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Full text of "Southern Medical and Surgical Journal"

SOUTHERN 

fttcMcai avto Surgical Imtttutl 

D BY 

HENRY F. CAMPBELL, A. M., M. !>.. 

U BFICIA1 iX" roiii-ArATlVi- IXATOXl IN TV. 

ItOBERT CAMPBELL, A. M., M. D., 

1 IX THE Mi" 







./, prends h bi n ou je U trouve. 



VOLUME XVII.— X<>. X 1 1 . — 1861. 
AUGUSTA, GEORGIA: 

DH. WILLIA PUBLISHER, 

1861. 



1402 



SOUTHERN 
MEDICAL AND SURGICAL JOURNAL 

(sew series.) 
Wl. XVII. AUGUSTA, GEORGIA, JANUARY, Ml. NO. 1 

ORIGINAL AND ECLECTIC. 

ARTICLE XXIV. 

FIRST UKPORT TO THE "COTTOX PLANTERS' 
CONVENTION" OF GEORGIA. 

On the Tert/iary Zdrru Formation of Georgia., by Joseph 
Jonsb, M. D., Professor of Chemistry in the Medical Col- 
lege of Georgia, and Chemist of the Cotton Planters' 
Association. 

(continued.) 

From these several analyses of the rocks from which 
these valuable wheat soils have been derived, it will be 
-1 — 
First, Lime enters largely into their composition. The 
lime is found in combination with sulphuric acid, carbonic 
fcwid and phosphoric acid, and with chlorine. The sulphate 
of lime appears to he derived principally from the beds of 
Mini, which are found amongst the shales, 
•ond. Magnesia is an important and constant con- 
stituent of the shales and limestones. These observa- 
tions in New York demonstrate that this element, 
when not in the caustic condition, but combined with 
carl. | other acids exerts beneficial influences upon 

cereals. Observations upon the influence of dolomites 
(lim< containing a large amount of carbonate of mag- 

in K- ' v : rc, Massachusetts, in England, and in other 
countries, f^M^istrate the cor of the conclusion 



Tertiary I ■ /' [January, 

that magnesia saturated with carbonic acid gas is aol inju- 
rious to vegetation. 

Third. These rocks contain all the salts of soda and 
potassa, as well as those of lime and magnesia, necessary 
for vegetables and animals. 

Fourth. These rocks also contain organic matters which 
are supposed to have been derived from the plants and 
animals which lived at the period of the deposition of these 
rocks. 

According to the returns of the wheat crop of New York 
from 1*44 to 1845, the soils resulting from the decomposi- 
tion of the older and harder rocks, as those of the Taconic 
and Hudson and Mowhawk districts, yielded only from 8 
to 9J bushels to the acre, whilst the soils of the western and 
central wheat district yielded on an average L5| bushels to the 
acre. The differences in the yield of the lands in these regions 
have been shown by Professor Emmons to be due to differ- 
ences in the physical and chemical constitution of the soil, 
and to differences of the chemical and physical constitution 
ot the rocks from which they have been derived. 

We might multiply examples to show that a deficiency 
n\ lime causes sterility, whilst its abundance promotes fer- 
tility. The following examples, however, in addition to 
those which we have just recorded, will be sufficient to 
place the question of the value of lime beyond all doubt or 
dispute. 

Long bland, if we except the drift upon its northern 
»r that which faces the sound, lias been recovered 
from the ocean — it is based upon a reef of rocks upon which 
Band has been washed up by the waxes, the soil is therefore 
ed almost entirely of washed sand, which is exceed- 
ingly porous, and contains hut little lime. Tt yields but 
pom- returns to the agriculturist, unless highly manured. 
The sea islands upon th >a8l o\' Georgia have a sim- 

stitutiou to Long Island, but they are in many cases 
e productive, on account o\ the vasl number of shells 
deposited upon them by the Indian-, and left upon the sur- 
ifter the last elevation of the Atlantic co 



1861,] Of Georgia. 3 

The soil from Schodack, New York, the analyses of 
which are recorded in the tahle, contains only a trace of lime 
and magnesia, is a very poor soil and is soon exhausted by 
culture. 

In Smitkfield, Rhode Island, a very luxuriant soil has 
resulted from the mixture of the detritus of hornblende 
rock and limestone. The effects of lime in rendering this 
soil fertile, is demonstrated by the fact that white and red 
clover, and other sweet grasses spring up upon it as they 
would do upon carefully limed soils.* The tertiary soils of 
Rhode Island, on the other hand, are wanting in vegetable 
matter and lime, and are correspondingly poor and easily 
exhausted. 

The Black Jack lands of York and Chester, South Caro- 
lina, which have resulted from the decomposition of porphry, 
and which contain, according to the analysis of Professor 
Tuomey, near three per cent, of carbonate of lime, and an 
appreciable amount of soda and potassa, prove, when pro- 
. perly drained and cultivated, to be equal to the best grain 
lauds in the State of South Carolina. 

From the disintegration of " rotten limestone " are pro- 
duced the richest prairie soils of the counties of Green, 
Sumpter and Marengo, in Alabama. 

In a still farther examination of these tables, the next fact 
which strikes our attention is : 

(b.) — The proportion of Sand and Clay varies greatly in differ- 
ent soils. 

The texture of soils depends in great measure upon the 
proportions of sand and clay. 

Pure sand forms a soil without any tenacity. The effects 
of manures speedily vanish upon sandy soils. 

Pure clay forms a soil of the greatest tenacity, and a soil 
which is with difficulty drained. 

It would be important and interesting to consider these 
properties of soils in their relations to drainage, but we 
most defer the thorough discussion of this subject to the 

Jackson's Agricultural Report on Rhode Island, p. 128. 



4 Tertiary Lime Formation [January, 

report upon the soils of Georgia, and confine our attention 
to their relations to lime. 

The texture of the soil has important bearings upon the 
action of lime, and determines in a great measure the 
amount which should be applied. 

And here again a knowledge of the chemical constitution 
of the rocks from which the soil has been derived is of 
great importance. The proportion of hard insoluble coarse 
particles in soils which are generally denominated sand, 
difter both in physical and chemical characters, according 
as the rocks from which they have been derived differ in 
these characters. Thus, we may have a coarse or a fine 
sand. Thus in the highland or primary districts of New 
York, the soil is coarse and the quantity of finely divided 
matter is evidently deficient, because derived from hard 
rocks which decompose slowly; whilst the soils derived 
from theTaconic rocks are finer than those of the Primary, 
and contain a greater proportion of finely divided matter, 
and yet they are inferior in fineness of division, from the 
soils of central and western New York, which have been 
derived from Sedementary rocks of a newer date, which arc 
still more rapidly decomposed. That texture alone will 
influence the fertility of a soil, might be illustrated by nume- 
rous examples; the following well established facts will, 
serve to show the effects of division: Soils composed almost 
entirely of coarse sand silex, allow the salts applied to 
enrich the soil to be washed out by the rains, and both their 
capillary power for fluids, and their absorbent power for 
gases are weak. The power of such soils to absorb moisture, 
and ammonia, and other leases from the soil, and to draw 
up by capillary attraction the water from beneath will be 
greatly increased by comminution or by adding sonic 
material which will absorb readily moisture, which will de- 
compose the coarse particles, and thus give tenacity to the 
soil. Now lime is precisely the substance which accom- 
plishes these effects. 

It has been calculated bv Professor Leslie that in a soil 



L861.] Of Georgia. 

o\* gravel, the pores of which are l-100th of an inch in 
diameter, water will ascend in these pores by capilliary 

attraction not more than four inches; whilst if the coarse 
sand have interstices oi only l-500th of an inch, water will 
rise through a bed of this sand sixteen inches ; and if the 
pores he still farther diminished to the l-10000th part of an 
inch, water will rise in such minute capillary tubes twenty- 
live and a half feet. The effect of the addition of lime to 
the soil is to diminish the size of its pores, and thus increase 
its power of capillary attraction. 

The effect of fine division upon gases is well shown in 
the case of spongy platinum — if a solid piece of ordinary 
platinum be plunged in a stream of hydrogen gas no effect 
whatever will pe produced; whilst if finely divided pla- 
tinum be plunged in the hydrogen, it will condense 
the gas with such rapidity that it will become red hot, 
and inflame the gas almost instantaneously. In our 
own bodies the great changes of life take place in 
the delicate capillaries and in the minute blood corpuscles, 
not more than the l-3000th part of an inch in diameter. 
Division promotes contact, and close contact allows the 
play of those molecular forces which act only at infinitely 
small distances, and the greatest of these forces, which can 
alone be excited by close contact is chemical affinity, which 
generates electricity, and is the great force in all animal and 
vegetable existence. Chemical action is inseperable from 
activity upon our globe — it is the great source of force in 
animals, and whether excited by the sun or by the secon- 
dary electrical forces generated in the bowels of the earth, 
it is the great force upon which vegetation absolutely de- 
pends. 

The following table will present a condensed view of 
many of the important physical relations of Lime to Soils : 



Tertiary Lime Formation 



[January, 



<4H 

o 



s 

s 



p 

p* 








3Q 




pa 




9 


'~ 


^3 


c3 


P 


>ri= 




U 


r -^- 


X 






0) 

o 
d, 



fcJO 






•J 



C S 









222 



IP 
Pi 



Hi 



B2* 

-/. 3 



I~a : 









a £S 



) 


1 













GO 




b 




p 




— 












o 


• 


CQ 






E 








i - 


s 










il 

i 



i a 

B2fc fiaB'S* 



hh t. -. o o>j? 



T.l'4I-f l-l- - - 



' = 



5°M 



§°£J 






g-S.S^c-^ 



>, - — 






■r. - - 






6u 

I I 

gS83$S98S ; 






■ z z — jHO^oxet-e 

i : ■: — BG -r -r S G i — — 10 1 rr 



■ _ . - i - z -ci-r'f-c 

s i ■-- r -I — •- — . ■ : -. ' : ■ ". 
c) ' e> od ««♦» oo oo< 



CflOCOISflCI 






4ifliet»ioot»oiain9H 
tie<c-ff»'t — .-: .-: n .-: *• 



0O&) - — 'T i - 



I <T) OS C« C". 



II It'-- 



• onr-tooomocoo 






2 9 «« 






: : 



III 



^*9 5 ' ii 



k55oS. 






c-=5tafcic-S--e 



7.-: = /:v:j>:«- I 



61.] Of Georgia. 

From a careful comparison of these results, the following 
conclusions, bearing more directly upon the employment of 
Calcareous manures in agriculture may be drawn : 

First: The tenacity of fine calcareous earth is less than 
one-tenth of that oi' sandy clay soil, less than one-twelfth 
of stiff clay soil, less than one-sixteenth of the tenacity of 
Btiff clay, and twenty times less than the tenacity of pure 
clay. 

The tenacity of calcareous earth is Less than one-four h 
the tenacity of arable land, and approaches more nearly 
to that of Humus, and of the richest and best garden earth. 

In wet weather stiff clay lands, o)i account of the rapid 
ity and extent with which they absorb, and the obstinacy 
with which they retain water, are soon converted into a stiff 
cohesive mud, which is worked with great trouble and dif- 
ficulty on account of the increased tenacity. In long con- 
tinued dry weather, stiff clay lands on account of the extent 
to which they contract and of the consequent increase of 
their tenacity, not only become so hard that they are with 
difficulty worked, but the roots of corn and cotton and of 
all vegetables penetrate the hard dry soil with great difficul- 
ty, and are greatly exposed and injured by the shrinking 
and cracking of the clay during drying. Not only theory 
and philosophical experiments performed in the Laboratory, 
but more especially practical agricultural experience, de- 
monstrate in the clearest and most indisputable manner, 
that the addition of marl and of calcareous manures gener- 
ally to clay soils, diminishes their tenacity in both wet and 
dry weather, counteracts the tendency to shrink and crack 
during dry weather, and thus renders them more easy of 
cultivation, and more suitable to sustain vegetation. 

•oinl : Inasmuch as calcareous earth absorbs water far 
more rapidly and to a much greater extent, and retain.- it 
much more tenaciously than sandy -oils, and than even 
1 arable land, it is evident that the addition of marls 
and calcareous manures generally to sandy lands will in 
crease the power of absorbing and of retaining water, and 



8 Tertiary Lime Formation [January, 

thus remedy a most prominent and injurious defect in this 
class of soils. Here again the results of experiment and 
the deductions of reason, correspond with those of actual 
agricultural experience. 

Third: The Ilygrometic power of calcareous earth, is not 
only far greater than that of sand and sandy soils, but it is 
nearly twice as great as that of good arable land. The abil- 
ity to absorb moisture readily from the atmosphere is a most 
valuable property in its relations to the germination and 
development of the vegetable kingdom. The moisture in 
the atmosphere contains not only water, which enters so 
largely into the composition of all plants, but it also con- 
tains small quantities of Carbonic Acid gas, Ammonia, and 
in certain conditions of the atmosphere, Xitric Acid — com- 
pounds which play an essential part in the economy of vege- 
tation. It is evident, therefore, that the addition of marls 
and of calcareous manures to sandy soils, and in fact to 
almost all arable lands, will increase their fertility, by in- 
creasing their power of absorbing water and valuable com- 
pounds from the atmosphere. 

Fourth : Calcareous earth absorbs heat less rapidly, and 
is far less subject to variations of temperature than sandy 
soils, and in fact, even than good arable soils. 

The rapidity with which soils allow their water to evapo- 
rate influences their temperature, for during the evaporation 
of the water the thousand degrees required to change the 
water to the state of vapor, is abstracted principally from 
the surface of the soil, upon which the evaporation is taking 
place. It is evident from this fact that soils which retain 
their moisture with tenacity, and consequently allow 
their water to escape by evaporation slowly, and at 
the same time absorb heat slowly and part with it cor- 
respondingly slowly, must necessarily possess a far more 
uniform temperature, and must as a necessary consequence 
be far more favorable to vegetation than soils which allow 
of rapid evaporation, and rapid aborption and radiation of 
)ieat. 



1861.] 0/ Georgia. 

The addition of marls and of calcareous manures, gen- 
erally to sandy soils will render their temperature more 
uniform. 

A still farther comparison of the results embodied in the 
tables of the composition of the soils of various countries 
and States in Europe and America, leads to the observation 
that soils differ greatly in the proportion of organic matters. 

An accurate knowledge of the amounts of organic mat- 
ter in soils, is essential to the intelligent and successful ap- 
plication of calcaceous manures to land. 

The intelligent and successful application of calcaceous 
manures must depend upon a knowledge of the chemical 
relations of lime to the inorganic and organic constituents 
of the soils. 

(c) Chemical Relations of Lime to the Inorganic and Organic 
Constituents of Soils. 

The effects of lime upon the constituents of soils are not 
merely physical effects ; as marked and as important as are 
the physical effects of calcareous manures upon soils, the 
chemical effects are still more decided and important. 

l>y the following simple experiments, the planter may 
demonstrate to himself, that lime exerts chemical effects 
upon manures, soils and rocks. 

If lime be mixed with Peruvian Guano there will be pro- 
duced, almost immediately, a strong smell of Ammonia; 
the Hnie has displaced the Ammonia, and combined with 
the Carbonic Acid and other organic and inorganic acids 
which had formed with the Ammonia of the Guano, solid 
compounds; the same effect will be produced by the addi- 
tion of lime to stable or cow-pen manure. This effect of 
lime upon the compounds of Ammonia, is exceedingly in- 
teresting to the planter, as indicating the impropriety of ad- 
ding quick lime to manures which contain the valuable 
ingredient Ammonia. 

If we carefully wash out all the soluble matters from 
manure of any kind, and then add lime, we will obtain,, at- 



10 Tertiary TArru Formation [January, 

ter allowing the mixture to remain for several hours, an ad- 
ditional amount of soluble matter. 

[f we place a definite quantity of soil upon a filter, and 
pass pure water through it until every trace of soluble mat- 
ter is removed, (which may be determined by evaporating 
the distilled water after its passage through the soil, in a 
clear watch glass or silver plate,) and then add to the soil 
lime, and allow the mixture to remain in a moist state for 
several days, and again pass distilled water through the 
mixture, we will obtain an additional portion of soluble 
matter, together with a portion of the lime which has been 
rendered soluble by chemical combination w r ith the ele- 
ments of the soil. 

[f we boil Felspar, one of the constituents of Granite, 
which contains the silicates of Potash and Alumina, with 
water, or even with acids, they will dissolve but little out 
of it, even after days and weeks ; if however, the Felspar be 
mixed with lime, the alkali Potash maybe readily dissolved 
out by means of acids, and even by water. 

These experiments clearly show that when lime is added 
to the soil it causes chemical changes in both the inorganic 
and the organic compounds of the soil. 

It is important that we should examine more closely the 
chemical effects of lime upon these tw r o great classes of 
compounds, which exist in all fertile soils. 

(d) Chemical effects of Lime upon the Inorganic Constituents 

of Soils. 
Every fertile soil is composed in large measure of insolu- 
ble Silicates, which are commonly called clay. The differ- 
ent varieties of clay, although possessing many properties 
in common, still differ in chemical constitution, and each 
variety, although apparently nothing but a plastic mass «>! 
a homogeneous simple substance, is in reality composed of 
eral different substances. The varieties of clay will differ 
with the rocks from which they have been derived, and with 
the various changes through which they have passed. Thus 
kaolin or china clay may arise from the decomposition of 



1861.] Of Georgia. 11 

the same rock Felspar, under two different conditions; and 
the kaolin will be different in each case. When felspar, 

which consists of one atom of the silicate of potash, com- 
bined with two atoms of silicate of Alumina, decomposes 
in a wet or rainy atmosphere, the silicate of potash appear 
to be simply washed away by the water, and the resulting 
clay has the composition of three atoms of silica and two 
atoms of alumina; when however, the felspar decomposes in 
a moist, but drier atmosphere, the silicate of potash, instead 
of being entirely washed away, is first decomposed, the 
silicic acid combines with the silicate of alumina, and the 
potash escapes as a carbonate, and the clay resulting is 
composed of four atoms of silica and two of alumina. 

There are nnmerous other minerals which, during their 
decomposition, afford clay of various constitutions. 

To illustiate this important truth to the agriculturist, 
that clays are composed of a great variety of substances, 
we have selected as examples three specimens of clay, 
from one country (the Netherlands) taken from the Zuider- 
zee, and analyzed by E. H. Von Baumhauer. 

We shall, at a subsequent part of this report, present 
analyses of the Joint clays of Georgia, and not only illus- 
trate the propositions here announced, but also demonstrate 
their great value in agriculture. 

TABLE 30. CHEMICAL COMPOSITION OF CLAYS FROM THE ZUI- 
DERZEE. 

First. Second. Third. 



Insoluble Quartzose 


sand, wit 


h 






Alumina and Silica, 


- 57.646 


51.706 


55.372 


Soluble Silica, 


- 


- 2.340 


2.496 


2.286 


Alumina, 


- 


- 1.830 


2.900 


2.888 


Peroxide of Iron, 


- 


- 9.039 


10.305 


11.864 


Protoxide of Iron, 


- 


- 0.350 


0.563 


0.200 


Protoxide of Manganese, 


- 0.288 


0.3f>4 


0.284 


Lime, 


- 


- 4.092 


5.096 


2.480 


Magnesia, 


- 


- 0.130 


0.140 


0.128 


Pota 


- 


- 1.026 


1.430 


1.521 



L2 



Tertiary TJme Formation 



[January, 











First. 


Second. 


Third. 


Soda, 


- 


- 


- 


1.972 


2.069 


1.937 


Ammonia, 


- 


- 


- 


0.060 


0.078 


0.075 


Phosphoric Acid. 


- 


- 


- 


0.46G 


0.234 


0.478 


Sulphuric Acid, 


- 


- 


. 


0.896 


1.104 


0.576 


Carbonic Acid, 


- 


- 


- 


6.085 


6.940 


4.775 


Chlorine, 


- 


- 


- 


1.240 


.1.302 


1.418 


Ilumic Acid, 


- 


- 


- 


2.798 


3.991 


3.428 


Crenic Acid, 


- 


- 


- 


0.771 


0.730 


0.037 


Apoerenic Acid, 


- 


- 


- 


0.107 


0.160 


0.152 


Ilumic, Vegetable 


remains 


and 








Water chemically 


combined 


5 


3.324 


7.700 


9.348 


Wax and Resin, 


- 


- 


- 


trace 


trace 


trace 


Loss, 


- 


- 


~ 


0.512 


0.611 


0.753 



100.000 100.000 100.00 

We are .at once impressed with the important fact that 
these clays contain all the elements necessary for the growth 
and development of plants and animals. We shall hereafter 
show that the Joint clay not only in like manner contains ail 
the elements necessary for the constitution of plants and 
animals, but also contains a much larger proportion of 
Phosphoric Acid, than theseclays; and has by the abundance 
of this fertilizing element rendered the soils with which it 
has been mixed exceedingly fertile and durable, and has 
through the vegetable kingdom exerted most marked and 

o o o 

important influences upon the physical structure ot^ the in- 
habitants. 

Xotwithstanding that many clays contain all the inor- 
ganic compounds necessary for the production of vegeta- 
bles, Btill, in almost every case, these compounds are insol- 
uble, andean be obtained by the plants growing in the soil, 
only in small quantities. 

Carefully conducted experiments have demonstrated con- 
clusively, not only that these inorganic salts are absolutely 
accessary to the existence of the higher spe* ies of plants 
QSed by man for food and clothing, but also that these salts 






1861.] Of Georgia. 13 

to be available to plants must be in a soluble condition. 
It is evident therefore, that whatever tends to decompose 
and render soluble the insoluble constituents of clays, will 
add to the fertility of the soil. 

This is precisely the effect accomplished by lime. By its 
action upon the inorganic constituents of the soil, the in- 
soluble silicates of the clay are decomposed, and alumina 
and magnesia, and the alkalies, potash and soda, are set 
free, and silica is rendered soluble. 

In adding lime to the insoluble silicates of the soil, the 
agriculturist acts in precisely the same manner that the 
chemist does when he wishes to separate the constituents of 
some insoluble and apparently undecomposable mineral as 
felspar. In both cases the silica is separated and the alka- 
lies liberated; and it is well known to agriculturists that 
these alkalies are of the greatest importance in the success- 
ful cultivation of corn and cotton, and in fact, of all plants. 
To substantiate the value of these alkalies combined with 
silicic acid, we need look no farther than to the valuable 
effects of the Green Sand of New Jersey, the chemical 
composition of which we have before given. See page 4(3, 
table 12. 

(e) Chemical effects of Lime upon the Organic Constituents 

of Soils. 
The organic matters existing in the soil have been derived 
from both the vegetable and the animal kingdoms. It is 
well known that these two kingdoms are mutually depen- 
dent — the vegetable kingdom is a great laboratory, worked 
by the forces of the sun and fixed stars, in which materials 
are prepared and elaborated for the animal kingdom; whilst 
the animal kingdom' consumes these materials prepared by 
plants, and derives from their chemical changes precisely 
the same amount of force which was expended by the sun 
and fixed stars in the vegetable laboratory, it does not 
destroy this matter, but merely changes its form. The 
vegetable products, the starch, the sugar, and all the 
various compounds consumed by the animal kingdom, are 



14 l\i !'» i r >i L> me Formation [January, 

converted into various compounds and restored to the soil, 
and to the atmosphere. The principal portion restored to 
the atmosphere, the poisonous Carbonic acid gas constitutes 
an important element of the food of plants — the same is 
true o{' the ammonia resulting from the decomposition of 
the feces and urine, and bodies of animals. It is admitted 
thai from the atmosphere, Carbonic acid gas, water, ammo- 
nia and the inorganic salts, furnished by the animal king- 
dom, all the various vegetable products may be formed. 

The vegetable kingdom in like manner with the animal 
kingdom, is liable to constant change, generation succeeds 
generation ; and as in the case of animals, the dead are ad- 
ded to the soil and atmosphere. The products of the de- 
composition of the vegetable kingdom which we call Hu- 
mus, have all existed in the atmosphere, at some former 
period in the form of gas, and will exist in some future 
period again in the atmosphere in the form of gas, and will 
again be sbsorbed by the vegetable kingdom, and under the 
influence of the heat and light of the sun these gases will 
again be decomposed, the elements combined with other 
elements so as to form solids, destined to go through the 
same round of changes. 

The great fact which we wish, by these well established 
facts, to illustrate and impress upon the minds of the plan- 
ters is, that the organic matters of the soil are in a state o\ 
change, and that this change is absolutely necessary to 
the existence of the vegetable and animal kingdoms. If 
the organic matters of the soil remain unchanged, vege- 
tation would go ow consuming the Carboni3 acid and 
Ammonia, and the nitrogen <A' the atmosphere, and convert- 
ing the great proportion o\' the compounds resulting from 
the action of the vegetable kingdom into insoluble useless 
forms. Whilst it would be true that the animal kingdom 
would convert a certain portion of the compounds formed 
by plants into those gaseous compounds necessary for the 
existence ^\' the vegetable kingdom, still it is evident that 
there would be a constant diminution of the matter circula- 






1861.] Of Georgia. 15 









ting between the two kingdoms, for every leaf and tree that 
died would abstract a certain portion of this changing mat- 
ter, and place it in a state of permanent rest. 

Humus then is one of the states through which matter 
passes during its circulation between the animal and vege- 
table kingdoms. 

The principle of practical importance which we derive 
from these facts is, that the rapid change of vegetable and 
animal matters into gaseous products is favorable to the 
development and perfection of crops. 

If wood, leaves and vegetable matters generally be ex- 
1 to the action of the air, they gradually undergo de- 
composition, and various products as humic, ulmic, geic, 
crenic and aprocenic acids are formed, together with Car- 
bonic acid — that most important gas to plants. The rapidi- 
ty of the decomposition of the vegetable matters will de- 
pend upon the temperature, the moisture of the air, and the 
thoroughness with with the matters undergoing decomposi- 
tion are exposed to the action of the oxygen of the atmos- 
phere. When the atmosphere has free access, the oxygen 
of the air is converted into an equal volume of Carbonic gas, 
and a large quantity of water is evolved, whilst also a small 
portion of nitrogen is absorbed, and ammonia, that most 
valuable food of plants is generated. If on the other hand, 
the supply of air be cut off and the decomposition of the 
vegetable matters takes place under water, but a small 
portion of Carbonic acid will be generated, and the pro- 
ducts of the decomposition will be far more insoluble and 
stable than those resulting from the decomposition of the 
table matters freely exposed to the atmosphere. The 
insolubility and indestructibility of the products resulting 
from the slow changes of wood and vegetable matter in gen- 
eral, in positions where they are in great measure excluded 
from the action of tne oxygen of the atmosphere, may be 
readily seen in the varieties of coal, lignite and peat, which 
exert little or no effect upon plants, unless they be first de- 
composed by the action of some substance possessing power- 



1G Tertiary Lime Formation [January, 

ful chemical affinities and capable of exciting decomposition. 
Whilst peat in its natural state, on account of its insolu- 
bility and its power of resisting chemical change, is com- 
paratively valueless as an application by itself to land, still 
when mixed with lime, it acts most beneficially not only 
by the compounds resulting from the decomposition of its 
organic carbonaceous compounds, but also by the liberation 
during this decomposition of its inorganic salts. 

Insoluble organic compounds analagous to peat and com- 
paratively valuless in themselves, exist in every soil ; and 
the value of the organic matters of soils depends not only 
upon the quantity, but upon the state in which they exist. 

We conclude from these facts that any substance which 
is capable of exciting chemical changes in the various or- 
ganic constituents of the soil, will render, the soil more fer- 
tile bv assisting in these changes which result in the forma- 
tion of gases and soluble compounds, and in the liberation 
of inorganic salts, which are absolutely necessary to a luxu- 
riant vegetation. 

It is evident, therefore, that the effects of lime upon the 
organic constituents of the soil are as important, if not even 
more important than upon the inorganic constituents ; for 
it occasions the decomposition of the organic matters, and 
thus gives rise to the formation of carbonic and nitric acids 
and ammonia, and at the same time liberates the saline 
constituents of former vegetation, in states of combination 
well fitted for assimilation by the growing crop. 

In the application of lime to the soil it is important that 
planters should bear in mind the following principles : 

First, As lime promotes the decomposition of the organic 
matters, they must be carefully supplied to the land under 
cultivation, yearly, for if they be not, then the land will be 
exhausted more rapidly than if no lime had been applied. 

Second, As the organic matter of the soil is decomposed 
by the simultaneous action of the lime, atmospheric air and 
moisture, and as the formation o( the nitric acid and am- 
monia takes place at the expense, in part, of the nitro- 



1861.] Of Georgia. 17 

gen of the atmosphere, it is not necessary to add immense 
quantities of lime to the soil ; it is not necessary to in- 
corporate the lime with the soil to a great depth. It would 
be best to make yearly applications, and apply the lime near 
the surface. 

Third, Lime in the caustic state (quick lime from the 
kiln) acts more rapidly upon the organic matters than the 
carbonate of lime, which is the form in which it invariably 
exists in nature, hence quick lime may be employed in 
much smaller quantities than marl or shell limestone in its 
natural state ; hence quick lime should not be added to the 
manure pile, while marl and shell limestone may in many 
cases be mixed, with beneficial effects, directly with the 
cow-pen and stable manure ; and hence the effects of marl 
and shell limestone in their natural conditions upon vege- 
tation are slower than that of quick lime. 

Fourth : "Without a sufficient supply of lime to the soil 
we can never obtain the full effects of manures. 

A still farther examination of the chemical constitution 
of the soils of various countries establishes the following 
proposition : 
(f) Soils differ greatly in the proportion of Phosphate of Lime 

and of Phosphoric Acid, both in their natural and in their 

cultivated states. 

In the majority of the analyses of American soils, Phos- 
phate of Lime and Phosphorie Acid has not been separated, 
and in those in which its presence has been indicated it has 
been in most cases represented simpfy as a trace. 

In almost every American soil yet examined, Phosphate 
of Lime and Phosphoric Acid are deficient. 

Phosphate of Lime and Phosphoric Acid enter into the 
constitution of all plants and animals, and is absolutely 
essential to their development and perfection. 

Careful experiments in Europe and in this country dem- 
onstrate that the Phosphate of Lime is a valuable fertilizer 
to all lands. The fertility of the lands of England are due 
in great measure to the extensive employment of marls, 
rich in the Phosphate of lime; and the most wonderful 



is 



Tertiary Lime Formation 



[January, 



sta have been produced upon the exhausted lands of 
Maryland and Virginia, by the application of marl contain- 
ing, it" not as great an amount of Phosphate of Lime as 
those of England, still a quantity greater than that contain- 
ed in a Libera] application of the best Phosphatic Guanos. 

If we institute a comparison between the amounts of 
Phosphate of Lime contained in the soils of Europe and 
A a srica with the amounts of this substance existing in the 
various marls and shell limestone of Georgia, we will be 
convinced of the great value of these native deposits. 

We will consider the value of Phosphate of Lime more 
fully under the following division of our subject: 

VII. Relations of the Shell Limestone and Marls of 
Georgia to Plants and Animals. 

Lime is indispensable to the healthy constitution of 
plants and animals. 

This proposition will be conclusively demonstrated by the 
following tables, which will prove of great value to the 
planter, not merely in their present use, but also as afford- 
ing important information upon the constitution of the ashes 
of various plants and animals. 

Table 31 — Showing the proportions of Phosphate of Lime, 
Phosphate of Magnesia, Carbonate of Lime and Carbonate 
of Magnesia in various vegetable and animal structures. 



' 1 

NAUE or BUBBZAirOI. 


NAME Of CHEMIST. 


-3 3 
So So 

li H- 

oB pB 

6 ■ — ' 

i SftK 


si 

- ^ 

:c 

a —■ 

: E 

'• r 

s.-: 

0.41 
10.60 
5.88 


- p 

If 

S"B 

•7 « 




Prof. Shcpard 


36.44 tract 
61.64 .... 

1 
17.1T18.88 


6.86 




do do 


0.96 


Stalk 


J. 1.. Smith, M.D 

Dr. Ua 

■ pard 



do do 

do do 

do do 


S.00 


urn 

tato 



ir 




•J. 16 
8.80 

51 


3.00 

3.56) 


3.00 


1 26 




do 






99 







'.» 67 




do 






0.47 




do 

do 


0.30 




ii 83 




da 






1.2] 





do 


6 '.: J 4 '.'.'.'.. '. 




'"7 







1.16 




do 






1.19 






86.00 3.1)0 
83.071 2.»8 
84.89 2.16 
86.02] 1.78 


6.00 
10.07 
9.43 
9.06 

9.19 












do 














do :... 





1861.] Of Georgia. 19 

ANALYSES OF THE ASH OF COTTON, WOOL AND COTTON SEED.* 

Wool. Seed. 

Carbonate of Potassa. (with possible traces of Soda) 44.19 

Phosphate of Lirne, with traces ot Magnesia 25.44 61.64 

Carbonate of Lime 8.85 0.41 

Carbonate of Magnesia 6.87 0.26 

Silica 4.12 1.74 

Alumina, (probably accidental) 1.40 

Sulphate of Potassa 2.70 2.55 

Chloride of Potassium 25 

Chlorides of Potassium. Magnesium, Sulphate of Lime, Phosphate 

of Potassa. Oxide of Lime in minute traces, and loss 6.43 

Phosphate of Potassa, (with traces of Soda) 31.51 

Carbonate of Potassa, Sulphates of Lime and Magnesia, Alumina and 

Oxides of Iron and Manganese in traces 1.64 

Or the composition may be expressed thus : 

Phosphoric Acid 12.30 45.35 

Lime 17.05 29.79 

Magnesia 3.26 

Potassa 31.09 19.40 

Sulphuric Acid 1.22 1,16 

From these data Prof. Shepard calculates that for every 
10,000 lbs. of Cottou Wool, about 60 lbs. of saline matter 
would .be abstracted, having the following constitution : 

Potassa, 31 pounds. 

Lime, - 17 " 

Magnesia, 3 " 

Phosphoric Acid, 12 " 

Sulphuric Acid, 1 " 

ANALYSIS OF A COTTON STALK — BY J. LAWRENCE SMITH, M. D. 

The ashes of a healthy cotton-stalk, six feet high, and an 
inch in diameter, at the largest part, with some leaves and 
empty pods, consists of, in 100 parts : 

Lime, .... 30.3 

Potash, - - - - 24.3 

Phosphoric Acid, - - - 9.1 

Magnesia, - - - • - 5.8 

Oxide of Iron, - - - 0-4 

Sulphuric Acid, - - - ,1.3 

Chlorine, - - - - 0.8 

Carbonic Acid, - - - 27.0 

Sand, .... 0.5 

ANALYSIS OF THE FIBRE OF SEA ISLAND COTTON, BY DR. URE. 

Carbonate of Potash, - - 44.8 

Chloride of Potassium, - - 9.9 

Sulphate of Potassa, - - 9.3 

Phosphate of Lime, - - 9.0 

Carbonate of Lime, - - 10.6 

Phosphate of Magnesia, - - 8.4 

Peroxide of Iron, - - - 3.0 

Alumina, a trace, and loss, - 5.0 



20 



Tertiary Lime Formation 



[January, 



.2 % OTJ 



jn a o 




— . at c 



■z 
o> 

go ■ 
o * 
U 

Eh 
-a -J 

3 T3 



:2 a 
= £2 



c 

T3^ 



p hO 

<3© 



» S 



| g K«H 3^ 



9a 



o 



o 



jM 



is y S i> i- >. £ 
3 «> £ T3 T3 fcci 



c C5 









Chloride of Sodium, 













Peroxide of Iron 


E0 r-H CO O 04' •fc-OJ • CO O - • C© tJ* CO . W a. QO 00 ^i 

CiCOSOiCO • <3S CO • r-i «D •i-tCOOt- -MMOOW 

i-h O i-H O O • O © 'HO • i-J 04 rH • O O © © CO 


Silica, 


• •NfflHHW00ON'<tiJ) 

• • co ->t< ~. coo-^ocnoO'ji 

• •:: r— r-:^^xJi^-M— i 


• OQOiMWiOMOOirt 

• «5 M "* -+ 90 <G eo SO S3 


Sulphuric Acid 


r-( • • <M 'OM • CN i-H CN ■>*< 


. r-» C4 0» US • i-H 00 -00 

•0>MCH • !M rH • O 




O • •© • i-h o •©©©© 


• rH o o o •© o • o 


Phosphoric Acid 


W<MWHOCOt)*00-*OOH 


■NMONWOOH^rl 


J>050«CWOOW10-*HN!0 




Lime, 


s» C r.soo^HOMJioo 
HMHM»M»WOlT)IKJl 


• oj O oo co rf a. ' ; 3*. -* 

• <4<.C4 r-4 rH ng( rH Tia rH 



Magnesia. 



Soda. 



Potash . 



o»eo«0(Neofl©o5'*'>*rHcqec 


•MCJlMJiHUOia 


»C >^A4l • M O 'J M • .t- 
t- • ■* l- co . 00 OO US ■© 


• 00 «C CO 04 0C t- r~ Tf tK 

• ooococoa z — >. 


rH • SH • 


• •*-*OTt<ecHONN 


00 00 Oi Tf rH H « W N '- ^ S 


• to** M eo to i-H 04 «4< C 

•©JNSi^OOCOrHO 



Ishes in dry plants when all I : : 

tya teris artificially removed | : : 

Ashes in 100 parts of crop 

as taken from ground . . . 



. ,_ _ ^_ ;, -m _ 







i|jA\n.ir! osiajoj 't^u.W •puBi^ii^j ui 

u.uoalt 'H'^MAV uo^adojj 



1861.] 



Of Georgia. 



21 



% 6 

~ -, a a a 



bfl 



br. . 

~ - - 

X? pfi-Ja 

a a -3 

2 215 



2 o * o 



I * 5.2 2 



• * a 

*' «| 

a 'o — 

53 -S J3 

§ n§ 



w C oa a ■» 

«) 9) 9) S 'J 



o^>o 



Chlorine 



x eo -.o 

■* CC Lt 



Chloride of Potassium , 



Chloride of Sodium » 



iOO« • » ® ^ O h K O • O '-O tJ< co >o eo 

Peroxide of Iron « w .*» :T ra . <°^ • »• : w . "*. » ~ =! » 

'(MNH •.-<©©© — i .-i © • © O O O t-I O i 



Silica. 






Sulphuric Acid. 



■>■> ~ ~ 

O i-l i-i 



O © r* eo .-H <m • 



Phosphoric Acid. 



SC X 

CO r-t CO -* Tt< . 



to *c co :r ct> 



Lime. 



CO<MCNl-*!MiO->*COrH 



HHOlOMt-lt SO 



Magnesia 


■- r .- c ..-:^OL'5Ho>-fO«09«e»«'OHM'* 

»®OOhooonoiOO-* • ?) c c; » •* » 30 c t|i 

i>- 







Soda. 



t— x •-> x ec eo x co 

tc: WOSNON • 

so 

OrlrlW^SHH 



Potash. 



cc eo 00 eo 



Ashes irf artificially dried plants ; 



co o3 tj< -^ o* 



Ashes in 100 parts of crop as 
taken from the ground 



Ol ->1 "M ?1 "^ 



:.5-a 

. si ^ 

• fcc5 



J3 : ** 
2 33 '.2«m 



•TS 



sc.2 - - 
' o M>o o 



« E O 



i ca m t. <w — ^ 



s ° 

-^ d 

a ss; 

3 5 



c — *» 



'.2.22 « • 

p5tfapL,PHi 



00 



71 rtiary Lime Formation 



[January, 



p 

u 
g 

& 

C 

o 

I 

CO 

CT 

w 

pq 

< 



















■r. 

§55 5 






























HJ2 




o 






CCS 


C3 v'fi 




73 




6 

2 o o o o o o 


< 


l^Joo 




a 

C3 




3 "O "C "^ T3 *C "O 








A 




i§ ^^ '> 


— O O O 




a 




Mfe Q (-3 


P? 




EC 




o 














! a 
















S 








a -a 










■5 J? 


eg 


• o . • 

M = 73 






g o So 




3 

~ c o o <y o o 










►-J 


Z$1*h%* 












fe^Cio 




a &h 




t- eq 






0! 










Chlorine 








J- S 00-^ :: 




r- 








0-1 r- X VC 


05 Ol tJ< 


Chloride of Potassium. . . 


;:;;:;; 




• TlXHJ 

• • OJ to e© -^ 

• • Ol O-l ~H CO 
























H !•: -i B t« 55 

cs> crj a ~. •— > ^ 
















Chloride of Sodium 


CM • -tJISMO 




















>C 0OHO4N 




O Ut CO !N Tt< CO 








































Peroxide of Iron 


' ~ rji 1G CO i— i 00 iO c£> 

o" © © eo *n eo o © 




























) 




01 X — i.". i- (> 


LO » fO CO Tf H 

(OMHOCO 

t- ao n oi ua oo 


eOHHO^^er 


Silica 


C O Tit 5) H ffl O) «5 
tt CO •>! rn 1> ® •* CO 


NXiO»J)NtO 

lO CM u-0 O CO OS t* 
^t ^^ "^ ^ *^ *^ ^F 










i— i r— 1 1— i r— < 








u 


i) 


o 






NCOtHWNC)^ s. 


Ci 


SmoiHhoo «■ 




— -* n -o c x t— t- 


Sulphuric Acid 


T) 3 O '£ M • CO £ 


,£ .J3 "*J* CO 1— 1 T— ICffCO^T 


r ec - ic X — 




00 tJH X ■* oi CO .£ 


J3. 


eo >0 *- >c ec - .~ 


<;- o t? o t- o n 


















oj 




QD 










a> 


o 






«o » x o o ic n r 




SoocOOOOiOO- 


' iC N "J CO M CO t)I 


Phosphoric Acid 




p.-- * 






cc - ♦ ec so — ?J ec 




^XtOt-tOiOO o 


^COt-XTj^Xi^^ 






Ph 












- 








CSt-Hf-H-^©©*-M 




t-asMcoc 




CO W CO « IC N iC 




OQ0»«NH Oct 




tot»r. _ MO 
*- ■* t- t- a *C 




HHNr.t-Oi)( 
» CO OC X lit lit xrj< 














•m •» m •* tj* ^ 




1— < 






CO CO CO © 'C lit OC O 




O) t- N *- CO OS 




• - -o »— -^i co tj< a 




Jl CON/ X . ! — 




oi '- t~ r- uo o 
fr- co o» C* ■* CO 




C X •* X iC C5 N 
CO Q» -^ CO >0 C3 t-H 












r- 1 <— i 














. to co • 


■«*< ■ «o «c 




-o -co • • - 




CO -O --T CO >1 t-- CO 


Soda 


• eo as • 


co '0oj> 




<N • i.O • • o 




C M tr- i-h co co ^J 


• eo t-H 


© • i-l ■* 

T-H 




OJ • o • • o 




r— i CjpJ ^1 1— I C4 CO U3 






co oooo oo o w ■* 




OONtCr-lXTt 




oi -. : cr. n oi r- 


Potash 


as iC i - . o x n n 




O®* M CO rH 




:t OttOCC ' 






1 D «OiH r. -i 




t llOHH ct 


eo 




'.'.'" -H* T '~ "7* '0 O 








CI -H rl J) -I - 








Oni« • • • ©> 




oo»c X X 




=>oo 




Ashes in artificially dried 


= - I - 


. 93 




<73 C^l 3^ CO ^ CO 




CO X CO Tji CO 






Plants 


■* t}< CO 


• • CO 




CO CSI — 




-r^rlOICO 






Ashes in I'M) parts of crop 






i- r ec • 


























us taken from the ground 






i-t i-i o • 


























a 

PL, 

o 








v. 






. ■/ 

, - 


! ! or 


















~E 


••' \b 






• >. ■ ■ '" 


■> 
















l_ 


qj O O O O O q 

.O 73 "C "2 7T ~ - 

2 




a 


oSgoS 




C 


- 


o c 





e 


a 




o 




&IT3*~ w -t 




~ — ~ rs ~ ~ "^ 


/.' 


<M 




o «*- o c 




■- 


cs o o o o o 5^: 

"— 73 'O "C "^ T3 a>"r 




o O o G 




- 




o 75 .- c - - 


. 


?, o o o c o o 

-'-— T3 -c 73 13 73 




=M 










>\'~ 




E- 


p 


H < 




QQ 















Of Georgia. 




wOOOOP-Wuu 



~1 

CO 

- 
pq 

< 



Chloride of Sodium 1 :::::::::::? 


Peroxide of Iron ' -!'".=. ~. =. :t . =» -'. « -J « ^ 

r 30000«3»OOOt-iO 


Silica, * ! • 2 §ho ! 5 3 « < 

1 U H ?l cc :>! n l- M vt rs — cc 


>o • -- . — —-■-.- 

Sulphuric Acid • :® : "* « : '. 1 • » ; « 

o ■ c • o c c ~ o — • © 


Phosphoric Acid 


X <* X ~ — -. I — K Z> 

■ - <4 cr i- ~ ~. -r. 7-1 ^r ■- ■-. ~ 






— •*- r ^r — -r 


,i- -. i- .- ■ - X — X C <X5 ?! o 

Lime, »» ••"! °.*r « °° °.*:*: "* 

eoooeorH •- to cc ?i — -— c: cc 


Magnesia 


-..-•-~. T! -- CC CO «~ COtHO 

1 - ~ — : 3 1 i - • a C H C 1 - '. a 


X *# — X ~r B i r. — N rt S3 ?! 


,»#£-lC "M © ?l CT CO 94 O a 3 

Soda ! - x . - 1 . x -! -. ■". - ! . * "* ?J . ~: 

C - - K -M -Jl 't « T) - ri M 






Potash. 



water is artificially removed _: _ _j _' ~; 



- ID 100 parts of crop as g g g = => g ~ 7 g g 
taken from grotnd _; ^ ^ ^ ^ ,_',_',_;_;_; , 



•puB[8a3 3 : : 
ui uMoxa c • : 

rfiaq.u ajiq.u"^ -^ "S 
'jMU*g pan 



- > •' 



ooob 



o o 



24 



Tertiary Lime tbrmation 



[January, 



Table 34 — Proportion of Sulphur and Phosphorous in Plants and 
Grain, according to II. C. Sorby. Liebigs and Kopps, A. R. P. of 0. 

vol. 2. p. 12*. Sulphur and Phosphorous in 100 parts of substances, 
dried at 212°. 



Poa palustrls and trlviaUs 

Lolium perenne 

Italian Rye Grass 

Trifollura pretense 

do (In 

Trifolium repens(very fine kit 

do do (ordinary do ) 

M go lupulina (very fine) 

Medicago Sativa 

do do 

do do 

tiva 

Kidnej Potatoes (solanum tuberosum). 

Top* of Kidney Potatoes 

Fruit of Kidney Potatoes 

American Potatoes 



Danous Carota, roots 

do do tops 

Beta Altesshna, roots 

do dc tops 



Delta do do 

do do tops 

Brasdca < Ueracca, (Swedish Turnip) — 
do Oleifera, (Rap< ». 



; -, i Drumhead Cabbage. 
Wheal Plant entire, (Triticum Vulgare, 



after fiowerin 

do do do do 

Ear of the Wheat when the Grain was 

formed, but still milky 

Straw ofWheat when grain was formed. . 



1.166 
1.810 
1.829 
•.107 
►.087 

1.274 
1.452 

■ 
1.17 



164 
0.188 

0.145 
0.149 

0.046 
0.215 

o.-Jl." 
(1 .:.. -,7 



I.05E 

1.851 

o.4il 



15 



0.075 



II.. 'is- 



0.860 

0.4480.233 
0.421 



0.140 



0.271 

0.1. s: 



Ear of Wheat when ripe 

'traw of Wheat when ripe 

Red Wheal 

Straw of Red Wheat 

White Wheal 

Straw of White Wheat 

Wheat 

'•harl' of Wheat 

Very fine Barley, (Hordeum distichum). 

traw of Barley 

Poor Barley 

riev 

Barley PI 

oat Plant (Avena Sativa) juat flowering. 

I 'at Planl in Flower 

Green Oats 

Straw of Green Oats 

B'ack Tartarian Oats 

Straw of Black Oats 



Si raw of White < )ats 

White Oats 

Straw of White < >ais 

Rye ears (Secale cereale)when young. 

straw of Rye 

R 



:ve. 



Bean 1'lant (vica faba) in flower 0.045 

Beans 0.0 1 

traw of Beans 0.14)- 

Peas I Pisium sativum 0.15 

3traw i if Peas 0.214 

Fine Hops (Humulus Lupulus) 0.1 

Rind of Hops iO.OM 






0.079 
>,366 
1.112 
I. HO 
0.262 
0.498 
0.087 

0.066 

L94 

0.128 
0.110 
0.158 

n.057 



0. 



0.160 
0.258 
0.600 

0.206 
0.076 
0.574 



Table 35. — Ash of Yolk and White of Hen's Eggs — Poleck.* 



Chloride of Potassium 

Chloride of Sodium 

Soda 

Potassa 

Lime 

Magnesia 

Sesquioxide of Iron 

Byarated Phosphoric Acid, 

Phosphoric Acid , 

Carbonic Acid 

Sulphuric Acid 

Silica 



Albumen. 



No. 1 [No. 2 
41.29 

9.16 
28.04 

2.36 

1.74 

1,60 

0.44 



4.83 



11.60 
0.49 



+2,17 
14.07 
L6.09 
1.15 
2.79 
3.17 
0.55 



3,79 

11.52 

1,32 

2.04 



Yolk, 



No. 1 No. 2 



5.12 

8.93 

12.21 

2.07 

1.45 

5.72 
63.81 

0.55 



6.57 

8.05 

13.28 

2.11 

1,19 



66.70 
1.40 



IE pp's annual report on i fee, for I860, vol. i, p. 879. 



1861.] 



Of Georgia. 



25 



TABLE 36. — ASHES OP 


MAN AND OTHER ANTMALS — VERDEIL.* 




Do S . 


Ox. 
No.llNo.9 

23.2421.11 
L8.00 L4.40 
6.60 8.76 

0.47 0.59 
1. •_>:, 1.16 
8.40 8.09 
1.66 1.69 
0.86 o.T' 
9. IK) 8.80 
6.571 6.49 


Sheep. 


Pig. 

No. IN 0.2 


Calf. 


Man. 




No.l 

19.60 
5.78 

15.16 
0.67 
1.71 

1-2.74 
1.29 
0.10 

12.76 
0.52 


No.9 
90.94 
90.04 
3.02 

in. if. 

4.:;s 

1.08 
9.S4 
2.86 

0.70 
8.65 

0.37 


No.l 
84.66 
22.46 
18.88 
5.29 
0.30 
1.65 
3. S3 
L.88 
1.00 
S.70 
7.09 


No. 9 
80.72 
19.90 

13.40 
7.93 
0.8-2 
1.91 
3.41 
1.58 
1.10 
9.17 
6.35 


No.l 
30.46 
19.73 
10.39 
11.74 
1.15 
1.34 
4.91 
3.45 
1.88 
8.69 
3.77 


No. 2 

86.18 

•23.40 
10.41 
9.81 
1.19 
1.21 
3.76 
2.97 
1.60 
7.80 
3.57 


No.l 
87.60 
24.49 

2.03 
12.10 

0.99 
1.70 
7.48 
1.87 
1.68 
8.06 
1.48 


No. 2 


{Chlorine 

} Sodium 


25 07 
16.24 

7.6-2 
29 -21 

l.'ai 

1.71 

10.61 

1.68 

1.20 
9.10 

0.61t 


80.06 

19.46 
5.88 

18.54 
0.97 
1.34 

11.48 
1.27 
1.90 
9.52 
0.86 


88.76 
21.87 

6.27 




11.24 




1 -16 




1 64 


Phosphoric Acid 


9.74 
1.36 




1 85 




8.68 


Carbonic Acid 


0.95 


'Annual Chemical Pharmacy lxix 
vol. 3. 


89. 


Leiblg and Kopp's Annual 


Report on 


Chemistry for 1849, 



Table 37 — Composition of the Blood of Man and Animals 
in normal condition, in 100 parts, according to Poggiale.* 



Water 

Klxod Corpuscles 

Albumen 

Fibrin 

Fatty Matters 

Extractive Matters and Salts 

The Salts contain— 
Chloride of Potassium and Sodium. 

Chloride of Calcium 

Phosphate of Soda 

Sulphate of Soda 

ite of Potasaa and Soda 

Phosphate of Lime 

\ide of Iron 

:ite and Sulphate of Lime... 



5^ 


£ 


O 


o* 


a 




H 


B 


o 

89 


o 


3 


3 




4 


r 5 




2 


V 




3 


779.9 


767.6 


796.1 


788 2 


835 6 


798.0 


831.0 


798.0 


812.0 


785.0 


130.1 


143.0 


1-23.1 


1 26 . 2 


92.6 


10-2.0 


91 .5 


126.0 


109.2 


150.3 


77.4 


74.0 


65.5 


67 2 


55.3 


85.C 


63.8 


63.0 


64.1 


47.2 


2.1 


3.8 


5.4 


6.3 


4.1 


8.S 


3,2 


2.2 


2.2 


5.1 


1.1 


1.8 


2.2 


2.2 


1.3 


1.8 


1.6 


2.3 


2.1 


2.3 


9.3 


11.8 


8.7 


10.0 


11.3 


10.0 


8.9 


8.5 


10.3 


9.1 


4.7 


6.4 


4.7 


4.8 


6.1 


5.7 


4 6 


4.4 


5.6 


5.0 






0.2 


2 


3 


-2 


3 


0.2 


0.3 


0.1 


1.4 


1.7 


0.8 


8 


1 1 


1 


8 


0.8 


0.9 


0.8 


0.4 


0.4 


0.6 


o..", 


0.8 


0.6 


0.6 


0.5 


0.7 


0.4 


0.5 


0.6 


0.4 


0,9 


0.4 


0.? 


0.4 


0.3 


0.5 


0.4 


0.7 


0.7 


0.5 


1 


0,8 


0.7 


0.6 


0.5 


0.7 


1.2 


1.3 


1.5 


1.8 


1 4 


1 1 


1 1 


1.0 


1.5 1.2 


8 


o.a 


0.4 


0.2 


0.4 


0.3 


0.2 


0.3 


0.1 0.2 


0.3 


0.1 


0.2 


0.2 


0.2 


0.3 


0.2 


0.4 


0.1 


0.2 


0.2v 



95.0 
143.1 

48.1 
5.1 
1.7 
8.9 

5.4 
0.2 
0.8 
0.3 
0.2 
1.1 
0.6 
0.2 
0.2 



•Annual report of the Progress of Chemistry, by Liebig and Kopp, vol. 2, 1847, 1848, p. 154. 

Table 38. — Ash of Blood, according to Henneberg, 100 parts contaiu. 



Chloride of Potassium, 
Chloride of Sodium . . 

Soda 

Sesquioxide of Iron . . 

Lime 

Magnesia 



Blood 


Blood 


of 


of 


Fowls 


Turkey. 


29.14 


36.81 


16.87 


3.31 


21.04 


24.02 


3.89 


4.77 


1,03 


0.93 


0.22 


0.46 



Phosphate of Soda and 
Potassa 

Phosphates of Lime, 
Magnesia and Iron. 

Sulphuric Acid 



Blood 

of 
Fowls 

19.63 

6.99 
1.19 



20,24 

8.49 
0.97 



'Liebig and Kopp's annual report on Chemistry, vol. 2, p. 159. 



26 



lerUary Lime Formation 



[January, 



Table 39. — Ash of Blood, according to Enderlin. In 100 

parts of Ash. 






r. 












i *" 


M 


— 


- 


. _. >r; , m 








—■ 
























o 




» 




a 2 


B| 








- 






7? 


t; 




A 










?T3 


7?- 


TTr; 


7? = 






3 
















■ K 




• tna 


■ n 


• K 


















. ite ut" 
































1 r< >ii 




11.07 


. 






8.70 


:.:> 


7.6 


9.4 


10.0 


9.8 


10.0 


9.61 


10.6 


9.6 







































19 M 




| 13.26 


J14.79 


jl4.58 


jlB.O 


J16.9 
















r iate of 


6.04 


8.47 


13.2 


12.1 


13.4 


17.8 




7.!' 


9.6 




































26.24 




86.88 




63.84 


60.48 


35.0 


24.4 


20.4 


' 


34.9 


28.0 






m o 


Phosphate of 








Soda 


6.1£ 




8.11 


7.19 










26.4 




31.3 


17 1 




(fl 4 




Sulphal 


































2. 34 


0.66 




3.30 










1.9 






4.0 


1.6 


1.7 




of 
































Sodium 








46.56 






87.9 


88.4 






7.5 


21.6 


81.8 




13.4 


Silicate of 







































. 


























Silicate oiJPo- 
































taBM 










3.53 


•2.75 


14.6 


11 .4 
















Ash in 100 
































p:irts 


1.519 


1.28 


1.23 


1.18 










1.20 


1.29 


1.55 


L.08 


0.84 




1.11 



*Loc. (Jit., vol. 2, pp. 15'J— 160. 

The results embodied in these tables, not only sustain 
the proposition that lime is indispensable to all highly 
organized plants and animals, but they also establish nume- 
rous conclusions and principles of the greatest value to the 
agriculturist. We shall at present notice only those which 
have an immediate connexion with the commercial and agri- 
cultural relations of the tertiary lime formation of Georgia. 

(a). The proportion of lime varies in different plants and 
animals. 

(b). The proportion of lime varies in different parts of 
the same plant or animal. 

It follows from these two propositions : First, different 
crops abstract different quantities of lime from the soil, and 
if these crops be sent off the plantation, the loss of lime to 
the place will depend not merely upon the amount, but 
also upon the character of the produce. 

Second, if animals be raised tor market, the amount of 
lime abstracted from the soil through the vegetable king- 
dom, will depend upon the mode in which they are pre- 
pared lor the market. If they he driven oil' in the living 
condition, all the lime which they have abstracted from the 
soil 'will be losl to the place. If they be killed upon the 
place, quite a large proportion of the valuable salts which 



1861.] Of Georgia. 27 

they have abstracted from the soil will be restored in the 
form of blood. If they be consumed upon the place, the 
greatest proportion of the lime which they have abstracted 
from the soil will be found in the bones. 

Third, as animals, whether carnivorous, herbivorous, or 
graminivorous, subsist ultimately upon the vegetable king- 
dom ; and as the salts which they derive from the soil 
through the vegetable kingdom, are thrown oft' in the urine 
and faeces, it is evident that the lime will be transported in 
the bodies of the animals from one part of the place to the 
other, and will accumulate principally at the stables, cow- 
pens, and the habitations of man. 

(c). The proportion of phosphoric acid and of phosphate 
of lime, varies in different plants and animals, and also 
varies in different parts of the same plant or animal ; and 
hence different crops and animals abstract different quanti- 
ties of phosphorous and phosphate of lime from the soil. 

(d). Lime and phosphoric acid, although entering largely 
into the composition of plants and animals, are by no means 
the only inorganic elements necessary for the development 
and preservation of the animal and vegetable kingdoms. 
The salts of soda, potassa, magnesia and iron are equally 
essential to the perfection of plants and animals, and, as in 
the case of lime and phosphoric acid, they vary in amount 
in different plants and animals, and in different parts of the 
same plant or animal ; and hence different crops and ani_ 
mala abstract different quantities of these salts from the soil. 

(e). The quantity and character of the inorganic salts, 
although varying within certain limits, are still remarkably 
uniform in the same class of plants and animals. We have 
selected in these tables, to demonstrate this important agri- 
cultural fact (that each class of plants and animals must 
have a definite amount of inorganic salts of a definite con- 
stitution), numerous analyses of the same plant by different 
ob-ervers. 

It follows from this that the farmer can calculate not 
only the amounts, but also the character of the salts annu- 
ally removed from his lands. 



28 



lertiary Lime Formation 



[January, 



Tims in the following crops the amounts of ash in the 
right hand column would be removed from each acre pro- 
ducing the amount of produce to the acre, assumed in the 
table : 

Table W. 





Weight of crop 
per acre in lbs. 


A si i es per 




As gath- 
ered. 


Dried at 
212°. 


acre in lbs. 


Indian Corn — Grain 

" Stalks, leavefe and fod- 
der 

"Wheat — Grain 


2250, 

9000. 
1000. 
2000. 
1450. 
1500. 
2200, 
3500 


2000. 

8000. 

900. 
1900. 

1300. 
4300. 
2000. 

3200. 

750. 

550. 
2700. 
27ilO. 
3000. 
1000. 


12. 

288. 
is. 


u Straw 

Rye — Grain 


76, 
29. 


Straw. 


236. 


( lata — Grain 


64. 


Straw 


241 


Tobacco — Loaves 


son. 

600. 
3000. 
3000. 
9000. 
3000. 


108. 


Stalks 

Red Clover— Hay 


50. 
236. 


Timothy — Hay 

Potatoes — Tubers 

Tops 


153. 

124. 
150. 



Table 41. — Table illustrating the proportions of the various 

inorganic matters, abstracted from the soil by 1,000 
pounds of various kinds of produce. 





o 

i 


/. 

1 


£ 

5 
a 


\ 

- 


> 
c 
3 






» 


s 


• "2. 


c 
3. 


i. — : 

•/. ^ 
ft 


NAMK OF CROP. 








9 


9 


: c 

-•> 


9- ° 




• ~. 


; ." 




: B 




lbs. 


Lbs. 


lbs. 


Lbs. 


lbs. 


lbs. 


lbs. 


lbT 


lbs. 


lbs. 
0.40 


Lbs. 
0JL0 


lbs. 


A sh of Wheat-Grain 


-.1 ?. r > 


■1 -til 


0.96 


0.90 


0.86 






4.00 


o..M 


11.77 


" " Straw 


it 20 




■:.v 












0..-7 




0.80 


85.18 


Ash of Barley— Grain 


3 7" 


2.90 




1.80 




Irur 






2.10 


0.19 


28.49 


Straw 






5.54 


o.T,; 


1.46 


0.11 


O.'JO 




1.1* 


L.60 


".7o 


53 49 


Ash of Oata— Grain 








6 . -'.7 


0.14 






19.78 






0.10 


38 80 


Straw 




o OS 




0.22 


0.06 


0.0-2 


o OS 




o 7:' 


0.12 


^.or. 




Asli of Rye— Grain 


r, 83 




1 2S 


1.78 


0.24 


0.4-J 




L.64 




0.46 


] 09 


10.40 


Straw 




0.11 


1.78 


0.12 


0.25 






:■:.:<: 


1.7i 


0.51 


0.17 


37.93 


Ash Of] 


4.15 


B.16 




1.68 








1 . 34 


O.K.) 


2.93 


o.U 


01.36 


" '" >tr:iw 


If. ,v, 




t; 24 








o.ot 






2 26 


0.80 


• 1.31 


Aab of Field Pea -Seed 


6.10 








0.30 


0.10 




4.10 


O..V 


1.90 


88 


24.64 


Straw 


S 85 


.... 27.31 




0.60 




07 


9.98 




2. i" 


II (H 


49.71 


Ash of Vetch -8eed 




6.22 L.<H 


L.42 


0.33 








0.61 


1.40 


0.48 


22.90 


Straw 


18 1(1 






0.15 


0.09 


0.08 


1.42 


1.3S 




0.84 


51.01 






L.04 ".:■" 




0.0.-'. 


o 17 






0. -.' 


B7 


6 308 







18.09 


Carrot— Root* 








0.089 








0.51 


n 07 


6.619 




3.07 




0.27 




0.005 




o.iolo.io 


0.10 
0.40 


0.17 
16 


1.180 










B 19 




1.7" 


0.04 






1.940.43 


1.97 


0.50 






















0.06 







IS 95 


:, 29 27 80 




0.1 1 






■:.'•■! 4.47 


n m 


H B2 


7 1 . 78 



















5.06 


3 11 















0.30 








l."' 


18.07 












"7 










5.00 


',11 


9.16 
1.88 


L.67 


80.57 


















1.7" 










o.io 


1.90 







1861.] Of Georgia. 29 

These tables illustrate in a forcible manner, the exhaust- 
ing effects of crops, and demonstrate that, whenever the 

vegetation in any form whatever, as grain, or hay, or fruit, 
or timber, is removed from the soil the land is gradually 
impoverished, by the removal of those salts which are ne- 
aary to the fertility of the soil. 

The great question with the planter is, how can this drain 
be stopped, and from whence can materials be obtained 
which will restore to the soil these salts which are carried 
off in every pound of cotton, and corn and beef. 

The preservation of the soil permanently in a state of the 
highest fertility, is the great problem to be settled by the 
Southern Agriculturist. 

Up to the present time, the Planters of Georgia have at- 
tempted no solution of the problem, but have cleared tract 
after tract of virgin soil, abandoned the worn out lands as 
soon as they proved unprofitable, and pursued their course 
of reckless devastation and exhaustion of one of the finest 
countries in the world, until nothing but furrowed, washed 
gullied and barren red clay hills, and barren sandy plains 
are left to the present generation. 

The great question of the regeneration of the worn out 
lands will find its solution in the proper use of the Tertiary 
Lime formation'.of Georgia, and of the natural sources of 
organic matters so abundant in our State. 

If we institute a comparison between the amounts of 
Lime and Phosphoric Acid abstracted by the various crops 
from each acre of land and the amounts of lime and of 
Phosphoric Acid contained in a moderate application of the 
marls and shell limestones of Georgia, we will find that a 
single application is capable of supplying Lime and Phos- 
phoric Acid equal to the amount removed by the most pro- 
ductive crops of cotton, corn, wheat, rye, oats, potatoes, 
beans and peas for more than one hundred years. 

This demonstration of the value of the marls and shell 
limestone of Georgia should, we think, lead to their imme- 
diate ami extensive employment. 



30 T( rtiary Lime Formation [January, 

We do not for oue moment contend that the Te'rtiary 
Lime formation of Georgia contains all the ingredients 
essary lor the entire restoration and preservation of the 
fertility of the soil. 

Whilst Lime should in Georgia, as it does in England, 
and in every well cultivated country in the world, form the 
basis ot all permanent agricultural improvement and of all 
husbandry, still it represents only one class of the salts 
needed by plants and animals, and if, therefore, it be ex- 
clusively relied upon disappointment will surely follow, 
sooner or later. 

This leads us to the consideration of the following well 
established proposition : 

The absence from the soil of any one of the constituents 
of the Ash of Plants, will jrrove adverse to vegetation. 
The Prince of Salm-IIorstmar performed a series of 
careful synthetic experiments to determine which of the 
ash constituents are necessary to the growth of plants. lie 
chose for his experiment the oat plant, sowed the grains in 
an artificial soil of ignited sugar-charcoal, watered it with 
distilled water, and supplied the ash constituents by means 
of the following preparations, which were partly dissolved 
in the water and partly incorporated in the sugar-charcoal : 
Silicate of Potassa and Soda, Carbonate, Phosphate and 
Sulphate of Lime, the Salts of Magnesia, Sesquioxide of 
Iron, oontaining Protoxide, with and without Manganese, 
Sulphate of Protoxide of Iron, Carbonate of Manganese, 
Carbonate of Ammonia, Nitrate of Lime, Magnesia, and 
Ammonia. By modifying the experiment in various ways, 
omitting one, and sometimes all of these preparations — 
adding them at one time in increasing proportions, and at 
other times in decreasing quantities, and in each instance 
accurately observing the growth, appearance and character 
of the plants thus cultivated. Balm-Horstmar arrived at the 
following rosults : without the addition of any of the above 
mentioned Sails the plants remained dwarfish, but without 
any abnormal development. For the successful growth of 



1861.] Of Georgia 31 

plants Xitrogen (Ammonia) and the vegetable Ash, con- 
stituents must be added at the same time. Absence of the 
one, especially of the latter, enfeebles the action of the lat-. 
ter. In the absence of Phosphoric Acid, Sulphuric Acid, 
Potassa, Lime, Iron and Manganese, the plants in every in- 
stance, attained an abnormal growth, were feeble and of 
unnatural softness, and rapidly faded away; they were par- 
ticularly weak when no Silicic Acid and Magnesia were 
present. Iron acted most surprisingly upon the luxurious 
and vigorous appearance, especially in regard to the color, 
strength of stem and roundness ; but when an excess was 
added it produced dry spots on the plants. Too large a 
proportion of Manganese caused the leaves to curl up in a 
peculiar manner. Without weakening the plants, neither 
the Potassa could be replaced by Soda, nor the Lime by 
Magnesia. 

In the whole of these experiments the plants were placed 
in abnormal circumstances, and only in one single instance 
(and in that only a single grain was produced) did they 
yield corn. 

It is evident, therefore, that my duties as Chemist to the 
Cotton Planters' Convention do not end with the develop- 
ment of the inexhaustible stores of fertility in the Tertiary 
Lime formations of Georgia — other sources of fertility sup- 
plying the salts wanting in the Marls and Shell Limestone 
of Georgia must be supplied. 

CONCLUDED. 



Study on the Stoic Poisoning by Preparations of Lead, and its 
Influence on the product of Conception. By Constantine 
Pa.il. (Arch. Gen. de MeidL, May, , 1860. 
M. Paul, an interne of the Paris hospital, has drawn up a 
valuable memoir on the effects of lead-poisoning upon the 
product of conception. We will relate one of his observa- 
tions as an example, and present a summary of his research- 
In February, 1859, a woman entered the JSTecker Hos- 
pital, who had been for eight years working as a polisher of 
printing type. She was suffering from metrorrhagia, and 
had an evident satornine cachexia. She sad enjoyed good 



82 Pregnancy. [January, 

health, and had been delivered of three children, happily 
before taking to the occupation of polisher. Since then 
her health had been much shattered by lead-diseases. Three 
months after entering upon this trade she had a first attack 
of colic, and Pour years later another. At this time she 
became pregnant, and bore a dead child. Three years later 
still, she bore a child which died at the age of five months. 
She had eighl pregnancies all terminating in abortion at two 
or three months, attended with excessive metrorrhagia. She 
recovered in M. Bouley's ward, under tonic and restorative 
treatment 

This case led M. Paul to extended inquiries in the type- 
foundries and elsewhere. He found that those women almost 
alone who handle the type are affected by saturnine diseat 
In a first Beries of observations, lue found that 4 women had 
had 15 ascertained pregnancies — of these, 10 ended in abor- 
tion, 2 in premature labour, 1 in still-birth, and 1 child died 
within twenty-four hour.-. 

In a second series of cases, 5 women had borne an aggre- 
gate o\' 9 children at term before exposing themselves to 
lead, and had no abortion or accident of pregnancy. Since 
exposure to lead they had 86 pregnancies; of these, 26 
em led in abortion at from two to six months ; 1 in premature 
labor: 2 in still-birth; 5 children died, 4 of which within 
the first year ; and '1 children were living, 1 being puny and 
ailing, the other only three years old. 

In a third order, a woman had during her employment in 
a type foundry live pregnancies, all ending in abortion. 
She quitted the business and bore a healthy child. 

In a fourth order, is tlie ease of a woman who, having left 
the trade for two periods, bore during these intervals of 
freedom two healthy children ; returning to the trade had 
two abortions. 

In a fifth series M. Paul shows that the same disastrous 
influence 18 felt when the fathers handle lead. In 7 c;i 
every woman had an abortion : of 32 pregnancies occurring 
• luring the husbands' exposure to lead. 12 children were 

bom prematurely. Of twenty living children, 8 died in the 
iir>t year, 8 in the second, 5 in the third, 1 after the third 
year, m 2 remained living. 

In the Birth series the author shows that where the lead 
affection was Less marked there was a corresponding dimi- 
nution of the Injurious effect upon the product el' conception. 



1861.] Kyi:. /. v 3 on 'Jun 88 

ARTICLE II. 

ires on Tumors and Outgrowths of the Cervix Uteri, By 
Joseph A. Eve, M. D., Professor of Obstetrics and Dis- 
eases of Women and Children in the Medical College of 
Georgia. 

Lecture First — Uteeine Polypi. 
Gentlemen: — The subject of our present lecture will be 
Tumors and Outgrowths of the Cervix Uteri. If time 
would permit, we would prefer to treat of these affections 
in reference to the uterus generally, body and fundus as 
well as the cervix, but that would require a series of many 
lector 

At present, our attention will be restricted to those of 
the cervix, because they most frequently occur in practice, 
are most accessible to investigation and most amenable to 
treatment. 

The most useful and natural classification is into pedi- 
culatcd and sessile — simple and malignant. Another di- 
vision might be instituted into those which arise externally 
and those which, originating in the body of the uterus, or 
in the cervical canal, either grow downwards into the va- 
gina, or becoming developed internally, are afterwards, by 
the contractions of the uterus, expelled into the vagina. 

We will, in the first place, call your attention to non- 
malignant, pediculated tumors, generally designated polypi 
from having a pedicle or footstalk, by which they are at- 
tached to some portion of the internal surface of the ute- 
rus. The term polypus is derived from two Greek words, 
Polus and Pous. Strictly speaking, it does not apply to 
the tumors in question, as they very rarely have more than 
one origin; although it is said one polypus has been known 
to have two pedicles, and on the contrary, two polypi have 
.filiated from one pedicle. They are called polypi from 
a supposed resemblance to the animal called polypus. Dr. 
T. S. Lee's definition of a polypus is a tumor growing from 
the internal surface of the uterus, attached to it by a stalk, 
and usually having a pyriform shape ; it is smooth, hard 



84 Eve. Lectures on [January, 

and insensible, and gives rise to violent and frequent hem- 
orrhaj 

Causes. — The causes of polypi are so obscure that we 
will not waste time with any discussion of the subject. 
They arc found at all ages, and under all circumstances, 
from early childhood to advanced age ; they are mostfre- 
quenl during the reproductive period, but rather more fre- 
quently, it is thought by some, in the unmarried than the 
married. I have found them Tnore frequently in married 
women and widows. 

Pathology. — Our limits will not allow us to say much of 
the pathology of polypi. There are several varieties of 
polypoid tumors ; but there are three principal species 
which include much the larger portion of all polypi: the 
glandular, the cellular, and the fibrous. This is the divis- 
ion made by Dr. Churchhill, in his excellent work on dis- 
eases of women. We may occasionally meet with a case 
that may not conform strictly to the description of either of 
these species, but I believe they are very rare, such, at least, 
is the result of my own experience. 

i^t. The glandular polypi are enlarged Nabothian glands 
in the cervical canal. They may be found single, or two 
or more may exist together ; they are generally about the 
size of small grapes, attached by small and short pedicles ; 
they are usually of the color and firmness of glands ; it is 
-aid they sometimes contain some mucilaginous fluid. 
Some very small polypi about this location are found to 
consist altogether of mucous membrane, others of some- 
what larger size, consist of mucous membrane with the ad- 
dition of cellular tissue. 

I'd. The cellular polypus is the least frequent. I only 
remember to have met with two cases. They are said to 
appear singly or in clusters. The two which occurred in 
my practice were single. They bear some resemblance to 
the polypi of the nose ; they are described as of a violet or 
vellow color ; the two met with were not unlike a large oys- 
ter in color and consistence : their attachment to the ute- 



1861.] Tumors^ 35 

rua was exceedingly slight. I will refer to them again 
when detailing cases of each species. 

8d. The fibrous polypi are by far the most common. 
They resemble fibrous tumors in the body of the uterus 
and other parts of the system. They are generally hard, 
but vary in consistence and density ; there will sometimes 
be a difference in different parts of the same polypus. It is 
said they arc sometimes hollow, and contain a fluid; such 
instances, however, I have never seen ; they are also said, 
in some rare cases, to contain hair and other substances. 
The same polypus, in different stages or periods of develop- 
ment, will be of different degrees of density ; from being 
very soft, it may become harder progressively, until it shall 
have assumed an osseous or calcareous hardness. They are, 
at least generally, covered bv the mucous membrane of the 
uterus. The connection with the uterus is, in some cases, 
by fibrous tissue extending into, or continuous with, the 
proper substance of that organ ; in others it consists simply 
of mucous membrane and cellular tissue. 

Except in rare instances, polypi are insensible ; I have 
not known an exception. I do not, however, doubt the ex- 
istence of such cases. 'Insensibility lias been consider- 
ed a means of diagnosis between a polypus and an inverted 
uretus, but it is not absolute, as polypi may possess sensi- 
bility. When this is the case they doubtless have an en- 
velope of uterine fibres ; in some instances this covering 
only extends to the pedicle, and then, although the body of 
the tumor may be insensible, the application of a ligature 
causes great pain. Their shape is usually ovoid or pyri- 
form, but it may be modified by the uterus or vagina, in 
which it is contained. They are of all sizes, from that of a 
pea to a child's head, and sometimes much larger. Fibrous 
polypi generally are found single, but there may be two or 
more, and after the removal oi one, another may descend 
into the cervix, or through it into the vagina. 

When a polypus has a pedicle continuous with the fibrous 
or muscular coat of the uterus, it is doubtless an outgrowth 



Eye. Lectures on [January, 

from the internal surface of the cervical canal, body or 
fundus of the uterus. But when it is merely attached by 
mucous membrane alone, or with the addition of some cel- 
lular tissue, it is most unquestionably a fibrous tumor which, 
originating in the walls of the uterus, has been enucleated 
therefrom into its cavity, and by its active contractions ex- 
pelled through the cervical canal into the vagina. 

This variety of fibrous polypus, I believe, occurs as often 
as that with a fibrous pedicle, if not oftener. These enu- 
cleated fibrous tumors have very short pedicles, are held 
very closely to the surface to which they are attached, and 
with difficulty expelled from the cavity of the uterus ; 
they frequently remain a long time partially expelled and 
require to be removed by passing the ligature, scissors, or 
polyptome, within the uterus. When separated, the tumor 
is generally more globular and has no neck or pedicle; and 
the portion by which it was attached to the uterus is only 
known by being denuded of mucous membrane ; whereas, 
the other variety is more pyriform and has a portion of its 
fibrous pedicle remaining. The uterine portion of the pedi- 
cle always sloughs off. It never has, I believe, been known 
to grow again. 

The polypus with fibrous pedicle is said to be generally 
denser than the enucleated fibrous tumor, and denser than 
the uterine walls with which it appears identical, with the 
addition of some cellular tissue ; this is, however, not al- 
w ays the case. These polypi, when developed in the ure- 
tus, are more easily expelled by its contractions into th 
vagina, and sometimes even through the vulva, as I have 
known in a remarkable cas«-, which shall he related at the 
proper time. 

It is said the pedicle sometimes gives way, and the poly- 
pus thus becomes spontaneously detached. T have never 
known an instance of this kind, but consider it quite pro- 
bable, as I have known cases, in which the pedicles, wheth- 
onsistiug of fibrous tissue or mucous membrane, were 
wry slight, and easily divided, sometimes being ruptured 






1861.] Tumors, 

by tractions made on the polypus, for the purpose of excis- 
ion. The spontaneous separation of polypi may he ac- 
counted for in various ways. The neck of the uterus may 
act as a ligature on the pedicle, suspend the circulation, and 
thus cause it to slough off; inflammation may produce the 
same result, or the weight of a large polypus may possibly 
hreak the pedicle, when very small. 

It is said by Dr. Lee, that -polypoid tumors may uuder- 
.11 the effects of inflammation." though "very rarely." 
"An abscess," he says, * -may he formed" in their substance 
and produce great discharge; ulcerations may arise in their 
surface, sloughings may occur, and even cancerous degen- 
eration may commence." Dr. Churchhill says "they are 
seldom attacked by inflammation or ulceration, and they 
never degenerate into malignant disease." While I concur 
with Dr. Churehhill in this opinion, I am ready to admit, 
with Dr. Lee, that sometimes "the pressure of the foreign 
body in the mucous canal excites a profuse and foeted pur- 
ulent discharge, under which circumstances, it has been 
mistaken for malignant disease," a mistake I once made 
self in consultation. This case will be stated at the close 
of the next lecture. The detention of clots in the vagina may 
also produce the same effect, and lead to the same error in 
diagno:-: 

Symptoms. — The principal and most constant symptoms 
of Polypi are hemorrhage and leucorrhsea. But as these 
depend on so many other causes, they cannot be considered 
as diagnostic. 

The first indication is generally monorrhagia, which, af- 
ter a time, becomes usually very frequent, irregular and so 
profuse as to constitute alarming hemorrhages. There i-. 
generally more or less leucorrhoa, in the absence of 
the sanguine discharge. These losses of blood are attend- 
ed by their ordinary consequences, pallor of the face, orde- 
ma, disorder of the digestive organs and all the symptoms 
attendant on anemia. Hemorrhage is one of the most 
common symptoms attendant on polypi, whether con- 



38 Eve, J Art arc* on [January, 

tained in the uterus or the vagina. It is also veiy frequent- 
ly present in the cases of fibrous tumors embedded in the 
uterine walls ; and there are some cases wherein there is no 
hemorrhage, at least for a long time, after the polypi have 
commenced t<> grow. 

Levrel and sonic of the older authors believed that there 
was no hemorrhage attendant on polypi, while contained 
within the uterus, but they had evidently mistaken the ex- 
ception tor the rule. I have, however, known at least one 
remarkable instance, in which there was no material hemor- 
rhage, until after the polypus was expelled into the vagina. 

When there is little or no hemorrhage, there is generally 
more leucorrhceal discharge. 

There is often as much, and sometimes very much more 
bleeding from a very small than a large polypus. This is 
positive proof that the bleeding is not always or altogether 
from the polypus ; for if so, it ought to be in proportion to 
its size. 

Polypi, doubtless, induce a very vascular condition of the 
uterus in the vicinity of their origin — a congestion and de- 
termination of blood to that part, similar to what occurs at 
the time of menstruation. 

And this, I verily believe, is at least the principal source 
of the hemorrhage, although it may sometimes take place 
from the polypus or its mucous covering. Formerly, I sup- 
posed the bleeding was lrom the polypus itself, because 
when the polypus is removed or ligated, the bleeding 
ceases, but this results from the fact that when the polypus 
is removed, or its life destroyed by ligation, it no longer ex- 
cites that irritation which causes an afflux of blood to the 
uterus. They often cause more hemorrhage, while contain- 
ed in the uterus than after their expulsion into the vagina, 
an unanswerable proof that it depends on the irritation 
while internal: for it' the hemorrhage was 
mainly, or altogether from the polypus itself, it ought to be 
trained, while compressed by the uterus and much freer 



1861.] lumors,£c. f 39 

after the compression is removed by its expulsion into 
the vagina. 

After fair and ample discussion of the subject, Dr. Lee 
arrives at the conclusion, "that the hemorrhage arising, iu 
the- may he attributed to the very vascular state of 

the mucous membrane, at the insertion of the polypus with 
the uterus: that the veins of the parts are the principle 
sources of bleeding, and when the mucous membrane is 
absorbed, the vascular net-work which envelopes these 
growths may add materially to the result. Even when the 
mucous membrance is uninjured, this envelope may mate- 
rially increase its vascularity."* 

Diagnosis. — A vaginal examination is essential to diag- 
nosis. But when the polypus is contained within the ute- 
rus, a digital and eve 1 a specular examination will often 
throw little or no light on the subject. The uterus will 
feel larger and heavier, but to determine the cause of the 
increased size and weight will require further investigation. 
The speculum, especially with the aid of the speculum for- 
ceps to open the os, will sometimes reveal the existence of 
small polypi in the cervical canal, which the finger had 
failed to detect, or to afford a satisfactory idea of their form, 
size, cVe. When the polypus is in the cavity ot the womb, 
and the cervical canal not patulous, these means are totally 
inadequate : and a certain diagnosis would be impossible, 
were it not for other methods of exploration, for which the 
profession is indebted to the genius and enterprise of Prof. 
Simpson, of Edinburgh. I have reference to the uterine 
sound and the dilatation of the canal of the cervix by 
sponge tents. But a consideration of these valuable means 
of diagnosis must be deferred to another lecture, as we are 
now concerned with affections of the cervix, not of the 
body of the uterus. 

After the polypus has descended into the vagina, the di- 
aterinetu] •-• 4-1. 



40 Eve. Lectures on [January, 

agnosia is genera 1 ];: easily enough made out by a vaginal 
examination. J)r. T. Salford Lee says "when a polypus is 
found in the vagina, it is known by its being a smooth, 
bard, and generally an insensible tumor. This last char- 
acter, however, does not apply to all eases. When the poly- 
pus is form:",] by a tumor of the uterus, it may possess great 
sensibility. This is greater when the pedicle is thick, and 
becomes very great when a "muscular layer of the uterus 
covers the growth." If a polypus is attached by its pedicle 
to any portion of the body or fundus, the mouth of the ute- 
rus will form a soft ring all around the pedicle. If attach- 
ed to the cervix, the linger cannot pass all around the pedi- 
cle. If attached to the os itself, the pedicle does not enter 
the uterus at all, but the portion of the lip from which it 
arises seems to extend into the pedicle. 

We cannot conceive how a polypus in the vagina can 
possibly be mistaken for pregnancy, but an abortion slowly 
taking place might, by an inexperienced person, be mis- 
taken for a polypus ; thus if the membranes were contain- 
ing a firm clot of blood, or some round portion of the foetus, 
as the head, &c, were to protrude and remain some time 
stationary, without a knowledge or suspicion of the exis- 
tence of pregnancy, such a presentation would not appear 
very unlike a polypus. There might possibly arise some 
difficulty in distinguishing between pregnancy and an inter- 
nal polypus, but that does not appertain to our present sub- 
ject. The absence of all the signs of hernia would distin- 
guish a polypus from this affection. A vaginal hernia, too, 
I believe, is extremely rare. 

Vaginal eystoccle or prolapsus of the bladder into the 
vagina, or through the vulva, is of much more frequent oc- 
currence than vaginal hernia of the intestines. I have 
known Buch an error, but the diagnosis is easily determined 
by tin' variations in the position and size of the tumor, be- 
coming large and protruding through the vulva when dis- 
temled with urine ; again becoming small and receding 
after micturition, by its softness and elasticity, and by its 



1861.] Tumors, $c. 41 

being covered by the mucous membrane of the vagina. 
But if any doubt were to remain, it could be readily re- 
moved by the catheter, which, instead of passing as usual 
upwards behind the symphysis pubis, would descend into 
the tumor and cause it to disappear, by evacuating its con- 
tents It will be extremely difficult, sometimes, to distin- 
guish polypi from certain malignant polypoid outgrowths of 
the uterus, especially when the former arc in a state of ul- 
lccration. In general the absence of the peculiar symp- 
toms of malignant disease will suffice, but in some instan- 
ces, so many of those phenomena are present, that the dis- 
tinction can only be made by the microscope, determining 
the presence or absence of cancer cells. 

A polypus may be distinguished from a cauliflower ex- 
crescence by its greater smoothness and density, and gen- 
erally bv not bleeding: when examined by the finder ; but if 
one were mistaken for the other, it would not be important, 
as removal in either case would be proper. In cauliflower 
excrescence, however, no portion of the pedicle ought to be 
left, as it would be likely to grow again, and sometimes, at 
least, it assumes a malignant form. 

Prolapsus and procidentia uteri and the different flexions 
and versions, except inversion, could not, we think, be easily 
mistaken for polypi, for if a digital examination were to 
leave a doubt, it would certainly be dispelled by inspection 
if external, or by the speculum if m the vagina. 

Between polypus and inversion, the history of the case 
will, in most cases, decide, especially when of recent or 
sudden occurrence ; but when the case has come on slowly 
and imperceptibly, and has become chronic, and no reliable 
historv can be obtained, the diagnosis will sometimes be 
extremely difficult. A polypus is generally smooth and in- 
sensible, whereas the inverted uterus is rough and very sen- 
sitive, but as we have already said some polypi possess 
sensibility. If the finger fail to decide between polypus 
and inversion, the point may be determined satisfactorily by 
the uterine sound which, if it be polypus, would pass by the 



Eve. Lectures on [January, 

tumor, through the os uteri, the usual length of 2$ inches 
or more ; but if inversion, it could not enter the os at all, 
and could pass very lijtle way into the vagina. 

It' the question were to arise soon after delivery, the ab- 
sence <>r presence of the uterine glohe in the hypogastrum 
would he strong proof for or against inversion ; besides the 
symptoms of inversion occurring at such a time are usually 
well marked, and most decided, sudden collapse, severe 
pain, hemorrhage, l>;c. In inversion, if a male catheter he 
introduced into the bladder and the end turned downwards. 
it might be felt by a finger introduced high up in the rec- 
tum, but could not be felt if the body of the uterus were in 
its proper place, intervening between the extremity of the 
catheter in the bladder and the finger in the rectum. 

A polypus and inversion may exist together, the former 
being the determining cause of the latter, less perhaps by 
its weight, than by exciting the uterus to stong and long 
continued contractions for its expulsion. The polypus 
ovght fo be removed as quickly and easily as possible, and 
means promptly adopted to correct the inversion if practi- 
cable. 

Other methods are suggested by authors to determine the 
diagnosis between a polypus and an inverted uterus, but as 
they are uncertain and unreliable, we will pass them by. 

There are some polypi, which, though internal, occasion- 
ally protrude, and are therefore sometimes perceptible and 
at other times not discoverable to the sight or touch. The 
gnosis in such a case might require repeated examina- 
tions. This ought to make us guarded in our opinions in 
3 wherein although the symptoms indicate a polypus, 
ii- presence cannot be readily detected. 

Tiic principal danger to be apprehended from polypi de- 
pends immediately, or remotely, <m the hemorrhage, almost 
always consequent on them, that is from either the direct 
of the loss of blood, ov the impairment of health 
COnsequenl on the long continued or oft repeated drain on 
tin- constitution. 



1861.] Tumors. £c. 43 

But other bad effects sometimes result. They may pre- 
vent conception, or they may interfere with the regular pro- 
cess, or the safe termination of gestation. There are, how- 
ever, exceptional cases in which conception is not prevent- 
ed, nor is gestation or parturition materially affected by 
their presence, even when large. 

At the time of labor, a large polypus may obstruct the 
passage of the child or may cause dangerous flooding, by 
preventing the regular normal contraction of the uterus. 
We have already had occasion to refer to inversion of the 
uterus consequent upon the presence of a polypus. They 
are said sometimes to contract adhesions to adjacent parts, 
or by pressure, to cause ulceration through the rectum or 
bladder. They sometimes cause constipation, retention of 
urine and severe pains in the back and pelvic region, espe- 
cially during their expulsion from the uterus into the va- 
gina, and sometimes from the vagina through the vulva. 

Treatment. — Besides the employment of such remedies 
as may be indicated to restrain hemorrhage, and to improve 
the general health, the treatment of polypi consists in the 
use of the different methods devised for their removal. 
These are caustics, tortion, or avulsion, ligation and excis- 
ion. The first two are principally applicable to the removal 
of the small polypi, although some of the larger, having 
very small pedicles, may be torn or twisted off, and are 
sometimes thus cetached when not intended. Caustics are 
very seldom used, but some of the small and soft polypi, 
found in the cervical canal, may be destroyed by the stronger 
caustics, such as caustic potash, potassa cum calce, or the 
actual cautery. They are, however, more promptly and 
easily torn off by a suitable pair of forceps, or cut off by a 
long slender pair of scissors ; or if not turn off or cut off, 
they may be crushed and destroyed by the forceps. 

Some of the softer polypi, though of considerable size, 
may be twisted off by the fingers, or may be drawn away by 
a ligature applied around them as high up as practicable, 
by means of Gooch's double canula. 



44 Eve. Lectures on [January, 

The most convenient and advantageous mode of opera- 
ting ^n these small polypi within, or attached to the cervix, 
19 to introduce a glass mirror speculum, by which they may 
be broughl into view, and then nipped oif by the scissors, 
or twisted off by the forceps, passed through it. . It is ad- 
visable, after their removal, always to apply nitrate ot silver 
to the cervical canal, for the threefold purpose of more 
thoroughly destroying their pedicles and subduing inflam- 
mation which is very often coexistent, of also of prevent- 
in;;' oi restraining hemorrhage. Excision by the scissors is 
far preferable^*) torsion oravulsion. Soit polypi of large size 
•rding to my own experience, are of rare occurrence. 
Two are all [ remember to have seen. One I saw, in consulta- 
tion with Dr. McKie, in Edgefield District, S. C, May 11th, 
1 355. The patient was a negro woman about thirty years 
of age. The polypus was rather larger than a hen's egg, 
very soft, feeling somewhat, to the touch, like a small pla- 
centa ; it had been attended with considerable hemorrhage; 
its attachment was within the os tincae. I succeeded in de- 
taching and bringing it away by my fingers. There was 
no hemorrhage after its removal, and the patient rapidly re- 
covered good health. The other ease, I saw r in consultation 
with Dr. S. B. Simmons, in this city. The subject ot it 
was an old mulatto woman, about sixty years of age. This 
polypus w r as four or five inches long, and about an inch and 
;i half in thickness. It was very soft; this was attached 
within the os. Dr. Simmons applied a ligature to it, by 
means of Gooch's double canula, as near the uterus as prac- 
ticable, intending to draw it through the vulva and cut it 
but its attachment was so frail, that it separated on very 
gentle traction, and came away with the ligature. Dr. 
Simmons had, some months previous, removed a large 
iibi' lypus from 1 1 i i - patient, to which case we will 

have occasion to refer again, after having made some re- 
marks on the removal of fibrous polypi. 

[to be continued.] 



1861.J Emory. Starnmonium Poisoning. 4"> 

ARTICLE III. 

Laudanum an Antidote to Starnmonium Poisoning. By A. G. 
Emorst, M. D., of Roanoke, Ala. 

Was called, on the loth of October, at night, to a mulatto 
boy, aged rive years, who was supposed by runner to be 
having fits. 

After my arrival I learned that, in the evening, an older 
negro had given the boy a handful of the shelled seed of 
Strammonium to play with, as he said, thinking them 
harmless. There had been an elapse of some hours (four 
or five) after this before I saw the patient, who was labor- 
ing under delirium of a lively, active, vivid character, alter- 
nating, in short periods, with the most apparent horrified 
fright ; seeming to dread the approach of some imaginary 
monster, and giving utterance in the most piteous appeals 
for help — protection. His hearing was obtuse at times ; at 
others, natural. Pupil dilated to almost full size of iris ; 
tongue, mouth and fauces dry, with considerable diffi- 
culty in deglutition ; heat of surface elevated and dry ; 
pulse and respiration somewhat quickened (not more than 
could be accounted for from the fright and violent muscu- 
lar actions it had, which actions were very irregular.) The 
patient seemed to me to have very little control over the 
movements of the upper and lower extremities. 

From the circumstances, that the child had the seed, and 
the symptoms above, I was at no loss in forming a correct 
diagnosis — that of Strammonium poisoning. Actuated by 
this, I immediately administered an emetic of Ipecac, though 
with some difficulty, from spadmodic action of muscles 
ahout the throat at each attempt to swallow. This emetic 
brought up a little mucus and persimmons. 

Ordered an enema of warm water, strongly impregnated 
with salt and soft soap, which produced a small fecal evacu- 
ation. Having noticed, previously, in your journal, an ac- 
count of this poisoning successfully treated with small and 
often repeated doses of laudanum, I determined to test its 



4G Groover. Puerperal Fever. [January, 

efficaey in this case. I commenced "by giving three-drop 
doses, when, seeing no amelioration in the symptoms, I 
gave Beven or eight drops, and in one hour the child was en- 
joying a calm and profound slumber. 

Being called oft* at this juncture, I left a powder of calo- 
mel and rhubarb, to he given as soon as the child should 
wake, with instructions to re-commence with the laudanum 
in three-drop doses every hour, should there he a return of 
former symptoms, until relieved or sleep came on. Patient 
slept three hours and, on waking, there was a return of the 
same symptoms slightly ameliorated. The cathartic dose 
was given and laudanum resumed as directed; but before the 
second dose was given, voluntary emesis occurred, which 
brought up a great many seed, and in no great time, dis- 
charges, per rectum, showed that they were not in the least 
afraid to "follow suit," as they produced a teaspoonful of the 
« little fellers/' 

Laudanum, in the meantime, being continued, soon 
brought rest to the little sufferer again ; after which there 
was no return of unfavorable symptoms, except some un- 
steadiness of gait and imperfect vision, from dilated pupils, 
which continued three or four days and left the patient well, 
thus giving an unmistakable demonstration of the thera- 
peutic autidolal power of opium over strammonium. 



ARTICLE IV. 

Pm r/h ral Fever Successful!)/ Treated by Blood-letting and Colo- 
mi I and Opium. By J. S. Groovkr. M. P., of Groover- 
ville, Qa. 

Linday, (negress), act 24, (belonging to C. G.,) confined 
September 12th, 1860. Labor natural, easy and of ordinary 
duration. Convalescence progressing normally up to the 
I'.'tli. At this time she was seized with chills about 8 a.m.; 
:it :> > p. in., 1 Baw her with the following symptoms : Fever; 
pain in Lower portion of abdomen, extending upwards ; in- 



1861.] Umbilical Hcemorrhage. 

creased on taking long inspiration, or on pressure : pulse 
12"): respiration 36 ; expression of countenance anxious; 
tympanitis well marked ; lochia scanty, but not offensive. 
I abstracted twenty ounces blood, when the premonitory 
symptome of syncope appeared. In fifteen minutes she was 
in gentle perspiration and pain very much relieved 

Ordered Ilydrary, Gub-mu, grs. ji, pulv. opi. 8J, every 
two hours, which was continued with an intermission of 
two doses at night, up to 9 a. m., 20th. I found her so well 
that the medicine was stopped, and ordered castor oil jg, 
and opium gr.j at night. Patient was discharged and con- 
valesced finely. The post-blood-letting debility required no 
tonic or stimulants. 

I have been induced to write out this case from seeing- 
two reported in the Xew York Medical Times, treated by 
infusion of digitalis, in Bellevue /Hospital, so as to show 
the superiority of the lancet over other means. The first 
case was under treatment from August 3rd to 17th, when 
convalescence began. The second, from August 4th to 13th. 
The opposition to the lancet, and the endeavors to find a 
substitute for it in that Institution and others, are turning 
many from the path of nature. 



Umbilical Haemorrhage. — In the Charleston Medical Jour- 
nal and Review for November, Dr. A. X. Talley reports three 
cases of this unfortunate and troublesome accident. The first 
two were treated in the usual manner, not omitting the plaster 
of Paris recommended by Dr. Churchill. Remedial means 
were ineffectual, and both patients died. The third case was 
treated with Squiblrs liquor of the persulphate of iron. "The 
effect was instantaneous ; the haemorrhage, which, despite 
every appliance, had continued fearfully rapid, was at once ar- 
rested, and did not again recur. The child is now quite well, 
and has entirely recovered from the prostration consequent 
upon the excessive loss of blood." 

This one case is not sufficient to establish the merits of the 
agent employed ; but as the result was characteristic and in 
keeping with its well-known properties, hopes may be enter- 
tained of its usefulness in these formerly intractable cases. 



48 (lent and Articular Rheumatism, &c. [January, 

On (If Employment of Saccharate of Colchieum in the Treat- 
:,! qffeout and Articular Rh umaiism. By Dr. Joyeux. 
From a great number of cases which have come under the 
author's observation, he draws the following conclusions : 

1. That tin- Baccharate of colchieum, prepared with the fresh 
juice of the flower, is oneof the most reliable remedies whioh 
the physician can employ in order l<» combal the symptoms 
which depend upon the gouty or rheumatic diathe 

2. That the curative effects of colchieum are not owing to 
its irritating action upon the alimentary canal, but to the se- 
dative power oi the alkaloids which it contains; and that, 

lequently, it is of advantage to administer it in fractional 
and graduallv increasing doses, so as to avoid its purgative 
i ffect 

The saccharate of colchieum employed by M. Joyeux is 
prepared with 100 grammes of fresh juice and 500 grammes 
of sugar, and evaporated to dryness in vacuo, lie uses ako 
an extract of the juice of colchieum, evaporated in vacuo, as 
an external application, directing it to be rubbed on the pain- 
fid parts. The saccharate is given in the average dose of four 
grammes per diem, divided into ten parts, one of which is 
taken every hour. 

" Since I have made use of these preparations," says the 
author, " I have not met with a single case of gout which 
did not yield to treatment in two or three days. Acute arti- 
cular rheumatism disappeared in the space of fifteen or twenty 
davs. In subacute rheumatism, without an equally satisfying 
result, I have witnessed a great amelioration. I have found 
it of advantage, in the majority of cases, to let the parties 
take, as adjuvant, an infusion of lime-tree blossoms, contain- 

i,itre, in the proportion of two grammes to one litre of tea. 

Natural History of Stoni in the Bladder. — A fisherman 
presented, says M, Zennaro, of Chicago, {Oaz. 3f< d ItaL, 1859,) 
symptoms ol stone in the bladder at the age of 54r, and refused 
all surgical interference. Seven years afterwards, a fistulous 
rture showed itself in the scrotum, and the man was obliged 
t.» keep his bed. During the following 14 years live more 
apertures formed between the scrotum and penis, the patient 
Buffering, in the meanwhile, great torture. When 75 years 
..Id, he iiad suddenly a sharp attack of pain, and during the 
piercing cries he uttered, calculus weighing s ounces escaped 
from oneof the perineal openings. The urine then freely es- 
caped by this aperture: but the man stil! refused all interfer- 
ad put up with this inconvenient mode of micturition. 



1861.] Rabies in Early Ages. 49 

Rabies as an Epizootic in Early Ayes. By Dr. Huseman. 

Rabies has found, on more occasions than one, some 
special historians, Among these may be mentioned Kru- 
gelstein, on account of his k ' History of Rabies Canina and 
Hydrophobia/' Gothn, 1826 — an account of which deserves 
all approbation for the labor spent on it. All writers on 
rabies canina, however, take their notes of it from modern 
times — Krugelstein himself citing those only from the 18th 
century. And yet there were cases in earlier times, which 
came under the observation not only of contemporary 
medical men, but also of the chroniclers of those days. 

Thus, in the first part of a familiar historical book — 
"Theatrum Europium," by Joannes Phillipus Abelinus — 
(or Gottfried), Frankfort, 1634 — we find the following in 
page 712 : " In addition to all the distress, and war, and 
great famine, which extended over almost every place at 
this time, still another plague appeared, from harvest to 
November, 1621, in Rheinthal and the the territory of Ap- 
penzoll, and the surrounding country. For, during the 
previous summer, the bodies of many thus dying having 
been thrown into the Rhine and then cast upon its shores, 
the dogs fed upon thern ; on which account they became 
mad, and afterwards attacked the cattle in every direction, 
and destroyed them. The loss of the people in this way 
was estimated at 25,000 gulden. At last they were obliged 
to turn out with spears, rifles, and poles, and destroy every 
animal thus affected. 

•• At this period, the trees, as in spring, both in these and 
in other places, blossomed, and the birds laid their eggs and 
hatched forth their young. 

" In Siebenburgen the dogs also run mad, and not only 
bit cattle, but even men, causing them to go mad ; so that 
they were obliged, with great labor and grief, to put such 
infected men and cattle along with the dogs, out of the way, 
to prevent still further misfortune and peril, which could 
not otherwise be avoided." 

It is worthy of remark, that Siebenburgen was specially 
affected, since, according to Beecher's statistics of the Aus- 
trian Empire, it still suffers, most of all the provinces of 
the empire, with rabies. That, in the year 1621, men af- 
fected with rabies "were put out of the way to prevent still 
further misfortune, and peril," is perfectly credible, when we 
think of the manners of the age and the country. 



50 Rabies in Early Ages. [January, 

The erroneous idea, thai rabies, canina arose from de- 
vouring dead'bodies, was extensively believed in the 17tli 
and 18th centuries, and even finds an expression in the 
laws of the time. Tims, in the "Laws of the principality 
of Lippe," vol. iii, 1<>, the following circular may he found 
relating to the interment of dead cattle : 

" A> it is reported that the required interment of dead 
cattle has been neglected in some parts of the country, and 
in others it is not made deep enough, so that the dogs can 
dig the carrion out of the earth, eat it, and become mad; 
the authorities will take care to have a more strict compli- 
ance with the edict of May 4, 1771*, and bring those violat- 
ing it to punishment." 

That, by the consumption of carrion, a true epizootic 
might be produced in dogs, which should have a great re- 
semblance to contagious rabies, later investigations have 
shown. 

In the other volumes of the European chronicles of Abc- 
linus (the work is in 16 volumes) which Dr. lluseman has 
examined, he finds no record except that of this epizootic, 
among the dogs in the 17th century. But the misdeeds of 
wolves, that had gone mad, are recorded in various years. 
Thus, in 1651, it is stated that in Cologne, on March 31, a 
wolf, having lately gone mad at Ververs, destroyed twelve 
men before he could be slain. In his throat there was found 
a large piece of fresh human rlesh, which might have been 
from a soldier of Lothingia, as these were lying unburied 
in quantities in that region. In the woods or forests be- 
tween the Italian States of Pisa and Luca, six large, tierce 
wolves were seen together, who had become so famished 
that they not only attacked sheep and other flocks, but also 
their shepherds and herdsmen, destroying twenty of the 
latter. Hence, the Grand Duke of Florence despatched 
his upper master of the chase, with all his dogs and 400 
soldiers, to exterminate these wolves, hut they were not to 
he found. 

Similar wolf stories are related of Bohemia, Erfurt, and 
Touraine, in the years 1652, L653, and 1671, which cannot 
here he discussed, since they possess no special interest, and 
the proofs alleged, merely illustrate the characteristics of 
the Btyle employed in the "Theatrum Europseum." 



1861.] ' for Diabcs. 51 

A I it for h By E. C. Bidwell, M. P. 

The only test for glucoscuria which I luive hitherto found 

satisfactory — fermentation — involves a delay which is often 
edingly annoying, and sometimes fatal to a ory 

and seasonable diagnosis. Those founded upon the reduc- 
tion oi % metalic oxides, besides being complicated and incon- 
venient for clinical use, are liable to various fallacies. A 
better test than any I have seen described, seemec! to me a 
desideratum — one which should be delicate and conclusive, 
and at the same time ready and convenient. Moved by this 
sense of a want, to experiment for a new process, I have 
discovered one which seems to meet fully the needs of the 
: one, which, if it be not pre-eminently scientific, is 
nevertheless facile and reliable. For the benefit of any 
others who may have felt the same want, I herewith com- 
municate the result of ray investigations. 

Technically described, it is simply the conversion of the 
saccharine element of diabetic urine into caramel by heat. 
My mode is this. Upon a clean slip of tinned iron, place 
(me or two drops of the suspected material, and hold it over 
a spirit lamp : the fluid will speedily evaporate, leaving, if 
the process be arrested at that point, scarcely a trace upon 
the metallic surface. Continue the application of heat; in 
a few moments after the desication is complete, a spot of an 
inch or so in diameter, over which the drop had spread with 
the first ebulition, will gradually assume a rich reddish- 
brown color, with a brilliant lustre, as if coated with a film 
of varnish or Japan lacquer. A strong heat produc 
darker color, but the lustre continues till the heat becomes 
sufficiently intense to decompose the substances. 

This experiment has succeeded perfectly in my hands, 
when the urine on trial, previously known to contain glu- 
specific gravity less than 1030, and still further 
reduced by the adition of three or four times as much of 
water. It is thus proved to be a delicate test. I suppose it 
io be conclusive, also, for I have never yet found any other 
LStituent of urine, normal or abnormal, capable of pro- 
ducing anything at all like the same appearance under the 
treatment. The nearest approach is this : some 
oples of urine not diabetic, when treated in this way, 
leave a faint, dull, yellowish stain, easily distinguished from 
caramel by its paler color, and the entire absence of lustre. 
1 need scarcely add, that a solution of sugar, uot diabetic, 
exhibits almost exactly the same reaction. 



52 Action of Med Mental Faculties. [January, 

With tht; augmented interest attached to glucosurJa, since, 
besides being a Leading feature of a most intractable, but 
fortunately rare, disease, it is found Bymptomatically asso- 
ciated with several other diseases and injuries, an increased 
facility lor its detection is almost a necessity of the profes- 
sion. I trust they will find it in the simple and beautiful 
experiment above described. 



Action of Different Medicines on the Mental Faculties. By 

Professor Otto. 

All stimulant and exciting medicines increase the quan- 
tity of blood sent to the brain. If this quantity exceeds a 
certain amount, then most of the faculties of the mind be- 
come over-excited. Nevertheless the degree of this action 
is observed to vary a good deal in different cerebral organi- 
zations ; and it is also found that certain stimulants exercise 
a peculiar and characteristic influence upon special or indi- 
vidual faculties. Thus ammonia, and its preparations, as 
well as musk, castor, wine, and ether, unquestionably en- 
liven the imaginative powers, and thus serve to render the 
mind more fertile and creative. The empyreumatic oils are 
apt to induce a tendency to melancholy and mental halluci- 
nations. Phosphorus acts on the instinct of propagation 
and increases sexual desire ; hence it has often been recom- 
mended in cases of impotence. Iodine seems to have a 
somewhat analogous influence, but then it often diminishes 
at the same time the energy of the intellectual powers. 
Cantharides, it is well known, are a direct stimulant to the 
sexual organs, while camphor tends to moderate and lull 
rhe irritability of these parts. 

Of the metals, arsenic has a tendency to induce lowness 
and depression of spirits, while the preparation of gold serve 
to elevate and excite them. Mercury is exceeding apt to 
bring on a morbid sensibility, and an inaptitude for all ac- 
tive occupation. 

Of narcotics, opium is found to augment the eratic pro- 
pensities, as well as the general powers of the intellect, but 
more especially the imagination. Those who take it in ex- 
are, it is well known, liable to priapism. In smaller 
doses it enlivens the ideas and induces various hallucina- 
tions, so that it may be truly said, that during the stupor 
which it induces, the mind continues to be awake while the 
body is asleep. In some persons opium excites inordinate 



1861.] Phosphorus and Phosphorus Add. 58 

loquacity. Dr. Gregory Bays that this effect is observed 
more especially after the use of the muriate of morphia. 
He noticed this effect in numerous patients, and he then 
tried the experiment on himself with a similar result. 
Ee felt, he tells us, while under the operation, an invincible 
desire to speak, and possessed, moreover, an unusual fluen- 
cy ot^ language. Hence he recommends its use to those 
who may be called upon to address any public assembly, 
and who have not sufficient confidence in their own unas- 
sisted powers. 

Other narcotics arc observed to act very differently on 
the brain and its faculties from opium. Belladona usually 
impairs the intellectual energies; hyoscyamus renders the 
person violent, impetuous and ill-mannered ; conium dulls 
and deadens the intellect, and digiialis is decidedly anti- 
aphrodisiac. Hemp will often induce an inextinguishable 
gayety of spirits ; it enters into the composition of the in- 
toxicating drink which the Indians call bauss. The use of 
amanita muscaria is said to have inspired the Scandinavian 
warriors with a wild and ferocious courage. Tobacco acts 
in a very similar maimer with opium, even in those persons 
who are accustomed to its use ; almost all smokers assert 
that it stimulates the powers of the imagination. 

If the psychological action of medicines were better 
known, medical men might be able to vary their exhibition, 
according to the characters and mental peculiarities of their 
patients. The treatment of different kinds of monomania- 
cal derangement also might be much improved, and it is 
not improbable but that even a favorable change might be 
wrought on certain vicious and perverse dispositions, which 
unfortunately resist all attempts at reformation, whether, in 
the way of admonition, reproof, or even of correction. 



On (he Detection and Estimation of Phosphorus and Phosphorus 
id. By Professor Scherer. 
Within two years the author had occasion to gather much 
experience from a number of cases of poisoning animals, 
and of two men ; also from several attempts of poisoning by 
phosphorus. In one case, the phosphorus from thirty to 
forty matches, equivalent to half a grain, proved fatal to 
a woman in forty-eight hours. He establishes the presence 
of phosphorus by Mitcherlich's method, with the modifica- 



54 Apoplectic Affections of the Retina. [January, 

tionof filling the apparatus with carbonic acid, generated 
from a fewpiecesof calcarious spar introduced into the acid 
liquid. No luminous vapors arc obtained, but little of the 

phosphorus is oxidized, and if the tube dips into distilled 
water, this is phosphorescent when agitated in the dark, 
and its vapor blacks nitrate of silver. 

To estimate the phosphorus, the last bottle containing the 
water is connected with another phial containing either 
neutral or slightly ammoniacal nitrate of silver, which ab- 
sorbs all the phosphorus vapors that have not been retained 
by the water. Any globules of phosphorus which may have 
been obtained are fused together and weighed; the water 
is added and then evaporated ; the chloride of silver is 
filtered off: the phosphoric acid, which is contained in the 
filtrate, is estimated in the usual manner, and calculated for 
phosphorus. 

Very minute portions of phosphorus may be recognized, 
after first ascertaining the absence of sulphhydrie acid, the 
vapors of which will turn sugar-of-lead paper black, and 
paper moistened with nitroprusids of sodium blue ; papers 
moistened with nitrate of silver are suspended over the acid 
liquid, which gently heated; in the presence of phosphorus 
the silver will be reduced with a black color. The papers 
may now be macerated in chlorine water or aqua regia ; the 
filtrate will, after evaporation, contain phosphorus acid, to 
be recognized as ammonio-phosphate of magnesia, or as 
phosphomolybdatc of ammonia 

If phosphorus has been wholly or partly converted into 
phosphorus acid, the residue from the first distillation is 
heated in Mitcherlich's apparatus with sulphuric acid and 
pure zinc, until the hydrogen ceases to be contaminated 
with phosphurctted hydrogen, which is conducted into the 
silver solution, and estimated as indicated before. — Ameri- 
can Journal of Pharmacy. 

»- m m 

Apoplectic A /Fictions of the Retina. Under the care of Dr- 
Dixon, Royal London Ophthalmic Hospital. London 
Ophthalmic Hospital. (London Medical Times and Ga- 
zette, June 23, 1860, p. 02:3.) 

The value of the ophthalmoscope is well illustrated in 

eral cases where diagnosis would have been difficult in 

the absence of this means of assistance. The instrument 

in fart completed the history of the disease, so far as the 

eye was concerned, and furnished information which for- 



1861.] Apoplectic Affections of the Retina. 55 

merly could only have been obtained by actual dissection . 
In Que 1, the patient noticed while at work that there was 
"a dimness before his sight," and, on closing the eves alter- 
nately, he found lie could not see with the left. The next 
morning the right eye tailed in the same manner, and, on 
further trying the eye, he could only make out very large 
capital letters. Ten days afterwards vision in his right eye 
had improved, but in the left it was not materially affected, 
strong light he could not see at all. The optbalmoscope 
showed traces of effusion from the choroid beneath the re- 
tina, at the yellow spot in both eyes, the most in the left. 
This was a well-marked illustration of symmetrical apo- 
plexy beneath the retina occurring in an apparently healthy 
man. 

Cast '2 commenced *-as a little dimness like a mist before 
the eye," followed by the appearance of black spots float- 
ing before it. * His general appearance on admission was 
not the blank look of total blindness, but he could find his 
way in the hospital, only slowly, and not without directing 
himself somewhat by feeling. The pupils were unusually 
large, and did not contract by light. He could see better 
with the left eye. The eyes were examined at the time by 
the opthalmoscope, and clots of blood were distinctly seen 
in the fundus. Xo marked improvement followed the treat- 
ment. Constant headache presented a complication in this 
. the pain being chiefly in the forehead. 

3 afforded an example of apoplexy of one retina on- 
ly, but attended with frontal headache and epistaxis. The 
failure in the right eye appeared to have followed soon after 
a violent attack of bleeding from the nose. The headac 
were wholly relieved by the epistaxis. When last examin- 
ee described his sensations at night as follows : On look- 
ing at the ceiling, he sees a large "block," the size of two 
heads, the rest of the ceiling appeared pretty clear. (The 
pupils dilated by atrogine.) Upon making an examination of 
the eye with the opthalmoscope, a large irregularly circum- 
ibed patch was discovered, extending over and around 
the yellow spot, the ground of which was lighter colored 
than the surrounding parts, and on which were numerous 
dots of extravasation, very irregular, and in many pla 
consisting of five or six spots running into each other. Be- 
tween this patch and the margin of the optic entrance was 
found a large and apparently thick coagulum of a deep 
purple tint. Over the whole of the patch arc Small white 



56 rate of Iron. [January, 

Boots, appently about the size of pins' heads. Several dis- 
tinct apoplexies lnust, in this instance, have occurred at dif- 
fereut periods. The whitish patches were, no doubt, those 
of oldest date. The case is of interest on account of the 
age of the man being exactly that at which a sister of his 
had died of crebral apoplexy, and because in his own case 
severe frontal headache and epistaxis had preceded the effu- 
sion into the eye. 



On the Employment of Stearate of Iron in the Treatment of Soft 

or Phagendic Chancres. By M. Ricord, (Pharmaceutical 

Preparations of M. Braille.) 

From a communication of M. Calvo, nephew of M. 
Ricord, we learn that the latter has employed for several 
months, in the Ilopltll da Midi, an ointment or plaster of 
stearate of iron, prepared by M. Braille, pharmaceutist of 
the institution, to whom we are indebted for excellent means 
of dressing soft or phagedenic chancres. 

This new preparation, which can be prepared at a low 
price, and is of easy application, is destined, without doubt, to 
render great service in all those cases of so serious a char- 
acter where the phagedenic action seems to resist the 
numerous means which science directs against it, and con- 
tinues its destructive march without interruption. Up to 
the present time, at least, it has fulfilled, in the hands ofM. 
Ricord, all that it seemed to promise, and has become of 
daily use in his hospital as well as in private practice. 

The modus facienai of these new preparations, as commu- 
nicated by M. Braille, is the following: 

O'ndmcnt of Stearate of Iron. — IJr. Sulphate of Iron, 500 
grammes; Marseilles Soap, 1000 grammes. 

Dissolve the sulphate of iron in about 1500 grammes, of 
water, and dissolve the Marseilles soap in an equal quantity 
of water. On pouring one solution into the other, a whitish- 
green precipitate is obtained, which is dried, and then melt- 
ed at a moderate temperature of 80° to 84° K.; add to the 
melted mass, <-;i cooling, 40 percent, of essence of lavender, 
jtir it constantly until it becomes perfectly cold. 

Sparadrap of StearaL of Iron, (Braille's Plaster.) — ]{•. Stea- 
>btained by the process directed above. 
ii at a moderate temperature, and spread it on muslin 



1861.] Hydrochloric Arid in Chronic Dyspq>& 57 

like the ordinary sparadrap. This mass gives an adhesive 
sparadrap, which does not crack like the soaps of lead ob- 
tained by double decomposition. — Journal dc ¥harm\ 



dochloric Acid in Chronic Dy& By Dr. Schottin, oi 

Dresden. 

Dr. Schottin has used hydrochloric acid with great suc- 

- of chronic dyspepsia. The curative effect of 
the remedy is attributable to two circumstances : First, it 
suspends, like other powerful acids, the process of fermenta- 
tion ; and, secondly, it serves to dissolve the proteinaceous 
compounds, being, to a certain extent, a substitute for the 
disturbed secretion of the gastric juice ; it is therefore, the 
most natural remedy. In children who suffer from gastric 
and intestinal catarrh, the author prescribes the acidium 
muriaticum dilutum of the Prussian pharmacopoeia, in 
doses of six to fifteen drops, in a mucilaginous mixture, and 
adds, until the bowels are regulated, a few drops of tincture 
of opium. lie orders the'medicine to be taken half an hour 
after each meal, and confines the patient to a diet of milk 
and broth. In old age. when the stength of the system is 
gradually falling, disturbances of digestion are very fre- 
quent, the cause of which is to be found, in many instances, 
solely in a diminished secretion of the gastric juice. A 
double indication is to be fulfilled in these cases : to arrest 
the process oi fermentation, and to stimulate the stomach, 
in order to increase the secretion of the gastric juice. Dr. 
Schottin recommends for this purpose small doses of chloride 
of sodium and sulphate of quinia, to be followed, a short 
time aiterwards, by sulphuric acid. The chloride of sodium 
is decomposed by this means into sulphate of soda, and hy- 
drochloric acid. lie prescribes ten grains of chloride of 
sodium and one-third of a grain of sulphate of quinia, to 
be taken four times a day wrapped up in a wafer, lets the 
patient drink some water, after it, and administers, about 
five minutes later, eight to twelve drops of the elixir acidum 
Halleri in half a wineglassful of water. 

The dyspepsia of drunkards requires a double dose of 
sodium and sulphuric acid. Dr. Schottin attributes the ef- 
fect of hydrochloric acid in typhus, anaemia, and chlon 
likewise to its property of suspending the process <.t* fer- 
mentation within the stomach, and i ing the deficient 
secretion of the gastric juice — Archie der Houkunde. 






Prolapse of th Rectum. 



[January, 



onneckd with the Pathohqy and Treatment of 
i ' ' the Reetwu* By Henry Smith, F.R.C. S. 

It is not my intention in this paper to treat generally of 
the important subject under notice, but I am going to re- 
quest your attention to one or two particular points connect- 
ed with the pathological features ol prolapsus of the rec- 
tum, and with the treatment which is suited to certain forms 
i>\' the disorder. 

There has not been much room for discussion respecting 
the main pathological changes which take place in the pro- 
duction of this disease, for the simple reason that a prolaps- 
ed rectum can be readily examined on the living body, 
both by the eye and the fingers, and some most able sur- 
as have described in their works with remarkable ac- 
curracy the principal features ; but on one point there has 
been, and is now, a strong divergence of opinion as to 
whether most frequently the prolapsed part consists of the 
mucous and muscular coats of the rectum, or of the mucous 
membranes simply. Some of the older writers have leaned 
strongly to the opinion that the mucous membrane of 
the bowel alone was involved, while of late there has been 
an opinion expressed as strongly on the opposite side. 
There cannot be a doubt in the mind of any one who has 
investigated the subject by studying morbid specimens 
taken from the dead body, that, although in the majority of 
instances the prolapsed part consists of the mucous mem- 
brane alone in a relaxed and thickened condition, yet, in- 
some cases, the muscular coat of the bowel is protruded be- 
yond the sphincter as well as the mucous membrane. It is 
nol only an interesting hut an important fact to ascertain 
properly, because it will happen that the treatment which 
will be adapted for the one the form of disease will not suit 
the other. In cases where the mucous membrane is pro- 
lapsed lo.al measures, and those of a less energetic nature, 
are Buffich nt tor a cure, whereas in instances where the 
muscula is brought down beyond the spincter, local 

measures alone will either fail, or it will be necessary to 
• loy means mmv decided and more severe. As an ilus- 
tration of the prolapsus consisting ^\' all the tissues of the 
bowel 1 may refer you to those large descents which are 



mtli Hants Medical and Chirurgical Society, 
2, I860. !»;•. Wiblin, President, in the Ohair. 



Sept. 



1861.] Prolapse of the Pedum. 59 

somestimos seen in children as the result of some irritation 
in the intestinal tract or in the bladder. ~\\ r e know what a 
difficulty there is occasionally in keeping np such a prolapsus 
after it has been carefully returned, and that the best regu- 
lated local measures will not suffice for a cure until the 
general health of the child is improved by nutritious diet 
and powerful tonics, which especially tend to enhance the 
power of the muscular system. We know how elaborately 
the muscular tissues are supplied with blood-vessels, and 
how largely their nutrition and power of action are under 
the influence ol remedies which increase the tone of the 
system. 

The other instances in which we find that there is pro- 
trusion of the entire structure of the bowel are seen in those 
cases of long standing pro ] apsus in adults, where the pro- 
trusion is of immense size, as large as the fist or a foetal 
head, and coming down on the least exertion of the patient. 
Within the last week, I have been consulsed on a case of 
this description, occurring in the case of an old gentleman, 
of a weak frame and feeble circulation. The prolapsus had 
existed for forty years, and it has reached its present enor- 
mous size in consequence of neglect of proper surgical treat 
ment. In such cases as this, there is no doubt that at first, 
the mucous membrane of the bowel was simply protruded, 
but afterwards the other tissues became involved, and at 
length the tumor consisted not only of thickened mucous 
membrane, but the muscular coat also was extended beyond 
the sphincter. 

In those cases of prolapsus of the rectum of much more 
frequent occurrence, where the disease is more limited 
in extent, and where the mucous membrane alone is pro- 
truded, there is a considerable difference in the pathological 
features, and that, too, of considerable practical importance, 
•ially when viewed in relation to a mode of practice I 
am in the habit of adopting. In some of these cases it will 
be found that the mucous membrane is simply extended 
beyond the sphincter, in but a very slightly altered con- 
dition, the whole circumference of the lining membrane of 
the bowel may be down, or only one or two semi-circular 
folds may be prolapsed ; in either instance, however, besides 
this prolapsed membrane, the protruded part may consist of 
the muco-cutaneous lining of the sphincter, in a highly con- 
gested and thickened condition, forming in fact, the greater 
portion of the disease. This is protruded first, and may 



60 Prolapse of the Rectum. [January, 

be scon as a dark blue ring around the anus, while situ- 
ated above it is the proper mucous tissue of the bowel 
simply relaxed and prolapsed, but otherwise in a normal 
Btate. 

There is a point of considerable importance, both patho- 
logical and practical, in connection with prolapsus, to which 
I wish to call your attention, and which has not been suf- 
ficiently alluded to by writers; this is the condition of the 
sphincter ani. In some cases we shall find that this muscle 
acts in a normal manner and that the anal aperture is not 
larger than ordinary, although there may be a considerable 
prolapsus of the mucous membrane ; in other instances the 
sphincter seems to have losta considerable degree of its con- 
tractile power, the aperture is enlarged and easily distended 
eel ; in a few cases to such an extent that the whole fingers, 
when formed into a cone, may be passed into the rectum. In 
these instances this laxity of the sphincter is the chief cause 
of misery, for when it exists in a great degree the patient 
loses, either partially or entirely, control over his rectum, 
and the frees escapes involuntarily. A remarkable instance 
of this fell under rny care in the person of a patient, aged 
TO, who had suffered for twenty years with prolapsus, and 
indeed it was this circumstance which drove him to consult 
me. When there is a partial loss of the power of the 
sphincter the patient is continually harassed by calls to the 
closet night and day, although there may be any actual in- 
voluntary discharge of faeces. Of course this loss of power 
of the sphincter is the greater misfortune of the two, but in 
e instances of prolapsus of the mucous membrane when 
the sphincter is in a healthy condition, the following acci- 
dent may and does occur, especially when the protruded 
membrane has on its surface one or more distinct hemorrh- 
oidal tumors, the protrusion occurs on one occasion, to a 
larger extent and the patient cannot return it as usual, the 
mosl severe symptoms of course rapidly set in, and although 
this accident is very likely to be followed by a cure in con- 
ce of sloughingof the constricted parts, yet one would 
b • very unwilling to bring about this condition purposely, 
for death has followed upon the intense amount of inflam- 
mation which has occurred. X<>t long since! was called to 
■ Id lady, 7<» years of age, to whom this accident liappen- 
and not being in a healthy condition she was reduced 
to a great amount of suffering, for violent in ilammation and 
ighing of the protruded membrane had taken place; 



1881.] Prolapse of the Rectum. Gl 

this latter process was hastened hy placing ligatures around 
the diseased parts, and she made a good recovery. 

The treatment which should he adopted in case of pro- 
lapsus of the rectum must differ according to the pathologi- 
cal condition of the part, especially as regards size and the 
state of the sphincter. It lias hitherto heen customary 
anions: surgeons to use the ligature in most of the cases of 
prolapsus requiring surgical operation, and of these I am 
only now talking : and undoubtedly, where the disease has 
become very extensive, and particularly when associated 
with distinct hemorrhoidal tumors, 'the ligature must be 
used, if there be not any contraindication to a surgical ope- 
ration. This is especially .the case when, from the large 
size and the peculiar feel of the tumor, there is every rea- 
son to believe that the muscular coat of the bowel is protru- 
ded as well, for any operation short of the ligature will be 
useless in removing the disorder. In some ©f the cases also 
alluded to, when the prolapsus is voluminous, and there is 
a very relaxed state of the sphincter, the ligature alone can 
be depended upon ; but for such instances, which are by no 
means nncommonly met with in old people of the middle 
and upper classes, I have lately put in practice an operation 
which I do not wish to claim as particularly new, for it is a 
combination of two agencies employed before for similar 
conditions, but which I particularly wish to bring before 
your notice. It consists in first applying the strong nitric 
acid, on one or more occasions, to the mucous membrane ; 
and subsequently, when this agent has had some decided 
effect, to remove with curved scissors narrow strips of skin 
and mucous membrane frem around the verge of the anas 
at right angles to the orifice. The latter remedy alone was 
employed both by Hey and Dupuytren, and lately recom- 
mended by some ; but my experience tells me that alone it 
is not to be depended upon ; but if the mucous membrane, 
which is always in such cases in an extra-vascular and re- 
laxed condition, is first brought into a more healthy state 
by the contracting and slightly escharotic powers of an agent 
like nitric acid, the effect of removing the loose fold of skin 
which are so generally associated with the relaxed state of 
the sphincter, is very admirable. Two objects, in such in- 
stances, are sought by the surgeons, and indeed are abso- 
lutel} 7 necessary for an efhcieient remedy, viz : the contrac- 
tion of the mucous membrane, and the biacing up of the 
sphincter : these two results are brought about by the com- 



62 Prolapse of the Rectum. [January, 

biiicd proceedings mentioned. I must, however, not omit 
to state thai it is perfectly useless to employ the nitric acid 
in those instances where the prolapsed mucous membrane 
has become tinned and indurated, as is very often the case: 
the agent will produce no good effect; both patient and 
surgeon will be disappointed. The application of the acid 
is more especially advisable in those cases where the mucous 
membrane is granular, very vascular, and readily bleeds : 
the effect of one application in such an instance is sometimes 
really astonishing. But there is one caution I wish to im- 
press; and that is, that the surgeon must not be misled in- 
to the abandonment of further measures because after one 
application of the nitric acid he finds that the bleeding and 
prolapsed bowel suddenly disappears. It will sometimes 
happen that one application will be followed by remarkably 
good results like these, and that afterwards the symptoms 
return. It is better, in cases of extensive prolapsus, that 
the acid should act gradually than suddenly; the effect will 
be more permanent. It will be necessary to apply the nitric 
acid when the disease is extensive, on several occasions per- 
haps four, six, or eight times ; but it is generally attended 
with so little pain, that the patient does not object to sub- 
mit to it. If the sphincter ani be not in a weak condition, 
but acts normally, there may not be any necessity of cutting 
away the thin slips of muco-cutaneous covering; but if 
there are any pendulous flaps of integument, these should 
be exercised. These operations, which should be effected 
by sharp curved scissors, are of course painful; but the ap- 
plication of the freezing mixture of ice and salt will much 
deaden the pain. 

This treatment may be considered as perfectly free from 
danger, and is so admirably adapted for those cases where 
the "patient will either not submit to the ligature, or where 
there is some contra-indication to this proceeding. For 
instance, many of the worst cases of prolapsus oecur in 
aged people who are, or who consider themselves too old to 
undergo the ligature; others have some symptoms of lurk- 
ing organic disease about their brain or heart, and it would 
be highly perilous to use the ligature, but the treatment I 
advocate may be used with perfect assurance of safety. To 
illustrate this important fact I will allude to two cases which 
have lately lately been under my notice. The first w r as a 
gentleman aged 73. lie had a bad prolapsus, and when 
told by me that I could only recommend the ligature with 



1861.] Prolapse of the Rectum. 63 

confidence, to destroy his disease, lie refused to undergo 
it. I tried by some applications of nitric acid to remedy it, 
but lie became dissatisfied and consulted a surgeon of great 
eminence who strongly recommended the ligature and ap- 
plied it; the patient died three or four days after from an 
attack of apoplexy. 

£Tow, there were certain indications about this gentleman 
which would have prevented a surgeon who knew them and 
carefully considered them, as Iliad done, from frequent ob- 
servation of his case, from performing this operation. The 
patient was very peculiar in his manner and habits, and 
thought by his friends to be very "strange," as the term 
goes, and in addition to this he had almost entirely lost the 
control over his bladder during the few last months of his 
life, without the existence of any stricture or disease of the 
prostate. 

Xow, these two facts indicated some lurking mischief 
about the nervous system, and should have prevented the 
surgeon from operating. Xo doubt the stimulus of the 
operation of the ligature which is much more severe than 
is imagined, lit up the lurking mischief in his nervous sys- 
tem and destroyed life. To this the eminent surgeon who 
performed the operation readily assented when he was ques- 
tioned by me. 

The other instance is that of an old military man £ nearly 
TO, who has had prolapsus with severe pain and bleeding. 
He was anxious to get some relief; he had a peculiar nerv- 
ous twitching about his face, and a feebleness of his lower 
limbs; and on making inquiry of one of his family, I ascer- 
tained that he had something approaching a fit on two oc- 
casions. I at once decided against employing the ligature, 
for this reason, and resorted to the employment of the treat- 
ment I have advised with great benefit. 

It is not to be supposed from the remarks I have made that 
I am averse to the ligature in suitable cases, but if it can be 
dispensed with, and a milder mode of treatment can be suc- 
cessfully adopted, the surgeon is bound to put it in force. 
For, although I believe, when properly performed and in 
healthy subjects, the operation of ligaturing portions of the 
mucous membrane of the rectum is by no means dangerous 
still we cannot conscientiously tell a patient there is no risk; 
independent of the peculiar danger attending the proceed- 
ing, such as pycemia or tetanus, some serious and annoying 



<;i Ptolapse of the Mectum. [January, 

accidents are Liable to follow this operation, and I shall here 
draw attention to some of these. 

One very peculiar and unlooked-for sequence of this ope- 
ration for prolapsus worthy of relation occurred in practice 
not long since. I operated upon a fat old lady who had 
not much stamina — the circumstances of the ease were such 
us to demand a speedy and efficient operation; I used the 
ordinary precautions in the process, and the patient did 
wvy well the first day or two. On the third day, however, 
to the greal surprise of her medical attendant and myself a 
severe hemorrhage suddenly took place from the part, and 
had such an effect on the patient that it made me very 
anxious. 1 was at a loss to account for this very unusual 
occurrence, wherencither the knife or scissors had heen used; 
hut on going to make an examination I found that there 
had heen a rapid slough as large as a shilling formed by 
the side of the rectum, laying hare the muscular coat of the 
bowel for near an inch in extent, and no doubt one of the 
inferior hemorrhoidal arteries had been opened up and 
hence the bleeding which was so profuse and which occur- 
red on a second occasion ; but fortunately by keeping up 
pressure, and local application of strong nitric acid, the 
sloughing process was stopped and the patient made a good 
recovery. But this might have destroyed the patient had it 
gone on further. The cause of the sloughing was this : — 
The patient, who w r as very fat and heavy, lay a great deal 
on her back after the operation, and the pressure of the bed 
induced the sloughing of the part already of necessity irri- 
tated by the close proximity to the ligature. We learn from 
this interesting case the importance of not allowing patients 
to lie much upon the back after this operation, they should 
rather be induced to lie on their side. 

There is another point connected with the operation of 
the ligature of the mucous membrane of the rectum which 
there is considerable divergence <A' opinion. I refer to the 
-apposed danger of suddenly arresting the great discharges 
which ;ire so frequently seen instances, the sudden arrest or 
bleeding, or of a very profuse muco-purulent discharge by 
tie- Ligature, is liable to be followed by fatal consequences, 
although many erroneous notions have been promulgated 

it this. In very robust or full-blooded persons, the sud- 
den stoppage of the dis charges may predisposr to, or bring 

ome internal congestions of the brain or lungs; and, 
therefore, in BUch, one should be careful about employing 



1861.] Prolapse of the Rectum. 65 

the ligature. I have never had good cause, in my own prac- 
tice, to suppose that any serious result of this kind has oc- 
curred, but I will briefly detail one case which, if the cir- 
cumstances had not been accurately investigated, would 
have led one to the supposition that the operation produced 
a disastrous result of this kind. 

In March last one of the finest-looking officers in the 
army, of large frame, in robust, ruddy health, and aged 50, 
consulted me for the prolapsus and haemorrhoids of a severe 
nature, which had existed for many years. lie was a caval- 
ry officer, and had seen arduous service in various cam- 
paigns, having to ride much ; and for many years, on such 
occasions, the haemorrhage was very profuse; but — and this 
•portant — there had been scarcely any bleeding for the 
last two years. I advised the ligature, which operation was 
also strongly recommended by Mr. Fergusson, who, at my 
request, was consulted. I performed the operation, which 
was followed by no untoward symptom, and in the course 
of seven or eight days, the ligatures had separated, and I 
left the patient under the care of his medical attendant, Mr. 
Coleman, of Kingston. The patient was out in a fortnight 
but did not regain his strength so readily as is the case after 
this operation; and one night, about three weeks after- 
wards, he suddenly dropped down dead. 

Xow, at first sight, one would be inclined to say that here 
was the very case to prove the danger of suddenly stopping 
the discharge from the rectum. And had I not investigated 
the point, I should certainly have supposed that a sudden 
<•< ingestion of the brain had been caused by the cessation 
of the discharge; but the fact of there having been scarcely 
any bleeding during the last two years, militates against 
this doctrine. Mr. Coleman, who is a very able and shrewd 
practitioner, considered that it was disease of the heart that 
destroyed life — that the man had a feeble heart, and that 
the low diet to which he had been of necessity reduced, had 
further enfeebled it, and hence its action had suddenly 
ceased. It was a most unfortunate thing that no post mor- 
tem examination could he obtained. 

Before I conclude these straggling remarks and imperfect 
observations, I will make one allusion to the diagnosis of 
prolapsus of the rectum. It may seem unnecessary to insist 
upon the importance of making a correct diagnosis, but this 
surprise will cease when I inform the Society that I lately 
saw a morbid specimen taken from the body of a dead 



66 Affections of the JBemaU Breast. [January, 

woman, where the whole circumference of the prolapsed 
rectum had been encircled by a ligature, under the suppo- 
sition that the tumor was a prolapsus of the uterus. As 
may be imagined, death was the result of the occlusion of 
the canal. The proceeding, too, was effected by a man of 
considerable repute. 

Time will not allow me to make any further remarks, 
although there are several other points of interest connected 
both with the pathology and treatment of prolapsus; but I 
trust that the few subjects I have hit upon so transiently 
and imperfectly may be considered worthy of discussion. 



Treatment of Inflamniatory Affections of the Female Breast. 

By W. H. Byford, M. D., of Chicago. 

After fully describing the character, of these affections, 
Professor Byford comes to their treatment. lie arranges 
that for inflammation of the nipples under the heads of pro- 
phylactic, palliative, and curative. The nipple must be pre- 
pared for its duties. The causes operating upon it produce 
abrasions, and their actions is facilitated by the natural and 
acquired tenderness of the structures, particularly the epi- 
dermis and skin. Hence these must be hardened. The 
nipple should be covered lightly during pregnancy and nurs- 
ing ; the thinner and more permeable the covering the bet- 
ter. It should freely admit the air. At the time the organ 
''should be subjected pretty constantly to moderately rough 
friction.'' 

An excellent dressing for the nipple for the last two 
months, is a rough, coarse sponge, so cut as to cover the 
areola ; surround and cover loosely, but touch every part of 
the nipple. Over this there should be but one thickness of 
clothing, so as to allow of the evaporation of fluid as fast as 
secreted, and the free admission of air. In cold weather, of 
course, the parts should be covered more when going out. 
The nipple should be occasionally moistened with water, 
and allowed to dry slowly ; friction with a dry towel or the 
lingers will assist. 

During lactation, the same rules should be observed, and 
after nursing, the nipple should be wiped clean and dry be- 
fore being covered. A little glycerin or olive oil will pre- 
vent cracking. When inflammation comes on, palliatives 
and curative measures are demanded. The healing pro- 
being continually interrupted by the performance of 



1861.] Affections of the Female Breast. 67 

the functions of the organ, it is necessary to protect the 
part from the effect of these interruptions. 

Artificial means are required, which intervene between 
the month of the child and the nipple. For this purpose 
the shield must be employed. This should be made in the 
form of a conical hat, having a rim, a crown cavity, with a 
draught tube rising out of the top for the passage of the 
milk. This rim should be large enough to cover the areola, 
the crown passing over the nipple, merely touching it on 
the sides. If the abrasions are on the summit of the nipple 
the shield should be so deep that, when drawn, the top of 
the ogan will not touch, or else it will cause pain. But if 
the cracks are on the side or base of the organ, then the 
cavity of the shield must be shallow, so that the top of. the 
nipple touches its bottom in such a manner as to prevent 
any stretching, and to bring the pressure entirely on the 
top. In this latter case, the bottom of the cavity should be 
as smooth as possible, and correspond in shape to the sum- 
mit of the nipple, in order to prevent unequal pressure. A 
soft linen rag, properly adjusted over the draught tube, is 
preferable to any other envelope. 

M. Legroux mentions the following ingenious contrivance. 
He applies this mixture: — 

]J. — Collodion, p. xxx; 
01. Eicini, p. ss ; 
01. Terebinth, p. jss. 
This is quite adhesive, and dries less quickly than collo- 
dion, on the areola with a brush, so as to encircle, but not 
touch, the nipple for the width of an inch. While yet soft 
the nipple is covered with gold-beater's skin, w T hich is press- 
ed well down upon the mixture. Thus is formed a smooth 
and pliant covering. Holes are pricked through the skin 
with a needle, to aliow of the passage of the miTk. Before 
sucking, this must be moistened with sugar and milk. 

The curative means for sore nipples are various. The 
Bame will not do for abrasions as w r ell as ulcerations. Na- 
ture is to be imitated by forming a cuticle for the part. 

Abrasions may be covered with starch and mucilage. 
The following is a good mixture : 

]£-.— Ceret. Alb. gij ; 

01. Amyg. Hulc. 5j; 
Mel. Despun. 5ss. M. 

Dissolve with gentle heat, and add Bals. Oanad 5ijss. 



68 Affections of the Female Breast. [Januar 

Apply each time of nursing. WTienthe cracks are dee] 
them by pressing their edges together, and coverin 
with collodion in a thick and wide coat; this must be r 
newed when found necessary. When ulceration exists, 
will be acute or chronic. Act as for this affection elsewhere 
ete, if acute, by leeches, and apply cold emollient pou 
ticea ; or envelop the nipple in a thin layer of thick muci 
covered with oil-silk, so as nearly to fit the organ, kej 
cold by ice applied in a bladder. When these remedic 
are not necessary, apply mucilaginous and bland ointmer 
applications. Alum and tannin are good at first; sulphat 
of zinc and borax came next in respect to time. On 
scruple of tannin to one ounce of rose-water, five grains c 
alum, or sulphate of zinc are useful in the early stagei 
when the acute symptoms are subdued. The following ar 
useful : — 

R. — Soda? Subborat. 5ss ; 
Glycerin, 5ij ; 

At{. Rosar. f5jss. 

M. Use as a wash after sucking. 
R. — Sodee Subborat. 5\j I 
Cretse Prsep ?y ; 
Spts. Vini, 

Aq. Rosar. aa Siij. 
Mix and dissolve. 
The latter may be used when the ulcer is becoming ii 
dolent. In the chronic form strong astringents and stimr 
lants become necessary. .V skillful use of the sulphate c 
copper and nitrate of silver will shorten the course of thes 
ulcers. The laUer applied solid to the surface, not oftene 
than onvtv in eight days, is excellent. In the interval th 
sore may be dressed with tannin or alum in solution. Whe| 
irritable, an ointment may be \\>^\, made of belladonu:.. 
ayoscyamus, or opium. One very good expedient, whio 
will often entirely change the character of the ulcer, is I 
anesthetize the part with ice, as practiced prior to opf 

rating. 

When the lymphatic glands become affected, antiphl 
gistic measures must be employed; and when chron' 
alteratives, tonics, liniments, etc., according to the peol 
liarities of the ease. The treatment of milk abscess is F 
ereal importance. It should be prevented if possible, ■ 
proper management at the outset. When the nipple 4 
deficient, or, from any cause, apprehension is deemed ii- c 



1861. J . [fections of (he Female Breast. 69 

sible, it is decidedly improper to attempt nursing. In 
other cases, prolonged and judicious efforts should be made 
to render the organ useful. The first tiling is to take per- 
pendicular pressure off the top of the nipple, by some device 
to prevent the dress from forcing it in, and this, if possible, 
should be commenced early in pregnancy. For this pur- 
pose a shield should be employed, which will cause a pitting of 
the anterior surface of the breast, and a projection of the 
nipple. When called upon to treat a rudimentary nipple, 
after parturition, the effect must be more prompt. In 
many cases the organ may be made available by causing it 
to erect itself by simple titillation by the finger, and imme- 
diately applying the child : or by placing a thick layer of 
collodion, around it on the areola, which, drying, elevates 
the nipple. Then, by keeping the reservoirs empty, ab- 
5S is prevented. To aid in this, we have various tubes 
and pumps, but all of which are objectionable. A puppy is 
often used, but it likewise is liable to irritate and exciriate 
the nipple. The only proper way is by the mouth of an 
adult, varying the pressure of force to suit the tenderness of 
the part. 

A very useful class of measures are those to suppress the 
etion, and thus relieve the distention, as opium in large 
)s, or applied as an ointment ; but belladonna seems to 
have acquired most renown. Numerous instances are re- 
ported of its great value in such cases. Much depends upon 
it- strength and application by inunction till the production 
of its characteristic effect upon the system. Cold, as a local 
remedy, is beneficial. The temperature of the breasts for 
this purpose should be kept steadily at about 40 or 4o c . as 
by water running through an india-rubber enveloping the 
organ, or the application of a bladder. No bad effects are 
to be apprehended from it. Internally, a saline cathartic 
may be given ovovy other day, and two grains of iodide of 
3ium every four hours will materially assist. 
\>ute inflammation, the effect of congestion, is apt to be 
extensive, and will require energetic treatment. Warm 
fomentations may be applied for the first few hours with 
the hope of establishing the secretion of milk. A decided 
ion will often turn the balance in favor of resolu- 
Immediately after this, the use of the veratrum viride 
may be commenced in doses of six drops every four hours, 
till the pulse is brought down below the normal standard, 
and kept there. One grain of calomel, with a quarter of a 



70 Affections of the Female Breast. [January, 

grain of sulphate of morphia, may he given, if the pain is 
urgent, say every four or six hours. A lotion of one part 
of sulphuric ether to two parts of alcohol will he a good 
soothing adjunct, after the inflammation becomes perma- 
nent. These measures should not he abandoned for warm 
poultices until suppuration is clearly evident, by which plan 
we may often limit the extent of this process. . In this state 
of the gland, the most moderate means only should be em- 
ployed to draw the breast. Retained milk is not the cause 
of inflammation here, as in milk abscess. If glandular in- 
flammation is complicated with that of the reservoirs, the 
treatment for both must be combined, as local and general 
antiphlogistics with means to arrest the secretion and empty 
the reservoirs. 

Chronic inflammation will be cured by treatment similar 
to that for other glandular inflammations, as leeches, mer- 
curials, iodine, and vegetable alteratives, internally and ex- 
ternally. Much reliance can be placed upon well-regulated 
pressure with adhesive straps, pressing the diseased part 
against the ribs ; or with collodion thoroughly incasing the 
breast. When pus forms, evacuate it early, though where 
the abscess is deep, it is desirable to wait until the pressure 
from within has caused condensation of the overlying tissues 
otherwise a large opening will be required. In milk ab- 
scess the earlier and smaller the opening the better. The 
effect of suppuration and evacuation of a milk reservoir is 
often to destroy its cavity, but in some cases a milk fistula 
is formed. This may be closed by an occasienal application 
of the nitrate of silver. Worse than these are the tortuous 
lacuna 1 , that sometimes result from the deep glandular ab- 
scess of the breast, and which are generally very difficult 
to cure. Injection of iodine is most to be relied upon. This 
may be done by inserting a soft, flexible catheter to the bot- 
tom of the canal and throwing the injection through it so 
as to apply it without dilution to the bottom of the fistula. 
This favors the shallowing instead of the narrowing of the 
cavity. Of course it is never advisable to slit up these ob- 
stinate puriferous ducts, because of the amount ot tissues 
that might be damaged, which it is desirable to save. — Chi- 
cago Med. Exam. 



1861.] Leucocythamia. 71 

A Gisc of Leucocythcemia. By Dr. George Sheaber, Resi- 
dent Physician, Royal Infirmary, Edinburgh. 
A young man aged twenty-four, a miller by trade, admit- 
ted to the infirmary under the care of Dr. Gairdner, afford h 
an interesting illustration of leucocythfiBmia. Three weeks 
elapsed from his admission to the time of his death, and 
• k the following is a summary of the facts of the case in 
regular sequence: Ansemi, languor and debility; epistaxis; 
headache; bleeding from the gums; renal pain, with lithi- 
asis ; febrile symptoms ; disappearance of lithic acid, and 
appearance of lithates and albumen; diarrhoea; re-appear- 
ance of lithic acid ; uncontrollable epistaxis; haunatemesis; 
otitis; exhaustion and death." 

The crystaline deposit in the urine, on third or fourth 
day after admission, consisted mainly of hexagonal crystals 
of the lithic acid, with a few of the ordinary rhomboidal 
crystals. These, we have already said, afterwards disap- 
peared. Post mortem examination revealed leucocythaemia, 
enlarged spleen, fatty liver, petechia? on the mucous mem- 
brane of stomach and on the serous surfaces of the pericar- 
dium and endocardium. 

The case detailed by Dr. Shearer gives him a field for re- 
flection, which he discusses in the following suggestions: 

1. Enlargement and activity of the spleen is not the only 
condition involving increase of the white corpuscles, there 
being at present a ease in the infirmary in which this con- 
dition of the blood eo-exists with enlargement of the whole 
lymphatic system -of glands, without detectable enlarge- 
ment of the splenic organ. 

2. The fact of a great excess of white corpuscles in the 
blood in cases of leucocythsemia being accompanied by con- 
stant diminution of the red discs, appears to militate against 
the theory put forward by Wharton Jones, and supported 
by Bennet and others, that the latter are derived from the 
former by liberation of their included neuclei ; for, accord- 
ing t<> their theory, increased activity in the formation of 
the white ought, paripassu, to be attended by increased de- 
velopment of red discs, while the reverse is the case. 
Comparative increase of the white corpuscles is seen in a 
variety of organic discuses, especially chest affection.- ; but 
it also occurs in dysentery, diarrhoea, paraplegia, etc.; in all 
of which one general condition was observed, viz: depreci- 
ation of the appetite, and emaciation. These facts, Dr. 
Shearer thinks, point to the blood itself as the primary 



72 Santonin. [January, 

source of origin of the red discs, and in the diseases men- 
tioned there is either a deficiency of nutritive pabulum 
taken into the blood for the production of the red corpus- 
cles, or these are rapidly melted down to supply the ele- 
ments of the discharge. In leucocythsemia, again, the 
nutritive pabulum is appropriated for the formation of the 
white corpuscles, the blood being thereby impoverished to 
the extent to which these are increased ; development of the 
red discs is consequently kept in abeyance, and anaemia is 
again the result. 

3. The deficiency of color in the urine and the salts ob- 
tained from it depends probably upon the same cause as 
the pallor of the general surface, viz : deficiency of red 
globules and hsematin in the blood. 

4. Careful study of the deposit of lithic acid seemed to 
warrant the inference that the common or lozenge-shaped 
crystals is derived from the perfect hexagonal form by 
shortening of the lateral planes of the latter; but this does 
not explain the formation of the true rhombic crystal, 
which is an irregular form, 

5. Hemorrhage from various mucous surfaces form as 
prominent feature of this disease, and may depend partly 
upon the increased tension maintained in vessels by the 
absolute increase of volume in the mass of the blood, and 
partly upon the imperfect nutrition of the walls of the capil- 
laries from the inferior quality of the blood for histogenetic 
purposes. 

6. The white corpuscles, we know, are closely allied to 
fibrin in composition and character ; fibrin is increased in 
febrile and inflammatory diseases, and accompanying this 
is an increased elimination of lithic acid, or lithates, by the 
kidneys. Can any relation exist between the lithuria 
present in this case, and the increase of white corpuscles in 
the blood? 



On Santonin. By Profssor Falck, of Marburg, and l)rs. V. 

Hasselt and lieinderhoff. 

Professor Falck communicates in his treatise the result of 
fifteen experiments made by himself and Dr. Manns, with 
the view of investigating the physiological effects of san- 
tonin. The conclusions at which he arrives are the follow- 
ing: 

1. Santonin and santonin-soda arc poisons; at the same 



1861.] - 7o 

time it is not to be denied that they are valuable remedies. 
'J. A solution o\' santonin in dilute alcohol, introduced 
in proper quantity directly into the blood, rapidly causes the 
death of a dog, and undoubtedly also that of any other ani- 
mal. 

3. Injected into the subcutaneous cellular tissue santonin 
soda is absorbed into the blood. Also, if introduced into 
the Btomach, santonin as well as santonin-soda may pass into 
the blood. 

4. ruder conditions not completely known, santonin as 
well as santonin-soda are changed, within the animal body, 
wholly or partly into a substance which is secreted with the 
urine, and can be demonstrated in the latter by means 
of caustic alkalies. 

■~>. The change of santonin, respectively santonin-soda, 
into this substance which reacts, on the addition of caustic 
alkalie-, with a red color, may take place under certain cir- 
cumstances, in a very short time. The elimination of the 
substance with the urine, lasts, under certain conditions, a 
very long time. 

o\ Under the influence of santonin and santonin-soda the 
urine assumes readily a peculiar, yellow color. This color 
is evidently owing to the substance which is formed, in the 
animal body, out of the santonin. 

7. On evaporating urine containing this substance, in a 
water bath, the latter is changed so much that it does not 
react any more with a red color on the addition of caustic 
potas 

8. The urine secreted under the influence of santonin is 
not always of a saffron tint, but may occasionally assume a 
red color, viz : if ammonia is formed by decomposition of 
area, or if the santonin has been administered in combina- 
tion with alkali' 

Santonin and santonin-soda exert a remarkable influ- 
ence on the brain and the organs of vision : they produce 
incoherency of ideas and chromatopsy. 

10. The chromatopsy caused by santonin or santonin- 
soda is undoubtedly connected with the formation of the 
substance, reacting with a red color on addition of caustic 
notassa; we, t!: call this condition "xanthopsy." 

more the blood contains of this substance, the greater 
is the ehromatop 

11. Chromatopsy can not be caused by dropping an aque- 
ous solution of santonin-soda directly into the eye. 



/tin. [January, 

12. The phenomena produced by santonin poisoning are 
different according to the difference of circumstances and 
conditions, heath is almost always preceded by convul- 
sions. — Deutsche Klinik. 

2. — Messrs. V. Hasselt and Eleinderhofi* publish, in the 
Nederl. Tijdschvoor GeneesL, 1860, " a contribution to the 
toxicodynamic knowledge of santonin." They draw from 
their experiments the following conclusions, important to 
the practitioner as well as to the toxicologist : 

1. Santonin can act as a poison. 

2. As it seems to belong, in general, to the class of nar- 
cotica spinalia, without leaving in the dead body any per- 
ceptible sign of its irritating secondary effect, although 
symptoms of it are observed in man during life. 

3. Its action, on the administration of large dosei 
analogous t<' that of tetanic poisons. 

4. In relatively smaller doses, for instance of sixgrammes, 
il produces, in dogs, slight symptoms of poisoning. 

5. [n large doses of sixty to ninety grammes, it can act 
fatally on these animals with relative activity. 

antonin manifests its action then, at first, in the sphere 
of the motory nerves, which action is shown by spasmodic 
contractions of the muscles without an increase of sensibil- 
ity. The course of the affection makes it evident that the 
motory pail of the spinal narrow is acted upon progressive- 
ly from below upward. Tin 1 fatal termination seems to be 
owing to spasms of the respiratory muscles and of the 
muscles of the larynx. These spasms may be considered 
the cause of the asphyxia which finally takes place. 

7. The post-mortem appearance, hypenemia <>\' the 
lungs, engagement of the heart, hypenemia of the eere- 
bro-spinal membranes, and capillary injection of the medulla 
spinalis and oblongata, arc probably in causal relation to 
the spasmodic contractions of the muscles as well as to 
the death by asphyxia. 

Without having the intention of assuming, from their ex- 
periments, that the effects upon man are equal to those upon 
rs still believe that, considering their obser- 
vations in regard to the action of santonin upon man, they 
have sufficient reasons to conclude that santonin is, by no 
rnea yarded as an innocent remedy. — Med 

X< uigh 



1861.]. Mania a Potu. 75 

Digitalis in the treatment of Mania a Potu. By G. C. Cat- 

lett, M. D. 

The experience of the physicians of this city, so far as my 
knowledge extends in the treatment of Mania a Potu, lias been 
very unsatisfactory. Most of the attacks assuming a remark- 
ably accute fcrm; with great violence of delirium, furious 
mania, and persistent mental aberrations, have generally re- 
el the opium and stimulating as well as all of the former 
established methods of treatment for this unfortunate class of 
sufferers. 

So great has been the mortality from this disease during 
the last four or five years, notwithstanding we have attempted 
to discriminate between the chronic and the acute forms, that 
we have become apprehensive that we have not been treating 
alcoholic poison. Indeed so general has become the impres- 
sion that the various alcoholic drinks generally used, contain 
a foreign poison, that those who are in the habit of becoming 
intoxicated are significantly said to have taken passage on the 
strychnine line for an unknown destination. While the symp- 
toms of the numerous cases that have come under my obser- 
vation do not, in the slightest, resemble those from the poison 
of strychnia, yet, the great apparent difference in the charac- 
ter of the Bymptoms as well as in the result of the disease — 
produced by excessive use of alcohol — at the present and 
former periods, that it would very naturally create apprehen- 
sion and strike terror the spirituaily infatuated. 

There have been a few persons, by a prolonged debauch 
have induced inflammation of the mucous membrane of the 
stomach or at least, such a degree of irritability that a continu- 
ation of indulgence was impossible, -as nothing introduced in- 
to it would be retained, soon, therefore, from the withdrawal 
of the stimulous, delirium tremens would supervene, charac- 
terized by intense hallucinations, great tremulousncss, incapa- 
city to sleep, irritability of stomach, tender epigastrium, and 
deticiency of the secretions. Counter irritation to the epigas- 
trium, a mercurial cathartic, stimulants judiciously adminis 
tered (I prefer Tinct. Serpentaria ; and Tinct. Valerian, equal 
proportions,) and Morphia^ro re nata, will generally in my 
hands relieve such cases. But that form of this disease that is 
produced by the constant daily use of alcohol long continued, 
poisoning the blood and resulting in acute mania, is the fatal 
form, or properly Mania a Portu. in relation to this form of 
the disease Prof. Stone of New Orleans says : 

" Brain fever and apoplexy arc terms often kindly substitut 



76 Mania a Pot a. [January, 

ed as being more respectable; but names do not alter tacts. 
Mania a Potll usually occurs with the robust who habitually 
iN' 1 alcoholic stimulants, hut not to any great excess, except 
upon occasions, and when they are carried to a certain extent, 
a necessity for their continuance is created, and their excessive 
use cannot, or will not, he resisted until the stomach gives way 
and finally reject them. During this process the mucous 
membrane becomes engorged, the digestion, and finally the 
a] (petite, entirely fail, and the patients is sustained for some 
days after, by stimulants alone, until furious delirium sets 
in. 

"This madness is not due to the stoppage of an accustomed 
stimulant, for it often sets in while the subject is in the full 
use of it, but it is plainly due to alcoholic poison and the ab- 
sence of proper nutritive matter in the blood. I think I may 
add another cause which has often something to do in causing 
the delirium, and certainly much to do in causing death, under 
some modes of treatment, and that is suppressed excretions. 
So long as the stomach is intact, and the apetite and digestion 
good, an immense quantity of stimulant may be disposed of 
without serious immediate consequences ; but when the organs 
finally from constant excitation, became engorged, nutrition 
ceases, and the alcohol is retained more in the blood, instead 
of being carried off" by excretions, and a wild delirium soon fol- 
lows. 

"It is plain, under these circumstances, that the indication- 
arc to establish the excretions, disgorge the system of the al- 
coholic poison, and to introduce proper nutriment. The first 
two are accomplished by one and the same means. The 
stomach is generally irritable : at least, there is frequent vomit- 
ing; but it is owing to the accumulation in the stomach of 
morbid secretion, rather than from inflammation of even irri 
tation; fur calomel in small doses, frequently repeated, arrests 
it with great certainty. If the subject is governable, and will 
take medicine willingly, calomel should be given in two or 
three ^rain doses every hour, or oftener if the case is urgent, 
until fifteen or twenty grains are given : if medicine has to be 
given ; by force, it is best to give a full dose at once; and this 
is the better, for in the worst cases the stomach is not nauseat- 
cd. ami the eedative effect, of a large dose of calomel calms the 
nervous excitement, and at the same time produces the ap- 
propriate effect upon the excretory organs and mucous coat of 
the Btomach and bowels. It requires some hours for this ef- 
fect to be produced, and it is improper to give anything to 
promote its action upon the bowels under ten or twelve bonis. 



1861.] Mania a Potu. 

and I think even a longer time would be better, if the case is 
not urgent. Small and frequently repeated doses of saline 
medicine are the best after calomel (sulphate of magnesia is 
best), which promotes the excretions, disgorges the stomach and 
bowels, and clears the system of its alcoholic poison, to its 
great relief. An active cathartic may afford some relief, but 
the system is not so well disgorged by it ; more or less serum 
from the blood is carried off, causing weakness ; while, in the 
other process, by giving time for the action of the calomel, and 
then promoting it by gentle but continued means, the organs 
exercise a selection in excreting, and thereby a large amount of 
effete matter is discharged, and the patient feels the stronger 
for it, being freed from an incubus that was weighing it down 
and producing apparent exhaustion. After this process, we 
should lose no time in introducing nutriment, and for this pur- 
ducing apparent exhaustion. After this process, we should 
lose no time in introducing nutriment, and for this purpose 
milk is almost universally applicable ; and as the mucous 
membrane of the stomach seems to be denuded of its eptheli- 
11111, the addition of lime water renders it particularly grateful 
and soothing. Patients in this condition generally loathe ani- 
mal substance, but milk is almost always grateful to the taste 
aud is particularly appropriate, for it furnishes the most inno- 
cent solid for the bowels, that have been long deprived of 
their wholesome stimulus. If it should happen that a patient 
could not take milk, well boiled corn-meal gruel is the next 
best diet most likely to be relished ; ond for something more 
substantial, strong, well-seasoned broth, frozen, will be the 
most likely to agree. 

In all acute cases, alcoholic stimulants should be withheld, 
for they act like poison and will often bring back delirium. 
Should stimulents be thought necessary (and it is not often 
really necessary) the carbonate of amonia, or the aromatic 
spirits of amonia are preferable ; or it may be proper, in some 
case, to allow malt liquor. Opium in all forms should be pro- 
hibited, until the system is relieved of its alcohol and even 
then I find it can generally be omitted : and when it can be, 
the patient recovers sooner and better. The patient is not ex- 
pected to sleep well, but if the blood is renewed by its appro- 
priate nutriment, natural sleep will follow. 

Occasionally, when, previous to the debauch which imme- 
diately caused the mania, a free use of stimulants had been in- 
dulged in some time, we have an exalted state of the nervous 
system, attended with hallucinations and sleeplessness, which 
rerpiire special attention. Potent stimulants operate badly, 



78 Mania a Pot a. [January, 

and opium alone docs not operate well, though in large doses 
sleep may be forced, though not without some risk, in some 
cases, to the brain; but equal parts of morphia and tart, anti- 
mony, given in small and repeated doses, will soon calm the 
nervous system and induce sleep without injury either to the 
1 train or stomach. There is nothing that cools off the heated 
imagination in these cases like nauseating doses of tart, anti- 
mony, and opium in some form maybe added, if it is thought 
necessary. The too general opinion that sleep is the all-im- 
portant thing in the disease has led to fatal errors in treatment. 
( )pium, given freely, as it often and very generally is, while 
the blood is charged with alcohol, produces a very unfavorable 
effect upon the nervous system, and tends to check the excre- 
tions, which are already diminished, and the patient, without 
being narcotized, often goes into a stupid state resembling the 
effects of uremic poison ; and if about one-half (about the 
usual proportion), by the vigor of their constitution, weather 
it, in spite of all the poisons imposed upon them they recover 
slowly, and their organs are left in bad condition." 

We make this lengthy extract from Prof. Stone's communi- 
cation on this subject, because he makes the important distinc- 
tion between delirium tremens and Mania a Potu, and in his 
usual clear manner points out the rational treatment in the two 
forms of the affection, those views, we think, should be more 
thoroughly impressed upon the profession, notwithstanding 
Ave are satisfied that the difference in the two forms of alcoholic 
poison is clear, the treatment of Dr. Stone is the rational treat- 
ment, yet the Mania a Potu that has occurred in this city for 
the last few years, has been remarkably fatal, and all methods 
of treatment very unsatisfactory. 

Therefore I determined to try the Tinct. Digitalis in large 
doses, recently two cases presented an opportunity, The first 
a man, the second a woman. A description and treatment of 
one case will describe both in all essential particulars. 

Mr. after a debauch of several weeks, and while yet 

stimulated to as great a degree as all the varieties of alcoholic 
drinks could produce: in attempting to light a segar, fell upon 
the floor in the most frightful convulsions, raving and foam- 
ing at the mouth, and mutilating his lips, tongue, hands and 
arms with bis teeth. In a half an hour after this convulsion 
he was furiously delirious, recognizing no one, muttering his 
imaginary Pears, and now and then making fearful struggles to 
escape from his bed, his face almost livid, eyes deeply inject- 
ed and eyes greatly swolen, pulse one hundred and sixty, weak 
and thread-like. 



1861.] Cataract, Iritis, &c. 

In the interval of the convulsions, and before my arrival. 
one-half a grain of morphia had been administered to him. I 
immediately administered five grains of Ipecac and two grains 
Tarter Emetic, and repeated it every fifteen or twenty minutes 
until he had ejected everything from his stomach. This occu- 
pied several hours when his symptoms were not in the slight- 
est improved. I then determined to watch the action of the 
digitalis and commenced by administering a large spoonful 
every half hour. The first dose improved his pulse, it dimin- 
ished in frequency and increased in volume. The second dose 
lessened his ravings and made a more palpable improvement 
in his pulse. The third dose was increased one-half, when all 
of his symptoms in one hour, were manifestly improving. I 
then increased the dose and lengthened the time of adminis- 
tration, in about seven hours from the taking of the first dose 
his pulse was fult, slow and regular, his delirium had entirely 
vanished, and he was sleeping though interruptedly, now and 
then disturbed by his hallucinations. I then continued the 
Tinct. Digitalis in smaller doses, giving a mercurial cathartic. 
His sleep became sound and tranquil, he awoke in about six 
hours, sane in mind and almost well in body. The only re- 
maing vestage of disease, was extreme nervousness. I ' then 
prescribed Tinct. Valerian and compound tincture of cinchona 
in equal quantities. The second case was almost a severe as 
the first and was treated in like manner and resulted as favor- 
ably. If Digitalis acts by sedation, will not Veratria be a 
more efficient remedv in Mania a Potu \ 



\tio Atropice Glycerinea; a P reparation for the Dilata- 
tion of the Pwpil in Cataract, Iritis, &c. Br Charles E. 
C. Tichborne. 

Since atropia was first brought into notoriety for the above 
application, by Heisinger, it has completely superceded bella- 
donna where introduction into the eye is necessary, but the 
extract is still resorted to for painting the eyebrow and cheek 
in such operations as absorption of cataract or anything simi- 
lar, where it is indispensable in order to prevent adhesion of 
the iris to render the dilatation permanent ; no preparation of 
the alkaloid yetintroduced being applicable to the exigencies 
of such cases. A few of the objections to the use of the ex- 
tract may be enumerated as follows : Liability to produce 
cutaneous irritation ; secondly, its requiring great attention in 
keeping the surface moist with some some lotion to prevent 



Su tract. Iritis, &c. [January, 

its drying; and thirdly, want of cleanliness, as the extraneous 
manner of this inspissiated juice are certainly very much out 
of place when manipulating with so delicate an organ as the 
eye; in some. eases complete failure results either from the 
use of a bad preparation or non-absorption from harshness of 
the epidermis. 

Some time ago glycerine was found to possess great solvent 
properties, particularly as regards the alkaloids and some of 
the nun-nitrogenous organic principles. The author has de- 
termined its action and solvent power in connection with 
atropia with a view to its use as an elegant and efficient mode 
of exhibiting thissubstance where permanent dilatation of the 
pupil is requisite. A saturated solution in glycerine gave, on 
analysis, four per cent. (=gr. xvijss. ad. 5 i.) of the vegeto- 
alkali. It does not dissolve readily in the acid, but is soluble 
to almost any extent on applying a gentle heat ; the excess, if 
it is not great, deposits on cooling in fine transparent colorless 
prisms, but if the amount is considerable it becomes, when 
cool, a solid mass. From this it is evident its solubility in 
glycerine is much greater than in water, it requires 189 parts 
of the latter menstruum to dissolve it in the cold ;* indeed the 
atropia is recoverable to a considerable extent by precipita- 
tion on the addition of water to the glycerolic solution. The 
easiest method of making this solution is as follows : — One 
decigramme (—1,553 grains.) dissolve in a few drops of alco- 
hol is added to 20 grammes (=368.680 grains) of distilled 
glycerine ; the mixture is then subjected to a gentle heat, viz: 
110° Fah. for half an hour in an evaporating capsule to vola- 
tilize the spirit. This will contain one-half per cent., i. <\, 
2.187 grains to the ounce, and may be labelled "Fortior." On 
smearing the surrounding parts of his eye the writer found 
(without dropping in any solution) the dilation of the pupil 
perceptible in 15 minutes, from which it steadily increased. 
A weaker solution, i. e., one containing one-fourth per cent, 
made by using one decigramme to 40 grammes, may be used 



I'hv author was induced to enter into the examination of the solubility 
in water from observing tin- non-conformity of works of reference on this 
subject. Bis experiments gave as a mean result 1 part atropia, to be 
soluble in 189, generally given as soluble in 800 parts, whilst Lowig gives 
ii a- requiring 2000; the writer thinks this must be a typographical error 
and must be intended for 200 parts. This diversity might he accounted 
for in -ouie degree, a- an amorphous modification, produced by action of 

atle heat, as apparently much more soluble. This uncrystallizable 
variety ia equally efficient with the other in dilating the pupil. 



II.] < Si 

to determine the dilation, by an-occasional application, and 
also to allow for absorptioi olution inglycerine ofatropia 

may be made containing 16 grains to the ounce, without any 
danger of its crystallizing out. 

The advantages to be derived from the use of this pre 
ation, ar properties of the glycerine, 

which, by softening and relaxing lows 

»fption of the active principle ; secondly, the certainty 
of ab ie alkaloid in the soluble form, and . 

Lai distribution from the hygrostatic properties of 
of the glycerine, which could not be obtained from the u- 
anyscqueous solution, even in the form of a malate, as in the 
extract, and also itse pplication, freedom fr» ntion 

as it always remains moist; and lastly, the certatnty appertain- 
ing to the employment of all medicaments of a definite cohi- 
ion. — ( ' W8. 



[Many of the following extracts are from the valuable month- 
ly summary prepared by Dr. 0. C. Gibbs, for the Ameincan 

'lied Monthly. — Eds. S. M. & S. Jo: 

.—In the Chi Medical M , for No- 

vember, there is a published report upon praetici cine, 

furnis Dr. C. Goodbrake, for the Illinois St; deal 

Society. Under separate heads we shall allude to a few of 
the more novel opini , then, of scarlet 

fever: Dr. J. N. Niglas' trea 
and contains nothing local treatm 

- : -'The region of the paroti 1 and submaxillary glands, 

from the beginning, I advise jd with cotton, and 

mel wrapped around the neck n as the slightest 

swelling com to be pe . -. a liniment composed of 

_■ la!, dale, oij., liq. ammon. 5>j. 5 nii. 5j., gum 

camphor gr. x , is repeate bed ('faring the day. tin 

I around ; and glad am i that 

, nunc of the C 
under my charge were lost by consecutive suppuration." 

Dr. Prince would control the pulse with the veratrum viride 
and then use the stimulating trea sly and fr< 

Dr. Hiram recovi . 

full .' carbona e of ammonia, that he thii kJ must have 

ation. 1: (ammonia) \va 
Lmended by a French physician, and Dr. X: □ ■ 



ria. [J 



iiiiuai'v 






•ly allied in nature, or in 
thera ' -. and sclarlet fever. 

• ific poison, affecting the system 

ically. We have noi Bpace to enlarge — 

ic tincture of iron, quinine, and 

rvice in ml diph- 

ng benefit in Bcar- 

V- no doub 3 of quinine 

ents that can be 
fever. Though foreign from our 

■ excused for quoting from a trans- 
journal in support of these views. In the London 
American reprint,) Dr. J. Hawkes, 
• For those who may 
have such cases to m >ul t they occur only too 

recommend the use of quinine. My at- 
> it in thi by the excellent 

Eood, in which lie so strongly urges 
ion in all forms of scarlet fever. I have put his plan 
.1 a large dispensary practice, and have 
every reason to bear 

- an addi \ idence in support of the tonic and stimu- 

lating treatment in scar! ain (juote from the 

■ number of the 1 Dr. T. J. Graham, speaking also 

<>f malignant scarlet fevei . is abundant evidence 

ie profession in proof that the sesquicarbonate of am- 
monia p pecilic powers over the worst forms of scarla- 
tina, and that, when the eruption recedes, no means known 
iwer in repi : it, and relieving the 
lent." :: ' fully con vinced that this 
prep of ammonia, administered regularly, day and 
.':. and trusted to alone, with a mild aperient and a suitable 
. will be found fully equal to the restoration of the patient. 

nt medicine in 
half apprehended." 

J)i new or 

Dr. P ays that the local applica- 

tion 'this ex; 3! "A 

fusion of capsicum and a saturated solution <>!' chlorate 
«.f p 1 m, have proved more satisfac- 

ocal application to the 

mur. tr. iron to answer the 

all ■; that came under our treatment. We 



II.] Diarrh ■ Uldren. S8 

tried the nitrate of silver, sulph. of copper, alum and sulph 
copper combined ; but the ti the 

■ilVct in our hands. 
The best remedies internally seemed to be quinine, tinct. of 
iron, chlorate ofpotassa, and good porter or brandy, with good 
nutritive diet." No allusion is made to asaturated solution of 
tnon salt, ,£s a wash or gargle to the throat; this, of all 
means, has pleased us the best. WYhave applied tins remedy 
to the throat for another trouble, which we may as well men 
tion here as elsewhere. A lady of oar acquaintance had, for 
man years, been subject to frequent attacks of quinsy, which 
always passed on to suppuration, hi tin.' last year, we have 
aborted two severe attacks by the local application of muriated 
tincture of iron, applied several times a day. We have re- 
duced the remedy with about two parts of water to one of 
tincture. 

Diarrhea i of Children. — In regard to tl tse, wo .-hall 

quote that one remark from the report. Dr. J. O. Harris re- 
marks upon the treatment as follows : 

"I found that after exhausting all the usual remedies ad- 
vised by our standard authors, and by my brother physici 
that quinine in full doses, frequently repeated, (acted or seem- 
Imirably. lthou me that I was pre- 

scribing empirically, and now I do not. pretend to explain the 
of the remedy. [ only know this, thai my 
patients recovered under the use of quniue, and I still frequ 

. it. when I see no particular indications for its 

Typhoi I Dr. Nance's treatnn 

of this form of fever: 

My treatment, stated in brief, con-:-:* .1 of spts. nitri. dale, 
5viij., Norwood's tinct. veratrum viri 

one teaspoonful to an adultevery tin . the 

active stage rem reasing i 

requires. It may be ne< mtinue this medicine 

for eight or ten <h\x>, or more. rescribe at the e 

time turpentine emulsion, usuall combined with tinct. opis.: 

prescription ■ the activity of the ] 

favorably npon the urii iratory . the 

latter, containing laudanum, q . promoti 

and the spts. turpentine has its ^jx-c-i ii<- action npon th" glands 
of the mucous membrane of the When conva es- 

cenc* iblished, or if the 

mpport. "My pi Ion during the fall, un< 



If- mop/ . [January 

circumsti nl. conchonia, grs. iij.; camphors 

. iij. Mix, and give every four hours 
and alteraatc from two to three teaspoonfuls." 

We apprehend 1 in the treatment of ty- 

hoid fever consists in "prevenfing" rather than "treating" bad 
symptoms. Many p re turpentine only when the 

tongue is dry and the bowels tympanite will heal* the ulcerated 
state of the bowels, which ' . in the late 

asonable to suppose that, in 
:' this condition, ii may act curatively and 
prevent the diarrhoea, tympanitis, the red and dry tongue*, &c. 
Many only support the syst< death seems imminent 

Tonic-, such as quinine modified by opium and wine, can he 
irted to much earlier than they often are in this disease. 
When prostratio decided, we think Dr. Nance's two 

or three teaspoonfuls of wine will nol bring out the full influ- 

atment. 
We have given n tolerably full synopsis i I this report, be- 
cause i f modern treatment, among 
rn physi( some of our more common disea 

.// ■ r, of Iron, dkc. 

In the ( Examine? 1 , for November, Prof. N. 

►avis reports an alarming ease of hemoptysis, occurring in 
a lady l ; ! years old, who had a decided hemorrhagic diath( 
inasmuch as the father of the patient and one sister had previ- 
ously died from hem unon salt, gallic acid, acetate 
of lead, opium, alum, tinct matico, gelseminum, oil turpentine 
and quinewere thoroughly tried, with partial and temporary 
benefit. "Atthi of the case," he says, "we advised 
the tinct. ferri muriatis, and tinct. o . equal parte 
which forty drops were taken every two bours. Under the 
use of this mixture the hfiemorrha than 24 
hours, and In 

Diphtheria. — in "October, 

Dr. S. P. iencewith diphteria. With- 

in the la In these c 

all b culiar diphteritic exudation. We 

Dr. Bryan's remarks upon the treat- 
ment in lull, for [uite judicious; and, besides, 

3 hut one: but want of space 
will prevent. We simply copy his recapitulation : 

limited ( n the light in 

rard meaeleB, variola and typhoid fever, bu1 

duration may be materially abridged, as well as its 



1S61. menorrhcea. 

violence greatly mitigated, by prompt and proper I 
ment. 
2. "The milder cas ui-re no 

than the local appli 
and the internal use of chlorate of potash, together with -•oner- 
ous diet and the cautious use of such mild aperient m 

vll maintain a soluble condition of th 
mon - may generally be very promptly controlled, 

if -the treatment is early i ced, by the addition 

quinine, and occasionally of brandy and ' - the for 

ing. 

"Depletion in this d whether din [-let- 

ting, or indirect by purgation, &c, is not only a vain. 
pedient, but, in consequence of its debilitating effects, is posi- 
tively injurious, by favoring the accession of typhoid symp- 
toms, and preventing .1 rapid and 
cenc 

The nitrate of silver is applied — 20 grains to the ounce — by 
thorougly in the thr< r four times a 1 

This followed, hall' an hour later, with a solution of chlorate or 
potash — 5ij- to iv to water Oj — . In severe 

is main di [uinine, which, to 

adjal ins a day. "T 

5, "appeared I the fever, ai 

of the di 

rred to, in from two to five days." ! [e says further : 
"It ; the quinine urative influ- 

inferior to thai whic srts in ordinary malarious 

hich before -1 rapid. 

numbering in - Von: L20 to 140 heats per 

mini ce, fuller, 

stronger and sloi 

Dysm rg. Jou\ . 

mber,Dr. J. B. Snelson has an articl u dysme- 
norrhoea, in which he recommends quinine in combina 
with pri 1, particularly in tic or neural- 
He would treat the menstrn pium 
and the warm bath, and the in' with the 
followin 

Iph. Quinine, 

M . 

Divide into pills No. xx. On 1 be tal 

morning, noon and night ; tl mtinued dur- 

le intermenstrual ." [f we rightly remem- 



Throat Di nary, 

p, : hi the /. •!• L851 . re" 

line in < with sulphate of iron 

or most of the unnatural manifes- 

We are not certain that 

From the change which strych- 

mr hands over the rheumatic or neuralgic difficul- 

p, we would suggest it in connection 

. in dysn • oea. 

/•'■ morrhage. — in the Lancet and 

tber, Prof. G ML"endenhall reports a 

of post-partum uterine haemorrhage. The usual 

mean tout benefit; the hand was inserted 

the uterus, also lumps of ice, but still with no check upon 

r en, but with no perceptible 
atheter was introduced to the uterine 
three ounces of the saturated solution of 
of iron injected through it into that organ." 
ion was I for a few minutes by the hand in 

the nterud. The injection produced no pain, but 
>m that moment not another drop of fresh blood was dis- 
charged from the uterus and vagina.'' The patient "recovered 
without an unpleasant symptom." 

it Distemper" of the Last Century. — In the 

Surgical Journal, for November 15th, 

Dr. Q. II. Gay republishes a paper upon the above subject, 

written by Jonathan Dickinson, of Elizabethtown, }\. J., in 

the year 1738, and published in Boston in 1740. Dr. Gay 

3 that ti use described, and for which direc- 

given for treat was none other than diph- 

ia. Dr. Dickinson d ss no less than six varieties 

ud some of the symptoms do conform very 

irately to those of the last named d When he 

whole throat,and sometimes the roof of the 

ith and nostrils, vered with a cankerous crust, 

whic »us parts, and frequently tcrmi- 

sonable applications 
embling diphtheria. 
3 mi epidemic, often 
it fatality ' hoarseness, difiicull 

mal bubo-like ulcerations, 
>n of large quantities of tough, whitish 
we also recognize con- 
Li in diphtheria. Again, in uni- 
rmptoms, L 



L] S T 

"The tonsils first, and in a Little time the whole throat, is 
red with a whitish crustula; the tongue is furred and 
the breath foetid." Bu1 other symptoms rationed 

that show a dissimib diphtheria, as ' 

itself; thus, the 2nd, 3d or 4th day, if pro- 

per methods are used, the patient is covered with a ml 
eruption,ins mblingthe measles; in 

like the scarlel fever, (for whic mper it 

has frequently been mistaken,) but jn • very much 

resemble* influent small pox."' 

It may be interesting to notice, in this connection, a 
remark or two in regard to treatment. local means 

to the throat, h< found the following method 

most successful : Take Koman vitriol,! 
lie as near the fire as a man can bear h id, till it be 

thoroughly calcined and turned white ; put about 8 grains 
of this into halfapinl of water; lay down the tongue > 
a spatula, and gently w. s much of the crust as will 

easily separate, with a line ra< lo end of a pi 

or stick, and wet in this liquor, made warm. This opera- 
aid be i py three or tour hours." 
Ln conclusi Dickin 
treatment of which is reported to 
larkably d in all forms of the dis- 

administration of a 
"de< [uaw-root," pre- 

pared in the foil 

of this • I in a quart of i he 

adds, when two ounces of loaf 

ar, and b the consumption of one-quarter 

tienfs frequently to drink, and 
i gargle their thr< i 
alio-. the 

conclusion." 

. — Jn the Medical and tfurgu 
. 27th, and November 3d, the pape ilton 

i which 
■ only • 
Lts in the argument. [1 

I 
ally ecretion the 

of opium ; yet there 

practical importance, and \ tate it in 



Vm [January, 

Dr. Hamilton. "P< ion is nearly al- 

wa\ 3ed by a moderate or full dose of opium, and 

d activity of the cutam halents is gener- 

! by an »n of the heart and 

►wu in such ised color of the 

Dr. Hamilton considers the various 
in which opium is appropriate. Wehave notspace 
lor an abstract. We will only instance peritonitis, dyi 
bery, typhoid fever, and various forms of inflammation. In 
his paper various distinguished physici- 
ans took part. We will here refer to only one idea: Prof. 
taking upon this subject in reference to conges- 
lion and inflammation, says, that in congestion of the lut 
the administration of opium has always a tendency to in- 
crease it. We wry much doubt the correctness of tins 
rtion ; we believe that opium has a tendency to relieve 
all internal congestions. We know of no remedy that will 
he cutaneous circulation, and produce free per- 
spiration, as will opium, lu congestion of the lungs, a 
harassing and perpetual cough but ii the congestion. 

Opium, by allaying this cough, determining the circulation 
to the superficial blood-vessels, and the free perspiration 
consequent upon this, can have no other influence than to 
tie internal congestion, Here we leave the subject, 
referring our readers to the paper of Dr. Hamilton, and 
the discussion following, as worthy of attentive consider- 

• 

Vari ins of the Leg. — In a former number, we re- 

ferred to the treatment by subcutaneous ligation, as prac- 

I by Dr. R. J. 1. Philadelphia. In the Med 

and Surgical Reporter, for Xovember 17th, Dr. Levis has an 
ani i this subject. Ee regards varix of the log as. 

practically, a disease of the saphena veil proper treat- 

ment he beli consist in the obliteration of this vein. 

manner of its accomplishment is described in the paper 
I to. lie thinks the operation is best performed 
while the pa tanding. To have the limb at a con- 

venient height, he would have him stand upon a chair or 
table, and so placed that the patient can steady himself 
insl the wall. He prefers a round, straight needle, to 
i one with the common surgical 
needle | I the n< inserted 

licularly, until ii reaches the under service of 
i. The - then de oint pa- 



L861.] Broncl 

under the vein, and passed out on the opposite side. The 
needle is now made to enter at the orifice of exit, and pi 
ing now ahove the vein, em I the point o[' original 

entrance, it should have been observed that the needle 
should previously be armed with a silver or iron wire of 
small size. The wire is now drawn down upon the vein. 
tightened, and fastened by twisting. Adhesive or isinglass 
piaster is novv* applied over the wounds, and the limb is 
bandaged from the toes to the knee. Dr. Levis regards this 
treatment as eminently - ul, and accompanied with no 

danger. 

onic Bronchitis — A New Remedy in. — In the Medical 
and > Reporter j for November 17th, Dr. II. AVilson has 

an article upon the treatment of chronic bronchitis. He 
regards local medication as of the first importance, and 
aiders in review most of the means, the use of which 
has been recommended in this manner. Suggesting a new 
remedy, lie For several years past I have been in 

the habit oi using a remedy, which may not be new, but 
which tar surpasses that of any other which I have tried in 
relieving, and in many instances entirely eradicating, the 
affection. I refer to the leaves of the common mullein, 
(verbascum thapsus,) dried and smoked in a pipe. In that 
form of the disease in which there is dryness of the trachea, 
with a constant desire to clear the throat, attended with 
little expectoration and eonsiderable pain in the part ailect- 
ed. the mullein, smoked through a pipe, acts like a charm 
and affords instant relief. It seems to act as an anodyne 
in allaying irritation, while it promotes expectoration and 
removes that glutinous mucus which gathers in the larynx: 
and at the same time, by some unknown power, completely 
changes the character of the disease, and, if persevered 
in, will produce a radical cure/" He says the remedy 
should be used as indicated abov< . 
a day. 

Ra I )f Obliqi lal Hernia. — Or. 1). Ihi 

Agnew has invented new instruments for the radical cure 
blique inguinal hernia. The pri of cure does not 

differ materially from that put in pi ers: the 

instrume 1 may enhance the coir. of the ope- 

ration. We have !. 'ption. 

it to say, that the scrotum is in va linal 

.!. and i- hold there, andthc canal rendei by 



00 BeUadonna in Sore Throat [January, 

an instrument not unlike a bivalve speculum. A long, 
ar-pointed, curved needle is now armed with a wire, car- 
1 up in the groove of the blades, and made to pierce the 
integurn cning out through the walls of the abdomen. 

Th< < '.id of the wire is now threaded, and the needle 

is made to pierce again the | >ut a short distance from 

the first insertion. The wire is now drawn down and fas- 
tened ; the objed being to make a plug of integuments fill- 
ingthe inguinal canal. Several stitches are now taken 
nal.in front of the cord, the object of which is 
bo aid tl in retaining the invaginated portion of the 

1 thus forming a permanent tegumentary plug, 
filling the canal, and thus preventing the descent of the 
howel. We condense the above from an article in the 
I Surgical Reporter, for Xovember 17th. 
Bearing upon this point, we might remark, that Prof. 
Tyme, of Edinburgh, says that all apparatus for this opera- 
tion is unnecessarily complicated. "A piece of candle," he 
, "with a little piece of twine through one end. will 
i r all purpo- 

adonna in Sore Throat. — In the Medical and Surgical 
Reporter, for Xovember 10th, Dr. J. W. Thompson has an 
article upon belladonna. He has used belladonna in 
inflammation of the breasts with good effect. He dissolves 
&ij. in f§j. of water, and applies to the inflamed brei 
We use the fluid extract without dilution, and it has never 
disappointed us, when used to prevent inflammation incases 
of delivery of still-born children. Neither has it disap- 
pointed us in tl, >f inflammation of the breast, where 
suppuration had not already commenced. We ] i rre< I 
to the paper of Dr- Thompson more for the purpose of giv- 
ing his experience with belladonna in sore throat. He says. 
"My experience with it in incipient sore throat would lead 
me to rank it almo iifficiently early. 
My plan is togive the sixtieth of agr. of atropii I rely 
m it confidently if given within six hours of thefirstap- 
of inflammatory symptoms. I have tried it 
ionm; and have to 
ilure." I influem 
limited to th 

ihrymal Duct. — : 
November L7th, Dr. -i. 1'.. Macdonal des- 
■ ration. Ee done 



il.] Dyspnm. 91 

away entirely with the direotor, and only employ a blunt- 
pointed, narrow, aim Blightly curved bisctoury, the blade of 
which is only about three-quarters of an inch long, the heel 
about three-sixteenths of an inch broad, and which tapers 
to a fine blunted point, a very little probe-shaped. It is 
sharp on its concave edge, cutting to the point, which is 
very narrow: and to provide for its strength, the back is 
somewhat stout, and delicately clubbed at its extremity." 

Dyspnoea from Cardiac Disease relieved by the Inhalation of 
Oxygen. — In the American Medical Times, for November 17th. 
Dr. J. C. Acheson, reports a case, in which a troublesome 
dyspnoea was relieved by the inhalation of oxygen. In the 
rase reported, the pulse was imperceptible, with other 
symptoms corresponding. Pic says : "Within 15 minutes 
after the patient began to inhale the oxygen, signs of relief 
were apparent. The restlessness ceased; the breathing be- 
came much easier: pulse became perceptible at wrist; -in- 
telligence began to return ; and waking from his lethargy, 
he complained of the coldness of his body, and desired more 
clothing." The patient died, but the benefit resulting from 
the inhalation of oxygen argued better results in more favor- 
able En extreme dyspnoea, in the last stages of con- 
sumption, we have resorted to the inhalation of small doses 
of chloroform, with very decided benefit. 

Diphtheria. — In the Cincinnati Medical and Surgical JS< 
for November, Prof. TV A. Iieamy has an article upon this 

-non. He says he lias treated 250 cases, and remarks: 
"I will here assert, that, in my humble judgment, any one 
who will, at the very outset ot the attack, administer full 
to »i grs. to children 8 to years old) of sulph. of 
quinine, and continue its use, in connection with chlorate 
of potash, and apply nit. silver in solid stick locally, avoid- 
ing mercurials in any quantity or form, catharticizing as 
little as possible, will find such su< cess attending his treat- 
ment as will lead him, if he had doubts as to t\\o nature 
and pathology of the disease, to settled and satisfactory 

fusions. Id many cases, I deem it better to use nitric 

I in connection with the quinine treatment, than chlor- 

of potash." 

Diphtheria. — Jnth< ■ al Re- 

, for November, one of the editors, Dr.T.S. Case, has an 

article upon diphtheria. We take pleasure in </i\inL r the 



92 [January 

treatment of those who have had experience with the dis- 
. be that treatment what it may. In a typical case Dr. 
( Jase's treatment is the following : "During thefebrile sta 
it' there be any indication of an overloaded condition of the 
stomach and bowels, i give an emeto-cathartic ; alter the 
operation of which, I direct the i 'ill doses of Dover's 

powder to quiet ai:v nervous excitement, to prevent the too 
action of the cathartic, and to encourage perspiration. 
In addition to this, 1 prescribe, to he taken until the kidn 
are acted upon freely, the following* mixture: 
R- — Spts. etheris nit., ^ij. 

Olei Terebinth., 'r y \). 

Mucil. gum. Acaeiie, 5vj. M. 

1 )ose for an adult — desertspoonful every hour or hour and % 
it half. For a child, this mixture might he rendered more 
pleasant by the addition of sugar &c. After the subsidence 
of the fever, I immediately commence upon the tonic and 
stimulant treatment, consisting of beef tea. egg-nogg, &c, 
bitum; and in addition, quinine, comp. tr. cinchonae, 
muriatic acid diluted and sweetened, chloric ether, carbon- 
ate of ammonia, chlorate of potash, &c. These various 
remedies are to be applied, in quantity and time, as indi- 
cated by the condition of the pulse and nervous system/' 
Any person who will take the trouble to examine our 
••Summary" for the last year, will find the therapeutic ex- 
perience of the most influential in the profession, whether 
at home or abroad. 



Lecture* on t) ses, 

'ally of Epilepsy, 1 >y Charles Bland Radcliffe, M. D.. 
Kellow of the College, Physician to the Westminister 
Hospital, etc. 

Mr. President and Gentleman — Of the three Lectures 
which T haveHhe honor of delivering before you. I pro] 
to devote that of to-day to the Physiology of Muscular Mo- 
tion ; and this J do because 3 to be necessary to re- 
id. T the whole of this subject, and to change our opin- 
py important particulars, bef< an hope 
to I ingthe theory and therapeutics 
of convulsive di 

I opinion r> g muscular action, I 



! 1 1 ; 

need scarcely say, is, that muscle is endowed with a vital 
perty of contractility, and that the state of contraction is 
brought about when this property is called into action. 
When the muscle contracts, thai is to say, this vital proper- 
ty of contractility is supposed to be roused or excited, or 
stimulated into action, and the more the muscle contri 
the more is this property supposed to be thus acted upon. 
But this is not the only opinion which maybe held respect- 
ing muscular action. On the contrary, it may be held that 

;rue type of muscular contraction is to be found in rigor 
mortis. It may be held, indeed, that muscle contracts, not 
because a vital property of contracility has been roused into 
action by a stimulus, but because some antagonizing influ- 
ence has been withdrawn, which previously prevented the 
free action o\' common muscular attraction in the muscular 
tissue. 

When, upwards of ten years ago,* I endeavored, for the 
first time, to show that the latter view of muscular action 

the correct one, I believed that I stood alone in this 

ion. In point of fact, however, others had gone before 
me, whose thoughts were, more or less, akin to mine. 
Writing in 1832,fDr. West of Alford, in Lincolnshire, says: 

pvous influence is imparted to muscular fibre for the 

n of the will, and of all other deposers to contraction, 

withdraw for a while this influence, so as to al- 

pcrty of muscular Able (contractility) to 

w itself/' And in support of this opinion he appeals, 
amongst other arguments, to the fact of rigor mortis being 
deferred until all traces of nervous action have disappeared, 
and to the fact, not less certain, of spasmodic action taking- 
place when we have evidence of co-existent nervous debil- 
ity. It would appear as if this idea had been suggested by 
a remark of Sir Charles Bell, for Dr. West refers to a lecture 
at the Royal College of Surgeons of England, in which, 

<• saying that the question of the modus operandi of motor 
nervous influence could never be settled, Sir Charles adds, 
that he had been led to suppose that muscular relaxation 
might be the act. and not contraction, and that physiologists, 



• :' Vital motion. 8vo. London : Churchill. ! - 

er Muscular Contract] mIod 

al Journal, edited by Michael Ryan, M. I >. Vol. 1. 



04 tures on [January, 

in studying the subject, had too much neglected the con- 
sideration oi the mode by which relaxation is effected. 

!n years later — Dr. "West is followed b\ 

physiologist ofn name — Professor Duges, ofMont- 

pellier — who maintains that all organic tissues are the seat 
of two o movements — expansion and contraction; 

and that contraction, which is in no sense peculiar to muscle 

►thing more thau the cessation of expansion — "in con- 

tion musculaire ne consiste que dans i'annihilation de 
expansion."' The muscle contracts, he thinks, in virtue of 
its elasticity, just as a piece of caoutchouc might contract, 

( fr< e from a previous state of extension ; and an analo- 
gy is hinted at between the expanded state of the muscle 
and the :lui 1 state of the fibrine of the blood, and between 
rigor mortis and the coagulated state of the fibrine. Analo- 
in its effects to electricity, the vital agent is supposed 
to accumulate in the muscles and produce expansion by 
causing the muscular molecules to repel each other; and 
contraction is supposed to be brought about either by the 
sudden discharge (as in ordinary contraction) or by the 
gradual dying out (as in rigor mortis) of this vital agent. Ir 

apposed further, that the rhythmical movements of 

muscle are caused by successive discharges of the vital 

■at, which discharges arc brought about whenever this 

at acquires a certain degree of tension; and that the 
cramps of cholera, or the spasms of tetanus or hysteria, are 
produced by the development of the vital agent being for 
the time suspended. After Professor Dugesi' comes the 
present distinguished occupier of the Chair of physics in 
the I niversity of Pisa. Writing, in 1847, about nervous 
influence. Professor Matteucci says: tw Cc fluide, developpe 
principalement dans les mus repand. et, doue d'une 

nave repulsive entre ses parties, comme la fluide electricque, 
il tient les elements de la fibre musculaire, dans unetat de 
i analogue a celui presente par les corps electrises. 
Quand ce fluide nerveux cesse d'etre libre dans le muscle, 
de la fibre musculaire s'attirent entre eux, 

ime on le voit arriver dans la roideur cadaverique . . . . 
Suivant la quantite de ce fluide quie cesse d'etre libre dans 



e de Physiologic Comparee de V Homme el des Auimaux. s \<>. 
March 17th, 1847. 



loin atraction est plua ou moim 

hypothesis appears to have beeD framed partly ii 
quen< lerationswhi bow that 

the | ntraction" wasowingto the 

in the muscle in which the "induc- 
ing contraction' 1 anifested — an idea originating with 
M. Becquerel — and partly in consequence of the analogy 
which is found to exisl between the law of contraction in 
muscle and the law of tl barge in electrical fishes; 
but it is right to at Prof Matteucci does not 
appear to have attached weight to his opinions upon 
the subject.* 

Xext in order, f and preceding myself by not more than 

a month or two, is Professor Ennel, then o f Zu ri c h, now the 

ipier of an important chair in the University of Vienna. 

The action of nervous influence, according to this physiolo- 

i antagonize muscular contraction, and this opinion 

Hinds upon the fact that rigor mortis supervenes when 

all signs of nervous action arc at an end, that the muscles 

are more irritable when removed from the influ- 

rhc ner. intres, and that cramps and other 

rive muscular contraction are often seen to 

happen spontaneously in paralysed parts. And later still,! 

. the date of my first publication on the subject 

— a similar jpectingthe action of nervous influence 

upon mi sd to Professor Stannius, of 



[ have received several pamphlets, 

Columbia. U. S. of Ann 

in which i determines a state of ac- 

and that contraction proceed- from the with- 

The protrusion of the tenacles ol the snail and 

• ;' the head and limbs of the 

muscular 

r. Mackall thinks, are unintelligible withoul 

igaticn. And that contraction is the 

al l]v- 
. athor aims, for it i- die 

a muse] 
which 

. K'oii. ( :• sellsch. den 

a and Todl 
■!. Heilkunde, Stuttgart. 1- 



96 lures on [January, 

Rostock, by bod oua experiments, in which lie has 

>r mortis relaxing, and the losl irritability returning 
to, the muscle under the injection of blood into the 
vess< 

I do no1 stand alone, then, then, in thinking that a great 
change i • iry in the theory of muscular action — a 

change amounting to no less than a complete revolution: 
and i am glad that it is so, for, thus supported, I am more 
b >ld to challenge attention to the arguments upon svhich I 
opinion. 

h is only within a comparatively recent period that it has 

been possible to demonstrate the necessity of a fundamental 

change in the theory of muscular action. When I wrote 

first on the subject, I did not command the facts which are 

ntial to such a demonstration, and I do not think that 

the writers whose names I have mentioned were a whit 

re fortunate in this respect. Now the ease is cntirely 

erent, and the present difficulty is, not to find facts, hut 

to make a selection, and to marshal those that aie chosen 

in 1 1 10 short time at our disposal. 

The true key to the interpretation of the phenomena of 
muscular action, as it seems to me, is to he found in the 
weries which have recently taken place respecting tin- 
electrical condition of muscle and nerve; hut before at- 
tempting to find and apply this key, it will he well to see 
how muscle behaves under the action of blood and nervous 
influence. 

I. Arguing from the comparative anatomy of muscle it 
would seem as if muscle were not most disposed to contract 
when it is most liberally supplied with blood. It would 
if the degree as well as the duration of contraction- 
were inversely related to the supply of blood. Thus the 
degree and duration of contraction) is greater in the volun- 
tary museles of fishes and reptiles than in the voluntary 
muscles of mammals and birds : greater in the muscles of 
any given animal during tli pe of hybernation than 

during the fever of summer Life. 

The fact, moreover, that rigor mortis may he "relaxed," 
and the lost irritability restored to the muscle by the injec- 
tion of blood into the vessels — a fact which has been abun- 
dantly demonstrated by Dr. Brown-Sequard* and Profes 



Comptea Rendus, Jnhe 9th and 25th, L831 



would appear to bo in direct contradiction 
the idea that the muscle is in any way stimulal con- 

; by the blood. 
One of Dr. Brown-Sequard's experiments pon the 

arm of a criminal who had been guilotined at 8 a. m., on 
the 1-th of July. 1851. The experiment, whi< 
in injecting and re-injecting a pound of defibrinated d 
blood into the brachial arte 
— fourteen hours after decapitation. At tb 
in a state, of perfect rigor morti 

into the vessels, som sd in 

different parts of tb rm, of the arm. and 

more particularly of the wrist. Tb 

larger, and the skin acquired tb has in rube- 

ola. Soon afterwards the whole surface had. n reddish-vio- 
let hue. A little later, and the skin natural 
living color, elasticity, and softness, and the veins stood out 
distinct and full as during life. Then the 

in the fi ly in the shoulders, and on ex- 

amination they were for.: Lave recovered their lost 

irritabili uarter t • muscles were i 

irritable than they had been at five p. m., at which time 
the as first exam and this incr 

was kept up without abatement until 4 a. m., when fiiti 

■r to abandon 
the experiment was commence 

and that of the room 6 
The of another experine n rab- 

which I. ; killed by 

[uard waited until ri hen 

I the defil one 

lie hind lim 

m the body. Fifteen minut tnent 

d re- 
adily t Ivanic in 
From this time, through the night, until 

day, the blood intervals of 

to 3d minute.-, and during tb time the ma 

All this whi 
>ther hind limb < limal, and 

of the rest of t' mor- 



>Op. cii. 



98 iures on [January, 

p. in. the injections were discontinued. 
On resuming the experiment after this interval of an hour 
and a half, the limb, with the exception of a few bundles of 
fibres here and there, had again become rigid. The effect 
of I tions was precisely as at first; and when, from 

the of the evening, the experiment was again aban- 

doned, the muscles were perfectly soft and irritable. On 
the morning following, the limb upon which the injections 
had been practiced was in a state of perfect cadveric rigid- 
. while the muscles of the rest of the body, which had 
1 left to themselves, were already beginning to pass out 
his state. On the third morning, the rigor mortis of the 
Limb was undiminished, and the other muscles of the 
were soft and in an advanced state of putrifaction. 
About the time Dr. Brown-Sequard was engaged in these 
resting experiments, Professor Stannius, without the 
knowledge of what was being done in Paris, was carrying 
out an analogous series of inquiries in Rostock. 

On the 21st of July, 1851, at 7.1 a. m., Professor Stannius 
a ligature around the abdominal aorta and crural arter- 
ies i ppy. About a quartea past ten, the muscles had 
begun to stiffen in the parts from which the blood was ex- 
cluded. At a quarter to eleven, both hinder limbs Avere 
stretched out, and perfectly stiff and cool. At twenty 
minutes past eleven, the ligatures were loosened, and the 
blood was seen and felt to penetrate into" the empty vessels. 
At a quarter to twelve, the natural warmth had returned in 
some degree, and the right hinder limb was a little more 
Hexible than the left. At noon, both the limbs had recover- 
ed their flexibility, and it appeared once as if the left had 
moved spontaneausly, but no sign of ] . caused by 
pinching the toes. At half-past twelve, the muscles of the 
paralyzed limbs cantracted everywhere upon the applica- 
tion of the galvanic polos ; and at one point the galvanism 
cause pain, for the animal, which was before quiet 
gave a sudden plunge iorwards. Death happened unex- 
; edly at twenty-( i nutes past twelve p. m. 
A similar experiment was performed upon another pup- 
arly in the morning of the following day. At noon, 
. there was no evidence of stiffness in either of 
hind limbs, but the muscles below the knee had ceased 
e touch <-f lee electrodes. At a quarter- 
limbs were stretched out and 
nd all e Li'ritibility were at an end. At 






1861.] wulsive Diseases. 

twenty-five minutes to three, the ligitures were unti< 
twenty-five minutes to four, the application of the eh 
caused strong contraction in the muscles of both tl;i 
and weaker contractions in the muscles of the lel'i 
low the knee, while, at the same time nearly all tn 
rigidity had disappeared from both limbs. At tw< 
minutes to six, every trace of stiffness had disappeared, i 
the muscles responded- perfectly to the prick of a h 
well as to the touch of the electrodes. On the follov 
morning the animal was found dead, and with the rigi< 
of death fully established everywhere. 

Now, that the stiffness of which mention is here made 
is perfectly identical with rigor mortis will appear frefm the 
following experiment. In this experiment, the aorta and 
crural arteries of another puppy were all carefully tied. 
Four hours afterwards, the muscles behind the ligature 
were perfectly rigid, and all traces of irritability had cl: 
peared in them. In the evening' of the day following, the 
animal was still alive — at least in its anterior half — and, 
upon the whole, it was comparatively fresh and quiet. 
Twelve hours later, the animal was found dead, with the 
parts before the ligature in a state of rigor mortis, and with 
the parts behind the ligature, which had been rigid before 
death, flaccid, moist and partially putrescent; in other words, 
the parts behind the ligature were in the state which comes 
on after rigor mortis, and hence it follows that the stiff] 
which existed in these parts before the complete death of 
the animal must have been identical with rigor mortis. 

Here, then, are certain experiments which would seem 
to show that the influence of the blood, be this what it may, 
;ercised in counteracting the contraction of rigor mortis; 
! this inference, which I had drawn from the experiments 
of Dr. Brown-Sequard before my attention was directed to- 
those of which Professor Stannius, is the same as that wl 
the last-named physiologist has drawn from his own experi- 
ments. 

There are, however, certain facts* which 
that muscle is affected differently by arterial and by venous 

ive led Dr. Brown-Sequard to think 
the omee of arterial blood is to minister to the n 
tion of muscle and other til i of 



'Compter Rendus, Xo. xvi, 



J Oo [January, 

of power, and that office of 

apply a stimulus, by which the power 

called "mto action — a view 

the function of the black Mood is no 

conomy than that of 

arteriai 

guuient in favor of the idea that venous blood 
adowed with these stimulating properties is based upon 
well-known fact, that the muscles contract violently 
en the wholi >:." blood becomes venous, as in as- 

xia. Another argument is derived from the fact, also 
fjui. the phenomena of asphyxia, that the left 

ventricle of the heart appears to pulsate more violently dur- 
moments of the process of suffocation; for at 
.e pulse is firmer and fuller, and the mercury 
higher point in the haemadynameter. Other 
' asedupon some original experiments of Dr. 
Brown-Sequard, in which it was seen that certain involun- 
tary museles might be thrown into or out of a state of i 

ion by injecting alternately black and red blood into 
their ve £ these experiments, the uterus of a 

pregnant rabbit parated from its connexions with the 

spinal centres, and blood injected into the aorta. 
On injecting black blood, the uterus contracted, and two or 
thrc ere expelled; on injecting red blood, these 

contn Lediately passed off. 

But, it may be asked, is it not possible that these convul- 
!(1 contractions may be due to the want of arterial 
d rather than to the presence of venous blood ? And 
iplanation the less difficult of the tw 
It violently con- 

ed when as when it is strangled to 

th. Ct is certainly true, thai ay, that an animal is 

ddenly emptied 

they are all luddenly 

d with blackbiood. AndtL mrely 

the convi ttending upon heemorr- 

• of arterial blood — seeing 

h cases — rather than to 

• of ven- eingthat this cause can only 

L1 any rate, with the fact of convul- 

: it is evident that 

ntial to convulsion. 

•c allowed that the fuller pulse of the first 






1.] Conmrts 101 

moments of -Buff is due to increi mulation of 

the left ventricle on the part of the venous blood, for this 
phenomena may be the result Lifficulty which 

nnarterialized blood experi< trough 

>mis capillaries — a difficulty by which the ordinan i 
traction of the venti 
in distending tin >f the intermediate arteries. 

And it is certainly unn( 
any stimulating properties in the venous blood to explain 
the contraction of the uterus which by 

injecting such blood into the aorta of a pregnant 
for is it not a well-known fact that the uter ten < on- 

tracted and expelled its contents \ regnant animals 

have been bleeding to death in I 

It would seem, also, that an argument in favor of the 
idea that the contraction in these several cases is really due 
be absence o al blood may be found in a recent 

experiment, in which Dr. Ha r that stri 

nia and brnsia act, in part at least, ] 
alization of the blood. 1: scperiment, 

measures two equal portion :alf into 

and mi; - all quantity of strichnia with 

portion. Then, after thoroughly saturating the blood 
in ea c 1 1 I re p eatedl y shaking it wi tl l f re si i 

quantity up with 100 air, and 

A hours 
the air within tl 1 by Bu 

and. it of thi found I 

whic in contact with 

tains mo vnandi- mic acid than the air 

which had b in contactwith the simple blood — th 





i position 


ion of 




Air after h 


■ hav- 




ing b< 


Li in 


— Common Air 


mtact w 


' 




Blc 


i 




'iOUl 


a i n i n •/ 












17. 








. . . 79. 


.71 






100 


.00 



tares on [January, 

[no chuia has prevented the blood 

..t'ii and giving off carbonic acid. It has 

• say, from becoming arterial, 

and for this reason the action ofthe poison may he said to 

of blood. I be -aid, in- 

i! to very copious loss of blood, for in 
experimi suits are given in the accom- 

panying ddition of a very minute portion ofpoi- 

red as equivalent to a loss of two-thirds 
of the whole amount of blood, inasmuch as this addition 
- of the power which this blood had of 
sygen, and of so becoming arterial. When 
brucia is be only difference is one of degree. 

The f the blood, then, be that what it may, would 

: i to be exerted in counteracting, rather than in causing 
muscular contraction. At any rate there would seem to be 
bo far as we have seen, for supposing that blood 
se a stimulous to muscular contraction. 
II. It is very far from certain that muscular contraction 
is produced by any stimulation derived from the nervous 
em, * On the contrary, there are certain facts which seem 
bher fatal to such an opinion. 
One of these (acts is to be found in the extraordinary in- 
muscular power in the hind legs of a frog after 
. of the spinal cord. In illustrating this fact, 
Dr. Brown-Sequard attaches a small hook to one of the hind 
3 a little above the ankle, and tests the muscular power 
the limb by hanging weights upon this hook. First of 
all, he finds a weight which is just a little heavier than that 
which the muscles of the Limb are able to lift, when they 
thrown into contraction by pinching one of the toes. 
This done, he then divides (he spinal cord immedi- 

ihind the second pair of nerves, and goes on testing 
the of the paralysed legs by changing the 

upon the hook. The results are very strange. Im- 
: yi : of the cord, the muscular pow- 

er pul forth by the weighted leg when it.- to is pinched is 
-7. but generally i1 is about a third or a fourth of] 
was befo operation. Fifteen minutes later 

idently rallying. In twenty or twenty-rive 
had lost. At the end of an 
■ r than it was before the operation- — perhaps 
An lion: Later still, it is certainly doubled 

n bled: and from this time up to the twentv-fourth 



A. 


B. 


60 






10 






60 




80 


GO 


130 


100 


140 


120 


140 


130 


150 


140 


150 


140 



1851.] h uses. 

hour, when the inert rally attains its maximum, il 

i on slowly augmenting. The particulars of two experi- 
ments with very fine frogs (A and B) were as follows, 
(weights raised being expressed in grammes : 

- experimented upon . 

»n of the spinal i 
Immediately aft< 
In five minutes . 
In fifteen minutes . 
Grammes raised after In twenty-five minutes . 
the division of the^ In one hour .... 
spinal cord. In two hours .... 

In four hours . . . 
In twenty-four hours 
In forty-eight hours 
At this la int the muscular power may remain 

nearly stationary for six, ten, fifteen, or twenty days. In a 
month, if the animal lives, the power in question will, in all 
probability, have fallen to its original value before the ope- 
>n. In six, seven or eight months it may not be more 
than a third or a fourth of this v It is possible, how- 

. that some part of this failure might have been pre- 
vented if care had been taken to exercise the paralysed limbs 
Ivanism. 

other experiments, moreover, which show 
plainly that the muscular power is similarly augmented 
n the muscle has been altogether cut off from the spinal 
thus contradict Dr. Mar [all's no 

se of muscular power, after division of 
al cord, is due to increa aulation on : of 

the cord, which ;ed stimulation has come into' ] 

controlling influence of the brain lias b 

In one experiment, for example, Professor Engel clips out 
whole of the cerebro-spinal system of a frog, bones 
all, and, after five or ten minutes, lie finds that the mua 

irritable as to be thrown into a state of 
".on by a blow upon the table. lie finds, indeed, 
under these circumstances are quite a 
re in the case of a narcotized fr< 
lit, Dr. Bro 

. behind the roots of the brachial 

r this he cuts through ; . res proceed- 

»f the hind . he 



104 Lectures on [January, 

th hinds limbs from the body, and on compar- 
ing their irritability by pinching and galvanizing the nerves, 
thai the "irritability is augmented*' in both limbs, 
which had been previously cut oil" from 
rd by the division of its nei 
But what of this augmented irritability? There is, no 
bt undue readiness to contract on the part of themuscles 
undue readiness to bring about contraction of the part 
• but there are sundry difficulties, of a very 
e character, which must be removed before it can be 
allowed that this change is owing to augmented irritability. 
Two such difficulties are presented by the two following 
sriments in Dr. Harley's very valuable investigations 
Biological action of strychnia and brucia. 
In one of these experiments the hearts of two frogs arc 
cut 3 in distilled water, the other in a 

': solution of strychnia or brucia. Placed in distilled 
water, the heart is found to go on pulsating for a longer 
time. still, even for hours; placed in the poisoned solution, 
heart is found to cease beating almost immediately, and 
ate of rigor mortis before the other heart has 
any of its power of contracting rhythmically. 
In the other experiment, instead of the hearts of two frogs. 
the two hind limbs of the same frog are placed, one in dis- 
tilled water, and the other in a solution of strychnia or brucia 
strength, and arrangements are made for test- 
he irritability of the two limbs by galvanism. This is 
experiment. The result, which is not less marked than 
in thi .lie re the hearts are concerned, is that the limb 

imni< n e 1 in plain water contracts strongly for some time 
1 the limb is immersed in the solution of strychnia or 
brucia Is d into the state of rigor mortis. 

It would seem, indeed, as if the poisons acted upon the 
irriti ues in the same way as that in which they have 

bees i act upon the blood; for, as Dr. Harley points 

if the irritability of the muscle may 
I to imply the suspension of that process of ab- 

onic acid — the so-called 

le — whs inly most energetic 

•marked." But be the expla- 

. tl mains, that the so-called ir- 

rapidly when the irritability is said 

ited — tor in no the irritability 

ntedthan : f rychnine poisoning: 



1861.] Con 

and thus, instead of ascribing the undue disposition to i 
tract to augmented irritability, it. would seem more in ac- 
cordance with the fact to BUppose that this undue disposition 
ro contract ia dues to a change which is the very opposite 
of augmentation. At any rate, after what has been said. 
it is impossible to refer the phenomena of a so-called aug- 
mented irritability to augmented innervation. 
• 

Nor docs the permanent contraction, which comes on 
sooner or later in paralysed parts, appear to be in any way 
dependent on the sitmulus of nervous influence. This per- 
manent contraction comes on sooner or later in all paralysed 
parts, and the fact may easily be verified experimentally. 
Thus, after destroying the spinal cord in the lumbar region 
of pigeon, the muscles of the paralysed parts are at first soft: 
in a few days they become somewhat hard : after a few 
- they pass into a state of permanent contraction — con- 
traction by which the legs are kept extended and divergent. 
The muscles, indeed, would seem to become contracted, 
because the action of the nervous system upon them was 
suspended, and to remain contracted because this state of 
things was permanent. 

It would seem, also, as if the facts which still re 
the background are equally unfavorable to the idea that 
cular contraction is produced by any stimulation derived 
from the nervous system. It is impossible, for instance, to 
look upon the convulsions produced by haemorrhage, and 
find a reason for believing that they arc connected with 
undue stimulation on the part of the nervous system. For 
if it be a law in physiology, as it undoubtedly is, that the 
functional activity of an organ is proportion to the activity 
of the circulation in that organ, then it follows that the ac- 
tion of the nervous system must be at zero during the con- 
vulsions of haemorrhage, seeing that at this time the vc 
are alim ty of blood, and the heart is well-nigh still. 

The inference, also, which maybe drawn from the general 
fact of convulsion in haemorrhage is confirmed and rendered 
more circumstantial by some re< erimental investiga- 

tions of Dr. Kussmaul and Tenner/" 1 of which the import- 
ance cannot well be overral 

In one of the experim hysiolo- 



:. v.. Xatii chen. u. d. Thii 

vol. ii. Frankfort. I 



Ift! 1 ) 5 on [January, 

gists, Is are passed behind tL »innominate 

and rabbit,* and arrangements 

which these thi be tied and untied in a 

moment. On tyi the animal was violently 

com ligatures about si onds 

: at their he"; 

were instant] ight to an end. Convulsion is brought 

on, thai of blood to the 

brain, the medulla oblongata, the upper part of the spinal 

I, and the cervi< al ganglia of the sympathetic nerve ; and 

►nvulsions are instantly suspended by allowing the 

blood to return to those organs. In other words, the con- 

vulsions would seem to be connected with a state ol inaction 

of one or more of the nervous centres named ; for how can 

there be any action where blood is wanting ? Xor can it 

be said that there may be over-action in the rest of the 

spinal cord and in the thoracic and abdominal ganglia of 

Lpathetic system — over-action in consequence of part 

of the blood which cannot find its way to the head and neck 

Ided to the blood which, under ordinary circum- 

ices finds its way to these organs — for there is another 

experiment which furnishes conclusive evidence upon this 

poi\ 

In this experiment the subclavian arteries of a rabbit are 

tied at their origin, and a ligature is also placed around the 

; of the aorta, a little beyond the opening of the left 

subclavian artery. The ligatures, that is to say, are so 

placed as to bring about a result which is the very opposite 

of that which was secured in the last experiment. In that 

blood was cut off from the head and neck, and the 

circulation confined to the trunk and limbs; in I the 

blood is cut off from the body and limbs, and the circulation 

I to the head. In tl to say, I 

of the brain, medulla oblongata, upper part of the 

spinal cord, and the cervici Le sympathetic 

nerve. p< than th< : for all 

the blood of the body is diverted in this direction; while 

the i abdominal 

: at all. 



tnmenco 
• inde- 



1861.] Convulsive Diseases. 107 

And what is the result? The result is paralysis of the 
parts behind the ligatures, without convulsion. In one or 

two instances the paralysis was preceded by trembling; but 
in no instance was there convulsion, or anything approach- 
ing to convulsion. It Was ascertained, also, that this ab- 
sence of convulsion was not due to paralysis of the spinal 
cord from want of blood, for on compressing the carotids so 
as to prevent the flow of blood through these vessels the 
animal was instantly seized with violent convulsion. 

Here, then, are two experiments, the significance of which 
cannot well be misunderstood. In the first, we see that 
convulsion is instantly arrested by allowing the blood to re- 
turn into the great vessels of the neck ; in the second, we 
see that convulsion is not caused by cutting oil' the blood 
from the body and limbs, and in that way increasing the 
rush of blood to the head and neck. In the first we see, 
further, that convulsion is instantly brought about by tying 
the great vessels of the neck ; in the second we see that the 
same result is brought about by compressing these vessels. 
In other words, we see that convulsion is absent when the 
presence of an undue quantity of blood may be supposed to 
imply an over-active state of the cranial and cervical nervous 
centres, and that convulsion is present, when, from com- 
plete want of blood, these centres must be supposed to 
be in the very lowest degree of activity compatible with 
life. 

In the second of these experiments, we may also find 
proof that the convulsion is equally unconnected with an 
over-active state of the spinal cord, and of the thoracic and 
abdominal ganglia of the sympathetic system; for, after the 
circulation lias been for some time at an end in these ner- 
vous centres, and when, therefore, the functional activity of 
these centres must be nil, convulsion is brought about by 
compressing the carotids. 

And lastly, an indirect argument in support of the infer- 
ence arising out of these experiments — that it is the absence 
and not the presence, of blood in the cranio-cervical nervous 
centres which ha3 to do with the convulsion — may be de- 
rived from the fact that drowsiness, and not convulsion, is 
the consequence of that capiliary injection of these centres 
arising from the division of the sympathetic nerve in the 
neck, or of that venous engorgement brought about by ty- 
ing the jugulars, or that double artcrio-venous eonjection 
which happens when the sympathetic nerv< divided 



[Janua 

in the neck and lie jugular veins in the same 

animal. 

with blood, then, so with the "nervous influence," the 
evidence throughout would seem to be altogether opp< 
to the idea that the anion upon muscle isthatofa stimulus 
to contraction : but upon this point it may be well to refrain 
from forming an opinion until we have bad an opportunity 
onsidering some facts which find a place more conveni- 
ently in following sections. 

[TO BE l ED.] 



Rhus 71 idronin Paratysis. By Dr. Michalowe 

Dr. Michalowski advises the use of fresb rhus toxicoden- 

i in paralysis, and reports the following ease in support 
of his recommendation : 

A farmer, 35 years of ag< 

years with violent rheumatic a tiie bones and joint.- of 

the j olumn and of the lower extremeties. At last 

-welling' of the joints supervened, and exostoses of the size 

ben's egg appeared at many points of the vertebral 

column, and two similar tumors, as large as a child's head, 

on the transverse rami of the pubic bones. The lower ex- 

mities of the patient were completely pa] ; his di- 

Ld his urine was discharged by drop-. 

many different ithout success, \h\ 

Micbalowski tried the extract of rhus toxidendroi .red 

fron the plant, freshly gathered in botanical gardens. He 

administered one grain of the extract, made into a pill, with 

half a grain of the leaves. After t lie patient had ta] 

ounces of the extract and one ounce of the leaves be was 

npletely cured. During this treatment the swelling 
the bones dimini ud of the cure 

the patient had the t and in the sacral 

were pricked by pins: be also had the 
ing of a current going from the sacral region down into bis 
Once only, the a< the medicine had to 

be interrupt the patient complained of pain and a 

burning sensation in his 



1861.] 109 



EDITORIAL AND MISCELLANEOUS. 



OUR PRESENT NUMBER, 

Our readers will observe that our present Dumber contains over one 
hundred pages of reading matter. This issue opens with the valuable 
investigation into the Marls of Georgia and the Adaptation of the various 
Soils of this State to different kinds of Culture, by our colleague, Prof. 
Joseph Jones, Chemist of the Cotton Planters' Convention. This valu- 
able scries of papers is now concluded, its completion having been pre- 
sented in the form of an extended Heport to the Association. As many 
of our readers must have been deeply interested in Professor Jones' agri. 
cultural researches, we refer them to the Book Stores of this city for the 
volume containing this Report. It is the privilege of the country prac- 
titioner of Medicine to relieve the tedium and drudgery of the daily round 
^cultural pursuits, on a more or less extended scale, and we there- 
fore, have no apology to offer for occupying a portion of our pages for 
the several last numbers with matter bearing on Scientific Agriculture ; 
but those who may have felt less interested in the-discussion, have still 
no reason to complain, as, from an unusual press of original and selected 
matter, t: number is nearly one-half larger than our usual 

edition. 

We call the attention of our rca l ming Lecture ot a 

. on Outgrowths of the Cervix Uteri, by Dr. Joseph A. Eve, Pro- 

r ot Obstetrics, etc., in the Medical College of Georgia. Dr. Eve's 

vast experience and extended reputation in this department of his branch, 

will certainly give great value to these Lectures and render them a most 

contribution to the Literature of these important snbj 

of this journal has been greatly delayed, but ju 

requires that we should exonerate our indefatigable and liberal publisher 

: any charge of delinquency. The delay was solely attributable to 

r, a severe dissecting wound having incapacitated him for fur 

Dishing editorial for the number, and even now, ehirography is performed, 

without pain. 

•ill remember that this is the beginning of our 



110 'f /((<>/(<■ . [January 

volum > be filled with useful, practical matter, 

doing credit to the Medical Literature of the .South and contributing its 
to that of American Medicine. We invite their earnest 
ith us, in keeping this journal what it has ever been, the 
liberal exponent of true Medicine, a garner for the treasures of all parts 
of the world 1 , and tfylTdispensor only of Medical doctrines wherever it 
may bo read. 



On Urc i^y Professor Jakscjii. — Vierteljahrsrli riff fur die 

ilkund, xvii. Jahrgaqg. 1860. — The author of this pa- 
per holds that these arc two varieties of uraemia which should be carefully 
distinguished; one being caused by the decomposition of urine and ab- 
;.iii df carbonate of ammonia into the blood (ammonaemia), the other 
being the variety which accompanies Bright's disease of the kidneys. 
lie has secu the former occur under the following circumstances : 

1. In torpor and paralysis of the bladder. 

2. [n dilatation of the pelvis and callices of thekidneyin consequence 
of the ureter- being blocked up. 

bscess, renal tuberculosis and sacculated kidneys. 
The following are the main differences characterizing the two forms of 
uraemir ; we shall, to save circumlocution, use the word ammonaemia as 
:iic of the one, and Bright's uraemia as the name of the other : 
;. In advanced ammonaemia the urine discharged from the bladder 
man; 'ong ammoniacal odor, which Professor Jaksch has never 

noticed in any sta^e of Bright's uraemia. 

qs, either acute and febrile, or chronic and 
afebrile, have not been observed in ammonsemia. 

.'). Advanced ammonaemia is characterized by persistent dryness of the 
mucous membrane covering the mouth and fauces, as if every particle of 
moisture had been removed by blotting-paper; the membrane looks dry 
and shining, and the dr\ . extends to the mucous membrane of 

the nose, the conjunctiva, and even to the chorda? vocales; these syrup-' 
il occur in Bright's uraemia. 

4. The distinctly ammoniacal odor of the air exhaled, and of the cu- 
taneous secretions of patients affected witli ammonaemia, does not occur 
in Bright's di,- 

5, Patients suffering from ammonaemia always show a marked dislike 
to meat, and especially brown meats, even if their . have not 

very far; a feature rarely seen in the other variety. 
>» r Jaksch bus never observed in Bright's disease the violent 

intermittent rigors, stimulating intermittent fever, which occur in animo- 

none of the < i r epilepti- 

Qor oroupy or di exudations notl 

8. Disturbed vision, a I in Bright's disease by exudation on 

appear to tube place in ammonaemia. 

nie ammonaemia is characterized by a uniformly pale and tal- 



18GL] Mi ill 

low complexion, and by gradually increasing emaciation ; very acute 
and advanced aramonsemi I with very rapid wasting ol 

turcs, and muscular debil » to paralj 

10. In all caj b ran a rapid course there 
vomiting, with concurrent or consequent diarrhoea ; in chronic an 
naeniia both phenomena were often entire! . or only occurred 
temporarily. 

11. In ammonsemla, whether acute or chronic r Jaksch has 
always seen death occur after sopor, varying in duration from several 

sf vend days. 
The author d interesting paper gives numerous 

illustrative of 1 and^enters very fully into the various 

questions connected with diagnosis and treatment, fur which we are un- 
able to make room. 

0)i Glycosuria as an accompaniment of Marsh Fever. — By Dr. 
Bcrdel, Physician to the Vierzon Hospital. — (L' Unioi Medicate, No. 
lo9, 1859,) — Dr. Burdel regards marsh poison as a myth, and looks 
upon marsh fever as result of a perturbation of the cerebrospinal centre 
and the sympathetic system, adopting very nearly the same phrase as 
the " ich Bernard defines glycosuria. The author of the pre- 

. in his researches into the nature of marsh fever, has con- 
firmed the above view of its character by ascertaining in the majority of 
of sugar in the urine. 

Dr. Burdell employed the test with liquor potassae, Felling's liquids, 
the test with bismuth and potash or carbonate of soda, and the yeast test, 
ecially in the fi tencement of the attack that the quan- 

tity of sugar was considerable ; it diminished gradually towards the ter- 
mination of the paroxysm, and generally disappeared entirely during the 
interval. The closer the attacks approach one another, the larger the 
amount of sugar. 

In 80 ca 11 marked intermittent fever the author uniformly- 

found sugar; in CO other cases, in which the fever was at first in- 
subsequcntly become remittent, the sugar was present, 
but only in small quantity and for a brief space. In of inter- 

mittent fever following- typhoid fever, a considerable quantity of sugar was 
shown to be present. 

In the cases presenting the 1 y of sugar, as much as 10 

per 1000 was found. 

TVoorara. — Dr. Vella, the physician who applied this subscance in a 

case of " itanus on the battle-field of Magenta, reports to the Academic 

Sciences, a number of experim • by him to establish its value 

lie claims that woorara besides being a sovereign 

dy in tetanus is almost an roia, to which conclu 

Gonorrheal Treated with T . — In an article in the 

Medical Journal and. Review, by Dr. P. Poroher, I 



11:2 Miscella 

emetic is recommended in gonorrhoea. Tn regard to his method of using 
it, he baa the following : 

"In the formative stage of the di q after its appearance — with- 

in the first 1") to 36 hours, if possible and before the inflammation has 
made any advance, order the recumbent posture to be preserved and the 
use of warm mucilaginous drinks, with nitre and doses of tartar-emetic 
sufficient to keep up constant nausea. The sedative circulates to the 
remote parts of the system, the progress of the inflammation is thus 
put an cud to, and in my experi snee, with hut one exception, tlie disease* 
ipletelv arrested." 



Hoffman's Anodyne in Dilirum Tremens — In the same article 
above referred to in the same journal. Dr. Porcher speaks highly of 
Hoffman's anodyne in delirium tremens. He says he has used it- with 
satisfactory results in eight cases — "one drachm being administered, 
diluted with water, repeatedly, until nervous tremor was allayed and 
sleep induced." In the insomnia connected with this disease, he thinks 
opium has better effect when combined with tartar-emetic, as follows : — 
"11. — Tr. opii., gtt. xl ; T. emetic, peated every half hour till 

sleep is induced." 



Large Doses of Opium in Centric Convulsions in Children. — In 
the same paper above referred to, Dr. Porcher commends opium in full 
doses, in cases of convulsions in young children, when not dependent upon 
worms or errors in diet. An illustrative case is reported. Dr. Porcher 
;ests that a combination of chloroform and laudanum would probably 
be beneficial in these cases. For the last five years we have been in 
the habit of trusting these cases to chloroform by inhalation, and the re- 
sults have been so satisfactory that we have had ; to seek further 
remedial aid. 



Neuralgia. — In the Charleston Medical Examiner for June, Or. 
L. D. Ilobinson has an article upon neuralgia, in which his views of its 
pathology are given, and also his plan of treatment. We subjoin only 
the treatment. In a case reported, the treatment advised, which he says 
was that usually advised by him, . lowing: 

R. — Chinoidine, l24 grs. 

Pulv. Capsicum, 5 grs. 
Strychnia, 1 gr. 

M. — flat. pil. No. 10. Dose — a pill before each meal. 
After using the above sufficiently long to break down the paroxy 
and give the patient relief, we prescribe the following: 
1\- — Quevenne's iron, GO grs. 
Quinine, 60 grs. 

Ext. Hyosciami, 40 _ 
Pulvis Capsici, 20 grs. 
wde into 40 pills. Dose, a pill after each meal and to bo continued 
until completely relieved of debility." 



SOUTHERN 

MEDICAL AND SURGICAL JOURNAL 

(new series.) 



U IV1I. AUGUSTA, GEIIICIA. FEBRUARY, 1861. KO. I 



ORIGINAL AND ECLECTIC. 

ARTICLE V. 

The Diagnosis [Physical and Differential) of Phthisis Puhno- 
nalis. A Clinical Lecture, delivered at the City Hospital, 
leb. Qth, 1861, before the attending Class of the Medical Col- 
lege of Georgia of 1860-61. By William Henry Doughty, 
If. D., Hospital Physician. 

Gentlemen : — Perhaps, if I had canvassed the entire cata- 
logue of diseases to which humanity is heir, no single one 
of them could have brought greater claims for its consider- 
ation, or have made stronger demands upon our patient and 
earnest attention than the one that has been selected. The 
history of our profession abounds in lengthened essays, 
learned disquisitions, and numberless memoirs upon this 
subject, all of which attest the profound interest that has 
been felt in it. The annals of the past show that some of 
the brightest intellects of the profession have been ardently 
and scientifically devoted to the pursuit of a full establish- 
ment and recognition of those features — both signs and 
symptoms — which might be assuredly taken as indicative 
of phthisis, distinct from all other diseases of the respiratory 
organs. I remark again, tl^at profundity of thought, acute- 
of observation, penetrating research, and logical acu- 
men, together with most careful comparison, have been 



114 Doughty. Clinical Lecture on February, 

deeply exercised in order to its fall accomplishment. How 
far they have succeeded, the doubtful response that rises 
instantaneously in the mind of every practitioner will suf- 
ficiently attest. This response, doubtful though it be, will 
not be regarded as the negativing of the proposition, but 
simply as expressive of the doubts and difficulties which 
still hang around some of the cases submitted for examina- 
tion. In a large majority of cases the land-marks, both 
physical and rational, are so plain and distinct as to render 
unequivocal the existence of the disease ; but the remain- 
ing minority, often requiring of us a most positive opinion 
are enveloped in doubt and encircled by the shades of ob- 
scurity. The former, from their unmistakable characters 
at once release our minds from farther consideration of 
them except in a pathological and therapeutical view, whilst 
the latter, from their indistinctness and subtle nature, be- 
come anxiously interesting in a diagnostic view. Putting 
out of mind the pathological interest of all cases, we do not 
fear to assert that the latter — the doubtful — have been those 
to awaken the energies of the profession, and to contribute 
most largely to the present exactness of diagnosis of phthisis. 
It is but common experience and observation in every de- 
partment of life, that the grandest results are the fruits of 
the hardest toil, whilst ease engenders superficiality. So 
it has been in this instance, where openness of features and 
distinctiveness of characters were well marked, it has, in a 
measure, paralysed energy, but where evidences of disease 
were obscure and pathological changes or manifestations 
were ill-defined and mystic, all the powers of a nice dis- 
crimination have been taxed, and the highest energies of 
the system bent to the unravelling of its diagnostic phe- 
nomena. 

Thus the diagnosis of tuberculosis comes to us as second 
to no other question that appertains to the subject, and per- 
haps only equalled in importance by those of its pathology 
and curability. 

1 have selected this subject solely on account of its practical 



1861.] Phthisis Ptdmonalis. 115 

importance and because of the prominence which it assumes 
in the case upon which I have twice endeavored to lecture. 
Of its practical importance you cannot be too sensibly im- 
jsed, for though it were rehearsed in your hearing daily 
you would still have need of assiduous attention in order to 
remain practically familiar with it. Of course, gentlemen, all 
that I can do is to repeat to you the conclusions and deter- 
minations of others whose time and labor have been almost 
exclusively devoted to the study of diseases of the chest, 
and whose ripened experience and enlarged observation, 
therefore, entitle them to our willing acceptance and judici- 
ous verification. 

Prior to the discovery of auscultation by Launec, and of 
percussion by Auenbrugger, in the early part of this century, 
no just apprehensions of the phenomena which characterize 
the various diseases of the respiratory organs could be form- 
ed by reason of which the utmost confusion existed, both 
in regard to their nature and their treatment. The dia£- 
nosis of these various affections was particularly obscured, 
insomuch that bronchitis was often mistaken for more serious 
pulmonary lesions, pleuritic changes were also mistaken for 
disease of the lung structure itself, and every form of chronic 
pulmonary disease confounded with phthisis pulmonalis. 
It did not stop even here, for affections of the heart and its 
membranes, as well as the larger blood-vessels, were fre- 
quently regarded as pulmonary maladies. At this period 
the profession was wholly dependent upon the rational 
symptoms ot disease, and by reason of the community of 
action existing between the respiratory organs and their vari- 
ous parts, it became hardly possible for them to escape the 
commission of errors of diagnosis. But since the inaugu- 
ration of this superior method of examining these diseases, 
viz : by physical exploration, a greater part of the obstruc- 
tions to correct diagnosis has been removed, and the com. 
munity of action to which we have referred, has been made 
to illuminate, instead of darkening, the path of the explorer, 
by developing the study of their correlative signs. Thus> 



11(5 Doughty. Clinical Lecture on [February, 

as it wore, the beclouding circumstances of former periods 
have become, through scientific analysis, the instrument of 
light, the lens by whose converging rays objects of vision 
have been rendered bright and intelligible at this date. 
But you are not to suppose that the results obtained by the 
latter method are so grand and overshadowing as to render 
useless or unworthy of attention the other mode. By no 
means. These results, though grand, constitute but apart of 
that brotherhood which must necessarily exist between the 
signs and symptoms of disease. Were we to confine our- 
selves to the signs educed by physical exploration alone, we 
would be overtaken in numerous instances, by the most 
palpable and egregious errors. Yea, more : should we ignore 
the rational symptoms of diseases of the chest we w r ould not 
only be involved in error as were our ancient brethren, but, 
and I am sure you will agree with me in the assertion, 
we should be far less excusable than the latter. 

From these remarks you will at once perceive that we 
are not to cultivate or adopt either method of examining 
disease to the exclusion of the other, but to associate them 
together, and to interrogate both alike upon all the patho- 
logical phenomena that you may be called to pass judgment 
upon. Connected or related to each other in this manner, 
each will become an assistant to the other, and in doubtful 
ciises, either a correlative or a corrective. The latter obser- 
vation also extends to the various methods of physi- 
cal exploration, each having to the other a reciprocal rela- 
tion which is as steadfast as the principles of physical science 
themselves. Tn the absence of this proper correlation each 
ulso becomes a corrective of the other. 

Furnished, then, with these various methods for the 
interpretation of diseases of the pulmonary organs, we are 
prepared, fully prepared, in a vast majority of instances cor- 
rectly to understand them and rightly to appreciate them. 
Hence we can be no longer justified in the commission of 
those errors of diagnosis, with their evil effects in practice, 
which were formerly abundant. On the contrary, abun- 



1861.] Phthisis Pubnonalis. 117 

dant facilities for qualification being afforded us, we are 
bound by duty and conscience to acquire a knowledge 
them in order that we may discharge, satisfactorily, the ob- 
ligations which our relations to society devolve upon us. 
And I may bo allowed to remark in this connection, that, 
under no other circumstances in professional life will you be 
enabled to experience more gratification than flows from 
the conscious discharge of your whole duty, than in the pre- 
sent particular. 

But, having made these general observations by way of 
introduction, let us proceed now to a direct consideration 
ot^ the subject. The power to diagnosticate tubercular con- 
sumption presupposes a full acquaintance with the natural 
history of the disease, as its hereditariness, as well as its ac- 
cidental acquirement ; its relations to age and sex ; its mode 
of commencement usually insidious and almost insensible ; 
its almost universally slow progress and development ; its 
pathological cause and changes, viz ; the tubercular deposit, 
its character, its changes and its results ; the laws which the 
latter seems to observe, both in the points of its earliest de- 
posit and its mode of progress to other portions ; the re- 
lations of hemoptysis to it as evidence of tubercular deposit 
already taken place, and its frequency as a symptom; the 
products of the changes wrought in the lungs as manifested 
by the expectoration ; its constitutional sympathies, as in- 
creased frequency of the pulse, hectic fever, dyspnoea, night- 
sweats, diarrhoea, chronic laryngitis, and general marasmus. 
Besides this, we must have a practical acquaintance with all 
of the physical signs that are discoverable in diseases of the 
respiratory organs, for, as you should not fail to remember, 
there are "no special pathognomonic physical signs" which 
belong to it. You need never expect to find a certain set 
of physical signs present in all cases, incident alone to the 
conditions of the pulmonary structure induced by this dis- 
ease, for the tubercular deposit may and does vary greatly 
•» its place of deposit, its extent, its character, as when in 
an isolated, scattered manner or coniined to a single spot. 
ain, these would vary with its location near the super- 



118 .Doughty. Clinical Lecture on [February, 

fices of the lung or deep within its structure. For instance, 
let us suppose the existence of a deposit near the pleural 
iring of the lung, under the progressive softening and 
maturation there occurring, the pleura becomes ulcerated, 
and an admission of air allowed into the pleural cavity, we 
would then have the physical signs of pneumo-thorax su- 
per-added, whereas if a similar deposit existed deep with- 
in the structure of the organ, we should only have develop- 
ed the ordinary signs by percussion and auscultation. Or if 
it existed in the form of milliary tubercles scattered irregu- 
larly throughout the organ, the physical signs would again 
be found to vary from those evolved from a circumscribed 
deposit in any portion of it. 

Then again, there is nothing special in the sounds elicited 
from pulmonary tissue hardened by tubercular deposit, for 
the same or similar sounds would be produced if the solidi- 
fication proceeded from any other cause, as inflammatory 
adhesions, etc. The signs afforded by auscultation of a 
tuberculous cavity wherever seated yield no distinctive dif- 
ferences from those given forth from a similar cavity, the 
result of any other species of diseased action: in otherwords, 
the physical signs are the same whether it be a tuberculous 
cavity or a local abscess resulting from pneumonitis. The 
same remarks might be extended to any of the physical 
signs for they represent morbid conditions whether the re- 
sult of the tubercular cachexia or not. In the language of 
Professor Flint, "the phenomena which it embraces belong 
also to other affections. They represent morbid conditions 
not peculiar to tuberculosis, but existing in other forms of 
disease." He further remarks thus : " isolated from other 
other signs, and dissevered from symptoms, pathological 
laws, and associated circumstances, none of the physical 
phenomena which have just been considered would possess 
marked diagnostic importance. Nevertheless, from their 
combinations, their conjunction with vital phenomona and 
with facts pertaining to the natural history of the disease, 
acquire a positive value, and are hardly less significant 
than if they belonged to it exclusively." 



1861.] Phthisis Pulmonale. ' L9 

The physical signs produced by tubercles in the In 
fer according to the stage or state of the deposit If the 
chest be examined during their existence in a crude Btate 
they will be observed to differ widely from those produced 
during the stage of softening or after the formation of* 
ities. This is very apparent, ami you must be prepared to 
meet these differences in practice, otherwise you will often 
be foiled in your efforts. It is common to divide tubercu- 
lous disease into several stages, founded upon the condition 
of the deposit itself as that of crude tubercle, of its soft- 
ening, and of excavation. Connected with physical explor- 
ation, this division is not so convenient as that suggested by 
Professor Flint, because we are not always able to define 
the exact state of this product, and very often these various 
states are united. Some of the earlier deposit may be ma- 
turating and breaking down the vesicular structure into ab- 
jses, whilst at other points it may be in a crude con- 
dition, and this Btate of things may exist, either in the differ- 
ent lungs or in different parts of the same lung. Besides 
this, the term crude tubercle simply expresses the state of 
the deposit itself, without regard to the mode of it- di 
bution through the lung, whether ag^ into mat 

or disseminated in minute particles throughout it. It i> 
more or less indefinite, and sugj of lew of the 

signs incident to its presence. Professor Flint suggests the 
following basis of division, viz: (1) "Small, disseminated 
tuberculous deposits;" (2), "Abundant deposition, involving 
considerable solidification ;" and(3), "Tuberculous dis< 

inced to the formation of cavities." Size and mode of 
distribution are the distinguishing feature.-: in the first two 
divisions, and are, to a greater or less extent 
various physical signs incident to them ; the third ie 
cal with the corresponding one in the other division. \V 

come to apply this in practical auscultation and perc 

you will then find that it is not an unim] 
matter, for it will require but a limited experience to 
quaint you with the material differences whic 



120 DOUGHTY- Clinical Lecture on [February. 

tween the physical phenomena elicited from a lung or lobes 
of a lung occupied in the one case by small disseminated 
tubercles, and in the other by an abundant deposit. In the 
former, the intervening portions of healthy vesicular struc- 
ture, particularly if they assume a complcmental action, 
will modify the percussion sounds to such an extent as to 
render them, in some cases, almost inappreciable, certainly 
doubtful, whilst the auscultatory signs may be so obscure 
as to require the nicest tact for their detection. In the latter, 
however, the aggregated mass, limitable and circumscribed, 
affords the clearest evidences under both methods of physi- 
cal examination. The correlative phenomena in the latter 
instance, associated with the semeiological and historical fea- 
tures of the case establish the diagnosis, whilst in the other, 
doubts only become confirmed. 

There is a law in tubercular consumption of which you 
should, at an early period, be apprised, viz : that "the de- 
posit, in the vast majority of cases, takes place at or 
near the apex of the lung." This is not invariable, though 
exceptions to it are rare. In examining then for tubercu- 
lar deposits you will first direct your attention to this point 
and any evidences, however slight, of solidification when 
not owing to the natural disparity existing between the two 
lungs becomes highly suspicious, and if accompanied with 
increased vocal resonance, and with any of the elements of 
broncho-vesicular respiration, may warrant a positive opin- 
ion. If occurring in a patient liable to its inheritance and 
accompanied with symptomatic manifestations, however 
slight, it may be regarded as certain. Usually this deposit 
occurs "at the summit of the lung on one side before the 
other lung is attacked," though the other is subsequently 
invaded. Hence it is observed that "in the bodies of per- 
sons who have died with tuberculosis, the two lungs almost 
invariably are found to be diseased, but the deposit is most 
abundant or the ravages are more extensive on one side." 
1 1 you remember, the case in connection with which these 
remarki are mad§ presented this feature or rather conform- 



1861.] Phthisis Pulmonalis. 121 

ed to this law, and this fact becomes presumptive of tuber- 
culosis. By reference to the notes of examination, I find 
the following statement : Percussion over apex of left lung 

anteriorly and posteriorly, gave appreciable dulness; of 
right lung, over apex, marked dulness, extending in a 

varying degree, over the entire upper third of the lung. 
The correlatives o\' auscultation were, in the left lung, 
broncho-vesicular respiration, and increased conduction of 
sound; in the right, bronchial respiration, the expiratory 
murmur being greatly prolonged, and much greater conduc- 
tion of sound than was observed on left side. 

Here, then, we have the evidences of structural disease at 
the apices of these organs, more advanced and prominent 
than in any other portion of them, and farther advanced on 
one side than the other, thus, according to the law of 
tuberculosis to which I have adverted, affording strong pre- 
sumptive evidence of tuberculous solidification. 

In regard to the normal disparity between the right and 
left lungs, it is said that "distinct dulness, however slight, 
on the left side, is highly significant, while on the right side, 
if slight or moderate, it is to betaken as a morbid sign with 
considerable reserve." And again, "distinct dulness at the 
left summit, be it ever so slight, in connection witli the di- 
agnostic symptoms of tuberculosis, may almost suffice to es- 
tablish the fact of the existence of the disease, when, if 
situated on the right side, other corroborative evidence is 
requisite." In our patient above, unfortunately all of the 
diagnostie symptoms of tuberculosis arc not present, not- 
withstanding the evidence of extensive solidification in both 
'ungs, so that the diagnosis is not in every particular con- 
firmed. Hut few diagnostic symptoms arc present, and 
they are not such as you would expect from the advanced 
appearance of the case. They are pain in the chest rati 
obtuse than lancinating, slightly increased respiration, 
paroxsymal cough with mixed .ration, scanty and 

tight, and general emaciation, with lose of muscular strength. 
Those absent are hectic fever, niL r ht-s\veats, diarrl 



1 __ 



Doughty. CUniccU L 



e on 



[February 



chronic laryngitis, and the thick suppurative expectoration 
common to consumption. About thirty years ago he recol- 
lects having "spit blood," but his subsequent history rather 
militates against t\ic supposition that lie Jwas then tubercu- 
lous. He is not hereditarily predisposed to the disease, and, 
until thirteen months since, was as hearty and robust as any 
one. At that time lie contracted a severe acute disease ot 
the chest, probably pneumonia, and has been declining ever 
since. 

But let us return to the division which we have adopted 
and pursue the course there marked out. What physical 
signs may we expect to find when the tuberculous deposits 
exist in a small, disseminated state ? Of course we can expect 
little or no aid under this state of things from any of the 
collateral methods of physical cxpploration, as inspection, 
palpation and mensuration ; for the lung maintains, to a 
great extent, its natural resiliency and elasticity, thereby 
abolishing all evidences usually afforded by them. In this 
condition of the deposit, our resources are limited chiefly to 
the two modes, percussion and auscultation, and in order that 
the signs elicited by these be diagnostic, they must establish 
their proper correlation, and must be conjoined with the 
symptomatic phenomena however obscure. Percussion usu- 
ally affords what is termed appreciable dulness or simple 
dulness, or technically diminished vesicular resonance. If 
the deposit though small, be confined to the apex or a single 
lobe of the lung, as the upper, this diminution of reso- 
nance will extend only over that particulai region, or if it be 
disseminated throughout the entire lung or lungs, as it oc- 
casionally is, it will be found to embrace the entire super- 
ficies of the chest. The dulness will correspond to the 
degree of encroachment of the masses upon the vesicular 
structure or the relative size of the m [f the encroach- 

ment be small, the variation of the vesicular resonance will 
• ' versa. But sometimes the vesicles im- 

mediately surrounding these small deposits become em- 
physematous or assume an increased action, and acquire an 



1861.] Phthisis Pulmonalis. 128 

increased capacity, in this case instead of appreciable dry- 
ness on percussion, you wil or may have an increased sonor- 
ousness, but not of the normal vesicular quality — it is called 
tympanitic resonance. This abnormal clearness need not 
be confounded with the normal vesicular resonance, if at- 
tention be paid to its quality and pitch. It is non-vesicular 
and high in pitch. The normal vesicular resonance has a 
certain timbre or tone, and is low, grave in its pitch, whilst 
tympanitic sonorousness is always high in pitch and its 
quality has a type in the sounds elicited by percussing over a 
hollow organ. This sound is one of the characteristic signs 
of emphysema of the lungs, and when evidence of tubercu- 
lar disease is most apt to to be found over the left lung on 
account of its anatomical relationship with the hollow ab- 
dominal organs. Of this relation you should at all times be 
mindful, since the gastric sounds are frequently transmitted 
over its surface, and under numerous circumstances are 
found modifying the percussion resonance. 

Sometimes you will find instances in which the normal 
vesicular resonance is not abolished, and yet there are some 
of the indications of tympanitic resonance present. It is 
neither strictl}^ vesicular nor non- vesicular, but a combina- 
tion of the sounds of each. This modification is called 
vesiculotympanitic resonance, and is entirely compatible 
with certain relations of the solid deposits to the adjoining 
pulmonary structure. 

In the next place let us consider the signs elicited by aus- 
cultation from a lung occupied by this species of deposit. 
In a large majority of cases they consist in simple modifi- 
cations of the healthy respiratory sounds. And yourability 
to detect them necessarily depends upon the degree of your 
familiarity with the latter. The chief of them, the most 
important because most frequently met with, have types or 
representatives in the healthy respiration to which they arc 
referred and with which they are compared. Thus we have 
a certain abnormal respiration charact* - bronchial 

respiration — a sign which is constantly present in extensive 



124 Douc.hty. Clinical Lecfure 011 [February, 

solidification of the lung whenever occurring — because its 
characters have a more or less exact resemblance to those 
sounds produced by the rush of air to and fro through the 
larger bronchial tubes in health. The normal vesicular res- 
piration has certain distinguishing features, the absence or 
modifications of which become the signs of disease. I would 
impress you, gentlemen, with the importance of this great 
truth as the first requisite to skilful and accurate ausculta- 
tion, the absolute necessity of a knowledge of the charac- 
ters oi' normal respiration in each and all of its branches. 
Possessed of this knowledge, you will find physical auscul- 
tation comparatively an easy task, whilst in its absence, you 
will often be involved in error and darkness. 

The most commonly observed modification of the healthy 
respiration is that called broncho-vesicular respiration — by 
some called rude, and by others, harsh and dry respiration. 
The former we adopt because it piesents the types with 
which it must be compared, and also because it suggests 
the particular place whence it must be evolved — the smaller 
bronchial tubes, and the vesicular portion of the lungs. 
But what is the broncho-vesicular respiration, or how may 
you recognize it ? In the language of Prof. Flint, who first 
proposed it, if all of its characters are present, "we shall have 
an inspiratory sound, neither purely tubular nor vesicular 
in quality, but a mixture of both, (broncho-vesicular,) the 
duration somewhat shortened, (unfinished) the pitch raised ; 
a brief interval followed by an expiratory sound, prolonged, 
frequently longer and more intense than the inspiration, 
and higher in pitch." It includes, then, modifications both 
of the inspiratory and expiratory sounds, and implies a sub- 
stitution of certain features of bronchial respiration (normal) 
in certain parts of the vesicular structure of the lungs — 
sometimes a few only of its features may be recognizable. 
The normal features of the vesicular murmur, may not be ob- 
literated, yet they are so far obscured by those which belong 
to the other, as to have its low-toned, soft, expansive mur- 
mur supplanted by a rude, harsh sound. This kind of (lis- 



1861.] Phthisis Pulmonalis 125 

ordered respiration is always heard when the encroachment 

is but slight, or has not extended to a great degree of solidi- 
fication ofthe parenchymatous structure ; when the latter is 
accomplished well-marked bronchial respiration is pro- 
duced. 

Sometimes the expiratory murmur presents the very ear- 
liest indication or becomes the earliest cognizable physical 
sign of tuberculosis. In health, there is but a small propor- 
tion of individuals — one-third — in whom a well-marked ex- 
piratory sound may be heard, when, therefore, it exists in 
an appreciable degree and possesses any of the characters 
which pertain to broncho-vesicular respiration, it may be 
taken in connection with associated symptoms as evidence 
of disease. The most usual changes which it undergoes in 
the early period of tuberculosis are a prolongation and ele- 
vation of pitch, in these respects occasionally outstripping 
the sound of inspiration. It is not difficult to understand 
the reason of its prolongation, for the elastic recoil of the 
lung is impeded by the presence of these deposits, conse- 
quently the escape of air from it is retarded. The expira- 
tory sound is, upon an average, only one-fifth the length of 
the inspiratory, therefore, any material prolongation of it 
becomes at least suspicious, and justifies us in attaching 
great importance to it when other corroborative evidence 
exists. 

Another modified respiratory sound occasional!}- discover- 
ed in this condition ofthe tubercular deposits is exagger- 
ated vesicular respiration. It is rather significant of dis- 
at neighboring points to the region over which it is 
heard, and is not essentially abnormal. It is synonymous 
with puerile respiration, and exemplifies what I have allud- 
to as the coinplemental action of a part. This sound is not 
so frequent an attendant upon disseminated tuberculous 
deposits as upon abundant deposit of circumscribed dimen- 
sions. In the former, it is obscured by the presence and 
universality of the broncho-vesicular respiration. 

A very important physical sign usually available also is 



126- Doughty. Clinical Lecture on [February, 

increased vocal resonance — an increased conduction of the 
sounds of the voice into the ear of the observer. In auscul- 
tating the healthy chest over the vesicular pulmonary struc- 
ture, the act of speaking is attended with a peculiar vibration 
not, however, possessed of much intensity. It varies great- 
ly with individuals, and in the two lungs, and in different 
parts of the same lung. There seems to be no direct trans- 
mission of the sound, but a widespread diffusion of it over 
the porous structure. It is too extensively diffused to ob- 
tain much intensity, but when, from any cause, the vesicu- 
lar structure becomes solidified, it acquires an increased 
conducting capacity, and this latter corresponds with the 
degree of solidification. Therefore, increased vocal reso- 
nance becomes an important physical sign of tubercular de- 
posit, whether aggregated or disseminated; in the latter in- 
stance, being the correlative of diminished vesicular reso- 
nance and the broncho-vesicular respiration. 

But, again, if these scattered deposits have becomes often- 
ed and are being discharged by expectoration, you will 
have superadded to these various signs, some of the adven- 
titious rales, i. e., such as have no natural type in the healthy 
chest. It may be, that in one part of the lung they are 
being discharged, whilst in another they are still in a crude 
state, under which circumstances some one or other of 
the moist rhonchi will be heard, most probably the sub- 
crepitant. You are aware that these rales are produced in 
the bronchial tubes, and are most generally treated of in 
connection with bronchitis. If the time and occasion war- 
ranted I should be glad to digress at this point and make 
further allusion to them. 

Let us briny recapitulate : the percussion sounds are di- 
minished vesicular resonance or dulness — or ''tympanitic 
dulness' ' — or the vesiculotympanitic variety: the ausculta- 
tory signs are broncho-vesicular respiration, increased vocal 
•nance, perhaps exaggerated vesicular murmur, and 
some of the adventitious rales, as the subcrepitant. 

There is a manifest tendency in such deposits as we have 



1861.] Phthisis Putmonalis 127 

considered, ultimately to become consolidated, both under 
the usual progress in deposit and the resultant soitening of 
the pulmonary structure. Hence the physical signs here 
enumerated would become gradually intensified, and final- 
ly merged into those of the second division of our subject 
which I will now proceed to discuss. 

In cases of abundant tubercular deposition, involving ex- 
tensive solidification, most of the auxiliary methods of 
physical examination become available, and the evidence 
adduced by them is by no means unworthy of notice. If 
you remove the patient's clothing and inspect the chest you 
will very probably discover some depression either in the 
post-clavicular or sub-clavicular regions, caused by the di- 
minished expansion of the lung beneath, and also be able to 
detect diminished respiratory movements on the diseased 
side or at the diseased point. Palpation will reveal to 
you an increased sense of resistance over the solidified por- 
tion, abnormal vocal fremitus, and diminished elasticity of 
the thoracic walls. Mensuration will also disclose deviations 
from the natural dimensions, and thereby assist, although 
this method is much less needed in this disease than in some 
oth 

Percussion over an abundant deposit yields much great- 
er dulness than in the other division — marked dulness is 
the term used to express it. If the bronchial tubes includ- 
ed in it remain open, especially if they be at all dilated or 
enlarged, or if the surrounding vesicular structure be high- 
ly emphysematous, it will partake, more or less of a tympa- 
nitic sonorousness. 

The signs commonly afforded by auscultation arc well 
marked bronchial respiration occupying the seat of the de- 
':. broncho-vesicular respiration, and some of the adven- 
titious rales in the immediate vicinity of it ; exaggerated 
vesicular respiration may also be present at some points. 
The crepitant rhonchus may be heard, indicating circum- 
scribed pneumonitis, or the sub-crepitant, indicating capil- 
lary bronchitis or the presence of the softened tubercular 



128 DoufliiTY. Clinical Lecture on [February, 

materials in the smaller tubes, or any of the moist or dry 
rales may be present The latter only become diagnostic 
of phthisis when heard at the summit of the chest in the 
vicinity of a tuberculous deposit. They are incidental and 
depend in most instances upon the existence of circum- 
scribed bronchitis or pneumonitis. "Their value is en- 
hanced by association with other phenomena, physical aud 
vital, pointing to tuberculous disease." 

The correlatives of the voice are also well developed — 
there is well-marked bronchophony over the solidification, 
and in many instances, pectoriloquy. In the latter there is 
a transmission of the articulated voice — it is " articu- 
late through indistinct speaking/' There may be also 
an abnormal transmission of the heart sounds in addition . 
Another sign that frequently accompanies abundant tuber- 
culous solidification is a bellows sound attendant upon whis- 
•d words. It is said that "this sign may be present in a 
lotable degree, when the bronchial respiration, broncho- 
phony, or exaggerated vocal resonance are not strongly 
marked/' 

"When the tuberculous deposit has advanced to the stage 
of excavation it is exceedingly difficult to be able at all 
times to diagnose it. Indeed it is not always possible be- 
cause the varying size, position and relations of the cavi- 
ties often prevent the evolution of those signs distinctive of 
their existence. Repeated examinations are frequently 
necessary to settle the question of their presence or absence. 
More or less solidification always remains in connection 
with these cavities, hence the most of the physical phenom- 
ena which we have just considered still remain though 
combined with those peculiar to cavities. Cavernous respira- 
tion is the technical name for the latter. The features of 
this sound are different both from those of bronchial respi- 
ration and the vesicular. Thus Professor Flint describes 
them as follows : "They consist of an inspiratory sound. 
non-vesicular or blowing, but compared with the bronchial 
inspiration, low in pitch, hollow, more slowly evolved; and 



L] Phthim Putmonatis 129 

of an expiratory sound if present, lower in pitch than the 

sound of inspiration." — (page 481.") All of these characters 
may not be distinguishable ; von may have only the 
inspiratory sounds present ; the distinguishing characteris- 
tics are lowness of pitch and absence of the vesicular qual- 
ity. 

Bronchial respiration generally exists in the vicinity of 
the cavity, with which you may compare it, and for which 
you should not mistake it. Recollect that the chief ele- 
ments of the latter are tubularity of sound and highness of 
pitch. Cavernous respiration is a variable sign, and may be 
present at one examination and absent at another. This 
variableness depends, to a great extent, upon the amount of 
tluid matter contained in it at different times, and also upon 
the rigidity of its walls. Thus if it be filled of course it 
will disappear, and with the discharge of its contents by ex- 
pectoration will re-appear. Hence it is recommended in 
the examination of patients for cavities in the lungs, not to 
do so shortly after rising in the morning, but to wait some 
hours so as to permit the discharge of the matter accumu- 
lated during the night. This sign is much more available 
when one large cavity exists than when a number of small 
ones are scattered throughout the lungs. In the latter case, 
their size prevents its perfect formation, and it is often or apt 
to be, obscured by the co-existing bronchial sounds. Under 
the act of coughing sometimes in a large cavity, a gurgling 
may be detected. This is conclusive of the existence of a 
cavity when heard ; they are rarely so large, however, as to 
render it of much value. 

Pectoriloquy is a vocal sign supposed by some to be in- 
dicative of a cavity, but by others said not to be exclusively 
so. It may accompany solidification of tisssue either with or 
without an excavation. You will recollect that this sign 
was quite prominent at the posterior angle of the scapula in 
in our patient, on the right side: it may or may not be in- 
dicative of a cavitv there. 1 was unable to detect the cav- 



l30 Doughty. Clinical Lecture on [February, 

it! 11 his respiration at that point. When associated with the 
hitter in any ease it may be regarded as diagnostic. 

Metallic tinkling is another incidental sign produced as 
a vocal or tussive phenomenon, supposed to be produced 
when a cavity of some size is partially filled with air and 
fluid. I can only mention it and pass to the physical signs 
educed by percussion. As in auscultation, those of solidifi- 
cation still remain with modifications or superadditions. 
Thus if the cavity be full of fluid it will be remarkably dull 
on percussion, perhaps fiat; or, if empty and of some size, 
it will give a circumscribed tympanitic resonance, or some- 
times a modification called amphoric resonance (a metallic 
sound) or a cracked metal sound (bruit de potfele.) The 
first "maybe imitated by striking the cheek when the 
jaws are moderately separated and the integument rendered 
somewhat tense," and the second "by folding the palms of 
the hands loosely and striking the dorsal surface on the 
knee, in the manner frequently done to amuse children, 
producing a sound as if pieces of money were placed be- 
tween the palms." "The production of this sound is now 
generally attributed to the air being suddenly and forcibly 
expelled from a cavity communicating with the branchiae 
by several free openings, precisely as the blow on the knee 
expels the airbetwecn the palms in the experiment mentioned 
by which the sound may be imitated." — (Flint, page 120.) 

Thus, gentlemen, I have viewed in detail the three di- 
visions adopted, imperfectly, but I trust truthfully. And 
wherever the combination of signs and sounds here men- 
tioned occur, or whenever these various correlative physical 
signs are present associated with the usual symptomatic 
phenomnea which belong to tuberculosis, your diagnosis is 
positive and complete. But in some cases, the symptomatic 
evidences are few and dubitable, and then the importance 
of the physical signs becomes greatly enhanced and demand 
on your part a most skilful survey and judicious consider- 
ation. Under these circumstances, the differential diag- 
is of tuberculosis acquires almost exaggerated import- 



1861.] Phthisis Pulmonalis. 131 

ance because the same physical signs may he common to 
other affections, as dilatation of the bronchial tubes — the 
ultimate result of bronchitis — or chronic pneumonitis. The 
latter is so rare as scarcely ever to give rise to discussion 
but the other is not so infrequent. When the diagnosis 
devolves mainly upon the physical signs it is exceedingly dif- 
ficult, if not impossible, always to discriminate between tuber- 
culosis and dilatation of the bronchial tubes. I confess my 
inability in the patient up-stairs. The difficulty originates 
in the fact that has already been mentioned, that there are 
no physical signs peculiar to tuberculosis, but any or all 
of them may be attendant upon the physical conditions giv- 
ing rise to them, however produced, whether from tubercu- 
lous changes or any other diseased action. It is onlv in 
the exceptional cases, however, that such difficulties arise ; 
for, as a general rule, the diagnosis is plain and satisfactory. 
But you must be prepared to meet these exceptions, for 
come they will in practice, and it may be that the only test 
of your opinions will be found in the results of your prac- 
tice. 

AVhen I conceived this lecture, gentlemen, it was my inten- 
tion to confine it to the differential diagnosis of tuberculosis, 
and dilatation of the bronchial tubes. But upon reflection I 
thought it would be of more interest to you to dwell upon 
the simple diagnosis of the disease, without special refer- 
ence to any other. If, however, you will indulge me I will 
give a brief summary of the chief points involved in the dif- 
ferential diagnosis. 

Bronchophony, increased vocal fremitus, and bronchial 
respiration are physical signs of dilatation of the bron- 
chia?; and in its saccular variety, you may have superadded 
cavernous respiration, gurgling, and "in some instances 
pectoriloquy." If there be any degree of bronchitis present 
as there usually is, more or less of the moist rales will be 
found also. Bronchial dilatation usually affects the upper 
lobes, though not especially the apex like tuberculosis. The 
bronchial voice and respiration are due more to the enlarged 



L32 Doughty. Lecture on Phthisis Pulmonalis. [Feb., 

calibre of the tubesthan to the solidification of tissue, and 
hence are not bo intense as in tuberculous solification. Di- 
latation of the bronchiee is not progressive, in the sense in 
which that word may apply to tuberculosis, and usually exists 
on one side. But, says Prof. Mini : "the point to which 
most importance ia to be attached is the absence of the 
rational evidence of phthisis derived from the history and 
symptoms. In cases of dilatation, cough and expectoration 
generally have existed for a long period. If the affection 
he tuhcrculous. certain events are to he expected which, if 
the affection he dilatation, the case will not be likely to pre- 
sent. Among these events and results the most prominent 
are progressive and marked emaciation, loss of muscular 
strength, pallor of the countenance, hemoptysis, lancinating- 
pains in the chest, diarrhoea, marked acceleration of the pulse, 
hectic paroxysms, night perspirations, chronic laryngitis. 
If all these are absent, the fact favors the supposition of di- 
latation being the pathological change giving rise to physi- 
cal phenomena which, associated with more or less of the 
svmptomatic phenomena just enumerated, would devote un- 
equivocally the existence of tuhcrculous disease. Occasion- 
ally, however, it happens in cases of phthisis, that nearly 
all these rational indications are wanting. Hence, under 
these circumstances it is not safe to decide positively from 
their ahsence that tuberculosis ma}' not be excluded." How 
shall I determine that this is not one of those occasional 
cases of tuberculosis, in which "nearly all these rational indi- 
cations are wanting?" The most important ones wanting 
acceleration of pulse and respiration, hectic fever, night 
and chronic laryngitis. Thirty years ago he had hemop- 
tysis, but never had a cough until thirteen months since, at 
which time he contracted some acute disease of the chest, 
probably pneumonia; he is not hereditarily predisposed 
to consumption. The history of his cough and expector- 
ation furnishes no light. Finally, gentlemen, following the 
admonition of the learned professor to whom I have refer- 
red, I consider it unsafe to declare that tuherculosis does not 
exist. 



1861.] Dugas. A Case of 133 

rCLE VI. 

■ Iremity } mly 

orted by D. ;.\s. 

M. D., &c, Professor of Surgery in the Medical Coll< 

rgia. 
On the 18th of January last Mr. James Gaines, of I);r. 
boro', in this State, brought his man servant (Reed) to me 
for j nal advice, and gave me the followingh istoryof 

the ease : — Reed is a negro about twenty years of age ; 
fine constitution, and well developed muscular system. He 
was out with some friends hunting at night about two month". 
. when they u treed a coon." While Reed held up a torch 
Tor his comrades to cut down the tree the blows of the axe 
caused a large dead limb to fall, which prostrated him. 
His friends ran to him and found him unconscious and ap- 
parently insensible. They removed the branch which still 
ed upon him : lifted him up, and in a short time he re- 
red his consciousness and was carried home. His ma- 
ter examined him and found that he had entirely lost the 
>f the right arm, and that it was insensible to any de- 
gree of pinching. Medical aid was obtained i as pos- 
sible, and it was found that the blow had been sustained 
alone by the right shoulder. This wag considerably bruised 
and somewhat swollen; the: skin over tin- deltoid muscle 
and just beyond tin- extremity of the acromion process was 
abraeded : but the most careful examination could de- 
tect neither fracture nor dislocation of any of the bonc<. 
The pulse at the wristwas normal, the surface of the limb 
was (.-old, the insensibility complete from the lingers to the 
upper part of the arm. and the patient unable to move any 

stele of the limb. There was no injury to the h< . 
any other part of the body. 

>re-arm was put in a sling, lotions applied to the 
shoulder, and stimulating frictions made to the limb for A 
month without a mendrnent. Electric shocks and cur- 
rent >rted to for sometime, and it was found 
that he conld feel th ks above the elbow' but not be. 



134 Paralysis. [February, 

low it. They did not seem, however, to excite any muscu- 
lar contractions, and were discontinued. 

It i nowjusi nine weeks since the accident. On strip- 
ping the patienl and examining him in the erect posture no 
inequality of height can ho detected in the shoulders, and 
the only visible difference between them is the partial atro- 
phy of the deltoidand scapular muscles on the affected side. 
The entire right limb is smaller than the left; it is percept- 
ibly cooler than the other; the pulse is normal; severe 
pinching can he Blightly felt above the elbow r , but not at all 
w this: he can move neither finger nor any muscle of the 
limb and shoulder. I now proceeded to make a most care- 
ful examination of the scapula, clavicle andhumerusandjoint 
without being able to detect any fracture nor any displace- 
ment whatever. The roughest manipulations werepainless 
and not the least cripitation could be induced. Everything 
was in its proper place andposition. The ulnar nerve was 
insensible to pressure at the elbow. The limb dangled by 
the side of the body as if dead. 

Xow what could have occasioned this paralysis if not an 
injury to the axillary plexus by being suddenly and violent- 
ly jammed against the ribs by the shoulder joint? And yet 
there arc some who deny that this is possible. 

This case derives additional interest when taken in con- 
nection with several others I have had occasion to report 
within the last few years. (See Southern Med. $ Surg. Jour- 
nal for 1857, p. 323^ and for 1859, p. 741.) It is worthy of 
remark that in the two first two cases I published, and in 
which the drooping of the shoulder consequent upon frac- 
ture persisted, the patients continued to suffer much pain 
in the limb ; whereas in the third and in this (the fourth I 
have seen) they suffered none after the subsidence of the 
immediate effects of contusion. In the former cases the 
axillary nerves continued to be pressed upon and irritated — 
in the latter they suffered only at the time of the blow. 



1861.] Convul D 

/. By Charles Bland Radcliffe, M. D., 
>llege, Physician to the Westmini 
Hospital, etc. 

LECTURE I. — CONCLUDED. 

Iii the able hands of Prof, du Bois-Keymond,* the gal- 
vanometer has recently brought to light certain facts which 
appear to be essential to the full interpretation of the mode 
in which muscle is affected by electricity. 

Of these facts those which require to be mentioned first in 
the present inquiry are these: — that* there are electrical cur- 
rents in living muscle and nerve ; that these currents die 
out J ' with the irritability of the nerve and muscle : 

and that they have finally disappeared before the occurrence 
ot' vigor mortis. 

The next fact to which I would prominently direct at- 
tention is this, that the electrical currents of muscle and 
nerve are weakened during ordinary muscular contrac- 
tion. 

In the beautiful experiment by which this weakening of 
the muscular current during contraction is demonstrated 
by Prof, du Bois-Reymond, use is made of the gastrocne- 
mius of a frog, with a long portion of the sciatic nerve at- 
tached to it. The muscle is placed upon the cushions of 
the galvanometer, and the nerve is laid across the poles ot 
an induction coil, which coil is not then in action. Onplacing 
the relaxed muscle upon the cushions of the galvanometer, 
muscular current transverse the coil, and the needle is 
deflected to a considerable distance from zero. Passing a 
series of alternating induction currents through the nerve, 
and so producing a state of tetanus in the muscle, the needle 
swings back, and for a moment or two passes to the other 
side of zero. Under the current of the relaxed muscle, 
that is to say, the needle passes from zero; when 
contraction is produced, the needle passes towards zero. 
How, then, is this : Is the needle acted upon by a 
reverse current during contraction, or is it left free to < 
late back to its point of rest in consequence of the cessation 
of the current which had previously kept it away from this 
point! To answer this question, the experiment just des- 
cribed is modified in the following manner: 

Having fin tained the point to which the needi 

bnngenuto sche Eloctrioitat. 8vo. Berlin. ! 



136 Lectures on [February, 

deflected by the current of the relaxed muscle, the current of 
the coil is broken, and the needle allowed to return to rest 
at zero. Then, throwing the muscle into a state of tetanus, 
the circuit of the coil is closed. In other words, the experi- 
ment is so conducted as to test the current of the contract- 
ed muscle. And what is the result? It is this: that the 
needle moves in the same direction as that in which it 
moved under the current of the relaxed muscle, but not to 
the same distance from zero. That is to say, the current of 
the gastrocnemius is found to be weakened during the con- 
traction, not. reversed. I have often verified this fact, and 
I shall be happy to show the experiment after the lecture 
to any who may be sufficiently interested in the subject to 
remain. 

In showing the corresponding weakening of the nerve- 
current, the ischiatic nerve of a frog is divided in the ham, 
and dissected out for a sufficient length towards the spine. 
This being done, the divided end of the nerve is bridged 
over the cushions of the galvanometer, so as to touch one 
cushion with its end and the other with its side, and a note 
is taken of the degree to which the needle is deflected by 
the nerve-current. The frog is then poisoned by placing a 
little strychnia under the skin, and when the tetanus occurs, 
the needle is seen to recede three or four degrees nearer to 
zero ; and this not only during the principal attacks, but 
also during the more transitory shocks which are produced 
on touching the animal. It is seen, further, that the needle 
again diverges from zero when the spasms pass off. For 
this fact also we are indebted to Professor du Bois-Rey- 
mond. 

And thus in ordinary muscular contraction as well as 
rigor mortis, the phenomenon of contraction would seem 
to be coincident with the absence rather than with the pre- 
presence of the natural electrical currents of muscle and 
nerve. 

The influence of artificial electricity in muscular action is 
a difficult problem ; but even here there are facts which 
show that the full solution may be hoped for before long. 

When the hind limb of a frog is attached by means of its 
sciatic nerve to the conductor of an ordinary electrical ma- 
chine, and the conductor is in turn charged and discharged^ 
the Limb js seen to be at rest in the former period and to be 
convulsed in the latter. Xow, in this experiment, the limb 
as part of the conductor, must participate in all the changes 



1861.] 



Convulsive Diseases. 



137 



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of charge or discharge which pass over the conductor; and in 
thiscase therefore the muscular contraction would seem to he 
related to the dis appearance of ordinary electricity from the 

muscle, and not to the pre- 
sence of ordinary electric- 
ity in the muscle. 

The muscular move- 
ments resulting from the 
action of a galvanic [cur- 
rent are not a little com- 
plicated, and their full in- 
terpretation',! ^proportion- 
ately difficult. 

The muscular move- 
ments, resulting from the 
action of a galvanic cur- 
rent upon a motor or 
mixed nerve, provided 
nerve "be divided and its 
end lifted up are divisible 
into periods of double, 
alternate, and single con- 
traction. In the first 
period — that of double 
contraction — there is con- 
traction at the beginning 
and end of the current, 
and the only point to be 
noticed is, that the con- 
traction at the beginning 
of the "direct" current* 
is the strongest. In the 
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alternate contraction — 
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ternately at the beginning 
of the "direct" and at the 
end of the inverse current. 
In the third period — that 



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♦The current is spoken of as "direct" when it passes towards the muscle, 
s "inverse" when it passes from the music. In other words, the current 
s ''direct'' when the positive pol • is farthest from the muscje, and "in 
when nearest to the muscle. 



L38 



Lectures on 



[February 



of single contraction — there is, first of all, contraction at the 
beginning of the direct current, and at this time only; and, 
later still, there is apparent irregularity. Later still, that 
is to say, contraction may attend upon the beginning of the 

inverse current, after it has ceased to attend' upon the bc- 
ginning of the direel current; and not only so, but it may 
return to the beginning of the direct current after it has 
ceased to attend upon the beginning of the inverse current. 

Ney, these alternate revivals 
of contraction, which are 
known as "voltaic alterna- 
tives," may occur several 
times in succession upon 
thus reversing the current. 
The muscular movements 
resulting from the action of 
a galvanic current upon a 
loop of nerve are found to 
he divisible into the same 
three periods of double, al- 
ternate, and single contrac- 
tion ; but the movements 
themselves occurin very dif- 
ferent order within these pe- 
riods. In the period of double 
contraction, the contraction 
at first is strong at the begin- 
ning of both currents direct 
and inverse ; and then, a 
moment or two later, it is 
strong'only at the beginning 
of the inverse current. In 
the period of alternate con- 
traction, the time of the 
contraction is at the end of 
the direct and at the begin- 
ning of the inverse current. 
In the period of single con- 
traction, the contraction, 
first of all, is at the begin- 
ning of the inverse current; 
and aftcrwa r d s, without 
any a p pa rent regularity, 
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l.] D 139 

of i lie direct, and now at the beginning of the inv< 

current. It is only, indeed, in this final of appar- 

ent irregularity, or "voltaic alternatives," that the 

movements correspond with those which result from the 
►n of a current upon a nerve which has been divided 

and lifted up at its end. All this may he seen at a glance 
►mparing the ahove (able with one preceding it. ?; 

In commenting upon these phenomena, i( is convenient 
insider them as belonging to the three groups in which 
they have been arranged. And first, of the movements be- 
longing to the first period — that of double contraction. 

In looking at the movements belonging to the first peri- 
od, it is not difficult to find a reason which will, in some dc- 
, explain how it is that contraction is confined to the 
Beginning and end of the current, and to these times only. 
It is not difficult to see that the beginning and ending of 
the galvanic current in the nerve may involve certain 
changes in the strength of the nerve-current, and that these 
changes may in their turn give rise to momentary induced 
currents in the nerve and in its neighborhood; for such 
momentary currents are induced, not only when a current 
begins to pass and when it ceases to pass, but also at the mo- 
ments when it undergoes any change of strength. It is not 
difficult to see, also, that the muscular fibres to which the 
nerve is distributed may be the seat of some of the second- 
ary currents thus induced, and that these fibres may on this 
account be made to contract. Xor is it difficult to see — if 
the contraction be thus connected with the induced current 
— that there will be no contraction in the interval between 
the besnnnins: and ending of the inducinc; galvanic current; 
for if this latter current passes steadily there is no induced 
current in this interval. It does not follow, however, that 
the contractions are caused by the presence of the induced 



hot Claude Bernard has recently stated that a period of si 
Contraction precedes the three periods of which mention is made — a | 
od which i- distinctive of the undisturbed and perfectly unexhausted □ 
and of which the el. iture ia contraction at the beginnii 

the two currents, inverse as well as direct. On farther inquiry, however, 
I think Prof, Bernard will per le phenomena a titled 

to this pr< significance; for, d in a recent communi- 

cation to the Royal Society, [find that they are producible at \ ill in the 
the period of double contraction bj under particu- 

lar circnm>tan 



140 Lectures on [February, 

currents which are thus developed. On the contrary, these 
currents are no sooner communicated to the muscle than 
they arc with drawn from the muscle, and it may be that 
the contractions arc really due to this withdrawal. At any 
rate, it is in connection with the induced currents of which 
mention bas been made that we seem to have a reason which 
will, in some degree, explain why it is that contraction is 
confined to the beginning and end of the galvanic current, 
and to these times only. 

In considering the movements belonging to the second 
period — that of alternate contraction — the first thing to be 
done is to ascertain how it is that the order of contraction 
as set down in the first table is reversed in the second table 
and this thanks to Dr. Rousseau, of Vezy, is no very diffi- 
cult matter.* 

A\ lien the current acts upon a loop of nerve, it is not enough 
appose that the only current is that whicb passes direct- 
ly between the positive pole and the negative pole. On the 
contrary, there is a more roundabout way — a way which is 
made up partly by the portions of nerve beyond the poles, 
and partly by the intervening muscles of the thigh: and 
along this more roundabout way another current will pass 
in a contrary direction to that of the other current. In this 
case, that is to say, in addition to the first current, which is 
distinguished by the name of primitive current; there is a 
second current, which is known as the derived current. 

Where, on the contrary, the galvanic current acts upon a 
nerve which has been divided and lifted up at its end, the 
only current acting upon the nerve is the primitive current. 
In this case, indeed, the circuit of the derived current is 
broken, and for that reason there can be no derived cur- 
rent. 

2sow, it is in the action of the derived current that Dr. 
Rousseau has found an explanation for that reversal in the 
order of alternate contraction which takes place in the case 
wbere the galvanic current is made to act upon a loop of 
nerve through ordinary poles. 

One proof of this is afforded by an experiment in whicb 
the galvanic current is passed through a rheophorc bifurquc 
— a Vhcophore. that is to say, in which one of the poles (say 



Logons sur La Physiologie et Pathologic du Systeme Serveux. P 
latide Bernard. Tom i. Leoon 10. Paris. 1858. 



1801 .] Diseases. 141 

the negative) is forked and so arranged as to receive the 
pther pole (the positive) between its prongs. It is Been, in the 
first place,that the portion of nerve which lies across the p< 

[od upon by two primitive currents, and that these cur- 
rents pass in opposite directions from the central positive pole 
to the outlying negative poles. It is seen. also, that there 
no outer or derived current, and that there can he no such 
cnrent in this case, inasmuch as the two out poles are both 
of the same character — both negative. It is obvious, more- 
over that there will be no difference in the result where a 
nerve which has been divided and lilted up at its end is laid 
across the rheopliore bifurque ; for where there is no deriv- 
ed current it cannot matter whether the circuit of this cur- 
rent is interrupted or not. What, then, it may be asked, is 
the result of using this arrangement of the poles? Will 
the two primitive currents neutralize each other, and pro- 
duce no action in the muscle ': Theoretically, such a con- 
clusion is not improbable ; for it is a well-known fact that 
opposite currents of equal value do neutralize each other. 
Practically, however, the muscle is found to contract; and 
not only so, but the order of contraction is found to be one 
and the same in the case where a loop of nerve is acted 
upon, and in the case where the nerve acted upon is divided 
and lifted up at its end. It is found, also, that the muscle 
responds to the current which passes in the portion of nerve 
nearest to the muscle to which the nerve is distributed. In 
other words, it is found that the reversal of the order of 
alternate contraction which occurs where a loop of nerve is 
acted upon by the ordinary poles of the galvanic apparatus 
is due to the action of a derived current; for on excluding 
this derived current by means of the rheophore bifurque, 
this order of alternation is made to merge in that which 

irs where a nerve divided and lifted up at its end is acted 
upon, and where there can be no derived current. 

or does Dr. Rousseau content himself with this negative 

>f. On the contrary, he shows very clearly that the ac- 
tion of the derived current will reverse the order of alter- 
nate contraction in the case where a loop of nerve is acted 

Q by ordinary poles. 
Passing through ordinary poles, the inverse primitive cur 
rent gives rise to contraction at the moment when the cir- 
cuit d. It acts, that is to say, as the direct current 

when there is no derived current to complicate its action. 

•v, if the order of alternate contraction is reversed bv the 



142 Lectures on [February, 

action of a derived current, and if two opposite currents (ah 
•n in tlic experiment with the rheophore bifurque,) it is 
that which passes through the portion of nerve nearest to 
to the muscles which acts upon the muscles. It may, also, 
do this by because the current acting upon the muscles actr 
ing upon the portion of nerve nearest to the muscles, is not 
the primitive inverse current, but a portion of derived cur- 
rent the course of which is diametrically opposite — that is, 
direct. In other words, the acting current, underthese cir- 
cumstances, is one which ought to be attended by contrac- 
tion at the closure of the circuit, for it is a direct current. 

We arc now enabled to sec why the direct primitive cur- 
rents acts like an inverse current, when this current is made 
to act upon a loop of nerve through ordinary poles ; and 
this it may do because it will show that the current acting 
upon the muscles, by acting upon the portion of nerve near- 
est to the muscles, is not the direct primitive current, but 
an inverse portion of derived current. In a word, the act- 
ing current is inverse, not direct ; and, therefore, we should 
sxpect to have the result of the action of the inverse current 
— contraction at the end of the current. 

In this period of alternate contraction, then, there would 
;u to be one and the same law for the muscular move- 
ments resulting from the action of the galvanic current upon 
nerve — a law by which the muscle is made to contract at 
the beginning of the direct and at the end of the inverse 
curent. 

In the period of alternate contraction, then there would 
seem to be one and the same rule for the muscular move- 
ments resulting from the action of the galvanic current upon 
nerve — a rule by which the muscle is made to contract at 
the beginning of the direct, and at the end of the inverse 
currents. 

How, then, is this ? Why is it that muscle contracts thus 
alternately V It is, perhaps, too much to expect a full ans- 
wer to this question at present ; but a partial answer, as it 
seems to me, may lie found in the collation of the three 
facts which follow. 

The first fact is this — that the direction of the nerve-cur- 
rent in the sciatic nerve of a frog (except in those last mo- 
ments in which the action of the galvanic current upon the 
the uervegives rise to the "voltaic alternatives") is inverse or 
centripetal. In these lasl moments the nerve-current may 
ometimes inverse and sometimes direct; and this change 



II.] Convulsive Diseases. 143 

may take place more than once, but, except in these last 
moments, the direction of this current is, as I have said, al- 
ways Lnv< 
The second fact is furnished by Professor dn Bois-Rey- 

mond in an experiment in which the two ends of a Long 
portion of nerve are placed upon the cushions of two gal- 
vanometers and the middle of the same nerve is laid across 
the poles of a galvanic apparatus. Looking at the needles 
of the galvanometer before passing the galvanic current, 
these needles are seen to diverge under the action of the 
nerve-current, and from the direction of this divergence it 
ident that this current sets from the end to the side of 
the nerve : looking at these needles while the galvanic cur- 
rent is passing, one needle is found to move still further 
from zero, the other is found to return towards zero. 

The third tact, which has been recently furnished by 
Professor Eckhardt,* is to be found in an experiment which 
may be illustrated as follows: — In this experiment the nerve 
of the leg of a frog, properly prepared for the purpose, is 
placed, one portion (that nearest to the leg) across the poles 
of an induction coil, another portion across the poles of a 
galvanic apparatus. Having done this, the leg is first 
thrown into a state of tetanus by passing a scries of induc- 
tion currents, and then, the tetanizing influence still con- 
tinuing in operation, the continuous current of the galvanic 
apparatus is transmitted in turn to and from the leg. This 
is the experiment. The result, which is not a little remark- 
able, is : that the tetanus ceases when, the inverse current 
passes, and continues when the direct current passes. Nor 
is this result altered by inverting the order in which the 
continuous and induction currents are made to act upon the 
nerve. Thus applied after the direct current the induction 
current produce contraction, but not so if they are applied 
after the inverse current. Nay, it would even seem as if 
the direct current is actually favorable to the production of 
tetanus; or, with this current passing, a solution of salt, 
which of itself is too weak to cause tetanus, will have this 
effect In observing this fact, Professor Eckhardt proceeds 
as follows — First of all, he tetanizesthe limb by placing the 
portion of nerve nearest to it in a strong Bolution of salt ; 



on Medical Electricity, \>. 111. Bj Dr. Althaus. 8vo. 



144 hires on [February, 

after this, he adds water until the strength of the saline 
solution is no longer sufficient to provoke this state of con- 
traction in the muscles; and then, all things being- as they 
were, lie passes the direct current. The result is that the 
tetanus immediately returns. 

Now, on comparing this last fact with the two previous 
facta, we may have, as it seems to me, some insight into the 
mode by which the galvanic current acts upon the nerve in 
the period of alternate contraction. On the one hand,itisseen 
that tetanus is prevented or arrested by the inverse current. 
Tetanus is prevented or arrested, that is to say, when (as 
the first and second facts show) the galvanic current coin- 
cides in direction with, and imparts power to, the nerve- 
current. On the other hand, it is seen that tetanus is not 
prevented or arrested by the direct current. Tetanus is not 
prevented or arrested, that is to say, when (as the first and 
second facts still show) the galvanic current differs in direc- 
tion from, and diminishes the power of the nerve current. 
The one result, indeed, is in harmony with the other; for 
if contraction is counteracted by imparting power to the 
nerve-current, it is to be expected that contraction will be 
favored by detracting power from the nerve-current' And 
this result, moreover, is not at variance with the premises. 
For has it not been seen that ordinary contraction is coinci- 
dent with the discharge of ordinary electricity, and with 
weakening of both nerve and muscular currents ? And has 
it not been seen that rigor mortis is associated with abso- 
lute and permanent annihilation of the two last named cur- 
rents ? 

And if this be so — if in this manner the inverse current 
antagonizes, and the direct current favors, contraction — 
then it seems to be possible to apprehend, in some degree, 
why it is that contraction occurs alternately at the brgin- 
ning of the direct, and at the end of the inverse current. 

When the inverse current passes, the influence upon the 
nerve current is one which antagonizes contraction, and 
hence it is not to be wondered at that there should be no 
contraction at the beginning of the current ; when the in- 
verse current ceases to pass, there is an end of the influence 
which antagonized contraction, and contraction may there- 
fore follow as an equally natural consequence. When, on 
the other hand, the direct -current passes, the influence upon 
the nerve current being one which favors contraction, the 
occurrence of contraction at the beginning of the current 



18G1.] 145 

may be accounted for : when the direct current ceases to 

. the influence which flavored contraction is at an < 
and therefore the absence of contraction at this time is not 
to be wondered at. 

In the third period — that of single contraction — the mus- 
cular movements resulting from tl. d of a galvanic 
current upon nerve i d somewhat perplexing, 
hut with a little thought it may n that the key 
will apply to their interpretation. 

If. as ha.- just been seen, contraction attends upon the be- 
ginning of the direct current because this current is found 
to favor contraction, it is not difficult to find a reason which 
will explain, not only why in the first period of double con- 
traction the contraction at the beginning of the direct cur- 
rect is strongest, but also why in the first part of the period 
at present under consideration — that of single contraction : 
there should lie contraction at the beginning of the di 
current, and at this time only. Xor arc the apparenl 
ilarities in contraction — the "volaic alternatives" — which 
ir in the latter part of this third period of single cont 
tion entirely inexplicable ; for it may he that these apparent 
irregularities — this apparent shitting of contraction from 
the beginning of the direct to the beginning of the inv< 
current, and so backward and forward once — may be 
thing more than the natural conserpience of the chai 
which at th'. and are taking place, 

in the direction of the nerve-current. 

Looking back, then, at the arguments which have been 

advanced in the pr< ction, there would to be 

littl i for su] - vital property of eon- 

lility has been called in: >n during contraction by 

ricity; for has it not appeared that 

»r mortis ident with the utter extinction of 

nerve and muscular currents ': — that ordinary contraction i- 

mded by weak< 

tion attends upon the d' of stntical electricity'.' 

and that contraction i- favored when tl, 
vanic current is to detract power from the nerve-curr* 

is it not I that contraction is antagonized 

when the action of I • current is found to impart 

power to the nerve-cui oking hack, indeed, i, 

i as it muscular coincident with 

id contraction with the. 
10 



146 Lectures on [February, 

of this action. In a word, it would seem as if mus- 
cular m< otliing more than a physical proci 
it is quite in accordance with what we know of the physi- 
cal action of electricity that should mark the impartation of 
this action, nnd that contraction 3hould attend upon its ah- 
ion. 

Lt would seem, also, thai this view of muscular motion 
under the action of electricity is one which tallies well with 
what h;; 'ready said concerning muscle under the 

ion of nervous influence and blood. Indeed, knowing 
i we do of the action of electricity, and knowing also 
that the nerve-current is a componant part of, and the only 
intelligible idea in, nervous influence, is there not some dif- 
ficulty in supposing that nervous influence can do other- 
than counteract muscular contraction ? And with re- 
■t to the blood, is there not some ground for believingthat 

- fluid must counteract contraction by keeping up those 

mical changes in the muscle and nerve upon which the 
electrical currents of muscle and nerve may be supposed to 
be based : At any rate, the view of the action of electricity 
upon muscle, which has been advanced in the present 
don, is one which appears to support and explain the view 
already arrived at respecting th< of blood and nerv- 

ous influence upon muse 

LY. In constructing a theory of muscular motion, there 
are many facts which still remain to be considered, and 
some of which must not be left unexplained. How is it for 

mple, that muscle undergoes no change of volume in 
contracting ; that contraction is brought about by "mechani- 
cal irritation;/' that muscle contracts with diminished 
power as it contracts upon itself; that the waste of muscle 
is proportionate to its contraction ; and so on? An 

- to be explained without the aid of a vital property of 
contractility and a doctrine of stimulation ? 

The fact that muscle contracts without undergoing any 

change in volume — the gain in breadth being precisely 

loss in length — has been often appealed to as 

an argument that the process of contraction is beyond the 

| >e of any physical explanation ; but, in point of fact, this 

nge in muscle has its strict parallel in the change which 
passes over a bar or iron under the action of magnetism. 
The experiments of Mr. Joule* are quite conclushe upon 

phical Magazine, February and April. 



1SG1.] ' 1 

the latter point. In 01 i be 

magnetl in the ated 

copper wire. One end of this bar was I 

was attached to i of levers by which an} 

length was multiplied 3 

rectangular iron wire, one-fourth of an iuch 

ith of a an inch thick ; the i 
in length, and one-third of an inch in 

_ the coil with a current c 
bar to saturation, or nearly so, the index of the multiply 

aratus sprang from its position, and vibral at a 

point l-10th of an inch in advance — a distance giving 
L-oOOOOth of an inch for the actual elongation of the 
After a short interval the index cei rate, and be- 

to advance gradually in 
of the bar under the heat radiating from the coil; and 
continued to do until the ci bar 

demagnetized, when it immediately vibrated abou 

l-10th 01 an inch lower than that to which it . 
pre\ attained. In order to show that the bar under- 

went no change of volume in thus elongating, Mr. Joule 
placed a bar of annealed ir< yard long and half an 

inch square, in a gh ■ y inches long, an inch and 

a half in diameter, and surrounded by a coiled conductor 
ipperwii l-20th of an inch in di- 

amel 110 yards ii xtremity ot this 

was closed ; the other v. as fitted with a stopper, the centre 
of which was pierced with a graduated capilliary tube 
whi division was equal 0000th part of 

iron bar. This being done, the tube was filled with water, 
the Btopper adjusted so as to force t r to a convenient 

height in the capillary tube, and the coil alterternately con- 
nected and disconnected with a Daniell's battery of live or 
sixc . apparatus of sufficient power to m; 

iron bar to the full. T ! he experiment. Th 

atno perceptible occurred in th 

fluid in the eapilliar i making or on breaking 

with the battery, and this equally whet! 

try, orwhel sing or falling any 

inperature acco 
bar. T riment, iud hich ail'- 

moat conclusive proof that the bar und 
volume on being magnetized or dei 

tjon of the bar which tai on m : tiou 



Lectures on [February. 

had not been accompanied by a corresponding loss in breadth 
water would have been forced through twenty divisions 
of the capillary tube wheneverthe circuit of the battery was 
plcted. 
Under the influ< magnetism, therefore, there arc 

a in a bar of iron which are strictly parallel to tbo.se 
which take place in muscle ; and this parallelism extends 
also to that point which is so characteristic of muscle, viz: 
suddenness with which the contracted and elongated 
state- may alternate one upon the other ; for, in Mr. Joule's 
experiment, the bar was seen and heard and felt to 
jam}) suddenly from the longer to the shorter form, or from 
Bhorter back again to the longer, according as the elec- 
tricity was communicated to, or withdrawn from, the coil. 
is a vital property of contracility at all necessary to 
iain the next fact — the contraction which i- brought 
about by what is called " mechanical irritation." ( >n the 
contrary, it is very possible that this phenomenon may 
nothing more than the natural consequence of the mechani- 
cal interference with the electrical currents in nerve and 
muscle. It may be supposed, as in a previously related 
e, that a certain interruption in the nerve-current will 
a result of the pressure which is implied when a nerve 
is subjected to a ''mechanical irritation;"' and that, conse- 
nt upon this interruption, momentary currents will be 
induced in the nerve and in the neighborhood. It may be 
-apposed, further, that the muscular fibres to which the 
nerve is distributed are the scat of some of the secondary 
currents thus induced, and that these fibres are thrown 

►f contraction by the disappearance of these currents.' 

. also, when the muscular fibre is directly subjected 

to mechanical irritation, it may be supposed that there has 

:> some interruption of the muscular current in the part 

I upon, that this interruption may give rise to mo- 

atary induced eurrentsin the neighboring muscular fibre 

and that the disappearance of these induced currents may 

ilarly bring about contraction in the fibres included 

within the circuit of the currents. And, surely, after what 

id, it is easy to believe that the contractions rc- 

mechanical irritation" arc thus due to definite 

; intelligible changes in the nerve and muscular currents 

cribe them to au unintelligible "irritation" of a 

not very intelligible vital property of "irritability" in n< 

and mm 



1 i:" 1 

Nbristhe ' fca with diminished 

power as the muscle conl elfan argument that 

the law of muscular contraction is different fromany known 

physical law paction. \i is no don M. 

inted out that the force of muscular conti 

the muj ipon itself; but 

rgumen 
mus< different from the law of 

all physical attn Indeed, ela $, in 

shrinkin Dgation, behave in ev 

riment, and undoubtedly 

coutracti< hysical proc 

ipeal cannot be made to the fact that the 
- proportionate to the amount ofmucular 
>n, in order to show that muscular contraction is the 
tional activity in the muscle ; ter what has 

y that this waste has not been iucur- 
: n restoring the- At any rate, i ; 

tain that the electrical condition of nerve and muscle which. 
according to the prei is connected with the state 

relax rid not with the state of contraction, 

which cannot be kept up without a, correspondin nical 

—in the tissues concerned, 
conclusion, (for thoug <-\i- 

:d there is no time to bring it forward) 

; argument? i- i 
ion rather than contraction 
h- it not this— I 
whirli are said to belong 
ntractility which is called irritability . 
lertain ag 
that the nt contract: 

referred to that form of contractility w 
[eristic persiste: 
which antagonized contraction during 
lid ? And if so, what need is there 

of the doctrine of stimu- 
i which is founded thereon ? 

> doubt, a difficult matter to abaudoi 

d in the mind, [is that which 
.ntractility to ; 
itractility 
ii when !i. 1 

final purpose of 



L50 L loses. [February, 

traction, aud particularly thai form of contraction which is 

of the will — instead of being 
brought about by the infusion of more life into the muscle, 
ht about by the induction of a change which is re- 
xtent in rifformortis. But this difficul- 
tly which diminishes when it is steadily 
looked in the face. Solar as the will is concerned, the 
theory under consideration requires one to suppose that 
voluntary muscular contraction is brought about, not by im- 
parting something to the muscle, but by removing some- 
thing from tl "lc which had previously antagonized 
contraction. • idea changes with reference to the 
muscle, but nor with reference to the vital activity of the 
will, for in either case and equally the will is a living act- 
ing power. And as to the rest, it is surely as easy to sup- 
pose that the willacts through the instrumentality of a force 
•ii must belong to muscle as a physical structure, as it 
suppose that it requires the super-addition ot a vital 
tractility, and a special provision for stimu- 
ls, I repeat, a difficult matter to abandon old 
views, ami, turning round completely, to regard muscular 
contraction as a process which is most fully realized in rigor 
mortis; but we have at least this advantage in so doing — 
that we gain an explanation which is physical and intelli- 
gible — an explanation, moreover, which applies to rigor 
as well as to ordinary muscular contraction. For 
what is the case with respect to rigor mortis? The case is 
-imply this: that as long as there is any sign of " irritabil- 

" or any trace of nerve-current or muscular current. 

long is there is no rigor mortis. If these signs and traces 

diiy, as in persons in whom the vitality of the 

>een exhausted by long life, or by chronic disease. 

as consumption, the muscles become speedily rigid ; if 

and tra< -low in dying out, as in persons 

en cut down suddenly in the full glow of health. 

arc equally slow in passing into the state of ca- 

rigidity. Once contracted, moreover, the muscles 

remain contracted until the supervention of putrefaction — 

rent which mosl speedily in the casewhere the 

. in their physical integrity least perfectly. The 

d, which arc utterly unintelligible upon the hy- 

that contraction depends upon the stimulation of 

vital property of contractility, are precisely what they 

lit to be according to the premises : for according to the 



premises all I ' » the commencement ofri 

} uon dying out of that action in muscle and nei 

of which the electrical current is one of the signs ; and all 
t ' TU | jsaryto its continuance is the absence of thia 

.„. and the physical integrity of the muscular structure. 
- the premises, indeed, there is no difficulty in 
explainii unexplained, and hitherto contradict 

cn a r . ihis form of muscular contraction; . 

it would seem that rigor mortis ma; 
type of muscular contraction in general, and 
's in favor of the theory of muscular 
tion of which I have had the honor of sketching the 
broader outlines in the present lecture. 

o modern da ns of the use 

\e Treat) Syphilis. ByDr.ETHae 

Grriefswald. 
The contention concern];. ■• admissibility of mercury 
• 1U t he treatn iilis (Die Xaehtheile der Murkurial- 

kur. Vienna. 1859. 8) recently excited by Dr. Hermann 
__ : , ike that of the advantages resulting 

lation and blood-letting, must be witnessed at 
each generation, has virtually, in my opin- 
io hings of Virchow and Waller 
hr. 1859. 111.) The following lines 
,1 onlv as a supplementary examination of the 
rts adduced by the opposers of mercury to 
-rain their opinions. 
The very first li ireface prove tha 

■r happily belongs to that class who are fully con- 
the glorious progress we have made." "The in- 
lercurial treatment were but little known 
uutil our times : indeed, ancient physicians scarcely ha< 
indi isgivingthat mercury incorporated into 

ns man in the organism, and may pro- 

. various destructive and often incur- 

igation of the present til 

,r ki D d, are du- 
ration of mercury. ' 
dof proof that what we designate a 
• .itional syphilis was well known to the earl- jrvera 



152 Mercury in the [February, 

of syphilis at the time of its general prevalence at the end 

of the 15th and during the first decade of the 16th centuries. 
Now Hermann asserts that this constitutional syphilis" 
originated from the administration of mercury to cure the 
hitherto far milder diseese. Hermann supposes that "consti- 
tutional syphilis firsl occurred when mercury began to be 
used, particularly about the middle of the 16th century, by 
Francis 1.. and in the form of Barbarossa's pills." 

Although these words do not place the historical know- 
ledge of Hermann with his subjectina very favorable light, 
yoi his immediately following explanation as to the method 
by which those physicians arrived at self-deception concern- 
ing the true nature of constitutional syphilis, does so in a 
much less degree. 

"The first physician," says Hermann, after asking the 
reader to '■imagine" himself in their position, "treated 
syphilis, doubtless both chancre and gonorrhoea, with mer- 
curials." Notwithstanding the complete ignorance evinc- 
ed by tb 'Is. in regard to the earliest periods of syph- 
ilis, tiie recommendation is made to "suppose" one's selfin 
the position of those physicians, when a recommendation to 
study their writings, winch are accessible to every one in 
the collection of Luisinus, Gruner, Fuchs, etc., would have 
been more to the point. By such a proceeding the com- 
piler would soon have made the discovery that "primary 
syphilis" did not at all present itself "undoubtedly" to those 
sicians as gonorrhoea and chancre, and that they least of 
all treated gonorrhoea and chancre with mercurials. 

The cardinal assertions of Hermann amount to this, that 
-•constitutional syphilis is the product of mercury," and 
• w this fact which has been, for the first time, verified by the 
exact investigation of the present time," might better be 
road "by \h->. Hermann, Lorinserand Kletzinsky." 

Lei us examine whether these assertions are founded in 
tact. 

The earliest observers of syphilis did not determine to 

ly mercurial inunction until a long-continued opposition. 

they feared the most injurious consequences from 

Iness," particularly in cutaneous affections, which, 

prominent sympl p ed a very large share 

ention. Besides, the powerful effect of mercury 

upon the mouth was well known, as it had for a long 

time been a common remedy in various cutaneous dis- 



L861.] Treatment of Syphilis 

eases.* The su Pits application observed in i' 

diseases induced its use in this new malady also; soon be- 
coming a remed leral use among physicians, but op- 
.1 l»y many, its abuse by the profesi ion, and the dangers 
salivation being depicted in the most frightful colors. 
Many writers also affirm that mercury was by no means a 
certain remedy in syphilis; consequently, the use of guiac- 
uin became for a time the pr ; mode. 

li to understand that the mercurial treatment fre- 

quently produced the worst consequences, and in); infre- 
quently death, when we read in Torella, for example, that a 
salve weighing 54 ounces contained 4 ounces of mercury, 
and that inunction with this of the whole body was con- 
tinued for nine days (Luisinus, p. o2T). Yet the assertion 
that "constitutional syphilis" was produced by mercur 
wot found in the writings of any of the early writers. They 
had, as Hermann says, w - no idea " of this effect of the 
metal. 

Among i he most decided opp . mercury is Leoni. 

His detestation of it is as great as could be desired. wi There 
is nothing more injurious to those affected with syphilis 
than to use mercury externally or internally, under the form 
<>i ointments or fumigations. From such applications per- 
always suiter in important organs/' (Luisin. p. 904.) 
"Important organs" arc the brain, from which was suppo 
to flow the material of the saliva, the lungs, the heart, the 
liver. Leoni likewise describes the gummata, the no 
the pair nit he had "no idea that these mi 

be artificial «. 

Yet even at that time such objections were not wanting. 
y are most definitely • discussed by Fallopia, the anato- 
mist, during the late period of the guiacum method of cure. 
Fallopn the gummata, tophi, etc., of the major- 

ity of cai I of mercury, and puts the 



■ riod of tb 
>f syphilis, ai 

earliest and most important: Mi mus^ a S in his 

lime-wa1 
"ad libiti 
. 

.rulara el ana, ed 



L54 Mercury in the Treatment of Spyhilis. [Feb., 

stress upon this opinion. "The causes of the tumor 

Fallopia, "originate in the affected viscera, but, in most 
the inunction by mercury." (Luisin. p. 826.) 
Accordingly, Fallopia asserts that gummata, etc., may be 
produced by the disease itself, but occur most frequently 
after the use of mercury which has not cured the disease. 
He explains this pro follows : "When these parts arc 

anointed tluy become enfeebled, and are thus then selected 
by the di He believes, therefore, that gummata, etc.. 

arise because the mercury has weakened the particular part, 
thus inviting the disease there." .Luisin. p. 827.) But. 
irom the preceding words, it appears that evenFallopiafinds 
a residue of cases in which gummata are not to be ascribed 
to mercury. On the other hand, Fallopia attributes caries 
of the bones in syphilitic patients entirely to the influence of 
mercury. "The infection of the bones in syphilis is terrible 
and the more so because they are infected in such parts as 
do not permit of a cure, as the bones of the head which are 
designed to inclose and protect the brain, and these I have 
seen so much affected as to be all carious. I have many 
examples. Some times the bones of the palate are so much 
involved that the whole palate decays, and not these only, 
but the usual bones also ; and it should be borne in mind 
that it is not in every inveterate case of syphilis that this oc- 
curs, but only in those in which mercurial inunction has 
been enployed." (Luisin. p. 827.; 

Notwithstanding, Fallopia had not the idea that mercury 
produced only injurious effects under all circumstances, for 
wit! i all these objections, he considered mercury capable of 
overcoming the disease. (Luisin. p. 810.) We quote also 
the following, from the same source : "A third most excel- 
lent methodis with pure mercury, which being absor 
overcomes the disease, expelling excrementa at the palate. 
For me it does this admirably/' (Luisin. p. 782. • 

The principal reason for the distrust with which Fallopia 
regarded mercury was his preference for the "cura regia," 
. by the use of cvacuants and the methodic employmenl 
guiacum. "Why use mercury by which health is not 
certainly nor If it does not cure, it 

ravatesand the disease becomes more stubborn.'" Fal- 
lopia does not therefore doubt the curative power of i 
. . but considers it less certain than the cura re 
Whether this opinion was well founded, we may learn from 
what bur author says further; "I do not approve of this 



StH.J Mer Treatment of & 

licament, bu1 

i by the curia r The cura regia, there- 

bre, sometimes fail d, and then Fallopia had i - to 

'ii ry, under what circumstances and with what suc< 
■e following quotation will show: "I have seeu a young 
Dan lahorin g under syphilis in which ( 
■led. An empiric cured him with mercury. Where! 
[have made use of it in stubborn and desperate cases, and 
ieularly where L have first tried all other methods.*' 
And many others after him who ne 
weary of declaiming* against mercury, had, like him, 
recoui ibborn and desperate ca Every 

died them, but unlike Fallopia, they did not 
dways honorable let the world know the truth. 

If the quotations hitherto given from the writing- of the 
opponents of mercury are but little calculated to support the 
opinion of Hermann, that constitutional syphilis first ap- 
>eared after the employment of this metal, and that 
sarher } 3 had "no idea" of such an effect produced 

ertions of other physicians, who did not parti- 
cipate in the opinions of those named in regard to mercury. 
ire still less favorable to his vicv 
Thai mplaints mentioned by Hermann were not 

in the earlier periods of the general prevalence of 
from the fact that several physicians de- 
ny pointedly and fully against these objections. 
mple, Leonardo Botallo, one of the most experienced 
. syphilis in the lGth century, says : " *•■■ 
the body become inflamed and uL 
.en not being exempt, in patients who have 
mercury? Why does their color become lead- 
VThat produces, keeps up and increases other various 
yraptoms before mercury has been used, ui 
id hurno: 

Then, as now, thoe :ury care- 

fully, and by such use not only produced no constitutional 
but, on tl . avoided tl 

unfounded are such objectipns. 
pie of tli 

ired 
ili — ••turn membrorum do 

•rcula et nod 



L56 Wasting Paraly, [Februa 

Effects which remind mo of Sigmund's process followed 
myself in many cas< 

So much for a doctrine which, like its predecessors, \ 
in a short time, and it is to he hoped forever, he consigi 
to oblivion, a place assigned to it by a. non-professio 
write!* 3 I since, when, as at the present, the most 

founded aspersions were heaped upon physicians who w< 
at least our equals, and the "exact investigations" of t 
present are boasted without the examination having be 
made, as Waller has shown, as to whether mercury m 
not be found even in the urine of persons who have 
been syphilitic and have never been subjected to a mercur 
treatment. 



Wasting Paralysis. By William Roberts, M. D., Londo 

Physician to the Manchester Royal Infirmary. 

The next case, which has only recently come 
care, is one of the best marked examples of wasting pal 
that I have witnessed. The disease is presented simple ai 
uncomplicated, without neuralgia or rheumatic pains, wit 
out cramps or contractions of the muscles, and without tl 
least trace of nervous paralysis. In the parts affected, 
combines the two instances before related ; for the atropl 
has seized upon the upper segments of both the upper an 
lower extremities, leaving the lower segments umnjurd 
and thereby occasioning a strange and curion aorij 

The patient is a healthy-looking man of 38 years. B 
was formerly a warehousemen, and subsequently he 1 
a school. He thinks the muscular strength has been slow! 
declining for 16 or 18 years, but during the last two or thr< 
years the disease has made much more rapid progrei 

When he is stripped, the nature of his ailment is at oil 
aled, without the necessity of asking a question. Tl 
two upper arms are like those of a child — so small and thi: 
while the shoulders above, and the forearms and hands b 
low, are of the full proportions of a moderately muscul 
man. The odd appearance of the shoulder-blades likewil 
immediately strife beholder. Instead of being bona 

s surface of the ribs in 1 JcapuJ 

lie loosely beneath the shin. attempt i 

moving the arms, their lower angles are thrust backwal 
and upward above the level of the arm-pits; and they pn 



fl.] Wat 1 



1 1 



t uuder I prominently as to look like a pair of 

nt wings. This singular condition arises from the 

lal destruction oi the muscles binding the shoulders to 

■ trunk, namely: the serrati, the rhomboidei, thepector- 

c trapezii, and the lav. dorsi. In the lower extremi- 

• atrophy has followed a corresponding course. The 

Irhs are greatly emaciated, while the legs are stout and 

muscular action is weakened in proportion to the 
»phy of the muscles. The hands and fore-arms pos 

iction all their proper movements. The patienl 

with facility, and grasps with force. The forearm 

flexed and extended with readiness, but so feebly, 

two-ounce weight in the right hand and a four-ounce 

in the left, suffices to overcome the utmost resistance 

[the biceps and brachialis anticus. 

atient stands erect, the abdomen is protruded 

d a corresponding dee}> concavity occupies the lumbar 

behind. He walks slowly and with evident difficul- 

accomplish considerable distances — three or 

n* miles — if permitted to walk at hi iding 

Irs is a painful labor to him. 

right and left are affected almost exactly alike, and 

onfined to four groups of muscles on each 

in the upper limb, (a) those which unite the 

:st, (b) those which move the elbow-joint ; 

id in the lower limb, (c) those which move the hip, and (<1) 

i»t. 

igularity in the upper limb which is ab- 

m the lower, that the scapulo-humcral muscles, com- 

the deltoid, the supra and infra-spinatus, the sub- 

;-is and the teres major and minors, continue vigor- 

1 well-nourished, isolated betwecnthe group above and 

•up below, of which the muscles have degenerated 

to the verge of annihilation. 

baracteristic feature of wasting p 
. is here represented. I allude to i1 
irse — the singling out of a muscle or a part of a musle 
id the decay of the surrounding 

scicuius in tolerab 
lie of each trapezius is lil pared. 

KVha ins of the wasted muscles is perfectly under 

ic control of the will. The skin is acute! . anda 

•elim ■ ly complained of. 




[February 



Concerning the determining' cause of this man's corn 
plaint, then rching inquiry has failed to elicit an; 

ig satisfactory. The most reasonable explanation is on'i 
red by the patient himself — who, I may remark, is a mar 
musual intelligence — that it has arisen from excess 
exposure to cold. When occupied as a warehouseman, h< 
lied to work in rooms di fire. The cold 

y iclt by him at the time, and lie frequently 
be benumbed. It is from this period that he 
-t commencement of his ailment. - 
By far the largest number of cases of wasting palsy are 
produced by undue and too long continued strain on the 
muscles ; accordingly artizans are found to be the most fre- 
quent victims of partial atropy, and the disease Hills with 
unerring certainty on the groups of muscles most tried, 
same fact comes out with clearness when the frequency 
of the disease in the right arm, and the left is considered. 
On a comparison of a large number of cases, I found that 
the right arm was more than three times more frequently 
eked than the left : and in the two hands the proportion 
was three to one in favor of the right. 

Masons and mechanics, who wield heavy hammers, have 
the muscles of the shoulders first attacked ; shoemakers, 
tailors, and milliners are iirst seized in the hands. 

A Middleton silk weaver lately under my care, exhibited 
an example of wasting palsy, confined to a single muscle. 
When he was employed at the loom the index linger of the 
right hand was used to lift up a portion of the machinery 
ach throw of the shuttle. This was effected by the con- 
traction of the extensor indicis. Xow the power to elevate 
the index with sufficient force to lift this weight had been 
failing in this man for the last eighteen months, lie was 
able to work for a time as usual, but in half an hour or so 
the linger was thoroughly fatigued, and he was compelled 
to repose. By alternate periods of work and repose he was 
able to do about a quarter of a day's work. 

The grasp of the hand was powerful, and there was no 
alteration of sensation. On uncovering the forearms no 
different perceived. No doubt this arose from the 

small magnitude and deep position of the extensor indicis, 
but the nature of the case was rendered clear by its perfect 
analogy with corresponding ailments in writers, tailors, and 
er artisans, m all whom the atrophy falls on the muscles 
most used. 



1.] Wasting Parol: L59 

muscnlar atrophy froi »rk, 

well-marked group, easily recognized, and not 
Their pathology and mode ot production ap- 
3 plain. The fatigued muscles suffer in their nutriti 

:,r o[' duerepose, and become a prey to fatty and 
ular degeneration of their fibres. There is no tendency 
.tension of the disorder to the muscles of the trunk 
the exciting cause has only a local operation. IT 
early, perfect rest of the injured n 
will generally suffice to bring about restoration, but if 
>phy have existed a twelvemonth or more the rase is well 
i hopeless ; and even, if seen early, I have never been 
to obtain success in treatment unless the patient has 
particular work which had pro- 
, fortunately it is seldom that an ar 
n do this upport of his family depends upon 

. and he persists in the labor that is slowly ; rely 

lermining all his usefulness. The hest advice to give 
a patient i - his occupation at once. The 

Middleton weaver above-mentioned, acting under my 

ion, became a gardener, and is now doing well in that 

>ne of the tailors turned letter carrier, and he 

dates himself on the change, which appears nbtun- 

igresg he has since made continues, to lead 

ration of his hand. A writer should be 

immended to accustom his left hand to do the work ot 

the ri that the latter may rest. 

iderable number of cases of wasting palsy are pro- 
duced by cold and wet. These also form a concise group, 
ervers have wished to set apart under the 
rion ot "rheumatic form of muscular atrophy." The 
invasion of the complaint when thus caused is often some- 
what sudden, and the v ccompanied by cramp.-. 

rheumatic pains; but 
eculiariti warrant a separation into a dis- 

hat set in with the so-called 

umatic complexion, subside soon after into the ordinary 

story of the groom, whoe describ< 

art oft:. ■, betrays much of the rheu- 

tic natui ! from neuralgi< through- 

- the whole of his illness, yet it does not appear that cold 

iate .-hare in producing the atrophy 

the thigh. On the other hand th miner, whose 

Led, although the m< 



• ting Parab/ [February. 

constantly immersed in water, never suffered pain during 
the four years that his complaint had endured. 
The frequency of excessive muscular exercise, and of ex- 

; re to wet and cold as determining causes of partial 
wasting palsy, explains why tt\e great majority of such cases 
occur in the male sex. In ten eases of this sort that I have 

i only two were women ; one a domestic servant and the 
other a iactory hand. 

palsy has sometimes been known to be conse- 
cutive to other disorders. The boy whose case was related 
first, had an attack of infantile paralysis previously to the 
setting in of the wasting- palsy. An old pupil brought me 

tild about three months ago, in which the left upper 
arm was excessively wasted, with good preservation of the 
forearm and hand. The history of the ease pointed un- 
equivocally to the infantile paralysis of the whole limb as 
the first disorder. The forearm and hand recovered in a 
months, but the muscles of the upper arm underwent 
a gradual atrophy until they had been completely de- 
stroyed. 

It is well known that acute diseases aie sometimes fol- 
lowed in the course of convalescence by partial or total 
a very inexplicable nature. Typhus and ty- 

id fever, dysentery, cholera, and diptheria, the three 

especially, have furnished frequent examples of such 
paralysis. 
Avery curious circumstance in the history of wasting palsy 

s disposition to run in families. There has been pub- 
lished an account of at least ten families in which the dis- 
ease has appeared hereditary. In four of these it was con- 
fined to two brothers in each. Another family, whose his- 
tory has been supplied by Dr. Meryon, had four boys affect- 
ed, and there were eight healthy sisters. In another family 
mentioned by him all boys, namely: two, had wasting palsy 

1st the two sisters were sound. A sea-captain mention- 
u'an had lost two maternal uncles and a sister from 
the disease, but two other Bisters and three brothers con- 
tinued healthy. In a later instance recorded by the same 
observer the patient's two aunts had died of general muscu- 
lar atrophy. In a family known to Oppenheimer two 
uncles and a cousin of the patient were already deceased, 
while another cousin and two brothers still suffered from 

ting palsy. 
Altogether, these ten families included twenty-nine indi- 



1861.] Wasting Paralysis. ltil 

viduals struck with wasting palsy, and of these only lour were 
females. This great preponderance of males is quite inex- 
plicable. It cannot depend, as in the previous case, on the 
greater exposure of one sex to the common exciting cause 
— cold, wet, and hard work — because in the hereditary 
rases the disease frequently appears in early youth or child- 
hood, longbefore the sexes are unequally subjected to fatigue 
and exposure. 

Cases of hereditary origin have another peculiarity. In 
nearly all of them the wasting spreads eventually to the en- 
tire muscular system, consequently they tend to a fatal ter- 
mination, and offer hut a small chance of recovery. Such 
- are not, however, absolutely hopeless. I have recent 
information that, in the family mentioned by Dr. Meryon, 
although the three eldest sons have died, the fourth has 
every prospect of surviving, and for more than four years 
has exhibited a steady improvement. 

AVasting palsy is essentially a chronic disorder. Wc 
measure its advance by months and years. Some cases 
complete their history in six or eight months, others linger 
tor many years. I found the mean duration of a consider- 
able number of cases to be a little over three years. 

The disease may terminate in one of three ways, namely : 
in recovery, permanent arrest, or death. The second mode 
of termination occurs when the wasting of the muscles 
ceases, and the limb continues tor an indefinite period in 
its maimed condition, neither amending nor deteriorating: 
the muscles, which are entirely destroyed, do not reappear, 
and those which are only partly consumed continue to ex- 
ercise their feeble powers under the control of the will, hut 
do not regain their former bulk or vigor. This stationary 
condition being once ushered in by the arrest of the atrophy 
the disease may be said to have reached its ultimate term, 
and the skeleton-like footprints it leaves behind are to be. 
regarded not as the malady itself, but, like the scar of a 
healed-up wound, only as the commemoration of a morbid 
activity which has now altogther passed away. 

Generally speaking, when the disease has fairly entered 
on the stationary phase, and has continued so a year or two, 
there is very little danger that it will resume its active ca- 
reer. Individuals have lived twenty and even thirty years 
with their crippled limbs unaltered. There are cases, how- 
s', where the malady, after lying torpid lor years, ha- 
awakened to new activity. Aran has related three info 
11 



162 Wasting Paraly* [February, 

Lng examples. One was a woman who, when a child, had 
atrophy of the muscles of the right hand, from which she 
recovered completely in her twelfth year. When forty 
years of age she was attacked again in the .same place. In 
another instance, the right leg became the subject of wast- 
ing palsy, but gradually recovered. Sixteen years after the 
shoulders were seized, and the disease involved both upper 
extremities, and several muscles of the trunk. In a third 
case, the right leg was the seat of debility and atrophy. 
Alter remaining quiescent for eight years, the disease start- 
ed into fresh activity in the left leg and right arm. 

On the question of the nature of wasting palsy and its 
true pathology, opinions are divided under two suppositions. 
Some suppose thalthe seat of the disease is in the nervous 
centres, and that the muscles are affected through their 
nerves, while others, and I reckon myself of the number, 
consider the muscles as primarily affected. I will not 
weary the reader with a discussion at length on this point, 
but must refer those who are curious on the subject to my 
essay, where the question is fully debated. I may, however, 
shortly state the results of postmortem examinations where 
the disease has proved fatal. The wasted muscles have 
always, of course, been found diseased; usually there lias 
been found fatty degeneration of the primitive fibres. In 
other cases the fibres have simply withered away until 
nothing remains but the empty sarcolemma, and, at length, 
even this disappears. The two conditions maybe found to- 
gether in the same subject. The muscles of the lower ex- 
tremity appears more prone to the fatty change, while those 
of the upper extremity more frequenty suffer simple atrophy. 
Hence ilie wasting is a more conspicuous symptom in the 
latter than in the former. The muscles in the calf have been 
known to be completely changed to masses of fat, without, 
any material change of shape or bulk. 

The state ot the brain and medulla oblongata has invari- 
ably been that of perfect health, hi nine out of thirteen 
autopsies of cases of general wasting palsy the spinal cord 
was sound, but in the remaining four there was softening or 
degeneration. Cruveilhier found, in two eases, atrophy o\' 
the anterior roots of the spinal nerves, and this has been 
found since, in two instances. In live other eases, where 
this pecularity was especially searched for, it was not found : 
on the contrary, the anterior roots possessed their usual 
. and showed no sign of degeneration. 






1861.] Pathogenesis of (Morot L68 

The nervous branches, which supply the wasted muscles, 
have been examined in a few instances. Cruveilhier and 
Virchow found the muscular branches much atrophied. 
Dabonlbene, however, found no change in the peripheral 
branches, and Mr. Partridge, who examined one of Dr. 
Mervon's cases, states briefly that the tendons and nerves 
were unchanged. Amid this conflict of evidence, it is im- 
possible to come to a certain conclusion regarding the pa- 
thology of the disease, but the weight of evidence inclines 
very strongly to the belief that the muscles are primarily 
affected, and that the morbid changes sometimes found in 
the several parts of the nervous system are secondary. 

Wasting palsy is especially liable to he confounded with 
lead palsy and reflex paralysis, especially the essential par- 
alysis of infancy and childhood. Lead pal sy is distinguish- 
ed by its comparative sudden invasion. In a day or two, 
or a fortnight at most, lead palsy has reached its height, 
and the muscles assailed arc reduced to complete immobil- 
ity, whereas, in wasting palsy, the waning strength keeps 
pace with the gradually decreasing volume of the muscle, 
aim the precursory symptoms of lead palsy are very 
marked. These are colic, anaesthesia, tremblings of the 
limbs, general dyscrasia, undue mobility of the emotions, 
especially the depressing ones ; inline, all those anomalous 
symptoms and conditions embraced by the term lead cach- 
exy. It is also usually easy in such eases to trace wry dis- 
tinctly the entrance of lead into the system. — London Med. 



U'.e Pathogenesis of ( nloro* 
It is known that fewer colored blood-corpuscles are found 
in chlorotic than in healthy blood : while in the latter, one 
cubic millimetre contains from four and a half to five mil- 
lions, the number in the former falls as low as to two and a 
half millions in the Bame quantity. It is known, too, that 
the colored blood-corpuscles contain iron, and chlorotic 
blood is, therefore, deficient in iron: and, further, that the 
deficiency of chlorotic blood in colored blood-corpuscle-, 
and in iron, is the consequence of an impaired Btate of the 
formative funct; tamorphosis), and not the resull of 

increased waste (Eatamorpo >r the urine of chlorotic 

patients is poor in solid materials. Lastly, it is known that 
the small amount of iron which the healthy organism ap- 



1 1>4 Pathogenesis of [February, 

propriates to itself from the most varied diet — as from flesh, 
milk, eggs, water, etc., fully suffices for the needs of the 
system : especially as in the healthy state the bile is the only 
secretion that contains iron, and yet the ferruginous con- 
tents of the bile are in great measure re-absorbed from 
the alimentary canal. How, then, is the occurrence of 
chlorosis in a healthy girl to be explained? She receives 
still the same ferruginous articles of food; it cannot, then, 
depend upon a want of iron, or upon a withdrawal of iron 
from the system, for these conditions do not exist; and yet 
I he girl, with a constant supply of the same amount of iron, 
becomes chlorotic, i e., there is a failure in the formation 
of red blood-corpuscles. What is this owing to? The vi- 
talist, who ascribes to the sanative power of nature a Pro- 
metheus-like contrivance and action in the preservation and 
restoration of health, is compelled to have recourse to a sup- 
posed error or caprice in regard to the direction that this 
sanative power takes, in order to explain the occurrence of 
chlorosis. But I am glad that the time is past in which 
such phrases and terms are deemed satisfactory, and in 
which it was fancied that an already obscure subject was to 
1m- explained by something utterly unintelligible. Xow, 
when we ask for a substantial reason as to why chlorosis 
should occur with a sufficient supply of iron, the theory 
hitherto held is at a loss for an answer. The theory, to be 
sure, contains the truth, but it does not contain the whole 
truth ; a link is wanting in the account of the origin of the 
disease. The organism, in fact, lacks the power to apply 
the iron furnished it to the formation of a hematine. Upon 
what does this want of power depend? We find the an- 
swer to this fpiestion in a discovery of Lehman n. Physio- 
logical chemistry has, tip to this time, made various excre- 
tions the objects of its researches, and especially the urine 
Its results, therefore, at best, have been of interest only as 
means of diagnosis. But where it has more thoroughly 
investigated the changes of tissue, fruitful results are to be 
found for practice, for pathology, and for therapeutics. I 
may mention, for example, the value of that beautiful dis- 
covery of Halwachs and Kuhne, that benzoic acid in its pas- 
through the liver is converted into hippuric acid by the 
decomposition of the glycocholic acid. From this, Falck 
inferred that benzoic acid must be almost a specific against 
the condition known as icterus ; and experience has proved 
il t.» I.,- so. In like manner, for the explanation of the ori 



I.] CM 165 

of chlorosis, I will show the value of Lehmann's discoi 
ery, that hematine is a glucoside. 

We know from Bernard that the liver is a sugar-secretipg 

an : and, we know, also, that in disease the seer*' 
of the different glands vary in amount, appearing at one 
i iiu- Lvely increased, and. at another, diminished 

even entirely suppressed. There is no conceivable reason 
why this should not be the case with the seerction of si 
in the liver; indeed, we know already that this secretioi 
increased in many forms of diabetes mellitus, and that in 
all febrile diseases it is entirely suspended. We will 
supposo, for a moment, and the supposition does not stand 
a! all in our way, that the sugar-secretion of the liver has for 
some time been diminished : what will be the first co 
quence of such diminution? Inasmuch as the hematine 
requires sugar for its formation, (for, according to Leh- 
mann's beautiful discovery, it is like saliein, phloridzin, 
tannin, >mbination of sugar or a glucoside), there- 

fore, when there is a failure in the supply of liver-sugar, 

formation of the coloring* matter of the blood will not be 

'inplished, even when the amount of iron is sufficient, a? 
and, consequently, the construction of colored 
blood-eorpusclcs will be stopped; or, in other words, the 
chlorotic condition will originate. The essential cause, then, 
of the occurrence of chlorosis is a deficiency or cessation of 
the secretion of liver-sugar; the feet that the supply of iron 
in forming hematine, is only a consequence of 
the former circumstance, and it is not the real cause of the 

If the supposition thus made be true, viz: that chlor 

depends upon a defective secretion of sugar by the liver — a 

supposition, the corr of which has, we think, been 

proved analytically and synthetically — three inferences may 

Irawn from it : 

cured by means of sugar, which 
supplies what is wanting through the failure of the liver. 
2d. Chlor > be treated by every means which can 

ire the sugar-making function of the liver to the norma! 
condition. 

3d. T\ the preparations of iron with whicli 

chlo mpirically treated, effect the cure. not. as is 

universally believed, by supplying the requisite iron to the 

large doses operate by promoting 
and Li tion of sugar in the lr 



1<)<) Pathogenesis of Chlorosis. [February, 

I. [f the deficiency of Liver-sugar is to be supplied by the 
ingestion of sugar, it must be a sugar like that of the liver, 
i.e., grape and not cane-sugar. For though the health or- 
ganism may be able to convert the cane-sugar into grape- 
sugar, yel the question is whether the impaired digestion of 
chlorotic patients is equal to the task. l)oes grape-sugar, 
then, cure chlorosis? In northern Schleswick, where I 
practiced medicine for twelve years, and, as I have been 
told, in many parts of Hanover, honey is a popular remedy 
for chlorosis; and lean attest its efficacy from my own ex- 
perience. Even though the honey may contain a small por- 
tion of iron, yet this is not the curative agent, for other ar- 
ticles of diet which contain just as much iron, are entirely 
powerless. As honey, by long-continued use, in large 
doses, may produce flatulence, acidity, colicky pains and 
diarrhoea, it may be well to combine it with suitable correc- 
tives, as the hitters, carminatives, etc., and to take it fasting 
in the morning in the dose of a tablespoonful. 

II. We are still entirely in the dark as to the means 
which increase or diminish the secretion of liver-sugar. 
There is here a wide field open for inquiry into the powers 
of remedial agents. But, little as we know with regard to 
this subject, we are yet acquainted with one agent which 
promotes the secretion of sugar, and we find it efficacious 
in the treatment of chlorosis; it is nothing else than cold 
water. It was shown, some years ago, by Dr. Fetters, in 
the "Prager Yierteljahrschrift," that the secretion of sugar 
iii diabetes is increased by drinking cold water copiously; 
and the experience of every hydropathic institution pioves 
that chlorosis may be cured by the same means. 

Many physicians regard the free use of cold water as a 
means which acts only by powerfully increasing the waste 
of tissues ; and, therefore, they give no credit to the assur- 
ances of hydropathic physicians, that chlorosis is cured by 
this means; for, according to their theoretic views, it must 
aggravate the disease. 

1 n chemical processes, water at one time plays the part of 
an acid, at another that of a base ; it has, also, a twofold ac- 
tion as a remedy. Acting in one way it greatly increases 
the waste of tissue (Katamorphpsis) ; acting in another, it 
promotes its formation (Anamorphosis). Indeed, a glance 
at the development of the foetus throws light on the action 
of water in the organism, and may remove some rusty pre- 
judices. Schlossherger has shown that in the earliest con- 



1861.] Chlorodyne. 167 

dition of the foetal life, the blood is of all the parts poorest 

in water, while alter birth it is richest. Since, then, the 

vouncrer the foetus is, its vegetable life is the more energetic 
■ » « • ^ . 

and the formation of tissue is more active than its waste, ii 

is evident that this formation is increased in activity by ;i 

large amount o\' water. 

ill. Whether the last of these three inferences will be 
verified the future will show. What is chiefly needed in 
the inquiry is an accurate method of investigation, in order 
to measure exactly the variations observed in the secretions 
of liver-sugar alter the employment of different agents. 
When Buch a method is found, then the question as to the 
effect of iron will he easily decided. 

These remarks are not vet sufficient to prove beyond all 
doubt that a failure in the secretion of liver-sugar is the im- 
mediately cause (A' the disease; yet, I think I have shown 
the insufficiency of the prevailing opinions on the subject 
to explain the morbid process, and on the other hand tic 
high probability of the new theory. The future may give 
sentence in the matter. Should every doubt be finally re- 
moved, it would then be shown that chlorosis and diabetes 
mellitus are, in their essential nature, diametrically opposite 
morbid processes ; and experimental pathology might one 
day succeed in producing chlorosis artificially, as has been 
done in the i diabetes, so that the means would thus 

be found for the radical cure of diabetes. — Maryland and 
Virginia Med. J 



Ghlorodj/m . V>y Dr. Edward Squibb, of Brooklyn. 

This most extraordinary humbug does not deserve a mo- 
me; onsideration ; and w T ere it not for the cir- 

cumstance that physicians occasionally resort to it by name 
or by it* misrepresented, and without a due know- 

its heterogenous composition and quackish charac- 
be little else than waste of time and space to 
allude to it. It claims English origin, or rather to have 
n invented in the English East India service; and in 
order to secure for it the magical power of mystery and 
nam ;omposition was concealed, or indefinitely stated 

as a u of perchloric acid and a new alkaloid. 

•i it was stated to have been analyzed by a Dr. Ogden : 
latter i snted as having given the formula 



L68 Chlorodync. [February, 

by which it i.s prepared. As it nevcrcould have been either 
invented or analyzed, it is not improbable that its whole 
story and career are fictitious. It mainly consists of chloro- 
form and muriate of morphia, but contains besides,perchloric 
acid, oil of peppermint, hydrocyanic acid, tincture of capsi- 
cum, molasses, and tincture of cannabis. 

Such a villianous mixture could never by any possibility 
have been invented, though it may have resulted from some 
uncommon degree of empirical ignorance and stupidity; 
and such a mixture, once made, would have defied the skill 
and knowledge of any analyist whatever, chemical or logi- 
cal. And yet an analysis is said to have been made, and 
i he proportions are given in drachms, drops, and grains. 
Then, of its properties. It is said to be twice as heavy as 
water, which, from its composition, is impossible. It is said 
lo be sedative, diaphoretic, astringent, antispasmodic,diuretic, 
etc., and to improve the pulse in all imaginable respects, 
including that of increasing it by decreasing the frequency 
of the beats ; and finally, the sum of its impossibilities ac- 
complished, lias the accustomed climax of such cases, viz: 
that it cures consumption in about the usual proportion of 
cases, viz : eight out of twelve, and all of the usual un- 
doubted diagnosis and gravity. That any mixture not ab- 
solutely antagonistic in its elements, containing two-thirds 
of its weight of chloroform, and eight grains of muriate of 
morphia in nine drachms, beside hydrocyanic acid and Indian 
hemp, should be sedative in effect, is not suprisiug ; and 
the molasses, capsicum, and peppermint are so many ad- 
ditional shot to be fired into the bushes ; but the perchloric 
acidis a novelty. Hitherto regarded chiefly as a chemical 
curiosity, it now makes its appearance in the materia 
medica, under circumstances most unfavorable for obtain- 
ing any definite character or classification. In the small 
quantity in which it enters the company of these power- 
ful narcotics, its chance of effecting anything more than the 
peppermint and molasses, is remarkably small. The whole 
thing is, in effect, an absurd sarcasm upon the appetite for 
novelty and complexity, which appetite, in a proportion of 
the medical profession, is industriously catered to by the 
crowd of nostrum — or rather money — makers, who are so 
easily found in the rauks of all sciences and professions. — 
American Med. Time*. 



1861.] Relapsing or E rr< ni /■' L69 

\rrent Fever. By Dr. Tweedie, Physi- 
cian to the London Fever Eospital. 
Relapsing or recurrent fever 1ms been thought by some 
to resemblethese*«Weor sweating fever of Normandy and by 
others the yellow fever of the West Indies. Pr. Wardef] 
say 8: "There were undoubtedly some considerations which 
led to the supposition that the epidemic relapsing fe 
bore resemblance to the suette, or sweating fever of Nor- 
mandy. In a few instances, though these were of rare oc- 
currence, the epidermoid tissue was raised into vesicular 
eminence, varying from the size of a millet seed to the sec- 
tion of a small pea, these vesicles containing a transparent 
fluid, and quite unattended with any areolar blush. On the 
third day they become shrivelled and opaque, and desqua- 
mated in thin, furfuraceous scales. From the occasional 
presence of these bullae with other more logical characters, 
some degree of similarity certainly was manifest between il 
and the suette. There were physicians who endeavored to 
show its near alliance to the yellowfever of the West Indies 
— indeed gave it as their opinion that, in some respects, 
there was a positive identity between the two, only that the 
epidemic prevalent in this country had become greatly 
modified by climate and other circumstances calculated to 
alter its general features. When we take into consideration 
the usual number of yellow eases, together with two or three 
cases of less important correspondent symptoms, we are 
compelled to admit thatthe assertion is not wholly unfound- 
ed. Xo trace of its importation into Scotland, however, 
could be found, which has generally been the ease where 
yellow fever has been communicated from one country to 
another." 

Relapsing fever has always appeared to the author to be 
a form intermediate between the continued and periodic, 
but having a more close analogy to the latter. lie has been 
led to this view by considering the suddenness of the inva- 
sion, the abrupt termination of the symptoms after a defin- 
ite period by copious and apparently critical sweat, the in- 
terruption of the convalescence by a similar, though shorter 
paroxysm, or it may be paroxysms of nearly certain dura- 
tion, and a final abrupt cessauouof the disease generally af- 
sweating. Even in the more sevej -. ii 

which there was gastric disturbance with jaundi ! oc- 

casionally cerebral symptoms, the resemblance to the ma- 
lignant or pernicious periodic fevers, more particularly those 



170 Relapsing or [February, 

included under the bilious remittents of tropical climat* 

striking. 

Symptoms and 'progress. — In relapsing fever the invasion 
Is sudden. Thepatient, previously in good health, without 
warning, is seized with a feeling of indisposition, complain- 
ing of chilliness or shivering, acute headache, Languor and 
lassitude, Bevere muscular aching and arthritic pains. The 
appetite fails, the skin becomes hot and dry, the tongue 
white, the desire for fluids cosntant, and the urine scanty 
and high-colored. Towards evening the symptoms are ag- 
gravated ; the night is passed either in restless agitation or 
snatches of unrefreshing sleep. Occasionally the heat of 
the skin is relieved by irregular Bweating,but still the other 
symptoms suffer no diminution. Vomiting of bilious fluid, 
often accompanied with pain at the epigastrium, is an early 
and nearly constant symptom. It may occur in the first or 
primary fever only, or it may come on in the relapse also. 
A.s the disease progresses, the patient becomes more pros- 
trate and disinclined for bodily or mental exertion, the 
pulse more rapid and tense, the tongue more thickly coated. 
the bowels constipated, the muscular and arthritic pains 
more acute ; and the nights are passed in restlessness and 
wakefulness, unless the nervous system be calmed by the 
aid of opiates. 

About the third day a marked remission of the symptoms 
is often observed ; but whether there be a remission or not, 
at a period varying from three to seven days — more com- 
monly on the fifth day — a copious general sweat breaks out 
and almost immediately afterwards the fever vanishes, leav- 
ing the patient unexpectedly free from the painful Symp- 
lon is with which a few hours previously he had been har- 
assed. Dr. Cormack, who watched the phases of this sin- 
gular disease, tells us that the change for the better was 
often sudden and complete, thepatient one day moaning 
and groaning in pain, and the next at his ease and cheerful. 
complaining only of hunger and weakn< 

This apparent convalescence, however, is not of long du- 
ration, for when the patient and his medical attendant rea- 
sonably conclude, from the favorable change that lias oc- 
curred, that the fever is at an (Mid. and that time only is re- 
quired for complete restoration to health, a sudden and un- 
lo >ked for recurrence of the pre aptoms takes place 

This relapse happens at Borne period between the twelfth 
and the twentieth day (from the beginning <*\' the disease), 



1861.] irrmtFi 171 

oe on orabout the Beventh after thecrisis, and without appar- 
ent cause or indiscretion on the part of the patient The 
relapse is indicated by the same symptoms as the primary 
fever — rigors, headache, muscular aching, ho1 skin, thirst, 
quickened pulse (the rapidity being o\' often disporportion- 
ate to the other symptoms) coated tongue, and Loss of appe- 
tite. 

After a few daya — two, three, lour or five — this Becond 
attack suddenly ceases after a profuse sweat, and the patient 
becomes a second time convalescent. The return to health 
is comparatively rapid and complete in the young and 
and vigorous, but in the aged, and especially in those who 
have been previously in indifferent health, the strength is 
more slowly gained. 

Nor does the mildness or severity of the relapse appear to 
he influenced by the previous attack; for it has been ob- 
served that the symptoms of the second are sometimes more 
mild, and at other times more severe, than those of the 
primary fever. In some instances, for example, in which 
the first attack was by no means severe, the second has 
been characterized by delirium, deep jaundice, violent purg- 
ing, and other grave symptoms. Such cases are, however, 
immon, 

metimes. again, a second but mild relapse takes place, 
generally about the twenty-first day: and I have already al- 
luded to the circumstance, that patients have suffered thi 
four, and even live separate and distinct attacks. Such 
frequent relapsinu-s have been seldom noticed in the epi- 
demics in England. 

Other anomalies are/jn some instances, observed. Thus 
the symptoms of the relapse, instead of appearing suddenly, 
come on gradually and insidiously ; or, instead of the ordin- 
ary well-marked progress of the symptoms, there may b< 
only Blight acceleration pulse, and a little increased heat of 
skin, to mark its occurrence ; occasionally, in place of the 
abrupt termination of the attack by sweating, the crisis ha-' 
apparently been connected with some other evacuation, 
such as hemorrhage from the nose, diarrhoea, or the n 
trual discharge. In some on the other hand, in 

which the ordinary symptoms of the first attack have b 
well marked, there has been no relapse, nor anything a] - 
recurrence. 
There appears, too, to be n greater tendency in relapsing 



172 Relapsing or [February, 

fever than in other acute diseases in pregnant women to 
abortion or premature delivery. 80 invariably, indeed, 
according to Dr. Wardell's experience, did this happen. 
that throughout the whole duration of the Edinburgh epi- 
demic — a period extending over at least fourteen or fifteen 
months — ho never discovered even a solitary instance of the 
impregnated uterus not expelling its contents; and the 
statements of others, whose opportunities of observing this 
fever were equally ample, confirm this statement. The same 
tendency to abortion was observed in the patients received 
into the London Fever Hospital. 

The relapsing fever sometimes, however, assumes a more 
severe character, the aspect of the symptoms from the com- 
mencement indicating a much more serious disease. The 
rigors are violent; the heat of the skin is intense; the 
heart's action depressed, indicated by the softness and com- 
pressibility of the pulse; the patient complains of extreme 
prostration, and feelings of exhaustion or sinking; there is 
often incessant vomiting of bilious fluid, accompanied with 
a more or less deep-jaundiced appearance of the skin, 
though the evacuations exhibit no deficiency of bilious ad- 
mixture, but the urine is generally loaded with bile. 

In some cases, sudden collapse takes place — the pulse be- 
comes rapid and feeble; the skin universally cold, more 
especially the hands and feet; the face livid ; partial or com- 
plete unconsciousness succeeds; the sphincter become re- 
laxed, and death takes place after a few hours. 

The diagnosis of relapsing fever may be given in a few- 
words. 

It differs from other forms of fever — 1, by its sudden in- 
vasion; 2, by the short duration of the primary fever, and 
its termination by an evident crisis ; 3, by the almost uni- 
form occurrence of a relapse — occasionally a second or third : 
4, by the unusual number of cases with more or less jaun- 
dice or yellow color of the skin, accompanied often with 
gastro-enteritic and gastro-splenic symptom ; and 5, by the 
absence of characteristic rash. 

The small mortality, or death-rate, of relapsing fever 
shows its comparative mildness, being about one in twenty - 
nve, or under 3.9 per cent. 

Anatomical characters. — This singular form of fever, if un- 
complicated, seldom proves fatal. In examination of the 
fatal cases, no special lesion, so invariably present as to in- 



11.] Recurrent 1 

dicate the anatomical character of the disease, has been dis- 
covered. 

The blood lias in some cases been found throughout the 
body in a fluid state indicating a decrease in the normal 
amount of fibrin. lam not aware that it has been subjected 
to further chemical analysis. 

The brain, with the exception of a moderate amount of 
sub-arachnoid serosity, and perhaps an increased quantity 
in the ventricles, shows no remarkable deviation from a 
normal state. 

The heart and lungs exhibit no evidence of disease. 

The liver has been found enlarged from congestion, and 
the gall-bladder more than usually distended with bile ; and 
what may be considered worthy of being noted, no obstruc- 
tion to the free escape of the bile through the ducts, even 
in cases in which the jaundice had been well marked, can 
be detected. 

Xo disease in any portion of the alimentary canal is dis- 
coverable. 

The spleen exhibits the most marked and constant lesion, 
more especially as to the size or volume. It was noticed 
in a considerable number of cases in the Edinburgh epidem- 
ic, in 1*43-4. Dr. Wardell saw several in which this or- 
gan was three or four times larger than natural ; in one, it 
weighed twenty ounces. This splenic enlargement was ob- 
served by other physicians during the same epidemic; 
tli us. in a fatal case examined at the London Fever Hospi- 
tal, the spleen weighed thirty-eight ounces. It thus appears 
that, this organ is occasionally larger in relapsing than in 
cither typhus or enteric fever. 

Urea has been found in the blood. In a fatal case re- 
led by Dr. AVardell, in which the patient fell into a state 
iipor twenty-four hours before death, crystals of nitrate 
of urea were discovered in considerable abundance in tin- 
blood taken by cupping, ordered for the relief of the cere- 
bral symptoms. 

It thus ap] >ears that, with the exception of splenic enlarge- 
ment — a lesion common to the other forms of fever, con- 
tinued and periodic — there is no special lesions found after 
death in relapsing fever. If structural changes is discover- 
ed, they are to be regarded as accidental, and due to some 
ondarv or intercurrent affections. — Laneet. 



174: Cretinism. [February, 

Cretinism. 

In a former number oi the London Medical Review we ad- 
verted to the increasing spread of one of the most hideous and 
loathsome diseases which afflict mankind, viz : leprosy. It is 
now our object to draw attention to another equally distressing 
malady, which owing to its nature and close affinity to 
scrofula, affords many points of interest for consideration, al- 
though, fortunately we may claim an almost total exemption 
from it in this country. 

The most common continental seats of the affection are the 
hern provinces of France, and certain districts in Switzer- 
land, and in the north of Italy. The inhabitants of the two 
great chains of mountains, the Pyrenees and the Alps, where 
it has existed from a remote period, suffer most severely. In 
addition to these European localities, China, Syria, Northern 
India, the bleak shores of the Polar Seas, and some parts of 
the continent of America, furnish frequent instances of cretin- 
ism, and the kindred disorder, goitre. 

The causes and treatment of cretinism are so amply discus- 
sed in most systematic treatises on medicine, although the 
etiology of the affection has not yet been clearly solved, that 
we shall not dwell upon this portion of the subject further 
than in making the consolatory remark that it is, to a large 
extent, amenable to judicious treatment and removal from the 
affected districts, a fact which is sufficiently evidenced by the 
circumstance referred to by Dr. Watson, in his lectures, that, 
ont of the total number of patients admitted into Dr. Guggen- 
buhPs special hospital for cretin children, during twelve years, 
one-third became perfectly restored to health and reason, while 
the rest were improved in mind and in body. 

The statements of most recent French and Italian writers 
upon cretinism tend to show that it is upon the increase, and 
we. therefore, in accordance with the sound principles enun- 
ciated in the aphorism, Venienti succurrite morbo, and in the 
hope of obtaining information upon the point from medical 
gentlemen residing in those districts of this country in which 
fcre may be said to be endemic, publish, at full length, the 
iiication of cretinism, given in a recent memoir 
\L Morel, avIio has paid considerable attention to the sub- 
We need scarcely permise that numerous modifying 
a dependent upon the climate, mode of living and cus- 
tho locality, must determine, more or less, marked 
diffi rences in the character of the disease. 

First Division. — Goitrous individuals with symptoms of 



II.] Mm. 

cachexia and of mental dulness. All the cduntries which con- 
tain cretins, joitrous individuals, and no example can 
be given in opposition to this fact. Nevertheless, goitrous 

>ns do not necessarily become cretins, and goitre docs nor 
form an indispensable accompaniment of cretinism. When I 
have visited districts where goitre is endemic, such as certain 
Localities in Meurthe and Moselle, people have not failed to 
tell me that I should find no cretins there, but an attentive 

rvation of tacts has proved to me that goitre is the start- 
ing point of cretinism. In countries where goitre is endemic, 
we may already distinguish the iirst lineaments of cretinism 
in the appearance of individuals ; the lips arc thicker, the 
nose is rounded and slightly flattened, and the zygomatic 
arches are more prominent, hi other cases the respiration is 
sibilant, difficult and sometimes stertorous ; the cretinous 
cachexia begins to show itself. In these same countries when 
there is a complication with malarious elements, the degene- 
ration is displayed in an aspect which approaches still more 
closely to cretinism ; we observe the lymphatic temperament, 
hernias, tumid abdomen, mental dulness, &c. 

There is a close connection between the goitrous and the 

'ions epidemicity, the goitrous being only the iirst stage 
of the cretinous, and it is very rare that we find actual cretins 
where there are not also goitrous individuals. 

;ond Division — Cretins possessing the power of continuous 
reproduction. — The cretins in this second division are capable 
of continuing their species, and many of them marry. They 
have the ordinary appearance of the healthy individuals of 
their country, but begin to be distinguished from them by a 
more faulty conformation of the skull. They often have the 
head flattened at the posterior and upper parts, whilst it is 
considerably enlarged laterally. They present a greater de- 
velopment of the zygomatic arches ; the nose is more flatten- 

the lips are thicker, and the chin is square : the distance; 
fmm the root of the nose to the commissure of the lip 

. the bones are coarse and large, and the thickened 
articular surface are unsymmetrical ; there is generally a dis- 
proportion between the upper and lower extremities. Goitre 
- a characteristic of the individuals in this division. 
• cretins never surpass a certain intellectual limit ; their 
'i and embarrassed. 
Third Division. — The cretins in this division may be divided 
into two The first is composed of those who can, 

although only with difficulty, propagate their Bpecies ; the 

nd. of those who are sterile. 



i7<; ('/■etinism. [February 

First Seel ion Cretins limited in their fecundity. — These 
are remarkable on account of the Bmallness of their stature, 
which makes them appear like stunted dwarfs, and by their 
uncertain and wavering gait. Their hair is very dark and 
bristly, their skin is black and rugged, and probably contains 
more pigment than in the normal condition. The f imdamental 
principles of cretinism are strongly shown in the superior and 
posterior flattening of" the head, and in the exaggerated devel- 
opment of the temporal portion and of the zygomatic arches. 
The nose is small, rounded and crushed down at its upper 
part, the lips are thick and coarse, the tongue is hypertrophi- 
cal, the flesh is soft and flabby, and the chest is narrowed. 
Menstruation is tardy and irregular, and is in proportion to 
the limited fecundity of these degenerate beings, who produce 
only an abortive offspring, or scarcely living children. 

Second Section — Sterile Cretins. — The external appearance 
is the same as in the preceding ; the stature and physical con- 
stitution are also identical. In both sections the upper eyelid 
is disproportionately elongated, void of contractility, and over- 
Laps the eyeball in an ungraceful manner; the tongue is 
thickened, and the speech cmbanasscd. The difference arises 
in the internal characteristics. The organs of generation are 
either atrophied, or only sparingly developed. Many of the 
cretins in tnis class have no second dentition; their average 
length of lie is limited, and at twenty-five or thirty years of 
age they present symptoms of decay. Goitre is very rare in 
this division. 

Fourth Division. — Cretins presenting complex degenera- 
tions.-— In all countries where cretins exist, we may observe 
individuals who appear to deviate from the ordinary type of 
inism by a grouping of frequently very variable peculiari- 
ties. Amongst them we find all the varieties of misshaped 
heads, from the prcternaturally small head up to the hydro- 
cephalic, and also many goitrous persons, deaf-mutes, and in- 
dividuals suffering from single or double hernia, or afflicted 
with diseases of the hip, or congenital dislocations. The ano- 
malies shown in the organs of generation are remarkable ; in 
fact, in contradistinction to the sterility of some, we mayper- 
ceive a development of the genital organs in other.-. 

Fifth Division — Deformed Cretins.— These cannot walk. 

bu1 drag themselves along, or remain fixed to the place where 

!. They only present to the view a shapeless 

j; their eye- are blear and lustreless, and the saliva drib- 

between their thickened lips; their skin is black and 

and their hair bristly ; sometimes they have enor- 



18G1.] itment of Skin D 177 

mous goitres. The speech, which is rudimentary and incom- 
plete in the third and fourth division.-, is replaced in this by 
inarticulate, wild cries; and the perceptive facilities are 
obtu- \don Med-. ./*• view. 



On the Employment of Chloride of Zinc in the Treatment of 

Skin 1> 

After having for a considerable period employed the chlo- 
ride of zinc, exclusively in its property of a caustic, in cs 
of Lupus and some analogous cutaneous affections, Dr. Yeiej, 
of Caustadt, has extended its use to the treatment of chronic 
leers of the legs, of sycosis, of chronic eczema, &c. 

He uses either an alcoholic solution (composed of equal 
parts') or an aqueous solution, consisting of ten parts of chlo- 
ride of zinc, and ten parts of hydrochloric acid to 500 parts; of 
water, or the solid caustic moulded by fusion into cylindri 
sticks. 

In tins last form. Dr. Veiel propose-, like all other surgeons, 
to produce an energetic caustic action. He has especially had 
recourse to this methad of treatment in thirteen cases «<f lupus 
with most satisfactory result-. His method of applying it is 
thus: — When the epidermis roved and replaced by 

more or less thick crusts, these are detached by mean.-, of 
emollient poultices: in case the epidermis is intact, the chlo- 
ride of zinc, is applied until the skin is previously denuded by 
the use of a blister; by means of a pointed pencil of chloride 
of zinc, he penetrates deeply into the hypertrophied tis- 
those which are surmounted by tubercles, in such a 
manner as to apply the caustic to all the affected parts, and 
this application is continued beyond the diseased textures 
to an extent of a few lines. All around the lesion the suri 
which is riddled with holes, somewhat analogous to a hoi 
comb, exudes, immediately after this operation, a sangnino- 
lent blackish liquid, and subsequently a serosity of a fighter 
color, which, at the end of some hours, harden- into a smooth 
and firm crust. Towards the third and fourth day a & 
purulent discharge raises up the (-di:^ of this crust, and 
should be afforded to it by a few puncture-. A hour the sixth 
or the eighth day the civ rated at its edges, ami can be 

detached by the application of poultices continued daring 
some days. It is rarely neco-sarv to renew the application of 



17* Treatment of False Articulations. [February. 

the caustic more than three times, except in cases where the 
morbid tissue possesses unusual thickness. When the suppu- 
rating surface which succeeds upon the fall of the eschar no 
longer presents any granulations of a bad nature, aud becomes 
raised to the level of the healthy parts, it is covered with 
poultices during some days, and then lightly touched with the 
alcoholic solution of chloride of zinc every three or four days. 
When the edges begin to contract, the aqueous solution is 
substituted lor the alcoholic, and continued occasionally until 
the cure is completed. The time requisite for obtaining tlii^ 
result rarely exceeds three or four months. 

Dr. Veiel employs the alcoholic solution of chloride of zinc 
with advantage in the treatment of inveterate eczema of the 
eyelids, of the lips, of the genital organs, and about the anus. 
The aqueous solution sometimes cures cases of eczema solare, 
or eczema impetignodes, which have resisted all the usual 
remedies. The alcoholic solution readily removes the indura 
tions which occasionally remain as a sequel of psoriasis on the 
neck, the back and the thighs ; it is only necessary, in order 
to apply it in these cases, to be careful in removing the scales 
which cover the indurated parts. 

There is a form of psoriasis palmaris accompanied by warty, 
painful indurations, which only gives way to the solid chloride 
of zinc, which is employed after having perfectly removed the 
epitlermis by means of a blister. 

The aqueous solution is very useful in cases of sycosis . 
iavus. — Zeitschrift der GeselUcJwft ckr Aerzte su W' 



2 he Treatment of False Articulations l»i Periosteal Autopktshj. 

The method by which M. Jourdan has given the name 
Periosteal Autoplasty consists essentially in the oblique resec- 
tion of the two fragments between which the false joint has 
been formed, after having detached the periosteum, either 
upon the two portions, or upon the upper fragment only ; one 
or more clefts are then made in the periosteum, into which 
-lips of the periosteum covering the other fragments of bone 
are inserted, and the lips of the clefts are brought together by 
sutures, or the delicately constructed forceps called serrefinc*. 
edges of the wound in the soft parts are then incomplete- 
ly brought together; and, finally, the limb is maintained in a 
of perfect immobility, for as long a time as is necessarv, 
in an appropriate apparatus. 



1861.] Innalation of Chloroform, ITS 

This operation has fully realized M. Jourdan's expectations 
in the eases in which lie has tried it, a circumstance which 

will be fully understood if we bear in mind the important part, 
which is played by the periosteum in promoting the union of 

a bone after its fracture. 



7%. Chief Soura of the Danger Resulting from th* Inhala- 
tion of Chloroform. 

In a recent communication made to the Academy of Sci- 
ences at Paris, M. Jeaucort stated that his observations and 
researches had convinced him that upon every occasion when 
the patients breathe freely during the inhalation of the chloro 
form, ansethesia was produced readily and quickly, and that he 
was also of opinion that if nothing offers any obstacle to the 
regular and continued play of the respiratory current, not 
only does the inhalation not present any danger, but in addi- 
tion, it is exempt from what have been called the physiologi- 
cal effects of the chloroform, or, at least, these are less marked. 

Hut the respiration may easily become changed during the 
inhalation, especially at its commencement, and it is in this, 
change that the danger resides ; if any obstacle interferes with 
the continuity of the respiratory action, the anaesthesia ccase^ 
to lie really producible, and the effort to produce it gives rise 
;«• various accidents, more or less to be feared. The interrup- 
tion to Yvqo respiration may arise from different causes de- 
pending either upon the operator, as in cases where he admin- 
isters the chloroform either too rapidly or in too great 
abundance, or upon the patient himself, where he voluntarily 
ceases to respire, and even resists the injunctions which are 
made to him upon that, head ; the immediate result is the 
modification of the quantity and quality of the air contained 
in the lungs; the secondary result is variable, and may occa- 
sion the production of a transient, slight sense of suffocation, 
or of fatal asphyxia. The explanation of the latter phenome- 
na may be found in the double source from which they arise, 
viz : the sudden deprivation of respirable air, and the poison- 
ing resulting from the gaseous mixture retained in the lung-. 
M. Jeaueourt considers that we may thus account for the 
occasional fatal effects which have attended the employ- 
ment of anaesthetics, and which have; been doubtfully referred 
yncope ; the default of inervation of the heart appearing !<• 
result from the complex character of the asphyxia itBelf. 

An attentive examination into the causes of these accident- 



180 Dysmenorrhea and Sterility. [February, 

furnishes an indication of the means which it is necessary to 
adopt for the purpose of obviating them, and the rules upon 
this point may be comprised within the following general for- 
mula : In order to avoid all chances of accident in the in- 
ducement of anaesthesia, it is necessary to watch carefully that 
there exists an unfailing renovation of the air contained in the 
lungs until the invasion of sleep. If the respiration is carried 
on up to this time in an equable and continuous manner, it 
will not be interrupted afresh. 

Elsewhere, M. Jeaucourt who recommends the employment 
of chloroform in most cases of labour, and who considers that 
it diminishes the frequency of puerperal complications, states 
that the amethesia, under these circumstances, ought not to be 
pushed further than the abolition of sensibility, and the relaxa- 
tion of the upper extremities. The labour loses its ordinary 
gravity, and is accomplished in a normal manner, without any 
risk even of suspending or abating it, if we take the precaution 
of commencing the administration of the vapor at the moment 
when the os uteri is completely dilated. 



Causes and Treatment of Dysmenorrhcea and Sterility. By 

Beverly Cole, M. D., Professor of Obstetrics, &c, in the 
"Medical Department of the University of the Paciiic, San 
Francisco. 

At a recent meeting of the San Francisco Medico-Chirurgi 
cal Association, I made a verbal communication upon the 
subject of Dysmenorrhea, (as met with in this country) in 
which the causes and treatment were discussed. I took the 
position that the immediate causes were, in a majority of 
eases, of a mechanical character, and. consequently, require a 
treatment essentially surgical. 

1 now propose, briefly, 1st, To show the connection between 
Dysmenorrhcea and the subject of this paper, viz: Sterility ; 
and, 2dly, The identity of the treatment indicated in the two. 

It must be borne in mind that Dysmenorrhcea is a vague 
term, which obstetricians have applied to a symptom of vari- 
ous conditions; that, indeed, by tin's term, is meant painful 
no ftstr nation, arising from whatever cause it may, such, -for 
instance, as a neuralgic diathesis, congestion of the womb, in- 
flammation of its lining membrane, membraneous exfoliation* 
and mechanical obstructions of the cervix. Excepting the 
neuralgic diathesis ami inflammation, the others may all !>♦• 



L861J DywMnorrhaa and SteriUty. 18] 

included under the general head of Mechanical Causes, and 
those are, by tar, the most frequent in this country. Thai 
congestion should be considered a mechanical cause, may, al 
first appear Btrange, yet, upon reflection, it will be seen thai 
its operation or influence upon the catamenial flow, attended. 
is, with swelling o\' the cervix, at the expense of its canal, 
thus oftering a barrier or obstruction, is essentially of a 
chanical character. 

The causes above enumerated will, at once, be recognized 
by the observant practitioner, as operating, in the majority of 
-. in the production of Dysmenorrhcea. Now, if eonges- 
, membraneous exfoliations, and a narrowness (congenital 
or acquired) of the canal of the cervix produces painful men- 
struation, through the mechanical obstructions which the) 
offer to the flow, the proposition is tenable that the same ob- 
struction will pro-cut itself to the admission of the male mah 

into the cavity of the uterus, and, hence, conception under 
such circumstances, is a physical impossibility. 

In either the one or the other of these conditions, namely, 

Dysmenorrhcea or Sterility consequent upon the mechanical 

can- umerated, the indications, in treatment, must be 

same. No one would hope to cure a painful menstruation 

ing from congestion, without directing bis treatment to 

that cause, endeavoring to unload the turgescent vessels of the 

lb, and thereby relieve the patient. This condition being 

and the canal restored to its original capacity, 

in tin- act of coitus the sperm is permitted to enter the uterus, 

takes place. 

The Bllbjectof this, condition may be either of the *anguin<' 

i the nervous temperament. In the due case, the patieni 

; - plethoric and robust in appearance, but usually indolent, 

raking little exercise, subsisting upon a rich diet, rendered the 

tnulating by the free use of the various condiment-, 

and the drinking of wines, &c As the result of this modi 

lite, the chylo-poietic viscera are kept in an over-excited state, 

tiie venaportarum and liver are over-tasked, and a general 

venous congestion of the whole abdominal viscera i- present, 

including the rectum and uterus ; hence, in these cases, we are 

also liable to encounter hemorrhoids. 

The c :* treatment indicated in these cases is obvious- 

Alteratives and purgatives are to be administered for several 
days preceding the expected menstrual period, with the view'' 
ofexcitin tions and unloading the vessels, and thus 

relieving the ted state of the womb. But, sometimes, 

it occurs that (this condition having continued some til 



132 Dysmenorrhea and Sterility. [February, 

there will be a permanent construction of the cervical canal, 
the same as would result from congestion or inflammation of 
the urethra. In these cases, as in stricture of the urethral 
• •anal, you should dilate the stricture at the same time that the 
treatment above named is followed, and have the patient 
placed upon a prescribed diet. 

[t is proper that inflammations, when encountered, should 
be treated as under other circumstances ; but often, when it is 
chronic, and confined to the canal, the use of the bougie, in 
dilntation, will be sufficient to excite a healthy action in the 
part and cure the case, without any other specific interference. 

In that form of Dysmenorrhcea, known as ''Membraneous 
Dysmenorrhea," we usually meet with the same general and 
local conditions as just described, with the exception that the 
patient, during the "period," passes a membrane from the in- 
terior of the uterus, some times entire, retaining the form of 
the cavity of that organ — at others, in shreds : in either case, 
she suffers intensely, which is due to the transit of the exfoli- 
ated membrane through the constricted cervical canal. The 
treatment indicated in this case is the same as in the simple 
form of Congestive Dysmenorrhcea. 

Many cases of this character, in married women, have fallen 
under my observation; iti the majority of which, the patients 
have consulted their physicians on account of barrenness, 
rather than for relief of their sufferings ; and in many of them 
which had been considered hopeless, so far as possibility of 
conception taking place was concerned, the women have, after 
dilatation was effected, conceived and borne children at the 
lull term of gestation. 

But it is in that form of Dysmenorrhcea which authorities 
denominate "Mechanical Dysmenorrhcea," or rather Dysmen- 
orrhcea arising from mechanical causes, in which the treat- 
si icut by dilatation should be expected to accomplish most. 

Now, the immediate causes of this form of disease are vari- 
ous, consisting, usually, of stricture at the external os, within 
the canal, or at the internal os, and to these is added tumors. 
occupying the canal. 

In these cases, there may or may not be congestion pre- 
sent, the patient complaining merely of excessive pain during 
tin.- whole menstrual period, with bearing down, and sickness 
a[ the stomach. She tells you that it is necessary for her to 
take the bed. whenever she menstruates, her sufferings are so 
exquisite. Upon examination with the speculum, it will be 
discovered, possibly, that if an external os exists, it is difficult 
to discern it, and that, in passing the uterine sound over the 



I.] Dyt rhcea and Sterility. L83 

cervix, aa presented through the speculum, a mere depression 
or dimple marks the ^p<>t whore the month of the womb should 
be. It' the sound is now pressed firmly upon this point, po 

bly the instrument will enter the canal, or, as sometimes 
occurs, you will timl it necessary to make a small incision be- 
fore the instrument will pass. 

In otlu in, there will he no unusual appearance 

about the external os, hut, on passing the sound beyond, into 
the canal, it will he suddenly arrested in its progress, by ;i 
stricture, either in the eanal itself, or at the internal os. 
When the instrument is arrested at the internal os, it may be 
due to a simple stricture of that part, such as described of the 
externa] • a retroversion of the body and fundus of the 

insider the shape of the uterus, its great Ha 
bility to displacement, particularly backward, and the. effect 
of this retroversion upon the shape and direction of the cervi- 
cal canal, we can understand how this character of trouble 
must be productive, more or less, of stricture at the point at 
which the organ i> doubled upon itself; and, further, that bo 
il continues, so long must the patient be the subject of 
Dysmenorrhcea, and, if married, be disqualified for the per- 
formance of that function upon the consummation of which 
depends, in many instances, the happiness of both husband 
and wife. 

To illustrate tic- effect of Retroversion upon the shape and 
direction of the cervical canal, it will be but necessary to take 
►11 of cylinder of paper, bend it on itself, and it. will bo 
that the two sides of the cylinder will approach each 
otht to narrow. \<:vy materially, the caliber of tin- 

tube. The same effect, exactly, is produced on the cylindrical 
the cervix, in backward displacement of the womb. 

1 am . i viction, from an extended observation in 

this cases, that no one cause of Sterility is so common 

in women, otherwise healthy, as stricture of the cervix, 
and, in a large proportion, this is dependent on Retroversion. 

A- ha a ted, the treatment, in these ease-. ; 

n'all al in its character, and consists in dilating the 

strictured part, whether it be of the simple variety or due to 
Ret] In the latter case, however, this treatment it- 

indicated only after the ordinary means for righting the ut< 
have failed. 

I can:: propria * Me medical a«l\ i 

-ion of this organ, dooming hi« 

pati- spair, by concluding that it will be im- 

lier to ever become a mother ; or, at least, until 



lS-i Dywrienorrhasa and Sterility. [February. 

he has made every effort to overcome the constriction, and 
thereby cure the case. Vet this is the daily practice of many, 
and women are too frequently rendered, through these hasty 
opinions on the pari of their physicians, the subjects of cruelty 
or desertion ; when a well-directed course of treatment might, 
in a very short time, overcome her difficulties, and bring 
comfort and happiness both to herself and husband, when per- 
haps hope had seemed to have faded. 

In my remarks before the Medico-Chirurgical Association, 
already referred to in this paper, and which will be found in 
the report of the transactions of that body, the particulars of 
treatment in these eases were given, and consists, 1st, in the 
introduction of a piece of compressed sponge to the point of 
stricture, previously guarding it with a ligature, by pulling 
upon which it may, at any time, be removed. This is allowed 
to remain intact for twenty-four or forty-eight hours, when it 
may be removed and replaced by a fresh piece, which may 
usually be carried higher than the first. When the dilatation, 
through this means, has been carried sufficiently far, the 
Knghsh elastic bougie is to be substituted. This should be 
introduced at least once in forty-eight hours, and at each ope- 
ration one a size larger than was used previously, should be 
selected. 

The daily or tri-weekly introduction of the bougie must be 
continued some weeks, (as in the treatment of an urethral 
stricture) or until the part ceases to contract (at least to any 
extent) ; when, not unfrequently, to the satisfaction of patient, 
friends and physician, the object of their solicitude is attained, 
and the woman finds herself, in a short period, likely to be- 
come a mother. 

The foregoing lias been written rather with a view of call- 
ing the attention of practitioners to the frequent causes of Ste- 
rility in this country, and the importance of surgical interfer- 
ence in the class of cases referred to, than to establish any 
claim to originality in their treatment. 

In conclusion, I would remark, that in many of the cases 
which have fallen under my care, I have entirely failed in the 
attempt to use the compressed cones of sponge kept in the 
stores for sale, and made after the suggestion of Prof. Simp- 
son, of Edinburgh. The difficulty has been that they were 
much too large, and, therefore, I prepare my own tents, as 
follows : Select a tine piece of cup or "surgeon's sponge," and 
lui\ ing melted a quantity of blanched beeswax in an ordinary 
•1, the sponge is to be dipped into the liquid wax, and im- 
mediately placed between two smooth surfaces (board or mar* 



1861.] On Union of Fractv/rea in Syphilis. 185 

ble) and a weight applied sufficient to compress the sp< 

and free it from the surplus wax : in a few minutes it will \>^ 
ready tor use. By this process, a ilat cake of compressed 
sponge is obtained, from which pieces may be out, of such 
size and at such times as required. The piece to be intro- 
duced should be well oiled and carried to the point of stric- 
ture by means ot a long and Blender forcep. 

Reports of cases, illustrative of this general plan of treat- 
ment, will be furnished for the next number of the Medical 
Pre.—. 



On ttu Union of Fractures in Mercurio-SyphUitic P 
By Prof. Sigimmd, of Vienna. 

A young man in the Hospital of Vienna, while undergoing 
treatment by means of mercurial inunctions, on account of 
syphilitic ulcers of the skin and affection of the bones, met 
with an injury : as the result of which, he sustained an oblique, 
fracture of the humerus, about an inch below the tuberosities, 
accompanied with considerable contusion of the soft parts, and 
extravasation of blood. Cold applications were made use of, 
and the arm was put in splints, in the usual way ; no unpleas- 
ant symptom occurred, and consolidation of the fractured 
bone was complete on the thirty-third day from the receipt of 
the injury. Around the united ends of the bone there was ;i 
very considerable bony swelling ; in other respects, the form 
and direction of the limb were quite normal. On the day 
when the fracture was sustained, the patient had undergone 
the ninth of a series of fifty mercurial inunctions : this treat- 
ment was not discontinued, but was carried on uninterrupted- 
ly until the disappearance of the syphilitic symptoms. 

Prof. Sigmuna has met with five case- where syphilitic pa- 
tients have sustained fractures while undergoing mercurial 
treatment. The bones broken in the were, the righl 

radius (twice.) the left fibula, the left clavicle, and the 
humerus. Complete union of the fractured bone had occurred 
on the twenty-third, the twenty-sixth, the thirtieth, the twenty- 
second and thirty-fourth day- respectively. In all the 
the result- were satisfactory. In none of tin- was the 

mercurial treatment discontinued, nor was any change mad- 
in the diet of the patient 

It is well known that in syphilitic patients no important 
viation from the normal course occurs in the heal in 



L86 Phagedenic Ulcers. [February, 

of the soft parts. Prof. Sigmund has had occasion to perform 
numerous and various operations in syphilis, and his observa- 
tions entirely confirm the general opinion. 

Prof. Sigmund does not believe that the bones of syphilitic 
patients, whether or not they have been treated with mercury, 
are more readily fractured than the bones of those who have 
not had syphilis, and have riot taken mercury. — Boston Med. 
and Surg. Journal^ 



Phageden it ■ Ulce rt . 

Phagedenic, from the Greek word phago, I eat, is much 
more expressive, of the literal meaning of the word whence it 
is derived, than most ether medical terms derived from the 
Latin or Greek. 

The margins of a Phagedenic Ulcer have a strong resem- 
blance to a worm-eaten substance, or the surface ot a sub 
stance upon which a mouse has been gnawing. 

What is a Phagedenic Ulcer? The Phagedena Gangreno- 
sa, or Hospital Gangrene, so common in some of the European 
cities, is never known on this coast. But there is a true 
Phagedenic Ulcer often seen here, attacking the integument 
and subcutaneous cellular tissue, generally about the face, and 
is extremely difficult to cure. Sometimes it attacks the deeper- 
seated structures of the face, as well as of other parts, even 
the tendons themselves, resulting in a most alarming destruc- 
tion of the tissues, without any assignable cause. The fingers, 
for instance, are sometimes attacked, and the bones laid bare 
by the ravages of the disease, in a few days. 

The remedy we have found available, in such cases, is calo- 
mel and morphine, in the following proportion- : 

lv Morph. Sulph. - »i 
llvd. Sub. Mur. 5ii- 

M. 

Sigria. — Apply to the ulcer every day twice. If the con- 
stitutional effects of the morphine become manifest to an 
undue extent, the preparation must be used very sparingly. 

Thisis the only remedy upon which we repose confidence 
in the treatment of the Phagedenic Ulcer of California. — ! 
Francisco Medical J y rcss. 



I860.] Diphtk 1ST 

7% f Diphtheria. 

The Union Medicale has recently published two letters from 
M. Loiseaa and Trousseau on the use of tannin and alum 
locally in the treatment of pharyngo-laryngeal diphtheria. 

M. Loiseau, considering the false membranes, in all cases, to 
be but consequences of diphtheria, and, with the exception of 
croup, rather useful than injurious, provided their putrefaction 
be prevented, again lavs stress upon the beneficial action of 
styptics, and especially tannin; these seem to convert the 
morbid secretions into an imputrescible epidermis, which af- 
fords protection to the denuded surfaces and promotes their 
cicatrization. M. Loiseau performs insufflation of alum five or 
bix times a day, and of pure tannin equally often ; he states 
that a cure may thus be effected in three or four days, on the 
>ame principle, which M. Trousseau adopted in his practice in 
1S2S. A quotation from an articte published on the subject 
in 1833, by M. Trousseau in the Dictionnaire Medical, has 
elicited from the learned Professor a reply which we repro- 
duce, as it explains the changes his views have undergone on 
the efficacy of the medical treatment of diphtheria, and more 
especially of croup. 

"It i> perfectly true," says M. Trousseau, at the date 
September 20th, "that in the epidemics of diphtheria, which 
from 1S18 to 1^2S prevailed in the departments of Indre-et- 
Loire, Loir-et-Cher, and Loiret, the disease of the lances readi- 
ly yielded to frequent insufflation of alum, and to cauteriza- 
tion with muriatic acid or nitrate of silver. It is equally true- 
that, when the complain! was met in its early stages, foe; 
tive days were sufficient to effect a cure, excepting, of course, 
when diphtheria had invaded the larynx. 

"For ten years past, however, diphtheria has acquired in 
Paris and in the provinces a degree of gravity and of malig- 
nancy which it did not, by any means possess thirty years 
ago ; and I declare that it is now a long time since I have 
had the good fortune to see genuine pharyngeal diphtheria 
yield to treatment in four or live day-. Common pseudo- 
membranous angina, or herpes of the fauces may be cured in 
twenty-four or forty-eight hours, but not real diphtheria such 
;i- we too frequently meet with. 

••I resort to the same d au and perform in- 

sufflation into the throat every two hour-, and even e> 
hour, if necessary, alternating the use of equal p mgar 

and alum or tannin. From time to time I brush rather rougnrj 
the uvula and tonsils, before restoring to insufflation, in oi 



188 Treatment of Eruptions around the Anus. February, 

that the medicinal agents may come into immediate contaet 
with the mucous surface, and I consider myself very fortunate 
when, after ten days' treatment, all trace of false membranes 
lias disappeared. 

"In live adults whom, within the last few months, 1 attend- 
ed with my friends, Drs. Bernard, Patouillet and Blond eau, 
the disease lasted nine days in one case, and more than a fort- 
night in the others, and 1 repeat that it would have been 
utterly impossible to use with more persevering energy the 
remedies extolled by M. Loiseau, which I consider most use- 
ful, namely: alum and tannin. 

"Appealing to the testimony of my learned colleagues of 
the Hospital for Infancy, JVI. M. Blache, Bouvies, Roger, Sec, 
and of Dr. Barthez, Iiind their statements are perfectly simi- 
lar to mine, and that they agree with me in thinking that the 
singularly rapid, extraordinary and numerous cures effected 
by M. Loiseau may perhnps be accounted for by his not hav- 
ing allowed himself sufficient time to establish an incontrover- 
tible diagnosis. 

"It is difficult at first, and especially in children, to distin- 
guish genuine diphtheria from pharyngeal herpes; and 
although in doubt I prescribe the local application of alum 
and tannin, I do not flatter myself that I have effected a cure 
of tonsillary diphtheria when, after twenty-four hours, I cease 
to detect in the throat any peculiar concretions.*' 

We are happy to be confirmed by so competent an authori- 
ty, in the remarks we have offered above on the importance 
- >f diagnosis in the appreciation of the various remedies recom- 
mended for a disease the gravity of which, far from subsiding, 
seems rather on the increase, especially when observed in an 
epidemic form. 



Treatment of Eruptions Around the Anus. By J oseph Bell, 
Ksq., Gateshead. — Occasionally Ave see obstinate cutaiieou- 
ulceration surrounding the anus in children. Considerable 
tumefaction attends it betimes, and deep fissures are occa- 
sionally seen. This disorder is probably herpetic, and al- 
most always can be cured with yellow wash. The propor- 
tions being from 1 to 1} grains of hydrarg, bicblorid, to 1 
ounce aq. calcis. The part is to be frequently bathed with 
it, and should the lotion produce pain, it is to be diluted 
with water, and when at rest, a little lint, soaked in the 
lotion is to be applied and left on the part; deobstruents 
being at the same time administered. — Med. Time* J- Gaz. 



1861.] Editorial 180 



EDITORIAL AND HISCELLANEOUS. 



A COMPENDIUM OF HUMAN HISTOLOGY, 
1 . 3Ior el, Professor Agrege a la Faculte de Medicine Je Stras- 
bourg. Illustrated by Twenty-eight Plates. Translated and edited 
by W. H. Van Buren, M. D., Professor of General and Descriptive 
Anatomy in the University of New York, &c., &c. Bailliere 
Brothers. New York : 1861. pp. li«>7. 

Dr. Van Buren and the Brothers Bailliere have certainly rendered 
an important service to the profession iu the translation and publication 
of this valuable work. Our readers must know that we cannot always 
read thoroughly the works which it is our duty to notice as journalists. 
This, however, is one of which we can speak witha personal knowledge 
and we have found it both concise and comprehensive — very interesting 
and advanced to the last hour, of pathological investigation. 

The author, after defining in his introduction the object and purpose 
of the science of Histology, presents us with what we consider a wi\ 
convenient and simple division of the ultimate organic elements : 

D the present state of Science, all of the simple elements of which 
the body is composed may be reduced to one of the following typical 
forms, viz: 1st, Structureless Material; 2d, Cells; 3d, Fibres; 4th, 
Crystalline Substance." 

In accordance with this brief and, at the same time, most philosophic 
itication of the elements, our author proceeds to arrange them iutu 
the several tissues which they arc found to compose, and, to systematize 
Ilia labor, ho divides the work into ten convenient and rather brief 
Chap- 
Chapter I, Cells and Epithelial Membranes; Chapter II, Fibre-: 
Connecting Tissue; Chapter III, Cartilage, Bone, Teeth: Chapter IV, 
Muscular tissue ; Chapter Y, Elements of Nervous Tissue ; Chapter 
VI, Vessels, Arteries, Yeins, Capillaries, and Lyphatics ; Chapter VII, 
Glands : Chapter YHI, Skin and its Appendages ; Chapter IX, Intesti- 
nal Mucous Membrane; Chapter X, Organs of Sen* 

iu the treatment of these several departments, our author is clear, 
. id happy in his illustrations With the description of each tissue, 



190 31iscellaneous. [February 

brief directions are given for the selection and preparation of specimens 
for microscopic examination which is, in itself, a most valuable feature 
of the work. The book is evidently preparedfor the elementary student 
"11 as for the more advanced pathologist, and, on this very account, 
must soon become generally popular. 

Dr. Morel is very decidedly a follower of the celebrated Yirchow, 
whose doctriue of ''Cellular Pathology" seems to have taken firm hold 
upon his belief, and appears to enter as a necessary part into all his 
reasoning. "The Plasmatic Cell" takes a place in the minds of these 
pathologists, almost of every other element of nutrition as the very 
cause, orgin, sole agent and pcrfecter of all organic processes — self- 
governed and uncontrolled by any other element in the entire organism. 
Though to all this, we cannot, as yet, give our full assent, "still it can- 
not be totally denied that some processes of nutrition are completed with 
a certain degree of self-government in the system of organic cells ;•'* 
;iud both Yirchow and our author may be, in the main, correct, though 
only out of time, being a little too much in advance of the general ideas 
now dominant in the world* of Physiology and of Pothology. 

The above work will be found in this city at the Book-store of Messrs. 
T' Ttiehards & Son. 



In addition to the above work we have received also from Messrs. 
BaiJliere Brothers, the notice of work on the now all-important subject 
of Diphtheria. The work itself has not yet come to hand, but doubt- 
less will and shall receive due attention in our next issue. We refer 
our Students at present in the city to Messrs. Richards k Son, where the 
work may probably be purchased. Price, $1 50. 



AN ELEMENTRY TREATISE ON HUMAN ANATOMY. 
By Josi:rn Leidy, M. D., Professor of Anatomy in the University of 
Pennsylvania, &c, &c, ao, &c Philadelphia. 1S61 J. B. Lip- 
pincott & Co. pp. 663 — octavo — with three hundred and ninety-two 
Illustrations. For sale by Messrs. T. Richards & Son. 
As an elementary Treatise on Human Anatomy, Dr. Leidy's work \> 
certainly a success. So long accustomed as we have been to the house- 
hold words of Anatomical nomenclature, we arc scarcely abfe to do justice 
in any attempt on the part of an author to simplify these terms, altering 



;• from Mr. Doubovitsky, of St. Petersburg. This letterwe maj 
publish in a future number of this journal. 



1.] MisceUanec 191 

what, by dint of long use, has become, to us at least, familiar as the al- 
phabet This impression, however, must not receive too much import- 
ance in the mimls of teachers in recommending a work for beginners, 

they must remember, if possible, as Dr. Lckly seems to have done, the 
mountain in the way, which the nomenclature of anatomy present- 
ed, and, knowing that simple terms are easier of acquisition than more 
ot mplicated ones we should give full credit to the task accomplished 
by our aathor. 

The work is filled with clear and beautiful illustrations, the text open 
and large, with each principal word or subject struck in large block type 
to fix the attention of the student — and the cream-colored paper on 
which the print is executed is, by no means, an inconsiderable point c 
value. 

The authors descriptions are clear and concise, evidently from oil' 
he is known to be, thoroughly familiar by daily and constant handling 
with every portion of his subject. 



Camphor as an Antidote to Strychnine Poisoning. — In the 
Pacific Medical and Surgical Journal, for June, Dr. M. T. Dodge 
reports a case of poisoning with strychnine, entirely relieved by the ad- 
ministration of camphor. According to the report, five grains of strych- 
nine had been taken three hours previously. Ten grains of camphor 

given in emulsion, and repeated every half hour or hour for seven 
hours, when the spasms entirely ceased, and the patient rapidly recover- 
ed. It would certainly be a fortunate discovery should camphor be 
found to be a reliable antidote of strychnine. The case reported lacks at 
least two essential points to make it available as proof upon this point. 

thought by many that much of the strychnine in use is nearly inert 
and if taken as claimed, there is no proof that the article was genuine. 
More than this, there is no proof, but the patient's statement, that the 
five grains of strychnine had been taken at all. There is certainly one 
tuspicious fact in the case, that must in some measure detract from our 
confidence in the antidotal power of camphor. Three hours had elapsed 
from the taking of the poison before remedial aid was had, and yet the 
patient was sitting up, and presented no very alarming symptoms. Prof. 
Wood says that, in cases of poisoning from strychnine, the alarming 

ims usually folkw the administration in from ten minutes to half an 
hour. One of two things is evident : the five grains were not all taken 
or the poison was not of standard strength ; either would effect the result 

;• as relate^ to the antidotal powers of camphor. 



Ra medyfor Burns from Phosphorus. — The skin should be wetted 
with a solution of chloride of lime or of soda, or if these are not at hand 
it should be dipped into a vessel with lead water. 



1 92 Miscellaneous. 

Glycerine in Skin Diseases. — This substance has been justly recom- 
mended in various affections of the skin, and especially in those attend- 
nd with desquamation. In that troublesome affection pityriasis capitis, 
in which the hairs become dry and fall off, during the abundant epidemic 
exfoliation, undiluted glycerine may be applied with excellent and dura- 
ble effect. In pityriasis rubra and pityriasis simplex, a mixture, 
composed of equal parts of oil of almonds and glycerine, and one-half of 
oxide of zinc, has proved very useful. — Dublin Hospital Gazette, May 
15, I860,;;. 158. 



On the Therapeutic Methods of Preventing Pitting of the Face 
in Confluent Small-Pox — By Dr. Stokes, Dublin. — During the last 
five years Dr. Stokes has employed gutta percha and collodion in a con- 
siderable number of cases of confluent small-pox, for the purpose of pre- 
venting pitting of the face. In most of the cases the crust came off in 
large flakes or patches, composed of the dried exudations and the cover- 
ing material, leaving the skin uninjured. This kind of treatment was 
most successful in cases of a typhoid character, but appeared to be not 
so well adapted to those presenting a more sthenic type. Dr, Stokes 
considers that the application of poultices over the face is the surest 
method of preventing disfigurement in small-pox. Their use should be 
commenced at the earliest period, and continued to an advanced stage of 
the disease. In most cases they may be applied over the nose, so as 
•to cover the nostrils, This plan should fulfil three important indications 
of treatment — namely, to exclude air, to moderate the local irritation, 
and to keep the parts in a permanently moist state, so as to prevent the 
drying and hardening of the scabs. The best poultice is formed of lin- 
seed meal, which should be spread on a soft material ; such as French 
wadding, and covered with gutta percha paper or oiled silk. The con- 
clusions to which Dr. Stukes arrives are the following . 1. That the 
chances of marking are much greater in the sthenic or inflammatory than 
in the asthenic or typhoid confluent small-pox. 2. That considering the 
change in the character of disease observed during late years, we may 
explain the greater frequency of marking in former times, 3. That, in 
the typhoid forms of the disease the treatment of the surface by an arti- 
ficial covering, such as gutta pcocha or glycerine, will often prove satis- 
factory. 4. That in the more active or non-typhoid forms the use of 
constant poulticing, and of every other method which will lessen local 
inflammation, seems to be the best mode of preventing disfigurement of 
the focc. — British and Foreig?i Mcdico-Chirurgical Review. 



Atropine. — Strength of Solution Used. — "When it is wished to 
dilate the pupil for opthalmoscopic investigation, the strength of the 
solution used should not be more than one-halt' a grain of the sulphate 
i ■» an ounce of water. This will suffice for the purpose, and the unpleas- 
ant effects of a stronger solution will be avoided. 



SOUTHERN 

MEDICAL AND SURGICAL JOURNAL 

(new sbru 



[flL , AUGUSTA. (iEOMl. MAM, 1861. 

ORIGINAL AND ECLECTIC. 

ARTICLE VII. 

-1 ( By A. AY". Bailey, M. D., 

Clinical Clerk of Jackson Btreet Hospital, Augusta, ( 
It is needless for me to endeavor to give a treatise on 
this< all who may desire to acquaint themselves 

fully with the subject can, by reading some Surgical work, 
or Dr. Bozeman'a pamphlets, gain more knowi an! 

would be able to impart. 

It being my object merely to report a case, havin a 

several successfully treated by Drs. Campbell during my 

in their Hospital as a private student, and to add to the 

already cured by the profession, and iour- 

the attempts for the treatment of the disease, no matter 

how formidable the case may appear. 

• Dr. Bozeman. of Montgomery, Ala., the pi :i. is 

indebted for the mofi Lplanforthe f this af- 

Aljout tw> man published his mam 

■ lure, andth — which he had met within the 

the button suture and silverwire. I:. his 

• the sir 

lighter and "less likely to yield un isure, admits 

a higher polish, and allow- the wires drawn thro 

the small holes without dragging :" but admitting all this. 
1 •• 



194 Bailey. A Case of [March, 

I lis experience has taught him that the button suture made 
of lead is by far the most preferable for several reasons. 
In using the silver button the Surgeon has to have a regular 
smith, who may not understand' the nature of the parts, 
and even if he did, there arc many little modifications in 
shape required which he could not give unless the operator 
was present to point them out; but with lead it is indiffer- 
ent. The Surgeon can make his button while around the 
operating. table, and beat it into any shape he may desire ; 
for it is not until he has adjusted his sutures, that ho can 
tell exactly the shape of button required. Lead is also 
more flexible, and can be made to adjust itself to any sur- 
face that may be presented to the operator, and hence more 
likely to bring the parts in adj uxtation, and thereby cause 
a more successful closure and adhesion of the fistulous open- 
ing. I having assitsed in several operations performed by 
Dr. Bozeman's plan with a leaden button suture, and hav- 
ing taken great interest in taking notes on the cases from 
the time of their entrauce until their departure, have select- 
ed it as the subject of the present paper. 

Vesico vaginal fistula generally occurs, as all are aware, by 
the pressure of the child's head against the soft parts, or the 
improper use of instruments during first labor, though it is 
liable at any period during child-bearing when the labor 
is such as to give rise to this dreadful complaint, for instance 
in impeded labor when the head has descended low down 
into the pelvis, and presses against the vagina and urethra 
sufficient length of time to produce inflammation, gangrene, 
and sloughing, or when the instruments have to be used to 
effect delivery, which very often produces abrasions, and 
also brings on sloughing of the parts. As to the position, 
shape and space that the fistula may occupy, is altogether 
owine to circumstances. Bozeman adds two more that the 
operator may be enabled to classify all eases that may pre- 
• en1 themselves under its appropriate head. 

Velpean's classifications are as follows : "The first class 
eml I] those fistulas which cause a communication 



1861.] Vest nal Fistula. 

between the urethra and vagina; tin 1 class ie made 

up of those which are established at the expense of the tri- 

goone vesiealis ; the third class comprises all those situated 
in th< 'id o( the bladder." Dr. Bozeman adds the 

following two agreeing with Velpean so far as he 
" The fourth class embraces all those fistulas formed at the 
expense of a part, or the whole of the vesical trigone, and 
the root of the urethra: of trigone and the bas-fonc 1 of the 
bladder: or, all three of the regions together. The fifth 
class include all those complicating the cervix uteri, either 
with or without injury." 

The following is a case in which the posterior wall and 
fundus have sloughed away to a considerable extent. 
implicating the cervix uteri, and forming an opening in the 
shape of a horse shoe, or segment of a circle, the point <>i 
which severed the left ureter. 

.lane, servant girl of Mr. X. J., of Fort Gaines, Georgia, 
age eighteen, of robust constitution, ordinary height, well 
proportioned and had always enjoyed good health. This 
accident occurred, as 1 have formerly stated it does, in 
ing birth to first child about twelve months previous to 
entering the Infirmary. Ber labor was a very protracted 
one and finally required the use of instruments to effect de- 
livery. From the patient's weakened condition, and other 
circumstances connected with her, not necessary to mention 
here, an examination was delayed for nearly three weeks 
after her entrance. 

May 23d. — An examination Was made byUrs. Campbell, 
and "the opinion was that an operation would be attended 
with but little success: a further opinion would be taken at 
another time. 

May 26th — To-day a second examination was made, and 
the opinion of the 23d strengthened, as the parts had slough- 
ed to I greater extent than they had su die 1 ore 
the operation with apparently SO little pain that it was 
noted as an indication of gangrene having taken place. 
May 81at — A third examination was made to-day. and a 



196 Bailey. A Case of [March, 

prospect of a cure very unfavorable. It was, however, de- 
termined that an attempt would be made as soon as all 
things were more favorable. The patient did not complain 
very much from excoriation or scalding, nor did the secre- 
tion of calcarious matter take place to a great extent. In- 
jections of warm water and castile soap were used several 
times a day up to the day of the operation, the main object 
being to strengthen and have the system in as good a con- 
dition as possible. This was accomplished by nutritious 
diet and tonics of iron and quinine in five grain doses three 
times a day, in syrup. 

July 29th. — Gave an ounce of castor oil to put the bowgls 
in a suitable condition. 

.July 31th. — To-day an operation was performed by Drs. 
Campbell, assisted by myself. The patient being placed on 
her breast and knees with a mirror situated so as to throw 
the reflection of the light on the parts to be operated upon. 
The edges of the fistula were thoroughly pared to their full 
] '.; ilver wire were made with Simp- 

3 needles ; the edges were then approximated as much 
as practicable, and secured with shot over the leaden but- 
ton ; the ends of the wires were partially twisted and lapped 
with a piece of linen, and allowed to hang from the vulva. 
This operation lasted nearly four hours, the delay being 
chiefly occasioned by the irritable and nervous condition of 
the patient, and the knife having wounded some small 
blood-vessels at the farther end of the fistula, and caused 
slow but troublesome hemorrhage, filling the vagina with 
clots of blood and obscuring the veiw. Injections of acetate 
of lead were used, vagina washed out, and the patient was 
then put to bed, a catheter introduced and kept there con- 
itantly, save for the purpose of cleansing, when it was re- 
moved twice a day. 

Recipe tine, of opium in twenty drop doses w T as given, 
the purpose being to constirpate the bowels and secure rest 
for the patient. 

August 9th. — The sutures were removed to-day, and (lis- 



1861.] Vaginal Fistula. 197 

covered that there is an opening :h end of the line of 

adhesion, and the result of non-union was suspected the 
entire length of the opening, from the fact that the bladder 
was not relieved entirely by the catheter, hut that a portion 
oi" the urine came away through some pari of the fistula 
while the catheter in situ. 

LUgustlOth. — The patient is losing strength and flesh 
from irritation and confinement to bed. 

R. — Tartrate iron, potash and quinine in live gr. d<> 
three time a day ; diet, heef soup, bread, &c. 

August 16th. — Improving-, goes about the house and yard, 
feels a little uneasiness, other than that caused by the un- 
natural discharge of about half the urine, the other half re- 
maining in the bladder, and passes off at intervals through 
the urethra. 

August 30th. — General health improving, hut urine pass- 
ed oft* as at last note. 

October 14th. — Up to this time the second, operation has 
been put off from time to time for several unavoidable 
causes. She has been subject to fevers occasionally : these 
paroxysms have been successfully met with quinine, and 
also her periods < ration are irregular and painful. 

At this operation the edges of theoj 

a button applied on one requiring two sutures, the 

other one. The wires being well clamped, were cut off 
to the shot, and the vagina plugged with lint to prevent 
the recto vaginal septum from being wounded by the ends 
of the wires, besides the protruded wires from the vulva are 
liable to be jarred to some extent from the movements of 
the patient, and may cause displacement of the button. 
\v;is placed in bed, opiate- given, catheter introduced, 
and removed occasionally as before. This time all the 
urine was conveyed from the bladder by the catheter, as 
none could be discovered coming from any other source. 
v were not sanguine on this point, as the pi suf- 

ficient to prevent its passage into the vagina. 

O 24th. — Removed the buttons and sutures, and 



198 Ford. Report of a [March, 

find only one of the openings partially united, the inferior 
one at the neck of the bladder ; to this the application of 
solid nitrate of silver was made, hut with little effect; the 
other openings where the fistula crossed the ureter, there 
was Little hope of union taking place from the impractibil- 
ity ol' reaching the point sufficiently to insert the suture 
carefully owing to its length and direction. The severed 
end of the ureter, they were also unable to direct into the 
bladder for the same cause. 

A third operation was, however, determined upon which 
succeeded only in partial closure of the fistulous openings, 
still leaving two small holes, one the size of a small pin's 
bead, and the. other a little larger. Repeated applications 
of solid nitrate of silver at intervals of every ten or fifteen 
days were again made, which succeeded in the cure 
of the case, though at first seemed to be of but little or 
no benefit. 

The great obstacle in this case which made it of interest 
to study and take notes upon, arc the following : 

1st. The direction and extent of the fistula. 

2nd. The great amount of sloughing and consequent loss 
of tissue — the greater and lesser curves of the opening were 
so disproportionate that when the edges were pared and 
drawn together there were formed on the edge of the greater 
curve duplications or pouches, and this was really the cause 
of non-union at each end. 

3rd. The difficulty of directing and securing the bisected 
ureter in its normal position. 



ARTICLE VI I i. 

.: Case hi which portions of a Foetus made their way from the 
•us through the Abdominal toalls by Ulcerative 7V 
Patient R I. By DbSaussurb Ford, M. P., Demon- 

of Anatomy, &c., in Medical College of Georgia. 

Mrs. li , widow aged 35 years, stated she had been 

delivered of three children — one still living, the other died 



1861.] // - 199 

ismus nascentium — with a third child had beeo preg- 

nant, about five and a half months, up to January, L860, 
when she aborted, the presentation a footling; the trunk. 
superior and inferior Limbs protruding beyond the vulva. 
the head remaining confined tightly by the contractions — 

which must have been anomalous — of the 08 tinsse. f • 
ing detection, (for her pregnancy was the result oi criminal 
she cut off that which was hanging from her, 

when, to use her own language, the bead went hack. She 
supposed the foetus to have been dead about nine days. 
When questioned, she denied that there was any bleeding, 
or other discharge at the time, and could give no account of 
>rd, or placenta. 
April 18th. — Four months after this most strange and 

unnatural occurrence. Mrs. H was admitted into the 

Augusta City Hospital, with a fistulous opening immediate- 
ly below the umbilicus, which was discharging, very freely, 
a dark yellow and offensive matter, undoubtedly partly fecal 
which could be accounted for after the extraction of the 
bones. She continued in this state until July 25th, when 
■k charge of the Hospital, discovering the bones of a 
,1 head protruding through this opening, then about two 
inches in diameter. In receiving a report — not a detailed 
<>ne — from the attendant physician before my service, I 
gathered : that she was affected with chronic constipation, 
which was at first relieved by enemas and cathartics, which 
latter — castor oil was generally used — he thought could be 
tected in the secretions from the fistulous open:: 
At first I this a case of extra-uterim 

indeed the opinion was unsettled, until the examination had 

. with th( 

in a deplorable and emaciated - 

prompt relief, b; 

the 27th. It was ii' aary tor an i 

of the abdomen, but bone after bone — 

rounding them having been disorganized — was extra 

by a rotary traction with a pair of strong for- hich 



200 Ford. Report of a [March 

bones were the following: — two parietal ; two temporal, 
without petrous portion attached ; one petrous portion ; one 
malleus; one tympanic bone; sphenoid ; one malar ; occipi- 
tal; frontal, in two pieces; one scapula; radius and ulnar, 
with phalanges and metacarpal hones of one linger. 

These bones arc, in development, as near the size of a six 
months foetus as could be determined, which fact substanti- 
ates her story. that she had been pregnant about six months. 
After these bones were extracted, a digital examination dis- 
closed a large cavity, answering to the internal form of the 
uterus, which cavity, in the mesian line, had an outlet like 
the form and position of the passage through the cervix. This 
large cavity communicated, by an extensive opening, with 
the ascending colon, the finger readily tracing the interior of 
the intestine, above and below, as far as it could reach. 
The 28th day after the operation, prescribed: 

]}•. — Valet's Proto. Carb. Ferri, Sg5j 

"Water gviii — M. 

Give a teaspoonful three times a day. 

Apply to the wound, cloths wet with a solution of chlor- 
ide soda. Had taken §g castor oil this morning — no effect 
Fecal matter discharging through opening. 

29th. — This morning passed aliving worm, 4 inches long, 
through fistulous opening, with large quantities of fecal mat- 
ter. Had an action through rectum yesterday. Ordered an 
ma of warm salt and water. 

30th. — Ordered daily enemas of warm water every morn- 
in<>\ an hour after breakfast. Fecal matter dischanmia;. 

31st. — Fecal matter still discharging, though much di- 
minished in quantity. Strength better. 

August 2d. — Passed a worm through the opening. Had 
an action through rectum, after enema. Ordered, instead 
of enema in the morning, castor oil 5g and spts. turpentine 
gtls. v. ' ■ 

A.ugus1 1th. — Fecal matter still discharging. Continued 
enemas. Strength much improved. 



II.] // Case. 201 

August 6th. — Continue treatment Condition some bet- 
ter. Left the city and record was not kept until 

August 14th. — la having natural operations through the 
rectum, with very little discharge from opening. Strength 

and general condition improved. 

A.ugust L8th. — Had an attack of ^astralgia. Ordered 
. xxx tinct opii. and mustard over epigastrium. Con- 
tinued to improve daily, havingnatural evacuations through 
rectum, with fistulous opening very nearly healed, and no 

inconveniences from discharges. Mrs. 11 left the 

ptember 7th, two months and ten days after 
the extraction of the bones. 

Remarks. — The fact that a foetus has escaped through the 
abdominal walls, by ulceration, and the patient recovering, 
indeed, impregnation existing, after such an accident, is by 
no means novel. (See report of a very remarkable case 
of Extra-Uterine Foetation in Keatino-'s edition of Rams- 
botham's System of Obstetrics, page 580.) In this case 
it will be noted that a fistulous opening was made, by ulcer- 
ation, into some portion of the intestinal tube, and still the 
patient survived, but exactly the counterpart of the case of 
Mrs. II . I cannot find, in which the uterus itself re- 
tained a part of a fioetus, that part ulcerating through its 
wall _• extracted as detailed. 

The fiendish criminality, and un naturalness of the act of 
cutting off a foetus, on the part of the mother, and the ap- 
parent discrepancy of her account, together with some of 
the bones extracted, viz : a radius, ulnar, scapula, phalan 
would seem to invalidate the opinion formed of the ca 
. however, when we consider all the circumstan 
cially the fri s Icitudeof the mother in any attempt, 

however enormous, to avoid detection. The fact of t! 
bones of the arm having been found will explain, in a m 
. the difficulty of the delivery, in that a footling presenta- 
>ne of the arms remains impacted with thehead, 
could have I aily delivered, it' the head was not ab- 

normally ment, the inferior and superior 



202 Ford. Report of a Hospital Case. [March, 

limbs and trunk hanging out, to the contrary notwithstanding. 
The absence of the presence of a humerus ; a second malar 
bone ; a second petrous portion of temporal bone ; a second 
tympanic bone, &c, explains a statement she made, thatsomc 
small"bones had come out of the fistulous orifice, from time to 
time. Why, then, the number of these bones indefinite, might 
not bones have escaped, which would show the case one of 
extra-uterine foetation ? Because, by examination, after the 
remaining bones had been extracted, neither the opening into 
the colon, nor the passage through the cervix uteri, could 
have been confounded with the openings through the fal- 
lopian tubes, their size, form, position excluding the possi- 
bility of such an error. 

The time which elapsed after she aborted, before the first 
appearance of the opening in the abdomen, could not be 

determined, and the exact condition of Mrs. H from 

the time she severed the body of the foetus from the head , 
to thetime she was admitted into the Hospital is unknown, 
the probability, however, is that the detritus of the foetus 
passed out per vaginam, and the uterus contracting down 
upon the bones of the head caused them to ulcerate their 
way through its walls. Adhesive inflammation was set up, 
which prevented the escape of the discharge into the perito- 
neal cavity, the exudation of plastic lymph, forming a distinct 
cavity, by agglutinating the edges of the uterus with those 
of the abdominal walls. The fistulous opening into the 
colon was, most probably, formed by the bones cutting 
through its walls. The exudations of plastic lymph, as in 
the external opening, formed adhesions similar to artificial 
annus. This internal opening, so to speak, had closed en- 
tirely before Mrs. H left the Hospital, as evidenced 

by the absence of any fecal discharge. 

It is unfortunate the patient did not remain in the Hos- 
pital until the perfect closure of the opening through the 
abdominal walls had been effected; it was, however, granu- 
lating healthily, then about J inch in diameter; this fact, 
with her generally improved condition, warrants the opim 



1861.] tures on Convulsive 1 

ion of recovery, the principle difficulty (the opening into 
the intestinal canal) having already been perfectly closed. 

Mrs. I] was much agitated at the probability of 

legal investigation, suggested by some of her female ene- 
mies, who, hearing' the horrible enormity of her mode of 
delivery, seemed determined to torture the unfortui 
wretch, by exposure. With this anticipation hang- 
ing over her, she left the city by stealth. Means were em- 
ployed to follow her, but with no success. 



hares on the Theory and Therapeutics of Convulsive Diseases, 
especially of Epilepsy, By Charles Bland RadclifFe, M. D., 
Fellow of the College, Physician to the "Westminister 

Hospital, etc. 

LECTURE II. 

In my last lecture I endeavored to show, as far as was 
Bible in the time, that it is necessary to adopt a new 
theory of muscular motion. I endeavored to show that a 
fundamental change in this matter is absolutely demanded 
by many of the facts which have come to light during the 
past ten or twelve years, and chiefly by the messages which 
may be said to have been telegraphed, along the three miles 
of wire which enter into the coil of a galvanometer, such as 
that which was then upon the table. For what are ti 

One is, that there are electrical currents in liv- 
ing muscle and nerve. Another is, that rigor mortis does 
not occur until the final extinction of these currents. A 
third is, that these currents are weakened in ordinary mus- 
cular contraction. A fourth is, that contraction is produced 
when the nerve-current is weakened by the action of a gal- 
vanic current upon nerve. A fifth is, that contraction is not 
produced when the nerve currentis strengthened by the action 
a galvanic current upon nerve. In a word, the needle 
of the gavanometer appears to show that muscle elongates 
under the action of the muscular and nerve currents, and 
that mm rhen this is weakened or 

inted out also, keeping with these facts, that 

inn- tion if connected with the T<>r- 

dinary electricity, and not with the charging or charge, 



204 Lectures on [March, 

I endeavored to show, further, that there are no sound 
reasons for supposing that "blood and nervous influence pro- 
duce contraction by acting as a stimuli to a vital property 
of contractility, and that there are many grounds for believ- 
ing that these agents act upon muscle in the same way as 
electricity, antagonizing contraction, not causing it — an- 
tagonizing contraction, possibly, by means of electricity — 
nervous influence by the nerve-currents — blood, by keeping 
up the muscular and nerve currents, for it is easy to suppose 
that these currents may be kept up by the respiratory or 
chemical changes which are produced by blood in muscle 
and nerve. 

As to the rest, I endeavored to show that there was no 
need of a vital property of contractility, and of the doctrine 
of stimulation founded thereon, to explain certain other 
facts which must be accounted for by any true theory of 
muscular motion. I endeavored to show, for instance, that 
the fact of muscle undergoing no change of bulk in con- 
tracting, the gain in breadth being precisely equal to the 
loss in length, has its exact parallel in the change which a 
bar of iron undergoes in passing out of the magnetic state — 
that contraction under "mechanical irritation" may be 
nothing more than the natural effect of the discharge of 
secondary currents, which currents are induced by mechani- 
cally interrupting the nerve and muscular current — that 
muscular waste is proportionate to muscular action, not be- 
cause contraction is the sign of functional activity, but be- 
cause a given amount of waste is necessarily incurred in 
that renewal of the muscular current which is necessary to 
relax the muscle after each contraction — that the will may 
act in voluntary contraction by suspending the muscular 
and nerve-currents ; that rigor mortis, which is utterly un- 
intelligible on the accepted theory of muscular motion, may 
be the natural result of the action of the common molecular 
attraction of the muscular tissue upon the final dying out 
of the muscular and nerve currents. 

To briii"; forward all the arguments belonging to so com- 
prehensive a subject within the space of one lecture was 
manifestly impossible, even with the additional moments 
which you, sir, so graciously placed at my disposal; and 
thus I was obliged to leave much unsaid. I said nothing, 
for instance, about the rhythmical movement of the heart 
and other muscle, though 1. might have found in the theory 
a key to their physical interpretation, and in them no small 



1861.] Convulsive D 205 

confirmation of the theory, I said nothing about the par- 
turient contractions of the uterus, though in the theory I 
may have hoped to have found the way of explaining how 
it is that^ these contractions, begin at a certain time, and 
continue until the completion of birth. Butthough obliged 
to leave much unsaid, I hope I was able to say enough to 
show that a fundamental change is necessary in the theory 
of muscular motion, and to prepare the way for what 1 have 
now to say upon the theory of convulsive diseases. 



Epilepsy is at once the great type of convulsive diseases, 
and the key to their interpretation. Epilepsy, however, is 
a name which indicates much less than it did formerly. 
Thus it does not indicate the epileptiform convulsion which 
is connected withcertain positive diseases of the brain, with 
fever, with uraemia and other retained excretions, with "ir- 
ritation" in the gums and elsewhere, or with the moribund 
state. And it is difficult to say precisely what it does indi- 
cate ; for, as our diagnosis gains in exactness, epilepsy 
changes from a special malady into a mere symptom, or 
congeries of symptoms. At the same time, it is convenient 
to take an ideal type of epilepsy, and regard it as a special 
malady ; for there arc numberless cases, in which, in their 
earlier >taL r es at least, it is very difficult, if not impossible, 
to recognise the disease of which the convulsion is merely a 
symptom. 

AVhat, then, I would begin by asking, is the theory of 
simple epilepsy ? Upon which theory of muscular motion 
is it to be based '." And, first, what are the facts? 

An epileptic will often say — never oftener than upon the 
very eve of an attack — "I am quite well," and many are 
ready enough to echo what he says; but he and they have 
little right to say so. Where the malady has not made 
much progress, there may be a cheerful countenance, a 
sharp digestion, a firm limb, and at the first glance it may 
not I to say what is wrong; but, in this case, there 

are always certain features which are incompatible with 
true health and strength. In many instances there is a 
want of tire in the countenance, and a dilated and sluggish 
State of the pupil, which point to the brain as lacking in 
energy: ami in keeping with these signs, it is found on 
inquiry that the memory is more or less treacherous, the 
ideas more or h-ss incapable, the imagination more or less 
dull, the temper more or Less irritable, the will more or les< 



200 Lectures on [March, 

feeble, the character more or less undecided. It is, no 
doubt, common enough to meet with epileptics, who, with- 
out a i iv want of candor on their part, will maintain that 
their minds are free from all infirmity; but if care he taken 
to examine their history, it will always be found that their 
friends have very different opinion upon this point. 

In very many instances there is a marked disposition to 
tremulousness and cramp; thus in upwards of seventy cases 
which fell under the notice of my friend and colleague, Dr. 
Reynolds, these symptoms occurred at one time or other 
and in one form or other, in more than half of the whole 
number. 

In very many instances, again, if not in all, the hands 
and feet are cool or cold, the pulse is weak and slow, and a 
feeling of chilliness is almost habitual. Indeed, so far as 
my own experience extends, the powers of the circulation 
are always very defective in ordinary epilepsy. 

In confirmed cases, these general features are so marked 
as to be altogether unmistakable. Not only are the pupils 
dilated and sluggish, but the under eyelids are puffy and 
coarse. Often, moreover, the complexion has accpiired a 
dull tinge — a change which appears to depend in part upon 
an habitually bloodshot state of the skin. At any rate, 
this bloodshot condition is rarely absent, and where it is 
most marked, as about the forehead and eyelids, it is often 
accompanied by numerous spots of ecchymosis of about the 
size of a pin's head. The torpid features are now rarely 
lighted up with the fire of feeling or thought, the seme- 
are duller than ever, the memory more treacherous, the 
ideas more confused, the power of attention more distracted 
the imagination more drowsy, the temper more uneven, 
and the will more incapable. At this time, also, there is, 
for the most part, little of that fine susceptibility of feeling 
which is necessary to enable one to be miserable about any- 
thing. 

This change for the worse is particularly marked after 
the fit. Indeed, at this time the senses may be so blunted 
and the mind so clouded and confused, that the features of 
the epileptic may become blended in those of the demented 
person. Or symptoms of mental aberration may show 
themselves, and transform the epileptic for the time into 
the; lunatic. The fits, also, mayrecur so frequently, that the 
mind may never have the chance of clearing up in the in- 
terval, and in this way the general features of the convul- 



1861.] Convulsive Di$eai J<<7 

Bive malady may never cease to be confounded with thos 

dementia or insanity. Xot unfrequently, also, there is the 
gravest degree of mental infirmity from the very first, and 

instead of ending in dementia the history of the epileptic 
may begin in idiocy, hi deed, epilepsy is so frequent an 
unpaniment of this saddest of all conditions, that it can 
scarcely be said to be an accident. 

The signs of the approaching paroxysm are very variable. 
The patient himself will generally say, and say truly, that 
the lit takes him by Burpise ; and certainly the signs of dan- 
ger are not those which are likely to arrest his attention. 
These signs also are very apt to vary in the same person. 

As the time of danger approaches, the, patient may be- 
come unusually fidgety, irritable, moody, forgetful, absent, 
6r drowsy ; or he may sleep restlessly, grinding his teeth, 
snoring or snorting, dreaming about things which distress 
or terrify him, or even somnambulizing; or he may have a 
disagreeable feeling of tightness about the throat, with 
cramps or tingliugs in the limbs and elsewhere; or he may 
be unusually "shaky,'' or may be annoyed with shudderings 
of a very disagreeable and violent character. 

Another sign of danger mav be giddiness or headache; 
but, so far as the latter symptoms is concerned, I should not 
be disposed to lay much stress upon it as a warning in simple 
epilepsy. 

Occasionally, the pupils may be more dilated and slug- 
gish than usual, or one pupil may be more dilated and slug- 
gish than the other ; or the eyes may be rotated in a pecu- 
liar manner. 

Usually, so tar as my experience goes, the pulse may be- 
come feebler than it was before ; and not unfrequently the 
patient will complain that nothing will warm him or k 
him warm ; or he may sigh in a way which shows that he 
is not breathing as freely as he ought to do : or, if as] rep, 
the breathing may at times become imperceptible and in- 
sufficient as to suggest the idea of death. The breathing 
fails in this remarkable manner before the tit in a patient 
at present under the joint care of a medical practioner in 
the country and of myself, and we can both testifyas to the 

Later still, there maybe certain vague and (indefinable 
nations or movement varying in their eharaeter, 

but all comprehended under the term aura — sensation 

pain, numbness, tingling, and a feeling as of cold vapor, 



208 Lectures on [March 

movements, of shuddering or spasms, beginning in a distant 
part, as in the hand or foot, and travelling towards the 
head. In other words, there maybe symptoms which, as 
Dr. Watson thinks, are in some degree analogous to globus 
in hysteria, or to the numb and tingling feelings which arc 
the precursors of paralysis and appoplexv. 

In some cases there may be special premonitions. In one 
of my patients, the lit is invariably preceded by an intense 
feeling <>1* hunger. In another patient, since insane, a little 
blue imp made its appearance, and grinned and mocked at 
him as he lost his consciousness. In a third, a guitar seem- 
ed to be roughly grated close to the ear. But these signs 
are of little value, for they arc only perceptible to the pati- 
ent, and not even to him until he has ceased to be able to 
bestir himself. 

Last of all, there is a sign which is very difficult to catch 
and this is the death-like pallor which overspreads the 
countenance immediately before the fall. M. Trousseau 
called attention to this sign five years ago as one which 
is diagnostic of epilepsy ; and, since that time, I have seen 
it in every instance in which I have seen the fit from the 
very beginning. "II est une signe," says M. Trousseau, 
"quie se produit du moment de la chute, et qui n'est inst- 
able pourpersonne : e'est la paleur tres prononcee, cadaver- 
ique, qui couvrc pour un instant la face l'epileptive. ]STous 
ne le voyons pas, parceque nous arrivons toujours trop tard, 
alors que la face est dija d'une rouge tres pronunce." M. 
Delasiauve has also noticed the same phenomena in several 
cases. 

In the severest and most characteristic form of the parox- 
ysm, the patient utters a peculiar choking noise, or a sudden 
and startling cry, and at once falls down convulsed and in- 
sensible. The convulsions are usually more marked on one 
side of the body than the other. They drag the mouth to- 
wards the side which is most affected, and twist the face in 
the opposite direction until the chin may press upon the 
shoulder. They push forward the tongue, and crush it be- 
tween the teetln They clasp the thumb upon the palm, 
and hold it down with the force of a giant. They seize the 
walls of tin- chest and abdomen, and prevent the possibility 
of breathing. They stiffen the limbs, so that the joints can- 
not be bent without some risk of breaking the bones. In 
sonic instances, they even take hold o\' the bladder, the 
bowel, <>r the seminal vesicles, and expel the contents ; in 



1861.] Omvulsi 209 

others they may be bo violent as to bite ofl a large portion 
of the tongue, to break the tooth, orto dislocate a limb. At 
first, it seems as if the Bpasms would never relax; but after- 
wards they are separated by intervals, which grow wider 
and wider as the paroxysm draws to an end. The con- 
vulsions, that is to Bay, are tetanoid at first — clonic after- 
wards. 

At the instant of the fall, a corpse-like paleness over- 
spreads the countenance ; a few instants later, and the livid, 
black, and bloated head and neck, and the hissing, gurgling 
choking sounds proceeding from the throat, BUggest the 
idea of a person struggling undei the bowstring of some in- 
visible exeeutioner. At times, however, the signs of suffo- 
cation are absent, and the ghastly pallor of the beginning re- 
mains throughout. 

When the lit is at its height, a quantity of flrothy salvia 
is usually blown or puffed from the mouth, and this is not 
anfrequently reddened with blood, if the tongue or cheek 
happens to have been bitten. 

Jf the eyelids are open, the eye is seen to be projected 
and distorted, with the pupil dilated to the utmost, and ab- 
solutely insensible to light. As rule, however, the eye- 
lids would seem to be closed: and well it is that they are 
so, for it requires some nerve to meet the hideous stare of 
the epileptic eye. 

All this while, it is usual for the hands and feet to be 
cool, and bedewed with clammy perspiration. Except the 
head and nook, indeed, the whole body is cooler than na- 
tural, and any little additional warmness of the head and 
neck would seem to be simply due to the fact that their 
are more distended with venous blood. 

The other and less obvious features of the paroxysm are in 
keeping with the 

At first, it ma}- be difficult, perhaps impossible, to tool 
the pulse, and the heart acts very feebly; but if the liin 
of one hand kept upon the wrist, and the other hand Ik- 
placed upon the bosom, it is found that the pulse rapidly 
acquires a force and fullness which it never had in the in- 
tervals between the fits, and that the heart beats more and 
more tumultuously and violently as the pulse In 

.•• instances, however, the pulse may remain almost 
lent, and the action of the heart be extremely feeble from 
the beginning to the end. 

From the first all conscioui happily suspended — 



210 Lectures on [March, 

lli is is our only consolation in so sad a spectacle — ami the 
most powerful stimulants fails to evoke any sign of action 
in the dormant mind. The water which may be thrown 
upon the face (with few exceptions) causes no blinking in 
the eye if this be open and staring; the fire upon which the 
patient may have fallen may char the flesh without causing 
a single pang. 

After continuing for two or three minutes, which seem 
drawn out to hours, the convulsions cease, and the patient 
is Left with all his muscles unstrung, like a person dead- 
drunk, or struck down by appoplexy. The lungs, no long- 
er restrained by the suffocating spasm of the earlier part of 
the fit, resume their play with deep inspiration, and then 
act with loud and strenuous breathings ; and as the respira- 
tion rightss itelf, the veins of the head and neck become 
unloaded, the natural color returns to the surface, and pre- 
sently the patient wakes to an obscured and troubled con- 
sciousness. "Je suis brise," Calmeil tells us were very of- 
ten the first words of the returning epileptic at the Salt- 
petriere or Charenton. The time during which the patient 
lies in a fit before awaking is very variable, but (except in a 
first attack) it is rarely more than half an hour, and it may 
not be more than two or three minutes. 

This is the usual, but by no means the invariable, course 
of the fit. Often, indeed, the attempts at rallying may be 
very imperfect, and fit after fit may recur for a long period 
without any interval of waking; and occasionally all rally- 
ing may be prevented by death. 

"After waking, there are generally some symptoms of re- 
action in the circulation, but in simple epilepsy these are 
never marked. They may be enough to give a dull flush 
to the cheek and a little fulness to the pulse for a short 
time after the patient wakes ; but, as a rule, they cease 
when the coma ceases, and coma is never much prolonged 
in simple epilepsy. Usually the patient is headachy and 
exhausted, listless and stunned, moody and iritable, until a 
night's rest has enabled him to recover the balance of his 
shaken nervous system. The jaded countenance also tells 
plainly of the past struggle, even though it may present 
none of those numerous and minute dots of ecchymosis 
about the eyelids and upon the forehead which are such un- 
equivocal signs of a severe attack of epilepsy. 

- time goes on, the mental faculties recover more and 
more imperfectly, and more and more tardily, and at last 



1861.] Corv&aU - 211 

their habitual state may bo one of pitiful fatuity from which 

single ray of the Divine principle beams forth. Or the 

moodiness and irritability which often follow attacks may 

>me more and more marked, until at last they mi 
into attacks of downright mania. Orsymp 
may make their appearance. Or death may happen in a fit. 
mortly afterwards. The natural tender. >ilepsy is 

assuredly towards dementia: and dementia is the frequent 
doom of the epileptic, if his disorder be uncheckd and life 
prolonged sufficiently; but at the same time it is possible 
for an epilectic to live many years, and to have many fits, 
without losing- powers which are necessary to render him 
an agreeable and serviceable member of society. When 
death happens, it appears to be, most generally, from ex- 
haustion in the period of prostration immediately following 
the paroxysm. 

But the symptoms of epilepsy are not always so startling 
as have been represented, and in some instances they may 
i softened down as to be recognised witli difficulty. 
In the slightest form of the malady, the patient pauses 
suddenly in the midst of anything he many happen to be 
doing <>r saying at the time, Ins countenance becomes pale 
and blank, his lungs cease to play, and, after a moment of 
absence or giddiness, he is himself again. His memory has 
kept no record of this sad passage in his history, and if it 
had escaped the notice of others he might remain in happy 
ignorance of it. Or in addition to those symptoms, a lurid 
flush may succeed to the paleness of the countenance the 
veins of the neck and forehead may start out in prominent 
relief, the face may turn slightly towards one of the shoul- 
ders, and there may be some convulsive twitching in tin- 
. neck and arms, hi such a case there is no scream or 
. no fall, no bitten tongue, no foam at the mouth, and at 
st there is only some obscure gurgling in the tin 
son, j rni £> and some slight moistening of the lips 

with salvia. In such a case the convulsive movements are 
very partial, rarely extending beyond the face. neck. <-;• 
arms, but in some few instances the whole frame may be 
agitated by one or two violent convulsive Bhocks. Tins 
te of giddiness and al rad partial spasm may be 

followed by fatigue, loss of memory, confusion of thought, 
depression i irritability of temper, and at tu 

it may end in drowsiness or actual sleep; but usually recov- 
ery is almost instantaneous. At the same time there is rea- 



212 Lectures on fMarch, 

son to believe that dementia is a more likely as well as a 
more Bpeedy consequence in this, le petit mat, than in ordin- 
ary epilepsy, lc grand mat. 

In some of these cases, moreover, it would seem not only 
that the patient does not cry, or foil or suffer from general 
convulsion, but that the state of intellectual eclipse — the 
; characteristic symptom of epilepsy — is far from com- 
plete. Esquirol says : u il est dcs acces dans lesquels on 
n'obscrve pas la perte de connaisance ;" and M. Herpin di- 
rects particular attention to these cases. Cases like these 
are common enough in certain chronic diseases of the brain 
as meningitis or tumor: but in simple epilepsy they are by 
no means common, if other proof be wanting than the mere 
rtion of the patient. I have met with tour such cases, 
and have put them on record in various places. 

The morbid appearances after death from simple epilepsy 
arc necessarily very obscure, if the case have really been one 
of simple epilepsy, and not one of epileptiform convulsion 
connected with some special disease. In cases fatal during 
the fit the brain has been found to be congested ; but this 
appearance is clearly owing to the mode of death, and it is 
allowed to be so. 

In cases, again, where epilepsy has been complicated with 
insanity, the brain or its membranes may present various 
signs of inflammation, or of changes more or less akin to 
inflammation ; but these signs are clearly referable to the 
mental disorder, and for no other reason than this : that 
they are as common, or more common, in insanity without 
epilepsy. 

In other cases there are signs of degeneracy, such as pallor 
of the grey matter, softening, induration, atrophy, dropsi- 
cal effusion ; but these are the very signs which belong to 
the demented state. It is this very fact, however, which 
furnishes some grounds for supposing that signs of this 
character may have something to do with epilepsy. It 
docs so, because the demented state is intimately connected 
virh convulsive disorder for if a demented person be not 
epileptic, he is almost sure to be affected with palsied shak- 
ings, or cramps,* or spasms, in one form or another. 

In other cases, again, theskull may be thicker and heavier 
than usual, and several internal projections — as the* clinoid 
proc< m — maybe considerably developed, or various parts 
of the dura mater may be converted into bone. Indeed, 
ther< are no constant changes in the brain proper or its 






1S61.] Convulsive Diseases. 213 

coverings — not even that change in the pituitary boch 
which bo mnch has been said by Wenzel ; forwritic 
Rokintasky Bays that he lias "frequenly failed to discover 

it in those who had notoriously suffered from epilepsy and 
convulsions," and that he has "met with it in others who 
were thoroughly healthy." It*is in the medulla oblongata, 
indeed, that we alone meet with any appearances after 
death which can be regarded as constant. In early cases of 
epilepsy, it is true, we may fail to find anything' character- 
istic even here ; but in confirmed cases Wm medulla oblon- 
gata is often harder than natural, from the interstitial 

lot' a minutely granular albuminous matter, or i 
softened, swollen, and presenting evident signs of fatty de- 
generation. Professor Van der Kolk, who was the first to 
detect these appearances, has also detected some marked 
changes in the bloodvessels, of the part, andto these changes 
he directs particular attention. lie has examined fifteen 
epileptics after death, and in them all the posterior half of 
the medulla oblongata, on making a transveise section, was 
found to be redder and more hyperaemic than it ought to 
and this was the case whether death happened in an. 
attack or not. On more minute examination, he found the 
bloodvessels dilated to thrice their natural dimensions, and 
their walls much thickened. And on comparing the me- 
dulla oblongata of several epileptics who bit their tongue, 
with the medulla oblongata of other epileptics who did not 
bite their tongue, he found (what is a very curious fact) that 
the capillaries were especially dilated in the course of the 
hypoglossus and the corpus olivare in the former case 
the tongue was bitten in the fit, and in the course of 
roots of the vagus in the latter case, where the tongue 
not bitten in the fit. These discoveries of Professor 
der Kolk are the most recent as well as the most important 
- in connection with the post-mortem appearances of epi- 
lepsy. 

What, then, is the theoretical purport of the foregoing 
To which view of muscular motion do. dntV 

And first — for herein may be found the key to the whole 
matter — what is the theory of simple epilepsy to bo dedu 
from the facts which concern the circulation and respiration 
of the epileptic? 

1. No very certain conclusion is to be drawn from a con- 
ration of the state of* the circulation and respiration in 
the interparoxysinal period, except this — that plethora in 



214 Lectures on [March, 

the form so often exemplified in the butcher is never met 
with, and that feverish activity, even as an accident, is of 
rare occurrence. There are, indeed, cases of epilptiform 
diseases which the circulation may exhibit at times some 
signs of activity ; but these cases, as we shall sec in the next 
lecture, present no objection to the conclusion which is 
forced upon us by ilio, tacts — that the pulse is rarely other- 
wise than weak and slow in the interparoxysmal period of 
simple epilepsy. 

In the fit itself, the facts, when fairly read, admit of one 
conclusion, and one only. At the instant of the fall, a 
corpse-like pallor overspreads the countenance and the pulse 
dies out at the wrist — phenomena which seem to be only 
intelligible on the supposition that the arteries are nearly 
empty of red blood. A moment or two later, and the black 
and bloated face, the choking sounds, and the absolute sus- 
pension of all respiratory movements, show very plainly 
that the formation of red blood is arrested for the time. 
During the course of the convulsion, indeed the state is one 
ofsuffocation. I hiring the convulsion, that is to say, the 
supply of arterial blood is cut on at the fountain-head. 

There is, however, one fact which, at first glance, might 
o to show that there is an increased injection of arterial 
blood during the convulsion. Such injection is manifestly 
very imperfect at the onset of the fit,for upon no other suppos- 
ition can we explain the corpse-like paleness of the counten- 
ance and the feeble and imperceptible pulse. But if the fin- 
ger be kept upon the wrist during the convulsion, it will be 
found that the pulse will go on rising until it has acquired 
a force and fullness which it never had in the interparoxys- 
mal period ; and if the hand be placed on the breast, it will 
he found also that this rising of the pulse is accompanied 
by increased action of the heart. These facts arc evident 
and unmistakable, but they do not show, as without reflec- 
tion they might seem to do, and as they are often supposed 
t'> do, that red blood is being injected in greater quantity 
into the arteries during the convulsion. 

W"hcn the proc< piration is arrested, the right side 

of the hcaii and the venous By stem generally are soon gorg- 

ncl distended with black blood. (Tnder these circum- 

indeed, the gorged and distended state of the 1 right 

of the heart may reach a point in which the folds of 

the tricupsid valve are forced widely apart, and an opening 



1861.] Oonvulswe Diseases. 215 

loft through which the beatings of tlio ventricle are made 

to toll almost as much in driving the blood back through 
the auricle into the veins. a> in sending it onward through 
the pulmonary artery into the lungs. But it is not right to 
suppose that the left Bide of the heart and the arterial trunks 
are empty of blood; and this may he readily verified by 
watching the changes which take place in the carotid and 
jugular of a rabbit during the process of suffocation. On 
exposing the 3, the artery is seen to bo filled with red 

and the viens with black blood. On suffocating the animal 
by tying a ligature around its windpipe, the color of the 
blood in the artery darkens rapidly, and in about two 
minutes and a half it is every whit as black as that of the 
blood moving in the neighboring veins. Nor is the vein 

CI O o m 

_ed and distended and the artery comparatively empty. 
On the contrary, the artery is felt to pulsate as strongly 
under the rush of black blood as it did previously under the 
rush of red blood. Nay, the pulse of the black blood is actu- 
ally stronger than the pulse of the red blood ; for, on testing 
with hsemadynometer, the late Professor John Reid (who 
first directed attention to these facts, and who has investi- 

1 the condition of the circulation in asphyxia more care- 
fully than any other observer) found the mercury highest at 
the moment when the blood in the artery had become 
thoroughly venous and black. 

A full pulse and a throbbing heart, therefore, must be 
looked upon as natural accompaniments of asphyxia : ami 
thus the full pulse and the throbbing heart of the epileptic 
paroxysm, instead of showing that a larger quantity of red 
blood is being injected into the arteries at the time, may 
show that these vessels are then laboring under a load of 
black blood, as they do in asphyxia. And that the full pulse 
and the throbbing heart of the epileptic paroxysm must 
have this Latter significance is evident, for the livid black, 
and bloated head and neck, and the complete suspension of 
all respiratory changes, show very clearly that black and 
not red blond is coursing through the vessels at this time. 
When the convulsion is over there is little to notice in the 
the circulation and respiration. When the spasms 

•. the respiration is speedily re-established, and the re- 
admission of arterial blood into the system may be attend- 
ed with some transient and inconsiderable febrile reaction ; 
but • rion has nothing to do with the convulsion, for 

when reaction is present convulsion is absent, and if con- 



216 Lectures on [March, 

vulsion returns, it is not until every trace of reaction has 
taken its departure. 

Regarding, therefore these facts — the corpse-like paleness 
and the comparative pulselessness at the onset of the parox- 
ysm, and the signs of positive and unequivocal suffocation 
by which this stage of paleness and pulseness is succeeded 
— and remembering the previous arguments, which show 
that the convulsion is not to he ascribed to the presence of 
the Btimulous of venous blood, there appears to be only one 
conclusion, and this is, that the convulsion of epilepsy is 
connected with the want of a due supply ot arterial blood 
in the vessels. 

Nor is it an objection to this view that the convulsions 
cease when the blood has become thoroughly deprived, of 
its arterial properties. In order to discharge their office of 
conductors, it is certain that the nerves must be supplied 
with a sufficient quantity of arterial blood. If, for example, 
the principal vessels of a limb be tied, the nerves of that 
limb, wanting their due supply of blood, are unable to carry 
messages to the mind, or to transmit mandates from the 
mind to the muscles, until the collateral circulation is suf- 
ficiently established ; and. hence it is a fair inference that 
there must be a point in the process of suffocation where, 
wanting a due supply of arterial blood, the nerves must 
cease to be conductors, and where, consequently, the con- 
vulsions will come to an end ; for, upon an}' hypothesis, the 
convulsions will come to an end when the nervous centres 
cease to be in proper connection with muscles. 

But, it may 'be asked, is there no change in the blood 
itself? Is there not. some important truth in the "humoral 
theory of epilepsy," as recently advanced in this place by 
the late lamented Dr. Todd ? "I hold,*' said this distinguish- 
ed physician, "that the peculiar features of an epileptic 
seizure are due to the gradual accumulation of a morbid 
material in the blood, until it reaches such an amount that 
perates upon the brain, in, as it were, an explosive man- 
ner; in other words, the influence of this morbid matter, 
when in sufficient quantity, excites a highly poralized state 
ol the brain, or of certain parts of it, and these discharge 
their nervous power upon certain other parts ofthecerebro- 
;il centre, in such a way as to give 1 rise to the phenomena 
of a m. A very analogous effect of that which results from 
the administration of strychnia, which is best seen in a cold- 
blooded animal, like the 1'vo^. You may administer the 



18G1] Convulsive / 217 

drug in very minute quantities for some time without pro- 
ducing any sensible effecl ; bul when the poison has ac- 
cumulated in the system up to a certain point, then the 
smallest increase <^l' dose will immediately give rise to the 
peculiar convulsive phenomena. This is the humoral theory 
of epilepsy. It assumes that the essential derangement oi' 
health consistsin the generation of a morbid matter, which 
infects the blood : and it supposes that this morbid matter 
has a special affinity for the spinal cord. The source of this 
morbid matter is propablyin the nervous system, it may be 
in the I) rain itself. It may owe its origin to a disturbed 
nutrition — an imperfect secondary assimilation of that organ 
— and in its turn will create additional disturbance in the 
functions and in nutrition of the brain." And again : 
Ling to the Immoral theory, the variety in the nature 
and severity of the fits depends on the quantity of the poi- 
sonous or morbid material, and on the part of the brain 
which it chiefly or primarily affects. If it affect primarily 
the hemispheres, and spend itself, as it were, on them alone, 
you have only the epileptic vertigo. If it effect primarily 
the region of the quadrigeminal bodies, or if the affection 
of the hemispheres extend to that region, then you have 
the epileptic tit fully developed." 

This theory is based upon the well-known connection be- 
tween the presence of urea in the blood, or carbonate of 
ammonia resulting from the decomposition of urea — the 
i It of defective renal action — and one form of epilepti- 
form convulsion; and it might also have been based upon 
the connection between convulsion and blood overloaded 
with bile. But if there is any evidence in these facts in 
favor of the existence of this hypothetical morbid material, 
there is none in favor of the idea that the modus op< randi of 
the material is in exciting a highly polarized state of the 
brain, if by this state is meant anything like a condition of 
excitement. On the contrary, it ia certain (as will be shown 
in the next lecture) that the action of the brain and of the 
em generally is reduced to the very lowest ebb 
at the time when convulsion is brought aboul by the accu- 
mulating i and bile in the blood; and it is not less 
tain that strychnia, instead of actin , Todd e 

iting a highly poraliz< 

ing the 
stimulating powers of the blood and by diminishing the 
sfion of both nerve and muscle. 



218 I ."■lures on [Marcli, 

There is little doubt, however, thai retained excretions 
must play an important pari in the production of epilepsy 
A free discharge in the office of excretion, not only in the 
kidneys and liver, bul in every excretory organ, is essential 
to the preservation of healthy blood ; and it may well be 
believed thai an imperfect discharge of the office of excre- 
tion, in oik' or other of the excretory organs, may lead to 
the accumulation of eftete matter in the blood, and that this 
accumulation ofeffete matter may be a not unimportant 
cause, in bringing about an attack of epilepsy. Hut there 
is no reason for supposing that \\w blood under these cir- 
cumstances become stimulating. On the contrary, the con- 
clusion which arises out of the history of the cases where the 
area or bile is suppressed, is the natural conclusion, and 
this is, that blood thus altered is less fit to discharge its 
several offices ; in other words, less stimulating. 

Nor does there appear to he any reason for supposing that 
venous congestion has a more important part to play in the 
production of epilepsy than that which has been assigned to 
arterial injection. No doubt the veins of the brain and 
head generally arc congested from a \cvy early moment, 
butthere is a moment antecedent to this in which the death- 
like pallor of the face is a sufficient proof that the veins 
were emptier than usual before they became congested. At 
any rate, the acknowledged anatomical difficulty must be 
overcome before it can be supposed that Dr. Marshall Hall's 
hypothesis of trachelismus — or the prevention of the return 
of Mood from the brain by the spasm of certain muscles in 
the neck — has anything to do with the causation of epi- 
lepsy. 

Et would seem, then, as if there was something utterly 
uncongenial between epilepsy and arterial excitement. Jt 
would seem, indeed, as if the spawns, as well as the loss of 
consciousness and sensibility, were connected with want 
of arterial blood — empty vessels in the first instance, ves- 
sels tilled with black blood afterwards. It is not imp 
bable, also, that the blood may have been previously 
rendered less stimulating by the retention of something 
which ought to have been eliminated by one or other of 
the organs of excretion. In a word, the phenomena are 
entirely in harmony with the previous considerations re- 
specting muscular motion ; for according to them, the ac- 
tion of arterial blood is to antagonize construction, and 
not i. it. 



. 



1861,] Convulsive Disecu 219 

'1. Interrogating the nervous system, the facts are found 
to have that theoretical significance which the state of Hie 
circulation and respiration would lead us to expect. 

These facts will scarcely warrant the idea that epilepsy 
ifconnected with anything approaching to over-action of 
the brain proper. On the contrary everything seems to 
point to a state which is the very opposite of over-activity. 
Thus, the comparative want of memory, intelligence, fancy, 
and purpose, which marks the intcrparoxysmal condition; 
the utter annihilation of everything mental in the fit itself; 
and the gloom and prostration following the fit, are facts 
which can have no double meaning. 

Xor is a contrary opinion to he drawn from the morbid 
appearances which are disclosed after death. If these 
chance to indicate previous inflammation, it does not fol- 
low that convulsion had any direct connection with the in- 
flammation as inflammation ; on the contrary, the convul- 
sion may have happened hefore or after the inflammation, 
when the energies of the brain were prostrate or exhausted 
— an alternative which we shall see to be the correct one 
when we come to speak of elcptiform disease connected 
with special disease of the brain. And surely it is not pos- 
sible to draw any but one conclusion from the appearances 
which arc common to epilepsy and dementia — pallor of the 
grey substance, atrophy, chronic softening and induration, 
dropsical cfl'usion and the rest? 

But what of the state of the medulla oblongata V for, as 
►r Schrosder Van der Kolk has well shown, the seat 
of the characteristic spasms, the bilateral character of the 
spasms, and the appearancespresented after death, all point 
to this organ as one which is specially concerned in bring- 
ing about the epileptic paroxysm. 

The spasms of epilepsy begin in muscles which receive 
nerves from the medulla oblongata — in muscles, that is to 
. which are supplied by the facial, the accessory, the hy- 
poglossal, and the portio minor trigemini; in slighter <•; 
they are limited to these muscles. The spasms of the walls 
of the chest and abdomen, which are the most prominent 
and marked features in the complete attack of epilepsy, 
and which may be so fierce and unyielding as i fatal 

suffo . also point to the same nervous centre; for a 

similar state of things is brought about by the action of a 
strong stimulus upon the great afferent nerve of tins centre 
— the pneumogastric. 



220 Lectures on [March, 

The bilateral character of the spasms is another argument 
that the medulla oblongata [ally affectedin epilep- 

sy. The lateral halves of this organ are connected in the 
most intimate manner by transverse fibres and commissures 
— much more intimately than the lateral halves of the brain 
and spinal cord ; and hence it is that the corresponding 
nerves belonging to the two sides of the medulla oblongata 
are under a stronger physical necessity to act together than 
that which rides the corresponding nerves "belonging to the 
two sides of the brain and spinal cord. In the ease of the 
two latter centres, the nerves belonging to one side may be 
paralysed or otherwise affected without any obvious injury 
to the nerves of the other side; hut not so in the case oi 
the latter centre. Indeed, it is evident that the actions 
which eminate from the latter centre — the play of the fea- 
tures, the motion of the tongue, the vocal adjustments of 
the larynx, the respiratory movements, kc— must at once 
come to an end unless there he the strictest sympathy and 
concert in the action of the corresponding nerves of the 
two sidi 

Xow in epilepsy the spasms are always more or less bi- 
lateral, and for this reason, therefore, it may he supposed 
that they have some special connection with a nervous 
centre of which one lateral half cannot act without the 
other. 

The appearance after death point also to the medulla ob- 
longata as especially concerned in the production of epilepsy. 
In an early stage of the disorder, we may fail to find any 
characteristic changes; hut, in confirmed cases, the texture 
is harder than natural, from the intestinal deposit or a 
minutely-granular albuminous matter, or else softened, 
swollen, and exhibiting signs of evident tatty degeneration. 
The posterior half of the oblongata is redder and more 
hypersemic than it oughttobe; and, on examining the hlood- 
3els in this congested portion, they are found to be of 
thrice their natural dimensions, and with their walls much 
thickened and altered — this dilatation and alteration being 
chiefly in the corpus olivare and in the course <>f the hypo- 
in the ease of epileptics who bite their tongues, and 
in the course of the rool vagus in th< fepilep- 

. who d<> qoI bite th< ir tong 

It is evident, then, that the medulla oblongata is especial- 
ly affected ii sy; but it does not follow, as Profee 
Van dcr Kolk supposes, that the essential cause of the con- 



1861.] 221 

vulsive affection is to be found in an exalted sensibility and 

activity of the ganglionic cells of this centre. 

In favor of this view — that epilepsy is dependent upon 
exalted sensibility and activity of the ganglionic cells — ap- 
peal has been made to the fact of spasms, to the presence 
of a full, bounding pulse, and to the freedom from attack 
which is for some time the fruit of an attack, particularly if 
this has been violent ; but the answer is not necessarily that 
which Professor Van der Kolk supposes it to be. After 
what lias been said about muscular motion in the first lec- 
ture, it is not possible to allow that spasm in itself is an 
argument in favor of exalted sensibility and activity in gang- 
lionic cells. After what has just been said about the 
phenomena of the circulation in epilepsy, it is impossible to 
allow that the condition of the circulation favors spasms by 
bringing about a more active state of the medulla oblongata, 
'the functional activity of this, as of every other organ, be- 
ing in direct proportion to the activity of the circulation of 
red blood in the organ;) for it has been seen that the 
bounding pulse to which reference is made, is- filled with 
black blood, and not with red. Xor can the freedom from 
attack, which is for some time the fruit of an attack, be ap- 
pealed to as a certain proof that the attack is the sign of the 
discharge of some overcharge of excitability previously pre- 
sent. On the contrary, it maybe argued with some degree 
of plausibility, from certain facts which have to be mention- 
ed in the next lecture, that the attack was preceded by de- 
pression of the circulation and innervation, that the convul- 
sion supervened when the depression had reached a certain 
point, and that the recurrence of the attack was prevented 
tor a time by the state of reaction in the circulation and in- 
nervation, which is a conserpience of the convulsion. The 
may be one, indeed, of which the history of the rigors 
of ague may serve as so inapt illustration ; for here we hi 
first, the circulation failing more and more until the bathos 
of the cold stage is reached; and, secondly, a state of re- 
action which banishes the rigors most effectually so Ion . 
it contin 

It would even seem as if appeal might be made to the 

appearances after death, and to the actual condition of the 

circulation in the fit, for positive arguments against the idea 

aything approaching of the medulla 

obi- 

Ti. of fatty degeneration can have but one signifi- 



222 Lectures on [March, 

cance — under-action, not over-action. The interstitial de- 
posit, also, implies an equivalent absence of healthy nerve- 
structure, and so does the dilated condition of the blood- 
vessels; and this absence of nerve-structure must necessitate 
a corresponding absence of nervous action. The appearances 
after death, indeed, ifthey show anything, show that the 
medulla oblongata of the epileptic is damaged in structure, 
and because damaged in structure, weaker in action, than it 
ought to be. 

The ureal argument against the idea of anything like 
over-action of the medulla oblongata in epilepsy, however, 
is to be found in the state of the circulation; for if, as may 
safely be assumed, the activity of any organ is in direct re- 
lation to the activity of the circulation of red blood in that 
organ, how far from anything like over-action must be 
the state of things in which as is the case in the epileptic 
paroxysm, the vessels arc at first comparatively empty of 
red, and afterwards completely filled with black blood ? 

Nor can the curious discovery of Dr. Brown-Sequard, that 
certain injuries of the spinal cord are followed by an epilep- 
tiform affection, be construed into an argument that there 
is anything like a state of exalted action of the spinal cord 
in epilepsy. This curious result, which is brought about by 
puncturing or dividing more or less completely almost any 
part of the spinal cord, is developed, not immediately, but 
in the course of three or four weeks after the injury. The 
attacks, once developed, occur spontaneously at various in- 
tervals, often several times a day ; they may also be brought 
on by pinching or otherwise irritating the portion of the 
skin which corresponds to the region of the whiskers in 
man. This excitable spot is supplied by twigs belonging 
to the suborbitary, the auriculo-temporalis, the second, and 
perhaps the third, cervical nerves ; and it is a curious fart, 
that the irritation which brings on a tit when applied to the 
skin in which these twigs terminate, has no such effect 
when applied to the twigs, themselves. Any other part of 
the skin may be pinched or irritated with impunity, butthis 
one spot can scarcely be touched without at once bringing 
(Hi a lit. 

These facts are very curious, and in the main, very un- 
intelligible : but this much at least is evident, thatthey do 
not countenance the idea of any over-action of the spinal 
I in epilepsy. The fad thai the epileptiform affection 
- doI make its appearance until four or live weeks after 



] m;i.] Convulsive Jbiaeat 228 

the injury would appear to show very clearly that the tits 
have nothing to do with that local inflammation in the cord 
which may be supposed to have been Bet up in the first in- 
stance by the injury. After such a lapse of time, indeed, 

is it not the natural conclusion, that any over-action of the 
cord arising from the inflammation produced by the injury 
must have died out, and left the cord damaged, weakened, 
under-acting! Nor is a contrary conclusion to be drawn 
from the excitable condition of the nerves proceeding from 
the neighborhood of the cheeks ; for both sides of the face 
are thus affected, if both sides of the spinal cord have been 
injured. What the full significance of this curious fact may 
be we may have yet to learn, but at any rate there is no 
reason to suppose this excitable condition of the skin im- 
plies an over-acting condition of the nerves or nervous 
centres concerned in the phenomenon. The excitable por- 
tion ot skin is not over-sensitive, for the animal manifests 
no signs * f uneasiness when it is handled immediately after 
a lit. Over-sensitiveness, moreover, would seem to have 
nothing to do with the matter. At any rate, pain, and not 
convulsion, is the consequence of handling those portions 
of the skin of the animal which may have been rendered 
highly hypersesthetic by the injury to the cord which 
brought on the convulsions. It i^ certain, also, that a some- 
what similar condition ol' excitability is brought on when, 
in several experiments related in the first lecture ante. 
June-July, the skin is cut off from the full influence of the 
nervous -: and hence the natural inference would be, 

that the action of the nervous centres in the epileptic guinea- 
nus rather plus. 

As in the former instances, however, so here; we turn to 
the condition of the circulation ami respiration in order to 
know what is the actual functional condition of the spinal 
cord in epilepsy; and so turning, we see that the action of 
the cord under these circumstances must be almost or alto- 
gether nil. For what action can there be when little or no 
arterial blood is injected into the vessels? 

A similar argument will also dispose of the idea of over- 
activity of the ganglia of the sympathetic system as a a 

ible that the contracted state of 

the arteries, which is implied by the death-like pallor of the 

countenance and the comparative pulsel al the wrist, 

may show that the coats of the vessels are in a state of 

: and it ifl also possible that the cause of this spasm 



22 1 Lectures on [March, 

may have to be sought in the sympathetic system; hut it 

docs not follow that over-action of this system is this cause. 
On the contrary, the experiments of Drs. Kusmaul and 
Tenner already referred to show most conclusively that 
strong epileptiform convulsion is possible when the action 
of the sympathetic ganglia is entirely suspended by arrest- 
ing the supply of blood to these organs. 

And certainly no opposite conclusion is to be drawn from 
the vague and undefinable sensations or movements very 
varying in character, but all comprehended under the term 
—sensations of pain, numbness, tingling, or a feeling 
of cold vapor; movements of shuddering or spasm, begin- 
ning in a distant part and travelling towards the head ; for 
the most probable interpretation of these symptoms is that 
of Dr. Watson — that they arc in some degree analogous to 
the numb and tingling feelings which are the frequent pre- 
cursors of paralysis and apoplexy, or to the globus of hys- 
teria — phenomena which by the most perverse process of 
reasoning can scarcely be supposed to indicate other than 
a state of defective innervation somewhere. 

But, it may he asked, is there nothing else ? Is there no 
peculiar state of the nervous system in epilepsy? Is there 
no morbid irritability.? In order to answer this question, 
it is necessary to ask another — What is morbid irritability ? 
It is not inflammation; it is not fever; it is some indefin- 
able and negative state which occurs frequently in teething, 
in worm disease, in uterine derangement, and in many 
other cases — a state in which the patient is unusually de- 
pressed by depressing influences, and unusually excited by 
exciting influences. But what is this state ? Is it any- 
thing more than lucre exhaustion? In difficult teething, 
the strength is worn away by pain and want of sleep ; in 
worm disease, the parasites help to starve and exhaust the 

em; in uterine derangement, the health is undermined, 
in all probability, by pain and by sanguineous or other dis- 
charges. In each case there is unequivocal exhaustion of 
body and mind, and the signs of morbid irritability appear 
to be nothing more than the signs vf such exhaustion. A 
weak person is more affected by the Beveral agencies which 

upon the body from within and without, and he is so 
because he is without some of that innate strength which 
which belongs to the strong person : and the person who is 
morbidly irritable, is in reality one who, \\yr want of this 
principle of strength, responds impatiently to the several 



1861.] True Ringworm. 

stimuli, whose office it is to elicit his vital phenomena. Tn 
a word, this undue morbid irritability may be nothing else 
than the natural consequence of that general want of power 
the signs of which are written so legibly upon the vascular 
and nervous systems of the epileptic. There is no neec ■- 
then, to look upon this morbid state of irritability as an 
evidence of the existence of any peculiar condition in some 
part of the nervous system ; for, thus interpreted, it only 
shows that the state of muscular contraction is ill antagon- 
ized by nervous influence. Thus interpreted, indeed, mor- 
bid irritability only becomes another name for inefficient 
innervation. 

The theory of simple epilepsy, therefore, which may be 
deduced from a consideration of the facts relating to the 
nervous system is in harmony with that to which we have 
been led by a review of the state of the circulation and res- 
piration in the epileptic ; and this theory is one which tal- 
lies as completely with the view of muscular motion set 
forth in the first lecture, as it disagrees with that commonly 
received opinion according to which the muscles are sup- 
posed to contract convulsively because they are subjected 
to excessive stimulation. 



Clinical Report on True Ringworm (Tinea Ton 

By Jonathan Hutchinson, Assistant-Surgeon to the London 
Hospital, and Surgeon to the Metropolitan Free Hospital. 
The diagnosis of ringworm to the practised eye is not usual- 
ly difficult. Its patches differ from those of eczema, impetigo, 
and common porrigo, in that they have no inflammatory crust, 
only a thin branny desquamation being present, hi the latter, 
the hairs are not destroyed, but simply matted together in 
the crust, while in ringworm they are broken off short. The 
roundness of its patches, and their abrupt definition; together 
with the paucity of scales, distinguish it from all the forms of 
psortasis ; and the latter are beside- veryrare on the scalps of 
children. In alopecia circumscripta the patches are glabrous, 
(piite destitute of hair, and free from even the Bmallest scales, 
a in which ringworm departs from its usual type 
— for instance, if attended by inflammation — its differential 
diagi comes difficult. In all Buch cases the appeal is to 

the microscope. To make a Satisfactory diagnosis with the 
microscope the hairs from the patch should be carefully pulled 
15 



226 True Ringworm. [March, 

out with tweezers, and some of the branny scales should also 
be scraped off. Those should be put into a drop of glycerine 
on the microscope-slide, and covered in the usual manner. 
The addition of acetic acid renders the hair structure more 
transparent, and the sporules, therefore, more conspicuous, 
but glycerine is usually quite sufficient. After observing the 
general size ot the hair-fragments, etc., with a half-inch ob- 
ject-glass, a quarter-inch, or a fifth, should be employed^ 

Microscopic Diagnosis. — The presence of sporules of a fun- 
gus is an essential character. These are usually best seen in 
groups on the outside of the hairs ; but a little practice will 

o enable the observer to detect them in great numbers in 
the interioi of the hair-shaft itself. It any hairs have been 
pulled out with their bulbs the sporules may most probably 
be Been very distinctly in the lower and less opaque part of the 
latter structure. But. the peculiarities presented by the hairs 
themselves (apart from the actual demonstration of parasitic 
elements) are very marked. Instead of being round, of regu- 
lar thickness, in long portions, and partial translucent, they 
are black, in short broken fragments, swollen, bulging at 
parts, and with their external layers split off in places. The 
black tint (which is due, not to pigment, but to altered refrac- 
tion from disturbed arrangement of the hair-fibres) is arranged 
in longitudinal bars, giving the hair a fasciculated appearance. 
If the extremity of a ringworm-hair is brought under view it 
is seen to be broken and split up into fibres, resembling on a 
small scale the stump of a worn besom. In, and on, the epi- 
dermic scale sporules will also be found. It is consistent with 
my own observation, that the younger the patient the more 
likely is the disease to be restricted almost solely to the hairs 
of the scalp, whilst in those beyond the age of about, ten years, 
the epidermic scales are often attacked, the hairs being less 
extensively affected. When the patches are situated on the 
skin of the trunk, neck, or anus, t\io small hairs of the part are 
almost always attacked, but they do not become infiltrated in 
the manner so often seen on the scalp, nor do they usually 
break off. In these regions the disease is primarily one of the 
epidermis rather than of the hairs. 

1- tine Ringworm Contagious? — The popular # belief in the 
extreme contagiousness of ringworm is of old landing, very 
firm, and ver) widely spread. It i- also Bupported by the 
experience of most dermatologists. ( me or two authors, how- 
ever giving descriptions by which it is placed beyond 
doubt that they were writing about the disease in question), 
deny it- contagiousness. Thus, one authority writes: "Thia dis- 



1861.] True Ringworm. 227 

ease is not contagious ;" and adds, "that it is not communi- 
cable by inoculation/' I am not aware that any evidence is 
on record supporting the view that it is not inoculable, while 

there are many tacts conclusively proving the opposite. The 
experiment is one easily tried, and on such a mailer the anus 
prubandl certainly rests with those who deny it.""' Mr. En- 
nuis Wilson, after broaching the theory that the Buppi 
cryptogamic sporules are in reality oil-globules, the result of 
fatty degeneration of the hair-shafts, has the following extra- 
ordinary passage : 

w * Another consequence naturally follows the admission of the 
explanation here given, which is, that this disease being in- 
herent in the hair, and being due to an abnormal nutrition of 
the system, is in nowise contagious. I need scarcely observe, 
that this is a question of the utmost importance as affecting 
the peace and happiness of families and the education of 
youth. The disease occurs as commonly among the children 
of the wealthy as among the poor ; and when the idea of its 
being contagious is entertained the scourge is rendered doubly 
severe." 

Thus it would appear that a theoretic conjecture as to the 
pathology of the affection is to decide this important question, 
there being no need for clinical investigation as to what is 
really the fact. Let me ask any one who has glanced ever so 
cursorily over the cases I have cited whether he would to try 

"secure the peace and happiness of a family,'' or "promote 
the education of youth,'' by assuring an anxious mother, <>;• 
the head of a children's boarding-school, that the disease in 
question cannot sj^read by contagion, and that no precautions 
need be taken ( The clinical proof of the contagiousness of 
true ringworm is as conclusive as is that of similar nature in 
respect to scabies. When we see a disease in itself slight 
and easily curable by local means, suddenly showing itself in 
live or six individuals in the same family of different ages and 
states of constitution, and none of whom were ever liable to it 
before, it is surely futile to allege that constitutional causes are 
sufficient to explain the occurrence. The case is yet stronger, 
if possible, the affected children belong to different families; 
and it culminates when we find that the disease has spread to 



*It is <io.-irul»k' that the ed in the microscopic examination of 

ringworm products should be careful lest they innoculate themselves. 
This occurred to myself, and [had a large, well-characterised 

patch on one side the neck. 



True lilngicoviii. [March 



the neck and hands of the mother or nurse of the patient. To 
rl that a disease is actively contagions under assisting 
conditions is quite a different tiling from alleging that it wifl 
inevitably affect every one who touches the patient. It is 
not at all infrequent to witness scabies confined to a single in- 
dividual in a family, although the exposure may apparently 
have been considerable. In my report on favus I showed 
that although undoubtedly capable of spreading by contagion 
yet the fungus of that disease is difficult to transplant, and will 
nol grow on a new soil unless precautions be taken to give it 
a lair chance. The fungus of ringworm is much more easily 
transferred from one to another, yet it also may well be sup- 
posed to require certain conditions (i, <?., a soft skin or succu- 
lent hairs and a fair opportunity of access) in order that it may 
implant itself. 

Is Ringworm a Constitutional Disease I — With regard to the 
question as to whether any constitutional predisposition exists 
in cases of ringworm, it has already been answered by the 
facts adduced as to contagion. These facts are of the same na- 
ture in scabies and in ringworm. In both these, the invariable 
presence of a parasite has been proved; both are curable 
easily by local means, which destroy the vitality of the para- 
site ; both are easily contagious ; both are constantly seen in 
most healthy individuals. It is impossible to believe that 
any form of dyscrasia can produce scabies, and it is equally 
inconsistent with clinical evidence to hold that ringworm can 
be produced by such causes. That scabies is a much more 
severe disease in some individuals than others is well known, 
and the same is no doubt equally true of ringworm. In the 
n'rst place, early age, which involves softness and succulency 
of the cutaneous structures, predisposes to both, or rather it 
would be more correct to say, that advancing age pari pa 
protects from both. Both are attended with a greater 
amount ol* irritation in those of fair complexion, and probably 
are more liable to occur in such. But to admit this is a 
different matter to admitting that the strumous diathesis. 
or any other form of general ill-health, predisposes to them. 
:.nd in support of the latter suspicion there does not exist any 
evidence whatever. 

ntity of Ringworm on the Scalp with Ringworm on the 

ral Surface.— The great frequency with which ringworm 

ire in the same individual, both on the seal}) and on other 

of the surface, and the common occurrence of the dis- 

• different parts in different individuals of the same 

ly, from mutual contagion set at rest all doubts which 



1861.] True Ringworm. 229 

might have been felt as to the identity of the affection. Every 
now and then, even in young children, Ave see cases in which 
the disease appears to avoid the scalp ; but this is probably 

explained by some peculiarity of the hair in such individuals. 
The hair of the scalp in adults appears to be proof against the 
inroads of the fungus, and in them we always see the patches 
on the skin of the chest or arms. It may easily be supposed 
that the hair-structure in different children differ considerably 
ns to the hardness of its cortex. When the patches occur on 
the skin of other parts, the fungus usually attains a more lux- 
uriant development than when on the scalp. The small hairs 
of the chest on the affected parts, are usually attacked by the 
fungus, but are rarely infiltrated extensively. The ravages 
are much more superiicial than on the scalp, and for that rea- 
son ihe cure is much more easily effected. Upon the ques- 
tion of the identity between ringworm and some forms of sy- 
: 3 1 shall not here enter. 
Treatment. — From time immemorial it has been customary 
to employ various local irritants for the cure of ringworm. 
Ink is the favorite application of mothers, and is a scientific 
and frequently successful remedy. At the Hospital for Skin 
diseases. Mr. Startin always blisters the patches with the veri- 
cating fluid. A single blistering is usually sufficient for 
patches on the skin, but those on the scalp often require two 
or more. Many Burgeons employ nitrate of silver in solid 
stick. M. Bazin insists strongly on epilation as a means of 
cure, and there can be no doubt that it is an extremely impor- 
tant one. By removal of the affected and adjacent hairs we 
can reduce a ringworm patch on the scalp to the same con- 
dition as one of the general surface, thus rendering it. much 
more accessible to the influence of parasiticides. Of the lat- 
ter it probably does not matter much which we select. The 
ointment is a very good one, so also is the application 

rong acetic acid. The great point in treatment is to keep 
clearly in mind that the destruction of a vegetable parasite is 

•bject aimed at. It is needless to point out how strongly 

fact that ringworm is curable by local means supports 
the "pinions held in this report as as its purely local patholo- 
gy. 

-. — 1. True ringworm, or tinea tonsurans, may 
ffectmg either the scalp or the gener- 

irface, in which circular patches are formed, on which the 
haii-- break off short, and a short, and a slight, branny desqua- 
•;i, both hairs and epidermic scales exhiting under 
the mi pe the sporules and thalli of a fun; 



2:30 Irish Poisons. [March, 

2. Ringworm in the scalp is rarely seen, excepting in 
children ; but on the general surface is not very unfrequent 
in young adults. 

It is contagious, and spreads by contagion only. 

4. It is not attended by any peculiar form of dyscrasia, but 
on the contrary, often "attacks children in perfect health. 

5. It is much more easily curable on the general surface 
than on the scalp, owing to the circumstances, that in the lat- 
ter situation the fungus has obtained access to the follicles of 
the hair. 

6. Being a purely local disease, ringworm does not require, 

iy constitutional treatment. 

7. A purely local treatment, if efficiently pursued, is always 
and rapidly successful. 

8. Epilation, and the use of one or other of the known parasi- 
ticides, are the measures of treatment required.- 

1). There is no real difference between ringworm on the 
general surface. 

10. Ringworm, although not unfrequently causing minute 
vesicles, has no true analogy with herpes. — Med, Times. 



Remarks on Pish Poisons. By Dr. Reil. 
The observations made by the author on this subject are, 

ially, the following : 
Fish may prove injurious to health either in the preserved 
condition, that is salted, pickled, or dried, or in the fresh state. 
Their poisonous properties in the simple or fresh state may be 
■• to the following circumstances : 

1. They may themselves under all circumstances be poison- 
ous, as has been maintained in regard to several species of 
fishes, although the fact requires further proofs. 

2. They may under certain circumstances acquire poison- 
properties, as for instance, by diseases peculiar to them, 

or at certain seasons of the year, or, as is known of the Cyprius 
harba and Cyprius carpio, at the spawning season. 

3. Poisonous substances, such as Hydrocarpus incbrians, 

•mum occulum, Delphinium staphysagria, etc., may 

been used in catching them, or they may have been 

I in .-mother manner — for instance, by acids and me- 

talic salts, which contaminate the water in the neighborhood 

; i • - . 

Their injurious properties may be owing to commencing 

putrefaction. 



1861.] /.<>. 231 

The different modes of preserving fish give rise to chemical 
processes which cause the formation ot poisonous mal 
Injurious consequences from eating salted fish, particularly 
salted sturgeon, are frequently observed in Russia. But also 
codfish, and the smaller kinds of preserved fish, have given 
rise to Byniptoms of poisoning. Cases of poisoning from her- 
rings are perhaps the rarest, and this is probably owing to the 
fact that the time f«>r catching herring is limited to a certain 

•n, that they are salted without delay when still at 
and that they are more rapidly consumed. 

The character of the poison generated in preserved fish is 
still doubtfnl : at the first the poisonous substance was thought 
to he of cryptogainous growth, or a tatty acid ; more recently 
Schlossberger advanced the view that the propylamin (tri- 
methylamin) contained in the brine is the poison in question 
but this opinion has been refuted by the experiments of Buch- 
lieim. 



Clinical Report on Epithelial Cancer of the Lip. By Jona- 
than Hutchison, M. D. 

This report embraces a statistical analysis of one hundred 
ami twenty-seven cases of epithelions of the lip, occurring in 
hospital practice, in allot' which operations for the removal 
of the disease had been performed. The lower lip was air 
ed in ninety per cent, of the cases, the upper in four per cent, 
and the angle of the mouth in six per cent. From the series, 
we rind that women are subjects of the disease in the propor- 
tion offive t«» every hundred males, and when they are affect- 
ed, it frequent in those who are in the habit of smoking. 

of the patients was fifty-eight years, the 
tremes being twenty-eight and eighty-two years. In all 
cepting about twelve cases was the disease primary. 

The results of the operations for the removal of cancer of 
the lip in one hundred and twenty-seven cases may be 
:ned up a- follow 

tree patients died of erysipelas within ten days of the 

operation : in seven, the cancer returned in the wound : nine 
had a return of the disease in the cicatrix at different periods 
r the operation; in five the lymphatic glands becami 
ibsequently; three had the same ion the op- 

posite part of the lip : and one hundred and five are reported 
as having recovered from the operation, having left the hos- 



232 Diagnosis of Apoplexy. [March, 

pita! with sound cicatrixes. Inasmuch as most of the reports 
were made within a few months of the operation, a sufficiently 
long period had not elapsed to discover whether the disease 
had returned in a larger proportion of cases than above indi- 
cated. 



Diagnosis of Apoplexy. 
Mr. Foelman, the Professor of Physiology in the University 
of Ghent, communicated to the Academy of Sciences at a re- 
cent meeting, an account of some curious phenomena which he 
had observed in a a dog, with some remarks upon an exami- 
nation which he made of the animal after its death. During 
several months, while attending a family as physician, he had 
noticed a dog which appeared to be in perfectly good health, 
and possessed of all his instinctive faculties, but which was 
totally unable to co-ordinate his voluntary movements; fre- 
quently, during the course of the day, he was observed to 
whirl himself round, always in the same manner, and for 
more than a quarter of an hour at a time. Upon making an 
examination of the body, M. Poelman found nothing peculiar 
in the thoracic and abdominal vicera, but in the cerebellum, 
and especially in the middle cerebellar peduncles, there ex- 
isted a considerable number of calcareous concretions which 
gave a very firm consistence to these parts ; the scalpel, which 
he employed for the purpose of cutting into this substance was 
much notched; in short, the cerebellum, with the exception 
of the vermiform process was, so to speak, petrified. M. 
Flourens who brought the communication before the Academy 
after commenting upon the exact relation which was shown in 
this case between the pathological phenomena, and symptoms 
and the functions of the disordered parts, said : 

On this occasion, I request the Academy to permit me to 
make some general remarks upon the diagnosis of apoplexy, 
the feasibility of which appears entirely proved by my re- 
searches upon the encephalon. By these researches I have 
shown that the encephalon, considered as a whole, is com- 

1 of three distinct parts essentially, that is to say, function- 
ally. 

1. The brain, properly so-called, consisting of the cerebral 

• or hemispheres, the seat of intelligence. 

The cerebellum, the seat of the co-ordinating power. 

:t keeps in equilibrium the movements of locomotion. 

The prolongation of the spinal cord, or more exactly 
at part of this prolongation which I have named 



1861.] Delirium Iremens. 233 

the vital protuberance or point, the seat of the principle of 
life itself. 

Hence, three classes of apoplexy may be arranged; the 
cerebral apoplexy, the cerebellar apoplexy, and the bulbous 
apoplexy. The symptoms of these are only deranged func- 
tions ; the functions once known, nothing is more easy than to 
trace the symptoms to the organ which is injured or diseased, 
intelligence marks the seat of the apoplexy to be in the 
brain properly so-called (the cerebral lobes or hemispheres) ; 
the derangement of the balance of the movements of locomo- 
tion denotes the seat of the apoplexy to be in the cerebellum ; 
whilst sudden death would lead to the opinion that the seat of 
the apoplexy (apoplexie foudroyante), was to be found usually 
in the vital protuberance, although sudden death may depend, 
of course, upon a certain degree of lesion in several other 
parts of the encephalon. 

I suppose, here, simple cases of apoplexy, because 1 speak 
from a physiological point of view, the science of thh physiolo- 
gist being to separate organs and their peculiarities, in order 
to arrive at simple facts. In pathology, facts are almost al- 
ways complicated ; it is seldom that a single organ only is dis- 
ordered, and several organs are frequently, more or less, in 
this condition. Hence, for the physician diagnosis is more dif- 
ficult than fur the physiologist; but the plain laws, laid down 
by physiology, may serve as guides, and lead to the unravell- 
ing and analysis of complicated cases. — London Medical Re- 



Hoffman!* Anodyne in Delirium Tremens. F. 13. A. Lewis. 
I was at Deer Island Hospital for a few months after my 
graduation, and while there treated quite a number of cases 
of delirium tremens, and of intemperance, the latter in- 
cluding those who had irritation of the stomach, and the 
"shakes," as some term the state, but not amounting to de- 
cided delirium. I employed the various means presented 
by the text books, and watched the success of students in the 
same Institution, with variable success ; and atone time, think- 
ing that Hoffman's anodyne might answer the indications, I 
: it in 17 cases of delirium tremens and 14 cases of intem- 
perance, in doses 5-s. every hour, and of the 31 cases I did not 
'»ne. Perhaps this will not in the least interest you, but 
as I see the journals tilled with new treatments for this dis- 
. and being a subscriber to the Journal, I thought it pos- 
sible it might deserve a space in its pages. — Huston Mea.dk 
Surg. Journal. 



234 Continued Fever. [March, 

On the use cf stimuLents in the treatment of Continued Fever. 

By I). Tweedie, Physician to the London Fever Hospital, 

&c. 

Speaking upon this subject in his recent Lumleian lectures 
before the Royal College of Physicians, Dr. Tweedie says : 

" It is always necessary to watch the effects of the h'rst few 
doses of wine, and if the pulse abates in frequency, becomes 
soft and fuller, the tongue moist, and the heat of the skin not 
increased ; and, when there lias been delirium, if the- patient 
becomes more calm, and has intervals of sleep, we may feel 
Bure that the wine is doing good. On the other hand, if the 
pulse increase in frequency and strength, the skin becomes 
hotter, and the patient restless, flushed and excited, with 
throbbing of the temporal and cartoid arteries, we may con- 
clude either that wine is -not suited to the case, or has 
been given too earh', and should therefore be withdrawn. 
But, as a general rule, it is perhaps better to give wine a little 
too early than a little too late, since, if it appears to disagree, 
it is easy to suspend its use ; but it may be very difficult to 
restore the vital powers if they have been allowed to remain 
too long unsupported. 

"Nor should the wine or brandy be discontinued until con- 
valescence is fairly established ; but as the symptoms for 
which the stimulants have been prescribed disappear, the quan- 
tity should be gradually abridged by giving smaller portions 
and at more distant intervals. 

"In regard to the amount of wine and alcoholic stimulants 
that may be administered in typhus, no precise rule can be 
laid down, as the ever-varying circumstances presented by in- 
dividual cases can alone determine this. It is prudent to be- 
gin with half an ounce or an ounce, and to repeat this amount 
at longer or shorter intervals, according to the effect produced, 
from six to twelve ounces may be considered to be an aver- 
age daily allowance, but sometimes it is necessary to give two 
or three pints, or even more, in twenty-four hours, and, it is 
surprising to observe, without the slightest intoxicating effect, 
even when the patient has been previously unaccustomed to 
stimulants. Indeed, in low lever-, the exhausted state of the 
nervous system appears to be antidote to the effects of stimu- 
lants — in short, to create a tolerance of vine and diffusible 
stimulants. 

'The wine should always be conjoined with nourishment, in 
onicr to assist its due assimilation, though in many cases the 
digestive powers are so feeble that they are unable to elabor- 



1861.] tinned Fever. 285 

ate oven the Lighest articles of \'oo(\, and therefore the wine 
or brandy may be given simply diluted with water. 

"I have just alluded to the daily quantity of wine that it 
may be necessary to prescribe in typhus, and stated th.it no 
precise rules can be laid down, as the circumstances of each 
must determine it. You are doubtless aware that there 
is a great tendency in the present day to revive the Brownon- 
ian Bystem, which flourished for a time in the latter part of 
the last century, in all acute diseases, including fevers, without 
regard to individual peculiarities. The doctrine inculcated 
by some teachers with respect to inflammation is, that this 
process being a deranged nutrition, involving supply and 
waste, and the waste being considerable while the inflamma- 
tory process lasts, there must be a compensating supply ; that 
as the supplies for the formation of the abnormal products of 
pus and lymph must be drawn from the blood, or from both, 
the vital powers become exhausted, in proportion to the or- 
ganic disintegration that takes place. Hence it is concluded, 
that the more the inflammatory process drawn upon the blood 
the greater will be the exhaustion of vital force, and the con- 
sequent effect upon the whole frame. 

"Upon this physiological theory of the phenomena of inflam- 
mation is based the overthrow of established therapeutic prin- 
ciples, on which the treatment has been for ages conducted. 
But surely'even the abettors of this theoretical view must ad- 
mit, that the object of treatment is to anticipate or prevent 
those. so-called destructive processes : in other words, to pro- 
mote resolution by all available means. Is this to be accom- 
plished by extravagant doses of wine and brandy, regardless 
of the ever-varying condition of the sufferer or period of the 
disea- 

"Similar reasoning is adduced in regard to the phenomena 
- whatever be their type or special circumstances. It 
gainst the indiscriminate employment of stimulants in fever 
that we protest, being convinced that their proper adminis- 
tration requires as much consideration as is generally bestow- 
ed on other measures employed as curative agents. 

"The enormous quantities of wine and brandy recommend- 
ed in even the early stage of fevers, whatever be the form, the 
individual circumstance.-, or whether there be local affections 
present, have often surprised me, and inclined me to doubt 
the accuracy of the statements. 1 have certainly Been inter- 
current inflammations materially aggravated by the injudici- 
ous stimulation adopted, and on more than on< n all the 
ordinary characters of acute delirium tremens supervene 



236 Acute Rheumatism. [March, 

when the unlimited administration of brandy had been left to 
(lie discretion of a nurse, who fancied that she was only obey- 
ing instructions when she poured down dose after dose of pure 
brandy. There is surely no practical philosophy in such in- 
discriminate abuse of a really valuable remedy when given 
on rational principles; and I deem it the duty of every physi- 
cian who is convinced of the dangerous tendency of the 
Brownonian doctrine applied indiscriminately in the treatment 
of diseases, acute as well as chronic, to express his opinion 
boldly and decidedly, that the young and inexperienced prac- 
titioner may be warned of the dangerous consequences of this 
recently revived doctrine. •• " :; " "' : ' 

"Let me also allude to the importance of giving the wine 
at stated intervals, and only when the excitement is moderate. 
It is especially necessary to give it during the night, when there 
is often great exhaustion. A dose of wine judiciously given 
at this diurnal period is often followed by calm, refreshing 
sleep; and hence the incalculable advantage of an interested, 
experienced nurse, on whom so much responsibility — indeed 
the life of the patient — often rests.'* 



The conditions attending every attach of Acute Rheumatism . 

By Dr. Wheelock, of Belfast, Maine. 

An experience of twenty years, we are told, has convinced 
the author that every access of acute articular rheumatism is 
immediately preceded by a special condition of the nervous 
system, induced by mental anxiety or by the action of the de- 
pressing passions; and that if, when the body is in this con- 
dition, a suppression of the sensible or insensible perspiration 
have taken place, the result is invariably acute rheumatism. 
"This truth," Dr. Wheelock natively adds, "though a simple 
one, is to my mind, startling, and, without egotism, the most 
important pathological discovery in the present century." 

Reference is made to fifty cases of acute rheumatism as 
supporting this view, and a dozen of these is given in illustra- 
tion, which can scarcely be regarded as altogether conclusive, 
seeing that few human beings suffering from any malady will 
not present some traces of the action of mental anxiety or de- 
ing passion, if such traces be sought after. 

This view, according to Dr. Wheelock, suggests an addition- 
al indication of treatment. "It is to bring into operation the 
requisite normal influences. The patient is to be made to 



1861.] Purpura Hemorrhagic*. 237 

understand the true nature of the disease and its cause. Though 
it cannot be expected that every individual shall exercise the 
force necessary to the forgetting or ignoring mental agitation 
in these cases, yet it may be presumable that a knowledge of 
the real producing cause may not only prevent a recurrence 
of it, but will greatly assist in fortifying the sufferer against 
its protracted continuance. In my own experience, I have 
found, when patients are informed that it has been brought 
on themselves by a mental agitation that might seem to have 
been avoided or was inexcusable and needless, the disease has 
been shortened in its course or immediately stopped ; and 
where there had been successive attacks, the patients 
had thus been apparently spared these recurrences." 



On the use of ScsquleJiloride of Iron in the treatment of Pur- 
pura Ilemorrharjia. By M. Pize, of Montelimart la 
Drome. 

This paper, which was read before the Parisian Academy 
of Medicine, is divided into two entirely distinct parts ; one 
relating to the exposition of practical facts, the other to the 
modus operandi of the remedy. M. Pize holds, without much 
show of reason, that the drug has a sedative action upon the 
heart ; and this opinion led to a prolonged and futile discussion 
in the Paresian Academy of Medicine upon the action of 
medicine in general. The practical facts are of considerable 
interest. 

In the tirst case, a girl, twelve years of age, presented for 
six days all the symptoms of typhoid fever, and simultaneously 
suffered from epistaxis, turgidity and sanguineous exudation 
of the gums, expectoration, emesis, sanguinolent motions and 
urine ; numerous ecchymoses were disseminated over the 
surface of the limbs. This condition had persisted for a wholo 
:. in spite of sulphuric acid, lemonade, extract of rhatany. 

. mustard poultices, &c. 
three and a half ounce mixture, containing fifteen grains 
of liquid sesqui chloride of iron, was prescribed. In twenty- 
four hours, the hemorrhagic tendency was checked, the urine 
alone remaining sanguinolent. The pulse, which had been 
very frequent, returned to 80 pulsations. On the following 
day no blood was discharged, and the spots of purpura as- 
sumed a dark hue. From that period, the disease proceeded 
rapidly towards cure. 



238 Purpura Hemorrhagla. [March, 

The subject of the second case was a lad of sixteen, who, 
after considerable growth and hard work, with insufficient 
food, was seized with febrile symptoms, extreme prostration 
of strength, and, on the fourth day, presented numerous spots 
of purpura on the limbs, witli sanguinolent motions and epis- 
taxis ; the pulse rising to 100 pulsations. 

A four-ounce mixture, with fifteen grains of sesquichloride 
arrested the hemorrhage in twenty-four hours, and reduced 
the pulse to 90 pulsations. The p"btion was continued the 
next day, and all the symptoms ceased. The Medicine was 
then discontinued for two days. Epistaxis returned twice, 
but with less violence than before. The pulse again rose to 
100. The mixture was resumed ; on the ensueing day no 
hemorrhage took place, and the pulse declined to 82. Con- 
valescence was very rapid under the influence of the sesqui- 
chloride, which was continued for several days; a small 
quantity of substantial food and wine were also prescribed. 

M. Pize's last case refers to an unmarried woman, twenty- 
five years of age, who, two years before, had presented symp- 
toms of chlorosis. After live or six days' indisposition, intesti- 
tinal hemorrhage appeared, epistaxis and numerous spots of 
purpura on the limbs. The pulse was weak, and rose to 119. 
The day after the use of the chalybeate potion, hemorrhage 
ceased, the pulse returned to S6, and fell two days later to 02. 
The disease terminated as in the two preceding cases. 

M. Pize then adverts to the analogous case, published sub- 
sequently to his own, by Bourguignon, a case in which the 
reporter deemed it expedient to add a fourth, recently publish- 
ed in the "Gazette Medicale de Strasbourg,'' by Sir. Leroy, 
de Saint-Ybars. 

The following, in M. Pize's estimation are the obvious infer- 
ences from these four eases, all relating to purpura hemorr- 
agia. 

1. Sesquichloride of iron is pre-eminently the agent for the 
cure of the disease ; it arrests the hemorrhagic tentendeney 
in the space of twenty-four or fourty-eight hours, and, con- 
tinued, for a few days, rapidly brings about the convalescence 
of the patient. 

2. This medicine produces an immediate diminution in the 
rapidity of the circulation, decreases the quickness of the 
pulse; in twenty-four hours Irom 110 to SO pulsations, and may 
therefore fairly be considered as a direct sedative of the ac- 
tion of the heart. 



1861.] Observations on Syphilis. 239 

Observations on Syphilis. 

In an essay read before the Rutherford County Medical 
Society, May 3, 1860, Dr. L. M. Wasson, of Murfreesboro, 
Term., attempted to prove syphilis to be the parent of 
scrofula (Nashville Jour, of Med. and Surg. But this asser- 
tion, although admitted in part by others, is loosely based 
upon the impaired vitality, prostration and cachetic condi- 
tion of the system, induced by syphilis, and resulting in the 
"lymphatic temperament, which is the temperament of 
scrofula." The system is thought to become inclined to 
the scrofulous diathesis, because every fibre of the economy 
cannot but be affected by "blood vitiated with ingredients 
so incompatible with every tissue of the body," as the 
venereal virus. Supposing that to be true, as far as it goes, 
it does not follow as undeniable fact, "syphilis does pro- 
duce, in every particular, the scrofulus diathesis," nor that 
it is "a most powerful and frequent cause of scrofula." 

In order to corroborate the assertion of Dr. Cullerier that 
hereditary syphilis is always % due to maternal influence, 
[Memoires de la Societe de "Chirurgie, torn, iv., p 230) Dr. 
Xotta has published a memoir containing a number of ob- 
servations which go to show, that the issue will be free 
from the disease when at the time of conception the mother 
was free from it, notwithstanding the father may have been 
affected either at the time or previously, but that syphilitic 
children will be the result where the mothers have been 
subjected to the influence of the virus previous to concep- 
tion, while the father was then suffering or had passed 
through the disease. In registering these facts, we are not 
prepared to admit the conclusions drawn from them, pre- 
ferring to wait for the result of a more ample experience. — 
Arch. Gen, de Jlcdec. 

Prof. Sigmund, of Vienna, finds the proto-iodide of mer- 
cury only applicable to the papular and pustular forms of 
syphilis, and even there it is slower in effect than other 
mercurial preparations. Its reputed peculiarity of not in- 
ducing salivation is groundless ; even when combined with 
opium, it gives rise to diarrhoea, and in obstinate forms of 
the disease, it is of little or no use, while in anemia it is 
positively injurious. It by no means deserves the prefer- 
ence given to it in the treatment of children, and admits 
only of further trial in some obstinate" forms, combined with 
iodide of potassium, but not in subjects disposed to catarrh 



240 Observations on Syphilis. March, 

of the longs, stomach or intestines. — Wien Wochensehr.: 
Mai Times and < < 

Prof. Ik-bra has given, in one of the late meetings of the 
Medical Society of Vienna his experience since 1858 of the 
treatment of syphilis by syphilization. Taking the matter 
from a simple chancre, he continues the inoculation as long 
as pustules are formed, or until all the syphilitic symptoms 
have entirely disappeared. Patients, upon whom no more 
pustules arc produced, even by repeated inoculations from 
different chancres, are pronounced "immune." The inocu- 
lations were made three times a week, commencing with 
four punctures in the side or upper arm and then in the 
thighs. The aggregate number of punctures reached from 
7 to G04. The earliest immunity ceased after the nineteenth 
inoculation, or the forty-second day, with seventy-six punc- 
tures; the latest by 219 punctures after 150 days. The pa- 
tients, with the exception of two, received no medicine, not 
even a warm bath, but were allowed nutritious food and 
walking at pleasure. The artificial pustules were covered 
with a piece of oiled linen : frequently it took from three 
to six weeks to heal them up. A few patients, in whom 
inoculation had not been pushed to immunity, were attack- 
ed again with syphilis. Out of twenty-four (three with pri- 
mary chancres, nineteen with secondary syphilis, two with 
non-syphilitic lupus serpiginosus) fourteen had been dis- 
missed, the rest remaining under treatment. The applica- 
tion of mercurial ointment in two cases did not influence 
the development and course of the artificial pustules. All 
patients made perfectly immune are permanently cured. 
They feel perfectly well during the inoculation, improve in 
appearance and gain in weight; by and by all syphilitic 
symptoms disappear. Parallel experiments, however, prove 
the decided superiority of mercurial treatment. — Wien 
Wochensehr.: Oglethorpe Med. and Surg. Jour. 

Against syphilitic chaps and fissures of the toes, an oint- 
ment containing litharge, white precipitate and a few drops 
of laudanum, has been used with marked success in many 
of the hospitals of Germany. The same ointment is recom- 
mended for the serpiginous and phagedenic ulcers which 
asionally supervene upon vaccination in children of a 
Bcrofulous or syphilitic- constitution. The process of cica- 
trization is practiced by bathing the soivs with a decoction 
of hemlock and marsh-mallows. — Med. CJdr. li 



1S61.] mors of the Breast 4 J U 

On (he Diagnosis of Tumors of (I '. By John Erich- 

Ben, Professor of Surgery and of Clinical Surgery in Uni- 
versity College, &c. 

[In the present article Mr. Erichsen treats principal! 
the diagnosis of cancer of the breast from cystic and adenoid 
tumors of that organ.] 

These cystic growths, though not so common as cancer 
and the other solid tumors, are yet of by no means infre- 
quent occurrence. They are of three distinct kinds : — 
1. Those in which the tumor consists of a singular unil- 
ocular . 2. Those which consist of several independent 
segregated together into one tumor — multilocular 
3. Those in which a series of small cysts are dif- 
fused through a fibrous or hypertrophied mass; in fact, a 
combination of cysts with a chronic mammary tumour. 
Two theories are in vogue as to the origin of this form of 
ic development. According to one set of pathologists, 
it is produced by the obstruction and subsequent dilatation 
of a lacteal duct. But this theory, I think, is weak : from 
the fact of our not being able to trace one of these ducts 
into the cyst ; from the fact that the fluid contained in these 
cysts Bhowfc no trace of lacteal origin ; and from the fact 
that such cysts are met with elsewhere, in places where no 
lacteal duct previously existed. The other theory is, that 
these cysts entirely new formations ; and this, partly for the 
reasons before mentioned, and partly because tin- 
closely resemble those met with in other secretory glaj 
both as to structure and contents, appears to me to be t 
more tenable of the two. 

These tumors, I must premise, whether unilocular, mul- 
tilocular, or consisting of cysts diffused in a mass of fibrous 
or hypertrophied gland-tissue, are always composed of thin 
Avails, formed of condensed cellular tissue, and containing 
in their interior a fluid variable in amount and character ; 
being in one serous, in another glairy, and in a third bloody ; 
it is very commonly of a light straw color, not unfrequently 
it is brown, and sometimes sanguineous, but these differ- 
ences are accidental and of no importance. 

We will now consider the diagnosis of tin 
growths from cancerous and other solid tumors of the 
breast. And, first, with regard to the unilocular cyst ; this 
is the most common form, and occurs generally in women 
at what one might call the "cancerous age," forty-five to 
fifty ; it is frequently referred to pressure, or to a 'blow on 
10 



242 Tumors of the Breast. [March, 

the part, or it may be connected with uterine disturbance 
at the period of the cessation of the mensus. Thus so far 
as the age and proximate cause are concerned, the history 
throws comparatively little light on the subject, and the 
diagnosis has therefore to be made entirely by palpitation 
and examination of the tumor. Xow you can easily con- 

«■ that, depending only on manipulation to form a cor- 
rect judgment of the nature of the tumor, the surgeon may 
be exceedingly liable to form an erroneous opinion. I could 
relate to you many cases in which error of diagnosis has 
occurred, but I will confine myself to a few of the more 
illustrative. 

I was requested some time ago, by my friend, Mr Wal- 
ter Wilson, to see a married lady, aged 45, who had in the 

it breast a tumor oi about the size of an apple, hard and 
painful on pressure. This, she said, had been diagnosed 
as a fibrous tumor by a surgeon in the country, who had re- 
commended her to come to London and have it removed. 
On examining the tumor I suspected it to be a cyst. It had 
not the stony hardness of a solid tumor, but felt obscurely 
elastic on deep pressure. Acting on this supposition, I in- 
troduced an exploring trocar and let out about two ounces 
of dark serous fluid ; the cyst never refilled, and the patient 
went borne perfectly cured. 

I was requested one day to see an unmarried lady, aged 
On going to the house I found her bathed in tears, and 

Bisters in great distress around her. I was told she had 
a tumor of the breast, which had been pronounced to be a 

or. On examination I found a tumor in the right 

nma, about as large as a pigeon's egg. It had been no- 
ticed about fourteen months previously, and the patient had 
been under both medical and surgical treatment for it. It 

rounded, circumscribed, situated at the outer and upper 
pari of the gland, hard but smooth, and not heavy to the 
feel, On close manipulation, I felt some elasticity. I told 
the patient that I did not think it was a cancer, but a cyst, 
and that if I punctured it and drew off the fluid contained 

in it she would probably have no further trouble. She 

>rmed me that she had seen an eminent surgeon, 

mii.) had pronounced it to be a cancer ; had explained that 

ration was necessary ; that the whole of the breast 

removed, and had fixed an early day for its perfor- 

i requested to meet this gentleman, but this was 

ed by the patient and her friends; and as our opinions 



1861.] Tumors of the .Breast. 243 

differed so widely, it was agreed that she should have the 
benefit of Sir B. Brodie's opinion. That distinguished 
geon saw the case with me the next day, and, lie haying 
acquiesced in the opinion I had expressed, I tapped 

. and let out about an ounce and a half of yellowish 
serous fluid. The tumor collapsed, all idea of operation was 
abandoned, and the patient has continued well up to the 
present time. 

I saw the other day a very similar case. It was that of 
an unmarried lady, aged 48, who had had for about twelve, 
months a tumor in the left breast, which had gradually in- 
creased in size, until it had attained the magnitude of a 
Tangerine orange. It was hard, circumscribed, situated at 
the axilary border of the gland; it had also been pro- 
nounced to be scirrhus. But, suspecting from its elasticity 
that it was cystic, I punctured it with an exploring trocar, 
and drew off about ten drachms of clear fluid, causing the 
immediate subsidence of the tumor. 

Xow here were three cases of simple cystic or fluid tumor 
of the breast, which had erroneously been pronounced to 
be solid, and which would have been submitted to amputa- 
tion of the mamma if the mistake had not been discovered 
in time. It is of very great consequence, therefore to be 
cautious in these in pronouncing a definite opinion, 

and to neglect no means in perfecting your diagn< 
How is this to be don : As l have already stated, the 
history very often throws no light on the nature of these 
case*. Cysts occur at the same age and among the same 
class of people as cancer of the breast, but there is one cir- 
cumstance of great importance to which you must al . 
attend, and that is the presence or absence of elasticity. 
This last character may be said to be the great diagnostic 
point between these tumors and cancer; and whenever you 
feel, or even suspect, elasticity, you ought to introduce an 
exploring trocar. If the tumor is c^ystic, the fluid escapes, 
and you probably hear no more of the case. But if, on the 
contrary, it is solid, a drop or two of blood only oozes out, 
the puncture soon closes, and no harm is done. In making 
tin* puncture, there is one little point to be attended to, and 
that is, if you use an exploring needle, take care to posh it 
aight in, and not to make the puncture in any way valvu- 
lar: for if you do, the fluid may not escape, and rims , 
rious mistake may arise ; it is, however, far better, in all 
cases, to use the exploring trocar in preference to the 
grooved needle. 



-44 Tumors of the Breast. [March, 

If this little operation — tapping — does not procure the 
closure of the cyst, you must resort to other measures, such 
as injecting it with iodine, introducing a seton, or, if these 
fail, excision of a piece of the cyst-wall. But you will gen- 
rally find that tapping and the subsequent use of iodine lo- 
tions will suffice to effect a cure. 

The next kind of cyst — the multiloeular — is more difficult 
to diagnose than the unilocular; firstly, because it is gene- 
rally seated deeply in or beneath the gland, while the unil- 
ocular occurs chiefly at the border or anterior surface, and 
because there is not so much fluctuation, owing to the fluid 
being divided among several cysts. But vet there is that 
never-failing sign of cystic disease — elasticity. You will 
find, however, that there often exists a good deal of con- 
densed fibrous matter round about these tumours, and hence 
the removal of the whole gland may be required, the extir- 
pation of the cystsalone being impossible. ( )ne reason why 
cyst-tumors are often so difficult to diagnose as such., is that 
they arc often associated with cancer. There great difficulty 
exists, especially in the early stage ; and these eases are ex- 
lingly liable to be confounded with cystic sarcoma, and 
indeed in some cases you cannot make your diagnosis until 
the tumor is removed, and then only by a careful micro- 
scopic examination. 

A woman, aged 45, was admitted into this hospital with 
a tumor of the size of an orange, situated in the right mamma 
deeply over the pectoral muscle. It had existed for about 
five years, was not adherent to the skin, and there Were 
several cysts of the size of plums. .At the upper part of the 
mass, which could be felt through the lately mucuous co- 
vering, the nipple was not retracted; there was only one 
slightly enlarged gland in the axilla. Now here were all 
the characters of a "cystic sarcoma" — slow growth, no adhe- 
sions, eysts, and no material glandular implication; and 
yet. after the removal of the breast, the microscope reveal- 
ed the tumor to be distinctly and decidedly cancerous. 

?OU will sometimes find that tumors of a tixed, possibly 
a semi-malignant character, occur with cyst.-, and give rise 
to great difficulty in the diagnosis of their exact nature, and 
render it Impossible for you to pronounce with certainty 
whether tiny are benign or malignant. The following is a 
of this kind. 

An unmarried lady, 40 years of age, and in excellent 
health, was sent up to me by my friend, Mr. Tuxford, of 



1861.] Tumors of the Breast. 245 

Boston, last November, with a tumor of the right breast, 
which, without assignable cause, had commenced growing 
about live years and a half ago : it increased slowly until it 
had attained the size of an orange about two years since, 
but afterwards much more rapidly, until at last it reached 
the size of an adult's head. The skin covering it was not 
reddened, and though thinned, was neither adherent nor in- 
filtrated. There was no pain at night, or after handling it; 
and no enlarged glands could be felt in its neighborhood. 
The superficial veins were much enlarged over the tumor, 
and a good sized artery was felt to pulsate over its upper 
part. It was elastic, lobulated ; and a large mass, of a cvs- 
tic character, projected from its anterior surface. There 
were no adhesions between it and the pectorals, or to the 
skin. The operation was performed on November 10th. 
On removal, I found that the tumor weighed ninety-six 
ounces, and consisted of large encapsuled masses, of a dull 
grey or brown color. One section, it was solid in parts, and 
infiltrated with a gelatinous fluid; in others, there were 
large cysts, containing several ounces each of dark stringy 
mucoid fluid. Dr. Harley, who examined it, pronounced 
it to be colloid. There were also masses of fibroplastic 
deposit in some par 

Now her* 1 was a case that approached closely to malig- 
nancy in its local characteristics, without any constitutional 
symptoms of cachexy ; and which presents an appearance 
nn examination that renders it doubtful whether it may or 
not yet recur. 

The next class of cases to which 1 would direct your at- 
tention are the chronic mammary or adenoid tumors. These 
are uf exceedingly common occurrence ; and there are two 
or three coeditions with which they are often ass< 
the knowledge of which materially assists the surgeon in 
his diagnosis. 1. With regard to the age, they generally 
;r before the cancerous age, in early womanhood, be- 
tween the ages of 18 and 25. 2, They are almost invaria- 
bly slow in their progress. 3. They are lobulated, dist: 
non-adherent to the skin or pectorals and eireumscrl 
4. There is no cachexy or glandular enlargement: and, in 
fact, they appear to be ^uite local and benign. T 
usually I to which they can be assigned ; but I be- 

lieve that they frequently occur in young women of nervous 
temperament, and are commonly associated with uterine 
disturbance kind. The chief diagnostic points are, 



246 Tumors of Ike Breast. [March, 

therefore, the age of the patient, the slowness of growth of 
the tumor, and the perfect freedom from constitutional 
symptoms ; but yet any one of these conditions may be 
present in cases of undoubted cancer of the mamma. 

Scirrhus very rarely occurs at the early period at which 
the adenoid tumor is common ; but yet it is occasionally 
met with in young women. Some years ago I removed in 
this hospital a tumor from the right breast of an unmarried 
female, aged 23. It was as large as a small flattened 
orange, was hard, nodulated, but not adherent to the skin. 
There was no retraction of the nipple, and it had been 
growing for about eight months. No cause could be as- 
signed for its appearance, and it was supposed to be adenoid. 
However, on account of the large size of the tumor, as com- 
pared with that of the somewhat atrophied mamma, I 
removed the whole of the breast, together with the tumor ; 
and it was well that I did so ; for, on microscopic examina- 
tion, it was found to be scirrhus. The patient subsequently 
married : and when I last heard of her, two years after the 
operation, she was in good health. Now here is a case in 
which cancer occurred within the period usually assigned 
to chronic mammary tumor ; and hence you cannot rely 
altogether on the age of the patient as a means of diagnosis. 

Next, with regard to the slowness of growth ; although 
it is an undeniable fact that benign tumors usually grow 
slowly, and that rapidity of growth is generally a sign of 
malignancy of action, yet this rule must also be taken with 
exceptions, as in the following case : 

Last June, I was requested to see an unmarried lady, 
I 40, of a nervous sanguineous temperament, who had 
been in bad health tor many years, suffering from uterine 
disturbance, dyspepsia, and latterly from pulmonary symp- 
toms. At the age of 18 — that is, twenty-two years previous 
to my advice being sought — she noticed for the first time 
a small tumor in her left breast. This continued perfectly 
stationery, and about the size of a pigeon's egg, until last 
February, when it for the first time became painful, and be- 
rapidly to enlarge. Being at this time in Italy for the 
• (it of her health, this lady saw two distinguished 
.an surgeons, who, after careful examination and ex- 
ploratory punctures, pronounced the tumor to be a " mye- 
." and recommended extirpation of the mamma. The 
patient, however, preferred to return to England, and have 
the operation performed here. On her way home she saw 



1861.] Tumors of the Breast. 247 

Velpeau in Paris, who with a great accuracy of diagu 
pronounced the tumor to he benign, and gave her a written 
statement to that effect. AVhen I saw her, on her return to 
this country, in June last, I found a tumor of the left: mam- 
perfectly mobile, firm, solid, inelastic; it had attained 
the size of an adult's head, and was rapidly increas 
There was no glandular enlargement in the axilla ; the skin 
was thinned and reopened, but not adhered; the super:' 
vessels were much enlarged, a tortuos network of veins and 
one or two large arteries running over the tumor. There 
was no constitutional cachexy : but the patient's health 
and strength were at the lowest ebb, from general and J 
standing constitutional derangement: and she could not 
sleep at night, not so much from pain (which, however, was 
constant, and at times very severe,) as from the constant 
anxiety of mind which the presence of the growth pro- 
duced. Sir B. Brodie and Dr. Walshe, who saw the case 
in consultation with me, both agreed that it was probably 
benign, but that no operation was practicable until the 
patients state of health was improved. However, by atten- 
tion to diet, and by being put on a proper plan of treatment 
this was so much ameliorated that in July last, I was ena- 
bled, with the assistance of Mr. Marshall and Dr. Cowan, 
of Glasgow, to perform the operation for its removal. This 
was attended by no difficulty, and by very little hemorrhage, 
notwithstanding the size of the tumor, which weighed 
rather more than live pounds. The patient made an excel- 
lent recovery, and was able to leave town in less than three 
weeks. On examination after removal, the tumor was found 
to be lobulated on its surface. The section showed it to be 
homogeneous, and of a uniform greyish color, with no soft 
points or cysts, but distinctly and firmly encephalous. Dr. 
Harley, who examined it microscopically, found it to be a 
specimen of the chronic mammary tumor of Sir Astley 
Cooper. In the plastic matter taken from different lobules, 
examples of the glandular tissue were found. Some of the 
blind tubes were remarkably distinct, and well filled with 
cells. There was no trace of cancer. 

Xow here was a tumor which, after remaining of sm;ill 
size and stationary for more than twenty years, suddenly, 
and without obvious cause, began rapidly to increase : so 
much so that in less than six months, it had increased in 
size from that of a pigeon's egg to the magnitude of a mas- 
weighing more than four pounds. Here was extreme ra- 



Tumors of the Breast. [March 

pidity of growth without malignancy of character. In fact, 
this extreme rapidity of growth resembled rather what is 
not un frequently found in cncephaloid disease, than what 
we exped to meet with in the chronic mammary tumor, 
and rendered the diagnosis not a little difficult; the more 
was possible that the chronic mammary tumor, 
which had existed for so many years in a stationary and 

ive condition, might have suddenly undergone malig- 
nant degeneration, and thus taken on rapid increase of 
bulk. This, however, was disproved by the careful micro- 
pical examination made by Dr* Ilarley, who found that 

tumor did riot present a trace of malignant structure. 
It is, however, important to hear in mind that cystic and 

told tumors may remain for a long time inahenign and 

ive state, and then assume a malignant character. This 
happened in the case of a woman, aged 48, who was sent to 
the hospital by my friend, Mr. Adams, two years ago. At 
the age of 27, she had first observed a tumor in the left 
breast. This had slowly increased in size, until it had at- 
tained, at the end of fifteen or sixteen years, the size of the 
foetal head. When I first saw it, in January, 1858, one of 
the cysts <>f which it was composed, had ulcerated, and a 
thin sero-sanguineous discharge oozed out of the opening. 
The general health was good. There was no glandular en- 
largement iu the axilla, or adhesions of the skin, except, 
around the ulcerated parts. It was freely moveable on the 
pectorals. An operation for the removal of the tumor was 
] >roposed, hut this the patient refused to consent to. At the 
end of six months, she returned with a large ulcerated 
cavity in the centre of the tumor, and fungati ng masses 
sprouting from the bottom of it. There was still no cachexia 
or enlarged glands in the axilla. The patient now consent- 
ing to an operation, I extirpated the whole mass with the 

ama. <>n examining the tumor after its removal, it was 
found to he cystic. There were several large cysts, of the 
size of pigeons' containing turbid hut light colored 

►us fluid. The central portion of the tumor, and that at 
: the fungus were .-olid, grey, and rapidly under- 
going softening and disintegration. (>n squeezing the por- 
tion of the mas# (the base of the fungus) a milky juice 

led; and Dr. Ilarley who examined the tumor, stated 
n to be encephaloid. the sarcomatous structure heyond 
this, constituting the general mass ^l' the tumor, appeared 
1,. be adenoid. The Burface oi' the fungus, when exposed 
and protruding heyond the cyst, was epitheliomatous. 



1861.] On the Treatment of Favus. 249 

Now here were cjt oma, cncephaloicl and epithe- 

lioma, associated in one growth. The encephaloid was 
staled by Dr. Ilarley to be cellular, without fibres, showing- 
rapid development. The epithelioma was confined to the 
surface of the fungus. The history of this case, the very 
lengthened period (more than twenty years) that the tumor 
had existed, the absence of all constitutional cachexy, ot 
deep adhesions, or of glandular enlargement or other secon- 
dary deposits, and its appearance only six months previous 
to removal, all pointed to primary simple cystic disease of 
the mamma, in which, as the result of secondary changes, 
encephaloid had developed itself; being an instance of the 
conversion of a simple into a cancerous tumor of the 
breast. This patient died about a twelvemonth after the 
operation, of gangrene of the foot and disease of the heart. 
The cicatrix was quite sound ; but in the substance of one 
of the ventricles a nodule was found, which was considered 
by those who examined it to be of a cancerous nature. — 
MedicalJournal, April 14, I860,;;. 279. 



On the Treatment of Favus. By Dr. W. T. Gairdner, 
Physician to the Royal Infirmary of Ediuburgh, Lecturer 
on Clinical Medicine and on Practice of Physic. 

[In the case which forms the text of the following re- 
marks, the head was at first covered with yellow crusts, of 
long standing ; exactly four days afterwards, there was not 
a vestige of a crust to be seen, nor even any broken sur- 
face, though the patches of absolute baldness and the 
stunted and diminished hairs in many places, showed clearly 
the deep hold the disease had taken. The change was en- 
tirely due to the successful poultices of linseed meal.] 

tuch has been written about favus. and so many 
perfi - have been recorded in periods varying from 

six week veral months, [am almost afraid t<> state 

my conviction ti result above mention 

obtained in four days under linseed meal poultices, was 
quite as much entitled to the name of a cure a- any that I 
hav< -i or heard of either in the nature or in tic 

cord with 

<>PI ortunitn ion emending over less than a year 

or two [fi idence of nothii than the 



250 On the Treatment of Fat [March, 

most entire ignorance of its habits. I do not, however, 
doubt the cure of favus. Soap and hot water, with abun- 
dant scrubbing, the hair being kept short, will commonly 
keep the yellow crusts indefinitely in abeyance : as will 
also, perhaps, more thoroughly and effectually, the simpl 
oil inunction. There seems no reason, therefore, to beli< 
(though hospital physicians can but seldom hope to witness 
the result) that those simple means, long and perseveringly 
usea\ will not erl'cct the cure of a disease which owes its 
origin and perpetuation to nothing else than want of clean- 
lin< - 

Under ordinary circumstances, what takes place after an 
apparent cure of favus, is this : So long as the hair is kept 
shaved, and an alternation of oily applications with soap and 
water is maintained, the disease does not reappear: but on 
neglecting these precautions for a few weeks, yellow dots 
begin to crop up. and these rapidly extend so as to become 
distinct favus crusts, which in no long time, if uninterfered 
with, will cover the whole head. I have repeatedly kept 
eases under observation after the head had been completely 
cleared, in order to observe the first beginnings of the erup- 
tion after the suspension in the treatment ; and I have also 
employed a great variety of medicated ointments and lo- . 
tions, including sulphurous acid, iodine and sulphur oint- 
ments, empyreumatic oils, mercurial ointments, and mixed 
medications of various kinds. After most of these, I have 
seen the disease reappear about as quickly as under the 
simpler treatment b} T oil and soap. If there is any of them 
in which I have faith more than another, it is in empyreu- 
matic oils, as the juniper tar oil or common pitch ointment. 
But the inveteracy of the disease evidently depends, not on 
the difficulty of removing its visible traces, but on the com- 
plete infiltration (so to speak) of the scalp with the sporules 
of the fungus in all old standing eases ; and no treatment 
will be of the slightest avail towards a radical cure that is 
not deliberately and carefully pursued until a complete 
growth of scarf skin has been obtained, perfectly tree from 
all traces of the noxious germs. This must, of course, be 
the work of a considerable time: just as it i^ a work of 
time, and of unwearied attention to simple details, to rid a 
virgin soil of ragweeds and whins, or even of stones. No 
application of a specific can he expected to meet the one 
any more than the other. • 

One point, not always Observed by those who have writ- 



1S6L] Ulceration of the Rectum. 251 

ten on this subject, is, that favus is often, perhaps even in 
the majority of cases, implanted on the basis of a previous 
eruption ; in other words, that the fungous crusts, or vege- 
table mould, are sown on a soil already the seat of impetigo, 
eczema, or some other variety of disease of the skin. Some- 
times the original disease has died out when the favus first, 
comes under treatment ; at other times, it still persists and 
requires separate treatment. In the corirse of considerable 
and varied experience of true favus, however, I have not 
seen a single case that did not at once yield to local treat- 
ment, to the extent I have indicated above ; and I am very 
far from believing that any constitutional disorder has to 
do with the production of the fungus, further than that 
favus and other diseases may arise simultaneously, under 
exposure to the same causes of filth, neglect and hygienic 
errors of every kind, in every variety of boclilv constitution. 
— Edxn. Med. Journal, May, 1860. p. 1003. 



On Ulceration of the Lower Extremity of the Rectum : its Va- 
rieties. Diagnosis and Treatment. By James Rouse, Esq., 
Assistant Surgeon to the Westminster Ophthalmic 
Hospital, kc. 

Xotwithstanding the numerous works published on dis- 
eases of the rectum during the last few years, there appears 
still to be great difference of opinion as to the best mode of 
treatment ; more particularly with regard to those ulcera- 
tions situated on the mucous membrane lining the sphinc- 
ter ani, and in the fossa immediately above that muscle. 

There are three forms of ulceration of the lower extremity 
of the rectum, which gave rise to very acute suffering ; and 
although they vary considerably in position, have neverthe- 
been described by most authors under the general head 
of fissure. It is proposed, in the present paper to po'ntout 
that three distinct forms of ulceration occur in this region, 
which, by ordinary investigation may be distinguished from 
each other, and which require different modifications of 
treatment. 

The most common form of ulcer found at the lower ex- 
tremity of the rectum is that which is known i re of 
the anus. This disease does not seem confined to any par- 
ticular period of life, though it rarely or ever exists until 









252 aeration of the Rectum. [March, 

after puberty. It is more particularly common among per- 
who lead a Bedentary life, and for the same reason it is 
rather more frequent in women than men. The fissure ap- 
pears to be by a tearing of the mucous membrane 
lining the sphincter ani, by the passage either of hardened 
>• of a foreign body contained therein. The follow- 
ing cases will, however, show that fissure of the anus may 
lally be the result of external violence: 
Case 1. — A gentleman, aged 24, was riding a restive 
horse, when it. suddenly bolted. He was thrown with some 
violence, on the hind part of the saddle before he recovered 
his seat. He felt some pain about the anus at the time, 
and, on changing his shirt, he noticed a lew drops of blood. 
For the next few 'lavs he experienced a slight burning pain 
during the evacuation of the bowels, and in about a week 
the characteristic pain of fissure was established. On an 
examination being made, a small crack was perceived on 
the posterior surface of the sphincter; it commenced about 
two lines within the anus, and extended upwards for about 
half an inch. Various local means were tried without 
benefit, and an operation to he hereafter described, was had' 
recourse to with perfect suet 

Case 2. — A captain in the navy fell off a ladder, and came 
to the ground on his buttocks, with considerable force. He 
did not observe any particular pain until he went to stool 
the- following morning, when he experienced considerable 
smarting, and noticed that he had passed a small amount 
of florid blood. About a week alter the accident, he ap- 
plied for advice, lie then, alter every evacuation of the 
bowels, had pain, which lasted for several hours. On ex- 
amination, an ulcer was found on the posterior surfac 
the lining membrane of the sphincter : e not 

indurated, and the surface was florid. An ointment, con- 
taining mercury, was applied twice a day : and in the 
course oi' a week a cure was effected. 

Persons afflicted with this die describing the origin 

of their Buffering, frequently state that while -training vio- 
tly a1 stool, tlicy felt something give way, and on look- 
heir evacuations, they n«>lice<l a small quantity of 
iod. h has more than oner occurred to mete be told by 
with fissure thai the \\"r<>< were so bard that it was 

from the an 

This crack or fissure is almost invariably situated on the 
!• surface o\' the sphincter. 1 have seen upwards of 



1861.] ration of the Rectum. 

a hundred cases, and in only six did the position vary; in 
three of these the fissure was situated on the perineal sur- 
face of the muscle, and all occurred in women ; in two it 
was Bituated on the leftside ; and in one on the right. It 
commences about three lines from the margin of the anus, 
and extends upwards in a straight line to the extent, usual- 
ly, of half an inch, though sometimes as high as the supe- 
rior margin of the sphincter. It the fissure he seen within 
a week or ten days of its occurrence, it presents the appear- 
ance of a bright red line with a sharply defined edge, and 
does not appear to extend through the thickness of the 
mucous membrane. A little later, if no treatment he 
adopted, one or two florid granulations may frequently he 
D protruding ahove the margin ; and it is during this 
. v that a small amount of blood is voided on going to 
stool. This appearance is very soon changed ; the edges 
hecome everted, and more or less hard, and the surface of 
the ulcer itself looks excavated and pale, like any other in- 
dolent sore. The pain caused by this solution of continuity 
is at first trifling, and only exists while the motion is pass- 
ing ; hut it soon becomes most severe. It usually com- 
mences about half an hour after the bowels are relieved 
(the sensation up to that time being only uneasiness) and 
continues for live or six hours. As the disease progresses, 
the pain becomes more continuous and easily excited, and 
even walking or sneezing will bring it on. At this stage, 
the ulceration is found to have extended through the sub- 
mucous cellular tissue into the fibres of the sphincter; 
there is a constant desire to pass urine, a serious addition to 
the other suffering, and this continues until relief is obtain- 
ed by means of an operation. 

This second form of ulceration is situated immediately in 
front of the os cocygis, and was first described by Sir B. 
Brodie, in a clinical lecture delivered at St. George's Hospi- 
tal. This ulcer, which is almost invariably co-existent with 
an enlarged and varicose state of the veins about the rec- 
tum, does not, like the one just described, appear to be 
Bed by a tearing of the mucous membrane. Mi". Quin 
Btates, in his recent work 'On the Diseases of the Rectum ' 
that he has noticed a case in which, "the disease having 
been of no long duration, and the suffering comparatively 
slight, the membrane appeared to be thinned from beneath." 
The ulcer, once formed, soon increases in size, and usually 
remains quite superficial for a considerable time ; but at 



254 Ulceration of the Rectum, [March, 

-!h, from the continual irritation, the edges become 
and hard. The surface, however, seldom becomes 
so indolent as in cases of ordinary fissure ; and in this form 
of the disease the ulceration seldom, if ever, implicates the 
fibres of the sphincter ani. The pain which, as in fissure, 
-used by the evacuation of the bowels is most intense; 
there is usually very little spasm of the sphincter, but the 
patient complains of severe lancinating pain, which gradu- 
ally subsides into a sensation of burning, which continues 
for three or four hours. 

The third form of ulcer is situated in the fossa which ex- 
ists between the external and internal sphincters; it is by 
far the most painful and serious affection of the three. It 
appears to be caused either by the lodgment of a small por- 
tion of hardened freces, or by injury done to the mucuous 
membrane in that situation by the passage of some foreign 
body, such as a fish-bone. Two cases are known to me 
where the presence of a polypus of the rectum (the extre- 
mity of which was pressed into this fossa every time the 
bowels were relieved) caused an ulcer in this position. 

The ulcer, at first, is seldom more than the eighth of an 
inch in diameter, and it is generally somewhat deeply exca- 
vated. As the disease progresses, the ulceration extends 
into the substance of the sphincter ani ; so that, when the 
finger is passed into the rectum, the end of it sinks into a 
small cup-like cavity, the inferior part of which is formed 
at the expense of the superior margin of the sphincter. 
Except in cases of long standing, the edges are not indura- 
ted, and the surface almost invariably remains florid. In 
this disease a certain amount of pus and blood is passed at 
each relief of the bowels. If this ulcer be not cured by 
means of an operation, it leads to a most troublesome form 
of stricture of the bowels. The constant irritation set up 
by the action of the bowels gives rise to inflammation of 
the submucous cellular tissue ; this causes thickening and 
hardening, by which means the calibre of the outlet is seri- 
ously diminished. 

The following case will illustrate this kind of termination : 
—Mrs. S., aged 23, complained of very severe 
pain before, during, and after the relief of her bowels. She 
had consulted a surgeon, who, on examination, found an 
ulcer immediately above the external spincter. An inci- 
sion was made through the ulcer into the tissue below ; but 
this did not produce "the slightest relief. Six months after 



1861.] Ulceration of (he Rectum, 

the operation, she noticed that the discharge was much in- 
creased in amount, and she found more difficulty in passing 
her motions, which were small and flattened. A year sub- 
sequently to the operation, I saw her, and, on examination, 
discovered an ulcer of considerable size situated on the 
posterior surface of the rectum, and involving the superior 
margin of the sphincter, and such extensive thickening of 
the submucous tissues that the finger could not be passed 
through. Subsequently, by means of bougies, considera- 
ble benefit was obtained. 

In these cases, the pain complained of is most severe, and 
there is more spasm of the sphincter than in simple fissure : 
in some of these cases the amount of spasm is so great that 
the muscle increases considerably in size. The pain ap- 
pears to commence some little time before the bowels are 
relieved, probably this is caused by the pressure of the load- 
ed bowels upon the ulcer. 

Diagnosis. — The diagnosis of these cases is by no means 
difficult. The peculiarity of the pain complained of, the 
fact of its coming on either during, or soon after, the action 
of the bowels, and the ease with which these ulcers may be 
detected by the finger, when it can be introduced into the 
bowel, render a mistake almost impossible. There exist 
only two diseases with which these ulcers may be con- 
founded : to wit, a syphilitic ulcer and spasmodic contrac- 
tion of the sphincter. Neuralgia in the neighborhood of 
the sphincter has such well-marked symptoms of its own, 
that it can scarcely be mistaken. With regard to the syphi- 
litic ulcer, its characteristic appearance, the class of persons 
affected, the existence of syphilitic ulceration about the va- 
gina, remove all doubts as to the nature of the complaint. 
The diagnosis between spasmodic contraction of the sphinc- 
ter and fissure is rather more difficult; in fact, it is only by 
a most careful examination that the surgeon can determine 
whether an ulcer exists or not. There arc, however, a few 
points of difference which it would be well to remember. 
In spasmodic contraction of the sphincter, the muscle very 
rapidly increases in size ; the anal orifice becomes so con- 
tracted that even a gum catheter cannot be introduced with- 
out producing extreme suffering. This amount of spasm 
is most rare in ulceration, and it is the pressure caused by 
the finger on the ulcer itself that produces the pain. 
rin, in ulceration, it matters little in which form, sooner 
or later, there is always discharge of pus and blood : in 






■ 






Ulcerations of the Rectum. 



[March, 



smodic contraction, this never occurs. Lastly, the pa- 
tient having been placed under the influence of chloroform, 
a careful examination of the bowel can he made (which it is 
impossible to do without producing insensibility) and, as 
in the following case, no ulcer is found to exist. 

—George , aged 45, a man of spare habit, sal- 
low complexion and depressed vital powers, complained of 
intense pain, which occured during the lime the bowels 
ting, and for several hours after. The pain was not 
Lnuous, but came on in paroxysms every few minutes. 
The motions were very small and flattened ; but there was 
no discharge or appearance of blood. On examination, the 
Bphineter muscle appeared more developed than usual, and 
the anus was so contracted that it was impossible to intro- 
duce the finger. A speculum ani was employed, and the 
most careful examination failed to discover any ulcer. Un- 
der these circumstances, a small bougie, about six inches 
long, was introduced every other night. At first the pain 
caused was very great, and he was unable to retain it for 
more than three or four minutes ; but he was soon able to 
bear it for a longer time. The size of the bougie was grad- 
ually increased, and he was ultimately cured. 

Case 5. — A gentleman, aged 35, of spare habit and ner- 
vous temperament, had suffered with symptoms like those 
just described, for six months, and the pain had become so 
severe that he could not take exercise; he had tried various 
means to obtain relief without success. The most careful 
examination failed to discover any ulcer, but the sphincter 
was immensely hypertrophied. Bougies were employed 
for two weeks without producing the slightest relief, and 
the patient was so worn out and irritated by the pain he 
suffered, that he could not be induced to continue the use 
of them. It was therefore decided to divide the sphincter, 
and with the exception of the pain produced by the passage 
of the fieces through the wound, this patient never suffered 
any inconvenience afterwards. 

I should not have insisted so strongly on the existence of 
this disease, but one of the most recent writers on diseases 
of the rectum doubts the existence of simple spasmodic 

Dstriction of the sphincter. 

There is one other precaution necessary in these cases; 
and that is, to be quite certain that only one ulcer exists. 
It is not very unfrequent to find two; they may be either 

. above the other, or situated on opposite sides. 



1861.] Ulceration of the Rectum. 257 

The treatment required for the ulcer in front of the os 
coccygis, and for fissure, varies according to the si 
the disease. If it be treated before it has become indoli 
local applications, and attention to the state of the bowels, 
are all that is necessary. Grey oxide of mercury and s] 
maceti ointment, (half a drachm to the ounce) or a scruple 
of calomel to an ounce of lard, with ablutions night and 
morning, and after each relict' of the bowels with yell 
soap and water, will usually effect a cure. Great cure must 
be taken in the choice of a laxative, the object being not to 
purge, but to render the faeces soft, so that as little stretch- 
ing as possible of the ulcer should take place. Confection 
of senna or milk of sulphur generally produce the desired 
effect. A very common medicine in these cases is confec- 
tion of pepper : this, combined with confection of senna 
very useful in cases of hemorrhoids, but it is apt in all cases 
of ulceration to produce considerable aggravation of the 
patient's suffering. When the ulcer has once become indo- 
lent, the best and only treatment (likely to prove beneficial) 
is by the knife. The operation is best performed in the 
following manner. The patient being placed on the right 
side, with the knees drawn up to the chin, the forefinger of 
the left hand is to be introduced into the rectum, and the 
knife passed up in front of it; the incision is then to be 
made, commencing a few lines above the superior margin 
of the ulcer, and to be carried through it down to the ex- 
ternal skin, care being taken not to cut into the fibres 
the sphincter, except in those cases where the disease has 
•already involved that muscle. After the incision has been 
made, a small piece of oiled lint may be introduced into the 
wound. It is better not to allow any action of the bowels 
to take place for two or three days after the operation ; 
this may be effected by giving a small dose of opium or n 
milk diet. 

The treatment required for the ulcer situated above the 
sphincter is division ot the muscle. Local remedies never 
appear to afford the slightest benefit, but only tend to wear 
out the patience and spirits of the sufferer. The operation 
is to be performed in the same way as for fissure : but, in- 
stead of merely making an incision into the submucous 
tissue, the sphincter must be divided by one cut, the wound 
is then to be dressed in either with oiled lint or silk. 

It is of course always prudent to try local means before 
proceeding to an operation ; and the best application is the 
17 



268 



Essential Nature of Asthma. 



[March, 



ointment of grey oxide of mercury, already mentioned. 
most satisfactory method of applying the remedy is by 
>fa suppository tube. The tube should first be lu- 
bricated outside, and then filled with the ointment ; it is 
then to be passed into the bowel to the extent of an inch or 
an inch and a half, and the piston then pushed down; by 
this means the entire surface of the mucous membrane 
lining the sphincter is covered by the ointment. 

Some surgeons recommend the application of nitrate of 
silver for these forms of ulceration ; but it seldom proves 
very beneficial, and the pain it causes is quite as severe as 
that of the division. If it be attempted, a speculum should 
be introduced into the bowel ; by this means, the ulcer is 
brought into view, its surface should be dried by a piece of 
sponge or list, and the caustic freely applied. — British Med. 
Journal, May 12, 1830, p. 358. 



On the Essential Nature of Asthma. Bv Dr. II. Hyde 

Salter, F. R. S. 

There are two ways (which I have not mentioned in my 
work) as indicated to be by my friend, Dr. Brown Sequard, 
in which bronchial spasm, when once established, may be 
kept up by the very conditions which it generates; one is, 
the power which carbonic acid gas possesses of producing 
contraction in smooth muscles. In asthma, the deficient 
standard at which respiration is carried on, and the dimin- 
ished interchange of the gases, produces an accumulation, 
in the air locked up in the air passages, of carbonic acid to 
an unusual degree. This, by the action to which I have 
just referred, sets the bronchial muscles still further con- 
tracting, and thus increases the very condition which at first 
caused the accumulation of the effete gas. In this way, 
asthma keeps up asthma. The other way is by the bronchial 
3m stimulating the afferent or perceptive nervous fila- 
ments, and thus giving rise to retlex muscular contraction ; 
just as the stimulation of the sensitive roots of the spiral 
nerves produces reflex muscular phenomena in the parts to 
which the corresponding motor nerves are distributed. In 
way, muscular spasm becomes a stimulus to muscular 

But in both these, as in the other ways 1 have indicated 
iu my book, the bronchial spasm is secondary to an antece- 
dent nervous condition. — British Medical Journal July 28, 
18M, p. 589. 



1861.] Gonorrheal Rheumatism. 259 

Reasons for regarding Ghnorrhceal Rheumatism and Ophthalmia 
as simply Urethral Rheumatism or Ophthalmia, fie. By Dr. 

Elliotison. 

u My first knowledge of the disease in question," says 
Elliotson, "was obtained from Sir Astley Cooper's lectures, 
which I attended at St. Thomas's Hospital in 1806-7, and 
1807-8. How many years previous he had mentioned or 
seen it, I cannot say. He pretended to no merit of discov- 
ery, but related, in the most artless manner, the communi- 
cation of the facts to him by a patient. 'An American 
gentleman,' he said, 'came to me with the clap, and I told 
him he might think himself well off to be so little affected.' 
4 Oh,' said he, 'a clap with me is a serious thing. When I 
had it before, I was attacked a few days after the infection 
with an obstinate inflammation of the eyes that was follow- 
ed by rheumatism.'" "I thought," continued Sir Astley, 
''that he might have caught cold while taking mercury; but 
he said he had taken none. I therefore watched the disease, 
and in a few days his eyes became inflamed, and after that 
one of his knees swelled, and then the other became affect- 
ed with chronic inflammation. He was attended by Dr. 
Relp, of Guy's Hospital, and myself, for many months. He 
left this country uncured; but I heard that he got well on 
his voyage. Since this case I have seen a great many more 
such." 

"It was very natural to suppose, before our experience 
became enlarged, that the disease was the result of gon- 
orrhceal contagion, and that the appelation gonorrhoeal 
rheumatism, given naturally to it from its alliance with 
gonorrhoea, must have increased the tendency to this view. 
We cannot, therefore, at Sir Astley Cooper believing that 
the ophthalmia was produced, not indeed by the application 
of gonorrhoeal secretion accidentally to the eye, as may 
happen with any careless patient, but still by the absorp- 
tion of it into the system, and that the proper treatment of 
the rheumatism, produced to his view of course by the same 
poison, was the same as of gonorrhoea — half a drachm, ac- 
cording to him, gradually increasd to a drachm, of copaiba, 
with spirits of turpentine three times a day. We have no 
ific remedy for gonorrhoea, any more than for measles, 
latina, or small-pox ; and those drugs must in many 
-Tavate gonorrhoea; and they would aggravate many 
cases of the rheumatism. Copaiba, cubebs, and some analo- 



260 



Gonorrhoea! Rheumatism . 



[March, 






goua drugs, arc useful occasionally in gonorrhoea, but not 
more so than in similar uncontagious affections of the geni- 
tal passages, and possibly of some other mucous membranes. 
If there is no reason to ascribe specific powers over gonorr- 
hoea to them, neither is there any to conceive that they can 
be remedies of the rheumatism bearing the distinction of 
gonorrheal. Xor are the}'. 

"The belief now generally prevalent, of the rheumatism 
in question — rheumatism with urethral discharge — and in- 
deed of the ophthalmia, being really the product of gonor- 
rhoea! poison, is, I am satisfied, as unfounded as previous 
generally prevalent disbelief that rheumatism and ophthal- 
mia arc ever connected with gonorrhoea. It was long be- 
fore this struck me; for I had always read of these forms of 
disease, and heard them spoken of, with the epithet gonor- 
rheal ; and had not seen them except in gonorrlicoal patients. 
After a time I received the assurance of one or two patients 
that the affection of their genitals could not have arisen 
from infection ; but it made no impression upon me, be- 
cause I am familiar with the untruths which arc often told 
upon these subjects, and because patients do really some- 
times fondly deceive themselves as to the character of those 
with whom they intrigue. But, as years passed on, more 
instances of the alleged impossibility of infection presented 
themselves to me and some such patients, I felt certain, 
could have no reason to deceive me, were too much endowed 
with self-respect to stoop to an untruth, and were too acute 
to be themselves in error. Some have told me this, long 
afterwards, when they had ceased to incur the possibility of 
catching any disease of the genital organs. I knew no one 
inclined to this view till five years ago, when, accidentia 
meeting with a surgeon, a married man and a father, who 
had consulted Sir Astley Cooper and myself twenty years 
at least previously for what we had all termed gonorrhecal 
rheumatism, and since which time I had not heard of him, 
I was told by him that, before he married, he had again 
suffered a few attacks of rheumatism and urethral discharge, 
"ii which occasion the idea of infection was altogether out 
of the question, as he had not been exposed to the possi- 
bility of risk. At this period he had no inducement to de- 
ceive me as to his former lite; and formerly he had always 
been candid when suffering for irregularities. He added, 
that since his marriage he had occasionally suffered in the 
Bame twofold manner as when he was irregular and single. 



1861.] Gonorrhml Rheumatism. 261 

I was much pleased, and I communicated to him that my 
convictions of these affections being improperly termed 
gonorrheal was as strong as his own. 

Farther experience, up to the present moment, has set 
the question completely at rest in my mind. Indeed, al- 
though the circumstance is not noticed by the profession, 
some writers clearly entertain this opinion, and state facts 
which establish it, and yet lay no stress upon its difference 
from the commonly received views. I have just found that 
Sir Benjamin Brodie, in his Pathological and Surgical Ob- 
servations on Disease of the Joints, published in London in 
l s l s . gives live cases of the disease witnessed by himself; 
and remarks that in one the patient could not ascribe the 
discharge to infection, and in another patient suffered from 
strictures in the urethra, and, although rheumatism took 
place twice with gonorrhoea, it took place twice also when 
there was no gonorrhoea, but the urethra was in a state of 
irritation and discharge through the mere introduction of 
bougies employed on account of the strictures. He there- 
- it may occur without infection. Brandes also con- 
siders that the rheumatism may be re-excited after all gon- 
orrhoea lias ceased, if the urethra is irritated by any common 
cause; and speaks of this rheumatism as blenorrhaqique 
(gonorrho&al) and trawrnatiqiie (such as from the introduction 
ot a foreign body into the urethra.; Marechal gives a case 
o{ rheumatism, that had followed an urethral discharge pro- 
duced by nothing but the immoderate use of new beer, and 
had never occurred in the man before. 

"My own experience, extending through so many years, 
renders it impossible for me to doubt that specific and con- 
tagious nature i< unnecessary to the urethral irritation 
which in certain persons gives rise to rheumatism and to 
ophthalmia also in others — that the mere irritation is suf- 
ficient, and in fact La the cause, and that the gonorrhoea], 
conts character is incidental only. The combination 

<»f ti <>f other writers with my own will, I hope, settle 

stion. The single case of syphilitic infection of a 
lady by secondary symptoms in the hand of her maid record- 
ed by me in the Medical Times of September 4th, 1 
removed all possibility of farther doubt respecting the 
occurrence of infection from secondary sores. The d< 
mination of the production of rheumatism by simple urethr- 
al irritation is effected by the repeated experience of many 
of us continued through a large number of years. The im- 



262 



Gonorrheal Rheumatism. 



[March, 



pedimenl to the perfect knowledge of what is known as 
gonorrhoea! rheumatism was its extremely rare occurrence 
among the instances of rheumatism at large on account of 

comparatively small number of persons affected with 
irritation of the urethra, and the still smaller number of 

ons among these that have the unfortunate peculiarity 
of liability to rheumatism from it. The impediment to the 
knowledge of simple irritation of the urethra being the cause 
was still greater on account both of the great rarity of simple 

oared with gonorrhoeal irritation of the urethra, and of 
few individuals indeed being the subjects of both 
simple urethral irritation and liability to rheumatism from 
irritation of the urethra. Those who, from habit, regard 
this kind of rheumatism and ophthalmia when allied with 
gonorrhoea as, therefore, gonorrheal, must remember that 

very case of gonorhcea there are two circumstances 
united — the irritation of the urethra and the specific nature 
— and that the latter cannot exist without the former may 

* without the latter. Consequently, no case of gonor- 
rhoea! rheumatism or ophthalmia depends upon the specific 
— the gonorrhoea! — nature of the urethral affection, and not 
upon the irritation irrespective of specific nature. 

V little experience of this rheumatism impressed me, as 
it has done many others, with certain characteristics, audi 
detailed them in clinical lectures above twenty years ago. 

1. I saw and see it so frequently in the feet that when- 
ever a rheumatic man has walked into my library lame 
from rheumatism of his feet, I have startled him with the 
question how long he had been suffering under gonorahoea. 
It not unfrequently affects the hands, perhaps, as I once 
saw, a single joint only; the wrists and elbows; but the 
lower extremities most frequently, the knees as well as the 
feet : the lips also. It may effect any joints, and several at 
one time or in succession ; the loins also and back of the 
neck. I saw it once in the joint of the jaw. 

2. Its obstinacy and extreme duration are remarkable. 
The longest ease 1 ever saw was the jaw, and after two or 
three attacks imperfect rigidity, I believe, became promi- 



nent. 



3. I am not aware of ever bavins: seen it in a femal 



e. 



Bui gonorrhoea is comparatively rare in women, as one loose 

t!<- contaminates Bcores of men, and, however great the 

number of Loose women, the number oi'men who have been 



1861.] Gonorrhce.al Rheumatism. 263 

occasionally loose is almost equal to the number of all 
men. 

4. But the most important and perhaps an invariable 
point in its character, is its inflammatory nature at first, and 
for a very considerable time. This struck me before I had 
seen many instances of the disease, and I did not find that 
it had been noticed. But Sir Benjamin Brodie, whose book 
upon diseases of the joints I had never seen, had possibly 
made the same remark ; for previously, in fact above twelve 
years before I was aware of witnessing the disease, he had 
written that colchicum was the best remedy for it ; and the 
great utility of this medicine against rheumatism I believe 
to be in the inflammatory form. Not only is the disease, 
but its inflammory nature, disposed to coutinue very long. 
Yet at length, and after a long period, the time may arrive 
when the iodide of potassium, tonics, and general and topi- 
cal stimulants are the suitable means ; and forcible exten- 
sion of the joint may be proper. Till that time arrives, the 
treatment should consist of patient abstinence from ferment- 
ed and distilled liquids and flesh food, the removal of exter- 
nal stimulants, rest, and a position which favors the presence 
of as little blood as possible in the affected part or parts, the 
discreet use of colchicum and other purgatives, and the re- 
peated application of leeches. The same kind of treatment 
is suitable to the ophthalmia, which, however, is seldom so 
obstinate. I believe that the rheumatism occurs in general 
earlier than the ophthalmia; it often occurs alone, and 
and there may be differences in these two particulars in the 
same individual in different attacks. 

5. These two affections bear no relation to the intensity 
of the urethal. The smallest discharge will produce the 
rheumatism, and perhaps the ophthalmia likewise, in the 
predisposed ; nor is the intensity of duration of these in 
proportion to the degree of the urethal ; and they, or one of 
them may continue after the urethal. 

[ have known several persons suffer from gonorrhoea 
more than once without either of these consequences, and 
then become subject to them ; but only one individual es- 
cape an attack of rheumatism after every occurrence of 
gonorrhoea when once rheumatism had followed the appear- 
ance of urethal discharge. I have seen the predisposition 
to this urethal rheumatism in several men of the same fami- 
ly, whether the irritated state of the uretha was gonorrhoeal 
or not. 



2G4 GonorrhcBol Rheumatism. [March, 

"The predisposition is a great misfortune, because, as 

, as the urethal affection begin, the patient feels certain 
of an attack of chronic rheumatism; and though it may 
take place in a few days, it may not for a considerable time, 
but is sure to come ; and the mildness of the urethal affec- 
tion dors not foretell a mild attack. 

U I will tinish by relating two cases — one illustrating the 
benfit <>f employing the living hand in treating urethal 
rheumatism, the other the power of rigid abstinence in diet 
to prevent it. 

"Mr. C , set. 29, a married man with a young family, 

living at 25, C G , got wet while affected with 

gonorrhoea, and was seized suddenly out of doors with rheu- 
matism. He became crippled, and could walk only with 
;-.v«- sticks, for the parts attacked were his hips, knees, and 
soles of the feet. His eyes become inflamed. He took a 
large quantity of medicine, and the medical attendant 
honestly told him that drugs would do him no good. When 
he had thus suffered for four months from rheumatism, the 
having recovered, it was resolved to try the effect of 
merely drawing a hand very lightly, slowly, and straight, 
along the affected parts for half an hour daily. This treat- 
ment was commenced on September 24th. In a fortnight 
his pain was lessened ; in another fortnight so great was 
the improvement that he could walk a considerable dis- 
tance ; in another he declared himself nearly cured, and be- 
fore the end of another he was well and able to work. 
Without this treatment he, no doubt, would have been crip- 
pled till at least the end of the year. 

Although the disease was excited by cold and wet, yet, 
as the man was laboring under gonorrhcea at the time, he 
will henceforth probably be attacked with rheumatism 
whenever he catches gonorrhcea. The case is interesting 

ffording an example of urethal rheumatism originating 
from ordinary exciting causes during the urethal affection, 
for in general these have not been noticed in the first attack 
ami certainly are not requisite for the production of subse- 
quenl ones. 

"The other case is mosl important. A married gentle- 

q had labored under very obstinate rheumatism of the 
m his last two contractions of gonorrhoea. T had no 

btthat this would occur now as often as he caught a 
rhoea, and i begged him to let me sec him as soon 
he found he had contracted it again, lie did so a 



1861.] Short-Sight. 265 

year ago, and I immediately prevailed upon him to abstain 
entirely from all fermented and distilled fluids and every 
description of flesh food. Ho strictly obeyed my injunctions 
for several months, and has perfectly escaped rheumatism, 
although the urethal discharge continued slightly all the 
time in spite of injections weak and strong and of all kinds, 
for, although he lived low, it was not in his power to refrain 
from walking." 



Or the Surgical treatment of Short-Sight. By Mr. J. V. Solo- 
mon, Surgeon to the Birmingham Eye Infirmary. 
Mr. Solomon appears to have hit upon an operation by 
which the focal range of short-sighted persons whose corner 
are not conical, may be doubled in length. He has found 
the plan especially successful, whether the eyes are promi- 
nent or small, the aqueous chambers deep or shallow. He 
has tested the operation on cases varying from the age of 
twelve to fortv-five vears. A man of the latter aire, who 
had worn double concave glasses of immense depth (Xo. 16) 
for a great number of years, and, unaided by lenses, could 
vith clearness the features of a person to know them at 
a distance of nine feet only, obtained at once by the opera- 
tion an increase of seven feet in his focal ranire. In a child 

o 

of twelve years of age, the operation increased the reading 
distance from four to eight inches, and the power of identi- 
fying persons' features from twenty to forty yards : and in 
one sixteen vears of age, the effect was still more remark- 
able. 

These results have been obtained by dividing in a trans- 
verse direction some fibres of the muscles of the lens — the 
ciliary muscle. Mr. Solomon does not consider it material 
which part of the muscle is selected for division, but gener- 
ally prefers either the upper or the lower part of the circle. 
Supposing the latter situation to be selected, and the patient 
to be seated in a chair, the operator stands behind, and 
fixes the globe with the left fin.: in extraction, hold- 

ing a cataract knife in his right hand, with the fiat of the 
ie directed upwards, he pushes the point in succession 
through the corneo-selerotic union, the pillars of the iris, 
I the ciliary muscle. The direction given to -tru- 

ment is obliquely downward and ontwai is taken 

that the incision in the muscle is of the same Length as the 



L 2GQ Strangulated Hernia. [March, 

puncture of entrance, namely, about two lines or two lines 
and a half in diameter. In some cases Mr. Solomon has 
found that the power of adapting the eye to distant objects 
has been increased by practice and lapse of time. 

In a young man who had been myopic from his child- 
hood, and had suffered for the last three years from conges- 
tion of the retina, the visual power and focus have been so 
much increased that the outlines of large buildings at a dis- 
tance of a mile and a half can now (six weeks after the 
operation) be distinctly made out ; whereas before the cili- 
ary muscles were divided they appeared as mist. 



A new method for the reduction of Strangulated Hernia. By 

Mr. Walter Jcssop, Surgeon to the General Hospital and 

Dispensary, Cheltenham. 

In May last, Mr. Jessop was called to a case of strangu- 
lated hernia (left oblique inguinal), in a man aged fifty-two 
years. The accident had occurred some thirty-six hours 
previously. The taxis, opium, chloroform, hot baths — in 
short, all the ordinary modes of treatment, had been perse- 
veringly applied, without success. 

At the time of his visit, he found his patient in a partial 
state of collapse, in a profuse cold perspiration, with great 
tension of the abdomen, and symptoms of hiccough and 
nausea coming on. The patient complained bitterly on his 
lightly attempting an examination ; indeed, the part seem- 
ed so exquisitely painful as at once to negative all hope of 
success irom further direct efforts at reduction. An imme- 
diate operation was proposed, but firmly declined by the 
patient and his friends. Desiring them to seek further ad- 
vice, Mr. Jessop left the room, but was immediately recalled 
with a request that he would permit an hour's delay. 
Agreeable to this, and while waiting in the house, a thought 
struck him that it might occasionally be possible to relieve 
a patient under such circumstances without having recourse 
to the knife. On explaining this to the patient and his 
friends, they at once consented to a trial of the means pro- 
posed. 

Calling a male attendant into the room, he directed his 
patient, still lying on his hack, to the edge of the bed, and 
with assistance, separated his legs, placing one over each 
shoulder of the attendant, who, facing the bed, stooped to 
receive them; and, in this position, by passing his hands 



1861.] Strangulated Hernia. 267 

round the fore part of the thighs, was enabled to obtain suf- 
ficient purchase to permit of his raising him on to his head 
and shoulders on the bed, thus throwingthe intestines baek 
upon the diaphragm, and to some extent necessarily making 
traction behind and directly from the scat of strangulation. 
After two or three minutes' manipulation of the abdomin- 
al parietes, he found the tumor become less tense, and 
drawing forward the integuments round the point of rup- 
ture, he made lateral upward, and downward movements — 
jerking as it were, occasionally, the parts immediately con- 
tiguous to the structure. This seemed to excite but little 
suffering ; in fact, the patient, so for from uttering complaint 
declared himself, after the first two or three minutes, decid- 
edly relieved — that "the dead sickening weight that killed 
his groin," as he termed it, was better. Continuing these 
efforts, and varying them as they seemed to occasion dis- 
tress, he presently felt a slight gurgling under his head, and 
almost immediately had the satisfaction of finding the 
hernia reduced, and his patient in a comparatively safe state. 

The whole proceeding did not occupy ten minutes. Slight 
peritoneal tenderness existed for some days, but the man 
eventually did well. 

The rationale of the proposed plan is simple. A mass, 
large or small, of displaced intestine or omentum must as- 
suredly be more readily withdrawn from its point of incar- 
ceration or strangulation by traction from behind, than by 
the best directed efforts of the taxis. Any one, for illustra- 
tion, taking the trouble to put a fold or two of his handker- 
chief in a ring formed by his finger and thumb, and lightly 
strangulating it, will, on attempting to return it by pushing 
or kneading from before backwards, find indefinitely great- 
er difficulty in effecting his purpose than it he were to make 
traction from behind. In short, the employment of the 
taxis is at the best a clumsy and most uncertain mode of pro- 
ceeding, and in future the author intends to make it mere- 
ly supplementary to the plan he now advocates. 

"One swallow fails to make a summer," and it may be 
said that the practice of turning patients a posteriori up- 
wards is opposed to all orthordox notions of propriety. Ad- 
mit all this. Others, with greater opportunities, may hap- 
pily be enabled to add to this single case; and granting 
that the position of the patient may be dot positive 

inelegance, it may, at any rate, contrast favorably with our 
proceedings in lethotomv, and in many other operations on 
the perineal region. 



268 Phimc [March, 

New operation for Phimosis. By M. Ridreau. 

The well-known operation lor phimosis, practised by M. 

Ricord, leaves scarcely anything to he desired under ordi- 

circumstances, at least in the opinion of the majority. 

Some, however, object to the permanent exposure of the 
glans which asive a removal of the foreskin entails. 

To meet the views of surgeons holding this opinion, we 
quote the description of an operation, designed and success- 
fully practised by M. Ridreau, a French military Surgeon. 

'•Stretch the prepuce by drawing the mucous membrane 
forward, and the skin back, so as to lay bare the orifice of 
the foreskin: introduce a slender cylindrico-conic wooden 
rod into the aperture of the prepuce ; perform a circular 
incision at about half aline from the mucous margin, di- 
viding the skin only, which immediately shrinks backward 
on the glands: maintain the mucous lining upon the wood- 
en rod, and remove circularly a sufficient quantity of it to 
give i'veo play to the glans in the aperture resulting from 
the operation. Join the edges of the wound of the skin and 
of the mucous membrane by a few small needles and twist- 
ed suture. If a vessel bleeds, apply one of the sutures on 
that spot." 

The wounds heals in a few day.- with water dressing, and 
then the condition of the organ is perfectly normal, the glans 
being covered or exposed at will. Examination of the 
anatomy of the parts explains the success of this operation. 
The constrictionis seated in the mucous membrane, and this 
is removed. Moreover, the skin of the penis unites with the 
mucous membrane, not by a diminution of its substai 
but by accommodating itself by numerous wrinkles (in the 
usual manner of skin surrounding the sphincters) to the 
destined aperture; accordingly, the moment it is divided 
iilarly, it may, without difficulty, be drawn back upon 
the penis. This operation p - peculiar io 

'i; a very limited portion of the texture is removed, a 
•ring for the glans is retained ; no deformity results: the 
. icatrix is Li: imperceptible as to be mistaken for the 

natural junction of the skin and mucous membrane, and is 
entirely concealed when the prepuce is drawn forward upon 
the glans; the portion of mucous membrane removed be- 
ing rephn-ed by integuments. 



1861.] Editorial 



EDITORIAL AND MISCELLANEOUS. 



BOOKS FOR REVIEW. 

We have received recently, from authors and publishers, quite a num- 
ber valuable works ; some of which are the following : — Researches upon 
the VcDom of the Rattlesnake with an Investigation of the Anatomy 
and Physiology of the Organs concerned, by S. Wier Mitchell, M. D., 
Lecturer on Physiology in the Philadelphia Medical Association. Tins 
thorough and elaborate Essay is a publication of the Smithsonian Insti- 
mtion, aud is presented in 145 pages 4to. When we can devote time 
to its examination we feel assured that its condensation and review will 
be of much interest to our readers. 

From Messrs. J. B. Lippincott & Co., of Philadelphia, the two follow- 
ing works, viz : Lectures on the Diagnosis and Treatment of the Prin- 
ciple Forms of Paralysis of the Lower Extremities, by Dr. Brown- 
Sequard, pp. 118, octavo. 18G1. 

Also, by the same author, A Course of Lectures on the Physiology 
and Pathology of the General Nervous System, delivered at the Royal 
College of Surgeons of England, in May, 185S, published in this country 
in i860, pp. 265, with beautiful illustrations. 

From Messrs. Blanchard & Lea: Diseases Peculiar to Women, in- 
cluding Displacements of the Uterus, by Hugh L. Hodge, M. D., Pro- 
fessor of Obstetrics and Diseases of Women and Children in the University 
of Pennsylvania, pp. 469, octavo, with numerous illustrations. Phila. 
delphia. 18G0. 

From same: Diphtheria, Its Nature and Treatment, with an account 
of the history of its prevalence in various countries, by Daniel Denson 
Slade, M. D., being the dissertation to which the Fisk Fund Prise wa.s 
awarded July 11th, 1*60, pp. 85, octavo, with illustrations. 

All of the above works have been trasnmitted to us through Me 
Thomas Richards & Son, of this place, at whose store they will be found 
by purchasers in this section. 

Volume loth of the Transactions of the American Medical Associotion 
has also come to hand, which, together with the other valuable works 
above noticed, shall receive careful attention at our hands at a future 
time. 



270 Miscellaneous. [March, 

Tartro-Ci/ric Lemonade — Prof. J. Lawrence Smith expresses 
(American Journal of Pharmacy, September, 18G0) his surprise that the 
tartrate of Soda should have given place as a purgative to the citrate of 
magnesia, a preparation which he very justly considers as obnoxious to 
very many objections. Among these he enumerates "the not unfrequent 
irregularity of its operation, sometimes not acting as promptly as de- 
sired, at other times with too great and continued energy, requiring ano- 
dynes to arrest its operation. Again, owing to the manner in which it is 
made, and the want of uniformity in the composition of the commercial 
carbonato and calcined magnesia, the amount of free acid in the solution 
varies much when made at different times by different lots of materials. 
There being sometimes two or three drachms of free acid present in a 
bottle, and besides, under all circumstances, the mixture must be quite 
acid in order to retain for any length of time the citrate of magnesia in so- 
lution. Mitscherlich and Bcnce Jones has have both made experiments 
on citrio acid, and they consider it a poison analogous to oxalic acid. 

"Yet another objection to citrate of magnesia is the certainty of its 
undergoing decomposition, resulting in the deposition of an insoluble 
citrate of magnesia, a change that takes place very rapidly when the bot- 
tle is opened. 

"With these facts before me, I compounded a preparation of tartrate 
of soda with lemon syrup and water (at first I introduced a small portion 
of citric acid, calling the mixture tartro-citric acid lemonade.) 

"It is free from the objections of the citrate of magnesia, is a prompt 
and certain purgative, without excessive action, and uniform in compo- 
sition, does not undergo decomposition even after the bottle is opened, 
even more agreeable to the taste and less costly than citrate of mag- 
nesia." 

" Sal soda 21 lbs. 14 cz. avoirdupois. 

Tartaric acid 15 " " 

Sugar (white) 24 '■ 
Water to make 25 gals. 

"It is then put into strong twelve ounce bottles, and thirty-five grains 
of bi-carbonate of soda added to each bottle, and immediately corked and 
fastened with twine or wire. 

"This preparation has been used in Louisville for about six years, and 
is gradually extending over various parts of the west and south." 



Banquet to M. Ricord. — The banquet given to M. Ricord by his 
confreres came off on Thursday evening. December, 20th, at the Hotel 
du Louvre. The great dining room of this establishment, itself one of 
the lions of Paris, afforded hospitality to about two hundred members of 
the medical profession, who assembled for the double purpose of doing 
homage to the great syphilograph and justice to a very copious and 
recherche dinner. Great Britain, Germany, Sweeden, Ilussia, Greece, 
Italy, the United States and South American Republics were all duly 
represented on the occasion. — London T^anrct. 



1861.] Miscellaneous. 271 

Strychnine in Typhoid Fever. — In a clinical lecture, delivered at 
the Mercy Hospital, and reported for and published in the Chicago 
Medical Examiner, Prof. N. S. Davis remarks upon the treatment of a 
bad case of typhoid fever. Quinin, alcohol, turpentine, &c, had been 
used and yet the patient contiued to sink. At this juncture, in connec- 
tion with the turpentine, a tea-spoonful of the following admixture was 
givcu, and directed to be repeated every four hours : 
R- — S try chin, i. gr. 

Nitric Acid, 5 j- 

Tine. Op ii, 5 *!• 

Water, § ij. 

From this date the patieut improved rapidly. In reference to the 
use of strychnin in continued fever, the doctor remarked, that in many 
cases between the fifth and fifteenth days, the impulse of the heart be- 
comes weak, the voluntary muscles unsteady, the capilary circulation 
feeble, with an evident tendency to passive congestions in some of the 
internal viscera ; and in such, he had seldom failed to find a remedy 
strikingly beneficial. 

In a review of Dr. Reeves' work on Enteric Fever, and published in 
the Monthly for September, 13-39, we made use of the following lan- 
guage : 

"There is one agent that Dr. Reeves has not alluded to, which, be- 
cause of its peculiar adaptation to certain conditions frequently present 
in enteric fever, should not be passed over in silence. When there is 
subsultustendinum, low muttering delirium, and the evacuations are in- 
voluntarily discharged, all showing a complete prostration of the nervous 
system, there is probably no combination of medicines equal to strychnin 
which may be beneficially combined with small doses of opium." 

S3 far as we know, we were the first to use and advise strychnin in 
typhoid fever, and we are glad to see that so able an authority and ju- 
dicious an observer as Prof. Davis should coincide with us in opinon. — 
Med. Monthly. 



Deaths of Distinguished Physicians. — We find noticed in the re- 
ibreign journals the deaths of Dr. Edward Rigby, President of the 
Obstetrical Society of London, at the age of Dtj ; Sir Henry Marsh, M 
D , of Dublin ; Dr. Andrews, of Birmingham, Professor of Physiology 
in Queen's College ; and Dr. Franci3 Broussais, last surviving son of the 
celebrated Broussais, and himself an author of many valuable articles in 
the medical journals. 



We reget to record the decease of the distinguished Dr. John W 
Francis, of New York, which took place last week. Dr. Franci.g has 
been for a long time at the head of the profession in his adopted city, 
and his death will be widely lamented. 



262 Ifisccllaneous. 

Sulphate of Quinia and Fcrrocyanurct of Iron in Rheumatic 
Dysmenorrhea. — Dr. J. B, Snelson states (St. Joseph Medical and 
Surgical Journal, November, I860) that he has employed the sulphate 
of quinia with the fcrrocyanurct of iron, for several years in rheumatic 
dysmenorrhea, with very satisfactory results. lie commences the treat- 
ment by emptying the alimentary canal by purgatives : during the men- 
strual period he uses the warm bath, and gives opium combined with 
camphor and ipecac to relieve the pain. After the period has passed, he 
commences with a pill composed of two grains of sulphate of quinia and 
an equal portion of fcrrocyanurct of iron, to be taken morning, noon and 
night. These arc to be contiuuod during the intermenstrual period. 



Frequency of Accidents or Irregularities during first Labour. — 
Dr. Richard McSherry states (Maryland and Virginia Medical Journal, 
October 1860) that, in looking over his notes, he could not but observe, 
with some surprise, to how great an extent primiparce are more liable 
to accidents than multipara). In his own practice he has- had notable 
irregularities or disturbances to contend with in more than 33 per cent, 
ofhisprimiparac, while in multipara) this has happened in only 10 per 
cent. 



The Stereoscope. — It is said that Sir David Brewster, in inquiring 
into the history of the stereoscope, finds its fundamental principle was 
well known even to Euclid ; that it was distinctly described by Galen 
1500 years ago ; and that Gambatista Porta had in 1599 given such a 
complete drawing of the two separate pictures as seen by each eye, and 
of the combined picture placed between them, that we recognize in it not 
only the principle, but the construction of the steoreoscope. — Chemist 
and Digest. 



Ague. — M. Eissen states that quinic ether, when inhaled during prr* 
oxysm of ague, arrests the attack, and prevents the recurrence of future 
attacks. This, however, is open to doubt, as the ether only oontains 
kinic acid, which is known not to possess the tonic and antiperiodic 
properties of quinine. 



Homaipathic College. — The Hahnemann Medical College, of Chicago, 
has closed for want of support. The concern matriculated three students 
on credit. Hahnemann taught, the smaller the dose the better the re- 
sult, a statement singularly verified in this instance. 



Spina Bifida treated by I?ije/tions of Iodine. — Dr. Emil Fisher 
reports (North American Medico-Chirurgical Review, Nov., 1860) two 
cases of spina bifida treated by injections of iodine, by Prof. Gross, at the 
surgical clinic of the Jefferson College. Both terminated fatally. 



SOUTHERN 

MEDICAL AND SURGICAL JOURNAL 

(new series.) 

■< — * 

Vol. XVII. AUGUSTA, GEORGIA, APEIL, 1861. NO. 4 

ORIGINAL AND ECLECTIC. 

ARTICLE II. 
(CONCLUDED FROM JANUARY NUMBER.) 

Lectures on Tumors and Outgrowths of the Cervix Uteri By 
Joseph A. Eve, M. D., Professor of Obstetrics and Dis- 
eases of Women and Children in the Medical College of 
Georgia. 

Lecture Second — .Treatment of Fibrous Polypi. 

The only appropriate treatment for fibrous polypi is by 
excision or ligation, although, when they have very small 
pedicles, they may be twisted off or torn away and are 
sometime detached, by traction intended to bring them 
in proper position for excision, by the bistoury, scissors, 
polyptome, or ecraseur. 

Some authors and practitioners prefer the ligature from a 
belief that it is safer. The correctness of this opinion is, 
we believe, by no means established. The only danger to 
be apprehended from excision is hemorrhage, which, it is 
admitted, very rarely occurs, and then is easily arrested by 
astringent injections, such as a strong solution of sulphate 
of zinc, or of copper, or the persulphate of iron, or most 
certainly by the tampon or colpeurytner. 

In two hundred cases of polypi, removed by excision, 
Dupuytren had hemorrhage only in two, and in these, it 
was promptly arrested by proper means. Lisfranc had 
18 



274 JEve. Lectures on [Apri 

hemorrhage to occur only twice in one hundred and sixt; 
five cases, in which excision was performed. In both < 
these it was stopped by the tampon. I have never know 
hemorrhage after excision. The only instance in which 
have witnessed hemorrhage, was one in which a very lar<; 
polypus was detached by traction, without excision or lig; 
ture. It ceased immediately on application of a tampon. 

You thus perceive, the danger of hemorrhage is imagi] 
ary. The advocates of the ligature assert that the polypi 
is more effectually destroyed by ligation. This we consic 
er a mere assertion unsupported by facts. It is as effectua 
ly destroyed by one method as the other, for the remnant ( 
the pedicle always shrinks away or sloughs off. By exci 
ion, the polypus is removed at once, and the tedious unce] 
tain process of sloughing avoided. There is no danger c 
local inflammation, constitutional irritation, or pyemia froi 
the absorption of pus or putrilage into the blood. I hav 
no hesitation myself in giving a decided preference to e^ 
cision over ligation, and this decision is supported by a larg 
majority of tho most eminent authors who have written o 
these subjects. When the stem is very large, or when a 
artery can be felt pulsating in it, prudence might dictat 
the application of a ligature previous to excision, whic 
should be performed below it, the ligature being allowed t 
remain a day or two as a security against hemorrhage. J3u 
this precaution would, I think, rarely if ever be necessary 
In such cases the ecraseur might be the most eligible in 
strnment. 

Dr. Churchill says "there are other cases in which excis 
ion would be impossible or hazzardous, as for for instance 
when the polypus has only just descended through the o 
uteri. If doubtful, the ligature should be used." In thes< 
very cases I consider excision most decideclly preferable, a 
being more easily accomplished and much safer. But tin 
difficulty of applying the ligature is not so great as the dan 
ger to 1)0 apprehended from allowing a metalic instrumen 
t<> remain in contact with the internal surface of the uterus 



1861.] Tumors, fa 

liable to irritate or pierce through its walls, and form a pu- 
trid mass contained within it for several days. 

No antiseptic vaginal or uterine injections could be re- 
lied on to prevent absorption from the sloughing tumor. 

It sometimes becomes necessary to tighten the ligature 
repeatedly, or to apply a second ligature. The time neces- 
sary for separation by ligature is indefinite. Days are al- 
ways required and sometimes weeks ; during all of which 
time the patient is confined to bed, kept in a state of anxiety, 
and liable to fever or phlebitis from the absorption of putrid 
matter. 

If the polypus could not be drawn down low enough for 
the pedicle to be divided, by a suitable pair of curved scis- 
sors or the polyptome, I would infinitely prefer a method 
proposed by Prof. Sympson, which is to crush the polypus, 
and thus destroy it, by a properly constructed pair of for- 
ceps, or to divide and bring it away piecemeal. 

When a polypus is discovered, during pregnancy, or dur- 
ing or soon after parturition, some authors advise to defer 
its removal, unless delivery be obstructed by it, as the uterus 
is more disposed to hemorrhage under such circumstances, 
in consequence of its vascular system being so much more 
developed. But as a polypus is itself a great determining 
cause of hemorrhage, it would, I think, be the much safer 
practice to remove it, if practicable. 

J )r. West says : "the general rule, and one, concerning 
the wisdom of which there can be no doubt, is not to meddle 
with a uterine polypus, either in labor or after delivery." 
It is always with regret and deference I differ from author- 
ity I respect so highly. I would not willingly mislead you: 
J give you my opinion with diffidence ; I may be wrong ; 
I have had very little experience with polypi during 
pregnancy orparturition. Dr. West's experience has doubt- 
been much more extensive, and his judgment is reliable. 
Numerous and various instruments and methods have been 
devised for applying ligatures to polypi and polypoid tumors 
— time would fail were I to attempt a description of one- 
half of them. 



270 



Eve. Lectures on 



[Ap 



The double Canula, invented by Dr. Gooch — the inst 
inn it I now exhibit to you is, perhaps, equal, if not super! 
to any other. Various changes have been suggested ; bu 
is doubtful whether it lias been improved. There may 
an advantage in some cases to have the extremities curv 
The instrument and its use cannot be better described tl 
in Dr. Gooch's own words : "The instrument which I 
for this purpose consists of two silver tubes, each eij 
inches long, perfectly straight, separate from one anoth 
and open at both ends. A long ligature, consisting 
strong whip cord, is to be passed up one tube and down 
other, and the two ends of the ligature hang out at 
lower ends; the tubes are now to be placed side by s 
and, guided by the finger, are to be passed up the vagi 
along the polypus, till their upper ends reach that part 
the stalk around which the ligature is to be applied; t 
now the tubes are to be separated, and while one is fix 
the other is to be passed quite around the polypus, til 
arrives again at its fellow-tube and touches it. It is ol 
ons that a loop of the ligature will thus encircle the sta 
The two tubes are now to be joined, so as to make th 
form one instrument; for this purpose two rings joined 
their edges, and just large enough to slip over the tubes, 
to be passed up till they reach the upper ends of the tu 
immovably. Two similar rings, connected with the up; 
by a long rod, are slipped over the lower ends of the tu 
so as to bind them in alike manner; thus the tubes, wh 
at the beginning of the operation were separate, are n 
fixed together as one instrument. By drawing the end* 
the ligatures out at the lower external ends of the tu 
and then twisting and tying them on a part of the insl 
ment which projects from the lower rings, the loop roi 
the stalk is thereby tightened, and, like a silk thread rot 
a wart, causes it to die and fall off." 

Dr. Churchill says: "In many cases I found great 
vantage from the cautious use of Musaux's forceps. 
continued gentle traction, it is quite possible to draw 1 



1861.] Tumors. 277 

polypus within view; often to produce it externally, so as 
to apply the ligature without any difficulty, after which the 
forceps should be removed, and the polypus permitted to 
return into the pelvis. It may doubtless, by gentle tractions, 

In m 3, he drawn through the vulva ; hut T cannot 

agree with Dr. Churchill that it should he permitted to 
return : when once it makes its appearance externally, it 
never returns with my consent ; it is too late then to think 
of ligatures; it should he removed at once by the bistoury, 
3ors or polyptome. 

I have sometimes applied a ligature as a means by which 
to draw down the polypus for the purpose of excision ; but 
this could rarely be necessary, if supplied with suitahleYor- 
ceps. unless the polypus were too soft to affo rd a suffi ciently 
firm hold to the forceps. 

I was formerly much inclined to the application of a 
igature before excision as a means of traction, from a belief 
►hat the hemorrhage was from the surface of the polypus; 
but I now believe that is certainly not the principal source. 

The removal of a polypus by excision is generally easily 
effected. The patient may lie on her back or side, with her 
knees drawn up ; the operator should then insert one or 
two lingers, high up on the polypus — if practicable on the 
pedicle — as directors for the forceps, which should be intro- 
duced, one blade at a time, as obstetric forceps, and then 
united at the lock, after their extremities are firmly fixed 
on the polypus; gentle traction should then be made until 
the polypus, if practicable, is brought out of the pelvis, when 
it should be cut off, as near the os tincae as possible. Some, 
I am aware, advise to divide it far from the os tincrc ; but 
I cannot perceive that there can be any advantage in this 
pours -poets excision; it may be proper sometii 

even necessary in applying a ligature, as the pedicle is in 
pome ositive near the uterus, in - nee 

of an extension of the uterine tissue. There is so much pain 
sometimes that it becomes necessary to remove the ligature; 
but excision of the sensitive portion could be attended with 



278 Eve. Lectures on [April, 

no bad effect, beyond a slight momentary pain. The 
patient' B suffering may be partially or entirely relieved, if 
necessary, by chloroform. When the pedicle cannot be 
drawn beyond the vulva, it may be divided in the vagina 
by a pair of curved, blunt-pointed scissors, or by the polyp- 
tome. The pedicle may sometimes be divided by the polyp- 
tome without traction, and afterwards removed by the for- 
ceps or the lingers. The polyptome resembles a small, 
blunt hook with the inner or concave edge sharp. It is a 
very convenient and valuable instrument which I have found 
very satisfactory in practice. 

One pair of forceps or hooks may sometimes prove not suf- 
ficient for drawing the polypus down, and two or three 
pairs may be required. It may even occasionally be neces- 
sary to have recourse to obstetric forceps to deliver a large 
polypus from the vagina. I employed obstetric forceps in 
one case, but I believe serrated polypus forceps and hooks 
would always answer a better purpose. 

It is advised to plug the vagina in every case after excision; 
but in a large majority of cases it is certainly unnecessary ; 
it is time enough when a disposition to hemorrhage is 
evinced. Although not so essentially necessary, as after 
ligature, it is advisable that the patient should remain in 
bed a few days, and not be neglected by her medical at- 
tendant, that hemorrhage or any other unpleasent symptom, 
may be detected in its incipiency and promptly treated. 
A Large Internal Polyus Mistaken for an Ovarian 

Tumor. 

The 15th of August, 1846, Mary, a negress about thirty- 
five years of age, the property of Mr. Wm. Jones of Colum- 
bia county, was sent to this city for treatment, on account 
of a large tumor which had existed, a considerable time, in 
her right side. On examination I supposed it to be an 
ovarian tumor. Although she had not borne a child, dur- 
ing the last seventeen years, notwithstanding she had en- 
joyed comparatively good health most of that time, to my 
great surprise I discovered that she was pregnant. As it 



1861.] Tumors, $c. 279 

was apprehended that she might have a difficult, if not a dan- 
gerous delivery, she was allowed to remain in this city until 
after her confinement. After a protracted and difficult labor, 
she gave birth, on the 19th, Jan., 1847, to a large healthy 
female child. She had a favorable convalescence and was 
able in a month or six weeks to return to Columbia county, 
the hard tumor still in her right side uninfluenced by treat- 
ment. 

About August, 1851, four years and a half after this la- 
bor, my friend, Dr. John T. Smith, of Columbia count}', 
attended her in another accouchment, in which she was 
soon delivered of a fine girl ; but in this case the placenta 
was retained so long, and its delivery attended with so 
much difficulty, that Dr. Smith sent to Augusta for a con- 
sultation. Dr. II. F. Campbell delivered the after-birth 
after a retention of twenty-four hours. It was detached 
and extruded from the uterus into the vagina, so that Dr. 
Campbell had not an opportunity to introduce his hand into 
the uterus, where he would probably have discovered the 
true nature of the case. 

At my request, Dr. Smith very kindly furnished the fol- 
lowing succinct history of this patient subsequent to the 
placental delivery by Dr. Campbell: "Her recovery was 
rapid. About six months after delivery, I was called to see 
Mary ; found her suite ring with prolapsus uteri ; replaced 
the womb, and after removing inflammation, used a glass 
globe pessary to keep it up. At her monthly periods, she 
suffered with menorrhagia and in the intervals with leucor- 
rhea ; I was called to see her on the night of January 24th, 
1853 ; found her laboring under considerable mental ex- 
citement suffering some pain ; on examination discovered 
a large tumor protruding through the vulva ; being at night 
I could not inspect it satisfactorily ; directed cold astringent 
applications, and an opiate for the night ; called early next 
morning ; the opiate produced a pretty good night's rest. 
On examining it carefully I found, instead of an inverted 
uterus, a large polypus. After you removed the tumor she 



280 Eve. Lectures on [April, 

complained only from a little soreness ; the stalk soon 
sloughed off, and she has been perfectly well ever since, a 
period now of several years." 

On the night of the 25th January, 1853, 1 saw this patient 
with Dr. Smith and Dr. Thomas. The patient was suffer- 
ing very much ; her pulse very feeble and frequent. There 
was a large tumor protruding five or six inches beyond the 
the vulva. It was perfectly insensible when touched or 
pricked with a pin; but when moved, it caused severe pain 
at the connection with the uterus. Having put the patient 
under the influence of chloroform, we made gentle traction 
on the tumor, until we brought the os tincae in view, after 
which we divided the pedicle very near to it. This tumor 
was pyriform ; about six inches long and about four in 
width. It was redder and softer than most of the fibrous 
polypi I have seen, not much firmer than muscular tissue. 
From the length of time it had been retained in the uterus, 
I would have supposed it to have been a fibrous tumor that 
had been slowly enucleated from the parietes of the uterus 
into its cavity, thence expelled into the vagina, and finally 
from the vagina through the vulva ; but its pyriform shape 
and thick pedicle clearly identify it as an original polypus. 
Had it been primarily a fibrous tumor, embedded in the 
walls of the uterus, it would most probably have assumed a 
move globular shape, and certainly would have had no fibrous 
pedicle connecting it to the uterus, its only connection with 
the uterus could have been by mucous membrane with 
the addition perhaps of some cellular tissue. From the 
larsre size this tumor had attained, at the time of her 
pregnancy, in 1846, it must have existed some years before, 
during all which time, during the interval between her two 
gestations, and during the time Dr. Smith treated her for 
inflammation of the womb and prolapsus, it must have been 
internal. It is impossible to determine precisely at what 
time it was expelled from the uterus into the vagina; but 
from all I have been able to ascertain of the history of the 
case, she was certainly not subject to hemorrhages, at least 



1861.] Tumors, #c. 281 

the greater part of the time that the polypus was unques- 
tionably internal : whereas she was subject to monorrhagia, 
when it is fair to conclude the polypus must have been in 
the vagina. 

It is a very singular feet that, although living with the 
same husband, she was sixteen or seventeen years sterile, 
had two children while the polypsus was in the womb, and 
has had none since, notwithstanding she has enjoyed good 
health. 

Ir is to be regretted that we have not a more particular 
history of this most remarkable case ; but Dr. Smith's notes 
were unfortuately lost, and the account furnished was prin- 
cipally from memory. 

The next case I will describe was a large enucleated 
fibrous tumor. The subject of this tumor was a lady of first 
respectability, about forty-three years of age. She had been 
in bad health for twenty years. During several years pre- 
vious to the time I saw her, she had been reduced by hemor- 
rhage to the last extremity. This patient was brought to 
me in May. 1853, by my friend, Dr. Pinkerton, of Hancock 
county. She was at that time very feeble and anemic from 
frequent hemorrhages. On examination I found an insen- 
sible tumor, filling the whole pelvis, as large as the foetal 
head at terms; the pedicle could not be reached; ligation 
appeared to be impracticable, if deemed expedient. Dr. 
Pinkerton and myself requested the counsel and assistance 
of our friends, Drs. L. D. Ford and R. Campbell. In con- 
sultation it was determined to deliver the tumor by a deli- 
cate pair of obstetric forceps and divide the pedicle. TTith 
difficulty we introduced the forceps and produced the tumor 
partially through the external parts, at which juncture the 
forceps losing its hold, we seized the tumor with two crotch- 
ets and brought it through the vulva. To our surprise it 
came away detached, no vestige of a pedicle remaining; the 
only sign of attachment to the uterus was indicated by a 
small portion being denuded of mucous membrane. 

During the passage of this tumor through the external parts 



282 Dugas. Lecture on [April, 

there was a slight laceration of the perineum which I think 
was attributable to the slipping of the forceps ; with the in- 
struments now presented to you (a strong pair of plain poly- 
pus forceps, and another pair with strong hooks, both 
separable from each other like obstetric forceps) this 
accident might possibly have been avoided; but it was 
most probably inevitable under the circumstances, as the 
tumor was very large and hard, and the patient had never 
borne a child. It was, however, not extensive and the 
patient recovered from it without any unpleasant conse- 
quence. 

This was the only case in which I have known removal 
of a polypus followed by any material hemorrhage ; and this 
was only alarming on account of the very feeble and 
anemic state of the patient ; it was promptly arrested by a 
sponge tampon. 

This patient convalesced rapidly and was soon restored to 
£Ood health. 



b 



[Other oases related in the lecture are here omitted.] 



ARTICLE IX. 

A Clinical Lecture upon Rheumatism, delivered at the City 

Hospital. By L. A. Dugas, M.D., &c. 

Gentlemen : — As we have here several cases of Rheuma- 
tism to which I desire especially to direct your attention 
hereafter, I beg leave to read to you the following paper 
which I published in one of the early numbers of the Medi- 
cal Journal of this city, and which contains a brief history 
of some of the views I have long entertained upon the sub- 
ject. I will then add some of the results of subsequent ex- 
perience : 

Rheumatism is a disease of which we find no satisfactory 
account prior to the sixteenth century, towards the close of 
which the attention of the Profession was called to it by the 
justly celebrated Ballonius, under the singular appellation 
it still retains. Subsequently, the able pen of Sydenham 
delineated its characteristics in bold relief, and made it a 
prominent feature in Nosology. 



1861.] Rheumatism. 288 

The term Rheumatism, according to Villencuve, (Diet. 
des Sciences Med. torn. 48) is now applied to "a dis< 
classed amongst the Phlegmasia, located in the muscular 
and fibrous tissues of animal life, and attended with the 
following symptoms: pain; more or less intense, either con- 
tinued or intermitting, fixed or wandering, and with or 
without heat, tumefaction, redness, and pyrexia. It usually 
terminates by resolution, sometimes suddenly, followed or 
not hy metastasis, rarely by suppuration, and still more sel- 
dom by gangrene. Lastly its course is extremely irregular, 
and its recurrence very frequent." 

Scudamore defines rheumatism to be: "Pain of a peculiar 
kind, usually attended with inflammatory action, affecting 
the white fibrous textures belonging to joints, such as ten- 
dons, aponeuroses, and ligaments, the synovial membranes 
of the bursas and tendons ; and nerves ; occasioned by the 
influence of variable temperature, or by direct cold, or by 
moisture." It is called either acute or chronic, according 
to the intensity and combination of the above symptoms. 
The causes of this disease are extremely obscure, although 
they have, by universal consent, been referred principally 
to atmospheric vicissitudes. Exposure to a cold and humid 
air is peculiarly favorable to its development. Whether the 
low temperature and hygroscopic condition of the atmos- 
phere, alone concur in such cases to give rise to rheumatism, 
is extremely questionable. I believe it by no means im- 
probable that the electric state of this medium is highly in- 
fluential in the production of rheumatic pain, as well as of 
many other phenomena connected with nervous affections. 
It is not my design on the present occasion to inflict on the 
reader even a recapitulation of the numerous predisposing 
and proximate can- ied to this disease. The pro- 

rioo is happily becoming satiated with speculations on 
causes which must ever escape ourprcsent means of investi- 
►D ; and we are now disposed to cultivate a more fruit- 
ful field — that of effects. Let us, therefore, hasten to the 
nature or pathology of rheumatism. 



284 Dug as. Lecture on [April, 

V, r c have already said that it is now generally regarded as 
an inflammation of the muscular and fibrous tissues. This 
is, indeed, the doctrine which has prevailed, more or less, 
from the earliest notice of this disease. It is true that 
many have considered this inflammation as of a peculiar 
kind. Sarcone and other believers in the agency of animal- 
culsa, &c, in the causation of disease, explained this pecu- 
liarity by referring it to the action of those diminutive be- 
ings on the white humors of joints, &c. Quarin viewed it 
as a constriction of the vessels, from cold. Boerhaave call- 
ed it an inflammation not sufficient to cause suppuration. 
Cullen admits the inflammation, but adds that the muscu- 
lar fibres are in a state of rigidity, which impedes and ren- 
ders painful any movement. "It is," according to this dis- 
tinguished pathologist, "an affection of these fibres which 
gives an opportunity to the propagation of pains from one 
joint to another, along the course of the muscles ; and 
which pains are more severely felt in the extremities of 
the muscles terminating in joints, because, beyond these, 
the oscillations are not propagated." (Cullen's 1st lines.) 

Bichat and Scudamore insist that it is a peculiar inflam- 
mation, but do not attempt to define its nature. Villeneuve 
states that "several authors, without determining whether 
the proximate cause of rheumatism be spasm, irritation, or 
debility, affirmed in general terms, some that rheumatism 
was a peculiar affection of the nerves, others that it was a 
lesion of sensibility, and a third class that it was a special 
modification of the vital powers." (loc. cit. p. 462.) Villen- 
euve admits that the nerves of animal life may be the seat 
and even the primary seat of rheumatism, but does not think 
those of organic life ever invaded by it. Scudamore, in his 
definition of rheumatism, enumerates very specially the 
nerves among the tissues affected by this peculiar inflamma- 
tion. Sciatica is accordingly considered by him a rheu- 
matic affection of the nervous trunk itself; whether of 
the nervous matter or of the neurilemma, he does not de- 
termine. 



1861.] Rheumatism. 285 

It is- evident that all the writers above cited looked upon 
rheumatism as located alone at the seat of pain. Of late 
vears, however, attention has been called to a peculiar con- 
dition of the spinal marrow as intimately connected with 
lesions of sensibility, as well as with many of those affec- 
tions classed among the Xeuroses. 

It appears that as far back as 1821, Mr. Player, in a letter 
to the editor of the Quarterly Journal of Science, stated 
that "the occurrence of pain in distant parts (from the spine) 
forcibly attracted my attention, and induced frequent ex- 
amination of the spinal column ; and after some years' at. 
tention, I considered myself enabled to state, that in a great 
number of diseases, morbid symptoms may be discovered 
about the origins of the nerves which proceed to the affect- 
ed parts, or to those spinal branches which unite them ; and 
that if the spine be examined, more or less pain will com- 
monly be felt by the patient on the application of pressure 
about or between those vertebrae from which such nerves 
emerge." 

In May, 1828, Dr. Thomas Brown published in the Glas- 
gow Medical Journal a very interesting article "on Irrita- 
tion of the spinal nerves," the substance of which he asserts 
he read before the Medical Society of that city in 1823. In 
this paper he refers the morbid phenomena of the spinal 
nerves to a state of increased irritability of their origin, 
which he terms "spinal irritation." This affection of the 
spinal marrow is attended with more or less pain on pres- 
sure of the vertebrae at the diseased point. Some of his 
cases were evidently rheumatic, and indeed had been treat- 
ed as such by the previous attendant. His treatment con- 
sisted principally of applications to the spine. 

Dr. Darwall, early in 1829, inserted in the Midland Medi- 
cal and Surgical Reporter, his "Observations on some 
forms of Spinal and Cerebral Irritation." He would estab- 
lish the principle "that disorders attacking the origins of 
nerves, or their attachment to the central mass, whether 



280 



1)U(JAS. Lecture on 



[April, 



this be the brain or spinal chord, always disturb the func- 
tions of the organs to which such nerves are destined." 

"A treatise on neuralgic diseases, dependent upon irrita- 
tion of the spinal marrow and ganglia of the sympathetic 
nerve," by Thomas Pridgin Teale, was issued from the 
London press in 1829. This invaluable publication has 
opened to our researches one of the most fertile fields ever 
explored by the profession ; one from which have already 
been elicited some of the most important truths in the do- 
main of pathology. The observations of Teale not only 
confirm the views of those who wrote before him on Spinal 
Irritation, but are also extended to lesions of the sympa- 
thetic ganglia. I would, however, at present, refer only 
to that portion of his work which relates to our subject. It 
contains a number of cases illustrative of his doctrines, some 
of which, like those reported by Brown, had been consider- 
ed as rheumatic by other physicians, and indeed presented 
symptoms such as are usually said to characterize some 
forms of this disease. It is not a little remarkable that 
with such facts before them, neither Brown nor Teale 
should have thought of treating the more acute forms of 
rheumatism in the same manner. They make no reference 
to it, and the merit of introducing a new and rational mode 
of treatment of rheumatism, was reserved for our country- 
man Dr. J. K. Mitchell, of Philadelphia, who, in May, 
1831, published in the American Journal of Medical Sci- 
ences, his first article on the subject. In addition to the 
eight cases then reported, Dr. M. inserted five and thirty 
more in the same Journal, August, 1833 ; all of which con- 
cur in confirming the spinal orgin of rhematism, whether 
acute or chronic. 

I must confess that neither of the transatlantic publica- 
tions to which I have referred, had led me to reflect on the 
nature of rheumatism; nor was my attention drawn to it 
until the appearance of Dr. Mitchell's first paper. On read- 
ing this, however, and comparing his doctrine with the pre- 
vailing theories of the Pathology of this malady, I became 



1861.] Rheumatism. 

at once convinced that it was Impossible to reconcile the 
various symptoms of this disease, on any other principle 
than that of spinal irritation, and that with this view of the 
subject, the treatment would be perfectly simple and effica- 
cious. 

From the definitions usually given of rheumatism, the 
pain is manifestly considered as dependent on the inflam- 
mation of the parts in which it is seated. That simple in- 
flammation of the muscular or fihrous tissues should be the 
sole cause of the pain, I cannot admit. It is true that the 
patient's sufferings are generally proportioned to the de- 
gree of the apparent inflammation, and consequently that 
acute is more distressing than chronic rheumatism. But, I 
would ask, why are not other inflammatory affections of the 
same tissues equally painful ? It is impossible not to per- 
ceive, on a close examination of the phenomena of rheumatic 
inflammation, that they present several peculiarities, which 
evidently distinguish it from ordinary inflammations ; and 
indeed they are so strong as to have led some eminent pa- 
thologists to deny that they constituted a whole, entitled to 
the denomination of inflammation. Inflammation is usual- 
ly said to be characterized by redness, heat, tumefaction, 
and pain, all of which we find united in the most violent 
forms of rheumatism. But there are sequela? or tcmina- 
tions enumerated as belonging to inflammation, which never 
follow rheumatism. Inflammation terminates by resolu- 
tion, suppuration, or mortification. Its rise, progress, and 
termination, are more or less gradual ; subject to certain 
laws, and it is in most cat vptible of removal by 

antiphlogistics. Rheumatism obeys no such laws of develop- 
ment, progress and declension ; but, not [infrequently mani- 
•If and disappears with a degree of suddenness ut- 
terly at variance with the course of ordinary inflammations. 
\x< mode of termination is invariably the same (by resolu- 
tion) never proceeding to suppuration, nor to mortification; 
ami finally, it rarely, if ever yields to the antiphlogistic 



288 



Duu as. Lecture on 



[April 



treatment directed to the seat of pain.* The theory of 
spinal irritation is that alone by which all these peculiarities 
can be explained. If the point from which, a given nerve 
arises be diseased, the functions of this nerve must neces- 
sarily be vitiated; and if its functions be vitiated, the con- 
dition of those parts to which said nerve is distributed must 
also be morbid. In the case of rheumatism, the morbid 
condition of the parts deriving nerves from a diseased por- 
tion of the spinal chord, consists of inflammation of a pe- 
culiar character, increased sensibility of the nervous ex- 
tremities, amounting usually to pain more or less acute, 
and, in many instances, diminished motility. All admit 
lesions of motility to depend on an affection of the motor 
system of nerves, and, inasmuch as the motor cannot be 
separated or distinguished from the sensitive fibres after 
their union in a common nerve, such lesions are referred to 
the spinal chord. Why, then, should we not also regard 
all lesions of sensibility not the result of local injury, f as at- 
tributable to a morbid state of that chord which presides 
over this function ? 

Again, we see that not only the onset of rhematic inflam- 
mation, but also its termination or cessation, is in many 
instances extremely sudden, and indeed that sudden me- 
tastasis is by no means unfrequent. These circumstances 
are most satisfactorily accounted for by the fact that nerves 
arising very near each other may be distributed to parts 
very remote. For instance, the nerves of the right hand, 
though very distant at their termination from those of the 
left, arc nevertheless very near them at their origin in the 



*I am aware that there arc eases on record, of suppuration and even of 
mortification having occurred in parts affected with rheumatism, but they 
arc so few that we may be permitted to doubt their authenticity, or rather 
to look upon them as mere coincidences, dependent on complications or 
peculiarities of habit. The success of the antiphlogistic treatment direct- 
ed to tin 1 scat of pain, is equally doubtful, especially when we bear in mind 
the strong tendency of rheumatism to translation or sudden cessation 
without appreciable cause. 

I (lout, rheumatism and neuralgia. 



1861.] « Rheumatism, 289 

medulla spinalis ; and hence a slight affection of the medulla 
might for a time exist in one column, and subsequently ex- 
tend or remove to that adjoining it; thus producing at first 
a derangement of function on one side of the bodv, and then 
on the other. My opportunities have not as yet been suf- 
ficient to cnable]mc assert, from observation, that metastases 
of rheumatism are limited to the periphery of nerves arising 
in the proximity of each other. This, however, I am 
strongly inclined to think, will most frequently he found to 
be the ease. Whenever an upper and a lower extremity are 
simultaneously affected, they most frequently belong to the 
same side of the bod}\ It will probably also be observed 
that the justly dreaded translation of rheumatism to the. 
heart, is a much more common sequel of an affection of the 
upper than of the inferior extremities. 

The difficulty attending post mortem examinations of the 
medulla spinalis, has very much retarded our knowledge of 
the pathological anatomy of this organ. Its condition in 
fatal cases of rheumatism has never been systematically in- 
vestigated. We find, however, on record, a few eases which 
I think calculated to throw much light on our subject. One 
of these is reported in Johnson's Medico-Chirurgical Re- 
view, (Oct, 1*27, p. 4G4) under the title of "Inflammation 
of the Spinal Marrow." A youth, some time after bathing 
in the Seine, experienced wandering pains, which subse- 
quently extended to the whole surface of the body, and be- 
came so intense that the least touch would occasion loud 
cries. The pains continued unabated, delirium and diar- 
rhoea ensued, and he died on the ninth day. On opening 
the spine, the medulla was, from the 7th cervical to the 8th 
dorsal vertebffi, evidently softened and infiltrated with pus. 
In the same periodical (Jan., 1828, p. 184) is contained 
another ease, in which the patient had suffered severely 
from rheumatic pains in the upper part of the back, shoul- 
ders, and arm-, and finally became paralyzed in his arms. 
Dissection evinced that from the 5th cervical to the 11th 

dorsal vertebrae, the membranes of the spinal canal were in 

1" 



290 Dug as. Lecture on [April, 

flamed, thickened, and covered with a bloody effusion. The 
marrow itself, for the same space, was similarly inflamed 
and softened. 

Dr. Mitchell gives the history of two cases of spinal dis- 
s, as corroborative of his views of rheumatism. The 
first* was one of caries of the lumbar vertebrae, in which 
one ankle, and the knee of the opposite side were tumefied, 
red, hot, and painful, afforded a fair specimen of acute rheu- 
matism. Relief promptly followed leeching and a blister 
to the affected spine, although the ordinary treatment for 
rheumatism had been previously resorted to without effect. 
The second case was that of a physician who, after receiv- 
ing an injury of the cervical vertebrae, experienced an at- 
tack oi acute rheumatism ot the hands and wrists, which 
"was always relieved by remedies applied to the affected 
part of the spine, and aggravated by pressure or rough fric- 
tion there." 

These four cases conclusively establish the fact, that irri- 
tation of the spinal contents is attended with the train of 
Bymptoms known to characterise rheumatism. May we not, 
then, by legitimate deduction, infer that there is a spinal 
disease whenever we encounter this train of symptons ? If 
further evidence be requisite, it is abundantly furnished by 
the numerous instances in which genuine, uncomplicated 
rheumatism has been speedily cured by medication applied 
exclusively to the spine. Dr. Mitchell, reports 41 ca 
successfully treated on the new principles. 

Pressure over the vertebrae corresponding to the origin of 
the nerves supplying the seat of suffering, though in many 
instances attended with more or less pain, is not uniformly 
In some, not the slightest uneasiness is produced by it. 
I cannot, however, coincide with Dr. Mitchell, in consider- 
ing the tenderness, merely a proof of an irritated condition 



"American Journal of the Medical Sciences, M.-i\. 1831, p. 56. 
American Journal of the Medical Sciences, Aug., L833, p. 880. 



1861.] Rheumatism. 291 

of the "spinal braces ;" for, whenever this tenderness does 
exist, it almost invariably corresponds to the origin of the 
affected nerves. The degree of sensitiveness may perhaps 
be indicative of the condition of the membranes alone of 
the medulla. 

In the case before us, we have a happy illustration of the 
importance of localizing, and properly localizing diseases ; 
for so lone; as rheumatism was thought to be an affection 
of the whole system, manifesting itself indifferently in one 
joint or another, all remedial agents were directed to the 
general system. How many poor wretches have we not 
seen subjected to the cruel inflictions of a regular mercurial 
salivation, a systematic course of sudorifics, antimonials, 
guaiacum, sarsaparilla, &c, the ordeals of steaming, vapor- 
izing, sweating, &c., and after all, the patient doomed to 
limp the remainder of his days ! But I say that it must be 
properly localized; for those who view the disease as con- 
lined to the seat of pain, will torture their patients with fric- 
tions, fomentations, vesications, &c., with as little success 
as those who endeavored to drive out or neutralize the con- 
stitutional impurity. 

We have now, I trust, traced rheumatism to its true 
source, and every remedy based on this belief, gives ad- 
ditional evidence of its correctness. Regarding the disease 
as seated in the spinal marrow, and believing its nature to 
be irritation or sub-inflammation, the treatment to be insti- 
tuted is perfectly obvious. The local abstraction of blood, 
by leeching or cupping the surface over the affected medul- 
la, followed by the more permanent revulsive action of vesi- 
catories, constitutes the most efficient treatment of rheuma- 
tism. In many slight cases, the mere application of a sina- 
pism will readily allay the pain; in others a blister will 
be required and may be, or not, preceded by cupping, ac- 
cording to the tenderness of the spine, the constitution of 
the individual, &c. AVhen the local affection is 80 intense 
as to induce high febrile excitement, it may be prudent to 
take blood from the arm, though this should not be carried 



292 Ls. Lecture on [April, 

to excess. The opiates will occasionally be found useful 
adjuvants. In obstinate chronic cases, the counter-irritation 
will be most advantageously kept up by the ointment of 
tartarized antimony, and should be persevered in, as long 
iis the (1: a tendency to return. With this 

plan of treatment, I repeat, the disease will be found almost 
uniformly to yield in a few days, and without any internal 
remedies, or applications to the seat of pain. 

Yon perceive that I have, in the paper just read, used the 
term Rheumatism in a general sense, and without discrimi- 
minating between the different forms assumed by the dis- 
ease. 1 will, therefore, add a few remarks in order to pre- 
vent any misconception as to the pathology advocated, and 
which 1 still regard as entirely applicable to every form of 
rheumatism, with the exception, perhaps, of the acute 
arthritic variety, in which other elements are added to the 
spinal. 

There is a form of rheumatism usually designated by 
authors as acute articular rheumatism, the peculiar character- 
istics of which are a fixed inflammatory action in one of 
the joints, attended with intense pain, more or less tume- 
faction, and high general febrile action ; all of which symp- 
toms will continue, in spite of our endeavors, a certain 
length of time, usually varying from four to eight week-. 
This is, therefore, a self-limited disease, the intensity of 
which we may abate, but whose duration we can rarely 
shorten, fn this form of rheumatism we never find more 
than one joint affected at a time, and this is usually one of 
the larger joints, as the knee, ankle, elbow, or wrist. It is 
in this form of the disease that we observe the heart so of- 
ten implicated. According to my observation the cardiac 
affection very rarely supervenes as a complication of any 
other form of rheumatic disease. Again, acute articular 
rheumatism differs radically from all other forms of rheu- 
matism in the circumstance that one attack usually secures 
complete immunity from any subsequent attack of the same 
affection. 



II.] Rheumatism. 293 

That this form of rheumatism is, like the oilier varieties 
to be hereafter noticed, dependant, to a certain extent, upon 
a lesion of the spinal marrow, I firmly believe ; bul ii i i 
also evident that this docs not constitute its whole patholo 
gfVi for it is attended with a degree of constitutional disturb 
ancc that cannot be accounted for either by the spinal 
lesion or by the local inflammation. \\ r e moreover find that 
a radical change is effected in the composition of the blood 
in such cases, and that these obey many of the laws which 
govern the diseases said to beoi the blood. It is, therefore, 
no! surprising that the treatment which is applied directly 
and exclusively to the spinal lesion, should only mitigate 
and never arrest the disease. I know of no treatment en- 
titled to much confidence in the curation of this form of 
the disease. Yet, I must acknowledge that [ have some- 
times thought that I derived advantage from the use of 
opiates, quinine, antimonial emetics, lemon juice, &c. 

But there is another form of rheumatism also called acute, 
in which there are usually several joints implicated simul- 
taneously, and in which there may be considerable febrile 
excitement. This form of the disease is usually the effect of 
exposure in inclement weather, and the patient will gener- 
ally state that he has caught cold in all his limbs. AVc not 
unfrequently see violent cases of this kind in which the 
morbid sensibility invades most of the joints, as well as the 
muscles and even the cutaneous surface; all of which are 
exceedingly painful tothetoueh or upon the slightest motion, 
so that the patient can neither move nor turn over in bed 
without excrutiating pain. It is in this form of rheumatism 
that we find revulsives, applied over the origin of the nerves 
affected, most signally beneficial ; for without any other 
treatment the disease will yield usually in a few days to 
cupping and blistering over the affected region of the spine. 
This variety I would, therefore, designate as acute neuralgic 
rheumatism, in contradistinction to the former which I 
would term acute arthritic rheumatism. 

You will perceive that there can he no difficulty in cs- 



294 Dugas. Lecture on [April, 

tablishing the diagnosis as well as the prognosis of these 
two forms of disease, [n the former the attack comes on 
without any evident cause, affects but one joint, and that a 
largo one, is attended with high febrile excitement and 
yields t«» no remedy, but goes on steadily increasing in 
intensity until it has reached its acme in three or four weeks, 
and then gradually declines in about the same length of 
time. The latter is, on the contrary, usually induced by 
exposure, affects more than one joint, is not attended with so 
much febrile excitement, and yields very readily to treat- 
ment. I should also add that whereas the former usually 
attacks the young and the robust, the latter affects all ages 
indiscriminately, and one attack so far from securing im- 
munity from others, rather predisposes the patient to them 
in after life. It is in this neuralgic form of the disease that 
quinine acts most advantageously and may sometimes be 
substituted for the more painful spinal revulsives. 

There is finally a third form of rheumatism, very general- 
ly denominated chronic rheumatism. This variety usually 
affects one or more joints, is not so painful as the two we 
have just considered, occurs most frequently after the 
meridian of life in the temperate, and is very common 
with drunkards of all ages. This, like the last described 
variety has also its origin in the spinal marrow, is amen- 
able to the same treatment, but is apt to recur more or less 
frequently in subsequent life, especially with the intemper- 
ate, in whom I have never known it to be permanently 
eradicated. The tendency to relapse may, however, be en- 
tirely overcome in persons of good habits, by a faithful per- 
severance in the use of revulsives to the spine. 

While I place no reliance in the use of liniments, nor in 
frictions of any kind, in this and the other forms of rheu- 
matism, there are yet cases in which the joints, after re- 
peated attacks, become so much involved that their 
tea will not return wvy speedily to the normal con- 
dition. In these cases frictions with neat's foot oil, opo- 
deldoc, "i- even stimulating linaments, at the same time that 



1861.] Rheumatism* 

gentle motion is imparted to the joints, are advantageous. 
I have derived derided benefit from the application to them 
of the tincture of iodine once or twice daily as long as it 
could be tolerated. I have also used advantageously a so- 
lution of shellac. This may be made by dropping bits of 
shellac in alcohol, successively, until the solution acquire 
the consistency of mucilage. This, when applied with a soil 
brush or mop, once or twice a day, will form a thick and 
adherent pellicle which should he reproduced as fast as it. 
may he disposed to scale off. 

L will now read to you, from my note hook, a lew cases to 
illustrate and impress upon your minds the several forms of 
the disease I have just endeavored to define : 
Acute Articular Rheumatism. 

January 31st. — Mr. A. L., aged 25 years, of robust con- 
stitution and of full plethoric habit, was, last night, without 
any evident cause, taken with pain in the right knee, which 
to-day confines him to his bed. Is rubbing the knee with 
with liniment. Ordered cream of tartar as a laxative, and 
allowed the frictions to he continued. 

22d. — Pain increased: has some fever; knee a little 
tumefied : very little tenderness at the lower end of the 
si tine, which is ordered to he freely cupped. 

27th. — lias heen gradually getting worse under the use. 
of tincture opium applied to the knee, morphine taken in- 
ternally, and cooling beverages. Has refused to be blister- 
but is now willing to submit to the application of tartar 
emetic ointment to the spine. Morphine continued, pro re 
. and a tahlespoonful of tine, guaiac. to he taken three 
times a day. 

29th. — Pains increased ; fever high ; unable to move his 
limbs in the slightest degree without intense pain ; tume- 
faction increasing. Took 24 ounces blood from the arm. 
Ordered the knee to he poulticed with flaxseed and laudan- 
um. 

31 st — 1 '-ease still progressing. Ordered the spine to be 



2&6 Dugas. Jjcctureon [April, 

freely cupped to-day and to-morrow, and then blistered, pulv. 
dov., at bed time. 

February 8th. — Xo amendment. He-apply the blister 
and lake denarcotized opium as freely as may be necessary 
to relieve pain. 

L3th, — Still suffers dreadfully ; fever still high and con- 
tinuous. The blistered surface has healed. Ordered 
another blister and the anodynes to be continued as hereto- 
fore . 

18th. — Febrile symptoms less intense, and pains not so 
excruciating. Thinks his knee would feel better if rubbed. 
Ordered a liniment consisting of oil, tinct. opii. and sp. 
tereb., also tinct. guaiac. and morphine internally. 

28th. — Is gradually improving; same prescription con- 
tinued. 

March 10th. — Has improved very little since last date, 
with the exception of a considerable diminution of the fever. 
Ordered a blister to the knee. Continued the guaiacum 
and anodynes. Bowels kept open with laxatives. 

16th. — All symptoms subsiding rapidly ; knee blistered 
again; ung. ant. applied to the spine. 

26th. — Still improving ; knee blistered again. 

April 5th. — Case discharged, although the knee is so stiff 
as to allow but little motion. The patient ordered to con- 
tinue frictions with neat's foot oil, and to exercise the limb 
as much as possible until he regain its free use. 

Remarks. — We have here the details of a case such as we 
have denominated acute arthritic rheumatism, which occur- 
red without evident cause in an individual in the full vigor 
of life; which alfccted but one joint; which ran its course 
uninterruptedly and without being modified in the least by 
any remedy prescribed, whether directed to the spine or to 
the general system ; and which continued upwards of 70 
days, attended with a degree of febrile excitement entirely 
dispr portionedto the local affection. This gentleman had 
neve suffered from rheumatism before, nor did he experi- 
any subsequent attack for fifteen years afterwards, 



[861.] Rheumatism. 297 

when he died of a dropsical affection which may have been 
occasioned by some disease of the heart, consequent upon 
the above attack of rheumatism. I did not sec him in his 
last illness. His exemption from subsequent attacks of 
rheumatism is the more remarkable from the fact that he 
became very intemperate a number of years before hisdeath, 
ami that intemperance is a very common cause of one of the 
other forms of rheumatism. 

Acute Neuralgic Rheumatism. 

January 20th. — Thomas Bernard, a native of Ire- 
land, about 30 years of age, and of sanguineous tempera- 
was taken about the first of this month with rheumatism 
when working on the railroad; was subjected to a variety 
of treatment by a country physician, the details of which 
are unknown. I found him stretched upon his back, with- 
out the power to move either of his limbs, and complaining 
of the most excruciating pain in the loins knees, ankles, 
shoulders, elbows and wrists. Fever high, pulse full and 
strong, great thirst, no appetite, and costive. Ordered free 
blood-letting from the arm. 01. ric, and diluent drinks. 

January 21. — Fever still high; cathartic operated well; 
passed a wretched night, without a moment's rest. Upon 
examination found the spine extremely painful on the least 
pressure over the origin of the nerves of the lower extremi- 
ties. Tenderness also existed, though to a much less de- 
gree, in the upper portion of the dorsal vertebrae. Pre- 
scription — To be cupped freely over the origin of the nerves 
of the superior and inferior extremities ; pulv. dov. at night; 
light diet ; diluent drinks. 

January 22. — Pains much less intense ; can draw up his 
3. Cups repeated; pulv. dov. at night. 

January 23. — Can turn over in the bed, and feels pain only 
when he move-; swelling at the joints reduced, blisterover 
lower end of spine. 

January 24. — Legs entirely relieved with the exception 



208 Dug as. Lecture on [April, 

of a little weakness. Fever entirely subsided. Cups to 
the upper portion of the spine. 

January 25. — Arms much better. Cups repeated. 

January 26. — Can rise and move about the room, though 
stiit' and weak. Ung. tart. ant. to be applied at each ex- 
tremity of the spine. 

January 28. — Has improved so rapidly that he now walks 
about the streets, and the case is discharged. 

February 4. — Exposed himself considerably, and has 
again taken his bed, with great pain in the upper and lower 
extremities. Blister to the lower end of the spine, and ung. 
ant. to the upper. 

February 5. — Much better. Fulv. do v. at night. 

February 6. — Walks about the room. Saline carthartic ; 
pulv. dov. 

Februaiy 11. — Feels quite well in every respect. 
Chronic Neuralgic Rheumatism. 

February 17. — Resumed his work on the railroad. 

Case 1. — March 21. — Mr. J. Gr., aged 25 years, had syphi- 
lis abont eighteen months ago, for which he was treated 
successfully with mercurials, but was seized with rheumatic 
pains about six months afterwards in various parts of the 
body, which he says have returned repeatedly under ex- 
posure to bad weather. He has now been suffering severe- 
ly several days with pains in the knee and wrist of the left 
side, both of which joints are swollen and very sensitive to 
the touch; has slight fever; pressure upon the spinal 
column reveals great tenderness over the two lower lumbar 
vertebrae alone. Freely cupped over these vertebrae, and 
also over the uppermost dorsal and the cervical vertebne. 

March 22. — Feels no pain whatever; swelling consider- 
ably diminished; feels a little stilt'. Ung. tart. ant. to be 
rubbed over scarified surfaces, and a plaster of the same 
kept on all night. 

March 23.— Js apparently well, and complains of nothing 
but the soreness of the scarified parts. Case discharged. 



1861.] Rheumatism. 200 

April 4. — Has had qo return of pain and continues well. 
ise 2. — February 3. — Mrs. C. P., aged about 20 years, 
of* robust constitution, experienced, about a week ago, pains 
in her limbs, which, in a few days, were locatedinthe knee 
and wrist ot' the right side, whichare now very much swollen 
and painful. Liniments have been used freely without the 
least relief. Pressure on the spine causes slight pain only 
in the upper dorso- cervical region ; no fever. Ordered sina- 
pisms t<> the upper and lower portions of the spine. 

Februry2. — Pains much alleviated; sinapisms repeated. 

February 8. — Swelling rapidly diminishing, particularly 
in the knee ; no pain of consequence. 

February 7. — Walks about tlie house, and complains of 
nothing but a little stiffness. Case discharged. 

Case 3. — January 31. — Mr. G. F. P., about 30 years of 
age, has been suffering excruciating pain from rheumatism 
of the head for three weeks, during which time he has been 
subjected to venesection, cathartics, a low diet, frictions, 
void affusions, to the head, &c, without relief. Pressure 
over the last cervical and first dorsal vertebra) produces 
considerable pain. The hair had been shaved from the 
upper part of the neck and a small blister applied, but this 
did not extend as low as the sensitive part and it produced 
no diminution of pain. I now ordered the application of 
another blister of sufficient length to extend from the upper 
cervical to the second dorsal vertebra?. 

February 1. — Blister has drawn very well, but still suf- 
n much as ever. Ordered simple dressing. 

February 2. — Pain rather less severe ; ung. tart. ant. to be 
spread over the blistered surface. 

binary 3. — Much relieved. Same prescription. 

February 4. — Quite well and gone to work. 

This case illustrates the importance of making the revul- 
sive application immediately over the seat of irritation, or, 
in other words, over the painful vertebra in order to insure 
success. 



300 Dugas. Lecture on Rheumatism. [April 

Bub- Acute Neuba^lgki Rheumatiim. 

April 1. — Mr. S. W., about twenty-five years of age, s 
circus rider, 1ms just arrived from a country tour wit! 
severe pain in the right shoulder and right hip, which In 
says he has had nearly a week. He can neither stand upoi 
the a Heeled leg, nor remove the arm from the side of the 
body. The aftected joints are tender to the touch, and sc 
are the vertebrae at the origins of the nerves of the nppei 
and lower extremities. He has some fever, and is confined 
to his bed. lie begged to be relieved as speedily as pos- 
sible, without regard to the severity of the treatment, as h( 
was an important member of the company to which hewai 
attached. I accordingly ordered him to be cupped freeb 
over the tender vertebrae at each end of the spine, and t( 
have the scarified surfaces immediately covered with blister 
ing plasters. 

April 2. — Patient much relieved, and states that he wa 
enabled to move his limbs with but little pain immediately 
after the cupping. Ordered simple cerate to the blisters. 

April 3. — Entirely relieved. 

April 4. — Resumed his performances at the circus. 

Symptomatic Lumbar Pain. 

March 26th. — Mr. II. J., affected with orchitis for 
several days, complained of pain in the lumbar region tc 
such a degree as to prevent any rest at night. On exami- 
nation found that he could not bear the least pressure ovei 
the vertebrae of that region. Ordered a large sinapism tc 
be dept on as long as he could bear it. 

March 27. — Relief complete. 

• March 30. — The sinapism was re-applied and he has since 
had no more pain in the back. 

In this case the pain in the loins was probably symptom- 
atic and not rheumatic. Yet it was very promptly relievec 
by the same treatment. 



1861.] / won Convulsiv I 301 



ores on the Theory and Therapeutics of Convulsive Diseases, 
'>/ of Epilepsy. By Charles Bland Radcliffe, M. I >., 
Fellow of the College, Physician to the Westminster 
Hospital, etc. 

LECTURE III. — (CONTINUED PROM MARCH NUMBER.) 

Iii the last lecture I spoke of simple epilepsy, and en- 
deavored to show that the facts are more in accordance with 
the theory oi' muscular motion propounded in the first lec- 
ture than with that ordinarily received theory which would 
ascribe the convulsion to over-stimulation on the part of one 
or other of the nervous centres. In doing this, I insisted 
particularly upon the asphyxial state of the circulation and 
respiration, and argued that the want of red blood during 
convulsion must necessitate at that time a corresponding 
want of action in every one of the nervous centres. In the 
present lecture I propose to continue the inquiry, and see 
whether the same theory is applicable to convulsive diseases 
generally. I also propose to add a few words upon the thera- 
peutics of these maladies. 

I. — The Theory of Convulsive Diseases Generally. — In pro- 
ceeding to a cursory examination of convulsive diseases 
generally, I shall divide these diseases into three catego- 
. of which the distinctive signs respectively are tremor, 
convulsion and spasm. In the examination itself, I shall do 
as I did when speaking of simple epilepsy, and consider 
first the condition of the circulation and respiration, and 
afterwards review the several nervous phenomena, other 
than tremor,jconvulsion, or spasm, which must not be pass- 
ed by in silence. 

/. — Tlu Theory of Tremor. — The category of convulsive 
diseases of which the distinctive mark is tremor, includes 

the tremblings of delicate and aged persons, of paralysis 

aiis, of delirium tremens, the rigors and subsultus of 

ers, and the shakings of slow mercurial poisoning. 

1. The state of the circulation and respiration in these 

r al conditions is sufficiently obvious. There is no 

doubt that both these functions are much depressed during 

common trembling ; for this is evident as well in the paleness 

and chilliness of the person trembling as in the decided relief 

afforded by wine. In delirium tremens, the perspiring 

skin, the cold hand, the quick compressible, fluttering pulse 



302 Lectures on [April, 

arc all significant and unmistakable facts. It is evident, 
also, that the trembling is connected with this state ofthings; 
for if the dry skin and excited pulse of true meningitis 
make their appearance, the trembling is at an end. On the 
other hand, an argument to the same effect is to be found 
in the fact that tremor is exaggerated into subsultus, or even 
into convulsion, as the heart and pulse fail in the downward 
course of the disorder. Rigor, moreover, is coincident with 
a sense of coldness, a feeble pulse, a sunken countenance, 
a corrugated skin, and subsultus, with a pulse faltering in 
itsfinal throes; and that this coincidence is not accidental, 
is seen in the fact that rigor disappears as the pulse and 
warmth return, and that subsultus may be checked for the 
time by the use of wine. And in mercurial tremor, an in- 
ference as to the real state of the circulation may be drawn 
from the general practice prevailing amongst the subjects 
of this disorder of resorting to gin and other stimulants to 
make themselves steady. 

2. The nervous phenomena, other than tremor, arc 
in accordance with the foregoing facts. In a bout of ordinary 
trembling the mental faculties are all unstrung ; and in the 
permanent and extremest form of this trouble, as in paraly- 
sis, they have altogether succumbed before the inroads of 
age or disease, <ind the sufferer lives only to sleep and eat. 
In delirium tremens the mental state is passive in every 
point of view. The patient lies unmanned, as it were be- 
fore some dim phantom of evil ; or if not — if, that is to say, 
active delirium takes the place of the delirium tremens, and 
other symptoms betoken the existence of active inflamma- 
tion — then the affection ceases to be delirium tremens, for 
the trembling has disappeared. In the initial rigors of 
fever, the mental state is one of dejection, languor, stupor: 
in subsultus, it is one of vague dreaminess, or of drowsiness 
not removed from mortal sleep. In slow mercurial poison- 
ing, the failure ot the mental powers keeps pace with the 
decay of the bodily strength, and the condition is one of 
premature old age. 

In the different forms of tremor, therefore, the state of 
the nervous system, as reflected in the condition of the 
mind, is one of comparative inactivity. Xor is it easy to 
suppose that the condition of the brain is different from that 
of any other part of the nervous system ; for if a due sup- 
ply of blood be necessary to the due exercise of the differ- 
ent nervous functions, as it undoubtedly is, then it follows 



1861.] Con 303 

the medulla, oblongata, the spinal cord, and every other 

nervous centre, must he in a similar state of comparative in- 
action during trembling. 

II. — The Theory of Convulsion. — The second category, in 
which convulsion is the distinctive feature of the muscular 
disturbance, is divided naturally into two sections by the 
absence orpresence of consciousness during the convulsion. 
Where the consciousness is preserved the convulsion maybe 
called simple ; where consciousness is in abeyance, the con- 
vulsion is epileptiform. Simple convulsion occurs in hys- 
teria, in chorea, and in those strange affections which take 
an intermediate position between the two, as the dance of 
St. Vitus and St. John, tarantism, and other affections of 
the kind. Epileptiform convulsion includes the convulsion 
connected with certain diseases of the brain — chronic soften- 
ing, chronic meningitis, tumor, induration, hypertrophy, 
atrophy, congestion, apoplexy, inflammation — with fever, 
with uraemia and other suppressed secretions, with "irri- 
tation" in the gums and elsewhere, and with death from 
haemorrhage and other causes. 

A. The Ihcorj of Convulsion. — 1. The pulse of persons who 
Buffer from hysteric convulsion is generally soft, quick, and 
variable. The skin is frequently pale, and the hands and 
feet are often subject to chilblains, even whem the weather 
is not very cold. Xor is there any real excitement of the 
circulation during the paroxysm. Indeed, the mode of 
breathing which is slow, embarrassed, and accompanied by 
deep sobs and hiccough, is altogether incompatible with any-* 
thing like excitement in the circulation. There is, more- 
over, some reason to believe that unncessary stress has been 
laid upon a disposition to inflammation as one of the 
characters of hysterical subjects ; but, be this as it may, 
there \< no reason for supposing that any inflammatory dis- 
turbance of the circulation in any organ has anything to do 
with the symptom with which we are here concerned — the 
convulsion. 

As in hysteria, so in chorea, the circulation is subject to 
considerable fluctuations, but the habitual state is one of 
marked depression. The pulse most generally is quick and 
weak, and the heart Lb readily thrown in a state of palpita- 
tion. In many cases, also, as additional evidences of a 
feeble circulation the face, lips, gums, and tongue are pale, 
the skin La pasty, and in extreme cases the serous cavities 
are more or less water-logged. In some instances there 



304 Lectures on [April, 

may be all the signs of actual chlorosis; in other instances 
there may be predisposition to rheumatic fever, but this pre- 
disposition cannot be urged as an objection to the idea, now 
very generally admitted, that chorea is essentially a fever- 
less malady; for it is certain that chorea is never coincident 
with rheumatic fever. 

2. The habitually feeble state of the brain in persons sub- 
ject to hysteric convulsion is shown in a variety of ways — 
indecision, irresoluteness, fickleness, pliability, over-sensi- 
tiveness, fidgetiness, and so on. And in the fit the will is 
altogether in abeyance, and the mental state is one approach- 
ing very closely to unconsciousness. The condition of the 
circulation at the time of the convulsion is also incompatible 
with any but a very low degree of action in any one of the 
nervous centres. ]STor is it necessary to suppose that the 
uterus has anything to do with hysteric convulsion beyond 
this — that many common and important causes of weak- 
ness and exhaustion refer more or less directly to this 
organ. 

The subjects of chorea present the same evidences of 
mental feebleness as those which are met with in hysteria 
— the same vacillation, irrationality, inordinate sensitive- 
ness, timidity, fretfulness, irritability. It is to be supposed, 
also, that the mental state reflects the state of all the ner- 
vous centres* for the circulation is manifestly unequal to 
maintain the action of these centres at the normal pitch. 
Nor is any contrary evidence presented after death. In a 
certain number of cases, no doubt, traces of inflammatory 
action have been found in or on the brain or spinal cord ; 
but as such traces are notYound in the majority of cases, it is 
evident that inflammation of the brain or cord cannot be re- 
garded as essential to chorea. What the occasional traces 
of inflammation may signify is another matter. It may be 
that the inflammation preceded the chorea, and left the 
nervous centres damaged, and to that extent weakened ; 
and this opinion would not seem to be improbable where the 
signs of mischief were evidcntl}' of no very recent date. It- 
may be that the inflammation has been a consequence rather 
than a cause of the chorea — the nervous centres in con- 
nexion with the muscles, like the muscles themselves, break- 
ing up, as it were, from sheer fatigue. At all events, it 
may be seen now, and will be seen more distinctly presently, 
that inflammation of the brain or cord is not to be regarded 
as a direct cause of any kind of choreic movement. 



1861.] Convulsi 305 

1>. leptiform Convulsion, — 1. Cn a case 

oi general epileptiform convulsion, the state of the circula- 
tion is as Ear removed from anything like excitement as it is 

in simple epilepsy. There is, indeed, the same failure of the 
pulse at the commencement of the lit, and the same state 
of positive BnfTocation during the fit. In the case of partial 
epileptiform convulsion, the only difference is one of degree. 
In any ease, the pulse is scarcely to be felt at the beginning 
of the paroxysm, and everything shows that the circulation 
is at a very low ebb ; and if the pulse acquires any sem- 
blance of power as the paroxysm proceeds, the dusky and 
livid color of the face, the interrupted breathings, and other 
unequivocal signs of suffocation, afford sufficient proof that 
this phenomenon is due, not to the increased injection of 
red blood into the arteries, but to the impeded circulation 
of black blood, as explained in the last lecture. 

Xor is there any evidence of a contrary character, in the 
antecedent history of epileptiform convulsion, for in those 
cases in which the malady is of an inflammatory or febrile 
character, it will be seen that the lit occurs either in the period 
oi prostration which precedes the development, or else in the 
period of collapse which comes on after the dying out of the 
fever or inflammation. 

In chronic softening of the brain, the habitual coldness of 
the hands and feet, the weakened and perhaps degenerated 
heart, the atheromatous or calcareous deposits in the arterial 
coats, are amongst the many signs which show the innate weak- 
- of circulation — a weakness to which fever and inanima- 
tion are alike uncongenial. 

In chronic meningitis, as might be expected from the un- 
mistakable evidences of a scrofulous, habit, and from the state 
of weakness and exhaustion which are so generally present, 
the pulse, for the most part is quick, weak, and much affected 
by changes of posture. There may be some hectic excitement 
in the evening, the cheeks flushing, the eyes shining, and the 
aching head becoming a little hotter than it was before ; but 
this faint excitement is not sufficient to raise the pulse to a 
normal pitch of activity. In no case, indeed, is this reaction 
of the circulation a marked and conspicuous phenomenon, and 
in the majority of instances it is scarcely sufficient to impart 
even a semblance of power to the weak and feverless pulse. 
And if there is little vascular excitement in ordinary chronic 
meningitis, there is. if possible, less in that form of the dis< 
which is known as chronic hydrocephalus. 
20 



300 Lectures on [April, 

In tumor of the brain the pulse is quick, weak, irritable, 
fluctuating, or if not, it will be so as soon as pain, want of 
sleep, and despondency — common symptoms of tumor — have 
had time to bear their natural fruit of weakness and exhaus- 
tion. 

In induration of the brain, such as met with in lead-poison- 
ing, &c., the phenomena presented by the circulation differ 
very little, if at all, from those which occur in advanced 
stages of ordinary epilepsy, and any difference there may be, 
is one which indicates a state still more fully removed from 
fever. 

In atrophy of the brain, as in simple epilepsy, there is no 
evidence of anything like excitement in the circulation. 

In congestion of the brain, the head and face are congested 
and dusky, the lips purplish, the jugular, full, the pulse and 
respiration slow and labored, the hands and feet habitually 
colder than the head. There are, indeed, many evident 
signs which show that the circulation is not carried on with 
proper vigor, and which appear to point to imperfect arteri- 
alization of the blood as one cause, of this defect. 

In apoplexy the convulsion is most apt to happen at the end 
rather than at the beginning of the period of coma, when the 
purpled lips and the inadequate breathings show the respira- 
tory changes are rapidly failing. Or, if it happens at the be- 
ginning, it is in those forms of apoplexy in which the con- 
dition of the circulation at the time is more akin to collapse 
than anything else, and not in those forms in which there is 
an excited pulse, and strong determination of blood to the 
bead. 

In inflammation of the brain, the condition of the circula- 
tion may vary a good deal with respect to the inflammation, 
but little with respect to the convulsion. 

Simple meningitis begins with paleness of the skin, a feeble 
depressed pulse, cutis anserina, vomiting, rigor, perhaps con- 
vulsion. Then follow rapidly the symptoms of high febrile 
reaction and cerebral inflammation, the pulse becoming hard 
and frequent, the breathing irregular and oppressed, the skin 
— particularly the skin of the head— hot and burning. After 
continuing for two or three days, these symptoms of high fe- 
brile reaction give place to an opposite state of things, in which 
the |>ulse loses its force, and becomes weak, small, irregular, 
and the breathings are interrupted by frequent sighs and 
pauses. ( )r, if at this time the pulse retains any degree of re- 
sistance, it is evident, from the dusky color of the skin and the 
Buspirious and labored respiration, that the whole of this re- 



1861.] Con* i 307 



sis 



stance is not due to the injection of arterial blood into the 
artery. Now, it is in this stage of collapse, or semi-suffoca- 
tion, which follows, or else, in the cold stage which precedes, 
the febrile and inflammatory excitement, and never during the 

period of excitement, that the convulsion happens. And this 
rule is constant. Indeed, the history of Simple meningitis 
shows most conclusively that vascular excitement is as in- 
compatible with convulsion as it is with rigor and subsul- 
tus. 

In tubercular meningitis, the pulse is weak and variable 
from the first, now quick, now comparatively slow, rising in 
frequency when the head is raised from the pillow, and falling 
when it is laid down again ; and from the very first the respira- 
tion is irregular, unequal, and interrupted with frequent sighs 
and pauses. For some time there may be little disturbance 
of a hectic character, particularly in the evening, but this soon 
conies to an end, and the prostrate pulse forgets to put on 
even this taint semblance of fever. In some cases, there may, 
indeed, be a short stage of fever, and something like active 
cerebral inflammation, especially in young children; but as a 
rule the symptoms are altogether of a passive, non-febrile, 
non-inflammatory character. In any case, however, the con- 
vulsion is connected with a depressed state of the circulation, 
and never with febrile and inflammatory excitement, if such 
state there be. 

In rheumatic meningitis, also, there is little or no febrile ex- 
citement fr<>m the beginning, and the pulse has become 
powerless and utterly weak before the convulsion happens. 

In general cerebritis, the pulse, at first Blow, soon becomes 
variable and readily affected by change of posture; the respi- 
ration, also, is very variable and suspirious. From the first, 
indeed, there is scarcely any fever, and little heat of head, ex- 
the phenomena of cerebritis are mixed up with those of 
simple meningitis ; but if such symptoms are present, they 
. pass off, and give place to Bymptomsof slow .-inking — a 
in which, hour by hour, the breathing is more interrupt- 
ed with sighs and pauses, % and the pulse more powerless, un- 
'.- may have a fictitious power, from the presence of more 
or less black blood in the artery, in which case the dusky 
countenance and the purple lips will show very clearly that 
any increased injection of red blood is at this time out of 
the question. 

In partial cerebritis there is even less febrile disturbance 
than in general cerebritis, ami at no stage of the malady is 
there anything like increased vascular action. 



LectUTi [April, 

The immediate antecedents of the epileptiform convulsion 
which may attend upon the onset of fever arc — paleness of the 
face, coldness of the hands and feet, a feeble, soft, and fluctu- 
ating pulse, a respiration that is short, accelerated, and inter- 
rupted by frequent sighs. The immediate antecedents of the 
convulsion which may attend upon the: end of the fever are, a 
weak and thready pulse, a frigid hand, and lungs too much 
gorged with blood to allow oi any proper respiration — a state 
in which, febrile reaction having long since died out, the hand 
of death is already upon the heart or brain. The convulsion 
which may attend upon fever, indeed may take the place 
either of rigor or subsultus, and like these forms of muscular 
disturbance, it is associated, not with the state of depression, 
which is as much below the natural standard as any febrile 
excitement is above that standard. 

In the convulsion connected with dentition, there may have 
been little or no previous fever, and by quick degrees the 
pulse may have become excesssively weak, or there may have 
been symptoms of cerebral inflammation with high fever, and 
afterwards a state bordering very closely upon collapse. In 
any case, the immediate antecedents of the lit are indicative 
of great vascular depression — great vascular depression 
brought on slowly without any very obvious fever or deter- 
mination of blood to the head, or else that which precedes or 
succeeds active fever and determination. And so likewise 
with the convulsion which is connected with worms or other 
sources of irritation in the alimentary canal; for if there has 
been any febrile disturbance, this has passed off, and left the 
patient not only feverless, but pale and chilly. Nor is it 
otherwise with those forms of convulsion which are referred 
to uterine irritation. In the convulsion connected with men- 
struation, the circulation is in the state in which it is in ordin- 
ary epilepsy or in ordinary hysteria ; and a similar remark 
a] iplies to several of the convulsions which may happen in the 
course of pregnancy. In the convulsion of flooding, the face 
and even the tongue is blanched, the hand frigid, the body 
bathed in cold sweat, the pulse fluttering and well-nigh imper- 
ceptible, the breathing a continuous sigh or gasp. In the 
convulsion occurring in labour without flooding, the head is 
often greatly congested, and the aeration of the blood seri- 
ously interfered with, partly in consequence of the way in 
which the lungs sympathize with the semi- comatose brain, and 
partly because the regular expansions of the chest are inter- 
fered with by the constant efforts at straining. In such a case 
the pulse may be full; bnl if bo, the venous color of the lips 



L861.] Ckmrnd* 309 

will show that this fullness is due to the circulation of black 
blood rather than to the circulation of red blood in the ves- 
sels. \\\ the convulsion. which may happen daring puerperal 
r, the vascular antecedents are the same as those which 
may happen towards the end of every fever. And lastly, the 
condition of the circulation before the convulsion which is re- 
ferred t«> "irritation" of a sexual character, it' it differs at all 
from that which is met with in ordinary epilepsy, differs only 
in being one of still deeper depression. 

Nor is there any trace of vascular excitement before the 
convulsion which may happen in the moribund state. In the 
convulsion attending death by haemorrhage ov asthenia, the 
blanched face and tongue, the frigid hand, the sighing or 
gasping respiration, the faltering pulse, art signs which re- 
quire no comment; and in the convulsion attending death by 
idy or gradual suffocation, the state of things is equally 
opposed to the idea of vascular excitement ; for how — to ask 
this question once more — can vascular excitement and a state 
of suffocation be compatible conditions i 

In a word, there is no instance in which epileptiform con- 
vulsion can be supposed to have any connection with an ex- 
cited state of the vascular system, and there are many instan- 
ces in which the circulation is as far as possible removed from 
such a state : and the only conclusion which can be drawn 
from these facts is one which seems to harmonize with the 
physiological premises, and with the previous conclusions re- 
specting simple epilepsy. 

'2. In a case of general epileptiform convulsion, the mental 
faculties are as completely suspended as they are in epilepsy. 
The dilated pupil remains immovable under the brightest 
light ; the ear is deaf to the loudest noise ; and when the 
patient recovers — if he do recover — his memory is absolutely 
blank as to everything which happened during the lit. In 
partial epileptiform convulsion, such as occurs not unfrequent- 
lv in chronic softening or tumor of the brain, as in partial 
epileptic convulsion, the mental faculties may not be altogether 
ended, and the memory is occasionally able to recall some 
of the circumstances attending the fit. In the case of general 
epileptiform convulsion, therefore, the condition of the mind is 
evidently one of inaction. Of this there is no doubt. Nor 
can there be any doubt that the state of the mind is one of 
parative inaction in partial epileptiform convulsion : for 
the utter bewilderment, the inability to collect and control 
the thoughts, the trepidation, and the want of power over the 
muscles, are all signs which cannot be mistaken. 



310 Lectures on [April, 

It would seem, also, that the brain is not less inactive than 
every other centre of nervous action, for (to repeat the 
argnmenl already u>v<\ so often) none but the very lowest 
degree of action is compatible with the circulation of unarteri- 
alized blood in the vessels. Nor isthere anything contradictory 
in this conclusion in the tacts which remain to be mentioned. 

In chronic softening of the brain the fits are preceded by 
unquestionable, and often very marked, impairment of the 
mental faculties, and in some cases the mind may be a total 
wreck. Fire and energy are dyingoutand dulness and drowsi- 
ness point to the coming coma, ofwhicb they are the forecast 
shadows. The brain, also, is blighted, not inflamed. Jt is 
pallid, whiter than it ought to be, deficient in red spots, and 
in parts, softer than natural : and, on microscopic examination 
the softened substance is found to consist of broken-down 
brain tissue, with a greater or less number of cells containing 
oil, and sometimes reddened with blood corpuscles, (for 
haemorrhage is a common consequence of softening) but with- 
out any of the products of true inflammation — exudation and 
pus-corpuscles. 

Impairment of the mental faculties, progressively increas- 
ing, is also a prominent symptom of chronic meningitis — im- 
pairment which would seem to be more marked by peevish- 
ness, impatience, fidgetiness, and not unfrequently this wan- 
dering may settle down into insanity. Or there may be no 
positive symptoms of any kind. After death the principal 
sign of disorder is effusion of serum beneath the arachnoid or 
into the ventricles, and this is often the only sign. In some 
instances there may be congestion of the pia mater, or evi- 
dences of tubercular degeneration in this membrane and in 
the contiguous parts of the brain ; but, ajs a rule, the appear- 
ances are altogether negative. Indeed, in some instances, 
where the quantity of effused fluid is large, as in chronic hy- 
drocipalus, the brain has a blanched, bloodless appearance, 
and the effused fluid is much less rich in solid constituents 
than the serum of the blood — a fact which is somewhat calcula- 
ted to show that inflammation has no share in its production. 

In the majority of cases of tumor, the intelligence does not 
appear to suffer in any very marked manner, and when it is 
otherwise, it is owing, in some degree at least, to the presence 
of chronic meningitis. The pain, however, the want of sleep, 
the depression of spirits, all combine to exhaust the brain, and 
this exhaustion is generally shown by vagueness in the ideas, 
by inability to fix the thoughts, or in some other manner. 
Nor is the pain, which is usually so very prominent and dis- 



1861.] Convulsive J) 311 

3ing a symptom, an objection to the idea, that the brain is 
acting inefficiently in these eases, indeed, pain in the head is 

a sign that the brain is insufficiently supplied with arterial 
blood, ir ceases, and gives place to delirium, when the arterial 
injection increases. Nay, in some instances there is reason to 
believe that the nervous energy is lessened during pain, and 
that pain may be as much a sign of want of action in a senti- 
ent nerve as spasm is a sign of want of action in a motor nerve. 
At any rate Professor dn Bois-Raymond has shown that the 
nerve-current in the nerve of a frog fails when the cutaneous 
ramifications of the nerve are subjected to a treatment which 
must give rise to pain. But be this as it may in other instan- 
ces, in tumor of the brain it must be difficult to regard pain 
as a sign of over-action, for the companion symptoms during 
life, and appearances after death, are alike opposed to such a 
conclusion. 

In induration of the brain, there is as little evidence of any 
excitement in the mental faculties as in any of the previous 
cases, probably less ; and the condition of the brain after death 
affords no countenance to the idea of inflammation, for the 
brain is harder, darker in color, drier, more bloodless than it 
ought to be. 

In cases of atrophy of the brain, where the condition is con- 
genital, the probability is that the patient is idiotic as well as 
epileptic. In cases of hypertrophy of the brain, which cases 
are occasionally met with in children, while the bones are suf- 
ficiently yielding to allow expansion in the enclosed organ, 
the patients have not had any other inconvenience beyond 
the deformity — a taint argument, possibly, that want of brain 
and therefore want of cerebral action, had really to do with 
the convulsion which would seem to be a constant phenomenon 
in atrophy of the brain. 

A person suffering from congestion of the brain is less 
"bright" than he was, his conceptions are wanting in clear- 
ness, he is deficient in the power of attention and spplication, 
his sight is dim, his hearing dull and perplexed with ringing 
or rumbling sounds, he is drowsy, and feelings of weight in 
the head and pain arc familiar .troubles. Everything, indeed, 
indicates an oppressed and inactive brain. 

In apoplexy, the mental antecedents are those of congestion 
• ir softening, not of inflammation as such. There would, in- 
deed, appear to be a strange absence of inflammatory tendency 
in the brain in apoplexy; and if there are any evidences of 
inflammatory action around the clot, it will generally be found 
that this action was anterior to the hemorrhage in point of 



! 1 1 2 Lee lures mi f Apri ] , 

time that, in fact, the blood had escaped in consequence of a 
previously softened state of brain. It is possible, also, that an 
argumenl in favor of a tendency directly opposed to the idea 
of inflammation may be found in the fact pointed out by 
M. M. Andral and Gavarral, that the blood in apoplexy is 
deficient in fibrine ; for if the effect of inflammation be to 
increase the amounl of fibrine contained in the blood, it may 
be supposed that a deficiency of fibrine indicates a state of 
things which is the reverse of inflammatory. 

Nor is there the least reason to believe that any over-action 
of the brain is concerned in bringing about the convulsion 
which is connected with inflammation of the brain. 

In simple meningitis, convulsion may attend upon the very 
onset of the disorder. In this case, it coincides with the cold 
stage which ushers in the true inflammatory reaction, a stage 
of which the mental signs are, depression, confusion, perhaps 
drowsiness. Or convulsion may attend upon the period of 
final prostration which follows the true inflammatory reaction, 
a period in which the mind is rapidly sinking towards a state 
of coma. Convulsion may occur at one or other of these times 
but it never occurs in the true inflammatory stage, when the 
pupil is contracted to the size of a pin's head, when the im- 
patient sensitiveness of the eye and ear is scarcely to be quiet- 
ed by absolute darkness or silence, and while there is agoniz- 
ing pain in the head or fierce delirium. 

hi tubercular meningitis the acute pain, the wild delirium, 
the intolerance of light or sound, which mark the outburst of 
simple meningitis, are wanting, and the course of the disease 
is insidious. Inordinary cases, "where the symptom set in 
thus stealthily, the usual period for the convulsion is after the 
brain and the system generally have given many unequivocal 
signs of exhaustion. In other cases, where there may be more 
marked febrile disturbance, the convulsion may happen in the 
initial cold stage, or after the febrile symptoms have calmed 
down and Left the system in a jaded and exhausted state. As 
a rule, however, the idea of inflammation has as little to do 
with this affection as with phthisis pulmonalis ; for when the 
diseased products are examined microscopically, they are 
found to consist, not of products of inflammation, but of the 
well-known elements of ordinary tubercle. 

In rheumatic meningitis the convulsion observes the same 
rule, occurring either in the initial cold stage of the fever, and 
preceding the accession of the violent pain and delirium, or 
else waiting until the excitement has passed off, and. the patient 
18 left drowsy and semi-comatose. 



L861.] Cbnv '' i 313 

In general cerebritis anything like wild delirinm or acute 
pain in the head is absent, unless the affection is complicated 
with meningitis; and the characteristic state is dulness and 
drowsiness, rapidly progressing into typhoid prostration. 

In partial cerebritis the course of the disease is less rapid, 
and the downward progress may be interrupted by pauses of 
longer or shorter duration, but in other respects its characters 
are the same. From beginning to end, in either case, there 
are no evidences of an excited condition of brain to be gather- 
ed from an analysis of the mental phenomena, or at any rate 
there are no such evidences at the time the convulsions make 
their appearance. 

In fever, convulsion may precede the establishment of the 
febrile excitement, in which case the mental state is one of 
great depression, oppression, prostration, stupefaction. In 
other words, it may occur in the initial period of collapse or 
rigor — the cold stage ; or it may occur in the final period of 
prostration, when a few incoherent mutterings are the only 
traces of the previous delirium — when the last traces of men- 
tal action are rapidly succumbing to the drowsiness of ap- 
proaching death. It may occur at one or other of these times, 
but not during the active period of fever. 

In epileptiform convulsion depending upon retention of 
urine, the patient before the attack is drowsy, stupid, listless, 
despondent, his eyesight dim, his hearing dull, his speech 
drawling ; and in convulsion depending upon retention of bile, 
delirinm is at an end, and drowsiness has beceme well-nigh 
comatose before the time for the attack has arrived. 

In difficult dentition the brain is exhausted by pain and 

want of sleep, and drowsiness is taking the place of fretful- 

a and wakefulness before the occurrence of the fit ; or if 

there be any cerebral inflammation, the tit follows the rule 

which has been already laid down. 

In worms, and in other forms of irritation in the alimentary 
canal, the mind as well as the body is not braced up to the 
proper pitch of health, and the patient is jaded, irritable, and 
drov. 

In convulsion arising from ''uterine irritation" the mental 
state is that which belongs to either epilepsy or hysteria. 

In the convulsion of flooding the pupil is dilated, the thoughts 
are undefined and incoherent, and before the tossingg change 
into convulsion the last trace of mental action has died out." 

In the other convulsion occurring during labour the brain 
is exhaut pain and straining, and upon the point of 

lapsing into a Btate of coma when the convulsion happens. 



314 ProstatorrhcBa. [April, 

In the convulsion of true puerperal lever the mental con- 
dition is the same as in the convulsion of ordinary fever. 

And, lastly, the epileptiform convulsion referred to "sexual 
irritation" has the same mental accompaniments as ordinary 
epileptic or hysteric convulsion, one or other. 

Nor can there be any doubt as to the condition of the 
brain connected with the moribund state. In death haemor- 
rhage or asthenia, mental action fails pari passu with the 
flowing of the blood out of the vessels, and the sufferer has 
become altogether insensible to pain and trouble before he is 
seized by the convulsion. And when death is brought about 
by suffocation, whether slowly or rapidly, it is no less certain 
that all mental action fails pari passu with the failure in the 
respiration, and that the last spark of mind has vanished be- 
fore the time for the convulsion has arrived. 

Whenever epileptiform convulsion makes its appearance, 
therefore, the attack is preceded by some evident failure in 
mental energy, and in several instances this failure is almost 
or altogether complete. Nor is it possible to suppose that this 
state of inaction is confined to that part of the nervous system 
which is the scene of mental life ; for the depressed or op- 
pressed state of the circulation which precedes the attack in- 
volves a corresponding degree of inaction in the complete 
chain of nervous centres. 

In a word, there is nothing in the history of epileptiform 
convulsion which is not in perfect accordance with the history 
of simple epilepsy, or which may not be interrupted in the 
same manner. 

(to be continued.) 



On the nature and treatment of Prostatorrhra. By Professor 

Gross, of Philadelphia. 

J Vostatorhoea is denned to be a discharge from the prostate 
gland, generally of a thin mucous character, dependent upon 
irritation, if not actual inflammation, of the component tis- 
sues of that organ. It has generally been confounded with 
other lesions, as gleet, or chronic urethritis, seminal losses, 
and cystorrhcea, or chronic inflammation of the mucous 
membrane of the bladder. It does not often occur among 
children or old people, but is most common during the ac- 



1861.] Prostaiorrhasa. 315 

tivity of the sexual organs, and is most frequently met with 
in those whoso sexual propensities are the strongest. The 
exciting causes are not always evident, but the disease lias 
generally been traceable, either directly or indirectly, to 
venerea! -, chronic inflammation of the neck of the 

Madder, stricture o{ the urethra, or some affection of this 
canal ; it may have its origin in diseases of the rectum, and 
the me ot internal remedies, as cantharides; turpentine, 
may excite a temporary prostatorhoea ; a common cause in 
young men is masturbation. The symptoms are a discharge 
of mucus, generally perfectly clear, ropy, varying from a 
drachm upwards in twenty-four hours ; in efforts at defeca- 
tion the flow is greatest. It is attended, also, with a 
pleasurable, tickling sensation sometimes. Prostatorrhoca 
may be distinguished from urethritis by the gradual super- 
vention of symptoms, the transparency of the discharge, the 
absence of charges in the urine, or difficulty in micturition. 

The pathology of this affection consists in a disorder of 
the follicular apparatus, leading to an inordinate secretion 
oi its peculiar fluid. This may be due to inflammation, but 
in some instances the organ appears to be entirely healthy, 
in which case it is supposed to be due to a heightened func- 
tional activity. The prognosis is generally favorable, as 
this affection is not a disease, but a symptom of disease, 
usually slight, and easily removed ; it is often, however, 
very obstinate, and when the mind deeply sympathizes with 
the local affection is very difficult of management. 

The treatment should be directed to the removal of the 
cause, and to this end there should be a thorough exploration 
of the genito-urinary apparatus, the anus, and the rectum, 
and a careful inquiry as to the habits of the patient. If he 
is weak, gentle exercise, nutritious diet, wine and tonics arc 
indicated. The tincture of the chloride of iron in union 
with tincture of mix vomica is especially recommended ; if 
he is plethoric, the antimonial and saline mixture is useful; 
the most useful topical applications are cooling and anodyne 
injection* ■ulard's extract with wine of opium in the 

proportion of one or two drachms each in ten ounces of 
er, three times daily; in obstinate cases, cauterization 
i a week may be necessary; the cold hip bath is also 
important, and if the symptoms do not yield, leeches should 
be applied around the anus and to the perinreum. 



3 16 Goitre, [April, 

On the treatment of GoUreby the external application of Biniodide 

of Mercury. I>v Dr. Frodsham, Physician to the Farring- 

don < General Dispensary. 

Dr. Frodsham reports veryfavorably respecting this plan 
oftreatmenl — :i plan to which we have already directed at- 
tention ("Abstract," XXVI, 150), as having been carried 
out with marked benefit in India, by (/apt. Cunningham, of 
the 11th Irregular Cavalry. 

"I have myself," says our author, "had considerable op- 
portunity of testing its efficacy, and always with a most for- 
tunate result. A certain amount of difficulty is, however, 
experienced in its application, as the influence of the solar 
rays appears to he absolutely essential to its curative action, 
and therefore in this country it can only be adopted with 
perfect success during a few of the summer months. The 
following is the plan I have invariably pursued with the 
patients under my care: . 

"An ointment of the biniodide (biniodide of mercury, six- 
teen grains ; lard, one ounce) has been first rubbed into the 
swelling for several days. Then seizing the opportunity of 
a powerful mid-day sun, the patient has been exposed to its 
influence, the throat being thoroughly smeared with the 
same application, and the head well elevated. It is gener- 
ally borne for upwards of an hour, when a severe sensation 
only of blistering is produced. The patient should then 
be allowed to return home, and cautioned not to rub off the 
ointment. 

"Dr. Moreal suggested the application of artificial heat; and 
thinking it possibly might have a similar influence, though 
in a modified degree, I made several experiments, though, 
I regret to say, with but little success. In one case I caused 
the patient to sit before a large fire; in another, I held a 
hot flat-iron a short distance oft* the swelling. In the latter 
case, the pain was so great as to demand immediate discon- 
tinuance. 

"Some of the cases in which this treatment was most 
eminently successful had been of long standing, and all the 
usual remedies, both internal and external had been tried 
in vain. One woman had Buffered from the swelling for 
tour years, and for upwards of one year had been taking the 
iodide of potassium internally, and applying the iodide of 
potassium ointment externally, but without deriving the 
Blightest apparent benefit. The biniodide was only applied 
e ; and before the expiration of a month a diminution of 



186L] Delirium Trent* 317 

two inches, by measurement, in the Bize of the tumor had 
taken place. At the end of six months no Bign of the form- 
er disease was perceptible, 

"The superiority of this mode of treatment consists in its 
great cleanliness, its not discoloring the skin, and causing 
no external breach of surface, together with its speedy 
remedial action (one application generally sufficing). As 
to the modus operandi, whether it is due to rapid absorption 
or to chemical changes, is, I believe, as yet undecided." 



On Delirium Tremens. By Dr. Jeffrey A. Marston, Assist- 
ant Surgeon, Royal Artillery, Maine. 

[The following paper by Dr. Marston is a most sensible 
one, and they w r ho are now treating all cases of delirium 
tremens without alcohol will do well to consider it. Few 
are more strenuous advocates of total abstinence from all 
stimulants than ourselves in cases of health, but in certain 
diseases we have found it indispensable to carry the patient 
over certain periods of exhaustion. Dr. Marston says : 

First of all, let us see that our terms are precise and clear. 
I would say that there are three separate and distinct forms 
of the disease in (question ; that if any one plan of treat- 
ment be pursued in all, and if, without reference to their 
distinctive features, they be individually and severally 
heaped together under one head, we can obtain no reliable 
data. Xot a little misconception, it seems to me, has arisen 
from this very source: 

I. Delirium e potu, or Delirium Ebrictatis properly so 
called. 

II. Delirium Ebriosorum. 

penal 

III. Delirium Hepatic 

complicated < Gastro-Enteric > Diseases, 
with Cardiac 

^Central J 

1'rofessor Todd, in one of his clinical lectures, has some 
admirable remarks upon the two first forms, and their dis- 
tinctions. The first I would illustrate thus : — It happens in 
the younger and more acute drunkards (if I may so term 
them.) The disease follows quickly after a debauch — 
within 21 or 48 hours. The symptoms are — the tongue 



318 Delirium Tremens. [April, 

very foul and tremulous; great headache; face rather 
flushed : tenderness often upon pressure of the epigastrium; 
nausea; sometimes vomiting ; perfect anorexia ; sleepless- 
ness; tremors; hallucinations; illusions; restlessness; an 
excited manner; a quick, sort, and tolerably full pulse; 
and often t lie re is present a smell of spirit. Now, these 
- are by far the most frequent. The disease occurs in 
a man whose means prevent a regular steady soaking, but 
in one who drinks very hard whenever his pocket allows it. 
I [owever frequently this may be, there is always a good and 
distinct interval — weeks or months. The subject of the 
disease goes in for a heavy night or so at a time — his 
money is exhausted — he does or does not go to prison, but 
at any rate he does not drink again for some period, for the 
best of all reasons — want of means. Here is the ordinary 
form of the disorder : An acute alcoholism — the drink 
being in the man. An emetic purgative, with quiet and 
repose for two or three days, sets him all right again. 

The second form is a delirium of drunkards, in contra- 
distinction to a delirium from drink. The illustration of 
this form will be : — The subjects of it arc older — have the 
outward and visible signs, and bring the history of a habit 
of drinking; hard drinking indeed, if the aggregate be 
looked to — the steady weekly consumption of spirits, to 
wit — but less hard than the first variety in a given space of 
time. Those men who have kept out of the guard-room, 
and are shrewd enough to keep aloof from their officers ; 
bear a good regimental character; arc seldom, if ever, in 
hospital ; and although long suspected in the regiment of 
being secret drunkards, yet are only proved so by some ac- 
cident — as turning out at night to a tire — or admission into 
hospital lor some trivial disease. At last he is caught, and 
lodged in the guard-room ; or by some means or other he 
is with all suddenness deprived of his drink ; and delirium 
tremens sets in, appearing from the second to the seventh 
day after confinement, while perchance the man is awaiting 
his court-martial. 

In short, you get the history of a man who has drank for 
years and years ; during which time he has performed his 
duty under sharp supervision, and has not suffered from 
any disease, lie is deprived suddenly of his stimulus, and 
takes delirium tremens. 

Complicated Form. — This variety will take in the various 
symptoms of any organic disease present, and complicating 



1861.] Delirium Tremens. 319 

the case. It would be impossible and needless to enume- 
rate the various complications, further than to remark that 
that their recognition and diagnosis is all important ; the 
difficulty of their treatment very great ; and that the mor- 
tality tar exceeds that of the other and simpler forms of the 
disease. 

The visceral or glandular derangements become evident 
for the first time during the attack of delirium tremens — 
the man never having been before in hospital — and are then 
only arrived at, from the fact that some unusual symptoms, 
as convulsions, jaundice, oedema, persistence and peculiarity 
of the delirinm, or albuminous urine, make them apparent. 

The treatment of such cases must necessarily be modified 
according to the diseased state and its indications. 

Having premised this much, let us turn to the points in 
dispute, which appear to be : That the theory of the causa- 
tion or etiology of the disease hitherto propounded is 
wrong, its pathology wrongly stated, the indications for its 
treatment misunderstood, and the special modes of treat- 
ment themselves (particularly that by opium and stimulants) 
have been erroneously and injuriously pursued. 

It is often better to watch than correct, and I would ask 
how many cases classed under the first form have be 
enumerated with the second and third varieties ? I fane 
that by far the larger number of the so-called statistics con- 
sists of individual cases of the first form, and if so, the 
generalization from them cannot fail to be vitiated, when 
applied to the whole disease. 

Dr. Watson expressly says, that some cases occur after a 
long debauch, and others in which the patient has not ab- 
stained, but is continually fuddled ; and here the disease 
arises because the man goes from his ordinary positive to 
the comparative degree. 

There is no doubt that those cases are numerous, and 
their plain inference is "poisoning;" but so much has been 
made of them, as virtually to exclude the occurrence of 
other forms. 

FMology. — Taking the objections seriatim, the etiology ; 
Watson says, the predisposing cause is drink; the exciting 
cause, the privation of it. Against this view there is urged 
the frequency of the disease following a debauch, &c, with- 
out any privation ; in short, the frequency of the first form. 
Such frequency it is argued, proves the disease to be the 
result of poisoning, and the sufficiency of the poison alco- 



320 Delirium Tremens. •• [April, 

no! to form at once the exciting and predisposing cause. 
The occurrence of some disease, such as catarrh, influenza, 
gastric disturbance, in a drunkard, may he also an exciting 
cause. Lastly, the statistics of prisons are against the 
theory, it is said, of privation. The first objection is shortly 
this, that we have proof of one cause (toxaemia from alcohol) 
being sufficient, and hence it is unphilosophical to seek a 
second. I can only meet this by stating, that there are dif- 
ferent forms of the disease, which may have different 
causes, nay, a plurality of causes. Besides, I shall adduce 
positive evidence of the disease following the withdrawal 
of alcohol. With regard to prisons, I can only speak of 
military ones. No cases occur in them, I am aware, and 
am not suprised at the fact; hut they occur antecedently, 
coming on in the guard-room, where, if a man be tried, he 
awaits his court-martial, probably for many days ; and I 
state as a fact, that, cases of delirium tremens commonly 
occur from the first even to the seventh day after the priva- 
tion of liquor. The guard-room statistics would hence be 
every bit as strong the other way. I am aware that statis- 
tics do not settle the fact, they do not prove cause and 
effect, viz : deprivation of accustomed stimuli as a cause of 
delirium tremens ; but they cannot certainly be urged 
against it, for they support at least the view of this priva- 
tion being frequently an antecepent to the appearance of 
the disease. Is it a necessary antecedent ? I believe it is 
in some cases. Take the following : 

Sergeant D., ?et. 39 years — in daily expectation of a good- 
conduct medal. — Admitted April 13, suffering from a small 
boil upon the lobular appendage of the right ear ; in per- 
fect health apparently. Upon the afternoon of the 14th, I 
noticed that he was very tremulous and nervous, and asked 
him privately about his habits. lie denied m the most 
positive and awful terms, that he drank hard, and refused 
my offer of a glass of brandy. Upon the morning of the 
15th, I learnt that he had slept badly, and found him suf- 
fering from a decided attack of delirium tremens. He 
talked incessantly, was bathed in perspiration, had illusions, 
and fancied he saw strange animals, and heard strange 
noises. His tongue was coated, and very tremulous ; the 
eves ferrety, the pupils moderately contracted. lie was or- 
dered a sharp purgative, and cold douche to the head, fol- 
lowed by a basin of beef-tea. At 12 noon he took 33 of 
Laudanum, but was sick, vomiting nearly it all ; at 2 p. m. 



18G1.] / >> It'rium Tremens. 321 

lie had some warm brandy and water, with 5js of lauda- 
num, which he kept down ; about 3 p. m. lie had more 
-tea, and said he thought he should sleep, lying down 
for that purpose ; I happened to be in the ward at the mo- 
ment, and my attention was arrested by his livid face and 
heavy breathing. In about a quarter of an hour he had an 
epileptiform convulsion ; two or three followed after a short 
interval, and in about three quarters of an hour he died 
with symptoms of apneea. Besides cold douche, artificial 
respiration by Marshall Hall's method, and enemata of 
brandy, were tried without avail. The post-mortem. w r as 
made most carefully by myself, and I could detect no 
organic disease to account for his death. The left ventri- 
cle of the heart, however, was in an advanced degree of 
fatty degeneration ; and, besides some venous congestion 
of the membranes of the brain, there were a few drachms 
of fluid in the cerebral ventricles. 

Xow, I would remark how strong is the tendency of the 
evidence, negative and positive, of the facts here. A man 
is entitled to a good-conduct medal — which presupposes 
eighteen years' absence from the defaulters' book as regards 
courts-martial. I learnt from his wife, subsequently, that 
for six or eight years he had drank very hard, and that, al- 
though she had never seen him drunk, yet she could not 
say that he was ever perfectly sober any night ; that she 
did not remember his ever having been in hospital, or suf- 
fering from any disease. He comes into hospital, is de- 
prived of his liquor directly, and in fifty-six hours is dead. 
This appears to me a strong case, but it is not by any means 
an isolated one ; and others, equally positive, will be cited, 
tar more than sufficient to meet the logical requirements 
of one grain of positive against a bushel of negative evidence. 

Pathology. — Dr. AVatson's views may be epitomised thus : 
The disease is "Exhaustion with nervous irritation ;" the 
remedy, "sleep." Against this is urged the toxemic view, 
and the positive chemical evidence of the presence of alco- 
hol in the cerebral ventricles, and that sleep is an effect and 
siirn of the improvement in the disease, and not the cause 
ofit 

Dr. Watson uses his terms advisedly. He does not pass 

them for more than they are worth. Are there not certain 

acquired physiological conditions or states of system which 

produce uncontrollable cravings and desires ? and are not 

se eravincrs instinctive desires of a need felt by such an 

21 



322 Delirium Tremens. [April, 

abnormal system ? and supposing them unyielded to, do we 
hot get nervous exhaustion and depression ? Is it true that 
horses fed upon arsenic fall into a had state of health when 
its exhibition is discontinued ? The facts related of the 
Styrian and Hungarian peasantry relative to their frequent 
sc of arsenic, and the evils which almost invariably arise 
om its discontinuance ; the almost universally spread in- 
stinct in man to the use of narcotics, stimulants, &c, (such 
as opium, betel nut, tobacco, cocoa, with the rest); the 
growth of the custom into a habit, and the way in which 
men are impelled to the continuance of that habit, from the 
fear of the chain of morbid phenomena which follow the 
cessation of it ; — do not these run very parallel to the facts 
we observe from the use and abuse of alcohol ? Chossat's 
experiments upon the effect of starvation on animals would 
indicate that the nervous tissues undergo remarkably little 
relative loss compared with the other tissues, in spite of the 
great quantity of fat they contain, and their almost fluid 
consistence. This has been held to explain the cause of the 
curious psychical phenomena preceding death by starvation. 
Restlessness, delirium and prolonged sleeplessness, are 
common precursors of death in such cases. Xow it will be 
said, that no analogy can be established between such cases 
and the same phenomena following the withdrawal of alco- 
hol. But I am not convinced of that. The whole doctrine 
of diets, however satisfactorilyjit maybe settled on a chemi- 
cal basis, is decidedly not settled upon equally certain phy- 
siological data. We have facts in abundance to prove that 
the chemical value of food is not the physiological one, and 
that both man and animals live and grow upon substances, 
and in proportions, perfectly different from what a chemical 
view would indicate or conceive possible. When we ob- 
serve how spirit is meat and drink to a drunkard ; how his 
Bystem affords the proof of an altered and abnormal nutri- 
tion ; how, in short, he has a special physiology of his own, 
ins to me a natural and rational consequence that the 
poison to him is no poison, but, on the contrary, a 
special fuel lor his nutrition and development — albeit, dis- 
eased. Liebig has shown how the chemico-physioiogieal 
theory oi the action of stimulants upon the human system, 
is in accord with the actual experience of landlords and 
others, viz : that a far larger amount ^[' food is consumed 
by the abstainer from alcoholic fluids, than by one who par- 
takes a moderate quantity of them. It seems to be a well- 






1861.] Delirium Tremens. 323 

ertained fact, that alcohol economises the food and tis- 
sues, by arresting the amount of secondary metamorphosis. 
Then Ave have the influence of the custom producing a 
habit, and its known effects upon the body. Can any habit 
be suddenly discontinued and broken without some, nay, 
even a grave effect upon the nervous system ? 

There seems to me to be no end of evidence to prove that 
the sudden curtailment or withdrawal of any habit may 
produce nervous exhaustion ; and if so, why, irritability is 
a necessary concomitant and index of that condition ! 

In regard to sleep. A drunken sailor knows very well 
that if he can "sleep it off," it is the best and most natural 
way of terminating his fit. Xo doubt the tendency to sleep 
is a sign of improvement in a case of delirium tremens. 
Dr. Watson and others urge that sleep is the necessary pre- 
cursor of improvement ; but if I understand the objection 
raised to this view aright, it amounts to this, that before a 
patient recovers from delirium tremens, and as a sign and 
effect of his improvement, he sleeps — very probable ; but I 
am sure the jwst hoc is often a propter hoc, viz., not that he 
sleeps after he improves, but he improves because he has 
slept. 

'■se. — G. S., aged 30, admitted June 8, 1858, from the 
guardroom, where he had been confined two days. Had 
been for years a hard drinker. It was stated (but not upon 
reliable evidence), that prior to enlistment he had been con- 
fined for a few months in a lunatic asylum. Upon inquiry 
it was found that he had been drinking very hard for some 
days, and that the debauch terminated about three days 
prior to his admission into hospital. He was laboring un- 
der all the symptoms of unmistakeable delirium tremens. 
After the administration of a purgative and a saline anti- 
monial mixture for twenty-four hours, without any amend- 
ment, opium in grain doses was commenced, and continued 
until his pupils became somewhat contracted, when it was 
omitted, itc was allowed milk diet, with a basin of soup 
at bed-time. Forty-eight hours having elapsed in hospital 
without any sleep, and his delirium, tremor, and symptoms 
of exhaustion augmenting, it was determined to give him 
chloroform, for which purpose another assistant surgeon 
with myself, alternately, sat at his bedside all night ; and 
he was kept, at intervals, under its influence for eight 
hours, during the greater part of which time lie slept 
soundly. At the expiration of this period he awoke, and 



.".-I Delirium Tremens. [April, 



i-i 



partook of some broth. lie appeared far less tremulous, 
had lost his rapid delirious conversation, but retained his 
suspicious manner, and was evidently haunted by illusions. 
After some interval he was again put under the influence 
of chloroform, and slept for four hours deeply. Awaking, Jem 
he was still more rational and restored ; and after drinking 
two bottles of porter, he spontaneously fell asleep. In this 
state lie continued six hours, and awoke rational and well, 
lie was retained in the hospital for some period, on account 
of some dyspeptic symptoms and boils, and with the view 
to invaliding on account of his uncontrollable habit of 
drinking. This man was a dipsomaniac indeed. I think I 
never beheld features so expressive of a true drunkard in 
my life. During his fits he seemed to have labored under 
certain dominating passions, and these had left such im- 
pressions upon the facial muscles as to have permanently 
altered his whole physiognomy. 

Xow, here we have a case of delirium occurring in a chro- 
nic drunkard, who had been deprived of his stimulus for 
two days. lie is admitted into hospital, and does not sleep, 
his symptoms becoming worse ; by the aid of chloroform 
he slept for six or eight hours — improves — and by the ad- 
ministration of more chloroform with the aid of porter, he 
sleeps again, and is cured. 

A. B., a mess sergeant in a line regiment, had always 
been suspected of drunken habits. One day he absconded 
with some money, was caught, and confined to the guard- 
room. Whilst there, he became the subject of delirium 
tremens, and was brought to hospital, with the history of 
having endeavored to poison himself with arsenic. This 
case was a very severe one, for the patient had an ever-pre- 
sent sense of his crime, a fear of punishment, and was, 
moreover, suffering from all the symptoms of the disease. 
Numerous means were used (including opium) without any 
benefit, and a fatal prognosis was formed of his ease. The 
regimental surgeon administered chloroform by inhalation, 
and procured artificial sleep for many hours. The man 
awoke so much improved, that its administration was re- 
commenced, and he was quite restored by its aid. 

Here we have the symptoms continuing for a certain pe- 
riod without any improvement, while induced artificial 
(» or narcotism was attended with such marked improve- 
ment as to have impressed the medical attendant with the 
belief that his patient owed his life to the chloroform. 



161.] Delirium Tremens. 325 

It would be tedious to cite other cases proving the same 
ing. I conclude from them, that to procure sleep is 
and, excellent advice, the i:ood effects of which arc borne 
t by actual experience. 

Treatment. — The use of stimulants (alcoholic) in cases oi 
tlirium tremens with the view of removing the exhaustion, 
laying the morbid irritation, and procuring- sleep, would 
1 looked upon as even more wrongly directed. If the 
iology usually propounded be radically and totally erro- 
^ous, then Ave are guilty of adding more poison to an al- 
ady poisoned blood, to procure what is not needed, and 
hat the presence of alcohol in the system is preventing — 
sep. 

G. M., aged 45, but grey, and looking much older, was 
Imitted into hospital for some gastric disorder. This man 
is, and had for years been, a very hard drinker, and his 
itures, particularly the nose, indicated "potations deep." 
:ie morning (after he had been in hospital for some days) 
vas called to him. He appeared insensible, was breath- 
£ very heavily, the face and lips dark and turgid, the 
ipils contracted. "Whilst examining him he had a coll- 
ision of a tetanic character, the body being arched in the 
isition of opisthotonos. The muscles of the fore-arm 
3re so tense that the radial pulse could not be felt. The 
sarts' impulse was scarcely perceptible. Having thrown 
bucket of cold water over the head, I took advantage of 
few moments of apparent consciousness to pour a glass of 
)t brandy and water into his stomach; and he recovered 
most immediately, so much so, that the medical officer, 
hose patient he was, could scarcely credit the state in 
Inch I found him. 

G. P., aged 3G, admitted April 14, 1858, from the guard- 
om, where he had been confined two days. His disease 
is unequivocally delirium tremens, and no remedial mea- 
res seemed to benefit him. He was tremulous, restless, 
lirious, and did not sleep even with the aid of the fresh ad- 
pistration of opiates. Two bottles of porter were given him 
bed-time, and he was observed to smoke during the day 
lie strong tobacco. His hands were so tremulous that the 
:lerly had to hold the pipe in his mouth. By these means 
slept and slept well, and made a good recovery, after hav- 
£ been dosed unavailingly for four days previously to pro- 
re that result. 
At this moment I have a soldier in hospital who has always 



326 Delirium Tremens. [April* 

drank freely. He lias been under treatment upwards of eight 
days for trivial bronchitis, and symptoms of incipient delirium 
tremens appearing now, necessitate the use of alcohol and 
opium with manifest advantage to the man, as regards sleep, 
appetite and the disease itself. 

These cases illustrate two points : the actual occurrence of 
delirium tremens, after and during the privation of liquor; 
and the speedy removal of the symptoms by the re-establish- 
ment of the custom, when other means failed. 

I have purposely selected these cases, because they illus- 
trate also the fact, that whilst the men were taking their ac- 
customed stimuli, they continued well, for they were men 
who never appeared at hospital at all. 

I shall not give cases of apparent cure by the adminis- 
tration of opium, as they can be found in any work ; and, 
after all, they are no proof that your patient recovered by the 
treatment, but, perhaps it will be urged in spite of it. 

The most curious cases are those in which the delirium con- 
tinues for a long period, but in a modified degree ; the patient 
sleeping tolerably every night, eating and drinking, and per- 
forming all his functions well. It is well to look out here for 
some complication (particularly renal or hepatic disease) for it 
is surprising how small an amount of urea circulating in the 
system may give rise to a persistence of anomalous symptoms. 
Besides the ursemic, we have a peculiar and difficultly treated 
form of the disease when jaundice is present, whether arising 
from fatty degeneration, cirrhosis, or other hepatic disease. 
These cases, of course, are more frequently fatal ; but I find 
that, after local depletion, purging, or diuresis, stimulants, 
more particularly gin, are not only not contra-indicated, but 
are decidedly useful, more particularly if the patient be an 
old chronic drunkard. 

The most fatal form by far is that in which we have deli- 
rium tremens occurring in a person already the subject of ty- 
phoid fever — cases by no means uncommon in this climate. 
Having separated, however, these cases, there will remain 
many in which a chronic derangement of the nervous system 
is manifested, the patient sleeping night after night, for longer 
or shorter intervals, and performing all his functions well. 

In a few cases, opium given in full doses at bed time will 
secure a deep sleep and manifest improvement. In others, a 
liberal but regulated allowance of stimulants will prove ad- 
vantageous, when everything else has been tried in vain. In 
some, do plan .of treatment will succeed, although the patients 
frequently reaocrer gfibei a Jong fnteryaj, while others lapse 



1861.] Delirium T 327 

into chronic mania, melancholia, or some form of Insanity, 
ending their days in a lunatic asylum. 

With reference to that singular phase of our mental life- 
sleep, Sir Henry Holland advances views which my observa- 
tion of the sleep of delirium tremens patients lias led me to 
think perfectly truthful. 

He is of opinion that sleep is not a unity of state, but a 
Beries and succession of states, ever varying from moment t<» 
moment These variations having every degree of diversity, 
from complete wakefulness to the most perfect -hep of which 
we hove cognisance. It has long occurred to me that the 
p of drunkards, and in delirium tremens, differs much 
from the normal standard of intensity. Every one must have 
experienced in his own person, whenhe was anxious to awake 
at a certain hour, how he awakes at that time with a feeling 
that he has not slept well, or at all, although he may he as- 
sured that he has slept very soundly. 

Sir \\. Holland's observations are so good upon sleep and 
dreaming, in relation to delirium and insanity, that I shall 
quote his words : "I know of no principle so capable of afford- 
ing a guide, as that which views all the forms ot' insanity, in- 
cluding delirium, in their relation to corresponding healthy 
states of mind, tracing this connection through those interme- 
diate grades, which are so numerously exposed to us in the 
various conditions of human existence. The diversities of 
mind in what is accounted its healthy state, the effect of pas- 
sions in suddenly altering its whole condition, of slighter 
emotions in gradually changing it, and of other incidents of 
life in affecting one or more particular faculties ; its subjection 
periodically to sleep, and casually to the states of intoxication, 
somnambulism and reverie; its gradual transition in fever 
from a state where there is consciousness of vague and wan- 
dering ideas to the state of perfect delirium ; all these furnish 
so many passages through which we may follow sanity into 
insanity, and connect the different forms of disordered intel- 
lect as well with each other as with the more natural and 
healthy functions of the mind." 

To sum up, I would say that the first and most frequent 
form an i liers of this disease requires rarely indeed 

opium, particularly at the commencement of the attack ; in 
short, no specific treatment is necessary. In the second 
variety, J would give it cautiously in moderate doses, after free 
purgation, provided I did not find my patient improving by 
and tranquility. The opium had better be given at any rate 
in a full fore the accustomed hour of sleep. Should it 



328 Opening the Joints. [April, 

not succeed, my experience would indicate a "hair of the dog 
that bit him," in the shape of porter or hot brandy and water, 
spite of what has been urged to the contrary. If the surgeon 
avoid both opium and stimulants, and his patient goes on badly, 
depend upon it the chances are in favor of another doctor ad- 
vising one or both these noxious agents, with much advantage 
to the patient, to the no little chagrin of the first medical at- 
tendant. Where great irritability of the stomach is present 
there is nothing better than a sedative dose of calomel (gr. 
vj.), with or without opium, and a large enema. 

Supposing the physiological effects of opium upon the system 
to be manifested, without sleep, or improvement following, I 
should omit its use for some hours, give my patient some good 
broth, flavored with brandy or wine, and induce artificial 
sleep at night by the aid of chloroform. 

I trust it will be seen that the use of opium is advocated as 
a measure requiring discrimination and caution, but as a re- 
liable one in many instances. 

Of course the complicated forms require that the greatest 
discretion should be exercised in its administration. Where 
an embarrassed circulation exists, marked by venous conges- 
tion of the mucous membranes and duskiness of the face, it is 
better avoided altogether. Pulmonary emphysema, if exten- 
sive, cardiac disease, or indeed any thoracic complication, will 
require also great care, if they do not indeed prohibit opium 
in any form. — Edinburgh Monthly Journal. 



On Opening the Joints. On Opening freely the large Joints 
for the purpose of Discharging Purulent Matter, as well 
as for the Better Treatment or Ulcerations of the Articu- 
lar Surfaces. Remarks upon the Inocuousness of Atmos- 
phere admitted into the Joints, &c, &c. By E. S. Cooper, 
A. M., M. D., Professor of Anatomy and Surgery in the 
Medical Department of the University of the Pacific, San 
Francisco. 

This is the first of a series of articles I design publishing 
on purpose to show truths which, for the most part, are in 
direct opposition to all established authority upon the sub- 
ject, and are as follows : 

1st. That admosphere admitted into the joints or other 
tissues is not a source of irritation or injury, excepting 
where it acts mechanically ; as when admitted into a vein 



1861.] Opening the Joints. 329 

by producing asphyxia, into the thoracic cavity "by its pres- 
sure producing collapsion of the lungs, or when, by the 
long-continued exposure of a large amount of surface of 
any of the internal organs whose normal temperature is 
much above that of the atmosphere, it reduces it so as to pro- 
duce a morbid action. 

2d. That the division of entire ligaments about the joints, 
is not only no impediment to their ultimate strength but 
facilitate the cure by enabling the surgeon to open the af- 
fected part fully, for the purpose of applying medical sub- 
stances to the articular surfaces when these are ulcerated or 
otherwise diseased. 

3d. That the only true mode of treating ulceration of 
bone, however slight, within a joint, is to lay it open freely 
and apply remedial agents directly to the part affected. 

4th. That opening the joints early in cases of matter bur- 
rowing in them is far more imperiously demanded than the 
opening of other parts thus affected, and the operation pro- 
duces no further pain or inconvenience to the patient, in 
any respect, than when performed upon parts remote from 
the joints. 

5th. That after opening a large joint, the knee, for in- 
stance, by an incision several inches long, the wound should 
be kept open by the introduction of lint or other similar 
substance until the parts within the articulation become 
healthy, and in all cases it should be made to heal by granu- 
lation. 

6th. That extensive wounds opening freely the large 
joints, such as the knee, (even when lascerated as by a saw, 
which must necessarily heal by granulation) do not as often 
give rise to violent symptoms as very small wounds, such 
as are made by the corner of a hatchet, an adz, or a pen- 
knife, which heal on the outside by first intention. 

7th. That there are no known limits beyond which a ten- 
don or ligament will not be reproduced after division, pro- 
vided the parts are made to heal by granulation, and that 
the present acknowledged rule of two inches being the 
maximus, distance in which the divided ends of a ligament 
to tendon can safely be separated, has not the least founda- 
tion in fact. Each of the above propositions has been fully 
tested by experience in numerous cases, which, during the 
course of this series of articles, shall be drawn upon a3 
largely as brevity will admit. 

Case 1st. — Mr. A. J., set. 29, received a penknife wound 



330 Opening the Joints. [April,, 

in the knee joint, immediately on the outer edge of the pa- 
tella, which being small and causing little inconvenience, 
gave him no concern whatever. 

The wound healed by first intention on the surface, and 
he continued his work as drayman as usual for two weeks, 
having nol the least suspicion that mischief was brewing. 

At the end of that time, however, the joint began to in- 
flame, and shortly after attended with the most excruciat- 
ing pain. The inflammatory action rapidly extending, the 
tissues of the whole joint were soon involved, and in a week 
more, when I was called, extensive fluctuation could be dis- 
tinctly fell not only about the articulation, but in the lower 
part of the thigh. Chloroform and morphine had been used 
extensively, affording only temporary relief from the in- 
tense pain. 

The case being a common one, I at once opened the joint 
freely by two incisions, eight inches long each, just back of 
the patella, on the internal and external side of the leg, 
which gave exit to nearly a quart of purulent matter, which 
was burrowing in the joint and lower part of the thigh. 
The smarting of the incisions had hardly subsided before 
the patient pronounced himself relieved, and the following 
night slept as well as if nothing had been the matter. The 
incisions were filled with lint, wet in an evaporating lotion 
composed of one part of alcohol and ten of water ; a roller 
wet in the same was applied all over the limb as tightly as 
the patient could conveniently bear, commencing at the 
foot. About 24 oz. of spr. mindereri were given every 24 
hours for the first three days, and an opiate administered 
occasionally. 

On the fifth day, the wound being in a state of suppura- 
tion, the cold lotion was discontinued and poultices applied 
instead. 

The roller was still continued upon the limb from the 
foot to the upper third of the thigh, a small opening simply 
being left at the most dependent portion of each incision. 
The poultices were applied outside of the roller. 

The lint was permitted to remain in the wound for about 
two weeks, when it was removed. Tincture of iodine was 
applied every day all over the joint after suspending the 
use of the evaporating lotion. 

A gentle motion was instituted about the tenth day, and 
kept up through the major part of convalescence, which 
lasted about nine weeks, when the patient was able to walk 



1801.] Opening the Joints. 

comparatively well. He improved rapidly after that until 
very was complete, though the wound was not entirely 
cicatrized for over five months. Not the least immobility 
followed in this ease, and the patient recovered completely 
in every respect. 

Remarks, — In this case a single incision would doubtless 
have answered the purpose, though not so well as two. The 
true plan of operation in these cases is not only to discharge 
every drop of purulent matter that may he collected, hut 
likewise prevent any more collecting; and free incisions 
kept well open until the parts inside become healthy, to- 
gether with a roller tightly applied to the limb, are the 
means of securing this object. The operation is not a 
severe one when well performed, as it may be done safely 
with great rapidity. 

The knee-joint is surrounded by a large number of ten- 
dons covered with sheaths lined by bursre mucosa, which 
on being wounded are liable to cause the burrowing of pur- 
ulent matter among the surrounding parts, and may there- 
by give rise to symptoms almost as violent as when the mat- 
ter forms in the joint itself; and though not so apt to gene- 
rate a disorganizing disease of the joint, still, if neglected, 
this often would occur, and it is difficult to ascertain before 
an operation whether matter has formed internal or external 
to the capsular ligament. In the treatment, however, it 
makes but little difference whether the capsular ligament 
contains the pus or not, so far as the operative procedure 
is concerned, because it is nearly the same in both cases. 

The surgeon should be sure that he opens the parts to a 
sufficient extent to admit of the discharge of all the puru- 
lent matter that may be accumulated, and it is immaterial 
whether he involves the joint or not in the operation. It 
is necessary to keep the incisions well open, other matter 
might burrow still after the operation, and the worst con- 
sequences ensue. 

To sum up, it is the accumulation of purulent matter 
that is to be prevented or removed in the treatment of injuries 
about the joints ; and without this, all remedial measures 
will be abortive, and local, and constitutional symptoms of 
the highest grade will crime on. jeopardizing the limb, if not 
the life of the patient. 

When matter forms between the d< ed facia and 

capsular ligament, involving the bursa* mucosa lining the 



332 Opening the Joints. [April, 

Bheaths of tendon about the knee, the pain is almost as 
great as when within the capsular Ligament 

The bursffi mucoso being tin- same instructure as mucous 
membranes, are disposed to suppurate under slight inflam- 
mation ; and being extensive here, pus is rapidly formed as 
soon as the parts are lighted up by inflammation. 

Case 2d. — M. R. set. -!4, received a wound on the outer 
side of the knee by the corner of a sharp new hatchet, which 
gave exit to a drop or two of blood. The external wound 
was about half an inch in length, and. as it gave him no 
pain, was not the source of the least anxiety, and the patient 
continued his employment of day laborer as usual for a 
week. At the end of that time the knee became painful, 
which induced him to go to bed. From this time on, for 
live days, when I was called, the pain he suffered was most 
agonizing. Finding fluctuation all over the knee, I at once 
made an incision seven inches long, which gave exit to 
more than a pint of purulent matter, and with it perfect 
relief. After the pus had been discharged it was found 
that the capsular ligament had not been opened, but that 
the pus had. collected between it and the deep-seated fascia, 
which had not been freely opened by the knife. 

After Treatment. — The after treatment was the same as in 
case first, excepting that the tincture of iodine was not used. 
Gentle motion was instituted, in about one week from the 
time of the operation, and continued more or less every day, 
until the patient recovered sufficiently to walk, which was 
seven weeks. He has since recovered perfectly, without 
the least weakness or immobility of the joints. 

Remarks. — The incision was made on the outer side of 
the knee, which is the point of election in all cases where 
one incision only is made, for the better discharge of puru- 
lent matter in or about this joint, seeing that the patient 
nearly always wishes to take a position on his back, with 
the knees separated, and the diseased limb flexed, which 
brings the wound on the outside of the knee, in the most 
dependent position. Without giving this matter due con- 
sideration, I have occasionally operated differently, but 
seldom with entirely satisfactory results. In the next two 
articles I shall give cases ot division and reproduction of the 
ligamentum patell®. — American Medical Gazette, 



18G1.J Origin of Cow-Pox. 333 



Ni to Experiment Regarding the Origin of CowPox. 

The opinion of Jenner regarding the origin of vaccinia, 
alternately supported and contradicted by various observa- 
tions, is at present, at Toulouse, being tested by new experi- 
ments, of which, Dr. A. Fontan has given the following ac- 
count, dated Toulouse, May 24th, 1860 : 

"A happy accident occasioned my passing through Tou- 
louse at a time when a question of the highest importance 
waa being submitted to experiment, I mean the question of 
the origin of vaceinia. The following is an abstract of the 
principal facts: Some weeks ago, M. Sarans, of Rieumes, 
observes that several mares brought back to his establish- 
ment for the second or third time, were affected with the 
grease (eaitx-aux jambes.) There was a sort of epidemic of 
the affection, for nearly a hundred horses were found to be 
suffering from it. The variety of grease was the pustular 
form. 

"One of these mares was taken to Toulouse to the veter- 
inary school, where the learned Professor M. Lafosse recog- 
nised the true character of the epidemic. He inocculated 
with some of the matter of these pustules the teat of a cow, 
in the presence of his assistant and numerous pupils. Soon 
afterwards, fine pustules made their appearance on the ud- 
der of the cow. One of the most distinguished physicians 
of Toulouse, Dr. Cayrel, the official vaccinator of Toulouse, 
vaccinated with matter from the pustules of the cow, several 
infants who had never been vaccinated. Well character- 
ized vaceine vesicles followed, presenting their pearly as- 
pect, central depression, and rose-colored areola, increasing 
m size from day to day without any trace of erysipelatous 
inflammation. 

A second cow was vaccinated with matter from the first 
cow, and infants were vaccinated with the matter from the 
second cow; the results were equally satisfactory as in the 
former case. At present they have arrived at the fourth 
vaccination from the first cow, and at the third from the 
second cow. I was present at this vaccination ; the 
Lclee were very fine. One was photographed in my pre- 
sence, with a tolerable satisfactory result. The vesicle pre- 
ted the most characteristic appearance of vaceinia. 
When pricked, no purulent matter escaped, but gradually 
rous fluid oozed out in great abundance, with which 
several infants were vaccinated. 



334 Chronal Laic of [April, 

"The new matter is very active, and succeeded in the 
case of a pupil of the veterinary school, vaccinated in infan- 
cy, and in whom all attempts at re-vaccination had failed. 
I saw a vesicle in an infant produced by the virus of this 
pupil, finer and more developed than three other vesicles 
produced by an ordinary vaccination in the same infant. 
(Xo doubt the two vaccinations were performed simultane- 
ously.) 

-•Already thirty infants have been vaccinated at Toulouse. 
Xo unpleasant symptoms have manifested themselves in 
any ease ; and in all, the result has been most satisfactory." 

"Dr. Izarie, formerly vaccinator in Paris, considered the 
vesicles so good, that he had his son vaccinated this morn- 
ing with virus from one of the infants." 

"An official commission has been named by the Prefect 
to carry out these experiments. A report will be drawn up 
and communicated in due time. — Edin. Med. Jour. 



A Treatise on a Chronal Law of the Pulse. By Alex. Mc- 

Bride, M. D., Beria, 0. 

In 1850, I treated more cases of bilious fever than any pre- 
vious year. The cases were mostly in and about a marshy 
district. In the course of the season I observed that dur- 
ing the principal part of the fever the pulse was, in the men 
patients, at 96 per minute; in the women generally higher. 
This was so uniformly so as to attract my attention ; and 
further observation through the season confirmed the fact ' 
that 90 in man and 108 in woman was the standard pulse of 
the season. In cases where there was gastro-enteria, or 
gastro-cntcric irritation or inflammation, or other special 
irritation, superadded to the ordinary fever, the pulse rose 
to a higher point. I further observed, during the same sea- 
son, that quinine would not interrupt the fever in man, un- 
less the pulse was at or below 72, nor in woman till at or 
below 84. My observations this season, 1860, have con- 
firmed, accurately, the above, having treated numerous 
- of miasmatic fever. 

Recently I was struck with the remarkable fact that 
those numbers which the pulse usually indicated were exact 
multiplies of 12, and that the stages of increase and dimi- 
nution were 12; from which I conceived that there must 
be some exact law of gradation. I began, therefore, a 



1861.] the r 335 

Belies of careful observations on the pulse of individuals in 
all conditions, both of health and disease, which resulted in 
a remarkable confirmation of the conception, and from 
which observations I deduce the following ehronal law : 

1st. The number of pulsations per minute in the adult 
man, in a state of health and repose of body and mind, arc 
00; of the adult woman, 72. There arc a few exceptions, 
in which they will be found respectively 48 and 60. Both 
in sickness and health, the corresponding grade of woman's 
pulse is twelve above man's. 

'2nd. Uneasy attitudes, and various disturbing causes, 
vary these numbers. The pulse of men, generally, during 
business hours, and also of women, is often found from 12 
to 36 above these numbers ; hut it is seldom found to re- 
main long on any other point than one of the multiplies. 

3d. The accidental variations from the multiplies of 12 
are more common in ordinary health than in fever. 

4th. In fever the pulse will always be found, when regu- 
lar, at 72, 84, 108, 132,144, 156 ; above which last point the 
patient will die, if a woman, and when above 144, if a man. 
In some exceptional cases the patient will die with pulse 
not above 108 up to the time of death, or until it is lost. In 
other cases the pulse will arise to 144 or 156, near the time 
of death, and then descend with some regularity till lost a 
short time before death. 

5th. The pulse will be found at intermediate points for a 
brief period during the transit from one point to another, 
and while thepateint is under temporary excitement, either 
mental or physical ; but under permanent or continued ex- 
citement it will settle on a regular point. 

6th. The lowest grade of febrile pulse in man is 72, in 
women generally 84, except in some peculiar typhoid states, 
when it falls actually below standard. But it is questionable 
whether fever really exists in such a state. 

7th. The pulse of children obeys the same law of grada- 
tion by 12, though it is often difficult to keep a child quiet 
long enough to make an accurate observation. 

8th. There are some apparent and probably some real ex- 
ceptions to these laws ; but in by far the most cases, when a 
pulse is found to vary from these numbers it will settle to 
the grade above or below in a few minutes except regular 
sub-grades, which frequently continue longer. 

9th. In person- iu ordinury health there will be found 
more variation when hungry, when greatly fatigued, and 



Chronal Law of [April, 

after a full meal, than at ordinary times. Excessive use of 
tobacco, and other causes which weaken or derange the 
nervous force, cause irregularity. 

10th. A pulse of 84 or 96 is not of rare occurrence in per- 
sons of ordinary health, during business hours; 72 and 84 
arc the most common numbers during the day. 

11th. In many cases, hotli in health and disease, the 
pulse will rapidly increase or diminish in frequency when 
first manipulated, and in some persons this irritability will 
continue several minutes, so that it will be found at any ir- 
regular point between the true point and the grade next 
above and below; but unless there is some peculiar state or 
disease, it will generally soon settle on a regular grade or 
sub-grade. The regular differences of number between ly- 
ing, sitting and standing, are by grades and sub-grades de- 
pending upon the nerve force of the individual. 

12th. There is a regular sub-gradation by six found in 
persons of ordinary health, while standing, sitting, etc., and 
in convalescents: these pulses of 54, 66, 78, 90, etc., but in 
most cases of short duration. There is also a more tran- 
sient under sub-gradation — sixths and thirds of 12, which 
gives pulses of 58, 62, 64, 68, 70, etc., as high as 154 ; these 
are all more transient than the regular sub-gradation by 6. 

Uneven numbers are of exceedingly rare occurrence. 
Pulses of the under sub-grades and uneven numbers may 
all properly be called transition pulses. 

Remarks. — I think the reason we often have pulses re- 
ported at irregular numbers is, that they are not care- 
fully counted long enough. Example : An error of count- 
ing of one in a quarter, or two in the half minute, gives an 
error of four in the minute ; hence we get 64, 68, 76, 80, 
etc. An error of one in the minute gives 61, 70, 73, 83, 
etc., which must generally be erroneous. Another fruitful 
cause of error is the omission to notice the irregularity of 
the first ten or fifteen seconds. 

Since discovering the facts of the above laws I have not 
seen much of continued fever ; but what cases I have seen 
were confirmatory. Phthisis, and diseases of the heart, are 
obedient to the same laws, but for obvious reasons are more 
subject than fever to transient variation in time. 

I think any one who has carefully observed in continued 
fever can call to mind particular cases in which the pulse 
remained tor days at some of the numbers given above. The 
following observations will suggest some reasons why this 






1861.] the Pulse. 387 

t gradation has not been noted by many : Most pi 
eians examine the pulse without counting by a watch: I 
many of those who do use a watch count only a minute, 
or a part ot' a minute, by which means it is impossible to 
arrive at accuracy. The other qualities of the pulse than its 
lency convey different notions of frequency through the 
je of touch, to wit: A very round and tolerably soft 
pulse, without jerk, bound or vibration, conveys the notion 
of unfrequeney : a hard, jerking, bounding, or vibrating 
pulse conveys the notion of frequency. The particular men- 
tal or physical condition of the observer varies his percep- 
tion of time, viz.: when one examines a pulse when drowsy, 
or just after rising from sleep, the pulse seem to him more 
frequent ; when one is in a hurry it will seem slow, and 
the like. There is only one way to arrive at accuracy, and 
that is to carefully and for a length of time count by a 
watch. 

The subject is so new that it would be premature for me 
to attempt many deductions at this time ; but if these are 
found to be the real time laws of the pulse, the conclusion is 
obvious that important hints can be taken from them in 
diagnosis, prognosis, and treatment. I shall only venture 
the following: 

L) . — I have already intimated that quinine oper- 

n antiperiodical when the pulse in the two sexes is at 
or below 12 and 84, which are the lirst fever grades ; but I 
suppose if the pulse, during an intermission, were, in conse- 
quence of special excitement, at or above these numbers, 
the medicine would operate nevertheless. Let it be borne 
in mind that quinine is an anti-intermittent, and not an anti- 
Littent, and then it will be apparent why it operates with 
1st- below the lirst four grades ; itifl simply because it is 
an intermission. Then, if this be true, we gain some light 
on the question of administering quinine in the various 
forms of continued fever, viz : we need not give quinine in 
continu ■ with a view to terminate directly the fever, 

because it is not intermittent. It is continued by some 
cause over which quinine has no direct control ; and 1 1 1 i 
may know by observing the grade of pulse; and many will 
ing the rale, a I; rant of the medi< 

When we visit our fever patient, and 

I the pulse averaging below the grade on which it was 

stationary the previ . we may rest ; that the 

fever is about abating on grade, at least ; if we find it above 



338 Chronal Law of [April, 

we are sure the fever is increasing by a regular amount. If 
our woman patient has a pulse of 108, we know that she is 
not more sick than the man witli a pulse of 96. If the wo- 
man's pulse arises to 144, we do not conclude that she will 
certainly die ; but if the man's pulse arises to that point, 
and above, we announce to his friends that they have no 
grounds of hope in the case. This at least is the general 
rule, and the exceptions are few. 

I give below numerical statistics of observations with tin- 
prominent peculiarities of each case briny noted. I give 
the particulars of such a large number of observations, so 
that it may be seen that I have not formed my conclusions 
from a partial or hasty view. While engaged in the obser- 
vations, I have been careful to note all the cases carefully 
observed, as well as those which give regular grades and 
even numbers, as irregular and uneven numbers; and it 
will be seen, in nearly every case where there is an irregu- 
lar number, that tnere was some reason for it. I have not 
noted the pulse of all the patients visited during the time, 
because I could not always have time and opportunity to 
carefully count the pulse long enough to get its true num- 
ber. Those persons who were examined in ordinary health 
were sitting, unless otherwise noted ; others were in bed, or 
sitting, as noted. My method of examination is to continue 
the observation in each case till the temporary excitement, 
if any exists, abates, and then count the beats from one to 
live or more minutes, and then immediately note down the 
result and the particulars of the case. In some cases the 



Note. — T do not court controversy with those who talk of curing bilious 
fevers with quinine, or of breaking up terrible western fevers by giving 
the quinine in the high febrile stage: I merely say I cannot do it. I 

know very well that quinine may sometimes, during theparoxysm of an 
intermittent, and if he does not happen to vomit it up, take good effect 
during the intermission ; hut 1 never found it profitable to either the patient 
or mysclfto give it in that way. During one Beason J made numerous 
attempts to break up remitting bilious lever with the medieine, given 
both during the paroxysm and the remission : the result was that a good 
many doses were wasted by vomiting. I concluded that ipecac ■ 
cheaper and better emetic than quinine, and so hit off that kind of prac- 
tice. However, in some cases ox bilious fever, where the patient is ooma- 
witli thick, yellow, hrown, or black coat on the tongue, quinine w ill 
aid in changing the action. 



1861.] 339 

minutes gives as true an indication as longer time ; but 
frequently it requires several minutes. 

As it is the chronal law that I am aiming to demonstrate 
no attention has been paid in my notations to any other 
qualities of the pulse than its cnronal oualities. In my note 
book the learly all more fully described than in 

the synapsis; but I deemed it more important to present a 
large number oi ban to present a few more fully des- 

cribed; for it is the numerical character aimed at solely, 
and the larger the number of op 'lited the more near- 

ly we approach the truth. 

- my numbers and facts appear tome conclusive, it only 
remains for the reader to consider whether my observations 
have been carefully made and faithfully recorded and pub- 
lished; in proof of which I have nothing to offer but the 
here stated, and leave it for each person interested to 
prove by his own observations, which he can do in a very 

lays, by careful observation. 
There will be found a larger proportion of irregular pulses 
in the city than country, for very obvious reasons. 

[Dr. McBride here adds a tabular statement of more than 
100 observations of the pulse, giving in detail t\ic occupa- 
tion, mdition of health or, disease, etc., etc., of each 
individual. This table is of considerable length, and we 
take the liberty, with our press of matter, to crowd It out: 
remarking, however, that these observations in a remark- 
able degree confirm and justify the deductions of the essay. 
—Eds.] 

There are carried out in the table 120 actual observa- 
tions, which give : Regular multiples, '.til; sub-grades, 8; 
irregular, 31. Total, !-!!>. Proportion: 2^ regular, \o 1 
Bub-grade and irregular. 

With a view to further confirm or refute the principles 
declared in the chronal laws, I recently, in November, 1800, 
carefully made and noted 4o observations, not one of which 

a regular fever ; 5 were on a woman who had nearly 
died of monorrhagia, : 3 on a boy with atonic hydrocepha- 
lus; several were upon persons drinking and smoking, 

te of whose pulses would oi course be irregular; several 
upon p> bo had come in from hard labor, riding, 

.. in cold, windy weather; some hysterical, etc., etc. In 
nearly every irregular case there was some very obvious 
causes apparent. They resulted thus: Regular multiples 
from 00 to 132, b-grades from 54 to 114; 31, 



340 Popliteal Aneurism. [April, 

irregular and under sub-grades from 56 to 98, 9 — the multi- 
ples in this medley of cases being one more than half, and 
the irregular cases one-fifth of the whole. It will also be 
seen hereby that there are more irregular pulses at this 
season of the year than in the fever season. — Cincinnati Lancet 
Sf Observer. 



Popliteal Aneurism Cured by Digital Compression. By George 
C. Blackman, M. D., Professer of Surgery in the Medical 
College of Ohio, Surgeon to the Commercial, St. John's, 
And St. Mary's Hospitals. 

In June, 1859, I was consulted by Joseph Humbrick in 
reference to a large pulsating tumor in the left popliteal 
space. He was an American, and was 27 years of age. For 
some years he had been engaged in carting lumber, and 
consequently was often compelled to sustain heavy weights. 
He was not aware, however, that he had ever received any 
injury upon the part affected. About thirteen months be- 
fore I saw him he suffered excrutiating pain, which extend- 
ed along the inner part of the thigh and calf of the leg as far 
as the heel. About three days afterwards he noticed a small 
pulsating tumor, about the size of a pigeon's egg, in the 
middle of the popliteal space. His case was regarded as 
acute rheumatism, and he was treated accordingly. The 
swelling continued to increase ; and when I first saw him, 
on the 5th of June, it measured about four and a half inches 
in the axis of the limb, and five and a half in its transverse 
direction. It had a pyriform shape, the apex being above. 
For two months the pain had been severe ; and at the time 
of his visit he was unable to extend his limbs completely. 

Having noticed the favorable reports of cases which had 
been treated by the London surgeons by flexion, I deter- 
mined to unite this to the combined method of compression, 
manipulation, and the internal administration of veratrum 
viride, which I had successfully employed in a case of 
femoral aneurism of large size. On the 7th of June, after 
having given four drops of Norwood's tincture, I broke up 
and dislodged sonic of the layers of fibrin in the sac, by means 
of pressure with my thumbs and fingers ( Fergusson's mani- 
pulation); after this I applied a bandage, as recommended 
by Prof. Dudley of Lexington, in 1818. The foot and leg 
were bandaged from the toes to the inferior margin of the 



1861.] Popliteal Aneuri 341 

aneurism, over which a compress was placed, and a still 
firmer one along the coarse of the femoral artery reaching 
to Poorpart's ligament These were covered by the ban- 
dage which extended to the groin. The leg was strongly 
flexed upon the thigh, and secured in that position. The 
only effect of the veratrum was to cause an intermission of 
the* heart's action every thirteenth heat. For an hour alter 
the manipulation the pain was intense ; but morphia, freely 
administered enabled him to pass a comfortable night. On 
the following day, however, the patient became exceedingly 
restless, and the compressor and bandage became deraged. 
After a week's trial. Dudley's dressing was abandoned and 
Petit* s tourniquet substituted. At the expiration of another 
week this was changed for Skey's. At this time the tumor 
had diminished somewhat, but still pulsated strongly. 
Under the use of digitalis the patient's pulse rose from 85 
to 110, and it was discontinued. Compression was continued 
for another week, by the alternate use of the tourniquets 
above mentioned. The patient now left for his home in 
Xewport, Ky., the tumor having diminished about one- 
third in size, but the pulsation being quite distinct. 

On the 1st of July I requested my pupil, Mr. John Bil- 
lings, and Mr. Charles Greenleaf, then a medical student, 
to go to the patient's house and try digital compression at 
the goin. This was employed for three hours, when the 
pulsation entirely ceased. 

On Monday last (February 4th, 1861,) the patient came 
before the class of the Medical College of Ohio, and declar- 
ed that his left leg was as good as the right. The contracted 
and indurated aneurismal tumor can still be felt, by pulsa- 
tion has never returned. It is a question whether this in- 
durated mass will ever disappear ; for M. Paget has report- 
ed an examination of a case fifty years after the cure by 
ligature — John Hunter's fourth patient — and even after this 
long period a hard, olive-shaped mass still occupied the pop- 
liteal space. 

Shortly after the treatment of the above case, a patient 
came under our care having an aneurism of the innominata 
of small size. Instead of ligating the subclavian and caro- 
tid on the distal side, I applied Bourgery's tourniquet, or 
compressor, for the subclavian, while a truss was adjusted 
to the neck to compress the carotid. Veratrum in this case 
had a happy effect in moderating the force of the circula- 
tion ; and with compression above mentioned, I succeeded 



842 Post Partum Detachment of th Placenta. [April, 

in producing a temporary consolidation of the aneurism. In 
a few hoars, however, pulsation returned, and in the course 
of fl few days it became again consolidated. 

Thus alternating, matters progressed for several weeks, 
when, after trying digital compression for some hours, at 
era! trials, it became evident that all our efforts were in 
vain. The patient left the country, the tumor constantly 
increasing; and in a few weeks more, after reaching and 
enormous size, it hurst internally and suffocated the patient. 
A post mortem revealed an aneurism of the innominata ; 
and the opening communicating with the sac was of large 
size. — Cincinnati Lancet £ Obsert 



A New sign of Post Partum Detachment oft) By 

John Ctay, M.R.S.C., of Birmingham. 

From investigations, with a view of improving upon the 
old plan of management of the delivery of the placenta, Dr. 
Clay ascertained that a very simple sign existed, by which 
its separation, after the birth of the child, might he indicat- 
ed, having tested it in upwards of nine hundred cases. Be- 
fore dividing the umbilical cord he applies two ligatures. 
If tin; maternal part is now examined, it will he found in a 
flaccid condition, and almost live from blood ; hut after an 
interval of from om 4 to three minutes, it will he found to 
have acquired specific weight, and that the vessels are more 
or less tilled with blood. The one fact may he ascertained 
by poising the cord on the fingers; t]\v other by slightly 
grasping the cord near the vagina, with the thumb and fore- 
finger of the left hand, and, with the right hand, suddenly 
compressing it, when a well-marked sense of fluctuation is 
perceived, a kind of resilience like that felt when an elastic 
tuhe filled with fluid is suddenly compressed. "When the 
placenta is detached the cord loses its increased specific 
weight and the hydrostatic property just mentioned. This 
is so invariable, that the loss of the previously acquired hy- 
drostatic properties of the cord after the birth of the child 
constitutes the sign of detachment. ■ 

The whole <>t the phenomena are manifested in three 
stages — flaccidity, repletion, flaccidity. 

It' the cord be tightly grasped by a spasm of the os, or 
by irregular contractions of the atertts, the loss of the hy- 



1861.] The Nervous System. 343 

drostatic properties may lor a short time be delayed. These 
signs are not, of course, equally marked in every case. 
When the uterus is tlaecid. they are but slightly manifest- 
ed, though perfectly reliable. When, on the other hand, 
the contraction is firm, the most inexperienced may detect 
them. In eases of partially adherent placenta, the disap- 
earance of the hydrostatic properties, and the failure to de- 
liver the placenta by the usual manipulations indicate the 
necessity for artificial detachment by introducing the hand. 
In twin cases, the signs persist till after the birth of the 
►nd child, except where the two placentas are present. 

It sometimes occurs that the placenta is separated simul- 
taneously with the birth of the child. Here the first series 
of phenomena are absent, and it may be be generally effect- 
ed with safety. 

The practical value of these facts is obvious, as the pla- 
centa, when thus known to be separated, may be at once 
extracted. The prompt delivery of the placenta is very im- 
portant, as the uterus then contracts more effectually, the 
risk of hemorrhage is not so great, and it may be fairly as- 
sumed that the convalescence is less protracted. 

To inexperienced practitioners it might be a safe instruc- 
tion to impart, not to interfere in the extraction of the pla- 
centa, so long as the hydrostatic properties herein defined 
nt — Dub. Quar. Jdur. 



action of Alcohol, Anaesthetics and the Carbonic Gases upon 
the Cer >>l Nervous System. 

M. Lallemand read the following memoir containing his 
own views and those of MM. Pemn and Duroy upon the 
comparative action of alcohol, anesthetics, and the carbonie 
: the cerebrospinal nervous sytcm : 

"When etherization was first discovered Flourens demon- 
strated that there are successive stages in the action of sul- 
phuric ether and of chloroform upon the nervous centres, 
and that the sensibility and motive power of the spinal mar- 
row are abolished by both of these 4 agents- In repeating the 
experiments of Flourens we have studied the action of these 
in the same manner, and we have ascertained 
that while alcohol andamylene, like ether and chloroform, 
abolish the sensibility and motive power of the spinal 
cord, the inhalation of carbonic acid and carbonic oxide al- 



344 The Nervous [April, 

lows those properties to be retained up to the moment of 
death in animals subjected to the influence of the two 
gas< 

Action of Alcohol ami Anaesthetic Agents. — Into the 
stomach of a C\o^ of middle size we introduced 100 grammes 
ofalqoliol, at 21 degrees, dihfited with an equal quantity of 
water, in three doses at intervale of fifteen minutes. One 
minute after the administration of the first dose the animal 
was in a state of complete Intoxication. The limbs were 
flaccid, the skin had lost its sensitiveness, as had also the 
ball of the eyes ; the pupils were dilated, the pulsations of 
the erural artery were 120, and the acts of respiration 22 in 
a minute. The posterior arches of the last three dorsal 
viriebne were then elevated, and the spinal marrow WW 
laid bare to the extent of about twenty-five centimetres. 
The posterior and anterior columns were pierced, and the 
posterior and anterior roots of a spinal nerve were seized 
and drawn out with the forceps. Xo sign of sensibility was 
elicited, and not the slightest muscular action. Four hours 
after the operation this lethargic condition gradually passed 
off; the tongue and jaws of the animal began to move, and 
the eyelids closed when the balls of the eyes were touched. 
Upon piercing the cord again the animal uttered mo 
and the hinder limbs were convulsed. The dog was then 
strangled." 

Experiments with cloroform, sulphuric ether and amylene, 
from which analogous results were obtained, are described, 
after which the authors of the memoir continued as fol- 
lows : 

"Thus the action of alcohol, chloroform, ether and amy- 
lene completely interrupts the sensibility and motive power 
of the spinal cord and nerves. We have also ascertained 
that by passing an electric current through the spinal mar- 
row, when its action is thus suspended, its excitability may 
be aroused, and may be manifested by muscular action. 
^\*e would add that the interrupted properties of the 
cord and nerves will reappear upon the cessation of the 
disturbing influence of the agents that have been adminis- 
tered. 

Action of the Carbonic Gases — Carbonic Acid. — The 
erior arches of the last two dorsal vertebrae of a la 
were removed, and the cord exposed to the extent of 
ul three decimeters. The animal was then made to in- 
carbonic acid mixed with a very small quantity of 



1861.] \ S stem. 846 

water. Ai the end oflO minutes it was entirety insensible and 

motionless, and the arterial blood had assumed the dark 
venous hue. The posterior columns 01 the cord and the 
posterior root of one of the nerves were then pierced with 
a pointed instrument, without producing any manifestation 
of feeling : bu1 by puncturing the anterior root and the an- 
terior columns, violent agitation of the hinder limbs was oc- 
casioned. The sciatic nerve being exposed and irritated, 
convulsive motions were excited in the muscles of the limb 
to which it was distributed. The muscular contractions 
produced by irritating the cord and nerves grew more and 
more feeble, but did not entirely cease until the animal ex- 
pired. 

Another experiment in which the oxide of carbon was 
used, gave results similar to those just described. 

The preceding facts allow a very distinct line of demarka- 
tion to be drawn between alcohol and the anaesthetic agents 
— chloroform, ether and amylene on the one side, and the 
carbonic gases on the other — with respect to their physio- 
logical action. 

I. Alcohol, chloroform, ether and amylene act primarily 
and directly on the nervous centres, in the substances of 
which they may accumulate. 

II. The carbonic gases exert their primary and special in- 
fluence on the blood; carbonic acid imparting the venous 
hue to the arterial blood, and carbonic oxide altering the 
condition and physiological properties of the blood corpus- 
cles. 

It seems difficult not to admit that the insensibility pro- 
duced by inhalation of these gases is merely the secondary 
and consecutive effect of an alteration of the»blood. It is 
known, in fact, that innervation is accomplished only under 
the physiological condition of the excitement of the nervous 
em by blood ; and it is also known that when the blood 
cannot obtain a due supply of oxygen — as in asphyxia pro- 
duced by a mechanical obstacle to respiration, or in cronp — 
an anaesthetic condition supervenes betokening imminent 
danger, and, indeed, the speedy extinction of life. 

Amesthetic agents, then, depress the factions of the nerv- 
ous system, and by their progressive action suspend the 
respiration ; which is under the control of the medulla ob- 
longata. They produce anaesthesia primarily, and asphyxia 
secondarily or indirectly. 

Carbonic acid and carbonic oxide, on the other hand, 



S46 Epilepsy. [April, 

modify the properties of the blood — disqualify it for sus- 
taining innervation, and thus produce asphyxia primarily, 
and anaesthesia secondarily or indirectly. 

Conclusions. — 1. Alcohol, chloroform, ether and amylene 
art immediately upon the nervous system. 

2. Carbonic acid and carbonic oxide act immediately upon 
the blood by modifying its properties ; and it is by means 
of this modification of the blood that they produce insensi- 
bility. These substances then are only pscudo-ances the lies. — 
Jour, des Connaissanccs Medicates. 



Woorara in Epilepsy. By M. Thicrcclin. 
M. Thiercelin, struck by the counteraction of artificially- 
produced convulsions by woorara, has been led to adminis- 
ter the drug in the treatment of several convulsive disc; 
more especially epilepsy, and with most marked effect. 
Particulars of two cases of epilepsy, which had resisted a 
variety of previous treatment, were laid before 1 the mem- 
bers of the Academy of Sciences at their last Bitting. One 
of the subjects treated by woorara was a young man, aged 
23. In him the disease was hereditary and congenital. 
The patient had passed 4 years at Charenton, and was ac- 
counted incurable. The number of attacks during the 
month amounted to 20, whereof the greater part was most 
re. The second case was that of a girl of 17, a suffer- 
er from epilepsy for 8 years past, and during the last 12 
months subject to daily tits. Under the influence of the 
woorara, treatment, (the drug being applied daily in d< 
varying from #ialf a grain to a grain to the suppurating sur- 
face of a blister,) the attacks dimished in frequency so con- 
siderably that in the first case they tell in number from 20 
to 5 per month, and in the second, from 29 or 30 to S. 
only did the frequency of the fits decrease, but a striking 
general improvement occurred in the health of both patients, 
and a marked diminution of the nervous irritability always 
accompanying epilepsy was also noticed. Unfortunately, 
the treatment could only be persisted in for 8 weeks, as the 
stock ot woorara ran short; nevertheless, the results ob- 
tained were decidedly of a nature to encourage other prac- 
titioners jn following in the footsteps of* M. Thiercehn. — 
Lan 



■iV) Editorial. 347 



EDITORIAL AND MISCELLANEOUS. 



THE MEDICAL PROFESSION—ITS GRATUITIES. 
Th following paper has boon in our hands for sonic time ; but has es- 
caped our notice till this late period. We deem the subject of culling 
the attention of the public to the unjust draft made ou the Profession, of 
BO much importance, and also for the able manner in which the grievance 
is presented, that we here make room in our editorial department for the 
Memorial of the Committee appointed by the Medical Association of 

rgia : 
To the Senate and House of Representatives of the State of 
Georgia : 

MEMORIAL. 
At the Annual Meeting of the Medical Association of the State of 
iblcd at Rome, April 11th, 1860, the following Resolu 
wore adapted, viz : 
Resolved^ That this AfiBOOiation Memorialise the Legislature of 
>lish the Professional Tax upon Physicians, and to urge 
the passage of an Act requiring the Inferior Court or each county to set 
apart such portion of the county tax as the (J rand Jury shall recommend 
to poi ngsfor the use of the poor. 

Th gned were appointed a Committee to bring this matter bc- 

r honorable body. 
In performing this duty wv, beg respectfully to submit a few reas 
f'u- this appeal to the Laic Making Power . 

It is a fact, apparent to every observing mind, that Medical men, far 
more than any other class of citizens, contribute gratuitously, their time, 
and money, to the relief of the indigent. And as it i s the duty of 
State authorities, and not of a particular class to bear the burden, 
gratuitous services can ; • 1 in no other light than centri- 

ng to the State. 

per centagc of population requiring those §crviecfl is by no means 
inconsiderable. Taking thecomr 1 as an average county, obser- 

vations have been made by which we arc enabled, confidently, to 8 



348 Miscellaneous. [April, 

that the amount thus donated by medical men in Georgia, in the single 
article of quinine can scarcely fall short of Thirty Thousand Dollars 
per annum, with a strong probability that it largely exceeds that amount. 
Tf, in connection, with this startling fact we consider the value of the 
time and labor and other Medicines contributed, it is evident that the 
amount of this gratuitous outlay of physicians to the State is enormous. 
It is remarkable that the public, and especially the Legislature, has so 
little appreciation of the extent of these gratuitous labors of medical 
men. True it is that the Inferior Court, under existing laws, is re- 
quired to provide for the poor, and the physician pays his part of the 
annual tax, levied for this purpose. But, whether from defects of law, 
or gross neglect of the Courts, it is well known that the instances in 
which the poor are thus provided for are very few, and the procuring of 
medical services and drugs do not seem to be regarded as belonging to 
their list of duties. Indeed, except in cases of Lunacy, or in extreme 
and rare instances of helplessness, where the subject has been entirely 
abandoned by his acquaintances, it is seldom that the Courts make any 
provision whatever. Yet even in these extreme cases, deserted by all, 
the physician alone is expected, without compensation or thanks, to give 
not only his personal attention, but his money, to the relief of the suffer- 
er. At all seasons, in all kinds of weather, in the dark hours of night 
when others are asleep, the medical man passes from one scene of dis- 
tress to another, bestowing his labor, risking his own health, and dispens- 
ing drugs to the indigent sick. To this course he is impelled by two 
powerful forces. The first and greatest is the demand of humanity, 
which to a conscientious man leaves often no alternative by which to es- 
cape the call. The second is the force of public sentiment which will no^. 
tolerate in the physician that freedom of action which it allows to others. 
The merchant may refuse credit to whom he chooses. The druggist may 
decline to sell to an insolvent customer and it is well, but the physician 
who exercises this liberty brings upon himself the severest censure, and 
consequent injury to h\$ character and business. 

To the many cases of casualty and death which occur in this fast age, 
a large proportion of which is amongst the poorer classes, the physician 
stands a ready servant, subject to every beck and call, and is expected 
and required to have in readiness all the appliances and material, at 
whatever cost — adapted to every emergency. By his promptness and 
benevolent agency he relieves large numbers, and oft times rescues them 
from impending death. When, under analagous circumstances, a party 
is snatched from a burning dwelling, or a watery grave the individual 



1861.] Jllisccllaneoits. 349 

who performs the deed is exalted into a hero. When a mariner rushes 
to the rescue of a distressed crew, he gains for himself Laurels of Praise 
and Medals of Honor. Not so the Physician. He is regarded as hav- 
ing discharged a mere common-place duty, and scarcely meets with a 
passing commendation. And such is the tyranny of custom and law, 
that if he fail to respond to every call, he encounters the indignant frown 
of the community, and failing from want of proper facilities or other 
cause to adopt the most scientific treatment he becomes liable to prosecu- 
tion and heavy damages. Although medical men, as a class, are pro- 
verbially benevolent and kind, and are ever ready to heed the call of 
suffering humanity ; and while they claim and desire no special exemp- 
tion from the moral responsibilities and duties incident to their noble 
profession; yet* they feel that the public authorities can and ought to do 
more than is or has been done for the poor in this particular, and that 
they ought not to require the physicians services nor his drugs without 
compensation ; much less to heighten the infliction by imposing a speci- 
fic tax. If it be urged that a physician's profession is his capital and, 
therefore, ought to be taxed, we reply that it is taxed, and that heavily 
in the manner, and for the reasons above stated. The calls of humanity, 
and the necessities peculiar to the practice of the medical profession ; the 
exposure, irregular hours, impairment of health, encountering contagi- 
ous maladies and raging epidemics, witnessing painful scenes, suffering 
and death, and the moral and legal responsibilities incurred ; all bear 
heavily upon the practitioner, and can find no adequate compensation, 
even though the tax were removed, and the ordinary fees allowed in all 
cases. 

We, therefore, respectfully petition your Honorable body to abolish 
the specific tax, and extend such relief to the poor and the medical pro- 
fession in the matter under consideration, as wisdom and justice may 
suggest to the patriotic Representatives of a great State. And we feel 
well assured that such legislation so obviously necessary, so manifestly 
just and proper, and so highly called for by the growing philanthropy and 
benevolence of the present age, cannot foil to meet the sanction of a 
liberal and enlightened constituency. 

Robt. 0. Word, M. D., Home, Georgia. 

Robt. Southgate, M. D., Augusta, Georgia. 

.1. <r. Westmoreland, M. I)., Atlanta, " Committee. 

8. W. Brn.NEY, M. ])., Forsyth, 

B. B, Brown, M. D., Dalton, " J 



350 Miscellaneous. [April, 

ETHER VERSUS CHLOROFORM ET. AL. 

Having received the following Circular, and seeing that it interests the 
whole Profession, we submit it to our readers in the hope that by so do- 
ing we may promote the laudable purpose of the learned Society at whose 
instance the appeal is made for facts tending to settle the question of the 
relative danger of some of the anaesthetics in most common use : 

Boston, Massachusetts, U. S. 

The question of the entire immunity from danger which is claimed for 
Anaesthesia produced by Ether, being still under discussion, the Boston 
Society for Medical Improvement has appointed the undersigued a Com- 
mittee "to investigate the alleged deaths from the inhalation of Sulphuric 
Ether, and to report thereon," 

They would, therefore, request the Medical Profession, or any person 
into whose hands this may fall, to communicate to either of them such 
cases, coming within their observation as shall serve to this end ; 
giving the place, time and circumstances of their occurrence, with 
the mode of iuhalation adopted, and, especially, information in regard to 
the following points : 

1st, The kind of Ether used, whether pure Sulphuric Ether, Chloric 
Ether, or Ether combined with Chloroform. 

2d. The period after inhalation at which death occurred ; — 
also any other facts which may enable them to form an opinion on the 
subject to their investigations. 

Richard M. Hodges, M. 1>. 
George Hayward, M. D. 
Solomon D. Townseno, M. 1>. 
Charles T. Jackson, M. ]). 
J. Baxtkr Upham, M. J). 

February, 186 1. 

Have you known death to occur from the inhalation of pure Sulphuric 
Ether ? 

Where did this occur ? 
" At what date ? 

For what purpose was Ether administered ? 

What method of inhalation was adopted .' 

What kind of Ether was used ; was it pure Sulphuric Ether, Chloric 
Ether, or Ether combined with Chloroform ? 

At what period after the inhalation did death occur, and how did death 
take place ? 

1 'lease state may other circumstances connected with the case. 
(Signed) 



1861.] Miscettmec 351 

ON DISEASES PEC/ULIAR TO WOMEN, 
Including Displacements cf the Uterus. Bj Hugh L. Hodge, M. D., 
Prof of Obstetrics and Diseases of Women and Children in the 
L'niversity of Pennsylvania. With original illustrations. Philadel- 
phia. Blancha&d & Lee, lsGO — 8vo. pp. 470. 
Book-making is so often resorted to as a mere trade by persons of in- 
experienee, that we instinctively welcome the productions of those who, 
like the author of the volume before us, bring forward the result of ex- 
tensive observation, enlightened intellect aud mature judgment. Zeal- 
ously engaged in the practice of his profession in a large field for up- 
wards of forty years, the unostentatious record of his final conclusions 
must be of great value ; and although he may sometimes differ from 
whose opportunities are equally advantageous, the student of truth 
will thus, like the juror in a court of justice, have the benefit of argu- 
ment upon both sides of difficult questions. In the author's neat letter 
to Prof. Meigs he says : "I know well that our productions — each char- 
acteristic of its author — differ exceedingly in theory and in practice; but 
aevet be student who examines each book may discover the 

truth more clearly, and be prepared to render such truth more efficient. 
The very opposition, which may be perceived in the views of experienced 
men in the profession, is often beneficial — ex collisione scintilla." 

.Prof. Bodges 1 work is divided into -\ parts; the 1st comprehending 
the"! of Irritation;" the k 2d, 'Displacements of the Uterus;" 

and the 3d, the "Diseases of Sedation," As the limits of this notice will 
not permit any comments upon the special views of the author, we can 
only indicate the scope of the work by a brief reference to its contents. 
In Part 1 he treats of Nervous Irritations and its consequences; irrit- 
able uterus, its local and general symptoms, its progress and result.-, its 
and pathology, its complications, and its treatment. Under the 
bead of displacements of the Uterus, we find chapters devoted to the 
anatomy of the pelvic organs, to the various displacements of the uterus 
and their causes, to the symptoms of these displacements, and to their 
:ient by hygienic and by mechanical means, of which latter he pre- 
fers the "Lever pessaries," designed by himself. The diseases of seda- 
tion are disposed of in three chapters on sedation and its consequences, 
sedation of the uterus, amenorrhaca, and diagnosis and treatment of 
lion of the uterus. 

This volume is destined to take a conspicuous place among the most 
valuable original contributions to American medical literature. We, 
therefore, cheerfully recommend it to the attention of our readers. 



352 Miscellaneous. 

THE BLOOD IN MANIA. 
In England the investigations of W. C. Wood, M. D., as far as they 
go, indicate that there is a marked deficiency of fibrin during the period 
of maniacal excitement, and a correction of this deficiency during con- 
valescence. 



RESIGNATION OF PROF. MEIGS. 
We learn that Dr. Charles D. Meigs has resigned the Professorship of 
Obstetrics, etc., he has so long filled with marked ability in the the Jef- 
ferson Medical College, Philadelphia. Professor M. is a Georgian by 
birth. 



Hydrocyanate of Iron in Ejrilejisy. — The Cincinnati Lancet & 
Observer says: "Dr. G. S. Bailey, a retired physician of Iovra, states in 
a letter to the editor of the Journal of Materia Medica, that his only son 
after having been treated six years for epilepsy with every remedy that 
medical skill could suggest, without success, was finally cured with the 
hydrocyanate of iron, by Prof. D. L. McGugin of Keokuk. The formu- 
la employed corresponds with the one used by Dr, Treat (Cin. Lancet & 
Obs., June, 1860, p. 388); hydrocyanate of iron, one drachm; powder 
of valerian, two drachms ; extract of Indian hemp, one drachm, being 
originally added by McGugin. Make into one hundred and twenty pills. 
One of them is to be taken three time3 a day. gradually increased to 
four. 



How to Improve the Taste of Cod-Liver and Castor Oils. — The 
Louisville Medical News says : "Cod-liver or castor oil, shaken up with 
an equal volume of water distilled off the leaves of the wild cherry-tree, in 
a manner similar to that directed in Edinburgh or Dublin Pharmaco- 
poeia for cherry laurel water and left to rest forty-eight hours before 
separation, acquires by this simple operation an extremely sweet per- 
fume and agreeable taste of almonds ; the taste remains as long as the 
digestion lasts. Oil flavored in this way could be taken by many 
patients who reject it in its natural state. Castor oil is not affected in 
its purgative action by this process." 



Criminal Insane. — A State Asylum for the Criminal Insane comj 
prising 290 acres of land, and accommodations for 500 convicts, is about 
to be completed in England. The number of this class of persons has 
steadily increased for several years, until, at the beginning of the pre- 
sent year, not less than 731 were reported. — American lournal of 
Insanity. 



SOUTHERN 

MEDICAL AND SURGICAL JOURNAL. 

(NEW SKIM! 

[TIL AUGDSTA, GEORGIA, HAY, 1861. NO. 5 

ORIGINAL AND ECLECTIC. 

ARTICLE X. 

Tape Worm — The Symptoms, Progress, Development, Duration 

and Spe< ." itment of a case* 

The writer was for several years a subject of the disease 
of tape worm ; a statement of his case may prove beneficial 
to others similarly affected. It is given as follows : 

During the year 1835 he had frequent attacks of what 
was Bupposed to be cholic, returning at Intervals, to Janu- 
ary, ISoT ; but not of a character to excite much alarm y 
though accompanied by sick stomach, predisposition to 
vomit, and piles. 

The usual alleviatives for the supposed disease, were re- 
sorted to without relief; the patient being also subject to 
frequent cramps of the abdomen, in the region of the right 
side, especially after inclining the body downward in that 
direction, on resuming an erect posture. 

At the' time last named (January, 1857) the disease was 
demonstrated to . be tape worm, by the voluntary es- 



*T!. -port is by a distinguished gentleman of the legal profesion 

in this city. We regard the paper a highly useful <>ne, for while this report 

;:.d intelligently made, the statement is freed from a vast 

nt of unnecessary detail, which too often encumber the reported 

The al>-. ihnical terms, apologized for, is 

not to be deplored and will be regarded by ourreadera rather a relief limn 

otherwise. M. & >. Joub.1 

28 



854 A Case of Tape Worm. May, 

cape of several separate joints, crawling away, they being 
alive and continuing to move l>y extension and contraction. 
The specimens were of rather a fiat round, an inch in length 
near the size of a common broom straw, square at one end 
and tapering at the other, and most exceedingly tenacious 
oflife under experiments, to which they were subjected. 

The escapes, either voluntary, in detached pieces, or on 
being expelled by remedies, sometimes in joints and at 
others in continuous pieces, varying from 3 to 14 feet in 
length, continued to May, 1841, at an average per day of 12 
joints, or one foot; though irregular, sometimes daily and 
then at intervals of 3 to 5 and 10 days, increasing in quan- 
tity in proportion to the length of the interval, the voluntary 
escapes producing an unpleasant itching and tickling sensa- 
tion about the anus. 

In these intervals the abdomen became distended and 
painful, the breathing short, with frequent cramps, such as 
before described, accompanied by an internal lowering 
down of the intestines and aggravation of the piles. 
Throughout the disease, contrary to the generally existing 
belief in the subject, that in such cases the patient was sub- 
ject to a ravenous appetite, in this instance it was the re- 
verse, being quite moderate, the health very delicate, and a 
general debility of the system. 

From the development of the disease to the cure, many 
physicians w r ere consulted ; but four of whom professed any 
practical knowledge as to the disease or its treatment. It 
being, I suppose, somewhat rare, there being but two who 
pi-escribed remedies producing any sensible relief. 

The first was the family physician of the patient, the late 
Dr. Milton Antony, distinguished for his skill in the sience 
of his profession, at the head of which he stood in this, his 
native State, and the first President of the Faculty, and 
founder of the Medical College of Georgia, which position 
lie retained during his lite. He was first consulted and pre- 
scribed spirits of turpentine, which finally effected a remedi- 
al cure. 



1861.] AQiseofTape Worm. 

The other was quite a young, bat very intelligent gentle- 
man, Dr. Thompson, not a graduated M. D., hut a man of 

reading, who was met with in 1838. in Louisville, Ky. lie 
prescribed assafoetida and gum camphor, in parts of § of 
the former to J of the latter. This produced temporary re- 
lief; the assaf etida, acting as a gentle cathartic, relieved 
the bowels of the accumulation of the disjointed pieces of 
the worm; while the camphor counteracted the too great 
relaxing tendencies of the other component on the system. 
These. two remedies were resorted to alternately from 1838 
to 1840, the pills "being taken from 3 to 5 at a dose. 

The prescription of Turpentine and the mode of adminis- 
tering it were as follows : 

Fast 12 hours (or rather abstain from all hutliquids), then 
empty the bowels with salts ; afterwards take a teaspoon- 
ful of spirits of turpentine in loaf sugar, and this repeated 
in 15 or 20 minutes, and followed by castor oil in thirty 
minutes. 

This course was always effectual in expelling portions of 
the worm; but its effects on the system of the patient were 
such as to deter a repetition until compelled by after ac- 
cumulations and the accompanying symptoms before des- 
cribed ; it leaving the patient under strangury and a gener- 
•al affection of the kidneys and spine, and consequently was 
not resorted to except from necessity, and at intervals of 2 
months. In the meantime the pills were taken for 
temporary relief; but the odor being so offensive as to deter 
their use as long as could be dispensed with. 

The gentleman who prescribed the pills, though not a 
lar practitioner, had been compelled to put into requisi- 
tion his skill, as an acting Assistant burgeon, at a United 
States Military post in the West, in the absence of any one 
larly in charge, of that department, and during such 
time he stated that two cases of similar disease had been 
temporarily relieved by that treatment; and in the case of 
the writer the prescription came fully up to the representa- 
tion. 



356 A Case of Tape Worm. [May, 

In 1839 the lamented Dr. Anthony was one of the early 
victims of the yellow fever of Augusta of that year, and 
the patient was deprived of the further benefit of his skill 
and left to the use of his prescribed remedy at discretion, 
and having read some few miscellaneous articles on the 
subject, and attetively noticed the effects of the prescription 
in the disease, as well as on the system, it occurred to him 
in the fall of 1840 that there might be propriety in varying 
the manner of administering the turpentine from two tea- 
spoonfuls at an interval, to that of the wholejquantity at one 
dose. He made the experiment, taking a desert spoonful 
at one time. The change was successful, acting instantane- 
ously and directly on the worm, aiding the oil as a cathartic 
wihont entailing the previous injurious effects on the kid- 
neys and spine and resulted in expelling 14 feet. 

Thus encouraged, it was repeated at shorter intervals, 
with similar success, the specimens exhibiting irregular and 
imperfect formation ; but showing that there was a square 
break-off, leaving a portion behind. Again, in 1 to 4 weeks 
this treatment was repeated till 1st of May, 1841, when 5 
feet was expelled, tapering from the full size at one end to 
nearly a point at the other, having rather a soft, jelly-like 
appearance. This suggested the propriety of immediate 
perseverance, and the treatment was repeated in 3 to 4 days, 
which happily resulted in bringing at that time 3 feet, about 
half the usual size at the large end and tapering to a point 
at the other, not longer than the point of a common darn- 
ing needle, perfect in formation, the joints shortening 
as they decreased in size. At the time, this was believed to 
be an entire relief from all remains of the worm, and has 
been verified by a lapse of near 20 years without any return- 
ing symptoms whatever. 

It may be remarked as showing the obstinacy of the dis- 
ease and the tenacity of the worm, that during its continu- 
ance the writer was, in 1830, a subject of the yellow fever, 
having a dangerous attack, and for which he was treated 
with the appropriate remedies for that disease. On conva- 



1861.] Bkbad. Thpe Worm. 357 

Lescing, he flattered himself that the remedies for the fever 
had subdued the worm; but was disappointed in finding 
that by the time lie was able to Leave the house the old dis- 
ease returned in all its symptoms. 

The appearance of the disjointed portions have been des- 
cribed. Those connected, of various lengths, resembled 
gourd seeds strung lengthwise on a thread, and varied from 
3 to 14 feet. 

After a la] ime 10 years the ease, with the particu- 

lars, &C, was related to a friend, a highly respected and 
eminent gentleman of South Carolina, and which had pass- 
ed from the memory of the writer, till recalled about 3 
vears since bv a letter referring; to the circumstance and 
stating that he had a son 10 years of acre similarly afflicted; 
and that none of the physicians consulted seemed to under- 
stand either the disease or remedy, and requesting a full 
statement of my ease with the symptoms, prescriptions, &c, 
it was given with full directions: but suggesting the pro- 
priety, if the turpentine was resorted to, of leaving it to a 
phpsician to prescribe the decrease in the proportion for the 
child, as compared with an adult. 

Some two or three months afterwards a second letter was 
received from this friend, communicating the pleasing in- 
telli_ >r his having used the prescription as directed, 

with complete success, his son being entirely cured, and ex- 
pressing his grateful acknowledgements, and the belief that 
I had. under Providence, been the instrument in saving the 
life of his child. 

nsidering the result in this latter case us establishing 
the efficacy of the remedies in the two, it was determined at 
• leisure time to make a statement of the same for the 
benefit of the public, waiving all apparent delicacy involved, 
believing that the cause of humanity demands it, that purpose 
has been delayed to the present only v by other engagements. 

Medical readers, as well us others, will, doubtless, make 
due allowance for the absence of the use of t<'clmi<-;il terms 
«ne not versed in them. 



358 Berlingkbr. Becicd Touch. [^foy> 

ARTICLE XT. 

Rectal Touch w early Pregnancy. By Martin Bellinger, M. 

[»., Barnwell, s! 0. 

The diagnosis of utero-gestatiou lias drawn the attention 
of medical philosophers from the earliest age. Its import- 
ance behooves every one to investigate the signs closely, for 
at every step in prorfessional life occasion may call for a 
prompt and decisive opinion. Xot only in a medico-legal 
point of view is it of importance, but the moral integrity 
of the family circle may rest on the medical man to estab- 
lish, or refute the suspicion of conception, and his fiat con- 
signs to ignomy or restores to social purity. The suspect- 
ed female may traverse an humble path, may be a slave to 
minister to the wants of those to whom God has given her 
services, but her social rights must be maintained. She 
may be the highest lady in the land, whose hand it was an 
honor to touch, and yet the fell suspicion can rest heavily 
on her and drive her to seek companionship with degraded 
beings. Her own sexw^ouldbe the first to spurn, for her hyper- 
critical at all times towards each other, they pitilessly lash 
the fame of the frail sister who deviates from rectitude. 
More vindictive than the slouth hound, for he pauses at 
blood ; the shroud of female scandal often envelopes the 
pale remains of the fallen. 

The object of this paper is to call attention to an import- 
taut element in the physical diagnosis of pregnancy. It is 
presented in this crude form in the hope that some of my 
'professional brethren may deem it of sufficient moment for 
the subject of investigation. To those of ample obstetrical 
practice, each day will furnish opportunity for the truth of 
the sign herein mentioned, and to those I look to prove its 
truth or falsity. 

I will briefly relate the circumstances which led me to its 
observation. Several years since, when first commencing 
to practice, I was requested by Mr, Andrew Dunbar, a 
planter of this vicinity, to ascertain if one of his negro 
women was pregnant, the work allotted to such being lighter 



1861.] Bellinger. Rectal Tmoh 35^ 

than otherwise. She was said to be two months advanced, 
I found morning Bicknees, suppressed menses and depres- 
sion of the aterus with enlargement of its neck. The 
mamma afforded no evidence, as she was nursing a twelve 
months child, which, of course, roughened the nipple. In 
addition to these Bigns 1 could detect no evidence of dis- 
. nor was there any complaint made. My opinion, 
therefore, to the owner was that though far too early to form 
a positive one. in all probability the woman had con- 
ceived. 

Time proved it to he a false diagnosis — the woman was 
not pregnant It was a ease of amenorrhea, with slight en- 
_e:nent of the cervix uteri. 

Cliarles Wot says, that he who learns truly from person- 
al ohscrvation, derives benefit even from his errors ; that 
his mistake will serve as beacons to indicate the breakers 
among which he was once wrecked. Bat the lesson taught 
here — never to give an opinion till the case was sufficiently 
advanced to be unmistakable — was of little avail. For, in a 
lice almost entirely of negroes, where the question of 
morality could never be considered, cases of amenorrhea 
would come and had to be discriminated from pregnancy. 
And frequently it is of primary importance to know the 
true uterine condition to avoid the detrimental use of certain 
drug 

So that whether I expressed an opinion or not, I was often 
compelled to form one or refrain from decisive treatment of 
the e: 

Tired of this uncertain course, I read every available 

work relative to the subject, but none, not even the work of 

the great Montgomery, afforded satisfaction. My attention 

er, drawn to Meigs' two recorded cases of al>- 

Uterus, and especially the means by which his 

ed. 

In case No. 1 he writes : "J requested the lady to lie on 
her back, and introducing the index finger of the right hand 



360 Bellinger. Rectal Touch. [May, 

as far as possible into the rectum, I explored with it the ex- 
cavation of the pelvis, in order to discover any tumor or 
organ that might he contained within that cavity; hut as 
all the tissues were ductile and very yielding, I began to sus. 
pect there was no womb in the case. Therefore, laying the 
fingers of the left hand upon the lowest part of the hypo- 
gaster and pressing them firmly towards the finger that was 
used in exploring the internal parts, I found they could be 
brought so near each other as to make it perfectly clear that 
there was no womb in the case; otherwise I must have felt it, 
so near was the approximation of the fingers of the right 
to those of the left hand." — (Meigs' Treat. Obstetrics, p. 
153.) 

Whilst a student I read the above case, merely regarding 
it as a good description of lucus naturcv. Now it acquired 
the utmost importance, for the deduction drawn was that 
the same procedure by which the absence of the uterus 
could be noted, would determine not only its presence but 
condition whether enlarged or not. 

Since then I have in numerous instances put the idea to 
the test of experience and every investigation, but serves to 
confirm my opinion of its value. 

I can speak with confidence as regards the rectal touch 
of pregnant and unpregnanted uteri of child-bearing woman. 
It has never fallen to my lot to examine the virgin uterus. 

The normal position of the unimpregnated uterus of the 
child-bearing woman is with its fundus on a level with the 
interoseous cartilege of the first and second verteba?. This 
point is distant, per rectum, from the anus about 4 J inches. 
If the anus is pressed strongly toward the uterus the dis- 
tance is lessened from \ to \ inch. When conception takes 
place the uterus, increasing in weight, decend still lower, 
there to remain till a little beyond the third month, when it 
gradually ascends into the abdomen. 

When a woman is to be examined, she may be placed on 
her back, or what is better, on the left side in the ordinary 



1861.] Bellinger, Rectal Touch. 361 

obstetric position. One hand of the accoucher is placed on 
the hypo-gastrium and pressed firmly downwards and 
backwards toward the uterus. The middle (being the long- 
finger of the other hand is well oiled and passed into 
the rectum as far as the metacarpo-phalangsel joints. The 
finger now comes in contact with tbe uterus, situated an- 
teriority. If pregnant it will he found encroaching on the 
rectum, its characteristic pear-shaped enlargement well de- 
fined ; if not pregnant, the finger carried strongly fowards 
ascertains its size. 

The second and third months arc the most favorable 
period- tor exploration for then the uterus is fully within 
reach of the finger audits enlargement more plainly noted. 
Rut even up to the fourth month it can he examined with 
sufficient accuracy to form a diagnosis. 

It may he established as a principle that the uterus in the 
female can he examined per rectum with the same facility 
as the prostate gland in the male, and any deviation from 
the ordinary size as accurately detected. On this principle 
ts this simple means of diagnosis. Applicable only to 
the early months, at a time when all other symptoms are 
ohseure, it is of great value. As a negative sign it is abso- 
lutely certain, for the ahsence of uterine enlargement indi- 
cates its non-impregnated condition. It is not an absolutely 
positive sign because merely increased uterine size can 
never he held as pathognomonic of utero gestation. Here 
the method of diagnosis by exclusion must he instituted, 
having reference to uterine hypertrophy, tumors, &c. And 
when the enlargement is pear-shaped, when its progressive 
increase corresponds with other (per se equivocal) signs of 
ad where there is an ahsence of all evidence of 
. the woman on the contrary in blooming health, 
we will have woven a tissue of evidence before which all 
must vanish. 



362 Neeson. Dislocations of [May, 

ARTICLE XII. 

A Diagnosis of the Dislocotions of the Hip Joint By Horace 

Neeson, M. !>., Augusta. 

| A s a supplement to an excellenl inaugural thesis, our 
iV'u'Tul Dr. Horace !N"eeson, presents the following sugges- 
tions on the diagnosis of dislocations of the hip joint. It is 
highly gratifying to us to find that the prolific idea of our 
distinguished colleague, Professor L. A. Dugas, has been so 
ingeniously extended and applied by one of his own pupils 
in the Medical College of Georgia. It will be remembered 
by our readers that I>r. Dugas presented his new method of 
diagnosis in a communication to the American Medical As- 
sociation during its session in the city of Nashville, Tenn., 
in the year 1857, and that it was published in the succced- 
ng volume of the Transactions of that body as well as in this 
journal, with four excellent photographic wood cut illustra- 
tions, showing definitely the idea of the author. Dr. 
Xeeson, whose ingenuity and thorough apprehension of the 
principle, is not the less entitled to great credit, deserves 
the thanks of the profession for thus adding his own valu- 
able quota to a, sometimes, difficult point of diagnosis. — 
[Eds. S. M. & S. Jour.] 

It has ever been the desire of man to do something for 
the good of his fellow man, from the raising of a blade of 
grass to the giving up of his life for a friend, so have I ad- 
ded this diagnosis in my thesis with the, perhaps, presump- 
tuous hope of assisting my fellow students, and not with 
any view towards extending it over a greater space. In 
studying Professor Dugas' diagnosis of the dislocation of 
the shoulder joints, I concluded that as the mechanical ar- 
rangement of the glenoid cavity in the upper circle of 
bones resembled that of the acetabulum in the inferior 
circle^ that this diagnosis could he applied to the dislocations 
of the former, if I. could learn the principle upon which it 
acted. Accordingto a well known geometrical axiom, "the 
zadii of all circles of the same length and with the same 
axis will describe the same arcs." 



1861.] The JI<p J 368 

Now, in the dislocation of the shoulder joint, if we take 
the glenoid cavity as the axis of a circle and the humerus as 

its radius, it will describe many arcs of circles, in this posi- 
tion which it will ho impossible lor il to do in the dislo- 
cated state. One of Huso arcs which it describes in the 
normal state is the placing of the ulna radial end of the 
humerus against the pazieties of the chest and moving it 
upwards towards the ensiform cartilage until the hand of the 
rotating arm can be placed upon the sound shoulder. This 
circle, or segment of a circle, our distinguished Professor of 
Surgery has often proved to he impossible for it to describe 
in the dislocated state. Now, if we will, in like manner 
take the acetabulum as the axis of a circle and the os femozis 
as one of its radii, we will find it will also describe arcs of 
circles in its normal position which are impossible for it to 
perform in the dislocated state. The most prominent of any 
of these arcs, that I have noticed, is that described by the os 
femozis in crossing the legs. If we thus cross tlie legs in 
the sound subject by letting the ankle fall, or pass just over 
the external condyle of the opposite femur we will be able 
to rotate the flexed leg though quite a large segment of a 
circle. Suppose we place the axis of this circle back upon 
the dorsum of the illiuni above the acetabulum. It would 
first be impossible to cross the legs, either at the knees or 
placing the ankle of the injured by upon the opposite knee, 
much less to flex it after crossing them. Thus it will be 
the same with any other displacement of the head of the 
humerus. This is not the case with a fracture of any part 
of this bone the great difficulty there is that it rotates too 
freely. 

Hoping that I have made this sufficiently lucid to be 
comprehended, I mi ctfully submit this means of di- 

agnosis to the consideration of those capable of b ling 

its value than mvself. 



3G4 Lectures on [^fay, 

/ fares on the Theory and Therapeutics of Convulsive Disea 
especially of Epilepsy, By Charles Bland Radcliffe, M. 1)., 
Fellow of the College, Physician to the Westminster 
Hospital, etc. 

LECTURE III. — (CONCLUDED FROM APRIL NUMBER.) 
///. The Theory of Spasm. — 1. In catalepsy, the state is 
closely akin to that of a corpse. The blood, indeed, is well- 
nigh Btagnant in the vessels ; and it may bo necessary to apply 
the car to the chest to know for a certainty that the heart 
continues to beat.' 

hi tetanus there is no fever. All observers are agreed upon 
this point. It is found also, that the spasms are apt to become 
more general and more violent as the pulse weakens and the 
animal heat departs. The bouts of spasm, moreover, are dis- 
tinctly coincident with paroxyms of difficulty of breathing; 
and in this way the spasm would seem to be connected, not 
with excitement of the circulation, but with a state in which 
the aeration of the blood is considerably interfered with. 
And, in the tetanus caused by strychnia, there is certainly 
nothing like vascular excitement; indeed, as we have already 
seen, the experiments of Dr. Harley afford conclusive proof 
that the addition of a very minute quantity of the poison to 
the blood might be considered as equivalent to a loss of two- 
thirds of the whole amount of blood, inasmuch as it diminished 
by two-thirds the power which the blood has of absorbing 
oxygen, and so becoming arterial. 

During the spasms of cholera, the skin is frigid, clammy, 
and blue, the breath cold, the pulse well-nigh imperceptible ; 
and that the coincidence of this state of collapse with the 
spasm is more than accidental, would seem to be evident from 
the fact that the spasms relax pari passu with the reaction of 
recovery. 

In hydropholtui, the state of the circulation is the very op- 
posite of fever, as is proved by the cold hands and feet, the 
perspiring skin, the quick and feeble pulse, the sobbing and 
sighing respiration, as well as by the fact that the agitation, 
spasm, and convulsion increase in violence as the circulation 
fails. Jt would seem also, that this very depression of circu- 
lation must be connected with the agitation, spasm, and con- 
vulsioo ; for, on looking over the histories ^i' a large number 
of cases, [find that there was less agitation, less spasm, less 
convulsion where the circulation was less depressed than usual. 

In spasmodic ergotism, so far as we know, the pulse pre- 
sents no siii-n of excitement throughout tin 1 whole course oi 
the malady. 



1861.] Convulsive Diseases. 365 

In the "early rigidity" of cerebral paralysis, there may he 
at first no very evident alteration in the cireulation, and the 
heat may nut fall below the normal standard ; hut before long, 
both pulse and heat fail in the paralysed parts. In " late 

rigidity," the local circulation is always feeble, and the heat 
in the part is kept up with difficulty. 

In acute spinal meningitis there may be symptoms of active 
fever at the onset, but, if so, these symptoms very shortly 
lapse into those belonging to the typhoid condition. Usually, 
however, the symptoms have a typhoid aspect from the begin- 
ning, and the respiration is too labored and imperfect to allow 
of a different state of things. In acute myelitis, the circula- 
tion is utterly without power ; and, as a collateral evidence of 
this fact, there is a marked disposition to slough in all the 
parts subjected to pressure. In chronic spinal meningitis, and 
10 chronic myelitis, the state is one of hectic exhaustion. 

In the different forms of minor spasm there is, for the most 
part, no evidence of over-action in the circulation ; nor is it 
otherwise when the phenomena of fever are mixed up with 
the spasm, as in whooping-cough. For what is the fact \ The 
tact is that the whoop, which is the audible sign of the spasm, 
- not make its appearance until the febrile or catarrhal 
stage has passed off; that it disappears if pneumonia, bron- 
chitis, or any other inflammation be developed in the course 
of the malady; and that it returns again when the inflamma- 
tion has departed. In this case also, as in laryngismus stridu- 
lus, the way in which the spasm is mixed up with the phe- 
nomena of partial suffocation is an argument that the blood is 
imperfectly arterialized during the spasm. 

•1. In the more severe forms of the disorders which arc 
characterized by spasm, the mental state is indicative of ex- 
haustion, prostration, or inaction. In catalepsy, the mind is 
in a deep sleep, or else lost in some dreamy vision. In tetanus, 
the patient is alarmed, absorbed in Ids sufferings, agitated. 
The cramps of cholera are attended by indifference to the 
future and utter hopelessness, than which there can bo no 
surer sign of utter mental prostration. In hydrophobia, every- 
thing denotes the want of mental energy, for the state is an 
exaggeration of delirium tremens. In ergotism, the mental 
borders closely upon fatuity. In both form- of the rigi- 
dity <»f cerebral paralysis, early as well as late, the brain has 
n r.eriously damaged by white softening, by apoplectic 
effusion, by red-softening, or in some other way, and the 
mental power has suffered accordingly. Nor is the case dif- 
ferent in other forms of spasm 



866 Lectures on fMay, 

The state of mind, indeed, is what it might be expected to 
be from the depressed state of the circulation ; and the de- 
pressed state of the circulation (to use once more the argu- 
ment used on so many previous occasions) is one which neces- 
sitates, as it would seem, a corresponding state of inaction, 
not only in the brain, but in the medulla oblongata, the spinal 
cord, and in all other parts of the nervous system. Nor do 
there appear to be any objections to this view in the back- 
ground. 

The traces of inflammation which are occasionally met with 
in the brain or spinal cord of persons dying of tetanus need 
be no such objection. It is evident that inflammation of these 
organs or their coverings is not an essential condition of the 
disease, for in the majority of cases — as in those occurring in 
Guy's Hospital since 1825 — there was not the slightest trace 
of such a lesion. Nay, it may even he said that the inflam- 
mation, where present, had served to mitigate or antagonize 
the tetanic contractions ; for it is certain that these contrac- 
tions may be developed in their most violent and perfect form 
where inflammation is most unequivocally absent, and that 
the contractions may be absent where- (as in many cases of 
inflammation of the cord or its membranes resulting from ac- 
cident) inflammation is most unequivocally present- 
In hydrophobia, also, as in tetanus, the cases in which traces 
of cerebro-spinal inflammation are not found after death are, 
to say the least, quite as numerous as the cases in which they 
are found ; and hence it is equally impossible to suppose that 
such inflammation is essential to the malady. It must be un- 
derstood, also, that the traces of inflammation in hydrophobia 
are met with almost anywhere and everywhere ; and thus it 
may be conjectured, with no small share of reason, that the 
inflammation in this malady is in reality a depurative process 
by which the system strives to rid itself of the virus, and that 
traces of inflammation are not usually found because death 
has happened before there had been time for the development 
of them. This vagueness in the seat of the traces of inflam- 
mation is well seen in a careful analysis of forty-six cases of 
hydrophobia by my brother, Mr. Kadeliife, of Guildford- 
Btreet. 

And certainly it is not easy to suppose that inflammation of 
the spinal cord or iis membranes is necessarily concerned in 
the production of spasm. On the contrary, it may be held 
that the inflammation lias antagonized or mitigated the spasm. 
For if violent and general tetanic Bymptoms may be developed 
in cases where the spinal cord is altogether untouched by in- 



1861.] : > ,; « 

{lamination, as in many cases of tetanus : and if, as is certainly 

the case, the tetanic symptoms are comparatively slight and 
fined to the back and nock, where the spinal cord is actu- 
ally and unmistakably Inflamed, Is it not fair to suppose thai 
the inflammation has had the effect of antagonizing or miti- 
gating the spasm \ 

As in the different varieties of tremor and convulsion, 
therefore, so in the different varieties of spasm, the facts would 
seem to be altogether at variance with the idea that the mus- 
cles are provoked to excessive contraction by excessive stim- 
ulation of any kind. The facts, it would seem, are at complete 
variance with this idea, and in as complete harmony with that 
theory of muscular motion which was propounded in the first 
lecture. It would seem, in short, that the key to the pathology 
is supplied by the physiology, and that the physiology is con- 
tinued and established by the pathology. It is the same story 
throughout. 

J I. — The Therapeutics of Convulsive Diseases. — Arguing 
from the physiological and pathological premises, it may be 
inferred that the fact of tremor, or convulsion, or spasm, can, 
in no single instance, be urged as a plea for the adoption of 
" lowering measures." It may be inferred, indeed, that the 
great desideratum in every convulsive affection is a more vig- 
orous circulation and a purer blood, and that the remedies to 
be sought after will be those which bring about these changes. 

1. I know of no facts which show that a low diet is bene- 
ficial in epilepsy. On the contrary, I know of many instances 
where the patient has been undoubtedly benefitted by the 
abandonment of such a diet. The meals, of course, must 
always be regulated .-<» as t<> guard the stomach from an over- 
load of food; but of the two evils, abstinence is more to be 
dreaded than repletion. It would seem, iifdeed, as if the sto- 
mach of a confirmed epileptic can never be allowed to remain 
entirely empty, without some risk of an attack. As a rule, 
Qulants, of one kind or another, would seem to be very 
serviceable, in some cases, it is true, malt Liquors may be 
objectionable: but in thi >s it will generally be found 

that unquestionable good will result from a proper allowance 
nerrv, weak brandy-and-Water, or, belter still; of claret. 
Indeed, I am satisfied that epileptics, and nervous patients 
rally, will have good rea overlook the shortcomings 

aty by which, at reasonable rates, they will 
substitute the light wines of France for tin- fiery 
wine- Mt" Spain and Portugal, and the strong ales of our own 
bre . would Beem to bo a more suitable 



3G8 Lectures on [May* 

beverage than its Lees stimulating companion, tea, particularly 
at an early period of the day. 

It is, no doubt, of extreme importance to prevent the accu- 
mulation of effete matters in the bowels, and to remove such 
accumulation when it lias taken place; but whether purga- 
tives are the proper remedies is not quite so certain. If the 
bowels do not act with sufficient regularity, there is, in all 
probability, some error in the diet — some excess of animal 
Food, some deficiency of culinary vegetables and fruit; and 
the first thing to be done is, obviously, to correct this error. 
And this is often all that is wanted, if care be taken to explain 
to the patient that his bowels can act without purgatives, and 
that he need not — particularly if advanced or advancing in 
life — be altogether cast down if now and then they do not act 
every day. Indeed, if the diet be properly regulated, and this 
explanation made, the patient will generally have the satis- 
faction of finding his tongue clean, when he remembers to 
look at it, and of forgetting his stomach and bowels altogether. 

Or if the result be not quite so satisfactory, an occasional 
injection of cold water or brine, on getting up in the morning, 
will rarely fail to set matters right, and that without disturb- 
ing the digestion in any way, or producing disagreeable feel- 
ings of depression or irritability. 

As to the rest, it appears to be advisable to order the habits 
in such a way as to save the strength as much as possible. 
Proper exercise is, of course, necessary ; gymnastic exercise, 
by which the chest is expanded, and the respiratory capacity 
increased, are valuable adjuvants; but it is no less certain that 
muscular exertion upon or beyond the verge of fatigue must 
be looked upon as a common cause of the epileptic attack. 
As a rule, also, it would seem that epileptics require more 
than the average amount of sleep, to enable them to recover 
from the multifarious fatigues of the day and night. 

The more strictly medical part of the treatment of epilepsy 
is a subject of no small difficulty. The treatment of the pres- 
ent day is very different from what it was when almost all 
disorders were referred to inflammation or over-action of one 
kind <>r other. Practically the lancet is new abandoned, and 
leeches are in a fair way of being left undisturbed in their 
swampy homes; practically, also, it has ceased to be the habit 
to distresf the Btomach and bowels by the frequent use of 
strong purgatives or emetics ; and this change may be appealed 
to as an argument that " Lowering measures" had disappoint- 
ed the hopes of those who had tried them so long and so pa- 
tiently, and who gave them up so unwillingly. Be this as it 



18G1.] Coi> 369 

may, cliaoge has come over the treatment of epilepsy, 

and the remedies at present most in vogue in this country arc 

►f zinc, copper and silver, particularly the 
le of zinc, ami the ammonio-sulphate of copper. 

r fancy for oxide of zinc has been caught from 
M. Herpin, who has dei ibstantial volume to the pnr- 

ihat many cases of epilepsy may be cured by 
the vigorous and persevering use of this remedy. In this 
work, M. Herpin relates thirty-ei f epilepsy or epi- 

leptiform disease, in nearly all of which he gave the oxide <>t" 
zinc; but, as I have elsewhere shown, the favorable opinion 
of thi - I > the virtue of this medicine is by no 

means home ont by an analysis of those cases. It would ap- 
pear, liar M. Herpin himself has become less con- 
fident than he was in 1852, when he wrote the work in ques- 
a more recent statement is, "que l'oxyde de zinc, ne 
mt point d'etre convenable pour les enfans et les vieil- 
lards, echoue tres souvent chez les adults." M. Delasiauve, 
liese words, tells us that one reason for this change 
of opinion was the absolute failure of an experiment in the 
Bicetre, in which one of the physicians of the establishment, 
M. Moreau, treated eleven adult epileptics in every particular 
after M. Herpin's method. M. Delasiauve also tells us that 
M. Herpin now gives the preference to the ammonio-sulphate 
:• in the treatment of adults. I might argue, also, 
that his faith is even shaken in this remedy, for I have recently 
ne patient, who had previously been under 
him, in wIioe lie abandoned the copper after a very short 

ble simple, of which I shall have 
.1 speak favorably as to the re- 
the trials, nine in number, in which 1 gave oxide of 
zinc after M. Herpin's method ; and my experience in this 
ct agrees fully with that of my friend and colleague Dr. 
Marcet, who, more perhaps than any other man in this cpun- 
put this ' treatment to the test of experience. 

At the same time, it does not follow that zinc is of no value 
in epilepsy. On the contrary, the probability is, that it is a 
lerable value in the proper case and in mod- 
and thi- opii a little supported by the 

-ult.- which Dr. Marcet has recently found to at- 
tend In many form- of nervous excitability. Of the 
rprepan zinc it is no! ak, for there 
ilieve that their action for good or evil is 
ride. 
It i tain any sound evidence of the value of 
24 



870 hires on [^ a y 

tlir aminonio'sulphate of copper in epilepsy. Speaking of the 
cases recorded in his published work, M. Herpin says that, 
including relapses, he obtained fourteen cures in eighteen pa- 
tients; but when these cures are fairly analyzed, they do not 
turn out to be a whit more satisfactory than those which he 
ascribes to the oxide of zinc. Nor do I know of anything 
thoroughly satisfactory in the experience of others. For my- 
self I oughl scarcely, perhaps, to express an opinion, for I 
have never given the medicine a fair trial ; hut I have met 
with several patients who have taken it, under the advice of 
other physicians, and of these I have no hesitation in saying, 
that n<>r a few, on being asked how they were affected, have 
said that they felt more nervous while taking it, and that no 
beneficial change was produced in the fits. 

With respect to nitrate of silver little need be said. I have 
had three patients under my care whose skin, before they saw 
me, had been tinged of a dismal grey color, and whose fits had 
been worse, rather than better, during the time they were ta- 
king the silver ; and many cases arc on record which show 
that this evil may happen without any countervailing good. 

"Of all the metallic remedi s Dr. Watson, " I should 

prefer some preparation of zinc or iron ;" and I believe there 
are signs of change of opinion in the minds of many thought- 
ful men, and that before long iron maybe placed before zinc, 
and not after it. If, as has been said, the inferences from the 
premises is that the desideratum in epilepsy is a more vigo- 
rous circulation and a purer blood, it is to be expected that 
iron may not unfrequently be wanted ; and this expectation 
is not belied by my own experience. At the same time I 
must confess that there are many cases in which this remedy 
fails to bring about any beneficial result, and where harm 
rather than good may be said to attend its use. 

In many cases, also, another common remedy, which is not 
mentioned in Dr. Watson's chapter on epilepsy, and which is 
also overlooked by almost every other author, would seem to 
do good. This is quinine. But with this remedy, as with 
iron, it must also be confessed that there arc other cases in 
which, to say the least, the good done is not unequivocal. 

In a w<»rd, it i> exceedingly difficult, in the present state of 
our knowledge, to decide as to the value of these remedies in 
epilepsy; bur that zinc i- no specific, and that the common 
tonic- mentioned are not of themselves sufficient, must, I doubt 
not, be the c d "T every one who has had sufficient ex- 

perience in the matter. 

Where, then, must we turn for what is wanting? Is it to 



1861.] 871 

remedies of a directly stimulating character! Is it to reme- 
dies which may be supposed to purity the blood from certain 
matters which ought to be excreted, but which being retained 

produce a depressed or oppressed state of the circulation \ 

"It"." saysJ)r. Watson, "] were called upon to name any 
single drug from which, in ordinary case.- of epilepsy, I should 
hope for relief, I should Bay it was the oil of turpentine. 
And 1 find that other physicians have come to the same con- 
clusion. Dr. Latham, the elder, was, I believe, the first per- 
son who made known its efficacy in this disorder. Foville 
states that he has seen excellent effects from it. It is highly 
spoken of by Dr. Perceval in the 'Dublin Hospital Reports' 
It is not given in large doses, but in smaller ones frequently 
repeated ; from half a drachm every six hours/' And that 
turpentine is a valuable remedy in epilepsy, very valuable, I 
have no doubt whatever. 

Another remedy which puts in its claim for approval is 
valerian. This is a very favorite remedy, both in this coun- 
try and elsewhere, and its claims, though not equal to those 
of turpentine, appear to be in every way deserving of atten- 
tion. Recommended by Aretaeus and Dioscorides, and in use 
ever since, it was never other than a favorite remedy. Xow 
the prominent action of valerian is that of a stimulant — an 
action depending upon the presence of a composite volatile 
oil, of which one portion is a volatile acid, capable of forming 
It with bases, and known under the name of valerianic 
acid : and it is a natural guestion, after what we know of tur- 
pentine, whether the stimulating action of the drug does not 
show that it may be efficacious, and explain the secret of its 
efficacy. 

It is somewhat significant ako, that the sclinuni palustre is 
one of the four principal remedies to which 2>I. Iierpin has 
pinned his faith ; and not only so, but the one to which he 
gives precedence. These four remedies, ranked in the posi- 
tion belonging to them in an ordre dt are — sclinum 
palustre, ammonio-sulphate ot copper, oxide of zinc, and vale- 
rian. Now, selinum palustre is an unbelliferous plant, of 
which several grammes may be taken at once ; and, on ques- 
tion] four patients who have taken it, the answer 
was that they were warmed ami comforted by it. In other 
words, it- action would seem to be that of a feeble stimulant. 
circumstances, therefore — believing that a more 
act/ of the circulation is a desideratum in epilepsy, and 
having these practical i ats in favor of turpentine and 
valerian — a sufficiently natural question was whether cam- 



372 Lectures on [May, 

phor, naphtha, or ether in its various forms, or any of the 
stimulant gum-resins, or musk, or castor, or some other stim- 
ulant would be of use in epilepsy. Nor, if I can read aright 
the lessons of my own experience, is the answer different from 
what mighl be expected. 

That camphor is often a very valuable remedy in epilepsy, 
I have no doubt in my own mind. In doses of about three 
grains, twice or thrice a day, for a time, I have seen such re- 
sults as to justify me in ascribing to champhor all the virtues 
belonging to turpentine, with this addition in its favor — that 
it is not unpleasant to the taste, and that it exercises, or seems 
to exercise, a directly quieting influence over the generative 
and urinary organs. 

Naphtha also would seem to have the advantages without 
the disadvantages, of turpentine. In doses of from half a 
drachm to a drachm, and taken for some time, I have often 
had what seemed to me unequivocal evidence of its beneficial 
action. As a rule, also, a patient soon becomes indifferent to 
the taste, particularly if it has been redistilled more than once. 

Of the stimulant gum-resin, my experience is not very am- 
ple ; but I think I have seen enough to satisfy myself that, in 
several cases, they are of considerable value. Of musk and 
castor I have no experience. 

With respect to the different forms of ether, Hoffman's 
anodyne, chloric ether, spirits of nitric ether, and so on, there 
can, I think, be no doubt as to their great value as occasional 
remedies; and the same may be said of ammonia. In the 
majority of instances, it is only to this class of remedies we 
can trust for warding off a fit. In some cases, also, ammonia 
would seem to be of much use as an alkali in a point of view 
of which we have now to speak. But however beneficial 
stimulants may be, it is necessary to confess that they will not 
do all that is wanted. It would appear, indeed, as if some- 
thing were wanted which will carry out the second indication, 
and ensure — what has been spoken of as — a purer condition 
of the blood. Xor are we here altogether in the dark. 

" About fourteen months ago," wrote Sir Charles Locock 
in 1S53, "I was applied to by the parents of a lady who had 
had hysterical epilepsy for nine years, and had tried all the 
remedies that could be thought of by various medical men 
(myself amongst the number) without effect. This patient 
began to take oromidi of potassium last March twelvemonth, 
having just passed one of her menstrual periods, in which she 
had two attacks. She took ten grains three times a day foi 
three months; then the same dose tor a fortnight previous to 



v / 878 

each menstrual period; and for the last three or four months 
she lias taken them for only a week before menstruation. 
The result has been that Bhe has not had an attack during the 
whole of the period. I haw- also tried the remedy in fourteen 
or fifteen cases, and it has only failed in one, and in that one 
the patient had tits not only at the times of menstruation, hut 
als.> in the intervals." 

In using bromide of potassium in these cases, Sir Charles 
Locock's object was to calm an erotic disposition, which at- 
tended and aggravated the epileptic symptoms, and this end 
may have been, and in all probability was, answered. But 
this is certainly not the only way in which this remedy acts 
beneficially. On the contrary, after trying it in scores of 
- during the last two year.-. I can testify that bromide of 
potassium is a very valuable remedy in cases where there is 
not the slightest sign of an erotic disposition. I can testify, 
indeed, that this remedy has proved more or less serviceable 
in cases the most dissimilar in character — so serviceable that 
the name of Sir Charles Locock ought always to be remem- 
bered with gratitude by every epileptic, and by many suffer- 
ing from other kinds of convulsive disorder. How to explain 
the modi ndi of this medicine is no very easy matter ; 

but I am inclined to think that this in part at least, is by an 
alterate action upon the blood analogous to that produced by 
iodide of potassium and common salt — an action by which, 

sibly, the blood may be kept free from compounds analo- 
gous to uric acid. And this I do, because for a long time, 1 
have found decided benefit from occasional doses of a mixture 
containing bicarbonate of potass and iodide of potassium, with 
or without a drop or two of tincture of colchicum or wine of 
white hellebore At any rate, the alkaline character of the 
pound would seem to be necessary in some cases; for on 
looking over about thirty cases in which I tried bromide of 
iron, as well as bromide of potassium, I find that in the ma- 
jority the latter preparation had a more beneficial action than 
the former. 

At any rate there can be no doubt that a healthy action of 
the kidney, and of every organ by which the blood is kept 
in a state ofpuri ssential to the successful treatment of 

epih 

But, it may be asked, what is to be said of the thousand 
which have been recommended from time to time \ 
What, amongst others of strychnia, belladonna, conrum, coty- 
ledon, umbilicus, poudre de Neuchatel, tracheotomy and cau- 
terizatic i 



374 Lectures on [May, 

Strychnia, as all know, was a favorite remedy with the late 
Dr. Marshall Hall ; but the dose was attenuated to such a de- 
gree as to render it somewhat difficult to believe that much 
good came of it. Dr. Hall, indeed, distinctly allowed that 
harm is done if the dose be sufficient to produce the physio- 
logical effects of the drug. 

Belladonna — a remedy recommended by Stoerk, and used 
some years afterwards by MM. Debreyne and Bretonneau — 
has been again brought into notice by M. Trousseau, who 
says he has employed this remedy for twelve years, and al- 
ways had under treatment from eight to ten patients. He 
says, further, that of 150 persons so treated, 20 have been 
cured, or, at any rate, that their fits have not returned; and 
that Mr. Blacke > who employed it during the same period in 
a large private practice, has met with a like proportion of suc- 
cesses and failures. It is a fair question, however, whether 13 
per cent, of successes (which may, possibly, in part at least, 
be explained in a different way) can be regarded as sufficiently 
conclusive evidence in favor of the remedy ; and this the 
more, as other practitioners, M. Delasiauve among the num- 
ber, have been less successful. Judging from my own expe- 
rience, my impression would be that belladonna is of very 
doubtful value. JSTor is a more favorable conclusion to be 
drawn respecting conium. I have tried this remedy in several 
cases, in small and also in full doses; but the result was no 
more satisfactory than that which had been already arrived at 
by Professor Sc'hroeder Van der Kolk. 

With regard to cotyledon umbilicus, it is not very easy to 
believe in any powers beyond those which may be derived 
from the imagination acting upon a new and innocent medi- 
cine. It is very possible, also, that some part of the benefit, 
where there has been any benefit, may.be ascribed to the 
leaving off of some less innocent drug. 

Poudre de JS'euchatel is a remedy which has some credit in 
Switzerland, and which has lately been brought prominently 
under our notice by having been given in some of the cases 
recorded by M. ITerpin. And what is this remedy ? It is 
none other than the powder of taupe grille — in plain English, 
fried mole. It is, indeed, a relic of the days when animal re- 
mains, of a more objectionable character, fried or otherwise, 
were offered to the unhappy epileptic, hi justice to Mr. 
Herpin, however, it must be said that he does not believe in 
this out-of-the-way remedy. lie enly tries it when other 
remedies have failed. 

And certainly it must be allowed that tracheotomy does not 



1861.] 375 

realize all the original hopes of Dr. Marshall Hall. It does 
not always, perhaps usually, make the convulsion slighter. 
It does not prevent danger, for (as I have shown elsewhere) of 
the few patients upon whom the operation was performed, 
three have died either in the tit, or in connection with the fit, 
and of the three the opening was free from all obstruction, at 
least in one. The first two eases, indeed, were calculated to 
damp the hopes of any one less sanguine than Dr. Marshall 
Hall. In the first case, the patient was a boatman, aged 
twenty-four, epileptic for seven or eight years, and whose tits 
were frequent and severe. The operation was performed by 
the late Mr. Cane, of Oxbridge, during a fit of u asphyxial 
coma," which had lasted nineteen hours. The relief was im 
mediate, and for some months afterwards the fits were absent; 
but unfortunately for the credit of the operation, the patient, 
not liking the gurgling noise and the muteness consequent 
upon the unnatural opening in his windpipe, had chosen to 
icear the tube with its opening carefully corked up. This in- 
formation I had from Mr. Cane himself. Very soon after- 
wards the man was lost sight of, having been discharged from 
his situation for drunkenness. In the second case, that of a 
woman, aged thirty-six, death happened in a jit about twenty 
months after the operation, and it is certain that the tube was 
open at the time. It is certain, also, that the fits continued 
after the operation, possibly a little less frequently and se- 
verely, but decidedly of the same. 

As to the value of cauterizing the larynx, it is less easy to 
come to a conclusion. Dr. Brown-Sequard says that a third 
of his epileptic guinea-pigs were cureel by this mode of treat- 
ment, and that all the rest, with the exception of two or three, 
were relieved ; and he suggests a similar mode of treatment 
in epilepsy. A little later, Dr. Eben Watson, of Glasgow, 
recommended a similar mode of treatment, and relates three 
cases — two by himself, and one by Dr. Horace Green, of New 
York — in which the treatment appears to have been carried 
out with benefit. Dr. Brown-Sequard also lays .-tress upon 
cauU ■ parts, as in the nape of the neck, and 

especially in the neighborhood in which the aura originates, 
and he prefers the moxa or hot iron to milder measures. This 
practice, he tells us, proved wry successful in his epileptic 
guinea-pigs. In a word. Dr. Brown-Sequard furnishes us with 
some additional facts in favor of counter-irritants as a means 
of cure in epilepsy ; and not only so, but he gives a hint which 
may prove I some practical value, in pointing out the 

larynx, and the locality in which the aura originates, as sites 



376 Lectures on [May, 

in which "counter-irritation" may le especially serviceable. 
Now, the verdict of past experience is very much in favor of 
counter irritants, and I can well believe that this verdict is 
true — true because the inflammation caused by the counter- 
irritant may for the time rouse the sluggish circulation of the 
epileptic towards a pitch of safety, and because the discharge 
may tend to rid the blood of some impurity ; but my own ex- 
perience in this matter is too limited to enable me to arrive at 
a sound conclusion. 

With regard to the treatment of the epileptic lit little need 
be said. As a rule, it will be only necessary to take care that 
the patient does not injure himself ; that the head is not al- 
lowed to hang too low ; and that any necklace or neckerchief 
be loosened. If salt be at hand, a spoonful may be put into 
to the month ; if water be within reach, a little may be sprin- 
kled upon the face, though the advantages of such a practice 
are scarcely sufficient to compensate for disadvantages and 
risks arising from wetted garments. In ordinary epilepsy, it 
can scarcely ever be necessary to have recourse to chloroform, 
as it may be in some prolonged epileptiform affections ; but 
if the convulsive stage is unusually prolonged, no remedy 
would seem to be more appropriate and effectual. 

In concluding these brief remarks upon the therapeutics of 
epilepsy, we may say with Marshall Hall — "There is no royal 
road to the cure of epilepsy. The idea of a remedj^ for the 
disease is unphilosophical ; and the treatment should consist 
in a well-advised plan, embracing every means of good, and 
avoiding every means of harm." 

2. A single word must serve for what has to bo said upon 
the therapeutics of other convulsive diseases. Where these 
diseases are of a chronic character, whether the convulsive 
symptom be tremor, convulsion, or spasm, it matters not which, 
there appears no reason for adopting an opposite plan of treat- 
ment to that which has appeared to be necessary in ordinary 
epilepsy. Nor does the case appear to be different where the 
convulsive symptom is associated with disease of an acute 
character, inflammation, in itself, is no longer regarded as a 
sound argument for the adoption of lowering measures ; and 
if inflammation in itself does not cull for these measures, it 
certainly does not follow that a louder call is made by the oc- 
currence of tremor, or convulsion, or spasm, before or after 
the inflammation. On the contrary, the natural inference 
from the premises is, that the convulsive movement might 
often have been prevented by more carefully husbanding the 
strength" of the patient. According to the premises, indeed, 









mvnlsion, or spasm, would be a reason 
• Casing blood, ratber tban for abstracting blood exccp , 
>e rbap in one single case, and there is where, from the unn- 
El prolongation and severity of the asphyxia in a first atta ck 

3Ua i .. t v . ... ,a„+ ,n Kviin'ini nun's. And 



;Ul>lVH01l' r ;iUi'iianu .^^l.^. -- , 

ttere is danger of baemorrbage into tlie Wain and lungs. And 
Mainly there is no practical ob ection to bis view, or all 
, st know that we have no reason to be satisfied with the re- 
Ste of a lowering plan of treatment m acnte convulsive dis- 
ordci 



er 
m 

si 



Rattlesnake Bites. 3 ?? 



he Treatment of Rattlesnake Bites, with Experimental 
ms upon the various remedies now in use. Jiy b. 
Wler Mitchell, M. D. 



The subject of the poisons made use of by certain animals 
has been in all times of the utmost interest to the popular 
bind That it has failed to attract an equal or proportion- 
al amount of scientific investigation, can only be accounted 
for by supposing that the popular aversion to serpents as 
Cell as the real danger which more or less surrounds the 
pursuit have combined to deter toxicologists from engaging 
In such researches. The admirable effort in this direction 
bade by the Abbe Fontana, who has left us the record ol 
periments on viper poisoning, may also have done 
to prevent further study of this serpent, since 
his opinionshavebeen reverentially received as imaland the 
multitude of his experiments has caused them to be looked 
a as exhaustive of the subject. 
In other than European countries, and where the moic 
virulent poisonous snakes abound, observers have been 
wanting, or they have lacked those means of pursuing the 
study which only a great city affords. It has thus happened 
that through want of material where observers were plenty, 
or lack of these where material was abundant, the know- 
ie dg pent venoms has advanced but little Bince the 

davs of Fontana. . 

JBefore the time of thai great toxicologist, viper venom 

had tudied by Charas, 1669, Redi, 1672 and 1675, 

aiul vi« A multitude of others had also touched 

the - but on the whole, they added nothing import- 

rmation which came down from the Greek 

•nan fathers of medicine; or. when they added any- 

tlli] tape of fanciful conjecture, and served 

on i, Q ore difficult thetask of unraveling the united 



Rattlesnake Bites. [May, 

web and woof of popular and scientific beliefs as to venom- 
ous serpents. 

Without carefully reviewing this mass of strange 
opinions and superstitious conceptions, it is not possible to 
appreciate the services done by Fontana in clearing the 
ground for modern research and in setting at rest a host of 
minor absurdities. .Most of the definite and novel views 
which he put forth as the direct results of his experiments 
have been more or less unsettled by various partial inquiries 
of more modern date: but, on the other hand, some of the 
most valuable facts which he discovered have never been 
questioned; and, as a whole, his essay, or series of essays, 
is still a monument of industry, ingeniously directed, and of 
experimental sagacity of the highest order. 

From 17(37, the date of his essays, no contributions of any 
moment were made to the toxicology of venoms until the 
publication of Russel on the Poisonous Serpents of India, 
in 1787. 
% In 1798 and 1709 appeared in this country Dr. Barton's 
ys, which were rather records of his own thoughts and 
of popular and other opinions than of original research. In 
1817, Mangili settled the question of the innocency of venom 
taken by the mouth ; and 1843, Prince Lucian Bonaparte 
analyzed the venom of the viper, and determined its albu 
minous nature. At various periods also appeared numer- 
ous papers by East Indian surgeons and European physi- 
cians on the therapeutics of snake bites; but with trifling 
exceptions, no further experimental papers were produced 
until Drs. Brainard and Green recorded their researches in 
1853. Dr. Brainard's separate Essay, 1854, contained in- 
teresting observations as to the phenomona of venom poi- 
soning, but the main object of both ihe papers alluded to 
was the examination of the value of iodine used locally as an 
antidote. The tendency to regard the subject chiefly from 
a therapeutical point of view has indeed prevailed through- 
out nearly all of the res< made either in this country, 
in India, or in Europe, so that if we omit the essays of 
Bonaparte, Mangili, Russel,and Davy, the work of Fontana 
still remains without a companion — no one since his time 
having examined any one serpent poisonas to its chemistry, 
toxicology, and mode of formation. Yet, as every physician 
musi concede, the treatment of snake bites can never be 
rationally understood until we retrace our steps and study 
anew and more profound the venom malady and its cause, 



II.] Rattlesnake Bit 379 

in place of playing at perilous hap-hazard with its difficult 
therapeul 

Whenlfira tudy of the venom of the 

rattlesnake, it was with the intention of ascertaining what 
value Bibron's antidote possessed. To effect this single 
end I procured four or five snakes from th< ylvania 

Alleghanies and proceeded to subject animals to their fangs, 
and afterwards to give the supposed antidote.' 

After destroying many animals and attaining only nega- 
tive results. I began to perceive that I was working in the 
dark, and that it was altogether impossibe to obtain useful 
results without possessing definite knowledge as to the 
nature of the venom, the mode of its formation and ejection, 
and the whole natural history of the disease to which it 
gave rise. 

The information which I desired was yet to be created. 
It existed in none of the hooks, and even so much of it as had 
[uired by Fontana with regard to the viper, might 
rue of the rattlesnake. 
With a clear sense of these deficiencies in the present 
knowledge as to venom poisoning, I laid aside my 
on remedies, only to resume them after the 
mmers had removed from my path the im- 
pediments which have hitherto rendered the study of anti- 
dotes practically . The result of these research* 

riled at length in a paper recently published by the 

Smithsonian Institution, and to which I desire to refer the 

Ler for full details of my experiments, and for the con- 

- to which they led me.* The principal difficulty 

which I encountered at the outset was the want of snakes ; 

owii . to the ready and constant aid which I re- 

from the Smithsonian Institution, I was enabled to 

ply from the Virginia Alleghanies, and 

with these and such other chance supplies as I could pur- 

rocured for me through the kindness of 

:ahled to pursue ray purpose with only 

long to the subject. 

difficulties which lay in the way of one 



ition 
Wier 
ition. 

Jam: Vv> V«»rk: 1) 

■ 



380 Rattlesnake Bites. [^fay, 

studying the treatment of snake bites were among the most 
easily resolved of the many questions which multiplied in 
number and increased in perplexity as I advanced on this 
interesting path of study, fn fact,* I cannot but perceive 
that I have re-opened a field of research which promises 
most valuable and strange results to the toxicologist, nor 
can [fail to comprehend that the whole subject of venom 
poisoning is to be reconstructed, and that on no branch of 
science are we so utterly ignorant as on this one. M. Ber- 
nard alone, of all the recent writers, seems to be aware of 
our lack of knowledge in this direction, and strongly urges 
a re-examination of the principal animal poisons, such as 
the venom of toadsf and serpents. 

At the close of the Smithsonian Essay, just referred to, 
1 have given a brief statement of my views as to antidotes, 
and as to the great difficulties attendant upon their thorough 
study, and I have appended a short discussion of the rela- 
tive value of various remedial means now in repute for the 
treatment of snake bites, as well as my own opinion on the 
rational method of treating these injuria 

The object ot this present essay is to consider all the best 
known antidotes by the light of the practical criticism of 
experiment, and, finally, to point out what means of treat- 
ment appear to be best calculated to relieve the sufferers 
from these dreaded accidents. 

The course of study thus laid down will involve an ex- 
amination of the following points, which I shall consider at 
such length as my space permits: 

1. Fallacies in regard to the use of antidotes of all kinds, 
arising from want of exact knowledge as to the secretion ot 
venom, and the mode in which the serpent uses its fangs and 
ejects the poison. 

2. Falacies as to antidotes, arising from want of informa- 
tion on the natural history of the disease caused by the 
venom. 

3. General considerations as to antidotes, and as to the 
mode of conducting researches in this direction so as to 
avoid errors. 



ind Gazette, Sept. i2-.m1i. I860, p. 296. M. Bernard 
mak< teresting remarks on the venom Of the toad. ~S\. Gratiolel 

had already examined thissnbjecl mid arrived at somewhat similar con- 
clusions, to which, however, M. Bernard does not allude. See Gratiolet. 
Oomptes Rendus, vol. xxxiv. p. 732, 1851. 



1.] fi / 381 

Description of the ph< a of rattlesnake 

anal tc. 

:al treatment Experimental examination of tho 

medication most in repute. 

aeral or constitutional treatment. Experimental 
examination of the principal constitutional remedies. 

7. Sketch of the author's views as to treatment, local and 
general. 

1. Fallacies in regard to the use oi antidores oi all kinds, 
arising from want of exact knowledge as to the »u of 

venom, and the mode in which the serpent uses its fangs 
and ejects the poison. When antidote has been given, 
any treatment used after a snake has bitten a man or a lower 
animal, it is usually taken for granted that the danger of 
any two bites is much the same if the subjects of the bites 
are alike in age or vigor. Xow, even when the serpents are 
themselves of equal bulk and have at disposal drop for drop 
the same amount of venom, it may chance, that the danger 
of the two bites is utterly unequal, and thus that in one an 
antidote might fail, and in the other appear to succeed. 
This arises from one of the following reasons : 

The snake fails to elevate its fangs sufficiently when 

striking, and the fang points touching the skin are driven 

backward toward their usual position of repose without 

•irating the part aimed at. When this accident occurs 

no wound is inflicted unless the teeth of the lower jaw be- 

. tangled in the skin of the bitten part, in which i 
the small wounds thus made maybe easily mistaken for 
fang mark-. When experimenting with Bibroh's antidote, 
in duly, 1859, a large dog was scoured and placed within 
:h of a -make which struck it fiercely and became fasten- 
ed for a short time, so that I was able to perceive that the 
fangs were doubled backward, their anterior convexities 
the skin to which the Berpent was attached 
by the curved teeth of its lower jaw. The wounds made by 
-e teeth were of c and the d^'j; experienced 

no further inconvenience. Thie >f failure in the bite 

rt be difficult of detection, under ordinary circumstances 
the s!iak «', since it would be dangerous to ap- 

proa e the snake is usually entangled i'nv 

out a brief period. When, however, ti held 

by the middle, in a leathern loop at the end of a stiif, and 
thus allowed to bite, they not unfrequently fail to elevate 
triciently, and, as in experiments on antid 



382 Rattlesnake Bites. [May, 

it is often necessary to secure the serpents in the manner 
described, the possibility of this occurrence should not he 
overlooked. 

'When tin 1 rattlesnake bites, whether it he at perfect free- 
dom or not, both fangs do not always pierce the skin of the 
animal stricken. I have sometimes suspected that the ser- 
pent does not always elevate hoth fangs. This, however, 
is a point which does not readily admit of direct observa- 
tion in snakes at liberty, and can only add, that of seven 
dogs bitten by serpents at freedom, four had two fang 
] narks, and three had hut one. Now, as the fang, duct, 
and gland of one side are quite distinct from those of the 
other, if only one fang he used, the dose of poison adminis- 
tered will he hut one-half of that which would he injected 
were hoth fangs employed. 

Apart from the possibility of the snake using only one 
fang at will, there are other facts in this connection which 
may enahle us to explain the frequent occurrence of single 
fang marks. When, for example, the snake strikes 
obliquely at the Hank of an animal, one fang sometimes 
remains out of reach of the part penetrated by the other, 
and this is the more apt to occur, because, in elevating the 
fang teeth, at the moment of attack, their extremities are 
made to diverge widely.* For a like reason, when the ser- 
pent strikes a small limb or member, it sometimes chances 
that the fangs either straddle the part completely, or that 
entering it, the other passes it to one side without in any 
way injuring its tissues. 

Besides these cases of fang marks, many instances occur 
in which, although hoth fangs penetrate the opposing tis- 
sues, only one is in reality active, or, hoth entering the flesh 
for reasons to be presently detailed a part,. or perhaps in 
some cases the whole of the venom fails to he injecteel, and 
the danger of the wound is materially lessened. 

"When the fangs in biting arc fixed in the flesh, the lower 
jaw of the serpent is pressed upward against the part bitten 
and at the same instant the temporal muscles, and especial- 
ly the anterior temporal, compress the venom gland, and 



Tin- object of this Beemsto he to protect the lower jaw from injury in 
■:iis< their aim and are driven downward, in which cases 
they would pierce the lower lip of the snake were it not that their diver- 
throws their points outside o\' it. 



1861.] 383 

urge its accumulated venom along the duct and through the 
!i. In most rhere both fangs have been used, the 

actions which bury the fangs more deeply, and inject the 
- 'ii, are consentaneous on both but sometimes a 

perceptible interval appears between the contraction of the 
right and left sets of muscles, so that a sudden motion of 
the bitten animal occasionally libera • fang 1>< 

charge of venom lias been duly deliver* 

Still more curious, however, is it, that we may have both 
fangs deeply buried in the flesh of an animal, and yvt not a 
drop of venom injected. The explanation of this source of 
fallacy in the use of remedial means is to be found 
in the following facts li, in his >hes on 

viper venom, published in 1675, Btates that the poison } i 
es down alongside ol the fang, and between it and the 
mucous cloak which covers it when at rest, and which is 
now known as the vagina dentis. Fontana disproved this 
statement, showing that the venom passes out through the 
canal of the fang. If, as I presume is the case, the arraj 
ment of which I shall presently speak belongs to the viper 
ell as the rattlesnake, both were right and both were 
wrong. Professor Christopher Johnston, of Baltimore, and 
Professor Jeftries Wyman have both of them recently des- 
cribed the venom duct of the rattlesnake as ending in a 
papilla, which projects into the basal aperture at the base of 
the fang. Upon close inspection it can be seen that no 
tissues connecting these two parts together in any direct 
manner, the end of the duct being held in close contact with 
the tang by the gum, which envelopes flic tooth, and through 
which the extremity of the duct When the far. 

couched, at rest, in its mucous sheath, the apposition of the 
tang and duct is still kept up, but is less perfect than when 
the fang is erect, since then the mucous cloak is thrown off 
the anterior convexity of the fang, and gathered in firm 
folds at the base of the tooth, firmly presses the papillary 
end of the duct into the lower orifice of the flu 

•h being the case, it can be seen that if the fang is not 
fully erected, or if, from any cause, the end of the duct is 
rated from the fang opening, a part or the whole of the 
m may escape between the fang and its mucous cloak, 
and tail innocuous on the skin of the bitten animal, hi a 
modified form this result often happens, and a part at least 
of the poison is cast on the skin, the larger portion travers- 
ing the duct, and probably the excess alone being wasted. 



384 Rattlesnake Bites. [Majl 

In direct experiments on animals I have often noted tin 
escape of venom alongside of the fang, and in general, the 
mure serpent's motions are interfered with during the experi 
ment the more likely is it that the whole or apart of the poisoi 
will he lost in the way I have mentioned. It thus happens thai 
\\w most vigorous serpent may become innocent at the verj 
moment of the bite, and that not even the most watchful 
attention will enable the observer to say that the remedj 
given was the cause of a bite proving mild in its effects! 
I have here urged, this, like other sources of fallacy, is 
most apt to appear when the serpent is held, and when thus 
we endeavor to cause the bite to occur in a particular part 
of the body of an animal. 

2. Fallacies to the value pf antidotes, arising from wan] 
of information in regard to the natural history of the dis- 
ease caused by the venom of serpents. There exists as 
idea, not confined to the popular mind, that the bite of the 
rattlesnake is an extremely fatal accident. Although wc 
have no full statistics which are available to settle the mat- 
ter, I have gathered enough information from various sources 
to enable me to assert with great confidence that it is fai 
less fatal than has been supposed. When making this 
statement, I do not mean to be understood as saying thai 
the rattlesnake is not a dangerous animal, but only that 
neither man nor dog need be regarded as condemned to 
death when wounded by it, whether remedial means arc 
afterward employed or not. A large rattlesnake long re- 
strained from biting will use his weapons no doubt with 
deadly effect, and'hence, when showmen have been bitten, 
they have rarely escaped. On the other hand, the greater 
number of such accidents, arising from serpents at freedom, 
will be apt to prove serious in their results, but not very 
often fatal. Of fifty-seven cases of rattlesnake bites which 
are given in full or merely mentioned in the journals, only 
five died ; and even if we make every allowance for the 
character of the reports, this evidence still remains sufficient- 
ly strong; nor have I found that it lost force in the pre- 
sence of such facts as my experiments on animals have 
brought before me. A close analysis of the table of casei 
in my Smithsonian essay, (p. 100,) with reference to the 
treatment and the result, brings us to the conclusion either 
that all treatment (oil, alcohol, iodine, ammonia, etc.,) is 
successful, or else that the greater part oi the cases must 
have survived under any form of medication. It can be 



1861.] fi 

shown, moreover that most of the plana of treatment em- 
ployed are utterly useless. 

Here, then, is a malady from which at least seven-eighths 
of the patients recover. The mere fact of their surviving 
can assuredly be no test of the value of apian of treatment. 
. that this or that ease did not die has been thus con- 
strued, and this cardinal error exists in almost all of the 
earlier examinations of antidotes, and in some of the later 
ones. 

Authors who have reported successful cases of the treat- 
ment of snake hires hy various means, have been further 
misled by a want of knowledge as to the duration of cases 
not treated at all, and as to the character of the recovery. 
general survey of a number of cases, and a careful study 
of animals bitten and not treated, can alone supply this lack 
of information as to the average natural nistory of cases un 
disturbed by any therapeutic resorts. Ai the result of such 
study, we learn that a few cases of rattlesnake bite die, that 
a few linger long ere recovery is complete, and that the 
larger proportion get well, and that with a degree of sudden- 
- which is sufficiently surprising, considered with refer- 
• to the serious character of the symptoms, and well 
calculated to deceive the credulous therapeutist. 

In many cases this abrupt departure of all serious symp- 
toms at remarkable ; a man is bitten, thought to be 
dying, treated this or that way. and on horseback or »t 
work forty-eight hours from the time of the bite. In dofc? 
bitten, alike result obtains and the recovery after the mot*, 
urgent symptoms is usually rapid and compl 

Now nothing is more gratifying to the physician thai. 
the sudden effect of his remedies; and the speedy and 
favorable change of a case from an appearance o\ % extreme 
danger to one of relief and convalescence, naturally leads 
him to attribute that result to his medication, which really 
was natural to the malady. A fuller acquaintance with the 
rt annihilate this source of error for any but the 
r incautious minds, 
[t will now be fitting to consider the third section of 
our subject, and to comprehend clearly how we avoid the 
of falacy above pointed out, and how the study of 
antic 1 serpent] should be conducted. 

And first, what is an antidote ': The popular mind usu- 
ally conceives of it as a remedy having power to neutralize 
directly in the system a given poison, destroying its potency 



". s 'i Rattlesnake Bites. [May, 

by acting upon it chemically or otherwise, in some more 
mysterious way. It is possible that agents of this kind may 
exist, lmt thus far we are ignorant of any possessing such a 
relation to the venom of the rattlesnake. The pretensions 
of remedies supposed to he so gifted may be easily settled 
by mingling them with the venom, and afterward injecting 
the mixture into the tissues ot an animal. 

The more rational conception of an antidote, is of an 
agent which merely counteracts the effects of the poison, 
and which may have no chemical influence on the poison 
itself. Such an antidote may enjoy no power to affect the 
toxic activity of venom when mixed with it, and yet may 
prove to be an active constitutional preservative against its 
effects. Just this position seems to he held by one of the 
supposed antidotes most in repute. 

So far as I am aware, no great difficulty is likely to arise 
in the study of antidotes, owing to their nature as such, for 
although some of those most in esteem, such as Bibron's 
antidote (bromine) and the Tanjore pill, (arsenic,) are poi- 
sonous in a high degree, it is easy to learn how much may 
be given with impunity. Hence, although in one or two 
instances observers have actually and plainly destroyed ani- 
mals with the very agents which were designed to relieve 
them, it is not probable that errors of this kind will be per- 
petuated, or even occur so often as to bring into disrepute 
any really useful remedy. The mode in which the study of 
antidotes and local remedies should be conducted, so as to 
avoid all the fallacies to which I have alluded above, will 
now claim our attention. 

Opportunities of studying the use of remedies, local and 
general, in connection with cases of venom poisoning in 
man. are of course more or less rare, and it is scarcely pos- 
sible to eliminate or allow for the varied fallacies which sur- 
round with difficulty this method of studying the subject. 
Owing to this, and to the comparative ease with which the 
means of study may be created in animals, it is preferable 
to employ these, and to use only such treatment in human 
cases as may appear to promise enough of success to justify 

its usage. 

The larger the animal employed the better will it be for 
the purpose, since the symptoms are more easily studied in 
large animals, and since they are less likely to be injured 
by active antidote-. Almost all toxicologists who have; in- 
\ estigated this subject, have been content to submit animals, 



L] Rattlesnake Bit 887 

as dogs, etc, to be bitten by the serpents themselves. We 

have seen, however, that when this course is followed, a 
number of fallacies interfere to prevent the observer, from 
drawing satisfactory conclusions, and although great care 
and thorough acquaintance with the anatomy and habits of 

the serpent may enable us to overcome this difficulty in part, 
some portion of the obstacles in question are in the nature 
of things unavoidable. In my own researches I have 
sought to escape from these embarrassments: first, by a 
fill study of the natural history of venom poisoning in 
- and other animals : second, by injecting into the ani- 
mal experimented upon known quantities of venom previ- 
ously removed from the ducts of active serpents. The 
venom to be thus employed is secured in the following man- 
ner : 

A serpent is seized by the middle, with a leathern loop at 
the end of a stall'; then the neck is caught and held down 
on a table with a notched stick, while a tube an inch and a 
half in diameter, and holdidga sponge soakedin chloroform, 
is slipped over the snake's head, and by a dexterous motion 
carried downward so as to include one-third of the length of 
the serpent, the notched stick being at the same time re- 
moved. About twenty minutes are required to stupefy the 
snake. It is then seized by the neck, and the i^d^c of a 
slipped under the upper jaw, so as to elevate the 
fangs. This is done by an assistant while the operator with 
his right thumb and forefinger strips forward the glands 
and ducts on both sides. The yellow venom runs out 
through the fang and along- his weapon. A known 

amount of this fluid may then be injected into the tissues 
of an animal, the instrument employed being a minute tro- 
car and Itmaybe objected to this method of us- 
ing the venom, that it is supposed by many persons that the 
poison i- less fatal when used artificially than when injec 
by the snake. Of this, however, there is no adequate proof, 
and Iha nothing to induce me to believe that it is 
at all correct. On the other hand, the advantages arising 
i the artificial use of the venom are manifold and obvi- 
. ami it is only essential to know what amount of venom 
troyadogifno remedial agency intervenes, 
a addition to this, th wr is thoroughly cognizant 
te ordinary phenomena of ti he will 
table ni< ansof insuring accuracy, which 
are now attainable. Antidotes mav then be used internallv 



388 Rattlesnake Bites. [May, 

in one or two ways to be hereafter illustrated, or mingled 
with the venom, and injected where this mode of study is to 
be desired. 

Before stating my experiments upon the plans of treat- 
ment now or recently in repute, it will he proper to give the 
reader certain necessary information as to the nature of 
venom poisoning, the forms it affects, and the symptoms 
which characterize its varieties. These details must of ne- 
»sity be brief, and the reader who wishes more complete 
information is referred to the author's previous paper. 

The venom of the rattlesnake is a yellow, albuminous 
fluid, of an acid reaction of a sp. gr. of 1044, and coagulable 
at a temperature of 140° to 160°. Its toxic activity is un- 
affected, or but slightly affected by boiling, and not at all 
by freezing. Acids and alkalies, alcohol, etc., do not de- 
stroy its virulence, and when dried it retains dreaded power 
for an unlimited period of time. Closer qualitative analysis 
discovers in it at least two albuminous substances: one co- 
agulable by boiling, either when alone or diluted with 
water, and also by alcohol ; the other, also albuminoid, co- 
agulable by alcohol only, and constituting the active ele- 
ment of venom. This latter agent I have described as cro- 
taline. 

Effects of venom on man and animals. — When an animal 
receives in any way a dose of venom, one of two things 
happens. If the animal is small, or at all events if relative- 
ly to the size of the animal the amount of venom injected 
is large, the animal dies very suddenly, acutely poisoned. 
If, on the other hand, the dose of venom is relatively small, 
the animal suffers to some extent with the symptoms of 
acute poisoning, and then passes into what I shall term the 
stage of chronic or secondary poisoning, which may endure 
for an indefinite period, and end in death or recovery. 
Acute poisoning in a man is rare,* and is more and more 
common the smaller the bulk of the animal bitten, until 
we arrive at cold-blooded creatures, in whom this sudden 
ending is the exception, and great prolongationof the mala- 
dy (/'. e, secondary or chronic poisoning) the rule. In dogs I 



►ugh rare, not impossible; men have died from this cause within 
ty minutes of the time of the bite, although no such cases are oo 
rd in the journals, and arc only known to me by personal informa- 
tion. 



;L] RaUUsnah B 

have rarely seen the very rapid death I speak ofj but it is 
not ancommoD whore the serpents are large and active and 
their venom abundant 

Let it be clearly understood then, that when man or ani- 
mal is poisoned by venom, a set of symptoms occur which 
wind up with death, or. being prolonged, pass into others 
of a somewhat different nature, constituting the chronic 
r those which survive long enough to exhibit the 
- which characterize the secondary poisoning. 

When, for instance, a pigeon is bitten, or receives in any 
way three or four drops of venom, it walks a few m 
crouches, - i'ov breath, rolls over and is dead in a few 

minutes, convulsed or not in the moment of agony. So 
sudden and speedy is this ending in some eases, that the 
pigeon may die within a minute. The only additional 
symptoms which we can percriveare the rapidly quickening 
and enfeebled motions of the heart, and sometimes vomiting 
and evacuations from the cloaca. In larger animals the 
same symptoms take place, but the vomiting is more com- 
mon and the expression of general debilitv more percept- 
ible. 

Men who have been bitten describe their symptoms 
much the same in kind, but, as before stated, they rarely 
end in death in thia t least : the power of resistance 

acquired by increased bulk being, I presume, the chief pro- 
tective agency. In some eases the more formidab 
of prostration do not declare themselves before some 
minutes or even halt* an hour has passed. In one 
man engaged in splitting wood was bitten ; lie picked up a 
stick and pursued the snake a few feet, when suddenly he 
:: at the stomach, complained of deadly nausea 
and general weakness, reeled a few steps farther, and fell 
on the ground. In another instance, the sufferer walked 
briskly for twenty minutes before the symptoms of debility 
;.me very well marked. 

It - important to our purpose to decide th< 

mptoms and what organs are affected. .Ml 
auth s ■ in speaking of the condition as one of debility 
and all describe the pale face and cold the hurried 

ih and (piick and feeble pulse. If we examine an ani- 
mal dying rapidly with these symptoms, we find absolutely 
no 1 ihe blood and the t. re alike healthy in 

app- — both to the naked and I eye. 

of experiments, the relation of which would be misplaced 



•°)00 Rattlesnake Bites. [May, 

here, lias shown that the heart does really become enfeebled 
and that the arterial pressure is singularly diminished, and 
this appears to be a direct effect on the arterial system, 
since it is impossible long to sustain life by artificial respi- 
ration ; at the same time the nerve centres are attacked, 
and the respiratory movements failing on this account, 
become jerking and labored; the sensory and motor 
nerves seeming still to preserve their functional in- 
tegrity. Such, in general terms, I suppose to be the 
causation of death in these cases. Far different are the 
symptoms which arise for study when the patient sur- 
vives the stage of acute poisoning. The duration of this 
stage is indeed difficult to define; this only we know, that 
alter a time the debility continuing, as shown by vomiting 
and syncope, the blood becomes affected in a marked and 
singular manner, while the relations of tissue and fluid are 
so altered that passive hemorrhages take place ; jaundice 
occurs, and a variety of symptoms declare themselves as .this 
or that organ becomes diseased and the seat of congestion 
and eechymosis. Meanwhile the local symptoms assume 
an importance which they do not possess in the acute stage 
and may even become paramount influence in deciding the 
fate of the patient. 

If then the patient die very early, there are symptoms of 
weakness alone, and there are no perceptible lesions of 
1)1 ood or tissue ; supposing life to be prolonged, the early 
symptoms continue, while signs of blood poisoning appear 
in addition, and lesions closely resembling those of yellow 
fever are found post-mortem. If, again, the patient success- 
fully resists the secondary evils here described, he may still 
perish from the results of the local injury, which increases 
in danger and importance as the case progresses. 

To make this matter clear, we will now examine more 
accurately the various symptoms and the character of the 
wound. 

Wound. — The wound is usually described as very painful, 
but so far as my own experience informs me it is not always 
so in animals, nor do all men who are bitten speak of it as 
painful at first. Indeed, the wound has sometimes been 
for a while disregarded, and at all events the hooked form 
of the fang, the forcible injection, and the sudden with- 
drawal of the weapon, account sufficiently for the pain, 
without supposing it to be specific. The succeeding local 
ymptoms are rarely notable when the patient dies within 



a.] Eaitl make Bii 393 

half an hour, except that in animals the muscles twitch most 

violently, of which wo hear nothing in the human ca 

advances, the part swells, becomes discolored 
and increasingly painful, and these 4 changes extend np the 
limb involved, and, reaching the trunk, swell and bloat 
side, or the whole body. 

This swelling is not inflammatory, but arises from the 
gradual effusion of blood, which has lost power to coagulate 
and which therefore extends from the broken vessels, at the 
seat ot the wound. The later swelling is also due moi 

ma than inflammation, although it seems probable thai 
in man the tendency to inflammation under venom poisoning 
eater than in the lower animals. In dogs bitten, the 
local swelling is sometimes slight, sometimes enormous, and 
and when cut into is found to depend on a collection of 
blood, either fluid or semi-coagulated. The pain which ac- 
companies the swelling is excruciating in many cases, and 

- not lessen until the part becomes vesicated, loses heat 
and falls into gangrene. Ln man this process destroys the 
skin only, or the whole of the limb, but in dogs I have seen 
no such extensive sloughs, and the skin often escapes, so 
that we find only a small opening, and beneath it a cavity 
containing the debris of broken-down tissues, mixed with 
pus. I suspect that in man the swelling would occur I 
rapidly were it not for the constant use of the ligature about 
or above the wounded part. If the case be a serious one, 
the early constitutional .signs of prostration continue ; 
casional vomiting, or at least nausea, is present, frequent, 
syncope occurs, and the pulse continues weak and rapid. 
In general the bowels are constipated, unless the case be 
greatly prolonged, when diarrhoea, may take place as a sequel. 
The mind is. in most instances, clear up to the time u{' 
death, or at all events it is only confused, excited, or sub- 
ject ry delusions, while convulsions seem to be of 
extreme rarity in any period of the malady in man. The 
tall of temperature in the skin is usually described as an 
early symptom of the general weakness, but no accurate 
thermometric observation have been made in human cfl 
The duration of cases of rattlesnake bite is very various, 
although both in dogs and men the recoveries are often 
rapid and unex] 

- it is impossible for me to dwell in full detail upon the 
symptoms of the venom malady, and equally impossib] 

cribe the great variety of lesions which may occur, I 



392 Rattlesuake Bites. [May, 

have thought best to state three typical eases of poisoning 
in animals, and two in men. The following arc quoted in 
full from the essay so often referred to : 

" Eperiment. — The dog, a small terrier weighing about 
fifteen pounds, was intended to make one of a set of obser- 
vations on the value of Bibron's antidote. For this purpose 
he was placed in the snake-box, where instantly he was 
struck twice by a large snake, both wounds being double 
fang marks, and both being in the right flank. On remov- 
ing him I observed that from one of the wounds blood was 
running in a thin stream. After it had run for some time, 
I caught a few drops in a watch-glass, and found that it co- 
agulated well. Before I thought fit to use the supposed 
antidote, I was called away. Returning at the end of an 
hour I found the dog standing with his head pendant, having 
just vomited glarily mucus. His pulse was quick and feeble, 
his respiration occasionally panting. The hemorrhage had 
ceased. Owing to an accident which at this time deprived 
me of the supply of Bibron's antidote, which I had pre- 
pared, I was unable to employ the animal in the manner 
proposed, and not desiring to lose the observation altogether, 
I made use of the opportunity in the following way : 

" One hour and a half after he was bitten I drew a 
drachm of blood from the jugular vein. It clotted perfect- 

"Four and a half hours after the bite a drachm of blood 
from the same vein coagulated equally well. 

" Twenty hours from the time of the poisoning, the dog 
was found on his leftside, having passed slimy and bloody 
stools in abundance. At intervals he seemed to suffer 
much from tenesmus, but was so weak that he stood up 
with difficulty. His gums w T ere bleeding, a symptom I had 
seen before, and his eyes were deeply injected. At this 
time about two or three drachms of blood were drawn. It 
was very dark, and formed within five minutes a clot of 
feeble texture. 

" Twenty-seven hours and a half after the time at which 
he was bitten, the dog was weaker. His hind legs were 
twitching, and the dysentery continued. Three drachms of 
blood were drawn as usual, but no clot formed in this speci- 
men although it was set aside and carefully watched for 
some time. While I was collecting the fluid for observation 
the dog suddenly discharged per anum at least four ounces 
of dark, grumous blood. At this time I supplied the dog 



1861.] Rattlesnake 398 

with water, and left him. Fifty-four hours after the bite 
he was seen again, and found to have drunk freely of water 
and to have passed fewer stools. Up to this date he de- 
clined all food. 

" From this time he improved rapidly, and took with 
trness whatever nutriment was offered^ On the fourth 
day his blood again exhibited a clot, although it was very 
small and of loose texture. 1 made no further examination 
of the blood. The dog lost flesh as he gained strength, and 
had profuse suppuration from an abscess in the bitten flank. 
At the close of two weeks he was active and well, except 
that the wound was still open. 

" The case last related is doubly valuable, as pointing out 
even in a single instance the time at which the blood be- 
came altered, and also as showing, once more, how pro- 
found may be this change, and how perfect the recovery. 

*• Experiment. — A dog of mongrel bull-terrier breed, 
weighing thirty-one pounds, was lowered into the cage, 
where he was struck on the outside of the right hind leg in 
the thigh. He drew up the leg when released, and whined 
for a few minutes. The wound, which was a double fang 
mark, bled a drop or two, and the muscles about it twitch- 
ed considerably at intervals for an hour, when this symptom 
was obscured by the swelling. His pulse, which was natur- 
ally about 145 and irregular, was, at the fifth minute, 140 
and regular, respiration 35. At the fifteenth minute lie lay 
down much weakened, pulse 1G0 and feeble, respiration 40. 
At the twentieth minute the bowels moved loosely, with a 
gray discharge, and there seemed to be some tenesmus in 
the rectum. Twenty-fifth minute, pupils so far natural and 
mobile ; he could stand when urged, but lay down again at 
once, and was much weaker. Forty-fifth minute pulse 160, 
respiration 45 and laborious. Fifty-fifth minute, loss of 
power in the hind legs. Eightieth minute, quick and 
labored, and so irregular as to make it impossible longer to 
count the heart pulses. The eyes were natural, and follow- 
ed motions ; and lie wagged his tail when fondled. At this 
time the observation was temporarily interrupted, and, on 
its resumption at the third hour, the dog was found dead, 
lb- had no foam about his mouth, and probably died 
quietly. 

"Post-mortem section. — The whole muscular and areolar 
tissue of the leg and thigh, lnilf way up and down the limb, 
was dark with infiltrated blood. About the wound the 



394 Rattlesnake Bit [May, 

swelling was due bo a mass of blood partially coagulated. 
The extravasated blood extended through the limb, and on 
the inside it passed halfway up the sartorius and adductors, 
and along the Bheath of the vessels to within two inches of 
the femora] ring. Nearly an inch of the sheath was clear 
of it, but one-half inch below the ring tissues were shaded 
with blood, and the same appearance was ^aon around the 
ring itself. From this point the extravasation extended 
under the peritoneum, into the pelvis, and on to the inner 
face of the ilium. The color of the tissues thus stained was 
a brilliant scarlet. The abdominal viscera were healthy, 
]>t that the mucous membrane of the lower bowels was 
somewhat congested. The lungs were sound. The heart 
was relaxed, the right side full, the left nearly empty. The 
blood on the right side was a little darker than that on the 
left ; on both sides and even-where else it was perfectly 
fluid and free from clots. Placed in a phial, it remained 
fluid until decomposition enusued. Two hours after 
death, some of the blood globules found in the heart were 
slightly indented ; those taken from the small vessels of the 
ear were perfectly normal. At the period of examination, 
the muscular and nervous irritability had entirely de- 
parted."' 

A third observation on a smaller animal, and also drawn 
from a like source, will answer my present purpose. 

"Experiment. — In this instance the animal, a rabbit, was 
struck once in the back by a large snake already exhausted 
by frequent use. A few minutes after the bite took place, 
the rabbit was seized with weakness, gritting of the teeth, 
and rapid respiration. It passed urine and feces, and re- 
mained feeble during some hours. From this period the 
weakness abated somewhat, but the back continued to swell. 
On the second day the local signs were improving, but the 
animal had passed a very albuminous urine, and a large 
amount of blood mixed with The symptoms of 

general weakness now increased, the hind legs began to drag, 
the motions were uncertain, and the bloody purging grew 
worse. The rabbit died on the third day, during my ab- 
Bencj 

"Post-mortem section. — Kigor well developed. The 

period of death being uncertain, the irritability of the tissues 

was not toted. The wound was surrounded by half an 

ounce or more of dark fluid blood. The vessels in the 

liborhood were full of a similar fluid, but there was no 



L] Rattlesnal 

ilar redness, like that of acute inflammation. The 
muscles in the track of the bite, which • double fang 

mark remarkably softened and could be torn with the 

utin The brain was highly congested, and there 

was a good deal of bloody serum in the cavities of that or- 
gan. Similar congestion existed in the spinal canal, and at 
several points the white nervous tissue was Btained with 
small patches o( blood. The lungs were healthy. The 
pericardium was curiously distended with bloody serum. 
The heart was contracted and contained hut little blood, 
that dark and diffluent. Tl e intestine- were spotted at 
intervals with ecchymoses lour to five lines in diameter and 
apparently just beneath the serous covering, the cavity of 
which contained a little bloody serum. The intestines from 
the oesophagus to the rectum were dotted with ecchymoses 
and tilled, especially tie gut, with hlood and mucus. 

The right kidney was large and absolutely soaked with dark 
rluid blood. The left kidney was more healthy. The blad- 
der and ureters contained a good deal of bloody urine. How 
the rabbit lived so long with such a singular complication 
-ions it is difficult to conceive. In most cases 
ironic poisoning, some one or two organs may become 
of local extravasations, but for extent and character 
of lesions this case stands alone in my experience." 

Ti. i its given l»y our own authors of the cases oi 

human poisoning stremely meagre and unsatisfactory 

— the best reports being those by Sir E. Home* and M. 
Pih' ith of whom described cases which took place 

in showmen. 

{Dr. Homer's case is perhaps one of the best among our 
own reports, but like the more curious one given by Sigaud,§ 
the patient was not altogether a healthy subject. I shall 
quote Dr. Korni with the statement that the local 

vere belter illustrated in the second case quoted, 
that by Dr. R. Hark 



ol., vol. viii. i,. 

ains the follow] 

every 

a the bite of the 



896 Rattlesnake Bites. [May, 

\d;iiij Lake, aged about 40, a robust, muscular man, 
acting in a laborious capacity, and wbo, from his own ac- 
count, was in the habit of drinking from half a pint to a 



rattlesnake cures the leprosy (lepre leontine of Alibert) without injury to 
the patient. Many facts would seem to show that lepers have been bit- 
ten without fatal results, not only by thecoroline viper, by the jararaeasu, 
but even by the rattlesnake. Among these tacts may be cited those 
which have been collected by Dr. Jacintho Pereira Reis, and by the 
deputy, Estevao, Rafael de Carvalho. The firsl is that of a leper of the 
district of Rio-das- Velhas, in the province of Minas Geraes, who having 
been bitten by a rattlesnake, was cured of his disease in fifteen days. The 
second is furnished by a negro slave of the province of Maranhao, who 
recovered from his leprosy in a very short time after having been bitten. 
>.i. de Lima assures as that being one day in the town of Saint Charles, 
province of Carabobo, in Colombia, he observed a man whose face was 
covered with a single large cicatrix, which at first he attributed to a burn, 
but on inquiry learned that it was the result of a radical cure of a case of 
leprosy, by the bite of the rattlesnake. The same observer tells us that 
an opinion favorable to this means of cure is entertained throughout the 
district of Caracas and Apure, where leprosy is common. These state- 
ments which, after all, are but hearsay, induced a leper to resort to this 
tearful mode of relief. According t<» Dr. Jacintho Rodrigues Pereira Reis, 
another leper bad already made this experiment in this capital, (Rio de 
Janeiro.) This person had the courage to allow himself to be bitten at 
one time by the coraline viper, and at another by the jararaca pre^uicosa. 
Each time he was left for (lead, but notwithstanding, gradually revived 
without aid. After this he still had the pain to observe that his original 
malady continued its fearful progress. 

"Case. — Mariano Jose Machado, born at Rio Pardo, province of Rio- 
Grande do Sud, aged 50, had been for six years afflicted with tubercular 
lepra, during 4 years he had resided at the leper hospital, at Rio de 
Janeiro. On third of September, he came out, resolute to put to the tot 
the bite of the rattlesnake, despite the prudent and wise counsels of divers 
physician8, who saw in the means he desired to employ a more than dubi- 
ous chance of SUCC6SS, and who also were aware that the patient had not 
exhausted all the more available and proper remedies. The patient final- 
ly resorted to the Louse of M. Santas, a surgeon, Rue de Vallonga, No. 
61, who possessed a rattlesnake." 

After describing the appearance and character of the leprosy, and 
mentioning those who were present, M. Sigaud continues as follows: 

"Marianno Jose Machado, before proceeding, declared that he acted on 
his own responsibility, and then having signed a paper to this eifect, put 
his bund into the cage and twice 3eized the Berpent. The reptile at first 
and finally licked his hand, but, feeling itself pinched with force, 
turned and bit him at the metacarpal articulation ofthe little finger and 
ring finger. The bite took place at 10 minutes of 12, September 4th. The 
patient did not feel the bite, and only knew of it by the remarks of those 
around him. His hand wasa little swollen, but painless, and bled some- 
what, the pulse and respiration remaining normal, five minutes later, 
d a Blighl sensation of cold in the hand, with a little pain 

in the palm, which, in a few minutes, increased considerably. 17th 



1.] Ttatllesnah 

pint of alcoholic liquors daily; on Friday, July 1, 1831, 
was in a crowd collected at Fisher's tavern, in Kensington, 

to witness a popular exhibition of rattlesnakes, confined in 



minute, pain in the wrist. 20th minute, hand swelling. 80th in., pnlse 

nger and fuller, mind tranquil. 55th in., sensation of swelling in 
sides and back of neck ; size of hand increasing; pain extends to two- 
thirds of the forearm. 69th m., general numbness. 1 hour and 20 min., 
general tremor; hyperesthesia, I h. • ,, « , '» m., mind troubled, j>ul>e more 
frequent; difficulty in moving the lips; tendency to sleep; choking sensa- 
tion; intense pain in the hand and whole arm: hand swelling. 1 h. 45 m.. 
pain in tongue and pharynx, extending to the stomach; increased pain 
and swelling in the bitten hand; feet cold. 2 h. 5 m., difficulty Gf speech, 
and a little later, difficulty of swallowing; anxiety; copious sweating 
the chest :'» h., weakness; nose bleeding; inquietude; pulse %. 3 h. 4 

general sweat, and a little after, involuntary groans; pulse 100; greal 
pain in the arm; face injected; continual epistaxis. .'5 h. 35 m., the patient 
swallowing wine and water readily, and changes his shirt; a red color i- 

throughout the body, and a little blood leaks out of one of the pus- 
tules under the arm; the color deepens, especially in the bitten limb ; 
atrocious pains are felt incessantly in the arm-; the throat seems to be 
narrowed, and the breathing becomes difficult. At 4 h. 30 m., pulse 104; 
salivation; great heat of body. 5 h. 30 m., pulse 104; torpor; urine abun- 
dant: saliva thick; muscular weakness; groans from excessive pain; respi- 
ration tranquil; pulse lull: increased, swelling of the bitten hand. 7 h.. 
'leiiee: awaking, oompls .r pain in the chest, and of a sense 

ttstriction in the throat; free and full urination.-; deglutition more 
difficult; saliva abundant; continued epistaxis; entire inability to swallow. 
8 h.. inquietude; copious urination. !» h. 15 m., profound sleep. 10 h., 
patient took .3 teaspoonfuls infusion ofguaco; refused sugar & water which 
were also offered; the epistaxis ii" regular; thelep 

tubercles o:i the face and arms are a little depressed, and have erysipelat- 
ous look. 1" h. 20 m., made two ounces of clear urine: betl for a 
few moment-; pain in the ches i. and pain is now felt in the legs 
and feet, which with the bitten hand are -till cold; : liar; 
thirst; the patient drinks water; sitting up with facility. At 11 h., I 

-poonfulsot Btrong infusion ofguaco. 11 h. 45 in., urinated a col 
urine; continues to drink without trouble: pulse 119; arm and hand much 
inflamed, with excessive pain. 12 h., sleep: excitement; urination. 12 h. 

- face: cries of pain; the patient demands tic last of 
of his church, and refuses remedies. Rather later, emission of urine; 
jrreat heat in the limbs; the patient take- two do» 

re half hours; symptoms as before. 14 h., -its up twice, to drink 

:•: the difficulty of Bwallowing augmenting. 14 b. 13 m.. takes the 

-: pulse 110. 15 h. 30 m., mictural 15 h. 45 m.. 

the remedy; in voluntary movement- of the right hand ami 

Left leg. 16 h. 46 m.. tak aful of the remedy; repose; pulse 100; 

>f urine during 17th and 18th hour-; respiration being < 
21 h. 45 m.. L'reat prostration; convulsive mo jaw and lower 

tromil ly urine. 22 h.. pulse quickened and absent at ]on;_ r inter 

val-: increase of convulsive movement-: diminution of swelling of extremi- 



398 Rattlesnake Bites. [May, 

a cage. hake being somewhat intoxicated, opened the 
door of the cage, and allowed one of the animals to creep 
oul and ascend his hare arm ; as it was going up, he caught 
the animal somewhat abruptly by the neck, it immediately 
struck at him, and inflicted two small wounds. In the evening 
he felt some itching about the bend of his arm, and he rubbed 
it accordingly, without thinking of the snake. The itching 
increasing, he was induced to examine the part, and there 
he found a little red spot. The recollection of the rattle- 
snake then occurred to him, and he began to bathe the part 
in salt water. This not relieving him, he called upon Dr. 
Elkinton, at which time the whole extremity was swollen 
to neatly double its size, and was very painful. Dr. Elkin- 
ton applied a dry cup over the part which had originally 
itched, and was bitten; it was near the cephalic vein at the 
bend of the arm; scarified cupping was also done in three 
or four places in the same region, and some ounces of blood 
were extracted by a repetition of the cups; the forearm 
was also rubbed with the terehinthinate tincture of canthari- 
des, which produced vesication. In the course of the even- 
ing, some doses of spirit of hartshorn were administered, 
and also some tablcspoonfuls of the expressed juice of plan- 
tain (alisma planlago,) and hoarhound, (marubium milgare.) 

"The next morning (July?, 1831,) the patient was 
brought to the almshouse, about half-past eight o'clock. He 
bad vomited in the conveyance, lie was sensible, and 
stated that the scarifications had bled much during the 
night; they were then bleeding freely. The arm, from 
the shoulder and front of the thorax to the fingers, was 
swollen to twice its natural size, and was very painful when 
moved. His pulse was almost imperceptible and thread- 
like, his extremities cold he was disposed to cramp in the 
legs, and his debility very great. His respiration was natur- 
al and easy. His eyes were muddyand heavy; his face was 
somewhat bloated. Feeling the desire to go to stool, he 



ties and of the dark color of the skin; deglutition very difficult: breathing 
labored; blisters were applied to the thighs, and the infusion of guaco 
givi i). 22 h. 50 in., convulsive; motionless; an inject ion of brandy given. 
22 h. 55 in., oonvulsions Btopped. 23 !u same condition; an ounce of oil of 
1 given by the mouth; was taken with great difficulty. Death, at ::•': 
h, 30 in. The corpse became livid, and swelled considerably in n few 
hours, being mottled with violet-colored spots, The odor was such, next 
day. as to forbid an examination post-mortem." 



I.] Uattltsnak 

was assisted from his bed for that purpose, but was seized, 
while on his way, with a general spasm, without foaming at 
the mouth: being laid down on the floor of the ward, ii 

went off in a few minutes, and lie there had an involuntary 
evacuation from the bowels, of a dark billions color. This 
occurred before 1 saw him. He received from the resident 
physician five grains of ammonia and an ounce and a half 
ol. blivarum. 

"Sinapisms were also applied to his ankles and breast; 
lie was directed to take liquor volat ammonia, 5j ; sp. vin. 
dibit, .vs. every two hours, and intermediately use ol. oli- 
varum. Si - of the former prescription, he took two doses be- 
fore he died, and one of the oil. Another application of 
cups over the old scarified parts was made, and the hemorr- 
hage from them diminished. The extremity was then en- 
veloped in cloths, dipped into ice water. 

" The symptoms continued stationary till 11 J a. m., he 
then complained of violent pain in the course of the colon, 
and on taking his last dose oi' medicine, he said, he felt 
sleepy, closed his eyes, and in a few minutes died without 
agony or convulsion. 

"Dr. Harlan's case. — On Monday, the 13th of Septem- 
ber, 1830, Daniel Steel, a showman of living animals, in 
this city, was severely bitten by a large male rattlesnake, im- 
mediately below and on the metacarpal joint of the index 
finger of the left hand ; the accident occurred about four 
o'clock, p. m., <>n a warm day, while he incautiously seized 
the reptile by the neck, not so close to the head but that the 
animal was able to turn upon him. Immediately after the 
bite, the blood flowed freely from both the fang punctures; 
the parts in the immediate vicinity of the punctures became 
tumid and livid, notwithstanding the efforts of the patient 
at suction with his mouth — which faintness obliged him 
□ to relinquish. On my arrival, about half an hour 
after the accident. I found him extremely pale 'and faint, 
and was informed that he laid fainted several times, the 
whole of the back of the hand was puny and tumid, with 
infused non-coagulated blood, which appeared to have in- 
filtrated from t; els and forced its way through the 
cellular tissue; a ligature had been, previously applied on 
the wrist ; another was now.placed ^m the arm, the forearm 
having already commenced -welling. 

••'I'; e situation of the wound rendered the use of cups in- 
applicable, and the flow of blood was bo rapid as to make 



400 Rattlesnake Bites. [May, 

their application inexpedient. The punctures were separ- 
ated some distance from each other, which rendered it re- 
quisite to excise two large portions of integument; the ex- 
cisions extending down to the tendinous fascia; the blood, 
which flowed freely after the operation, did not appear dis- 
posed to coagulate; cold water was now poured on the 
wounds in a continued streams, from the mouth of a pitcher, 
held at a considerable elevation, and the swollen parts in 
the vicinity of the wounds were forcibly passed, in order to 
expel the effused blood. The patient again became very 
taint, and was held in a recumbent posture. The wounds 
were next washed with spirit of hartshorn, several doses of 
which were administered internally ; butbeingnow inform- 
ed that the patient had drunk freely of sweet oil, the harts- 
horn was omitted, until the stomach should be evacuated 
by drinking warm water. A poultice of bread and water 
was next applied, to encourage the bleeding, and the patient 
was put to bed. At ten o'clock p. m., I was sent for in 
haste ; the patient was thought, by attendants, to be dying. 
The bleeding of the wounds had been extensive, the tume- 
faction had extended up to the arm, the inner and inferior 
portions of which were discolored by effused blood; the 
patient vomited incessantly ; he complained of insatiable 
thirst, and drank cold, water cve,ry few minutes ; he had 
pain and stricture at the pit of the stomach, great restless- 
ness and anxiety, cold skin, with the exception of the 
wounded arm, which was verypainful; add to which, there 
existed delirium, singultus, difficulty of breathing, and pulse 
at the wrist scarcely perceptible. The poultice, banda< 
and all ligatures were immediately removed; the back of 
the hand was blacker and more swollen, and the skin of 
the forearm was hot and tense. As a substitute for the 
poultice, and in order to suppress the bleeding, which ap- 
peared to endanger the life of the patient by the debility it 
occasioned, large Hat pieces of fresh meat, were bound on 
the wounds, hand, and forearm. Before this operation was 
completed, the patient exclaimed, 'That feels comfortable.' 
The indications arising from the present syptoms, were: 

1. To allay irritation and thirst. 

'2. To arrest the vomiting. 

3, To procure sleep, if possible. 

4. To excite the sanguineous I the depres- 
sing power of the poison, which had so emphatically mani- 
fested itself on the >v»tein in general. 



1861.] Rattlesnake Bit 401 

••A mustard plaster was directed to be applied to the pit 
of the stomach; Bixtydrops of laudanum to be administered 

every half hour, until the vomiting should be arrested ; al- 
ter which the following bolus, to be taken every two hours 
until sleep should he induced : 

R. pulv. opii, six grains : puiv. gum. camph., 18 grains ; 

pulv. carb. ammonia, 30 grains. M. ft. in three holuses. 
Big. as directed. 

Of these pills he took three before the effects desired 
wxre manifested. On the morning of the second day, his 
pulse was raised : the extreme thirst and irritability of the 
Btomach were allayed, and re-action of the system in sever- 
al respects was manifested; but the tumefaction of the arm 
had extended to the shoulder, with broad black streaks up 
to the axilla: Btricture at the breast and great local pain 
were now the chief complaints. The application of raw 
meat was renewed, as it afforded comfort to the patient, and 
appeared to reduce the swelling of the hand, and by pres- 
sure, had nearly suppressed the hemorrhage. In order to 
allay the pain and tension of the whole arm, he was direct- 
ed to expose it naked to the fumes of burnt wool, in a con- 
venient apparatus, which was attended by BUch marked al- 
leviation of symptoms, that the patient himself was desirous 
to have the operation frequently repeated, and continued 
for two or three days: the swelling always dimishing after 
each application ; it caused the arm to perspire profusely, 
and covered it with blackish soot impregnated with am- 
monia, resulting from the decomposition of the wool. Dur- 
ing the intervals, the arm was rubbed with volatile liniment, 
raw meat having become offensive from its disposition 
to ferment and putrify, was omitted, and flaxseed poultices 
substituted: the anodyne boluses were continued in half 
d<»-es through the day, and the quantity increased at night 
t<> produce Bleep. The system again became depressed and 
appeared to struggle with the effects of the poison ; as the 
patient had been somewhat addicted to intemperance, he 
3 allowed milk-punch to support his strength. On the 
third day, a greater degree of reaction was obvious; the 
bowels wei lated by castor oil; the dose of the 

anodyne was diminished, and by carefully nursing the arm, 
in less than u week suppuration supervened, and the patient 
was able to leave his bed." 

ft is much to be regretted that physicians in this country 
Bhould have paid so little attention to the venom malady as 
26 



402 Operations on [May, 

only to report cases in which the}- supposed themselves to 
have been successful. Hence is it that no good history of 
the disease can be made out from their statements, 'and 
hence it is that post-mortem examinations of the lesions are 
almost unknown— there being only three on record, of 
which two took place in Europe. The reader need not be 
surprised then at the small amount of accurate knowledge 
of symptoms placed at the author's disposal: fortunately 
the ability to create the disease in animals enabled us in 
some measure to fill up this gap. 

The information now in possession of the reader will 
enable him, I trust, to follow the remarks upon the use of 
remedies. A number of these, whether local or constitution- 
al, may be readily dimissed, either because their value or 
want of value is plain, or else because former observers have 
settled their therapeutic position in some conclusive man- 
ner. 

In treating of this matter, I have been obliged to deny 
notice to a host of herbs which enjoy repute in small sections 
of our country, and which, in turn, have once possessed and 
lost a wider reputation. The reader who calls to mind what 
has here been said as to the many fallacies which surround 
the observer, will not fail to perceive in the accounts of 
these remedies given by authors the reason of their apparent 
success and ultimate los3 of favor. — North American Medico- 
Chirurgical jRevkw. 



A Statistical View of Operations on the Tongue, and more es- 
pecial!.}/ in reference to their danger from Hemorrhage. By 
Otto Just, Jr., M. D., of Zittan. 

Dr. Just divides the different methods of removing the 
tongue into the following groups : A. Operations with the 
knife. 1. Amputation or partial excision. 2. Amputation 
bv iiap-incision, or wedge-like incision. 3. Total amputa- 
tion or extirpation. B. Ligature. C. Ecrasement lineaire. 
I). Cauterization. 1. By the actual cautery, galvanocaustic. 
2. By the potential cautery. 

A.* Operations with the knife. i. Amputation. — Dr. 
Just has collected thirty-three cases of partial removal of 
the tongue for carcinoma, and sixteen for hypertrophy. To 
render the organs more accessible to the knife, as well as to 



1861.] The Tongue. 403 



ligature the vessels with more facility, it should be fixed 
by forceps, or by a stout ligature carried through its entire 
thickness. When the incisions have to extend toward the 
base of the tongue, on account of the small space we have 
to operate in, the procedure becomes more difficult and the 
arrest offiemorrhage is not so easy. In these cases more 
room can be gained by slitting open the cheek of the affect- 
ed bide, or by drawing out the tongue through an aperture 
in the neck, or by sawing through the symphysis of the 
lower jaw. These me thous will, however, be unnecessary 
if the lingual arteries he previously ligated. '2. Wedge-like 
excision. — Under this head are mentioned 12 cases of can- 
cer, one of telangiectasis, and 11 of hypertrophy. 3. Extir- 
pation. — The author considers this operation justifiable 
when the whole of the tongue is diseased. Ofthree cases, 
one recovered. 

Methods of stopping the hemorrhage. — The following 
means were emploved for the arrest of hemorrhage, in 62 
cases in which it is mentioned : In 20 cases, ligature of the 
Is in the wound : in 2, ligature en masse ; in 7, pro- 
phylactic ligature of the lingual artery; in 7, the actual 
cautery; in 6, ice and cold water ; in 7, suture of the edges 
of the wound after dap-incision ; in 3, styptics ; in 1, bleed- 
ing spontaneously stopped. Ligature of the arteries in the 
wound is the method, and has never been followed, 

when employed alone, by secondary hemorrhage. The 
actual cautery, cold or styptics should bo restricted to slight 
S ;ondary hemorrhage ensued rather frequently 
when the actual cautery had been applied. Suture of the 
- of the wound is unsafe, for in three-sevenths of the 
cases it was followed by secondary bleeding. Ligature of 
the lingual artery above the hyoid bone should be resorted 
to when the base of the tongue is diseased and the mouth of 
large size; two of these cases died of pyaemia. 

Period of recovery. — The most rapid recoveries took 
place when sutures hail been used after excision of a wedge- 
shaped piece; in 16 of these cases, 14 united in from 6 to 
14 days. After amputation in general, it required from 12 
day- to 4 weeks. The cases treated by -awing through the 
symphysis took from l to 1 months. 

Result — Eight of 86 cases terminated fatally, being U| 
per cent. In 5 cases death resulted from pyemia. 

B. Removal by ligature. — Nineteen cases are quoted of 
ligature for cancer, and 7 for hypertrophy; and 2 of tic 



404 Operations on the longue. [May, 

ended fatally, 1 from pyremia, and 1 from poisoning by 
the offensive discharge. This method is troublesome and 
disgusting from the very fetid discharge, occasioning the 
patient great misery. Gangrene commences in about 24 
hours after the application of the ligature, and on an aver- 
age 11 days are required for the separation of the mass. 
The wound left after the detachment of the slough will heal 
generally in about 14 days. Hemorrhage occurred in three 
instances, twice from too early a separation of the ligature, 
and once from the wound made for the passage of the 
thread. 

C. Amputation by means of ecrasement lineaire. — The 
ecraseur has answered an excellent purpose in removal of 
the tongue, hemorrhage being effectually prevented when 
the instrument is made to act slowly. Twenty-one cases 
were treated by this method, and all recovered, the period of 
convalescence averaging three weeks. 

D. Amputation by means of the cautery. 1. By the gal- 
vanic cautery. — Eight cases come under this head, hemor- 
hage attending 4. The vessels required ligation in the 
wound twice, and once after previous ligation of the lingual 
artery. Secondary hemorrhage followed in about one-third 
of the cases. To prevent bleeding, the wire should be thick, 
the galvanic current weak, and the wire of the loops should 
not be heated beyond a black heat, 2. Extirpation of the 
whole tongue by means of the potential cautery. — One case 
only is given, in which the organ was destroyed by means 
of chloride of zinc. 

The author has collected 72 cases of cancer of the tongue, 
in 49 of which the subjects were males, in 23 females ; the 
frequency in males being pretty nearly in the ratio of 5 to 2. 
In 63 cases the age is noted, showing that it occurs most 
frequently between 40 and 60 years. In 55 cases the seat of 
the disease was, in 7, the tip of the tongue ; in 9, the whole 
breadth of the organ ; in 19, the right ; and in 20 the left 
side. In 72 cases there were 18 recurrences ; but the num- 
ber is too small, as many of the cases were published soon 
after the operation. 

To sum up the different methods of treatment, we find 
that the knife is especially adapted for removing small por- 
tions near the tip of the organ; the ligature has but one ad- 
vantage, that of preventing hemorrhage, and the ecraseur 
has shown more favorable results than those of the knife. — 
Jjondon Medical Review. 



1861.] khicum. 405 



Further Experiments Relating to the Dieuretic Action of 
Ichicum. By William A. Hammond, M. D., Professor 
of Anatomy and Physiology in the University of Mary- 
land. 

In the Proceedings of the Academy of Natural Sciences, 
of Philadelphia, for November, 1858, 1 gave the results of a 
series of investigations relative to the diuretic properties of 
digitalis, juniper, squill, and colchicum, by which it was 
shown that the latter alone possesses the power of increas- 
ing the amount of organic matter eliminated by the kid- 
neys. From this circumstance, the argument was adduced, 
that this substance, of all those experimented with, was the 
only one that could be regarded as a true depurator of the 
blood. 

The results obtained by earlier investigators cannot be 
regarded as satisfactory, owing to the .faulty manner in 
which their analyses were made. The urine was concentrat- 
ed by heat, and thus a large quantity of its organic matter 
underwent decomposition. 

Since the publication of my experiments, Dr. Garrol, of 
London has studied the physiological action of colchicum : 
but, led away by his theory of the nature of gout, he limited 
his researches mainly to the determination of its influence 
over the excretion of uric acid, which, as is well known, 
forms but a small proportion of the total amount of organic 
matter excreted by the kidneys. As the result of his inves- 
tigation he announced that colchicum does not increase the 
quantity of uric acid contained in the urine, and. that it is 
not by any action on the kidneys that the remedy in ques- 
tion exerts its curative influence in gout. His result, as 
relates to the uric acid, does not, so far as I know, conflict 
with mine, as I did not separately determine the quantity 
of this substance present ; but his conclusion, that colchi- 
cum is not a diuretic in the true sense of the term, is cer- 
tainly not borne out by his own experiments, and is direct- 
ly at variance with those which I performed. 

It was, therefore, obviously necessary that additional in- 
tdgationa should be instituted, and I accordingly under- 
took the task of furnishing further contribution- to the sub- 
ject. Before proceeding to detail these, I desire to call at- 
tention to the valuable memoir of Prof. Austin Flint, in the 
number of this journal for November, 1800, entitled "Clini- 
cal Researches on the Action of Diuretic Remedies." In 



406 Colchicwn. [May, 

this essay, in addition to much other valuable matter, the 
conclusion at which I had arrived relative to the action of 
colchicum is confirmed ; Prof. Flint finding it to produce a 
marked increase in the amount of solid matter eliminated 
by the kidneys, without, however, increasing the quantity 
of water of the urine. 

The investigations to which the present paper relates 
consisted of experiments upon adult males, in a good con- 
dition of health. In all cases, the officinal tincture of the 
seeds of the colchicum autumnal e was given. 

The determinations made were the following: 

1st. The quantity of urine. 

2d. Its specific gravity. 

3d. The total amount of solid matter. 

4th. The quantity of inorganic matter. 

«5th. The quantity of organic matter. 

6th. The amount of uric acid. 

The quantity of urine was determined in cubic centi- 
metres. 

The specific gravity was ascertained by means of the 
specific gravity bottle and a delicate balance. 

The tula! amount of solid matter is given in grammes, 
and was determined in the following manner : 

Ten cubic centimetres of the urine were evaporated to as 
complete dryness as possible in vacuo over sulphuric acid, 
and the residue accurately weighed. By simple proportion 
the amount of solids in the whole quantity of urine was 
easily ascertained. 

Although it is impossible to get rid of all the water by 
this process, the quantity remaining is extremely small, 
and the results obtained are far more accurate than those 
obtained by evaporating to dryness in the water-bath, as 
generally practiced. No matter how carefully this latter 
process is conducted, the loss of urea by decomposition is 
always an important item, and involves far more serious 
errors than the imperfect declaration by the former pro- 
cess. 

For the determination of the amount of organic and in- 
organic matter separately, the solid residue obtained as 
above was mixed with ten or fifteen drops of moderately 
strong nitric acid, and gently heated till the mass was well 
dried. The heat was then gradually raised till all the car- 
lion was consumed, and the mass, in c< nsequence, became 
white. It was then cooled in vacuo over sulphuric acid. 



1861.] Colchicum. 407 

and weighed. The inorganic matter was thus determined, 
and the loss showed the proportion of organic substance. 

The quantity of uric acid acid was determined by adding 
chlorhydric acid to a known volume of urine. 

The tirst experiments were instituted upon myself. In 
three days immediately preceding their commencement, the 
average quantity of urine for each day was 1425 cubic cen- 
tum specific gravity 1021.73. The average amount 
of solid matter was 64.28 grammes ; of which 30.18 were 
inorganic, 34.10 organic substances. The average amount 
of uric acid excreted for each period of 24 hours was 0.77 
gramme. 

Daring the experiments with the colchicum my manner 
of living was not materially altered from that of the three 
days above referred to : i. e., I ate the same food and took 
the same amount of exercise, and endeavored to make all 
the collateral circumstances the same, so as to ascertain 
as nearly as possible the exact effect produced by the col- 
chicum. 

First day. Cm this day I took one fluid drachm of the 
tincture, three times: at 8 a. m., - p. m., and 10 p. m. The 
total quantity of urine excreted was 1685 cubic centimetres, 
o^ which the specific gravity was 1021.50. The total amount 
of solids was 70.15 grammes, of which 30.90 were represent- 
ed by inorganic, and 39.25 by organic matter. The quan- 
tity of uric acid was 0.81 gramme. 

cond day. One and a half fluid drachms ol the tincture 
were taken, as on the previous day. Quantity of urine. 
17:20 cubic centimetres: specific gravity. 1020.87; total 
solids, 75.29 grammes ; inorganic solids. 32.44 grammes; 
organic solids, 42.85 grammes : uric acid, 0.69 gramme. 

Third day. Same quantity of colchicum taken ason previ- 
ous day. Quantity of urine. 178-1 cubic centimetres ; spe i 
fie gravity, 1022.57; total solids, 80. 13 grammes; inorganic 
solids, 35.11 grammes ; organic solids, 45.03 grammes; uric 
acid. 0.82 gramme. 

Fourth day. On this day the quantity of colchicum was 
reduced to half a fluid drachm, taken as before. Quantity 
of urine. \'Ao cubic centimetres : specific gravity, l<'ii:;.17 : 
total solids, 69.23 grammes; inorganic solids, 31.09; or- 
ganic solids, ;.;*. 14 gramme- ; uric acid. 0.78 gramme. 

Fifth day. On this day the quantity of colchicum was 
increased to 1] fluiddrachms of the tincture before mention- 
ed. Quantity of urine, 1698 cubic centimetres: specific 



408 Colchieum. [May, 

gravity, 1023.08; total solids, 70.14 grammes; inorganic 
solids, 83.26 grammes ; organic solids, 42.88 grammes ; uric 
acid, 0.7(5 grammes. On this day there was some derange- 
ment of the genera] health, manifested by increased heat of 
shin, fever, and severe abdominal pains. There was also a 
little diarrhoea. The experiments were, therefore, discon- 
tinued. 

From an examination of the results obtained b} T the fore- 
going investigation, the effect of the colchieum upon the 
urinary excretion cannot fail to be perceived. The conclu- 
sions which I think may be formed are: 

1st. That the colchieum increases the quantity of urine. 

2d. That its increases the total amount of solid matter 
eliminated. 

3d. That this increase is mainly due to an augmentation 
of the organic matter. 

4th. That the amount of uric acid does not appear to be 
affected. 

These conclusions are rendered much more probable from 
the fact that on the fourth day, when the quantity of the 
tincture of colchieum taken was reduced one-third, the ef- 
fect upon the urine was less decidedly marked; and that 
when, on the fifth day, it was again augmented to a drachm 
and half, the urinary excretion was materially increased in 
quantity, and the solds, the organic especially, remarkably 
raised in amount. The relation of cause and effect would 
therefore appear to exist; and accordingly, it would be 
contrary to the principle of sound reasoning to assert that 
the change in the composition of the urine was accidental. 
It is doubtless true that the urine changes greatly from day 
to day, and even from hour to hour; but this fact is due to 
the other fact, that we are constantly varying our food, ex- 
ercise, &c. When, however, as in the investigation cited 
in this paper, these circumstances are tixed, and only one 
difference exists between the ordinary mode of living, and 
that practiced during the continuance of the experiments, 
we arc justified in attributing any change in the urine or 
in any other excretions to the influence produced by that 
difference. 

Tn the next series of experiments the effect is just as di- 
rectly shown, though, for reasons beyond my control, they 
were not continued as long as was desirable. 

The subject of these experiments was a young man 23 
ra of age, and weighing about 140 pounds. Before tak- 



L] Cbkhkwn. 400 

ing the colchicum, I examined bis urine whilst be was 
taking a fixed quantity of food and exercise, he being at 
the time an attendant in the hospital under my charge. As 

the results of these examinations for three consecutive 
davs, 1 obtained the following as the averages for each 
day: Quantity of urine, 989 cubic centimetres; specific 
gravity, 1020.14 : total solids. 51.20 grammes; inorganic 

solids.' 22.4.~> : organic solids, 28.75; uric acid, 0.47 gramme. 

First day. On this day one drachm oi the tincture of col- 
chieum was taken three times. The effect upon the urine 
was as follows : Quantity, 1021 cubit centimetres; specific 
gravity, l<>24.18; total solids, 64.25 grammes; inorganic 
solids, 23.57 grammes : organic solids, 40.68 grammes ; uric 
acid, 0.59 gramme. 

cond day. One and a half drachms oi the tincture 
were taken to-day three times, as previously. Quantity of 
iirin cubic centimetres; specific gravity, 1026.11 ; 

total solids. 60.25 grammes; inorganic solids, 20.38 
grammes; organic solids, 30.87 grammes; uric acid, 0.51 
gramme. 

On this day diarrhoea was produced. This was of quite a 
severe character, and in consequence, the colchicum was 
not further continued. 

The remarkable effect of the colchicum in increasing the 
amount of organic matter excreted is, however, very de- 
cidedly shown. This increase is so great as to render the 
probability of its being accidental extremely small, and wc 
cannot do otherwise than regard it as being directly due to 
the infiuence of the eolchienm. 

The details of the third case in which the colchicum was 
given have been unfortunately mislaid. I am, however, 
enabled to Btate with certainty, that the same well-marked 
er the amount of organic matter excreted by the 
kidi exerted as in ti the particulars of which 

have been in full. The experiments were continued for 
>ix days, with variable quantities of the tincture. 

What are we to infer from these investigations ? It ap- 
pears to me that the conclusion must 1>" admitted that col- 
li true deputator of the blood, and hence we 
have an explanation of its good effects in those blood dis- 
>ut and rheumatism. 

that no constant effect was produced upon the 
quantity of uric acid eliminated, and hem experi- 

ments do not conflict with those of Dr. Garrod* We are 



410 .Delirium 'Iremens. [May, 

not, however, hound to admit the presence of uric acid in 
the blood in increased amount during a paroxysm of gout or 
rheumatism, is the cause of that paroxysm ; and conse- 
quently, because colchicum docs not increase the quantity 
of this substance found in the urine, we are not to srfp] 
that the remedy in question does not exert its influence 
through the kidneys. — Am. Med. Monthly, 



The following are from Dr. O. C. Gibb's Monthly Sum- 
mary : 

Delirium Tremens treated with Digitalis. — In the American 
Medical Times, for December 1st, is the report of two cases 
of delirium tremens, treated with large doses of digitalis, 
by the advice of Dr. Stephen Smith. In botli cases the 
delirium was active at the commencement of treatment. 
Tinct. of digitalis was ordered in two-drachm doses, and to 
be repeated every two hours until the patient slept. After 
the administration of the second dose both patients be- 
came quiet, and one of them slept ; the other slept after the 
fourth dose. In one case the pulse came down from 108 
to 82. 

It will be remembered that, some month ago, we recom- 
mended veratrum viride in the stage of excitement of de- 
lirium tremens. The indications for the use of the digitalis 
are based upon the same principles. We cannot help 
thinking the veratrum viride is the safer of the two. Qui- 
nine and strychnine we would recommend after the stage 
of excitement is passed, to give tone to the nervous system. 
Though we have never used it, we cannot help thinking 
that from 10 to 15 grains ol quinine might be given with 
benciit, even in the stage of excitement : we should expect 
it, in connection with veratrum, to produce quiet and free 
perspiration. We believe that opium has been the death of 
many patients suffering from delirium tremens. 

Diphtheria. — In the American Medical Times, tor Dec. 

8th, Dr. Win. M. Turner has an article upon the subject of 
diphtheria, and more particularly its treatment. Jlis views 
are stated with earn- and his treatment given in de- 

tail, and in a tone that gives evidence of a supposition ot' 
novelty. His views of its pathology are doubtless correct. 



l.] Glycerine and Camp) 411 

and bis treatment judicious : l>ut the pathology and treat- 
ment arc such as have been for some time advocated by the 
first physicians of Europe and this country. But one novel- 
ty is mentioned, and that will be alluded to. In regard to 

its nature he L think the disease Is owing to malarial 

influence, and that it is essentially a blood-poisoning, with 
sneracy and breaking down of the vital force." 
\\ e will not enter into detail in regard to treatment; it is 
thus briefly stated: "Tonic and disinfectant, (the latter in- 
ternally and topically,) all combined with rich diet. Best 
.! disinfectant, in form of gargle, Labarraque's solution 
,ua pura, or any gargle in which, with other ingredi- 
ents, a disinfectant bears a large proportion." The novelty 
to which we have referred, and because of which we have 
referred to this paper, is in regard to local means. lie 
Bays, *•! studiously avoid probangs ; 1 look upon them as 
instruments of torture and of death. I know I have seen 
lich died from the constant mopping to which the 
throat was Bubje 

Among the local means employed, the following is well 
"Equal parts of ol. olivse and spir. terebinth," * 
be applied with a soft rag, and touched very 
gently.'" In addition, a flannel irated with ol. tere- 

binth lied to the neck externally. 

-in tiie Savan- 
nah Journal of Medicine, for Xovember, Professor Juriah 
Han n article upon the influence of remedial agents 

in a: etion of milk in the human female. In 

■Madonna, he says, he has u<ed it often and per- 
ringly; and over milk secretion, he says: 

"In this, I have been invariably disappointed. In no case 
up to my expectations ; indeed, I have never 
any beneficial results from its use." Tone isult 

have used it fifty 
»• disap- 
' premature delivery, where the 

cpected,and also where the child 
f mature birth, we have commenced 

• ract 
i. and a mammary . 
us as the sequel of such When we r< member how 

mon such al were wont to be. in such cases, in our 



412 



Sutures-. 



[May, 



practice, anterior to the use of belladonna, we cannot think 
this different result is altogether accidental. 

Prof. Harris prefers, and speaks highly of, a saturated so- 
lution of camphor in glycerine. With this he lubricates 
the surface of the gland, and covers the same with a flannel 
cloth moistened with the same 5 the application to be made 
at least three times a day. lie regards it equally efficacious 
in sore nipples: though, for this purpose, he usually adds 
four grains of tannin to the ounce of the mixture. 

Silver Sutures, — In the American Medical Times, for 
December 15th, Dr. T. C. Moffatt has the following remarks 
upon silver sutures : " For three years past I have used 
nothing else in operations of every kind where sutures have 
been required. In all amputations, from that of the thigh 
to the fingers, I have almost invariably employed the silver 
suture alone. Its advantages are manifold and palpable; 
indeed, I can heartily subscribe to all that an enthusiastic 
friend has said of them, so far as my experience will war- 
rant me in saying anything, at all. My custom is, in large 
amputations, to put in so many of them as perfectly to co- 
aptate the flags, and to leave them in as long as they sub- 
serve any useful purpose. They may be allowed to remain 
for an indefinite period, without the risk of exciting undue 
inflammation, or even irritation. I have often left them in 
until after the stumps had entirely healed, without occasion- 
ing inconvenience of any kind. They always hold the 
parts in more perfect apposition than silk can do, for the 
reason that they do not appear to cause any suppuration at 
all." 

As connected with this subject, we would refer to a paper 
by Dr. John Swinburne in the Medical and Surgical Re- 
porter for December 8th. He there recommends as a uni- 
versal substitute for all forms of sutures, to be applied upon 
the surface of the body, the common entomology pins. lie 
says: "The introduction of small entomology pins is attend- 
ed' with but little pain in comparison with that produced by 
the passage of a needle and thread. The points are 80 
carefully prepared and the instrument so perfect that 
patients declare the pain to be much less than that accom- 
panying the drawing through the thread, even after the 
needle has perforated the skin. By the use of those, the 
edges of a wound can be approximated in the nicest pos- 
■■ manner by means of the thread as used in ordinary 



1861.] Varusasi Vans oftfu Leg. 413 

hare-lip operations, so that union by the first intention 
is more Btire to follow than in any case of simple interrupt- 
ed or even quilled sutures. This pin, from its tenderness 
and pliancy, will bond and accommodate itself to the parts, 
thus doing away with the chief objection to the use of the 
stiti' common pin." He says further: "I have used the 
silver wire a long time, and believe that the encomia pag 
upon it are deserved ; but that it is, on the whole, unequal 
in value to, and not BO worthy of employment, as the pin, 
will he evident from a tabular comparison : 

Silver Wire. 

1. Expensive and difficult to obtain. 

*J. Pain and difficulty in introducing. 

S. Danger of tearing soft and tender skin in the process 
of twisting. 

4. The interstices between the sutures have to be sup- 
plied by adhesive plaster, &c. 

Pin Suture. 

1. Cheap; 75 cents per thousand. 

2. Less painful, and easily introduced. 

3. The most delicate skin is in no danger of being lacer- 
ated. 

4. The edges of the wound are completely covered by the 
thread through its whole extent.'' 

Entomology pins were, perhaps, firsl used by Prof. Alden 
March, of Albany (see Transactions of the Medical Society 
of the State of New York, for 1855.) Prof. March, how- 
ever, only used them as hare-lip pins. This priority of use 
by no means detracts from the honor due to J>r. Swinburne, 
who recommends them as universal sutures. 

of the Leg. — The treatment of this trouble- 
some affection is a matter of interest, and more particularly 
s«> because surgeons of equal eminence differ in regard to 
it. We quote a lew opinions that have fallen under our ob- 
servation during the last month. In the American Medical 
Times, for December 1st, Prof. A. ('. Pos1 makes the fol- 
lowing remarks: "The treatment of varicose veins is palli- 
ative or radical. The radical treatment consists in obliter- 
ation of the diseased v. ,d the process is always at- 
tended with more or less danger to life ; it should theref 
her- . _ avated cases. The palliative treatment 
consists in giving a uniform support to the limb by means 
ot bandage-, or of elastic laced stockin. We have pre- 



414 Varicose Veins of the Leg. [May, 

viously referred to the radical treatment of varicose veins by 
subcutaneous application of the metallic ligature, as prac- 
ticed by Dr. 1i. J. Levis. En a private letter to us, Dr. 
Levis says his method of cure "in always efficient, and is 
absolutely safe." [n the American Medical Times, for 
December 15th, Dr. T. C. Moffatt has a lew remarks upon 
the treatment of this affection by injection into the diseased 
vein. We quote one case in illustration. The case referred 
to was an unusually bad one. Dr. Maffatt says: "Placing 
a tourniquet upon this (themostprominently enlarged vein) 
above, and making pressure below, so as to isolate about 
two inches of the vein, I threw into it eight drops of the 
persulphuret of iron diluted with as much water. — (Squibb.) 
The instrument used was the syringe commonly employed 
for injecting morphia into the cellular tissue. After a few 
minutes the pressure was removed, and a hard plug re- 
mained; the blood coagulated almost instantly. The in- 
flammation which followed was not immoderate. Cooling 
anodyne lotions were applied, and subsequently lead poul- 
tices. A very slight amount of suppuration resulted, and 
in just three weeks the limb was perfectly cured." 

Bearing upon this point, Prof. E. 8. Cooper, in the Octo- 
ber number of the San Francisco Medical Press, has a few 
remarks. He has not much confidence in the treatment by 
injections of Monsel's salt. That the injection will produce 
an immediate clot, he does not doubt ; but this clot will ar- 
rest the undecarbonized blood in its way back to the heart, 
and this arrested blood will become a great source of irri- 
tation. He says. "After trying the various methods of treat- 
ing varicose veins of the lower extremeties, we are convinced 
that there is none like that of free incisions, followed by 
keeping the wound open until granulations begin to till up 
the incision, in the mean time keeping a roller as tightly 
upon the limb as the patient can conveniently bear, com- 
mencing its application at the foot. By this means, blood 
is prevented from entering the veins to any considerable 
extent." 

Besides the objections to the injections above stated he 
says : "We do not believe that even a very small quantity 
of Monsel's salt can be introduced into a blood-vessel, with- 
out risk of fatal consequences." 



1861.] Lectures on Diphtheria. 41f> 

Lecture* hfhcri'i. \ Eqyptian Disease.) Delivered at 

L'Hotel Dieu 9 i By M. Trousseau, 

entlemen: — For several years the reports sent to the 
demy of Medicine, the communications addressed to 
various scientific journals, have indicated that fatal epidem- 
ics of diphtheria prevailed in different parts of France, in- 
vading' all departments ; those of the south, as well as those 
of the north, of the west, and of the east. These epidemics 
also prevail abroad, in England, where for sixty years it 
has hardly been known ; in America, in Germany, and in 
the Spanish Peninsula. The attention of the public, as 
well as of physicians, is more than ever aroused in relation 
to this dreadful calamity. The cases which have lately in- 
creased in my service afford me the opportunity of giving 
you my ideas upon this important subject, and it is my 
duty to communicate them to you. I shall, then, in a series 
of lectures, consider this disease, one of the most serious 
which affect humanity. I do not intend to exhaust the 
subject, promising some day to write a treatise upon diph- 
theria. I shall, therefore, take up only the most practical 
points, illustrating them, as far as possible, by the patients 
we shall see together. Do not expect, gentlemen, a resume 
of the numerous observations which, have been made under 
your eyes, hi making use of them, in sustaining my pro- 
positions by the experience of my confreres, and that of dif- 
ferent authors who have written upon the subject, I shall 
be chary of long histories, citing only what is necessary to 
make everything I say clear and comprehensive to you. I 
shall also insist, .gentlemen, upon the necessity of a treat- 
ment the utility of which is to-day questioned. I shall 
oppose that deplorable tendency among observers of the 
highest order to leave the true road, which has been pe 
vered up to this time. 

Diphtheria is a specific disease, par excellence, contagious 
in its nature, displaying itself upon the mucous membranes 
and the skin, and presenting the same characteristics in 
both places. I say, that it shows itself upon the skin and 
mucous membranes, because, in fact, diphtheria has this m 
common with certain specific and contagious diseases 
eruptive f e philis ; with this difference, however, 

that it affects the external teguments only when it is denu- 
ded of its epidermis. Still, the disease which we are about 
to study shows a marked preference for the pharynx, for 
the air-, j, the larynx especially, constituting the af- 



41G Lectures on Diphtheria. [May, 

fections commonly known under the denominations o£ 
malignant, false membranous angina, otherwise designated 
gangrenous sore throat, suffocating angina, and now more 
particularly called croup, when the angina seizes upon the 
larynx. Diphtheria is frequently observed to attack the 
nasal mucous membrane, the buccal mucous membrane, 
the vagina, the prepuce, the glans penis. Of all the differ- 
ent forms, whether pharyngeal, laryngeaul, nasal, buccal, 
vaginal, anal, or cutaneous, the first is by far the most 
common. In certain epidemics, it is this form it almost 
exclusively assumes, destroying those affected, by its exten- 
sion to the larynx and trachea, by croup, in a very different 
manner from malignant diphtheria, which kills by a kind 
<>f general poisoning like septic and pestilential diseases. 
To this first form the attention has always been more par- 
ticularly drawn, because it is the most common ; it is this 
which has been described by the older writers, and which 
served as a type for the treatise on diphtheria by M. Bre- 
tonneau ; it is with this that we shall commence the study 
we are about to undertake. 

Diphtheritic Angina and Croup. (Pharyngeal and Lar- 
yngeal Diphtheria.) 

A young boy, four years old, in excellent health, was 
suddenly taken with symptoms in the throat, which at first 
were so slight that they did not alarm his family. After a 
day or two, it was noticed that he grew pale : that he was 
quieter than usual, and remained indifferent to his ordinary 
playthings. lie coughed a little, but had no fever, and 
although his appetite was not as good as usual, lie still sat 
up all day. Accident alone revealed the disease with which 
lie was attacked. The family physician, who had been 
called to see another infant affected with epileptiform ver- 
tigo, was casually consulted for the boy. lie was struck 
with the pallor of the skin, and perceived a slight swelling 
in the submaxillary region. Thus, having ascertained the 
existence of tumefied ganglions, he examined the throat, 
and found the pharynx and the tonsils quite red, while the 
latter were increased in size, and one of them, the right, 
was covered with a quite thick grayish membrane. He 
immediately decided that the case was one of diphtheritic 
angina, and acting upon this belief, he instantly cauterized 
the diseased part with the caustic nitrate of silver, taking 
care to detach the false membrane by means of the nitrate. 



1861.] hares on Diphtheria, 417 

The cauterization was repeated the same evening, and the 
next day both morning and evening, and in the interval 
between the cauterizations he made, or had made, several 
insufflations of the powder of alum. The child was well 
fed, according to the express instructions of the physician, 
and took, besides, a tonic mixture, the base of which was 
the wine of cinchona. The disease was arrested, but the 
general pallor continued for some time, and a paralysis of 
the veil of the palate succeeded. The child was taken into 
the country, returning at the end of six weeks in perfect 
health. 

This, gentlemen, is an example of pharyngeal diphtherit- 
ic angina. The insidious maimer in which the disease began, 
the mildness of the general symptoms, the absence of fever 
at the time the physician ascertained the condition of the 
patient, the soberness of the child, the pallor of the skin, 
the tumefaction of the submaxillary ganglions, and finally, 
the presence upon the right tonsil of the characteristic false 
membrane, abundantly sustain the diagnosis. The para- 
- of the veil of the palate, which occurred a few days 
after, also confirms it, and I have no doubt the energetic 
treatment adopted in the early stages cut short the disease, 
which might have extended by degrees, and having invaded 
the larynx, would have produced croup. 

Pharyngeal diphtheritic angina is ob'served at all seasons, 
in all climates. It is not without a certain degree of aston- 
ishment that I somewhere read that, this disease was seen 
more especially in northern countries, in cold and moist 
climates, and that it was almest unknown in the south of 
France and Italy. Whoever advanced this singular asser- 
tion," must have had a very slight knowledge of the history 
of medicine, not to know that the cisease described by Ar- 
18, and which was none other than a pseudo-membra- 
nous angina, was endemic in Egypl and Syria, whence the 
name ot Egyptian Ulcer and Syrian Ulcer, which was given 
to it at an epoch contemporaneous with Homer rather than 
Hippocrates, according to M. Bretonneau, or not to know 
that Carnevale, Nbla and Bgambati have given to us histo- 



•Inopp • this proposition, we recollect thai an author of the 

last century, Wedel, has said, that diphtheritic angina, which he called 

'lis contagiosa, was more frequent in Italy than in the north 

of Europe. --In Italia frequenMor quam "]>>/</ Boreale* magU Ehtropaos." 

— De Morb. Iitfant., cap. 20, page 77. 



418 Lectures on Diphtheria. [Ma 

ries of epidemics of the morbus strangulatorius which reign( 
in Italy at the commencement of the 17th century; whi 
Villareal, Fontecha, Nunez, Ilercra de Heredia, Mercatu 
and Tamajo ohserved it at the same time in Spain. At th 
time we see that these same sore throats prevail throughoi 
all France, as I have already said. It would seem that 3 
the same latitude pharyngo-tracheal diphtheria becom< 
developed at the time that catarrhal affections are mo 
common. 

Diphtheria spares no age; still, it principally attack 
young subjects, and ordinarily those between the ages c 
three to five and six years. 

It commences by a greater or less redness of the pha 
ynx, by a swelling of the tonsils, most usually of one 011I3 
upon this is soon seen to appear a very sharply circun 
scribed whitish spot, at first formed by a layer resemblin 
coagulated, semi-transparent mucus, which becomes thiol 
er, and very rapidly takes on a membraniform consistenci 
This exudation, when first formed, is easily detached froi 
the mucous membrane, to which it adheres only by ver 
fine filaments, which penetrate the muciparous follicles. 

The mucous membrane underneath is perfectly healthy 
with the exception of the destruction of the epithelium 
and if sometimes it appears furrowed, it is, because aroun 
the exudation it is swollen, and forms, by this means, 
kind of depression. Ulceration is the exception. Gene] 
ally, I repeat the mucous membrane is healthy, or at leas 
presents no alteration beyond an increase of vascularity, fo 
upon detaching the false membrane with care, it can be r( 
moved without being followed by the least sign of blooc 
By means of the microscope, the epithelium of the mucou 
membrane, with its vibrating cilia, may often be seen upo 
its adhering surface. 

After a few hours the pseudo-membrane, convex at it 
centre, thin at its edges, has increased ; it now covers a' 
most the whole tonsil, is adherent at the points where i 
first appeared, and has taken on a yellowish-white coloi 
This color may vary from a yellowish-white to a deep ye 
low, to a gray, or even to a black. Then the veil of th 
palate usually commences to be inflamed, the uvula swells 
and after a few hours more, or a day, the side of the uvul 
corresponding to the tonsil which is covered with a fals 
membrane becomes covered with an exudation of the sam 
color. Frequently, within the space of twenty-four c 



1861.] iwres on Diphtheria, 419 

thirty-six hours, the entire uvula is enveloped like the fin- 
ger of a glove. At the same time, a spot of the Bame nature 

appears upon the other tonsil, which is soon entirely cov- 
ered by it. The bottom of the pharynx beginning to be 

lined upon both sides, long, narrow. Longitudinal streaks 
of a deep red are sometimes seen, in the midst of which art' 
formed lines of concrete mi unetimes membranous 

patches, which finally unite with each other. At this time, 
if the child he docile, and can be easily examined, by press- 
ing down the tongue, the uvula, both pillars of the veil of 
the palate, both tonsils, and the bottom of the pharynx will 
be found completely covered with the coating I have just 
described. Portions oi % these false membranes can be de- 
tached by means of a pair of forceps; we have removed 
some in this manner, which, having enveloped the uvula, 
had the form of a sewing thimble. 

Generally, from the commencement, the lymphatic gang- 
at the angle of the jaw, those necessarily which cor- 
respond to the tonsil first attacked, are engorged. This, 
gentlemen, is an almost invariable symptom, which is not 
absent once in ten times. Its impc rtance is then consider- 
able, so much the more for the reason, that in ordinary an- 
gina, a disease usually of no serio .^ness, but which might 
•nfounded with the disease of which we are speaking, 
this ganglionar;/ incut is g nerally absent ; or if it 

be present, it is in a much less degree than in pharyngeal 
diphtheria. 

On the invasion of the die • fever is high, but it 

diminishes after the second day, and entirely subsides the 
.lowing day. or tie- day after; the patient feels only a 
slight m ridenced by a desire to be at rest; a sense 

of feebleness ; and as the only thing complained of is a dif- 
ficulty often very slight, in deglutition, the beginning of the 
liso:t ; usually alarming. 

Left to itself, it remains for three, four, five, or six days 
limited to the pharynx; the older the person, the longer 
>d of development, the longer it takes for the (lis- 
to invade progressively the parts within sight. If it 
that false membranes form more rapidly in in- 
fants than in the adult, it is, perhaps, because the blood of 
former is richer in plastic materials than the latter. It 
I always v that in children of three, lour, five, and 

ix years, the two tonsils and the posterior part of the phar- 
ynx can ered with diphtheritic concretions within 



420 Lectures on Diphtheria. [Mi 

thirty-six to forty-eight hours ; in the adult, and parti* 
larly in old persons, five, six, seven, and eight days p: 
before all the parts are completely covered. 

In patients whose pharynx can be well examined, t 
false membrane may be seen increasing each day by t 
addition of new layers which are formed underneath th( 
first developed. These different layers take on a stratifi 
arrangement. The most superficial become softened, a 
are easily torn ; altered in their color by the food, the drir 
the matters vomited, the medicines taken by the patiej 
by blood from the pharynx or posterior nares, these me 
brancs become grayish, black, and resemble the detritus 
gangrene. The resemblance is the greater, from the fi 
that, in these conditions, the false membranes putrefy a 
exhale a very repugnant foetid odor. This was the ca 
you may recollect, with the young girl twelve years old, 
recently had under our observation in the ward St. B 
nard. Her breath had an insupportable gangrenous od 
and when we removed the detritus which covered the t< 
nils and the veil of the palate, by means of a pledget 
charpie, we found it to be composed of a grayish matt 
which was very like the detritus of gangrene. And yel 
was not, for when the diseased surfaces were afterwai 
cleaned, the mucous membranes, but a short time bef< 
covered with false membranes, appeared red, hardly ex< 
riated, but showing no traces of gangrene. 

This appearance of gangrene which the diphtheritic p: 
duction assumes, is a point sufficiently important to be cc 
sidered more particularly. It explains to us how, for a lo 
time, diphtheritic angina was confounded with gangrene 
angina, and gave rise to the names of angina, of gangrem 
sore throat ; names which some physicians use even at tl 
time. 

If we study diphtheritic angina in the infant and co 
pare it with what occurs in the adult, we shall observe tl 
the disease almost never presents the gangrenous aspe 
which, on the contrary, is very frequently seen in the adi 
Should we therefore conclude that gangrene is really p 
sent in diphtheria of the adult? No ! These are only 
pearances of gangrene, and do not exist in the adult a 
more than in the child; there is no true gangrene, unl 
in exceptionally rare cases ; so rare, that, in the wh 
course of my medical career, I have met only three exa 
pies of it. I admit it is very difficult not to believe in 






$61.] fures on Diphtheria. 421 

ven now, although I have so seldom witnessed gangrene 
these cases, although I know when a recovery has taken 
ace, or when, at the autopsy, with the pathological speci- 
ens in my hand, I discover no traces of sphacelus upon 
e tonsils or the mucous membranes, finding only some 
ght excoriations, and in many cases not even these; not- 
ithstanding this, I cannot at first, even now, disabuse 
keif of the idea that gangrene exists. In the young girl 
the ward St. Bernard, I was sure that there was no gan- 
•ene, and you also were convinced of it; still, the extreme 
kidity of the breath, that grayish secretion which covered 
)th tonsils, could not fail to suggest to our minds a mor- 
ication of the mucous membrane, a sphacelus of the sub- 
cent cellular tissue, or even a deeper destruction of the 
5sues. 

These are the reasons why diphtheritic angina has been 
nfounded with gangrenous angina; why certain physi- 
; 11 confound these two diseases; and why, in the 
scrip tion of epidemics of croupal angina, you still often 
ar of gangrenous sore throat, even when they were only 
llicular or pseudo-membranous affections. 
One word more, relative to the mode of circumscription 
the membranous exudations at the points upon which 
ey are developed. Sometimes they are surrounded by a 
lall bright-red line ; sometimes they do not appear limi- 
i; and. as I remarked in the beginning of my lecture, the 
Ise membranous concretion, growing thinner at its edges, 
reads out over the surrounding parts. In such a case, the 
■dency to spread is greater and more to be feared than 

former. 
If pharyngeal diphtheritis, left to itself, does sometimes 
come limited to the pharynx, examples of which have 
en cited by M. T>retonneau, and which every one may 
serve in certain epidemics, it usually, however, continues 
; .In some eases it passes into the oesophagus, 

d reaches even to the cardiac orifice. The distinguished 
in of Tours lias reported two instances of this char- 
ter, and Borsieri has instanced others; but almost inva- 
-bly it invades the larynx and trachea, and constitutes 
its ordinary course, the most common ter- 
nation of diphtheria. In fact, we see more persons al- 
ied with this disease die of croup, than from those malig- 
nt anginas, of which I shall speak hereafter, which <!<■- 
oy life in the manner of septic disea- 






422 Diphtheria. [May 

The propagation of the diphtheritic affection to the laryru 
was noticed a long time ago. Aretseus speaks of it in hii 
chapter, I)e tcnsillarum utceribus, where you will find tin 
first mention we have of membranous agina, which In 
designated under the name of ulcera pestifera, repeating the 
names of Egyptian, Syrian ulcer, by which it had been call 
cd. Read the histories of epidemics recorded in the annali 
ofmediciue, and you will see that the propagation of tin 
disease to the larynx was perfectly well known, and that i 
particularly occupied the attention of physicians. "What- 
ever name was given to it, the laryngotracheal affection u 
indicated as the cause of death, and hardly anywhere if 
there any mention of the malignant form of which I have 
just spoken. 

I repeat, then, that persons affected with laryngeal diph 
theria die from croup ; and I speak not only of that disease 
which is developed in isolated cases of sporadic diphtheria 
but also of that which takes place in a great number of case: 
during an epidemic. 

When, then, arc the symptoms of that affection called h\ 
the Spaniard and Italians of the 17th contury, garrotillo 
male in carina; by their physicians, moeiis strangulator ins , 
by the Americans, at h.-^ close of the last century, suffocat 
ing angina, and which we to-day recognize as croup, a name 
given to it by the Scotch ? — Am. Med. Monthly. 



Idlic ri a. 

The subject of diphtheria receives more than usual atten- 
tion in the journals for , of which the present article 
is a summary. Risking the charge of repetition, we shall 
endeavor to give, in ai few words as possible, the practical 
import of the papers that have come under observation. In 
the Maryland and Virginia Medical Journal, for the montli 
above indicated, Dr. [£. W. ['Anson, has an article on thic 
subject. In the treatment, unmends, first, an emetic 
of salt and water, or ipecacu nha, to be repeated as occ;. 
may require, to clear the throat. After the cinesis, he would 
move tli'' bowels with oil and turpentine, and subsequently 
keep them open with rhubarb, should medicine be required 
fortius end. k 'A stimulating and supporting plan of treat- 
ment should now be adopted. rucIi as camphor and quinine — 
1 to 5 grains each." "Capsicum, used in 



i 



!.] Diphtheria. 423 



combination with the powder of camphor and quinine, will 
•und an excellent remedy." In cases complicated with 
nenmonia, ;> the main reliance must be placed in repeated 
ering, both in front and behind the chest. At this stage 
advantage will be derived from the use of spirits of 
turpentine, together with simulating expectorants, as decoc- 
tion of seneca and syrup of squills." 

- local remedies, he recommends nitrate of silver, 20 
£i\ to the ounce of water, to be applied only once a day. 
We have ordered a saturated solution of common talt to be 
thus used, and to be repeated every hour or two, wish decided 
relief. It clears the mouth and throat of the adhesive and 
nauseous secretion better than anything else we have tried. 
After the removal of the diphtheritic membrane with a strong 
solution <»f nitrate of silver, the salt and water, thus applied, 
will prevent any extensive subsequent formation. In pneu- 
ic complications, he would advise mercury until the 
gums become tender. 

He says he lias treated over thirty cases, with but two 
deaths. We should consider the mercurials objectionable, 
but then his experience is satisfactory. He says nothing of 
whisky as a stimulant. In our experience, as has been stated 
in former summaries, we have regarded it of the first impor- 
tance. In about twenty cases, we have had two deaths, and 
both . »t' these refused the stimulant. All the others expressed 
a confidence that the milk punch or egg-nogg was staying 
them up against the excessive feeling of prostration. 

In the Berkshire Medical Journal, for January, Prof. Win. 
H. Thayer has an article of thirty-eight pages upon this sub- 
ject. He shows a thorough acquaintance with the literature 
of diphtheria, and enters quite fully into its history. We 
shall deal only with his treatment, which is not dissimilar 
from that previously advised by other writers. 11^ Bays, 
phtheria is clearly not a self-limited disease; and in order 
to make treatment effectual, it mast be begun at an early 
Of local means, he gives his preference to the nitrate 
! that in nearly or quite full strength. k> I prefer 
to apply the stick to the exudation, and a solution of ii dr. t<> 
surrounding mucous membrane for the early ap- 
plications, to be omitted or diminished as the disease begins 
A variety of chlorinated mixtures arc Bpoken of, 
lapted to the milder cases, or the convalescing Bta§ 
ral treatment, muriated tincture of iron, chlorafe 
quinine, turpentine, and alcoholic stimulants, are 
mmeuded. "Chlorate of potash has an advantage over 



424 Dtphtneria. [May? 

the tincture of the sesquichloride of iron, as an alkali — in its 
resolvent effect on the fibrin of the blood, and hence a proba- 
bility of its diminishing and arresting the exudation.'' In our 
experience, this statement has hardly been borne out. AVe 
think we have seen the most positive results from the tincture 
of iron. "Besides quinine, chlorine, or turpentine, diphtheria 
requires alcoholic stimulants. The flagging powers of life 
need frequently repeated excitants to sustain them against the 
steadily depressing influence of the disease." these, he 
thinks, can usually be commenced with as early as the second 
or third day. We have frequently commenced with them on 
the first manifestation of the disease, and are confident that 
we have seen those severe neuralgic pains, so common in the 
outset, yield to a full do? e of hot sling. The absence of sur- 
face heat he regards as an indication for the commencement 
of the stimulant, and adds, " but we might, without hesitation, 
say that the presence of the disease is alone a sufficient 
indication." 

In one regard Prof. Thayer and Dr. I' Anson are at variance. 
Prof. Thayer says, " I cannot avoid thinking it especially ill- 
judged to mercuralize v patient — if wise at any stage — at the 
somewhat advanced period at which the croupal symptoms 
usually appear in diphtheria, as the peculiar adynamic condi- 
tion also is approaching, if not already begun, which must be 
hastened and aggravated by a mercurial course." As in 
typUoid fever, so in diphtheria, he thinks a tongue dry and 
black requires turpentine, and not calomel. We have used 
the turpentine in about half of our cases, in all that were 
protracted, and at any time gave a dry and red, or black 
tongue, and always with an e idence of improvement. 

In an article of twenty pages upon diphtheria, by Dr. C. 
II. Cleveland, the subject is discussed with some novel views. 
As his treatment is somewhat different from any previously 
given, we subjoin it in substance. Dr. Cleveland thinks 
alhalien are of the first importance, and recommends the bi- 
carbonate of soda, to be given in from one to ten grains, ac- 
cording to the age of the patient, every half hour, or every 
hour. As a local application, he prefers a strong solution of 
common salt. We make one quotation: "A gargle, com- 
posed of a very Btrong solution of common table salt, if the 
pellicle is not ycl formed, will produce an osmotic flow of 
fluids through the epithelium, and thus cause the fauces and 
throat to be too moist to allow a pellicle to be formed. It 
taken early in the attack, repeated very often, at the same 
time that plenty of soda is taken internally, most cases of 

I 



L861.] 425 

diphtheria will pass off without any appearance of the mem- 
branous exudation. Without doubt, By thus preventing the 
formation of a pellicle, many cases of genuine diphtheria 
have been made to remain so mild in their action, that even 
rvant physicians have been led to suppose the 
Lse was simply an ordinary pharyngitis." 
In the Nashville Journal of Medicine and Surgery, for 
January, Dr. J. 0. Calhoun lias a short article on this subject. 
He says that last fall the disease prevailed in an aggravated 
form. The first few cases he treated "in the usual manner, 
with alterative d mercury, an occasional emetic, and 

nitrate of silver to the throat," and all died. (Dr. Calhoun 
should know that this is not the usual treatment.) " But 
Bince we have adopted the following treatment, not a single 
■ has terminated fatally, so far as I have heard : 

It. — Two table-spoonsful of fresh tar. 
The yolk of an egg. 

Spread on a piece of coarse cloth, cover it with a piece 
of old muslin, and apply to the throat. This plaster should 
be removed once in eight hours, li the subject is an adult, 
direct him to use a strong decoction of cayenne as a gargle, 
every two hour-. For children a weaker decoction should bo 
used, and applied to the throat with a mop. This, together 
with keeping the bowels in a soluble condition, will as cer- 
tainly cure diphtheria, as quinine will arrest intermittent 
■:*. The efficiency of the above treatment has become so 
generally known in this locality, that physicians are seldom 
called t<> diphtheria patients." 

This statement, in our opinion, is quite too sweeping. We 
are not prepared to believe that an external application to the 
throat will cure a constitutional disease, of the severity which 
diphtheria frequently assumes, with that certainty "'if It which 

in the Medical ami Surgical Reporter, for January 5th and 
12th, Dr. W. Pepper has lectures npon diphtheria. We sub- 
join the more important points of treatment. "1 am in the 
habit ing the muriated tincture of iron, in fifteen 

a day, and sulphate of quinia in 
that fiv all bo taken in the coin- 

the • ne tin.' . tain the 

(1 water, wine whey and porter, and 

ration present, 1 employ 

itine, the ric (typhoid) 

mercury, lie thinks there are 






420 . Diphtheria. [May, 

some cases of u sthenic character that may be benefitted by 
the use of mercury, under certain conditions ; but in adyna- 
mic cases, he thinks there is no doubt of its impropriety. He 
also uses the chlorate of potash. As to local remedies, he 
thinks powdered alum, or borax and sugar, preferable to 
nitrate of silver in substance. He thinks there are many 
cases, the local symptoms of which might have remained 
mild, but lor an aggravation by the use of the nitrate of silver. 
He occasionally uses the nitrate of silver, but in weak solution 
— under twenty grains to the ounce. Where emetics are 
indicated, he prefers alum with ipecacuanha. 

In the St. Louis Medical and Surgical Journal, for January, 
Dr. S. T. Newman has an article upon diphtheria. He con- 
cludes his paper with a letter from Dr. J. W. Bright, of 
Lexington, Ivy., in which a slight modification from the or- 
dinary treatment is advised. Dr. Bright commences the 
treatment with a gentle purgative, and afterwards the bowels 
are kept soluble by means of oil and turpentine. The mem- 
branous exudation he removes with a fine sponge, and applies 
a solution of nitrate of silver, 50 grs. to the 5j., or the sulphate 
of copper, 3j. to 5j- of water, once a day. For general treat- 
ment : "I give the muriate of ammonia in full doses, say, to 
a child eight years old and upward, 10 grains every two 
hours (in solution), and ten drops of the sesquichloride of 
iron in the intermediate hours ; and these are not to be 
omitted for thirty-six hours ; then rest four or five hours, and 
again give them in like manner. Continue this treatment for 
four or five days, according to circumstances." 
" The cure should be completed by the uye of tonics ; I have 
found beeberine the best. Diet nourishing. I have treated 
three hundred and thirty-four cases after this method, without 
the loss of one" The result is quite satisfactory. 

In the American Medical Times, for January 19th, Dr. E. 
W. Spafford has a short article upon the treatment of diph- 
theria. He says, " I have lost none to whom I was called 
within Ibrty-eight hours after the attack. My first business is 
(if it has not been done) to relieve the stomach and bowels of 
their morbid contents by the use of a gentle cathartic ; apply 
//■. iodine to the neck, three times per day, and with a sponge 
probang, alternately apply a solution of chlorate of potash and 
nitrate of silver to the ulcers in the throat ; sponge the body 
with diluted nitro-muriatie acid; give gum water, beef-tea, 
wine, quinine and iron, as the case may require. Tonics are 
indispensable. If neglected or too sparingly used, alarming 
debility may ensue, the surface of the body become colorh 



1 .] Diphtheria. 427 

muscular power in a very short time lost, and the patient soon 
- to breathe. 
*• 1 have been much gratified at the beneficial results grow- 
ing out of the use of mtro-muriat ' \ the surface. It not 

only acts as a counter-irritant, but as a tonic. Where I have 
had opportunity to use it early in the disease, I have not 
witnessed the debility, the flabby, soft condition of the 
muscles, or colliquative sweats, which bo often lead us t<> an 
unfavorable prognosi 

In the American Medical Times, for January 20th, Dr. 
Jonathan Kneelaud has an article upon this subject. In 
< raondaga and vicinity diphtheria has prevailed somewhat 
an epidemic since July last. About eighty cases have 
occurred, and A. a deaths. Of these eighty cases, Dr. Knee- 
land lias treated seventeen, all of which have recovered. AVe 
shall make a few extracts from his treatment, and thus give 
what is peculiar. " En giving briefly the treatment I found 
. [ would claim no other merit but that of 
having somewhat early learned that we must at the onset 
ain our patients by specific constitutional remedies, and 
■ much on local treatment. " 
The bowels were first emptied, in Dr. KneelaiuFs course, 
and then the patient put directly upon the chlorine mixture : 

•* R. — Chlorate of potash, 5ii. 

Hydrochloric acid (dil.) 5ij. 
Water, Sviij. 

sweetened to the taste, giving from a dessert-spoonful to a 
large spoonful, according to the age of the patient." To this 
nail amount of morphine was added in some cases; and if 
muriated tincture of iron was considered advisable, it was 
given in connection with this mixture, in which connection he 
thinks it is better borne than when given alone. Quinine, in 
iders all-important : " In no disease have 
ell borne." Like almost eve rver, 

Dr. Kneeland found "good broths and food ^( easy assimila- 
tive capacity ttial service. He says, "1 have found 
nitro-muriatic acid (equal parts of each acid), given in doses 
in water, and taken atb . well 
borne in patients, who did not bear either the iron or 
chlorine mixture well." •• Alcoholic drinks 
in aid ' f quinine, general stimulants and nourishing broth-, 
id in some cases. But li wc found that the 

:i-eed 
better than ardent spin We have more confidence in ap- 



428 Diphtheria. [May, 

propriate stimulants than anything else in diphtheria. Upon 
this subjeet we have frequently expressed our opinion. A 
few days since, a gentleman called upon us for advice, in re- 
gard to a sore throat and general prostration of the system. 
( )n examination, we found the fauces soft, palate and roof of 
the mouth presenting that erysipelatous redness peculiar to 
the first stage of diphtheria. Ilis business was such as to 
render it important that he should keep about. I advised 
him to use all the rye whisky that he could and not become 
intoxicated; also, to use a saturated solution of potash as a 
mouth wash and gargle to the throat. We should have said 
that his tongue was swollen, so as to leave the prints of every 
tooth upon it, and was heavily furred, and ulcerations had 
appeared at various points. My directions were adhered to ; a 
pint and a half of whisk}' was used daily, and the patient re- 
covered without taking his bed at all. In regard to hard 
cider, we have seen many cases of typhoid fever, in which 
this stimulant has been almost irresistably craved ; in such 
cases, we have always gratified the desire, and good lias al- 
ways resulted from it. 

As an article of diet, Dr. Kneeland recommends the fol- 
lowing : " As an article of diet, remedial, and yet palatable, I 
would recommend, where they can be obtained, sour-baked 
apples, mixing the tender pulp with sugar, or giving them 
alone, if the patient so prefers them. For many years I have 
used apples in this way as the diet par excellence in scarlatina; 
and how many grateful little ones, nauseated with pap, por- 
ridge and panada, have risen up to call me blessed, for the 
grateful change to the apple diet !" 

As a local treatment, he has no very high opinion of nitrate 
of silver; "To prevent the secretion from forming after re- 
moval (as it often does), I would use tannin and dried alum, 
applied with a soft linen rag, or on the moistened linger, to 
parts within reach, and blown into the throat through an 
ivory or glass tube; or two or three quills introduced into 
each other answer a good purpose ; no harm follows inhaling 
this powder, as a short paroxysm oi' cough clears all out 
again. 1 ' 

The pulverized burnt alum we first saw recommended in 
the N. 0. Medical and Surgical Journal, by Dr. Bigelow, 
then of Paris. We have used it often, and with satisfactory 
results. We prefer it to nitrate of silver. For a gargle, the 
loll., wing is my preference, after trying a variety: 



1861.] Strangled Hernia. 42!) 

R. — Hyd. chlo. ammonise, 5jj. 

Iffi niuriat., oiv. 

Pulv, capsici, ' §jj. 

Yin. 5ij. 

And <>ne and a half pints hot water; cool, and use freely. 
If any is swallowed, no harm foil " :: " "I 

apply externally, over the throat, salt pork, moistened with 
turpentine, and <]uiekened with pal. sem. sinapis, or capsi- 
cum, it' need be."' 

The views, of Dr. Kneeland, in regard to treatment, corre- 
spond very well with our own ; we conclude with the follow- 
ing paragraph in regard to its nature : u From what I can 
gather from the recorded or narrated knowledge of others, 
and my own knowledge of the disease as gleaned from a 
limited number of cases, I have concluded that diphtheria is 
a blood-changing disease, and that lesion of function in the 
spinal nerves occurs early in grave cases ; that we would not 
wait for sinking, but, if possible, anticipate and prevent it ; 
and, finally, that to oxygenate the blood, and rouse and vita- 
lize the nervous system, are the leading indications to be 
_ht. v — American Medical Monthly. 



Strangulated Hernia. — Chloroform. — Unless chloroform be 
given to a very free extent, it does not produce perfect re- 
laxation of spasmodically contracted muscle, hence in 
^ of strangulated hernia it must be given so as to pro- 
duce a perfect state of comia, as indicated by stertor. If 
this be produced there are but few cases of inguinal hernia 
which will not yield to efforts at reduction, if the case is 
seen sufricienty early. Success to the same extent cannot 
be hoped for infemoral hernia, as statistics show that this 
form of heri requires operation 25 per cent, more fre- 
quently than inguinal. — Mr. T. Byraat, p. 167. 



Incontinence oj . — In a boy of fourteen, give one- 

third of a grain of extract of belladonna twice a di.y in cin- 
namon-water, in thofi where the affection issuspe 

from weakness or paralysis of the sphincter of the 
bladder. Belladonna acts by toning or exciting the gang- 
lion, m, and depressing the cerebrospinal system. — 
Dr. R. Hughes, p. 395. 



430 Mitorial [May, 



EDITORIAL AND MISCELLANEOUS. 



OUR PRESENT NUMBER. 

We call attention to the original department of our present issue. The 
three short articles here presented arc, each, of much practical value to 
the physician. The paper on Tape Worm presents the details of a case 
"by a most intelligent patient and his observations, though not those of a 
medical man, will he found suggestive and practical. Turpentine, it is 
well known, has been long regarded as among our most valuable anthel- 
mintics, but heretofore, it has been thought more particularly adapted to 
the lumbricoid form of parasites — the experience of the two cases re- 
ported in our present number, certainly appears to admit its claim as no 
less reliable in Tape Worm. The mode of its administration should be 
well considered and followed by any of our readers who may wish to ap- 
ply the remedy in a similar case. 

J)x Bellinger's paper, on the Diagnosis of Early Pregnancy by Rectal 
Touch, presents many points of originality and practical value. It can- 
not be denied that our means of the certain diagnosis of early pregnancy 
are deficient and though Rectal Touch may not present an unquestion- 
able criterion, still we are disposed to give great credit to any extension 
of our means of determining a matter, often, of so much importance. 
Dr. Bellinger deserves the thanks of the profession for this valuable 
contribution. 

No less valuable than the two foregoing is the communication of Dr 
Horace Neeson, on Dislocations of the Plip Joint. W r e forbear extended 
observation on his views, in this place, as we have already discussed their 
merits in our introductory remarks heading the paper. 

We again earnestly call on our correspondents for contributions No 
scientific work can be supported and kept valuable except by the joint 
labors of both its readers and editors. The South is teeming with 
knowledge and experience of the most valuable and practical kind. It 
requires but little industry and self-sacrifice to place all this before the 
profession and to render what is now but "the property of a few, attain- 
able by all." We say, then, to our readers, still let the Southern Medi- 



1861.] Miscellaneous. 431 

cal and Surgical Journal remain, as it lias ever been, an object of inter- 
est to (ill sections, if not for the spirit and vigor of its editorial disquisition g 
at least because it furnishes fully and fairly its own quota of experience to 
the general fund of American Medicine. 



Hypodermic Injections of Atropine and Cutaneous Revulsions 
in Sciatica. — Hypodermic injections with narcotic fluids do not, as 
might have been expected, relieve pain in all cases of neuralgia. "When 
the symptoms remain unaltered after such injections, various therapeu- 
tical resources are left ; and it would appear — in sciatica, for instance — 
that linear cauterizations with sulphuric acid along the course of the nerve 
niay prove very efficacious. This was lately proved by M. Legroux, 
physician to the Hotel Dieu of Paris, in two cases, Both patients were 
men, aged 35 years. Injections of sulphate of atropine, one grain to 
one hundred of water, did not remove the pain, though giving rise to 
symptoms of Belladonna poisoning. Sulphuric acid was now applied 
by means of a brush rapidly carried from the origin of the sciatic nerve 
to the ham, the skin being thus cauterized in a linear direction. The 
severe pain caused by the acid not did last long; and the neuralgia gradu- 
ally diminished. In the two cases alluded to, several operations were 
necessary ; but the complaint was completely subdued in a few days. — 
London Lancet. 



Obstinate Neuralgia. — ElcUricity. — It is well known that if an 
instense current of electricity be applied in the course of a nerve, its 
sensory power is benumbed for a time, and the same result follows if the 
nerve is the seat of neuralgic pain. After a time the pain returns, but 
on repeating the electrisation the recurrence each time at longer and 
longer intervals, until finally a cure is effected. Sciatica, lumbar, inter- 
costal, crural, and trifacial neuralgia may be thus treated successfully. 
Nineteen cases of scatica, many of them old standing and obstinate cases 
have been cured by this plan of treatment. — M. Becquerel, p. 49. 

Atropine — Strength of Solution used. — When it is wished to di- 
late the pupil for ophthalmoscopic investigation, the strength of the so- 
lution used should not be more than half a grain of the sulphate to an 
ounce of water. This will suffice for the purpose, and the unpleasant 
effects of a stronger solution will be avoided. — Mr. 11. Walton, p. 

Vaginitis. — Tannin Ointment. — In cases of simple vaginitis, or 
superficial inflammation of the neck of the uterus, an excellent local ap- 
plication is an ointment composed of tannin and lard. This may be 
smeared over a piece of wadding and introduced through a speculum, a 
thread being attached to it, so that the patient can remove it herself. 
This docs not supersede the use of constitutional remedies as well. — Dr. 
Foucher, p. 264: 



432 t/fa/ieous. 

Tetanus. — Aconite. — It is worth while to try the affect of aconite in 
tetanus, as from souk: cases related its employment seems to have been 
followed by some amelioration of the symptoms. In one case five 
minims of the tincture were given every two hours at first, then increased 
to eight minims. The improvements in the symptoms dated from the 
employment of the aconite. The patient was well sustained by beef-tea 
and brandy. This remedy must be administered very cautiously, how- 
ever, as though it certainly is a powerful nervine sedative, it acts much 
more powerfully on the heart. Death from aconite usually occurs from 
Byneope. It is cumulative in its action. — Ed. Lancet, p. 45. 



Profuse Moist ruation — Quinine. — The periodicity of tWb menstrual 
process is to be referred for its cause to the ganglionic system of nerves. 
There is considerable analogy between each individual menstrual flow 
and an attack of ague. Now, when the process occurs too frequently, 
every fortnight or three weeks, it may generally be controlled by quinine 
(unless owing to severe inflammation of the neck of the womb). The 
quinine may be given in doses of two or three grains every night or 
every other night, and if nervous symptoms predominate, it may be com- 
bined with sedatives, or if anaemia is present, with iron. — Dr. E. J. 
Tilt, p. 286. 



Pulmonary Hemorrhage. — In the intercurrent haemoptysis of ph- 
thisis, the tincture of larch-bark, in doses of half-a-drachm to a drachm 
every second or third hour is a very effectual remedy, succeeding in 
some cases when the usual remedies (ipecacuanha, lead, tannin, and gallic 
acid) had failed. It is now the remedy principally used in these c 
in the wards of St. Vincent's Hospital. 



Flooding after Delivery. — Inject about half a pint of very cold 
water (iced if it can be obtained) into the rectum ; at the same time give 
cold brandy and water, with otic drachm of Cnrtis's liquor secali cornuti 
in it.— Mr. T. Ilubbcrt, p. 244. 



Larch Bark is also recommended in cases of purpura, hsematuria, and 
metorhagia. The tincture may now be obtained of most respectable 
chemists^— Dr. J. M. (J'Fcrrc?l, p. 77. 



" Solution of Gold in, the Body. — By T. Wordsworth Poole, M. 
1). — Saving known considerable anxiety caused by the swallowing of 
pieces of dentists' gold plates, I was led to make a few trials on animals 
with solid mercury and diluted sulphuric acid, given some time after the 
gold was swallowed. The gold was rendered brittle and partly dissolved 
in the mercury, and the animals seemed to suffer no bad consequen 
I hope that by your permitting this suggestion to appear in the Lancet 
some one of more experience may undertake the matter, and form a 
di terminate method of treatment.'' 






SOUTHERN 
MEDICAL AND SURGICAL JOURNAL. 

(XEW SEKIEtf.) 



Vol. XVII. AUGUSTA. GEORGIA, JUNE, 1SG1. NO. I! 



ORIGINAL AND ECLECTIC. 

ARTICLE XIII. 

A Lecture upon Tetanus. By L. A. Dugas, M. 1)., Professor 
of Surgery in the Medical College of Georgia. 
GENTLEMEN: — Having studied with you the nature and 
treatment of wounds in general and in particular, it remains 
for me to direct your attention to a very remarkable affec- 
tion which occasionally presents itself as an effect of injuries 
apparently trivial in themselves ; I allude to tetanus. This 
is a spasmodic affection of some or many of the muscles of 
voluntary motion, which usually shows itself between the 
nth and tenth days after an injury, and which most 
frequently terminates fatally in a few days. Tetanns is said 
to be partial or general, according to the number of muscles 
implicated, for it may be in its early stages, and sometimes 
throughout the whole case, restricted to a xavy small num- 
ber of muscles, whereas in other instances it will invade 
them extensively. Tetanus isalso said to be idiopathic and 
traumatic, 

1 have, however, never seen a case I considered strictly 
idiopathic. There is occasionally some difficulty in ascer- 
taining the seat of the injury, for this is sometimes so trivial 
scaped the notice of the patient. Some patients 
will also pertinaciously conceal the truth, as I have had oc- 
casion to see in two instances in which the injuries had been 
BUStained under circumstances that would not be confessed, 
but which I fully verified. 

28 

j 



434 Dugas. Lecture on Tetanus. [June, 

Most writers speak of tetanus as being either acute or 
chronic. This is a distinction I think calculated to mislead 
the inexperienced, i fwe carefully study the natural history 
of this disease, unmodified by ])erturbating influences, we 
will find that while the fatal cases terminate in a few days, 
those thai arc successful occupy a much longer time to run 
their course. As a general rule, the disease cannot be cut 
short by treatment, nor does it ever abruptly give way, if 
let alone It may terminate abruptly by death; but 
when this does not occur and the disease is allowed to pass 
through all its stages to a favorable termination, itprogress- 
rradually to its maximum of intensity and declines by 
degrees almost imperceptible from day to day, until, at the 
end of weeks or even months the last symptom of rigidity 
will disappear. What is called chronic tetanus, then, is in 
reality nothing but the regular course of the disease when 
it does not terminate fatally. It is always a matter of prim- 
ary importance to know the course a disease will run when 
left to the unaided efforts of nature, for without this know- 
ledge we cannot treat it judiciously. Is it not probable that 
much of the want of success in the management ot tetanus 
is attributable to a neglect of this study ? 

This disease is infinitely more common with the African 
than with the Caucasian race ; so much so, indeed, that 
injuries which excite little or no apprehension in a white 
person, are never considered without danger if sustained 
by a black — and the danger lessens in a direct ratio with 
the infusion of the Caucasian element into the constitution 
of the individual. Among our domestic animals the horse 
is exceedingly liable to tins affection, especially when prick- 
ed in the foot. 

The scat of injury seems to exert a decided influence in 
the development of tetanus, for it unquestionably oftener 
follows wounds of the extremities, especially the foot and 
hand than those o\' the trunk. Wounds of the external ear 
and of the occipital region are also thought to be peculiarly 
apt to induce it. 



1861.] Dugas. Lecture on Tetanus. 43o 

Suppurating wounds are less dangerous than those appar- 
ently more trivial. Veterinarians are so well aware of this 
that when a horse is pricked in the foot they lose no time 
in provoking active suppuration by pouring spirits of tur- 
pentine into the wound and searing it with a hot iron. 
They consider the horse comparatively safe if they can se- 
cure a free flow of pus, for eight or ten days. Our negroes 
act upon the same principle witli their children ; hut after 
using turpentine they paddle the sole of the foot instead of 
resorting to the hot iron. 

Tetanus is thought to he more common in hot than in 
temperate climates. It is certainly very common in the 
West Indies; hut it is not satisfactorily estahlished that 
white persons are more subject to it there than in the tem- 
per zones of Europe and America. The negro population 
beinii: very large in those islands will account for the fre- 
quency of the disease. Sudden or prolonged expose to cold 
will frequently induce tetanus in those who would probably 
have escaped it, as the records of military surgery abun- 
dantly testify. AVounded persons should not be allowed 
even in warm climates, to be exposed to cold or moist air. 
especially during the night. It is still worse in cold climates 
a> has been often painfully exemplified in the case of 
wounded soldiers left exposed to freezing weather without 
adequate protection. The intense cold of arctic regions has 
induced it among the explorers of those inhospitable locali- 
ties, probably in consequence of previous frost bites. 

Men are supposed to be more liable to tetanus than wo- 
men and children; and the young more so than the aged. 
This may probably result from the circumstance that men 
are more exposed; moreover, the statistics are chiefly derived 
from army practice where men are almost exclusively treat- 
ed. I doubt that in civil practice those positions would be 
sustained. In my own the number of males is only slightly 
n excess of that of females. 

Symptoms. — In studying the smyptomatology of tetanus 

ou must bear in mind that this is essentially a spasmodic 



136 Dugas. Lecture on 'lelanus. [June, 

affection and that its manifestations must, therefore, be 
sought for in the muscular system. The functions of the 
other organs suffer comparatively little modification until 
the disease has progressed considerably, as I will point out 
as we proceed. The inception of tetanus is not preceded by 
premonitory indications, and is often so insidious as to es- 
cape observation for sometime. Usually the first smyp- 
toms are a sense of stiffness in the back of the neck and 
the occipital region, with an inability to open the mouth 
widely. The rigidity extends to the temporal and masseter 
muscles, thus increasing the difficulty of opening the mouth, 
and down the back giving to the trunk a peculiar air 
of stiffness. The patient may be still walking about the 
room, under the impression that he has caught cold in the 
muscles or that he is rheumatic. Muscle after muscle be- 
comes implicated, however; those of deglutition obey the 
will so imperfectly as to make it difficult to swallow without 
being strangled; the jaws are locked; the abdominal 
muscles become tense and hard to the touch ; the diaphragm 
draws painfully upon the ensiform cartilage as it were ; 
the sterno-leido-mastoideus feels like a cord on each side of the 
neck ; and all the muscles of the face become so fixed as to 
give to the countenance an expression so peculiar and char- 
acteristic as never to be forgotten when once seen. Every 
feature appears immovable and sunken as though greatly 
emaciated. 

In violent cases the body may be bent in various direc- 
tions, constituting peculiarities designated by authors as 
opisthotonos, when the body is carried backwards, empros- 
thotonos when it is drawn forward, and pleurosthotonos when 
the inclination is to one side or the other. The most com- 
mon form is that in which the body is bent backwards, and 
cases are recorded in which this was so extreme that thehcad 
and heels were brought nearly in contact. I have never 
Been an instance of this degree of violence. 

A- tin- disease progresses all the respiratory muscles be- 
come more or less rigid so as to interfere materially with 



1861.] Dugas. Lecture on Tetanus. 487 

respiration, which is then short, and will he found, by dose 
observation to be tremulous. The abdominal muscles in- 
eluding the diaphragm are so fixed that the respiration is 
almost entirely thoracic, the shoulders being seen to rise and 
fall in each act of inspiration and expiration. Many cases 
proceed to a fatal termination without any serious rigidity 
of the limbs; but these are often found affected — the lower 
extremities more frequently than the upper. 

I have thus far spoken only of the persistent rigid- 
ity of the muscles. I say it is persistent, because, although 
under the influence of sleep or of powerful medication, the 
tension may be temporarily lessened, it never ceases 
entirely. But I must now direct your attention to a 
peculiarity which may be regarded as characteristic 
dt this affection, and which has, therefore, been 
termed the "tetanic jerk." Every now and then, at in- 
tervals varying froml to 15 or 20 minutes, or even longer, 
thejoatient experiences a sudden and forcible contraction of 
the muscles implicated, resembling very much an electric 
shock, and which is more or less painfhl. Sometimes he 
will simply groan as it occurs, but in some instances he 
will cry out with pain. In the beginning of the attack you 
may have to watch the patient half an hour before you can 
detect one of these jerks; but as the disease progresses the 
intervals become shorter and shorter, until they will not 
exceed a few minutes ; and the violence of the shocks in- 
creases correspondingly. They are then induced by the 
slightest circumstance