 

5030  of  urine,  grs.  1.050;  amount  of  uric  acid  in  1000  parts  of 
urine,  grs.  0.200. 

Sept.  22nd,  12  o'clock  M.  Tongue  moist  and  normal  in  ap- 
pearance; skin  cool;  face  of  natural  color.  Pulse  65;  respira- 
tion, 18.  Temperature  of  atmosphere,  84°5F. ;  temp,  of  hand, 
93°;  temp,  under  tongue,  99a5. 

$.  Quassia  and  soda;  continue  infusion  of  Virginia  snake- 
root  and  sulpli.  of  quinia,  tablespoon  ful  every  six  hours.  Ain't 
of  urine  passed  during  the  last  24  hoursy  grs.  20.800 ;  normal  in 
color ;  sp.  or.  1001. 

7  o'clock  P.  M.  Pulse  57;  respiration  16.  Temperature  of 
atmosphere,  8i°;  temp,  of  hand,  98°;  temp,  under  tongue,  99-°5. 
Amount  of  urine  passed  during  the  last  8  hours,  grains  7021; 
sp.  gr.  1003  ;  light  colored. 

Sept.  23rd.  Examination  of  Blood  No.  V. — Clot  appeared  to- 
be  softer  than  normal.  Serum  of  a  light  yellow  color.  Specific 
gravity  of  blood  1042.4;  sp.  gr.  of  serum  1021.3. 


Water 

In  1000  parts  of  Blood,        827-901 

"     "         "     "  Serum,        928-370 

(1)  "         "     "  Liq.Sanjr.,  926937 

(2)  "         "     "     u       "       887-034 


Solid  Matters 

In  1000  parts  of  Blood,        172-099 

"     "         "     "  Serum,  71-630 

(1)  "         "     "Liq.Sang.,    73-297 

(2)  "         "     "    "       "        112-965 


Solid  Matters  in  Serum  of  1000  parts  of  Blood,  62*789. 

Ftxed  Saline  Constituents, 

In  1000  parts  of  Blood, 4-041 

"       "     Serum, 4-035 

(1)  "       "     Liquor  Sanguinis,   ------  4-045 

(2)  "       "         "             " 6-246 

"       "     Solid  Matters  of  Blood,    -----  23-202 

"       "         "         "         "  Serum, 56-338 

"       "         "         "         "  Blood  Corpuscles,   -         -        -  4-584 

"       "     Moist  Blood  Corpuscles,  -         -  1-119 

In  Blood  Corpuscles  of  1000  parts  of  Blood,          -         -         -  0-490 

"  Serum  of  1000  parts  of  Blood, 3-551 

1000  Parts  of  Blood  Contained, 

Water, -  827-901 

Dried  Blood  Corpuscles,     107-877  }  °Sj™°  Ma»ers*       J  10™*> 

Fibrin, 1-433 

Albumen,  Extractive  and  Coloring  )  Organic  Matters,        -  59*210 

Matters,           -         -         62-789  [  Mineral         "             -  3*551 

1000  Parts  of  Blood  Contained, 

)  Water,          -         -         -  323*631 

Moist  Blood  Corpuscles,  431.508  [  Organic  Matters,  -         -  107*320 

)  Mineral         "        -         -  0*490 


1858.]  Jones,  on  Malarial  Fever.  655 


Liquor  Sanguinis,     -       568*492 


Water,         -         -  -  504-270 

Organic  Matters,  -  -  592 10 

^Mineral       "         -  -  3-551 

Fibrin,                   -  -  T433 

1000  Parts  of  Moist  Blood  Corpuscles  Contained, 

Water, 750-000 

Organic  Matters,     - 248-709 

Mineral  Matters,     --------  1-119 

(1)  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 926-703 

Organic  Matters, 67-380 

Mineral  Matters,     --------  4-035 

Fibrin,           -                  1-667 

(2)  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 887-034 

Albumen,  Extractive  and  Coloring  Matters,       -  104  000 

Mineral  Matters,     -         -         - 6-246 

Fibrin, 2-520 

A  few  days  after  this  observation,  numerous  small  boils  ap- 
peared over  all  parts  of  the  body  of  this  patient.  These  were 
productive  of  nothing  but  pain  and  uneasiness,  and  disappeared 
in  the  course  of  two  weeks.  The  patient  continued  to  improve, 
and  was  discharged  from  the  hospital. 

This  case  exhibits  the  following  points  of  interest: 

1.  The  cerebral  symptoms  were  strongly  marked.  There  was 
a  constant  tendency,  in  the  active  stages  of  the  disease,  to  pro- 
found stupor.  The  flushed  face  and  hot  head  and  torpid  intel- 
lect, indicated  congestion  of  the  brain.  Sinapisms,  blisters,  cut 
cups  and  purgatives,  diminished  the  apparent  congestion  of  the 
brain,  and  relieved  the  intellectual  faculties  temporarily,  but  not 
permanently.  Stimulants  and  sulphate  of  quinia,  so  far  from 
increasing  the  apparent  congestion  of  the  brain,  diminished  it 
permanently,  and  relieved  the  intellectual  faculiies.  Under 
their  action,  the  red,  dry,  rough  tongue,  became  pale,  moist  and 
soft — under  their  action,  the  circulation  and  respiration  were 
equalized,  and  diminished  in  frequency;  the  temperature  was 
diminished  and  the  intellect  restored  to  its  normal  exercise. 

As  the  sinapisms,  blisters,  cut  cups  and  purgatives,  were 
used  in  conjunction  with  the  stimulants  and  sulphate  of  quinia, 
we  cannot  assert  that  the  restoration  of  the  functions  were  due 
solely  to  the  action  of  the  stimulants  and  sulphate  of  quinia.  It 
is  evident,  however,  from  the  history  of  the  case,  that  the  action 
of  the  former  was  temporary,  whilst  that  of  the  latter  was  per- 
manent. It  is  probable  that  the  recovery  of  this  patient  would 
have  been  doubtful  in  the  extreme,  if  cither  of  these  modes  of 
i  treatment  had  been  omitted. 


656  Jones,  on  Malarial  Fever.  [October, 

During  the  height  of  the  disease  I  had  no  hopes  whatever  of 
his  recovery.  The  brain  was  more  affected  than  all  the  other 
organs.  Long  after  the  pulse  and  respiration,  skin  and  digestive 
functions  were  restored  to  their  normal  actions,  the  patient  was 
scarcely  able  to  stand  or  walk  on  account  of  the  condition  of  the 
brain.  His  first  efforts  at  walking  resembled  those  of  an  infant 
just  learning  to  stand  and  walk  alone.  This  was  not  due  to  the 
loss  of  muscular  power,  for  there  had  been  but  a  slight  reduc- 
tion of  the  size  of  the  muscles.  It  was  due  rather  to  the  dis- 
ordered state  of  the  cerebro-spinal  system. 

2.  The  urine  was  abundant — of  low  specific  gravity  and  light 
color.  In  these  particulars  this  excretion  presented  a  marked 
difference  from  the  urine  of  the  cases  recorded  in  previous  num- 
bers of  this  journal. 

8.  The  uric  acid  was  diminished  during  the  active  stages  of 
the  fever,  and  under  the  action  of  sulphate  of  quinia. 

4.  The  analysis  of  the  blood  shows  that  the  organic  matters 
of  the  blood  corpuscles  were  diminished  slightly,  whilst  the  min- 
eral matters  were  greatly  diminished.  The  fibrin  was  dimin- 
ished in  amount,  and  appeared  to  be  softer  than  normal.  The 
albumen  and  extractive  matters  of  the  serum  were  somewhat 
below  the  normal  standard. 

When  we  consider  that  this  patient  was  in  a  state  of  almost 
complete  starvation,  during  the  height  of  the  disease,  it  is  evi- 
dent that  the  malarial  poison  acted  but  slightly  upon  the  con- 
stituents of  the  blood.  The  malarial  poison  appeared  to  act 
almost  entirely  upon  the  brain  and  nervous  system.  This  ac- 
tion may  have  been  greatly  increased  by  circumstances — as 
peculiarities  of  constitution,  irregularities  of  habit,  and  continu- 
ed exposure  to  the  hot  sun  on  the  light-ship. 

I  was  afterwards  informed  that  this  boy  was  in  the  habit  of 
using  ardent  spirits  freely. 

It  is  probable  that  one  or  all  of  these  causes  may  have  pre- 
disposed the  brain  to  congestion,  and  converted  a  light  attaek 
into  a  severe  and  dangerous  disease,  It  is  probable  that  the 
dose  of  malaria  was  small,  and,  aside  from  these  circumstances, 
would  have  produced  only  a  mild  disease,  We  are  led  to  this 
conclusion  by  the  fact,  that  its  effects  upon  the  blood  and  excre- 
tions were  comparatively  slight, 

Case  XXIX.  American  seaman,  native  of  Philadelphia: 
age  30  ;  weight  150;  heights  feet 8 inches;  brown  hair;  brown 
eyes;  dark  complexion. 

August  7th,  XL  o'clock  A.M,  Has  entered  the  hospital  in  a 
stupid,  torpid  condition.  It  is  difficult  to  arouse  him,  and  then 
his  answers  are  incoherent. 

His  companion  states  that  "  he  has  been  running  up  and 


1858.]  Jones,  on  Malarial  Fever.  657 

down  the  Savannah  river  in  a  steam-tug.  One  week  ago,  was 
attacked  with  chill  and  fever^  which  was  treated  with  sulphate 
of  quinia,  by  one  of  his  companions.  Two  days  ago  took  blue 
piil  and  castor  oil.  He  is  of  intemperate  habits,  passing  much 
of  his  time  in  a  state  of  intoxication."  Skin  hot,  but  in  a  pro- 
fuse perspiration  ;  tongue  coated  with  light  yellow  fur;  pulse 
112,  moderately  full;  respiration  38,  hurried,  thoracic— chest 
heaving.  Temperature  of  atmosphere,  &1°F. ;  temp,  of  hand, 
103°;  temp,  under  tongue,  104°.  The  patient  breathed  through 
his  mouth,  was  restless  and  stupid,  and  hence  it  was  difficult  to 
determine  accurately  the  temperature  under  the  tongue.  Has 
just  passed  a  considerable  quantity  of  clear,  limpid,  high-colored 
urine.     #.  Castor  oil,  f  I  ss.     Diet,  gruel. 

August  8th,  9  o'clock  A.M.  Skin  hot  and  dry;  pulse  120. 
Continues  stupid.  Urine  passed  during  the  night  arid  this 
morning,  clear,  high  colored,  (reddish  orange).  Sp.  gr.  1013. 
Nitrate  of  urea  well  formed — silvery  white  crystals. 

ANALYSIS  LVIIL— 1000  Parts  of  Urine  Contained, 

Water, 957-282 

Solid  Matters, 42  618 

Urea, 7-108 

Uric  Acid, 0*394 

Extractive  and  Coloring  Matters,      -         -,        -         -         -  32-570 

Fixed  Saline  Constituents, -  '  2-621 

11  o'clock  A.M.  Skin  moist;  pulse  112.  During  the  last 
three  hours  the  pulse  has  lost  8  beats  to  the  minute.  Respira- 
tion 36.  Temperature  of  atmosphere,  80°  F. ;  temp,  of  hand, 
103°.  Temperature  under  the  tongue  could  not  be  ascertained, 
on  account  of  the  stupid  condition  of  the  patient.  Castor  oil 
acted  six  times — stools  very  offensive;  breath  offensive — acid. 
His  body  has  a  peculiar,  disagreeable  smell.  Epigastric  region 
.somewhat  tender  upon  pressure. 

$.  Blister  to  epigastric  region  ;  soda  powders.     Diet,  gruel. 

Aug.  9th,  11  o'clock  A.  M.  Worse:  stupid.  When  aroused 
by  shaking,  cannot  converse  intelligently — attempts  to  pro- 
nounce words  and  fails.  Passes  his  urine  and  feces  in  bed. 
Skin  hot  and  dry.  Has  a  pustular  eruption  over  the  surface  of 
trunk  and  limbs — most  abundant  over  the  chest  and  abdomen. 
Pulse  112;  respiration  40.  Temperature  of  atmosphere,  80°; 
temp,  of  hand,  10o°o.  Stools  dark  colored  and  fetid.  Blister 
has  drawn,  and  he  has  torn  off  the  cuticle  with  his  hand — sur- 
face red  and  raw.  Urine  of  a  bright  reddish  brown  color — 
cloudy,  with  epithelial  cells  from  the  mucous  membrane  of  the 
.kidneys,  ureters,  and  bladder  and  urethra,  and  with  mucous 
corpuscles  and  spermatozoa. 

The  deposit  at  the  bottom  of  the  vessel  consisted  of  spermato- 


G58  JONES,  on  Malarial  Fever.  [October, 

zoa,  epithelial  cells,  mucous  corpuscles,  prismatic  crystals  of 
triple  phosphate,  and  small  acicular  crystals,  soluble  in  hydro- 
chloric acid. 

The  acicular  crystals  were  in  such  small  numbers  that  I  was 
unable  to  determine  accurately  their  chemical  constitution. 

The  presence  of  the  epithelial  cells,  mucous,  corpuscles,  and 
spermatozoa  in  the  urine,  were  due  to  the  action  of  the  canthara- 
din,  absorbed  from  the  blistered  surface. 

ty.  Calomel,  grs.  xij. ;  James's  powder,  (pulvis  antimonii 
cornpositus,)  grs.  xxij.  Mix,  and  divide  into  six  powders.  Ad- 
minister one  every  three  hours.  Diet,  gum-water  and  gruel. 
•$.  Apply  blisters  to  the  calves  of  his  legs. 

6  o'clock  P.  M.  No  improvement  of  symptoms.  Yery  rest- 
less. Intellect  wandering.  Bowels  are  loose — has  several  stools 
daily.  Passes  his  urine  and  feces  in  bed.  Pulse  104,  weaker 
than  this  morning;  skin  not  so  warm;  tongue  dry ;  blistered 
surface  of  the  epigastric  region  red,  and  without  any  discharge 
of  serous  fluid.  The  blisters  upon  the  legs  are  very  slow  in 
their  action. 

#,  Camphor  water,  f^viij.;  Oil  of  turpentine,  f  3  i j . ;  Sugar, 
3 ij. ;  Powdered  gum-arabic,  3ij.;  Carbonate  of  magnesia,  3j. 
Mix.  Administer  a  tablespoon ful  every  three  hours.  Stop  the 
calomel  and  James's  powders.  Diet,  arrow-root  and  a  small 
quantity  of  brandy. 

August  10th,  9  o'clock  A.  M.  No  improvement  of  symptoms. 
Passes  his  urine  and  feces  involuntarily.  Urine  of  a  bright  red 
color;  sp.gr.  1012*6;  reaction  decidedly  acid — contains  small 
quantities  of  albumen.  It  has  been  carefully  tested  for  grape- 
sugar,  without  the  discovery  of  a  trace.  Amount  of  uric  acid 
in  1000  parts  of  urine,  0-296. 

11  o'clock  A.  M.  Countenance  has  a  peculiar  look  of  stupidi- 
ty and  anxiety,  or  rather  horror.  These  two  apparently  incom- 
patible expressions  are  combined.  Has  had  two  stools  this 
morning.  Pulse  120,  feeble  ;  respiration,  40 ;  blistered  surfaces 
red  and  dry  ;  complexion  pale,  sallow. 

$.  Continue  the  mixture.  Administer  brandy  and  arrow- 
root every  hour. 

Urine  a  shade  lighter  in  color  than  that  passed  during  the 
night — after  standing  a  few  hours,  gave  off  numerous  small 
bubbles,  which  coated  the  sides  of  the  glass  vessel.  After  stand- 
ing 12  hours,  a  heavy  deposit  of  crystals  of  triple  phosphate,  of 
mucous  corpuscles,  and  of  spermatozoa  fell. 

August  11th,  10  o'clock,  A.M.  Stupid,  almost  insensible; 
expression  of  countenance,  vacant.  When  aroused,  mutters 
lomething,  inarticulately,  for  a  few  seconds,  and  then  relapses 
into  his  former  state  of  stupor.      ...,.,, 

The  eruption,  alluded  to  before^  is  oat,  quite  thickly,  on  the 


1858.]  Jones,  on  Malarial  Fever.  659 

back,  and  is  distinctly  pustular.  Some  of  the  pustules  are  com- 
mencing to  slough.  His  elbows  and  shoulders,  and  hips,  upon 
which  the  weight  of  his  body  has  rested,  are  or  a  dark  purplish 
color,  and  the  skin  is  commencing  to  slough  at  those  parts  most 
exposed.     This  patient  has  a  peculiar  disagreeable  smell. 

Tongue  dry  and  rough  ;  teeth  coated  with  sordes.  Pulse  132 ; 
respiration  47.  Temp,  of  atmosphere,  80°  F.;  Temp,  of  hand, 
104°;  Temp,  under  the  tongue  could  not  be  taken  with  abso- 
lute accuracy  ;  it  was  about  105°. 

$  Continue  mixture.     Diet,  milk-punch  and  egg-nog. 

After  leaving  the  ward,  the  nurse  raised  the  patient  and 
placed  him  upon  the  night  stool.  Immediately  his  respiration 
became  hurried,  he  gasped  for  breath,  his  head  fell  upon  his 
breast,  and  the  nurse  called  out  that  he  was  dying.  He  was 
immediately  placed  in  bed.  It  is  probable,  that  if  he  had  re- 
mained in  the  sitting  posture  a  few  moments  longer,  death 
would  have  resulted  from  the  exhaustion. 

12  o'clock,  M.  •  Examination  of  Blood  No.  VI.  Color  of  the 
venous  blood  when  first  abstracted,  dark  purple,  almost  black. 
After  exposoure  to  the  atmosphere,  the  surface  of  the  clot 
changed  to  a  cherry-red  color,  and  not  to  the  bright-red  color 
assumed  by  the  surface  of  healthy  venous  blood,  when  exposed 
to  the  atmosphere.  Coagulation  took  place  in  the  course  of  ten 
minutes,  and  the  clot  was  moderately  firm.  Under  the  micro- 
scope, the  colored  blood  corpuscles  were  found  united  together, 
forming  rolls  as  in  inflammation,  and  in  the  blood  of  the  horse. 
Many  of  the  colored  corpuscles  appeared  to  be  altered  in  form 
and  appearance.  The  colorless  corpuscles  appeared  to  be  more 
numerous  than  normal.  Serum,  of  a  golden  color,  like  that 
which  escaped  from  the  blistered  surfaces.  Specific  gravity  of 
blood,  1035;  specific  gravity  of  serum,  1021. 


Water 

In  1000  parts  of  Blood,         860*976 

u     u         u     u  Serum,        923-786 

(1)  "         "     "Liq.  Saner.,  921-233 

(2)  "         "     "    M       "       900-473 


Solid  Matters 

In  1000  parts  of  Blood,         139-024 

u     u         u     u  serun]?  76-214 

(1)  "         "     "Liq.Sang.,    78767 

(2)  "         "     "    "         "        99527 


k         Solid  Matters  in  Serum  of  1000  parts  of  Blood,     71-032. 
Fixed  Saline  Constituents, 

In  1000  parts  of  Blood, 7*317 

"     "         "      "  Serum, 5-480 

(2) "     "         "      "  Liquor  Sanguinis,         ....  6-489 

u     «         "      ■  Solid  Matters  of  Blood,         -         -         -  52-631 

"     "         "      "     u           "         "  Serum,        -         -         -  71-902 

"     "         "      "     "           "         "  Blood  Corpuscles,         -  42-751 

u     "         "      "     "           "         "  Moist  Blood  Corpuscles,  10-649 

"  Blood  Corpuscles  of  1000  parts  of  Blood,  -         -         -  2-795 

■"  Serum  of  1000  parts  of  Blood,           ....  4*522 


660  Jones,  on  Malarial  Fever.  [October, 

1000  Parts  of  Blood  Contained, 

Water,              ---_..  860*976 

Dried  Blood  Corpuscles,      -     65-612  i  ?rrganif  Matters,     -  62-703 

r                                   j  Mineral       "             -  2*795 

Fibrin,               ---.-_  2-380 

Albumen,          -             -           60-105  I  ?/Sani?  Ma*ters>     "  67'985 

,                                                                       WU   LVO    |   MlneI.al             U                         m  g-OlO 

ExtractiveandColor'g  Matters,  10-927  i  °^f  Mf  erS'     "  ?"?}S 

to                             )  Mineral       "             -  2'ol2 

1000  Parts  of  Blood  Contained, 

)  Water,           -         -  196*836 

Moist  Blood  Corpuscles,         262-448  >  Organic  Matters,    -  62-703 

J  Mineral       "           -  2-795 

Water,         -  664-140 
Albumen,       j  Organic  Matters,     57*985 

60-105          \  Mineral       u  2-010 
Liq.  Sanguinis,    737-552   y 

Ext.  and  Color'g  j  Organic  Matters,      8-415 

Matters,  10-927  (  Mineral       "  2-512 

J  Fibrin, 2-380 

1000  Parts  of  Moist  Blood  Corpuscles. 

Water, 750*000 

Organic  Matters, 239-296 

Mineral  Matters,     --- 10l64& 

(1)  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 918-57& 

Albumen,      -         -         -          64.632  i  ^ani?  Mfers'    "  «*?" 

9                                                )  Mineral       u           -  2-010 

Fibrin, -  2-553 

Ext  and  Coloring  Matters,       14-236  [  ^  Ma«ers-    ;  "Jg 

(2)  1000  Parts  of  Liquor  Sanguinis  Contained, 
Water, 900-473 

*■>■-■■  -    -        8«1£M^ :  'SE 

Fibrin, 3-206 


Ext.  and  Coloring  Matters,        14*815  I  ^iferlf  ^^%    ' 


11-409 
3-405 


Examination  of  Urine  passed  just  after  the  Abstraction  of  the 
Blood. — Urine  a  shade  higher  than  normal ;  reaction  acid  ;  spe- 
cific gravity  1013'2 — slightly  cloudy  from  mucous  corpuscles 
and  spermatozoa.  After  standing  12  hours,  the  urine  threw 
down  alight  yellow,  almost  white,  deposit  of  triple  phosphate, 
urate  of  soda,  epithelial  cells,  mucous  corpuscles,  and  sperma- 
tozoa. 


1858.]  JONES,  on  Malarial  Fever.  661 

ANALYSIS  LIX.— 1000  Parts  of  Urine  Contained, 

Water,              ------  961-112 

Solid  Matters,  ------  38888 

Urea,    -------  12304 

Uric  Acid,         ------  0-592 

Extractive  and  Coloring  Matters,  Mucus,  &c.      -             -  22-259 

Fixed  Saline  Constituents,          -  3333 

August  12th,  7  o'clock  A.  M.  Kespiration  hurried.  Patient 
is  entirely  insensible,  and  is  evidently  dying.  Urine  passed  at 
this  time,  normal  in  color;  reaction  acid  ;  sp. gr.  1011*5.  When 
treated  with  nitric  and  hydrochloric  acids,  there  was  considera- 
ble efferescence.  Crystals  of  nitrate  of  urea,  well  formed  and  of 
a  white,  silvery  appearance. 

ANALYSIS  LX. — 1000  Parts  of  Urine  Coxtained, 
Water,  ------  972-728 

Solid  Matters,  ------  27-272 

Urea,  -------  5-228 

Uric  Acid,         -  -  -  -  -  -  0-158 

Extractive  and  Coloring  Matters,  -  18543 

Fixed  Saline  Constituents,  -  -  -  -  3  030 

This  patient  died  one  hour  and  a  half  after  this  observation,  at 
S  J  o'clock  A.  M. 

(2)  Autopsy  four  hours  after  Death. 

Exterior. — Muscles  full,  well  developed.  Body  appears  to  have 
2ost  but  little  flesh  during  sickness.     Universal  sallow  color. 

Head. — Dura  mater  perfectly  natural ;  arachnoid  membrane 
opalescent  (pearl  colored)  in  most  parts.  There  were  different 
degrees  of  this  opalescency,  from  almost  perfect  transparency  to 
semi-translucency.  This  change  was  especially  evident  in  the 
neighborhood  of  the  large  blood-vessels,  and  in  those  portions 
of  the  arachnoid  which  covered  the  depressions  between  the 
convolutions. 

Blood-vessels  of  pia  mater  somewhat  more  distended  with 
blood  than  usual,  but  not  so  much,  however,  as  to  account  for 
the  cerebral  symptoms  during  life. 

Substance  of  brain  firm,  and  not  more  congested  with  blood  than 
normal.  Weight  of  brain  without  membranes,  grs.  21000,  which 
equals  ozs.  -18 :  equals  lbs.  3,  avoirdupois.  The  appearance  of 
the  structure  and  condition  of  the  brain,  and  its  blood-vessels  and 
membranes,  do  not  correspond  to  the  condition  of  congestion, 
effusion  or  softening,  which  the  cerebral  symptoms  led  us  to  ex- 
pect. The  brain  was  not  examined  microscopically,  and  there 
may  have  been  minute  changes  in  the  delicate  structures,  chemi- 
cal or  physical,  which  escaped  the  observation  of  the  naked  eye. 
This  is  possible,  but  not  probable.  It  is  hardly  probable,  or 
possible,  that  profound  alterations  could  take  place  in  so  deli- 


662  Jones,  on  Malarial  Fever.  [October, 

cate  an  organ  as  the  brain,  without  some  changes  in  its  color  or 
consistence,  palpable  to  the  naked  eye. 

Chest. — Lungs  normal  in  appearance  and  structure;  lower 
portions  more  congested  with  blood  than  the  superior.  Old  ad- 
hesion of  the  pleura  in  several  places.  Weight  of  lungs  10,320 
grains. 

Heart. — Normal  in  size.  Eight  auricle  and  ventricle  present- 
ed the  appearance  of  incipient  fatty  degeneration.  Columnoe 
carneaeof  left  ventricle  remarkably  well  developed.  Weight  of 
heart,  4440  grains. 

Abdomen. — Liver  externally  of  a  slate  color.  When  cut,  the 
surface  of  the  incision  was  of  a  dark  bronze  color,  and  appeared 
to  contain  more  blood  and  bile  than  normal.  The  liver  pre- 
sented the  true  malarial  color. 

Gall  bladder  filled  with  bile  of  a  greenish,  black  opaque  color, 
when  seen  in  mass,  and  of  a  gamboge  yellow  color,  when 
spread  out  in  thin  layers. 

Structure  of  liver,  with  reference  to  firmness,  appeared  to  be 
normal.  I  did  not  discover  any  softening.  Liver  cells  appear- 
ed to  be  normal  in  structure,  under  the  microscope.  Their  color 
appeared  to  be  a  shade  darker  than  usual,  inclining  to  a  light 
green.  Blood  of  liver  dark,  and  did  not  change  to  the  arterial 
hue  when  exposed  to  the  atmosphere. 

Filtered  decoction  of  the  liver  of  a  bright  golden  color,  and 
resembled,  in  this  respect,  the  serum  of  the  blood.  After  this 
yellow  colored  decoction  of  the  liver  had  remained  twenty -four 
hours,  it  changed  to  a  dark  brown  color.  When  the  liver  was 
boiled  with  a  strong  solution  of  potassa,  it  dissolved  rapidly  and 
completely,  and  the  solution  resembled  in  color  venous  blood, 
when  viewed  in  mass.  In  thin  layers,  the  color  was  of  a  bright 
purplish  pink. 

The  liver  also  dissolved  completely  and  rapidly  when  boiled 
with  concentrated  nitric  acid.  The  same  complete  dissolution 
took  place,  but  more  slowly,  when  the  liver  was  allowed  to  re- 
main in  cold  solutions  of  potassa  and  nitric  acid,  without  boil- 
ing. The  decoction  of  the  liver  was  carefully  tested  for  grape 
sugar — not  a  trace  was  discovered. 

Weight  of  the  liver,  25,642  grains,  equals  3  lbs.  11 J  ozs. 

Spleen. — Externally  of  a  dark  slate  color,  two  shades  darker 
than  the  liver.  Enlarged,  lobulated.  There  was  a  small  addi- 
tional spleen  of  the  size  of  a  rifle  ball.  This  presented  the  same 
slate  color,  as  the  large  spleen. 

Structure  of  the  principal  spleen,  soft.  When  pressed  gently 
between  the  ringers,  the  tissues  appeared  to  give  way. 

The  contents  of  the  cells  of  the  spleen  (pulp  or  mud)  was  of  a 
dark  reddish  brown.  When  exposed  to  the  atmosphere,  this 
oolor  was  not  altered.     Under  the  microscope,  the  pulp  was 


1858.]  JONES,  on  Malarial  Fever.  663 

found  to  consist  of  numerous  colored  and  colorless  corpuscles 
and  granules.     Weight  of  spleen,  7,920  grs.,  equals  1  lb.  2  ozs. 

The  lymphatic  glands  in  the  region  of  the  liver  and  spleen, 
were  larger  and  darker  and  more  congested  with  blood,  than 
normal. 

Judaeys. — Normal.     Weight,  5,760  grains,  equals  13  ozs. 

Alimentary  Canal. — Stomach.  Internal  surface  of  stomach, 
colored  yellow  with  bile.  As  far  as  the  unaided  eye  could  as- 
certain, the  mucous  membrane  was  continuous  and  unaltered  in 
structure. 

The  blood-vessels  of  the  mucous  membrane  were  filled  with 
blood,  and  several  spots  were  more  engorged  with  blood  than 
the  rest  of  the  surface,  presenting  an  ecchymosed  appearance. 

The  mere  stagnation  of  the  blood  in  the  vessels  and  capilla- 
ries of  the  mucous  membrane  is  not  a  pathological  condition. 
To  the  naked  eye,  there  were  no  pathological  alterations  in  the 
structures  of  the  stomach. 

Intestines. — The  color  of  the  intestines,  externally  and  inter- 
nally,  was  darker  than  usual.  The  small  intestines  contained 
fecal  matters,  epithelial  cells,  mucous  corpuscles,  and  mucus, 
colored  yellow  with  bile. 

Blood-vessels  of  the  mucous  membrane  of  the  small  and  large 
intestines  injected  with  blood.  The  mucous  membrane  was 
most  injected  with  blood,  and  presented  a  purplish  color,  in  the 
last  eight  feet  of  the  inferior  portion  of  the  ileum.  This  engorg- 
ment  of  the  blood-vessels  was  greatest  in  the  immediate  region 
of  the  ilio-caecal  valve. 

The  solitary  glands  were  numerous,  enlarged,  elevated  and 
distinct,  and  of  a  brown  color. 

When  the  intestines  were  held  up  to  the  light,  blood-vessels, 
engorged  with  blood,  were  seen  passing  to  each  gland.  The 
blood-vessels  supplying  the  solitary  and  Peyer's  glands,  were 
more  engorged  with  blood  than  those  supplying  the  mucous 
membrane  generally.  These  solitary  glands  were  most  numer- 
ous in  the  neighborhood  of  the  ilio-caecal  valve,  and  were  found 
scattered  over  the  superior  portion  of  the  colon,  and  over  the 
caecum,  and  over  eight  feet  of  the  inferior  portion  of  the  ileum. 

Peyer's  glands  were  enlarged  and  elevated.  These  glands 
were  of  various  sizes,  from  one  quarter  of  an  inch  to  three 
inches  in  length,  and  from  a  quarter  of  an  inch  to  half  an  inch 
in  breadth.  They  occurred  at  intervals  of  from  one  to  two 
inches  from  each  other,  and  extended  from  the  ilio-caecal  valve, 
along  the  mucous  membrane  of  the  ileum,  for  about  nine  feet. 
The  blood-vessels  around  these  glands  were  engorged  with 
blood.  This  part  of  the  mucous  membrane  of  the  ileum,  studied 
with  the  solitary  and  Peyer's  glands,  was  far  more  injected  with 
blood  than  the  stomach,  jejunum,  or  superior  portion  of  the 


66$:  Jones,  on  Malarial  Fever.  [October, 

ileum.  Although  these  glands  were  enlarged,  elevated,  and 
injected  with  blood,  still  they  could  not  by  any  means  be  com- 
pared to  the  condition  of  these  glands,  in  an  advanced  stage  of 
typhoid  fever. 

It  is  however  interesting  that  a  small  dose  of  castor  oil  caused 
an  unusual  action  upon  the  bowels,  and  also  that  the  fever  re- 
sembled, in  the  continued  elevation  of  the  temperature,  and 
pulse,  and  respiration,  typhoid  fever. 

We  will  now  state  the  points  of  interest  presented  by  this 
■case: 

The  Pulse  was  feeble,  and  varied  from  104  to  132  beats  in  the 
minute. 

The  Respiration  was  hurried,  thoracic,  and  varied  from  36  to 
-47  in  the  minute. 

The  Temperature  under  the  Tongue  varied  from  101°  F.  to  105°. 

The  Temperature  in  the  Hand  varied  from  103°F.  to  104°. 
'The  temperature  of  both  the  trunk  and  extremities  was  remark- 
ably uniform.  When  we  compare  the  rapidity  of  the  circula- 
tion and  respiration,  and  the  temperature  of  this  case,  with  these 
phenomena  manifested  in  the  cases  of  intermittent  fever,  report- 
ed in  former  numbers  of  this  journal,  (see  pp.  377,  393,  436, 
449)  it  is  evident  that  the  elevation  of  the  temperature  corres- 
ponded more  accurately  with  the  increased  action  of  the  circu- 
latory and  respiratory  systems  in  the  latter,  than  in  the  former. 

The  pulse  and  respiration  were  more  accelerated  in  this  case, 
whilst  the  temperature  did  not  rise  higher  than  that  of  inter- 
mittent fever. 

The  state  of  the  Skin  varied :  sometimes  dry,  and  at  others, 
bathed  in  perspiration. 

Tongue  dry  and  coated  with  fur;  and  towards  the  termination 
of  the  disease,  the  tongue  and  teeth  were  coated  with  sordes. 
It  is  evident  from  these  facts  that  there  was  no  distinct  remis- 
sion of  the  febrile  excitement. 

The  Urine  was  copious :  of  low  specific  gravity :  of  higher 
color  than  normal  in  the  earlier  stages  of  the  disease.  Twenty 
hours  before  death  the  urine  changed  to  its  normal  yellow  color. 
The  urine  contained  small  quantities  of  albumen.  The  urea 
was  diminished  relatively  to  the  extractive  matters.  We  can- 
not say  absolutely,  because  the  whole  amount  of  urine  excreted 
was  not  determined.  The  extractive  matters  were  increased 
relatively  to  the  other  constituents  of  the  urine.  The  uric  acid 
was  normal  in  amount. 

The  Blood  exhibited  profound  alterations.  The  dried  colored 
corpuscles  were  only  65*612,  and  the  moist  colored  corpuscles, 
262*448  in  the  the " thousand  parts.  They  were,  therefore,  di- 
minished more  than  one  half.  Many  of  the  colored  corpuscles- 
were  altered  in  shape  and  appearance,  and  had  in  a  great  meas- 


1858.]  JONES,  on  Malarial  Fever.  665 

ure  lost  the  power  of  changing  from  the  venous  to  the  arterial 
color.  Many  of  them  united  together  and  formed  rolls,  as  in 
the  blood  of  inflammation!.  The  fibrin  was  not  diminished. 
The  serum  was  of  a  golden  color,  and  low  specific  gravity.  The 
albumen  was  diminished,  whilst  the  extractive  matters  of  the 
serum  were  increased. 

The  mineral  matters  of  both  the  blood  corpuscles  and  liquor 
sanguinis  were  diminished  relatively,  but  not  absolutely.  That 
is,  their  diminution  corresponded  with,  but  did  not  exceed  the 
diminution  of  the  other  elements  of  the  blood — the  diminution 
of  the  mineral  matters  appeared  to  be  due  solely  to  the  diminu- 
tion of  the  solid  elements  of  the  blood — the  remaining  elements 
of  the  blood  possessed  the  usual  amount  of  mineral  matter. 

The  pustular  eruption,  the  offensive  smell,  the  stasis  of  the 
blood  in  the  parts  of  the  body  exposed  to  pressure,  and  the  ten- 
dency of  these  parts  to  slough — all  indicated  alterations  in  the 
constitution  of  the  blood,  and  derangement  of  the  capillary 
circulation. 

The  loss  of  muscular  power,  exhaustion,  stupidity,  coma, 
low  muttering  delirium,  insensibility  to  pain — all  indicated  de- 
rangement of  the  cerebro-spinal  system. 

The  alterations  in  the  actions  of  the  capillary  and  general 
circulations,  and  of  the  respiration — the  profound  alterations  in 
the  blood — the  alterations  of  the  secretions  and  excretions,  and 
of  the  structures  of  the  liver  and  spleen,  and  of  Peyer's  and  the 
solitary  glands  of  the  intestine,  were  all  indicative  of  derange- 
ments of  the  sympathetic  system  of  nerves. 

Our  knowledge  of  the  early  symptoms,  and  pathological 
changes  of  this  case,  do  not  permit  an  arbitrary  decision  as  to 
which  system  of  nerves  was  affected  primarily.  The  fact  that 
the  post  mortem  examination  revealed  (to  the  naked  eye)  no 
prominent  lesions  of  these  two  systems  of  nerves,  would  seem 
to  indicate  that  the  poison  or  poisons  acted  primarily  upon  the 
blood,  destroying  and  altering  the  blood  corpuscles,  the  active 
agents  in  the  elaboration  of  the  elements  of  the  secretions,  and 
of  the  muscular  and  nervous  systems. 

When  the  proper  chemical  changes  in  the  blood  were  altered, 
when  the  compounds  for  the  secretions,  and  nutrition,  of  the 
nervous  system  were  altered,  or  not  elaborated,  then  both,  the 
cerebro-spinal  and  sympathetic  systems,  manifested  aberrated 
action.  As  the  circulation  and  respiration,  and  the  secretions 
and  excretions,  and  the  action  and  integrity  of  the  organs  de- 
pend, in  great  measure,  upon  the  integrity  of  the  nervous  sys- 
tem, it  is  evident  that  the  derangement  of  the  cerebro-spinal 
and  sympathetic  systems,  through  the  derangement  of  the  blood 
and  secretions  and  excretions,  would  in  turn  act  in  concert  with 
the  disturbing  agent  or  agents,  and  thus  still  greater  derange- 
ments of  the  solids  and  fluids  would  be  produced. 


666  Jones,  on  Malarial  Fever.  [October, 

Another  theory  may  account  for  the  changes,  and  that  is, 
that  the  poison  or  poisons  acted  primarily  upon  one  or  both 
the  grand  portions  of  the  nervous  systems,  and  the  cerebro- 
spinal and  sympathetic  systems,  singly  or  combined,  in  turn  al- 
tered the  actions  of  the  organs  and  apparatus,  and  the  secretions 
and  excretions,  and  chemical  and  physical  actions,  over  which 
they  presided. 

In  the  present  state  of  Medical  science,  we  are  not  able  to  de- 
cide positively  upon  the  truth  of  these  theories,  because  the 
ultimate  facts  are  wanting.  What  is  the  poison  or  poisons 
which  we  have  assumed  to  exist  and  act  upon  the  organs  and 
tissues,  solids  and  fluids?  What  is  the  relation  of  these  substan- 
ces, physically,  chemically,  physiologically  and  pathologically,  to 
the  cerebro-spinal  and  sympathetic  systems,  to  the  blood  cor- 
puscles and  elements  of  the  blood,  organic  and  mineral,  and  to 
the  organs,  tissues,  and  secretions  and  excretions? 

In  other  words,  what  physical,  chemical,  physiological  and 
pathological  changes  are  they  capable  of  producing  on  the  solids 
and  fluids  of  the  human  body,  and  what  effects  would  these 
changes  have  upon  the  development  and  action  of  the  vital  and 
nervous  forces? 

These  questions  have  not  as  yet  been  answered.  Until  they 
are  answered,  we  will  broach  our  hypotheses  as  hypotheses,  and 
not  as  truth.* 

The  destruction  of  the  colored  corpuscles — the  golden  color  of 
the  serum— the  slate  color  of  the  liver  upon  the  exterior,  and 
bronze  color  in  the  interior — the  color  of  the  bile — the  absence 
of  grape  sugar  from  the  structures  of  the  liver — the  slate  color 
of  the  spleen  and  the  disorganized  state  of  its  tissues,  and  the 
inability  of  its  pulp  to  change  from  the  dark  reddish-brown  to 
the  arterial  color,  gave  decided  evidence  that  this  was  a  case  of 
malarial  fever. 

There  were,  however,  other  symptoms  and  other  lesions, 
which  indicated  that  there  was  something  besides  malarial  fever. 

The  cerebral  and  nervous  symptoms — the  continued  febrile 
excitement  without  intermission — the  loose  state  of  the  bowels 
— the  unusual  action  of  a  small  dose  of  castor  oil — the  enlarged 
and  congested  glands  of  Peyer,  and  solitary  glands  of  the  intes- 
tines— indicated  the  presence  of  typhoid  fever. 

The  history  of  the  case,  (the  recent  attack  of  intermittent  fe- 
ver,) and  the  fact  that  the  glands  of  Peyer  showed  the  marks  of 
recent,  only  partially  developed,  inflammation  and  pathological 

*  These  relations  of  the  Nervous  System  to  Febrile  Phenomena  have  been  dis- 
cussed, at  length,  in  an  Essay,  (now  in  type  for  the  11th  volume  of  the  Transac- 
tions,) read  before  the  American  Medical  Association,  at  Washington,  D.  C,  May 
5th,  1858,  by  Henry  F.  Campbell,  M.  D.—[Edts.  Southern  Medical  and  Surgical 
Journal. 


1858.]  Jones,  on  Malarial  Fever.  667 

changes,  and  not  the  changes  produced  by  typhoid  fever  of  only 
moderate  standing,  lead  us  to  the  conclusion  that  the  remittent 
fever  preceded,  or  was  at  least  simultaneous  with  the  appearance 
of  the  typhoid  fever. 

The  treatment  of  this  case  was  radically  different  from  that  of 
all  the  cases  of  intermittent  and  remittent  fevers,  which  we  have 
as  yet  recorded. 

The  typhoid  symptoms,  masked  to  a  great  extent  those  of 
remittent  fever,  and  our  diagnosis  was  partially,  but  not  wholly 
incorrect.  The  plan  of  treatment  was  correspondingly  partial 
and  incorrect.  We  considered;  and  treated  the  disease  as  un- 
complicated typhoid  fever,  when  we  should  have  considered  and 
treated  it  as  typhoid  and  remittent  fevers  combined.  The  ma- 
larial fever  was  left  entirely  out  of  view,  and  marched  on  speed- 
ily and  unchecked  to  a  fatal  issue. 

The  true  mode  of  treatment  would  have  been  the  free  admin- 
istration of  sulphate  of  quinia,  stimulants  (brandy,  carbonate  of 
ammonia,  and  oil  of  turpentine,)  and  nutritious,  stimulating 
diet  (wine-whey,  milk-punch  and  beef  and  mutton  soups,  and 
arrow-root),  and  the  application  of  revulsives.  Purgatives 
should  have  been  rigidly  avoided. 

If  this  mode  of  treatment  had  been  pursued,  it  is  probable 
that  the  patient  would  have  had  a  chance  of  recovery. 

We  will  now  proceed  to  consider  several  cases,  which  illus- 
trate in  a  forcible  manner,  the  fact  which  we  have  stated,  and 
demonstrated  in  several  previous  articles  in  this  journal,  that  in 
malarial  fever  the  blood  undergoes  profound  alterations. 

Case  XXX.  Irishman — age  26:  height  5  feet  11  inches; 
weight  170 lbs. ;  black  hair;  black  eyes;  full,  dark-brown  beard 
and  mustache.  Has  been  in  America  (New  York)  nine  years, 
and  in  Savannah  three  months.  During  this  time,  he  has  fol- 
lowed, steadily,  the  occupation  of  a  baker. 

Sept.  11th,  12  o'clock  M.  Has  just  entered  the  hospital  with 
remittent  fever.  His  pulse  is  accelerated,  but  feeble,  and  his 
complexion  shows  the  effects  of  malarial  fever.  Says  that  he 
has  been  sick  for  one  week:  has  been  living  near  the  Albany 
and  Gulf  railroad,  in  a  low,  malarious  situation. 

Under  the  action  of  sulphate  of  quinia  and  stimulants,  the 
febrile  excitement  disappeared  in  the  course  of  four  days.  The 
patient,  however,  was  left  in  a  very  feeble  condition — complain- 
ed of  great  weakness;  his  pulse  was  feeble,  the  action  of  the 
brain  slow,  and  he  had  a  peculiarly  disagreeable  smell,  which 
was  not  permanently  removed,  either  by  water  or  by  a  change 
of  clothing.  Under  the  action  of  tonics,  he  recovered  sufficient- 
ly to  walk  about  the  ward ;  but  continued,  however,  weak,  low 
.  spirited,  and  indisposed  to  action. 

y.i. — vol.  nv.  vo.  x.  37 


663  Jones,  on  Malarial  Fever.  [October, 

Sept.  27th.  Complained  of  a  want  of  action  upon  his  bowels. 
A  mild  cathartic  was  administered. 

Sept.  28th.  lias  a  cough.  The  wind  has  been  from  the  North- 
east for  some  time,  and  the  weather  has  been  cool  and  damp, 
and  epidemic  catarrh  is  prevailing.  About  two-thirds  of  the 
patients  in  the  hospital  are  suffering  with  the  influenza.  This 
patient  was  up,  and  about  the  wards,  assisting  and  nursing  the 
patients,  all  this  day.  He  was  up  and  about,  when  I  went  the 
rounds  of  the  wards,  at  9  o'clock  P.  M.  Shortly  after  this  he 
complained  of  oppression,  difficulty  of  breathing,  and  loss  of 
muscular  power. 

Sept.  29th,  9  o'clock  A.  M.  During  the  night,  took  a  sudden 
and  remarkable  change  for  the  worse.  Respiration  spasmodic, 
and  sounds  as  if  the  air-cells,  bronchial  tubes  and  trachea,  con- 
tained lar^e  quantities  of  fluid — loud  rattling  sound  in  the 
throat.  The  churning,  rattling,  gurgling,  crackling  sounds  of 
the  lungs  and  trachea,  are  very  loud,  audcan  be  distinctly  heard 
over  the  upper  wards  of  the  hospital.  Muscular  power  com- 
pletely exhausted,  lies  upon  his  back,  and  is  unable  to  turn  upon 
either  side.  Surface  of  extremities  cold  ;  surface  of  trunk  cool, 
several  degrees  below  the  normal  standard.  The  temperature 
of  the  extremities  does  not  differ  essentially  from  that  of  the  sur- 
rounding medium.  The  expression  of  his  eyes  and  counten- 
ance, and  his  efforts  to  converse,  show  that  he  is  intelligent. 
He  is,  however,  entirely  unable  to  articulate  or  expectorate. 

Sinapisms  were  applied  to  the  extremities,  epigastric  region 
and  chest,  and  stimulants  were  administered  freely.  These  did 
not  produce  any  beneficial  effects — did  not  arouse  the  circula- 
tion, and  did  notincreasc  the  animal  temperature,  because  the 
supply  of  oxygen,  necesrary  for  the  chemical  changes  which 
generated  the  pl^sical,  muscular  and  nervous  forces,  was  cut 
off.     The  mustards  scarcely  reddened  the  skin. 

The  patient  continued  in  this  state,  with  a  gradual  diminu- 
tion of  power,  until  1  o'clock  A.  M.  the  next  morning — when 
the  painful  respiratory  sounds  were  hushed  in  death. 

(3).    Autopsy  8  hours  after  death 
Exterior. — Body  in  good  condition,  not  emaciated — limbs  full 
and  round ;  muscles  of  trunk  and  extremities  covered  by  a  thick 
layer  of  fat;  face  and  hands  sallow  and  sun-burnt;  surface  of 
the  skin  which  had  been  covered  by  the  clothes  was  fair. 

Head. — Dura-mater  presented  the  usual  appearance.  Arach- 
noid membrane  transparent;  blood  vessels  of  pia-mater  filled 
with  blood.  When  the  dura-mater  was  removed,  an  ulcer  in 
the  substance  of  the  brain  was  discovered,  occupying  a  position 
near  the  centre  of  the  superior  surface  of  the  left  hemisphere  of 
the  cerebrum.     This  ulcer  was  three-fourths  of  an  inch  in  length, 


1858.]  Joras,  on  Malaria!  Fever.  669 

half  of  an  incli  in  breadth,  and  about  one-eighth  of  an  inch  in 
depth.  The  walls  were  thickened  and  much  harder  than  the 
surrounding  brain.  The  blood-vessels  of  the  surrounding  pia- 
mater  and  brain  were  congested  with  blood,  and  there  was  an 
effusion  of  a  small  quantity  of  bloody  serum  betweeu  the  arach- 
noid and  pia-mater,  in  the  immediate  neighborhood  of  the  ulcer, 
but  nowhere  else.  The  appearance  of  the  ulcer,  and  the  conges- 
tion of  the  blood-vessels  around,  by  no  means  accounted  for  the 
death  of  the  patient.  The  ulcer  appeared  to  be  of  long  stand- 
ing. Tne  thickened  walls,  the  absence  of  pus,  and  the  sound 
state  of  the  structures  of  the  brain  around,  show,  not  only  that 
the  ulcer  was  of  long  standing,  but  also  that  it  was  rapidly 
healing. 

The  existence  of  this  ulcer  will  account,  in  part,  for  the  dull, 
lethargic  state  of  the  intellectual  faculties,  but  not  for  the  death 
of  the  patient. 

The  ventricles  of  the  brain  contained  a  small  quantity  of  clear 
serum.  The  structures  of  the  brain  presented  the  usual  consist- 
ence and  appearance. 

C/iest. — Heart,  normal  in  size:  the  left  ventricle  contained  a 
large,  light  yellow  fibrinous  clot,  attached  to  the  chordae  ten- 
dineoe  and  earn  eae  column  a?,  and  extending  through  the  ariculo- 
ventricular  opening  into  the  auricle.  This  clot  was  firm  in 
texture,  and  weighed  one  ounce. 

The  left  ventricle  contained  a  small  light  yellow  clot.  The 
aorta  also  contained  a  small  flattened,  riband-like,  light  yel- 
low clot.  These  clots  were  evidently  formed  previously  to 
death,  when  the  circulation  was  exceedingly  feeble. 

Lungs. — The  lungs  were  greatly  inflated,  and  did  not  collapse 
in  the  slightest  degree  when  the  air  was  admitted  into  the  pleura. 
They  were  congested  with  blood,  and  resembled  liver.  When 
handled,  they  were  fouud  to  be  remarkably  heavy,  and  felt 
more  like  liver  than  lungs.  When  cut,  the  air-cells,  and  large 
and  small  bronchial  tubes,  were  found  to  be  filled  with  serous 
fluid  and  numerous  fine  bubbles  of  air.  When  the  lungs  were 
squeezed,  pints  of  this  serous  fluid  flowed  out.  In  many  por- 
tions of  the  lungs  the  serous  fluid  was  clear — in  others  it  was 
reddish.  The  fluid  resembled  serum  in  all  respects,  and  was 
not  mucus. 

Here,  then,  we  have  the  cause  of  the  death  of  this  patient.  He 
was  drowned. 

Abdominal  Cavity. — Stomach,  pale  and  perfectly  healthy  in 
appearance.  Intestinal  canal,  from  the  stomach  to  the  anus, 
pale  and  healthy  in  appearance. 

Liver. — The  normal  reddish-brown  color  of  the  liver  was 
changed  in  most  parts  to  a  mixture  of  light  bronze  and  light 
olive.     In  several  places  the  color  of  the  liver  resembled  the 


670  Jones,  on  Malarial  Fever.  [October, 

normal  color.  In  two  circular  spots,  about  three  inches  in  di- 
ameter, the  liver  was  of  a  dark-bluish,  slated  color,  like  that  of  a 
recent  case  of  malarial  fever.  The  cut  surface  of  the  liver  ap- 
proached more  nearly  to  the  normal  celor  than  the  exterior. 
The  blood  of  the  liver,  after  exposure  to  the  atmosphere,  assum- 
ed a  red,  arterial  color. 

It  is  evident,  from  this  examination,  that  the  structures  of  the 
liver  were  recovering  from  the  effects  of  the  malarial  fever,  and 
the  organ  was  regaining  its  normal  color. 

Spleen — slate  colored,  enlarged  and  softened.  The  pulp  of 
the  spleen  dark  purplish  brown.  It  did  not  change  to  the  red 
arterial  color,  so  rapidly  as  the  pulp  of  healthy  spleens.  The 
change  of  color,  however,  was  much  greater  than  that  of  the 
pulp  of  the  spleen  in  a  recent  case  of  malarial  fever. 

This  organ,  like  the  liver,  appeared  to  be  recovering  from  the 
effects  of  malarial  fever. 

Kidneys — healthy. 

We  believe  that  we  have  now  all  the  facts  necessary  for  a 
rational  explanation  of  the  phenomena  presented  by  this  case. 

The  malarious  poison  and  its  effects  had  produced  profound 
alterations  in  the  blood  and  capillaries,  and  liver  and  spleen, 
and  secondarily  affected  the  nervous  system.  The  patient,  al- 
though weak  and  lethargic  on  account  of  these  pathological 
alterations,  and  the  ulcer  upon  the  brain,  was  nevertheless  in  a 
fair  way  of  recovery.  The  alimentary  canal  had  resumed  its 
healthy  actions,  the  liver  and  spleen  were  fast  recovering,  and 
he  was  gaining  strength  daily. 

We  can  safely  assert  that,  if  no  other  disease  had  occurred, 
the  lesion  of  the  left  hemisphere  of  the  brain,  and  the  effects  of 
the  malarial  poison,  would  not  have  proved  fatal. 

In  this  state  of  slow  convalescence,  the  patient  was  suddenly 
seized  with  the  prevailing  influenza.  The  mucous  membrane 
of  the  bronchial  tubes  and  air-cells  was  irritated.  The  irritation 
of  the  mucous  membrane  was  followed  by  congestion  of  the 
blood-vessels  and  capillaries  of  the  lungs.  The  capillaries  were 
in  an  enfeebled  state,  and  the  blood  in  a  watery,  altered  condi- 
tion. Healthy  limited  inflammation  was  impossible.  Diffused 
inflammation  of  all  the  structures  of  the  lungs  resulted.  The 
serous  portion  of  the  blood  poured  into  the  air-cells,  bronchial 
tubes  and  trachea — the  supply  of  oxj-gen  was  in  a  great  measure 
cut  off — the  chemical  changes  of  the  solids  and  fluids,  in  a  cor- 
responding degree,  checked — the  physical  forces,  heat  and  elec- 
tricity, and  the  nervous  force,  developed  by  these  chemical 
changes,  were,  as  a  necessary  consequence,  correspondingly  di- 
minished. 

The  immediate  cause  of  the  death  of  this  patient  was  a  depri- 
vation of  oxygen,   and  perhaps  the  partial  retention  of  the 


1S58.]  JONKS,  Oil  Malarial  /  071 

carbonic  acid  gas.     We  may  Bay  with  truth  that  he  was  drown- 
ed. 
The  attack  of  malaria]  fever  appeared  at  the  time  to  be  mild, 

and  it  is  highly  probable  that  all  its  effects  were  aggravated,  and 
a  fetal  issue  determined  bv  the  injurious  effects  upon  the  con- 
stitution of  this  patient,  of  his  occupation  and  previous  habits. 
He  was  a  baker.  As  a  general  rule,  this  elass  are  unhealthy, 
and  easily  succumb  to  disease.  This  will  be  illustrated  at  a  fu- 
ture time,  by  another  fatal  case  of  remittent  I'cxvr,  occurring  in 
this  cl 

The  only  two  bakers  which  entered  the  hospital  whilst  it  was 
in  my  charge,  died  from  the  effects  of  malarial  fever,  and  their 
occupation. 

The  following  remarks  of  C.  Turner  Thackrah,  have  an  inter- 
esting bearing  on  this  case: 

''Bakers  are  generally  pale  and  unhealthy.  The  temperoture 
in  which  they  are  placed  is  seldom  below  80°,  and  often  as  high 
as  100°.     The  heat  of  the  oven  is  rarely  lower  than  180°. 

"Bakers  are  subject  to  disorders  of  the  stomach,  to  cough  and 
rheumatism.*  The  two  former  of  these  two  affections  arise,  I 
conceive,  from  the  dust  which  is  largely  inhaled. 

"In  the  Plague  of  Venice,  we  find,  from  Mercurialis,  that  the 
bakers,  and  other  persons  in  similar  employments,  suffered  most. 
In  the  Diet,  des  Sciences  Medicales,  it  is  stated  that  during  the 
Plague  at  Marseilles,  in  1720,  all  the  bakers  died.  The  debility 
produced  by  great  heat,  probably  induces  this  susceptibility  to 
disease. 

"Bakers  work  by  night;  and  from  this  change  in  the  time  of 
sleep,  they  have  been  supposed  to  suffer  as  much  as  from  the 
dust  of  employ.  Observation,  however,  on  the  health  of  watch- 
men, and  others,  does  not  support  the  opinion." — {TJte  Effects  of 
Arts,  Trades  and  Professions,  on  Health  and  Longevity,  by  0. 
:r  Thackrah,  Esq.     London,  1832,  pp.  133-134. 


Cask  XXXI.  Irishman — laborer  and  boatman:  age  30; 
height  6  feet;  weight  150  lbs.;  tall,  spare  frame,  light  hair,  blue 
i\  pale,  sallow  complexion.  Has  been  running  on  (lat-boats 
and  rafts,  up  anddownthe  Savannah  river,  between  Savannah 
and  Augusta,  for  the  last  twelve  months.  Habits  irregular — 
addicted  to  the  use  of  ardent  spirits.  Says  that  his  constitution 
has  suffered  much  from  the  exposure  to  the  hot  sun  and  night  air 
on  the  river,  and  also  from  the  intemperate  use  of  ardent  spirits. 

*  In  a  report   ofa  Huml.  .  IOD,  it  aj»[).-:i!s  that  rlu-umat '■<■  t 

I  the  boken  l  one-fourteenth  of  the  c&binet*makere,  and  one- 

f  the  tailors,     Raadicei  graredii  morbi,  at  plearitidet, 

imonue — JUmazzim. 
MenU  says  a  great  number  of  bakers  ai  •  -j.itaU." 


672  Jones,  on  Malarial  Fever.  [October, 

Sept.  20th.  ."A  flat,  laden  with  wood,  which  he  was  bringiug 
to  the  city,  was  sunk  in  shoal  water."  He  was  all  day  in  the 
water,  up  to  his  waist,  fishing  out  the  wood.  This  night  had  a 
chill,  followed  by  fever.  The  fever  went  off  before  morn- 
ing, and  on  the  next  day  was  employed  again  in  the  water. 
The  chill  returned  at  night,  and  was  followed  by  fever.  Has 
been  sick,  without  any  medical  attendance,  until  the  present 
time,  September  27th.  Pulse  106 ;  respiration  accelerated,  la- 
bored; skin  hot  and  dry;  countenance  distressed — has  a  hag- 
gard, anxious  look;  complains  of  great  thirst,  of  pains  in  his 
back  and  bones,  and  of  great  exhaustion.  His  pulse,  although 
rapid,  is  feeble,  and  his  forces  appear  to  be  completely  exhaust- 
ed. His  fever  remitted  slightly  on  the  next  day,  but  returned 
on  the  29th  inst.  Under  the  action  of  large  doses  of  sulphate 
of  quinia,  stimulants,  sinapisms,  snake-root  tea,  and  milk  punch 
and  wrine  whey,  and  brandy  and  arrow-root,  the  febrile  excite- 
ment subsided,  the  urine  regained  its  normal  hue,  and  on  the 
4th  inst.  his  pulse  was  70,  and  respiration  18 — temperature  nor- 
mal, and  function  of  skin  normal ;  and  although  apparently  very 
feeble,  was  able  to  be  up  and  about  the  ward. 

During  tnis  attack,  the  saliva  was  acid,  and  the  urine  copious: 
from  20,000  to  25,000  grains  were  exereted  daily.  The  specific 
gravity  was  correspondingly  low,  from  1012  to  1014.  The 
abundant  discharge  of  urine  was  due  to  the  large  quantities  of 
water  which  his  thirst  led  him  to  take,  and  also  to  the  diuretic 
action  of  the  infusion  of  snake-root. 

Throughout  the  attack  his  pulse  was  feeble  and  his  forces 
greatly  exhausted,  and  he  required  close  attention  and  the  free 
administration  of  stimulants. 

October  5th.  This  morning  absconded,  clandestinely,  from  the 
hospital. 

Oct.  8th.  Has  returned.  Pulse  120;  skin  hot  and  dry;  res- 
piration accelerated,  labored;  complains  of  great  pain  in  the 
back  of  his  head  and  neck — these  parts  are  swollen,  and  painful 
upon  pressure. 

As  the  5th  inst.,  on  which  he  left  the  hospital,  was  the  day  of 
election  of  the  city  officers,  it  seems  probable  that  he  may  have 
received  a  blow  upon  the  head.  This,  however,  he  stoutly  de- 
nies.    $.  Cold-water  dressing  to  back  of  head  and  neck. 

Oct.  9th.  His  head  has  been  shaved,  and  the  tissues  above  the 
occipital  bone,  and  above  the  left  temporal  and  parietal  bones, 
are  swollen,  and  the  skin  looks  black  and  is  ulcerated  in  several 
places.  The  swelling  extends  down  along  the  neck,  and  reach- 
es the  superior  portion  of  the  left  shoulder.  To  the  finger,  the 
swollen  parts  feel  as  if  there  was  a  collection  of  fluid  beneath 
the  skin.  Says  that  he  is  suffering  intense  pain.  Countenance 
distressed  and  haggard;  pulse  128;  skin  hot  and  dry;  respira- 
tion thoracic,  labored,  accelerated. 


1858.]  JoXES,  on  Malarial  Fever.  673 

Oct.  10th.  Pulse  160,  feeble;  skin  hot;  respiration  spasmodic 
and  labored.  In  addition  to  the  intense  pain  in  the  back  of  his 
neck  and  left  side  of  the  head,  he  complains  of  intense  pain  in 
his  chest.  The  pain  in  the  chest  cuts  short  the  respiration  and 
renders  it  spasmodic.  His  countenance  is  expressive  of  great 
agony  and  terror. 

Oct.  11th.  Pulse  140,  rapid  and  very  feeble;  respiration  24r 
labored,  thoracic,  spasmodic.  The  pain  in  his  chest  is  intense: 
lie  groans  and  cries  out  at  every  breath.  The  expression  of  his 
countenance  is  indicative  of  great  agony,  terror  and  horror. 
AVas  restless  and  delirious  during  the  night,  and  during  his  de- 
lirious visions  spoke  and  acted  as  if  he  was  engaged  in  mortal 
combat.  Has  no  hope  of  himself,  and  refuses  all  medicine.  The 
back  of  neck  and  back  and  side  of  head  is  much  swollen,  and 
when  pressed  with  the  hand  there  is  a  distinct  fluctuation. 

Hoping  that  a  discharge  of  the  pus,  or  fluid,  would  afford  re- 
lief a  free  crucial  incision  was  made  at  the  most  prominent  part 
of  the  swelling.  Nothing  but  blood  issued.  The  hemorrhage 
was  so  great,  that  it  was  necessary  to  check  it,  by  the  applica- 
tion to  the  wound,  of  a  compress,  saturated  with  the  tincture  of 
muriate  of  iron. 

Oct.  12th.  During  the  night  was  delirious — would  rip  out  the 
most  terrible  oaths,  and  cry  out  that  the  devils  were  after  him — 
had  beaten  him  severely,  and  were  endeavoring  to  throw  him 
out  of  the  windows.  At  other  times,  he  would  speak  and  act  as 
if  he  had  been  in  mortal  combat,  and  was  wreaking  vengeance 
upon  an  imaginary  antagonist.  These  actions  excited  the  sus- 
picion, that  the  injury  on  the  back  and  side  of  the  head  was 
received  from  a  blow. 

The  patient  died  at  1  o'clock  A.  M.,  this  morning. 

(4).    Autopsy  9  hours  after  Death. 

Exterior. — Body  much  emaciated;  back  and  left  side  of  neck 
much  swollen.  The  inferior  surface  of  the  trunk  and  neck  pre- 
sented a  mottled  appearance,  from  the  settling  of  the  blood  by- 
gravitation,  in  the  most  dependent  parts  of  the  body.  On  the 
left  buttock,  just  below  the  position  of  the  glenoid  cavity,  was 
a  black,  gangrenous  spot,  about  one  inch  in  diameter.  An  in- 
cision showed  that  the  change  of  color  was  confined  entirely  to 
the  skin.  On  the  right  leg,  there  were  the  marks  of  an  exten- 
sive ulcer,  upon  the  skin  covering  the  tibia. 

The  cicatrix  presented  a  purplish,  angry  color. 

When  incisions  were  made  into  the  swollen  pans  of  his  neck, 
*  and  back  and  side  of  head,  the  spaces  between  the  muscles,  the 
meshes  of  the  fibrous  tissue  surrounding  and  connecting  togeth- 
er the  muscles  and  the  fibrous  tissue  of  the  skin,  were  found  to 
be  completely  filled  and  distended  with  golden-colored  serum. 


674  Jones,  on  Malarial  Fever.  [October, 

Head. — Dura  mater  healthy.  Arachnoid  membrane  transpar- 
ent throughout  its  extent  over  the  hemispheres  of  the  brain. 
At  the  base  of  the  brain,  it  was  slightly  opalescent. 

Blood-vessels  of  pia  mater  not\  more  filled  with  blood  than 
usual.  The  cortical  and  medullar^  substances  of  the  cerebrum, 
and  of  the  cerebellum,  the  pons  variolii,  the  medulla  oblongata, 
and  superior  portion  of  the  spinal  marrow,  appeared  natural  in 
consistence  and  color. 

Ventricles  of  brain  contained  f3iv.  of  golden  colored  serum. 

The  superior  longitudinal  sinus  of  the  dura  mater  contained 
a  golden  yellow  elongated  clot,  the  diameter  of  which  was  about 
one  half  that  of  the  longitudinal  sinus. 

Chest. — Heart  somewhat  enlarged.  Pericardium  contained 
f  li,  of  golden  serum.  All  the  cavities  of  the  heart  contained 
golden  colored  clots.  The  right  auricle  had  a  large  golden 
colored  clot,  which  was  attached  to  the  carneae  column  ae  of  the 
ventricle,  and  the  chordae  tendineae  of  the  tricuspid  valves,  and 
extended  through  the  auriculo-ventricular  opening  into  the 
right  auricle.  The  left  ventricle  and  auricle  also  contained  a 
large  golden  colored  clot,  which  was  in  like  manner  attached  to 
the  carneae  columnar  and  chordae  tendineae  of  the  auriculo-ven- 
tricular valves.  The  aorta,  carotids  and  pulmonary  arteries 
contained  elongated  golden -colored  clots,  having  diameters 
nearly  equal  to  those  of  the  arteries.  All  these  clots  were  firm, 
and  appeared  to  be  almost  organised. 

Lungs. — The  lungs  did  not  collapse  when  the  cavity  of  the 
thorax  was  opened.  Exterior  surface  of  the  pleura,  covering 
the  lungs  and  lining  the  walls  of  the  thorax,  covered  with  co- 
agulable  lymph  of  a  golden  color.  Adhesions  were  numerous, 
but  as  yet  not  strong  on  account  of  the  soft,  fresh  condition  of  the 
coagulable  lymph,  which  was  evidently  but  recently  effused, 
probably  within  the  last  70  hours.  This  inflammation  of  the 
pleura  accounts  for  the  severe  pain  in  the  chest  during  life. 

The  lungs  were  much  congested  with  blood,  and  when  cut 
they  resembled  liver.  The  bronchial  tubes  and  air-cells  contain- 
ed much  serum.  The  amount  of  serum  was  much  less,  however, 
than  in  the  previous  Case  XXX.  The  anterior  surface  of  the 
middle  lobule  of  the  right  lung  had  a  dark  blackish  red  spot, 
about  one  inch  in  diameter,  which  resembled  at  first  sight  the 
wound  from  a  sharp  instrument. 

The  examination  of  the  exterior  of  the  chest,  and  interior 
surface  of  the  ribs,  showed  neither  wound  nor  fracture  of  the 
ribs.  When  closely  examined,  this  portion  of  the  lung  was 
found  to  be  more  congested  and  solidified  than  the  surrounding 
portions,  and  would  in  all  probability,  if  the  patient  had  sur- 
vived, been  the  seat  of  an  abscess. 

Liver, — Liver  of  a  light  bronze  color.    The  color  is  lighter 


1858.]  Jones,  on  Malarial  Fever.  675 

than  that  of  a  recent  attack  of  remittent  fever,  but  resembles 
the  color  of  a  liver  which  was  recovering  from  the  effects  of  re- 
mittent fever.  Cut  surface  of  a  light  bronze  color,  and  of  not 
such  a  deep  and  decided  bronze  as  the  liver  of  a  patient  who 
had  died  from  a  recent  attack  of  malarial  fever. 

The  right  lobe  of  the  liver  had  upon  its  under  surface  a  slate 
colored  spot  three  inches  in  diameter,  which  resembled  in  all 
respects  the  liver  of  a  recent  case  of  malarial  fever.  "When  an 
incision  was  made  across  this  spot,  the  cut  surface  presented  for 
one-sixth  of  an  inch,  the  true  malarial  hue,  below  this  it  ap- 
proached more  nearly  the  normal  hue.  The  liver  appeared  to 
be  somewhat  enlarged.  The  weight,  however,  was  not  ascer- 
tained.    Its  structure  did  not  appear  to  be  materially  altered. 

Spleen. — Much  enlarged,  and  of  a  dark  slate  color.  Although 
much  softer  than  a  normal  spleen,  it  was  much  harder  than  a 
spleen  of  a  recent  case  of  malarial  fever.  This  organ,  like  the 
liver,  appeared  to  be  just  recovering  from  the  effects  of  malarial 
fever.     Weight  of  the  spleen,  grains  13562,  equals  ozs.  31. 

Kidneys  appeared  to  be  somewhat  enlarged.  The  calices, 
infundibula  and  pelvis  of  the  kidney,  contained  a  fluid  resem- 
bling (to  the  naked  eye),  in  all  respects,  pus. 

Alimentary  Canal. — Stomach  enormously  distended  with  gas. 
Mucous  membrane  pale  and  healthy  in  appearance.  Small  in- 
testines and  colon  healthy  in  appearance  to  the  naked  eye. 

The  following  appears  to  be  the  cause  and  history  of  this  last 
attack : 

The  patient  left  the  hospital  when  he  was  in  an  exceedingly 
feeble  condition,  after  a  severe  attack  of  remittent  fever.  It  is 
probable  that  upon  election  day  he  indulged  his  taste  for  ardent 
spirits.  The  wind  was  from  the  northeast,  and  the  weather 
damp  and  cool,  with  occasional  scuds  of  rain  and  mist.  Expo- 
sure to  this  cool  damp  wind,  fresh  from  the  ocean,  and  the  low 
grounds  and  swamps  of  Georgia  and  South  Carolina,  not  only 
during  the  day,  but  probably  during  the  night  also,  in  a  state 
of  intoxication,  induced  a  severe  attack  of  pleura-pneumonia. 

The  swelling  on  the  back  of  his  head,  was  due,  either  to  a 
blow,  or  to  inflammation  in  the  cellular  tissue  and  muscles,  an- 
alogous to  the  inflammation  of  the  lungs,  and  probably  arising 
from  the  same  cause.  The  large  amount  of  golden -colored  se- 
rum which  was  effused  into  the  cellular  tissue  of  the  neck  and 
head,  indicated  the  altered  condition  of  the  blood.  The  deter- 
mination of  the  true  mode  of  treating  this  case  was  exceedingly 
difficult. 

Here  was  a  patient  whose  blood  had  been  depraved,  organs 
impaired,  and  forces  exhausted,  by  dissipation,  intemperance, 
and  exposure,  and  by  a  severe  attack  of  malarial  fever,  sud- 
denly attacked  with  pleuro-pneumonia  of  both  lungs,  and  a 

N.  6. VOL.  XIV.     NO.  X.  38 


676        Harrison.    Case  of  Extra- Uterine  Pregnancy.  [October, 

painful  inflammation  of  the  cellular  tissue  and  muscles  of 
the  neck  and  head.  The  usual  treatment  for  pleurisy  and  pneu- 
monia was  impossible.  A  single  bleeding  would  have  taken 
life  immediately,  or  at  all  evenis  hastened  the  fatal  issue. 

He  could  bear  neither  purgation,  starvation,  nor  tartar  emetic. 
The  only  rational  plan  of  treatment  was  to  support  the  consti- 
tution and  strengthen  and  relieve,  if  possible,  the  congestion  of 
the  internal  organs,  by  revulsives.  The  only  hope  was  that 
nature  would  work  her  own  cure. 

This  was  the  plan  of  treatment  which  we  adopted. 

Many  other  points  of  interest  in  this  case  might  be  noticed, 
but  we  defer  them  until  a  future  time,  when  we  hope  to  gener- 
alize all  the  facts  and  phenomena  observed. 

(To  be  continued.) 


ARTICLE   XXIII. 


Medical  and  Medico-legal  Notes  of  a  Case  of  Extra-  Uterine  Preg- 
nancy.   By  G.  Harrison,  M.  D.,  of  Macon,  Ga. 

On  the  10th  of  June  last,  I  was  called  to  see  a  servant  girl,  of 
one  of  my  patrons,  who  was  suffering  from  abdominal  or  uterine 
pains,  at  intervals  of  six  or  eight  minutes,  indicating  that  she 
was  threatened  with  a  miscarriage.  I  judged  from  her  size,  in 
a  lying  position,  that  she  was  near  the  full  period  of  utero-gesta- 
tion  ;  but  on  investigation  I  found  that  she  was  (according  to 
her  and  her  mistress'  statements)  only  about  the  fifth  month. 
Learning  these  facts,  I  immediately  gave  a  teaspoonful  of  lauda- 
num, which  soon  arrested  the  pains. 

After  leaving,.  I  heard  nothing  more  from  her  until  the  month 
of  August,  two  months  after  I  was  first  called  to  the  case ;  when 
I  was  sent  for  again  about  three  o'clock  in  the  morning,  to  see 
the  girl,  with  a  request,  that  I  would  be  in  great  haste,  that  she 
was  thought  to  be  dying.  On  my  arrival,  I  found  her  dead, 
A  report  was  soon  put  in  circulation  that  she  had  been  killed — 
as  there  had  been  a  difficulty  the  day  before  between  her  and 
her  mistress,  who  had  stricken  her  several  blows.  This  gave 
rise  to  a  post-mortem  examination.  After  the  necessary  pre- 
parations, the  abdomen  was  opened,  by  a  crucial  incision  through 
its  walls,  exposing  to  view  a  great  quantity  of  blood,  which  was 
carefully  removed  by  the  sponge,  when  a  foetus  was  seen,  sepa- 


1858.]      HARRI30X.     Case  of  Extra- Uterine  Pregnancy.  677 

rated  from  the  cord,  lying  loosely  with  the  other  contents  of 
the  abdomen.  The  foetus  was  removed  and  examined;  no 
marks  of  injury  could  be  detected  on  it,  and  it  was  concluded, 
judging  from  its  size  and  general  appearance,  that  it  could  not 
be  more  than  a  five-month  child.  The  examination  was  con- 
tinued, and  it  was  found  to  be  an  extra-uterine  fcetation  of  the 
ovarian  class.  The  uterus,  with  its  entire  appendages,  were  re- 
moved, and  we  now  have  them  together  with  the  foetus  in  a 
state  of  preservation.  The  uterus  presents  no  unnatural  appear- 
ance— possibly  a  little  enlarged. 

Two  facts  connected  with  this  case  deserve  notice,  which  I 
will  give,  before  proceeding  to  remark  upon  the  general  interest 
of  the  case.  Attached  to  the  placenta  were  two  ligaments,  in- 
dependent of  the  cord,  one  about  six  inches  long,  connecting 
with  the  transverse  colon;  the  other  about  four,  connecting 
with  the  body,  just  above  the  point  of  the  ilium.  How  these 
attachments  happened  to  be  made  at  such  remote  distances  is  a 
matter  of  some  little  astonishment,  while  other  parts  were  so 
much  more  convenient,  as  might  have  served  the  same  purpose 
— is  left  as  a  matter  of  speculation  for  the  curious. 

In  a  medico-legal  point  of  view,  this  case  has  become  one  of 
some  interest  from  the  fact,  that  Rogers,  the  owner  of  the  wo- 
man, refused  to  pay  five  hundred  dollars,  a  balance  due  for  the 
purchase  of  the  woman  and  her  two  children,  alleging  that  he 
had  bought  her  and  paid  a  high  price  for  her,  because  of  her 
pregnancy,  and  the  future  prospects  of  raising  children  from 
her.  Rogers  alleged  in  his  plea  that  the  woman  was  warranted 
to  him  sound,  and  produced  a  warrantee  of  soundness,  a  fact 
which  defendant  did  not  pretend  to  den}-.  Yet  the  seeds  of 
death  had  been  sown  anterior  to  the  purchase,  and  of  right  he 
ought  not  to  pay  any  more.  The  reason  for  the  plea  was  not 
based  on  the  unsoundness  of  the  woman,  but  upon  the  fact  that 
she  had  in  her  system  at  the  time  of  sale  that  which  would  in- 
evitably produce  death.  To  prevent  a  suit  the  parties  agreed  to 
eave  it  to  arbitration,  under  the  late  law,  known  particularly  as 
"Judge  Cone's  arbitration  law."  A  jury  of  three  very  intelli- 
gent gentlemen  was  selected,  the  witnesses  were  summoned  and 
sworn,  and  their  testimony  taken.  After  which,  Thomas  P. 
Stubbs,  Esq.,  attorney  for  Rogers,  proceeded  to  the  investiga- 
tion of  the  facts  as  proved.     It  was  proved  by  several  witnesses 


678        Harrison.    Case  of  Extra- Uterine  Pregnancy.  [October, 

that  the  woman  was  represented  by  Mrs.  JefYers,  her  former 
owner,  as  being  pregnant  at  the  time  of  sale,  which  induced  her' 
to  ask  more  for  her  than  she  otherwise  would  have  done.  In 
addition  to  the  testimony  there  present,  Mr.  Stubbs  introduced 
the  sayings  of  the  woman  to  her  physician  when  called  to  visit 
her  professionally,  to  show  that  she  was  pregnant  at  the  time  of 
sale,  judging  from  the  ordinary  symptoms  usually  taken  as  the 
best  evidence  in  such  casesr  viz :  suppression  of  the  menstrual 
flux,  which  had  ceased  on  her  two  months  before  the  sale — 
morning  sickness,  etc. 

He  next  proved  by  Dr.  Fitzgerald,  who  assisted  in  the  post 
mortem  examination,  and  myself,  that  the  woman  was  pregnant 
and  of  the  class  above  specified,  and  under  such  circumstances 
death  was  inevitable. 

Judge  Nisbet,  the  counsel  for  Mrs.  Jeffers,  admitted  the  war- 
rantee  of  soundness,  but  insisted  that  the  negro  was  sound  at 
the  time  of  sale,  and  that  all  the  facts  taken  together  showed  no 
breach  of  warrantee.  He  showed  that  the  kind  of  pregnancy 
was  no  evidence  that  she  was  not  sound,  but  rather  good  evi- 
dence that  she  was  a  healthy  woman.  He  also  proved  that  a 
suppression  of  the  menstrual  flux  was  not  always  an  infallible 
sign  of  pregnancy,  and  that  most  or  all  of  the  symptoms  men- 
tioned in  this  case,  might  have  arisen  from  a  suppression,  pro- 
duced from  other  causes.  He  insisted  upon  the  rejection  in 
toto,  of  all  the  sayings  of  the  woman,  and  showed  from  the  sta- 
tute laws  of  Georgia,  that  her  testimony  was  inadmissible  and 
could  not  be  relied  on,  even  in  this  case.  He,  therefore,  con- 
tended that  the  plea  was  not  sustained ;  putting  it  upon  its  own 
merits,  assuming  that  the  woman  was  pregnant  at  the  time  of 
sale,  a  fact  which  they  had  failed  to  establish,  insisting  that  the 
suppression  had  been  produced  from  another  cause. 

The  examination  of  the  witnesses  being  through,  Mr.  Stubbs 
proceeded  briefly  to  argue  the  case  before  the  jury:  he  com 
mented  upon  the  testimony,  showing  that  he  considered  that  it 
made  out  his  case,  and  thought  that  he  ought  certainly  to  be 
entitled  to  a  verdict,  saying  nothing  about  the  sayings  of  the 
woman,  which  he  contended  should  be  taken  by  all  means  in 
this  case.  He  urged  this  fact  forcibly  on  the  minds  of  the  jury, 
and  in  support  of  his  argument,  produced  cases  which  had  beer 
decided  by  the  Supreme  Courts  of  Kentucky  and  Tennessee 


& 


1858.]      Harrison.    Case  of  Extra- Uterine  Pregnancy.  679 

and  a  case  by  the  Supreme  Court  of  this  State,  where  the  say- 
ings of  negroes  were  admitted  to  prove  the  existence  of  long 
standing  disease — the  doctors  who  testified  being  allowed  to  use 
the  statements  of  the  negroes  when  called  to  visit  them,  to  com- 
plete their  testimony.  He  concluded  his  argument  by  pleading 
the  justness  of  his  cause,  and  asked  the  jury  to  release  him  from 
the  farther  payment  of  the  purchase  money,  as  he  thought  he 
had  clearly  shown  that  the  seeds  of  death  had  been  sown  prior 
to  the  sale  of  the  negro. 

Judge  Nisbet  commenced  his  argument  by  admitting,  that  if 
Mr.  Stubbs  could  prove  positively  that  the  seeds  of  death  had 
been  sown,  in  this  case,  prior  to  the  sale,  it  would  be  good 
grounds  for  the  release  of  defendant  from  all  liability,  but  in 
this  he  had  failed.  He  said,  that  he  had  not  proven  this  fact 
by  any  witness,  for  all  had  testified  according  to  the  sayings  of 
the  negro  and  Mrs.  Jeffers,  which,  as  to  the  negro,  was  not 
good,  as  he  would  proceed  to  show.  He  insisted  upon  rejection 
of  the  sayings  of  the  negro  entirely,  and  would  now  show  from 
the  best  authority  that  the  woman  could  not  have  been  preg- 
nant at  the  time  Rogers  bought  her.  He  read  from  Ramsboth- 
am's  Midwifery  to  show  that  ovarian  pregnancies  seldom  if  ever 
passed  the  second  or  third  month,  rarely  reaching  the  fifth,  and 
never  exceeding  the  sixth.  He  read  a  number  of  extracts  from 
different  authors,  showing  the  strength  of  his  position,  and  con- 
cluded his  argument  by  a  few  extracts  from  Beck's  Medical  Ju- 
risprudence and  a  short  comment  on  the  statute  laws  of  Georgia, 
against  the  propriety  of  negro  testimony  as  against  white  per- 
sons, as  rebutal  to  the  decisions  of  the  courts,  read  by  the  oppo- 
site side  ;  that  the  facts  set  forth  in  the  plea  were  not  sustained ; 
that  Rogers  ought  to  comply  with  his  contract,  and  pay  the 
balance  of  the  purchase  money. 

I  have  the  opinion  of  two  distinguished  gentlemen,  both 
teachers  of  medicine,  one  saying  that  he  believed  the  woman 
was  pregnant  at  the  time  of  sale;  circumstances  and  appearan- 
ces, and  the  woman's  statement  (which  is  "  good  evidence  in 
medicine  if  not  in  law,")  give  sufficient  ground  for  the  belief; 
but  think  that  the  arbitrators  did  right  in  requiring  Rogers  to 
pay,  putting  it  to  his  charge  as  a  bad  and  unfortunate  specula- 
tion. The  other  gives  no  opinion  relative  to  the  pregnancy, 
•but  believes  that  the  verdict  ought  to  have  been  different ;  be- 


680  La  Taste.     Remarks  on  Effects  of  Honey.      October, 


a 


cause  of  the  high  price  paid  for  the  property,  and  that  in  justice 
a  division  of  the  loss  would  have  been  equitable,  since  the  whole 
would  have  fallen  on  the  other  party,  had  she  not  been  fortun- 
ate in  selling. 

Had  the  case  to  be  tried  again,  I  would  give  it  as  my  opinion 
positively,  that  it  was  a  seven  months'  pregnancy,  taking  all 
the  circumstances  into  view,  notwithstanding  most  of  the  author- 
ities— indeed,  all  which  I  have  consulted,  take  the  opposite 
grounds — and  say  that  ovarian  pregnancies  rarely,  if  ever,  pass 
the  fifth  month. 


ARTICLE    XXIV. 

Remarks  on  ike  Alleged  Deleterious  Effects  of  Honey.     By  YlCTOR 
La  Taste,  Pharmaceutist,  Augusta  Ga. 

Gentlemen  : 

I  have  been  making  various  observations,  enquiries,  &c,  with 
a  view  of  solving  the  question,  whether  honey  is,  within  itself, 
a  poisonous  substance,  but  must  acknowledge  a  total  failure  up 
to  the  present  time.  I  know  that  there  is  a  prevailing  opinion 
in  favor  of  the  affirmative  of  the  question ;  but,  then,  is  that 
sufficient  to  establish  the  fact,  any  more  than  that  turnips  will 
grow  better,  or  soap  more  successfully  made,  if  the  seed  of  the 
one  are  planted,  or  the  ingredients  of  the  other"  mixed  in  parti- 
cular reference  to  certain  stages  of  the  moon?  I  hope,  in  this 
enlightened  age,  such  superstitious  notions  are  confined  to  the 
illiterate.  In  the  progress  of  my  investigations,  I  addressed  a 
note  to  the  Editor  of  the  "  Druggist's  Circular,"  and  asked  to 
append  his  answer,  which  may  be  found  in  the  last  number  oi 
that  excellent  journal. 

"You  may  be  correct  in  your  opinion,  that  the  notion  that 
honey  is  sometimes  poisonous  is  one  of  the  popular  errors  of  the 
times.  It  is  perhaps  difficult  to  prove  it  to  ]oe  so ;  but  common 
opinions  have  generally  some  foundation  in  fact.  It  is  known 
to  most  persons  that  the  quality  and  flavor  of  honey  is  modinec 
by  the  sources  from  which  it  is  gathered.  It  may  therefore  be 
logically  inferred  that  the  change  in  quality  and  flavor  may  be 
so  great  as  to  render  it  pernicious  to  human  health,  when  it  it 
used  as  food.  What  the  changes  are  that  take  place  in  the  or 
gans  of  the  bee,  we  cannot  know;  but  that  changes  do  tak< 
place  is  extremely  probable,  as  the  saccharine  matter  of  the 


1858.]         Epithelial  Cancer  of the  Anus  and  Rectum.  681 

nectaries  of  flowers  are  not  exactly  identical  with  the  character- 
istic properties  of  honey.  Yet  the  change  effected  in  the  elabo- 
ration of  honey,  is  not  sufficient  to  eliminate  all  the  peculiarities 
of  the  flowers  from  which  the  materials  are  obtained. 

"Several  cases  of  poisoning,  from  eating  honey,  are  recorded 
in  the  New  Jersey  Medical  Reporter,  for  Nov.  1852.  A  few 
cases  of  this  kind  are  not  sufficient,  certain ly,  to  establish  the 
fact,  but  they  lead  to  strong  suspicions.  The  argument,  that 
honey  may  sometimes  be  poisonous,  is  one  of  the  post  hoc,  ergo 
propter  hoc  kind." 

All  that  the  learned  Editor  has  said  may  be  strictly  true ; 
still  I  am  of  the  same  opinion — that  honey  is  quite  harmless ; 
and  I  tli ink  so,  because  my  experience  with  the  bee  teaches  me 
that  this  insect  has  too  much  sagacity  not  to  know  the  difference 
between  those  flowers  having  noxious  properties  and  those  that 
have  not.  It  is  also  true,  that  naturalists  differ  as  to  whether 
honey  is  a  secretion  of  the  bee,  or  whether  it  exists  already 
formed  in  plants.  I  believe  that  it  does  exist  already  formed, 
and  deposited  by  the  bee  just  as  it  was  gathered.  If  this  were 
not  so,  the  honey  gathered  from  the  buckwheat,  and  that  from 
the  white  clover,  would  have  the  same  appearance — whereas, 
that  from  the  latter  is  much  whiter:  proving,  also,  that  whate- 
ver chemical  change  may  take  place  in  the  stomach  of  the  bee, 
if  any,  that  the  quality  of  the  honey  does  not  partake  of  the 
change.  But  leaving  all  theory  out  of  the  question,  does  it  not 
appear  that  if  honey  is  poisonous,  cases  of  poisoning  ought  to  be 
more  frequent,  taking  into  account  the  quantity  that  is  used? 
And  again,  when  you  physicians  prescribe  the  use  of  honey,  do 
you  do  it  with  the  same  understanding  as  when  arsenic  is  pre- 
scribed, or  do  you  recommend  it  as  an  innocent  adjunct?  I 
would  be  glad  to  have  your  opinion  in  full. 


Epithelial  Cancer  of  the  Anus  and  Rectum.     By  T.  B.  Curlixg, 
Esq.,  F.R.S.,  Surgeon  to  the  London  Hospital. 

The  parts  of  the  body  most  prone  to  epithelial  cancer  are 
those  in  which  a  junction  takes  place  between  the  skin  and  mu- 
cous membrane.  We  see  this  in  the  lips,  and  in  the  extrem- 
ity of  the  penis,  and  in  the  prepuce.  The  anus,  though  less 
frequently  attacked  than  these  parts,  is  nevertheless  liable  to 
this  form  of  cancer.  Its  occurrence,  however,  at  the  ver^e  of 
the  rectum,  and  within  the  bowel,  has  been  scarcely  noticed  by 


682  Epithelial  Cancer  of  the  Anus  and  Rectum.     [October, 

writers,  and  there  are  no  satisfactory  accounts  of  the  results  of 
operations  performed  for  its  removal  from  this  situation.  This 
may  be  owing,  in  part,  to  the  dise^le  being  somewhat  rare,  but 
is  more  probably  due  to  the  circumstance  that  epithelial  cancer 
has  been  distinctly  recognised  only  in  recent  years.  The  fol- 
lowing cases  in  which  growths  of  this  character  were  successful- 
ly excised  seem  deserving  of  record,  as  a  contribution  to  our 
knowledge  of  this  disease : 

Case  3. — Epithelial  Cancer  of  the  Rectum  cured  by  Excision 

after  repeated  Failures  of  Treatment. — Mrs.  M ,  aged  forty,  an 

English  lady  married  to  a  German,  but  without  having  borne 
children,  consulted  me  in  April,  1855,  on  account  of  an  obsti- 
nate disease  of  the  rectum.  On  examination,  I  found  a  large, 
elevated  and  slightly  indurated  sore,  occupying  the  whole  of 
the  right  side  and  part  of  the  back  part  of  the  rectum,  just  with- 
in the  sphincter  muscle,  and  extending  up  the  bowel  the  distance 
of  about  an  inch  and  a  half.  The  sore  was  somewhat  larger  than 
a  crown -piece.  There  was  slight  bleeding  from  the  surface  after 
the  removal  of  the  finger.  The  chief  symptom  she  complained 
of  was  a  frequent  smarting  pain,  which  became  more  severe 
after  an  evacuation.  At  this  time  there  was  usually  a  slight 
discharge  of  blood.  There  was  no  obstruction  in  the  passage. 
The  lady  looked  pale  and  anxious,  but  in  other  respects  seemed 
free  from  disease.  It  appeared  that  the  complaint  of  the  rectum 
was  first  noticed  two  years  before.  At  that  time  she  was  resid- 
ing in  Germany,  and  she  consulted  the  late  Professor  Siebold, 
of  Jena  (Saxe- Weimar),  who  excised  the  diseased  part  in  Sep- 
tember, 1853,  whilst  she  was  under  the  influence  of  chloroform. 
She  recovered  slowly  from  the  operation,  and  remained  appar- 
ently well  until  July,  1854,  when  a  return  of  the  disease  was 
noticed,  and  the  complaint  shortly  became  as  painful  as  before. 
She  subsequently  went  to  Paris,  and  in  August  placed  herself 
under  the  care  of  a  German  surgeon  practising  there.  He  made 
repeated  applications  of  a  caustic  nature  to  the  sore,  and  finding 
them  unsuccessful,  at  length  proposed  the  actual  cautery,  which 
was  used  in  February,  1855,  the  patient  being  placed  under  the 
influence  of  chloroform.  She  remained  under  the  care  of  this 
gentleman,  altogether  six  months,  but  according  to  her  account, 
she  derived  no  benefit  from  his  treatment,  and  was  not  free  from 
the  shooting-pains  any  part  of  the  time.  She  was  induced, 
therefore,  to  come  to  London  for  further  advice,  and  at  the  re- 
commendation of  Swayne  of  Clifton,  consulted  me. 

By  getting  the  patient  to  strain,  and  by  introducing  my  fin- 
ger into  the  vagina,  and  pressing  in  a  direction  to  evert  the 
sore,  I  managed  to  get  a  tolerably  good  view  of  the  part.  It 
was  an  irregular,   spongy-looking  ulcer,  of  a  deep-red  colour. 


1858.]         Epithelial  Cancer  of  the  Anus  and  Rectum.  683 

Judging  from  the  characters  of  the  sore,  I  had  little  doubt  that 
this  was  a  case  of  epithelial  cancer  of  the  rectum,  and  that  the 
disease  had  been  only  imperfectly  removed  in  the  various  pro- 
ceedings for  its  extirpation.  After  careful  consideration,  I  pro- 
posed the  operation  of  excision,  but  considering  the  failure  of 
the  treatment  previously  adopted,  I  advised  her  husband  to 
take  another  opinion.  Mr.  Hilton,  a  few  days  afterwards,  met 
me  in  consultation,  and  fully  agreed  with  me  that  the  disease 
could  be  entirely  removed  with  the  knife.  The  disappointment 
which  they  had  experienced  naturally  led  both  the  patient  and 
her  husband  to  distrust  a  repetition  of  excision.  I  consequent- 
ly saw  nothing  more  of  them  for  a  month,  during  which  period 
they  sought  other  advice,  and  also  communicated  my  proposal 
to  Professor  Siebold,  who  wrote  and  recommended  her  to  sub- 
mit to  the  operation,  when  they  again  applied  to  me. 

May  30th,  1855. — The  bowels  having  been  well  relieved  by 
castor  oil,  the  patient  took  chloroform,  and  I  then  excised  the 
growth,  taking  care  to  cut  wide  of  the  disease  so  as  to  extirpate 
all  the  morbid  parts.  In  doing  so,  I  removed  nearly  the  whole 
of  the  sphincter  muscle  on  the  right  side.  By  carrying  the 
point  of  the  forefinger  of  the  left  hand  beyond  the  upper  margin 
of  the  ulcer,  and  cutting  over  it,  I  made  sure  of  excising  com- 
pletely the  portion  of  the  disease  which  was  deeply  seated  in 
the  rectum.  Several  large  arteries  which  bled  freely  were  at 
once  secured.  This  was  attended  with  a  little  difficulty,  owing 
to  their  depth  in  the  pelvis  consequent  on  the  retraction  of  the 
levator  ani  muscle.  The  wound  was  afterwards  plugged  with 
sponge.  My  friend,  Mr.  Hamilton,  of  the  Richmond  Hospital, 
Dublin,  being  in  London,  accompanied  me  to  the  operation, 
and  gave  me  his  valuable  assistance.  No  unfavorable  symp- 
tom followed.  The  wound  healed  very  slowly,  but  steadily; 
and  by  August  9th,  had  quite  closed.  For  some  weeks  after 
the  operation,  the  patient  lost  the  power  of  retaining  the  faeces; 
but  it  was  regained  by  the  time  the  wound  closed,  except  when 
the  bowels  were  much  relaxed.  The  contraction  at  the  anus 
was  less  than  might  be  expected  considering  the  amount  of  sub- 
stance, and  of  the  sphincter  musele  removed.  The  aperture 
admitted  the  passage  of  the  forefinger  without  difficulty. 

Nearly  three  years  have  elapsed  since  the  operation ;  and 
during  this  period  I  have  repeatedly  examined  this  lad}',  who 
has  naturally  remained  anxious  respecting  a  recurrence  of  her 
disease.  In  February  this  year,  the  parts  were  quite  sound. 
There  was  no  warty  growth,  nor  any  appearance  of  a  return  of 
the  disease.  She  experiences  no  pain  in  the  part,  and  the  pas- 
sage is  free  and  ample. 

The  diseased  part,  when  examined  in  the  microscope,  exhib- 
ited the  characters  of  epithelial  cancer. 


684  Epithelial  Cancer  of the  Anus  and  Rectum.     [October, 

Case  4. — Epithelial  Cancer  of  the  Anus  and  Rectum  removed 
by  Excision. — E.  C ,  a  stout,  married  woman,  aged  forty- 
nine,  the  mother  of  several  children,  of  pale  complexion,  but  in 
tolerable  health,  was  admitted  into  the  London  Hospital,  Janu- 
ary 11th,  1855,  in  consequence  of  a  disease  of  the  rectum.  It 
appeared  that  she  had  suifered  from  what  she  believed  to  be 
piles  for  about  sixteen  years,  and  had  been  subject  to  bleedings. 
About  three  months  before  her  admission,  her  surgeon,  the  late 
Mr.  Aitkin,  of  Kiugsland,  excised  a  tumour  from  the  anus, 
which  she  described  as  being  the  size  of  a  hen's  egg.  The  part 
healed,  but  ofterwards  ulcerated,  giving  rise  to  the  present  dis- 
ease. Since  its  formation,  she  had  suffered  sharp  irregular 
pains  in  the  part,  and  soreness  during  the  passage  of  stools. 
None  of  her  family  had  suffered  from  cancer.  On  examination 
I  found  an  ulcerated  sore  occupying  the  right  side  of  the  anus, 
and  extending  some  distance  into  the  rectum.  It  was  about  the 
size  of  a  crown -piece,  and  not  very  hard.  Its  edges  were  raised, 
ragged,  and  slightly  overlapping;  its  surface  irregular.  A 
small  piece  detached  from  the  sore,  and  examined  in  the  mi- 
croscope, exhibited  the  characters  of  epithelial  cancer.  There 
were  also  some  warty  growths  in  the  vicinity  of  the  large  sore, 
and  on  the  opposite  side  of  the  bowel,  but  they  were  neither 
hard  nor  ulcerated;  and  I  did  not  regard  them  as  cancerous. 

On  the  day  after  her  admission,  the  bowels  having  been  well 
relieved,  I  excised  the  cancerous  growth,  taking  away  a  consid- 
erable portion  of  the  sptjincter  muscle  on  the  right  side.  There 
was  smart  haemorrhage  from  several  vessels,  their  orifices  being 
retracted  and  deeply  seated.  With  some  trouble  they  were 
secured,  and  the  wound  was  afterwards  plugged.  She  bore  the 
operation  very  well  without  chloroform,  which  she  objected  to 
take.  An  astringent  draught  with  opium  was  given  after  the 
operation,  the  bowels  remaining  unrelieved  until  the  fifth  day 
after  the  operation,  when  they  were  acted  on  by  castor  oil.  She 
quite  lost  the  sharp  pains,  and  the  wound  soon  began  to  heal. 
The  soft  warts  about  the  anus  were  touched  with  potassa  fusa, 
under  which  application,  repeated  three  or  four  times,  they  gra- 
dually disappeared.  She  was  discharged  from  the  hospital  on 
the  14th  of  April,  the  wound  being  quite  healed.  The  anus 
was  contracted,  but  it  readily  allowed  the  passage  of  the  fore- 
finger, and  no  difficulty  was  experienced  in  defecation.  She 
was  also  able  to  retain  her  motions  as  before.  There  was  still 
a  strong  disposition  to  warty  growths  about  the  anus;  and  after 
her  discharge  from  the  hospital,  she  returned  occasionally  to 
have  the  potassa  fusa  applied  to  them.  A  lotion  of  the  nitrate 
of  silver  was  also  kept  to  the  part.  After  a  time  she  ceased  to 
attend;  and  in  January,  1856,  she  was  again  admitted  in  con- 
sequence of  a  mass  of  soft  warts  having  sprung  up  close  to  the 


1858.]  dhelial  Cancer  of  Ote  Anus  and  Rectum. 

cicatrix  at  the  anus.     They  were  not  ulcerated,   and  caused  no 
pain ;  but  being  apprehensive  that  they  might  undergo  cancer- 
ous degeneration,  1  thought  it  desirable  to  remove  them.     Chlo- 
roform was  given,  and  they  were  excised  on  the  23th.     The 
tumour,  on  minute  examination,  proved  to  be  simple  epithelial 
growths,  or  hypertrophy  of  the  normal  elements  of  the  part. 
The  wound  healed  favourably,  and  she  was  discharged  in  the 
beginning  of  February,   and  recommended  to  keep  a  rather 
strong  nitrate  of  silver  lotion  to  the  part.     The  tendency  to 
warty  productions  in  the  skin  above  the  anus,  though  partially 
restrained  by  the  lotion,  was,  however,  quite  remarkable,  and 
in  September  of  the  same  }*ear  she  was  admitted  into  the  hospi- 
tal a  third  time,  on  account  of  fresh  growths  having  arisen. 
They  were  slightly  prominent,  and  exactly  similar  in  character 
to  those  removed  in  January,  and  free  from  ulceration  ;  but  she 
complained  of  their  being  painful.     Allowance,  however,  must 
be  made  for  their  repeated  recurrence  having  made  her  anxious 
and  apprehensive  of  a  return  of  the  cancerous  disease.     The 
warts  were  removed  this  time  by  the  repeated  application  of  a 
caustic  composed  of  muriate  of  antimony,  one  part;  chloride  of 
zinc,  one  part,  and  plaster  of  Paris,  three  parts.     This  composi- 
tion formed  a  sort  of  paste  very  convenient  for  use,   but  it 
caused  a  good  deal  of  pain,  which  lasted  some  hours,  and  had 
to  be  alleviated  by  full  doses  of  opium.     She  remained  in  the 
hospital  until  the  middle  of  November.     The  warts  had  not 
entirely  disappeared,  but' she  was  anxious  on  account  of  her 
family,  to  return  home. 

In  February,  1657,  I  again  admitted  her  on  account  of  large 
flattened  warty  growths  around  the  anus,  in  two  considerable 
masses,  and  one  small  one.  There  was  ulceration  on  the  sur- 
face of  one  of  the  former,  with  some  amount  of  induration,  and 
this  was  the  seat  of  a  good  deal  of  pain. 

On  the  12th,  I  examined  these  growths,  and  at  one  spot  near 
the  verge  of  the  anus,  applied  some  strong  nitric  acid.  The 
patient  was  under  the  influence  of  chloroform  during  the  opera- 
tion. 

In  a  few  days  the  nitrate  of  silver  lotion  was  applied  to  the 
wound,  which  healed  favourably,  without  further  contraction  of 
the  orifice,  and  all  pain  ceased.  There  was  afterwards  some 
indication  of  a  rising  of  fresh  warty  growths,  but  it  was  check- 
ed by  the  application  of  strong  nitric  acid.  I  should  now  have 
discharged  my  patient  cured,  but  for  some  weeks  a  glandular 
swelling  had  been  forming  in  the  neck,  on  the  left  side,  just 
beneath  the  lower  jaw,  and  it  ended  in   an  a:  .  hich  was 

opened  on  March  26th. 

About  a  week  afterwards  she  was  seized  with  erysipelas  of 
the  face,  which  unfortunately  had  a  fatal  termination  on  the 


686  Epithelial  Cancer  of  the  Anus  and  Rectum.     [October, 

8tli  of  April.  The  body  was  examined,  but  there  were  no  en- 
larged glands,  indeed  no  internal  organic  disease. 

About  thirty  years  ago,  M.  Lisfranc  performed,  in  Paris,  some 
bold  operations  for  the  removal  of  cancerous  rectums.  Those 
who  witnessed  these  formidable  excisions  gave  sad  accounts  of 
the  results,  such  as  death  from  haemorrhage  or  from  peritonitis, 
and  subsequent  obliteration  of  the  passage,  but  they  reported 
no  permanent  successes.  The  operation  was  generally  con- 
demned by  British  surgeons,  and  I  know  no  instance  of  its 
repetition  in  this  country.  The  objections  justly  made  to  the 
excision  of  cancers  of  the  rectum  do  not  apply,  however,  to 
cases  of  epithelial  cancer  at  the  extremity  of  the  bowel,  and  the 
cases  just  related  show  that  a  considerable  portion,  not  only  of 
the  anus,  but  even  of  the  rectum  itself,  may  be  removed  with  a 
satisfactory  result.  Excision  is,  indeed,  the  treatment  best 
adapted  to  the  entire  removal  of  an  epithelial  cancerous  growth 
of  any  great  size  in  this  part.  Powerful  caustics,  even  the  actu- 
al cautery,  failed  to  obtain  a  cure  in  Case  3.  There  is  this  great 
advantage  in  the  recourse  to  the  knife,  that  the  surgeon  can 
make  pretty  sure  of  thoroughly  removing  all  existing  disease; 
whereas  the  extent  of  the  operation  of  a  caustic  is  somewhat 
uncertain ;  it  may  destroy  too  much  or  too  little.  It  may  be 
objected  that  in  Case  3,  the  first  operation  of  excision  was  not 
successful,  the  disease  having  returned;  but  it  seems  highly 
probable  that  Professor  Siebold  was  not  then  aware  of  the  real 
nature  of  the  lesion,  and  regarding  it  as  an  innocent  growth, 
was  not  so  careful  to  excise  freely  all  the  morbid  parts.  We 
h%ve  some  ground  for  this  conclusion,  not  only  from  the  rarity 
of  the  disease,  but  also  from  the  circumstance  that  the  distin- 
guished surgeon  when  appealed  to,  twenty  months  afterwards, 
for  his  opinion  respecting  a  repetition  of  the  operation  which  I 
then  proposed,  advised  its  performance.  The  length  of  time — 
nearly  three  years  in  Case  3,  and  upwards  of  two  years  in  Case 
4 — which  elapsed  after  the  operations,  without  a  recurrence  of 
the  cancerous  disease,  is  sufficient  to  show  that  in  each  instance 
the  growth  was  entirely  removed. 

Case  4  is  remarkable  also  for  the  strong  tendency  which  ex- 
isted to  the  formation  of  warty  growths — a  tendency  which  was 
limited  to  the  skin  in  the  immediate  vicinity  of  the  contracted 
anus,  and  which  did  not  implicate  the  rectum.  Dr.  Andrew 
Clark,  who. examined  the  mass  removed  by  operation  in  Janu- 
ary, 1856,  a  year  after  the  excision  of  the  epithelial  cancer,  had 
no  hesitation  in  determining  the  simple  character  of  the  growths. 
They  consisted  of  areolar  tissue,  hypertrophied  papillae,  and 
enormously  accumulated  epithelial  cells  of  the  cutis.  From  the 
fact  that  these  elements  had  preserved  their  normal  relations ; 
that  the  cells  had  not  invaded  the  subjacent  tissues;  that  there 


1858.]  Diseases  of  the  Coecum.  687 

were  no  nest,  or  granule  cells,  and  no  heterogeneous  forms  of 
any  kind,  it  was  inferred  that  the  growth  was  innocent.  The 
warts  which  sprang  up  afterwards  were  removed  by  escharotics, 
which  caused  considerable  pain,  and  my  experience  of  the  action 
of  caustic  on  morbid  growths  connected  with  the  skin,  convinc- 
es me  that  they  produce,  as  in  this  instance,  more  suffering  than 
the  knife.  It  was  very  necessar}7  to  get  rid  of  these  warty 
growths  as  they  were  renewed,  not  only  on  account  of  the  irri- 
tation they  produced,  but  also  because  of  their  liability  to  de- 
generate into  cancerous  disease. 

These  cases  show  that  a  large  portion  of  the  sphincter  muscle 
may  be  excised  without  seriously  weakening  the  retentive  pow- 
er of  the  anus,  or  contracting  the  orifice  so  as  to  produce  any 
important  impediment  to  the  passage  of  stools. 

I  am  not  acquainted  with  any  recorded  case  in  which  a 
growth  ascertained  to  be  an  epithelial  cancer  of  the  anus  or 
rectum  has  been  excised.  It  is  very  probable,  however,  that 
operations  have,  in  some  few  instances,  been  performed  for  this 
disease.  Thus,  Mr.  Herbert  Mayo  mentions  having  removed 
from  a  woman,  forty  years  of  age,  a  painful  indurated  ulcer, 
which  extended  round  the  rectum,  half  an  inch  within  the  anus. 
She  died  two  years  afterwards  of  abdominal  inflammation, 
when  the  cicatrix  had  begun  anew  to  ulcerate.*  Dr.  Bushe 
also  states  that  he  also  excised  a  cancerous  transformation  which 
commenced,  apparently  at  the  verge  of  the  anus,  and  was  con- 
fined to  an  inch  and  a  half  of  the  intestine.  The  wound  healed 
rapidly,  and  the  patient's  health  afterwards  improved,  f  In  a 
future  communication  I  shall  adduce  some  more  cases  of  epithe- 
lial cancer  of  the  rectum,  but  which  were  unfit  for  operation. 
They  will  serve  to  illustrate  further  the  character  and  progress 
of  the  disease. — [London  Lancet. 


On  some  of  the  Inflammatory  and  Obstructive  Diseases  of  the  Cozcxim  ; 
with  Remarks  on  the  Abuse  of  Violent  Purgatives.  By  W.  R. 
Rogers,  M.  D. 

The  author  commences  by  alluding  to  the  slight  and  cursory 
notices  of  these  diseases  in  sjrstematic  treatises  on  medicine,  and 
how  frequently  they  are  confounded  with  essentially  different 
diseases  of  the  intestinal  canal.  They  are  of  frequent  occur- 
rence, are  dangerous,  and  often  fatal,  and  are  characterized  by 
a  train  of  symptoms  which  render  their  recognition  certain.  He 
believes  that  the  caecum  may  be  the  seat  of  fatal  diseases  without 
any  other  part  of  the  digestive  tube  being  implicated;  and  that 

♦Observations  on  Injuries  and  Diseases  of  the  Rectum,  1833,  p.  212. 
\  Treatise  on  the  Anus  and  Rectum,  p.  294. 


688  Diseases  of  the  Ccecum.  [October, 

it  often  is  first  in  the  chain  of  causation  of  other  disorders,  with 
which  it  has  been  generally  believed  to  be  only  accidentally  re- 
lated, these  evincing  the  most  marked  disturbance,  while  the 
caecum  apparently  exhibits  but  little  disorder.  Thus  its  diseases 
are  not  unfrequently  mistaken  for  hysteritis,  cystitis,  enteritis, 
peritonitis,  puerperal  fever,  and  pelvic  abscess.  The  author 
quotes  Tiedemann  and  Graelin,  Drs.  Copland,  Carpenter,  and 
others,  to  prove  the  importance  of  the  caecum  in  the  animal 
economy,  partaking  of  the  nature  of  a  stomach  in  the  gramniv- 
orous  and  ruminating  animals,  and  that  it  is  the  viscus  in  which 
the  last  act  of  digestion  is  performed,  secreting  an  acid,  albumin- 
ous, and  solvent  fluid,  and  also  pouring  out  of  its  numerous 
follicles  an  unctuous  and  oily  material,  with  hydro-sulphuretted 
gases,  to  be  eliminated  from  the  economy.  Thus,  like  the  lungs, 
kidney  and  skin,  it  is  a  depurating  organ,  so  that  when  costive- 
ness  exists  there  is  danger  of  these  excretions  being  reabsorbed 
and  contaminating  the  blood.  He  states  that  he  had  within  the 
last  twenty  years  met  with  not  a  few  cases  of  these  diseases, 
some  of  which  he  would  class  as  "acute,"  others  "chronic," 
inflammation  of  the  caecum — tuphlo-enteritis ;  they  had  not  ap- 
peared to  arise  from  the  ordinary  causes  of  inflammation — viz., 
exposure  to  the  vicissitudes  of  the  weather,  or  alternations  of 
temperature,  but  seemed  to  be  produced  by  some  mechanical, 
exciting  and  irritating  cause,  the  lodgement  of  impacted,  hard- 
ened feces,  undigested  food,  fruit-skins,  and  stones  of  fruit,  and 
concretions  of  varied  and  different  kinds,  and  often  arise  while 
the  person  is  in  good  health.  The,  symptoms  may  begin  mildly, 
and  gradually  proceed  to  greatnr  intensity ;  or  they  may,  in 
excitable  subjects,  be  violent  from  the  onset.  There  is  but  little 
febrile  disturbance  compared  with  the  local  pain  and  suffering; 
less  anxiety  of  countenance  than  in  enteritis;  pulse  not  small, 
or  much  quickened  at  the  commencement ;  there  is  great  tension 
and  tenderness  over  the  caecum,  so  that  the  least  pressure  cannot 
be  borne;  there  are  no  rigors;  the  pain  is  constant,  does  not 
intermit,  and  its  area  goes  on  extending  till  the  whole  abdomen 
is  involved;  but  the  right  ileo-inguinal  region  is  ever  the  most 
tender  part.  There  is  obstinate  costiveness;  nausea  and^violent 
vomiting  may  set  in,  especially  when  drastic  purgatives  have 
been  persevered  in;  the  position  is  characteristic — the  patient 
lies  on  the  right  side,  body  bent,  and  thigh  drawn  up ;  the 
countenanc§  has  not  the  anxious  aspect  of  enteritis.  If  neglect- 
ed or  wrongly  treated,  the  abdomen  becomes  tense  and  tympani- 
tic, and  general  enteritis  or, peritonitis  may  supervene.  Should 
the  appendix  be  inflamed  or  ulcerated,  all  the  symptoms  are 
more  acute,  and  likely  to  terminate  fatally  by  peritonitis  or  fecal 
abscess.  In  the  progress  of  these  diseases,  adhesions  are  often 
formed  in  its  interior,  or  to  other  parts ;  the  areolar  tissue  around 


1858.]  Diseases  of  the  Ccecum.  689 

may  inflame,  suppurate,  and  give  rise  to  abscess,  which  may 
tend  upwards  and  downwards,  and  require  to  be  opened;  they 
may  either  open  externally,  or  find  their  way  into  other  part3 
of  the  intestinal  canal,  the  patient  recovering,  or  may  die  worn 
out  by  the  discharge.     Should  the  ulceration  open  into  the  peri- 
toneum, peritonitis  of  a  diffused  and  fatal  character  will  be  set 
up,  as  in  one  of  the  cases  related  by  the  author.     This  termina- 
tion is  fortunately  most  rare,  though  not  uncommon  in  typhoid 
and  dysenteric  fevers.     When  resolution  takes  place,  it  is  pre- 
ceded by  action  of  the  bowels  and  gradual  subsidence  of  the 
pain,  tenderness,  sickness  and  fever,  about  the  fourth,  sixth,  or 
even  the  eighth  day.     This  result  can  only  be  obtained  by  most 
judicious  treatmeut;  but  when  mistaken,   and  treated  too  ac- 
tively by  large  and  repeated  bleedings,  or  violent  and  continued 
purgatives,  there  is  much  danger  of  a  fatal  termination,  or  of  a 
long  and  protracted  convalescence.     If  fecal  abscess  forms,  the 
drain  on  the  system  is  long  and  exhausting.     The  author  coin- 
cides very  much  with  Doctor  Burne,  whose  papers  in  the  "  Medi- 
co-Chirurgical  Transactions"  he  refers  to.     In  these  acute  cases, 
leeching,  fomentations,  soft  poultices,  mild  effervescing  aperients, 
and  large  bland  enemata,  will  often  resolve  the  inflammation; 
if  not,  calomel  and  opium,  or  opium  alone,  should  be  given,  but 
violent  purgatives  are  to  be  avoided.     Dr.  Kogers  places  great 
reliance  on  bland  mucillaginous  enemata,  passed  into  the  bowels 
with  a  long  O'Beirne's  tube,  with  which  he  has  often  relieved 
and  cured  cases  of  simple  obstruction  and  constipation  that  had 
resisted  other  treatment;  he  thinks  the  use  of  this  instrument  is 
much  neglected.     The  author  lays  great  stress  on  cautious  diet- 
ing, which  should  be,  for  a  long  time,  of  the  simplest  and  bland- 
est form — arrowroot,  rice,  milk,  eggs,  and  subsequently  beef  tea 
and  jellies.     In  those  forms  of  acute  inflammation  that  have 
supervened  on  some  subacute  chronic  form,  long  perseverance 
in  this  cautious  regimen  is  even  of  more  importance.     In  chronic 
inflammation,  careful  regimen  and  regulated  action  of  the  bow- 
els are  essential ;  the  symptoms  now  are  all  more  or  less  subdu- 
ed and  indistinct:  irregular  action  with  colicky  pains ;  diarrhoea 
alternating  with  costiveness  and  fetid  dejections  ;  hardness  and 
fulness  over  the  caecum,   with  tenderness  on  pressure.     The  au- 
thor relies  on  blisters,  iodine  and  liniments,  mild  saline  aperients, 
and  strict  attention  to  dietetic  rules :  from  neglect  of  these,  he 
has  had  occasionally  to  regret  the  loss  of  a  patient.     In  simple 
obstruction,  he  relies  on  a  large  enemata  and  mild  saline  aperi- 
ents, with  a  sedative,  as  hyoscyamus,  belladonna,  &c. ;  he  quotes 
cases  from  different  authors  on  the  frequency  of  these  obstruc- 
tions and  the  mistakes  often  committed  by  the  reckless  abuse  of 
violent  purgatives,   which,  even  in  cases  of  hernia,  have  been 
given  till  death  removed  the  sufferer  from  his  tortures.     In  the 


690  Autopsy  of  a  Woman,  &c.  [October, 

more  obstinate  cases,  electricity,  dashing  cold  water,  tobacco 
fomentations  over  the  abdomen,  and  inflation  with  bellows, 
have  each  been  successful.  Should  all  means  fail,  operative 
surgery  comes  to  our  aid. — [British  Med.  Journal,  and  Ranking^ "s 
Abstract. 


Autopsy  of  a  Woman  whose  Uterus  had  been  removed  thirty  years 
previously.     By  Dr.  G.  S.  Goddard. 

In  the  anatomical  collection  at  Rotterdam  a  remarkable  spe- 
cimen is  preserved:  it  is  the  uterus  of  a  woman,  in  whom  inver- 
sion of  that  organ  had  occurred  in  the  year  1821,  probably  in 
consequence  of  forcible  separation  and  removal  of  the  placenta. 
After  repeated  but  fruitless  efforts  to  reduce  the  uterus,  and 
when  the  symptoms  had  assumed  a  more  and  more  threatening 
aspect,  the  part  was  tied  by  Surgeon  Nortier  thirteen  days  after 
delivery;  and  eight  days  subsequently  the  tumor  below  the  lig- 
ature was  removed  with  a  pair  of  scissors ;  in  the  evening  of  the 
following  day  the  ligature  lay  loose  in  the  vagina,  and  exhibited 
the  small  opening  through  which  the  pedicle  had  passed.  A 
month  later  the  woman  had  quite  recovered,  menstruation  did 
not  recur,  and  the  sexual  passion  was  wholly  extinguished.  In 
the  preparation  the  uterus  is  seen,  of  the  size  of  the  head  of  a 
child  at  full  term,  with  an  internal  rough,  nocculent  surface, 
which,  at  the  right  side,  in  the  neighborhood  of  the  fundus  uteri 
(where  the  placenta  was  attached),  has  an  opening  with  uneven 
edges,  of  about  an  inch  and  a  fifth  in  circumference.  Less  ex- 
tensive on  the  under  side,  this  sacciform  body  ends  with  an 
opening  of  about  two  and  a  third  inches.  On  the  left  side  of 
the  fundus  portions  of  the  Fallopian  tube  and  of  the  round  liga- 
ment, both,  as  well  as  the  uterus,  still  enlarged,  are  seen  ;  while 
on  the  right  side  the  round  ligament  appears  to  be  partly  destroy- 
ed, and  a  much  larger  portion  of  the  Fallopian  tube  is  evidently 
also  destroyed  in  its  whole  length.  The  woman  died  in  1850,  in 
consequence  of  an  acute  disease,  in  which  the  genital  organs  were 
not  involved.  On  opening  the  body  the  internal  genitals,  on  a 
superficial  inspection,  presented  a  tolerably  natural  appearance, 
except  that  the  right  broad  ligament  was  rather  tense,  giving 
rise  to  a  degree  of  obliquity ;  there  was  a  great  accumulation  of 
fat  in  the  connective  tissue  around  the  vagina  and  between  the 
laminae  of  the  broad  ligaments,  in  which  no  cicatrices,  but  only 
modified  plaiting,  were  to  be  seen.  The  folds  of  the  mucous 
membrane  of  the  vagina  were  very  strong  and  irregular;  the 
vagina  itself  was  much  shorter  than  usual.  Of  the  uterus  only 
the  cervix  remained  ;  the  cavity  of  the  latter  was  scarcely  large 
enough  to  contain  a  lemon  pippin,  was  very  pointed,  and  was 
about  three  inches  in  length;  the  palmae  plicatae  were  very 


1858.]  Fatty  Degeneration  of  the  Heart.  691 

strongly  marked;  the  walls,  which  were  thicker  than  usual,  ter- 
minated as  cut  off;  on  the  surface  looking  towards  the  cavity, 
was  a  white,  firm,  cellular,  intervening  substance,  a  couple  of 
lines  in  length,  and  particularly  dense  on  the  right  side,  which 
as  the  cicatrix  had  filled  the  space  left  open  in  the  operation, 
as  well  as  the  truncated  substance  of  the  uterus,  had  become 
covered  with  peritoneum.  The  free  extremities  of  the  Fallopian 
tubes  were  normal;  each  terminated  in  a  cul  de  sac,  the  right 
was  shorter  than  the  left,  and  with  the  ovary  was  drawn  strong- 
ly downward  by  a  fold  of  peritoneum.  The  round  ligaments 
were  in  great  part  deficient  on  both  sides ;  the  right  was  the 
shorter,  and  was  surrounded  with  much  connective  tissue.  The 
left  could  be  followed  a  little  further.  The  ovaries  were  more 
atrophied  than  even  the  woman's  time  of  life  should  lead  one  to 
expect;  the  ligament  of  the  right  ovary  was  very  small ;  that 
of  the  left  still  in  a  great  measure  existed.  On  either  side  there 
was  one  of  those  pediculated  hydatid-shaped  bodies,  which  Ko* 
belt  and  Follin  regard  as  remnants  of  the  ductis  Mulleri  in  the 
corpus  Wolrianum;  the  right  possessed  a  short  and  broad,  and 
the  left,  on  the  contrary,  a  long  pedicle. — [Nederlandsch  Lancet, 
and  Dublin  Medical  Press. 


Fatty  Degeneration  of  the  Heart — Death  from  the  Inhalation  of  the 
Tincture  of  Chloroform.  By  William  A.  Hammond,  M.  D., 
Assist.  Surg.  U.  S.  Army.  (Read  before  the  Biological  De- 
partment of  the  Academy  of  Natural  Sciences  of  Philadelphia, 
April  19th,  1858.) 

Private  S ,  of  Company  "C,"  2d  U.  S.  Dragoons,  was  ad- 
mitted into  the  hospital  at  Fort  Riley,  Kansas  Territory,  on  the 
23d  day  of  November,  1856,  with  an  injury  of  the  left  elbow-joint, 
caused  by  his  falling  from  his  horse  whilst  intoxicated  on  the  af- 
ternoon of  the  previous  day.  I  did  not  see  him  till  eighteen  hours 
after  the  accident,  when,  owing  to  the  swelling  and  inflammation 
of  the  part,  I  was  unable  to  determine  the  exact  nature  of  the 
injury.  Erysipelatous  inflammation  immediately  ensued,  and 
lasted  for  ten  days,  requiring  absolute  rest,  and  the  ordinary  reme- 
dies for  its  removal.  At  the  end  of  this  period  there  was  still  a 
good  deal  of  swelling,  and  the  motions  of  the  joint  were  very  much 
impaired.  Dr.  Coolidge  (who  in  the  mean  time  had  joined  the 
post)  and  myself  were  unable  still  to  make  out  the  exact  condi- 
tion of  the  parts;  and  after  repeated  examinations,  we  decided  to 
induce  anaesthesia  with  the  view  of  obviating  the  great  pain 
caused  by  the  necessary  manipulations,  and  thus  to  make  a  more 
satisfactory  examination  than  had  yet  been  accomplished. 

A  sponge  wet  with  two  or  three  drachms  of  the  tincture  of 
chloroform  was  placed  in  a  tubulated  bell-glass  and  held  to  the 
n.  s. — VOL.  XIV.  no.  x.  39 


692  Fatty  Degeneration  of  the  Heart.  [October, 

mouth  of  the  patient,  he  having  previously  removed  his  coat  and 
stock,  unbuttoned  the  neck  band  of  his  shirt,  and  laid  down  on  a 
bed.  He  continued  to  breathe  the  vapor  for  five  minutes  with- 
out any  appreciable  result.  The  pulse,  which  at  the  commence- 
ment of  the  inhalation  was  100  per  minute,  remained  about  the 
the  same.  The  sponge  was  again  moistened  with  the  tincture  of 
chloroiorm,  then  placed  in  a  towel,  and  again  held  close  to  the 
mouth.  Full,  deep  breathing  was  directed,  and  in  two  or  three 
minutes  some  excitement  was  produced.  During  this  period  the 
face  became  red  and  flushed,  but  not  to  an  unusual  extent;  the 
respiration  was  not  affected  in  any  remarkable  degree,  nor  was 
there  any  notable  variation  in  the  pulse.  In  an  instant,  however, 
all  was  changed;  the  eyes  were  turned  up,  the  face  became  tur- 
gid, the  muscles  became  relaxed,  and  vomiting  ensued.  My  hand 
was  upon  his  pulse,  which,  from  beating  at  the  rate  of  100  per 
minute,  stopped  as  if  he  had  been  struck  with  lightning.  Dr. 
Coolidge  immediately  discontinued  the  inhalation,  and  judging 
from  the  character  of  the  vumited  matters,  thought  at  first  that' 
some  substance  was  closing  the  larynx.  Introducing  his  finger 
into  the  posterior  fauces,  he  removed  a  large  piece  of  cabbage. 
Subsequent  to  the  vomiting  the  patient  breathed  two  or  three 
times,  but  it  is  probable  the  heart  ceased  to  act  before  respiration 
was  entirely  suspended. 

Every  means  proper  in  such  cases  was  used  to  re-excite  respi- 
ration, Marshall  Hall's  method  among  others,  but  without  the 
least  success.  Stimulants  were  thrown  into  the  rectum,  the  body 
rubbed  sedulously,  &c,  but  no  evidence  of  life  was  perceived, 
and  after  persevering  for  nearly  two  hours,  we  abandoned  all 
hopes  of  resuscitation. 

Autopsy  twenty  two  hours  after  death. — Body  well  developed,  no- 
superabundance  of  fat.  Great  muscular  rigidity,  and  considera- 
ble hypostatic  congestion  of  the  back  of  the  head,  neck  and  body. 
The  brain  and  appendages  were  healthy.  The  stomach  was 
large  but  not  distended  with  gas,  and  contained  about  three  ounces 
of  pultaceous  matter,  and  several  large  pieces  of  unmasticated 
and  undigested  beef.  The  spleen  was  about  three  times  its  natu- 
ral size.  The  liver  presented  no  unusual  appearance  ;  it  was  not 
minutely  examined.  The  thoracic  cavity  was  free  from  effusion 
and  pleuritic  adhesions.  The  lungs,  especially  their  inferior  and 
posterior  portions,  were  intensely  congested,  and  of  a  deep  purple 
hue.  On  opening  the  pericardium,  the  heart  appeared  of  unusual 
size.  The  right  auricle  and  ventricle  were  distended  with  blood 
and  covered  with  fat.  On  removing  the  heart  in  the  usual  man 
ner  by  dividing  the  great  vessels  at  their  origin,  about  two  quarts 
of  dark,  thin,  uncoagulated  blood  escaped.  No  coagula  were 
found  in  the  heart  or  large  vessels  ;  the  left  ventricle  was  empty, 
The  heart  weighed  within  a  fraction  of  fourteen  ounces,  ami 


1858.]  Fatty  Degeneration  of  the  Heart.  693 

measured  in  its  longitudinal  diameter  full  six  inches,  and  in  cir- 
cumference, at  ils  base,  eleven  and  a  half  inches.  The  wall  of 
the  left  ventricle  at  its  base  was  f  of  an  inch  in  thickness,  at  the 
middle  f  of  an  inch,  and  at  the  apex  f  of  an  inch.  The  extreme 
thickness  was  one  inch.  The  thickness  of  the  right  ventricle 
ranged  from  \  to  §  of  an  inch,  exclusive  of  its  fatty  covering, 
which,  near  the  auricle,  was  quite  thick.  The  walls  of  the  right 
auricle  were  extremely  thin,  and  were  loaded  with  fat.  The  sub- 
stance of  the  heart  was  of  a  very  pale  red  or  dirty  pink  color, 
comparatively  soft  and  flabby,  less  resisting  in  the  right  than  in 
the  left  ventricle,  but  easily  penetrated  in  both  with  the  finger  or 
handle  of  the  scalpel. 

In  order  to  form  a  more  definite  conclusion  as  to  the  exact  pa- 
thological condition  of  the  heart,  I  submitted  several  sections  to 
microscopical  examination ;  many  portions  of  the  right  ventricle 
were  thus  found  to  consist  almost  entirely  of  fat-cells  and  oil-glo- 
bules ;  in  others,  muscular  fibres  were  visible.  In  the  left  ventricle 
both  fibres  and  striae  were  to  be  seen,  with  many  fat  cells  and  oil- 
globules.  The  more  precise  results  of  the  examination  are  as 
follows : — 

1st.  A  piece  of  the  right  ventricle  taken  from  the  central  por- 
tion of  its  wall,  t.  e.,  midway  between  its  external  and  internal 
surfaces,  and  in  which  no  fat  was  visible  to  the  naked  eye,  exhib- 
ited under  the  microscope  numerous  fat-cells  and  oii-globules. 
One  hundred  grains  of  this  character  of  tissue,  when  subjected  to 
the  action  of  ether,  yielded  32.75  grains  of  ether  extract. 

2nd.  A  section  of  the  right  ventricle  extending  through  its  en- 
tire thickness,  and  in  which  fatty  deposit  was  visible  to  the  naked 
eye,  yielded  69.92  percent,  of  ether  extract. 

3rd.  A  portion  of  the  left  ventricle,  in  which  no  fat  was  visible 
to  the  naked  eye.  was  perceived  by  the  microscope  to  contain  a 
few  fat  cells,  and  yielded  9.89  per  cent,  of  ether  extract. 

It  is  evident,  therefore,  from  tins  record,  that  the  heart,  besides 
being  loaded  with  fat.  was  in  a  state  of  fatty  degeneration.  It  is 
worthy  of  note  that  there  was  no  arcus  senilis  observed  in  this 
case, 

A  few  words  in  relation  to  the  anaesthetic  employed,  will  not, 
I  think,  prove  uninteresting. 

The  anaesthetic  issued  to  the  medical  officers  ofthearmyis 
(or  was  at  that  time),  the  tincture  of  chloroform,  or  chloric  ether 
of  Dr.  J.  C.  Warren  and  others.  When  properly  prepared,  it 
consists  of  one  part  of  chloroform,  and  two  parts  of  absolute  alco- 
hol, and  such  was  the  preparation  intended  to  be  furnished.  The 
contents  of  the  same  bottle  used  in  this  case  had  been  a  short  time 
previously  used  in  six  cases;  one  of  amputation  of  both  legs  ;  one 
of  Chopart's  operation  on  right  foot,  and  Hey's  on  left  foot;  one 
case  of  delirium  tremens  following  fracture  of  arm,  and  complica- 


694  Fatty  Degeneration  of  the  Heart  [October,. 

ted  with  severe  convulsions;  one  amputation  of  great  toe;  and 
one  excision  of  a  portion  of  the  fibula.  In  all  these  cases  the 
anaesthetic  had  acted  unpleasantly,  and  in  that  of  amputation  of 
the  great  toe  great  prostration  was  produced,  and  the  pulse  fell 
from  60  to  40  per  minute.  By  the  use  of  stimulants,  &c,  further 
ill  effects  were  obviated. 

It  did  not,  however,  occur  to  Dr.  Coolidgeor  myself, that  these 
consequences  were  due  to  the  peculiar  character  of  the  anaesthetic, 
but  after  the  death  of  S I  submitted  it  to  a  chemical  exam- 
ination with  the  following  result: 

The  specific  gravity  was  980.    The  reaction  was  strongly  acid. 

A  solution  of  nitrate  of  silver  caused  a  flaky  precipitate,  solu- 
ble in  ammonia,  and  precipitable  from  this  solution  by  nitric  acid, 
showing,  therefore,  the  presence  of  chlorohydric  acid. 

A  portion  was  put  into  a  glass  tube  graduated  to  tenths  of  a 
cubic  centimetre,  and  an  excess  of  water  added  so  as  to  destroy 
the  solvent  property  of  the  alcohol.  The  chloroform  thus  precipi- 
tated amounted  to  but  one -sixth  of  the  whole. 

The  alcohol  entering  into  its  composition,  instead  of  being  ab- 
solute, was  the  common  diluted  alcohol  of  the  Pharmacopoeia. 

The  tincture  of  chloroform  was  thus  shown  to  be  very  impure, 
and  not  the  article  contemplated  by  the  medical  department.  It 
had  been  carefully  preserved  whilst  under  my  charge  and  that  of 
Dr.  Coolidge,  in  closely  stopped  bottles  carefully  kept  from  the 
light,  so  that  it  is  probable  the  chlorohydric  acid  had  been  present 
from  the  time  of  its  manufacture. 

How  far  this  impure  character  of  the  anaesthetic  may  have 
tended  to  cause  death  in  the  case  related,  is  difficult  to  say.     I 
believe,  however,  that  it  was  not  without  influence.     The  condi- 
of  the  heart  was  doubtless,  however,  the  chief  cause  of  death. 
Persons  suffering  under  fatty  degeneration  of  this  organ  are  pecu-  ft 
liarly  liable  to  sudden  death,  and  it  is  also  true  that  there  are  no  f\ 
certain  signs  from  which  its  presence  can  be  determined  during  J 
life.     Of  fifty-eight  cases  cited  by  Dr.  Eichard  Quain,*  death  was  f 
sudden  in  fifty-four. 

Two  cases  have  recently  been  published  of  fatty  degeneration  ji 
of  the  heart,  in  which  death  occurred  from  the  inhalation  of  chlo-  b 
roform.  In  one  of  them,  that  of  Mr.  Erichsen,f  it  took  place  at  fco 
the  time  of  inhalation.  The  other  occurred  in  the  practice  oi  ^ 
Dr.  Macgibbon,J  at  the  New  Orleans  Charity  Hospital.  In  this  '&: 
latter  case  death  ensued  on  the  day  following  the  administration 
of  the  chloroform. 

Private  S was  23  years  of  age,  5  feet  6  inches  high,  o 

ruddy  complexion,  gray  eyes,  and  brown  hair.     He  was  exceed- 


k 


*  Medico-Chirurgical  Transactions,  vol.  xxxiii. 

\  British  and  Foreign  Medico-Chirurgical  Review,  January,  1855,  p.  222. 

\  American  Journal  of  the  Medical  Sciences,  Janury,  1856,  p.  261. 


L858.]  Hernia  of  the  Ovary,  695 

ngly  intemperate  in  his  habits.  He  had  never,  as  far  as  I  am 
iware,  complained  of  any  afFection  of  the  heart,  and  never,  to  ray 
knowledge,  had  any  symptoms  which  would  indicate  disease  of 
this  organ. 

In  the  preparation  of  this  paper  I  have  freely  availed  myself  of 
;he  notes  of  Dr.  Coolidge,  especially  those  relating  to  the  post- 
mortem appearances  and  measurements  of  the  heart. — [American 
Journal  of  the  Med.  Sciences. 


History  of  two  cases  of  Hernia  of  the  Ovary,  in  one  of  which  there 
was  periodical  Mnlargement  of  this  Organ.  By  Dr.  Oldham, 
Obstetric  Physician  to  Guy's  Hospital. 

These  cases  are  examples  of  a  rare  conformation  of  the  female 
sexual  organs,  in  which  the  ovaries  had  descended  through  the 
nguinal  canal,  and  become  permanently  lodged  in  the  upper  part 
:>f  the  external  labia.  In  both  of  them  it  was  impossible  to  detect 
sither  uterus  or  vagina;  and  in  the  first  there  was  a  periodical 
increase  of  one  or  other  of  the  ovaria,  followed  by  its  gradual  re- 
duction— a  direct  evidence  of  an  ovarian  menstrual  act. 

Case  1. — The  subject  of  tbis  case  applied  to  me  in  September, 
L851,  for  advice  on  account  of  never  having  menstruated.  She 
was  nineteen  years  of  age,  of  a  tall  figure,  symmetrical  frame, 
well-expanded  pelvis,  and  womanly  aspect,  bearing  all  the  marks 
of  a  full  completion  of  the  physical  changes  of  puberty  ;  and  her 
general  health,  though  not  robust,  was  fairly  good.  She  was  one 
of  a  family  of  five  children,  and  her  sisters  had  menstruated  be- 
tween 15  and  16  years  of  age.  The  principal  point  which  was 
elicited  from  her  history  in  connection  with  her  complaint  was, 
that,  eighteen  months  before,  a  swelling  had  somewhat  suddenly 
appeared  on  the  right  side  of  the  external  organs,  which  had 
caused  her  some  pain  for  a  few  days  and  had  then  disappeared. 
In  four  or  five  months  a  similar  swelling  again  appeared,  but  was 
attended  with  so  much  suffering  that  a  medical  man  was  consult- 
ed, who  took  it  for  an  abscess  and  ordered  it  to  be  poulticed. 
Again  it  passed  away,  again  to  recur  at  the  end  of  two  months; 
and  so  it  had  gone  on  at  irregular  intervals  until  the  time  of  her 
seeing  me,  when  the  pain  of  a  renewed  attack  of  unusual  severity 
had  occasioned  her  some  alarm.  On  examination,  a  swelling  the 
size  of  a  goose-egg  was  found  to  extend  between  the  external  ab- 
dominal ring  and  the  centre  of  the  labium  on  the  right  side,  which 
was  very  tense  and  firm  to  the  touch  ;  and  the  cellular  tissue,  skin, 
and  mucous  membraue  of  the  labium  were  cedematous  and  in- 
flamed. It  was  painful,  but  by  no  means  so  painful  as  a  labial 
abscess,  which  in  its  general  aspect  it  resembled  ;  and  there  was 
but  little  febrile  disturbance.     A  more  critical  examination  de- 


Hernia  of  the  Ovary.  [October, 

tected  the  presence  of  a  solid  body  of  an  oval  shape  within  the 
tissue  of  the  labium,  which  proved  to  be  the  ovarium,  whose  en- 
largement had  so  compressed  the  surrounding  tissues  as  to  swell 
and  inflame  them.  On  the  opposite  side  there  was  another  oval 
body,  the  size  of  a  walnut,  which  passed  just  beyond  the  outer 
ring,  but  readily  slipped  into  the  canal.  This  was  the  left  ovary 
in  a  quiescent  state.  The  external  sexual  parts  were  normally 
formed  ;  but  the  ostium  vaginas  was  closed,  a  slight  indentation  in 
the  median  line  alone  marking  its  position.  Frequent  careful 
physical  examinations  failed  to  detect  any  trace  of  a  vagina  or 
uterus,  and  the  conclusion  arrived  at  was  that  these  central  pelvic 
organs  had  not  been  developed.  The  mammary  glands  were 
fully  formed. 

1  have  had  repeated  opportunities  during  the  six  years  which 
have  intervened  since  first  ihe  case  came  before  me,  of  examining 
the  organs  both  during  the  periods  of  ovarian  excitement  and 
during  the  intervals.  For  nearly  two  years,  however,  I  complete- 
ly lost  sight  of  her,  when  I  learned,  to  my  amazement,  that  in 
spite  of  my  strong  admonition  both  to  her  mother  and  herself,  that 
she  should  lead  a  single  life,  she  had  married.  For  some  time  past 
I  have  seen  her  more  frequently,  and  have  watched  the  recur- 
rence of  the  ovarian  swellings. 

For  the  first  three  years  the  right  ovarium  was  exclusively  en- 
larged, and  the  intervals  were  not  so  regularly  marked,  varying 
between  three  and  six  weeks  :  excepting  for  the  first  year,  when 
thev  were  much  longer,  occasionally  extending  to  three  months. 
For  the  last  two  years  the  left  ovarium  has  been  far  more  frequent- 
ly affected,  the  right  remaining  quiescent ;  occasionally  both  are 
painful  and  tumid,  but  even  then  one  more  than  the  other.  The 
intervals  are  now  pretty  regularly  three  weeks.  The  acute  in- 
flammatory symptoms  which  accompanied  the  onset  of  these 
swellings  have  long  since  ceased  to  recur,  which  is  obviously  due 
to  the  loose  state  of  the  tissues  from  repeated  stretching,  so  that 
the  swollen  organ  is  no  longer  compressed. 

The  accession  of  a  menstrual  time  is  sometimes  suddenly  felt. 
She  will  go  to  bed  well,  and  in  the  morning  the  ovary  will  be 
swollen :  more  commonly,  however,  it  is  very  gradual,  augment- 
ino1  in  volume  for  four  days,  then  remaining  stationary  for  three 
days,  and  then  gradually  declining;  the  whole  process,  before  the 
ovary  is  reduced,  generally  lasting  tenor  twelve  days.  On  sepa- 
rating the  ovary,  when  at  its  -height  of  swelling,  from  the  tissues 
surrounding  it,  it  appears  scarcely,  if  at  all,  less  than  double  its  usu- 
al volume;  its  outline  is  clearly  defined,  and  it  is  plain  that  the 
whole,  and  not  merely  a  part  of  the  organ,  is  involved.  There  is 
no  suffering  worthy  of  notice  during  the  time;  the  swelling  is 
tender  if  pressed;  and  tender,  too,  in  the  act  of  sitting  down  or 
rising  up ;  but  she  walks  about  as  usual  without  distress,  and 


1858.]  Poison  of  the  Upas  Antiar.  697 

there  is  but  little  lumbar  or  hypogastric  pain.  Neither  are  there 
any  manifest  sympathies  excited,  either  of  the  mammary  glands 
or  other  organs.  Nor  is  there  any  vicarious  flux,  either  of  blood 
or  any  secretion,  with  the  exception  of  an  excess  of  saliva,  but 
this  is  not  in  any  large  flow.  The  ovary  alone  appeared  to  be 
engaged  in  this  periodical  act,  which  it  is  not  too  much  to  sup- 
pose, in  accordance  with  modern  physiological  views,  would  have 
been  attended  with  a  flux  of  blood,  had  not  the  organs  which  nor- 
mally supply  it  been  absent. 

But  while  this  may  be  said  to  represent  the  usual  course  of  a 
period,  yet  the  volume  of  the  ovary,  and  the  length  of  time  it  re- 
mains swollen,  is  subject  to  occasional  variation ;  sometimes 
being  much  less  tumid,  and  dying  away  in  a  shorter  time. 

The  repeated  attempts  at  sexual  union  have  only  had  the  effect 
of  somewhat  loosening  the  tissues  around  the  vulva,  but  the  vagi- 
na  remains  imperforate  as  before,  and  is  beyond  the  reach  of 
surgical  remedy.  It  may  be  added,  that  the  subject  of  this  histo- 
ry recognizes  an  increase  of  sexual  feeling  at  and  soon  after  the 
periods  of  enlargement  of  the  ovary. 

Case  2. — This  case  was  that  of,a  young  woman  who  had  at- 
tained the  age  of  twenty  without  having  menstruated.  She  was 
a  tall,  strumous-looking  person,  in  weak  health.  There  had  not 
been  any  well-marked  efforts  at  menstruation,  but  she  had  suffered 
slightly  from  lumbar  pain.  The  mammae  was  well  developed. 
The  pelvis  was  fairly  formed.  On  examination  I  found  the  two 
ovaviajust  appearing  beyond  the  external  abdominal  rings,  and 
readily  returning  by  pressure  into  their  respective  inguinal  ca- 
nals. They  were  of  equal  size  and  similar  shape,  being  ovoid 
bodies  about  the  size  of  small  chestnuts.  They  were  not  tender 
when  touched,  although  organically  sensitive,  and  she  had  never 
experienced  pain  in  them.  The  external  sexual  organs  were 
somewhat  less  perfectly  developed  than  usual  ;  the  vaginal  orifice 
was  closed,  and  no  trace  of  a  canal  or  uterus  could  be  detected 
by  exploration  with  a  catheter  in  the  bladder  and  the  finger  in  the 
rectum.  These  organs,  as  in  the  former  case,  were  absent.  Du- 
ring the  time  I  saw  the  patient,  which  was  only  for  two  months, 
the  ovaria  did  not  enlarge,  although  her  general  health  improv- 
ed.— [Proceedings  of  Royal  Society,  and  Hanking1  s  Abstract. 


Observations  on  the  Poison  of  the   Upas  Antiar.     By  Professor 

KOLLIKER. 

The  results  of  Prof.  Kolliker's  investigations  into  the  effects  of 
the  antiar  upon  frogs,  are  the  following: — 

"  1.  The  antiar  is  a  paralyzing  poison. 

"2.  It  acts  in  the  first  instance  and  with  great  rapidity  (in  5  to 
10  minutes)  upon  the  heart,  and  stops  its  action. 


698  Puerperal  Fever.  [October, 

"  3.  The  consequence  of  this  paralysis  of  the  heart  are  the  ces- 
sation of  the  voluntary  and  reflex  movements  in  the  first  and 
second  hour  after  the  introduction  of  the  poison. 

"  4.  The  antiar  paralyzes,  in  the  second  place,  the  voluntary 
muscles. 

"5.  In  the  third  place,  it  causes  the  loss  of  excitability  of  the 
groat  nervous  trunks. 

"6.  The  heart  and  muscles  of  frogs  poisoned  with  woorara  may 
be  paralyzed  by  antiar. 

11 7.  From  all  thisit  may  be  deduced  that  the  antiar  principally 
acts  upon  the  muscular  fibre  and  causes  paralysis  of  it. 

"  So  much  for  this  time.  My  experiments  with  the  antiar  upon 
warm-blooded  animals  have  only  begun,  and  I  am  not  yet  able  to 
draw  any  conclusion  from  them.  As  soon  as  this  will  be  possi- 
ble, I  shall  take  the  liberty  to  submit  them  to  the  Roval  Society, 
together  with  the  results  of  my  experiments  with  the  upas  teinte, 
which  poison  I  had  also  the  good  fortune  to  obtain  through  the 
kindness  of  Sir  Benjamin  Brodie  and  Dr.  Horsefield.  With  re- 
gard to  the  antiar,  I  may  further  add  that  experiments  made  inde- 
pendently, and  at  the  same  time,  by  my  friend  Dr.  Sharpey  with 
this  poison,  have  conducted  to  the  same  results  as  my  own." 

[Proceedings  of  the  Royal  Society,  and  Ranking 's  Abstract. 

Puerperal  Fever. 

The  Academy  of  Medicine  in  Paris  has  for  some  time  been 
occupied  in  a  discussion  on  Puerperal  fever,  in  which  the  leading 
obstetricians  of  the  French  metropolis  have  given  utterance  at 
length  to  their  opinions.  From  among  the  numerous  speeches, 
we  translate  that  of  M.  Cazeaux,  as  it  gives  a  very  good  digest  of 
the  different  opinions  entertained. 

I  think  that  it  would  be  superfluous,  after  the  speeches  you  have 
heard,  to  revert  to  the  symptomatology  and  anatomical  charac- 
ters of  the  disease  or  diseases  collectively  described  under  the 
names  of  puerperal  fever  or  puerperal  peritonitis.  These  points 
in  the  discussion  appear  to  me  to  have  been  sufficiently  studied 
by  M.  Depaul  and  M.  Cruveilhier.  You  are  aware  of  the  im- 
portance given  by  the  last  named  speaker  to  lymphangitis  among 
the  alterations  peculiar  to  puerperal  fever;  so  much  so,  that  he 
considers  it  characteristic  of  that  disease.  But  that  opinion  has 
been  vehemently  disputed  by  M.  Behier,  who  maintains,  on  the 
contrary,  that,  in  autopsies  of  women  who  have  died  of  puer- 
peral fever,  he  has  found  inflammation  of  the  veins  more  frequent- 
ly than  of  the  lymphatics.  This  assertion  of  M.  Behier's  has 
surprised  me  greatly.  I  have,  for  my  own  part,  opened  a  good 
number  of  bodies  of  women  who  have  died  of  puerperal  diseases, 
and  I  declare  that,  like  M.  Cruveilhier,  I  have  found  pus  much 
more  frequently  in  the  uterine  lymphatics  than  in  the  veins.    Does 


1858.]  Puerperal  Fever.  699 

not  M.  Behier's  error  depend  on  an  anatomical  confusion  ?  For 
it  is  remarkable  that,  although  he  describes  the  pus  as  being  in 
other  vessels  than  M.  Cruveilhier  does,  he  still  finds  it  in  the  same 
parts  of  the  uterus  or  its  appendages ;  that  is  to  say,  in  those  por- 
tions which  are  particularly  rich  in  lymphatic  vessels.  But  there 
is  one  question  which  has  in  an  especial  degree  excited  the  speak- 
ers ;  it  is  that  of  knowing  what  is  the  nature  of  puerperal  fever, 
and  what  nosological  rank  it  is  proper  to  assign  to  the  lesions 
which  it  presents. 

In  this  respect  the  speakers  have  been  divided  into  two  camps. 
In  the  one,  they  admit  the  existence  of  an  essential  fever — of  a 
pyrexia;  in  the  other,  they  see  only  local  phlegmasia?.  Up  to  the 
present  moment,  M.  Beau  is  the  only  one  who  has  formally  de- 
clared himself  in  favor  of  this  latter  doctrine.  With  regard  to  the 
doctrine  of  essentiality,  it  has  found  supporters  in  M.  Depaul,  who 
has  the  most  boldly  and  the  most  clearly  laid  down  the  question  ; 
In  M.  Danyau,  who  has  also  spoken  out  resolutely  enough ;  in 
M.  Trousseau,  who,  after  having  formally  rejected  the  puerperal 
fever,  has  so  well  generalized  it  subsequently,  that  he  has  admit- 
ted it  not  only  for  women  in  child-bed,  but  even  for  women  not 
in  the  puerperal  state  at  all,  for  the  foetus,  for  the  new-born  child, 
and  for  all  subjects  attacked  by  any  kind  of  traumatism.  M.  Du- 
bois has  equally  announced  himself  an  essentialist;  but  he  has 
produced  no  new  arguments  in  favour  of  that  opinion,  and  he  has 
enveloped  his  ideas  in  such  thick  clouds,  that  it  is  difficult  through 
such  a  veil  to  distinguish  a  pure  essentialist.  The  question, 
therefore,  is  solely  and  entirely  between  M.  Depaul  and  M.  Beau. 

M.  Beau  appears  to  me  to  have  replied  victoriously  to  M.  De- 
paul, invoking  the  epidemic  and  contagious  characters  of  the 
disease  as  proofs  of  its  essentiality.  I  will  not  revert  to  these 
arguments;  but  I  will  add  that  one  of  the  characters  of  pyrexia, 
viz.,  the  manifestations  of  the  fever  some  days  before  the  appear- 
ance of  the  local  symptoms,  as  is  the  case  with  typhus  and  small- 
pox, is  not  what  is  observed  in  puerperal  fever,  in  which  the  pain, 
which  is  the  sign  of  local  phlegmasia?,  shows  itself  almost  at  the 
the  same  time  as  the  shivering,  which  is  the  sign  of  the  general 
pathological  state.  I  find  also  a  very  good  argument  against 
i  essentialism  in  the  speech  of  M.  Dubois,  who  nevertheless  makes 
profession  of  being  an  essentialist.  Have  we  not  heard  that  hon- 
ourable professor  tell  us  that  the  multiplicity,  the  variety  of  the 
lesions  in  puerperal  fever,  would  be  consistent  with  placing  it 
among  pyrexiae,  the  principal  character  of  which  is  to  present 
anatomical  alterations,  constant  and  always  identical. 

With  regard  to  the  negative  autopsies  quoted  by  M.  Depaul 
as  an  argument  in  favour  of  essentiality,  while  I  admit,  as  I  do 
willingly,  that  they  have  been  well  made,  1  can  neither  consider 
them  as  convincing  proofs,  nor  as  motives  for  rejecting  the  doc- 


700  Puerperal  Fever.  [October, 

trine  of  local  phlegmasias.  In  fact,  do  we  not  see  peritoneal 
inflammations,  traumatic,  or  by  perforation,  kill  so  promptly,  that 
material  alterations  have  not  had  time  to  be  formed  ?  Do  we  not 
see,  also,  burns  in  the  first  or  second  degree  cause  a  rapid  death — 
the  effect  assuredly,  not  of  the  lesion  of  the  tissue,  but  solely  of 
the  extent  and  violence  of  the  inflammation  ?  On  the  other  hand, 
is  it  really  necessary  to  find  severe  organic  lesions  to  explain 
functional  disorders,  and  even  death,  in  puerperal  fever?  I  do 
not  think  it  is ;  for,  in  my  opinion,  the  blood  in  this  disease  has 
undergone  so  profound  an  alteration  as  to  acoount  for  all  the 
accidents,  and  for  the  usually  fatal  termination  of  the  disease. 

The  mistake  committed  by  those  nosologists  who  have  wished 
to  assign  a  place  to  puerperal  fever,  consists,  in  my  opinion,  in 
their  having  studied  it  under  its  epidemic  form.  In  order  to  form 
a  true  and  clear  idea  of  the  disease,  we  must  look  at  it  under  its 
sporadic  form  ;  that  is,  in  its  condition  of  simplicity,  disengaged 
from  the  special  elements  of  gravity  necessarily  given  to  it  by  the 
epidemic  character.  Let  us  then  imagine  a  physician  who  has 
never  seen  a  case  of  puerperal  fever,  and  who  has  never  read  a 
description  of  this  malady.  He  is  brought  into  the  presence  of  a 
woman  recently  confined,  in  whom  a  laborious  parturition,  a  pro- 
longed labour,  has  produced  numerous  bruises  and  lacerations, 
speedily  followed  by  violent  shivering,  by  very  severe  abdominal 
pains,  and  by  a  series  of  other  severe  general  and  local  symptoms 
which  will  rapidly  terminate  in  death.  At  the  autopsy,  he  finds 
pus  in  the  peritoneum,  in  the  veins  and  lymphatics  of  the  pelvis. 
What  idea  can  this  physician  form  of  the  nature  of  the  disease, 
but  that  it  is  phlegmasia? 

Now,  must  we  admit  that  tbere  exists  a  natural  difference  be- 
tween the  epidemic  and  sporadic  forms  of  puerperal  fever?  By 
no  means — any  more  than  that  there  exists  a  difference  between 
epidemic  and  sporadic  pneumonia.  Nevertheless,  M.  Trousseau 
has  brought  forward  one  difference  which  he  describes  as  very 
essential ;  it  is  the  existence  of  a  specific  cause,  of  a  kind  of  virus 
which  would  be  the  essence  of  the  epidemic  puerperal  fever. 
Well,  a  specific  cause  always  produces  a  corresponding  specific 
disease,  announcing  itself  by  signs  or  lesions  always  identical; 
thus,  the  virus  of  rabies  always  produces  rabies ;  the  virus  of 
syphilis,  syphilis;  the  smallpox  virus,  smallpox;  while  here  we 
have  to  do  with  a  disease  which  presents  itself  with  lesions  the 
most  varied,  sometimes  a  metritis,  sometimes  a  peritonitis,  some- 
times a  phlebitis,  at  other  times  a  lymphangitis,  a  pneumonia,  a 
pleurisy,  a  suppurating  arthritis,  etc.  We  cannot,  therefore,  al- 
lege a  sole  cause  for  effects  so  varied. 

The  difference  which  I  admit,  for  my  own  part,  is  not  where 
M.  Trousseau  has  placed  it — in  the  nature  of  the  disease;  I  find 
it  in  the  very  fact  of  the  epidemic,  which  renders  the  disease 


1858.]  Puerperal  Fever.  701 

more  severe,  without  changing  anything  of  its  essence.  It  is  here 
with  puerperal  phlegmasia  as  with  cholera,  angina,  dysenler}-,  and 
a  hundred  other  affections  that  I  might  name. 

Do  not  think,  however,  that  beyond  the  local  inflammation  I 
see  nothing  whatever,  and  that  I  believe  that  in  that  resides  the 
whole  gravity  of  the  affection.  If,  indeed,  1  do  not  admit  a  puer- 
peral fever,  1  do  admit  a  puerperal  state,  which,  in  preparation 
throughout  the  pregnancy,  arrives  at  its  maximum  of  intensity  at 
the  time  of  the  accouchement,  and  shortly  afterwards.  This  pu- 
erperal state  consists  in  a  notable  alteration  of  the  fluids,  which 
is  present,  in  a  greater  or  less  degree,  in  all  pregnant  women.  I 
have  heard  M.  Trousseau  speak  to  us  with  some  disdain  of  recent 
haematological  researches.  For  my  part,  I  think  they  are  destin- 
ed to  open  to  medicine  a  way  of  progress,  and  to  enlighten  us  on 
many  questions  which  are  still  obscure.  It  is  not  my  place  here 
to  recall  all  the  results  already  obtained  ;  but  I  cannot  be  silent 
on  the  very  special  services  rendered  by  haematology  to  obstetric 
physiology  and  pathology.  Thanks  to  that  science,  gentlemen.,  it 
is  now  admitted  that  pregnancy,  so  far  from  constituting  a  condi- 
tion of  plethora,  actually,  on  the  contrary,  engenders  an  anaemic 
state.  Thanks  to  haematologv,  we  now  understand  the  etiological 
analogies  existing  between  eclampsia  and  the  epileptiform  con- 
vulsions which  terminate  Bright's  disease.  It  has  been  establish- 
ed very  clearly  that  in  both  cases  the  nervous  phenomena  depend 
on  an  intoxication  of  the  blood  by  urea — on  an  uraemia. 

It  is  also  in  the  blood — in  the  blood  so  profoundly  modified  in 
pregnancy — that  we  must  seek  the  first  cause  and  the  point  de 
depart  of  puerperal  diseases.  Thus,  diminution  of  globules,  of 
albumen,  of  iron,  a  notable  augmentation  of  water  and  of  fibrine — 
such  are  the  modifications — I  ought  to  say,  the  alterations — of  the 
blood  in  a  woman  about  to  lie  in.  If  in  such  a  condition  there 
supervene  an  extensive  inflammation  of  an  important  organ,  you 
may  conceive  what  development  it  must  assume  in  invading  an 
organism  so  seriously  altered.  Who  can  foresee  to  what  extent 
these  alterations  of  the  blood  may  go,  and  what  may  be  the  con- 
sequence of  them  ?  For  myself,  I  do  not  hesitate  to  say  that,  in 
certain  cases,  they  may  be  carried  to  a  point  at  which  they  will 
produce  a  transformation  of  blood-globules  into  pus  globules;  and 
that  without  a  wound,  without  phlebitis,  without  any  lesion  of  the 
solids. 

And  on  this  subject,  let  me  recall  a  fact  reported  by  M.  Andral, 
and  which  is  very  well  adapted  to  impart  a  certain  value  to  this 
hypothesis.  A  man  was  brought  in  dying,  in  a  most  formidable 
atixo-adynamic  state;  he  died  at  the  end  oi  three  days.  At  the 
autopsy,  numerous  abscesses  were  found  in  the  brain,  in  the  lungs, 
in  the  spleen,  in  the  kidneys;  the  blood  everywhere  was  like  very 
loose  currant-jelly.     In  the  midst  of  the  blood-globules,  which 


702  Puerperal  Fever.  [October, 

were  misshapen,  strawberry-like  (framboise's),  a  great  number  of 
pus-globules  were  plainly  distinguished.  Nowhere  was  there  the 
slightest  trace  of  phlebitis.  Collections  of  pus  in  many  of  the 
solids,  and  pus  in  the  blood  itself,  were  the  only  alterations  de- 
monstrable. 

There  is,  therefore,  in  lying-in  women,  as  M.  Trousseau  has 
said,  a  great  morbid  aptitude,  which  I  will  at  once  call  a. pyogenic 
stale,  which  not  only  manifests  itself  in  abdominal  phlegmasias, 
but  makes  its  sad  influence  felt,  whatever  be  the  disease  attacking 
the  puerperal  female.  It  is  thus  that,  according  to  M.  Chomel 
and  M.  Grisolle.  the  pneumonias  which  supervene  during  the  pu- 
erperal state  acquire  an  extraordinary  degree  of  virulence,  which 
renders  them  promptly  mortal. 

Be  the  puerperal  fever  sporadic  or  epidemic,  it  always  consists 
essentially  in  an  alteration  of  the  blood  and  a  special  aptitude  of 
certain  organs  to  inflame,  and  to  rapidly  produce  pus ;  with  this 
sole  difference,  that  with  epidemics  this  aptitude  finds  itself  sin- 
gularly increased  by  this  agent,  unknown  in  its  essence,  but  so 
manifest  in  its  effect,  and  to  which  has  been  given  the  vague  de- 
nomination of  epidemic  influence  (genie  epidemique) ;  whence 
also  the  gravity  of  the  disease,  and  its  termination  more  promptly 
and  more  constantly  deadly. 

I  will  only  say  this  regarding  the  contagious  character  of  puer- 
peral fever,  that  I  adhere  without p reserve  to  what  MM.  Depaul 
and  Danyau  say  about  it.  After  a  demonstration  so  clear,  so 
peremptory,  as  that  furnished  by  those  two  speakers,  it  is  impossi- 
ble that  there  can  remain  any  incredulous  on  the  point.  M. 
Danyau  has  therefore,  with  good  reason,  insisted  on  the  precau- 
tions to  be  taken  to  avoid  the  dangers  of  contagion. 

What  shall  I  say  of  the  treatment?  The  speakers  who  have 
preceded  me  have  superabundantly  proved  the  uselessness  of  the 
different  methods  of  cure,  and  the  vanity  of  certain  remedies  con- 
sidered prophylactic. 

For  the  curative  treatment,  I  will  confine  myself  to  the  decla- 
ration that  all  the  means  I  have  tried  have  failed  in  my  hands,  as 
in  those  of  my  colleagues,  in  cases  of  virulent  or  epidemic  puer- 
peral fever.  I  must,  however,  say  that  I  have  obtained  good 
effects  from  the  employment  of  mercury.  I  have  seen  every  case 
get  well  in  which  powerful  doses  of  mercury  have  produced  an 
abundant  salivation ;  a  circumstance  which  induces  me  to  think 
that  he  who  shall  find  an  infallible  means  of  bringing  on  a  copious 
salivation  will  have  perhaps  discovered  a  specific  for  puerperal 
fever. 

As  for  prophylactic  measures,  I  see  none  better  at  present  than 
such  as  consist  in  diminishing  the  agglomeration  of  women  in 
lying-in;  and  on  that  point,  I  entirely  agree  with  M.  Danyau. 
The  measures  he  proposes  appear  to  me  the  wisest,  the  best  un- 


1858.]  Injection  of  Urea,  <£c,  into  the  Blood.  70S 

derstood,   and   the   most  conformable  to  the  rules  of  a  prudent 
hygiene. — [British  Med.  Journ.,  from  Gaz.  IIMomadaire. 


On  the  Injection  of  Urea  and  other  Substances  into  the  Blood.     By 
Dr.  VV.  A.  Hammond,  Assistant  Surgeon  U.  S.  Army. 

The  principal  object  in  undertaking  the  experiments  detailed 
in  this  paper,  is  that  of  deciding  upon  the  correctness  of  the  theory 
advanced  by  Frerichs  explanatory  of  uraemic  intoxication.  As 
is  well  known,  this  distinguished  author  regards  the  symptoms  of 
blood-poisoning,  so  frequently  present  in  Bright's  disease,  as  not 
directly  depending  upon  the  presence  of  urea  in  this  fluid,  but  as 
being  caused  by  its  conversion,  through  the  agency  of  a  ferment, 
into  carbonate  of  ammonia. 

Frerichs  performed  two  series  of  experiments,  which  he  regards 
as  tending  to  sustain  his  hypothesis.  In  the  first  series,  he  inject- 
ed a  solution  of  urea  into  the  blood  of  animals  whose  kidneys  had 
been  previously  removed.  In  from  an  hour  and  a  quarter  to 
eight  hours  they  became  restless,  and  vomited.  Ammonia  was 
detected  in  the  expired  air,  and  simultaneously  convulsions  ensu- 
ed. Death  occurred  in  from  two  hours  and  a  half  to  ten  hours 
from  the  commencement  of  the  experiment.  Ammonia  was  found 
in  the  blood,  the  contents  of  the  stomach,  and  in  the  bile  and  oth- 
er secretions. 

In  the  second  series,  a  solution  of  carbonate  of  ammonia  was 
injected.  Convulsions  ensued  almost  immediately,  and  were 
'  quickly  followed  by  stupor.  The  respiration  was  labored,  and 
the  expired  air  was  loaded  with  ammonia.  This  substance,  how- 
ever, gradually  disappeared,  and  the  animals  recovered  their 
senses. 

Frerichs  offers  no  explanation  of  the  nature  of  the  ferment 
which  he  conceives  to  be  necessary  to  produce  uraemic  poisoning, 
nor  does  he  even  attempt  to  demonstrate  its  existence,  except  in- 
directly, through  the  experiments  above  cited. 

While  admitting  the  facts  set  forth  by  these  experiments,  Dr. 
Hammond  differs  with  Frerichs  in  his  theory.  Ammonia  has 
often  been  met  with  as  a  constituent  of  the  expired  air  of  healthy 
individuals.  He  has  himself  frequently  detected  it  in  such  cases ; 
it  has  been  demonstrated  to  be  constantly  present  in  the  blood; 
and  Frerichs'  own  experiments  (those  of  the  second  series)  show 
that  it  was  not  capable  of  causing  death  even  when  injected  di- 
rectly into  the  circulation,  and  when  its  presence  in  the  blood 
was  evidenced  by  its  being  exhaled  in  large  quantity  from  the 
lungs. 

The  fact  that  in  the  first  series  of  investigations  the  kidneys 
were  extirpated,  while  in  the  second  the  animals  were  unmutila- 
ted,  while  different  substances  were  used  in  each,  prevents  our 
drawing  any  comparative  conclusions  from  the  results  obtained. 


704  Menstruation  during  Pregnancy.  [October, 

The  experiments  to  which  the  present  paper  relates  consisted 
of  two  series.  In  the  first  the  suhstance  was  injected  into  the 
blood  of  the  sound  animal;  in  the  second  the  kidneys  were  pre- 
viously extirpated.  The  two  series  were,  as  far  as  possible,  alike 
in  every  other  respect.  The  substances  injected  in  both  series 
were  urea,  urea  and  vesical  mucus,  carbonate  of  ammonia,  nitrate 
of  potash,  and  sulphate  of  soda. 

Dr.  Hammond's  conclusions  are: 

1st.  That  urea  (simple  and  combined  with  vesical  mucus),  car- 
bonate of  ammonia  and  sulphate  of  potash,  when  injected  into 
the  blood-vessels  of  sound  animals,  do  not  cause  death. 

2nd.  That  nitrate  of  potash,  when  thus  introduced,  is  speedily 
fatal. 

3rd.  That  death  ensues  from  the  injection  of  any  of  the  fore- 
going named  substances  into  the  circulation  of  animals  whose 
kidneys  have  been  previously  extirpated. 

4th.  That  in  neither  case  does  urea  when  introduced  directly 
into  the  circulation,  undergo  conversion  into  carbonate  of  am- 
monia.— \_N.  A.  Med.  Chir,  Bev.}  and  Banking's  Abstract. 


Menstruation  during  Pregnancy.     By  Dr.  Elsasser. 

This  contribution  to  a  disputed  topic  is  founded  upon  50  cases, 
extracted  from  the  journal  of  the  Stuttgart  Lying-in  Hospital, 
cases  which  are  said  to  rest  upon  the  most  certain  information. 
The  subjects  were  15  primaparae  and  36  pluriparee,  who,  with  the 
exception  of  two  women  (aged  36  and  41),  were  between  20  and 
30  years  of  age.  Of  the  51  children  born,  34  were  boys  and  17 
girls,  36  being  mature,  and  15  immature.  The  menstruation  du- 
ring  pregnancy  occurred  in  50  women,  in  the  following  manner; 
Once  in  8,  twice  in  10,  three  times  in  12,  four  in  5,  five  in  6, 
eight  in  5.  and  nine  in  2.  In  13  cases  the  peculiarities  of  the 
rhythm  of  the  discharge  were  inquired  into,  and  the  rhythm  was 
found  regular  in  4,  in  1  it  occurred  at  the  sixth*  week,  in  3  there 
were  pauses  between  the  epochs,  in  2  the  menstruation  first  ap- 
peared after  the  second  month,  in  2  after  the  fourth,  and  in  1  after 
the  fifth  month.  In  one  case  the  menstruation  first  appeared  in 
the  middle  of  gestation,  and  henceforth  came  on  every  four  weeks, 
lasting  three  or  four  days.  The  child  perceived  but  feebly  at 
first,  was  strongly  felt  during  the  last  four  or  five  weeks.  Hem- 
orrhage occurred  twice  within  a  week  before  delivery,  but  a  ma- 
ture, living  infant  was  born.  Indications  as  to  the  amount  of 
discharge  were  furnished  in  26  cases,  and  in  18  of  them  it  was 
less  than  in  the  non-pregnant  condition.  The  weight  of  the  35 
mature  infants  varied  from  5  lbs.  to  9  lbs. 

Dr.  Elsasser  observes  that  although  he  is  unable  to  state  the 
proportion  of  cases  in  which  menstruation  occurs  during  preg- 


1858.]  Investigation  of  Epidemicsby  Experiment.  705 

nancy,  it  is  by  no  means  so  exceptional  an  occurrence  as  suppos- 
ed by  some  authors.  It  occurs  more  frequently  in  pluriparae  than 
in  primiparae ;  and  it  takes  place  much  more  frequently  during 
the  first  half  of  pregnancy,  and  especially  in  the  earlier  months  of 
this,  than  during  the  latter  half.  The  amount  of  discharge  too 
is  smaller  than  in  the  normal  menstruation.  The  duration  of  the 
pregnancy  was  normal  in  more  than  two-thirds  of  these  cases  (36), 
while  in  nearly  one-third  (14)  of  the  cases  it  was  interrupted,  in 
4  during  its  first,  and  in  10  during  its  latter  half.  As  regards  the 
development  of  the  child,  which  by  some  authors  has  been  sup- 
posed to  be  impeded  by  the  occurrence  of  menstruation,  this  was 
found  to  be  normal,  or  more  than  normal  in  three-fourths  of  the 
cases — [Afonatschrift  fur  Geburtekiinde,  and  American  Journal  of 
the  Med.  Sciences. 


The  Investigation  of  Epidemics  by  Experiment.     Read  before  the 
Epidemiological  Society.     By  Dr.  Richardson. 

He  commenced  by  pointing  out  the  weakness  of  the  present 
system  of  epidemiological  study,  which  sought  after  results  by 
trying  to  descend  from  the  general  to  the  particular.  This 
method  lets  pass  simple  laws,  which  lie  at  the  root  of  all  inqui- 
ries. It  is  painful  to  say,  as  a  fact,  yet  a  fact  proper  to  be  said, 
that  the  researches  at  present  so  laboriously  conducted  do  not 
tend  to  such  proofs  of  unanimity,  or  to  such  positiveness  of 
science,  as  might  on  a  priori  reasoning,  be  expected  from  them. 
The  present  modes  of  research  may  bring  out  negatives — they 
may  bring  out  partially-accepted  positives,  and  a  sufficient 
amount  of  positive  evidence  to  satisfy  a  section  of  men  ;  but 
as  yet  they  have  failed  to  educe  such  demonstrations  that 
those  who  are  educated  to  the  same  maik  can  read  off  the  same 
phenomena  by  the  same  process  of  thought  and  inductive  learn- 
ing. The  author  next  proceeded  to  point  out  carefully  such 
experiments  as  might  be  reasonably  instituted  for  the  purpose 
of  investigating  particular  epidemic  disorders,  especially  small- 
pox, scarlet  fever,  and  typhus,  commenting  also  on  the  care  which 
should  be  taken  in  the  section  of  the  animal  subjected  to  experi- 
ment, and  showing  that  in  inquiries  relating  to  the  three  special 
diseases  named  above,  the  pig  is  the  proper  animal  to  be  selected, 
as  one  more  susceptible  of  these  diseases  than  other  members  of 
the  inferior  animal  kingdom.  Thence,  leaving  propositions  for 
the  history  of  experiment  itself,  as  a  means  of  investigation,  the 
author  explained  what  had  been  done  in  recent  times  towards 
the  production  of  some  diseases  artificially,  and  the  information 
derivable  from  this  form  of  investigation.  He  followed  up  this 
argument  with  a  minutely-revealed  account  of  some  experiments 
performed  by  himself,  in  which  all  the  characteristics  of  typhus, 


706  Aconitum  Napellus — Aconite.  [October, 

symptomatological  and  pathological,  were  produced  by  the  in- 
troctuction  of  alkalies  into  the  system.  He  showed  further  that 
the  typhous  condition,  which  could  be  introduced  by  the  injec- 
tion of  animal  putrid  matter,  was  coincident  with,  and  depend- 
ent on,  the  development  of  a  superalkaline  condition  of  the 
blood;  and  he  connected  the  pathology  of  putrid  fever,  so  call- 
ed, with  the  conditions  analogous  to  those  which  had  thus  been 
artificially  produced.  In  a  connected,  simple  mode  of  argument, 
which  peculiarly  arrested  the  attention  of  the  audience,  the 
question  was  next  put,  whether,  when  the  virus  of  a  disease  is 
introduced  into  a  healthy  animal  so  as  to  reproduce  that  disease, 
the  symptoms  and  the  pathological  changes  are  due  to  an  abso- 
lute reproduction  of  the  virus  itself,  and  to  the  actual  presence 
of  such  virus,  or  whether  the  virus  acted  by  setting  up  such 
new  changes  in  the  body  that  a  product,  generated  secondarily 
and  differing  in  character  from  the  original  poison,  was  the  cause 
of  the  symptoms  ?  He  (Dr.  Richardson)  was  inclined  to  the 
latter  view,  and  gave  some  clear  experimental  evidence  in  sup- 
port of  his  position.  He  admitted  at  the  same  time  that  further 
experiment  was  required,  and  argued  that  until  this  point  was 
denned  no  sound  progress  could  be  made  in  the  study  of  epidem- 
ics. 

It  is  impossible,  in  an  abstract  to  give  more  than  the  briefest 
outline  of  a  communication  written  in  so  condensed  a  style,  and 
opening  up  for  consideration  so  many  subjects,  each  differing  in 
detail,  yet  having  but  one  object;  but  the  final  propositions  laid 
before  the  Society  were  as  follows: — 

1.  That  by  experiment  it  might  be  ascertained  in  what  excreta 
the  poisons  of  certain  of  the  epidemic  diseases  are  located. 

2.  By  what  surfaces  of  the  body  such  poisons  may  be  absorb- 
ed so  as  to  produce  their  specific  effects. 

3.  When  the  virus  of  a  disease,  in  reproducting  its  disease  in 
a  healthy  body,  acts  in  the  development  of  the  phenomena  by 
which  the  disease  is  typified  primarily  or  secondarily — i.  e.  by 
its  own  reproduction  and  presence,  or  by  the  evolution  of  anoth- 
er principle  or  product. 

4.  Whether  climate,  season,  or  external  influences  modify 
the  course  of  epidemics,  by  producing  modifications  of  the 
epidemic  poisons,  or  modifications  in  the  system  of  persons  ex- 
posed to  the  poisons. — [London  Lancet 


Aconitum  Napellus — Aconite. 

Dr.  Edward  B.  Stevens,  of  Cincinnati,  reports  {Cincinnati  Med. 
Observer,  Oct.  1857)  his  success,  confirmatory  of  the  experience 
of  others,  in  the  use  of  aconite,  for  the  cure  or  relief  of  "almost 
the  entire  range  of  neuralgic  affections,  and  of  those  obscure 


1858.]  Cannabis  Indica.  707 

complications,  of  rheumatism  and  neuralgia,  in  which  there  is 
freedom  from  local  or  constitutional  trouble,  independent  of 
nervous  derangement." 

In  a  case  of  neuralgia,  "supposed  to  be  a  result  of  previous 
attacks  of  miasmatic  disease,"  and  which  was  treated  by  the  use 
of  quinine  and  other  remedies  with  but  temporary  relief,  Dr. 
Stevens  prescribed  a  mixture  of  the  tincture  of  aconite  and  tinc- 
ture of  cimicifuga,  which  gave  entire  relief  to  the  patient.  The 
proportion  was — $.  Tinct.  rad.  aconit.,  3i. ;  Tinct.  cimicifuga, 
fij. — M.  Dose,  a  teaspoonful  every  four  hours.  Three  doses 
were  sufficient  to  procure  the  desired  relief.  Ten  months  had 
elapsed  without  a  return  of  the  disease. 

A  case  of  neuralgic  rheumatism  of  the  arm,  of  peculiar  obsti- 
nacy, after  having  been  intractable  to  all  remedies,  yielded  to 
the  aconite.  In  the  above  formula,  each  close  should  be  equiva- 
lent to  about  four  drops  of  the  tincture,  although,  in  fact,  this 
latter  gives  somewhat  more  than  sixty  drops  to  the  drachm.  In 
this  dose  of  four  drops,  Dr.  Stevens  has  ."  never  seen  any  effects 
sufficiently  marked  or  evident  to  occasion  alarm." 

Dr.  S.  has  not  used  this  article  in  acute  rheumatism;  but  in 
chronic  rheumatic  pains,  particularly  in  old  people,  he  has  de- 
rived excellent  effects  from  it.  In  dysmenorrhcea,  or  neuralgia 
associated  with  uterine  derangement  at  or  subsequent  to  the 
catamenial  period,  entire  relief,  followed  by  refreshing  sleep,  has 
been  obtained  by  the  administration  of  the  aconite. 

In  the  diminished  and  sometimes  abolished  sensibility  and 
voluntary  motion  to  which  aconite  gives  rise,  we  find  similarity 
of  effects  to  those  produced  by  veratrum  virideand  gelseminum. 

[Xorth  American  Medico-  Chir.  Rev. 


Cannabis  Indica — Haschisch — Indian  Hemp;  called  also  Gungha, 
Bung,  etc. 

Dr.  John  Bell,  of  Derry,  New  Hampshire,  has  a  paper  in  the 
Boston  Med.  and  Surg.  Journal,  April,  1857,  on  the  effects  of  this 
plant,  chiefly  in  a  psychical  point  of  view.  He  describes  the 
manner  in  which  he  was  affected  when  he  put  himself  under  its 
influence.  Room  is  not  allowed  us  to  give  even  an  analytical 
notice  of  his  opinions  and  observations  on  this  interesting  theme, 
and  we  must  be  content  to  note  a  few  passages.  Among  these, 
is  one  on  the  resemblance  between  a  state  of  mind  produced  by 
the  Haschisch  and  that  occurring  in  Mania — a  resemblance  no- 
ticed both  by  M.  Moreau  and  Dr.  Bell: — "In  both  states  there 
is  the  same  excitement  and  abruptness  of  manner,  the  same  ra- 
pidity and  incoherence  of  thought,  the  same  false  convictions 
and  lesions  of  the  affective  faculties." — "There  is  no  error  of 
judgment,  no  delusion  or  lesion  of  the  will  or  moral  faculties, 

N.  8. VOL.  XIV.     NO.  X.  40 


708  Cannabis  Indica.  [October, 

which  is  seen  in  the  former  state,  [Mania,]  but  what  might  take 
its  rise  in  the  latter."  Dr.  Bell  describes  the  series  of  mental 
phenomena  which  were  produced  on  himself  by  this  substance: 
"  Amid  all  the  strange  vagaries  of  the  Haschisch,  the  mind  pre- 
serves the  power  of  taking  cognizance  of  its  condition,  and  to  a 
certain  extent,  of  analyzing  its  operations.  The  memory  of  eve- 
rything said  and  done  is  nearly  perfect;  but  of  the  multitude  of 
thoughts,  only  those  making  a  more  than  commonly  distinct 
impression  are  observed."  He  thinks  that  considerable  light 
might  be  thrown  on  insanity,  and  especially  delusions,  by  watch- 
ing and  analyzing  the  effects  of  the  Indian  hemp,  which  we  may 
take  as  a  picture  of  the  mind  when  under  another  and  more 
enduring  series  of  morbid  impressions. 

Speaking  of  its  operation  on  the  brain,  in  reference  to  the 
psychical  phenomena  produced  in  consequenceT  Dr.  Bell  thinks 
that^ive  grains  is  the  smallest  quantity  from  which  any  percepti- 
ble effects  are  to  be  expected,  and  generally  more  will  be  re- 
quired. This  opinion  coincides  with  our  own  experience  of  the 
drug  (the  extract  of  Cannabis)  when  we  have  administered  itfor 
the  alleviation  of  pain,  as  in  neuralgia,  and  to  procure  sleep  in 
delirium  tremens. 

Dr.  A.  Bryant  Clarke,  of  Holyoke,  {Boston  Med.' and  Surg, 
Journal,  MayT  1857,)  tells  us,  in  reference  to  Dr.  Bell's  statement 
of  the  dose  of  the  Cannabis  Indica  required  to  produce  the  de- 
sired effect,  that  a  pill  of  the  English  extract,  in  the  quantity  of 
two  grains  and  a  half,  given  to  a  maniacal  patient,  who  had  pre- 
viously taken  the  medicine  in  two-grain  doses,  produced  very- 
marked  effects.  On  visiting  his  patient,  two  or  three  hours  after 
she  had  taken  the  pill,  Dr.  Clarke  found  her  sitting  up,  and 
more  rational  and  quiet  than  she  had  been  for  weeks: — "The 
attendant  described  her  as  apparently  fainting,  with  respiration 
slow  and  regular,  a  blue  and  dusky  state  of  the  skin,  blood  set- 
tled under  the  finger  nails,  and  said  they  had  with  difficulty  kept 
her  alive."  Dr.  Clarke  being  incredulous  of  the  effects  attribu- 
ted to  the  medicine,  swallowed  one  of  the  pills,  soon  after  a 
hearty  dinner.  Within  an  hour  he  began  to  feel  its  peculiar 
effect's,  such  as  are  so  well  described  by  Dr.  Bell.  Dr.  Clarke's 
left  arm  was  paralyzed,  the  skin  looked  blue,  and  there  was  a 
blueness  under  the  finger  nails,  as  though  the  blood  were  im- 
perfectly arterialized  ;  the  pulse  was  natural.  The  effect  of  the 
Cannabis  was  at  its  height  in  about  three,  and  passed  off  in  about 
five  hours.  The  arm  was  in  a  powerless  condition  for  half  an 
hour,  but  friction  would  partially  restore  it 

Dr.  Merret,  of  Detroit,  in  a  short  article  on  this  subject,  (Medi- 
cal Independent,  Sept.  1857,)  describes  the  Cannabis  as  a  deliri- 
ant  which  produces  on  many  of  the  native  population  of  the 
East,  who  use  it  freely,  a  most  undesirable,  in  fact,  a  dangerous 


1858.]  Treatment  of  Trismus  and  Tetanus.  709 

frame  of  mind.  These  evils  are,  however,  fortunately  counter- 
balanced by  the  antispasmodic  effect  of  the  drug.  Dr.  Merret 
speaks  from  a  personal  observation,  during  three  years  in  a 
military  hospital  at  Calcutta,  of  its  administration  in  tetanus.  In 
idiopathic  cases  it  was  most  generally  successful,  and  even  in 
traumatic  cases  it  showed  its  superiority  overall  other  remedies. 
He  mentions  two  cases  of  its  successful  use  in  England.  Its  re- 
laxent  effect  has  been  proved  to  be  an  aid  to  taxis,  in  the  reduc- 
tion of  hernia. 

For  further  details  of  the  effect  of  doses  of  different  degrees  of 
strength,  and  the  descriptions  of  the  manner  in  which  haschisch 
affects  different  individuals,  we  would  refer  the  reader  to  an 
article  in  the  '"National  Review,"  copied  into  LittelVs  Living 
Age,  Feb.  20th,  1858.— [Ibid. 


Treatment  of  Trismus  and  Tetanus.  By  Dr.  Molxar,  of  Nim- 
burg,  Bohemia.  (Translated  from  the  Allgemeine  Wiener 
Medizinische  Zeitung,  by  Dr.  B.  Joy  Jeffers. 

The  uncertainty  of  most  of  the  recommended  means  of  treat- 
ing tetanus,  fortunately  a  disease  of  rare  occurrence,  makes  it 
the  duty  of  every  consciencious  physician  to  remedy  this  defi- 
ciency in  therapeutics  by  relating  any  single  case  in  which  the 
adopted  plan  of  treatment  was  successful. 

Ours  was  the  case  of  a  mason,  Vincenz  Holub,  of  Nimburg,  a 
robust  man,  previously  healthy,  aet.  45.  Sept.  22nd,  his  left 
fore-finger  was  so  crushed  by  a  stone  of  three  hundred  weight, 
that  amputation  with  a  flap  was  necessary,  close  above  the  head 
of  the  first  phalanx.  The  wound  was  healing  regularly,  without 
pain,  and  had  perfectly  granulated  "rose-red,"  when  the  patient 
began,  on  the  5th  of  October,  to  complain  of  painful  tension  and 
contraction  of  the  muscles  of  mastication,  and  of  difficulty  of 
deglutition.  In  spite  of  the  exhibition  of  opium  and  tartar 
emetic,  in  one  grain  doses,  baths,  followed  by  the  desired  dia- 
phoresis, and  of  the  greatest  care,  yet  by  the  9th  of  October  the 
highest  degree  of  tatanus  was  developed. 

The  patient  had  complete  consciousness;  pulse  normal ;  pu- 
pils, in  a  moderately  darkened  room,  strongly  contracted;  the 
teeth  firmly  set  together,  and  not  separable,  either  actively  or 
passively.  All  the  muscles  of  the  neck  and  trunk,  and  the  ex- 
tensors of  the  extremities,  were  hard  as  a  board.  The  stiffened 
body  was  thrown  into  various  positions  by  painful  electric-like 
shocks,  both  spontaneously  and  at  the  slightest  touch.  The  pa- 
tient was  sleepless.  The  urine  was  drawn  off  by  the  catheter. 
Fluids  (milk,  soup  and  water)  which  were  poured  in,  through 
an  opening  left  by  the  extraction,  several  years  previously,  of 


710  Beneficial  Effects  of  Pepsine,  [Octoberr 

two  upper  incisors,  were  mostly  regurgitated,  the  remainder 
flowing  down  as  through  a  pipe. 

Opium,  in  the  form  of  clysters,  gave  no  relief,  as  also  the  oth- 
er means  generally  recommended.  Baths  could  not  now  be 
used;  and  without  much  hope  of  success,  I  resolved,  on  October 
16th,  to  employ  chloroform.  After  the  first  inhalation  of  two 
drachms,  the  patient  was  greatly  relieved.  His  consciousness 
did  not  exhibit  the  slightest  disturbance.  The  painful  contrac- 
tions and  rigidity  were  lessened,  and  he  slept  for  two  hours. 

On  the  day  following,  three  drachms  of  chloroform  were  used; 
on  the  third  day,  four;  and  on  the  fourth  day,  six,  without  pro- 
ducing any  narcotism.  But  I  noticed  that  on  the  third  day  of 
treatment,  the  patient  could  separate  his  teeth  three  lines. 

The  chloroform  was  now  suspended  for  one  day,  and  then 
again  inhaled  for  five  days  in  doses  of  three  drachms  per  diem. 
All  appearances  of  tetanus  and  trismus  gradually  disappeared, 
so  that  the  patient  could  have  been  considered  well  by  the  8th 
of  November.  His  strength  speedily  returned.  In  all,  he  had 
used  about  four  ounces  of  chloroform. 

In  view  of  this  case,  I  have  no  hesitation  in  enrolling  myself 
with  those  physicians  who  consider  chloroform  in  this  disease 
as  a  "  Unicum." — [Boston  Med.  and  Surg.  Journal. 


Observations  on  the  Beneficial  Effects  of  Pepsine  in  the  obstinate 
Vomiting  of  Pregnancy.     By  Dr.  L.  Geos. 

In  a  great  majority  of  cases  the  vomiting  of  pregnancy  may 
safely  be  left  to  the  influence  of  time;  but  there  are  some  cases 
in  which  females  are  scarcely  able  to  retain  in  their  digestive 
system  a  sufficient  amount  of  nourishment  to  support  their  ex- 
istence, and  are  therefore  reduced  to  the  last  degree  of  emacia- 
tion. In  some,  also,  the  shocks  occasioned  by  this  obstinate 
and  repeated  vomiting  become  the  source  of  abortions,  which 
might  have  been  prevented  by  moderating  the  activity  of  the 
morbid  phenomenon.  A  very  remarkable  case  was  related  in 
1856,  by  M.  Tessier,  Professor  of  Clinical  Medicine  at  Lyons, 
showing  the  immediately  beneficial  effects  of  a  dose  of  pepsine 
in  a  case  of  vomiting  during  pregnancy.  In  this  case  the  symp- 
toms resisted  all  the  ordinary  methods  which  were  employed, 
and  the  patient  was  unable  to  retain  in  her  stomach  any  sub- 
stance whatever.  Under  these  circumstances,  the  patient  was 
brought  to  M.  Tessier,  who  found  her  in  the  following  condition : 
The  vomiting  had  continued  for  two  months,  and  she  was  at  the 
end  of  the  fourth  month  of  her  pregnancy  ;  she  presented  the 
appearance  of  a  skeleton,  having  the  aspect  and  cough  of  a 
phthisical  subject;  the  pulse  was  140,  and  M.  Tessier  thought 
at  first  that  the  case  was  one  of  pulmonary  tubercle.     Finding 


1858.]  Introduction  of  the  Catheter  in  Stricture.  711 

that  all  treatment  had  been  hitherto  inefficacious,  and  that  the 
lady  was  fast  actually  dying  of  inanition,  he  was  seriously  med- 
itating upon  the  propriety  of  inducing  abortion  as  a  means  of 
saving  her  life;  but  as  a  last  resource,  before  operating,  he  de- 
termined to  employ  pepsine.  He  accordingly  prescribed  one 
gramme,  to  be  divided  into  two  doses,  and  taken  every  day  in 
a  spoonful  of  broth.  At  the  very  first  dose  the  broth  was  re- 
tained, and  from  that  moment  the  vomiting  never  returned. 
On  the  third  day  the  lady  ate  some  chicken,  and  then  some 
beef-steak.  The  treatment  was  continued  in  the  same  manner 
for  three  weeks,  and  at  the  end  of  that  time  the  cure  was  com- 
plete ;  the  emaciation  was  replaced  by  embonpoint,  the  fever  and 
the  cough  ceased  with  the  vomiting,  and  at  the  end  of  the  nine 
months  the  lady  was  safely  deliverd. 

Dr.  Gros  then  relates  six  other  cases  in  which  the  pepsine  was 
employed  with  the  same  success,  and  he  thinks  himself  warrant- 
ed in  concluding  that  pepsine  undoubtedly  produces  good  effects 
in  the  vomiting  which  attends  pregnancy.  He  explains  the  re- 
sults by  supposing  that,  although  in  the  first  instance  the  vomit- 
ing is  due  only  to  the  sympathy  existing  between  the  uterus 
and  the  stomach,  yet  subsequently  the  stomach  itself  becomes 
affected,  as  is  proved  by  the  fact  that  in  the  beginning  of  preg- 
nancy the  vomiting  occurs  only  in  the  morning  or  the  evening; 
but  in  aggravated  cases  it  supervenes  every  meal,  and  all  ali- 
mentary matters  are  rejected.  In  such  cases,  therefore,  when 
the  stomach  has  taken  on  a  morbid  habit,  and  exhibits  an  alter- 
ation of  secretion,  the  pepsine  seems  to  be  really  indicated ; 
although  in  a  merely  sympathetic  action  between  the  uterus 
and  stomach  it  would  be  difficult  to  explain  the  efficacy  of  its 
action. — [Bui.  Gen.  de  llierap.,  and  Brit,  and  For.  Med.  Cliir.  Rev. 


On  the  Introduction  of  the  Catheter  in  Stricture.     By  Dr.  Slade, 
of  Boston. 

I  prefer  that  the  patient  should  be  in  bed,  that  he  should  be 
warmly  covered,  and  that  be  should  be  particularly  protected 
against  any  sudden  chill.  A  bougie  is  then  to  be  selected,  of  a 
size  corresponding  to  the  size  of  the  stream  passed,  as  nearly  as 
mav  be,  or  to  the  presumed  diameter  of  the  constricted  passage ; 
this  is  to  be  carefully  lubricated  with  lard,  cold  cream,  cerate, 
or  some  other  equally  tenacious  substance,  which  is  greatly  to 
be  preferred  to  the  olive  oil  so  commonly  in  use.  Thus  prepar- 
ed, the  instrument  is  to  be  carried  carefully  down  to  the  seat  of 
the  stricture,  and,  if  possible,  pushed  on  into  it.  the  entrance  of 
its  extremity  being  at  once  known  by  the  peculiar  manner  in 
which  it  is  grasped.     After  a  few  moments'  delay,  the  bougie, 


712  Introduction  of  the  Catheter  in  Stricture.      October, 

in  a  great  majority  of  cases,  may  pe  pushed  on  into  the  bladder. 
This,  however,  it  must  be  borne  in  mind,  is  not  always  neces- 
sary ;  the  mere  presence  of  the  instrument  at  the  seat  of  the 
obstruction  is  generally  sufficient  to  overcome  the  spasmodic 
action  upon  which  the  retention  depends.  The  only  difficulty 
in  carrying  these  delicate  instruments  down  to  the  stricture,  is 
from  their  becoming  entangled  in  the  various  lacunae,  which,  as 
is  well  known,  are  greatly  enlarged  in  this  disease. 

Mr.  Henry  Thompson,  of  London,  has  recently  suggested  a 
method  of  protecting  the  mucous  membrane  from  injury,  and  of 
rendering  the  introduction  of  small  instruments  more  easy,  par- 
ticularly in  these  very  cases  of  narrow  stricture,  which  on  trial 
will  be  found  very  useful.  It  consists  in  the  simple  method  of 
applying  the  oil  to  the  urethra  itself,  and  very  freely,  rather 
than  to  the  instrument.  In  order  to  effect  this,  he  says,  the 
nozzle  of  a  common  glass  syringe,  containing  from  four  to  six 
drachms  of  pure  olive  oil,  should  be  introduced  into  the  urethra 
as  far  as  it  will  go,  the  external  meatus  being  at  the  same  time 
closed  upon  the  nozzle  by  the  forefinger  and  thumb  of  the  left 
hand,  so  that  none  can  esoape.  Gentle  pressure  being  now 
made  upon  the  piston-rod,  the  oil  gradually  finds  its  way  down 
to  the  stricture ;  and  if  this  be  very  narrow,  the  urethra  in  front 
of  it  slowly  fills  and  becomes  slightly  distended ;  but  as  the  pis- 
ton continues  to  descend,  the  oil  will  gradually  pass  through  the 
stricture  and  onward  into  the  bladder,  thoroughly  lubricating 
every  part  of  the  canal.  At  the  moment  the  oil  passes  through 
the  stricture,  the  operator  may  sometimes  distinctly  perceive  a 
slight,  but  very  complete,  sensation  communicated  to  the  hand, 
of  resistance  overcome,  and  partial  collapse  of  the  previously 
distended  urethra  in  front.  The  syringe  is  then  to  be  removed, 
the  finger  and  thumb  still  commanding  the  meatus  of  the  ure 
thra  so  that  no  oil  escapes.  The  smallest  catheter  may  now  be 
introduced,  and  made  to  traverse  the  urethra — at  all  events  as 
far  as  the  stricture — with  \ery  little  or  none  of  that  difficulty 
arising  from  the  catching  of  its  point  against  the  walls  of  the 
passage,  so  often  experienced  with  very  small  instruments,  and 
which  renders  so  much  care  necessary  in  their  employment. 

Temporary  dilatation  is,  without  doubt,  the  safest  and  surest 
method  of  treating  organic  stricture.  Although  slow,  at  the 
same  time  it  can  be  easily  managed,  and  can  be  suspended  at 
any  moment,  according  as  circumstances  require,  and,  above  all, 
does  not  prevent  the  patient  from  pursuing  his  usual  avocation  ; 
and  for  the  early  treatment  of  narrow  irritable  stricture,  the  use 
of  gum  elastic  or  wax  bougies  is  far  preferable  to  metallic  instru- 
ments. I  have  seen  patients  who  have  suffered  so  much  from 
the  passage  of  small  metallic  instruments,  that  they  have  nol 
been  willing  to  allow   their  farther  use,  but  have  made  rapid 


1858.]  Strychnine  in  Sciatica.  713 

progress  under  the  employment  of  flexible  instruments.  When, 
however,  the  dilatation  has  proceeded  so  far  that  a  No.  5  or  b' 
bougie  passes  with  ease,  then  these  may  be  laid  aside  and  metal- 
ic  instruments  substituted. — [  Virginia  Med.  Journal. 

Strychnia  in  Sciatica. 

Dr.  0.  C.  Gibbs,  of  Frewsburg,  Chatauque  county,  Xew  York, 
{American  Medical  Monthly,  September,  1857,  relates  an  obstin- 
ate case  of  sciatica  which  had  resisted  colchicum,  ammouiated 
tincture  of  guiacum,  quinine  and  morphia,  oil  of  turpentine, 
tincture  of  cimicifuga,  iodide  of  potassium,  Dover's  powder,  blis- 
ters over  the  great  trochanter,  and  the  endermic  application  of 
morphia,  cups  over  the  same  part,  and  calomel  to  touch  slightly 
the  gums.  For  some  time  the  patient,  despairing  of  relief,  had 
been  in  the  habit  of  using  opium,  which  was  given  at  the  dis- 
cretion of  his  wife,  as  the  only  means  of  assuaging  the  pain. 
Dr.  Gibbs  describes  his  mode  of  using  the  strychnia,  and  its  suc- 
cess in  the  following  terms: — 

"We  now  took  two  grains  of  strychnia,  in  crystals,  and  put 
it  with  two  ounces  of  water,  slightly  acidulating  the  water  with 
sulphuric  acid.  We  also  took  four  grains  of  podophyllin  and 
five  of  sulphate  of  morphine,  rubbing  them  up  with  sugar,  and 
dividing  them  into  twent}r  powders.  We  ordered  thirty  drops 
of  the  solution  of  strychnia,  also  one  of  the  powders,  to  be  taken 
three  times  a  day.  The  patient  had  no  severe  paroxysm  of  pain 
after  this,  and  within  three  weeks  from  the  time  of  commencing 
the  strychnia,  he  went  down  the  Alleghany  and  Ohio  rivers  as 
a  pilot  on  a  lumber  raft,  and  up  to  the  present  time  he  remains 
free  from  a  return  of  the  affection." 

The  author  has  omitted  to  say  when  the  successful  treatment 
was  begun,  and  at  what  date  he  wrote  the  account  of  the  case. 
He  took  charge  of  his  patient  March  6th,  1857.  We  are  left  to 
gather  from  the  narrative,  that  the  trial  of  the  long  list  of  reme- 
dies above  mentioned  lasted  about  three  or  four  weeks  before 
recourse  was  had  to  strychnia.  Each  dose  of  the  solution  of  this 
substance,  as  directed  by  Dr.  Gibbs,  was  equivalent  to  the  six- 
teenth of  a  grain. — \_Xorth  American  Medico-  L'hir.  Rtv. 

Tobacco  in  Erysipelas. 
Dr.  John  G.  Stephenson,  of  Terre  Haute,  Indiana,  desires  to 
call  the  attention  of  the  profession  M  rn  Lancet,  May,  1867) 
to  the  treatment  of  erysipelas,  which  has  proved  so  beneficial  in 
his  practice,  that  the  use  of  it  has  become,  with  him,  a  matter  of 
routine.  "  The  treatment  is  simply  the  covering  of  the  inflamed 
surface  with  wet  tobacco  leaves,  (such  as  are  to  be  had  in  any 
cigar  shop.)  which  are  permitted  to  remain  until  much  nausea  is 


The  Influence  of  Water- Drinking  upon  the  Metamorphosis  of  the 
System.     By  Dr.  Mosler. 

Mosler  contributes  a  valuable  essay  "  On  the  Influence  of 
Water  on  the  Metamorphosis  of  Matter,''  which  has  gained  the 
first  prize  from  the  Verein  fur  Gemeinschaftlkhe  Arbeiten.  The 
author  divides  his  researches  into  those  made  on  children,  those 
on  adult  females,  and  those  on  adult  males;  in  all  of  them  he 
examined  the  phenomena  of  metamorphosis — a,  when  the  inges- 
ta  and  the  manner  of  living  were  as  usual;  b.  when  the  water 
taken  with  the  fluid  articles  of  food  was  withdrawn ;  c,  when 
various  quantities  of  water  were  added  to  the  amount  of  food. 
The  water  employed  was  pure,  containing  in  sixteen  ounces  only 
2.774  grains  of  solid  substances,  and  1.1036  grain  carbonic  acid. 
Abstinence  from  taking  water  led  to  the  diminution  of  the  secre- 
tions and  excretions,  principally  those  from  the  kidneys.  Al- 
though the  specific  gravity  of  the  urine  became  much  increased, 


714  The  Influences  of  Water- Drinking,  &c.        [October, 

produced."  Dr.  Stephenson,  while  he  admits  that  the  excessive 
and  distressing  nausea  produced  by  the  internal  use  of  tobacco 
prevents  its  administration  by  the  stomach,  is  willing  to  believe 
in  its  power  and  safety  when  cautiously  applied  to  a  cutaneous 
surface,  as  a  remedy  for  local  inflammation. 

We  must,  however,  be  aware  of  difficulty,  not  to  say  impossi- 
bility, of  determining,  after  no  matter  how  many  trials,  the 
extent  of  surface  to  be  covered,  and  of  absorption  produced  by 
this  application  of  the  tobacco,  so  as  to  procure  the  desired 
amount  of  sedative  effect  and  accompanying  nausea.  The  dif- 
ference between  the  internal  and  external  use  of  tobacco  is  only 
one  degree;  and  in  both  instances  there  is  uncertainty  and  risk 
of  alarming,  if  not  fatal  results.  Hence  the  great  caution  always 
practiced  in  the  administration  of  this  plant  as  a  therapeutic 
agent — a  caution  which  is  especially  called  for  in  cases  of  ery- 
sipelas in  old  subjects  with  broken-down  constitutions  and  slight 
powers  of  reaction. 

In  one  of  the  cases  related  by  Dr.  Stephenson,  the  patient  was 
pregnant  about  five  months.  She  soon  got  well  under  treat- 
ment. This  consisted  in  the  use  of  calomel,  followed  by  saline 
purgatives,  Dover's  powder,  sulphate  of  cinchona,  and  the  local 
use  of  tobacco.  In  another  case  of  a  person  aged  17  years, 
slightly  chlorotic,  in  which  tincture  of  the  chloride  of  iron  inter- 
nally and  tincture  of  iodine  externally  failed  to  prevent  the 
extension  of  the  inflammation  of  the  leg  from  above  the  ankle 
to  above  the  knee,  the  application  of  the  wet  tobacco  leaves  soon 
produced  extreme  nausea  and  prostration,  followed,  after  sever- 
al other  renewals  of  the  same  topical  treatment,  by  a  complete 
removal  of  the  inflammation. — [Ibid. 


1858.]  Editorial  715 

yet  not  only  the  quantity  of  water,  but  also  the  total  amount  of 
solids  excreted  within  a  certain  period  was  considerably  lessen- 
ed, and  most  so  that  of  the  urea,  after  which  ranks  the  chloride 
of  sodium,  the  phosphoric  and  sulphuric  acids.  Lesser  was  the 
decrease  in  the  excretion  through  the  skin  and  lungs.  The  stools 
were  more  bound,  the  tongue  rather  dry,  the  appetite  defective. 
Increased  ingestion  of  water  caused  an  acceleration  of  the  total 
metamorphosis  of  matter,  which  in  some  instances  manifested 
itself  more  through  the  skin  than  through  the  other  organs  of 
excretion  ;  in  most  cases,  however,  principally  through  increased 
flow  of  urine  containing  an  increased  amount  of  solid  constitu- 
ents ;  the  increase  was  largest  as  regards  urea,  after  which  follow 
chloride  of  sodium,  phosphoric  acid,  and  sulphuric  acid.  These 
phenomena  were  accompanied  by  loss  of  weight  of  the  body. 
On  the  days  succeeding  the  increased  ingestion  of  water  the  ex- 
cretions were  diminished,  and  the  body  gained  weight. — [Archiv 
d.  Vereins.  f.  gemeinsch.  Arbeiten,  and  Medico-  Cliirurg.  Rev. 


EDITORIAL  AND  MISCELLANEOUS. 

The  Question  of  Poisonous  Honey. — So  extensively  related  are  the 
interests  of  the  Medical  Profession,  that  there  is  no  subject,  however 
remotely  connected  with  any  branch  of  it,  which  is  not  worthy  of  our 
diligent  attention.  So  liable  to  change  are  many  of  our  apparently  best 
established  tenets,  that,  at  the  present  day,  no  one  is  surprised  to  find 
some  of  the  most  settled  and  long  accepted  doctrines,  brought  into  ques- 
tion, and  subjected  to  the  most  rigorous  re-examination.  In  the  brief 
communication  appearing  under  our  original  head,  our  respected  corres- 
pondent has  entered  into  an  examination  of  an  opinion  wThich,  for  many 
years,  has  maintained  its  hold  upon  the  convictions,  not  only  of  the  peo- 
ple, but  which  has  been  scarcely  ever  doubted,  so  far  as  our  knowledge 
extends,  by  the  Profession.  That  honey  sometimes  contains  elements 
which  are  deleterious  to  man,  many  facts,  not  only  of  occasional  daily 
occurrence,  will  corroborate,  but  the  long  chain  of  testimony  will  be 
found  even  reaching  back,  far  into  the  dim  records  of  ancient  history, 
connecting  the  familiar  occurrences  of  to-day  with  the  mythic  annals  of 
the  past.  The  first  account  we  have  of  an  accident  from  the  eating  of 
poisonous  honey  is  that  given  by  Xenophon,  of  the  effect  produced  upon 
the  Grecian  soldiers  during  the  celebrated  retreat  of  the  ten  thousand 
after  the  death  of  the  younger  Cyrus,  which,  though  it  did  not  operate 
fatally,  "gave  those  soldiers  who  ate  of  it  in  small  quantities,  the  ap- 
pearance of  being  intoxicated,  and  such  as  partook  of  it  freely,  the 


716  Editorial  [October, 

appearance  of  being  mad  or  about  to  die — numbers  lying  on  the  ground 
as  if  after  a  defeat."* 

In  more  modern  times,  we  have  well  authenticated  accounts  of  the 
injurious  effects  of  certain  specimens  of  honey.  The  author  just  quoted 
states  that  he  once  knew  a  lady  upon  whom  the  eating  of  honey,  or  the 
drinking  of  mead,  acted  like  poison,  and  that  he  had  heard  of  instances 
of  death  from  the  same  cause.  That  bees  sometimes  extract  their  honey 
from  poisonous  plants,  there  can  be  no  doubt,  and  the  results  are  not 
confined  to  individuals  of  a  particular  habit  of  constitution  or  idiosyncra- 
sy. In  the  fifth  volume  of  The  American  Philosophical  Transactions, 
will  be  found  an  account  by  Dr.  Barton,  of  an  extensive  mortality  which 
was  produced  amongst  those  who  had  partaken  of  the  honey  collected 
in  the  neighborhood  of  Philadelphia,  in  the  autumn  and  winter  of  the 
year  1790.  "  The  attention  of  the  American  government  was  excited 
by  the  general  distress,  a  minute  inquiry  into  the  cause  of  the  mortality 
ensued,  and  it  was  satisfactorily  ascertained  that  the  honey  was  chiefly 
collected  from  the  Kalmia  latifolia.v  It  is  also  said  that  a  specimen  of 
poisonous  honey,  which  continued  to  retain  its  deleterions  properties  for 
a  very  long  time,  was  sent  from  Trebizond,  on  the  Black  Sea,  to  the 
Zoological  Society  of  London,  in  the  year  1834,  by  Keith  E.  Abbott,  Esq. 

We  might  collect  from  various  sources  facts  which  clearly  prove  the 
occasionally  noxious  properties  of  honey,  but  these  are  certainly  not 
sufficiently  numerous  to  interdict  its  use,  either  as  an  article  of  diet,  or 
as  an  occasional  ingredient  in  pharmaceutical  preparations,  but  at  the 
same  time  these  facts  will  serve  to  assist  the  practitioner,  in  accounting 
for  any  phenomena  indicating  poisoning,  which  may  be  observed,  after 
partaking  of  this  kind  of  food.  % 

The  argument,  used  by  our  correspondent,  that  the  sagacity  of  the 
bee  will  be  any  protection  against  the  sometimes  poisonous  nature 
of  their  honey,  is  by  no  means  unanswerable.  The  instinct  which 
directs  and  governs  the  actions  of  insects  is  truly  remarkable,  and,  per- 
haps, in  no  race  more  conspicuously  so  than  in  the  bee ;  but  it  must  be 
remembered  that  this  "  mimic  of  the  reasoning  faculty"  is  an  endowment 
to  animals,  which  has  direct  reference,  so  far  as  we  can  see,  to  their  own 
preservation  and  to  the  propagation  of  their  own  species,  and  does  not 
refer  in  the  least,  except  incidentally,  to  the  welfare  of  man.  The  in- 
stinct of  the  bee  may,  in  most  instances,  preserve  him  and  his  race  from 
the  toxic  effects  of  the  deleterious  properties  of  flowers,  and  yet  what 
has  served  as  his  nutriment,  may  be  for  man,  a  most  destructive  poison. 
The  question,  perhaps,  cannot  be  definitely  settled  without  further  in- 
vestigation, as  to  the  frequency  with  which  we  are  to  find  poisonous 

*  See  Kirby  <fe  Spence. 


1858.]  Editorial  717 

elements  in  honey,  but  so  far  as  we  have  examined  the  subject,  the 
weight  of  historical  record  is  greatly  in  favor  of  the  opinion,  that  this  de- 
lightful natural  product  has  been  often,  the  medium  by  which  the  most 
deleterious  poisons  have  been  introduced  into  the  system.  The  ques- 
tion at  the  present  time  is,  however,  of  somewhat  less  importance  to  the 
physician  and  pharmaceutist  than  formerly,  when  most  of  those  prepa- 
rations in  which  sugar  is  now  used,  honey  was  an  important  adjuvant. 
In  its  relation  to  honey  as  an  article  of  food,  the  question  still  retains 
its  pristine  interest,  and  should  our  correspondent's  communication  in- 
cite useful  inquiry  upon  the  subject,  in  this  important  relation,  we  feel 
assured  that  he  will  be  much  gratified  by  the  result,  whether  it  corrobo- 
rates or  contradicts  his  own  present  convictions. 


Vaccination  for  Hooping  Cough. — In  presenting  the  following  in- 
teresting correspondence,  we  regret  that  time  has  not  been  allowed*  to 
make  such  references  to  the  records,  as  doubtless  there  are,  as  would  tend 
to  settle  the  question  in  dispute.  The  journals  some  years  back,  according 
to  our  recollection,  contained  numerous  references  to  the  subject,  but 
we  were  not  aware,  till  seeing  the  letter  of  Dr.  Parkhurst,  that  the  expe- 
riment had  been  tried  at  so  early  a  date  after  the  discovery  of  Jenner. 

Decatur,  Ga.,  August  24th,  1858. 
Editors  of  Southern  Medical  and  Surgical  Journal : 

Gentlemen, — The  question,  "  Who  originated  the  practice  of  vaccin- 
ation for  abating  the  symptoms  of  Hooping-cough  ?"  is  sometimes  asked, 
and  as  it  has  been  claimed  to  be  of  very  recent  origin,  I  beg  to  give  you 
the  copy  of  a  letter  which  I  received  from  an  old  practitioner  of  medi- 
cine.     ( 

Petersham,  Mass.,  17th  July,  1857. 

Dear  Sir, — I  received  yours  of  the  6th  instant:  "  You  ask  me  what 
success  I  have  in  treating  Hooping-cough  by  vaccination  with  kine-pox 
matter,  and  with  whom  did  the  idea  originate  ?"  Forty -two  years  ago, 
this  autumn,  I  moved  to  Petersham,  and  hooping-cough  was  prevalent 
at  that  time  in  this  place.  Dr.  Jos.  H.  Flint,  late  of  Springfield,  was 
my  predecessor.  He  was  using  at  that  time  vaccine  virus  as  a  remedy 
in  that  complaint. 

I  have  been  in  practice  over  fifty  years,  and  whether  it  was  in  use  at 
the  time  I  commenced  the  practice,  I  am  not  confident,  but  I  have  the 
impression  that  it  was. 

Who  originated  the  practice  is  beyond  my  power  to  tell.  If  vou  wish 
anything  more  definite,  you  can  obtain  it  from  Dr.  James  Jackson  of 
Boston,  an  aged  physician,  and  a  man  of  great  medical  learning  and 


718  Editorial  [October, 

long  experience — having  been  a  Professor  in  the  Medical  College  of 
Boston  for  many  years. 

You  ask  me,  u  What  success  I  have  had  in  the  use  of  this  remedy  in 
the  Hooping-cough  ?"  It  is  my  opinion,  when  used  early  in  this  dis- 
ease, it  mitigates  the  severity  of  the  complaint,  and  many  times,  seems 
to  cut  short  its  career.  Truly,  yours, 

WILLIAM  PARKHURST. 

If  this  is  of  the  least  importance,  you  are  at  liberty  to  use  the  facts, 
or  the  letter,  as  you  choose.  Respectfully, 

LEVI  WILLARD. 


Commendable  to  the  Profession. — The  Newbern  (N.  C)  Gazette, 
a  high-toned  and  spirited  secular  paper,  gives  the  following  rebuke  to 
everything  which  savours  of  Quackery: — "The  Howard  Association  is 
informed  that  the  price  of  admitting  an  advertisement  of  the  length  of 
the  size  it  sends  us,  would  be  about  $40.  But  we  would  not  insert  it 
under  any  consideration  :  Patent  medicines,  lottery,  humbug  and  obscene 
advertisements,  will  never  appear  in  the  columns  of  this  paper." 

We  have  never  exactly  understood  what  connection  that  highly  be- 
nevolent body,  the  Howard  Association,  constituted  as  it  is,  by  the  noblest, 
the  most  self-sacrificing  and  the  most  intelligent  of  our  countrymen,  may 
have  with  the  advertisements  found  everywhere  in  the  secular  press,  but 
certain  it  is,  that  if  they  do  not  indicate  a  felonious  misappropriation  of 
clarum  et  venerabile  nomen,  it  is  a  most  horrible  prostitution  of  the  spirit 
of  that  beneficent  Association. 


The  Health  of  Augusta. — While  we  have  to  regret  the  prevalence 
of  Yellow  Fever  in  our  sister  cities — Charleston,  Savannah,  Mobile,  and 
New-Orleans — we  can  but  feel  grateful  for  the  unexampled  health  of 
our  own  city.  "  The  official  report,"  says  the  Chronicle  and  Sentinel  of 
this  city,  "  of  the  number  of  deaths  in  Charleston  for  the  week,  ending 
Saturday  18th  (inst),  shows  a  total  of  171 — 128  of  which  were  from 
Yellow  Fever,  an  increase  of  25  over  the  previous  week.  Of  the  deaths 
by  Yellow  Fever,  99  were  white  adults,  23  white  children,  3  coloured 
adults,  and  3  coloured  children." 

This  almost  entire  exemption  of  the  coloured  population  is  indeed  re- 
markable, but  yet  not  without  precedent:  in  1839,  during  the  epidemic 
in  Augusta,  very  few  negroes  died  of  the  disease,  more  mulattoes  and  a 
large  number  of  whites.  So  complete  was  the  exemption  of  negroes, 
that  many  of  them  considered  the  disease  intended  as  a  special  affliction 
to  the  whites. 


1858.]  Editorial  719 

Our  own  city  still  maintains  its  character  for  health,  and  there  is  every 
indication  of  the  happy  condition  continuing.  Some  apprehension  was 
felt  by  a  few  citizens  when  the  Yellow  Fever  appeared  in  Savannah,  but 
this  was  the  only  foundation  for  the  uneasiness ;  every  other  circum- 
stance is  opposed  to  the  disease  appearing  here.  The  very  cleanly 
condition  of  our  city,  the  prevalence  of  western  winds,  and  the  refresh- 
ing and  wholesome  showers  during  last  month,  are  all  conditions  which 
did  not  obtain,  immediately  preceding  either  of  the  two  epidemics  here- 
tofore in  Augusta.  In  1839,  turnips  were  planted  in  the  dry  bed  of  the 
Savannah  River,  and  in  1854,  the  corn  crops  in  our  immediate  neigh- 
borhood were  destroyed  by  drought. 

We  fervently  hope,  that  an  early  frost  may  drive  the  destroyer  from 
all  those  cities,  now  mourning  under  his  sway. 


"Honey  Catches  more  Flies  than  Vinegar." — Let  us  Try  Honey. 
— Notwithstanding  the  alleged  noxious  properties  of  honey,  we  have 
concluded  to  initiate  a  series  of  experiments  which  will  be  calculated  to 
test  its  properties  in  a  very  important  relation.  Upon  the  result,  we 
are  almost  willing  to  stake  our  reputation  for  good  judgment,  at  least,  in 
matters  of  this  sort. 

Did  our  readers  have  the  opportunity  we  enjoy,  of  perusing  the  many 
"calls  upon  subscribers,"  "gentle  hints,"  " plain  talks,"  <fec,  in  which 
courteous  but  urgent  duns  are  presented  to  the  subscribers  of  many  of 
our  exchanges,  they  would  certainly  come  to  one  of  two  conclusions ; 
either  the  readers  of  the  Southern  Medical  and  Surgical  Journal  are  an 
unusually  prompt  corps  of  subscribers,  or  the  Editors  are  very  remiss  in 
their  calls  for  payment,  as  compared  with  those  of  other  journals.  The 
former  of  these,  we  are  happy  to  say,  comes  nearer  the  truth ;  we  have 
indeed,  as  a  general  thing,  an  excellent  list  of  subscribers,  who  by  their 
punctuality  have  afforded  us  but  little  excuse  for  showing  our  talents  in 
the  financial  department  of  the  Journal  office,  and  while  we  have  fre- 
quently had  occasion  to  thank  our  patrons  for  our  handsome  list  of 
monthly  payments,  we  have  not  once,  taken  occasion  to  make  any  call 
editorially  upon  delinquents. 

The  Southern  Medical  and  Surgical  Journal  has  been,  for  years,  a  self- 
supporting  periodical,  notwithstanding  the  heavy  expense  attending  its 
publication,  and  our  liberal  publisher,  Mr.  J.  Morris,  at  the  opening  of 
the  present  volume,  has  considerably  enlarged  the  work,  trusting  confi- 
dently to  the  high  appreciation  of  our  readers,  and  hoping  that  by  their 
punctuality  he  would  be  saved  from  any  embarrassment  in  carrying  out 
the  liberal  arrangements  he  had  contemplated  for  their  benefit.  These 
expectations  have  not  been  always  met  as  fully  as  they  should  have 


720  Editorial  [October, 

been  ;  but  on  looking  over  the  list  of  those  in  arrears,  we  are  convinced — 
for  many  of  them  are  our  personal  friends  and  familiar  acquaintances — 
that  a  simple  statement  of  their  dues  by  us,  reminding  them  that  the 
payment  is  now  important,  will  be  responded  to  promptly  by  them  all. 

Our  publisher  has  considerable  weekly  payments  to  meet,  and  de- 
pends mainly  upon  receipts  of  money  from  subscribers  for  their  liquida- 
tion. The  small  sum  of  three  or  six  dollars  is  but  little  to  each  individ- 
ual subscriber,  but  the  delay  in  receiving  it,  in  the  aggregate,  frequently 
causes  him  much  inconvenience.  We  know  so  well  the  business  habits 
of  that  species  of  the  genus  homo  termed  "  Doctor,"  that  we  can  well 
account  for  any  ordinary  amount  of  delay  attending  their  payments, 
and  yet  we  know  too,  that  of  all  men,  they  are  the  most  liberal,  just, 
and  kind  hearted — all  three  of  these  admirable  attributes  must  now  be 
put  in  requisition,  for  the  money  is  in  real  demand.  In  closing  this  ra- 
ther unusual  editorial,  we  would  say  to  each  reader;  "Before  you  leave 
the  chair,  enclose  your  Three,  or  your  Six,  or  your  Fifteen  dollars  in  an 
envelope,  with  a  short  line,  even  in  pencil-mark,  with  your  name  and 
address,  and  direct  to  J.  Morris,  Publisher,  Augusta,  Ga.  Your  name 
will  then  stand  clear  and  unblemished  upon  our  subscription  list,  and 
what  is  alwa}-s  gratifying  to  us  as  editors,  we  shall  feel  no  fear  of  losing 
an  intelligent  and  appreciating  reader.  "  Losing  a  reader,"  refers  to  a 
certain  surgical  operation  which  Mr.  Morris  sometimes  threatens  to  per- 
form, which  always  proves  fatal  to  the  relation  which  we,  as  Editors, 
sustain  to  our  subscribers.  But  we  are  baiting  now  with  honey  and  do 
not  intend  that  it  shall  even  smell  of  vinegar.  We  wait  in  anxious  but 
confident  expectation  the  result  of  our  entomological  experiment,  which 
perhaps  would  be  better  denominated,  "  An  experimental  inquiry  into 
the  relative  value  of  Honey  and  Vinegar  in  the  apprehension  of  Flies. 


Navy  and  Army  Appointments. — We  are  gratified  to  find  that  one 
of  the  two  out  of  twenty-seven  applicants,  receiving  the  recommendation 
of  the  Medical  Board  for  army  appointments,  was  a  Georgian : 

Naval  Appointments. — The  Board  of  Naval  Surgeons  recently  con- 
vened in  this  city,  consisted  of  Surgeons  Greene,  President;  Rusehen- 
berger  and  Foltz,  members;  and  Passed  Assistant  Surgeon  Howell, 
Recorder.  Twenty-seven  candidates  presented  themselves  for  examina- 
tion, of  whom  the  lollowing  gentlemen  were  selected  as  qualified  for  the 
post  of  Assistant  Surgeons  in  the  United  States  Navy  :  Drs.  Bertolette, 
of  Pa. ;  Leach,  of  N.  H. ;  Christian,  of  Va. ;  Megee,  of  Pa. ;  Gibbs,  of  N. 
J. ;  Burnett,  of  Pa. ;  and  King,  of  Pa. 

Army  Appointments. — The  Army  Medical  Board  met  at  Richmond, 
in  April  last,  and  selected  but  two  of  twenty-seven  candidates  who  were 
examined.  Drs.  J.  H.  Bill,  of  Pa.,  and  J.  H.  Berrien,  of  Ga.,  were  the 
successful  candidates. — \N.  Am.  Med.  Chir.  Review. 


1858.]  Miscellaneous.  721 

Professional  Dignity. — The  following  independence  of  bearing  to- 
wards those  in  high  places,  might  well  be  expected  from  the  physician, 
who  could  say  to  his  King's  messenger — "Tell  his  Majesty  to  wait :" 

Abemethfs  Figs. — When  Abernethy  was  canvassing  for  the  office  of 
surgeon  to  St.  Bartholomew's  Hospital,  he  called  upon  a  rich  grocer. 
The  great  man,  addressing  him,  said:  "  I  suppose,  sir,  you  want  my 
vote  and  interest  at  this  momentous  epoch  of  your  life  Y*  ,k  Xo,  I  don't, 
(said  Abernethy.)  I  want  a  pennyworth  of  figs;  come,  look  sharp  and 
wrap  them  up — I  want  to  be  off." 

Laceration  of  the  Ferinceum,  occurring  during  Labor  in  a  Girl  thir- 
teen yiars  old  ;  Conception  having  taken  place  at  twelve  years  and  three 
months.  Dr.  H.  Bigelow  reported  the  case. — The  patient  was  a  farm- 
er's daughter,  who  was  delivered  of  a  child  one  year  ago,  being  then  13 
years  and  11  days  old.  She  was  small,  rather  slender,  and  not  particu- 
larly developed.  The  rent  extended  nearly  to  the  top  of  the  sphincter, 
from  three-fourths  of  an  inch  to  an  inch  up  the  anus,  so  that  there  was 
a  constant  tendency  to  the  passage  of  faeces,  particularly  when  there 
was  looseness  of  the  bowels.  The  skin  had  formed  over  the  laceration 
wrhen  Dr.  B.  sa^v  it,  and  he  advised  the  operation  to  be  deferred;  the 
patient  recovered  without  it.  She  is  now  perfectly  well,  the  upper  part 
of  the  sphincter  having  assumed  the  function  of  the  whole  muscle.  The 
child  was  of  average  size  and  perfectly  healthy. — [Boston  Med.  &  S.  Jl. 

New  Haemostatic. — After  prolonged  experience,  M.  Lami  strongly  re- 
commends the  following  haemostatic:  R  Decot.  rhatanise,  300  parts; 
alum,  60  parts.  If  given  internally,  70  parts  of  syrup  are  to  be  added. 
Internally,  10  drachms  may  be  taken  three  times  daily ;  while  for  exter- 
nal use  it  may  be  employed  as  injection  or  lotion. — Boston  Med.  Jl. 


Sir  Benjamin  Brodie. — The  Council  of  the  Royal  Society,  London, 
have  recommended  Sir  Benjamin  Brodie  to  the  Fellows  as  president  of 
that  most  scientific  body.  As  it  is  usual  for  those  who  are  selected  by 
the  Council  to  be  elected,  Sir  Benjamin  will,  in  all  probability  be  placed 
at  the  head  of  a  society  of  which  he  has  always  been  a  distinguished 
member.  Not  only  is  he  the  leading  and  most  eminent  surgeon  of  that 
great  metropolis,  but  he  also  holds  a  high  rank  as  a  philosopher  and  a 
man  of  science,  so  that  the  Fellows  of  the  society  may  feel  proud  of  his 
election. — [JV.  Amer.  Med.  Chir.  Review. 


Sound  Common  Sense  and  Quackery. — There  are  few  more  danger- 
ous men  in  society  than  he  who  prides  himself  upon  his  sound  common 
sense.  Every  one  has  met  this  man,  and  knows  his  characteristics  well. 
He  has  no  book-learning,  and  is  inclined  to  be  thankful  that  he  has  not; 
he  is  none  of  your  recondite  book-worms,  full  of  cranks  and  nonsense; 
he  is  a  thoroughly  common-sense  man.  And  so,  without  any  special 
knowledge  on  any  subject,  he  thinks  himself  qualified  to  decide  upon  all. 
He  makes  his  own  will  in  a  plain  and  straightforward  way,  which  in- 
volves his  heirs  in  an  endless  chancery  suit.  He  does  everything  in  his 
own  private  and  sensible  fashion,  and  being  always  "  open  to  conviction," 


722  Miscellaneous. 

ten  to  one  but  lie  falls  a  victim  to  the  first  plausible  quack  whom  he 
meets.  He  eschews  the  mysteries  of  medicine,  and  laughs  at  the  care- 
fully-wrought theories  of  the  treatment  of  disease.  He  trusts  to  the  light 
of  common  sense,  and  adventures  by  its  aid  to  grope  obscurely  amongst 
the  complicated  ropes  and  pulleys  by  which  man's  frame  is  guided,  and 
to  tamper  with  the  delicate  machinery,  with  about  as  much  success  as 
an  ignorant  land-lubber  might  have  in  adventuring  to  handle  a  ship's 
ropes  in  a  storm,  reefing  when  he  should  furl,  and  hoisting  sail  when  he 
should  scud  with  bare  poles.  Common-sense  men  delight  in  acting  as 
their  own  physician  :  and  this  to  be  sure,  they  have  a  right  to  do ;  and, 
if  they  choose,  to  poison  themselves  with  lobelia,  salivate  themselves 
with  "vegetable"  mercury,  or  line  their  intestines  with  antiseptic  char- 
coal. We  should  be  very  little  inclined  to  dispute  this,  their  undoubted 
privilege.  But  they  are  commonly  unwilling  to  confine  the  benefits  of 
their  common  sense  to  their  own  proper  person,  and  in  their  anxiety  to 
extend  them  to  other  less  sensible  fellows  they  bring  themselves  within 
the  range  of  sharp  criticism.  It  is  thus  that  we  find  ourselves  called  upon 
to  concur  in  a  vigorous  rebuke  inflicted  by  an  inquest  jury  at  Woolwich, 
upon  a  Mr.  Clark,  a  dissenting  minister.  This  gentleman,  considering 
hydropathy  to  be  based  upon  reasonable  principles,  and  to  be  a  more 
44  sensible  system"  of  medication  than  that  recommended  by  the  great 
men  who  have  devoted  their  lives  to  the  study  of  medicine,  proceeded 
to  apply  his  principles  to  the  friendly  treatment  of  an  unfortunate  man, 
afflicted  with  pneumonia,  pleurisy,  and  pericarditis.  He  immersed  his 
victim  in  cold  water,  and  swathed  him  in  wet  bandages  a^  the  time  that 
he  was  undergoing  treatment  by  calomel.  Gross  deception  was  prac- 
ticed upon  the  qualified  attendant.  The  patient  sank  rapidly,  and  Mr. 
Clark,  finding  things  look  badly  for  him,  beat  a  hasty  but  untimely  re- 
treat. It  was  too  late  to  save  the  patient — if  at  any  time  he  could  have 
been  saved.  The  jury  included  in  the  blame,  Mr.  Clark  and  the  relatives ; 
they  greatly  censured  the  blind  assurance  which  could  presume  to  med- 
dle in  a  matter  of  life  and  death,  the  dangerous  ignorance  which  could 
so  mischievously  blunder,  and  the  unworthy  deception  which  could 
counsel  concealment  from  the  attending  surgeon.  It  is  hard  to  say  how 
many  lives  are  snuffed  out  by  sheer  ignorance  and  stupidity.  We 
chronicle  but  a  tithe,  and  yet  our  gathering  is  abundant.  Our  sheaves 
overflow  with  fulness,  and  the  sprouting  crop  of  quackery  almost  defies 
the  edge  of  the  scythe. — [London  Loncet. 


Death  of  Foreign  eminent  Medical  Men. — One  of  the  most  distinguish- 
ed surgeons  whom  Ireland  has  produced,  Sir  Philip  Crampton,  lately 
died  in  Dublin  in  the  82d  year  of  his  age.  We  also  notice,  in  the  Eng- 
lish journals,  the  death  of  Dr.  John  Snow,  an  eminent  physician  of 
London,  well  known  for  his  researches  on  chloroform  and  other  anaes- 
thetics. Dr.  Snow  died  from  an  attack  of  apoplexy,  June  16th. — [Boston 
Med.  and  Surg.  Journal. 


SOUTHERN 

MEDICAL  AND  STOGICAL  JOUMAL. 


(NEW  SERIES.) 


Vol.  XIV.]  AUGUSTA,  GEORGIA,  NOVEMBER,  1858.  [No.  11. 


ORIGINAL  AND  ECLECTIC. 

ARTICLE   XXV. 

Observations  on  Malarial  Fever.  By  Joseph  Joxes,  A.M.,  M.D., 
Professor  of  Chemistry  and  Pharmacy  in  the  Medical  College 
of  Georgia,  Augusta. 

[Continued  from  page  676  of  October  No.  1858.J 

Case  XXXII. — Irish  laborer,  age  23 :  has  been  in  America 
eighteen  years — the  last  three  years  has  resided  in  Savannah. 
This  summer  has  been  "running"  on  a  coasting  schooner,  be- 
tween Savannah  and  the  rice  plantations  on  the  Ogeechee  and 
Savannah  rivers. 

July  17th,  12  o'clock  M.  Has  entered  the  hospital  with 
oedema  of  the  abdomen  and  lower  extremities.  Says  that  he 
has  had  fever  for  three  weeks,  and  that  "it  was  broken  by  sul- 
phate of  quinia  and  five  Quack  pills. 

Complains  of  debility  and  great  irregularity  in  the  action  of 
his  bowels.  Has  had  no  stool  for  three  days.  Liver  and  kid- 
neys appear  to  be  torpid ;  tongue  clean;  respiration  20;  pulse 
61.  Under  the  action  of  alteratives  and  tonics,  the  action  of  the 
kidneys,  liver  and  bowels  was  restored,  the  oedema  disappeared, 
his  appetite  and  strength  returned,  and  he  left  the  hospital  July 
30th. 

August  18th.  Has  returned.  After  leaving  the  hospital, 
commenced  work  in  a  brick  yard,  situated  on  theThunderboldt 
road,  in  alow,  damp,  malarious  district.  The  operatives  at  this 
brick -yard  have  always  suffered  greatly  with  malarial  fever. 

His  skin  is  now  covered  with  an  eruption,   resembling  the 

severest  form  of  lichen  agrius.     This  eruption  is  thick  upon  his 

jface,  neck  and  chest.     In  these  regions,  and  especially  upon  the 

face,  the  papulae  are  very  numerous — prominent — of  a  vivid  red 

\  color,  and  in  many  places  closely  aggregated  into  large  clusters, 

y.s. — vol.  xrv.  no.  xl  41 


724  Jones,  on  Malarial  Fever.  [November, 

of  irregular  form  and  size.  Numerous  vesicles  and  pustules, 
containing  sero-purulent  fluid,  are  mingled  with  the  papulae. 
From  the  clusters  of  papulae,  vesicles  and  pustules,  an  ichorous 
or  sero-purulent  fluid  issues  which  desiccates  into  yellow  crusts. 
In  some  places,  from  the  thickening  of  the  skin,  the  density  of 
the  crust,  and  the  depth  of  the  fissures,  the  disease  might  be  mis- 
taken for  psoriasis.  On  the  legs  the  eruption  is  much  thinner 
and  resembles  lichen  tropicus  (prickly-heat).  The  vesicles  and 
pustules  are  so  large  and  numerous  that,  across  the  ward,  the 
eruption  resembles  small-pox.  Pulse  100;  skin  hotter  than 
normal. 

$.  Bitartrate  of  potassa,  H ;  Water,  flxvi.  Mix.  To  be 
taken  during  the  24  hours.     3.  Tepid  salt-water  bath. 

August  19th.  Pulse  100;  tongue  red  at  tip,  and  coated  with 
yellow  fur;  skin  normal  in  temperature.  Complains  of  great 
weakness,  dull  pain  in  his  head,  and  bad  taste  in  the  mouth. 
Bowels  torpid,  have  not  been  moved  for  two  days. 

#.  Calomel,  grs.  x.,  followed  with  castor  oil  in  four  hours. 

August  20th.  The  nurse  states  that,  last  night  he  appeared 
to  be  out  of  his  head.  Respiration  labored ;  pulse  120,  weak. 
The  acceleration  of  the  pulse  appears  to  be  due,  in  part,  to  the 
fact  that  he  has  just  returned  from  the  water-closet,  at  the  oppo- 
site end  of  the  ward.  Appears  to  be  completely  exhausted  by 
the  effort,  and  complains  of  great  weakness. 

Ifr.  Sulphate  of  quinia,  grs.  xv. ;  Infusion  of  Virginia  snake- 
joot,  fSxvi.  Mix.  Tablespoonful  every  three  hours.  Continue 
the  bitartrate  of  potassa. 

August  21st.  Complains  of  weakness.  Pulse  88;  tongue 
much  cleaner,  very  slightly  coated  with  yellowish  fur,  tip  and 
sides  of  tongue  redder  than  normal.  Eruption  appears  to  be 
drying  up  in  many  places.  Has  a  peculiar,  disagreeable  smellr 
which  was  evident  when  he  first  entered  the  hospital  on  the  18th 
inst.,  and  was  not  dissipated  by  the  salt-water  bath. 

#.  Citrate  of  potassa,  3j.;  Water,  f^xij.  Administer  a  wine- 
glassful  every  three  hours.  Discontinue  the  bitartrate  of  potassa. 
Continue  the  sulphate  of  quinia  and  infusion  of  Virginia  snake- 
root. 

August  28th.  Appears  to  be  improving.  The  eruption  is. 
fast  drying  up  and  disappearing.  The  pustules  are  covered  with 
dried  scales.  Notwithstanding  his  apparent  improvement,  he  is 
very  weak  and  low  spirited.  During  his  sickness  there  has  been 
an  unusual  depression  and  dullness  in  the  action  of  his  intellect. 

$.  Iodide  pf  potassium,  grs.  v.r  three  times  a  day. 

$.  Officinal  infusion  of  quassia  excelsa.  f  §xvi. ;  carbonate  of 
soda,  3j,     Mix.     Win eglassful  three  times  a  day. 

$.  Iodide  of  potassium,  grs.  v.,  three  times  a  day. 

August  30th,     This  morning,  before  taking  his  breakfast,  was- 


1858.]  Jones,  on  Malarial  Fever.  725 

suddenly  seized  with  a  strong  convulsion,  which  lasted  about 
ten  minutes,  and  was  succeeded  by  stupor.  Now,  four  hours 
after  the  convulsion,  cannot  be  aroused  by  the  loudest  interro- 
gations, or  by  violent  shaking.  Skin  moist.  The  perspiration 
stands  in  large  beads  upon  his  forehead.     Pulse  80. 

$.  Four  cui-cups  to  back  of  neck,  mustards  to  extremities, 
and  blisters  to  calves  of  legs.     Castor  oil,  f  3  j. 

August  31st.  Had  another  convulsion  at  10  o'clock  P.  M. 
last  night,  after  which  his  left  leg  appeared  to  be  paralyzed. 
His  left  leg  and  foot  continued  to  tremble  from  the  time  of  the 
convulsion,  during  the  night,  up  to  the  present  time.  The  left 
arm  is  drawn  up  across  the  breast,  and  appears  to  be  paralyzed. 
It  requires  considerable  force  to  straighten  it,  and  when  released 
it  flies  back  to  its  former  position,  like  a  steel  spring.  The  left 
leg  also,  in  like  manner,  returns  when  removed  from  its  posi- 
tion. 

The  oil  operated  three  times.  Tongue  moist  and  clean  ;  pulse 
96.  He  is  stupid,  and  it  requires  loud  talking  to  arouse  him, 
and  then  he  replies  only  by  a  low  grunt.  Although  exceeding- 
ly stupid  his  intellect  is  not  entirely  gone,  for  he  put  out  his 
tongue,  after  several  requests  in  a  loud  voice.  After  having 
protruded  his  tongue,  he  retained  it  in  this  posture,  notwith- 
standing loud  requests  to  the  contrary.  When  pressed  upon 
the  epigasrtic  region,  he  cries  out.  Pressure  here  appears  to  give 
him  great  pain. 

^.  Apply  blister  to  back  of  neck,  and  4  cut  cups  over  epigas- 
tric region.     Calomel,  gr.  i.  every  three  hours. 

Sept.  1st.     This  patient  died  this  morning  at  5J  o'clock  A.  M. 

(5).  Autopsy  five  hours  after  death. 

Exterior. — Body  much  emaciated,  complexion  normal,  erup- 
tion quite  dry,  and  the  scales  commencing  to  fall  off. 

Head. — When  the  scull-cap  was  removed,  about  Ovj.  of 
blood  flowed  from  the  base  of  the  brain.  Dura-mater  normal  in 
appearance.  Arachnoid  membrane  slightly  pearl-colored,  opa- 
lescent in  several  places.  Blood-vessels  of  pia-mater,  especially 
at  the  base  of  the  brain,  filled  with  blood.  Much  blood,  and 
bloody  serum  was  effused  between  the  dura-mater  and  arachnoid 
membrane.  Cerebellum  and  pons-varolii,  of  a  bloody  red  color 
upon  the  exterior.  The  ventricles  of  the  brain  contained  an 
unusual  amount  of  serum.  Structure  of  the  brain  appeared  to 
be  softer  than  normal,  and  the  blood-vessels  were  filled  with 
blood,  and  distinct.  Blood-vessels  of  meclulla-oblongata  and  su- 
perior portion  of  spinal  cord  filled  and  distended  with  blood. 
Much  bloody  serum  was  effused  around  the  spinal  cord.  No 
clots  were  found  in  the  blood  and  serum  effused  upon  the  brain. 
Weight  of  brain ,  grs.  21,655 — equals  lbs.  3,  ozs.  l£. 


726  Jones,  on  Malarial  Fever.  [November, 

Chest. — Lungs  normal.  Heart  normal.  Both  ventricles  con- 
tained light  yellow  clots,  which  appear  to  have  been  formed 
some  time  before  death.  Weight  of  heart,  grs.  5031 — equals 
ozs.  ll|. 

Abdomen. — Liver,  color  darker  than  normal.  When  cut,  the 
color  was  dark  reddish- brown  ;  when  squeezed,  no  bile  could 
be  seen  issuing  from  the  hepatic  ducts;  when  the  cut  surface 
was  exposed  to  the  atmosphere  its  color  became  redder  and 
brighter,  and  the  venous  blood,  flowing  from  the  veins  of  the 
liver,  assumed  the  arterial  hue  upon  the  surface  after  exposure 
to  the  oxygen  of  the  atmosphere.  The  blood-corpuscles  of  the 
blood  of  the  liver  presented,  under  the  microscope,  a  normal  ap- 
pearance. Cells  of  the  liver  appeared  normal — they  were  a  little 
paler  than  usual.  The  oil  globules  were  large,  and  in  many 
parts  of  the  liver  appeared  to  be  as  abundant,  if  not  more  abund- 
ant, than  in  health.  Trommers  and  Moor's  test  showed  the  pre- 
sence of  grape  sugar  in  the  liver.  The  process  of  Bernard  gave 
an  abundant  floculent  deposit  of  animal  starch.  When  the  de- 
posit, precipitated  from  the  decoction  of  liver,  by  alcohol,  was 
treated  with  tincture  of  iodine,  the  nitrogenized  matters  were 
colored  (under  the  microscope)  of  a  yellowish-red;  whilst  the 
animal  starch  was  changed  to  a  beautiful  blue  ar.d  purple  color. 
Weight  of  liver,  grs.  36,312 — equals  lbs.  5,  ozs.  3. 

Spleen. — Much  enlarged  and  softened — when  pressed  between 
the  fingers,  feels  as  if  the  tissues  were  giving  way.  Color,  light 
slate,  not  so  dark  as  malarial  spleens  generally,  but  resembling 
them  in  the  character  of  the  color  and  the  softening  of  the  fibrous 
frame- work.  The  anterior  surface  of  the  capsule  of  the  spleen 
was  attached  by  coagulable  Ivmph  to  the  peritoneum,  thickened 
and  of  a  white  color,  from  the  effusion  of  coagulable  lvmph. 
Pulp  of  spleen,  of  a  purplish  and  reddish-brown  color.  After 
exposure  to  the  atmosphere,  the  pulp  of  the  spleen  upon  its  sur 
face,  assumed  a  bright  arterial  hue.  Under  the  microscope,  the 
blood  of  the  spleen  presented  the  normal  appearance — the  dark, 
granular  masses  were  almost  entirely  absent.  Weight  of  spleen, 
grs.  12J687— equals  lbs.  1,  ozs.  13. 

Pancreas. — Normal  in  size  and  appearance.  Weight  of  pan- 
creas, grs.  1,431 — eqrjals  ozs.  3}. 

Kidneys. — Enlarged,  and  greatly  engorged  with  blood. — 
Weight  of  kidneys,  grs.  7,218 — equals  lbs.  1,  oz.  J. 

Alimentary  Canal.  Stomach. — Blood-vessels  upon  the  exterior 
filled  with  black  blood.  Internal  mucous  membrane  generally 
of  a  reddish  and  pinkish  color,  and  in  many  spots,  where  the 
congestion  was  much  greater,  the  color  was  much  deeper.  Brun- 
ner's  glands,  in  the  duodenum,  and  Lieberkuhn's  follicles,  in  the 
pyloric  extremity  of  the  stomach,  and  in  the  pylorous  and  duo- 
denum, appeared  to  be  enlarged,  and  gave  to  the  mucous  mem- 
brane a  mammillated  appearance. 


1858.]  JONES,  on  Malarial  Fever.  727 

Small  Intestines. — Mucous  membrane  of  a  reddish  color,  with 
blood-vessels  tilled  with  blood,  especially  at  the  superior  portion. 
The  glandsof  Peyer,  in  the  interior  poition  ofthe  iutestinep,  were 
distinct,  but  pale,  and  without  any  evidence  of  congestion.  The 
solitary  glands  of  the  inferior  portion  ofthe  ileum,  especially  in 
the  region  of  the  ileocecal  valve,  were  enlarged.  Solitary 
glands  in  the  superior  portion  of  the  colon,  also  enlarged.  Mu- 
cous membrane  ofthe  stomach  and  intestines  was  cjl<n\d  yellow 
by  the  bile.  The  small  intestines  contained  much  offensive  gas, 
tenaceous  mucous,  and  fecal  matters,  colored  yellow  by  the  bile. 
The  colon  was  distended  with  offensive  gas. 

It  is  evident  from  this  autopsy,  that  the  effusion  of  blood  upon 
the  brain  was  the  cause  of  the  death  of  this  patient;  fur  the 
eruption  was  fast  disappearing — the  liver  had  almost  regained 
its  normal  hue,  its  blood  possessed  the  power  of  changing,  upon 
exposure  to  the  atmosphere,  to  the  arterial  color — the  elabora- 
tion of  the  bile,  animal  starch  and  grape  sugar,  was  performed 
in  a  normal  manner. 

The  spleen  appeared  to  be  fast  recovering  from  the  effects  of 
malarial  iever.  Although  softened  and  enlarged,  still  its  pulp 
had  regained  the  power  of  changing  when  exposed  to  the  at- 
mosphere, to  the  arterial  hue,  and  the  blood  corpuscles  appeared, 
under  the  microscope,  to  be  normal  in  form  and  color.  The 
effusion  of  blood  upon  the  brain,  and  of  serum  into  the  ventri- 
cles, and  the  softening  of  its  structures,  appear  to  have  been  the 
results  ol  alterations  of  the  nervous  elements,  capillaries  and 
blood. 

Were  these  the  results  ofthe   action  of  the  malarial  poison  ? 

The  following  cases  have  an  interesting  bearing  upon  this 
question : — 

Case  XXXIII. — House  painter — native  of  Xew  York:  red 
hair,  blue  eyes,  florid  complexion  ;  height  5  feet  9  inches;  a^e 
30  years;  weight,  in  health,  160  lbs. 

October  20th.  Has  entered  the  hospital,  with  a  note  from  his 
attending  physician,  stating  that  he  had  an  attack  of  malarial 
fever  three  weeks  ago.  This  yielded,  in  the  course  of  one  week, 
to  the  action  of  sulphate  of  quinia.  Since  that  time,  has  re- 
mained in  a  very  feeble  condition. 

Lips,  tongue,  gums  and  complexion,  pale,  anaemic.  He  ap- 
pears to  be  suffering  from  an  impoverished  condition  of  the 
blood. 

He  was  placed  upon  iron  and  tonics,  and  appeared  to  be  do- 
ng  well,  when,  upon  the  night  ofthe  22nd  in.st.,  he  was  seized 
with  convulsions.  Had  iifteen  successive  convulsions  in  the 
iourse  of  three  hours,  which  left  him  in  an  insensible  condi- 
tion. 


728  Jones,  on  Malarial  Fever.  [November, 

Died  comatose,  seven  hours  after  the  termination  of  the  convul- 
sions. 

(6).  Autopsy  five  houks  after  death. 

Exterior. — Complexion  pale,  anaemic.  Did  not  appear  to  have 
lost  a  great  amount  of  flesh. 

Head. — Not  examined. 

Chest. — Lungs  pale,  anaemic.  Structures  appeared  to  be  nor- 
mal.    Heart  normal. 

Abdominal  Cavity.  Liver. — Upon  a  general  view,  it  was  of  a 
light  slate  color,  with  purplish  and  brownish  reflections.  Upon 
nearer  inspection,  it  presented  a  mottled  appearance — many  of 
the  lobules  presented  the  yellow  color  of  cirrhosis.  The  cut  sur- 
face presented,  upon  a  general  view,  alight  bronze  and  purplish 
yellow  color.  Upon  close  inspection,  the  yellow  lobules  were 
distinctly  visible.  Structure  of  liver  unusually  firm — it  required 
great  force  to  tear  it:  it  was  enlarged.  The  yellow  color  of 
many  of  the  lobules,  and  the  large  admixture  of  dense  fibrous 
tissue,  proves  that  this  liver  was  in  a  cirrhosed  condition  previ- 
ously to  the  attack  of  malarial  fever.  The  yellow  color  of  cir- 
rhosis was  masked  very  much  by  the  characteristic  effects  of  the 
malarial  poison.  Bile,  of  a  brownish-yellow  color,  in  mass,  and 
of  a  gamboge-yellow  color,  in  thin  layers.  It  was  tenaceous, 
like  mucus;  in  fact,  it  resembled  closeiy  colored  mucus. 

Specific  gravity  of  bile  1022'5. 

Spleen. — Enlarged,  and  softer  than  normal,  but  much  harder 
than  usual  in  the  active  stages  of  malarial  fever.  The  cut  sur- 
face presented  a  compact,  dark  brown,  almost  black  appearance. 
Numerous  small  white  bodies,  about  the  size  of  a  millet  seed, 
were  found  scattered  through  the  pulp  of  the  spleen.  I  have 
never  before  seen  the  splenic  corpuscles  so  numerous,  large  and 
distinct.  The  exterior  of  the  spleen  was  of  a  slate  color.  The 
compact  nature  of  the  pulp  of  this  organ  shows  that  it  was  re- 
covering from  the  effects  of  the  malarial  fever. 

Kidneys. — Normal. 

Alimentary  Canal.  Stomach. — Small  and  large  intestines  pre- 
sented a  healthy  appearance. 

The  cirrhosed  condition  of  the  liver  pointed  to  the  previous 
habits  of  this  man.  Although  the  malarial  fever  apparently 
yielded  to  treatment,  still  its  effects,  combined  with  those  of  in- 
temperance, produced  a  fatal  issue. 

Case  XXXIV. — Irish  laborer,  age  40  :  height  5  feet  10  inch- 
es; dark  brown  hair,  brown  eyes,  dark  complexion.  In  health, 
weighs  200  lbs.;  at  the  present  time,  his  weight  is  not  more 
than  100  lbs. 

August  13th.  Has  entered  the  hospital  in  an  exceedingly 
feeble  condition — says  that  he  has  had  a  severe  attack  of  fever, 


1858.]  Jones,  on  Malarial  Fever.  729 

complicated  with  bilious  diarrhoea.  Appears  to  have  been  he- 
roically medicated,  and  at  the  same  time  neglected  during  his 
sickness.  He  is  severely  salivated,  and  his  mouth,  tongue  and 
fauces  are  covered  with  small  ulcers.  Xeglected  sinapisms  and 
blisters  have  produced  large  ulcers  upon  the  epigastric  region 
and  upon  the  thighs  and  legs.  The  surface  of  the  body  has  nu- 
merous boils  and  ulcers,  and  has  a  disagreeable  nauseous  smell. 
Complexion  sallow — anaemic.  Says  that  he  is  "very  weak,  and 
completely  worn  out  with  pain  and  loss  of  sleep." 

Tonics  and  opiates  were  administered,  and  appropriate  reme- 
dies applied  to  the  mouth  and  ulcers  upon  the  skin. 

August  22nd.  Improves  very  slowly.  Mouth  still  sore,  and 
the  ulcers  show  no  disposition  to  heal. 

Examination  of  Blood  No.  YIL — Blood  coagulated  slowly. 
In  the  specific  gravity  bottle  the  colored  corpuscles  settled  to  the 
bottom,  leaving  above  a  clear,  transparent,  yellow  clot.  In  a 
small  shallow  porcelain  capsule  the  superior  central  portions  of 
the  clot  appeared  transparent  for  several  lines  in  depth. 

A  portion  of  blood  was  set  aside  in  a  glass  bottle.  In  twelve 
hours  the  clot  commenced  to  disintegrate  and  liberate  its  colored 
blood-corpuscles,  and  in  twenty-four  hours  the  blood  gave  forth 
a  putrid  smell,  and  the  serum  was  filled  with  the  liberated  co- 
lored, corpuscles,  presenting  the  appearance  of  blood. 

A  specimen  of  blood  drawn  at  the  same  time  from  a  patient 
who  had  recovered  from  an  attack  of  intermittent  fever  three 
weeks  before,  was  placed  in  the  same  room,  in  a  similar  bottle, 
by  the  side  of  this  specimen.  The  clot,  serum  and  odor  of  this, 
remained  unaltered  for  fifty  hours. 

Specific  gravity  of  blood  10424.  Serum  of  a  golden  yellow 
color. 


Water 

In  1000  parts  of  Blood,        839-589 

u     "         "     "Serum,        912779 

<1)  "         "     "  Liq.  Sang.,  909-839 

(2)  "         "     "    u       "       879-S13 


Solid  Matters 

In  1000  parts  of  Blood,        160-411 

u     u         «     "Serum,  87-221 

(1)  "         «     "Liq.Saug.,    90-169 

(2)  "         "     "    "         "      120-187 


Solid  Matters  in  Serum  of  1000  parts  of  Blood,     80-227. 

Fixed  Saline  Constituents, 

In  1000  parts  of  Blood, 7*500 

"       "     Serum, 4-056 

(1)  "       "     Liquor  Sanguinis, 4-066 

(2)  u       a                       " 5-405 

"       "     Solid  Matters  of  Blood, 46-754 

"       "         "                   "  Serum, 46-387 

"       "         "         "         "  Blood  Corpuscles,    -         -         -  51-046 

"       "     Moist  Blood  Corpuscles, 12-181 

In  Blood  Corpuscles  of  1000  parts  of  Blood,          -         .         -  3-770 

u  Serum  of  1000  parts  of  Blood, 3-730 


Liquor  Sanguinis,     -       690-064 


730  J  ones,  on  Malarial  Fever.  [November, 

1000  Parts  of  Blood  Contained, 
Water, 839-589 

D,iedB.ood  Corpuscles,       "*"  f85Sd  "^       '-  WW 

Fibrin, 2.710 

Albumen,  Extractive  and  Coloring  )  Organic  Matters,        -  76-88*7 

Matters,           -         -         80-227  j  Mineral         "             -  3-730 

1000  Parts  of  Blood  Contained, 

Water,          -         -  -  232-452 

Moist  Blood  Corpuscles,  309.936  J- Organic  Matters,  -  -  73-655 

Mineral         "  3-770 

Water,         -         -  -  607-124 

Organic  Matters,  -  -  76-387 

'Mineral       "         -  -  3-730 

Fibrin,                  -  -  2-710 

1000  Parts  of  Moist  Blood  Corpuscles  Contained, 

Water, 750-224 

Organic  Matters,    -         - •      237-645 

Mineral  Matters,  - 12-131 

(1)  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 909-839 

Organic  Matters, 83*075 

Mineral  Matters, 4-066 

Fibrin,            -                  2-948 

(2)  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 879813 

Organic  Matters, 110  695 

Mineral  Matters, 5*405 

Fibrin, 3'927 

August  26th.  Left  arm  is  swollen,  and  painful  to  the  touch. 
Ulcers  upon  the  surface  of  the  body  appear  slightly  improved. 
Still  Ytry  weak.     Disagreeable  odor  continues. 

$.  Apply  cold-water  dressing  to  arm.  Infusion  of  wild- 
chery  bark,  wineglassful  three  times  a  day.  Huxham's  tincture 
of  bark,  tablespoon ful  three  times  a  day. 

Sept.  3rd,  12  o'clock  M.  Lies  in  a  stupor.  Has  taken  a  sud- 
den change  for  the  worse.  During  the  last  week,  has  been  able 
to  dress  himself,  and  sit  by  his  bed.  Cannot  now  be  aroused  by 
hallooing  or  shaking.  This  morning  passed  his  urine  and  fe- 
ces in  bed. 

The  whole  of  the  left  arm,  from  the  shoulder  to  the  tip  of  the 
fingers,  is  greatly  swollen.  Pulse  140;  respiration  28.  Tem- 
perature of  hand',  9dt°5  F. 

$.  Administer  stimulants  freely,  in  conjunction  with  the 
tincture  of  bark. 

3£  o'clock  P.  M,    Lies  with  Ids  mouth  and  eyes  open,  and  ap- 


1858.]  Jones,  on  Malarial  Fever.  731 

pears  to  be  insensible.  Skin  in  a  profuse  perspiration,  which 
has  saturated  his  shirt  and  the  surrounding  bed-clothes.  Pulse 
128;  respiration  33.     Temperature  of  hand,  101°  F. 

Sept.  -ith,  12  o'clock  M.  Lies  in  a  stupor,  with  his  mouth 
open.;  teeth  coated  with  sordes;  passes  his  urine  and  feces  in 
bed.  The  odor  from  his  body  is  nauseating  and  exceedingly 
disagreeable.  Surface  of  skin  covered  with  a  clammy  sweat, 
which  resembles  bloody  serum.  This  sweat  stains  his  shirt  and 
the  bed-clothes,  just  as  bloody  serum  would  do.  Pulse  106;  res- 
piration 26.  Temperature  of  atmosphere,  81°  F. ;  temperature 
of  hand,  100°. 

Sept.  5th,  10  o'clock  A.  M.  Lies  in  a  stupor,  with  mouth  and 
eyes  open.  Every  tendon  and  muscle  of  his  body  is  twitching 
and  jumping  violently.  Kespiration  42,  labored,  thoracic,  spas- 
modic, like  that  of  a  irftin  during  a  severe  chill.  The  muscles  of 
the  thorax  and  abdomen  shake,  and  twitch,  and  jump  violently, 
as  in  a  severe  chill.  At  every  inspiration  and  expiration  he 
emits  a  sound,  like  the  hoarse  bark  of  a  thirsty  and  starved  dog. 
The  muscles  of  the  face  contract  and  relax,  and  contort  in  every 
possible  manner,  making  the  most  awful  grimaces.  During 
these  contortions  of  the  muscles  of  the  face,  every  expression  of 
ridicule,  sarcasm,  joy,  pain,  agony,  malice,  revenge,  hatred,  are 
depicted  in  rapid  succession.  The  jerking  of  the  muscles  appear 
to  be  paroxysmal — they  are  very  violent  for  a  few  minutes,  and 
then  moderate  for  a  few  moments.  The  nurse  states  that  it 
commenced  at  8  o'clock  P.  M.,  and  was  much  more  violent  du- 
ring the  night  than  at  the  present  time.  The  patients  in  this 
ward  state,  that  they  were  kept  awake  during  the  whole  night, 
by  his  barking  and  shaking.  Pulse  144,  feeble.  It  was  very 
difficult  to  count  the  beats  of  the  pulse,  on  account  of  the  vio- 
lent twitching  of  the  tendons  of  the  fore-arm.  Temperature  of 
hand,  103°  F.  Skin  covered  with  the  clammy  sweat,  resemb- 
ling bloody  serum.     Odor  of  body  intolerable. 

7  o'clock  P.  M.  Kespiration  40,  thoracic,  spasmodic  ;  pulse 
140.  Continues  in  the  same  jerking  state;  spasmodic  bark  is 
much  lower  and  hoarser;  skin  hot. 

Sept.  6,  10  o'clock  A.  M.  Lies  in  the  same  insensible  state, 
with  his  body  covered  with  the  clammy  reddish  sweat,  and 
emitting  an  awful  stench.  Twitching  and  jerking  and  contor- 
tion of  muscles  have  ceased.  Eespiiation  38,  spasmodic,  gasp- 
ing. Pulse  140.  Temperature  of  hand,  105°  F. ;  Temperature 
of  atmosphere,  80°.     He  is  evidently  near  his  end. 

This  patient  died  eight  hours  after  this  observation,  at  6  o'clock 
P.  M. 

His  superstitious  friends,  who  had  neglected  him  during  life, 
prepared  a  coffin  before  his  death,  and  placed  him  in  it,  and 
drove  off  half  an  hour  after  his  death. 


732  Jones,  on  Malarial  Fever.  [November, 

Although  exceedingly  anxious  to  perform  a  post-mortem 
examination,  could  not  resist  their  earnest  entreaties  to  the  con- 
trary. 

Case  XXXV*— German  Butcher,  age  23 :  height  5  feet  10 
inches ;  light  brown  hair,  brown  eyes ;  weight,  in  health,  180 
lbs. — his  present  weight  cannot  be  more  than  110  lbs. 

Has  been  suffering  with  chill  and  fever  for  two  months,  and 
has  had  no  medical  attendance  until  the  25th  of  September. 
His  physician  administered  calomel  and  opium,  with  a  view  to 
salivation,  and  placed  a  large  blister,  8  inches  by  7,  over  the 
epigastrium.  This  plan  of  treatment  appeared  to  act  in  concert 
with  the  malarial  poison,  and  exhaust  his  small  store  of  strength. 

He  came  into  my  hands  on  the  28th  of  September,  7  o'clock 
P.  M.,  in  an  exceedingly  feeble  and  critical  condition.  Com- 
plexion sallow,  anaemic ;  flesh  and  strength  greatly  reduced ; 
nervous  and  muscular  forces  very  feeble.  Pulse  120  ;  respira- 
tion 24,  labored.  Lies  in  a  stupor — cannot  be  aroused;  tongue 
dry  and  harsh  to  the  feeling;  skin  dry  and  rough  in  all  parts 
of  the  body,  except  just  around  the  nose,  where  there  is  a  slight 
moisture. 

ty.  Cut-cup  to  each  temple,  and  sinapisms  to  extremities. 
Sulphate  of  quinia,  grs.  v.,  every  three  hours,  up  to  grs.  xxxv. 

$.  Infusion  of  Virginia  snake-root,  Oxvi. ;  Brandy,  f^xvi. 
Tablespoonful  every  half  hour.  Diet,  milk-punch  and  arrow- 
root. 

Sept.  29th,  11  o'clock  A.  M.  The  mustards,  stimulants  and 
sulphate  of  quinia,  have  aroused  him,  and  he  is  brighter  this 
morning,  but  still  not  restored  to  the  full  exercise  of  the  reason- 
ing faculties.  Pulse  112,  fuller  than  at  7  o'clock  P.  M. ;  respi- 
ration 18.  Temperature  of  atmosphere,  80°  F.;  temperature  of 
hand,  95°  12.  Temperature  under  tongue  could  not  be  deter- 
mined, on  account  of  his  restlessness.  Tongue  slightly  coated 
with  yellow  fur,  dry  and  harsh  to  the  feeling. 

ty.  Apply  sinapisms  again  to  the  extremities,  and  continue 
brandy  and  infusion  of  Virginia  snake-root,  tablespoonful  every 
hour. 

4  o'clock  P.  M.  Examination  of  Blood  No.  VIII. — Blood  co- 
agulated slowly.  In  one  specimen  the  coagulation  was  remark- 
ably slow,  and  the  blood-corpuscles  gravitated  towards  the 
bottom  of  the  vessel,  and  left  above  a  clear  golden  colored  clot. 
This  transparent  portion  of  the  clot  was  about  one-fourth  of  an 
inch  in  thickness.  Serum  of  a  deep  golden  color.  Eeaction  of 
serum  alkaline.  Specific  gravity  of  blood  1036*6 ;  specific  grav- 
ity of  serum  1023'6. 

*  The  alterations  of  the  blood  in  this  case  have  been  previously  noticed,  by  the 
author,  in  the  May  number  of  the  Southern  Med.  and  Surg.  Journal 


1858.]  JotfES,  on  Malarial  Fever.  733 


Water 

In  1000  parts  of  Blood,         840511 

"     u         M     M  Serum,        913950 

(1)  "         "     "Liq.Sang.,  912-605 

(2)  "         "     "     "       "       882723 


Solid  Matters 

In  1000  parts  of  Blood,        159489 

"     "         "     u  Serum,  80-050 

(1)  "         "     M  Liq.Sang.,    80-978 

(2)  "  "     u    "       u        117277 


Solid  Matters  in  Serum  of  1000  parts  of  Blood,  79-135. 

Fixed  Saline  Constituents, 

In  1000  parts  of  Blood, 

"     "         "      u  Serum, 

(2) "  "  "  "  Liquor  Sanguinis,  - 
u  "  "  "  Solid  Matters  of  Blood, 
"     M         "      "     "  "         "  Serum, 

"     "         "      u     "  "         "  Blood  Corpuscles, 

"     "         "      "     "  "         -  Moist  Blood  Corpuscles, 

"  Blood  Corpuscles  of  1000  parts  of  Blood,  - 
"  Serum  of  1000  parts  of  Blood,  ...         - 

1000  Parts  of  Blood  Contained, 
Water,  ------ 

Dried  Blood  Corpuscles,      -     79-434  i  °?j™c  ^teTS>     '_ 
Fibrin,  ------ 

Albumen  Extractive  and  Color'g  )  Organic  Matters, 
Matters,  -         -         -       79-096  ]  Mineral        " 

1000  Parts  of  Blood  Contained, 
)  Water, 
Moist  Blood  Corpuscles,         317*748  >•  Organic  Matters,    - 

)  Mineral       " 

Water,    -         -         - 
Organic  Matters, 
Mineral       " 
Fibrin,    -         -         - 


1 

Liquor  Sanguinis,      -     -     682*252 


1000  Parts  of  Moist  Blood  Corpuscles  Contained. 

Water, 

Organic  Matters,    -------- 

Mineral  Matters, -- 


(1)  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 

Albumen,  Extractive  and  Coloring  Matters,       - 

Mineral  Matters,     -  

Fibrin,  -  

(2)  1000  Parts  of  Liquor  Sanguinis  Contained, 

Water, 

Albumen,  Extractive  and  Coloring  Matters,       - 

Mineral  Matters, 

Fibrin, 


5-796 

2-647 

3-498 

36-341 

30-178 

42-914 

10-728 

3-409 

2-387 

840-511 

76-000 

3-409 

0-877 

76-508 

2-387 

238-271 

76-000 

3-409 

602-240 

76-708 

2-387 

0-877 

749-873 

239-284 

10k728 

913022 

83-303 

2-647 

0-928 

882-723 

112-433 

3-498 

1-285 

734  Jones,  on  Malarial  Fever.  [November, 

This  examination  reveals  the  following  changes  in  the  blood : — 

1.  The  fibrin  is  greatly  deficient.  The  deficiency  of  fibrin  in 
the  blood  was  farther  demonstrated  by  the  fact,  that  the  blood 
oozed  from  the  cut-cups  upon  the  temples,  for  18  hours,  and  it 
was  finally  necessary  to  check  the  flow  by  cold  applications. 

2.  The  colored  corpuscles  are  greatly  diminished,  the  dried 
corpuscles  being  79434,  and  the  moist  blood  corpuscles  31 7'748. 
The  fixed  saline  constituents  are  correspondingly  reduced  in 
amount. 

3.  The  color  of  the  serum  is  changed  to  a  golden  color,  and 
the  albumen  is  diminished. 

It  is  worthy  of  note,  that  the  reaction  of  the  blood  is  alkaline, 
while  that  of  the  saliva  and  urine  is  strongly  acid. 

7  o'clock,  P.M.  Pulse  very  feeble ;  feels  like  the  vibration  of 
a  delicate  silver  thread.  Owing  to  its  exceeding  tenuity  and 
feebleness,  cannot  be  counted  with  absolute  accuracy.  The 
number  of  beats  to  the  minute  lies  between  130  and  150. 

Eespiration  34,  thoracic,  labored.  Tongue  dry  and  rough  ; 
feels  to  the  touch  like  sand  paper;  skin  of  trunk  and  extremi- 
ties much  cooler  than  normal.  Has  been  taking  brandy  and 
the  infusion  of  Virginia  snake-root,  and  milk  punch,  during  the 
day.  ty  Apply  sinapisms  to  extremities,  and  continue  the  sti- 
mulants, milk  and  arrow- root. 

September  30th,  2£  o'clock,  P.M.  Sinapisms  aroused  him, 
and  he  appears  to  be  more  intelligent.  Skin  warmer;  Pulse 
112,  still  feeble,  but  decidedly  better  than  last  night.  Eespira- 
tion 17,  full,  thoracic.  Temperature  of  atmosphere,  73°F.;  temp, 
of  hand,  91°.  Tongue  slightly  coated  with  yellow  fur,  moister 
and  softer ;  surface  of  blister  raw  and  red ;  urine  of  a  bright  red 
color;  specific  gravity  1016.  When  carefully  tested  ior  uric 
acid,  the  urine  was  found  to  contain  only  a  trace — a  few  small 
crystals.     Eeaction  of  urine  and  saliva  decidedly  acid. 

fy  Sulphate  of  quinia,  grs.  v.,  every  three  hours,  up  to  grs.  xx. 

ty  Continue  brandy  and  infusion  of  snake-root  tea. 

October  1st,  2  o'clock,  P.  M.  Eestless  and  stupid.  Pulse 
100 ;  respiration  IB,  full,  thoracic.  Temperature  of  atmosphere, 
79°F.;  temp,  of  hand,  88°  5;  temp,  under  tongue,  94°5.  The 
temperature  of  the  trunk  is  between  4  and  6  degrees  below  the 
normal  standard.  The  temperature  of  the  extremities  is  10  de- 
grees below  the  normal  standard.  Tongue  dry  and  rough ; 
teeth  coated  with  sordes;  refuses  to  take  nourishment. 

October  2nd,  2  o'clock,  P.  M.  Intellect  more  active,  but  still 
very  slow  and  dull.  When  aroused,  says  that  he  feels  easy ; 
has  a  disagreeable  smell.  Tongue  of  a  brownish  yellow  color, 
and  as  dry  and  rough  as  a  fresh  sawed  board ;  teeth  coated  with 
sordes;  pulse  124;  respiration  18.  The  incision  in  the  arm, 
where  he  was  bled,  has  not  healed.     It  bled  during  the  night, 


1858.]  Joxes,  on  Malarial  Fever.  735 

and  drops  of  limpid  serum  are  now  oozing  continually  from  it. 
The  left  side  of  his  head  is  swollen,  and  painful  to  the  touch  : 
this  compels  him  to  lie  upon  the  right  side  and  arm  in  which  he 
was  bled. 

$  Tincture  of  chloride  of  iron.  nix  v.  three  times  a  day. 

October  3rd,  2j  o'clock,  P.M.  Pulse  120:  respiration  24. 
The  state  of  his  tongue  presents  a  striking  contrast  with  what  it 
was  yesterday :  it  is  now  moist  and  soft.  Reaction  of  saliva 
decidedly  acid.  During  the  night  his  right  arm  has  swollen 
from  the  shoulder  to  the  end  of  the  fingers,  to  nearly  twice  its 
natural  size;  the  veins  upon  the  surface  are  filled  with  blood; 
the  lancet  wound  is  open  and  emits  a  serous  fluid.  The  lancet 
with  which  he  was  bled  was  carefully  washed  before  its  use. 
The  swelling  of  the  arm  appears  to  be  due  to  the  interference  of 
the  circulation  by  the  pressure  of  his  body,  rather  than  to  a 
poisoned  lancet. 

$  Continue  tonics,  stimulants,  and  nutritive  diet.  Paint  the 
whole  arm,  from  shoulder  to  tip  of  fingers  with  the  tincture  of 
iodine,  and  apply  cold-water  dressing. 

October  4th,  2  o'clock,  P.  M.  Says  "  that  he  feels  badly  ;  has 
pain  all  over."  The  swelling  on  the  left  side  of  the  face,  in  the 
region  of  the  ear,  and  angle  and  joint  of  the  jaw,  continues 
to  increase:  it  is  hard,  tense,  and  painful  to  the  touch.  Boils 
and  ulcers  are  appearing  upon  various  parts  of  his  body.  The 
blister  presents  a  purplish  red,  unhealthy,  raw  surface;  tip  of 
tongue  red  and  glazed;  superior  surface  coated  with  brownish 
yellow  and  black  fur;  tongue  is  so  dry  that  it  is  protruded  out 
of  the  mouth  with  great  difficulty;  pulse  120;  respiration  24. 
Temperature  of  atmosphere,  76°F.;  temp,  of  hand,  100°5.  The 
rise  of  the  temperature  in  the  extremities  is  probably  due  to  in- 
flammatory action. 

October  oth,  2  o'clock,  P.M.  Says  that  he  is  better.  Face  a 
little  flushed  :  up  to  the  present  time  it,  has  been  entirely  with- 
out color;  swelling  in  arm  stationary  ;v  swelling  on  side  of  face 
continues  to  increase,  and  is  very  painful;  pulse  118.  Tempe- 
rature of  atmosphere,  73°F.;  temp,  of  hand,  100°. 

fy  Paint  arm  and  side  of  face  with  tincture  of  iodine. 

October  6th,  4  o'clock,  P.M.  Skin  hot  and  dry;  has  never 
been  moist  since  his  entrance  into  the  hospital.  Complains 
greatly  of  his  head:  carotid  arteries  are  throbbing  violently  ; 
pulse  104;  respiration  24.  Temperature  of  atmosphere,  72°F.; 
temp,  of  hand,  101°;  the  temp,  of  the  trunk  is  about  104°F. 
Since  the  commencement  of  the  inflammation  his  pulse  has  be- 
come fuller  and  stronger.     Slight  moisture  about  the  tongue. 

$  Chlorate  of  potassa,  3i.;  water,  Oviij. — Dissolve.  Ad- 
minister during  the  24  hours,  and  continue. 

$  Compound  tincture  of  gentian,  f  3j.;  comp.  tine.  Peruvian 


736  Jones,  on  Malarial  Fever.  [November, 

bark,  f  3j. — Mix.  Administer  three  times  a  day  in  f  lij.  of  the 
infusion  of  Virginia  snake-root. 

October  7th,  4  o'clock,  P.M.  Arm  greatly  swollen,  and  when 
bent  much  serous  fluid  issues  from  the  lancet  wound.  Surface 
of  blister  shows  no  disposition  to  heal;  ulcers  upon  the  body 
are  increasing;  tongue  moister  and  softer  than  it  has  been  dur- 
ing his  sickness.  Temperature  of  hand,  102°F.;  temp,  of  trunk 
about  104°. 

$  Continue  stimulants,  alteratives,  tonics  and  diuretics.  Diet, 
soft  boiled  eggs,  milk  punch,  wine  whey,  arrow-root  and  mutton 
soup. 

October  9th,  4  o'clock,  P.M.  Appears  brighter  and  stronger. 
Abscess  upon  the  side  of  his  face  has  been  lanced  ;  it  discharg- 
ed a  large  quantity  of  pus ;  it  had  formed  a  communication  into 
the  meatus  auditorias  externus  from  which  much  pus  issued ; 
pulse  163,  probably  excited  by  the  lancing  of  the  abscess  one 
hour  ago. 

October  10th,  4  o'clock,  P.M.  Skin  hot  and  dry;  tongue  dry 
and  rough  ;  abscess  in  the  region  of  the  ear,  and  joint  and  angle 
of  the  inferior  maxillary  bone,  continues  to  discharge  large 
quantities  of  pus,  and  masses  of  cellular  tissue.  Arm  looks 
badly;  the  skin  presents  a  greenish  yellow,  unhealthy  appear- 
ance; the  cellular  tissue  appears  to  be  completely  infiltrated 
with  serum ;  when  it  is  flexed,  and  the  tissues  thus  compressed, 
considerable  quantities  of  this  fluid  issue  from  the  lancet  cut, 
which  has  never  shown  the  least  disposition  to  heal ;  pulse  130, 
full  and  strong;  respiration  28.  Temperature  of  atmosphere, 
70°F.;  temp,  of  hand,  103°75 ;  temp,  under  tongue,  104°5. 

October  12th.  The  surface  of  the  blister  has  commenced  to 
suppurate  and  discharge  an  unhealthy  looking  offensive  fluid. 
It  has'  never  shown  any  disposition,  either  to  healthy  inflam- 
mation or  healing.  The  ulcers  upon  various  parts  of  the  body 
have  steadily  increased  in  size,  and  like  the  blister,  discharge  an 
unhealthy  offensive  fluid,  and  show  no  disposition  to  heal. . 

October  13th.  The  arm  looks  dreadfully  ;  the  skin  over  the 
biceps  muscle  is  black  and  gangrenous ;  digestion  bad  and  bow- 
els loose. 

October  17th.  The  skin  over  the  entire  region  of  the  biceps, 
and  over  a  large  portion  of  the  triceps  mucle,  has  sloughed  en- 
tirely away,  and  exposed  the  red  quivering  muscles.  There 
has  been  no  hemorrhage,  but  a  large  discharge  of  the  serous 
fluid  which  had  infiltrated  the  cellular  tissue.  The  surface  of 
the  blister  and  ulcers,  and  exposed  muscles,  emit  a  disgusting 
stench.     Bowels  are  moved  frequently. 

October  21st.  The  biceps  muscle  has  sloughed  entirely  from 
its  lower  attachment.  It  is  impossible  to  give  a  correct  idea  of 
his  distressing  and  loathsome  condition.     He  is  completely  ex- 


1858.]  JOXES,  on  Malarial  Fever.  737 

haustcd  and  worn  out  by  diarrhoea,  and  by  the  discharge  from 
the  numerous  diseased  surfaces. 

This  patient  died  October  22nd,  Wo1  clock,  P.M. 

It  is  surprising,  that  although  the  patient  has  apparently  had 
the  exercise  of  his  intellect  for  the  last  three  weeks,  he  has  never 
once  been  heard  to  utter  a  complaint.  He  has  been  either  a 
man  of  extraordinary  resolution,  or  else  the  effects  of  the  mala- 
rial poison,  in  conjunction  with  the  changes  which  it  has  pro- 
duced in  the  nervous  system  and  all  the  organs  and  tissues, 
have  tended  to  blunt  the  sensibilities  and  render  the  patient 
callous  alike  to  pain,  disgusting  odors,  and  the  fear  of  death. 
He  has  nothing  in  his  face  to  denote  an  unusual  amouut  of 
either  intelligence  or  resolution,  and  the  latter  appears  to  be  the 
true  supposition. 

(7)  Autopsy  twelve  hours  after  Death. 

Exterior. — Trunk  and  limbs  greatly  reduced  in  flesh — a  skel- 
eton with  the  skin  stretched  over. 

Head,  not  examined. 

Chest. — Lungs  normal,  but  very  pale  and  anaemic. 

Heart,  normal.  The  auricles  of  the  heart  contained  a  quan- 
tity of  fluid  blood,  which  was  carefully  examined  under  the 
microscope.  Colored  blood  corpuscles  appeared  normal  in  color 
and  structure.  When  the  blood  was  treated  with  acetic  acid, 
the  colored  corpuscles  disappeared  and  the  colorless  corpuscles 
remained  behind.  The  colorless  corpuscles  appeared  to  be  more 
numerous  than  normal. 

Abdominal  Cavity.  Liver,  of  a  light  slate  color,  approaching 
ing  in  mauy  places  to  purple  and  purplish-brown,  as  if  it  was 
returning  to  its  normal  color.  The  cut  surface  was  of  a  bronze 
and  purplish-bronze  color,  as  if  its  substance  also  was  returning 
to  its  normal  color.  Structure  of  the  liver  unusually  firm. 
Blood-corpuscles  of  the  blood  of  the  liver  appeared  to  be  normal 
under  the  microscope.  The  liver-cells  were  normal  in  shape — 
only  a  little  paler  than  usual. 

The  Gall-Bladder,  was  filled  with  bile  of  a  brownish-yellow 
opaque  color,  when  seen  in  mass,  and  of  a  gamboge-yellow  in 
thin  layers;  and  with  numerous,  irregularly-shaped,  yellow 
masses,  of  various  sizes,  from  an  English  pea  to  a  grain  of  sand. 
These  yellow  masses  formed  about  two-fifths  of  the  contents  of 
the  gall-bladder.  These  masses  were  soft  and  readily  crushed 
between  the  fingers.  Under  the  microscope,  they  were  found 
to  consist  of  numerous  cells  from  the  mucous  membrane  of  the 
gall-bladder,  and  a  yellow  amorphous  matter.  The  bile  duct 
appeared  to  be  choked  up  with  these  cells  and  this  yellow  amor- 
phous matter.     Sp.  gr.  of  bile,  1036. 

/Spleen. — Enlarged;  surface  covered  with  effused  coagulable 


738  Jokes,  on  Malarial  Fever.  [November, 

lymph,  and  bound  to  the  liver  and  diaphragm  by  bands  of  co- 
agulable  Ipmph.  A  large  quantity  of  pus,  of  a  greenish -yellow 
color,  issued  from  the  anterior  border  of  the  spleen,  which  was 
firmly  attached  to  the  liver.  Whether  the  abscess  had  opened 
and  discharged  this  pus  before  death,  or  whether  the  abscess 
was  accidently  ruptured  during  the  opening  of  the  chest  and 
abdomen,  I  was  unable  to  determine. 

The  structure  of  the  spleen  felt  firm,  very  unlike  the  soft, 
yielding  structure  of  the  spleen  of  the  active  stages  of  malarial 
fever.  When  cut,  many  portions  of  the  spleen  resembled  a 
dark  bronzed  and  slate  colored  liver.  The  pulp  of  these  por- 
tions was  not  soft,  and  did  not  pour  out,  like  the  pulp  of  the 
spleen  of  the  active  stages  of  malarial  fever. 

The  liver-like  substance  of  the  spleen  was  found  to  consist, 
under  the  microscope,  of  fibrous  tissue,  and  numerous  colored 
corpuscles,  and  flakes,  composed  of  granules  resembling  the 
dark-colored  flakes  of  the  black  vomit  of  yellow  fever.  These 
flakes  were,  without  doubt,  composed  of  altered  colored  corpus- 
cles. The  colorless  corpuscles  of  this  portion  of  the  spleen  ap- 
peared to  be  more  numerous  than  normal. 

This  dark,  liver-like  substance  appears  to  be  nothing  more 
than  the  pulp  (mud)  of  the  malarial  spleen,  from  which  the  se- 
rum has  been  in  a  great  measure  removed,  and  in  which  altera- 
tions of  the  blood-corpuscles  have  taken  place,  and  fibrous  tissue 
formed. 

After  several  hours  exposure  to  the  oxygen  of  the  atmos- 
phere, the  color  of  this  portion  of  the  spleen  was  not  altered. 

In  addition  to  the  abscess,  opening  upon  the  surface  of  the 
spleen  attached  to  the  liver,  the  substance  of  the  spleen  contained 
numerous  other  smaller  abscesses,  of  various  sizes,  (two  or  three 
largest  of  the  size  of  a  bullet,  and  the  smallest  of  the  size  of  an 
English  pea,)  filled  with  thick  greenish-yellow  pus.  Portions  of 
the  spleen,  especially  surrounding  the  abscesses,  were  altered 
into  a  cheese-like  substance.  Under  the  microscope,  these 
cheese-like  portions  consisted  almost  entirely  of  pus  corpuscles, 
and  large  cells,  containing  granules  and  other  smaller  cells,  thus 
resembling  cancer  cells;  and  also  black  masses  composed  of 
granules  (probably  altered  colored  corpuscles)  like  those  from 
the  dark  dense  portions  of  the  spleen  ;  and  also  numerous  oil 
globules.  The  bodies  resembling  cancer-cells  were  not  numer- 
ous. The  pus  issuing  from  the  large  abscess,  resembled  ordina- 
ry pus,  under  the  microscope,  and  contained  a  few  of  these 
peculiar  cancer-like  cells. 

Kidneys,  normal  in  appearance.  Bladder  contained  a  small 
quantity  of  urine,  which  was  normal  in  color. 

Alimentary  Canal. — The  stomach  and  small  and  large  intes- 
tines were  greatly  contracted.      Blood-vessels  of  mesentery, 


1858.]  Jones,  on  Malarial  Fever,  739 

omentum,  and  exterior  surface  of  stomach,  and  small  and  large 
intestines,  engorged  with  black  blood.  The  mucous  membrane 
of  the  stomach  presented  an  appearance,  resembling  that  of 
chronic  inflammation.  The  exterior  of  the  large  and  small  in- 
testines was  of  a  purplish  color.  The  mucous  membrane  did 
not  appear  to  the  naked  eye  to  be  altered  in  structure.  Glands 
of  Peyer,  enlarged  and  distinct;  some  of  them  were  several  inch- 
es in  length.  The  glands  of  Peyer,  however,  did  not  present 
the  appearance  of  active  inflammation,  as  in  typhoid  fever. 
They  were  even  paler  than  usual.  The  solitary  glands  did  not 
attract  attention.  The  lymphatics  of  the  mesentery  were  much 
enlarged. 

Case  XXXVI. — This  case  is  recorded,  not  as  one  of  remit- 
tent malarial  fever,  but  for  the  purpose  of  illustrating  the  path- 
ological changes  of  the  spleen  in  malarial  fever. 

Native  of  South  Carolina:  age  37  years;  height  6  feet  2 
inches;  weight  200  lbs.;  large  chest,  full,  round  limbs.  Has 
been  living  on  the  river,  several  miles  below  the  city,  in  a  mi- 
asmatic situation.  Has  suffered  for  some  time  with  oedema  of 
the  extremities,  and  difficulty  of  breathing,  and  great  exhaustion 
upon  the  least  exertion.  Complexion  sallow,  bilious;  respira- 
tion 3i  to  minute,  laborious — can  be  heard  at  a  considerable 
distance;  circulation  in  the  extremities  very  feeble;  pulse  can 
scarcely  be  felt;  temperature  of  extremities  below  the  normal 
standard.  Auscultation  reveals  a  labored,  rapid,  and  strong 
action  of  the  heart ;  the  sounds  are  tumultuous  and  close  to  each 
other;  the  impulse  of  the  heart  against  the  walls  of  the  chest, 
and  the  point  at  which  it  strikes  is  much  below  the  usual  point; 
no  abnormal  sounds  could  be  heard  in  the  large  blood-vessels; 
dulness  upon  percussion  over  the  region  of  the  heart. 

We  conclude  from  this  examination,  that  the  heart  of  this 
patient  is  greatly  enlarged. 

Complexion  sallow,  anaemic;  conjunctiva  yellow;  tongue 
clean  and  pale. 

This  patient  was  treated  for  hypertrophy  of  the  heart,  torpor 
of  the  liver,  and  anaemia,  with  apparent  benefit,  from  the  time 
that  he  entered  the  hospital,  August  19th,  until  August  29th, 
when  he  was  taken  suddenly  at  night,  upon  his  bed,  with  op- 
pression of  breathing,  followed  in  the  course  of  half  an  hour  by 
profound  stupor,  accompanied  by  stertorous  breathing.  He 
died  in  nine  hours  after  the  supervention  of  coma. 

The  day  .previous  to  the  Altai  issue,  he  had  been  walking 
about  the  hospital  grounds,  and  said  that  he  was  decidedly  bet- 
ter. During  the  whole  time  that  he  has  been  an  inmate  of  tl  e 
|  hospital,  has  appeared  dull,  stupid,  and  indisposed  to  hold  a  con- 
versation with  any  one,  and  has  passed  most  of  his  time  in  sleep. 

U.S. — VOL.  XIV.   NO.  XI.  42 


740  Jones,  on  Malarial  Fever.  [November, 

Bowels  generally  torpid,  and  when  they  were  neglected  for 
several  days,  the  difficulty  of  breathing  increased,  and  his  lower 
extremities  commenced  to  swell. 

(8)  Autopsy  six  hours  after  Death. 

Exterior. — Trunk  and  limbs  round  and  plump.  A  close  ex- 
amination showed  that  this  fulness  was  due  to  serous  infiltration. 
On  making  the  first  incisions  through  the  skin  and  superficial 
facia,  serum  mixed  with  blood  flowed  freely. 

Head. — When  the  skull  cap  was  removed,  a  large  quantity  of 
blody  serum  escaped.  Dura-mater  presented  the  usual  appear- 
ance. A  fluctuation  of  a  large  quantity  of  fluid  could  be  felt 
between  the  dura-mater  and  the  substance  of  the  brain,  and 
when  an  incision  was  made  through  the  dura-mater,  a  consider- 
able quantity  of  serum  escaped.  A  considerable  quantity  of 
serum  was  also  effused  between  the  arachnoid  membrane  and 
pia-mater.  The  arachnoid  membrane  presented  a  decidedly 
opalescent  (pearl-colored)  appearance.  Lateral  ventricles  of 
brain  contained  an  unusual  amount  of  serous  fluid.  Brain  much 
softer  than  usual.  This  could  not  have  been  the  result  of 
changes  after  death,  for  the  time  (6  hours)  has  been  too  short. 

Chest — Lungs  congested  with  blood. 

Heart. — Pericardium  adherent  to  the  sternum  for  several  inch- 
es, and  distended  with  golden -colored  serum.  The  heart  ap- 
peared to  the  eye,  when  the  pericardium  was  opened,  to  be  as 
large  as  the  heart  of  a  bullock.  All  the  cavities  of  the  heart 
were  dilated,  and  the  walls  thickened.  The  dilation  and  thick- 
ening were  greatest  in  the  cavity  and  walls  of  the  left  ventricle. 
In  the  right  auricle  and  ventricle,  there  was  a  large,  elongated, 
light  yellow  clot,  adherent  at  one  extremity  to  the  columnar 
carneae  of  the  ventricle,  and  chordae  tendineae  of  the  tricuspid 
valve.  In  the  left  ventricle,  there  was  a  similar  light  yellow 
clot,  attached  at  one  extremity  to  the  columnas  carneae,  and 
chordae  tendineae  and  mitral  valves,  and  extended  full  eight 
inches  up  the  aorta.  That  portion  of  the  clot  which  extended 
into  the  aorta,  was  divided  into  two  flattened  cylindrical  por 
tions,  fimbriated  at  each  extremity,  as  if  they  had  been  whipped 
about  for  a  long  time  in  the  current  of  the  blood.  The  clots  in 
both  cavities  of  the  heart  resembled,  in  all  respects,  fibrin  from 
which  the  red  blood  corpuscles  had  been  carefully  washed,  and 
were,  without  doubt,  formed  previously  to  death.  Weight  of 
heart,  grs.  10,500 — equals  ozs.  24 — equals  lb,  1,  ozs.  8. 

Abdominal    Cavity.     Liver. — Color  peculiar,  and.  difficult  to 
describe:  mottled  lilac  and  brownish  yellow.     Upon  near  in 
spection  of  the  lobules,  they  presented  the  color  and  appearance 
of  cirrhosis.     The  structure  of  the  liver  was  firm,  and  cut  like 
soft  cartilage.     The  liver  contained  such  a  large  amount  of 


1858.]  Jones,  on  Malarial  Fever.  741 

fibrous  tissue,  that  after  vigorous  pounding  of  slices  in  a  mortar 
for  one  hour,  they  still  retained,  in  a  great  measure,  their  con- 
sistency. Microscopical  examination  showed  that  this  tough, 
resisting  substance  was  cellular  tissue.  This  liver,  then,  was  in 
a  cirrhosed  condition.  Under  the  microscope,  the  cells  of  the 
liver  appeared  paler  and  flatter  than  usual.  The  blood-vessels 
of  the  liver  were  filled  with  blood,  which  ran  in  considerable 
quantities  from  the  cut  surface  into  the  dish.  This  blood  readi- 
ly absorbed  oxygen,  and  changed  to  an  arterial  color.  Under 
the  microscope,  the  blood-corpuscles  presented  the  usual  appear- 
ance. They  appeared  to  be  diminished  in  number.  The 
structures  of  the  liver  were  in  tilt  rated  with  animal  starch  and 
cellulose.  After  thin  slices  had  been  pounded  in  a  mortar,  and 
carefully  washed  under  a  strong  stream  of  water,  apparently  for 
a  sufficient  length  of  time  to  remove  all  the  animal  starch,  and 
then  treated  with  sulphuric  acid,  or  with  liquor  potassae,  and 
then  treated  with  tincture  of  iodine,  the  large  body  of  it  was 
turned  to  a  blue  and  purple  color,  like  the  cellulose  of  wood. 

As  far  as  the  examination  extended,  the  cellulose  appeared  to 
enter  as  a  constituent  of  the  cellular  tissue  of  the  cirrhosed  liver. 
When  tested  for  grape-sugar,  24  hours  after  death,  no  evidence 
was  obtained  of  its  existence.  Weight  of  liver,  grs.  80,396 — 
equals  ozs.  69 1 — equals  lbs.  4,  ozs.  o£.  The  fibrous  tissue  of 
the  gall  bladder  was  infiltrated  with  serum.  The  gall-bladder 
contained  f  3iij.  of  thin  bile,  presenting  the  color  of  tincture  of 
iodine,  when  seen  in  mass,  and  a  gamboge  yellow  in  thin  layers. 

Spletn — Enlarged  and  indurated  ;  color  of  the  exterior  purp- 
lish red.  When  pressed  in  the  hand,  feels  dense  and  firm. 
When  cut  or  torn,  the  color  and  structure  resembles  that  of  a 
healthy  spleen,  in  all  respects,  except  that  it  has  a  much  larger 
quantity  of  fibrous  tissue.  The  pulp  of  the  spleen  absorbed  oxy- 
gen readily  when  exposed  to  the  atmosphere,  and  changes  to  a 
bright  scarlet  arterial  color.  The  pulp  of  the  spleen  presented 
nothing  peculiar  under  the  microscope.  Did  not  discover  those 
black  flakes  and  granules  which  were  so  abundant  in  the  spleen 
of  the  patient  previously  described  (Case  xxxv).  The  spleen 
contained,  like  the  liver,  animal  starch  and  cellulose.  When 
the  fibrous  tissue  was  washed,  and  treated  in  a  manner  similar 
to  that  of  the  liver,  it  gave  the  same  reaction,  with  tincture  of 
iodine.  Weight  of  spJeen,  grs.  13,343 — equal  ozs.  30| — equal 
lb.  1,  ozs.  14{.  Kidneys  unusually  small.  Weight  of  both 
kidneys,  grs.  3937 — equal  ozs.  9. 

Alimentary  Canal. — Stomach  of  enormous  size:  it  appeared  to 
be  capable  of  containing  two  gallons.  The  small  quantity  of 
food  which  it  contained  was  colored  yellow  by  the  bile.  Mu- 
cous membrane  presented  a  healthy  appearance.  Small  and 
large  intestines  appeared  healthy. 


742  Jones,  on  Malarial  Fever.  [November,. 

Passing  over,  for  the  present,  the  discussion  of  the  character 
of  the  disease,  and  immediate  cause  of  death,  and  many  other 
points  of  interest,  we  will  confine  our  attention  to  the  patholo- 
gical changes  of  the  spleen. 

A  companion  states,  that  this  man  resided  two  years  ago  on 
the  Ogeechee  river,  in  a  low,  miasmatic  situation,  and  was  very 
ill  with  fever  during  the  summer  season.  He  is  unable  to  de- 
scribe the  exact  nature  of  the  fever. 

From  the  situation,  it  is  probable  that  the  disease  was  malarial 
fever,  and  it  is  probable  that  the  pathological  alterations  of  the 
spleen  were  due  to  the  action  of  the  malarial  poison  during  this 
attack  of  fever.  If  it  was  malarial  fever,  the  spleen  during  the 
active  stages  was  engorged  with  blood,  softened,  and  the  trabe- 
cule in  many  places  ruptured.  When  the  action  of  the  poison 
ceased,  the  serum  of  the  extravasated  blood  was  removed,  and 
the  ruptured  trabecular  repaired,  and  numerous  bands  of  fibrous 
tissue  formed  throughout  its  substance.  These  changes  of  spleen 
during  convalescence  from  malarial  fever,  were  plainly  demon- 
strated in  Cases  xxxiii.  and  xxxv.  Finally,  the  colored  corpus- 
cles of  the  extravasated  blood  were  disintegrated  and  removed. 

Case  XXXVI. — Irishman  :  pastry  cook  and  baker — age  44: 
weight  150  lbs.;  height  5  feet  9  inches;  grey  hair,  blue  eyes — 
has  an  old,  feeble,  decrepid  look.  Has  followed  the  occupation 
of  pastry  cook  and  baker  for  thirty  years,  and  during  this  time 
has  worked  the  greater  part  of  the  night,  and  slept  during 
the  day.  In  order  to  keep  up  his  strength,  has  used  ardent 
spirits  freely.  The  loss  of  sleep,  combined  with  intemperate 
habits,  have  completely  broken  down  his  constitution,  and  he 
looks  and  talks  and  moves  like  an  old  man,  60  or  70  years  of 
age.  Eight  months  ago,  had  a  stroke  of  paralysis  which  affected 
his  tongue,  right  arm  and  lower  extremities.  Since  this,  he 
walks  with  some  difficulty,  and  has  but  little  use  of  the  right 
arm.  The  temperature  of  the  right  paralyzed  arm  is  generally 
from  one  to  three  degrees  below  that  of  the  left. 

The  following  observation  was  taken  on  the  7th  of  July: — 
Temperature  ol  atmosphere,  82°  5  F. ;  temp,  of  hand,  (paralyzed,) 
96°5F;  temp,  of  haud,  (sound,)  99° F.;  temp,  under  tongue, 
100° 25  F. 

Under  the  action  of  strychnia  and  tonics,  his  condition  was 
greatly  improved,  and  he  left  the  hospital  on  the  20th  of  Sep- 
tember. 

He  resumed,  in  a  short  time,  his  habits  of  intemperance,  and 
often  lay  drunk  all  night  on  the  commons  and  in  the  Park.  He 
was  taken  up  as  a  vagrant,  and  placed  in  confinement  by  the 
police.  It  was  soon  discovered  that  he  was  suffering  with  re- 
mittent fever. 


1858.]  JONES,  on  Malarial  Fever.  743 

Entered  the  hospital  October  8th,  in  an  exceedingly  feeble 
condition,  and  died  in  the  coarse  of  2-i  hours. 

(9.)  Autopsy  four  hours  after  Death. 

Exterior. — Not  much  reduced  in  flesh.  His  constitution,  en- 
feebled by  his  occupation  and  intemperate  habits,  did  not  long 
withstand  the  action  of  malarial  fever. 

Head. — Dura-mater  normal,  f  I  j.  of  clear  serous  fluid  escaped 
from  the  space  between  the  dura-mater  and  arachnoid  membrane. 
Blood  vessels  of  brain  did  not  appear  to  be  more  congested  with 
blood  than  usual. 

Chest. — Lungs  normal.  Heart  normal  in  size.  The  auricles 
showed  incipient  fatty  degeneration.  Weight  of  heart,  grains 
4:6 12 — equal  ozs.  11. 

Abdominal  Cavity.  Liver,  upon  the  exterior,  of  a  dark  slate 
color.  The  cut  surface  presented  a  bronze  and  olive  color.  The 
cells  of  the  liver  contained  more  oil  globules  than  usual.  With 
this  exception,  the}'  presented  a  normal  appearance.  The  blood 
of  the  liver  did  not  change  to  the  arterial  hue  when  exposed  to 
the  atmosphere.  The  liver  contained  animal  starch,  but  no 
grape  sugar:  it  was  set  aside,  and  at  the  end  of  15  hours,  again 
carefully  tested  for  animal  starch  and  hepatic  su^ar.  The  result 
was  the  same — animal  starch  in  apparent  abundance,  but  no 
grape  sugar.  The  cellular  tissue  of  the  blood-vessels  of  the  liver 
appeared  to  be  infiltrated  by  animal  starch.  Weight  of  the  liv- 
er, grains  29,312 — equal  ozs.  67 — equal  lbs.  -i,  ozs.  3. 

Spleen. — Of  a  dark  slate  color,  enlarged  and  softened;  when 
pressed  between,  the  fingers,  the  structures  appear  to  give  way. 
Pulp  of  spleen  of  a  dark  purplish  brown  and  reddish  brown  co- 
lor. After  exposure  for  20  hours  to  the  atmosphere,  the  pulp 
of  the  spleen  did  not  alter  its  reddish  and  purplish  brown  color. 
The  spleen  contained  animal  starch  in  considerable  abundance, 
both  in  the  pulp  and  also  in  the  meshes  of  the  fibrous  tissue  of 
the  trabeculae  and  blood-vessels.  Weight  of  spleen,  grs.  8093 — 
equal  ozs.  18^ — equal  lb.  1,  ozs.  2^. 

Kidneys — Normal.     Weight,  grs.  5687 — equals  ozs.  13. 

Alimentary  Canal.  Stomach. — Mucous  membrane  presented 
the  usual  healthy  appearance. 

Small  Intestines. — Mucous  membrane  appeared  to  be  healthy. 
Glands  of  Peyer,  large  and  distinct,  but  pale,  and  without  any 
marks  of  congestion  or  inflammation.  Several  of  these  glands 
were  three  inches  in  length.  The  solitar}-  glands,  especially  in 
the  region  of  the  ileo-caecal  valve,  were  enlarged  and  prominent. 
They  were  about  the  size  of  millet  seed,  and  of  a  reddish  brown 
color. 

(To  be  continued.) 


744    Douglass.    Disease  of  the  Mucous  Membrane.  [November, 


ARTICLE    XXVI. 

Cases  of  Disease  of  the  Mucous  Membrane.     By  TlLMAN  DOUG- 
LASS, M.  D.,  of  Alexander,  Ga. 

Case  I. — Mr.  A.  K.  Moore,  aged  45 ;  stout,  well  formed,  of 
fair  complexion,  light  hair — a  farmer,  of  excellent  character: 
was  attacked,  violently,  with  pneumonia,  the  9th  of  March, 
lfc>44.  He  had  fever  the  preceding  fall,  and  colds  and  general 
ill  health  during  the  winter.  I  relied  on  tartar-emetic,  quinine 
and  blisters,  stimulating  expectorants,  &c,  under  the  use  of 
which  he  was  convalescent  in  a  few  days. 

Some  three  months  after  this,  Mr.  Moore  was  able  to  ride 
about  his  farm,  his  usual  health  nearly  restored — he  came  to  see 
me  on  account  of  a  small  tumor,  the  size  of  a  cow-pea,  on  the 
inside  of  the  right  angle  of  the  lower  lip,  which  had  enlarged 
and  become  very  painful,  within  a  day  or  two.  I  declined  to  do 
any  thing  for  it,  and  advised  him  to  visit  Augusta;  which  he  pro- 
mised to  do,  but  deferred  it  from  time  to  time,  until  he  thought 
the  tumor  ceased  to.  enlarge.  Although  it  still  annoyed  him, 
and  sometimes  excited  his  fears,  he  had  very  little  done  for  it, 
until  the  13th  of  April,  1846,  just  two  years  and  one  month 
after  the  first  attack,  when  I  was  called  to  see  him  in  another 
attack  of  pneumonia.  The  cancer,  and  other  symptoms  of  bad 
health,  had,  by  this  time,  so  worn  him  down,  that  scarcely  any 
hope  of  his  recovery  was  indulged.  None  but  the  mildest  and 
most  supporting  treatment  could  be  resorted  to.  But  on  the 
30th  of  the  same  month  he  was  discharged  apparently  cured. 

The  novelty  in  this  case  was,  that  the  very  day  the  pain  was 
felt  in  the  side,  and  other  symptoms  of  pneumonia  were  devel- 
oped, the  cancer  began  to  heal,  and  in  a  few  days  the  ulcer  in 
the  lip  was  entirely  covered  over  by  new  cuticle.  Nothing 
could  be  seen  of  it  except  a  small  excavated  cicatrix. 

How  much  he  and  his  friends  rejoiced  at  the  supposed  happy 
termination  of  pneumonia  and  cancer  may  be  well  imagined. 
But  how  changed  the  scene,  when  in  a  few  days,  so  soon  as  he 
was  able  to  ride,  Mr.  Moore  visited  me  again  on  account  of  the 
same  sore !  It  had  broken  out  suddenly — was  swollen,  red, 
spreading,  and  intensely  painful;  the  new  tender  cuticle  destroy-  I 


1858.]      Douglass.    Disease  of  the  Muccms  Membrane,  745 

ed,  it  was  an  open  angry  nicer.  The  same  motives  which  caused 
me  to  decline  to  touch  the  cancer,  two  years  before,  of  course 
urged  me  to  the  same  course  now. 

After  suffering  all  the  horrors  of  this  most  awful  malady,  for 
several  months,  under  the  cruel  tortures  inflicted  by  the  officious 
ignorance,  usual  in  such  cases,  death  kindly  came  to  his  relief. 

Case  II. — Mrs.  S.  G-.,  aged  22  ;  light  hair,  fair  skin,  blue  eyes, 
weighing  about  150,  of  fine  form,  and  general  good  health  and 
spirits — the  only  child  of  Mr.  Moore. 

Before  proceeding  to  the  details  of  this  case,  it  may  be  best  to 
state  that  Mr.  G.,  the  husband  of  this  lady,  a  fine  healthy  young 
lawyer,  had  his  knee  hurt  in  the  spring  of  1857,  while  driving 
an  unruly  horse  in  his  buggy  :  a  very  bad  ulcer  formed  in  the 
wounded  part,  and  subsequently  not  less  than  twenty  almost 
literally  covered  the  leg,  down  to  the  ankle.  As  soon  as  one 
would  heal,  leaving  a  deep,  dark  cicatrix,  others  would  appear 
near  by. 

The  point  of  interest  in  this  case  is,  that  Mrs.  G.  had  ulcers  of 
the  same  character,  on  her  leg,  last  fall  and  winter,  which  healed 
about  the  time  of  her  confinement.  Her  child  was  born  the  12th 
of  February  of  this  year,  and  she  had  a  severe  attack  of  dysen- 
tery, with  discharges  of  bloody  mucus,  tormina  and  tenesmus, 
on  the  14th.  Cream  of  tartar  and  some  mild  diuretics  relieved 
her  very  promptly,  and  she  was  soon  up. 

In  a  few  days  I  was  called  again  to  see  her,  when  I  found  the 
tongue,  mouth  and  throat  red  and  intensely  sore;  deglutition 
very  difficult.  The  disease  was  confined  to  the  mucous  mem- 
brane— would  spread  over  a  considerable  surface  in  a  short 
time,  and  subside  as  quickly.  Fever,  which  abated  in  the  morn- 
ing and  returned  at  three  in  the  afternoon,  caused  an  increase 
of  the  burning  pain.  The  next  day,  constant  nausea,  with  oc- 
casional colic  and  great  prostration,  fits  of  fainting,  and  lancina- 
ting pains  through  the  abdomen,  made  it  but  too  evident  that 
the  whole  canal  was  involved.  Quinine  soon  arrested  the  fever. 
Solution  of  creasote  as  a  gargle,  and  a  very  weak  solution  of 
creasote  into  the  stomach,  followed  by  iodide  of  potassium,  after 
the  fever  was  arrested,  measurably  restored  her.  But  then  the 
returning  appetite  was  tempted  by  a  fine  perch,  which  aggrava- 
ted all  the  symptoms,  and  in  two  days  more  severe  pain  was 


746      Douglass.    Disease  of  the  Mucous  Menbrane.   [November, 

found  passing  down  the  rectum,  followed  by  discharges  of  bloody 
mucus,  affording  temporary  relief.  Two  days  later,  the  anus, 
and  the  vagina  and  urethra,  were  invaded  by  the  swollen,  pain- 
ful, burning  disease.  Emulsion  of  spirits  turpentine  and  gum- 
arabic  was  tried,  but  thought  to  be  too  exciting.  She  has  been 
taking  balsam  copaiba  with  gum  arabic,  for  some  time,  with  de- 
cided advantage.  Since  the  fever  has  given  way,  syrup  iodide 
of  iron  has  improved  her  strength  and  appetite. 
This  lady  is  now,  6th  of  July,  considered  well. 

Case  III. — Mrs.  M.  C,  aged  25 :  slender  frame,  tolerably  tall, 
sandy  hair,  fair  skin,  relaxed  fibre  and  very  little  stamina; 
about  five  years,  married ;  mother  of  two  children.  Her  hus- 
band, a  man  of  feeble  constitution,  has  a  troublesome  sore  on  his 
leg.  His  lady  had  ulcers  on  her  leg.  She  became  pregnant  the 
first  of  last  year,  lived  in  a  sickly  neighborhood,  and  had  two 
or  three  attacks  of  intermittent  fever — the  last,  in  Sepiember. 
The  bowels  were  very  obstinately  constipated,  with  tenesmus 
and  intolerable  tormina.  Was  relieved  by  quinine,  and  an 
emulsion  of  castor  oil,  balsam  copaiba  and  gum-arabic,  in  small 
doses.  She  was  confined  the  13th  of  December,  just  two  months 
after  the  attack  in  September.  On  the  second  day  after  the 
birth  of  her  child,  dysentery,  of  the  most  violent  grade,  set  in. 
The  tenesmus  and  tormina  were  as  severe  as  in  September;  and 
in  addition  to  that,  the  stomach  was  very  irritable,  and  she  pass- 
ed bloody  mucus  from  the  bowels.  The  stomach,  not  tolerating 
the  oil  emulsion,  she  was  relieved  with  small  doses  of  cream  of 
tartar.  This  was  the  18th  January,  one  month  and  five  days 
after  the  birth  of  her  child. 

I  heard  nothing  more  of  her  until  the  23rd  of  April,  three 
months  from  the  attack  of  dysentery,  when  I  was  called  to  see 
her  on  account  of  sore  mouth.  She  said  her  mouth  had  been 
sore  almost  ever  since  I  saw  her  before.  The  soreness  did  not 
confine  itself  to  the  mucous  membrane,  as  it  did  in  the  case  of 
Mrs.  G.,  but  penetrated  and  formed  ulcers  which  secreted  pus. 
They  would  heal  and  then  come  in  other  places.  For  several 
weeks  she  declined  in  flesh  and  strength,  until  she  became  so 
prostrate  as  to  keep  her  bed  constantly.  The  stomach  was  irri- 
table, and  the  bowels  either  constipated  or  excessively  loose. 

The  treatment  consisted  of  an  emulsion  of  balsam  copaiba 


1858.]  Diphtheritic  Affections.  747 

with  gum-arabic,  quinine,  iodide  of  potassium.  Washes  of  va- 
rious kinds  were  tried,  but  diluted  tinct.  mur.  ferri.  seemed  to 
afford  her  most  comfort.  The  irritable  stomach  was  relieved  bj 
a  very  weak  solution  of  creasote.  Animal  broths  were  pre- 
scribed as  a  nourishment.  Her  strength  so  improved  that  on 
the  26th  day  of  May  she  was  carried  to  her  mother's,  out  of  my 
neighborhood. 

All  treatment  was  abandoned,  except  laudanum  given  by  an 
old  lady,  and  all  rules  of  dieting  laid  aside,  until  the  5th  June, 
nine  days  from  her  removal ;  when  diarrhoea  set  in,  and  my 
friend,  Dr.  David  Perkins,  was  called,  who  called  me  in  con- 
sultation the  next  day. 

We  found  her  prostrated,  so  a«  noA  to  1  e  able  to  raise  her  head, 
or  even  to  be  raised,  without  idintmg  ;  ghastly  countenance,  nnd 
passing  watery  discharges  constantly  from  the  bowels — with 
cough  and  other  evidences  of  the  lungs  having  been  invaded  by 
the  same  disease.  The  ulcers  had  left  the  mouth.  The  only 
sore  which  had  remained  for  any  length  of  time,  on  the  tip  of 
the  tongue,  had  now  entirely  healed.  She  lingered  on,  almost 
motionless  and  speechless,  till  the  30th  of  June,  when  she  ex- 
pired. 


Diphtheritic  Affections. 

A  late  No.  of  the  Archives  Generales  de  Med.  contains  an  in- 
teresting paper  by  M.  Isambert  on  diphtheritic  affections  and 
on  the  malignant  angina  in  Paris  in  1855.  The  following  are 
the  authors  conclusions: — 

Diphtheritic  affections  sometimes  appear  sporadically;  they 
often  seem  to  be  endemic,  and  also  epidemic  and  contagious. 
Epidemic  influences  are  often  the  principal  causes.  Contagion 
does,  however,  really  exist,  as  several  medical  men  have  been 
infected. 

Shall  we  agree  with  M.  Bretonneau,  and  believe  that  diph- 
theritic is  not  propagated  by  the  air,  but  is  always  the  result  of 
a  kind  of  inoculation  or  actual  contact  of  the  morbid  secretion 
with  a  mucous  membrane?  The  author  thinks  this  opinion 
too  exclusive,  as  also  does  M.  Trousseau. 

Diphtheritic  affections  are  generally  preceded  by  initiatory 
symptoms  in  the  form  of  bronchitis,  with  more  or  less  fever. 
The  general  aspect  of  these  affections,  at  an  advanced  period,  is 

x.  s.— vol.  xrv.  vo.  xi.  43 


748  Epidemic  Diphtheritic  Angina.         [November, 

of  the  adynamic  kind,  except  when  there  is  much  agitation  and 
convulsive  effort  brought  on  by  croupy  exudation. 

These  ailments  are  of  a  decidedly  specific  nature ;  the  more 
they  are  studied,  the  more  we  remain  convinced  that  inflamma- 
tion is  of  secondary  importance,  and  is  sometimes  completely 
absent. 

Relapses  are  not  rare  in  diphtheritis;  this  complaint  therein 
differs  from  other  specific  diseases ;  as  variola,  rubeola,  and  scar- 
latina. 

The  general  treatment  should  be  directed  against  the  inflam- 
mation, if  it  be  present,  which  circumstance  is,  however,  rare. 
Abstraction  of  blood  should  be  used  cautiously  in  an  affection 
which  so  soon  assumes  a  typhoid  character.  Cutaneous  counter- 
irritation  should  be  completely  avoided,  as  the  irritated  regions 
soon  become  centres  of  new  diphtheritic  manifestations.  Emetics 
are  extremely  valuable;  and  alteratives,  mercury,  alkaline  car- 
bonates, and  cholorate  of  potash,  are  often  useful. 

Local  treatment  is  very  important,  and  consists  of  an  energet- 
ic modification  of  the  affected  surfaces.  Calomel,  alum,  hy- 
drochloric acid,  and  especially  solutions  of  nitrate  of  silver,  are 
always  indicated. 

The  patient  should,  finally,  be  well  sustained,  besides  taking 
medicines,  as  there  is  a  tendency  to  a  typhoid  state  in  this  kind 
of  affection.  He  should  also  be  given  tonics,  as  bark,  coffee,  and 
wine;  the  latter  tonic  is  especially  advisable  during  convales- 
cence after  severe  diphtheritis. — American  Jour,  of  Med.  Sciences. 


Epidemic  Diphtheritic  Angina  at  Lima.     By  M.  Odeiozola. 

About  the  close  of  the  month  of  July,  1851,  an  epidemic  grippe 
appeared,  and  suddenly  attacked  the  whole  population  of 
Lima,  and  was  fatal,  particularly  to  old  people,  in  consequence 
of  grave  pneumonias  which  were  developed  in  its  course.  The 
first  cases  were  observed  from  the  middle  to  the  twenty-fourth 
of  July,  and  extended  rapidly  and  simultaneously  to  all  the  in- 
habitants of  this  city,  so  that,  during  the  height  of  the  epidemic, 
the  streets  were  deserted  for  ten  or  fifteen  days.  Since  that 
period,  we  have  suffered  two  other  epidemics,  one  ever  memora- 
ble on  account  of  the  great  ravages  it  caused — the  yellow  fever,x 
the  first  invasion  of  which  occurred  in  the  summer  of  the  year 
18o2,  in  a  benign  form,  to  become  grave  and  fatal  in  the  years 
'53  and  '54;  and  the  diphtheritic  angina,  which,  though  not  so 
general  or  fatal  as  the  preceding,  did  not  fail  to  secure  some 
victims,  notwithstanding  the  small  number  of  persons  attacked. 

To  this  last,  which  still  prevails,  we  devote  a  few  lines. 

If  we  may  rely  upon  the  few  and  incomplete  records  left  by 


1858.]  Epidemic  Diphtheritic  Angina.  749 

our  predecessors,  relative  to  the  epidemics  which  have  afflicted 
the  inhabitants  of  Lima,  the  diphtheritic  angina  appeared  here 
for  the  tirst  time  in  the  year  1821,  and  then,  as  now,  merited 
the  epithet  epidemic,  because  it  appeared  simultaneously  in  a 
large  number  of  individuals.  Since  that  date,  we  have  no 
notice,  nor  does  there  exist  any  document  to  show  its  reappear- 
ance until  the  year  1850,  when  it  attacked,  sporadically,  a  small 
number  of  persons,  to  whom  it  proved  fatal.  Four  years  passed, 
and  in  1855,  it  extirminated  almost  an  entire  family,  without 
extending  beyond  the  house  in  which  it  caused  such  marked 
ravages.  And,  in  the  mouth  of  April  last,  1858,  it  appeared 
again,  and  from  that  time  to  the  present,  there  is  scarcely  a  prac- 
titioner who  has  not  had  at  least  two  or  three  cases  under  his 
care.  It  is  worthy  of  remark  that  our  estimable  fellow-member. 
Dr.  Jose  J.  Bravo,  prognosticated  the  invasion  of  this  diseass  in 
February  last,  on  the  ground  that  it  had  appeared  a  year  and  a 
half  ago  epidemically  at  Piura,  passed  to  Trujillo,  and  thence 
to  Huacho,  places  where  it  had  some  victims,  and  that  it  was 
rational  to  expect  so  fearful  a  guest,  which,  from  its  origin,  was 
propagated  from  north  towards  the  south. 

As  the  diphtheritic  or  pseudo-membranous  angina  now  pre- 
vailing does  not  differ  in  its  symptoms  or  anatomical  characters 
from  that  described  by  authors  under  the  same  name,  or  from 
that  which  we  have  mentioned  as  described  by  Dr.  Valdes,  we 
believe  ourselves  to  be  excused  from  entering  into  details,  con- 
tenting ourselves,  for  the  present,  with  merely  indicating  the 
class  of  society  in  which  the  diphtheritic  angina  appeared  more 
especially,  the  proximate  number  of  sufferers,  and  the  treatment 
resorted  to  in  preference  by  a  majority  of  the  profession. 

It  was  natural  to  expect  that,  once  developed  amongst  us,  th:s 
disease  would  find  its  largest  number  of  victims  in  the  needy 
class  as  happens  in  certain  European  populations,  where  it  pre- 
vails with  some  frequency  ;  but  the  contrary  has  happened,  for 
it  has  attacked,  in  preference,  persons  who  enjoy  all  possible 
comforts,  and  in  so  marked  a  manner  that,  in  the  hospital  for 
men,  there  has  not  been  a  single  case,  and  in  that  of  Santa  Ana, 
for  women,  there  has  been  only  two.  The  black  race,  up  to  this 
time,  has  been  as  resistant  to  this  angina  as  it  was  to  the  yellow 
fever.  It  is  to  be  regretted  that  no  data  on  this  point  cau  be 
obtained  from  the  history  of  the  epidemic  of  1821,  above  men- 
tioned. For  this  and  various  other  reasons,  we  have  character- 
ized the  description  by  Dr.  Valdes  as  incomplete. 

We  should  have  been  pleased  to  present  an  exact  statement 
of  the  number  attacked  by  the  angiua;  but  it  may  be  readily 
perceived  that  such  a  labor  is  impracticable,  inasmuch  as  it  has 
not  yet  ceased,  and  because  it  has  not  occurred  in  the  hospitals, 
where  it  might  be  accurately  made. 


750  Diphtheria,  or  Diphtherite.  [November, 

Notwithstanding  the  many  impediments  we  have  encountered, 
we  have  succeeded  in  obtaining,  from  a  majority  of  the  most 
respectable  practitioners,  the  number  of  cases  they  have  treated, 
with  the  following  results  : — 

Of  70  cases  of  diphtheritic  angina,  49  were  females  and  21 
males;  55  were  cured  and  15  died.  Of  the  15  deaths,  only  two 
were  adults,  the  rest  between  3  and  12  years  of  age,  much  the 
largest  number  being  between  3  and  5  years  old.  Of  the  55 
cured,  only  5  were  under,  and  the  remaining  50  exceeded  12 
years  of  age.  The  whole  70  patients  belonged  to  the  white  race. 
The  total  number  attacked  up  to  this  time  is  between  80  and 
90. 

The  majority  of  physicians  have  decided  in  favor  of  cauteriza- 
tions with  pure  chlorohydric  acid,  practised  two  or  three  times 
a  day,  according  to  the  gravity  of  the  case,  and  emetics  of  tartar 
emetic  or  ipecacuanha,  alternately  employed.  It  is  not  our 
object,  nor  is  it  possible,  to  decide  upon  the  degree  of  curative 
efficacy  in  diphtheritis  which  the  cauterizations  may  possess; 
but  we  ingenuously  confess  that  this  treatment,  employed  active- 
ly from  the  beginning,  has  yielded  happy  results  in  the  greater 
number  of  cases,  and  it  has  been  inefficacious  in  the  most  of 
these  cases  in  which  it  has  been  applied  two  or  three  days  after 
the  developement  of  the  disease. 

We  hope  that  time  and  experience  will  determine  the  true 
value  of  this  remedy,  which  is  considered  impotent  by  some  of 
our  practitioners.  We  have  employed  emetics  exclusively  for 
their  mechanical  effects  on  the  pharynx,  favoring  the  expulsion 
of  the  false  membranes;  but  it  may  be  said,  in  passing,  that 
their  abuse  in  children  produces  more  hurt  than  advantage,  and 
they  do  not  tolerate  them  as  well  as  adults,  in  whom  we  have 
observed  no  accident,  although  fear  caused  by  the  gravity  of  the 
disease,  may  have  induced  us,  perhaps,  to  carry  them  further 
than  we  ought.  As  purely  auxiliary,  we  have  used  opiate  gar- 
gles, and  the  liquor  of  Labarraque.  We  know  thai  some  have 
employed  different  therapeutic  agents  in  this  angina,  such  as 
bark,  internally,  baths,  gargles,  and  cataplasms  of  a  concentra- 
ted decoction  of  the  same,  sulphate  of  quinine,  cauterizations 
with  a  concentrated  solution  of  nitrate  of  silver,  or  sulphate  of 
copper,  &c,  &c. ;  but  we  are  entirely  ignorant  of  the  opinion 
which  should  be  formed  as  to  their  utility. — [Gaceta  Medica  de 
Lima.     Organo  qficial  de  la  Sociedad  de  Medicine,  and  lb. 


Diphtheria,  or  Diphtherite.    By  David  Thompson,  Esq.,  of  Lan- 
caston. 


About  three  years  since,  this  neighborhood  was  visited  by  an 
epidemic  of  this  rare  disease.     The  first  cases  occurred  in  the 


1858.]  Diphtheria,  or  Diphtfierite,  751 

town,  and  no  others  then  appeared  for  several  months,  when  it 
again  broke  out  in  the  district  north  of  this  place,  where  it  pre- 
vailed for  several  months,  whilst  the  south  side  was  comparative- 
ly free  from  it.  From  the  north,  it  gradually  spread,  until  the 
whole  line  of  country  had  been  visited  by  it.  There  appeared 
to  be  no  difference  in  the  geological  nature  of  the  country,  the 
level,  or  the  aspect,  in  increasing  the  severity  or  granting  an 
immunity  from  the  disease.  The  premonitory  symptoms  varied 
somewhat  A  few  retired  to  rest  comparatively  well,  and  awoke 
in  the  morning  with  the  throat  sore,  and  covered  with  white 
deposit.  In  the  majority  it  was  preceded  by  all  the  ordinary 
symptoms  of  pyrexia,  of  which  headache  was  one  of  the  most 
severe,  followed  in  the  course  of  a  day  or  two  by  the  usual 
throat  symptoms.  An  extreme  feeling  of  depression,  not  to  be 
accounted  tor,  by  the  amount  of  mischief  in  the  throat,  was  a 
characteristic  symptom  in  each  case.  An  external  examination 
of  the  throat  showed  the  tonsil  generally  to  be  swollen,  hard, 
and  tender  to  the  touch ;  while  sometimes  the  parotid  gland 
participated  in  the  swelling.  Internally  the  tonsil  was  swollen, 
and  either  covered  with  the  diphtheritic  deposit,  which  frequent- 
ly extended  over  the  pharynx,  and  sometimes  into  the  nares 
and  palate,  or  else  it  would  be  scooped  out  into  an  ulcer,  with 
raised  violet-coloured  edges;  the  floor  exhibiting  a  dark  ash- 
coloured  slough.  In  some  instances  there  would  be  no  deposit 
or  ulceration  at  first,  but  simply  the  tonsil  painful  and  enlarged. 
These  cases  generally  changed  for  a  state  of  ulceration,  which 
began  in  several  distinct  spots,  and  gradually  spread  over  the 
whole  tonsil.  In  the  most  severe  examples,  the  tonsils  sometimes 
sloughed  en  masse.  I  saw  one  instance  in  which  this  occurred, 
in  an  early  stage  of  the  disease  ;  and  where  now  (two  years  since 
it  occurred)  a  cavity  remains,  capable  of  containing  a  pigeon's 
egg,  across  the  surface  of  which  extends  a  small  band  of  mucous 
membrane,  which  did  not  slough  at  the  same  time,  and  gives 
great  inconvenience,  from  retaining  the  food  impacted  in  the 
hollow  during  deglutition. 

I  have  seen  no  case  in  which  I  could  detect  the  extension  of 
the  disease  into  the  oesophagus;  but  in  many  it  has  entered  into 
the  air-passages,  this  being  the  most  frequent  and  most  fatal 
complication.  Of  4b5  cases  that  came  under  my  own  observa- 
tion, the  instances  in  which  the  air-passages  became  involved 
in  the  disease  amounted  to  15;  and  of  this  number  II  died,  the 
greater  number  within  a  few  hours  after  the  first  symptoms  of 
croupy  breathing  began.  The  false  membrane  formed  on  the 
tonsil  and  pharynx  extended  into  the  larynx,  trachea,  and  fre- 
quentlv  far  into  the  minute  divisions  of  the  bronchi.  In  one 
..nee,  a  girl  aged  17  expectorated,  within  twelve  hours  after 
the  first  symptoms  of  croup  made  their  appearance,  a  complete 


752  Diphtheria,  or  Diphtherite.  [November, 

cast  of  the  larynx,  trachea,  and  bronchial  tubes,  extending  to 
the  fifth  division  of  the  bronchi;  in  a  few  hours  afterwards,  a 
fresh  membrane  formed,  and  she  died  from  suffocation. 

In  many  instances,  I  saw  numbers  of  minute  casts  expectora- 
ted from  the  lungs,  whilst  at  the  same  time  a  stethoscopic  exam- 
ination gave  all  the  symptoms  of  capillary  bronchitis.  A  gen- 
tleman aged  46,  died  from  this  condition  of  the  lungs.  His 
throat  was  first  affected.  After  a  few  days,  the  breathing  became 
impeded,  with  all  the  ordinary  symptoms  of  capillary  bronchi- 
tis in  the  first  stage,  the  throat  continuing  to  improve.  He 
gradually  sank,  constantly  expectorating  casts  of  the  small 
tubes,  precisely  similar  to  the  deposit  in  the  trachea. 

I  kept  accurate  notes  of  125  of  the  most  severe  cases,  inclu- 
ding all  the  deaths. 

Cases.  Deaths. 

Males 55  9 

Females 70  4 

Totals  125  13 

The  deaths,  with  two  exceptions,  were  all  below  fifteen  years 
of  age;  and,  with  two  exceptions,  were  all  from  affections  of  the 
air-passages.  In  the  two  who  died  from  other  causes  than  affec- 
tions of  the  air-passages,  death  occurred  in  one  from  the  slough- 
ing of  a  blister,  applied  for  three  hours  to  the  upper  part  of  the 
sternum;  and  in  the  other  from  extreme  debility  remaining  after 
recovery  from  croup.  There  was  a  very  remarkable  tendency 
for  blistered  surfaces  to  take  on  unhealthy  action  ;  and  I  fre- 
quently saw  the  irritated  surface  covered  with  a  deposit  similar 
to  that  on  the  throat. 

A  strong  similarity  appears  to  exist  between  this  disease  and 
scarlet  fever,  so  strong,  as  almost  to  lead  one  to  hazard  the  opin- 
ion that  it  may  be  a  modification  of  that  disease.  The  following 
are  the  reasons  for  considering  so : — 

1.  Diphtherite  prevailed  in  this  neighborhood  as  a  conta- 
gious (?)  epidemic  at  the  same  time  as  well-marked  scarlet  fever, 
and  chiefly  among  children. 

2.  In  the  same  house,  the  father  and  mother  had  well-marked 
scaflet  fever  severely  without  any  ulceration  or  deposit  on  the 
throat;  while  the  three  children  had  all  the  marked  symptoms 
of  diphtherite,  without  much  feverishness  and  no  rash,  though 
attended  by  the  same  premonitory  symptoms,  the  cases  occur- 
ring at  the  same  time. 

3.  In  many  instances,  cases  of  apparently  pure  diphtherite 
were,  after  some  days,  attended  by  a  rash,  that  seldom  remained 
more  than  a  few  hours. 

4.  The  disease  in  most  instances  commenced  with  all  the 
symptoms  of  fever,  its  duration  being  similar  to  that  of  scarlet. 


1858.]  On  the  Prevailing  Diphtheritic  Affection.  753 

5.  In  cases  of  apparently  pure  scarlet  fever,  the  throat  be- 
came, after  a  few  days,  covered  with  diphtheritic  deposit. 

6.  The  sequela?  of  the  two  diseases  nearly  resembled  each, 
other;  albuminous  urine,  with  casts,  being  present  in  eight  cases 
of  diphtherite,  and  anasarca  pro viug  fatal  from  convulsions  in 
one. 

It  would  occupy  too  much  space  to  give  more  than  a  mere 
outline  of  the  subject ;  but  future  and  more  extended  experience 
than  mine  may  prove  whether  there  is  any  connection  between 
the  two  diseases.  Deafness  was  a  not  unfrequent  sequela  of 
diphtherite  and  temporary  paralysis;  in  all  instances  these  were 
recovered  from.  1  have  only  known  one  case  of  diphtheritic 
ophthalmia  to  have  occurred  in  the  neighborhood.  In  that  in- 
stance, the  deposit  extended  over  the  lower  half  of  the  conjunc- 
tiva. 

The  treatment  most  successful  was  the  early  and  thorough 
application  of  lunar  caustic  to  the  throat,  together  with  the  use 
ot  a  stimulating  gargle  of  nitrate  of  potass,  and  capsicum,  or  so- 
lution of  chlorinated  soda  (Beaufoo's)  diluted.  When  there  was 
much  feverishuess  in  the  early  stage,  an  emetic  appeared  some- 
times to  benefit.  Mild  but  continued  counter-irritation  over  the 
upper  part  of  the  chest  appeared  of  great  service.  General  treat- 
ment, beyond  keeping  the  secretions  regular,  was  of  little  use, 
and  frequently  injurious.  Depletion  of  any  sort  did  an  infinite 
deal  of  harm.  Stimulants  were  often  required  in  an  early  stage. 
The  chances  of  recovery  when  croup  set  in  severely  were  but 
small.  The  only  chance  seemed  to  be,  in  the  rapid  exhibition 
of  small  doses  of  calomel- and  ipecacuanha,  with  stimulants. 
Under  this  treatment,  four  out  of  fifteen  recovered  who  were 
affected  with  this  complication.  Tracheotomy  was  tried,  but  of 
no  service,  as  the  false  membrane  extended  beyond  the  trachea. 

In  the  number  of  the  Lancet  for,  I  think,  the  }-ear  1832,  there 
is  a  most  characteristic  case  described  by  Dr.  Alison,  of  Edin- 
burgh, as  having  occurred  in  the  Royal  Infirmary,  and  which 
.terminated,  as  the  fatal  cases  here  did,  in  croup. 

A  careful  microscopic  examination  of  the  white  deposit  showed 
nothing  different  from  the  usual  appearances  of  exuded  lymph. 
British  Med.  Journal  and  lb. 


On  the  lately  prevailing  DiphUieritic  Affection.     By  Dr.  William 
Camps. 

This  affliction  has  been  variously  designated — as  croup, 
croupy  diseases  of  the  throat,  malignant  sore  throat  or  cynanche 
maligna,  diphtheritis  or  diphtherite,  throat  affection,  prevalent 
sore  throat,  &c  Under  one  or  other  of  these  terms,  there  could 
now  no  longer  be  any  doubt  that  a  disease  lately  prevailed,  and 


754  On  the  Prevailing  Diphtheritic  Affection.  [November, 

did  still  exist,  with  more  or  less  intensity,  in  various  parts  of 
the  United  Kingdom,  including  the  metropolis.  The  public 
health  authorities  had,  in  their  periodical  documents,  of  late 
solicited  information  respecting  it,  uuder  Jhe  term  diphtheria. 
Dr.  Camps  states  that  his  attention  was  directed  thereto,  in  the 
first  instance,  by  noticing  in  one  of  the  quarterly  returns  of  the 
Registrar- General  an  unusually  large  number  of  deaths  from 
croup,  as  having  occurred  in  a  rural  district,  with  the  popula- 
tion and  locality  of  which  he  was  tolerably  well  acquainted. 

It  was  well  known  that  a  form  of  pharyngeal  inflammation 
had  been  investigated  and  described  some  years  ago  by  M.  Bre- 
ton neau,  of  Tours,  and  that  to  this  disease  he  gave  the  name  of 
diphtherite.     It  was  probably  from  the  analogy  observed  between 
the  disease  lately  prevailing  here  and  that  described  by  M.  Bre- 
ton neau,  that  the  former  was  now  commonly  spoken  of  as  diph- 
therite,   diphtheritis,    diphtheria,    or   diphtheritic   disease.     M. 
Breton  neau  and  some  other  French  authorities  appeared  to  have 
regarded  it  as  almost,  if  not  absolutely,  identical  with  the  ordi- 
nary inflammatory  croup  of  this  country;  and  Dr.  Watson  in 
his  lecture  on  croup,  appeared  to  regard  Dr.  West  as  holding 
the  opinion  that  diphtherite  is  a  variety  of  croup — an  opinion 
in  which  Dr.  Camps  did  not  concur.     Whether  in  this  country 
or  in  France,  this  disease  had  heretofore  appeared  rather  as  an 
epidemic  than  as  a  sporadic   affection  ;  and  the  author  was  of 
opinion  that  many  of  the  cases  of  throat  disease  which  proved 
so  fatal  not  long  since  at  Boulogne,  might  have  been  cases  of 
diphtherite.     Here  it  assumed  quite  an  epidemic  character ;  and 
in  all  the  severer  and  fatal  instances  of  the  disease  in  this  country 
that  had  come  to  the  author's  knowledge,  such  cases  had  occur- 
red in  tolerably  rapid  succession   as  to  time,  and  in  tolerably 
close   proximity  as  to  place.     He   hesitated  to  commit  himself 
without  reserve  to  the  question  of  its  contagiousness,  although 
he  believed  that  practitioners  in  France  entertained  that  opinion. 

The  type  of  the  disease  in  its  severest  forms,  he  considered 
to  be  essentially  asthenic  or  adynamic;  and,  therefore,  attended 
with  more  or  less  languor,  depression,  and  diminution  or 
impairment  of  vitality,  thus  indicating  most  clearly  the  appro- 
priate mode  of  treatment.  Of  late,  in  many  of  the  metropolian 
dispensaries  and  hospitals,  stomatitis  had  been  very  prevalent; 
and  in  the  judgement  of  the  author,  there  existed  between 
stomatitis  and  the  diphtheritic  affection,  now  under  considera- 
tion, a  very  close  analogy  or  resemblance.  He  regarded  the 
former  as  the  standing  off  into  a  milder  form  of  the  latter,  yet 
both  as  the  result  of  the  same  morbific  general  cause ;  so  that 
the  difference  between  the  two  should  be  considered  as  one  of 
degree,  rather  than  of  kind.  The  tendency  to  the  production 
of  plastic,  pseudo-membranous  exudations,  as  observed  in  these 


1858.]  On  the  Prevailing  Diphtheritic  Affection.  755 

diseases,  was  one  mode  of  denoting  the  existence  of  an  adyna- 
mic or  low  form  of  inflammation  ;  and  the  correct  appreciation 
of  this  condition  was  of  the  highest  importance  in  the  treatment. 

A  description  of  the  disease,  as  detailed  by  M.  Bretonneau, 
was  then  briefly  adverted  to  by  Dr.  Camps,  who  then  stated  that 
he  was  indebted  to  Dr.  H.  W.  Fuller,  of  St.  George's  Hospital, 
for  having  drawn  his  attention  to  a  record  of  cases  of  diphtheri- 
tis  that  had  occurred  in  1849  at  Haverfordwest,  in  the  practice 
of  Mr.  Brown,  of  that  place,  and  which  that  gentleman  had 
communicated  to  the  " Medical  Times  and  Gazette."  Mr. 
Brown  in  that  year  had  had  no  fewer  than  two  hundred  cases, 
forty  of  which  had  proved  fatal ;  and  in  some  of  these  death  had 
ensued  in  a  few  hours  from  the  seizure,  others  lingered  on  for 
some  days.  In  its  course,  Mr.  Brown  said  that  some  of  the 
little  sufferers  appeared  to  get  through  it  easily  ;  while  others 
lingered  for  weeks  with  slight  but  deceitful  symptoms.  The 
treatment  adopted  by  Mr.  Brown  was  referred  to  by  the  author 
at  some  length.  He  affirms  that  he  did  not  lose  a  patient  in 
whom  he  succeeded  in  establishing  ptyalism.  That  gentleman 
advocated  the  topical  application  of  solution  of  nitrate  of  silver; 
in  regard  to  constitutional  treatment,  he  depended  upon  calomel 
in  combination  with  ipecacuanha,  in  doses  varying  from  half  a 
grain  of  each,  every  four  or  eight  hours.  He  found,  moreover, 
emetics  of  great  service  in  the  first  stage  of  the  disease ;  they 
then  always  relieved  the  distress  in  breathing,  carrying  away 
large  quantities  of  mucus.  The  only  cases  that  proved  fatal 
under  his  care  were  those  in  whom  the  pharynx  and  the  larynx 
were  simultaneously  affected.  The  post-mortem  examination 
of  all  the  fatal  cases  that  had  come  within  the  author's  knowledge, 
showed  the  pharynx,  tonsils,  larynx,  trachea,  and  upper  part 
of  the  bronchi,  to  be  more  or  less  coated  with  plastic,  pseudo- 
membranous exudation.  Eeference  was  made  by  the  author  to 
the  occurrence  of  the  disease  in  various  parts  of  the  country; 
namely,  in  Essex,  Norfolk,  Lincolnshire,  Staffordshire,  Wor- 
cestershire, Lancashire,  Devonshire,  and  in  the  metropolis. 

With  reference  to  the  cause  or  causes  of  this  and  similar 
diseases  assuming  an  epidemic  character,  it  was  usual  to  regard 
such  as  the  results  of  some  specific  epidemic  influence  or  agency, 
operating  upon  the  human  system  through  the  blood.  This 
explanation,  or  attempted  explanation,  the  author  stated,  was 
by  no  means  satisfactory  to  his  own  mind,  however  much  so  it 
might  be  to  the  minds  of  others. 

From  all  the  facts  or  particulars  which  Dr.  Camps  had  been 
able  to  collect  respecting  this  disease,  he  was  disposed  to  draw 
the  following  conclusions: — 

1.  A  disease  very  analogous  to,  if  not  identical  with,  that  des- 
cribed  by   M.  Bretonneau  as  diphtherite,  had   existed  in  this 


756  Some  Obscure  forms  of  Nervous  Affection.  [November, 

country,  and  had  prevailed  with  more  or  less  intensity  during 
the  iast  few  years. 

2.  This  disease  was  mainly,  if  not  essentially,  of  an  asthenic, 
adynamic  type;  and  characterized  in  the  severer  cases  by  the 
formation  of  plastic  pseudo-membranous  exudations. 

3.  This  disease  was  primarily  pharyngeal  as  to  its  seat,  and 
not  laryngeal,  except  secondarily,  and  by  complication;  thus 
differing  anatomically  from  croup. 

4.  Its  difference  from  stomatitis  was  a  difference  of  degree  or 
intensity,  rather  than  a  difference  of  kind;  and  that  one  chief 
point  of  difference  from  the  malignant  sore  throat,  consequent 
upon  scarlatina,  consisted  in  the  tendency  to  the  formation  of 
plastic  pseudo-membranous  exudations. 

5.  In  many  instances  this  disease  possessed  the  characters  of 
an  epidemic  disease. 

6.  Its  low  adynamic  type  clearly  indicated  the  mode  of  treat- 
ment to  be  adopted ;  which  in  the  author's  judgement,  should 
be  both  topical  and  general.  The  topical  consisting  of  free  ap- 
plications of  a  strong  solution  of  nitrate  of  silver  to  the  parts 
affected,  composed  of  from  one  scruple  to  two  drachms  of  the 
nitrate  to  one  ounce  of  distilled  water;  or  similar  applications 
of  chlorine  or  hydrochloric  acid  ;  the  general  treatment  compris- 
ing the  repeated  administration  of  chlorate  of  potassa,  with 
chlorine,  or  a  combination  of  cinchona  bark,  or  its  alkaloid  salts 
with  the  mineral  acids;  and  in  the  severer  cases,  calomel  in 
repeated  doses,  so  as  to  produce  ptyalism.  Emetics  in  the  early 
stages  of  the  disease  have  been  given  in  some  cases,  and  with 
good  result.  In  addition,  the  vital  powers  of  the  system  must 
be  well  sustained  by  liberal  administration  of  wine,  stout,  beef- 
tea,  and  other  invigoratihg  means. — [British  Med.  Journal. 


On  some  of  the  more  Obscure  Forms  of  Nervous  Affections:  their 
Pathology  and  Treatment.  With  an  Introduction  on  the  Physi- 
ology of  Digestion  and  Assimilation,  and  the  Generation  and 
Distribution  of  Nerve  Force.  By  Harry  William  Lobb,  L. 
S.  A.  and  M.R.C.S.E. 

Mr.  Lobb,  in  the  first  part  of  his  work,  advances  opinions, 
both  in  physics  and  physiology,  which  are  diametrically  oppo- 
sed to  those  ordinarily  received.  One  or  two  examples  will 
convey  a  notion  of  Mr.  Lobb's  matter  and  manner. 

Adopting  a  system  of  molecular  physics  (which  would  seem 
to  have  scarcely  any  other  foundation  than  ingenuity)  he  makes 
this  the  master-key  with  which  to  unlock  several  of  the  myste- 
ries of  physiolgy.  He  assumes  that  "the  ultimate  atoms  of  all 
matter  are  spheroids  in  a  state  of  vibration"  (p.  6) ;   vibration 


1858.]  Some  Obscure  forms  of  Xervous  Affection.  «•-* 

gives  rise  to  certain  definite  currents ;  "  currents  in  the  spheroid 
produce  rotation;  rotation  will  continue  the  currents;  they, 
therefore,  contain  within  themselves  the  elements  of  their  own 
existence"  (p.  8);  the  currents  are  electrical  currents,  and  as  a 
consequence  we  have  the  conclusion  liat,  as  no  change 
of  an}"  description  can  take  place  in  matter  without  causing  cur- 
rents of  electrical  fluid,  and  as  the  combinations  and  disruptions 
which  take  place  during  an  act  of  growth,  and  which  occur 
through  the  agency  of  what  is  termed  vital  force,  or  as  Mr.  Lobb> 
prefers  to  term  it,  cell  force  or  cell  electricity,  are  always  accom- 
panied by  molecular  changes,  therefore,  "Vital  force  is  merely 
a  modification  of  that  remarkable  fluid  pervading  all  matter  and 
space,  always  aiming  at  equilibrium  and  yet  so  easily  disarrang- 
ed" (p.  11). 

Mr.  Lobb's  views  will  scarcely  supersede  the  views  of  Mr. 
Groves  and  Dr.  Carpenter,  the  former  of  whom  has  dealt  most 
ably  with  the  physical  relations  of  electricity,  and  the  latter 
with  the  physiological.  (On  the  mutual  Eelations  of  the  Vital 
and  Physical  forces,  "  Phil.  Trans."  1850,  Part  II.) 

Mr.  Lobb  advances  a  theory  of  the  formation  of  chyle-cells. 
He  states  that  the  initial  step  in  the  formation  of  the  cell  is  the 
vibratory  movements  of  certain  minute  crystals  of  phosphate  of 
lime.  These  crystals  during  vibration  become  coated  with  the 
proteine  and  oily  compounds  of  the  chyle  forming  molecules. 
44  When  many  of  these  molecules  are  formed,  they,  upon  ap- 
proaching one  another,  become  attached  in  a  line  like  a  small 
string  of  beads,  vibration  still  continuing;  when  a  certain  num- 
ber are  thus  joined,  they  double  one  upon  another,  forming  a 
nucleus,  to  which  minute  atoms  are  continually  added  until  a 
tolerable  aggregation  is  the  result ;  this  is  a  mass  of  molecules. 
The  external  atoms  now  proceed  to  form  a  cell  wall,  which,  in 
this  period  of  its  existence  is  completely  invisible :  but  it  consists 
of  minute  atoms,  between  which  are  still  smaller  interspaces, 
which  admit  of  the  passage  of  fluids,"  &c.  (p.  31).  A  sad  short- 
coming of  this  theory  is  the  absence  of  all  proof  of  the  process 
of  formation  here  said  to  take  place. 

As  another  example  of  Mr.  Lobb's  mode  of  reasoning,  the 
following  may  be  quoted  :  "  Carbonic  acid  gas  is  constantly,  day 
and  night,  winter  and  summer,  although  in  varying  proportions 
according  to  circumstances,  being  excreted  by  the  blood  in  the 
lungs  ;  the  repair  of  tissue  surely  does  not  require  this  immense 
waste  of  material.  The  most  idle  man — the  fat  unwieldy  inhab- 
itant of  the  Eastern  harem,  who  is  afraid  to  move  lest  she  should 
lessen  her  value  in  the  eyes  of  her  lord  by  losing  a  portion  of 
her  obesity,  eats  largely.  Merely  to  throw  off  this  waste  from 
the  lungs?     Surely  not ;  there  must  be  a  cause,  and  it  is  this. 

11  The  nutriment  absorbed  by  the   lacteals,   converted  into 


758  Some  Obscure  forms  of  Kervous  Affection.  [November, 

albumen,  fibrine,  and  blood  cells,  is  conveyed  into  the  most 
minute  intensity  of  the  organism  by  the  capillaries;  here  the 
oxygen  brought  by  the  blood  seizes  upon  some  hydrocarbon 
with  which  to  unite,  giving  rise  to  molecular  change — to  currents 
of  electricity ;  these  currents  are  collected  by  the  nerves  always 
accompanying  the  vessels,  and  serve  lo  feed  the  nervous  system ; 
at  the  same  time,  some  portion  correlates  into  animal  heat,  &c. 
It  is  then  to  feed  the  nervous  system  that  this  tissue-change, 
beyond  that  really  required  for  repair,  is  constantly  going 
forward,  and  so  much  carbonic  acid  is  excreted  from  the  lungs. 
It  is  not,  then,  a  wilful  waste,  4his  apparent  carbon ;  on  the 
contrary,  life  could  not  last  without  it — aervous  energy  would 
lessen,  the  extremities  and  skin  would  get  cold — circulation 
would  become  sluggish,  and  death  eventually  ensue"  (p.  82). 

It  is  certainly,  a  somewhat  novel  view  to  regard  the  cabonic 
acid  given  off  by  the  lungs  as  wasted  material,  seeing  that  that 
gas  is  commonly  regarded  as  a  deleterious  product  of  the  decay 
of  some,  and  the  metamorphosis  of  other  tissues,  and  of  the  re- 
duction of  the  carbon  of  the  food,  which  reduction  has  especial 
reference  to  the  maintenance  of  animal  heat.  No  question  of 
physiology  has  been  more  carefully  and  successfully  investigated 
than  that  of  the  sources  of  the  carbonic  acid  given  off  from  the 
lungs,  and  its  relationship  to  the  amount  and  quality  of  food 
taken,  and  of  the  degree  of  metamorphosis  going  on  in  the  differ- 
ent tissues  of  the  body ;  but  Mr.  Lobb  appears  to  ignore 
altogether  the  results  of  the  researches  on  this  question.  Mr. 
Lobb,  moreover,  does  not  seem  to  be  aware  that  the  electrical 
conditions  arising  from  changes  going  on  in  the  intimate  struc- 
tures of  the  body,  particularly  in  the  nerves  and  muscles,  have 
been  made  the  subject  of  most  successful  experimental  research 
by  M.  E.  de  Bois-Eaymond  and  others,  and  that,  in  consequence, 
theories  upon  this  subject  which  are  not  based  upon  experiment, 
are  neither  necessary  nor  admissible.  When  Mr.  Lobb  makes 
use  of  the  expression  "  correlates  into,"  e.  g.  "  some  portion  {i.  e. 
of  the  electricity)  correlates  into  animal  heat"  (p.  83) ;  he  betrays 
a  singular  misapprehension  of  the  signification  of  the  term  cor- 
relation. 

In  the  second  part  of  his  work,  Mr.  Lobb  treats  of  "certain 
affections  of  the  nervous  system,  the  symptoms  of  which  are 
obscure,  and  which,  if  not  alleviated,  would  develop  themselves 
into  organic  degeneration,  fatal  disease,  or  insanity."  He  ex- 
presses the  opinion  that  the  affections  of  which  he  treats  depend 
upon  "partial  paralysis  of  some  portion  of  the  sympathetic 
system  of  nerves,  either  of  their  centres  or  their  peripheric  ter- 
minations, thus  upsetting  the  healthy  process  of  digestion  and 
assimilation  in  some  portion  of  its  extended  course,  causing 
functional  derangements,  nervous  irritability,  and  frequently 


1858.]      Effect  of  Local  Influences  on  Spasmodic  Asthma.  759 

sympathetic  complication  of  the  most  important  organs"  (p.  124). 
He  discusses  the  nervous  affections  which  accompany  certain 
morbid  conditions  of  the  urine,  B right's  disease,  and  diabetes. 
He  discusses,  also,  spermatorrhoea,  stammering,  hysteria,  chorea, 
and  epilepsy;  diet  and  regimen,  certain  medicinal  preparations, 
and  the  therapeutics  of  galvanism  and  electro-magnetism.  He 
adds  nothing  new  to  our  knowledge  of  the  affections  of  which 
he  treats,  and  his  therapeutics  are  in  great  measurs  derived  from 
the  peculiar  views  which  he  entertains  on  the  physiology  of 
digestion  and  assimilation. 

That  portion  of  Mr.  Lobb's  work  which  is  devoted  to  sperma- 
torrhoea would  appear  to  be  written  rather  for  the  public  than 
the  profession. — [Ranking* s  Abstract. 


The  Effect  of  Local  Influences  on  Spasmodic  Asthma.     By  Dr. 
Hyde  Salter,  Assistant  Physician  to  Charing-cross  Hospital. 

The  purport  of  this  paper  is  to  show  that,  in  a  very  large 
proportion  of  cases  of  asthma  in  which  it  has  been  fairly  tried, 
change  of  locality  effects  an  instantaneous  cure,  which  is  perma- 
nent as  long  as  the  asthmatic  continues  his  residence  in  the  place 
that  has  cured  him.  The  author  remarks  that,  although  the 
subject  of  his  paper  is  a  single  method  of  cure  of  a  single  disease, 
yet  that  the  efficacy  and  completeness  of  the  cure,  and  the  pain- 
fulness  and  intractability  of  the  complaint,  vindicated  it  from 
unimportance;  and,  indeed,  that  in  so  distressing  and  unman- 
ageable a  disease,  any  remedy  that  offered  even  a  small  percent- 
age of  cures  might  be  considered  the  greatest  possible  boon. 
The  paper  is  illustrated  by  nearly  thirty  original  cases,  and  the 
points  that  the  author  considered  to  be  established  are  as  follows  : 

1.  That  residence  in  one  locality  will  radically  and  perma- 
nently cure  asthma  resisting  all  treatment  in  another  locality. 

2.  That  the  localities  which  are  the  most  beneficial  to  the 
largest  number  of  cases  are  large,  populous,  and  smoky  cities. 

8.  That  this  effect  of  locality  depends,  probably,  on  the  air. 

4.  That  the  air  that  would  be  imagined  to  be  the  worst  for  the 
general  health  is,  as  a  rule,  the  best  for  asthma;  thus  the  worst 
parts  of  cities  are  the  best,  and  conversely. 

5.  That  this  is  not  always  the  case,  the  very  reverse  being 
sometimes  so — a  city  air  not  being  tolerated,  and  an  open,  pure 
air  effecting  a  cure. 

6.  That  there  is  no  end  of  the  apparent  caprice  of  asthma  in 
this  respect,  the  most  varying  and  opposite  airs  unaccountably 
curing. 

7.  That,  consequently,  it  is  impossible  to  predict  what  will  be 
the  effect  of  any  given  air,  but  that  probably  the  most  opposite 
to  that  in  which  the  asthma  seems  worst  will  cure. 


700  Influmce  of  Surgical  Affections,  Sec.      [November, 

8.  That  some  of  these  differences,  determining  the  presence 
or  cure  of  asthma,  appeared  to  be  of  the  slightest  possible  kind, 
arbitrary,  and  inscrutable. 

9-.  That  the  mere  conditions  of  locality  appear  to  be  adequate 
to  the  production  of  asthma  in  a  person  whose  disposition  to  it 
was  never  before  suspected,  and  who  probably  never  would 
have  had  it,  had  he  not  gone  to  such  a  locality. 

10.  That,  consequently,  probably  many  healthy  persons  who 
never  have  had  asthma,  and  never  may,  would  have  been  asth- 
matics if  their  lot  had  been  cast  in  other  localities. 

1L  That  possibly  there  is  no  case  of  asthma  that  might  not 
be  cured  if  the  right  air  could  only  be  found. 

12.  That  the  disposition  is  not  eradicated,  but  merely  suspend- 
ed, and  immediately  shows  itself  on  a  recurrence  to  the  original 
injurious  air. 

13.  That  change  of  air,  as  change,  is  prejudicial. 

14.  That,  from ^he  caprice  of  asthma,  the  constancy  of  the 
result  in  any  given  case  is  often  deranged. 

In  reference  to  the  frequency  with  which  London  air  is  bene- 
ficial to  asthma,  the  author  remarked  that  he  was  in  the  habit 
of  putting  to  country  asthmatics  the  two  questions — "Have  you 
ever  been  in  London?  have  you  ever  had  asthma  there?"  and 
that,  if  an  affirmative  answer  was  given  to  the  first  question,  a 
negative  one  was  pretty  sure  to  be  given  to  the  second.  In  his 
own  experience  he  had  found  hardly  any  exception  to  this 
rule. — [Lancet. 


On  the  Influence  of  some  Surgical  Affections  upon  Animal  Heat. 
By  M.  1)emarquay. 

M.  Demarquay  observes  that  although  many  observations 
have  been  made  upon  the  modifications  of  the  temperature  pro- 
duced by  internal  diseases,  with  the  exception  of  Hunter's  upon 
inflammation,  and  some  researches  upon  the  effects  of  ligatures 
on  large  vessels,  nothing  has  been  done  with  respect  to  surgical 
affections.  He  treated  upon  the  subject  in  his  inaugural  disser- 
tations in  1847,  and  since  then  has  continued  to  pay  attention  to 
it ;  and  the  present  memoir  is  an  account  of  some  of  the  results 
of  his  observations. 

The  pyrexia  following  amputations  and  other  operations  is 
accompanied  by  an  elevation  of  temperature  proportioned  to 
the  amount  of  reaction  ;  but  when  the  case  becomes  complicated 
by  other  phenomena,  as  phlebitis  or  erysipelas,  the  temperature 
may  undergo  notable  variations.  Thus,  in  a  case  of  amputation, 
of  the  thigh,  followed  by  phlebitis  and  purulent  affection,  the 
thermometer  has  risen  from  97°  or  99°  to  104°  Fahr.;  and 
although  this  increase  may  seem  in  itself  but  trifling,  yet  the 


1858.]  Influence  of  Surgical  Affections,  &c.  761 

observations  of  Andral  and  others  have  noted  but  a  few  degrees 
of  elevation  only,  even  in  the  intensest  fevers.  If,  however,  the 
elevation  of  the  general  temperature  is  inconsiderable,  that  is 
not  the  case  with  respect  to  the  local  temperature.  Thus,  in 
phlegmon  and  erysipelas,  comparing  the  condition  of  the  afflict- 
ed parts  with  that  of  the  healthy  ones,  it  has  been  found  that 
while  the  general  temperature  of  the  body  may  have  undergone 
a  notable  increase,  exceeding  that  of  the  neighboring  parts  Dy 
from  2°  to  5°  C.  All  serious  wounds  which  produce  febrile 
action  induce  an  elevation  of  general  and  local  temperature,  but 
when  the  membrane  covering  the  granulations  has  become  well 
organized,  the  temperature  is  then  found  to  be  like  that  of  the 
surrounding  parts ;  so  that  ice  applied  under  such  circumstances 
would  abstract  normal,  not  morbid,  caloric.  Experimenting 
upon  dogs,  too,  the  author  has  observed  that  the  application  of 
ice  leads  to  a  considerable  falling  of  the  thermometer  in  the  case 
of  subcutaneous  wounds.  The  same  experiments  showed  that 
a  wound  that  had  undergone  such  diminution  in  its  temperature, 
quickly  recovered  this,  and  went  beyond  it,  the  temperature  of 
the  wound  thus  undergoing  a  series  of  elevations  and  depres- 
sions, according  to  the  quantity  of  ice  employed,  and  its  degree 
of  fusion.  It  is  evident  that  such  a  powerful  modifier  requires 
great  reserve  in  its  employment ;  and  most  of  the  Paris  surgeons 
reasonably  prefer  in  the  case  of  great  breach  of  surface,  tepid 
irritations  to  these  freezing  applications.  As  to  the  temperature 
in  aneurisms,  MM.  Demarquay  and  Monneret  have  on  several 
occasions  observed  in  arterioso-venous  aneurisms  of  the  lower 
extremity,  an  elevation  of  from  1°  to  2^°  C. ;  but  they  have 
never  observed  a  similar  difference  in  the  case  of  such  aneurism 
existing  at  the  bend  of  the  elbow.  When  in  a  limb,  the  subject 
of  aneurism,  the  circulation  has  undergone  no  considerable  dis- 
turbance, no  important  variation  of  the  animal  temperature  is 
observable;  but  when  complications,  such  as  phlegmon,  are 
present,  an  elevation  of  2°  may  take  place.  After  ligature  of 
the  femoral  and  humeral  arteries,  the  author  has  found  a  dimi- 
nution of  temperature  to  take  place,  and  the  experiments  upon 
animals  which  he  had  made  with  MM.  Dumeril  and  Lecointe 
demonstrate  the  accuracy  of  the  assertion,  that  every  ligature  of 
an  important  artery,  performed  so  as  to  avoid  all  injury  to  the 
veins  and  nerves,  give  rise  to  a  diminution  of  the  temperature 
of  the  limb  beyond  the  ligature.  A  priori,  a  considerable  modi- 
fication in  the  temperature  of  a  limb  might  be  expected  in  limbs 
suffering  from  senial  gangrene;  and  the  author  has  been  some- 
what surprised  to  find  only  a  difference  of  1|°  or  2°C.  between 
the  two  limbs,  except  in  one  case,  when  the  difference  amounted 
to  5°. 

The  following  are  the  conclusions  of  the  memoir :  1.  Purulent 


762  Absorption  of  Medicinal  Substances.      [November, 

infection  and  erysipelas  give  rise  to  an  elevation  of  2°  to  3°  C. 
2.  Circumscribed  inflammations,  as  phlegmon  or  local  erysipe- 
las, give  rise  to  an  increase  varying  from  1°  to  5°.  Ice  quickly 
gives  rise  to  a  temporary  diminution,  but  the  parts  afterwards 
not  only  recover  their  former  temperature,  but  exceed  it.  3.  A 
true  aneurism,  if  the  limb  is  healthy,  give  rise  to  no  change  of 
temperature,  but  arterioso-venous  aneurism,  and  especially  in 
the  lower  extremity,  increases  it  by  1°  to  2\°  C.  4.  Hunter  and 
his  school  have  examined  into  the  effects  of  ligature  of  vessels 
on  the  temperature,  but  have  arrived  at  contradictory  results. 
From  my  observations  it  follows  that  ligature  of  the  artery  and 
the  vein  in  arterioso-venous  aneurism  of  the  lower  extremity, 
give  rise  to  an  elevation  of  temperature ;  while  when  the  princi- 
pal artery  of  a  limb  is  alone  tied,  there  is  always  a  diminution 
of  temperature.  5.  In  senile  gangrene  there  is  always  a  diminu- 
tion of  temperature  of  from  1°  to  5°  C.  in  the  parts  situated 
above  the  mortification. — \Comtes  Rendus.  and  Ranking 's  Ab- 
stract. 


On  the  Absorption  of  Medicinal  Substances  by  the  Large  Intestine. 
By  M.  Briquet. 

The  object  of  M.  Briquet's  two  memoirs  is  the  study  of  the  ab- 
sorption of  medicinal  substances  introduced  into  the  large  intes- 
tine by  means  of  clysters.  The  following  are  the  general  conclu- 
sions he  has  arrived  at : — 

1.  The  fluid  constituting  the  injection  may  easily  reach  as  far 
as  the  caecum,  and  consequently  may  be  brought  into  contact 
with  a  very  large  extent  of  absorbing  surface.  2.  The  mucous 
membrane  and  the  fluids  that  bathe  its  surface  do  not  exert  any 
chemical  action  upon  the  subslances  so  introduced  into  the  large 
intestine,  where  all  that  is  absorbed  is  that  which  was  previously 
in  a  state  of  solution.  3.  When  a  clyster  of  the  soluble  salts  of 
quinine,  in  doses  less  than  15  grains,  is  administered,  rather  more 
than  a  third  of  the  quantity  so  administered  is  eliminated,  and  has 
consequently  been  absorbed.  4.  When  large  doses  are  adminis- 
tered, they  are  ill-supported,  and  only  a  fifth  or  a  sixth  of  the 
quantity  is  absorbed.  5.  In  whatever  dose  the  the  quinine 
may  have  been  given,  it  generally  gives  rise  to  cerebral  symptoms 
only  very  slowly  and  to  a  slight  degree.  6.  Traces  of  elimina- 
tion and  consequently  of  absorption  are  only  met  with  an  hour 
after  the  administration  of  a  clyster,  and  even  then  the  elimina- 
tion is  incurable.  7.  The  duration  of  the  elimination  is  usually 
short — two  or  three  days  at  the  utmost.  8.  The  greatest  or  less 
dilution,  within  certain  limits,  the  more  or  less  viscous  nature  of 
the  liquid,  or  the  addition  of  the  salts  of  morphia  to  the  cinchona 
alkaloids  do  not  exert  any  sensible  modification  on  the  absorption. 


1858.]  The  Uses  of  Pain.  763 

9.  Absorption  takes  place  more  readily  in  the  young  than  in  the 
adult;  and  is  performed  with  difficulty  in  the  aged  of  either  sex. 

10.  The  salts  of  quinine,  administered  in  clysters  in  doses  of  less 
than  15  grains,  exert  the  same  effect  as  when  given  in  moderate 
doses  by  the  mouth,  and  may  be  very  well  substituted  for  these. 

11.  But  this  is  not  the  case  with  large  doses,  which  are  never 
absorbed    in  sufficient  quantities  to   produce   energetic  effects. 

12.  The  large  intestine  will  rarely  tolerate  a  larger  dose  than  30 
grains  of  the  sulphate.  13.  These  conclusions  more  or  less  exact- 
ly apply  to  the  various  substances  administered  by  clysters.  14. 
The  apyrexic  is  notably  more  favorable  to  the  absorption  of 
medicinal  substances  than  the  pyrexic  condition.  15.  The 
typhoid  condition  favours  such  absorption  less  than  other  states 
of  phlegmasia.  Nevertheless  it  is  more  energetic  than  hitherto, 
supposed,  being  only  about  a  tenth  inferior  to  the  absorption 
taking  place  in  the  pyrexic  condition.  16.  In  diabetes,  the  ab- 
sorption of  medicinal  substances  appear  to  be  very  feeble  in  the 
intestines.  17.  In  certain  diseases,  the  tolerance  or  intolerance 
of  medicinal  substances  may  depend  upon  a  special  susceptibility 
rather  than  upon  variations  in  absorption.  Thus,  in  hysteria  the 
tolerance  of  opium  nowise  depends  upon  an  absence  of  absorption 
but  results  from  a  special  susceptibility.  18.  The  rapidity  with 
which  medicinal  substances,  such  as  the  salts  of  quinine,  are 
eliminated,  is  in  a  direct  ratio  with  the  quantity  of  urine  passed. 
This  rapidity  is  the  exact  measure  of  the  time  which  the  econo- 
my takes  to  rid  itself  of  the  greater  part  of  the  fixed  substances 
taken  medicinally.  19.  The  absorption  of  medicinal  substances 
analogous  to  the  salts  of  quinine  is  far  more  rapid  in  the  young. 
20.  It  is  less  active  in  females  than  in  males,  in  the  proportion  of 
a  sixth  to  an  eighth.  21.  Abstracting  from  a  medicinal  effect 
the  portion  due  to  the  quantity  of  the  substance  absorbed,  the  re- 
mainder gives  the  measure  of  the  susceptibility  of  being  influen- 
ced by  the  medicinal  substance. — [Bulletin  de  I 'Acad,  and  Ameri- 
can Jour,  of  Med.  Sciences. 


The   Uses  of  Pain. 

Mankind  are  so  accustomed  to  shrink  from  pain,  and  so  eager 
in  seizing  upon  every  means  to  lessen  or  annul  it,  that  the  facts 
of  our  having  been  endowed  with  it,  as  with  a  sense,  by  a  benifi- 
cent  Creator,  and  with  the  kindest  intent,  does  not  readily  impress 
us.  Yet  that  this  is  strictly  true,  daily  observation  teaches. 
Without  pain  to  act  as  a  sentinel,  the  body  would  almost  moment- 
ly be  injured,  perhaps  hopelessly  so,  and  Death  would  revel  in 
such  wise  as  that  the  race  would  soon  be  extinct.  This  is  hardly 
an  exaggerated  statement ;  and  a  little  reflection  will  enable  any 

n.  s. — VOL.  XIV.  NO.  xi.  44 


764  The  Uses  of  Pain.  [November, 

one  to  realize  the  immense  amount  of  evil  which  would  ensue  to 
us  all,  were  the  "sense  of  pain"  abolished. 

A  very  interesting  and  instructive  article,  in  a  late  number  of 
the  Quarterly  Review,  is  transferred  to  the  pages  of  the  Living 
Age  of  the  24th  of  April,  1858.  It  is  a  critique  upon  "An  Essay 
on  the  Beneficent  Distribution  of  the  Sense  of  Pain,"  written  by 
Mr.  G.  A.  Kowell,  Honorary  Member  of  the  Ashmolean  Society, 
and  Assistant  Underkeeper  of  the  Ashmolean  Museum.  Most  of 
the  details  are  familiar  to  medical  men,  but  any  reader  will  be 
delighted  with  the  pleasant  style  of  the  review,  the  entertaining 
illustrations  and  the  facts  communicated.  It  is  a  paper  calculated 
to  do  good  to  the  general  reader  in  many  ways  ;  and  not  the  least 
by  the  noble  sentiments  with  which  its  last  two  or  three  pages 
ieem.  We  allude  to  the  remarks  upon  cruelty  to  animals.  Many 
seem  now  to  believe,  as  did  Malebranche,  that  dogs,  horses,  and 
such  like  animals  do  not  feel,  and  that,  therefore,  any  amount  of 
abuse,  by  means  of  kicks,  blows,  goading  and  spurring  is  admis- 
sible. We  say  many  persons  seem  to  suppose  this,  for  although 
they  hear  a  dog  howl  if  kicked,  and  know  that  a  horse  springs 
forward  under  the  spur,  they  do  not  realize,  or  do  not  think,  how 
much  unnecessary  pain  is  inflicted  by  them,  in  their  gusts  of  tem- 
per, upon  animals  almost  always  innocent  of  any  fault. 

To  recur  to  our  first  topic — the  wonderful  guardianship  over 
the  bodily  organs,  so  kindly  established  for  us  through  the  agency 
of  pain.  How  few  think  of  the  subject  in  this  light.  Accustomed 
too  much,  to  look  upon  pain  as  an  unmitigated  evil,  we  are  apt 
to  concentrate  our  hatred  upon  it,  rather  than  to  recognize  its 
function ;  and  we  strive  only  to  remove  it,  without  seeking  for 
its  cause.  The  latter  task  is,  it  is  true,  mainly  the  province  of 
the  followers  of  the  healing  art ;  yet  how  much  may  others  learn 
by  properly  considering  their  own  sensations. 

Pain  is  an  evil,  then,  but  it  is  also  a  blessing.  It  is  composite 
in  its  essence ;  and  in  this  it  resembles  many  medicinal  agents, 
which,  whilst  effecting  a  certain  good,  are  exceedingly  unpleasant 
in  their  action.  Of  course  it  would  be  foolish  to  term  pain  a  good 
in  itself,  and  therefore  not  seek  to  relieve  and  remove  it.  The 
future  Sir  Humphrey  Davy  doubtless  changed  his  opinion  very 
quickly  and  permanently,  untler  the  strong  personal  application 
of  the  argument  implied  in  the  story  referred  to  by  the  Quarterly 
Review,  in  the  opening  paragraph  of  the  article  we  have  cited. 
"  Sir  Humphrey  Davy,  when  a  boy,  with  the  defiant  constancy 
of  youth  which  had  as  yet  suffered  nothing,  held  the  opinion  that 
pain  was  no  evil.  He  was  refuted  by  a  crab,  who  [which  ?]  bit 
his  toe  when  he  was  bathing,  and  made  him  roar  loud  enough  to 
be  heard  half  a  mile  off.  If  he  had  maintained,  instead,  that  pain 
was  a  good,  his  doctrine  would  have  been  unimpeachable.  Un- 
less the  whole  constitution  of  the  world    were  altered,  our  very 


1858.]  The  Uses  of  Pain.  765 

existence  depends  upon  our  sensibility  to  suffering."  As  the  re- 
viewersays,  "  without  the  warning  voice  of  pain,  *  *  *  the  crab 
might  have  eaten  off  the  future  Sir  Humphrey's  foot  while  he 
was  swimming,  without  his  entertaining  the  slightest  suspicion 
of  the  ravages  which  wTere  going  on."  So  he  adds.  "  had  he  sur- 
vived the  injuries  from  the  crab,"  he  would  have  been  destroyed 
by  continuing  the  inhalation  of  carburetted  hydrogen,  after  it 
had  almost  caused  his  death,  and  yet  saved  him  by  inducing 
painful  sensations. 

The  preservation  of  infancy  is  alluded  to  by  the  reviewer,  as 
often  entirely  due  to  physical  pain.  Of  course,  in  the  absence 
of  parents  or  nurses,  thousands  of  children  would  perish  from 
mere  lack  of  that  experience  which  suffering  gives  them  by  de- 
grees. 

Another  phase  in  the  "beneficient  distribution  of  pain"  is  the 
undoubted  total  absence  of  it  in  what  is  termed  the  last  struggle. 
Dissolution  is  painless ;  the  agony  has  been  distributed  over 
other  hours  of  existence;  the  sunset  of  life,  like  those  of  many  a 
stormy  natural  day,  are  placid,  most  generally.  The  opinion, 
however,  is  still  commonly  entertained  that  there  must  be  pain 
whilst  the  spirit  is  leaving  the  body,  because  of  the  occurrence  of 
convulsive  movements  remarked  at  such  times.  The  suffering 
is  only  apparent,  not  real.  What  a  consolation  to  friends  is  this, 
and  what  a  source  of  comfort  to  all  poor  mortals,  who  know  that 
they  must  pass  through  the  gate  of  death.  Upon  this  point  the 
reviewer  says  :  "  In  fact,  though  disease  is  often  painful,  the  act 
of  dying  is  not.  Bodily  suffering  would  be  no  protection  then, 
and,  consistently  with  the  invariable  method  of  Providence,  we 
are  spared  a  useless  anguish." 

Anaesthetic  agents,  which  have  been  so  mercifully  revealed  to 
us,  and  whose  discovery  is  certainly  the  greatest  boon  to  humani- 
ty since  that  of  vaccination,  have  been  questioned  in  regard  to 
one  of  their  applications,  by  eminent  medical  men.  We  refer  to 
their  employment  in  obstetric  cases.  There  are  those  who  con- 
tend that  the  pains  of  labor,  being,  in  fact,  natural  and  healthy 
demonstrations,  ought  not  to  be  interferred  with ;  that  they  have  an 
important  part  to  play — and  that  they  have  such  uses  as  ought 
not,  even  partially,  to  be  lost  to  the  parturient  woman.  Whilst 
many  decry  this  view  as  foolish  and  unfounded,  we  confess  to 
seeing  much  truth  in  it.  There  can  be  no  dispute  as  to  the  bene- 
fit of  ether  and  chloroform  in  surgical  operations,  or  their  appli- 
cation for  the  relief  of  any  pathological  condition  ;  but  childbirth 
is  not  a  pathological  state,  but  wholly  a  natural  act.  It  may 
well  be  questioned  how  far  we  ought  to  interfere  with  what  are 
termed  its  "  pains."  Of  course,  if  the  woman  in  labor  begins  to 
sink  under  their  mere  endurance,  or  any  morbid  element  mingles 
with  the  process,  our  authority  is  at  once  established,  to  inter- 


766     Analysis  and  Principles  of  Human  Excrements.  [November, 

pose — the  state  has  become  pathological.  But  often,  anaesthetics 
are  used  in  short  and  easy  labors,  when  the  patient  would  have 
done  as  well,  or  even  better,  without  them.  We  can  refer  to 
several  instances  in  which  labor  has  been  undoubtedly  retarded 
by  the  action  of  ether  on  the  uterine  efforts  ;  and  within  a  few 
days,  a  case  has  been  mentioned  to  us  by  a  highly  intelligent  and 
observing  medical  friend,  where  this  was  distinctly  proved.  The 
labor  was  a  first  one,  and  the  birth  was  delayed  a  long  time  without 
any  apparent  reason.  The  suspension  of  the  inhalation  of 
ether  was  advised  by  the  gentlemen  referred  to,  and  on  comply- 
ing with  the  suggestion,  the  uterus  immediately  resumed  its  efforts, 
which  safely  and  speedily  resulted  in  the  expulsion  of  the  child. 

This  aspect  of  the  use  of  pain  deserves  closer  attention,  and  it 
may  be  well  to  sift  obstetric  cases  more  thoroughly  ;  using  anaes- 
thesia, only,  or  chiefly,  in  such  instances  as  really  demand  it. 

We  have  already  extended  our  remarks  beyond  the  limits  we 
had  assigned  to  them.  Pain,  as  an  evil,  has  of  late  been  placed 
more  than  could  ever  have  been  hoped  for,  under  the  dominion 
of  scientific  medicine.  As  a  good,  it  still  is  vouchsafed  to  us  in 
the  shape  of  a  watchful  guardian ;  and  it  must  be  ever  present 
on  the  earth  in  many  forms  and  with  every  shade  of  intensity.  It 
is  only  in  the  vision  of  the  Revelation  that  we  read,  "  and  there 
shall  be  no  more  death,  neither  sorrow,  nor  crying,  neither  shall 
there  he  any  more  pain.  [Boston  Med.  and  Surg.  Jour. 


On  the  Analysis  and  Immediate  Principles  of  Human  Excrements 
in  Disease.     By  Dr.  Marc^t,  F.  R.  S. 

The  object  of  this  communication  is — 1.  To  describe  an  easy 
and  very  practical  method  of  analisis  to  be  applied  to  feces  in 
the  diseased  condition.  2.  To  show  that  the  method  of  analysis 
in  question  is  essentially  anatomical  or  mechanical,  and  as  free 
as  possible  from  chemical  reactions.  3.  To  show  that  in  three 
instances  of  disease  where  the  bile  was  prevented  from  flowing 
into  the  duodenum,  the  feces  yielded  a  quantity  of  crystallizable 
fatty  acids,  (margaric  and  stearic  acids,)  which  immediate  princi- 
ples are  known  to  be  absent  from  healthy  evacuations,  except  in 
certain  cases  depending  on  a  peculiar  diet.  A  few  words  may 
suffice  for  describing  the  analysis.  The  evacuations  are  exhaust- 
ed with  boiling  alcohol,  and  the  solution  strained  through  muslin. 
On  cooling,  a  precipitate  or  deposite  occurs  in  the  fluid,  which  is 
separated  from  the  mother  liquor  by  filtration.  This  deposite, 
after  it  has  been  washed  with  boiling  alcohol,  is  found  in  healthy 
cases  to  consist  of  stearate  and  margarate,  or  soaps  of  lime  and 
magnesia,  with  or  without  earthy  phosphates — these  compounds 
existing  in  the  evacuations  under  examination  in  the  form  of  im- 


1858.]       Analysis  and  Principles  of  Human  Excrements.  767 

mediate  principles.  #The  alcoholic  washings  or  solution  obtained 
from  the  deposit  yielded,  in  case  of  retention  of  bile  ;  considera- 
ble quantities  of  free  margaric  and  stearic  acids  The  clear 
original  alcoholic  extract  being  mixed  with  miik  of  lime,  contain- 
ing a  considerable  excess  of  water,  is  converted  into  muddy  fluid, 
when  a  distinct  precipitate  will  be  noticed.  After  having  collect- 
ed this  precipitate  in  a  filter,  washed  it  with  water,  and  dried  it 
on  the  water-bath,  it  is  to  be  exhausted  with  a  mixture  of  alcohol 
and  ether.  The  clear  extract  thus  obtained  deposits  on  standing, 
in  all  healthy  cases,  impure  crystals  oi  excretine ;  a  substance 
easily  purified  and  prepared,  perfectly  colorless,  by  repeated  crys- 
talizations  in  alcohol  and  filtration  through  animal  charcoal.  The 
author  had  previously  described  the  characters  of  excretine  in 
communications  to  the  Royal  Society,  published  in  the  "  Philoso- 
phical Transactions"  for  1850  and  1S57.  Diseased  excrements 
do  not  always  contain  excretine,  as  it  was  absent  in  those*cases 
referred  to  in  the  present  communication,  where  it  was  searched 
for.  The  lime  precipitate  exhausted  with  alcohol  and  ether,  is 
now  to  be  mixed  with  water,  and  decomposed  by  means  of hvdro- 
chloric  acid  ;  chloride  of  calcium  is  formed,  and  an  insoluble*  sub- 
stance remains  floating  in  the  liquid  ;  this  he  has  found  very 
abundant  in  some  diseased  cases  and  also  in  a  few  exceptional 
instances  after  a  vegetable  diet ;  it  consisted  of  margaric  and 
stearic  acids  mixed  with  a  considerable  portion  of  oleic  acid. 
Finally,  by  concentrating  the  filtrate  from  the  lime  precipitate  on 
the  water-bath,  and  decomposing  the  residue  with  sulphuric  acid, 
certain  organic  acids  soluble  in  water  are  obtained,  possessed  of 
a  very  pungent  odor,  and  whose  properties  have  not  vet  been  in- 
vestigated ;  the  castings  of  carnivorous  animals  yield  in  this  stage 
of  the  analysis  butyric  acid,  a  substance  not  present  in  healthv 
human  evacuations.  It  must  be  remembered  that  the  animal 
body  contains  a  number  of  organic  acids  forming  known  soluble 
salts  with  lime,  and  consequently  the  examination  of  the  filtrate 
from  the  lime  precipitate  in  diseased  cases  is  not  to  be  neglected. 
The  above  description,  although  necessarily  most  incomplete, 
gives  a  rough  sketch  of  the  processes  recommended  for  the  analy- 
sis of  feces  ;  it  has  been  put  to  the  test  for  the  examination  of  a 
very  great  number  of  human  evacuations,  and  found  to  yield  con- 
stant results  in  health ;  it  is,  therefore,  perfectly  adapted  for  the 
investigation  of  the  composition  of  diseased  excrements.  Dr. 
Marcet  now  wishes  to  draw  the  attention  to  the  circumstance 
that  chemical  reagents  have  been  used  as  seldom  as  possible  in 
these  analyses,  in  order  to  avoid  the  decomposition  of  immediate 
principles  or  of  compounds,  such  as  they  exist  in  the  body. 
Alcohol  and  ether,  with  and  without  the  application  of  heat,  are 
the  principal  means  employed.*  It  is  not  impossible,  however,  to 
determine   immediate   principles   by   chemical   analysis ;  and  a 


768  Statistics  of  Tracheotomy.  [November, 

remarkable  instance  of  the  aid  obtained  from  chemistry  in  these 
investigations,  is  the  fact,  that  by  the  analysis  of  the  mass  deposi- 
ted in  the  original  alcoholic  extract  of  feces  on  cooling,  he  has 
been  able  to  ascertain  that  it  contains  phosphoric  acid,  fatty  acids, 
lime  and  magnesia,  exactly  in  such  proportions  as  are  required 
for  the  substances  to  combine  in  the  form  of  earthy  phosphates 
and  earthy  soaps.  These  compounds  had,  therefore,  previously 
existed  in  the  intestines  in  the  form  of  immediate  principles.  Dr. 
Marcet  then  gives  the  detail  of  three  cases  in  which  he  carried 
out  his  exaninations. — [Proceedings  of  the  Royal  Med.  and  Chir. 
Society,  and  Banking's  Abstract. 


Statistics  of  Tracheotomy. 

Tfce  statistics  of  the  operations  of  tracheotomy  performed 
during  a  number  of  years  at  the  Hopital  des  Enfans  at  Paris, 
where  the  effects  can  be  observed  upon  an  extended  scale,  must 
always  be  interesting  and  valuable.  In  former  years  we  have 
frequently  entered  into  practical  details  on  the  subject.  We  now 
quote  from  the  Journal  of  Practical  Medicine  and  Surgery  the  fol- 
lowing statistics  relative  to  the  operations  of  tracheotomy  per- 
formed during  the  eight  years  just  elapsed. 

The  following  is  the  list  of  these  operations  from  1850  through 
1857,  with  the  number  of  cures  obtained: 

1850 — 20  operations       - 

1851—31  "  ... 

1852—59         "  ... 

1853—61  "  ... 

1854—45         "  ... 

1855—48         "  ... 

1856—55         "  ... 

1857—71      .    "  ... 


6 

recoveries. 

12 

<< 

11 

» 

7 

(« 

11 

<< 

10 

« 

14 

<(. 

15 

<« 

Total,  390  86 

It  will  be  seen  by  the  above  table,  that  the  proportion  of  reco- 
veries, although  very  unequal  in  the  several  years,  presents  a 
very  similar  general  average ;  that  is,  from  1  in  4  to  1  in  5  of 
the  whole  number  operated  on  yearly.  It  should  be  mentioned 
that  the  majority  of  the  children  operated  on  were  in  the  last 
stage  of  croup,  and  were  consequently  in  imminent  danger  of 
death. 

M.  Guersant,  in  whose  wards  this  estimate  was  prepared,  gives 
the  following  summary  of  the  indications  for  and  against  trache- 
otomy, based  upon  the  age  of  the  children,  the  existing  complica- 
tions, &c. 

Age  is  an  important  element  to  be  considered.     Amongst  the 


1858.]  Statistics  of  Tracheotomy.  769 

cases  which  compose  the  above  table,  there  is  one  of  a  child  18 
months  old,  who  died  with  convulsions  during  tracheotomy.  M. 
Chaillon,  the  author  of  the  article  cited  by  us  from  the  Journal 
of  Praitkal  Medicine  and  Surgery,  states  that,  he  saw.  on  the  7th 
of  January  last,  a  little  girl  of  two  and  a  half  years  die  during  the 
operation,  notwithstanding  the  well-known  skill  of  the  surgeon. 
He  had  also  seen  a  similar  case  in  private  practice — the  patient 
being  also  a  girl  less  than  three  years  old. 

Nevertheless,  whilst  the  peculiar  difficulties  of  tracheotomy  in 
subjects  under  the  age  of  two  years  are  admitted — difficulties  as- 
cribable  to  the  restricted  relations  and  volume  of  the  parts  at  that 
age  ;  to  the  dangers  of  a  minute,  long  and  delicate  dissection;  and 
especially  to  the  small  size  and  mobility  of  the  trachea,  which 
often  allow  of  the  insertion  of  the  tube  only  with  extreme  difficul- 
ty— M.  Guersant  does  not  consider  the  youth  of  the  patient  an 
absolute  contra-indication  to  tracheotomy. 

The  same  is  true  as  regards  pneumonia,  when  it  complicates 
pseudo-membranous  croup.  For  a  long  time,  says  M.  Chaillon, 
the  existence  of  this  complication  was  thought  sufficient  wholy  to 
contra-indicate  tracheotomy.  At  present,  M.  Guersant  adopts 
the  opposite  opinion ;  and  he  has  become  convinced  that,  in  es- 
tablishing respiration  by  an  artificial  track,  he  has  favored  the 
resolution  of  the  pneumonia.  He  admits  but  one  decided  contra- 
indication to  opening  the  trachea  in  croup — and  that  is,  diphthe- 
ritic infection,  or  general  diphtheritis.  When  a  child  whose 
vocal  chords  have  been  invaded  by  false  membranes,  exhibits  at 
the  same  time  similar  morbid  products  in  the  nose,  the  ears,  or 
upon  the  skin ;  when  there  are  attacks  of  epistaxis  and  every 
sign  of  extreme  debility — tracheotomy  will  be  useless ;  the  child 
will  invariably  die. 

M.  Guersant  does  not,  moreover,  consider  the  extremest  degree 
of  asphyxia  an  insurmountable  obstacle  to  the  success  of  the  ope- 
ration, provided  the  condition  is  permanent,  and  has  continued 
for  at  least  an  hour,  with  a  persistent  character. 

Slow  and  continued  asphyxia  is,  indeed,  the  very  state  which  is 
the  chief  indication  for  tracheotomy,  according  to  M.  Guersant. 
It  is,  then,  the  only  thing  to  be  done — the  restablishment  of  res- 
piration being  that  alone  which  can  keep  the  child  alive. 

There  is  a  sort  of  asphyxia  which  does  not  so  imperatively  call 
for  the  operation — viz.,  the  intermittent  form.  M.  Guersant  has 
seen  children  making  violent  efforts  to  breathe  and  seemingly 
about  to  die  instantly ;  false  membrane  having  been  discharged, 
the  nature  of  the  disease  was  certain.  Notwithstanding,  the 
friends  having  opposed  the  operation  deemed  necessary  by  the 
surgeon,  the  usual  means  were  employed — such  as  eme^jcs,  calo- 
mel, alum,  and  chlorate  of  potash — and  the  patients  have  recover- 
ed.    But  with  the  exception  of  these  rare  instances  and  of  the  far 


770  Watery  Discharge  from  the  Uterus.     [November, 

more  common  cases  of  general  diphtheritis,  M.  Guersant  thinks 
that  as  a  general  principle,  tracheotomy  is  distinctly  indicated 
whenever  there  is  continued  and  increasing  embarrassment  of  the 
respiration. — [Gazette  des  Hqpitaux,  and  Boston  Med.  and  Surg. 
Journal. 


Watery  Discharge  from  the  Uterus  During  Pregnancy. 

Dr.  Harvey  made  the  following  remarks  on  this  affection  at 
a  meeting  of  the  Cork  Med.  and  Surg.  Soc,  Dec.  9,  Vobl:  "In 
some  books  on  Midwifery,  watery  discharge  from  the  uterus  is 
noticed  as  amongst  the  diseases  to  which  pregnant  women  are 
liable.  A  clear,  limpid,  colourless  fluid,  oozing  in  quantity 
from  a  few  ounces  to  pints  daily,  flows  away,  sometimes  stopping 
for  a  short  time,  and  recommencing;  and  in  the  majority  of 
cases  it  continues  nearly,  or  full  to  the  time  of  delivery.  The 
abdomen  does  not  appear  palpably  reduced  by  these  discharges, 
and  a  living  child  is  commonly  born  at  or  near  the  full  time. 
In  the  greater  number  of  instances,  also,  there  is  evidence  of  the 
usual  quantity  of  liquor  amnii  being  present  on  the  supervention 
of  labor.  Dr.  Alexander's  case,  given  in  the  third  volume  of 
the  Medical  Commentaries,  shows  this  very  prominently.  In  a 
case  by  Dr.  Petel,  also,  in  the  Gazette  de  Bojjilaux  of  July,  I808, 
the  liquor  amnii  is  specially  mentioned  as  normal  in  quantity. 

"What  is  the  source  of  this  fluid,  discharged  as  it  is,  to  the 
amount  of  hundreds  of  pints  in  the  course  of  a  few  months  ? 
The  supposition  of  its  coming  from  the  cervical  glands  of  the 
uterus,  or  from  the  vagina,  both  of  which  have  been  assumed  as 
sources  of  it  by  different  authorities,  appeared  altogether  unlike- 
ly from  the  nature  of  the  fluid,  its  quantity,  and  its  mode  of: 
coming  away  in  gushes  of  considerable  quantity  at  a  time. 
That  it  could  come  from  the.  space  between  the  decidua  and 
chorion,  or  between  the  chorion  and  amnion,  we  have  no 
pathological  facts,  so  far  as  I  am  aware,  to  warrant  our  suppo- 
sing such  a  source  for  the  flow ;  whilst  in  the  natural  condition 
of  parts  such  spaces  do  not  exist;  as,  at  a  period  of  pregnancy 
before  these  discharges  commonly  show  themselves  (say  the 
sixth  month,  or  thereabouts),  the  cavity  between  the  chorion 
and  amnion  has  disappeared ;  and  we  know  that  the  chorion 
and  decidua  are  in  contact  throughout. 

"  Under  these  circumstances  we  seem  driven  to  the  conclusion 
that  the  amnion  must  be  the  source  of  this  flow ;  that  there  may 
be  occasional  solution  of  continuity  in  this  membrane,  admitting 
of  discharges  from  time  to  time,  which  either  close  again, 
or  admit  by  the  mechanical  relations  of  the  bag  to  the 
neighboring  parts  of  the  amnion,  refilling  to  a  certain  extent  by 


1858.]  Watery  Discharge  from  the  Uterus.  771 

a  fresh  secretion  of  its  particular  fluid.  In  confirmation  of  this 
view  may  be  mentioned  cases  recorded  by  Dr.  Denman,  Profes- 
sor Burns,  of  Glasgow,  and  Dr.  Pentland,  of  Dublin,  in  which 
the  amnion  is  said  to  have  given  way  from  fright  or  other 
sudden  shock,  the  water  being  discharged  without  labour  coming 
on.  All  these  considerations  tend  rather  to  the  view  that  the 
escaping  fluid  may  be  liquor  amnii  than  to  any  other  which  has 
been  propounded.  In  the  case  which  I  am  going  to  relate  the 
symptoms  were  similar  to  those  which  were  present  in  the  cases 
of  watery  discharge  which  I  have  been  noticing,  and  in  this  in- 
stance, as  will  be  seen,  the  flow  was  undoubtedly  amniotic. 

"Mrs. ,  mother  of  several  children,  was  for  more  than 

a  year,  the  subject  of  heavy  sanguineous  discharges,  which  were 
so  little  influenced  by  the  treatment  adopted  thai  the  existence 
of  polypus  was  thought  possible.  An  examination  revealed 
considerable  congestion  of  the  os  and  cervix  uteri,  with  superfi- 
cial ulceration,  which  gave  way  to  treatment  generally  and 
locally  applied.  During  last  summer  her  health  was  considera- 
bly improved,  but  occasionally  menorrhagic  attacks,  which  lat- 
terly observed  more  or  less  closely  the  monthly  periods,  showed 
themselves.  Matters  were  going  on  thus  when  she  suffered  a 
considerable  shock  by  her  eldest  boy  meeting  with  a  severe  acci- 
dent, in  which  his  arm  was  fractured.  On  that  day,  for  the  first 
time  (six  weeks  before  deliver),  she  had  a  sudden  gush  of  clear 
watery  fluid  from  the  vagina,  and  since  that  time  to  the  date  of 
these  notes  (5th  November),  she  was  scarcely  free  from  it ;  it 
would  diminish  or  nearty  stop  for  a  few  days  at  a  time,  to  come 
on  again  in  gushes,  and  in  considerable  quantity.  The  quantity 
escaping  in  one  of  these  was  seldom  less,  and  generally  more, 
than  half  a  pint;  and  on  the  late  occasion,  when  the  flow  was 
accompauied  by  a  heavy  sanguineous  discharge  also,  she  thinks 
the  combined  amount  was  fully  a  quart.  It  came  on  in  the 
horizontal  position  as  well  as  in  the  erect,  and  apparently  with- 
out any  cause.  The  size  of  the  abdomen  did  not  appear  much 
affected  by  these  at  any  time. 

"The  occurrence  of  the  watery  discharge  suggesting  the 
probability  of  pregnancy,  notwithstanding  the  menstrual  changes 
which  had  been  going  on  with  some  regularity,  and  that,  if 
pregnancy  did  exist,  the  ovum  might  have  suffered  hydatid  de- 
generation, I  proposed  an  examination  for  the  purpose  of  ascer- 
taining the  point.  I  found  an  abdominal  tumour  occupying 
the  hypogastri urn  to  above  the  umbilicus,  and  on  laying  my 
hands  over  its  surface,  it  gave  a  good  example  of  the  value  of  a 
diagnostic  indication  lately  suggested  by  Dr.  Oldham  ;  it  afford- 
ed distinct  evidence  of  its  being  uterine  by  gradually  and 
regularly  hardening  under  my  hand.  The  movements  of  the 
'  child  were  also  felt,  and  foetal  pulsation,  distinctly  heard  by  the 
stethoscope,  put  an  end  to  all  doubts. 


772  New  Remedies  in  Yellow  Fever.       [November, 

"  I  told  the  lady  that  she  had  passed  some  six  or  near  seven 
months  of  her  pregnancy  without  being  aware  of  it,  and  that 
her  labor  would  probably  come  on  prematurely,  all  of  which 
she  entirely  disbelieved,  and  I  could  not  induce  her  to  make 
the  necessary  preparations.  Two  days  after,  I  was  called  to  her 
— the  first  stage  of  labour  having  set  in  with  unusual  distress 
and  irritation ;  the  pains  peculiarly  sharp  and  unbearable ;  the 
os  uteri  was  hard  and  unyielding,  and  the  breech,  presenting  in 
the  second  position,  was  felt  in  close  contact.  I  immediately 
put  her  on  antimonial  solution,  notwithstanding  which  the  os 
uteri  took  over  three  hours  to  relax.  After  a  first  stage  of  about 
four  and  a  half  hours,  and  a  second  of  less  than  half  an  hour, 
a  male  child,  of  scarcely  seven  months'  growth,  was  born.  The 
presenting  hip  and  buttock  were  perfectly  black,  evidently  from 
the  direct  pressure  to  which  they  had  been  subjected,  in  con- 
sequence of  the  loss  of  the  liquor  amnii.  None  whatever 
escaped  with  the  child,  and  the  sanguineous  discharge  was  also 
unusually  scanty.  I  do  not  think  I  ever  witnessed  so  dry  a 
labour. — [Dublin  Quart.  Journ.  Med.  Sci.,  and  Amer.  Jour.  Med. 
Science. 


New  Remedies  in   Yellow  Fever — Chlorine  and  Veratrum  Viride. 
By  E.  D.  Fenner,  M.  D. 

Up  to  the  present  time,  the  treatment  of  yellow  fever  may  be 
said  to  have  been  almost  entirely  empirical  or  based  on  expe- 
rience alone ;  but  empiricism  may  work  on  till  doomsday  and 
in  the  hands  of  skillful  practitioners,  achieve  great  success,  yet 
fail  to  satisfy  the  demands  of  the  inquiring  -and  philosophic 
mind.  Science  alone  can  do  this ;  by  which  I  mean  a  knowledge 
of  the  morbific  cause  and  an  explanation  of  its  modus  operandi 
in  the  production  of  all  the  phenomena  of  the  disease,  as  well 
when  it  terminates  in  recovery  as  in  death.  In  ignorance  of 
these  fundamental  desiderata,  the  practice  must  necessarily  be 
empirical — like  one  groping  in  the  dark,  who  might  stumble 
upon  a  jewel,  but  at  the  same  time  be  liable  to  fall  into  a  pit — a 
thrust  with  a  dangerous  weapon  by  the  looker-on  of  a  personal 
combat,  equally  liable  to  strike  friend  and  foe.  By  observation, 
much  valuable  knowledge  has  doubtless  been  attained,  and 
likewise,  great  skill  in  practice  has  been  acquired  from  experi- 
ence ;  but  all  this  is  still  unsatisfactory  and  incapable  of  being 
taught  or  transmitted  to  those  who  are  to  come  after  us. 

Various  plans  of  treatment  and  all  sorts  of  remedies  have 
been  resorted  to  in  yellow  fever,  but  neither  plan  nor  remedy 
has  ever  yet  attained  universal  approbation  and  acceptance. 
Cases  have  been  known  to  recover  under  every  plan,  and  others 


1858.]  New  Remedies  in  Yellow  Fever.  773 

to  die  in  spite  of  every  known  remedy  ;  but  the  most  important 
fact  of  all  is,  that  persons  may  recover  from  the  disease  without 
any  treatment  at  all — a  problem  full  of  instruction,  but  as  yet, 
remaining  unsolved. 

Of  all  the  remedies  for  this  disease  that  have  gained  notoriety, 
the  following  four  are  the  only  ones  that  have  been  supposed 
to  exert  a  special  action  on  the  morbific  cause  or  materies  morbi, 
viz:  mercury,  quinine,  salines  and  the  tincture  of  the  muriate  of 
iron.  The  virtues  of  all  the  rest,  such  as  emetics,  cathartics, 
diaphoretics,  diuretics,  blood-letting,  counter-irritants,  etc.,  are 
attributable  to  their  generally  known  therapeutic  action. 

Of  the  four  remedies  just  named,  not  a  single  one  has  suc- 
ceeded in  commanding  general  confidence  in  the  powers  claimed 
for  it.  Mercurial  ptyalism  is  no  longer  relied  on  as  a  protection 
against  the  danger  of  yellow  fever;  the  introduction  of  salines 
into  the  system  for  the  purpose  of  counteracting  the  morbid 
changes  of  the  blood,  has  been  tried  in  vain  ;  the  once  vaunted 
powers  of  quinine  are  fading  away,  and  the  tincture  of  iron  has 
fallen  into  probably  unmerited  neglect,  after  a  brief  but  brilliant 
career. 

A  correct  theory  is  absolutely  necessary  to  scientific  and  suc- 
cessful practice;  and  the  plrysician,  if  there  be  one,  who  has  no 
theory,  is  a  mere  empiric.  In  a  case  of  yellow  fever,  we  see  a 
contest  between  the  inherent  conservative  powers  of  the  body  and  a 
lethific  agent ;  be  it  a  poison,  a  ferment,  animalcule  or  vegetable 
cryptogam.  In  the  course  of  this  conflict,  we  may  suppose  that 
one  or  more  of  the  following  occurrences  will  happen:  The 
morbific  agent  may  be  only  capable  of  causing  a  perturbation 
or  disease  which  can  be  overcome  by  the  conservative  powrers 
of  the  system,  with  or  without  medical  aid ;  or  it  may  be  so 
powerful  as  to  defy  the  conservative  powers  as  well  as  any 
known  remedies,  and  prove  inevitably  fatal.  2.  It  may  be  neu- 
tralized in  the  system  by  remedial  agents,  in  the  way  that  cer- 
tain poisons  are  disarmed  by  certain  known  antidotes.  3.  It 
may  be  eliminated  from  the  system  by  the  emunctories,  or  secre- 
ting and  excreting  organs.  4.  By  the  disturbance  of  the  func- 
tions which  it  produces,  it  may  cause  the  retention  of  elements 
in  the  system  which  have  fulfilled  their  legitimate  purposes  and 
can  no  longer  be  retained  with  impunity ;  thus  adding  fuel  to 
the  destructive  fire  that  is  already  raging. 

The  physician's  theory  of  each  individual  case,  based  on  its 
history  and  sj^mptoms,  will  direct  his  practice  towards  the 
accomplishment  of  one  or  more  of  the  above  objects.  If  nature 
is  doing  all  that  is  necessary,  of  course  he  will  not  interfere; 
but  when  she  appears  to  be  unequal  to  the  task,  it  becomes  his 
duty  to  render  such  assistance  as  the  indications  of  the  case 
appear  so  clearly  to  point  out. 


774  New  Remdies  in  Yellow  Fever.        [November, 

Here  we  might  pause  and  inquire,  what,  that  is  really  beneficial, 
has  as  yet  been  discovered  ?  and  wherein,  lie  the  principal  de- 
fects of  our  practice  in  this  disease  ?  The  answer  to  these 
questions  would  require  a  critical  review  of  all  the  various  plans 
and  remedies  that  have  been  resorted  to  in  the  treatment,  of 
yellow  fever ;  a  task  which  we  have  neither  time  nor  space  to 
perform  at  present. 

The  foregoing  remarks  have  been  thought  necessary  as  a  pre- 
lude to  the  introduction  of  two  new  remedies  in  the  treatment 
of  yellow  fever,  which,  so  far  as  a  limited  experience  can  testify, 
promise  to  fulfil  in  a  most  satisfactory  manner,  three  of  the  most 
important  indications,  viz :  1.  The  controlling  of  excessive 
febrile  excitement :  2.  Maintaining  the  free  and  continued  action 
of  the  great  eliminating  organs,  the  skin,  liver  and  kidneys: 
3.  And  consequent  thereon,  the  preservation  of  the  integrity 
of  the  blood  and  tissues.  These  remedies  are  chlorine,  and  Nor- 
wood's iinclare  of  Ycrairum  Viride. 

I  brought  myself  to  the  experiment  of  chlorine  by  reflecting 
on  the  course  and  nature  of  this  fever,  and  the  want,  long  felt, 
of  something  that  is  capable  of  neutralizing  the  action  of  the 
morbific  cause,  or  of  assisting  the  efforts  of  nature  to  eliminate 
it  from  the  system.  Secondly,  by  recollecting  the  happy  effects 
of  the  muriated  tincture  of  iron  which  I  witnessed  in  the 
epidemics  of  1854  and  1855.  Thirdly,  by  the  flattering  testi- 
mony in  favor  of  chlorine  in  malignant  scarlet  fever,  to  be  found 
in  Watson's  Lectures;  and  lastly,  by  the  therapeutic  action  of 
chlorine  and  the  chlorate  of  potass,  as  recorded  in  Pereira's  great 
work,  and  other  late  writers.  I  resolved  on  using  the  chlorine 
mixture  mentioned  in  Watson's  Lectures,  p.  1002,  third  Ameri- 
can edition.  The  plan  adopted  was,  first  to  purge  the  patient 
moderately  with  castor  oil  or  some  other  simple  cathartic,  and 
bring  on  free  perspiration  by  means  of  the  hot  mustard  foot 
bath,  warm  orange-leaf  tea  and  covering  with  a  blanket ;  then 
to  give  to  an  adult  two  table-spoonfuls  of  the  chlorine  mixture 
every  two  hours. 

My  first  experiments  succeeded  beyond  my  most  sanguine 
hopes,  and  every  casein  which  it  was  timely  applied,  excepting 
one,  recovered  in  a  most  satisfactory  manner.  The  medicine 
sat  well  on  the  stomach,  but  occasionally  caused  griping,  which 
disappeared  on  omitting  it  for  five  or  six  hours  or  reducing  the 
dose  to  a  single  tablespoonful.  Under  its  use  the  febrile  excite- 
ment soon  declined,  headache  disappeared,  and  the  kidneys  and 
liver  acted  freely.  The  dose  was  diminished  or  the  interval 
prolonged  as  the  fever  went  down.  In  most  cases,  no  other 
medicine  was  given  till  the  end  of  the  third  or  critical  day,  when 
the  chlorine   was  stopped  and  I  gave  what  is  called  here  the 


1858.]  New  Remedies  in  Yellow  Fever.  lib 

Sydenham  Mixture,  composed  of  the  phosphate  of  lime  and  gum 
arabic  suspended  in  equal  parts  of  orange-flower  water  and  dis- 
tilled water.  The  bowels  were  kept  open  by  enemata,  as  occa- 
sion required,  and  the  patient  was  allowed  to  drink  orange-leaf 
tea  and  barley  water  ad  libitum. 

In  this  manner,  I  had  treated  some  eight  or  ten  cases  with 
satisfactory  success,  and  was  applying  it  to  all  my  cases,  both  in 
private  practice  and  the  Charity  Hospital,  when  I  happened  to 
meet  one  of  the  most  extensive  practitioners  of  our  cit}',  who 
stopped  to  relate  to  me  a  very  extraordinary  case  he  had  just 
been  attending.  He  then  asked  me  whether  I  had  ever  tried 
Veratrum  Yiride  in  yellow  fever?  I  told  him  I  had  not,  but 
had  long  intended  to  do  so.  He  begged  me  to  try  it  in  the 
Hospital,  as  he  did  not  like  to  experiment  on  patients  in  private 
practice,  yet  felt  the  necessity  of  our  endeavoring  to  find  out 
some  more  valuable  remedies  than  any  we  now  have.  I  promised 
him  to  make  the  experiment  very  soon,  and  we  parted.  On  the 
same  day,  I  learned  through  the  newspapers,  that  Dr.  White 
and  another  physician  of  Charleston,  had  met  with  very  extra- 
ordinary success  in  the  treatment  of  yellow  fever  with  the  Vera- 
tum  Viride.  In  the  evening,  I  went  to  the  Charity  Hospital 
for  the  purpose  of  commencing  my  experiments  with  this  medi 
cine.     This  was  on  the  20th  instant. 

In  Ward  16,  (under  my  charge),  I  selected  three  cases,  two 
of  which  had  entered  since  my  morning  visit. 

Case  1 — Was  a  fine  young  Irish  sailor,  aged  16,  who  had  ar- 
rived here  from  Liverpool  only  five  days  previously,  and  was 
attacked  this  morning;  entered  the  Hospital  at  5  P.  M  ;  had 
taken  a  mustard  foot-bath  and  a  dose  of  castor  oil,  which  had 
moved  his  bowels  freely.  He  had  headache,  injected  eyes,  skin 
very  hot  and  sweating;  great  thirst;  pulse  120.  Ordered  cold 
applications  to  head,  orange-leaf  tea,  and  five  drops  of  [Norwood's 
tincture  V.  V.  every  three  hours. 

September  21st.  Found  patient  sound  asleep  and  sweating 
freely,  eyes  less  injected,  headache  much  relieved,  tongue  moist; 
less  thirst,  pulse  100.     Continued  the  V.  V.  every  four  hours. 

5  P.  M.     Very  quiet,  but  pulse  up  to  112. 

September  22d.  Cool,  quiet  and  moist,  pulse  88.  Found 
the  urine  acid,  but  not  coagulable.  Continue  treatment ;  move 
bowels  by  enema. 

September  23d.  Cool  and  quiet ;  rested  well  and  apparently 
convalescent;  pulse  70.  Stopped  the  Y.  V.  and  allowed  chick- 
en water.     On  testing  the  urine,  found  it  albuminous. 

On  the  25th,  the  patient  had  slight  exacerbation  of  fever  in 
the  evening  and  took  neutral  mixture,  tablespoonful  once  an 
hour.     Urine  more  albuminous. 

September  26th.     Patient  does  not  improve ;  has  exacerba- 


776  Neio  Remedies  in  Yellow  Fever.        [Novsmbei, 

lions  in  the  evening;  bowels  open,  sweats  moderately  ;  urine 
now  highly  albuminous  and  bilious ;  threatened  with  haemor- 
rhage from  gums.  Put  him  on  my  chlorine  mixture,  tablespoon- 
ful  every  four  hours. 

27th.     Has  slight  haemorrhage  ;  is  improving. 

28th.  Kested  well :  is  cool,  quiet  and  hungry.  Now  fairly 
convalescent. 

Case  2.  Young  Irishman,  aged  19,  was  attacked  on  the 
morning  of  the  19th  September,  'and  went  immediately  to  the 
hospital.  I  saw  him  at  my  morning  visit  and  prescribed  hot 
mustard  foot-bath,  and  a  dose  of  castor  oil.  After  the  bowels 
are  well  purged,  to  take  two  tablespoon fuls  of  the  chlorine  mix- 
ture every  two  hours.  On  the  morning  of  the  20th  he  was 
doing  well,  and  ordered  to  continue  the  mixture. 

At  my  evening  visit  I  resolved  to  put  him  on  the  V.  V., 
and  found  his  condition  as  follows:  Considerable  fever;  skin 
hot  and  rather  dry ;  pulse  100 ;  tongue  white,  with  red  edges, 
and  moist;  considerable  thirst;  pain  in  the  head  and  back; 
bowels  rather  loose  and  uneasy.  Ordered  five  drops  of  the  V.  V. 
every  three  hours  and  the  chlorine  mixture  immediately. 

September  21st.  Much  better;  face  and  eyes  less  injected; 
skin  cooler  and  sweating  freely;  pulse  72  ;  headache  relieved; 
has  some  pain  in  the  back  ;  thinks  the  chlorine  gripes.  Ordered 
to  prolong  the  interval  of  the  Y.  Y.,  and  to  take  less  of  the 
chlorine.     His  urine  is  acid  but  not  coagulable. 

September  22d.  Completely  relieved ;  clear  of  fever  and  pain ; 
pulse  down  to  72 ;  is  quite  hungry ;  urine  acid  but  not  yet 
coagulable.  He  continued  to  improve  steadily,  and  was  dis- 
charged at  his  own  request  on  the  morning  of  the  26th.  His 
urine  was  then  beginning  to  show  albumen. 

Case  3.  Was  a  German  aged  about  30.  Entered  hospital 
this  evening,  September  20th,  in  the  second  stage  of  the  disease, 
(third  day),  having  been  vomiting  and  purging  from  the  com- 
mencement of  the  attack.  He  was  very  weak ;  eyes  much  in- 
jected; headache;  sweating;  tongue  moist;  still  vomits;  pulse 
100  and  feeble.  Wishing  to  see  the  effects  of  the  Y.  Y.  in  a 
desperate  case,  I  prescribed  five  drops  every  three  hours;  sinap- 
ism to  epigast. 

September  21st.  Pulse  80;  skin  cool,  moist  and  of  deep  red 
color ;  had  no  pain ;  attempts  to  vomit ;  very  thirsty ;  urine 
abundant,  acid  and  highly  coagulable.  At  noon  his  pulse  was 
clown  to  54 :  has  hiccup ;  stop  the  Y.  Y.  5,  P.  M.,  hiccup 
checked.  Contrary  to  orders  he  got  out  of  bed  and  the  hiccup 
returned.  He  lingered  till  the  23d  and  died.  He  passed  urine 
to  the  last  day,  and  it  was  highly  albuminous. 

In  reflecting  on  these  first  cases,  it  appeared  to  me  that  case 
one,  had  such  a  lingering  convalescence  from  the  want  of  some- 


1858.]  New  Remedies  in  Yellow  Fever.  777 

thing  besides  the  veratrum.  This  medicine  had  displayed  its 
wonderful  power  of  subduing  febrile  excitement,  but  there  was 
something  wanted  to  act  upon  the  blood,  liver  and  kidneys; 
that  the  rapid  convalescense  of  case  two,  was  probably  due 
in  some  measure  to  the  good  effects  of  the  chlorine  mixture  he 
took  for  about  thirty  hours ;  and  that  case  three,  could  hardly 
be  expected  to  recover  after  removal  to  a  considerable  distance, 
in  the  second  stage  of  the  disease. 

From  that  time  I  have  continued  to  use  these  two  remediesin 
nearly  all  cases  that  have  come  to  my  charge  in  the  first  stage, 
and  at  the  hospital  in  all  stages  while  there  was  febrile  excite- 
ment. I  directed  the  remedies  to  be  taken  alternate^,  at  inter- 
vals of  two  hours,  i.  e.,  first  the  veratrum,  and  two  hours 
afterwards  the  chlorine  ;  and  so  on  till  the  febrile  excitement  is 
sufficiently  reduced,  the  pulse  of  the  adult  brought  down  to  70 
beats  in  the  minute,  when  the  former  is  stopped,  but  the  latter 
continued  in  small  doses.  Previous  to  giving  these  medicines, 
the  bowels  should  be  well  evacuated,  but  not  severely  purged. 
Subsequently,  they  may  be  kept  sufficiently  open  by  enemata. 
Sweating  should  be  promoted  by  mustard  foot  baths,  warm  teas 
and  covering  with  one  or  two  blankets.  Yellow  fever  patients 
are  frequently  sweated  too  severely,  but  I  have  hardly  ever 
mown  one  to  do  well  without  maintaining  a  good  perspiration 
for  three  days. 

It  is  proper  that  I  should  mention  some  of  the  troubles  that 
may  arise  in  the  use  of  these  remedies,  for  there  is  no  medicine 
that  possesses  great  remedial  powers  without  being  likewise 
capable  of  doing  injury  if  improperly  administered. 

The  Veratrum  viride,  as  is  well  known,  is  a  very  powerful 
medicine  and  liable,  when  taken  in  excess,   to  produce  great 
prostration  of  the  vital  powers.     It  should  therefore  be  very 
cautiously  given,  and  its  action  watched  with  the  utmost  care. 
There  should  be  a  considerable  interval  between  the  doses,  so 
as  to  allow  time  for  the  medicine  to  display  its  effects.     It  will 
surely  reduce  the  frequency  of  the  pulse  and  febrile  excitement 
enerally  ;  but  if  carried  too  far,  it  produces  alarming  prostra- 
tion, great  restlessness  and  a  peculiar  wild  delirium,  all  of  which 
will  pass  off  in  a  few  hours  and  may  be  relieved  by  a  little  pare- 
goric and  brandy.     I   have  never  heard   of  its  producing  fatal 
affects,  although  it  has  recently  come  into  very  general  use  in 
ill  parts  of  the  country  as  a  remedy  in  pneumonia  and  typhoid 
fever.     The  dose  I  have  directed  is  of  course  intended  for  adults, 
ind   must  be   varied   according  to  the  age  of  the   patient.     It 
should  be  stopped  gradually  after  the  pulse  falls  to  72;  and  the 
-emainder  of  the  cure  left   to  the  chlorine   mixture,  with   such 
idjuvants  as  the  particular  case  may  require. 
In  respect  to  the  use  of  the  chlorine  mixture,  I  have  as  yet 


778  Antagonism  of  Opium  and  Quinia.     [November, 

met  with  no  other  trouble  than  the  occasional  griping  before 
mentioned,  which  has  never  proved  at  all  serious.  This  medi- 
cine certainly  acts  finely  on  the  liver  and  kidneys.  My  experi- 
ence with  this  remedy  as  yet  only  covers  some  twenty-five  or 
thirty  cases,  an  extent  too  limited  to  justify  any  farther  remarks 
at  this  time. 

In  offering  these  hasty  observations  to  the  profession,  at  the 
present  time,  I  beg  leave  to  say  that  my  only  object  is  to  call 
attention  to  some  new  remedies  which  I  have  reason  to  hope 
will  prove  to  be  highly  beneficial  in  the  treatment  of  this  terri- 
ble Southern  pestilence,  and  to  allow  physicians  residing  at 
places  where  yellow  fever  is  now  prevailing,  the  opportunity 
to  test  their  virtues  at  once.  This,  I  hope,  they  will  do  at  once, 
and  let  us  know  the  results  of  their  observation  at  their  earliest 
convenience. 

In  conclusion,  I  must  be  permitted  to  say,  that  if  the  veratrum 
viride  should  ultimately  turn  out  to  be  as  valuable  a  remedy  in 
yellow  fever,  as  it  unquestionably  is  in  pneumonia  and  tj^phoid 
fever,  Dr.  Norwood  will  be  entitled  to  ihe  meed  of  being  ranked 
among  the  greatest  benefactors  of  mankind. — [New  Orleans 
Med.  News  and  Hospital  Gazette. 


The    Antagonism   of    Opium   and    Quinia.     By  M.   Gubler. 
[Translated  by  J.  P.  Barrot,  M.  D. 

M.  Gubler  read  a  paper  before  the  Societe  Medicale  des  Hopi- 
timx  de  Paris,  on  the  antagonism  between  Opium  and  Sulphate 
of  Qninia,  of  which  the  following  is  a  synopsis  condensed  from 
the   summary  published   in  UL>  Union  Medicale,"   of  May  20, 
1850.     Being  unwell  himself,  M.  Gubler  took  sulph.  quirria  in 
0.50  centigrammes  doses  only  and  was  struck  with  the  fact  that 
they  produced  humming  in  the  left  ear  only,  although  his  hear- 
ing is  equally  good  on  both  sides.    This  peculiar  effect  occurred 
three  days  in  succession.     As  at  that  time  he  suffered  from  a 
head-ache  which  was  most  violent  on  the  right  side — on  which 
side   it  is  always  greatest  in  M.  G.,  he  was  led  to  suppose  that 
the  evident  congestion  on  the  right  side,  neutralized  the  effect 
of  the  quinia,  which  effect  M.  G.  considered  due  to  the  privation 
of  the  brain  of  blood,  (anemier  Vencephale  decongeetionner  le  cer 
veau)  the  removal  of  congestion  of  the  brain.     M.  G.  having  re 
covered  his  health,  resumed  his  attendance  in  the  wards  of  the 
Hospital.     He  there  saw  a  case  of  acute  articular  rheumatism 
in   which   large  doses   of  sulph.   quinia   and  opium  had   beer 
administered  for  several  days  without  success.     M.  G.  continued 
the  dose  of  sulph.  quinia — i.  e.,  1  gramme  50  centigrammes  witl 
0.25  centigrammes  extract  of  opium.     Finding  that  the  particu 


1858.]  Antagonism  of  Opium  and  Quinia.  779 

lar  therapeutical  effects  of  both  remedies  were  entirely  wanting, 
he  increased  the  dose  of  sulph.  quinia  and  diminished  that  of 
the  opiate,  without,  however,  any  better  success. 

Lastly,  he  left  out  the  opium  altogether,  and  gave  1  gramme 
50  centigrammes  of  sulph.  quinia  alone,  which  produced  in  a 
marked  manner,  the  peculiar  remedial  effects  of  that  drug.  And 
from  that  time  the  rheumatism  diminished  rapidly  and  marked- 
ly. This  and  other  subsequent  cases  of  the  same  nature,  con- 
firmed him  in  his  belief  that  opium  was  antagonistical  to  sulph. 
quinia,  or,  so  to  speak,  its  antidote. 

M.  Gubler  enunciates  his  particular  views  of  the  modus  operan- 
di of  opium  and  sulph.  quinia.  According  to  him,  opium  pro- 
duces congestion  and  hyperemia,  whilst  its  antagonist,  sulph. 
quinia,  produces  anaemia  and  dissipated  congestion — (anemie  et 
decongeslionne). 

The  following  are  the  conclusions  of  M.  Gubler  :  1.  Inverse- 
ly to  opium,  which  exalts  organic  action,  producing  sanguine- 
ous congestion  and  caloricity,  sulph.  of  quinine  acts  on  the 
nervous  system  by  condensing  the  forces  there,  in  such  a  way 
as  to  arrest  organic  action,  the  source  of  waste,  and  to  diminish 
as  much  as  possible  the  afflux  of  blood  in  inflamed  parts.    (Sic). 

2.  This  modus  operandi  once  admitted,  we  can  readily  under- 
stand the  innocuousness  of  sulphate  of  quinia  in  the  cerebral 
symptoms  of  rheumatism,  which  symptoms  recent  experiments 
have  already  tended  to  show  were  not  due  to  its  use. 

3.  Moreover,  the  use  of  sulph.  quinia  is  indicated  in  all  the 
inflammatory  forms  of  cerebral  rheumatism;  opium  being  ser- 
viceable in  the  nervous  forms  only,  and  in  these  only  when  not 
complicated  by  fever. 

4.  Sulph.  of  quinine  and  opium,  being  antagonistic  should 
not  be  given  together. 

5.  These  two  remedies  may  be  used  as  antidotes  to  one  another. 
M.  Guerard  thought  that  sulph.  Quinia  did  "  decongestionner  le 

cerveau"  and  stated  in  support  of  his  opinion,  that  its  use  produ- 
ced imminent  synchope.  Some  years  previously,  while  suffer- 
ing from  intermittent  fever,  he  had  taken  large  quantities  of 
sulph  of  quinia,  sometimes  for  a  month  at  a  time,  in  a  single 
dose  daily.  As  long  as  he  remained  in  the  recumbent  position 
lie  experienced  no  unpleasant  sensation,  but  when  sitting, 
syncope  was  imminent.     He  had  seen  a  second  similar  case. 

With  respect  to  the  antagonism  of  opium  to  sulph.  of  quinia, 
he  was  the  more  ready  to  believe  it,  inasmuch  as  in  his  tklse  de 
concours  for  the  Chair  of  Therapeutics,  he  had  shown  that  the 
effects  of  medicines  when  isolated  might  be  neutralized  by  com- 
bination ;  and  had  mentioned  that  M.  Caventou  had  given 
strychnia  combined  with  morphia,  each  in  large  doses,  and  that 
the  effects  of  the  combination  had  been  greatly   diminished. 

H.  S. — VOL.  XIV.    NO.  XI.  45 


780  Subcutaneous  Operation  on  Varicose  Veins.  [November, 


Substances  which  are  poisonous  by  themselves,  cease  to  be  so 
when  united. 

Note  by  the  Translator. — The  conclusions  of  M.  Gubler,  on  the  antagonism  of 
opium  and  sulph.  of  quinia,  although  endorsed  in  a  measure  by  M.  Guerard,  fail 
to  convince  us.  Further  trials  on  a  more  extended  scale,  would  show  the  correct- 
ness or  incorrectness  of  his  views.  Should  his  opinions  turn  out  to  be  correct, 
quite  a  revolution  would  take  place  in  the  administration  of  sulph.  of  qunine  in 
this  city,  where  either  from  fashion  or  e'onviction,  it  is  most  generally  given  in 
combination  with  opium.  The  Haustus  Quinice  of  the  Charity  Hospital,  which 
has  done  so  much  service,  would  then  have  seen  her  last  day. 

[New  Orleans  Med.  and  Surg.  Jour. 


The  Subcutaneous  Operaticnx  on   Varicose  Veins.     By  Mr.  Henry 
Lee,  Surgeon  to  King's  College  Hospital. 

When  blood  is  effused  into  the  cellular  tissue  in  the  living 
body,  it  undergoes  changes  varying  in  different  cases.  Some- 
times it  is  simply  absorbed,  leaving  the  surrounding  parts  as 
they  were  before ;  sometimes  the  fibrin  becomes  separated  from 
the  more  fluid  parts  of  the  blood,  and  remains  after  these  are 
removed.  Again,  the  effused  blood  may  remain  contained  in  a 
kind  of  sac,  of  a  dark  grumous  color,  for  weeks  or  months ;  or 
finally,  it  may  undergo  a  process  analogous  to  that  of  suppura- 
tion, and  be  discharged,  more  or  less  deprived  of  its  coloring 
matter,  as  from  an  abscess.  Blood  that  remains  for  any  length- 
ened period  stagnant  in  veins  undergoes  somewhat  similar 
changes.  It  may  be  deprived  of  its  serum,  and  its  more  solid 
parts  may  remain,  obstructing  the  veins  for  almost  an  unlimited 
period,  or  it  may  become  dark  and  grumous,  undergoing  a  kind 
of  slow  decomposition  ;  or  again,  in  the  fibrin  previously  separa- 
ted from  the  other  constituents  of  the  blood,  cell  development 
may  take  place,  and  an  abscess  will  form  in  the  vein. 

In  the  various  operations  which  have  from  time  to  time  been 
practised  for  the  obliteration  of  varicose  veins,  the  effused  and 
stagnant  blood  has  eccasionally  either  undergone  a  kind  of  de- 
composition, or  has  become  involved  in  an  abscess;  and  when 
the  products  of  these  changes  have  become  mixed  with  the 
blood,  it  is  now  well  known  with  what  fatal  certainty  their 
presence  is  manifested.  The  occasional,  although  rare  occur- 
rence of  the  symptoms,  now  recognized  as  those  of  blood-poison- 
ing, after  operations  on  the  veins,  had  led  surgeons  from  time  to 
time  to  seek  for  modes  of  operating  which  should  be  free  from 
the  dangers  previously  experienced. 

In  1815,  Sir  Benj.  Brodie  published  a  paper  in  the  "Medico- 
Chirurgical  Transactions,"  in  which  he  advocated  the  subcutane- 
ous division  of  varicose  veins.     In  that  paper,  the  advantages  of 


1858.]         Subcutaneous  Operation  on  Varicose  Veins.  781 

the  subcutaneons  mode  of  operating  are  clearly  pointed  out.  (A 
description  here  followed  of  Sir  B.  Brodie's  mode  of  performing 
the  operation.)  In  this  mode  of  operating,  no  adequate  provi- 
sion is  made  against  hemorrhage  frbm  the  divided  vessel  on  the 
one  hand,  nor  against  the  absorption  through  the  open  mouth  of 
the  vein  of  the  products  of  the  effused  or  stagnant  blood  on  the 
other.  If  a  vein  be  simpty  divided,  no  one  can  tell  exactly  how 
much  blood  will  be  effused ;  and  if  effused  in  quantity,  the 
changes  above  mentioned  will  occasionally  take  place.  These 
changes  may  occur  either  in  the  blood  outside  the  vein,  or  in 
the  stagnant  blood  still  within  the  vessel,  or  the  action  may  be 
communicated  from  one  of  these  to  the  other.  The  product  of 
these  changes  may  be  localized  by  the  unassisted  powers  of 
nature ;  the  vein  may  be  closed,  so  that  no  absorption  through 
its  canal  can  take  place.  In  like  manner,  an  artery,  when  divid- 
ed, may  spontaneously  cease  to  bleed ;  but  nevertheless  surgeons 
are  not  fond  of  trusting  to  these  unassisted  powers  of  nature. 
In  one  case,  as  in  the  other,  that  which  may  take  place  from 
natural  causes  may  be  with  tolerable  certainty  effected  by  arti- 
ficial means.  The  vein,  like  the  artery,  may  be  safely  and 
efficiently  closed.  If  this  be  carefully  done  before  an  enlarged 
vein  is  divided,  the  effusion  of  blood  is  in  the  first  instance  pre- 
vented, and  there  is  proportionately  less  risk  of  any  of  the  mor- 
bid changes  which  have  been  referred  to ;  and  secondly,  even 
should  such  changes  take  place,  the  products  of  such  changes 
are  prevented  from  entering  the  circulation  through  the  wounded 
vein. 

Such  were  the  considerations  which  induced  Mr.  Lee  in  the 
year  1853  to  try  a  new  mode  of  performing  the  operation  of 
subcutaneous  division  of  varicose  veins.  The  plan  then  adopted 
was  to  place  a  needle  under  the  vein  both  above  and  below  the 
part  to  be  divided.  A  ligature  was  then  placed  over  the  needle 
in  each  situation,  and  allowed  to  remain  for  a  couple  of  days. 
At  the  expiration  of  this  time  the  blood  was  usually  coagulated 
in  the  vein,  which  would  be  felt  as  a  round  soft  cord  on  either 
side  of  and  between  the  needles.  The  vein  was  now  divided  by 
subcutaneous  iucision,  and  two  days  later  the  needles  were  re- 
moved. After  three  or  four  more  days  the  parts  usually  had 
the  appearance  of  having  united  b}~  the  first  intention,  and  the 
patient  was  allowed  to  go  about  his  usual  occupation.  In  his 
first  attempts  to  perform  this  operation,  he  could  not  say  that 
his  success  had  been  quite  such  as  he  could  have  wished,  and 
indeed  expected.  One  case  in  particular  had  some  severe  local 
and  constitutional  symptoms;  and  he  had  reason  to  believe  that 
an  abscess  had  formed  in  the  vein,  where  it  had  been  traversed 
by  one  of  the  needles.  Eeflecting  subsequently  on  the  cause  of 
this,  he  became  convinced  that  the  origin   of  the  mischief  was, 


782  Different  Effects  of  Gaseous  Injections.    [November, 


• 


that  the  needle  had  pierced  the  vein  instead  of  being  made  to 
pass  fairly  under  it.  In  subsequent  operations  this  point  was 
attended  to,  and  performed  with  due  precaution,  as  it  has  now 
been  by  Mr.  Erichsen,  and  various  other  surgeons,  a  great  num- 
ber of  times,  and  it  has  not,  so  far  as  Mr.  Lee  was  aware,  been 
attended  with  danger.  During  the  last  twelve  months  a  further 
improvement,  as  he  conceived,  had  been  effected  in  regard  to 
this  operation.  The  vein  is  divided  as  soon  as  the  needles  have 
been  placed  under  it.  The  subcutaneons  incision  heals  in  about 
the  same  time  as  in  the  other  operation,  and  the  confinement  of 
two  days  previous  to  the  section  of  the  vein  is  avoided.  In  this 
operation  the  blood  which  the  vein  contains  between  the  two 
needles  is  allowed  to  flow  out  of  the  incision ;  and  thus  any  ten- 
dency that  there  might  be  for  stagnant  or  effused  blood  to  de- 
compose is  avoided.  In  performing  the  operation  in  the  man- 
ner now  described,  the  blood  contained  in  the  veins  between  two 
needles  escapes ;  the  sides  of  the  vein  necessarily  fall  together, 
and  are  maintained  in  apposition.  The  sides  of  the  vein  com- 
pressed by  the  needles  and  ligature  suffer  no  violence  or  injury. 
The  subcutaneous  incision  is  pretty  sure  to  heal  by  first  inten- 
tion, and  even  should  it  not,  the  vein  being  closed  above  and 
below,  no  diseased  secretion  can  find  its  way  along  its  channel. 
Various  cases  were  given  to  illustrate  the  different  modes  of 
producing  obliteration  of  veins  by  subcutaneous  division. 

British  Med.  Jour.,  and  Banking's  Abstract 


The  different  effects  of  Gaseous  Injections  into  the  cellular  tissue  and 
into  the  peritoneal  cavity.     By  J.  C.  Shapakd,  M.  D. 

M.  M.  Laconte  and  Demarquay  communicated  a  memoir  to 
the  Academy  of  Sciences  at  its  meeting  of  the  29th  of  March, 
1858,  on  the  pathological,  physiological,  and  chemical  phenom- 
ena produced  by  the  injections  of  air,  azote,  oxygen,  carbonic 
acid,  and  hydrogen  into  the  cellular  tissue  and  into  the  perito- 
neal cavity. 

From  facts  contained  in  this  memoir,  the  authors  conclude : — 

1.  That  air,  azote,  oxygen,  carbonic  acid,  and  hydrogen,  do 
not  produce  any  hurtful  effect  when  they  are  introduced  into 
the  subcutaneous  cellular  tissue  or  into  the  peritoneal  cavity. 

2.  That  all  these  gases  are  absorbed  after  a  longer  or  shorter 
time,  and  with  a  rapidity  which  varies  from  forty-five  minutes 
(carbonic  acid)  to  many  weeks  (azote).  The  rapidity  of  the 
absorption  is  always  presented  in  the  following  manner:  carbo- 
nic acid,  oxygen,  hydrogen,  air  and  azote. 

3.  That  the  injection  of  any  gas  whatever  into  the  cellular 
tissue  or  into  the  peritoneum,  constantly  determines  an  exhala- 
tion of  the  gases  contained  in  the  blood  and  the  tissues. 


1858.]       Suture  of  the  Exterior  Tendons  of  the  Fingers.  783 

4.  That  after  the  injection  of  the  gases,  mixtures  are  formed 
that  are  more  easily  absorbed  than  the  least  absorbable  gas  con- 
tained in  the  injected  part.  So  that  the  absorption  of  this  last 
does  not  commence  only  when  it  is  already  mixed  in  certain 
proportions  with  the  other  gases. 

5.  That,  in  general,  the  exhalation  of  the  gases  of  the  blood 
or  of  the  tissues,  has  been  more  considerable  in  the  the  experi- 
ments made  during  the  digestion,  than  in  those  made  during 
fasting,  and  more  in  the  peritoneum  than  in  the  cellular  tissue. 

6.  The  rapidity  of  the  absorption  has  not  seemed  modified  by 
the  state  of  fasting  or  digestion. 

7.  That  of  all  the  gases  injected,  hydrogen  is  the  one  which 
determines  the  most  considerable  exhalation  of  the  gases  of  the 
blood  when  the  hydrogen  has  already  disappeared  from  the 
mixture,  the  animal  still  preserves  the  volume  that  it  presented 
at  the  moment  of  injection,  which  would  induce  the  belief  of 
nonabsorption  of  hydrogen,  if  a  chemical  analysis  did  not  ex- 
plain the  phenomenon. 

8.  The  rapidity  of  the  absorption  of  the  gases  by  the  blood 
is  not  always  in  proportion  to  their  solubility  in  water  (azote 
and  hydrogen). 

9.  If  in  the  injections  of  air  into  the  cellular  tissue  and  into 
the  peritoneum  there  is  a  constant  absorption  of  oxygen,  and 
exhalation  of  carbonic  acid,  which  in  this  respect,  resembles  the 
phenomenon  of  pulmonary  respiration,  the  two  physiological 
facts  should,  nevertheless,  not  be  considered  as  identical,  for  in 
the  case  of  the  injections,  the  proportions  between  the  carbonic 
acid  axhaled  and  the  oxygen  absorbed  constantly  vary. 

[Nashville  Jour,  of  Med.  arid  Surg. 


Suture  of  the  Extensor  Tendons  of  the  Fingers,  with  a  Case  of  Cure 
by  this  Treatment.     By  M.  MouRGUE. 

Suture  of  the  small  tendons,  like  the  extensors  and  flexors  of 
the  fingers,  is  a  triumph  of  modern  surgery ;  and  the  happy 
results  which  have  followed  its  use  have  given  it  a  place  among 
legitimate  operations.  The  case  of  M.  Mourgue  adds  another 
instance  of  success  to  those  already  recorded. 

Case. — A  maker  of  wooden  shoes"  received  on  the  back  of  his 
left  hand,  on  the  10th  of  December,  a  blow  of  a  hatchet,  which 
divided  the  extensor  tendons  of  the  fore  and  middle  finger  at 
the  metacarpo-phalangian  joint.  The  lower  ends  presented  at 
the  wound,  but  the  upper  were  retracted  tendons,  allowed  them 
to  be  seized  by  forceps  and  pierced  by  a  needle  armed  with  a 
waxed  thread  ;  this  needle  was  then  passed  through  the  corres- 
ponding ends  of  the  tendons  below,  and  they  were  thus  brought 
into  contact  with  those  above,  and  tied.    The  external  wound 


784  Editorial.  [November, 

was  also  closed  with  sutures.  The  hand  was  extended  on  a 
wide  flat  splint,  and  the  wound  covered  with  a  linen  bandage 
spread  with  cerate,  and  compresses  wet  with  cold  water. 

12th.  There  is  considerable  swelling  of  the  wrist  and  great 
redness  ;  it  is  necessary  to  remove  the  sutures  from  the  wound. 
In  a  few  days  the  inflammation  subsided. 

20th.  The  wound,  which  is  open,  but  free  from  redness  and 
inflammation,  is  in  good  condition.  The  edges  were  brought 
together  with  sticking-plaster. 

The  ligatures  of  the  tendons  came  away  on  the  24th  and  26th  ; 
the  external  wounds  cicatrized  at  once.  On  the  8th  of  January, 
the  splint  was  dispensed  with. 

Jan.  22d.  The  man  has  resumed  his  work,  the  Angers  having 
gradually  recovered  their  strength  and  mobility,  and  having 
complete  power  of  extension  and  flexion.  In  a  word,  the 
suture  of  the  extensor  tendons  has  been  attended  with  all  the 
success  which  could  be  desired. — [Gazette  Medicate,  and  Boston 
Med.  and  Sur.  Journal. 


EDITORIAL  AND  MISCELLANEOUS. 

EDITORIAL  REFERENCE  TO  OUR  ECLECTIC  DEPARTMENT. 

Quinine  and  Alum  in  Diphtheritis. — We  have  here*  collected  in  a 
body,  a  number  of  articles  on  a  most  interesting  and  sometimes  fearfully 
fatal  form  of  disease.  As  we  have  seen,  it  most  commonly  prevails  epi- 
demically— though  sporadic  cases  are  referred  to.  Our  object  in  thus 
bringing  together,  in  the  compass  of  a  single  number,  various  accounts  of 
both  the  character  and  treatment  of  membranous  sore  throat,  is,  that  our 
readers  may  have  these  accounts  to  refer  to,  when,  in  their  practice,  such 
histories  may  become  of  particular  interest.  We  are  struck  with  the 
remarkable  uniformity  in  the  character  of  the  disease,  in  all  the  descrip- 
tions presented  from  various  sources — and  also,  by  the  entire  absence 
of  any  mention  of  certain  modes  of  treatment  which,  in  our  experience, 
have  been  of  the  greatest  practical  value — which,  indeed,  have  proved 
almost  specific,  in  the  latitude  which  bounds  our  practice. 

Just  ten  years  ago,  (in  the  year  1848,)  Augusta  and  its  vicinity,  toge- 
ther wTith  several  other  sections  of  the  State  of  Georgia,  were  afflicted 
sorely  by  the  incursions  of  an  Epidemic  Diphtherite,  the  history  of  which 
has  never  been  written.  It  is  not  our  design  to  write  its  history  now, 
but  simply  to  refer  to  some  of  the  peculiarities  which  the  disease  pre- 

*  See  pp.  747-'? 56,  present  number. 


1858.]  Editorial  785 

sented  during  its  prevalence  here  at  that  time,  and  to  give  a  summary  of 
the  treatment  pursued. 

The  year  1848,  in  its  meteorological  character,  presented  nothing 
very  unusual  in  this  region.  Late  in  the  autumn,  when  intermittent 
fever  was  prevailing  perhaps  to  a  greater  extent  than  in  the  earlier 
part  of  the  year,  we  suddenly  observed,  among  children,  certain  cases 
of  this  unusual  form  of  "sore  throat."  Our  attention  was  not  call- 
ed to  the  first  cases  until  the  disease  had  advanced  so  far,  that  remedial 
measures  were  unavailing.  The  fatal  croup  had  supervened,  and  the  two 
or  three  first  cases  soon  died  without  undergoing  any  modification  from 
the  treatment  applied.  "We  were  thus  early  made  painfully  aware  of  the 
serious  nature  of  the  affection  with  which  we  had  to  deal,  and  whenever 
called  early,  treated  the  cases  vigorously  upon  such  a  plan,  as  our  little 
personal  acquaintance  with  the  affection  could  devise.  Notwithstanding 
the  opportunity  afforded  by  early  attendance,  the  disease  rapidly  pro- 
gressed in  most  of  these  cases,  and  several  of  them  died,  on  the  super- 
vention of  the  croup. 

Our  description  of  the  cases  which  occurred  in  Augusta,  will  not,  we 
think,  differ  very  widely  from  that  found  in  several  of  the  articles  pre- 
sented to  our  readers  from  the  various  journals.  In  a  few  cases  the 
attack  was  preceded  by  premonitory  symptoms,  as  restlessness  at  night, 
slight  fever  and  loss  of  appetite,  but  seldom  with  any  actual  soreness  of 
the  fauces  which  induced  the  child  to  complain.  More  frequently  than 
otherwise,  the  parent  or  physician  would  have  the  attention  arrested  by 
a  peculiar,  offensive  odor  in  the  breath,  even  before  the  child  had  evinced 
any  symptom  whatever  of  any  ailment;  when,  on  looking  into  the 
mouth,  the  tonsils  and  larynx  would  often  be  found  covered  with  the 
white,  curdy-looking  deposit,  peculiar  to  this  form  of  disease.  On 
closer  examination,  the  upper  part  of  the  larynx,  the  nares,  even  as  far 
forward  as  the  opening  of  the  nostrils,  would  be  found  covered  with  the 
same  matter,  which  spread  itself  in  the  form  of  a  membrane*  over  the 
whole  surface  of  the  mucous  lining  of  these  more  external  parts  of  the 
air-passages.  Often,  at  this  first  examination,  a  croupal  hoarseness  could 
be  detected,  which  too  plainly  indicated  the  extension  of  the  disease  into 
the  larynx.  The  cases  in  which  the  affection  proved  most  fatal  were,  as 
may  be  seen  in  most  of  the  accounts  given  of  it  elsewhere,  children 
under  twelve  years  of  age,  and  death  seldom  transpired  here,  in  any  other 
way  than  from  the  croup. 

The  condition  of  the  subjacent  mucous  membrane  was  often  the 
6ubject  of  our  careful  inspection.  Excellent  opportunities  were  afford- 
ed us  to  examine  the  state  of  both  the  false  membrane  and  the 
mucous  membrane,  during  the  life  of  the  patient,  by  those  cases  in 


786  Editorial.  [November, 

which  the  deposit  existed  in  the  nostril ;  for  in  them,  it  often  extended 
forward  to  the  very  junction  of  the  skin  and  mucous  membrane,  and  we 
could  compare  the  appearance  of  the  three  surfaces  as  they  lay  in  regular 
order  of  super-position — viz.,*  skin,  next  mucous  membrane,  and  lastly, 
the  false  white  deposit — the  skin,  even  immediately  bordering  upon  the 
two  other  membranes,  seldom  evinced  any  change,  but  the  subjacent 
mucous  membrane  was  invariably  red,  to  nearly  its  entire  thickness,  and 
seemed  to  be  the  seat  of  a  certain  kind  of  inflammation — while  the  false 
membrane  was  perfectly  white  and  seemed  to  have  no  vascular  connec- 
tion whatever  with  the  mucous  surface.  In  a  few  days  the  first  layer  of 
the  deposit  would  be  elevated  and  loosened  by  the  effusion  of  pus  under 
it  and  them — it  was  easily  separable  from  the  mucous  membrane.  .  In 
the  pharynx  it  would  be  often  found  hanging  from  the  posterior  wall, 
and  even  from  the  velum,  in  the  form  of  a  white  ragged  curtain.  While  in 
a  certain  fatal  case  which  we  examined,  the  child  evidently  died  at  the 
moment  of,  and  directly  in  consequence  of,  this  kind  of  separation  of  the 
false  membrane  from  the  walls  of  the  larynx,  the  shreds  blocking  up  the 
rima  and  producing  death  by  suffocation.  The  case  appeared  to  us,  to 
die  in  getting  well.  Doubtless,  many  have  died  in  exactly  this  stage,  of 
what  may,  in  one  sense,  be  called  a  natural  process  of  recovery. 

We  had  many  cases  among  the  adult  population,  but  not  a  single  fatal 
case  over  twelve  years  of  age — indeed  the  nearer  the  child  approached 
to  infancy,  the  more  imminent,  in  our  mind,  was  the  peril  from  the  croup. 
From  a  close  observation  of  many  cases — comparing  the  cases  of  the 
younger  children  with  those  occurring  in  youths  and  adults,  we  came  to 
the  conclusion  that  the  greater  fatality  among  young  children  was  not 
due  so  much,  to  any  greater  susceptibility  to  the  disease,  nor  to  a  less 
power  of  resistance  on  the  part  of  the  patients  of  this  age ;  for  many  of 
our  most  violent  cases  occurred  in  children  over  twelve  years  of  age, 
whose  constitutions  were  comparatively  feeble,  and  yet  they  went  through 
even  the  -croup,  and  recovered.  The  circumstance  which,  in  our  opin- 
ion, decided  the  fate  of  the  patient,  for  death  or  for  recovery,  was  of  a 
purely  mechanical  nature — a  question  simply  of  space — space  to  breathe. 
The  little  advantage  in  the  calibre  of  larynx  which  the  older  children 
possessed  over  the  younger  ones,  was  certainly  the  determining  accident 
of  their  recovery.  The  deposit  on  the  inner  surface  of  the  larynx  varied 
but  little  in  its  thickness :  it  occupied  as  much  space,  absolutely,  in  a 
large  windpipe,  as  in  the  smaller  ones,  but  then  the  smaller  ones  could 
not  afford  this  space,  and  suffered  complete,  or  at  any  rate,  a  fatal  occlu- 
sion. We  are  very  confident  that  the  above  is  the  true  explanation  of 
the  marked  influence  which  age  appeared  to  exercise  over  the  result  of 
the  disease. 


1858.]  Editorial  787 

In  a  recent  communication  to  the  American  Medical  Association,* 
the  nature  of  Diphtherite  became  incidentally  the  subject  of  discussion, 
and  although  we  cannot  here,  without  inconveniently  extending  our 
remarks,  define  our  belief,  or  present  arguments  in  its  behalf,  we  yet 
state  that  we  regard  diphtherite  as  a  disease  which  is  eminently 
under  the  control  of  the  nervous  system,  which  underlies  and  governs 
its  phenomena  in  such  a  manner,  that  it  is  impossible  to  deny  its 
recognition  in  all  our  deliberations  upon  the  nature  of  this  affection. 
We  do  not  deny  the  ground  which  many,  doubtless,  will  take,  that  the 
disease  is  essentially,  a  peculiar  vitiation  of  the  blood,  as  is  clearly  mani- 
fested in  its  observed  phenomena;  but  from  our  own  observation,  which 
has  been  ample,  this  blood  affection,  or  toxaemia,  specially  affects  the 
pharyngeal  plexus  of  nerves,  aberrating  the  influence  which  they  exer- 
cise over  the  circulation  and  secretions  of  the  pharynx,  larynx  and 
trachea,  and  metamorphosing  their  normal  mucous  exhalation  into  an 
effusion  which  forms  the  material  of  the  false  membrane  of  diphtherite. 

In  the  earlier  part  of  our  epidemic,  the  disease  was  seldom  marked 
by  fever,  and  only  local  remedies  and  such  as  would  be  rationally  sug- 
gested by  the  special  symptoms  presented,  were  applied ;  but  later,  a 
few  cases  were  accompanied  with  decided  fever.  This  fever  was  inter- 
mittent, and  was  found  to  aggravate  the  local  symptoms  very  decidedly. 
Along  with  the  local  treatment  previously  applied,  quinine  was  freely 
administered  to  those  patients,  in  order  to  control  the  fever,  and  to  our 
surprise,  not  only  was  the  fever  arrested,  but  the  extension  and  progress 
of  the  membranous  deposit  was  promptly  arrested  with  the  breaking  up 
of  the  fever.  From  this  marked  influence  of  quinine  upon  the  disease, 
we  were  induced  to  apply  it  in  every  case,  whether  fever  presented  or  not ; 
our  mode  of  giving  it  was  the  following: — From  5  to  15  grains  of  quin- 
ine, according  to  the  age  of  the  child,  was  given  in  divided  doses,  during 
the  earlier  part  of  each  day,  for  several  days ;  and  no  less  in  the  apy- 
rexic  than  in  the  few  pyrexic  cases,  did  the  quinine  appear  completely 
to  control  the  progress  of  the  affection.  Seldom,  after  the  free  use  of 
quinine,  in  the  earlier  part  of  the  attack,  did  we  ever  find  the  disease  ex- 
tending into  the  larynx  and  producing  the  croup.  In  addition  to  the 
quinine,  we  frequently  advised,  in  the  beginning,  a  mild  cathartic,  con- 
taining from  5  to  8  grains  of  calomel,  but  if  called  later  to  the  cases,  this 
was  omitted. 

The  local  remedies  applied  here  were  numerous — nitrate  of  silver, 
both  in  weak  and  strong  solution,  was  freely  used  by  many  :  our  own 
experience  with  it  was  not  such  as  to  induce  us  to  recommend  it.  Dr. 


I*  Report  on  the  Nervous  System  in  Febrile  Diseases,  WftshiDgtoD,  D.C.,  May  '58. 


788  Editorial  [November, 

L,  A.  Dugas  lias  the  record  of  many  cases  which  illustrate  the  value  of 
strong  hydrochloric  acid,  locally  applied,  in  our  epidemic.  Pulverized 
alum  (sulphas  aluminae)  was  the  local  application  used  by  Dr.  J.  A.  Eve, 
and  by  several  other  of  our  practitioners,  with  much  success.  This  last 
was  the  only  local  remedy  applied  by  us.  The  method  of  using  the 
remedy,  was  the  following : — The  alum  was  first  ground  in  a  mortar  to 
an  impalpable  powder — occasionally  it  was  mixed  with  a  small  proportion 
of  sugar.  This  was  blown  against  the  posterior  wall  of  the  pharynx  five 
or  six  times  a  day,  through  a  reed  or  glass  tube.  The  most  advantage- 
ous mode  of  applying  it,  was  to  press  the  end  of  the  tube  upon  the  mass 
of  pulverized  alum,  so  as  to  engage  a  considerable  quantity  of  the  pow- 
der— have  the  child  properly  held  by  an  assistant,  and  then  with  a  spoon 
or  speculum,  press  down  the  tongue,  and  directing  the  tube  rather  down- 
wards, blow  the  powder  strongly  against  the  posterior  wall  of  the  pharynx. 
If  the  tube  were  directed  upwardly,  the  alum  was  liable  to  get  into  the 
posterior  nares  and  give  the  child  much  pain,  and  cause  it  to  resist  the 
subsequent  applications. 

Time  nor  space  does  not  allow  us  at  present  to  dwell  upon  the  advan- 
tageous results  of  the  above  treatment  of  Diphtherite,  nor  upon  the 
peculiarities  of  the  disease  as  it  presented  itself  in  Augusta. 

In  perusing  the  many  accounts  of  epidemics,  in  various  parts  of  the 
world,  which  have  recently  appeared  in  journals,  we  have,  with  much 
interest,  sought  for  the  results  obtained  from  the  use  of  quinine,  applied 
in  the  manner  we  have  herein  hastily  described ;  but  we  have  found 
quinine  but  rarely  mentioned  at  all,  and  only  in  one  of  those  accounts 
but  incidentally,  and  not  much  importance  attached  to  the  results  of  the 
treatment.  Having  experienced  such  beneficial  results  from  the  treat- 
ment, we  are  now  induced  to  record  our  views,  hoping  that  it  may  be 
found  valuable  to  those  of  our  readers  at  least,  who  may  have  to  con- 
tend with  an  epidemic  of  this  insidious  but  terrific  affection  in  a  South- 
ern, or  a  malarial  region. 


Medical  and  Physiological   Commentaries.     By  Martyn  Payne,  M,  D., 
A.  M.,  &c.     Vols.  1  and  2,  octavo,  pp.  V 16  and  816.     1840. 

Essay  on  the  Modus  Operandi  of  Medicines.     By  the  same  author. 

In  a  former  notice,  we  called  attention  to  the  great  value  of  this  dis- 
tinguished writer's  contributions  to  the  medical  literature  of  our  country. 
No  less  now,  are  we  impressed  with  Dr.  Payne's  commendable  industry, 
indefatigable  labor,  and  also,  with  the  value  of  their  results,  than  when 
we  reviewed,  a  few  months  since,  "  The  Institutes  of  Medicine,"  from 
his  distinguished  and  prolific  pen.     Leaving  out  of  sight,  that  difference 


.858.]  Editorial  789 

>f  sentiment  and  belief,  which  must  necessarily  exist  among  medical 
nen,  of  the  present  age,  on  such  long  contested  questions  as  Humoral- 
sm  and  Vitalism,  no  one  can  read  the  works  of  Dr.  Payne,  without 
:onceding  to  him.  the  opinion  that,  in  him,  the  one  has  met  its  most 
myielding  and  able  opponent,  and  the  other,  a  most  ardent,  learned  and 
>owerful  advocate. 

His  volumes  all  evince  an  amount  of  erudition  and  thorough  aequaint- 
mce  with  the  history  of  medical  science,  which  render  his  works  valua- 
)le,  together  with  their  other  points  of  interest,  as  a  rich  repertory  of 
nedical  facts  and  opinions,  collected  with  much  judgment  and  discussed 
vith  great  acumen  and  fairness.  But  these  are  far  from  being  the  most 
>rominent  recommendations  of  the  volumes  before  us.  In  an  age  when 
lumoralism  has  become  ultra,  and  the  influence  of  the  nervous  system 
s  somewhat  overshadowed  and  obscured  by  modern  chemical  doc- 
xines — which  are  doubtless,  in  great  part,  true  in  themselves,  Dr.  Payne's 
jarnest  advocacy  of  Vitalism,  which  we  are  free  to  admit,  is  itself  ultra, 
proved  a  valuable  defence  to  the  true  and  more  conservative  doctrines  of 
nedicine.  His  urgent  appeals  for  this  Vitalism  and  strong  arguments 
igainst  Humoralism,  catch  the  ear  and  arrest  the  attention  of  the  pro- 
fession: and  it  has  begun  to  be  admitted,  that  though  Humoralism  may 
t>e  true,  as  the  majority  has  heretofore  firmly  believed,  yet  the  nervous 
system  and  its  influence  upon  the  animal  economy,  may  also  have  at  least 
\  modicum  of  truth. 

In  the  volumes  before  us,  the  authors  considerations  are  embodied 
under  the  following  heads,  to  each  of  which  it  will  be  seen  he  has  devo- 
ted much  thought  and  a  goodly  number  of  pages: — 1st.  "The  Vital 
Powers,"  119  pages;  2nd.  '-The  Philosophy  of  Blood-letting,"  264  pa- 
ges; 3rd.  u  The  Humoral  Pathology,"  332  pages — which  completes  the 
contents  of  the  first  volume.  During  those  three  extended  essays,  he 
applies  observation,  research  and  able  reasoning  to  each  department  of 
his  subjects,  and  examines  them  not  only  as  they  exist  now,  but  as  they 
are  found  recorded  from  the  earliest  history  of  medicine  to  the  time  at 
which  the  author's  commentaries  were  written,  1840. 

In  volume  2,  we  have  78  pages  devoted  to  "  Animal  Heat,"  44  pages 
on  the  "  Philosophy  of  Digestion,"  with  an  Appendix  of  about  20  pages, 
on  "Spontaneous  Generation,"  74  pages  on  4' The  Theories  of  Inflamma- 
tion" ;  while  the  body  of  the  volume,  426  pages,  appears  to  be  devoted 
to  the  "  Philosophy  of  Venous  Congestion."  A  paper  on  the  "  Compara- 
tive merits  of  the  Hippocratic  and  Anatomical  Schools,"  together  with 
a  review  of  the  writings  of  Louis,  serve  to  complete  the  second  volume 
of  the  work. 

The  Pamphlet,  mentioned  at  the  head  of  this  notice,  is  a  series  of 


790  Editorial.  [November, 

"Essays  on  the  Philosophy  of  Vitality  as  contradistinguished  from 
Chemical  and  Mechanical  Philosophy ;  and  on  the  modus  operandi  of 
Remedial  Agents."  This  pamphlet  constitutes  a  part  of  the  third  vol- 
ume of  the  M  Commentaries,"  and  fully  sustains  the  character  of  the  two 
volumes  we  have  had  the  opportunity  of  examining. 

A  System  af  Human  Anatomy :  General  and  Special.  By  Erasmus 
Wilson,  F.  R.  S.,  author  of  "  The  Dissector's  Manual,"  "  A  Treatise  on 
Diseases  of  the  Skin,"  etc.,  etc.  A  new  and  improved  American,  from 
an  enlarged  London  edition.  Edited  by  William  H.  Gobkecht,  M.D., 
Professor  of  Anatomy  in  the  Philadelphia  College  of  Medicine,  Fellow 
of  the  College  of  Physicians  of  Philadelphia,  etc.  With  397  illustra- 
tions on  wood.  Philadelphia:  Blanchard  k  Lea.  1858.  Pp.616 
octavo.     (Through  H.  D.  Norrell,  Augusta,  Ga.) 

The  great  practical  value  of  Wilson's  Anatomy,  as  a  manual  for  the 
student,  the  practitioner,  and  for  all  who  may  desire  to  become  acquaint- 
ed with  the  subject,  is  too  well  attested  by  the  unprecedented  success  of 
the  work,  and  the  universal  verdict  in  its  favor,  to  render  recommenda- 
tion necessary.  The  present  edition  is  greatly  enlarged,  and  its  value 
much  enhanced  by  numerous  new  illustrations.  "The  extensive  addi- 
tions made  by  the  hand  of  the  author,  in  successive  revisions,  are  indica- 
ted by  the  fact,  that  it  contains  fully  one-fourth  more  matter  than  the 
previous  American  edition,  rendering  a  smaller  type,  and  an  enlarged 
page,  necessary  to  keep  the  volume  within  a  convenient  size." 

The  work  has  heretofore  been  edited  by  Dr.  P.  B.  Goddard,  but  the 
present  edition  bears  the  name  of  Dr.  William  H.  Gobrecht — well 
known,  both  as  a  teacher  of  Anatomy  and  as  the  Editor  of  works  in 
which  he  has  creditably  labored.  His  valuable  initial  chapter  is  an 
introduction  which  early  bespeaks  the  interest  and  attention  of  the  read- 
er for  the  balance  of  his  labor  upon  his  author's  work.  We  have  ever 
commended  Wilson's  Anatomy,  without  hesitation  or  reserve,  to  stu- 
dents of  medicine,  and  the  present  edition  only  increases  our  approbation. 


1 

I-. 


Lectures  on  the  Principles  and  Practice  of  Physic.  Delivered  at  King's 
College,  London,  by  Thomas  Watson,  M.  D.,  Fellow  of  the  Royal  Col- 
lege of  Physicians,  late  Physician  to  the  Middlesex  Hospital,  and  for- 
merly Fellow  of  St.  John's  College,  Cambridge.  A  new  American, 
from  the  last  revised  and  enlarged  English  edition.  With  additions 
by  D.  Francis  Condie,  M.  D.,  Fellow  of  the  College  of  Physicians  of 
Philadelphia;  member  of  the  American  Philosophical  Society,  etc.,  etc. 
With  185  illustrations  on  wood.  Philadelphia:  Blanchard  &  Kea. 
1858.     8vo.,  pp.  1224.     (Through  H.  D.  Norrell,  Augusta,  Ga.) 

Although  we  have  not  room  for  even  a  full  notice  of  the  above  work, 
we  yet  call  attention  to  it,  and  will  dwell  upon  it  more  fully  hereafter. 
This  is  truly  a  splendid  edition  of  a  splendid  work  on  the  Practice  off: 


1858.]  Editorial  791 


Medicine.  It  comes  to  us  just  in  time  for  the  opening  sessions  in  the 
various  Colleges.  The  English  work  costs  eight  or  ten  dollars.  This 
improved  American  copy  only  three  or  four.  Dr.  Condie  has  added 
largely  to  its  value,  and  has  adapted  it  well,  to  the  various  diseases  as 
they  prevail  in  all  parts  of  our  widely  extended  country.  This  notice  is 
intended  particularly  for  the  students  in  our  own  and  other  Colleges. 
We  shall  review  the  work  more  fullv  in  our  next  issue. 


The  Nashville  Record  of  Medical  and  Physical  Science. — The 
face  of  a  new  acquaintance  is  ever  agreeable  and  interesting  to  us ;  but 
with  far  more  interest  and  pleasure  do  we  contemplate  the  countenance 
of  old  and  familiar  friends — friends,  too,  concerning  whose  fate  we  had 
felt  somewhat  uncertain.  The  breaking  up  of  the  offices  of  our  two 
valued  exchanges,  the  Memphis  Medical  Recorder  and  The  Southern 
Journal  of  the  Medical  and  Physical  Sciences,  by  the  removal  of  their 
respective  editors  to  Nashville,  certainly,  suggested  the  inquiry — What 
is  to  become  of  our  interests  ? — The  question  has  been  promptly  an- 
swered— the  temporary  silence  of  the  two  parties  has  been  occupied,  it 
appears,  in  business-like,  matter-of-fact  courtship,  which  has  resulted  in 
the  happy  marriage  of  the  worthy  couple,  and  the  comely  offspring 
greets  us  in  the  Nashville  Monthly  Record.  The  name  of  Professor 
Daniel  F.  Wright  is  familiar  to  our  readers,  and  not  less  so  is  that  of 
Professor  Richard  0.  Curry.  We  wish  them,  in  their  congenial  and 
j  well-assorted  union,  even  more  happiness  and  success  than  they  enjoyed 
as  separate  journalists. 


Medical  Journal  of  North  Carolina. — The  two  first  numbers  of 
this  valuable  bi-monthly  are  before  us.  Its  original,  eclectic,  editorial 
rod  miscellaneous  contents  fully  assure  us  that  the  old  North  State  has 
?aked  up  in  medical  matters  to  some  purpose,  and  suggest  the  idea, 
hat  it  may,  ere  long,  not  only  overtake,  but  outstrip  some  of  her  sisters, 
nrho  had  taken  a  long  start  of  her.  The  editor  of  this  new  comer  to  our 
sanctum  is  Edward  Warren,  M.  D.,  son  of  Dr.  Edward  C.  Warren,  one 
>f  the  Vice-Presidents  of  the  American  Medical  x\ssociation.  Our  new 
jonfrere  is  well  known  to  the  Profession  as  the  successful  essayist  in  a 
Recent  contest  for  the  Fiske  fun*d  prize.  His  subject  was,  we  think, 
The  Influence  of  Pregnancy  upon  Tubercular  Development." 
It  affords  us  pleasure  to  place  the  North  Carolina  Medical  Journal 
ipon  our  list  of  exchanges,  and  we  will  endeavor  to  enrich  our  own 
_-s  from  its  valuable  fund.  It  is  published  bi-monthly,  at  Edenton, 
{  tforth  Carolina,  under  the  auspices  of  the  State  Medical  Society. 


792  Editorial  and  Miscellaneous.  [November, 

American  Dentists  in  Europe. — There  are,  we  believe,  from  twelve  to 
eighteen  American  dentists  engaged  in  practice  at  the  present  time  in 
the  different  parts  of  Europe,  and  all,  so  far  as  we  have  been  able  to 
learn,  are  receiving  the  most  flattering  encouragement.  There  are  two 
in  London,  one  in  Manchester,  three  or  four  in  Paris,  one  in  Berlin,  one 
in  Rome  and  one  in  Madrid.  There  are  also  others  whose  places  of  resi- 
dence we  do  not  know,  and  every  year  adds  to  the  number.  We  have 
recently  learned  that  Dr.  F.  Fuller,  of  Portsmouth,  N.  H.,  intends  visit- 
ing Europe  in  a  few  months,  but  whether  he  goes  merely  for  purposes  of 
pleasure  or  with  a  view  of  practicing  his  profession  abroad,  we  are  not  j 
informed.  A  gentleman  of  his  intelligence  and  professional  capacity 
will  scarcely  fail  to  meet  with  a  kind  receptiou  from  the  members  of  his 
j3i^ession  on  the  other  side  of  the  Atlantic.  We  wish  him  a  pleasant 
trip  and  safe  return. — [American  Journal  of  Dental  Science. 

We,  too,  have  a  friend  among  the  American  dentists  in  Europe.  Dr. 
J.  W.  Spear,  formerly  a  practitioner  in  this  place,  but  more  recently  of 
New  York,  has,  we  understand,  removed  to  England,  where,  we  are 
gratified  to  learn,  he  is  much  pleased  with  the  encouragement  he  has 
received.  We  sincerely  wish  him  that  full  amount  of  success  which  his 
urbane  manners,  gentlemanly  bearing,  and  fine  professional  abilities  are 
so  well  calculated  to  secure  him. 


The  Cauterization  of  Strictm-es  of  the  JVasal  Canal,  by  means  of  Cat- 
guts impregnated  with  a  solution  of  Nitrate  of  Silver.  By  Dr.  Raw, 
Professor  of  Medicine  at  Berne. — Ten  years  ago  I  conceived  the  idea  of  I 
employing  this  means  for  cauterizing  contracted  or  indurated  canals ;  I 
first  made  the  experiment  on  the  Eustachian  tube,  and  afterwards  on  the 
urethra,  and  on  the  nasal  canal.  Process:  The  cat-guts  are  cut  into 
pieces  of  convenient  length,  polished  at  one  extremity  which  is  smooth- 
ed with  a  very  fine  file,  then  washed  in  a  solution  of  potash  to  free  them 
from  the  oil  which  they  contain.  They  are  afterwards  plunged  into  a 
strong  solution  of  nitrate  of  silver  (1  part  to  10  of  distilled  water),  from 
which  they  are  taken  at  from  four  to  eight  hours,  according  to  their 
thickness ;  they  are  then  dried  by  suspension  in  the  open  air  in  a  dark 
place.  If  the  cat-gut  is  left  too  long  in  the  solution  it  will  become  twist- 
ed and  distorted.  After  drying,  the  surface  and  the  interior  are  satura- 
ted with  crystalized  nitrate  of  silver.  Should  there  be  any  inequalities 
they  must  be  removed  by  the  file.  The  pieces  of  cat-gut  thus  prepared, 
are* preserved  in  blackened  glass-tubes.  In  course  of  time  the  color  oi 
the  cat-gut  becomes  darker,  without  the  curative  effect  being  weakened. 

When  we  wish  to  use  these  cat-guts  in  strictures  of  the  nasal  canal, 
they  are  flattened  at  the  upper  extremity  so  that  they  can  be  applied 
and  fixed  to  the  fistulous  orifice  at  its  outlet.  After  performing  some 
abstergent  injections  the  cat-gut  is  introduced,  without  the  coat  of  oil 
until  it  becomes  strongly  pressed  in  the  contraction.  At  first  thepatiem 
experiences  scarcely  any  pain,  and  that  which  he  feels  afterwards  has 
never  been  so  great  as  to  compel  me  to  withdraw  the  cat-gut  before  th< 
lapse  of  twenty-four  hours.     If  the  irritation  is  not  too  great,  introduc< 


1858.]  Miscellaneous.  793 

every  day  a  new  cord,  after  having  previously  injected  with  fresh  water, 
or  what  is  better,  a  solution  of  sulphate  of  copper.  After  the  second 
trial  we  perceive  that  we  may  increase  rapidly  the  diameter  of  the  cords. 
When  the  irritation  becomes  too  great,  which  rarely  occurs,  we  intro- 
duce cat-guts,  not  nitrated,  nntil  the  irritation  ceases.  "When  the  canal 
is  sufficiently  dilated  throughout  its  extent,  and  the  secretion  has  lost  its 
purulent  character,  it  is  well  to  wear  for  some  time  a  leaden  nail,  before 
allowing  the  fistulous  opening  to  close.  The  strictures  of  the  nasal  canal 
not  caused  by  an  anomaly  of  the  osseous  duct,  heal  by  this  method  in  a 
few  weeks,  while  we  know  the  other  methods  often  require  several 
months.  I  have  also  in  several  cases  successfully  used  the  solution  of 
sulphate  of  copper. — [Charleston  Med.  Jour,  and  Rev. 


Facial  Neuralgia — Cauterization  of  the  Helix. — Our  readers  will  per- 
haps remember  the  singular  treatment  proposed  in  Sciatique  which 
consisted  in  cauterizing  the  helix  with  iron  at  a  white  heat.  However 
strange  this  process  may  appear  there  can  be  offered  in  its  favor  a  certain 
number  of  well  established  cures,  and  it  is  by  no  means  abandoned  by 
practitioners,  although  in  truth  the  failures  have  been  thus  far  quite  as 
numerous  as  the  successes.  The  same  means  have  just  been  employed 
in  Facial  Xeuralgia,  by  Dr.  Texier,  who  has  published  in  the  Moniteur 
des  Hopitaux,  a  communication  on  the  subject.  Dr.  T.  had  seen  the 
process  applied  in  this  affection  by  Professor  Jobert  de  Lamballe,  and  he 
resolved  to  repeat  it  on  the  first  occasion.  A  youn<r  woman  had  suffered 
for  six  weeks  with  intolerable  pains  on  the  right  side  of  the  head  and  in 
the  lower  jaw  :  she  had  had  no  rest,  and  at  times  experienced  inordinate- 
ly painful  exacerbations.  M.  Texier  effected  with  the  instrument  at  a 
white  heat,  the  cauterization  of  the  helix  at  the  moment  when  the  pain 
was  at  its  maximum.  The  patient  uttered  a  cry  and  began  to  weep, 
then  shaking  her  head  as  if  to  see  whether  she  had  been  dreaming,  she 
declared  herself  entirely  free  from  pain.     The  cure  was  permanent. 

Another  yonng  woman  was  for  two  months  troubled  with  a  trifacial 
neuralgia  on  the  left  side,  for  the  cure  of  which  various  expedients  had 
been  tried  in  vain.  The  pain  in  the  jaw  was  so  severe  as  to  render  mas- 
tication impossible,  and  she  lived  only  upon  soups  and  milk.  The  cau- 
terization of  the  helix  was  quite  as  successful  in  this  case  as  in  the  pre- 
ceding. 

A  third  observation  gave  precisely  the  same  result.  But  M.  Texier 
informs  us  that  this  process  does  not  always  succeed;  very  far  from  it, 
since  with  eight  patients  he  effected  only  one  cure.  It  seems  that  to 
apply  the  method  with  any  confidence  of  success  the  neuralgia  should 
be  fixed  and  without  complications.  Cauterization,  reserved  for  cases  in 
which  the  affection  is,  so  to  speak,  idiopathic,  without  any  particular 
character  but  a  violent,  steady  pain  in  the  course  of  the  trifacial,  may 
become  a  valuable  resource,  and  we  ought  to  be  the  better  satisfied 
thereat,  because  in  general  such  cases  are  the  most  difficult  to  manage, 
as  science  possesses  little  more  than  uncertain  and  too  often  inefficacious 
beans  of  controlling  them. — [Jour.de  Med.  et  de  Chirurgie,  and  lb. 

Convulsions  of  Children. — Irrigating  the  head  with  cold  water  is  con- 
iridered  by  Dr.  Lalesque  an  excellent  remedy  in  convulsions  of  children. 


794  Miscellaneous 

Paralysis  of  the  Facial  Nerve. — An  interesting  case  of  this  disease 
has  been  reported  by  Professor  Hohl,  of  the  Lying-in  hospital,  at  Halle. 
It  occurred  in  a  new-born  child  that  had  been  removed  from  the  mother 
by  the  aid  of  forceps.  The  pressure  of  the  left  blade  upon  the  side  of 
the  head  induced  a  paralysis  of  the  facial  nerve  which  resisted  all  treat- 
ment. In  consequenee  of  this,  the  child  was  prevented  from  drawing 
the  milk  from  the  mother's  breast,  since  all  the  fluid  ran  out  of  the  cor- 
ner of  the  mouth  on  the  paralyzed  side.  Nothing  could  be  swallowed 
until  it  was  placed  within  the  grasp  of  the  muscles  of  the  pharynx.  The 
child  died  on  the  twelfth  day  of  inanition.— [American  Journal  of  Dental 
Science. 


Treatment  of  Threatening  Mammary  Abscess.  R. — Linseed  oil,  one 
oz.,  Honey,  flour,  do.  To  be  stewed  over  a  slow  fire,  at  a  moderate  heat, 
until  the  flour  has  become  converted  into  a  paste,  and  completely  incor 
porated  with  the  honey  and  oil.  While  warm  add  to  this  one  ounce 
of  camphor,  ground  into  a  fine  powder,  with  a  little  sulphuric  ether  or 
strong  alcohol.  Mix  the  camphor  with  the  paste  intimately,  and  spread 
a  plaster  on  a  piece  of  cloth  or  cotton ;  apply  this  to  the  inflamed  breast, 
and  keep  it  on  night  and  day  until  relief  is  obtained.  It  is  well  to  take  *■ 
the  plaster  off  every  morning,  and  sprinkle  about  a  drachm  of  finely  pow- 
dered comphor  over  it ; — then  re-apply  as  before. 

(Dr.  Wilkinson,  of  the  parish  of  Plaquemine,  speaks  in  high  terms  of 
the  above  application  in  the  early  stages  of  milk  abscess,  or  rather  in 
cases  where  the  inflammation  of  the  mammary  gland  threatens  to  termi- 
nate in  an  abscess.  If  applied  in  the  forming  stage  of  the  affection,  he 
assures  us  it  will  seldom  fail,  especially  when  assisted  by  suitable  con-  *{ 
stitutional  treatment. — [New  Orleans  Med,  and  Surg.  Jour. 

k 
It 
b; 
A 
it 


Tetanus — Dr.  Winston  in  the  Nashville  Journal,  speaks  favorably  of 
heroic  doses  of  opium  in  traumatic  tetanus.  He  relates  several  cases  in 
which  that  agent  was  employed  to  advantage,  by  beginning  with  one 
grain  of  morphia  and  increasing  the  quantity  with  each  paroxysm. 

Hemorrhage. — Hemorrhage  of  the  temporal  artery  may  be  arrested 
easily,  by  using  a  common  tailors'  thimble  and  applying  a  compress  over 
it.  Hemorrhage  following  the  extraction  of  a  tooth,  may  be  relieved 
by  cutting  a  piece  of  dry  sponge  into  the  shape  of  a  cone,  and  inserting 
it  into  the  cavity,  making  the  patient  close  his  jaws  at  the  same  time. 
Hemorrhage  from  sloughing  can  be  arrested  by  the  local  application  of 
ergotine. 

Anus,  Prolapsus  of. — Dr.  Demarquay  condemns  Blandin's  method  of 
excising  a  portion  of  the  sphincter,  and  simply  removes  a  portion  of  the 
mucous  membrane,  using  the  galvano  puncture  in  connection  with  it. 

Mammary  Abscess. — The  extract  of  Belladonna  spread  upon  a  linen 
cloth  in  the  form  of  a  plaster,  and  applied  to  the  breast,  is  highly  recom- 
mended in  this  disease. 

[North,  Carolina  Med.  and  Surg.  Journal. 


SOUTHERN 

MEDICAL  AND  SURGICAL  JOURNAL 


(NEW  SERIES.) 


Vol.  XIV.]  AUGUSTA,  GEORGIA,  DECEMBER,  1858.  [No.  1!. 


ORIGINAL  AND  ECLECTIC. 

ARTICLE  XXVII. 

4.n  Essay  on  the  Physiology  of  Menstruation.  By  Eben  Hillyer, 
M.D.,  of  Eome,  Gra.  (Read  before  the  Medical  Society  of  the 
State  of  Georgia,  at  the  annual  meeting  in  Madison,  April, 
1858,  and  ordered  to  be  printed.) 

The  function  of  menstruation  has  always  been  a  subject  of 

Quch  discussion  among  physiologists.     Its  nature,  the  causes 

yhich  bring  it  about,  and  the  purposes  which  it  subserves,  in 

he  female,  have  never  been  clearly  understood.     There  exists 

auch  difference  of  opinion,  among  scientific  men,  upon  all  these 

i  >oints,  and  there  is  no  theory  which  has  yet  been  advanced, 

rhich  has  received  the  entire  support  and  approbation  of  the 

1  rofession ;  so  that  it  cannot  be  said  that  the  physiology  of 

i  lenstruation  is  established  upon  any  definite  theory. 

Menstruation  may  be  defined  to  be  a  sanguineous  discharge 
\  *om  the  uterus  of  the  human  female,   accruing  generally  at 
>f  lonthly  periods,  and  continuing  from  three  to  six  days :  it  is 
Dnsidered  to  be  peculiar  to  woman.     The  females  of  other  an- 
il nals  are  supposed  to  be  in  an  analogous  condition  during  the 
A  eriod  of  heat,  except  that  they  do  not  have  the  discharge.    We 
re  told  that  there  is  an  exception  in  a  certain  species  of  ape ; 
m  some,  this  exception  is  not  admitted — they  believe  it  to  be  a 
3jmp]e  flow  of  blood  from  the  rupture  of  some  small  vessel  of 
Le  vagina,  or  uterus,  and  that  it  is  not  true  menstruation. 

N.S. — VOL.  XIV.    NO.  XII.  46 


796        Hillyer  on  the  Physiology  of  Menstruation.  [December, 

From  the  accounts  given  us  of  the  discharge  in  the  ape,  it  is 
very  probable  that  this  animal  is  an  exception  with  the  human 
female,  to  the  usual  course  of  things,  during  the  period  of  ovu- 
lation. Its  early,  or  late  appearance,  depends  much  upon  the 
climate,  the  constitution,  the  habits,  and  the  hardness  of  living, 
to  which  the  girl  may  be  subjected.  Those  accustomed  to  a 
luxurious  life,  to  an  abundance  of  nutritious  and  stimulating 
food,  sleeping  upon  down-beds,  and  in  warm  rooms,  etc.,  will 
menstruate  much  sooner  than  one,  who  has  endured  hardships. 
In  the  one,  the  female  is  hurried  on  to  maturity,  as  in  the  hot- 
house plant,  under  similar  circumstances ;  in  the  other,  from 
her  mode  of  life,  the  privations  she  undergoes,  etc.,  the  discharge 
is  delayed,  as  are  also  other  developments,  which  are  signs  oi 
her  near  approach  to  womanhood.  Her  reading  of  exciting 
books  of  romance,  and  an  early  association  with  the  opposite 
sex,  will  tend  to  cause  her  to  be  early  in  a  condition  to  men- 
struate. In  warm  climates,  girls  have  this  function  to  come  or 
much  more  early  than  in  a  temperate  or  more  northern  latitude 
In  Greece,  we  are  told,  that  girls  are  subject  to  this  evidence  o 
maturity  at  eight  or  ten  years  of  age.  As  we  proceed  north 
the  more  do  we  find  the  function  postponed.  In  Lapland,  it  i 
said,  that  it  does  not  appear  until  a  mature  age,  and  that  ii 
some  far  northern  latitudes,  it  only  occurs  in  the  summer,  ano» 
then  is  very  slight,  and  continues  only  for  a  little  while.  Oj  to 
the  other  hand,  in  a  more  southern  region,  it  is  much  more  pre 
fuse,  and  lasts  for  a  longer  period.  In  this  latitude,  the  age 
which  girls  usually  begin  to  menstruate,  is  between  the  ages  o  & 
fourteen  and  fifteen. 

At  the  first  period  of  menstruation,  there  is  a  very  decide 
change  in  the  constitution  of  the  female.     Her  color  is  mucjtr 
improved,  her  cheeks  are  flushed,  her  countenance  more  anin 
ated  and  expressive.     There  is  a  decided  change  in  the  chara 
ter  of  her  conversation.     She  ceases  to  be  amused  with  hcjie 
dolls,  and  other  childish  playthings.     Her  sympathies  are  moi 
easily  aroused.     Her  affections  more  strongly  exhibited.     H 
whole  intellectual  nature  becomes  peculiarly  sensitive,  and  ir. 
prcssible.     Her  form  is  more  graceful,  the  contour  of  her  liml 
is  more  perfect;  her  breasts  expand,   her  voice  becomes  mo 
harmonious,  clear  and  distinct.     With  some,  the  discharge  tak 

I 


:■: 


1858.]         Hillyer,  on  the  Physiology  of  Menstruation.  797 

place  without  any  premonitory  symptoms,  but  generally,  it  is 
indicated  by  a  train  of  unpleasant  feelings,  which  announce  its 
approach.  For  some  time  previous,  the  female  is  troubled  with 
a  sense  of  weight,  pain,  a  bearing-down  in  the  pelvic  region. 
The  vascular  system  is  disturbed,  and  there  is  a  determination 
Df  blood  to  the  head,  and  to  the  mammae. 

The  quantity  of  the  menstrual  discharge  is  also  governed 
much  by  the  habits,  and  station  in  life,  of  the  individual.  The 
amotions  and  passions  of  the  mind  will  affect  it;  stimulating 
liets  and  drinks',  or  the  use  of  a  warm  foot-bath,  will  increase  it, 
as  will  any  cause  which  tends  to  produce  a  plethora  of  the  ute- 
rus. In  this  country,  the  quantity  of  the  discharge  is  estimated 
at  from  three  to  six  ounces  during  each  period.  At  the  ap- 
proach of  old  age,  this  peculiar  function  ceases ;  the  time  of  its 
cessation  varies  in  different  persons.  As  a  general  rule  it  may 
be  assumed,  that  in  those  cases  in  which  it  commenced  at  an 
3arly  period,  it  will  disappear  sooner,  while  in  those  in  which  it 
Dccurred  after  the  usual  age  of  puberty,  it  will  continue  longer 
in  action.  When  the  time  draws  near  for  the  menstrual  dis- 
charge to  cease,  it  becomes  more  uncertain  as  to  the  periods  of 
its  return  ;  also,  as  to  the  quantity  eliminated.  Sometimes  it 
will  miss  one  or  two  periods,  or  be  put  off  two  or  three  weeks, 
and  then  recur  with  increased  violence,  sometimes  amounting 
to  a  dangerous  hemorrhage.  Then,  perhaps,  there  will  be  sev- 
eral successive  regular  periods,  during  which  it  will  conform  to 
the  functional  habit  which  has  been  established ;  then,  perhaps, 
^mother  hemorrhage,  after  which  it  leaves  the  woman  forever, 
rhis  is  a  critical  period  in  her  life ;  it  is  known  as  the  "  change 
:>f  life,"  the  "  turn  of  life,"  etc.  In  temperate  latitudes,  men- 
struation commonly  ceases  at  from  forty  to  fifty  years  of  age. 

During  the  menstrual  period,  the  system  of  the  female  is  more 
rritable  than  at  other  times.  Any  sudden  or  irregular  check  to 
ihe  transpiration  should  be  avoided;  also,  every  kind  of  mental 
)r  corporeal  agitation,  or  the  process  may  be  impeded,  or  hys- 
erical  or  other  unpleasant  affections  be  excited. 

The  appearance  of  the  menses  is  an  evidence  of  the  capability 
)f  the  woman  to  become  impregnated,  and  their  cessation  the 
oss  of  such  capability ;  but  there  are  exceptions  to  this  rule, 
tforgagni  cites  instances  of  a  mother  and  daughter,  both  of 


798        Hillyer,  on  the  Physiology  of  Menstruation.  [December, 

whom  were  mothers  before  they  had  menstruated.  Sir  Everard 
Home  mentions  the  case  of  a  young  woman,  who  was  married 
before  she  was  seventeen,  and  having  never  menstruated,  be- 
came pregnant.  At  four  months  after  her  delivery,  she  became 
pregnant  again,  without  menstruating.  The  fact  that,  with  the 
cessation  of  menstruation,  woman  lose  the  power  of  bearing 
children,  has  been  long  known  to  mankind.  It  was  known  to 
the  old  patriarch  Abraham,  for  when  the  angel  appeared  to  him, 
and  told  him  that  Sarah,  his  wife,  should  bear  him  a  son,  he 
was  loath  to  believe  it,  and  gave  as  an  evidence  that  it  could 
not  be  so,  that  "  the  ways  of  woman  had  ceased  upon  her." 

There  is  usually  no  menstrual  flow  during  pregnancy  and 
lactation ;  in  fact,  the  cessation  of  the  discharge  is  one  of  the 
evidences  that  conception  has  taken  place ;  though  it  is  not  un- 
common for  the  discharge  to  occur  once  or  twice  after  concep- 
tion; and  I  have  known  one  or  two  instances  in  which  it  has 
continued,  at  regular  intervals,  throughout  the  period  of  gesta- 
tion. Its  absence  during  lactation  is  by  no  means  constant,  es 
pecially  should  the  period  of  lactation  be  prolonged :  but  when 
it  does  recur,  it  is  an  evidence  of  an  aptitude  to  conception. 
There  has  been  an  opinion  prevalent  among  mankind,  which 
probably  had  its  origin  among  the  Jews,  that  the  menstruous 
blood  of  the  female  had  malignant  properties.  A  woman  whc 
had  her  menses  upon  her  was  considered  unclean,  and  anything 
which  she  touched  was  polluted.  In  the  time  of  Pliny,  this  no 
tion  was  carried  so  far  that  her  touch  was  believed  to  blight 
corn,  to  arrest  the  growth  of  grafted  trees,  to  corrode  copper,  tc 
destroy  hives  of  bees,  to  drive  dogs  mad,  etc.,  etc. 

We  are  informed  by  Dr.  Elliotson,  that  many  in  England  be 
lieved,  that  meat  would  not  take  salt,  if  the  process  was  con 
ducted  by  a  woman  so  circumstanced.  There  has  been  for  som< 
time  past,  much  discussion  among  authors  and  teachers,  as  t< 
the  nature  of  the  menstrual  fluid ;  some  contend  that  it  is  a  se 
cretion  from  the  internal  surface  of  the  uterus ;  others  insist  it  i 
a  hemorrhage.  Hippocrates  declares  it  to  be  pure  blood.  Ma 
ny,  since  the  days  of  Hippocrates,  believe  it  to  be  a  secretion 
Haller,  Border,  and  John  Hunter,  besides  other  eminent  am 
learned  men  of  a  later  day,  are  of  the  same  opinion.  The  doc 
trine  that  it  is  a  hemorrhage,  is  at  the  present  time  the  mos 


1858.]       Hillyer,  on  the  Physiology  of  Menstruation.  799 

popular.  The  researches  of  Yon  Baer,  Purkinge,  Pruchet,  Ne- 
grier,  Bischoff  and  others,  have  rendered  it  clear  to  the  minds 
of  many,  that  the  catamenial  fluid  is  blood.  From  a  careful 
investigation  of  the  subject,  I  have  no  hesitation  in  saying  that 
I  am  in  favor  of  the  hemorrhagic  theory.  To  my  mind  the 
evidences  of  its  truth  are  conclusive.  I  do  not  believe  that 
there  is  a  single  argument  which  is  used  to  prove  that  the  fluid 
is  a  secretory  product,  but  what  can  be  refuted.  Those  who  be- 
lieve that  menstruation  is  a  hemorrhage,  contend  that  the  dis- 
charge is  co-existant  with,  and  a  part  of,  the  function  of  ovula- 
tion. The  rupture  of  the  Graaffean  follicle,  and  the  extrusion 
of  the  ova,  are  periodical. 

Dr.  Meigs  says :  "  That  at  this  time  the  ovaries  receive  a  much 
larger  supply  of  blood.  That  their  vascular  circulation  and 
nervous  intensity  is  much  augmented;  this  state  of  excitement 
passing  from  the  ovaries  to  the  uterus  and  vagina,  renders  them 
also  the  seat  of  sanguineous  engorgement. 

"Under  such  circumstances,  the  uterus  increases  in  weight, 
acquires  a  redder  hue,  is  more  sensitive,  and  sinks  lower  in  the 
pelvis.  Probably  the  glandular  tubular  matter  of  its  body  be- 
comes thickened.  From  such  engorgement  and  affluxion  it  is 
delivered  by  means  of  the  mensual  hemorrhage,  which  escapes 
from  the  vessels  on  the  interior  of  the  womb,  falls  into  the  vagi- 
na, and  thence  flows  upon  the  outer  surface  of  the  external 
genitalia,  and  is  called  'Menses,'  'Catamenia,'  *  Show,'  &c." 

This  doctrine  is  advocated  and  taught  in  many  of  our  colleges. 
[ts  most  successful  advocates  are  Gendrin,  Eacaborski,  Lee, 
Wharton  Jones,  Coste,  and  others. 

That  the  menstrual  fluid  is  a  secretory  product  is  contended 
for  most  strenuously  by  Dr.  Dewees.  He  says — "  I  look  upon 
this  discharge  as  a  genuine  secretion  from  the  mucous  membrane 
of  the  uterus  with  which  the  cavity  of  that  organ  is  lined." 

The  reasons  which  he  assigns  for  his  belief,  are  the  same 
which  are  generally  brought  forward  by  those  supporting  the 
same  views.     He  contends — 

"1st.  That  the  color  of  the  discharge  is  between  arterial  and 
venous  blood,  being  less  brilliant  than  the  former  and  more 
brilliant  than  the  latter. 

"  2nd.  It  does  not  separate  into  its  components. 


800        Hillyer,  on  the  Physiology  of  Menstruation.  [December, 

"  3rd.  Does  not  coagulate,  though  kept  for  years,  whilst  other 
blood  does,  when  exposed  to  the  air. 

"4th.  Its  odour  is  remarkably  distinct  from  that  of  the  circu- 
lating mass." 

To  his  argument,  that  its  color  is  between  arterial  and  venous 
blood,  we  would  reply,  that  this  change  is  clearly  owing  to  its 
admixture  with  the  secretions  of  the  cervix  uteri  and  vagina. 
To  his  second  and  third,  that  it  never  separates  into  parts,  nor 
coagulates  when  other  blood  does — we  answer,  that  the  power 
of  coagulation  is  lost  by  the  decomposition  of  the  fibrin  by  the 
vaginal  secretions.  To  his  fourth,  that  the  odour  is  not  the 
same  as  blood — we  answer,  that  it  is  not  reasonable  that  it 
should  be,  passing,  as  it  does,  slowly  through  the  vagina  and 
mixing  with  its  secretion,  which  has  a  peculiar  odour,  distinct 
enough  to  make  the  change,  and  to  entirely  neutralize  the  na- 
tural odour  of  the  blood,  We  ascribe  all  the  differences  which 
he  points  out  between  the  menstrual  fluid  and  pure  blood,  to 
the  effect  of  the  mixture  with  the  vaginal  mucous,  &c. 

He  asserts,  further,  that  it  is  from  the  mucous  membrane,  lin- 
ing the  uterus,  that  this  discharge  has  its  origin.  If  so,  why 
does  this  mucous  membrane  secrete  blood  globules  ? — Can  this 
be  possible  ?  This  is  not  all :  there  is  fibrin  found  in  the  dis- 
charge. Does  it  secrete  fibrin?  and  all  admit  that  the  other 
essential  elements  of  blood  are  in  the  discharge.  So  now  we 
have  all  the  constituents  of  pure  blood,  all  that  is  claimed 
to  belong  to  it,  and  secreted  from  a  mucous  membrane.  No 
other  mucous  membrane  in  the  whole  body  secretes  any  one, 
much  less  all  of  these  ingredients.  If,  then,  this  fluid  be  a 
secretion,  containing  these  elements,  it  must  be  regarded  as 
a  perfect  anomaly  in  physiology,  forming  a  single  exception 
to  all  the  laws  of  secretion  throughout  the  entire  system.  The 
uniformity  of  nature's  laws  forbid  us  to  accept  such  a  position. 

The  experiment  of  M.  Brierre  de  Boismont  proves  that 
when  it  first  issues  from  the  womb  it  has  all  the  constituents  o1 
pure  blood,  and  almost  in  the  normal  quantity.  In  conducting 
his  experiment,  "  he  adjusted  a  speculum  to  the  cylinder  of  the 
cervix  uteri  during  menstruation,  A  patient  of  his  alio  wee" 
this  to  be  done.  He  thus  carefully  collected  the  fluid,  as  ii 
passed  from  the  speculum.     It  contained  fibrin,  and  by  'analysis 


1858.]        Hillyer,  on  the  Physiology  of  Menstruation.  801 

was  shewn  to  have  all  the  constituents  of  blood,  and  nearly  in 
the  same  proportion  as  blood  drawn  from  the  arm." 

There  can  be  no  doubt  but  that  the  vaginal  secretion  will 
decompose  the  fibrin,  and  thus  prevent  coagulation.  Women 
who  have  passive  hemorrhages  from  the  womb,  rarely  pass  co- 
agula,  and  when  they  do,  it  is  when  the  hemorrhage  has  become 
so  excessive  that  the  quantity  of  the  vaginal  mucus  is  not  suffi- 
cient to  decompose  the  fibrin.  Within  the  last  twelve  months, 
I  have  made  enquiries  of  many  women  upon  this  point,  and 
they  all  have  told  me  that  when  they  only  had  a  slight  hemor- 
rhage they  passed  no  clots.  I  know  one  woman  who  had  a 
constant  hemorrhage  for  months,  and  she  rarely  .passed  coagula. 
What  docs  this  prove?  That  lite  discharge  of  blood,  bting  slight, 
the  secretions  of  the  vagina  were  wholly  adequate  to  produce 
the  changes  alluded  to  by  Dr.  Dewees.  These  women  do  not 
say  that  they  bleed — that  they  have  a  hemorrhage,  but  "they 
are  unwell  all  the  time" — that  they  have  their  courses  constantly 
upon  them.  Xo  man  will  admit  that  this  is  so.  All  will  agree 
that,  in  such  cases,  the  woman  has  a  passive  hemorrhage,  un- 
connected with  ovulation.  Will  it  not  appear  from  this,  that 
the  blood  of  a  passive  hemorrhage  and  the  menstruous  blood 
are  similar? 

It  is  now  generally  believed,  that  the  cause  of  menstruation 
is  from  the  excitement  produced  by  the  maturation  and  dis- 
charge of  the  ovulum  from  the  Graaffean  follicle.  This  is  sub- 
stantiated from  numerous  cases  collected  by  Negrier,  Eobert 
Lee,  Eacoborski,  and  others,  of  females  who  die  during  men- 
struation, in  whom  the  Graaffean  follicle  was  recently  ruptured, 
and  the  ovulum  just  escaped.  It  is  universally  admitted,  that 
3onception  is  more  likely  to  take  place  just  before  or  just  after 
menstruation.  Hippocrates  remarked  this  fact.  Boerhaaveand 
Haller  were  of  opinion  that  ovulation  and  menstruation  were 
coincident.  Both  functions  begin  in  the  female  at  the  same 
time,  and  leave  her  at  the  same  time. 

From  all  these  facts,  I  am  forced  to  believe  that  menstruation 
is  caused  by  ovulation,  and  that  it  is  a  hemorrhage.  There  have 
been  numerous  theories  advanced  as  to  the  purposes  of  the 
menses:  none  of  them  seem  to  have  much  weight  with  physi- 
ologists.    The  true  purpose  which  nature  intended  them  to 


802      Baker,  on  the  Sources  and  Qualities  of  Honey.   [December, 

subserve  in  the  female,  is  not  yet  clearly  understood,  and  this 
point  is  still  open  for  investigation,  by  those  who  are  interested 
in  studying  this  subject. 


ARTICLE  XXVIII. 


Remarks  on  the  Sources  and    Qualities  of  Honey.     By  Paul 
De  Lacy  Baker,  M.  D.,  of  Eufaula,  Alabama. 

Messrs.  Editors: 

In  the  October  number  of  your  valuable  Journal  I  find  dis- 
cussed, "  The  question  of  Poisonous  Honey ;"  and  the  importance 
attached  to  it  by  your  interesting  editorial,  induces  me  to  offer 
to  your  pages  a  few  brief,  and  matter-of-fact,  observations  in 
reference- to  the  subject. 

The  chief  object  of  this  communication  is  to  combat  the  erro- 
neous, yet  almost  universal  impression,  that  bees  "extract" 
honey  from  flowers,  and  that  as  some  blooms  possess  poisonous 
properties,  the  honey  extracted  from  them  must,  of  necessity,  be 
more  or  less  deleteriously  impregnated.  This  impression  pre- 
vails with  all,  I  believe,  who  have  written  about  bees  and  honey, 
and  it  plainly  exists  in  the  minds  of  the  three  writers,  whose 
articles,  in  reference  to  this  matter,  were  set  forth  in  this  Journal. 
Now,  I  propose  to  show  that  honey  is  not  the  juice  or  nectary 
of  flowers,  and  that  it  is  never  extracted  or  collected  from  flowers, 
but  that  like  dew,  it  falls  from  the  atmosphere,  and  is  gathered 
by  the  bees  and  deposited  in  the  cells  of  the  honey -comb  in  pre 
cisely  the  same  state  in  which  it  was  collected,  and  that  there 
fore,  in  all  probability,  honey,  "within  itself,"  is  ever  a  perfectly 
innocuous  substance. 

The  following  experience  forced  me  unavoidably  to  this  con 
elusion : — About  the  middle  of  June,  1850,  I  was  at  an  old 
hunter's  house,  in  South-Western  Georgia,  preparatory  to  start 
ing  with  him  on  a  deer  drive.  This  man  was  a  great  lover  and 
minute  observer  of  Nature;  in  his  yard  there  was  a  great  num 
ber  of  bee-hives,  and  he  sold  the  honey  in  large  quantities  to  the 
neighboring  villagers.  While  at  his  house,  I  heard  him  com- 
plaining that  there  was  a  honey  famine — that  the  hives  were  all 
ready  for  its  reception,  but  that  they  were  utterly  destitute  of 


1858.]       Baker,  on  the  Sources  and  Qualities  of  Honey.  803 

honey,  and  that  the  bees  would  soon  starve.  I  asked  him,  how 
such  could  be  the  case,  when  it  was  then  the  middle  of  June, 
and  the  country  full  of  flowers,  and  why  the  bees  did  not  collect 
it  ?  To  my  great  surprise,  he  replied,  that  bees  did  not  get 
honey  from  flowers,  but  that  it  "fell  from  the  clouds."  I  was 
amused  at  the  idea,  but,  of  course,  wholly  skeptical  concerning 
it.  He,  nevertheless,  assured  me  of  its  correctness;  and  to  my 
question,  why  did  we  always  find  bees  at  work  upon  flowers  ? — 
he  answered  that,  they  were  gathering  pollen,  from  which  they 
made  bee  bread  for  their  young,  and  that  they  were  also  collect- 
ing materials  for  forming  the  honey-comb  and  arranging  the 
cells, — to  convince  me,  he  exhibited  to  me  a  hive,  where,  sure 
enough,  existed  the  comb,  cells,  and  all  else,  perfectly  prepared, 
yet  not  a  particle  of  new  honey,  and  the  old  supply  nearly  ex- 
hausted. There  was  prevailing  at  the  time  a  severe  and  pro- 
tracted drought.  Of  course  I  had  to  believe  what  I  saw,  but  was 
still  an  unbeliever  as  to  the  "honey  falling  from  the  clouds." 

The  evening  of  the  same  day  we  went  fifteen  miles  into  the 
wild  woods,  where  our  hunting  party  camped,  far  away  from 
any  dwelling.  The  Old  Hunter  and  I  slept  under  two  beautiful 
young  hickory  trees,  and  at  dawn  the  next  morning  he  roused 
me  up,  exclaiming,  with  great  enthusiasm,  "the  honey  dew  has 
fallen  ! — get  up,  you  unbelieving  Thomas,  and  see  for  yourself." 
Upon  rising,  the  first  thing  that  attracted  my  attention  was  the 
buzzing  of  bees,  and  on  looking  up  to  the  top  of  the  hickory 
trees,  I  saw  myriads  of  them  working,  and  coming  and  going ; 
the  limbs  of  the  trees  grew  low  to  the  ground,  and  upon  its  be- 
ing pointed  out,  my  astonished  eyes  beheld,  for  the  first  time,  the 
"honey  dew,"  on  the  leaves,  and  occasionally  actually  roping 
down  and  dropping  from  the  pendant  points  of  the  smooth 
leaves ;  I  tasted  it  frequently,  and  at  once  recognized  the  pecu- 
liar flavor  of  the  common  honey.  I  saw,  and  felt,  and  tasted  it, 
and  my  mind  was  convinced  by  these  means,  which  God  had 
given,  to  lead  it  to  correct  conclusions. 

The  only  observable  difference,  between  this  substance  found 
on  the  trees,  and  honey  obtained  from  hives,  was,  as  to  their  re- 
lative consistency — the  latter  being  somewhat  more  inspissated ; 
but  I  have  no  doubt  that  the  difference  is  produced  by  time  alone, 
and  that  if  a  portion  found  on  the  hickory  leaves  had  been  col- 


804      Baker,  on  the  Sources  and  Qualities  of  Honey.  [December, 

lected,  and  preserved  in  a  test  vial,  its  properties  would  ultimete- 
ly  have  been  identical  with  that  found  in  the  hives. 

My  companion  remarked  that,  in  ten  days  all  his  hives  would 
be  ready  for  robbing,  and  that  the  next  morning  he  would  show 
me  the  bees  working  at  home,  and  collecting  honey  from  the 
leaves  of  the  tall  black  gum  trees  that  grew  in  his  yard.  He 
said,  bees  only  collected  it  from  the  smooth-leaved  trees  of  the 
forest.  The  same  evening  we  returned  to  his  house,  and  at  day- 
light the  next  morning  we  went  out  into  the  yard,  and  the 
smooth-leaved  black  gums  presented  the  same  appearance  as  did 
the  hickories  in  the  woods  on  the  previous  morning.  The  bees 
filled  the  air,  and  I  watched  them  fly  from  the  trees  straight  to 
the  hives — occasionally,  those  starting  from  the  lower  limbs 
would  come  to  the  ground  before  reaching  the  hive,  and  be 
compelled  to  take  a  second  and  sometimes,  a  third  flight  to  gain 
it, — some  of  these  we  caught  and  killed  and  opened,  and  in 
every  instance  were  their  stomachs  filled  with  the  honey.  I  tasted 
it,  and  found  it  identical  with  what  I  saw  the  morning  before. 
Through  a  glass  in  the  hive,  I  saw  them  storing  the  honey — 
they  invariably  backed  into  the  cell  and  deposited  their  burden. 

In  less  than  two  weeks  I  was  at  this  man's  house  to  see  the 
hives  robbed.  They  were  full  to  overflowing,  with  the  most 
beautiful  and  luscious  honey.  If  I  recollect  correctly,  there  still 
had  been  no  rain. 

I  am  aware  that  there  are  flowers,  such  as  the  common  honey- 
suckle and  woodbine,  that  contain  a  sweetish  juice,  not  visible 
I  think,  but  readily  detected  by  the  sense  of  taste,  but  the  flavor 
is  not  similar  to  that  of  honey.  It  is  true,  as  the  editor  of  the 
"  Druggists'  Circular"  remarked,  that  "  the  saccharineematter  of 
the  nectaries  of  flowers  is  not  exactly  identical  with  the  charac- 
teristic properties  of  honey."  I  would  also  observe,  that  this 
juice  occupies  a  situation  so  far  down,  in  the  long  tube  of  the 
flowers,  as  to  be  out  of  reach  of  the  bee,  and  only  attainable  by 
the  long  delicate  bill  of  the  humming-bird,  or  the  proboscis  of 
the  butterfly ;  and  even  could  it  be  attained  by  the  bee,  it  exists 
in  such  minute  quantities  as  to  preclude  the  possibility  of  a 
swarm's  collecting  from  such  a  source,  twenty  or  twenty-five 
pounds  of  honey  in  the  space  of  two  or  three  weeks,  as  was  evi- 
dently done  by  the  hunter's  bees. 


1858.]       Baker,  on  the  Sources  and  Qualities  of  Honey.  805 

Such  is  the  experience,  and  such  the  observations  that  have 
taught  me,  that  honey  is  not  the  "extract"  or  product  of  flow- 
ers; nor  is  it  the  result  of  any  elaborating  function  of  the  bee's 
stomach,  but,  that  it  falls  like  dew,  and  is  collected  as  ready- 
made  honey,  and  requires  no  more  extracting  or  elaborating 
process,  than  is  necessary  in  collecting  rain  water  in  a  cistern. 

So  much,  then,  as  to  "  whether  honey  is,  within  itself,  ever  a 
poisonous  substance ;"  but,  what  I  have  related,  does  not  do 
away  with  the  fact  that  persons  are  sometimes  injuriously,  if 
not  poisonously,  affected  from  or  after  eating  honey ;  nor  does 
it  explain  the  why  or  wherefore  of  such  accidents,  but  I  think 
it  does  establish  the  fact,  that  such  occurrences  depend  upon  ex- 
traneous matters  and  accidental  circumstances.  If  it  could  be 
ascertained,  I  think  it  would  be  found  to  be  the  fact,  that  when- 
ever deleterious  consequences  resulted  from  eating  honey,  the 
honey  -comb  was  masticated,  and  that  no  care  was  used  in  the 
selection  of  it ;  in  this  way,  it  would  be  quite  possible  to  intro- 
duce into  the  stomach  poisonous  materials;  for  it  is  a  well 
ascertained  fact,  that  there  is  such  a  thing  in  the  bee-hive,  and 
among  the  comb,  as  "  bee-bread  ;"  that  it  is  a  brown,  bitter  sub- 
stance collected  from  the  pollen  of  flowers,  as  food  for  the  young 
bees.  This  might  be  collected  from  poisonous  flowers,  and  to 
it  may  pertain  in  full  force  your  philosophic  remark,  that  "the 
instinct  of  the  bee  may,  in  most  instances,  preserve  him  and  his 
race  from  the  toxic  effects  of  the  deleterious  properties  of  flow- 
ers, and  yet,  what  has  served  as  his  nutriment  may  be,  for  man, 
a  most  destructive  poison." 

I  have  no  certain  knowledge  of  the  source  from  which  are 
collected  the  materials  for  forming  the  comb,  nor  what  the  na- 
ture of  those  materials  is  ;  but  I  would  sooner  look  to  them  as 
the  cause  of  the  mischief,  than  to  the  honey — knowing  as  I  do, 
the  source  from  which  it  is  gathered.  Again  :*  in  considering 
this  matter,  it  might  be  well  to  remember,  that  it  is  common  to 
find  in  honey — in  the  comb — dead  bees,  and  that  to  the  sting 
of  each  is  attached  a  bag  of  poison,  and  should  these  be  accident- 
ly  conveyed  into  the  stomach,  might  not  the  circumstance  have 
some  connection  with  the  ill  effects  produced  ?  Nearly  all  the 
cases  of  sickness  or  poisoning,  /ever  heard  of,  as  occurring  from 
the  use  of  honey,  resulted  from  eating  wild  honey  obtained  from 


806  Farell's  Remarks  on  Formulae.         [December, 

an  old  hollow  tree,  and  where  it  was  consumed  incautiously  and 
in  large  quantities,  during  the  frolic  of  robbing  the  bee  tree, 
which  is  generally  done  at  night;  and  it  should  not  be  forgotten, 
that  the  cavities,  of  the  trees  containing  the  honey,  are  the 
abodes  of  bugs  and  spiders  of  very  poisonous  natures,  which  by 
the  fall  of  the  tree  might  possibly  be  crushed  and  mingled  in 
the  honey,  and  in  that  way  be  conveyed  into  the  stomach.  In 
addition  to  the  suppositions  already  set  forth,  I  would  remark 
that  these  old  hollow  trees  are  frequently  covered  with  a  vine 
known  as  the  "poison  vine,"  and  would  suggest  the  possibility 
that,  cut  and  bruised  as  it  would  necessarily  be,  in  the  fall  of  the 
tree,  it  might,  in  some  way,  be  the  cause  of  the  mischief.  The 
frequency  of  these  cases  of  poisoning  is  by  no  means  so  great 
as  to  exclude  the  possibility  of  the  agency  of  such  circumstances 
in  producing  it. 

It  is,  however,  true,  that  these  accidental  and  isolated  cases 
afford  no  explanation  of  the  effect  produced  upon  large  num- 
bers, as  for  example,  on  the  Grecian  army,  as  related  by  Xeno- 
phon.  In  reference  to  such  examples,  all  I  can  say  is,  that  if 
such  an  effect  should  be  produced  among  soldiery  at  the  present 
day,  by  the  use  of  honey,  there  would  exist  in  my  mind,  strong 
suspicion,  that  there  was  mixed  with  it  an  undue  portion  of 
"  old  peachy 

The  only  way  in  which  I  can  imagine  that  honey  could,  in 
itself,  possess  toxic  properties,  is  in  the  same  manner  that  the 
dews  of  certain  latitudes  and  localities  are  rendered  poisonous. . 
This  is  said  to  be  the  case ;  if  so,  the  same  causes  and  circum- 
stances rendering  the  dew  nocuous,  might  also  deleteriously 
impregnate  the  honey  dew. 


ARTICLE  XXIX. 

Remarks  on  Formulae.  By  William  Farell,  M.D.,  of  Eome,  Ga. 

There  is,  perhaps,  no  duty  of  the  physician  so  badly  executed 
as  the  writing  of  prescriptions.  I  trust,  therefore,  a  few  practi- 
cal hints,  from  one  who  has  had  some  experience  in  deciphering 
and  guessing  at  these  important  documents,  will  not  be  entirely 
devoid  of  interest  to  those,  who  desire  to  furnish  their  apotheca- 


1858.]  Farell's  Remarks  on  Formula.  807 

ries,  and  the  public,  with  formulae,  creditably  written  and  in  an 
intelligible  form. 

Since  there  is,  probably,  no  better  reason  for  writing  prescrip- 
tions in  Latin,  than  a  sort  of  veneration  for  antiquity,  it  is 
greatly  to  be  desired,  that  physicians  would  employ  the  English, 
without  contraction,  leaving  out  no  important  words,  nor  add- 
ing those  that  express  nothing,  and  thus  avoid  the  many  glaring 
errors,  to  say  nothing  of  the  occasional  fatal  mistakes,  which 
expose  them  to  the  just  ridicule  and  contempt  of  the  intelligent. 
If,  however,  there  are  those,  who  insist  on  retaining  the  ancient 
custom,  let  them  make  themselves  sufficiently  familiar  with  the 
language  to  write  their  prescriptions  correctly. 

In  many  works,  whose  practical  precepts  are  justly  entitled 
to  high  regard,  we  observe  a  jumble  of  English  and  bad  Latin 
in  the  formulae,  disgraceful  to  the  merest  tyro.  For  illustration, 
the  following  recipes  are  taken  from  the  pages  of  most  respecta- 
ble practitioners  and  professional  writers : 

$.  Hydrargys.  praecip.  alb.     .         .         .  3ij. 

Ess.  lem..    .....  gwt.  x«£. 

Adeps  praeparat 3ij.    M. 

$.  01.  Eicini.  opt fjij 

"    Terebinth  Eecentis.  .  .  f^ss 

Sodoz  Bi.  Carb.  .  .  .  .  3  jj 

Pulv.  Acacia,  opt. 

"      Sacch.  Alb,      .  .  .  aa        Ij 

Sps.  Lavendid.  Comp.  .  .  .       f  §j 
Aquae  Camph 

"      Menth  Pip      .  .  .  aa    Hvj 
M    Ft    Emulsio. 

$.  Copaibae. 
Tinct.  Cubebae 

Syr.  Uva  Ursi  .         .        .         aa    f5ij 

Pulv  Acaciae  opt  .         .         .         .  I  ij 

Aquae  Cinnam  ....        f  3xvj 
M     Ft    Emulsio 

3.  Pulv.  Opii. 

Pulv.  ipecac      .        .        .        .        aa       3j 
Sulphate  of  potass      ....         3  viij     M 

The  above  formulae  are  medicinally,  and  pharmaceutical^, 
admirable,  but  gramatically,  bad.    In  the  first,  the  syntax  would 


808  Farell's  Eemarks  on  Formulae.         [December, 

have  been  greatly  improved  by  the  use  of  lim.,  and  Adipis  in- 
stead of  "lem."  and  "  Adeps." 

In  the  second,  the  "  Sodas  Bi  Carb,"  by  the  use  of  the  capitals, 
seems  to  consist  of  three  distinct  words.  The  word  "  Acacia," 
like  "lem"  and  "  Adeps,"  violates  one  of  the  simplest  rules  of 
syntax.  "Lavendul"  is  a  new  coinage,  neither  English  nor 
Latin,  and  must  be  guessed  at,  as  no  dictionary  defines  it.  The 
apothecary  arrives  at  the  meaning  of  such  mongrel  crosses  by 
the  following  sylogistical  process  of  reasoning.  The  word  lav- 
ender, and  its  Latin  equivalent,  lavandula,  both  mean  the  arti- 
cle we  call  lavender. — The  word  "Lavendul"  lacks  nothing  of 
being  the  one,  but  what  is  contained  in  the  other, — ergo,  it  must 
mean  lavender  also.  The  author  has  displayed  his  medical 
latinity  by  the  use  of  this  new  version  of  lavender  throughout 
his  work. 

In  the  third  recipe,  if  "Syr.  Uva  Ursi"  was  intended  for 
English,  it  is  in  the  wrong  place;  if  Latin,  it  is  in  the  wrong 
case. 

In  the  fourth,  the  simple  recipe  for  Dover's  powder  is  com- 
menced in  Latin  and  finished  in  English. 

Much  of  our  medical  literature  is  spoiled  with  such  formulas 
as  the  above,  to  the  discredit  of  the  authors  and  the  profession 
generally.  Until  we  reform  in  this  particular,  we  shall  never 
hear  the  last  of  our  dog-Latin.  The  evil  is  equally  great 
among  a  large  class  of  physicians,  who,  in  their  practice,  in  en- 
deavoring to  make  a  little  display  of  their  classical  lore,  couch 
their  prescriptions  in  a  jargon,  neither  English  nor  Latin,  leav- 
ing the  apothecary  to  guess  at  their  meaning,  which  he  will 
generally  do,  rather  than  ask  an  explanation,  and  incur  abuse 
for  want  of  proper  qualifications. 

The  gross  errors  of  some  of  these  learned  gentry  are  quite 
amusing.  One,  in  prescribing  the  citrate  of  iron  and  quinia, 
"comes  the  Latin"  with  a  grand  flourish,  after  this  fashion — 
"Ferri  Quinia  et  Citras."  Another  latinizes  Dover's  powders 
thus:  "Pulv.  Dov.  et  Ipecac.  Opii.  Compos.",  seeming  much 
pleased  with  the  length  and  mystery  of  his  recipes.  There  are 
others,  again,  who  pride  themselves  on  the  shortness  and  sim- 
plicity of  their  prescriptions.  It  was  one  of  these  who  drugged 
his  patients  for  a  long  time  with  saltpetre,  by  directing  simply 


1858.]  The  Medical  Uses  of  Wines.  809 

"  Nitre,"  when  sweet  spirit  of  nitre  was  intended.  On  learning 
the  fact,  he  abused  the  apothecary,  and  made  the  matter  worse 
by  ordering  "spirit  of  nitre,"  which,  the  apothecary's  apprentice 
learned  to  mean  nitric  acid,  and  sent  it  out  accordingly.  This 
was  too  much  for  the  doctor's  nerves :  he  stormed  the  dispens- 
ing shop,  and  had  the  master  of  bottles  arraigned  for  his  grave 
error(?),  who  proved  that  he  had  learned  a  thing  or  two,  besides 
the  detergent  qualities  .of  soap  and  water,  by  producing  no  less 
authority  than  Wood  &  Bache,  for  what  he  had  done.  This 
medicinal  doctor  would  have  done  much  better  to  have  orna- 
mented his  prescription  with  "spts.  nit.  dulc.  eth.",  which  would 
have  been  within  guessing  distance  of  the  true  mark. 

Now,  all  this  confusion  of  tougues,  errors  and  uncertainty, 
might  be  easily  avoided  by  the  use  of  plain  English,  and  thus 
save  the  profession  from  a  deal  of  wit,  sarcasm  and  just  blame, 
which  all  ages  have  been  disposed  to  direct  against  it.  Being 
no  Latin  scholar,  and  but  little  skilled  in  medical  Latin,  we  in- 
tend, in  our  own  practice  (should  we  have  the  occasion),  to  write 
our  prescriptions  in  English. 

As  above  indicated,  we  do  not  seriously  object  to  the  Latin, 
if  correctly  written,  yet  must  think  reform  in  this  particular  de- 
sirable. We  are  glad  to  see  that  this  reform  has  already  been 
commenced  by  some  of  ths  most  respectable  professional  writers 
of  the  day,  who  are  beginning  to  write  their  prescriptions  either 
in  good  Latin  or  good  English. 


The  Medical   Uses  of  Wines. 

This  is  a  subject  thickly  clouded  with  all  sorts  of  prejudices 
and  pre-possessions,  as  is  the  discussion  of  most  substances  used 
equally  by  the  sick  and  the  healthy.  Persons  argue  that  what 
is  good  for  themselves  must  be  good  for  their  patients.  We 
have  known  a  plethoric  dietician,  who  himself  loved  lobster- 
salad  and  champagne  in  the  small  hours,  advise  a  starveling 
dyspeptic  to  follow  his  custom  of  taking  no  breakfast  till  noon. 
So  a  hearty  rough  stomached  doctor  will  declare  one  diluted 
alcohol  just  as  good  as  another;  the  ascetic,  or  the  reformed 
rake,  will  pronounce  all  equally  bad;  the  gouty  will  dread  all 
that  is  thin  and  acid ;  the  aguish  will  have  a  predilection  for 
Port. 


810  The  Medical  Uses  of  Wines.  [December, 

It  is  very  possible  that  prime  wines  may  be  made  of  all  kinds, 
which  may  be  equally  and  perfectly  wholesome  ;v  but  their  rarity 
will  always  put  them  out  of  the  reach  of  our  patients,  and  what 
we  have  practically  to  think  of  in  naming  a  wine  for  use,  is  at 
best  a  second  or  third-rate  article.  We  must  also  choose  those 
which  are  capable  of  being  grown  in  quantity  proportioned  to 
their  popularity,  or  the  chances  of  adulteration  are  exagerated. 
When  Madeira  was  on  everybody's  table,  it  could  not  be  recom- 
mended to  patients,  for  in  nine  cases  out  of  ten  it  was  either  an 
inferier  sort  or  a  sour  imitation.  But  now  that  it  has  gone  out 
of  fashion,  a  wholesome  and  often  a  very  perfect  wine  is  to  be 
bought  of  that  kind,  and  the  adulterators  expend  their  ingenui- 
ty upon  Sherry.  What  we  want  is  a  liquor  which  is  either  pro- 
duced in  very  large  quantities,  or  is  not  sufficiently  known  to 
the  million  for  it  to  be  worth  imitating. 

The  medical  questions  concerning  the  employment  of  wine 
will  be  put  in  the  clearest  light  for  exhibiting  our  real  know- 
ledge and  ignorance,  by  considering  separately  the  physiologi- 
cal effects  on  the  human  frame. 

The  effects  may  be  practically  included  under  the  following 
heads:  Exhileration,  Nutrition,  Arrest  of  Destructive  Metamor- 
phosis, Inebriation,  Degeneration  of  Tissue,  Derangement  of 
Digestion.  The  three  first  are  good — the  three  last  bad ;  and 
the  object  is  to  secure  the  former,  while  avoiding  the  latter. 

Exhileration  is  not  merely  a  minor  degree  of  drunkness.  It 
may  be  produced  by  many  things  besides  alcohol,  and  which  do 
not  inebriate — such  as,  for  example,  the  essential  oils,  pepper- 
mint, onions,  valerian,  assafoetida,  tea,  coffee.  Even  eating,  and 
the  increased  circulation  of  blood,  produced  the  effect  to  some 
extent.  Alcoholic  fluids  truly  do  exhilerate  with  the  greatest 
certainty  and  rapidity,  but  not  in  direct  proportion  to  the  alcohol 
they  contain.  A  glass  of  wine  will  raise  the  spirits  of  a  healthy 
person  as  much  as  a  glass  of  gin ;  a  glass  of  fine  claret  as  much 
as  one  of  strong  tavern  port;  and  this  is  not  merely  from  the 
pleasure  of  taste  or  association,  for  the  same  may  be  observed  in 
fever  patients,  whose  gustatory  nerves  are  blunted  by  a  thick 
coating  of  sordes. 

The  distinction  is  not  only  a  subjective  one,  evident  to  the 
mind  of  the  recipient,  while  it  is  incapable  of  demonstration  to 
others.  There  is  a  real  physiological  difference  in  the  effects 
which  follow  exhilarating  and  intoxicating  doses — a  difference 
which  in  its  ultimate  results,  amounts  to  a  complete  contrast. 
The  former  mcrease  the  amount  of  vital  power  rendered  availa- 
ble in  a  given  period,  and  the  latter  decrease  them.  Can  there 
be  a  more  perfect  antithesis  ? 

This  is  too  important  a  matter  to  rest  solely  on  the  unassisted 


1858.]  The  Medical  Uses  of  Wines.  811 

ienses  of  patients  or  observer,  and  it  does  not  do  so,  for  the  ad- 
nirable  experiments  of  Dr.  Bocker  having  submitted  it  to  the 
>roof  of  chemical  analysis.  Though  the  whole  series  of  his  in- 
vestigations into  the  action  of  alcoholic  stimulants  bear  directly 
m  the  present  subject,  they  are  too  mutually  dependent  on  one 
mother,  and  too  lengthy  for  quotation.  The  general  results, 
lowever,  may  be  stated  as  follows : 

1.  The  special  action  of  alcoholic  drinks  is  to  arrest  destruc- 
ive  assimilation — to  stop  the  over-active  processes  of  life  in  their 
jffects  upon  the  organism ;  so  that,  for  a  certain  period  during 
he  stay  of  the  alcohol  in  the  system,  less  urea,  less  phosphates, 
ess  water  are  excreted  by  the  kidneys,  less  carbonic  acid  by  the 
ungs,  and  less  digestion  goes  on  in  the  alimentary  canal, 
ihowing  that  the  muscles,  bones,  nerves,  &c,  are  not  getting  rid 
)f  their  effete  tissue,  but  retaining  it,  and  making  use  of  it  as  far 
is  possible. 

2.  But  at  the  same  time  they  give  rise  in  the  body  to  a  defen- 
sive reaction,  which  is  prominent,  first  immediately  after  taking 
;he  dose,  then  gives  place  to  the  special  action,  and  on  this  ceasing 
s  again  manifested  to  a  greater  extent. 

3.  So  that  if  a  suitable  quantity  be  taken,  and  if  both  action 
ind  reaction  are  allowed  to  exhaust  themselves  before  the  dose 
oe  repeated,  more  manifestation  of  life,  represented  by  more 
excretion  and  more  consequent  renewal  of  the  body,  takes  place 
n  a  given  time  with  the  alcoholic  drink  than  without.  There 
aas  been  a  positive  gain  in  vitality. 

4.  But  if  such  a  large  quantity  is  taken  at  once  that  the  re- 
action is  overpowered,  or  if  it  is  arrested  by  a  continuous  repeti- 
tion of  the  dose,  the  manifestation  of  life  is  kept  down  ;  the  body 
is  not  renewed,  because  its  effete  particles  are  not  removed,  and 
:he  amount  of  vitality  must  certainly  be  reckoned  at  a  loss.* 

The  first  named  state  is  Exhilaration,  in  which  the  alcohol 
nay  be  fairly  called  a  food  or  medicine,  a  medicinal  food  or 
lietetic  medicine,  for  body  and  mind.  The  second  state  is  In- 
ioxication,  when  it  is  a  poison  to  both. 

Now,  the  exhilarating  effects  of  diluted  alcohol  are  very  much 
ncreased  by  its  admixture  with  sugar,  extractive,  vegetable 
essential  oils,  ethers,  and  the  allied  substances  which  have  been 
lescribed  as  producing  the  aroma  and  bonquet  of  wines. 
With  a  quantity  of  alcohol  which  taken  alone  would  be  ineffi- 
iient,  a  delicate  wine  is  able  to  produce  a  decided  impression 
lpon  the  nervous  system.     When,  then,  this  is  mainly  sought, 

*Beitrage  zur  HeiLkunde,  von  F.  W.  Bocker,  vol.  i.,  sect.  6.     Weingeist.     We 

lave   introduced  the  name  of  this  author  again  in  our  heading  list,   because  he, 

md  indeed  all  physiologists  of  the  Schultz-Schultzenstein  school,  are  much  less 

mown  in  England  than  they  deserve.     A  collection  of  translations  and  abstracts 

irould  make  an  admirable  volume  for  the  new  Sydenham  Society. 

jr.s. — vol.  xrv.  ko.  xii.  -47 


812  The  Medical  Uses  of  Wines.  [December, 

as  in  cases  of  mental  depression,  hypochondriasis  without  bodily 
ailment,  nervous  exhaustion,  over-anxiety,  hysterical  fainting, 
vomiting,  and  the  like,  or  when  wine  is  wanted  merely  to 
smoothe  down  the  roughnesses  of  daily  toil,  we  must  remember 
that  the  good  result  may  be  obtained  without  the  evil ;  and  we 
can  obtain  it  with  least  chance  of  the  evil  by  selecting  liquors 
richest  in  their  peculiar  scented  constituents.  Bordeaux,  Cham- 
pagne, Khine,  and  Moselle  wines  offered  a  variety  of  choice,  the 
first  being  the  most  perfect  and  suitable  to  the  greatest  number 
of  these  cases ;  whilst  the  others  have  certain  inconveniences, 
hereafter  to  be  mentioned,  which  often  forbid  their  use  in  the 
special  case  to  be  prescribed  for. 

The  beneficial  effects  on  the  nervous  system  are  increased  by 
effervescence;  thus,  sparkling  Champagne  will  sometimes  have 
a  most  magical  effect  in  stopping  vomiting  in  cases  accompanied 
with  much  nervous  depression.  And  even  in  health,  the  greater 
exhileration  caused  by  genuine  effervescing  wines  is  notorious. 
The  physiological  explanation  of  this  result  is  not  very  clear. 
It  cannot  be  due  to  the  carbonic  acid  alone,  for  the  inhalation 
of  this  gas  tends  to  completely  oppose  consequences.  Perhaps 
the  sudden  physical  change  in  the  liquid  during  the  extrication 
of  the  fixed  air  developes  ethers  which  in  a  nascent  state  are 
more  potent  than  at  other  times.  Perhaps  other  gasses  are 
generatedj  whose  properties  are  in  themselves  exhilarating.  In 
the  Champagne  sent  into  Wurtemberg  from  Eheims,  Baron 
Liebig  found  that  for  every  volume  of  carbonic  acid  there  were 
two  volumes  of  protoxide  of  nitrogen*  (laughing  gas);  and  it 
was  assumed,  without  absolute  proof,  to  have  been  artificially 
introduced  for  the  purpose  of  augmenting  the  joyous  results  ofl 
the  bottle.  The  subject  demands  chemical  investigation  on 
purely  scientific  grounds;  and  it  would  moreover,  be  useful  to 
know  if  we  could  thus  at  will  increase  the  required  exhilaration, 
while  decreasing  the  quantity  of  alcohol  or  carbonic  acid. 

The  gladdening  effects  of  alcohol  are  augmented  by  its  mix- 
ture with  other  constituents  of  wine,  but  its  intoxicating  or 
poisoning  effects  are  diminished,  and  thus  more  may  be  taken, 
with  its  advantages  and  without  its  evils.  So  that,  for  example, 
if  a  man  drinks  a  pint  of  Mr.  Branded  Marsala,  he  gets  a  some 
what  larger  dose  of  spirit  than  there  is  in  half  a  pint  of  gin,f 
but  it  is  unnecessary  to  say,  without  the  same  bad  consequences 
This  is  partly  to  be  attributed  to  the  presence  of  the  ethers;}:  and 


*  Medical  Times,  Nov.  1850. 

|  Marsala  contains  2603  per  cent,  of  absolute  alcohol  (Brande);  Geneva,  49.4 
per  cent.  (Jones). 

\  The  disinebriating  influence  of  ether  is  shown  by  its  being  actually  a  remedy 
for  drunkenness.  Twenty  or  thirty  drops  taken  neat  on  a  little  oil  will  restore  to 
temporary  sobriety.  The  knowledge  of  this  fact  has  been  popularized  in  France,, 
by  its  forming  a  point  in  a  wicked  railway  novel  (Le  Troup  de  l'Enfer),  the  author 
of  which  perhaps  owed  it  to  M.  Batilliat  (Traite  sur  les  Vins  de  la  France,  p.  1 90). 


1858.]  The  Medical  Uses  of  Wines.  813 

sugar,  but  also  in  a  great  degree  to  the  intimate  combination 
of  the  alcohol  with  extractive  and  albuminous  matter,  so  that  it 
is  not  absorbed  immediately  by  the  membranes,  but  gradually 
and  during  a  process  of  digestion.  It  is  obvious  that  its  local 
effect  on  the  mucous  surfaces  and  viscera  must  be  thus  much 
modified,  and  a  powerful  argument  is  afforded  in  favor  of  the 
use  of  wine  instead  of  brandy  for  invalids. 

Nutrition  is  an  indirect  effect  of  wine.  There  is  shown  by 
chemical  investigation  to  be  very  little  substance  in  it  capable  of 
building  up  the  body.  The  phosphates  and  albumen  are 
more  readily  found  elsewhere,  as  Franklin  has  imprinted  on  our 
memories  by  his  comparison  of  a  penny  roll  and  a  gallon  of  beer. 
But  alcohol  seems  to  render  the  alimentary  canal  more  ready  to 
absorb  nutriment.  Farmers  find  this,  and  always  try  to  put 
some  waste  beer  or  fermenting  grains  in  their  pig  troughs. 
Physicians  find  it,  too,  and  give  their  patients  cod-liver  oil  in  a 
glass  of  sherry  when  they  would  have  it  fatten  quickly.  The 
effect,  however,  is  probably  confined  to  oleaginous  food  and  the 
adipose  tissue,  for  the  digestion  of  albuminous  matter  by  the 
gastric  juice  is  certainly  impeded  by  alcohol. t 

Hence  we  gain  the  following  rules  concerning  the  administra- 
tion of  wine  as  an  aid  to  nutrition  : — 1st.  That  the  alcoholic 
contents  are  those  of  principal  importance,  and  that  the  amount 
of  solid  or  nutritive  matter  in  the  wine  makes  little  difference. 
2udly.  That  we  may  hope  help  from  it  in  increasing  adipose 
tissue,  but  not  muscle.  Brdly.  That  as  its  agreement  with  fatty 
food  is  the  prime  object,  we  must  avoid  those  wines  which  are 
likely  to  make  such  food  unassimilable,  as,  for  example,  by 
making  it  rancid;  and  therefore,  4thly.  That  sound  wines  with 
a  small  proportion  of  acid  to  their  alcohol,  and  but  little  body 
to  cause  re-fermentation,  should  be  selected ;  the  types  of  perfec- 
tion may  be  considered  the  dry  Spanish  wines,  Amontillado  and 
Manzanilla.  And,  5thly.  They  should  be  taken  along  with  the 
fatty  food  itself,  or  immediately  after  it. 

The  arrest  of  destructive  metamorphosis,  or  what  has  been  pic- 
turesquely called  "the  moulting  of  the  tissues,"  is  unquestiona- 
bly the  most  important  of  the  medical  uses  of  alcoholic  liquors. 
By  them  we  are  enabled  to  stay  the  progress  of  interstitial  death 
in  low  fevers,  till  the  period  of  the  zymotic  poison's  virulence 
is  passed,  and  it  has  either  been  evacuated  or  become  inert.  By 
them  we  can  check  the  exhaustion  of  the  body  through  exces- 
sive secretion,  as  in  cases  of  chronic  catarrh,  ulcers,  abscesses, 
amputations,  &c.  By  them  we  can  diminish,  in  ordinary  diete- 
tics, the  wearing  out  of  the  body  by  the  over-worked  mind, 
which  in  this  busy  metropolis  throws  so  many  into  the  hands  of 
the  physician.     But  in  the  wielding  of  this  two-edged  sword  the 


814  The  Medical  Uses  of  Wines.  [December, 

greatest  judgment  is  requisite,  lest  we  carry  the  effect  too  far- 
The  destruction  of  effete  tissues  is  part  of  life,  and  necessarily 
precedes  constructive  renewal ;  if,  then,  we  check  it  too  far, 
interstitial  life  is  diminished,  and  the  system  is  overloaded  with 
matter  incapable  of  vitality. 

It  is  better,  therefore,  to  give  alcohol  in  a  diluted  form,  even 
when  we  wish  to  produce  its  most  decided  action,  as  in  typhus 
fever,  for  example.  And  it  is  better  to  give  it  combined,  as  it 
is  in  wine,  with  other  substances  of  partially  corresponding 
action,  than  to  administer  it  merely  diffused  in  water,  as  is  some- 
times done  for  economy's  sake.  Sugar,  we  know  from  Dr. 
Booker's  experiments,  has  a  special  effect  in  limiting  the  destruc- 
tion of  tissues  containing  phosphates,  tissues  of  no  less  impor- 
tance than  the  bones  and  nerves.  And  it  is  likely  that  similar 
investigations  into  the  physiology  of  ethers  may  show  some 
special  effects  belonging  to  them.  The  acids,  too,  and  the  ex- 
tractive in  wines,  seem  to  prevent  better  than  water  those  injuri- 
ous effects  upon  the  mucous  membranes  which  spirituous  liquors 
exhibit.  There  is,  then,  no  extravagance  in  preferring  wine  to 
brandy  and  water  in  the  management  of  low  fevers  in  hospital 
and  parish  practice. 

This  is  not  the  place  to  discuss  details  in  the  mode  and  period 
of  administering  wine  in  acute  complaints.  But  one  remainder 
may  be  deduced  from  the  view  taken  of  its  physiological  action 
— viz.,  to  allow  intervals  to  elapse,  during  which  its  effects  may 
subside,  and  the  system  recovered  for  a  time  its  metamorphoses, 
so  that  the  effete  tissues  may  have  a  due  exit.  The  night  is  a 
convenient  time  for  this  in  general ;  but  if,  from  any  cause, 
that  is  considered  inexpedient,  some  hours  of  corresponding 
duration  should  be  selected,  during  which  the  administration  of 
stimulants  may  be  discontinued. 

The  wine  chosen  for  fever  cases  is  usually  Port ;  but  the  rarity 
of  really  good  Portugal  wine,  and  the  excessive  badness  of  all 
low-priced  imitations  now  in  the  market,  render  it  daily  more 
and  more  incumbent  upon  us  to  have  substitutes  at  hand.  The 
best  in  the  London  market  seem  to  be  the  red  Spanish  wines, 
Beni  Carlo,  and  Cadiz ;  especially  the  former,  which,  indeed,  is 
often  mixed  with  spoiled  Portuguese  wine,  and  sold  as  port.  It 
may  be  had  in  the  wood  at  a  low  price,  considering  its  strength, 
and  is  highly  to  be  commended  for  hospital  use  in  a  diluted 
state. 

Poor  people,  however,  are  not  the  only  patients  supplied 
with  Port  wine  unfitted  for  the  sick  room.  The  prepossession 
in  favor  of  antiquity  causes  many  cellars  in  wealthy  houses  to 
furnish  nothing  but  a  damaged  article.  To  find  fault  with  a 
bottle   that  cost  a  great  sum   a  great  many  years  ago,  is  flat 


1858.]  The  Medical  Uses  of  Wines.  815 

heresy ;  and  the  better  way  is  to  give  it  up  at  once,  and  order 
your  patient  a  good  full-bodied  wine  of  a  different  nature,  such 
as  Madeira,  Burgundy,  or  Hermitage. 

Inebriation  is  a  terrible  word  to  meet  with  in  periodical 
literature.  It  opens  up  a  prospect  of  so  many  social  and  politi- 
cal questions,  that  the  reader  is  apt  to  close  the  page  in  despair. 
He  shall  be  let  off  here  with  a  simple  remark  derived  from  way- 
side observation — viz,  that  in  all  countries  where  wine  is  plenti- 
ful and  cheap,  drunkenness  is  almost  unknown ;  where  it  is  most 
expensive,  that  vice  is  at  its  maximum. 

Degeneration  of  Tissue,  as  a  consequence  of  drinking,  appears 
to  be  a  chronic  state  of  that  arrest  of  metamorphosis  which  has 
been  already  discussed  as  a  remedy  for  disease.  The  effete  tissue 
remains  as  a  useless  burden  mixed  up  with  the  healthy,  and  is 
finally  converted  into  the  least  vitalized  of  all  the  organic  con- 
stituents of  the  body,  oil  or  fat.  Careful  and  valuable  observa- 
tions have  been  made  by  Dr.  Bocker,  on  the  abnormally  retained 
blood-discs  in  the  circulating  fluids  of  habitual  spirit-drinkers, 
and  the  appearance  of  the  degenerated  hearts,  livers,  and  kidneys 
of  these  miserable  suicides  is  familiar  to  us  all. 

Degeneration  arises  from  the  arrest  of  metamorphosis  being 
too  long  and  continuously  kept  up.  Hence  there  is  little 
danger  of  it  in  acute  cases,  where  the  large  quantity  of  alcoholic 
remedies  we  find  it  expedient  to  administer  is  necessarily 
diminished  as  the  disease  recedes,  and  during  convalescence  is 
reduced  to  the  ordinary  allowance  of  health!.  But  in  chronic 
cases  it  is  often  a  matter  for  serious  consideration  whether  we 
shall  employ  an  agent  capable  of  doing  along  with  the  gocd  we 
intend,  an  evil  greater  than  that  originally  to  be  combated.  If 
the  dose  of  a  stimulant  be  repeated  before  the  arrest  of  metamor- 
phosis has  ceased  and  the  reaction  of  the  system  has  begun,  a 
second  arrest  indeed  takes  place  as  before ;  but  the  postponed 
reaction  is  augmented  in  force  each  time  it  is  delayed,  and  when 
it  occurs  at  last,  it  is  so  painfully  depressing  that  it  becomes 
more  and  more  difficult  to  resist  the  instinct  to  put  it  off,  and  in 
the  end  it  is  rarely  dangerous  to  do  so  suddenly.  This  is  the 
short  history  of  confirmed  tippling;  and  often  we  fear  it  may 
be  traced  in  its  origin  to  the  carelessly  worded  advice  of  some 
medical  men.  Science  or  practice  has  taught  him  that  alcoholic 
action  will  alleviate  certain  morbid  phenomena,  and  he  recom- 
mends it  without  due  warning.  The  patient  knows  no  harm  in 
alcohol  except  drunkenness,  and  so  long  as  he  avoids  that  vice, 
thinks  he  cannot  keep  up  too  steadily  the  agreeable  relief  he 
experiences. 

Alas !  much  safer  for  him  would  be  the  occasional  debauch 
of  a  man  he  despises  as  a  profligate,  than  his  own  continuous 


816  The  Medical  Uses  of  Wines.  [December, 

steady  course  towards  death.  A  drunken  bout  brings  its  own 
cure,  and  is  usually  allowed  to  be  followed  by  reaction  after- 
wards ;  but  the  most  alarming  symptom  in  a  tipler  is  that  he 
cannot  get  drunk.  Day  by  day  there  is  a  little  less  and  a  little 
less  life  in  his  system,  till  at  last  his  degenerated  body  is  fit  for 
burial. 

Now,  the  result  above  described  are,  practically  speaking,  un- 
known as  the  consequence  of  wine ;  it  is  spirit  drinking  that 
leads  to  them.  There  are  several  reasons  for  this,  independent 
of  the  chemical  differences  of  the  liquors.  "Wine  is  rarely  used 
except  at  the  principal  meal,  or  as  a  sort  of  medicine  in  measur- 
ed quantity  at  other  hours,  so  that  the  effects  have  time  to  pass 
away  before  another  dose  becomes  due,  and  no  craving  for  in- 
creased quantity  is  experienced.  In  fact,  men  go  on  taking 
daily  for  quarters  of  their  life  the  same  identical  number  of  glass- 
es, feeling  daily  the  same  comfort,  and  never  finding  it  necessa- 
ry to  increase  the  quantity.  But  the  spirit  bottle  is  opened 
when  its  owner  "feels  to  want  it," — nay  it  is  very  often  carried 
about  the  person  under  the  appropriate  name,  as  regards  its  dead- 
ly results,  of  a  "pocket  pistol". 

We  have  been  in  the  habit,  in  insurance  practice,  of  omitting 
the  usual  inquiries  about  "sobriety"  and  "temperance",  &c, 
which  give  offence  and  elicit  no  information,  and  substituting 
for  them  the  simple  question — "Do  you  ever  take  spirits  between 
meals"?  This  is  something  definite,  not  to  be  shirked,  and  if 
answered  in  the  affirmative  should  lead  to  rejection. 

The  subject  of  spirit  drinking  takes  up  more  space  in  this 
article  than  our  promise  of  avoiding  temperance  common-places 
perhaps  led  the  reader  to  expect.  But  we  have  two  excuses: 
one  is,  that  it  occupies  quite  distinct  ground  from  the  question  of 
drunkenness,  has  much  more  to  do  with  the  production  of  disease 
and  is  therefore  much  more  the  province  of  a  medical  reviewer. 
The  other  excuse  is  (we  blush  to  write  it),  that  no  class  of  per- 
sons who  have  received  a  liberal  education  are  so  often  addicted 
to  it  as  medical  men.  Londoners  were  shocked  two  or  three 
years  ago  at  the  suicide  of  a  highly  moral  and  intellectual  sur- 
geon, who  left  a  paper  attributing  his  despair  to  the  habit  of 
secret  tippling;  but  they  would  have  been  less  astonished  had 
they  known  how  many  practitioners  all  over  the  country  suffered 
from  the  peculiar  dyspepsia  of  alcoholism.  The  long  robe  and 
her  Majesty's  uniforms  are  occasionally  disgraced  by  inebriation, 
clergymen  may  sit  too  long  at  the  bottle,  but  spirit  tippling  seems 
left  to  medical  men  and  the  classes  below  them.  They  have 
many  temptations:  hard  mental  and  corporeal  toil,  sudden  calls 
for  exertion  when  tired,  broken  rest,  irregular  exposure  to  cold 
and  wet,  weary  waiting  in  lone  farm-houses  for  lingering  labours, 


1858.]  The  Medical  Uses  of  Wines.  817 

the  dull  company  of  ill-educated  persons,  the  wish  to  be  sociable 
and  not  seem  proud,  are  a  few  of  them.  Into  these  temptations 
they  do  fall,  and  that  on  a  large  scale,  especially  in  rural  districts. 

To  require  of  an  unfortunate  patient  and  brother  practitioner 
that  he  should  give  up  at  a  blow  that  alcohol  which  instinct  and 
science  agree  in  teaching  him  to  be  necessary,  is  too  great  a  de- 
mand. If  he  becomes  a  teetotaller,  he  would  probably  die  all 
the  sooner.  Hard  common  places  about  the  virtue  of  temper- 
ance and  the  evils  of  its  opposite,  produce  no  more  effect  than 
schoolboy's  themes.  "What  he  wants  is — first,  kind  sympathy 
with  his  misfortune,  and  second,  a  rational  means  of  getting  rid 
of  it.  Now,  nothing  contributes  more  towards  the  latter  than  a 
clear  sketch  of  the  chemistry  and. physiology  of  the  subject,  and 
a  belief  that  the  advantages  of  alcohol  may  be  had  without  its 
disadvantages.  He  should  reflect  how  wine  differs  from  the 
spirits  which  are  in  it;  and  again,  how  it  is  not  so  much  the 
quantiey,  but  the  frequency  of  the  dose,  which  is  hurrying  him 
to  the  grave  and  his  children  to  poverty.  The  most  complete 
relief  is  the  substitution  of  wine  for  spirits.  The  very  economy 
which  was  perhaps  the  first  origin  of  the  habit,  will  prevent  ex- 
cess in  the  dearer  liquid.  If  that  cannot  be  accomplished,  let  at 
all  events  drams  between  meals  be  avoided  as  poison  ;  and  let 
the  addition  of  sugar,  and  flavors  in  the  shape  of  lemon,  fruit,  or 
a  few  drops  of  nitric  ether,  make  the  drink  approach  a  step 
nearer  to  the  juice  of  the  grape,  and  be  daily  more  and  more 
diluted. 

Among  the  Derangements  of  Digestion  arising  from  wine,  it 
will  not  be  necessary  to  dwell  long  upon  the  immediate  conse- 
quences of  a  debauch.  It  is  usual,  in  army  medical  returns,  to 
report  it  as  "  febris,"  as  indeed  there  is,  truly  enough,  an  ephe- 
meral fever,  but,  like  other  fevers,  it  works  its  own  cure,  and 
civilians  are  not  in  the  habit  of  applying  to  it  the  same  euphe- 
mistic nomenclature.  But,  without  being  taken  in  such  quanti- 
ty as  to  be  considered  an  excess  as  regards  alcohol,  wines  will 
sometimes  cause  a  disturbance  of  digestion,  which  prevents  our 
sanctioning  their  use  in  cases  where  otherwise  we  might  be  wil- 
ling or  anxious  to  do  so.  This  is  always  accompanied  by  the 
presence  of  a  large  quantity  of  acid  in  the  alimentary  canal. 

In  some  instances  this  excessive  production  of  acid  follows 
equally  all  sorts  of  wines,  and  even  spirits.  Then  it  is  due  to 
the  mucous  membrane  of  the  stomach  being  so  morbidly  sensi- 
tive that  it  becomes  irritable  and  temporarily  inflamed,  so  that 
it  refuses  to  secrete  its  solvent  juice,  and  to  perform  with  suffi- 
cient activity  the  peristaltic  movements.  Hence  the  alimentary 
mass  undergoes  the  acetous  and  lactic  fermentations,  instead  of 
being  digested.  These  patients  ought  to  abstain  from  all  alco- 
holic drinks  whatsoever  till  cured  of  their  morbid  condition. 


818  The  Medical  Uses  of  Wines.  [December, 

More  commonly  it  follows  only  wines,  and  some  sorts  of  wines 
more  than  others.  These  cases  deserve  much  thought,  because 
they  are  in  danger  of  falling  into  the  snares  of  spirit  drinking, 
and  also  because  very  often  the  patient's  system  especially  re- 
quires a  stimulus  which  yet  he  cannot  take  without  inconveni- 
ence. When  we  reflect  on  the  large  quantity  of  free  acid  exist- 
ing in  wine,  we  cannot  be  surprised  at  its  causing  some  trouble 
in  the  stomach.  If  a  man  drinks  hall  a  bottle  of  hock,  he  swal- 
lows one  hundred  grains  of  acid,  equal  to  five  tablespoon fuls  of 
lemon-juice;  in  a  pint  of  claret,  eighty  grains;  in  sparkling 
champagne  or  Madeira,  the  same  amount;  in  port,  if  he  takes 
even  this  comparatively  large  allowance,  he  does  not  get  above 
sixty  grains ;  but  then  in  the  three  last  there  is  nearly  an  ounce 
of  sugar,  which,  mixed  up  with  the  food,  has  a  strong  tendency 
to  ferment,  and  turn  into  a  fresh  portion  of  acid  at  a  more  advan- 
ced period  of  digestion. 

Here  chemistry  steps  in  with  valuable  aid.  In  the  simple 
instrument  of  a  standard  solution  of  caustic  soda,  we  possess  a 
means  of  testing  rapidly  the  whole  acid  contents  of  wines,  and 
rejecting  any  which  are  thus  declared  unfit  for  our  patient. 

But  it  makes  some  difference  what  sort  of  acid  is  contained 
in  the  wine.  Acetic  is  to  many  stomachs  much  less  injurious 
than  tartaric,  and  it  is  found  that  the  proportion  of  these  to  one 
another  varies  very  much  in  the  products  of  fermentation. 
Thus,  in  Madeira  nearly  one-third  of  the  acid  contained  is  acetic ; 
in  port,  only  one-fourth ;  in  claret,  one-fifth ;  in  champagne, 
one-seventh  ;  and  in  hock,  not  one-eighth,  whilst  the  rest  is  the 
least  digestable,  tartaric,  or  its  ally,  racemic*  Besides  these, 
the  tannic  must  be  allowed  for,  small  indeed  in  quantity,  but 
powerful  in  operation,  as  its  use  in  medicine  shows. 

Of  course,  both  the  quantity  of  acid  and  the  proportion  of  the 
several  acids  vary  within  certain  limits,  in  different  specimens 
even  from  the  same  vineyard,  and  still  more  in  growths  classed 
under  a  common  name  in  the  market.  So  that  to  give  an  opin- 
ion as  to  the  fitness  of  a  peculiar  wine  for  drinking,  we  must 
carry  our  investigation  rather  farther  than  merely  the  applica- 
tion of  the  soda  test. 

The  acetic  acid  may  be  estimated  by  distilling  it  off  from  the 
wine  slowly,  at  a  moderate  temperature,  so  as  not  to  decompose 

*See  Mulder,  p.  202.     In  100  grammes  of  wine  there  were — 

Milligrammes  of  Milligrammes  of 

acetic  acid  tartaric,  racemic,  <fec. 

Madeira 167 310 

Rhine  wine 66 480 

Port 95 ..283 

Bordeaux  ordinaire 86 390 

Champaigne 64 408 


1858.]  Paralysie  Generate.  819 

the  extractive,  and  measuring  it  by  the  standard  alkaline  solu- 
tion. 

Sugar  in  wine  which  is  to  be  taken  by  itself  as  a  medicine,  is 
often  beneficial  by  making  the  acid  and  alcohol  less  immediate- 
ly irritating  to  the  mucous  membrane;  but  in  that  which  is  to 
be  mixed  with  food  it  is  very  apt  to  increase  the  generation  of 
acid  in  the  stomach  or  caecum  to  an  injurious  extent,  generally 
two  or  three  hours  after  meals.  If  an  examiner  of  wine  is  dis- 
posed to  reckon  the  absolute  quantity  of  sugar,  he  will  have  to  go 
to  the  expense  of  Soleil's  saccharometer  (which  costs,  with  its  ac- 
cessories, not  much  under  £20),  and  even  then  may  have  his 
analysis  doubted  by  a  chemistf;  but  a  fair  comparative  valua- 
tion may  be  made  by  first  neutralizing  the  acids  with  lime,  and 
estimating  the  sweetness  which  remains  by  the  taste.  This  is 
done  by  measuring  the  quantity  of  water  which  requires  to  be 
added  before  all  trace  of  it  cease  to  be  perceptible  to  the  palate. 

The  injurious  effect  of  ill  prepared  effervescing  wines  is  easily 
explained  by  the  large  quantity  of  undecomposed  ferment  they 
contain.  This  is  set  in  action  by  the  warmth  of  the  alimentary 
canal,  andean  hardly  be  overcome  even  by  the  strongest  diges- 
tive powers.     Flatus  and  acidity  are  its  normal  consequences. 

The  proverbial  unwholesomeness  of  "mixed  wines"  is  not 
explained  by  chemistry.  In  most  cases  the  evil  may  be  traced 
to  the  temptation  to  increased  quantity,  or  to  the  taking  of  some 
sorts  which,  even  if  adhered  to  throughout  the  meal,  would  be 
equally  hurtful.  In  fact,  the  precept  of  keeping  to  one  wine 
seems  to  rest  on  the  same  principle  as  keeping  to  one  meat. 
[Brit,  and  For.  Medico- Chirurg.  Review. 


Paralysie  Generate.     By  M.  H.  Eannev,  M.D.,  Resident  Physi- 
cian of  the  New  York  City  Lunatic  Asylum. 

This  disease  has  been  but  recently  discriminated  from  other 
forms  of  paralysis.  The  attention  of  the  medical  profession  was 
first  called  to  it  by  Esquiro],  within  the  present  century.  It  may 
have  been  confounded,  perhaps,  with  the  results  of  apoplexy,  ram- 
ollissement,  tumors,  tubercles,  &c,  of  the  brain.  It  is  a  singular 
fact,  however,  that  its  frequency  has  greatly  increased  during  the 
last  sixteen  years,  as  will  be  seen  by  reference  to  the  various 
annual  reports  of  the  Superintendents  of  American  Hospitals  for 
the  insane.     In  the  report  of  the  McLane,  Asylum,  for  the  year 

\  The  fallacy  in  Soleil's  polarizing  saccharometer  as  a  quantitative  test  is,  that 
uncrystallizable  sugar  rotal  y  to  the  left,  whilst  glucose  and  cane  sugar 

rotate  it  to  the  right.  So  that  a  sample  of  sherry,  for  example,  with  its  usual 
allowance  of  the  uncrystallizable,  might  be  so  adulterated  with  white  lump, 
molasses,  caramel,  or  malt,  as  exactly  to  balance  and  appear  to  contain  no  sugar 
at  all. 

K.8. VOL.  XIV.    NO.  XII.  48 


820  Paralysle  Generate.  [December, 

1844,  Dr.  Bell  remarks,  "  I  have  regarded  it  as  a  somewhat  curi- 
ous fact,  that  it  is  only  within  the  last  three  years  that  this  disease 
has  been  admitted  to  this  institution.  As  late  as  my  visit  to 
Europe  in  1840,  it  was  unknown  within  our  walls  ;  nor,  after  seeing 
it  so  often  manifested  there,  can  I  recall  any  case  in  our  register 
which  would  at  all  meet  its  characteristics,  rendering  it  certain 
that  it  was  not  overlooked.  Since  that  period,  however,  wre  have 
abundant  evidence  that  it  is  not  a  form  of  disease  peculiar  to 
other  countries." 

The  recent  investigations  by  Calmeil,  Foville,  Rodrigues,  Fal- 
ret,  and  others  have  thrown  much  light  on  its  nature  and  charac- 
ter. The  name  adopted  by  Esquirol  does  not  give  a  correct  idea 
of  the  disease.  There  is  not  usually  complete  paralysis,  but  the 
power  of  volition  is  partially  lost,  so  that  muscular  action  is  im- 
perfect and  unsteady. 

The  characteristics  of  this  disease  are  found  in  the  paralysis, 
and  in  peculiar  mental  aberrations.  Either  the  physical  or  the 
mental  affection  may  be  antecedent  in  its  manifestation. 

The  first  paralytic  symptom  is  an  affection  of  the  muscles  of 
the  pharynx  and  larynx,  which  changes  much  the  tone  of  voice 
and  produces  a  difficulty  in  articulation.  There  is  a  peculiar 
"  cracked"  husky  tone,  and  a  hesitancy  between  syllables  and 
words  like  stammering.  A  slight  excitement  produces  a  spasmo- 
dic action  of  the  muscles  of  the  face,  particularly  about  the  cor- 
ner of  the  mouth  and  eyes.  The  tongue  when  protruded  is 
tremulous,  and  thrown  forWard  by  successive  efforts  resembling 
the  spasmodic  action  observed  in  chorea.  The  face  becomes 
expressionless ;  as  the  disease  progresses  all  of  these  signs  become 
more  marked,  and  a  difficulty  occurs  in  locomotion.  The  patient 
totters  in  his  gait,  and  if  he  attempt  to  change  suddenly  his  direc- 
tion, is  likely  to  fall.  In  falling  he  makes  no  apparent  effort  to 
recover  himself,  and  his  head  stikes  with  equal  force  as  other 
parts  of  his  body.  Deglutition  is  gradually  impeded,  and  even- 
tually there  is  a  loss  of  control  over  the  sphincters.  In  most  cases 
epileptiform  convulsions  follow  at  intervals,  varying  from  one 
week  to  three  months,  each  of  which  seem  to  lessen  the  vital 
power  of  the  system,  and  to  increase,  temporarily  at  least,  the 
extent  and  degree  of  the  paralysis. 

The  mental  changes  are  marked  both  in  the  susceptibility  and 
intellect.  The  patient  is  restless,  constantly  moving  from  place 
to  place,  peevish,  fretful,  and  impatient  of  contradiction.  He  is 
ever  discontented  with  his  present  condition,  although  the  past 
and  future  afford  unalloyed  happiness.  Opposition  to  his 
wishes  is  soon  forgotten.  Recent  events  are  generally  but  feebly 
retained,  whilst  the  past  affords  to  his  mind  images  of  unparalleled 
success,  and  the  future  glows  with  day  dreams  of  great  achieve- 
ments to  be  performed,  or  noble  actions  done.     The  disease  may 


1858.]  Paralysie  Generale.  821 

assume  the  form  of  mania,  monomania,  or  dementia.  The  most 
prominent  and  usual  characteristic  is  generally  exaltation  of  the 
imagination.  The  belief  is  permanent,  that  he  excels  in  every- 
thing, and  possesses  strength,  wealth,  influence,  and  intellectual 
capacity  far  beyond  that  of  any  human  being.  They  who  were 
previously  endowed  with  a  brilliant  imagination,  and  had  received 
high  mental  culture,  present  visionary  schemes  of  the  most  attrac- 
tive character.  Their  language  is  well  chosen,  and  their  style 
highly  poetical.  They  project  ships  on  an  immense  scale,  and 
palaces  of  pure  gold,  control  kingdoms,  and  discover  the  secrets 
of  Providence.  Great  subjects  alone  occupy  their  attention. 
The  following  extract,  from  the  register  of  the  New  York  City 
Lunatic  Asylum,  illustrates  this  phase  of  the  disease.  The 
imagery  of  the  delusions  is  entirely  that  of  the  patient,  and  his 
style  and  language  is  retained  as  far  as  practicable. 

"H.  H.,  born  in  Virginia,  aged  32,  admitted  1853.  After  re- 
ceiving his  degree  at  Yale,  he  was  supplied  with  an  abundance  of 
money,  and  unrestrained  in  the  gratification  of  every  desire.  His 
funds  becoming  exhausted,  he  endeavored  to  obtain  a  living  by 
his  own  exertions,  but  with  indifferent  success,  on  account  of  the 
impairment  of  his  mind  and  health  through  the  influence  of  his 
former  habits.  His  system  is  very  feeble,  and  a  large  ulcer  upon 
one  of  his  limbs  renders  him  almost  helpless. 

"  The  imagination  of  H.  H.,  naturally  active,  is  morbidly  exal- 
ted. He  believes  himself  to  be  the  'Earl  of  Warwick,  the 
King-Maker,'  and  adds  to  the  singularity  of  the  delusion,  by  the 
conception  that  he  is  fourteen  feet  high,  and  large  in  proportion. 
He  wishes  to  purchase  the  asylum  and  all  its  contents,  proposes 
to  bestow  the  most  magnificent  presents  and  the  most  extensive 
estates  upon  the  physicians,  and  signs  papers  to  that  effect. 
Nothing  is  beyond  his  reach  by  reason  of  its  expensiveness ; 
nothing  too  good  for  his  friends.  His  clothes  are  of  the  finest  cloth, 
lined  with  the  most  costly  satin,  decked  with  intricate  embroidery, 
and  ornamented  with  buttons  of  enormous  diamonds.  For  him 
magnificent  pictures  adorn  the  walls  of  mansions,  which  the 
highest  architectural  skill  has  reared.  The  souls  of  Praxitiles 
and  Canova  shine  through  the  marble  monuments  of  their  art 
which  fill  the  corners  of  his  libraries.  Through  the  stained-glass 
window,  shaded  by  the  heavy  folds  of  Genoa  velvet,  the  light 
falls  upon  the  most  rare  editions  of  the  works  of  those  men,  whose 
literature  is  eternai. 

"Carpets,  the  delicacy  of  whose  tints  rival  those  of  the  summer 
cloud  at  sunset,  cover  the  floors  of  his  apartments.  Tables  in- 
laid with  precious  stones,  which  cause  the  envy  of  the  brightest 
stars  of  heaven,  uphold  wines  sparkling  upon  the  brim  of  golden 
goblets,  as  if  anxious  to  kiss  the  lips  of  the  drinker,  and  viands 
which  have  been  prepared  with  the  consummate  skill  of  the  high- 


822  Paralysie  Generate.  [December, 

est  culniary  art.  Flowers  of  supernatural  beauty,  whose  delicate 
perfume  angels  might  use  on  their  spotless  garments,  fill  his  con- 
servatories. 

"  Among  the  spreading  branches  of  the  trees  of  his  pleasant 
gardens  birds  of  brilliant  plumage  and  unrivalled  song  pour  forth 
their  sweet  voices  in  harmony  with  murmurs  of  fountains,  whose 
silver-edged  bubbles  ripple  over  pearls  and  garnets,  and  whose 
banks  are  clothed  with  the  herbage  and  verdure  of  the  tropics". 

Even  they  who  previously  possessed  but  little  imaginative 
power  evince  now  the  most  lively  conceptions.  Matters  of  com- 
mon occurrence  may  occupy  the  attention,  but  are  so  vividly  and 
fancifully  described  as  to  render  it  difficult  to  detect  the  real 
nucleus  of  fact.  The  exhilaration  produced  on  certain  individu- 
als from  stimulating  drinks  bears  some  resemblance  to  the  expan- 
sive ideas  in  this  form  of  paralysis.  These  delusions  continue 
until  the  disease  has  progressed  to  a  low  state  of  dementia. 
There  is  an  occasional  exception  to  the  general  rule  of  exaltation. 
In  such  cases  the  mind  seems  depressed  and  enfeebled  from  the 
commencement  of  the  attack,  and  the  paralytic  symptoms  are 
very  strongly  marked. 

The  presentation  of  symptoms  and  the  diagnosis  being  the 
principal  object  of  this  paper,  I  select  a  case  from  Esquirol,  in 
which  the  prominent  characteristics  are  given.  "  M.  L.  I).,  thirty 
eight  years  of  age,  had  participated  in  the  last  campaigns  of  the 
empire,  and  was  elevated  to  the  rank  of  colonel  after  the  restora- 
tion ;  uniting  to  every  physical  and  intellectual  quality  all  the 
advantages  of  a  lofty  position  in  society,  and  a  large  fortune.  He 
was  of  the  opinion  that  he  had  experienced  injustice  on  the  part 
of  the  government.  His  self-love  was  deeply  wounded,  and  after 
many  days  of  insomnia  he  gave  himself  several  thrusts  with  a 
knife  in  the  region  of  the  heart.  He  was  promptly  secured,  and 
his  services  were  but  for  a  brief  period  discontinued.  From  this 
time  he  expressed  with  bitterness  his  dissatisfaction,  but  was  in 
no  respect  less  exact  in  fulfilling  his  duties  as  a  commanding  officer. 
Two  years  subsequently  he  has  an  attack  of  cerebral  congestion, 
for  which  he  is  largely  bled.  Two  days  later  he  has  a  second 
attack,  more  severe  than  the  first  He  remains  excited,  talks 
much,  is  agitated,  irritable,  and  exacting.  He  does  not  sleep,  and 
after  a  third  attack  a  true  mania  is  developed.  The  delirium  is 
generally  attended  with  agitation  and  notions  of  grandeur  and 
fortune.  He  commits  a  thousand  extravagances,  remains  almost 
naked,  talks  incessantly,  cries  aloud,  orders  a  thousand  things  at 
once,  is  impatient,  and  commits  strange  and  imprudent  acts,  which 
compromise  his  life,  though  he  entertains  no  idea  of  suicide. 

"Several  physicians  are  called  in  consultation,  and  the  mania- 
cal state  of  the  patient  cannot  be  denied.  His  age,  however,  and 
the  brief  duration  of  the  disease,  offer  to  the  counsellors  expecta- 


1858.]  Pardlysie  Generate.  823 

tion  of  a  cure.  I  affirm  that  the  patient  will  never  recover;  1st, 
because  three  severe  attacks  of  cerebral  congestion  had  preceded 
the  maniacal  state,  and  that,  consequently,  there  was  some  degree 
of  cerebral  lesion;  2d.  because,  notwithstanding  his  excessive 
loquacity,  certain  words  are  imperfectly  pronounced,  and  because 
his  gait,  although  lively  and  active,  is  uncertain.  I  added,  that 
active  medication  would  hasten  the  progress  of  the  disease  ;  that 
the  country,  exercise,  a  severe  regimen,  and  the  repeated  applica- 
tion of  leeches  to  prevent  new  congestions,  appeared  to  me  to  be 
the  only  proper  course.  One  of  the  consulting  physicians  did  not 
concur  with  me  in  my  unfavorable  prognosis,  and  proposed  certain 
tentative  measures. 

"After  a  month  spent  in  fruitless  attempts,  we  were  obliged  to 
renounce  all  hopes  of  cure.  Paralysis  had  progressed  and  demen- 
tia was  confirmed — the  patient  retaining  incoherent  notions  of 
grandeur,  which  persisted  for  more  than  two  years.  He  regard- 
ed himself  as  the  possessor  of  several  provinces  and  kingdoms; 
distributed  palaces,  and  gave  away  millions,  and  commanded  also 
an  army  of  giants.  His  cavalry  was  mounted  upon  horses  of 
gigantic  size;  he  possessed  palaces  of  diamonds,  and  his  stature 
was  20,  30,  and  40  cubits  in  height.  He  talked  both  night  and 
day  ;  now  in  a  low  tone,  now  loudly.  He  also  uttered  loud  cries. 
Beset  by  hallucinations  of  hearing,  he  listened  to  the  voices  of 
imaginary  beings,  and  replied  to  them,  boasting  of  his  person,  dis- 
puting with  and  even  abusing  them.  He  recognized  the  mem- 
bers of  his  family,  and  addressed  them  with  amiability  and  polite- 
ness ;  but  after  a  brief  interval,  however,  resumed  his  habits  of 
constant  conversation.     He  was  sent  to  the  country". 

Paralysie  generate  occurs  more  frequently  among  males  than 
females;  in  fact,  among  the  latter  it  is  of  rare  occurrence.  No 
good  reason  has  been  assigned  for  this — the  predisposing  and  ex- 
citing causes  to  which  the  disease  is  referred  being  found  in 
operation  in  both  sexes.  At  Charenton,  of  619  insane  {'SG6  men 
and  253  women)  there  were  109  cases  of  general  paralysis,  (95 
males  and  14  females).  Into  the  Asylum  at  Halle,  in  the  Tyrol, 
257  men  and  181  women  were  admitted,  among  whom  were  28 
cases  of  general  paralysis,  (22  men,  6  women)-.  In  the  New 
York  City  Lunatic  Asylum,  of  5,092  (2,391  men,  2,701  women) 
under  treatment  within  the  last  eleven  years,  85  deaths  have  oc- 
curred (76  males,  9  females)  from  this  disease.  It  is  a  disease  of 
adult  life,  rarely  occurring  before  the  age  of  twenty-five.  Those 
of  a  sanguine  temperament  are  more  liable  to  an  attack,  especial- 
ly if  of  a  full  habit,  with  a  tendency  to  apoplexy.  It  occurs  to  a 
great  extent  in  the  class  called  good  livers,  who  remain  up  late  at 
night,  and  indulge  in  suppers  with  a  free  use  of  wine,  the  mind  at 
the  same  time  being  actively  engaged.  Venereal  excesses,  a  free 
use  of  mercurials,  syphilitic  diseases,  a  hereditary  taint  of  insani- 


824  Paralysie  Generate.  [December, 

ty,  or  scrofula — in  a  word,  everything  that  tends  greatly  to  de- 
teriorate the  blood,  impair  the  constitution,  or  lessen  the  vital 
power  of  resistance,  may  act  as  a  predisposing  cause.  The  ex- 
citing cause  is  generally  some  sudden  mental  shock — a  loss  of 
friends  or  property,  great  anxiety  in  business  matters,  or  it  may 
be  an  indulgence  in  very  great  excesses. 

There  are  various  diseases  with  which  it  has  been  and  may 
be  confounded.  "  Ramollissement  du  cerveau"  has  some  symp- 
toms in  common  with  it;  but  the  continued  pain  in  the  head, 
occasionally  vomiting,  rigidity  of  the  flexor  muscles  of  the  limbs, 
and  stupidity,  instead  of  exaltation  of  intellect,  seem  sufficient  to 
distinguish  it  from  general  paralysis.  In  the  last-named  disease 
there  is  also  a  softening  of  the  brain,  but  it  is  the  cortical  portion 
that  is  particularly  affected,  and  this  gives  rise,  usually,  during  its 
progress  from  irritation  to  softening,  to  the  peculiar  mental  symp- 
toms that  have  already  been  described. 

Cerebral  haemorrhage  is  usually  accompanied  by  paralysis  of  a 
hemiplegic  character,  and  its  sudden  invasion  with  the  ordinary 
apoplectic  symptoms  is  a  distinguishing  feature  in  its  diagnosis. 

Inflammation  of  the  brain  or  its  membranes,  as  well  as  the 
affections  of  the  spinal  cord,  might  lead  to  error  from  superficial 
examination,  but  the  rapid  progress  of  the  one  and  the  paraplegic 
character  of  the  other,  without  any  peculiar  mental  aberrations 
would  indicate  the  nature  of  the  disease.  Delirium,  arising  from 
inflammation,  differs  essentially  from  delusions.  There  is  gener- 
ally a  low  condition  of  the  system ;  the  mind  is  not  occupied  with 
external  objects,  but  seems  to  retire  within  itself,  and  in  a  half 
comatose  state  is  manifested  by  incoherent  mutterings  without, 
ever  exhibiting  the  reasoning  power  of  insanity. 

Paralysis  caused  by  mercury,  alcohol,  or  lead,  may  be  distin- 
guished by  a  careful  study  of  the  causes  and  symptoms,  the  mus- 
cles of  the  extremities  being  in  these  cases  at  first  affected  either 
with  numbness,  trembling,  or  a  complete  paralysis  of  the  exten- 
sors. 

Morbid  growths  of  the  brain,  such  as  tumors,  (malignant  and 
non-malignant,)  tubercles,  &c,  present  many  features  in  common 
with  general  paralysis.  The  character  of  the  morbid  growth  can 
be  inferred  only  from  the  particular  diathesis,  or  by  the  external 
manifestations,  the  paralytic  and  mental  conditions  involved  in 
them  depending  principally  on  compression  and  inflammation, 
with  its  sequences.  The  change  occurring  in  the  mental  facul- 
ties is  that  of  general  enfeeblement,  presenting  eventually  the 
ordinary  characteristics  of  dementia.  The  last  stage  of  general 
paralysis  closely  resembles  this,  and  its  discrimination  requires  a 
knowledge  of  the  previous  history  and  a  careful  analysis  of  the 
successive  order  of  the  paralytic  symptoms. 

The  following  is  selected  from  the  case  book  of  the  New  York 


1858.]  Paralysie  Generate.  825 

City  Asylum,  as  an  illustration  of  this  error  in  diagnosis.  It  had 
been  considered  as  the  effect  of  a  morbid  growth  in  the  brain, 
previous  to  admission.  "C.  L  S.,  aet.  36,  by  profession  an  actor, 
was  on  the  10th  of  December,  1856,  admitted  into  the  Asylum. 
When  admitted,  he  was  found  to  be  completely  demented,  paraly- 
zed, unable  to  walk  or  stand,  and  with  difficulty  to  swallow.  He 
lingered  nine  days,  when  the  disease  terminated  in  death. 

"  The  iollowing  history  of  the  case,  communicated  by  his  brother 
together  with  the  post-mortem  appearances  of  the  brain,  indicate 
the  form  of  the  disease  of  which  the  patient  died  to  have  been 
paralysie  generate.  His  brother  states  that  he  had  always  been  a 
temperate  man.  Some  two  years  since,  in  consequence  of  domes- 
tic and  business  troubles,  he  passed  through  a  period  of  great 
mental  anxiety  and  excitement. 

"  A  year  ago  last  October,  while  in  Philadelphia,  he  exhibited 
strong  symptoms  of  insanity  of  a  maniacal  character,  succeeded 
by  a  condition  of  prostration.  Soon  after  recovery  of  physical 
health,  a  change  in  his  character  was  noticed ;  he  became  irrita- 
ble, impatient  of  contradiction  ;  at  times  despondent,  and  then 
verv  sanguine  of  success  in  his  profession  and  business.  His 
time,  following  such  recovery,  up  to  April  last,  was  spent  inform- 
ing business  plans  and  studying  the  important  characters  of 
Shakespearean  the  belief  that  he  was  to  become  a  prominent  actor, 
although  his  friends  knew  him  to  be  incompetent  in  this  respect 
from  the  great  impairment  his  memory  had  lately  suffered;  When 
slightly  excited,  twitching  of  the  corners  of  his  mouth  and  tremors 
of  the  muscles  of  his  face  were  noticed;  his  tongue  was  protru- 
ded wTith  difficulty,  and  his  voice  altered  and  'cracked5  in  its 
tone.  All  of  these  symptoms  increased  in  intensity  about  the 
beginning  of  April  last,  when  on  the  8th  of  the  month,  he  had  a 
convulsion  of  an  epileptiform  character,  as  described  by  his 
brother,  followed  by  prostration.  From  this  he  afterwards  grad- 
ually improved  until  August  last,  when  he  had  another  severe 
convulsion,  followed  by  loss  of  consiousness.  For  several  hours 
previous  to  this  last  convulsion,  it  was  noticed  that  his  left  arm 
had  become  paralyzed.  He  was  then  taken  to  a  hospital,  and  for 
a  short  time  improved  so  as  to  be  able  to  walk  about  the  ward, 
and  regained  considerable  power  in  the  use  of  his  tongue  and  arm. 

"During  the  four  months  he  remained  there,  his  brother  states 
that  he  had  several  convulsive  attacks  similar  to  those  already 
nentioned,  followed  each  time  by  increasing  helplessness  and 
greater  loss  of  mental  power,  until  he  became  reduced  to  the  con- 
dition in  which  he  was  brought  to  the  Asylum.  Autopsy  four- 
teen hours  after  death  :  skull  a  quarter  of  an  inch  thick,  and  of  a 
texture  less  dense  than  usual ;  dura  mater  and  arachnoid  closely 
adhered  over  summit  of  cerebrum  :  arachnoid  thickened,  and 
presenting  an  opaline  appearance,  with  serum  between  it  and  pia 


826  Paralysie  Generate.  [December, 

mater;  general  appearance  of  brain,  atrophied;  the  cortical 
structure  somewhat  softened  and  easily  scraped  with  the  knife  or 
finger-nail  from  the  white  medullary  substance;  this  latter  was 
found  to  be  hardened,  of  a  firm  texture,  and  glossy  in  appearance  ; 
the  ventricles  were  largely  distended,  and  contained  liv.  of  clear 
serum ;  the  floors  of  both  lateral  ones  had  a  feeling  of  roughness 
to  the  touch ;  the  foramen  of  Monro  was  large  and  patulous,  easily 
admitting  the  end  of  the  little  finger;  the  middle  or  soft  commis- 
sure was  wasted  to  a  thin  ribbon  of  almost  transparent  membrane  ; 
the  pons  varolii  and  medulla  oblongata  were  of  less  than  usual 
size,  and  the  pituitary  gland  shrunken,  and  the  upper  portion  of 
its  peduncle  enlarged.  The  weight  of  the  brain,  drained  of  the 
serum  in  its  ventricles,  was  two  and  a  half  pounds,  which  is  some 
ten  ounces  less  than  the  average  given  by  Solly". 

The  most  common  pathological  change  in  paralysie  generate 
is  a  softening  of  the  vesicular  neurine  of  the  brain,  especially  in  the 
anterior  portion  of  the  parietal  regions.  Sometimes  the  tubular 
neurine  is  also  involved.  Various  other  changes  are  occasionally 
found,  such  as  thickening  of  the  membranes,  effusion  of  serum, 
induration  of  the  cerebral  substances,  &c,  but  with  no  particular 
uniformity ;  and  these,  in  fact,  are  found  in  many  of  the  chronic 
diseases  of  the  brain.  The  length  of  time  in  which  the  disease 
has  progressed,  must  necessarily  vary  the  cadaveric  phenomena, 
and  if  death  occur  very  early,  there  may  be  no  manifest  softening  ; 
yet  from  this  it  does  not  follow  that  it  has  been  in  progress,  that 
there  is  no  organic  detritus.  Either  a  subjective  cause  like  over- 
excitement  of  the  mind,  or  an  objective  one  like  intemperance, 
or  moral  and  physical  causes  combined,  may  over-stimulate  the 
brain,  and  its  continuance  result  in  congestion,  from  which  con- 
dition serum  may  be  effused  into  the  primitive  cellules,  causing 
irritation  that  may  or  may  not  end  in  softening.  Why  softening 
follows  in  this  form  of  paralysis,  but  not  in  ordinary  congestion,  is 
not  wrell  settled.  It  may  depend  either  upon  some  particular  pre- 
disposition on  the  part  of  the  patient,  or  upon  some  unknown  pe- 
culiarity of  the  disease. 

The  prognosis  is  highly  unfavorable.  Rodrigues  mentions  a 
few  cases  of  recovery,  but  by  most  the  disease  is  considered  incu- 
rable. Death  follows,  generally,  in  from  one  to  three  years  after 
the  first  symptoms  appear,  but  life  is  occasionally  prolonged  be- 
yond the  last-named  period.  If  it  occur  early  in  the  disease,  the 
termination  is  usually  by  epileptiform  convulsions  ;  if  at  a  late 
period,  from  general  exhaustion,  or  disease  of  some  important  organ 
other  than  the  brain. 

The  object  of  this  communication  being  merely  to  call  the  atten- 
tion of  the  profession  to  the  general  characteristics  of  this  form  of 
paralysis,  I  will  not  dwell  upon  the  subject  of  treatment. 

M.  Roderigues  recommends  the  adoption,  at  an  early  stage,  of 


1858.]  Fevers — their  Identify  and  Treatment.  827 

active  measures,  such  as  frequent  venesection,  &c.  After  the 
disease  is  somewhat  advanced,  he  advises  the  occasional  abstrac- 
tion of  blood,  in  connection  with  tonics,  aromatics,  and  cold  baths, 
while  at  a  later  period  he  recommends  laxatives,  and  revulsives 
to  the  skin.  The  treatment  of  M.  Roderigues  has  not  been  found 
successful  when  adopted  by  others,  although  he  gives  a  very  fa- 
vorable account  of  its  results. 

The  observance  of  general  principles  of  treatment  to  meet  the 
indication  of  the  symptoms  has  seemed  to  be  attended  with  as 
much  benefit  as  the  adoption  of  any  other  system.  I  have  seen 
more  temporary  good  effects  follow  the  use  of  a  seton,  or  the  free 
application  of  Ung.  Tart.  Ant.  to  the  back  of  the  neck,  than  from 
anvthing  else  in  the  way  of  treatment.  If  at  a  very  early  stage 
the  habitual  excesses  which  had  partially  undermined  the  system 
were  corrected,  and  a  careful  hygienic  course  pursued,  some 
hopes  might  then  be  entertained  of  a  gradual  restoration. 

[American  Med.  Monthly. 


Fevers — Their  Identity  and.  Treatment.     By  W.  L.  Johnson,  M. 
D.,  of  Charleston,  Kv. 

There  is  no  class  of  disease  in  Xosonomy  of  such  importance 
to  the  physician  as  that  of  Fevers.  (Febris,  from  fievre  rel  fer- 
rore).  The  fevers  prevalent  in  the  different  climates  of  the  United 
States,  constitute  a  very  large  per  centage  of  the  disease  with 
which  the  physician  has  to  combat.  Moreover,  they  constitute 
a  class  of  disease  frequently  of  great  malignancy  and  fatality, 
sparing  neither  age  nor  sex ;  the  inhabitants  of  the  sunny  South, 
of  the  umbrageous  West,  of  the  frozen  X orth,  and  of  the  East,  are 
alike  often  victims  of  their  ravages.  Of  the  mortality  among  the 
people  of  the  United  States,  a  large  per  centage  die  of  the  great 
scourge  of  the  world,  fever.  How  often  does  the  scientific  disci- 
ple of  /Esculapius  find  his  skill  unavailing,  and  feel  his  strong, 
sinewy  arm  grow  weak,  as  he  beholds  his  patient  in  rigor  mortis, 
or  struggling  with  the  grim  monster  death.  From  these  and  other 
considerations.  I  am  induced  to  write  an  article  on  the  subject  of 
fevers,  hoping  that  it  will  merit  a  place  in  the  columns  of  your 
excellent  journal,  and  throw  out  one  glimmering  ray  of  light 
to  the  profession,  or  elicit  something  upon  this  important 
subject  from  others  of  greater  age  and  of  riper  intellects  than  the 
writer.  If  I  shall  present  ideas  or  views  of  the  pathology,  causa- 
tion and  treatment  of  fevers  different  from  others,  thev  will  be 
conclusions  or  deductions  arrived  at  from  close  observation  and 
study,  and  from  an  extensive  practice  of  several  years. 

Medical  literature  abounds  with  accurate  and  faithful  history 
of  all  the  phenomena,  symptoms  and  complications  of  fevers,  nev- 


828  Fevers — their  Identity  and  Treatment.     [December, 

ertheless  but  a  glimmering  ray  of  light  has  been  thrown  out  as 
yet  on  its  real  causations  and  pathology. 

In  physiology  as  in  chemistry  every  cause  produces  an  infalli- 
ble and  uniform  result,  and  like  results  or  consequences  must  be 
produced  by  identical  causes. 

The  blood  is  now  generally  admitted  by  the  most  renowned 
writers,  as  the  seat  of  these  phenomena,  denominated  fevers.  The 
idea  is  generally  inculcated  that  they  are  occasioned  by  the  intro- 
duction into  this  fluid  of  some  virus,  malaria,  miasm,  effluvia,  or 
vapors,  etc.,  so  called  by  writers,  which  materially,  chemically 
or  vitally  change  its  character. 

It  would  be  absurd  and  illogical  to  arrive  at  the  conclusion  that 
the  multifarious  substances  affecting  that  fluid  could  produce  the 
same  results;  hence  we  are  brought  to  the  conclusion  that  all 
similar  febrile  disturbances  or  diseases  have  the  same  or  identical 
causes  or  sources,  caeteris  paribus. 

The  analogy  between  fevers  is  striking  to  a  casual  observer, 
considering  the  difference  in  the  circumsUnces  under  which  they 
originate,  which  seem  to  indicate  or  est™lish  the  probability  of 
the  somewhat  plausible  hypothesis  that  they  are  produced  by  sim- 
ilar or  identical  causes. 

If  we  compare  the  miasmatic  or  autumnal  fevers,  we  will  find 
as  little  difference  between  them  as  exists  between  cynanche 
maligna  and  cynanche  simplex,  or  the  different  species  or  fevers 
of  variola,  scarlatina,  etc.,  etc. 

Now  let  us  search  out  the  localities,  circumstances  and  seasons 
favorable  for  the  prevailing  of  intermittent  fevers;  the  type  of 
those  fevers  which  are  admitted  by  all  authors  and  physicians, 
as  being  produced  by  some  vegetable,  and  peradventure,  in  some 
degree,  by  animal  poison. 

Intermittent  fever  is  most  prevalent  in  low,  swampy  lands,  of 
a  wild,  luxuriant  growth,  which  has  been  for  ages  enriching  the 
soil  by  its  decay,  until  its  whole  surface  has  become  covered  with 
abundant  vegetation,  where  the  plough  and  pruning  hook  have 
never  been  used  by  man,  where  the  land  is  often  inundated  and 
the  soil  is  alluvial  in  character.  It  is  there  that  we  see  the  sallow 
cheek,  the  yellow  tinged  conjunctiva,  enlarged  spleen,  anasarca, 
etc.,  among  the  poor  and  indolent  inhabitants  who  have  emigra- 
ted there  to  subsist  upon  the  game  of  the  forest,  and  the  fish  of 
the  creeks  and  rivers.  The  intensity  and  frequency  depends 
greatly  upon  the  overflowing  of  the  rivers,  creeks,  etc.,  and 
uniform  heat  or  temperature  of  the  season,  thus  producing  great 
and  rapid  decomposition  of  the  vegetable  matter,  the  prolific 
source  of  the  disease. 

It  prevails  to  a  great  extent  in  the  counties  of  Hopkins,  Chris- 
tian and  Caldwell,  Kentucky,  and  in  the  vicinity  of  Charleston, 
in  midsummer  and  in  the  latter  part  of  autumn  and  spring.     This 


1858.]  Fevers— their  Identity  and  Treatment. 

fever  prevails  in  almost  every  river  valley  in  the  west,  in  the 
savannahs  of  the  south,  and  in  the  marshes  and  flats  of  the  north- 
eastern States.  The  disease  becomes  less  prevalent  as  the  lands 
become  cleared  and  cultivated  by  the  agriculturist,  which  brings 
to  mind  an  old  maxim,  that  when  the  cause  shall  be  removed  the 
effect  will  cease  to  exist.  A  certain  amount  of  virus  or  malaria 
seems  necessarv  to  produce  intermittent  fever,  but  a  greater 
amount  produces  fevers  of  a  greater  malignancy  and  of  greater 
duration,  though  similar  in  character. 

The  high  lands  contiguous  to  these  regions  or  localities,  where 
intermittent  fevers  is  so  prevalent,  are  by  no  means  secure  or 
exempt  from  this  disease,  though  it  prevails  to  a  less  extent  and 
is  milder  than  in  the  low  lands,  and  is  often  contracted  in  the  low 
lands,  or  the  malaria  is  carried  through  the  medium  of  the  atmos- 
phere. 

Remittent  fever  arises  under  the  same  circumstances,  and  in 
the  same  localities,  seasons,  etc.,  only  requiring  perhaps  a  greater 
amount  of  malaria  or  heat. 

The  isthmus  and  yellow  fevers  are  confined  to  low  lands, 
marshes  and  swamps,  only  in  climates  of  higher  temperature,  and 
are  seldom  found  in  the  uplands  or  in  the  mountainous  districts. 

Typhoid,  typhus,  bilious  fevers,  etc.,  we  think,  from  deductions 
made  from  close  observation,  practice  and  study,  are  produced  by 
the  same  vegetable  poisons  in  the  same  localities,  though  at  differ- 
ent seasons  of  the  year,  or  in  climates  of  a  higher  temperature. 
They  are  the  most  prevalent  when  we  have  excessively  hot  sum- 
mers, and  when  decomposition  of  vegetable  matter  has  been  very 
great.  When  cold  weather  comes  on  and  the  decomposition  of 
vegetable  matter  is  arrested  by  frosts,  these  fevers  disappear,  and 
genuiue  cases  of  typhoid,  bilious,  or  typhus  fever  are  but  seldom 
seen  unless  the  disease  has  been  contracted  during  the  autumn. 
They  are  very  uncommon  in  high  latitudes  where  the  tempera- 
ture is  low,  or  in  a  dry,  upland  country.  Therefore  from  the  best 
knowledge  on  the  causation  of  these  prevalent  and  important 
diseases,  we  are  bound  to  come  to  the  conclusion  that  they  have 
identical  can 

Some  other  forms  of  fever  remain  unnoticed,  but  we  will  not 
examine  into  the  causation  of  any  more  in  this  article,  but  will 
now  show  the  great  similarity  of  the  initiatory  or  incipient  symp- 
toms of  the  general  or  prevalent   fevers  of  the  United  States. 

Taking  intermittent  and  remittent  fevers  as  the  type  of  all  the 
miasmatic  fevers,  we  will  first  give  a  meagre  description  of  their 
invasion,  phenomena  and  course.  These  fevers  are  mostlv  pre- 
ceded by  general  lassitude,  cephalalgia,  soreness  of  the  muscles, 
vning,  articular  pains,  etc.,  etc..  and  frequently  by  some  un- 
pleasant enteric  and  hepatic  symptoms,  the  tongue  coated  with  a 
whitish  yellow  fur.     All  of  these  are  ushered  in  by  a  chill,  followed 


830  Fevers — their  Identity  and  Treatment.     [December, 

byTever,  some  cerebral  disturbance  or  congestion.  Now  up  to 
this  stage  of  these  diseases,  there  is  but  little  or  no  difference 
between  intermittent  and  remittent  fevers  ;  this  difference,  should 
it  exist,  is  only  in  degree.  Intermittent  fever  has  three  distinct 
stages,  its  chill,  fever,  and  the  stage  of  perspiration  ;  these  are  suc- 
ceeded by  a  marked  intermission  of  duration  proportionate  to  the 
severity  of  the  attack  and  the  type,  whether  quotidian,  tertian, 
quartan,  etc.  But  remittent  fever  does  not  present  that  perfect 
intermission  as  in  intermittent  fever,  but  often  presents  remissions 
of  greater  or  less  duration,  according  to  the  nature  and  malignan- 
cy of  the  case,  and  often  runs  into  typhoid  fever,  unless  skilfully 
treated,  thus  showing  the  identity  between  these  diseases,  or  as 
is  sometimes  the  case,  it  runs  into  intermittent  fever.  The  simi- 
larity between  intermittent  and  remittent  fever  is  very  striking, 
nevertheless  easily  distinguished  by  the  practitioner,  and  the  indi- 
cations of  these  two  fevers  are  such  as  to  require  almostjbe  same 
treatment. 

Bilious  and  yellow  fevers  have  almost  the  same  incipient  symp- 
toms as  the  two  fevers  just  described,  only  differing  in  the 
severity  of  their  attack  and  character.  These  fevers  are  similar 
and  analogous,  the  latter  only  differing  in  its  great  malignancy, 
and  requiring  a  much  higher  temperature  for  its  developement ; 
both  of  which  have  great  hepatic  derangement,  pathognomonic  of 
these  affections,  the  viscus  of  the  liver  being  more  powerfully 
affected  than  all  others ;  the  whole  secret  of  success  in  the  treat- 
ment of  these  diseases  consist  in  addressing  remedies  to  that  organ, 
and  eliminating  its  poison  or  malaria  in  the  system  by  the  same 
medical  or  therapeutical  agents  as  in  intermittent  and  remittent 
fevers. 

We  now  come  to  typhoid  and  typhus  fevers,  almost  entirely 
analogous  or  similar  in  character,  incipiency,  stages,  duration,  etc., 
and  often  a  diagnosis  is  perplexing  to  the  most  scientific  physician, 
nor  can  it  be  made  with  great  certainty  until  the  disease  has  made 
considerable  progress.  As  in  remittent  fever  there  are  often  re- 
missions, though  imperfect.  They  are  ushered  in  by  a  chill  fre- 
quently, headache,  lassitude,  pains  in  the  back,  diarrhoea,  or  con- 
stipation, biliary  derangements  and  delirium,  though  this  last  symp- 
tom seldom  presents  itself  until  the  second  stage.  So  we  find  the 
phenomena,  the  invasions,  all  the  general  symptoms  of  these  two 
fevers  to  be  analogous  or  identical,  doubtless  produced  by  the  same 
cause  but  under  somewhat  dissimilar  circumstances ;  hence  the 
propriety  of  giving  them  different  names  in  our  text  books. 

From  this  hasty  view  and  imperfect  investigation  of  the  causa- 
tion of  fevers,  we  arrive  at  a  very  correct  or  at  best,  plausible 
conclusion,  that  the  difference  in  malignancy,  forms,  duration  etc., 
thereof,  is  caused  by  tbe  different  amount  of  malaria  introduced 
into  the  blood,  the  climate,  idosyncrasy,  previous  organic  derange- 


1858.]  Observations  of  Temperature  in  Patients.  831 

merits,  or  pathological  conditions,  and  circumstances  undei  which 
they  present  themselves. 

>w  the  inference  or  deduction  is  natural,  philosophical  and 
plausible,  that  fevers  have  the  same  existing,  identical  cause,  if  it 
be  admitted  that  what  we  have  stated  is  true  relative  to  the  locali- 
ty, temperature,  climate  and  circumstance  under  which  they 
originate.  Moreover  it  seems  equally  plausible  to  admit  the 
identity  of  fevers,  should  there  exist  the  great  similarity  in  the 
initiatory  symptoms,  exacerbations  or  paroxysms,  and  course,  con- 
comitant to  the  progress  and  termination  of  these  diseases,  des- 
cribed in  this  article.  We  think  that  the  contagiousness  of  yellow 
and  typhus  fevers  can  be  satisfactorily  explained,  upon  the  prin- 
ciple of  a  vast  amount  of  miasm  or  malaria  in  the  vascular  system, 
to  such  a  degree  that  it  is  given  out,  emitted  or  exhaled  by  the 
lungs,  or  excretory  ducts  of  the  cutaneous  system,  etc.,  so  that  the 
poison  may  be  imbibed  or  received  by  the  nurse  or  occupants  of 
the  sick  chamber  from  the  victims  of  these  malignant  and  alarm- 
ingly fatal  diseases,  especially  the  former,  yellow  fever.  In  our 
next  article  we  will  present  the  identity  of  the  treatment  of  fevers. 
Especial  attention  will  be  given  to  the  treatment  of  typhoid  fever, 
the  writer  believing  and  knowing  that  it  can  be  arrested  and 
greatly  shortened  in  its  course,  having  never  lost  a  case  of  this 
dangerous  malady,  or  any  other  fever,  though  never  having 
treated  a  case  of  yellow  fever. — [Xashville  Med.  and  Surg.  Jour. 


On  the  Observations  of  Temperature  in  Patients.     By  Prof.  C.  A, 
Wuxderlich  and  Dr.  L.  Meyer. 

Already  during  the  last  century  several  eminent  physicians 
endeavored  to  ascertain  the  temperature  of  the  body  in  different 
diseases.  These  efforts,  however,  were  soon  abandoned  again, 
and  only  quite  recently  the  thermometric  observations  in  pa- 
tients have  again  received  that  attention  which  they  so  much 
deserve.  Prof.  Wunderlich  has,  in  this  respect,  a  rich  experi- 
ence at  his  command ;  accurate  thermometric  observations  were 
regularly  made  in  his  clinic  in  more  than  5000  patients  during 
the  whole  course  of  their  sickness,  and  also  in  private  practice 
he  has  conviuced  himself  of  the  practicability  and  usefulness  of 
this  means  of  investigation.  He  considers  himself  justified, 
therefore,  to  pronounce  the  view  so  generally  taken,  and  recent- 
ly advanced  again  by  Lasegne,  (Arch.  Genrr.,  May,  1856.)  that 
thermometric  investigations  would  never  become  very  import- 
ant to  pathology,  as  perfectly  erroneous.  It  is  true,  that  for  the 
theory  of  diseases  these  observations  of  temperature  have  re- 
mained as  yet  without  direct  use,  and  that  they  do  not  throw 
much  light  at  present  upon  the  nature  of  fever,  inflammation, 


832  Observations  of  Temperature  in  Patients.    [December, 

etc.,  but  also  in  reference  to  theory  they  have  afforded  facts 
which  are  of  great  consequence  for  many  important  questions 
in  relation  to  pathological  physiology.  Of  far  greater  import- 
ance, however,  are  they  in  a  practical  point ;  Prof.  Wunderlich 
considers  them  even  of  more  value  than  most  of  the  other  means 
of  investigation,  provided  that  also  in  local  diseases  the  part 
taken  by  the  whole  organism  is  considered  of  sufficient  mo- 
ment. As  proof  of  his  statement,  the  author  gives  the  following 
facts: — 

1.  The  observation  of  temperature  offers  the  most  reliable 
means  for  deciding  the  importance  of  a  disease  of  recent  origin  ; 
with  normal,  or  but  little  elevated  temperature,  the  disturbances 
of  health  are,  with  some  exceptions,  (cholera,  apoplexy,  pulmo- 
nary hemorrhage,  strangulated  hernia,  poisoning,  etc.,)  first  of 
all  of  no  importance;  an  elevation  of  2°  E.  or  more,  announces, 
however,  with  certainty,  the  commencement  of  a  serious  disor- 
der. This  circumstance  is  a  valuable  guide,  particularly  in  cases 
of  children,  in  which,  as  is  well  known,  an  insignificant  disease 
is  frequently  accompanied  by  violent  symptoms,  as  also  in  re- 
ference to  the  continuation  of  the  patient's  business,  to  his  de- 
parture, or  transport,  etc. 

2.  The  observation  of  temperature  points  out  frequently 
important,  though  still  latent  disturbances ;  an  indisposition  with 
much  elevated  temperature  deserves  always  particular  attention  ; 
in  the  state  of  reconvalescence  from  serious  diseases  a  relapse,  or 
a  secondary  disease,  is  frequently  indicated  first  by  an  elevation 
of  temperature.  This  is  particularly  the  case  in  typhus ;  but 
also  in  intermittent  fever  an  elevation  of  temperature  without 
any  other  symptoms  is  frequently  observed  after  an  apparent 
cure,  and  a  relapse  can  then  only  be  prevented  by  continuing 
the  use  of  quinine. 

3.  If  the  disease  is  developed  the  observation  of  temperature 
offers  the  most  reliable  indications  for  the  diagnosis.  Diseases  in 
which  the  diagnosis  of  particular  forms  of  the  same  or  other  of 
pathological  processes  can  be  decided  in  this  manner  are,  ac- 
cording to  Prof.  Wunderlich,  the  following: — typhus,  (exanthe- 
matic;  enteric;)  intermittent  fever:  pneumonia;  meningitis,  (at 
the  base;  at  the  convexity ;)  serous  and  purulent  effusions  in 
the  pleura  or  pericardium ;  acute  exanthemata  ;  internal  suppu- 
rations; peritonitis,  (in  lying-in  women.) 

4.  The  diagnosis  being  decided,  thermometrical  observations 
are  of  the  greatest  use  in  reference  to  the  prognosis.  Intensity 
and  character  of  the  disease,  its  stage  the  commencement  of  a 
complication  which  is  often  not  indicated  by  any  symptom,  the 
usual  aggravation  and  increase  of  the  malady,  as  well  as  its  de- 
crease, can  be  recognized,  as  the  author  proves  by  many  exam- 


Observations  of  Temperature  in  Patients.  833 

pies,  the  earliest  and  surest,  sometimes  even  solely  by  the 
behavior  of  the  temperature  of  the  body.  A  certain  height  of 
temperature  (about  34°  R.)  indicates,  with  certainty,  a  fatal 
issue:  perse veringly  high  temperature  (over  32 '5°)  makes  the 
prognosis  always  more  serious;  a  falling  of  temperature  in  a 
proper  manner,  however,  permits  predicting  a  favorable  turn  of 
the  disease.  In  the  state  of  convalescence  changes  of  the  tem- 
perature of  the  body  deserve  no  less  consideration  as  a  means 
by  which  to  recognize  deviations  from  health,  otherwise  hardly 
perceptible.  Insufficient  falling  of  temperature  indicates,  in 
spite  of  apparent  convalescence,  an  incomplete  cure,  and  gives 
reason  for  fearing  the  development  of  a  chronic  disorder;  even 
a  small  increase  of  temperature  challenges  precaution  in  regard 
to  diet  and  regimen  of  the  convalescent. 

5.  Another  great  advantage  derived  from  thermometric  ob- 
servations is  the  proof  of  a  regular  typic  course  of  numerous  febrile 
diseases;  it  is  true  that  physicians  of  a  former  period  supposed 
it  to  exist,  but  it  cannot  be  demonstrated  -with  certainty  but  by 
accurate  observations  of  the  changes  of  temperature  of  the  body. 
In  the  same  way  deviations  from  this  regular  typic  course  are 
best  recognized  by  the  use  of  the  thermometer,  and  we  are  thus 
enabled  to  avert  them  by  removing  the  causes,  to  neutralize 
their  consequences,  or  also,  as  many  of  such  irregularities  are  of 
a  more  favorable  character  than  the  normal  course  of  the  dis- 
ease, to  bring  them  on  by  therapeutical  means. 

6.  From  what  has  been  said,  the  importance  of  thermometric 
observations  for  therapeutics  is  evident  enough;  they  indicate 
where  energetic  interference  is  necessary,  and  when  the  disease 
may  be  left  to  itself  again.  The  thermometer  gives  us,  however, 
also  reliable  and  accurate  information  in  regard  to  the  efficacy 
of  certain  remedies  and  methods  of  treatment  used  ;  for  instance, 
on  the  effect  of  general  bleeding,  of  calomel,  digitalis,  camphor, 
an  emetic,  and  other  energetic  means  in  febrile  diseases.  The 
observations  of  temperature  have,  as  the  author  shows,  so  great 
a  value  for  therapeutics,  particularly  for  the  reason  that  the  in- 
dications for  treatment  have  more  frequently  to  be  derived  from 
the  general  condition  of  the  patient  than  from  so-called  local 
disturbances  which  usually  disappear  spontaneously,  and  in 
which  direct  interference  is  not  of  much  benefit. — [Arch.f.  Phys. 
Heilk.,  and  North  American  Med.  Chir.  Rev. 

Dr.  Meyer  considers  observations  of  temperature  in  insane 
patients  of  very  great  use,  as  they  aid  the  physician  in  determin- 
ing whether  there  exists  a  direct  disease  of  the  brain,  or  whether 
the  latter  is  affected  merely  by  reflex  action  from  another  organ. 
In  the  former  case  a  corresponding  change  of  temperature  is  ob- 


834  Normal  Course  of  Certain  Typical  Diseases.  [December, 

served ;  if  the  delirium  is  accompanied  by  elevation  of  tempera- 
ture without  remission,  a  direct  irritation  of  the  brain  exists. 
In  reflex  alienations,  however,  this  change  of  temperature  does 
not  take  place;  if  the  temperature  rises  in  these  cases,  it  indi- 
cates the  occurrence  of  a  complicating  disease.  These  statements, 
the  importance  of  which  for  the  prognosis  and  therapeutics  of 
mental  diseases  is  very  evident,  the  author  proves  by  a  con- 
densed report  of  numerous  cases,  (mania,  progressive  paralysis.) 
As  the  peculiar  character  of  insane  patients  does  not  permit  a 
long  continuance  of  the  usual  mode  of  observation — viz.,  by 
placing  the  thermometer  in  the  axilla,  he  prefers  to  insert  it  into 
the  rectum. — [Deutsche  Klinih.,  1858 ;  Schmidt's  Jahrbuch.  1858, 
and  Ibid. 


On  the  Normal   Course  of  Certain  Typical  Diseases.     By  C.  A. 

WUNDERLICH. 

Professor  Wunderlich  considers  the  thermometer  (applied  to 
the  oral  cavit}',  the  armpit,  or  rectum)  as  the  best  means  of  de- 
termining the  type  of  a  disease,  because  its  indications  are  but 
little  liable  to  be  influenced  by  accidental  circumstances;  thus, 
the  character  of  the  pulse,  though  presenting  considerable  uni- 
formity in  different  morbid  states,  varies  too  much,  and  is  too 
dependent  upon  accidental  circumstances,  to  allow  of  our  using 
it  for  the  purpose  of  establishing  the  types  of  disease  by  its  aid. 
The  author  has  not  been  able  to  determine  any  definite  laws 
regarding  some  acute  diseases — as  acute  articular  rheumatism, 
peritonitis,  pleurisy,  and  pyaemia,  nor  for  chronic  diseases  gen- 
erally ;  but  he  has  found  that  febrile  affections  run  a  definite 
typical  course,  which  may  be  represented  by  the  curves  obtain- 
ed by  connecting  the  daily  fluctuations  of  temperature;  But 
even  in  these  typical  forms  of  disease  variations  occur,  which 
depend  upon  the  bearing  of  the  individual,  and  upon  influences 
to  which  he  is  subjected.  But  there  are  certain  influences  which 
are  so  uniform  in  their  effect  that  this  amounts  to  a  law,  and 
thus  a  new  type  is  established;  this  is  the  case  with  regard  to 
vaccination  in  its  influence  upon  variola,  venesection  upon  the 
course  of  pneumonia,  or  calomel  upon  typhoid  fever.  This 
knowledge  of  the  typical  course  of  a  disease  has  a  practical  va- 
lue, inasmuch  as  the  diagnosis  may  be  established  by  looking  at 
the  curve ;  the  deviations  from  the  normal  condition  are  recog- 
nized, and  the  exacerbations,  as  well  as  the  commencement  of 
oure,  are  rendered  visible.  Moreover,  when  the  typical  course 
of  a  disease  has  been  demonstrated,  a  look  at  the  curve  will  pro- 
tect from  all  illusions  regarding  our  therapeutic  achievements, 
while  it  affords  a  safe  means  of  judging  of  really  beneficial 


1858.]  Theory  of  the  Production  of  Hernia.  835 

effects  produced  by  remedial  agents;  the  unusual  reductions  or 
diminutions  of  the  course  being  shown  irrefragably  in  the  alter- 
ed curve.  Professor  Wunderlich  passes  successively  in  review 
his  observations  on  the  following  diseases  : — Ephemeral  fevers, 
which  he  does  well  in  restoring  to  nosology ;  quotidian,  tertian, 
and  quartan  agues ;  measles ;  erysipelas ;  scarlet  fever ;  variola ; 
typhoid  and  typhus  fever ;  and  several  forms  of  pneumonia. 
"Without  reproducing  the  curves  themselves,  which  give  an 
ocular  demonstration  of  the  rising  and  falling  of  the  thermome- 
ter in  the  various  diseases  mentioned,  it  would  be  futile  to  at- 
tempt giving  the  details  of  Professor  Wunderlich's  elaborate  and 
valuable  paper.  The  following  general  remarks  will  further 
indicate  the  kind  of  results  which  he  has  arrived  at  by  this  me- 
thod of  investigating  disease.  In  some  forms,  the  mode  in  which 
the  disease  commences  is  characteristic ;  the  increase  of  tempera- 
ture may  be  very  rapid  or  slow,  the  maximum  being  reached  in 
a  definite  period,  or  there  may  be  a  uniform  rate  of  increase. 
The  period  in  which  the  fever  arrives  at  its  full  development 
affords  numerous  important  points;  the  absolute  elevation  of 
temperature  is  determined  in  part  by  the  special  form  of  disease ; 
on  the  other  hand,  it  indicates  its  degree.  The  duration  of  the 
maximum  point  is  even  of  more  consequence  than  the  absolute 
maximum,  and  the  larger  or  less  variation  between  morning 
and  evening,  and  the  number  of  days  on  which  the  tempera- 
ture retains  nearly  the  same  elevation,  are  also  points  of  import- 
ance. The  duration  of  maximum  elevation  varies  somewhat, 
but  its  duration  must  be  regarded  in  the  main  as  forming  a 
characteristic  feature  of  the  individual  type.  In  some  diseases 
definite  fluctuations  occur  during  this  period.  The  termination 
of  the  process,  and  the  return  to  the  normal  condition,  which 
the  author  terms  defervescence,  exhibit  a  very  regular  type, 
which  is  characteristic  for  every  form  of  disease ;  the  phenomena 
of  defervescence  are  even  more  precise  than  those  of  the  com- 
mencement and  elevation  of  the  morbid  process,  and  serve  still 
better  to  mark  the  nature  of  the  disease. — [Archiv.  fiir  Physiolog. 
Eeilkunde.  and  Brit,  and  For.  Med.  Chir.  Rev. 


On  the  Theory  of  the  Production  of  Hernia.     By  Professor  Eoser. 

The  views  here  advanced  have  already  been  published  by  Pro- 
fessor Eoser,  seventeen  years  since;  but  as  they  have  not  exci- 
ted the  attention  he  believes  they  deserve,  he  reproduces  them 
with  the  advantage  of  being  able  to  add,  that  all  subsequent  in- 
vestigation during  so  long  a  period  of  an  active  career,  has  only 
confirmed  his  conviction  of  their  truth. 

Debating  with  a  celebrated  professor  of  surgery,  he  declared 

n.s. — VOL.  XIV.  NO.  XII.  49 


836  Theory  of  the  Production  of  Hernia.      [December, 

that  a  sudden  production  of  hernia  was  impossible,  according 
to  the  laws  of  mechanics.  The  professor  maintained  the  possi- 
bility inasmuch  as  he  had  examined  persons  who  had  shown  no 
signs  of  hernia,  and  yet,  after  violent  exertion,  its  presence  had 
become  manifest.  This,  Koser  regards  not  as  observation,  but 
as  a  post-hoc  conclusion.  It  is  well  known  how  difficult  (or 
when  small,  impossible)  it  is  to  detect  an  empty  hernia  sac.  We 
only  recognise  it  when  the  intestine  has  entered  it,  and  we  can 
feel  the  impulse  on  coughing,  &c ;  but  when  such  entrance  is 
prevented  by  various  circumstances,  the  most  we  can  say  is,  not 
that  no  hernial  sac,  but  that  no  hernia,  is  present.  Why  is  it 
not  possible,  as  Scarpa  and  Cloquet  have  shown,  to  produce  a 
hernial  sac  on  the  dead  body  by  the  use  of  violent  compressing 
power,  aided  by  apertures  made  in  the  tendinous  walls  of  the 
abdomen  ?  First,  because  the  peritoneum  is  not  sufficiently 
elastic  to  bear  the  necessary  extension ;  and,  secondly,  because 
compression  of  the  soft  and  fluid  contents  of  the  abdomen  acts 
by  hydrostatic  law;  and  although  the  peritoneum  may  be 
stretched,  it  is  not  thrust  out  as  it  is  found  to  be  in  hernia,  and 
as  it  may  be  to  some  extent  by  the  finger  locally  applied. 

Professor  Koser  advances  these  two  propositions,  that  femoral 
hernia  arises  from  the  dragging  out  (Herauszerrung)  of  the  peri- 
toneum, and  that  external  inguinal  hernia,  or  more  properly  its 
sac,  is  almost  always  congenital.  First,  with  respect  to  femoral 
hernia,  the  dragging  out  of  the  peritoneum  is  brought  about  by 
nodules  of  fat,  which,  appertaining  to  the  subserious  tissue,  are 
firmly  attached  to  the  peritoneum.  These  nodules  slide  between 
the  fibres  of  the  septum  crurale,  thrust  them  asunder,  and  lead  to 
their  disappearance.  The  anterior  part  of  a  nodule  passes  out 
under  the  plica,  covered  only  by  fascia  superficial,  and  increases 
in  size.  Its  movements  are  favored  by  its  pyriform  shape,  and 
by  the  motions  of  the  body,  and  the  peritoneum  following 
it,  a  sack  is  gradually  formed.  In  all  the  instances  of  commen- 
cing hernia  the  author  has  had  the  opportunity  of  examining, 
'  he  has  found  such  fatty  nodule  at  the  apex  of  the  sac.  We  can- 
not expect  to  find  this  in  old  or  large  hernias,  as  it  would  disap- 
pear under  pressure.  Professor  Linhart,  of  Wiirzburg,  the  only 
anatomist  who  has  of  late  years  investigated  the  subject  of  her- 
nia, has  confirmed  these  views,  stating  that  he  believes  that  trac- 
tion exerted  on  the  peritoneum  exerts  far  more  influence  in  the 
formation  of  hernia  than  the  pressure  exerted  by  the  contents 
of  the  abdomen. 

External  Inguinal  Hernia.— The  valvular  character  and  oblique 
course  of  the  inguinal  canal,  should  have  formed  a  sufficient 
reason  for  rejecting  the  ordinary  theory  of  the  formation  of  this 
hernia.     All  subsequent  investigation  has  convinced  Professor 


1858.]  TTieory  of  the  Production  of  Hernia. 


Koser  that  his  statement  made  long  ago,  that  this  hernia  is 
almost  always  congenital,  is  correct.  He  has  found  that  the  her- 
nia vaginalis  funiculi — i.  e.,  an  open  state  of  the  upper  part  of 
the  vaginal  process — occurs  much  oftener  than  is  supposed.  It 
has  been  found  in  almost  all  the  children  the  subjects  of  inguinal 
hernia,  whom  he  has  examined  ;  and  he  has  frequently  met  in 
adults  hernial  sacs  so  long  and  narrow,  that  they  could  only  be 
regarded  as  incompletely-developed  vaginal  processes  of  the 
peritoneum,  into  which  intestine  had  not  passed.  He  has  also 
found  the  anatomical  signs,  detailed  in  his  former  treatise,  ex- 
hibiting the  congenital  nature  of  the  affection.  Other  co-existing 
anomalies  of  the  peritoneal  formation  are  often  met  with.  Beside 
the  descent  of  the  testis,  there  is  a  descent  of  the  ccecum  and 
sigmoid  flexure,  and  disturbances  of  these  often  occur  at  the 
same  time.  As  the  author  has  feund  in  almost  all  the  outer 
inguinal  hernias  he  has  examined,  such  grounds  for  considering 
them  congenital,  he  has  come  to  the  conclusion  that  the  bulk  of 
cases  regarded  as  accidental  do  not  merit  the  appellation,  inas- 
much as  the  sac  has  been  in  existence  prior  to  birth.  He  refers 
in  confirmation  of  his  views  to  Camper's  statement,  that  of  63 
full-timed  children  in  whom  the  testis  had  descended,  the  vagi- 
nal canal  was  obliterated  only  in  7,  it  being  open  on  both  sides 
in  34,  on  the  right  side  only  in  14,  and  on  the  left  side  in  8.  So 
likewise  Professor  Engel,  whose  investigations  are  now  publish- 
ed in  the  '  Wien  Wochenschrift,'  states  that  in  children  at  birth, 
or  during  the  first  fourteen  days  afterwards  the  vaginal  canal 
is  found  oftener  obliterated,  or  at  least  considerably  shorter,  on 
the  left  than  on  the  right  side — a  fact  agreeing  with  the  prepon- 
derance of  hernia  on  the  right  side.  He  found  the  canal  entire- 
ly closed  at  birth  in  ten  per  cent.  After  fourteen  days  no  trace 
of  it  could  be  found  on  the  left  side  in  30  per  cent.,  while  it  re- 
mained open  on  both  sides  at  the  end  of  fourteen  days  in  69  per 
cent.  In  the  adult  the  presence  or  the  remains  of  the  vaginal 
canal  was  observed  in  31  per  cent,  of  the  bodies  examined,  on 
both  sides  in  37*5  of  these,  and  on  the  right  side  alone  in  62*5. 

Outer  Inguinal  Hernia  in  the  Female. — The  author  long  since 
proposed  the  question  to  Professor  Meyer  of  Zurich,  whether 
woman  were  not  liable  to  a  similar  descent  of  the  peritoneum 
as  men  ;  and  that  writer,  in  a  paper  in  Muller's  '  Archiv,'  has 
shown  that  in  the  female  as  well  as  the  male  foetus,  a  projection 
of  the  peritoneum  into  the  inguinal  canal  does  not  take  place. 
Its  metamorphosis,  however,  occurs  much  earlier,  as  soon  as  the 
fifth  month ;  and  it  is  also  less  considerable,  and  therefore  less 
liable  to  disturbance  than  in  the  male  sex. 

Internal  Inguinal  Hernia. — This,  Professor  Roser  observes, 
may,  in  some  cases,  have  a  fatty  origin,  like  femoral  hernia ; 


838  Apparent  Death  during  Intermittent  Fever.   [December, 

but  he  believes  that  other  cases  arise  from  a  local  protrusion  of 
the  peritoneum,  in  aged  and  relaxed  subjects,  in  whom  partial 
atrophy  of  the  fascia  transversalis  has  taken  place.  This  is  a 
very  different  thing,  however,  to  the  sudden  production  of  her- 
nia usually  admitted.  He  believes  with  respect  to  internal  in- 
guinal hernia,  that  the  fact  that  it  occurs  almost  exclusively  in 
aged  men  is  not  generally  known.  It  takes  place  indeed  much 
oftener  than  most  authors  admit ;  and  may  be  almost  said  to  be 
as  frequent  in  old  men  as  femoral  hernia  is  in  old  women.  The 
much  greater  narrowness  of  the  ring  is  the  reason  it  does  not 
occur  often  in  old  women. 

Umbilical  Hernia. — This  is  the  only  hernia  which  is  produced 
according  to  the  old  theory,  viz.,  by  a  vis  a  tergo,  and  even  here 
the  author  suspects  that  in  some  cases  it  may  arise  from  a  con- 
genital protrusion  of  the  peritoneum,  remaining  from  the  foetal 
state.  As  this  hernia  differs  in  the  mechanism  of  its  formation 
from  other  kinds  of  hernia,  so  does  it  in  the  remarkable  fact  of 
its  being  generally  spontaneously  curable,  as  may  be  seen  from 
the  small  number  of  cases  met  with  in  the  adult,  compared  with 
the  large  number  occurring  in  infancy.  In  aged  and  fat  indi- 
viduals, accidental  hernia  of  this  form  is,  however,  frequent. 

Originally  commencing  his  investigation  with  a  purely  scien- 
tific object,  Professor  Eoser  has  since  found  that  it  has  an  appli- 
cation to  legal  medicine,  the  question  not  unfrequently  arising, 
whether  a  hernia  has  been  produced  in  consequence  of  acts  of 
violence  in  scuffles,  assaults,  &c,  and  the  culprit  risking  to  be  dealt 
with  too  harshly  in  consequence  of  the  off-hand  way  in  which  the 
affirmative  is  pronounced. — [Arch. filr  Physiol.  Heilk.}  and  Ibid. 


Case  of  Apparent  Death  during  a  Paroxysm  of  Intermittent  Fever. 
By  Professor  Fkanqois. 

In  the  midst  of  an  epidemic  of  intermittent  fever  which  pre- 
vailed at  Mons  in  1822,  Professor  Francois  was  sent  for  to  a 
lady,  aged  40,  who  had  a  slight  attack,  which  was  soon  relieved. 
Two  days  after,  he  was  suddenly  informed  she  was  in  a  dying 
state.  She  had  been  seized  with  a  new  paroxysm,  #  and  after  a 
little  shivering  and  yawning,  became  almost  immediately  insen- 
sible. He  could  find  no  pulse ;  the  pupils  were  insensible  to  the 
action  of  bright  light ;  the  whole  surface  was  cold,  pale  and  dry, 
and  respiration  was  suspended  to  such  an  extent  that  a  mirror 
placed  before  the  mouth  remained  untarnished,  and  the  flame 
of  a  candle  undisturbed,  while  the  ear  applied  to  the  region  of 
the  heart  could  not  perceive  the  slightest  sound,  or  impulse. 
Every  kind  of  stimulus  was  applied  in  vain,  and  she  had  so 
completely  the  appearance  of  a  corpse  that  her  burial  was  alrea- 


1858.]         New  mode  of  treating  Purulent  Ophthalmia.  839 

dy  spoken  of.  Although  this  state  had  continued  nearly  an 
hour,  M.  Francois  prohibited  any  such  step  being  taken,  believ- 
ing it  possible  that  he  had  to  do  with  a  case  of  pernicious  inter- 
mittent, in  which  the  vital  process  might  be  merely  suspended, 
not  extinguished.  Stimuli,  in  the  shape  of  frictions  and  glys- 
ters,  were  therefore  resorted  to ;  but  it  was  not  until  about  four 
hours  afterwards  that  a  little  moisture  was  observed  on  the  fore- 
head. Sinapisms  and  hot  applications  were  again  resorted  to, 
and  shortly  afterwards  some  slight  pulsations  of  the  heart  and 
respiratory  movements  were  observed,,  followed  by  a  return  of 
the  pulse  and  complete  restoration.  Quinine  was  administered 
in  abundant  quantities  as  soon  as  possible.  On  the  second  day 
after  this  another  alarming  paroxysm  occurred,  but  this  was  the 
last,  and  the  cure  remained  assured.  The  lady  lived  for  many 
years  afterwards.  It  is  a  curious  fact  that  her  husband,  a  fort- 
night afterwards,  suffered  from  an  attack  of  pernicious  fever  of 
the  same  nature,  but  less  in  degree.  This  case,  in  which  the 
pulsation  of  the  heart  could  not  be  perceived  during  several 
hours,  forcibly  shows  the  danger  of  the  rule  laid  down  by  M. 
Bouchut,  that  such  complete  suspension  is  a  sign  sufficiently 
certain  ta  allow  of  interment  being  safely  undertaken. 

[Presse  Medicate  Beige,  and  Virginia  Med.  Jour. 


A  New  Mode  of  Treating  Purulent  Ophthalmia.   By  M.  De  Coxde. 

M.  De  Conde,  a  Belgian  military  surgeon,  dissatisfied  with  the 
present  treatment  of  this  disease,  which  seems  to  be  very  preva- 
lent still  in  the  Belgian  army,  lays  down  a  new  plan,  based  upon 
the  following  considerations: 

1.  The  greatest  danger  to  the  eye  arises  from  the  contact  of 
the  upper  lid,  which,  inflamed  and  swollen,  floods  its  surface 
with  an  acrid  and  corrosive  pus.  The  excessive  heat  of  the  eye- 
lid, the  internal  surface  of  which  is  rough  and  unequal,  inter- 
feres with  the  nutrition  of  the  cornea,  while  the  acridity  of  the 
pus  leads  to  its  softening  and  destruction.  2.  It  is  admitted 
that  it  is  of  importance  to  prevent  the  contact  of  inflamed  mu- 
cous membranes  by  the  interposition  of  an  isolating  body,  such 
as  sharpie  or  wadding.  This  is  seen  in  vaginitis,  balanitis,  and 
fissure  of  the  anus.  3.  This  body,  which  may  alone  produce 
great  amelioration,  or  even  in  some  cases  a  removal  of  the  dis- 
ease, may  exert  a  powerful  effect  if  impregnated  with  an  active 
agent.  In  this  way  lint,  soaked  in  a  concentrated  solution  of 
acetate  of  lead,  and  placed  between  the  glans  and  the  prepuce, 
will  cure  gonorrheal  balano-posthitis  within  forty-eight  hours. 
4.  Cod  liver  oil  exercises  a  powerful  action  in  disease  of  the 
mucous  membrane,  modifying  and  then  suppressing  their  secre- 


840      Successful  Operation  on  Children  Born  Blind.  [December, 

tions.  It  strengthens  the  fibrous  tissues  of  the  eye  and  the 
cornea,  and  tends  to  prevent  ramollissement.  It  is  especially  in 
ulceration  and  chronic  ramollissement  of  this  membrane  that 
this  double  action  is  perceived.  5.  The  red  precipitate  oint- 
ment (four  parts  to  fifteen  of  lard  and  fifteen  of  linseed  oil)  is  an 
excellent  substitutive  agent,  sufficing  alone  to  arrest  the  disease 
when  employed  early.  It  is  the  best  remedy  for  cutting  short 
the  ophthalmia  of  new-born  infants.  6.  A  solution  of  the  chlo- 
ride of  lime  (thirty  parts  to  two  hundred  of  water)  is  an  ener- 
getic modifier,  neutralizing  with  certainty  the  virulence  of  the 
secretions.  7.  Lastly,  perchloride  of  iron  exerts  an  instantane- 
ous haemostatic  effect  upon  the  hemorrhagic  mucous  membrane, 
and  an  indubitable  modifying  influence  upon  the  mucous  secre- 
tion. 

As  an  isolating  body,  M.  De  Conde,  after  trying  various  sub- 
stances, gives  the  preference  to  wadding,  as  forming  at  once  an 
inoffensive  application,  capable  of  imbibing  and  favoring  the  flow 
of  the  secretions,  and  of  being  impregnated  with  medicinal 
agents.  A  slip  of  the  wadding  somewhat  longer  than  the  trans- 
verse diameter  of  the  eyelids,  is  brought  opposite  the  palpebral 
aperture,  and  gently  pushed  up  beneath  the  upper  ^elid  by 
means  of  the  little  finger  or  a  large  probe.  Some  cases  are  rela- 
ted as  examples  of  the  manner  in  which  a  disease  often  so 
tedious  in  its  progress,  may,  upon  these  principles,  be  rapidly 
cured. — [Annales  d ]  Oculistique,  &nd  Brit.  &  For.  Med.  Chir.  Rev. 


Six  Cases  of  Successful  Operation  in  one  family,  on  Children  Born 
Blind.    By  Henry  W.  Williams,  M.  D.,  Boston. 

In  February,  1857,  I  visited  a  German  family,  residing  near 
the  southern  boundary  of  the  city,  of  which  five  members,  the 
mother  and  four  children,  were  affected  with  cataract  in  both 
eyes,  evidently  of  congenital  origin. 

The  mother  was  not  aware  of  any  cases  among  her  eight 
brothers  and  sisters,  or  among  her  ancestors.  In  her,  the  lens 
exhibited  in  each  eye  a  disseminated,  dotted  opacity,  the  cloudy 
spots  being  most  numerous  near  the  centre,  while  the  margin  of 
the  lens  was  comparatively  clear.  Consequently,  in  a  bright 
light  she  was  almost  entirely  blind,  but  in  a  moderate  light  saw 
sufficiently  well  to  perform,  in  a  slovenly  manner,  the  house- 
duties  of  a  laborer's  wife.  The  capsule  of  the  lens,  in  her  eyes, 
and  also  in  those  of  the  children,  was  transparent.  Her  hair  and 
irides  were  dark  ;  the  children  had  light  hair  and  a  grey  or  blue 
iris.  She  has  two  other  children,  whose  eyes  as  yet  exhibit  no 
trace  of  cataract.  The  order  of  succession  in  the  cases  was  as 
follows :  The  oldest  girl  had  cataract ;  the  second  child,  a  girl, 


1858.]       Successful  Operation  on  Children  Born  Blind.  841 

was  free  from  the  disease ;  the  third  and  fourth  children,  a  boy 
and  girl,  were  affected ;  the  fifth,  a  girl,  was  free ;  the  sixth  a 
boy,  was  affected. 

The  eyes  of  the  children  presented  nearly  similar  appearances, 
and  one  description  may  answer  for  the  whole.  Nearly  the  en- 
tire field  of  the  pupil  was  occupied  by  opacities,  consisting  of 
dots  of  various  sizes,  and  evidently  occupying  different  planes 
of  the  lens.  In  a  bright  light,  reflections  from  crystals  of  chol- 
esterine  could  be  plainly  seen.  All  the  patients  had  sufficient 
vision  to  enable  them  to  find  their  way  in  a  moderate  light, 
when  the  pupil  was  so  far  expended  as  to  allow  of  vision  through 
the  margin  of  the  lens ;  but  in  a  bright  sunlight  they  were  nearly 
blind,  and  their  sight  was  at  no  time  sufficient  to  enable  them 
to  learn  to  read,  or  to  gain  a  livelihood  by  ordinary  pursuits. 

Six  operations  were  performed,  on  the  afternoon  of  the  5th 
of  February,  on  the  oldest  girl,  aged  about  17,  the  boy  about  12, 
and  girl  about  ten  years.  As  I  believed  the  entire  lens  might 
be  safely  broken  up  in  these  cases,  the  same  method  was  pursued 
in  operating  on  all  the  eyes,  the  lens  and  capsule  being  freely 
divided  by  means  of  a  needle  introduced  through  the  sclerotica. 
Sparkling  reflections  from  crystals  of  cholesterine  were  distinct- 
ly seen  in  the  posterior  chamber,  by  several  physicians  who  were 
present.  The  eyes  were  covered  with  a  dry  compress  and 
bandage,  and  the  pupils  were  kept  well  dilated  by  the  use  of  a 
solution  of  atropia.  The  oldest  girl  had  very  little  pain  or  in- 
jection of  the  eyes,  and  no  nausea.  The  boy  had  considerable 
pain  in  and  around  his  left  eye,  and  some  nausea,  continuing 
for  two  days.  His  right  eye  gave  him  no  pain  whatever.  The 
youngest  girl  had  considerable  pain  in  the  right  eye,  with  in- 
tolerance of  light,  continuing  four  days.  Her  left  eye  gave  her 
no  pain  at  this  time;  but,  the  absorption  of  the  lens  going  on 
slowly,  a  second  operation  was  performed  some  months  after, 
which  caused  some  pain  and  nausea,  but  was  followed  by  imme- 
diate absorption  of  the  residue  of  the  lenticular  substance. 

As  the  size  and  density  of  the  fragments  diminished,  the  ab- 
sorption of  the  lenses  went  on  more  and  more  rapidly ;  but  it 
was  several  months  before  the  pupil  became  perfectly  clear  in  all 
the  six  eyes.  The  children  have  now  perfect  vision,  with  the 
aid  of  the  ordinary  cataract  glasses,  and  they  will  be  able  to  fol- 
low any  occupation  they  may  prefer.  The  mother  and  the  child 
of  two  years  have  not  yet  been  operated  on,  the  mother  being 
timorous  as  regards  her  own  eyes,  even  with  the  brilliant  results 
before  her  obtained  by  the  operations  on  her  children,  and  wish- 
ing to  have  the  little  one  left  undisturbed  till  he  is  older.  There 
is  nothing  in  either  of  their  cases  less  favorable  than  those  which 
have  already  been  relieved. 


842  On  the  Absorption  of  Abscesses.  [December, 

I  have  seen  another  instance,  in  a  family  residing  in  this  State, 
of  no  less  than  seven  cases.  Other  children  in  the  same  family 
were  free  from  the  disease.  Some  of  the  eyes  had  been  operated 
on,  but  I  think  without  much  success,  on  account  of  portions  of 
the  capsule  which  were  left  behind  and  had  become  tough. 
These  might,  however,  be  readily  removed  by  the  small  canula- 
forceps.  Mr.  Streatfeild  also  reports  an  example,  in  the  third 
number  of  the  "Ophthalmic  Hospital  Reports,"  of  six  cases-  of 
double  cataract,  five  children  and  their  mother.  Three  other 
children  exhibited  no  defect  of  vision.  Two  of  this  family  had 
been  operated  on,  with  partial  success.  The  cases  now  reported 
are  interesting  from  the  rare  occurrence  of  such  a  group,  and  the 
rare  occurrence  of  such  a  group,  and  the  still  more  rare  perfor- 
mance of  so  many  operations  at  one  time  in  a  single  family ;  and 
the  results  are  particularly  gratifying,  as  they  have  given  almost 
a  new  existence  to  those,  who,  but  for  the  resources  of  our  art, 
must  have  been  unfortunate  and  helpless  during  their  whole 
lives. — [Boston  Med.  and  Surg.  Journal. 


On  the  Absorption  of  Abscesses. 

M.  Chassaignac  brought  this  subject  recently  under  the  notice 
of  the  Paris  Surgical  Society,  stating  his  belief  that  purulent 
collections  are  never  absorbed,  at  least  the  solid  globular 
portions,  although  the  serum  may  sometimes  be  so  removed. 
Abscesses  said  to  be  so  removed  were  in  fact  non-purulent  col- 
lections or  lymph.  M.  Richard  pointed  out  the  error  of  suppos- 
ing that  pus-globules  were  not  absorbable  because  they  were 
solid,  inasmuch  as  tumours,  effusions  of  blood,  &c,  are  known 
to  undrgo  such  absorption.  It  is  by  no  means  rare  to  find  small 
axillary  or  peri-mammary  abscesses  becoming  absorbed;  ab- 
scesses the  size  of  a  pigeon's  egg,  will  in  chronic  farcy  disappear 
in  twenty-four  hours  ;  and  congestive  abscesses  not  unfrequent- 
ly  heal  without  any  aperture  having  been  made.  M.  Huguier 
thinks  every  one  must  have  seen  examples  of  the  spontane- 
ous disappearance  of  abscesses,  a  by  no  means  rare  circum- 
stance, in  inguinal  bubo.  M.  Yerneuil  referred  to  a  case  that 
came  under  his  care,  in  which  an  undoubted  abscess,  as  large  as 
the  fist,  situated  in  the  middle  of  the  thigh,  entirely  disappeared 
after  three  weeks  local  application  of  iodine.  In  another  case, 
two  abscesses  in  the  axilla  were  opened,  while  two  others,  just 
as  manifestly  fluctuating,  being  left  to  themselves,  were  sponta- 
neously absorbed.  In  a  case  of  hygroma,  M.  Morel-Lavellee 
obtained  a  few  drops  of  fluid  by  means  of  an  exploratory  punc- 
ture. This  was  shown  to  be  pus,  and  the  rest  of  the  fluid  being 
left  in  the  collection,  flying  blisters  were  applied,  and  entire  ab- 


1858.]         Carbonic  Acid  Gas  in  Diseases  of  the  Womb.  843 

sorption  was  induced.  M.  Chassaignac  observed  that  this  was 
the  only  demonstrative  fact  advanced  in  the  discussion,  and  he 
must  wait  for  others  to  be  convinced.  At  present  he  does  not 
believe  that  properly-characterized  abscesses  are  capable  of  ab- 
sorption. Many  cases  are,  it  is  true,  mentioned  by  authors,  but 
with  insufficient  proofs.  Fluctuation  and  other  symptoms  men- 
tioned are  not  sufficiently  rigorous  ones.  Thus,  in  a  case  of  an- 
gioleucitis,  in  which  he  opened  two  collections  apparently  alike, 
one  contained  pus  and  the  other  plastic  lymph ;  and  from  some 
inguiual  bubos  he  has  opened,  he  has  only  removed  such  lymph. 
M.  Broca,  however,  desired  to  know  what  M.  Chassaignac  de- 
signates as  "  collections  of  plastic  lymph ;"  for  if  he  means  those 
masses  of  yellowish  concrete,  semi-solid  matter  found  in  the 
centre  of  commencing  bubos,  M.  Broca  can  assure  him  that  this 
substance,  which  is  susceptible  of  absorption,  contains  an  enor- 
mous quantity  of  pus  globules.  M.  Collerier  declares,  that  since 
he  has  treated  bubos  by  the  method  recommended  by  Dr.  Sirus- 
Pirondi — viz.,  blistering,  followed  by  tincture  of  iodine,  he  has 
obtained  a  cure  by  absorption  of  the  pus  in  nine-tenths  of  his 
cases.  Even  when  the  blister  does  not  succeed,  it  still  exerts  a 
great  influence  upon  the  absorption  of  the  globules ;  and  if  the 
bubo  has  afterwards  to  be  opened,  pus  containing  a  large  pro- 
portion of  serum  is  discharged. — [Gaz.  des  Hojoitaux,  and  British 
and  Foreign  Med.  Chir.  Rev. 


On  Injection  of  Carbonic  Acid  Gas  in  Treatment  of  Diseases  of  the 
Womb,  and  their  Influence  upon  the  System.     By  Dr.  Bereaed. 

The  application  of  carbonic  acid  gas  in  cases  of  painful  uterine 
disease,  as  recommended  by  Drs.  Hardy  and  Simpson,  has  been 
tried  and  found  successful  by  the  author  in  several  instances. 
He  records  eight  cases,  four  of  carcinoma  uteri  far  advanced,  and 
four  of  a  simple  congestive  but  very  painful  character.  In 
almost  all  of  them  the  carbonic  acid  gas  had  an  anaesthetic  in- 
fluence, without  producing  any  alarming  symptoms,  with  the 
exception  of  one  case.  The  mode  of  application  is  very  simple ; 
a  bottle,  the  cork  of  which  is  pierced  by  an  elastic  canula,  is  fill- 
ed with  twenty -five  grammes  of  bi-carbonate  of  soda,  and  twen- 
ty grammes  of  bi-sulphate  of  potash,  with  a  sufficient  quantity 
of  water.  The  development  of  the  gas  begins  immediately, 
which  is  brought  up  to  the  diseased  portion  by  means  of  the 
elastic  tube. 

The  first  case  proves  much  in  favor  of  these  injections.  The 
patient  suffered  from  carcinomatous  ulcerations  of  the  neck, 
with  a  foetid  discharge  and  violent  pains.  After  application  of 
the  gas,  the  pains  not  only  disappeared  entirely,  but  even  the 


844  Operation  in  Obstinate  Vomiting.         [December, 

ulcers  began  to  look  better,  and  the  patient  improved  considera- 
bly in  health,  so  that  she  was  discharged  as  cured  after  two 
months,  because  only  two  or  three  red  excrescences  could  be 
detected  on  the  neck  when  she  left  the  hospital. 

The  second  case  shows  an  old  carcinoma,  with  violent  hemor- 
rhages and  deep  ulcerations  of  the  neck,  while  the  body  of  the 
womb  and  the  neighboring  organs  were  not  affected.  In  this 
instance,  the  gas  only  showed  its  anaesthetic  influence,  having 
no  influence  upon  the  disease  itself. 

In  a  third  case  of  ulcerated  carcinoma,  the  injections  at  first 
stopped  the  discharge,  and  diminished  the  pain  ;  but  afterwards 
symptoms  of  intoxication  were  remarked,  and  when  these  injec- 
tions were  tried  again  after  some  time,  they  had  a  very  bad  in- 
fluence upon  the  disease,  so  that  their  use  had  to  be  discontin- 
ued. 

The  fourth  case  is  one  of  far  advanced  carcinoma,  with 
violent  pains  in  the  lower  part  of  the  abdomen,  which  disappear- 
ed very  rapidly  after  the  first  injections.  The  disease  itself  was 
not  influenced  in  its  course. 

The  fifth  observation  is  one  of  inflammatory  induration  of 
the  neck,  with  violent  pains.  The  gas  had  a  local  quieting  in- 
fluence, but  produced  such  violent  symptoms  of  intoxication, 
that,  its  application  had  to  be  suspended. 

In  the  sixth  case,  which  was  similar  to  the  former  one,  the 
pains  disappeared  very  soon,  and  the  swelling  diminished,  but 
signs  of  intoxication  were  observed  also. 

In  a  seventh  case,  signs  of  absorption  of  the  gas  were  observed, 
but  the  pains  disappeared,  while  the  ulcerations  remained  un- 
changed. The  patient  remained  only  a  short  time  under  treat- 
ment. 

Eighth  case. — Metritis,  engorgement  of  the  neck,  violent  pains, 
against  which  a  great  number  of  remedies  were  applied,  without 
the  least  benefit.     They  disappeared  after  the  first  injections. 

The  anaesthetic  influence  of  the  gas  only  remains  a  short  time, 
therefore  the  injections  have  to  be  repeated  several  times  in  a 
day. — [Archiv.  Generates,  and  New  York  Jour,  of  Medicine. 


Report  of  a  Case  in  which  the  Operation  of  Paracentesis  Thoracis 
was  performed  for  the  relief  of  Obstinate  Vomiting. 

The  particulars  of  the  case,  communicated  to  the  Society, 
through  the  President,  by  Mr.  Heslop,  of  Birmingham  were  as 
follows : — The  patient  was  a  girl  aged  20,  who  had  been  for 
two  months  affected  with  effusions  into  the  left  pleural  cavity. 
Extreme  emaciation,  night  sweats,  etc.,  were  present,  but  in 
addition  to  these,  no  food  of  any  kind  was  retained   by  the 


1858.]  Menstruation  in  Austria.  845 

stomach.  No  relief  followed  ordinary  measures,  and  it  being 
evident  that  the  patient  was  dying  of  inanition,  Mr.  Heslop 
advised  the  performance  of  the  operation.  Two  pints  of  fluid 
were  drawn  off,  and  the  relief  which  followed  was  immediate 
and  complete.  The  patient  rapidly  recovered.  Mr.  Heslop 
added  that,  in  advising  the  performance  of  the  operation,  he  took 
the  same  general  line  of  argument  as  that  pursued  by  the  ac- 
coucheur in  inducing  artificially  premature  labor,  when  the  in- 
terference with  important  functions,  as  that  of  low  stomach,  calls 
for  that  proceeding — [Proc.  of  Path.  Soc.  of  London.. 


Menstruation  in  Austria.     By  Dr.  Fred.  Szukits. 

Of  665  women  born  in  Vienna,  and  menstruating  there  for 
the  first  time,  the  mean  age  for  its  first  appearance  was  fifteen 
years  and  eight  and  a  half  months;  in  210  cases,  in  the  begin- 
ning of  the  fifteenth  year;  in  87,  in  the  eighteenth  year:  in  84, 
in  the  sixteenth ;  6  women  menstruated  first  at  the  age  of  eleven 
years,  3  at  twenty- two.  The  period  during  which  menstruation 
may  primarily  occur  in  Vienna  comprises  twelve  years.  In 
Paris,  in  the  same  latitude,  it  occurs  one  year  earlier. 

Of  1610  women  from  the  country,  the  age  of  first  menstrua- 
tion averaged  about  sixteen  years  and  two  and  a  half  months. 
418  menstruated  during  the  fifteenth  year,  251  in  the  sixteenth ; 
then  followed  in  order  the  seventeenth,  eighteenth,  and  nine- 
teenth. More  than  half,  888,  menstruated  after  the  fifteenth 
year ;  less  than  one-fifth — 304  before  it.  Two  menstruated  at 
ten,  and  the  oldest — two  likewise — first  menstruated  at  twenty- 
five.  The  period  during  which  menstruation  may  primarily 
occur,  comprises  therefore  sixteen  years  in  the  country — four 
more  than  in  the  town  of  Vienna.  Of  these  1610  women,  a.  603 
were  from  Upper  and  Lower  Austria  Proper ;  of  them,  the  mean 
age  of  first  menstruation  was  sixteen  years  and  three  months  ; 
here  also  the  greatest  number,  142,  menstruated  in  the  fifteenth 
year,  88  in  the  seventeenth,  81  in  the  sixteenth,  and  72  in  the 
eighteenth  year ;  the  youngest,  5,  were  eleven,  and  the  oldest,  2, 
twenty-five  years  old ;  the  period  of  primary  menstruation  com- 
prising thus  fifteen  years,  or  three  more  than  in  Vienna,  b.  430 
were  Bohemians,  of  whom  the  mean  age  of  primary  men- 
struation was  sixteen  years  and  two  months ;  148  menstruated 
first  at  fifteen,  51  at  seventeen,  49  at  sixteen,  and  46  at  eigh- 
teen ;  the  youngest  was, ten,  and  the  oldest  twenty-four,  at  her 
first  menstruation  ;  the  period  of  primary  menstruation  com- 
prising fifteen  years,  c.  273  came  from  Moravia,  the  mean  age 
of  primary  menstruation  being  sixteen  years  and  three  and  three- 
quarter  months ;  69  menstruated  first  at  sixteen,  59  at  fifteen, 


846 


Menstruation  in  Austria. 


[December, 


and  32  at  seventeen ;  the  youngest,  8  in  number,  were  twelve, 
and  the  oldest,  8,  twenty-two  years  old ;  the  period  of  primary 
menstruation  comprising  thus  only  eleven  years ;  one  year  less 
than  in  Vienna,  and  four  less  than  in  Behemia  and  the  rural 
districts  of  Austria  Proper,  d.  180  women  came  from  Hungary ; 
and  of  them  the  average  age  of  primary  menstruation  was  fifteen 
years;  39  menstruated  first  at  fifteen,  19  at  fourteen,  16  at  thir- 
teen, 12  at  seventeen  ;  the  youngest  was  ten,  the  oldest  twenty- 
two  ;  the  period  of  primary  menstruation  comprising  twelve 
years,  e.  67  women  came  from  Silesia ;  the  mean  age  of  their 
primary  menstruation  was  sixteen  years  and  one  and  a  half 
months;  21  menstruated  first  at  sixteen,  14  at  fifteen,  8  at  sev- 
enteen, 87  at  18 ;  the  youngest  was  twelve,  the  oldest  twenty- 
two  years  old ;  the  period  of  primary  menstruation  comprising 
eleven  years.  /.  66  women  came  from  Bavaria ;  their  average 
age  for  primary  menstruation  was  sixteen  years  and  ten  months ; 
17  menstruated  first  at  seventeen,  15  at  16,  9  at  eighteen,  and  8 
at  fifteen;  the  youngest  was  eleven,  the  oldest  twenty-three; 
the  period  of  primary  menstruation  comprised  thirteen  years. 

Brierre  de  Boismont  fixed  in  Paris  the  age  of  primary  men- 
struation at  fourteen  years  and  ten  months  for  the  poor,  fourteen 
and  five  months  for  the  middling  classes,  and  thirteen  years  and 
eight  months  for  the  rich ;  and  with  this  the  observations  of 
Chomel,  Andral,  and  Eecamier  agree.  Of  our  author's  2275 
cases,  136  were  of  the  middling  classes — in  them  the  average 
age  of  primary  menstruation  was  fifteen  years  and  two  months; 
730  handworkers — medium  age  fifteen  years  and  ten  months  at 
their  first  menstruation ;  1207  female  servants,  of  whom  the 
mean  age  of  primary  menstruation  was  sixteen  years  and  two 
months ;  and  202  day  labourers,  whose  mean  age  at  their  first 
menstruation  was  sixteen  years  and  one  and  a  half  month ;  these 
results  agreeing  with  Boismont's  observation,  that  menstruation 
is  earliest  among  the  rich,  and  latest  among  the  poor.  Among 
the  2275  women,  the  ages  at  which  menstruation  first  occurred 
are  thus  divided : — 


At    10  years      2  women  menstruated. 


«  n  i 

15 

"  12  ' 

36 

"  13  ' 

149 

"  14  * 

204 

"     15  ' 

628 

"  16  * 

335 

u       17   < 

283 

At     18  years  259  women  menstruated. 


19  " 

147 

20  " 

95 

21  " 

34 

22  " 

30 

23  " 

4 

24  " 

2 

25  " 

2 

The  average  age  of  primary  menstruation  in  Austria  being  thus 
fifteen  years  and  seven  and  a  half  months.  As  influential  agents 
in  hastening  or  retarding  menstruation,  Sz.  enumerates  geogra- 
phical position,  climate,  populousness  of  a  town,  nationality, 


1858.]  Menstruation  in  Austria.  847 

mode  of  life,  occupation,  food,  clothing,  dwelling,  training,  mor- 
als, and  bodily  organization ;  according  to  some  authors,  heredit- 
ary tendency  is  also  influential.  Although  in  Austria  menstrua- 
tion most  commonly  occurs  between  the  fifteenth  and  seventeenth 
years,  many  cases  have  been  recorded  of  its  much  earlier  occur- 
rence. Wilson  observed  a  case  in  which  it  occurred  in  the  fifth 
year;  the  breasts  being  as  large  as  those  of  a  marriageable  fe- 
male. Scanzoni  records  one  case  at  eight  years;  D'Outreport, 
one  at  nine  months  ;  she  had  protuberant  breasts,  and  menstrua- 
ted every  four  weeks  till  her  death  in  her  twelfth  year.  Bois- 
mont  records  two  cases — in  one  menstruation  commenced  in  the 
third  month,  in  the  other  in  third  year.  Similar  observations 
are  recorded  by  Mad.  Boivin,  Dieffenbach,  and  Martin  Wall. 
In  France,  early  menstruation  is  more  common  than  in  Austria  ; 
as  Boismont,  in  1200  cases,  found  fourteen  who  had  menstrua- 
ted before  their  tenth  year.  According  to  Szukits'  observation, 
in  scarce  one-third  was  primary  menstruation  painful ;  while  in 
France,  according  to  Boismont,  this  was  the  case  in  more  than 
two-thirds.  In  one  case  of  dysmenorrhcea  our  author  observed 
trifling  acne  rosacea  on  the  chin  and  sides  of  the  nose — the 
woman  was  twenty-seven  years  old.  In  three  cases,  each  men- 
strual period  was  attended  by  an  eruption  of  uricaria  over  the 
entire  body ;  and  in  two  girls,  one  fifteen,  the  other  seventeen, 
the  molimina  of  primary  menstruation  were  attended  by  inflam- 
mation of  the  cellular  membrane,  which  again  disappeared  on 
its  cessation  in  three  to  five  days  after.  Strong,  healthy  women 
generally  menstruate  more  sparingly  than  feeble,  anasmic,  or  tu- 
berculotic  females;  the  latter,  if  not  labouring  under  amenor- 
rhea have  profuse  watery  menstruation,  lasting  from  ten  to 
fourteen  days.  Of  1013  women,  240  menstruated  sparingly, 
560  moderately,  and  187  profusely ;  of  the  latter,  26  passed  clots 
without  there  being  any  uterine  lesion  present.  Of  1013  women 
Sz.  found  that  only  642  menstruated  regularly  every  twenty- 
eight  to  thirty  days,  371  menstruated  irregularly,  269  menstrua- 
ted from  every  eight  days  to  every  three  weeks,  128  only  every 
five  or  six  weeks.  The  duration  of  menstruation  is  influenced 
by  the  same  causes  which  influence  its  early  appearrnce — its 
medium  duration  is  3f  days.  Three  times,  Sz.  saw  menstrua- 
tion occur  for  a  shorter  or  longer  period  during  pregnancy ;  also 
during  lactation  it  was  frequently  seen.  Trustworthy  cases  are 
recorded  in  which  menstruation  only  occurred  during  pregnan- 
cy or  after  delivery.  During  fourteen  years,  and  in  8000  cases, 
14  occurred  of  total  absence  of  menstruation  ;  four  of  these  had 
borne  children  repeatedly,  the  others  never ;  most  of  them  had 
from  time  to  time,  every  three  or  four  weeks,  molimina  menstrua- 
tionis ;  in  none  was  there  any  vicarious  menstruation ;  in  two 


848        Pepsine  in  Obstinate  Vomiting  of  Pregnancy.  [December, 

cases,  imperfect  development  of  the  uterus  was  discovered.  Of 
263  women,  menstruation  ceased  in  99,  between  forty-six  and 
fifty  years;  in  77,  between  forty-one  and  forty-five;  in  42,  be- 
tween fifty-one  and  fifty-five ;  in  26,  between  thirty-six  and  forty ; 
in  15,  between  thirty  and  thirty  five ;  and  in  6  cases,  between 
fifty -six  and  sixty  years.  The  youngest  woman  who  had  ceased 
to  menstruate  was  thirty-two,  the  oldest  sixty -one,  at  the  period 
of  cessation.  This  may  occur  suddenly,  without  interruption 
to  the  general  health,  or  it  may  take  several  years  for  its  comple- 
tion. Boismont  reckons  the  average  of  this  at  two  years.  Sz. 
found  the  mean  duration  of  uterine  power  to  be  thirty  years. 
125  women  menstruated  from  twenty-one  to  thirty  years ;  106, 
from  thirty-one  to  forty  years.  The  shortest  peried  of  menstrua- 
tion was  twelve  years,  and  happened  in  two  cases ;  the  longest, 
forty-five  years,  likewise  occurred  twice.  Boismont  found  one 
case  with  a  duration  of  only  five  years,  and  another  with  a  du- 
ration of  fortj^-eight.  Of  863  women,  64  were  never  pregnant; 
124  conceived  once;  73,  five  times;  63,  six  times;  74,  seven 
times;  38,  eight  times;  32,  nine  times;  27,  ten  times;  11,  eleven 
times ;  15  twelve  times ;  13,  thirteen  times ;  5,  fourteen  times ; 
2,  fifteen  times;  7,  sixteen  times;  2,  seventeen  times;  3,  eigh--. 
teen  times;  1,  twenty  times;  2,  twenty-two  times;  4,  twenty- 
four  times — 863  women,  of  whom  61  aborted ;  each  woman 
averaging  about  five  conceptions.  The  most  usual  period  of 
conception  in  Europe  is  between  the  fourteenth  and  fiftieth  year ; 
but  cases  of  child-birth  in  the  sixteenth  year ;  are  recorded  by 
Meissner,  Bernstein,  Osiander,  Mende,  and  Busch.  Haller  saw 
one  case  of  childbirth  at  sixty-three,  and  another  at  seventy ;  as 
also  Labatt  in  Dublin,  and  Capuron,  in  Paris. 

\_Zeitschrift  d.  Wien  Aerzte,  and  Ed.  Med.  Jour. 


Beneficial  Effects  of  Pepsine  in  the  Obstinate  Vomiting  of  Pregnan- 
cy.   By  L.  Gros,  M.  D. 

In  the  great  majority  of  cases  the  vomiting  of  pregnancy  may 
safely  be  left  to  the  influence  of  time ;  but  there  are  some  cases 
in  which  females  are  scarcely  able  to  retain  in  their  digestive 
system  a  sufficient  amount  of  nourishment  to  support  their  ex- 
istence, and  are  therefore  reduced  to  the  last  degree  of  emacia- 
tion. In  some,  also,  the  shocks  occasioned  by  this  obstinate  and 
repeated  vomiting  become  the  source  of  abortions,  which  might 
have  been  prevented  by  moderating  the  activity  of  the  morbid 
phenomenon.  A  very  remarkable  case  was  related  in  1856,  by 
M.  Teissier,  Professor  of  Clinical  Medicine  at  Lyons,  showing 
the  immediately  beneficial  effect  of  a  dose  of  pepsine  in  a  case  of 
vomiting  during  pregnancy.     In  this  case  the  symptoms  resist- 


1858.]       Animal  Charcoal  an  Antidote  for  Cantharides.  849 

ed  all  the  ordinary  methods  which  were  employed,  and 
the  patient  was  unable  to  retain  in  her  stomach  any  substance 
whatever.  Under  these  circumstances,  the  patient  was  brought 
to  M.  Teissier,  who  found  her  in  the  following  condition  :  The 
vomiting  had  continued  for  two  months,  and  she  was  at 
the  end  of  the  fourth  month  of  her  pregnancy ;  she  presented 
the  appearance  of  a  skeleton,  having  the  aspect  and  the  cough 
of  a  phthisical  subject;  the  pulse  .was  140,  and  M.  Teissier 
thought  at  first  that  the  case  was  one  of  pulmonary  tubercle. 
Finding  that  all  treatment  had  been  hitherto  inefficacious,  and 
that  the  lady  was  actually  dying  of  inanition,  he  was  seriously 
meditating  upon  the  propriety  of  inducing  abortion  as  a  means 
of  saving  her  life:  but  as  a  last  resource  before  operating,  he 
determined  to  employ  pepsine.  He  accordingly  prescribed  one 
gramme,  to  be  divided  into  two  doses,  and  take  every  day  in  a 
spoonful  of  broth.  At  the  very  first  dose  the  broth  was  retained, 
and  from  that  moment  the  vomiting  never  returned.  On  the  third 
day  the  lady  ate  some  chicken,  and  then  some  beef-s'eak.  The 
treatment  was  continued  in  the  same  manner  for  three  weeks, 
and  at  the  end  of  that  time  the  cure  was  complete :  the  emacia- 
tion was  replaced  by  embonpoint,  the  fever  and  the  cough  ceased 
with  the  vomiting,  and  at  the  end  of  the  ninth  month  the  lady 
was  safely  delivered. 

Dr.  Gros  then  relates  six  other  cases  in  which  the  pepsine  was 
employed  with  the  samesuceess,  and  he  thinks  himself  warrant- 
ed in  concluding  that  pepsine  undoubtedly  produces  good  effects 
in  the  vomiting  which  attends  pregnancy.  He  explains  the  re- 
sults by  supposing  that,  although  in  the  first  instance  the  vomit- 
ing is  due  only  to  the  sympathy  existing  between  the  uterus 
and  the  stomach,  yet  subsequently  the  stomach  itself  becomes 
affected,  as  is  proved  by  the  fact  that  in  the  beginning  of  preg- 
nancy the  vomiting  occurs  only  in  the  morning  or  the  evening  ; 
but  in  aggravated  cases  it  supervenes  after  every  meal,  and  all 
alimentary  matters  are  rejected.  In  such  cases,  therefore,  when 
the  stomach  has  taken  on  a  morbid  habit,  and  exhibits  an  alter- 
ation of  secretion,  the  pepsine  appears  to  be  really  iudicated ; 
although  in  a  merely  sympathetic  .action  between  the  uterus  and 
stomach  it  would  be  difficult  to  explain  the  efficacy  of  its  action. 
Brit,  and  For.  Med.  Chirurg.  Itev.,  from  Bull.  Gen.  dc  Therapeut. 


Animal  Charcoal  an  Antidote  for  Cantharides.     By  M.  Thouery. 

It  is  generally  known  that  charcoal  possesses  proprieties  which 
are  most  interesting ;  that  it  removes  most  of  the  metallic  salts 
from  water;  combines  with  oil  to  such  an  extent  that  it  cannot 
be  separated  by  ether,  and  fixes  certain  of  the  vegetable  princi- 


850  Inversion  of  the  Body  for  Renal  Calculus.  [December, 

pies.  M.  Thouery,  in  1851  and  1852,  made  a  series  of  experi- 
ments, from  which  he  concluded  that  animal  charcoal  possesses 
real  efficacy  in  combatting  poisoning  by  cantharides.  These  ex- 
periments were  54  in  number,  and  were  performed  on  dogs. 
Lately  M.  Thouery  has  published  the  details  of  an  experiment 
made  on  men. 

During  the  night  of  the  12th-13th  of  December,  1856,  An- 
toine  B.  experienced  very  acute  suffering  after  having  taken  an 
infusion  of  centaurea  from  a  vessel  which  contained  powdered 
cantharides.  Being  called  to  see  him,  M.  Thouery  recognized 
it  immediately  as  a  case  of  poisoning  by  an  irritant  corrossive 
poison,  but  none  of  the  liquid  remaining  for  examination,  he 
could  not  determine  the  nature  of  the  poison  ingested.  He  con- 
fined himself  to  the  administration  of  general  remedies,  uniting, 
however,  calcined  magnesia  and  animal  charcoal,  and  giving  them 
in  large  doses.  The  condition  of  the  patient  did  not  seem  to 
improve  at  first,  but,  after  two  days  of  intolerable  suffering,  re- 
lief was  obtained  and  health  was  restored. 

Thouery  afterwards  found  that  the  poisoning  had  been  pro- 
duced by  cantharides.  He  does  not  doubt,  then,  that  animal 
charcoal  largely  contributed  to  the  cure ;  and  he  regards  this 
observation  as  confirmative,  in  a  certain  measure,  of  the  results 
of  his  previous  experiments.  The  only  objection  which  we  can 
adduce  against  this  theory  of  Thouery  is,  that  it  does  not  neces- 
sarily follow  from  the  fact  reported*. — [American  Med.  Monthly. 


Inversion  of  the  Body  for  the  Relief  of  the  Symptoms  produced  by  the 
Passage  of  a  Renal  Calculus  along  the  Ureter. 

Professor  Simpson  exhibited  to  the  Edinburgh  Medico-Chir- 
urgical  Society  (May  5,  1858)  a  small  oblong  renal  calculus, 
from  a  patient  who  had  passed  them  at  different  times,  and 
always  suffered  terribly  during  their  transit  from  the  kidney  to 
the  bladder.  This  patient  had  been  now  twice  relieved  of  the 
agonizing  symptoms  accompanying  the  passage  of  the  calculus 
by  inversion  of  the  body.  Prof.  S.  had  subjected  her  to  this 
treatment  in  consequence  of  his  belief  that  the  passing  calculus, 
falling  down  into,  and  becoming  impacted  in  the  ureter,  acted 
at  its  point  of  arrestment  as  a  pea- valve,  and  by  its  accumula- 
ting the  urine  above,  or  in  the  pelvis  of  the  kidney  and  higher 
portion  of  the  ureter,  led  to  the  accompanying  distress  by  the 
morbid  distension  of  these  portions  of  the  urinary  ducts.     When 

*  We  have  translated  this  notice  from  the  French,  not  because  we  consider  the 
claims  of  charcoal  as  an  antidote  for  cantharides  to  be  established  as  a  certainty, 
but  with  the  view  of  calling  attention  to  it,  and  obtaining  from  our  own  country- 
men some  additional  facts  bearing  upon  the  subject  of  cantharides  as  a  poison. 


1858.]  Treatment  of  Diabetes.  851 

the  body  was  inverted,  and  the  affected  side  manipulated,  the 
calculus  probably  fell  backward,  and  consequently  upwards,  by 
its  own  gravity.  At  all  events,  whatever  be  the  explanation, 
the  practice  in  this  and  in  one  other  case  had  immediately  re- 
lieved the  patient.  He  had  seen  partial  relief  from  changed 
position  in  one  case  also  of  gallstones.  Position  was  a  more 
important  therapeutical  agent  than  was  generally  supposed,  not 
only  in  medicine,  but  also  in  surgery  and  therapeutics.  Several 
years  ago — and  shortly  after  the  famous  case  of  Mr.  Brunei — 
Dr.  S.  saw,  with  Dr.  Patterson  and  Dr.  James  Duncan,  a  case 
in  which  a  shilling  passed  into  the  windpipe,  and  where  upon 
inversion  of  the  patient  the  shilling  fell  back  into  his  mouth, 
thus  saving  the  patient  from  the  operation  of  tracheotomy.  Dr. 
Duncan  has  published  a  full  account  of  the  case.  In  prolapsus 
of  the  umbilical  cord  in  labour,  the  mere  gravity  of  the  cord  in 
the  usual  supine  position  of  the  patient  was  no  doubt  one  great 
cause  of  the  difficulty  of  retaining  it  in  utero,  above  the  head  or 
presenting  part  of  the  child,  when  once  returned.  But  some 
late  cases  and  observations  proved  that  the  return  and  retention 
of  the  cord  could  be  effected  with  comparative  facility,  if  the  aid 
of  position  was  called  in,  and  the  patient  was  placed  upon  her 
face,  or  upon  her  hands  and  knees,  till  the  presenting  part  filled 
the  brim  of  the  pelvis ;  for  in  this  prone  position  the  cord  gravi- 
tated toward  the  fundus  uteri,  instead  of  towards  the  os. 

[Edinburgh  Med.  Jour.,  and  Amer.  Jour,  of  Med.  Science. 


Rationale  of  the  Saccharine  Treatment  of  Diabetes. 

Dr.  John  Sloane,  in  a  paper  read  before  the  Leicester  Medical 
Society  (April  20,  1858),  gives  the  following  rationale  of  the  sac- 
charine treatment  of  diabetes  : — 

"Glucose,  the  variety  of  sugar  found  in  the  urine  of  diabetes, 
is  generated  in  the  livers  of  animals  throughout  the  animal  king- 
dom, almost  wholly  irrespective  of  the  nature  of  their  food.  The 
glucose  secreted  by  the  hepatic  cells  passes  into  the  hepatic  veins, 
thence  into  the  inferior  vena  cava,  and  through  the  right  side  of 
the  heart  to  the  lungs,  where,  being  exposed  to  the  atmosphere, 
it  sometimes  completely  disappears.  M.  Bernard  has  found  sugar 
in  the  livers  of  mammals,  of  birds,  of  reptiles,  of  fishes,  of  molluscs, 
and  of  articulated  animals.  He  has  found  it  in  omnivorous,  her- 
bivorous, and  carnivorous  animals.  That  the  secretion  of  sugar 
is  independent  of  the  nature  of  the  food,  he  proves  by  many  ex- 
periments, of  which  I  shall  mention  the  following.  He  fed  dogs 
exclusively  on  flesh  for  six  or  eight  months  ;  and  when  they  were 
killed,  at  the  expiration  of  that  period,  he  found  as  much  sugar 
in  their  livers  as  in  those  of  dogs  fed  upon  a  mixed  diet.     Owlets 

n.  s. — vol.  xrv.  NO.  XII.  50 


852  Treatment  of  Diabetes.  [December, 

taken  in  their  nests  were  fed  exclusively  on  raw  bullock's  liver 
for  three  months,  and  were  then  killed;  their  livers  always  con- 
tained the  normal  quantity  of  sugar.  Two  dogs  were  fed  solely 
on  flesh,  three  on  both  flesh  and  bread,  and  two  on  amylaceous 
or  saccharine  food ;  they  were  all  killed  at  as  nearly  as  possible 
the  same  period  of  digestion,  and  the  results  of  the  chemical  ex- 
amination of  their  livers  showed  that  the  quantity  of  sugar  secret- 
ed did  not  depend  on  the  nature  of  their  diet. 

"  Rollo  recommended  the  use  of  fat  for  diabetes.  M.  Thenard 
and  Dupuytren  made  them  eat  lard.  We  have  fed  dogs  with 
lard  and  axunge ;  and  we  have  found  this  very  curious  fact,  that, 
under  the  influence  of  this  alimentation,  the  sugar  diminished  in 
the  liver  absolutely  in  the  same  manner  as  if  the  animal  had  been 
kept  fasting.  In  dogs  to  which  M.  Bernard  has  given  nothing 
but  pure  water,  he  has  fouud  the  secretion  of  sugar  kept  diminish- 
ing, and  it  ceased  to  appear  about  three  or  four  days  before  their 
death.  For  the  first  thirty-six  hours,  the  quantity  continues  con- 
siderable, but  during  the  following  days  it  diminishes  very  rapidly. 

"  A  dog,  having  fasted  thirty-six  hours,  had  a  copious  repast  of 
boiled  sheep's  head,  and  three  hours  afterwards,  was  killed.  The, 
blood  in  the  portal  vein,  previous  to  its  entrance  into  the  liver, 
contained  no  trace  of  sugar ;  whereas,  in  the  blood  from  the  he- 
patic veins,  there  was  a  considerable  quantity.  This  experiment, 
writes  Bernard,  would  alone  suffice  to  cause  one  to  admit,  as  a 
natural  and  necessary  conclusion,  that  the  sugar  is  produced  in 
the  liver;  yet  we  have  accumulated  proofs  of  every  kind  about 
this  proposition  ;  and  wTe  have  shown  that  the  hepatic  tissue  con- 
stantly contained  sugar,  and  that  it  was  the  only  tissue  of  the 
body  which  offered  this  character. 

"In  an  animal  fasting,  the  blood  which  arrives  at  the  liver  pre- 
sents no  trace  of  sugar  ;  that  which  leaves  it  contains  a  considera- 
ble quantity.  Inversely,  the  blood  which  arrives  in  the  lung 
contains  sugar ;  and  that  which  leaves  it  presents  no  trace  of 
this  substance.  The  sugar  in  this  physiological  state  remains 
hidden  between  the  liver  and  the  lung,  and  does  not  show  itself 
at  the  exterior.  This  statement  is  true  only  in  an  animal  fasting. 
When  the  digestion  commences,  the  quantity  of  sugar  gradually 
augments  ;  yet  during  the  two  or  three  hours  following  the  inges- 
tion of  aliment,  notwithstanding  the  increase  of  the  saccharine 
secretion,  all  the  sugar  can  be  destroyed  before  it  arrives  at  the 
arterial  system;  and  it  is  only  after  the  lapse  of  time  that  the 
production  of  sugar  surpassing  the  limits  of  destruction  becomes 
temporarily  excessive  in  the  organism.  At  this  period  of  diges- 
tion, one  finds  sugar  in  all  the  vessels  of  the  body,  arterial  and 
venous,  and  even  in  the  renal  arteries;  but  the  proportion  is  too 
slight  for  any  of  the  sugar  to  pass  in  the  urine.  Yet  we  shall  see, 
that  under  certain  physiological  circumstances,  the  quantity  of 


1858.]  Treatment  of  Diabetes  853 

sugar  can  be  increased  to  the  point  that  it  passes  off  in  the  urine 
without  the  animal  being  diabetic.  Under  the  ordinary  circum- 
stances of  digestion,  this  species  of  saccharine  overflowing  is 
manifested  equally  with  animal  or  amylaceous  diet,  and  it  lasts 
about  three  or  four  hours.  It  is  not  less  than  six  or  seven  hours 
after  a  meal  that  the  excess  of  sugar  in  the  blood  commences  to 
disappear,  and  that  the  equilibrium  between  its  production  and 
its  destruction  tends  to  re-establish  itself  as  before  digestion.  This 
species  of  oscillation,  which  the  glycogenic  function  presents,  it 
is  very  important  to  know  ;  for  in  the  pathological  state  (diabetes) 
we  find  exactly  the  same  phases,  with  the  exaggerations  we  should 
expect  in  this  malady.  Different  observers — Raver  in  France, 
and  Traube  in  Germany — have  remarked  that  there  are  diabetics 
who  do  not  pass  sugar  in  their  urine,  except  at  the  time  of  their 
digestion ;  and  that,  in  the  interval,  their  urine  does  not  contain 
sugar.  This  phenomenon  can  be  reconciled  very  naturally  with 
the  physiological  fact  which  has  been  pointed  out  to  you.  There 
is  nothing  essentially  different  between  the  normal  state  and  the 
pathological  symptom,  save  the  intensity  of  the  phenomenon 
caused  by  a  deviation  of  vital  activity. 

"  The  sugar  is  formed  from  the  albuminous  substance ;  and 
this  sugar  is  the  result  of  the  physiological  action  of  the  liver  upon 
those  principles,  which  are  divided  so  that  their  oxygen,  hydrogen, 
and  carbon,  are  grouped  so  as  to  form  sugar,  while  their  azote 
enters  into  other  combinations,  and  probably  into  the  azotized 
principles  of  the  bile.  One  does  not  know,  indeed,  any  other 
origin  for  the  saccharine  matter,  which  cannot  be  produced  in 
the  intestine  by  digestion.  Experiment  has  shown  us  that, 
during  alimentation,  by  means  of  albuminous  substances,  the  in- 
testine and  the  blood  of  the  portal  vein  never  contain  saccharine 
matter  of  any  kind.  Neither  gelatine  nor  flesh  produce  sacchar- 
ine matter  in  the  intestinal  tube  by  the  known  digestive  pro- 
cesses. The  amylaceous  matters  taken  as  food  enter  as  sugar 
into  the  portal  vein,  and,  arriving  at  the  liver  in  this  state,  are 
then  destroyed  by  this  organ,  and  changed  into  another  matter, 
which  has  every  appearance  of  a  fatty  substance  converted  into 
an  emulsion  par  une  mature  proteque  speciale.  We  have  said 
that  the  sugar  introduced  into  the  intestinal  tube  does  not  augment 
the  quantity  of  this  matter  contained  in  the  liver,  but  that  it  is 
there  destroyed,  and  causes  the  appearance  of  an  emulsive  sub- 
stance. That  the  sugar  introduced  into  the  intestinal  canal  does 
not  augment  the  quantity  of  this  matter  contained  in  the  liver, 
M.  Bernard  shows  by  the  following  experiments.  He  takes  two 
rabbits,  whose  urine  he  first  finds,  by  testing,  to  be  free  from  sugar. 
Into  the  stomach  of  one  he  injects  a  quantity  of  sugar  in  solution, 
with  some  ferrocyanide  of  potassium.  Beneath  the  cellular  tissue 
of  the  other  he  injects  half  the  quantity  of  an  exactly  similar  solu- 


854  Treatment  of  Diabetes.  [December, 

tion.  He  examines  their  urine  an  hour  afterwards,  and  he  finds 
in  that  of  the  first  not  the  least  trace  of  sugar,  while  the  urine  of 
the  second  presents  it  in  considerable  quantities.  But  you  may 
say  that  this  difference  may  be  accounted  for  by  the  intestinal 
absorption  being  less  rapid  than  the  subcutaneous;  but  in  both 
the  ferrocyanide  of  potassium  was  readily  detected  in  the  urine. 
This  will  prove  that  the  absorption  is  equally  effectual  in  the  in- 
testine as  under  the  skin,  but  that,  in  the  first  case,  the  solution 
has  abandoned  one  of  its  constituents,  the  sugar,  in  traversing  the 
liver;  whereas  this  has  not  taken  place  in  the  second  instance. 
He  arrives  at  similar  results  in  the  following  experiments. 
Through  a  small  opening  in  the  abdomen  of  a  rabbit,  he  injects 
a  quantity  of  the  same  solution  into  one  of  the  branches  of  the 
portal  vein;  and  into  the  jugular  vein  of  another  rabbit  he  injects 
the  same  quantity  of  the  same  solution.  It  is  clear  that,  in  this 
mode  of  operating,  we  cannot  have  any  difference  in  the  absorp- 
tion, as  in  both  cases  we  introduce  the  substances  directly  into 
the  blood.  Nevertheless,  we  obtain  exactly  the  same  result ;  that 
is  to  say,  that  in  the  rabbit,  in  which  we  injected  by  the  jugular, 
the  sugar  has  passed  into  the  urine  with  the  ferrocyanide  of  potas- 
sium, and  with  very  great  rapidity ;  whilst  in  the  rabbit  injected 
by  the  portal  vein,  the  ferrocyanide  of  potassium  alone  will  have 
passed  into  the  urine,  where  one  cannot  find  the  least  trace  of 
sugar.  These  experiments  are  very  conclusive.  Bernard  proves 
by  experiment  that  starch,  taken  as  food  in  the  intestine  by  the 
influence  of  the  pancreatic  juice,  becomes  converted  into  sugar; 
and  this  passes  into  the  portal  vein.  That  sugar  is  destroyed  by 
the  liver,  receives  further  confirmation,  he  states,  by  the  facts 
known  in  the  fattening  of  cattle.  You  all  know  that  animals  fat- 
ten most  by  the  use  of  food  in  which  starch  predominates;  that 
the  geese  and  the  ducks,  in  which  the  fat  livers  are  artificially 
produced,  are  gorged  with  a  pate  of  maize  or  other 
amylaceous  food ;  that  the  fat  formed  by  an  animal  is  not  in  pro- 
portion with  the  adipose  matter  which  it  takes ;  that,  on  the  con- 
trary, the  animals  which  only  eat  fat,  far  from  becoming  fat,  get 
lean  rapidly.  Hereafter  it  is  not  only  the  biliary  secretion  which 
we  shall  have  to  look  upon  in  the  liver ;  it  has  two  other  func- 
tions of  capital  importance — one  the  production  of  sugar,  which 
is  dependent  upon  the  aliment  containing  albuminous  matters  ;  the 
other,  the  production  of  fat,  which  is  dependent  upon  the 
amylaceous  and  saccharine  matters  in  the  food. 

" Cane-sugar  is  never  destroyed;  it  is  constantly  eliminated 
by  the  urine  when  it  is  injected  directly  into  the  blood ;  but  this 
sugar,  when  in  the  intestine,  is  in  part,  at  least,  transformed  into 
glucose.  The  latter,  on  the  contrary,  injected  into  the  blood,  can 
be  destroyed  in  certain  proportions. 

"  When  we  prick  the  mesial  line  of  the  floor  of  the  fourth  ven- 


1858.]  Treatment  of  Diabetes.  855 

tricle,  in  the  exact  centre  of  the  space  between  the  origins  of  the 
auditory  and  pneumogastric  nerves,  we  produce  an  exaggeration 
of  the  hepatic  (saccharine)  function,  and  of  the  renal  secretion  ; 
if  the  puncture  be  effected  a  little  higher,  we  very  often  only  pro- 
duce an  augmentation  in  the  quantity  of  the  urine,  which  then 
frequently  becomes  charged  with  albuminous  matters  ;  while,  if 
the  puncture  be  below  the  indicated  point,  the  discharge  of  sugar 
alone  is  observed,  and  the  urine  remains  turbid  and  scanty. 
Hence  it  appears  that  we  may  distinguish  two  points  of  which 
the  inferior  corresponds  to  the  secretion  of  the  liver,  and  the  supe- 
rior to  that  of  the  kidneys.  As,  however,  these  two  points  are 
very  near  to  one  another,  it  often  happens  that,  if  the  instrument 
enters  obliquely,  they  are  simultaneously  wounded ;  and  the 
animal's  urine  not  onlv  becomes  superabundant,  but  at  the  same 
time  saccharine.  The  urine  becomes  saccharine  in  from  one  to 
two  hours  after  the  operetion,  but  seldom  continues  for  more  than 
a  day. 

"  The  secretion  of  sugar  is  not  under  the  direct  influence  of  the 
pneumogastric  nerve  ;  for  if  it  be  divided  before  irritating  the  floor 
of  the  fourth  ventricle,  sugar  still  appears  in  the  urine.  Bernard 
believes  that  the  influence  is  transmitted  by  reflex  action  through 
the  ganglia  of  the  sympathetic. 

"  There  is  a  phenomenon  which  is  manifested,  for  example, 
when,  after  fasting  a  certain  time,  a  great  quantity  of  sugar  is 
taken.  The  intestinal  absorption  then  proceeds  with  extreme 
rapidity.  A  great  quantity  of  sugar  arrives  in  mass  in  the  liver  ; 
the  mechanical  circulation  much  prevails  over  the  chemical ;  the 
sugar  is  poured  into  the  general  circulation  in  proportion  much 
greater  than  occurs  in  the  normal  state;  and  it  passes  then  into 
the  urine,  where  its  short-lived  presence  can  be  found  for  a  certain 
time. 

'•  M.  Bernard,  after  a  great  many  experiments  in  reference  to 
the  subject,  has  proved  that  there  is  a  species  of  election  in  the 
excretion  of  matters  which  pass  out  of  the  organism.  Sugar  is 
eliminated  in  two  ways  only — by  the  kidneys,  and  by  the  mucous 
membrane  of  the  stomach.  When  sugar  is  injected  into  the 
blood  of  an  animal  to  saturation,  and  puts  it  for  a  time  into  a 
state  of  diabetes,  we  do  not  find  sugar  in  the  saliva,  in  the  tears, 
pancreatic  juice,  bile,  nor  perspiration  ;  whilst  the  urine  and  _ 
trie  juice  contain  it  in  proportions  more  or  less  notable.  These 
results  entirely  resemble  those  obtained  in  diabetic  patients. 
Lehmann  states,  however,  that  he  has  obtained  sugar  from  the 
saliva  of  a  diabetic.  The  presence  of  sugar  has  been  pointed  out 
in  the  expectoration  of  diabetes.  Bernard  admits  that  sugar  can 
be  had  in  notable  quantity  in  the  expectoration.  But,  he  writes, 
we  must  not  confound  the  bronchial  mucus  which  these  patients, 
almost  always  phthisical,  in  the  last  stage  of  the  disease  expel  in 


856  Treatment  of  Diabetes.  [December, 

abundance,  with  the  salivary  secretion  properly  so  called  ;  it  is  the 
mucosities  formed  in  the  lung  which  contain  the  saccharine  mat- 
ter. Nevertheless,  this  fact  is  not  constant ;  for  M.  Rayer  has 
reported  to  the  Society  of  Biology  a  case  in  which  the  expectora- 
tion of  a  phthisical  patient  examined  by  M.  Wurtz  did  not  contain 
sugar.  Bernard  proves  by  the  following  experiments  the  state- 
ments regarding  the  election  in  excretion  of  matters  which  pass 
out  of  the  organism. 

"  He  takes  a  dog  with  a  parotidean  opening,  into  which  he  in- 
serts a  tube.  Nothing  flows  by  this  tube,  which  proves  that  the 
secretion  is  not  continuous.  By  putting  in  the  mouth  some  vine- 
gar he  excites  the  flow  of  saliva,  which  passes  out  of  the  tube 
rapidly  in  large  drops.  He  next  injects  into  the  jungular  vein  of 
the  animal  a  solution  containing  sugar,  prussiate  of  potash,  and 
iodide  of  potassium.  Immediately  after  this  injection  the  saliva- 
ry secretion  is  again  excited  in  the  same  way.  The  saliva  is 
received  into  three  glasses.  One  is  examined  for  sugar,  and  none 
is  found.  The  sugar  therefore  does  not  pass  in  the  saliva.  The 
second  is  examined  for  prussiate  of  potash,  and  it  is  not  present. 
The  third  is  found  to  contain  iodide  of  potassium.  This  substance 
then  passes  immediately  into  the  saliva,  whilst  the  prussiate  of 
potash  and  the  glucose,  equally  soluble,  cannot  be  found.  In  the 
saliva  extracted  before  the  injection,  none  of  the  substances  exist. 
In  the  urine  of  the  same  animal  after  the  injection  the  prussiate 
of  potash  is  found  in  considerable  quantity,  and  the  iodide  of 
potassium  in  small  proportion.  As  regards  the  sugar,  there  is 
none  yet,  but  we  shall  find  it  presently.  It  requires  an  hour  or 
more  for  the  sugar  to  appear  in  the  urine. 

"The  urine  then  eliminates  all  these  substances  in  a  manner 
more  or  less  rapid.  The  prussiate  of  potash  appears  first  and  the 
glucose  last. 

"  There  is  another  secretion  in  which  the  presence  of  sugar 
can  be  found  ;  this  is  the  gastric.  The  passage  of  the  sugar  into 
the  stomach  has  surprised  most  of  the  observers  who  have  seen 
long  since  that  when  diabetics  vomited,  although  they  had  eaten 
nothing  but  flesh,  the  vomited  matters  were  saccharine.  When 
it  was  believed  that  diabetes  proceeded  from  a  perversion 
of  the  digestive  functions,  it  was  considered  that  the  flesh  was 
changed  into  sugar  in  the  stomach.  But  one  need  not  now  be 
mistaken;  the  flesh  is  not  saccharine.  Bernard  himself  has  ob- 
served that,  in  diabetics  who  vomit  fasting,  in  the  vomited  matters 
the  presence  of  sugar  could  be  found.  But  this  has  only  occurred 
when  the  disease  is  at  its  greatest  intensity  ;  and  in  all  those 
cases,  even  in  the  animals  which  have  been  rendered  artificially 
diabetic,  it  is  much  more  difficult  to  obtain  the  passage  of  glucose 
into  the  gastric  juice  than  into  the  urine. 

"  The  sugar  is  formed,  as  we  have  seen,  at  the  expense  of  the 


1858.]  Treatment  of  Diabetes.  857 

albuminous  substances.  In  the  healthy  man  it  is  clear  that  a  part 
only  of  these  matters  is  consumed  for  this  purpose.  The  diabetic 
who  forms  much  sugar  expends  a  very  large  quantity  of  azotized 
material ;  the  blood  is  impoverished  ;  and,  although  the  patient 
eats  enormously,  he  gets  thin  like  a  man  badly  nourished.  The 
liver  takes  in  a  manner  the  ration  of  the  other  organs,  which  un- 
dergo a  considerable  attenuation,  because  the  albuminous  elements 
are  transformed  into  sugar. 

"  M.  Bouchardat  has  proscribed  the  use  of  amylaceous  and 
saccharine  matters  in  the  food  of  dibetics.  The  facts  which  Ber- 
nard has  himself  witnessed  in  the  practice  of  M.  Raver  proves 
clearly  the  utility  of  azotized  aliment.  In  the  regimen  of  these 
patients,  writes  Bernard,  vegetable  aliments  ought  to  be  forbid- 
den, as  it  is  evident  that  they  augment  the  functional  activity  of 
the  liver.  You  know,  also,  that  they  are  excitants  of  the  kidnevs  ; 
that  they  are  much  more  diuretic  than  animal  matters.  Thus 
all  the  herbivora  pass  much  more  urine  than  carnivorous  animals. 
In  the  azotized  regimen  diabetics  have  the  advantage  of  food 
which  is  nut  diuretic. 

"  I  have  at  great  length  reminded  you  of  M.  Bernard's  views 
regarding  the  formation  of  sugar  in  the  animal  economv.  As 
some  of  them  are  of  so  novel  a  character,  and  so  little  in  accord- 
ance with  the  notions  formerly  held,  I  have  thought  it  advisable 
to  mention  the  experiments  upon  which  he  founds  his  opinions. 
That  they  will,  upon  further  investigation,  be  more  or  less  modi- 
fied, is  not  improbable  ;  but  they  have  been  very  generally  receiv- 
ed by  the  most  distinguished  physiologists  and  pathologists. 

"  From  M.  Bernard's  investigations,  we  learn  the  following 
facts  of  importance  in  reference  to  the  saccharine  plan  of  treating 
diabetes : — 

"  1.  Sugar  may  be  rationally  administered  to  diabetic  patients, 
inasmuch  as  the  sugar  found  in  the  general  circulation  is  almost 
always  secreted  by  the  liver,  and  as  sugar  introduced  into  the 
intestinal  tube  in  its  passage  through  the  liver  is  there  altered  and 
converted  into  an  emulsive  substance,  which  serves  to  fatten  these 
patients,  and  thus  to  counteract  their  tendency  to  emaciate. 

iim2.  Substances  which  contain  glucose — such  as  honey  and 
fruits,  should  be  given  to  diabetics  in  preference  to  those  contain- 
ing cane-sugar,  because  the  latter  is  not  destroyed  when  injected 
into  the  blood,  but  is  constantly  eliminated  by  the  kidneys; 
whereas  glucose  can  be  destroyed  in  certain  proportions. 

"3.  Cane-sugar  would  be  beneficial  to  a  certain  extent ;  as  when 
taken  into  the  intestine  it  is  in  part  at  least  transformed  into 
glucose ;  but  if  given  in  too  large  proportions  to  be  thus  com- 
pletely transformed,  the  disease  would  be  probably  aggravated 
by  the  presence  in  the  blood,  and  subsequent  excretion  by  the 
kidneys,  of  the  former  variety  of  sugar. 


858  Editorial.  [December, 

<;4.  The  glucose  should  be  given  in  moderate  quantities  at  a 
time,  and  frequently,  rather  than  in  large  quantities  at  long  inter- 
vals; because,  when  much  sugar  is  taken  fasting,  it  is  absorbed 
too  quickly  to  admit  of  its  complete  destruction  in  the  liver,  and 
it  passes  into  the  general  circulation,  whence  it  is  eliminated  in 
urine." — British  Med.  Jour.,  and  American  Jour,  of  Med.  Sciences. 


EDITORIAL  AND  MISCELLANEOUS. 

End  of  the  Fourteenth  Volume. — The  present  number  closes  the 
Fourteenth  Volume  of  the  Southern  Medical  and  Surgical  Journal. 
While  carefully  reviewing  the  accumulated  results  of  our  labors  during 
the  past  year,  as  we  have  been  obliged  to  do  in  the  preparation  of  the 
final  Index,  we  can  but  feel  encouraged  by  the  high  style,  practical  char- 
acter and  great  value  of  many  of  the  original  papers  kindly  furnished  by 
contributors.  The  true  intent  and  purpose,  of  a  medical  journal,  as  we 
conceive  them,  are  never  so  fully  carried  into  effect  as  when  its  original 
communications  present  a  clear,  full  and  reliable  exposition  of  the  Pa- 
thology and  Therapeutics  peculiar  to  the  region  in  which  it  is  published. 
There  is  perhaps  no  circumstance  which  strikes  the  mind  more  forcibly, 
when  opportunity  for  observation  is  allowed,  as  the  difference  impressed 
upon  the  type  and  progress  of  disease,  and  no  less  on  the  treatment  re- 
quired, by  the  change  of  locality.  The  fevers  of  the  Northern  climates 
would,  we  opine,  but  illy  bear  the  active  medication  found  necessary  at 
the  South,  while  our  endemics  would  fare  badly,  if  the  temporizing  pre- 
cepts of  our  northern  brethren  were  not  mended  to  meet  the  dangerous, 
and  often  fatal  tendencies,  impressed  upon  them  by  our  peculiar  climatic 
and  thermotic  influences.  Medical  journals,  then,  must  record  these 
differences,  if  they  would  attain  their  full  degree  of  usefulness  in  their 
own  region,  or  supply  to  other  and  more  distant  regions  a  faithful  report 
of  the  history  of  disease  in  their  immediate  vicinity. 

But  a  restricted  record  of  local  medical  facts  and  precepts  would  not 
fully  answer  all  the  demands  of  even,  a  local  journal ;  the  neglect  to 
embody  in  its  pages  a  portion  of  the  vast  amount  of  valuable  information 
accumulating  in  other  portions  of  the  world,  would  deprive  its  readers 
of  much  which  justly  belongs  to  them.  The  Eclectic  department  there- 
fore, becomes  no  less  important  than  the  Original,  and  when  this  is 
carefully  and  judiciously  conducted,  a  monthly  medical  journal  can  be 
made  to  supply  a  greater  variety  of  practical  and  useful  information 


1858.]  Editorial  and  Miscellaneous.  859 

than  can  be  made  available  by  the  practitioner,  who  is  actively  engaged, 
even  from  the  largest  and  best  selected  library. 

To  such  a  purpose,  we  have  earnestly  endeavored  to  devote  the 
pages  of  the  Southern  Medical  and  Surgical  Journal,  and  to  the  same 
end,  we  shall  endeavor  to  labor  during  our  connection  with  it  in  the 
forthcoming  fifteenth  volume.  "With  this  view,  we  ask  the  assistance  of 
the  Profession,  not  only  in  extending  the  encouragement  of  prompt  pay- 
ments to  our  faithful  and  liberal  Publisher,  but  also,  we,  as  Editors,  invite 
contributions,  which  shall  enhance  its  scientific  value,  and  keep  it,  as  it 
has  heretofore  been,  a  store-house,  full  of  valuable  practical  information 
for  readers,  not  only  at  home,  in  the  South,  but  in  the  North,  the  East, 
and  the  West — wherever  its  pages  may  be  perused. 


Ocr  present  number  has  been  detained  somewhat  beyond  its  usual 
time  in  the  preparation  of  the  Index  to  the  volume.  For  the  delay,  the 
Editors  are  alone  responsible ; — the  work  of  the  publisher  was  fully 
ready  at  the  usual  time  of  issue.  Book  notices,  and  much  other  Editorial 
matter,  are  necessarily  delayed  for  our  next  number. 


Chloroform  in  Dentistry. — There  is  an  impression  abroad  amongst 
dentists  that  every  man  is  his  own  keeper,  and  that  his  life  is  in  his  own 
hands.  Lamartine  says  that  it  is  strongly  characteristic  of  the  weakness 
and  imperfection  of  humanity,  and  typical  of  our  earthly  nature,  that 
man  comes  into  the  world  impotent  to  save  himself,  or  to  add  one  day 
to  his  life  when  beneath  the  edge  of  the  mortal  shears,  destitute  and 
helpless,  but  armed  with  the  power  of  annihilation  and  self-destruction. 
This  privilege  the  dentists  of  some  sort  are  disposed  to  grant  freely  to 
their  dupes.  Chloroform  is  undoubtedly  a  mortal  agent,  an  agent  which 
may  become  inimical  to  life.  Its  risks  have  but  too  frequently  and  too 
fatally  been  shown  by  many  recent  accidents,  and  especially  by  the  un- 
happy death  at  Epsom  on  the  27th  ult,  of  a  person,  to  whom  it  was  ad- 
ministered by  a  druggist.  There  is  a  moral  as  well  as  an  intellectual 
side  to  our  art,  and  to  the  art  of  the  true  dentist.  It  is  time  that  the 
ethics  of  chloroformization  were  established.  The  extraction  of  a  tooth 
is  not  an  operation  which  in  any  way  bears  upon  life;  it  is  not  in  itself 
attended  with  any  risk.  The  deaths  which  chloroform  has  occasioned, 
when  administered  to  facilitate  this  process,  are  unbalanced  by  any  cor- 
responding gain  of  equal  import.  The  moral  duty  of  the  dentist  is  there- 
fore clear.  He  has  not  the  right  to  risk  the  patient's  life  for  the  extrac- 
tion of  teeth.  The  timidity  of  the  patient  or  her  pressing  entreaties  are 
not  more  germane  to  this  consideration  of  duty  than  her  rank  or  her 
wealth  would  be.  In  the  cause  of  life  everything  is  permissible.  It  is 
justifiable  to  refute  the  arguments  of  her  ladyship  ;  it  is  right  to  give  a 
flat  denial  to  her  grace.  However  crooked  those  cruel  fangs,  they  are 
less  pitiless  than  the  fangs  of  death  ;  and  though  the  patient  turns  rebel- 
lious from  the  door,  it  is  better  than  that  she  should  have  found  there 


860  Miscellaneous. 

"  that  bourne  whence  no  traveller  returns."  It  is  chiefly  our  fashionable 
ladies  who  demand  chloroform.  This  time  it  was  a  servant  girl  who  was 
sacrificed ;  the  next  time  it  may  be  a  duchess.  If  a  patient  should  press 
urgently  for  any  dangerous  poison  it  would  not  be  administered  to  her, 
notwithstanding  her  own  personal  responsibility.  Nor  should  chloroform, 
although  only  probably  dangerous  to  life.  Henceforward  we  think  that 
this  must  be  looked  upon  as  a  matter  of  conscience  amongst  operators. 
To  our  thinking  they  are  bound  to  withhold  Chloroform  for  the  extrac- 
tion of  teeth  by  every  consideration  of  right  and  moral  responsibility. 

[London  Lancet. 

Castration  for  Malignant  Disease. — The  diseases  which  may  lead  to 
the  necessity  for  castration,  as  given  in  Mr.  Curling's  work  on  "  The  Testis," 
are  the  different  forms  of  carcinoma,  incurable  struma,  abscesses,  and 
tedious  sinuses  consequent  on  inflammation,  and  cystic  disease.  We 
have  given  clinical  records  of  most  of  these  from  time  to  time ;  but  the 
most  common  form  which  demands  this  operation  is  carcinoma,  and  not 
unfrequently  the  medullary  form.  We  saw  the  right  testicle  removed 
on  the  10th  ult.,  at  Guy's  Hospital,  by  Mi*.  Cock,  from  a  man  twenty -five 
years  of  age,  who  was  married  and  the  father  of  a  family.  His  general 
health  was  good;  but  eight  months  ago  he  first  noticed  an  enlargement, 
and  this  gradually  increased,  until  latterly  it  has  become  rapidly  much 
larger.  There  was  no  history  of  having  received  a  blow,  and  there  was 
no  pain ;  there  was  a  degree  of  fluctuation  about  it  which  indicated  a 
surface  of  fluid.  A  needle  was  introduced  a  few  days  before,  which  gave 
exit  only  to  a  little  blood.  Mr.  Cock  suspected  it  to  be  malignant ;  for 
besides  the  suspicious  character  of  the  nature  of  the  swelling,  the  cord 
was  enlarged.  An  incision  was  made  over  it,  and  then  a  section  into  the 
body,  when  the  gland  was  found  to  be  completely  disorganized  from  soft 
cancer.  It  was,  therefore,  removed,  the  vessels  of  the  cord  being  tied 
before  the  tumour  was  detached.  The  cord  consisted  principally  of  a 
mass  of  tortuous  veins  in  a  varicose  condition,  but  was  not  otherwise 
affected,  and  therefore  held  out  a  favorable  prospect  of  cure  from  the 
operation. 

In  Mr.  Coulson's  case,  the  testicle  was  extensively  diseased,  as  a  result 
of  inflammation,  and  removal  was  equally  imperative,  as  in  the  foregoing 
instance. — [Ibid. 


Traumatic  Diabetes. — Dr.  Plagge  relates  the  case  of  a  young  man  who 
received  a  blow  upon  the  occiput,  and  the  following  night  complained  of 
strangury.  Three  days  after  he  suffered  from  excessive  hunger  and  thirst, 
and  passed  large  quantities  of  urine,  of  the  sp.  gr.  of  1*043,  containing 
much  sugar.  His  condition  remained  stationary  in  spite  of  the  employ- 
ment of  opium,  tannin,  and  an  annualized  diet.  A  drachm  of  the  bicar- 
bonate of  soda  (the  urine  being  slightly  acid)  was  then  given  to  him 
daily,  and  he  considerably  improved.  Nevertheless,  the  quantity  of  urine 
continued  in  excess  during  two  months. — \Gaz.  des  Hop.,  and  Virginia 
Med.  Journal. 


INDEX  TO  VOLUME  XIV. 


PAGE. 

Abdominal  Typhus  in  children.  .  .  . 
Absorption  of  Medicines  by  large 

intestine , 762 

Abscesses,  absorption  of 842 

Aconitum  Xapellus — aconite 706 

Acclimation  of  Xegroes 452 

After  treatment  of  Surg,  operations,  488 

Albumen,  discrimination  of 506 

Amaurosis  of  Laziness 645 

American  Med.  Association 417,  283 

American  Med.  Monthly,  notice  of. .   2S7 

American  Medical  Gazette? 287 

American  Dentists  in  Europ'e 792 

Ampelopsis  quinquifolia  or  Virgin- 
ia creeper 358 

Anaesthesis  by  Projection 216 

Anaesthetic,  a  new 433 

Animal  Heat,  influence  of  Surgical 

affections  on 760 

Anderach  bark,  a  new  febrifuge. . .   357 
Antony,  Dr.  E.  L.    Method  of  remo- 
val of  fish-hook 214 

Analysis  of  human  excrements. ...  766 
Antagonism  of  opium  and  quinine . .  77^ 
Animal  Charcoal — antidote  for  Can- 

tharides   849 

Appropriate  Treatment  of  Dysente- 
ry. Robert  Campbell,  M.D.  .107,  147 
Aphonia,  treated  with  electricity. .   564 

Apoplexy,  intellect  in 326 

Appointment  of  Prof.  Jos.  Jones 282 

Apparent  death  during  paroxysms 

of  fever 838 

Armor,  Prof.  S.  G 57  3 

Arthritis,  clinical  lecture  on 555 

Artificial  rupture  of  amniotic  sac 

in  labor 35 

Artesian  Wells  in  Sahara 218 

Asthma,  influence  of  atmosphere  on  486 
Atlanta  Medical    College,  resigna- 
tions, <fcc 69 

Augusta,  Ga.,  healthiest  city  in  the 

Union 650 

Augusta,  health  of 718 

Autopsy  30  years  after  removal  of 
uterus ..." 690 

Baker,  P.  De  L.,  M.D.  Sources  and 
qualities  of  Honey 802 

Barclay's  Manual  of  Diagnosis,  no- 
tice of  212 

Battey,  Robert,  M  D.  Subcarbon- 
ate  of  Bismuth 11 


PAGE, 

Beneficial    effects   of   Pepsine  for 

vomiting  of  pregnancy 848 

Bibron's   antidote   for   rattlesnake 

poison 485 

Binding  of  14th  volume 70 

Bismuth,  subcarbonate,  Robt.  Bat- 
tey, M.D   11 

Books  rec'd  for  review,  notice  of  69,  497 
Books,  journals  <fc  pamphlets  rec'd .  432 
Burns,  treatment  of  cicatrices  after  ii74 

Calcarious  Salts  in  treat,  of  rickets,  352 

Campbell,  H.F.,  M.D.  Classification 
of  Febrile  diseases  by  their  rela- 
tion to  the  nervous  system 13 

Campbell,  H.F.,  M.D.  Diphtheritis, 
quinine  and  alum  in 784 

Campbell,  EL  F,  MD.  Technicali- 
ties before  juries,  physicians  and 
lawyers 142 

Campbell,  H.  F.,  M  D.  Meckel's 
Ganglion 133 

Campbell,  Robert,  M.D.  Appropri- 
ate Treatment  of  Dysentery,  107,  147 

Campbell,  Robert,  M*D.  Letter  on 
Treatment  of  Typhoid  fever. . .  .  487 

Cannabis  Indica  Haschisch — Indian 
hemp 707 

Cancer,  manganate  of  potash  a  caus- 
tic in 217 

Cancer,  escharotic  treatment  of. . .   262 

Cancer  in  a  woman  80  yrs.  of  age,  358 

Carbonic  acid  gas  in  diseases  of 
womb 843 

Carnochan,  J.  M.,  M.  D.  Exsection 
of  5th  Nerve 126 

Case  of  Transfusion 280 

"     "  False  Conception 563 

Castration  in  malignant  disease 860 

Cathartics  In  Dysentery 42 

Caustic — Sulphuric  acid"  and  sulph. 
zinc 48O 

Caustic,  painless 578 

Cauterization  of  Strictures  in  nasal 
canal.. 

Chamomile,  new  property  of.  . .       017 

Chase,  D.S.,  M.D.,  D.D.S/  Electri- 
city in  extracting  teeth 433 

Chloroform  liniment  in  burns 73 

"         an  antidote  for  strychnia,  290 

in  paralysis * 48 1 

"         in  Dentistry 859 

Chlorate  of  potash,  uses  of 202 


862 


INDEX. 


PAGE. 

Chlorate  of  Potash  in  ulcers 358 

Cincinnati  Lancet  and  Observer. . .   287 
Clinical  Lecture  upon  some  of  the 
effects  of  Intemperance,  by  L.  A. 

Dugas,  M.  D 3 

Clinical  Lecture  on  Treatment  of 

Dysentery,  by  R.  Campbell,  M.D    75 
Clinical    Lecture   on   Appropriate 
Treatment  of  Dj^sentery,  by  R. 

Campbell,  M.D 107,  147 

Clinical  Lecture  on  Influenza 232 

Clinical  Lecture  on  Chorea  &  mye- 
litis of  chord 411 

Clinical  Lecture  ou  Dyspepsia. . . .  543 
Clinical  Lecture  on  Pulmonary  Hae- 
morrhage    550 

Clinical  Lecture  on  Arthritis 555 

Clinical  Lecture  on  Conical  Cornea,  623 
Cod-liver  oil  solidified  with  gelatine,  63 
Coffee  and  lemon-juice  in  ague. . . .  432 

Colica  Pictonum 71 

Compliment  to  Doctors 290 

Commendable  to  the  Profession. . .  718 

Convulsions,  pathology  of 210 

"  puerperal 505 

"  of  children 793 

Correspondence,  professional. ....  489 
Corrosive  sublimate  and  collodion 

an  escharotic 361 

Croup,  indications  and  treatment  of  345 

Daguerreian  Art  in  Med.  <fe  Surgery    74 

Death  of  R.  Q.  Dickinson,  M.D 434 

"  Robert  Hare,  M.D 506 

"       "  For'gn  eminent  Med.  men,  722 

Dentistry,  chloroform  in 859 

Diabetes  Mellitus,  a  case  of,  treated 

by  Jos.  Jones,  A.M.,  M.D 291 

Diabetes  Traumaticus 351 

Diabetes,  saccharine  treatment  of — 

rationale 851 

Diabetes,  traumatic 860 

Diagnosis  between  Cancer  and  Con- 
dylomata   488 

Different  methods  of  treating  Inter- 
mittent Fever 245 

Diphtheria 750 

"  Epidemic , 753 

Diphtheritic  Affections 747 

"         or  malig.  Sore  Throat,  274 
»       335 

Diphtheritis,  alum  and  quinine  in, 

by  H.  F.  Campbell,  M.D 784 

Diphtheritic  Aug.  epidemic  at  Lima,  748 
Diseases  of  Mucous  Memhrane,  by 

T.  Douglas,  M.D 744 

Diseases  of  Cervix  Uteri,  Notes  to 

Report  on,  by  J.  A.  Eve,  M.D. . .  92 
Diseases   of    Respiratory    Organs, 

treatment 472 


PAGE. 

Dissecting  Wounds,  treatment  of . .     72 

Doughty,  W.  H.,  M.D,  Report  of 
Cases  in  City  Hospital 602 

Dr.  P.  F.  Eve's  Address,  American 
Medical  Association 498 

Dugas,  L.  A.,  M.D.,  Lecture  on  Some 
of  the  Effects  of  Intemperance . .       3 

Dugas,  L.  A.,M.D.,  Lecture  on  He- 
morrhoidal Affections 219 

Dugas,  L.  A.,  M.D.,  new  principle 
of  diagnosis  in  dislocations  of  the 
Shoulder-joint 315 

Dugas,  L.  A.,  M.D.,  the  Indigenous 
Races  of  the  Earth — Review...     18 

Dunglison's  Med.  Dict'ry,  15th  ed. .     68 

Duration  of  Cancer 217 

Dysentery,  treatment  of,  R.  Camp- 
bell, M.D 75 

Dysentery,  appropriate  treatment 
"of,  R.  Campbell,  M.D tt>7,  147 

Dysmenorrhea,  valuable  remedy  in  642 

Ear,  Human,  Physiology  of, 47 

Eczema  of  Face  in  children,  local 

applications  in 432 

Editorial 350 

Edinburg  celebrities — Dr.  Simpson,  362 
Effects  of  poisoning  upon  the  Foetus,  629 
Electricity  in  extracting  Teeth,  D. 

S.  Chase,  M.D,  D.D.S 433 

Elimination,  doctine  of. 482 

Empyema,  injections  of  water  into 

pleural  cavity  in 175 

"  treated  by  injections. . .   261 

Emulsions,  Robert  Battey,  M.D. . .   538 

End  of  Fourteenth  volume 858 

Epidemic  Fever  and  Pharyngitis. .  252 
Epithelial  Cancer  of  Anus  &  Rectum  681 

Epilepsy — Lactate  of  zinc  in 478 

"         Ligation  of  common  Car- 
otid in 346 

Epidemics  &  Topography  of  Geor- 
gia, J.  F.  Posey,  M.D 106,  191 

Epidemics  investigated  by  experi- 
ment  705 

Ergot  in  Menorrhagia 479 

Errors  in  relation  to  Hysteria 461 

Erysipelas,  new  local  application  in  578 

"         tobacco  in 713 

"         perchloride  of  Iron  in. . .   483 
Escharotic  treatment  of  Cancer. . .   262 
"  collodian  and  corrosive 

sublimate  as  an 361 

Eve,  J.  A.,  M.D.,   Notes  on  Cervix 

Uteri 92 

Eve,  Dr.  Paul  F.,  President's  Ad- 
dress Amer.  Med.  Asso.,  at  "Wash- 
ington, D.  C 498 

Excision  of  the  Hip-jtoint 69 

Exsection  of  2d  branch  of  5th  nerve,  526 


INDEX. 


863 


PAGE. 

Facial  Neuralgia,  cautery  to  helix,  798 

Farell,  W.,  M.D.,  Formula',  remarks 
on.  . .  '. 8<)6 

Fatal  disease  of  Appendix  Vermi- 
form is 467 

Fatty  degeneration  of  the  heart — 
death  from  the  inhalation  of  the 
Tinct.  Chloroform 691 

Felder,  W.  I*,  M.D.,  remarks  on  the 
chlorate  of  potash 227 

Fenner,  E.  D.,  M.D.,  new  remedies 
in  yellow  fever 772 

Fenner,  E.  D.,  M.D.,  acclimation  of 
negroes 452 

Fenner,  E.  D.,  M.D.,  valuable  rem- 
edy in  dysmenorrhea 642 

Fevers,  their  identity  and  treatment  827 

Fever,    Malarial,  observations   on, 
by  Jos.  Jones,  A.M.,  M.D.,.  .363,  435 
507,  579,  651,  723 

Fistula  in  ano  <t  pulmonary  disease,  287 

Flint's  Report  on  PracticeMedicine  243 

Foreign  body  twenty  years  in  nasal 
passage .-. 474 

Forensic  medicine,  Cadaveric  sound,  287 

Foul  ulcers  of  the  legs 361 

Fourteenth  volume  of  South.  Med. 
and  Surg.  Journal 64 

Fractures,  ununited,  treatment  of.   277 

Gaseous    injections    into    Cellular 

Tissue 782 

Gelatinized  Chloroform 361 

General  paralysis  of  the  Insane. . .   342 
Glycerine  as  a  solvent  and  vehicle 

for  Iodine,  (fee 7  4 

"         in  Corns 215 

"         in  Phthisis 290 

"        with    alum    and    white 

precipitate 578 

Green,  W.  A.,  M.D.,  Malformation,  451 

Haemostatic,  a  new 721 

Haematuria,  sulph.  of  quinine  in. .   558 
Haemorrhoids,  sulphur  and  nux  vo- 
mica in 650 

Headache 612 

Head  symptoms  relieved  by  quinine  464 

Hemorrhage 794 

"  liquor  ferri  sesquichlo- 

rati  in 349 

Hemiplegia,  intellectual  faculties  in  026 

Hernia  of  the  ovary 695 

Hernia,  theory  of  its  production, . .   835 

Hippocrates,  discovery  of  tomb  of.  290 

Holmes,  O.  W.,  M.D.,  fine  simile. . .  218 

"         "         "     on  controvorsy,  362 

Honey,  question  of  poisonous 715 

"      catches  inoref  flies  than  vin- 
egar  719 


PAGE. 

Honey,  qualitio*  and  sources  of .  . . .  802 
"       alleged  deleterious  effects  of 

by  V.  La  Taste 680 

Honors  conferred  on  American  phy- 
sicians   145 

Hooping  cough,  vaccination  in. .. .  717 

How  to  keep  rooms  cool  in  summer,  434 

Hydrocele,  electricity  in 578 

Hypertrophy  of  the  tongue 359 

Incontinence  of  urine 216 

Increase  of  insanity  in  England.  .  .   506 
Indications  and  treatment  of  croup,  345 

Infants  found  dead  in  bed 578 

Inflammation,  acute,  internal  treat- 
ment of 269 

Influence  of  atmosphere  on  asthma,  486 
"  pregnancy  on  tubercles,  487 

"  of  surgical  affections  on 

animal  heat 760 

Injection  of  urea  and  other  substan- 
ces into  blood 703 

Intermittent  Fever,  treatment  of. .   348 

"  "       urethral 562 

Inversion  of  bod}'  to  relieve  renal 
calculus 850 

Jackson,  Dr.  Charles  T.,  of  Boston,  146 
Jones,  Prof.  Jos.,  appointment  of. .   282 
Jones,  Jos.,  A.M.,  M.D.,  case  of  dia- 
betes mellitus 291 

Jones,   Jos.,    A.M.,  M.D.,   Observa- 
tions on  Malarial  Fever,  363,  435 

507,  579,  651,  723 
Journal  de  Physiologie  de  l'homme 
et  des  Animaux 575 

Kinloch,   R.  A.,  M.D.,  Excision  of 
Hip-joint 69 

Labor  in  a  girl  13  years  old 721 

Laceration  of  Perinaeum 721 

Lactate  of  Zinc  in  Epilepsy 478 

Lead  Colic 352 

Lecture,  clinical,  on  effects  of  Intem- 
perance, by  L.  A.  Dugas,  M.  D . .  3 
Lecture,  clinical,  treatment  of  1)\ 

entery,  by  Robt.  Campbell,  M.D.  107 
Lecture,  clinical,  appropriate  treat- 
ment of  Dysentery,  by  Robert 

Compbell,  M.D../ 147 

Lecture,  clinical,  on  Influenza 232 

Lecture,  clinical,  on  Chorea  <fe  mye- 
litis of  chord 411 

Lecture,  clinical,  on  Dyspepsia 543 

Lecture,  clinical,  on  Pulmonary  Hae- 
morrhage    550 

Lecture,  clinical,  on  Arthritis 555 

"       on  Conical  Cornea,  623 

"          "       on  Scarlatina 26 


364 


INDEX. 


PAGE. 

Lecture,  clinical,  on  catamenial  gon- 
orrhoea and  Syphilis 63 

Lecture,  clinical,  on  Hemorrhoidal 
Affections,  by  L.  A.  Dugas,  M.D.  219 

Lectures,  Watson's,  on  Practice  of 
Physic,  notice  of 790 

Legal  Doctrines  concern'g  Insanity,  137 

Letter  on  treatment  of  T}rphoid  Fe- 
ver, by  Robert  Campbell,  M.D. .  487 

Liability  of  Negroes  to  Epidemics 
of  the  South 253 

Lichen  and  Cod-liver  oil 73 

Ligation  of  common  carotid  in  Epi- 
lepsy    346 

Liquor  Ferri  Sesquichlorati  in  hem- 
orrhage     349 

Local  Influence  in  Spasmodic  Asth- 
ma   759 

Maine  Med.  and  Surgical  Reporter, 

notice  of 576 

Malarial  Fever,  observations  on,  by 
Jos.  Jones,  A.M.,  M.D.,. 363,  435, 

507,579,  651,  723 
Malformation,  case  of,  "W.  A.  Green, 

M.D 451 

Mammary  Abscess,  treatment  of. .  794 
Manganate  of  Potash,  a  caustic  in 

cancer 217 

Meckel's  Ganglion,  Dr.  Carnochan's 

operation,  H.  F.  Campbell 138 

Medical.  College  of  Georgia,  annual 

commencement 284 

Medical  and  Surgical  Reporter. . . .  289 
"       College  of  State  of  So.  Ca., 

resignations  and  app'ts..  496 
"       Jour,  of  N.  Car.,  notice  of,  791 
"       and  Physiological  Commen- 
taries, Dr.  Payne's 788 

"       and  Medico-legal  notes  on 

extra  uterine  Pregnancy,  676 
"       Journals  of  the  U.  States. .   217 

Memphis   Medical  Recorder 288 

Menstruation  during  Pregnancy. .  704 

"  in  Austria 845 

"  Phvsiology  of,   by  E. 

Hillyer,  M.D 795 

Miller's   Principles    of    Obstetrics, 

notice  of 565 

Minutes  of  annual  meeting  of  Med. 

Society  of  State  of  Geoi-gia 353 

McClellan,  Prof.  J.  H.  B 572 

McDaniel,   R.,  M.  D.,  Tapping  in 

Ovarian  Dropsy 450 

Musgrove,  W.  C,  M.D.,  Phytolacca 
Radix 230 

Nashville  Jour.  Med.  <fe  Surgery, . .  287 
"        Monthly  Record  of  Med. 

and  Phys.  Sciences 791 


PAGE. 

Nashville  Medical  Society. 574 

Navy  and  Army  appointments...  720 

Negro,  liability  to  epidemics 253 

New  Antiperiodie 361 

New  Febrifuge — Anderach  Bark. .  357 

New  Hsemoslatic 721 

New  local  application  in  Erysipelas  578 

New  method  of  amputation 577 

New  mode   of  treatment  for  Puru- 
lent Ophthalmia 839 

New  Orleans  School  of  Medicine. .  573 

Med.  News  &  H.  Gaz.  288 

"         Med.  &  Surg.  Journal,  288 
New  Principle  of  diagnosis  in  dis- 
locations of  Shoulder-joint,  L.  A. 

Dugas,   M.D 315 

New  Remedies  in  Yellow  fever. .  772 

Non-Mercurial  treatment  Syphilis.  209 

N.  Am.  Med.  Chir.  Review 287 

Notes  to  Report  on  diseases  Cervix 

Uteri,  by  J.  A  Eve,  M.D 92 

Novel  method  for  foreign  bodies  in 

CEsophagus 214 

Observations  on  Malarial  Fever,  by 
Jos.  Jones,  AM,  M.D.,  363,  435, 

507,  579,  651,  723 
Observations  on  Diabetes  Mellitus,  479 
"  "  the  poison  of  Upas 

Antiar 697 

Observations  on  Pepsine  in  vomit- 
ing of  pregnancy 710 

Observations  on  the  temperature  of 

patients 831 

Obstinate  vomiting,  iodine  in   ....  481 

"  "  pepsine  in 710 

Obscure  forms  of  nervous  affections,  756 
Obstructions  from  disease  of  caecum,  687 

Obituary 434 

Oglethorpe  Med.  and  Surg.  Journal,  496 
Ohio  Med.  &  Surg.  Jour'l,  notice  of  574 

Oil  of  Tanzy 70 

Oil  of  Cedar 71 

On  the  use  of  Iron 398 

Ophthalmia,  irritating  applications 

in 345 

Our  exchanges,  changes,  fusions,  <fcc.  286 

Pacific  Med.  &  Surg.  Jour.,  notice,  212 

Pain,  the  uses  of 763 

Paine's  Insti'tes.  of  Med.,  notice  of,  570 

"     Med  &  Phys.  Commentaries,  788 

"     Vitality  &  action  of  remedies  788 

Painless  Caustic 578 

Paralysis  of  Facial  Nerve 794 

Paralysis,  Intellect  in > 326 

Paralysie  generale 819 

Pathology  of  Convulsions 210 

Pennsylvania  Medical  College 650 

Penin.  &  Ind.  Med.  Jour.,  notice. .  288 


IXDEX. 


865 


PAGE. 

Perehloride  of  Iron  in  Erysipelas. .  483 

Pertussal  Glucosuria 

Phagedenic  Clcen  treated  by  irri- 
gation  

Phytolacca  Radix,  W.  C.  Musffrove, 

M.D .....800 

Physicians  and  Lawyers,  technical- 
ities before  juries,  H.  F.  C 142 

Phosphates  in  Tuberculosis 

Platinized  Charcoal 505 

Pleuropneumonia,  treatment  of. . .   475 
Pneumonia  after  Laryngotomy. . .   414 

Polypus,  uterine,  ecraseurin 

Poison  census 362 

Practice  per  capita 646 

Pregnancy,  influence  of  tubercles « 

siting  of,  pepsine  in. .  710 

"         signs  of 216 

"         watery  discharge  of  Ute- 
rus in 770 

Pressurein  Phlegmasia  Dolenus. .   .  .434 
Prevention  of  ill  consequences  of 

Surgical  operations 

Professional  candor,  excision  of  the 

Tongue 213 

Professional  changes,  <fcc 572 

dignity 721 

Prolapsus  Ani 794 

Puerperal  Convulsions §06 

Puerperal  Fever 698 

Pulmonary   Epithelium 7ii 

Quack,  an  insect 362 

Quinine  and  alum  in  Diphtheritis. 
H  F.  Campbell,  M.D 784 

Rattlesnake  poison,  Bibron's  anti- 
dote for 485 

Remarks  on  Chlorate  of  Potash,  by 
W.  L,  Felder,  M.D 227 

Remarks  on  Hypophosphite- 

Remarks  on  Rheumatism 561 

Remarks  on  the  sources  and  quali- 
ties of  Honey,  by  Paul  De  Lacy 
Baker,  M.D 802 

Remarks  on  Formula,  by  "W.  Far- 
ell,  M.D ... 806 

Remitting  fever  of  children 243 

Remittent  fever,  treatment  of .  247 

Report  of  cases  in  City  Hospital,  by 
W.  H.  Doughty,  M.D 602 

Reproduction  of  joints 

Rev.  Sidney  Smith  on  Hay  fever. .   216 

Rheumatism  of  the  epithelial  and 
non-epithelial  tissues 48,  114 

Rheumatism,  chronic,  principles  of 
treatment  in   470 

Saccharine  Urine,  various  tests  for.  465 
Savannah  Journal  of  Medicine 284 


Scarlatina,  treatment  of 

"         yeast  in 

Shelby  Medical  College 

:  Pregnancy 

Sir  Philip  Crampton's  coffin 

Sir  Benjamin  Brodie 

Six  cases  of  Cataract  in  one  family, 
operatioas  successful 

Slitting  up  the  lachrymal  canal . . . 

Smith,'  Dr.  R.K.Bloekley  hospital, 

Sound  common  sense  and  quackery. 

Southern  Journal  of  Med.  and  Phy- 
sical B  

Specific  for  Scabies 

Statistics  of  coiling  of  the  funis.  .  . . 

Stricture,  introduction  of  catheter 
in 

Strychnia  in  Sciatica 

Substitute  for  human  milk 

Sulphuric  acid  and  sulphate  of  zinc, 
caustic 

Sulphur  and  nux  vomica  in  haemor- 
rhoids  

Supra-renal  capsules,  congenital  ab- 
sence  

Supra-renal  capsules  and  bronzed 
skin 

Surgery  in  San  Francisco 

1  Suture  of  tendons  of  fingers 

Symmetrical  morbid  action 

Sympathetic  inflammation,  eye-ball, 

Syphilis,  primary  rules  of  treatm't. 

Syphilis,  non-mercurial  treat,  in . . . 

Syphilis,  primary,  treat,  with  Iron, 

Syphilis,  primary,  treatment  of. . . 

Syrup  of  Super-phosphate  of  Iron, 

Tapping  in  O^tk&n  Dropsy,  by  R. 

McDaniel,  MT> 450 

Temperature  of  patients,  observa- 
tions on 831 

Temperature  of  body  in  Intermit- 
tent Fever * 215 

for  saccharine  Urine 465 

Test  for  Quinine  and  Morphine 70 

Tetanus 794 

Tetanus,   Traumatic,    relieved    by 

amputation 341 

Tetanus,  treatment  of. 74 

Traumatic 339 

The  Indigenous  Races  of  the  Earth, 

L,  A.  Dugas,  M.D 18 

The  Divine  unconscious  in  Medicine 

— nonsense 361 

The  "'  Sands  of  life  played  out" 

The  Uses  of  Pain * 763 

Thyroid  Body,  functions  of. 348 

Tobacco  in  Erysipelas 713 

Tongue,  hypertropy  and  amputa- 
tion of .  * ". 359 


AGE. 

248 
361 
574 
216 
650 
7-1 

360 

675 

721 

57S 
350 

711 
713 
254 
a 
480 

650 

290 

320 
215 
783 
576 

10 
486 
209 

65 
360 
263 


366 


INDEX. 


PAGE. 

To  Readers  and  Correspondents. ..  113 
Treatment  of  Diseases  without  Al- 
cohol    639 

Transfusion  of  Blood 343 

"  successful  case,     73 

Tracheotomy,  statistics  of 768 

Trismus  and  Tetanus,  treatment. .  709 
Tubercles,  influence  pregnancy  on,  487 
Tuberculosis,  proximate  cause  and 

specific  remedy 208 

Tuberculosis,  Bronchial 281 

"  Phosphates  in 207 

Typhoid  Fever,  letter  on  treatment 

of,  by  Robert  Campbell,  M.D. . .  487 
Typhoid  Fever,   Thoracic  form,  its 
treatment.     Translation,  by  J.  J. 

West,  M.D 178 

Typhoid  Fever,  ulcerated  larynx  in  359 
Typical  Diseases,  normal  course  of,  834 

University  of  Louisville 573 

University  of  Louisiana,  professori- 
al change 497 

Upas  Antiar,  poison  of 697 

Urea  and  other  substances  injected 

into  the  blood 703 

Urethral  Intermittent  Fever 562 

Urine,  saccharine,  various  tests  for,  465 
Uses  of  Chlorate  of  Potash 202 

Vaccination  in  Hooping  Cough...  717 
Value  of  a  young  lady's  teeth. . . .  290 


PAGE. 

Valuable  remedy  in  Dysmenorrhea,  642 
Varicose  subcutaneous  operation. .   780 

Venereal  Badge 359 

Virginia  Creeper,  Ampelopsis  Qnin- 

quefolia 358 

Vomiting  of  pregnancy,  pepsine  in, 

710,  848 
"        Puerperal  cured  by  indu- 
cing labor 45 

"         Paracentesis  Thoracis  in.  844 

"Watery  discharge  from  the  "Womb 

in  Pregnancy 770 

Water  drinking,  its  influence  upon 

the  metamorphosis  of  the  system,  714 
West,  J.  J.,  M.D.,  Thoracic  Form  of 

Typhoid  Fever 178 

West's  Lectures  on  Diseases  of  Wo- 
men, notice  of 68 

Westmoreland's  Syllabus 285 

Wilson's  Anatomy,  notice  of 790 

Wind  of  a  shot 650 

Wines,  the  medical  uses  of 809 

Womb,  Carbonic  acid  gas  in  dis- 
eases of 843 

Woorara.  properties  of 71 

Wright,  Prof.  Daniel  F 572 

Yeast  in  Scarlet  fever 367 

Yellow  Fever,  new  remedies  in. . .  772 
treatment  of 261 


1399 
Pi 


Southern  Medical  Mnd  Surgical  Journal 


.  Vol.  U,  1858 


_