(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Southern Medical and Surgical Journal"

Digitized by the Internet Archive 

in 2012 with funding from 

LYRASIS Members and Sloan Foundation 



http://archive.org/details/southmed1838medi 



SOUTHERN 



MEDICAL AND SURGICAL JOURNAL 



VOL II 



_, 

A TRULY VIRTUOUS WILL IS ALMOST OMNIPOTENT. 



EDITED BY 

MILTON M. ANTONY, M. D., 

PROFESSOR OF OBSTETRICS, &c, L\ THE MEDICAL COLLEGE OF GEORGIA. 



PRINTED BY W. T. THOMPSON. 

TS38T 



SOUTHERN 

HBHOAIL All ©OT©H(DAIL 
JOURNAL. 

Vol. II. AUGUST, 1837. No. 1, 

PART I. 

ORIGINAL COMMUNICATIONS. 



ARTICLE I. 



Report of a case of Extra-uterine Foetation, in the Sow; with 
remarks on the nutrition of the Foetus, by Addison Bean, 
M. D., of McDonough, Ga. 

In studying the economy of nature, the human mind is aston- 
ished at the beauty and simplicity of her laws ; at the peculiar 
adaptation of the means to the ends ; and perhaps, above all, at 
the stupendous effects which result from the operation of appa- 
rently simple causes. For instance, the whole phenomena of 
animal motion are produced by the simple contraction and re- 
laxation of the muscular fibres. Perhaps a more astonishing 
example is produced by the wonderful machinery of the plane- 
tary system; where we discover the whole retinue of planetary 
worlds, performing their ceaseless revolutions, with a velocity 
that almost outstrips fancy herself; and the cause of the whole 
is simple attraction and repulsion. But notwithstanding the 
laws of nature, when understood, appear simple and intelligi- 
ble ; — notwithstanding the human intellect can generally trace 
the cause from its effects; and from contemplating the cause 
can, with great probability predict the result: yet. we occasion- 



2 Extra-uterine Foetation in the Sow. [August, 

ally meet with such extraordinary freaks of nature, with re- 
sults so anomalous, that the utmost stretch of human ingenuity 
has never discovered the cause, nor the means, used in their 
production. 

Among the irregularities of nature which the physiologist is 
called to contemplate, few are more wonderful than extra-ute- 
rine foetation. When we consider the functions of the various 
organs subservient to conception, gestation &c, and the great reg- 
ularity displayed by each, in the performance of the office assign- 
ed it, were it not for positive facts, the utmost stretch of our cre- 
dulity would hardly permit us to believe such a thing as extra- 
uterine impregnation possible. But whether we shall ever be 
able fully to comprehend it or not, the fact is notorious; and 
perhaps there is scarcely a more singular case on record, than 
the one which I witnessed in December last, in a sow. 

My friend Mr. M. who resides a few miles from M'Donough, 
when slaughtering his hogs, was surprised to find a pig of near- 
ly the ordinary size of one at the full period of gestation, embed- 
ed in the fat which surrounds the cardiac orifice of the stom- 
ach of the sow. Being entirely unable to account for this phe- 
nomenon, he, without removing the pig, cut out a good portion 
of the fat which surrounded it, and brought the whole to me. I 
enquired into the history of the case, and was informed by Mr. 
M. that the sow was delivered of a litter about the last of Au- 
gust. That she was thrifty as usual. At the end of the period of 
lactation, she was fed with the intention of making pork of her. 
When she began to thrive, she again became pregnant. About 
a moiiih afteT she became pregnant, she was killed for pork, and 
was in every reaped healthy: The extra-uterine pig had ne- 
ver produced any appreciable inflammation nor disturbance of 
any kind, as the s<»u- had been perfectly healthy during the 
whole period. I carefully removed the fat, which almost entire- 
ly covered the fetus, in the presence of my friend Francis E. Man- 
\\. D. and: several other gentlemen; and what is most sin- 
gular, is the fact, thai there was nothing Like either placenta o* 
funis* I endeavored to ascertain whether it was surrounded by 
the usual membranes, but could not positively determine; but 
if it was. lliey were very thin and in immediate contact with the 
body, as I could seperate nothing with the scalpel and forceps, 



1837.] Extra-uterine Foetation in the Sow. 3 

but very small flakes of a mcmbraniform matter. There was 
nothing like liquor amnii present. 

The organization of the pig is not entirely complete : the poste- 
rior extremities are not as well developed as the anterior. The 
tail is wanting. The eyes and ears, deficient. The head is larger 
than natural, and not exactly of the ordinary shape, being lar- 
ger below the eyes than natural. Its teeth and hoofs are nearly 
natural. 

The dimensions of the pig are as follows; 
Length of the body and head, 4 1-8 inches 

,, ,, without the head, 2 5-8 

From the first cervical vertebra to- the os frontis, 1 3-8 
Circumference of the body about the middle, 4 5-8 

Circumference of the head above the eyes, 4 15-16 

From the dimensions it will be seen, that the foetus was near- 
ly the full size of one at full period of gestation ; and the organiza- 
tion, though not complete is not greatly deficient. 

Physiologists, generally, agree that Eccyesis Abdominalis, or 
abdominal fetation may occur in three different ways : 

1st. The fallopian tubes may be impervious from fat, or the open- 
ing into them be so small, that the impregnated ovum cannot 
pass, or the fimbriae may not clasp the impregnated ovum, at the 
moment it is detached, and in these cases the ovum falls into 
the cavity of the abdomen, 

2nd. The impregnated ovum may be unable to escape from 
the ovarium, till its growth is sufficient to burst its envelopes, at 
which time the ovum falls into the cavity of the abdomen. 

3d. The ovum may, after entering the fallopian tubes, be ar- 
rested in its passage to the uterus by fat, or the small diameter 
of the tubes; in which case its growth continues, and, in some 
instances, the parietes of the tube give way, and the embryo or 
foetus is precipitated into the abdominal cavity. In each of the 
two latter varieties, fatal inflammation is apt to occur, from the 
combined operation of the inflammation, caused by the rent in 
the tube or ovarium, and that, caused by the pressure of so large 
a foreign body on the abdominal viscera. In the first variety, 
the ovum, being very small, the parts accommodate themselves 
to its intrusion, and its growth takes place without exciting in 



4 Extra-uterine Fcetation in the Sow. [August, 

inflammation. The latter is the mode hy which the present 
case must have occurred. 

The present case is interesting from its locality, as well as 
from the entire absence of every thing like placenta, funis um- 
bilicalis, and liquor amnii. 

How the ovum performed the journey from that portion of 
the abdomen, into which it must have fallen from the ovarium, 
to the cardiac orifice of the stomach, where it was located, is a 
question which I am unable to answer. 

The source from which the ovum derives its nourishment 
has long divided physiologists. And notwithstanding the most 
able pens have been employed in the discussion, the subject is 
not yet completely settled. It is not my object to notice, in de- 
tail, all the facts and arguments which have been adduced on 
this interesting subject. The most prevalent doctrine, at the 
present time, is that which assigns the placenta as the source. 
Some, however, maintain that the fetus is nourished from the 
liquor amnii. 

In speaking of the circumstances, proven, or rendered proba- 
ble by extra-uterine foetation, Dr. Denman says that, "though 
the child be placed in one of the fallopian tubes, or in the cavi- 
ty of the abdomen, a placenta is formed, different indeed in 
structure, but capable of supplying the child with sufficient 
nourishment to bring it to perfection." Though this is perhaps 
true in the main, it is certainly not always so, as is proven 
})V the present case: and Dr. Good is more correct when, in 
speaking on the same subject he says "it, in some instances 
becomes surrounded with an imperfect kind of placenta, devel- 
opes the general structure of its kind, &c." Though I admit the 
placenta to be the usual source through which the fetus derives 
its nutriment, 1 cannot admit that it is the only source; tor there 
are many well authenticated cases on record, independent of the 
one I have just detailed, m which there was either no placenta, 
or no communication between it and the foetus. Dr. Good 
quotes a case, from I loiiinaii. of a foetus "born in full health and 
vigor, with the (inns sphacelated and divided into two parts" — 
from Vander Wiel, one where "a living, healthy child, was 
exhibited without any umbilicus, as a public spectacle" — and 
from a foreign collection of literary curiosities, the case of a hare, 



1837.] Extra-uterine Fcetation in the >SW\ 5 

which was found on being opened, to contain three leverets, two 
of them without placenta, or umbilical vessels, and the other 
with both." And other cases are recorded by Ploucquet in his 
Initia. In the history ot Dr. Good's case, which he witnessed 
in 1791, and published in 1795, he says, " The labour was natu- 
ral, the child scarcely less than of the ordinary size, was born 
alive, cried feebly once or twice after birth, and died in about ten 
minutes. The organization, as well external as internal, was 
imperfect in many parts. There was no sexual character what- 
ever, neither penis nor pudendum, nor any interior organ of gen- 
eration : there was no anus or rectum, no funis, no umbilicus ; 
the minutest investigation could not discover the least trace of 
any." And in a short time, the rudiment of a shriveled placen- 
ta followed, '-without a funis or umbilical vessel of any kind, 
or any other appendage by which it appeared to have been at- 
tached to the child. No haemorrhage, or even discolouration 
followed its removal from the uterus."* In a short time, a healthy, 
living child was born, attached to its proper placenta. 

From these facts, we are compelled to admit, that though the 
placenta be the organ through which the foetus derives its nour- 
ishment from the mother usually, it is not indispensable to its 
existence ; and that nature has other resources upon which she 
can draw, capable of sustaining the foetus to the full period of 
utero-gestation. 

It is well known, that the ovum exists, both before and after 
its arrival in the uterus, without a placenta ; and if nature has 
supplied the means capable of supporting the ovum during part 
of its stay in utero, without a placenta, is it not rational to con- 
clude, independently of facts, that she has furnished means ca- 
pable of sustaining it during the whole of its stay ? And facts 
fully sustain the inference : for independently of the cases already 
quoted, it is known to naturalists that the kangaroo, opossum 
and woombat, all breed their young without either placenta or 
funis. The embryos are not attached to the uterus, but are 
enveloped in one or more membranes, containing a gelatinous 
matter, from which they derive their nourishment, and apparent- 
ly their air. What then are these resources? Mr. Gibson, in 
the Edinburgh Medical Essays, has endeavored to prove that the 

♦Good's Study of Medicine, vol. 4, page 21. 



Extrauterine Floatation in (he Sow. [August 



. 



liquor amnii, and not the placenta, is the substance from which 
the foetus is nourished. But I must differ with him for the fol- 
lowing reasons : 

1. The embryo, during the early period of its existence, does 
not appear to be surrounded by the liquor amnii ; but by a gel- 
atinous matter, like those of the kangaroo, opossum and woombat. 

2. The liquor amnii is always in an inverse ratio to the de- 
mands of the fetus : being relatively smallest when the foetus is 
largest. 

3. The liquor amnii is often found exceedingly impure ; some- 
times acid, putrescent, feculent, bloody. — (Caldwell.) 

4. But the strongest objection is, that it is often deficient, 
and occasionally, entirely wanting ; constituting what are call- 
ed, "dry births."' 

But whilst I cannot admit the liquor amnii to be the ordinary 
source of nourishment, I am not prepared to deny that it ever 
is, but on the contrary, I believe that the fetus is capable of draw- 
ing nourishment, by cutaneous absorption, from that which 
surrounds it, when the placenta or funis is wanting. 

In the case I have detailed, the nutriment must have been 
extracted from the fat of the mother, as this was the only sub- 
stance with which it was in contact. 

The whole of the facts then, taken together, I think justify 
the following conclusions: 

1. That neither placenta, nor liquor amnii, is essential to the 
nourishment of the fetus. 

2. That either may be the source, when the other is wanting. 

3. That when the liquor amnii is the source of nourishment, 
the nutriment is conveyed by cutaneous absorption. 

4. That in extra-uterine fcetation, there is sometimes neither 
placenta nor liquor amnii, and when both are wanting, the fetus 
is capable of extracting sufficient nutriment, by cutaneous ab- 
sorption, from the surrounding parts with which it is in contact, 
to sustain it to the full period of utero-gestation, 



1837.] Verminous Irritation. 



ARTICLE II. 

Verminous Irritation as simulating other diseases. By Wm. 
Markley Lee, M. D. : of Indiantown, S. 0. 

Intestinal worms are often improperly supposed to excite fever 
in the human subject ; for every experienced physician can re- 
call instances in which worms have been discharged, and in 
which the friends of the patient have in consequence ascribed 
the febrile symptoms to verminous irritation, whereas their dis- 
charge was rather a consequence, than a cause of fever. 

I have often been astonished, however, that so few instances 
are recorded in medical periodicals, of worms as causing the 
symptoms of other diseases. They may, and I am convinced 
frequently do, irritate certain nerves, and produce symptoms 
which are never attributed to their influence. To demonstrate 
this position, I will describe certain cases which have occurred 
in my own practice, to all appearance totally disconnected with 
worms, but which were promptly cured by anthelmintics. 

Sciatica. — Soon after I commenced the exercise of my pro- 
fession in Charleston, I was requested to attend a lad about nine 
years of age, laboring under symptoms of Sciatica : — Blistering 
and the remedies usually employed, were tried in vain for several 
days. At one of my visits, when at a loss what next to prescribe, 
his mother informed me that he ground his teeth frequently in 
his sleep ; this led me to suspect verminous irritation ; I there- 
fore sent him anthelmintic -medicine, composed of calomel and 
spigelia, and at my next visit I was truly gratified to see him 
walking about the house, free from all pain, except the irritation 
of the blister. I was informed, that immediately after he had 
discharged a number of lumbrici, the rheumatic symptoms van- 
ished. He was from that time restored to perfect health. 

Phthisis Pulmonalis. — I was soon after requested to visit 
a young married woman, whose case was marked by symptoms 
of the above disease — cough so incesssant as to prevent sleep, 
and was exhausting her strength ; remedies usually exhibited 
in similar cases, here failed to afford relief, until one day she 
mentioned some symptom which led me to suspect verminous 



8 Verminous Irritation. August. 



=> 



irritation. After the exhibition of the anthelmintic already 
mentioned, in the space of 40 hours she discharged an equal 
number of lumbrici, and the symptoms of pulmonary disease 
were relieved promptly and permanently. 

Paraplegia. — I was called during the last summer to a 
young girl about 11 years of age, sick with bilious remittent 
fever ; she had been bled and purged without material benefit ; 
the febrile excitement was moderate, but in addition to consid- 
erable pain and soreness about the prsccordia, there was a re- 
markable loss of power over the lower extremities, amounting 
even to a total inability to turn in bed without assistance. A 
careful examination of the spinal column presented no symp- 
tom of local inflammation. In reply to my interrogatories, I 
was assured that she had received no blow, or injury of the 
spine, but that the symptoms of paraplegia supervened at the 
same time with the fever. Her friends united in stating that 
she frequently ground her teeth during sleep. A blister to the 
epigastrium was directed ; and as I had never seen nor read of a 
similar case from verminous irritation, my treatment was adapt- 
ed both to fever and worms. 

ft. Nit. Potass. 3i. 

Cal. 

Ipecac. & 

Camphor aa. 3ss. m. 
of this compound, a frequent prescription of mine in billious re- 
mittent, I directed 8 grs. every 3 hours during the paroxysm, 
and that 3ss. calomel be combined with the first dose. I was in 
hopes, from the well established efficacy of this preparation of 
mercury, and the success which is reported to attend the exhi- 
bition of camphor in Italian practice thai if this form of Para- 
plegia was caused by worms, relief would he promptly obtained. 
A dose of ol. ricini and sp. terebinthinae was also directed to be 
administered the succeeding morning. At my next visit, I as- 
certained thai she had discharged a large number of worms, and 
was enabled to walk about : she soon recovered. 

Such facts I consider interesting and important, and have 
been astonished thai they have excited so little attention from 
the profession. Have \ erred in attributing these cases to vermin- 
ous irritation ? In the two former, the treatment usually insti- 



1837.] Verminous Irritation, 9 

tutcd, had failed to produce the results expected, and it was not 
until worms had been evacuated, that relief was obtained. 

I trust this hasty article may elicit the experience of my med- 
ical brethren on this point. 

In conclusion, I will describe a case which came under my 
care while assistant physician of the (Charleston) Bispensa- 
ry, in 1828 — I was called to an elderly woman who for seve- 
ral years had been troubled with Tcenia ; several eminent 
physicians, in succession, had dislodged a portion of the worm ; 
but in the course of a few months, medical aid was again re- 
quired — for as the head of the Tcenia had not been discharged, 
new joints had been regenerated and morbid symptom renewed 
— the exhibition of calomel and gamboge, followed by ol. ricini 
and sp. terebinth, in a few hours caused the discharge of a 
toenia about 4 feet in length. Attributing the recurrence of the 
disease to an atony of the alimentary canal, after the exhibition of 
alkalies for the purpose of removing the tenacious mucus from 
the mouths of the absorbents, I prescribed the solution of acet 
of iron, formed by digesting the carbonate of iron in strong vin- 
egar, to be taken in doses of a tea-spoon full thrice a day. But 
a short time was necessary to demonstrate its efficacy, for her 
health improved rapidly. By my directions, she persisted in 
the use of the remedy for several weeks After all former at 
tacks, a year had never elapsed without a renewal of the symp- 
toms. Fully three years after, I again saw her, whe£ she stated 
that she had never since perceived any symptoms of the worm. 

A few months since, I attended a young negro, from whom, 
in the space of a week, I succeeded in dislodging more than 70 
lumbrici. The same tonic (acet. iron) was prescribed for him — 
and at the present time, his master has not a more healthy young 
negro. 

These latter cases, although not strictly connected with the 
above article, are adduced to show the expediency and necessity 
of following up the exhibition of anthelmintics by chalybe;i 
or other tonics, 



10 AnenccphaluS) or Human Monstrosity. [August, 



ARTICLE III. 

Account of an Anencephalus, or Human Monstrosity without 
a brain and spinal marrow. By Alexander Y. Nicoll, 
M. D. and Richard D. Arnold, M. D. of Savannah. Read 
before the Medical Society of Georgia, on the Gth May, 1837. 

On the 12th February, 1837, we were requested to examine 
a female negro child, which had the night previous been pre- 
maturely born at the eighth month, to give our opinions whether 
violence had been used or not, which in consequence of the sin- 
gular appearance it presented, was supposed by those who at- 
tended at the delivery. Upon a superficial examination, we 
pronounced that no violence had been used to destroy the child, 
but that it was a monster of an interesting character, and re- 
quested that it might be given to us for a more minute examina- 
tion, which was readily granted. We have, with the assistance 
of Dr. Lewis F. Nicoll, of New York, made as careful an ex- 
amination of this case, as our means and experience would allow 
us, and believe it is important in determining the question of 
the evolution of the brain and nervous system ; — not so much, 
however, from the deductions which we ourselves have drawn 
from the dissection, as from its affording additional facts to those 
which have already been presented to the profession on this sub- 
ject, by older and abler heads than ours. 

A front view of the child exhibited to us the eyelids as two 
round bodies placed upon the top of the head, as delineated in 
fig. 1st, which previous to the dissection, we considered as defor- 
mities in themselves. In this view, the chin was resting upon 
the chest, bringing tli<' head so low down, that the ears not only 
touched^ but were actually turned up by the shoulders. Upon 
looking ;ti Mi'- 1m ad laterally, if appeared ;is it* cut oil" l»y a plane 
which intersected it just above the nose: thence passing down tp 
the i<<;> of the ears and there exhibiting a slighl prominence, as is 
Bhown in fig. 2d, occasioned by the sponginessof the membrane, 
hereafter to be mentioned, the plane then passing down at a 
greater angle to the shoulder. 

Looking at the bead posteriorly, it appeared as if the whole 



1837.] AnencephahiS) or Human Monstrosity. 13 

scalp had been removed, with the exception of a small portion 
just back of the eyes, which passed down on each side close to 
the ears, and terminated directly upon the shoulders ; upon the 
whole of which hair had been formed. The central portion, in- 
stead of the convexity usually observed, presented a very irregu- 
lar appearance, dark and bloody, as if violence had been used. — 
This central portion was covered by a thin membrane, which we 
believed to be the Dura Mater. Upon pressing this with the fin- 
ger, it appeared to be in direct contact with the bones beneath 
with the exception of a small part in the centre, which felt spongy 
to the touch, but at the same time of very little thickness. 

Proceeding to the dissection and removing the scalp behind the 
eyes, we were surprised to find not the least rudiment of the 
frontal bone, except a portion of the orbitar plates which was at- 
tached to a confused mass of bone, hereafter to be mentioned. — 
Upon dissecting the membrane from the central portion, we found 
it closely adherent to the basis of the cranium, if we may call it 
so, (with the exception of the spongy central portion tlrat appear- 
ed to contain blood,) and traced it down to the spinal canal from 
which it appeared to emanate. Underneath this membrane was 
a confused mass of bone, very 'solid, without any marks of the 
usual divisions of the bones of the cranium. Continuing on, we 
found no trace of the parietal, the occipital, or the squamous 
portion of the temporal bone. After an attentive examination, 
we could not discover the least portion of the cerebrum or cere- 
bellum. That portion of the foramen magnum, which is form- 
ed by the sphenoid bone, and which is usually, more or less, 
round, was in this case angular, the angle being formed by the 
junction of the bases of two triangular plane faces, the vertrices 
of which terminated behind the ears, and there formed some- 
thing like the mastoid process ; which, however, instead of being 
round, presented a sharp edge looking outwards and backwards, 
as seen in fig. 3d. Believing that something might be contained 
in the confused mass of bone which formed what might be con- 
sidered the base of the skull, we sawed through it, but found it 
perfectly solid. In examining the cervical portion of the verte- 
bral column, we could not discover the atlas ; and found that it 
was composed of four, instead of seven, vertebra?. On opening 
the spinal column, there was no trace of the spinal marrow ; but 



14 Anencephatus, or Human Monstrosity. [August, 



the membranes were present from about the 2d dorsal vertebra, 
From the position and great prominence of the eyes, we doubted 
if there could be any antrui , maxillare ; which, upon dis- 
section, we found to be the case. The eye had made itself a 
socket in that portion of the upper maxilla commonly occupied 
by the antrum. In our lissection, we were particularly struck 
with the quantity of a dipcse matter we met with, as also the 
abundance of hair, which, in this particular case, covered the 
cheeks, the shoulders, the outside of the arms and fore-arms, the 
back down to the nates, and the outside of the thighs and legs. 

We next dissected down, to ascertain the appearance of the 
axillary and popliteal nerves, and found them large and well 
developed. We also dissected the neck, to ascertain the com- 
parative size of the internal and external caroted ; but regret 
that we were unable to determine this, in consequence of our 
wanting the means of injecting them ; and the common carotid 
Was so small, and not being injected, we lost all trace of the artery 
in a mass of caseous matter, behind the angle of the lower max- 
illa. With the exception of the head and neck, every other part 
of the child, externally, was remarkably well formed and plump. 

From the foregoing description, it will be at once perceived, 
that the monstrosity described answers exactly to that known as 
an Anencepiialus ; as that term lias been reserved to designate 
such as have the brain partially or completely absent, "with a 
corresponding defect of the parts by which it is protected." In 
<■ asc the external organs of the senses were present. 

< >ur object in bringing this subject before the Society, is not 

lythat a "lusus naturce" might be brought to the cognizance 

r medical brethren, and not be buried in obscurity— But in 

contemplating it, it cannot fail to strike every observer as being 

i plant with interest, in a philosophical point of view. In the 

ervations which follow, it is more our object to elicit re- 

h than to provoke criticism. In the article Anencephalus, 

in that excellent work "the Cyclopedia of Practical Medicine 

and " Dr. Geddings, of Baltimore, has the following 

(rations: 

"In that rariety ofanencephalous monsters in which the defect 

( ,st con i here is a total absence of both brain and 

spinal marrow: the peripheral portion of the nervous system ex- 



1837.] Anencephalus, or 1 In man Mnji.siro.slti/. [5 

ists and is well formed ; but the nervous centre, or cerebro-spinal 
axis, is altogether defective. This is by far the rarest form 
of this species of abnormal deviation, and is the only one to 
which the term antnccphalus can be properly applied. So 
seldom indeed does it occur, that only a few cases are to be 
found on record" 

In this, as in the case reported by Morgagni, and cited in 
that article, the cerebrum cerebellum and medulla spinalis were 
absent; and like that reported by Vaxhorne, "the deformed 
bones of the cranium were so thick and closely grouped togeth- 
er, that no cavity existed ; but the membranes of the medulla 
spinalis were developed. 

The membrane lying over the bones of the cranium was un- 
doubtedly Dura Mater ; because, after lifting it up, the perioste- 
rum was found adhering to the bones, and moreover the membrane 
was continuous from the cavity of the spine. In relation to the 
peripheral nerves, there are some facts worthy of attentive con- 
sideration. All the nerves of the periphery were not present. — - 
To obviate misapprehension, we beg leave to state, that in nerves 
of the periphery, we include those which establish a communi- 
cation between the brain and spinal marrow and the organs of 
the external senses. 

1st. Of the Nerves to the orbit of the Eye.— In the normal 
state, no single organ is so well provided with nerves as this.— 
Anatomists reckon no less than six, viz : — the optic ; the 4th pair, 
or pathetic, (the respiratory of Bell); a branch of the 5th, or Tri^e- 
ninus ; the 3d, or general motor of the eye ; the 6th, or external 
motor ; and a branch of the sympathetic which joins it on enter- 
ing the orbit. It will be recollected, that the ball of the eye rested 
on the upper maxilla, and had formed a fossa for itself in that 
part usually occupied by the antrum maxillare. A careful and 
minute examination failed to reveal to us a single nervous fila- 
ment about the bail of the eye, or in its vicinity. The foramen 
by which the optic nerve passes through the sclerotic, did not ex- 
ist ; and although every other part of the eye was satisfactorily 
apparent, the Retina (if it had existence) could not be perceived 
by us. The six muscles of the eye-ball were also deficient. 

2d. The Nerves to the Nares. — In the normal state, the Nares 
are supplied from two sources, the olfactory and the trigeminus. 
There was no trace of a single filament of either. 



16 Anencephalus, or Human Monstrosity. [August, 

3d. Of the Ear. — There was no cavity in the mass of bone 
which might be said to represent the petrous portion of the tem- 
poral bone. Of course all the auditory apparatus usually con- 
tained in it, must have been wanting. The external ear was 
present, and a small depression represented the meatus auditor- 
ius extemus. As might be inferred from there being no cavity 
in which to pursue its usual course through the petrous bone, 
the Facial nerve was entirely wanting. Indeed, the space 
behind the angle of the inferior maxillary bone, was filled with a 
kind of caseous matter, in which no muscular fibres nor nervous 
filaments could be found — Not the least interesting thing in this 
dissection, was the anatomy of the nerves going to the tongue 
and down the front of the neck. As all the nerves of the ence- 
phalon which we had looked for, and which should have come 
through foramina in the cranium, had proved deficient ; it was 
with no little curiosity that we commenced a careful examination 
of that part. The pneumo-gastric, the hypo-glossal, and the glos- 
sopharyngeal, equally with the portio-dura, trigeminus, patheti- 
cus, and motor-oculi, are in the normal state, involved in forami- 
na in the cranium ; and analogy would have led us to infer their 
absence. But, although from the shortness and imperfection of 
the neck, and the small developement of the muscles in its front, 
a little more than ordinary care was required in the dissection, 
the pneumo-gastric, the hypo-glossal, with its descending Ramus, 
and the glossopharyngeal, were distinctly visible. The prepa- 
ration now before the Society will make it apparent to every one. 
But they were lost above in the caseous matter which we men- 
tioned as existing behind the angle of the inferior maxilla. The 
common caroted and the internal jugular were also apparent, 
though small, and they were insensibly lost in the same matter. 

As all the other parts of the body, save the head, were well 
formed, it remained to be seen what was the condition of the 
nerves distributed in them. It was not deemed necessary to ex- 
amine more than one for each extremity. For the arm, the me- 
dian nerve was cut down to and exposed. It was of a full and 
natural size. The popliteal nerve was exposed in the same 
manner and with a similar result. 

What the nature of the energy of the nerves is, will probably 
always remain amattcr of .speculation. We can appreciate the 



1837.] Anencephalus, or Human Monstrosity. 17 

powers of life only by their effects. But let not uncertainty be 
hence attributed to our profession, above others. Who has ever 
approximated to the real nature of that wonderful law by which 
the planets are made to revolve in their respective orbits, and the 
harmony of worlds preserved? Yet, from a careful examina- 
tion of its effects, laws have been deduced and made the basis 
of unerring calculations — So the diligent observer of nature at 
the bedside and in the dissecting room, cannot fail to arrive at 
a knowledge of the laws of life that will be of inestimable value 
to him in the investigation of disease, which is a departure from 
their natural course. 

In this case, there could be no dispute as to the priority of de- 
velopement, between the brain and spinal marrow. Is it not 
then improper to speak of one taking its origin from the other ; 
and is not this case a confirmation of Haller's opinion that 
there is an evolution of the parts of the foetus without the addition 
of any new part? 

With the exception of the head, all the parts were well nour- 
ished. Certainly they did not depend on nervous energy derived 
from the cebro-spinal axis, for their nutrition. We must then 
look to the arteries as the source of nutrition, and as the cause 
of the developement of such nerves as did exist. It is evident 
that the arteries which exist in the normal state, could not exist 
in the confused mass of bone constituting the cranium in this in- 
stance ; hence a deficiency in evolution of the nervous, muscu- 
lar and bony matter of that part. 

The nerves that were developed must have had an energy in- 
dependent of the brain and spinal marrow. 

The result of the researches of Tiedeman on the developement 
of the brain in the foetus, is that the spinal marrow is the part of 
the nervous system first formed, and most distinct in its early 
months. The case before us, proves that the deficiency of the 
spinal marrow did not prevent the formation of most of the peri- 
pheral portion of that system ; and that such formation is not 
dependent in any way upon that of the Spinal Marrow. 

A few observations on monsters will close what we have to 
say on the subject. Like the majority of monsters on record, 
this was of the female sex. The observations of Meckel have 
proved the "genital organs of the two sexes are formed primitive- 



18 Case of Intussusception. [August, 

ly in the same model, and that they should be considered only as 
a modification of the same fundamental type ■;" and that the em- 
bryo is, in all cases, primarily of the female sex. The imper- 
fect formation thus occurring more frequently in females, has 
been supposed by Georget to be owing to a feebler eneroy of 
the formative or organic powers in the female than in the male ! 
Why a deficiency should exist in one part in preference to anoth- 
er, must remain a matter of speculation. 

The history of the mother affords no clue in this case. She is 
a woman about 30 years of age, well formed, and has been the 
mother of eight children, all of whom, with the exception of two, 
have been delivered at the regular time ; and her deliveries have 
generally been easy, and her recovery rapid. There had been 
nothing pecular during this pregnancy. In the delivery, there 
was nothing to lead to a suspicion of any thing unusual, and it 
was not until the child was fairly exposed to the light, that it was 
discovered to be a monster. There was said to be a larger quam 
tity than usual of the liquor amnii ; but this we are inclined to 
attribute to the birth being premature. The child showed no 
sign of life after birth. It had moved, sensibly, when in utero, 



ARTICLE IV. 

Case of Intussusception : by Dr. Judson ; communicated by 
Dr. Bacon, of 8t. Mary's, Geo. 

R. H. H., a fine, healthy boy, 3 months old, was attacked 
about 10 o'clock on the evening of the 16th of June, with a slight 
colic. The symptoms were so mild as to excite no alarm, A 
little paregoric was given by the mother, and it slept as quietly as 
usual all night. Next morning at 6 o'clock, violent symptoms 
appeared — severe vomiting, pain in the abdomen, and paroxyisms 



1837.] Case of Intussusception. 19 

of extreme distress. He had one natural stool after the first vo- 
miting occurred. The mother soon became alarmed and ad- 
ministered some magnesia, which was instantly thrown up. — 
Some castor oil was then exhibited, but no relief was obtained ; 
and, except the small stool above-mentioned, nothing had passed 
from the bowels but a few drops of pure blood — This took place 
several times, and always with great pain and straining. Dr. 
Bacon was now called in. The child had become alarmingly ill, 
and was vomiting matter of a stercoraceous colour and smell. — 
The case was at once recognised as Ileus of an aggravated 
character. But as the child had been seized in perfect health 
without exposure to any violence, or to any known error of diet 
or regimen, the cause was involved in great obscurity. The or- 
dinary remedies for Ileus were employed, but did not in the least 
check the fearful progress of the malady. The spmptoms con- 
tinued to increase in violence without other material change, till 
6 o'clock in the evening, when (12 hours from the onset 
of the complaint,) the child died. There was at no time much 
apparent tenderness in the abdomen and the tumour, so often 
noticed in cases of intussusception, was not observed at all. Du- 
ring the last three or four hours, the bowels became tympanitic 
and no tumour of the land could have been discovered, even had 
it existed. 

Post Mortem Examination. — The body was examined 18 
hours after death, by Dr. Bacon, in the presence of Drs. Church 
and Judsox. It was not in the least degree offensive, as pu- 
trefaction had not begun, except perhaps in the scrotum and 
groin, where a slight discolouration appeared. On laying open 
the abdomen, all the viscera except the intestines were found 
perfectly healthy. The stomach and intestines were greatly dis- 
tended with flatus, but devoid of all fsecal matter. From a point 
a little above the sigmoid flexure of the colon, a portion of the 
bowel six inches in length was found distended one-third beyond 
its natural size, discoloured almost to blackness, nearly gangren- 
ous and filled or rather bloated up with some soft substance. — - 
The intestines upwards from this point through the whole course 
of the ileum and part of the jejunum, were intensely injected 
and inflamed, the extreme redness and vascularity gradually di- 
minishing with the distance from the immediate seat of disease. 



20 Azalea, or Honeysuckle. [August, 

Indeed it was agreed by all present, that they had never seen so 
perfect and beautiful an injection as the intertinal coats exhibited. 
On removing the parts for a closer examination, a large portion 
of the ileum, the whole of the caecum, the ascending colon and its 
arch were found invaginated in the descending colon, and the 
whole so much displaced that the ileum seemed to be nearly 
continuous with the sigmoid flexture of the colon. Considera- 
ble effort was required to draw out the invaginated parts. They 
had completely blocked up the whole intestinal cavity for the dis- 
tance of three or four inches. Yet no adhesion had formed — no 
coagulable lymph was thrown out — nor were any of the ordina- 
ry products of inflammation seen, unless the blackness observa- 
ble at the point of intussusception be considered as proof of gan- 
grene. The inflammation produced by the unnatural situation 
of the bowels seems to have destroyed the child in its very first 
stage. The extreme pain accompanying such displacement and 
such violent inflammation, may have accelerated the fatal issue. 
It was made evident in the examination, that had the abdomen 
been laid open during life (as has been sometimes proposed) with 
a view to disengage the invaginated parts, they could not have 
been reduced without a degree of force amounting almost to vio- 
lence. I have seen no case on record that run so rapid a course. 



ARTICLE V. 

Letter from Dr. E. H. Macon, on the diuretic virtues of the 
Azalea, or Honeysuckle. 

Mercer Institute, April 5, 1837. 
Mr. Editor— It has been for some time my intention to make 
known to you, and through your valuable journal, to the profes- 
sion at large, a new article which has proved in my hands a 



1837. J Azalea, or Honeysuckle. 21 

most valuable therapeutic agent. I am not aware that it has ever 
been introduced into regular practice ; and that its virtues may 
be more fully tested by experiment, I wish to call the attention 
of the faculty of the College of my native state to the article in 
question. 

Azalea— Honeysuckle— the Root.— This shrub grows abun- 
dantly on the banks of small rivulets. Its flowers are red, and 
sometimes very pale. It yields a semi-transparent fruit* from the 
size of a quarter dollar to that of the palm of the hand. Children 
frequently pluck and eat it. It is a vegetable diuretic. 

About four years ago, I heard a countryman urging the claims 
of a strong decoction of Honeysuckle to powerful diuretic pro- 
perties, and I determined on testing its virtues at the first oppor- 
tunity. It was not long before an extremely distressing case of 
hydrotherax was placed under my care. The patient could not 
lie down, but was compelled to sleep in a sitting posture. He 
could scarcely walk ; the feet, legs and thighs, as well as abdo- 
men and face, being enormously swollen by anasaceous effusion. 

In addition to various remedies as advised by different authors, 
I ordered a strong decoction of the root of Honeysuckle to be 
drank at all times, and in any quantity, instead of water.t With- 
in ten days all the hydropic enlargements were entirely removed. 
So rapid had been the abduction of the effused fluid that the skin 
on the limbs presented a shrivelled and wrinkled appearance. — 
The patient, a robust negro man, was, in two weeks from the 
time the treatment was commenced, enabled to go to his ordinary 
labor; and within four weeks was discharged as perfectly well. 

I have since treated a number of dropsical cases, in only one of 
which have I failed to reduce the swelling forthwith. Some of 
the cases were treated three years ago, and continue well. 

I would not have it understood that I have not used other me- 
dicines during the treatment of these cases. My success in the 
first, made me unwilling to abandon the plan of treatment then 



*"VVe should consider this an excressence, instead of a fruit. It is not found 
on the fruit buds, but attached to the leaves, and other parts of the shrub. — Ed. 

tThe administration of the new remedy, in addition to the prescriptions recom- 
mended by authors, leaves the truth unrepealed, whether the new or the old rem- 
edies wrought the good in the case. There should be great precision in determining 
the value of new remedies. — lb. 



22 Azalea, or Honcysvr [August, 

adopted, and to which I have since, uniformly adhered, with on- 
ly a few trifling exceptions. 

According to my pathological views of dropsy formerly and at 
present, thus, as there is no lesion, injury or mechanical imped- 
iment to the proper performance of the peculiar function of the 
absorbent system, dropsy must be owing to a want of energy, or 
a state of atony or torpor in that system. With these views I pre- 
scribed, after the exhibition of a brisk hydragogue cathartic, the 
calomel and squill pill, and a strong decoction of honeysuckle 
root. It is not my purpose to dilate on calomel as having the 
virtue to stimulate and increase the power of the absorbent sys- 
tem when sluggish, nor to discuss the question of the specific 
influence of squills on the pulmonary system, nor that of its di- 
uretic properties. My chief reliance however for a diuretic, is 
the honeysuckle. I use such other remedies as the indications 
of cure may seem to demand, but of all articles with which I 
am acquainted, I repeat that the root of the honeysuckle is, for 
diuretic purposes, the most efficient. 

As I am not writing an essay on dropsy, I will proceed to no- 
tice its successful administration in some other diseases. 

In retention of urine from other causes than mechanical ob- 
struction and paralysis of the bladder, I have used it with great 
benefit ; so that in my limited practice, I have never had occa- 
sion to use the catheter but in one case, and that was one of re- 
tention of urine from paralysis of the bladder. 

In all cases of strangury and gravel, and of inability to dis- 
charge urine in gonorrhoea, gleet, &c, I uniformly prescribe the 
Honeysuckle — not, however, depending on this for the cure of 
the disease which may cause or accompany this retention, but 
simply for diuresis. In short, in whatever case a diuretic is in- 
dicated, the honeysuckle may be be used freely mid with safety. 
It has always proved perfectly con t rotable, its effects ceasing 
when its use was discontinued. 

The case of dropsy referred to in the former part of this let- 
ter, wherein I failed to reduce the swelling, was that of a negro 
woman who had been afflicted with ascites for three years, dur- 
ing most of which time she had been under the treatment of ex- 
perienced physicians. Her abdomen was enormously distend- 
ed. After usinjr various remedies which seemed to be indicated 



1837. J Azalea, or Honeysuckle. 23 

in this case, at length, during an interval of phyalism, produced 
by the use of the calomel and squill pills, I ordered her to make 
a constant and free drink of the Honeysuckle, excluding all other 
drinks and medicines for several days. I did not see her again 
for a week, at which time she informed me that when sitting 
down, she was afraid to get up if in company, because the water 
would run from her on every attempt to walk ; expressing at the 
same time great astonishment, that the quantity of fluid voided 
far exceeded that taken in. She was at one time reduced in size 
about two-thirds, and seemed for a time to promise continued 
amendment ; but after a time the swelling again increased, alike 
in defiance of this and all other remedies. In all the cases with 
the exception of this, and one of hydrothorox attended with hy- 
pertrophy of the heart, I succeeded in effecting permanent cures, 
so far as has yet appeared, or in procuring such amendment as 
to cause the patient to abandon the remedy too early, from the be- 
lief of no farther existing necessity. 

I might say much more on this subject, but consider that I have 
said enough to introduce the article in question to the attention of 
the profession. Will you and your colleagues adopt the use of 
the Honeysuckle, and give the results in the Southern Medical 
and Surgical Journal ? 



Dr. Macon requests information on the following cases : 
1st. A clergyman of Oglethorpe, whilst leading his horse by 
the fore-top, was by a sudden effort of the horse, caused to suffer 
great pain at the insertion of the deltoid muscle. He has almost 
entirely lost the use of the limb, being unable to raise it higher 
than his breast, or move it in any other direction except forward. 
The limb has been examined by several physicians, none of whom 
can detect luxation or fracture. All ordinary topical applications 
have been made in vain, 

2d. Mrs. L*****, in this vicinity, whilst stretching out a hank 
of cotton yarn, suddenly felt pain about the middle of the humer- 
us. In a few weeks, the biceps flexer cubiti became much con- 
tracted and still remains so, bending the fore-arm up to the breast. 
The limb is painful and almost useless. No dislocation or frac- 
ture can be detected. 



24 Azalea, or Honeysuckle. [August, 

3d. In October, a negro girl was struck by the falling of a tree 
in such a manner that her scalp was considerably lacerated and 
her left shoulder bruised and violently strained. No fracture of 
clavicle, scapula or humerus, nor dislocation, could be detected, 
after the most careful examination. All topical applications from 
the use of which benefit might be hoped for, were used to no good 
effect. Six weeks after, the arm was entirely useless, but moved 
in any direction without the least pain. The motion of the 
shoulder joint was free and without crepitus. The paralized 
state of the parts about the joint afforded a free examination of the 
head of the humerus, which was always in place with the 
glenoid cavity. The force which injured the shoulder was ap- 
plied from above. 

It is hoped that a clear and rational pathology of these cases 
will be given by some of the readers of the Journal. 

For the assistance of those who may be disposed to adopt the 
use of Dr. Macon's diuretic, we append the following extract of 
a letter from a scientific friend, on the subject of the Azalea : 

" The Azalea (or < Bush Honeysuckle/ as contradistinctive to 
the genera Caprifolium and Lenicera, which are called Wood- 
bines, from woodbind, and are twining or trailing plants) is 
arranged in the Linnaean class and order Pentandria monogynia, 
and the natural order Rhoderaceoe. There are ten species de- 
scribed in the 7th edition of Eaton 's Manual of Botany, and 
full as many more set down as varieties or sub-species ; — the 
growth of the United States. Elliott has five indigenous to South 
Carolina and Georgia, with three times that number of varieties, 
but he quotes Donrts Hortus Kewensis for his subdivisions, 
instead of resorting to the forests. If we pass to Europe and 
embrace their garden varieties, which are the only true varieties, 
we find in the collection of Messrs. C. Loddiges & Sons, near 
London, twenty three species, one hundred and eighty-six varie- 
ties and twenty-four sub-varieties ; seven-tenths of which are 
derived from North American species. 

"The Azalea nudiflora mid Azalea viscosa are the most abund- 
ant and widest spread over the United States : beginning at the 
borders of Canada and extending along the broken land, and par- 
ticularly the mountain range, to their most Southern extremity ; 
they often approach the sea board, but become more plentiful as 
you recede to the midland." 



1837.] Essay on Female Diseases. 25 

As Dr. Macon has distinguished no particular species or vari- 
ety, we presume he alludes to any or all the varieties of these 
species. It would be well however, for those who adopt its use, 
to observe the effects of the different species at least; the differ- 
ence of which will, we presume, be found, if at all, only in the 
degree, and not in the kind of power. — Ed. 



ARTICLE VI. 

An Essay on Female Diseases, and the Use of the Pessary 
in Uterine Displacements. By Dr. S. M. Meek, of Tusca- 
loosa, Ala. 

The present is an age of considerable speculation and enter- 
prise, in sience and scientific pursuits generally ; and no de- 
partment affords a more extensive and interesting field for inves- 
tigation than that of medicine ; nor can any be found with which 
the life and happiness of man (in his present state) is so closely 
connected : consequently there is no subject more worthy of deep 
thought and thorough investigation, by the philanthropist and 
scholar. This, however, becomes the peculiar duty of the med- 
ical profession. 

The interest taken by medical men, both in Europe and in our 
own country, indicates that they do not design the subject to 
slumber, as the increase in the number of medical journals and 
reviews, both in Europe and America ; and the general and sci- 
entific character of most of those periodicals omen well an im- 
provement in the healing art. 

In the United States, the North and West are in advance on 
this deeply interesting subject, nor have the Southern states kept 
pace with their northern and western sisters, in proportion to 



26 Essay on Female Diseases. [August, 

the talent, wealth and medical science of which they could boast. 

Our zeal in the good cause has recently aroused us from our 
lethargy, and even as far south as the city of Augusta, in the state 
of Georgia, we have a Medical Journal published, which in point 
of interesting subjects and scientific and practical research, 
(though but young) will not sutler by comparison with many of 
those of more mature years. 

Although on the healthy condition of the uterus, the health, 
happiness and stability of mankind almost entirely depend, still 
there is, in my humble opinion, no department of medical science 
more generally neglected or noticed with less concern, than female 
complaints, and especially uterine affections. 

It is true we have some works of considerable merit on this 
subject, both by ancient and modern writers ; yet I must insist 
that the profession have not afforded their successors that light 
on this subject which they could have done and which its impor- 
tance demands. 

I am happy, however to find that our southern physicians, 
through the medium of our journals, have at length manifested a 
consciousness of the thrilling interest which should be felt on this 
subject ; as it must be obvious to every close observer, that a 
southern climate and the constitution of females born and raised 
in the south, render them peculiarly subject to diseases of this 
organ, and should impose on the medical profession the duty of 
attempting to afford them that relief which is not to be looked 
for from any other source. 

I am perfectly aware that in relation to this as well as to most 
subjects occupying the attention of medical men, there will al- 
ways be a diversity of opinion, not only in relation to the remote 
and proximate cause of disease, but likewise as to the most pro- 
per remedial agents and their modus operandi. 

I would therefore beg leave to notice a few of the causes which 
in my opinion, contribute to render the number and extent of fe- 
male diseases much greater in southern than in northern lati- 
tudes — and 

1st. The precocity resulting from climates, by which females 
arrive at puberty from two to six years earlier than in northern 
latitudes. 

2d. The effect of the climate on the system producing greater 



I s :-)?.] Essay on Female Diseases. 27 

relaxation of the muscular fibre, and the parietes of the uterine 
and genital organs in general. 

3d. The effects of early parturition on the uterus and its liga- 
ments and on the vagina, and the imprudent exertions made by 
ignorant female accoucheurs to hasten the termination of labour. 
4th. The delicacy felt by young, inexperienced females, in ma- 
king known their condition with flour albus, prolapsus or proci- 
dentia uteri, producing delay in making application to the physi- 
cian for the necessary assistance. 

These, together with other causes, contribute largely to aug- 
ment the sufferings of females in southern latitudes beyond what 
they suffer in colder climates. 

The question then arises, what can be be done to relieve female 
suffering and ameliorate their condition ? 

In the first vol. of the Southern Medical and Surgical 
Journal, being No. xi. for April, 1837, I perceive the use of the 
Pessary in displacements of the uterus and vagina is brought up, 
and to some extent examined ; but the conclusion to which the 
author of the essay arrives from his own experience, and the au- 
thorities to which he refers, on the first blush, was to my mind 
perfectly astounding, and led me to enquire, can it be so 7 At 
this day, illumined as we certainly are (or should be) by the 
sun of medical science — shall we be led to abandon to immedi- 
ate sufferings, and finally to death, a vast number of the most 
invaluable human beings on the face of our globe, by takino- 
from them (shall I say) the sheet anchor of their hope, that, on 
which hundreds have rested and found (or believed they found) 
themselves delivered from some of the most distressing diseases 
incidental to human nature, and that without proposing any ade- 
quate substitute, on which to fix their hopes when laboring under 
such peculiar affliction ? When we recur to the medical history 
of gone-by ages, and enquire whether females then suffered as 
they do now, and whether these diseases were then known, and 
if so, how treated ? — We are informed that as early as the days 
of Hippocrates, Pessaries were in use, and almost every author 
who has written on the diseases of females and on midwifery 
from the days of the father of medicine, down to the present day, 
not only speaks of their successful application in practice, but con- 
siders them indispensable in many cases, as all other means resort 

D 



28 Essay on Female Diseases. [August, 

ed to have failed, while Pessaries have proved successful. And 
Dr. Devees speaks of their use and utility, in language and un- 
der circumstances which cannot be mistaken or doubted even by 
the most skeptical. 

I am authorised to say that most of the practising physicians in 
this city and vicinage, use the Pessary in their practice, and 
some of them believe that cases occur of both prolapsus and pro- 
cidentia uteri, in which neither a recumbent position, nor Hull's 
utero abdominal supporter, nor any known remedy, will super- 
sede the use of the Pessary. 

For the last twenty-eight years I have been engaged in the 
practice of medicine, in South Carolina, Georgia, and for the 
last nineteen years in the state of Alabama, in or near the city 
of Tuscaloosa ; during most of which time my attention has been 
called to the treatment of-female diseases, and especially uterine 
affections. 

While studying medicine, I formed a predilection for the 
sponge Pessary, not doubting, however, but that I should meet 
with cases which would in all probability require Pessaries of 
greater firmness ; and subsequent practice has produced no 
change of opinion in relation to the use of the sponge. In the 
course of my practice, I must have prescribed and used the Pessa- 
ry in more than two hundred cases, and I can confidently assert, 
that at least one hundred and fifty have derived evident benefit 
from their use : and in more than fifty cases they have been restor- 
ed to a healthy condition, and (suffer me to add) a large majority 
of the cases have been prolapsus, not procidentia And here I 
would offer a few reasons why I have been induced to prefer the 
sponge Pessary. 

1st. The sponge Pessary is softer and more yielding, so as to 
accommodate itself to the parts without injury to the vagina, or 
uterus, and on this account may be used when the parts are 
somewhat inflamed and irritable. 

2d. The sponge Pessary can be introduced and removed with 
less difficulty than any other kind, and that by the patient herself. 

3d. The sponge Pessary does not obstruct the ordinary excre- 
tions, but absorbs them ; and unless they should be reduntant, 
will imbibe the whole discharge when removed twice a day, as I 
always direct. 



1837.1 Essay on Female Diseases. 29 

4th. The sponge Pessary is the best vehicle by which astringent 
and refrigerant applications can be made to the relaxed and in- 
flamed parts ; at the same time injections may be used when the 
Pessary is removed : but this I have seldom found necessary 
when the sponge Pessary is well managed. 

5. The sponge Pessary is more easily suited in size and form 
to all cases than any other kind of Pessary. 

In many cases of displaced uterus, a recumbent position is in- 
dispensable to enable the parts affected to recover their natural 
position and tone, and in some cases this alone, or accompanied 
with suitable injections, may be all that is required ; while 
there are others (and especially when they have become chronic,) 
which would never be restored by position, injections or other 
means without the pessary. In such cases, when the Pessary is in- 
troduced, the patient, with but little inconvenience, can go on foot 
and attend to her ordinary business — and the parts thus kept in 
situ, the ligaments gradually recover their tone, the Pessary may 
then be dispensed with. I have had a number of cases of this de- 
scription. 

I am on this subject, as I would be on all others of importance, 
disposed to examine all the different bearings before I would at- 
tempt to controvert the views and opinions of others. 

This, however, is a subject which has long occupied my strict, 
and I may add, my (almost) undivided, attention ; and although 
" doctors" may " disagree," yet this disagreement should not ob- 
struct, but accelerate the progress of medical science ; and Dr. 
J. A. Eve, in his remarks on professional qualifications and cha- 
racter, very justly observes, (in substance,) that the medical pro- 
fession has fewer helps or way marks to assist and direct their 
course, than have those persons engaged in any other profession, 
and consequently they require stronger mental powers and more 
extensive scientific and literary acquirements. 

Much has been effected by a close attention to mechanical 
principles within a few years past, in the application of steam 
power, together with suitable machinery to facilitate the inter- 
course between distant regions, and much animal labor has been 
dispensed with, and incalculable advantages in mechanics, agri- 
culture and commerce, have been the result. Shall men use such 
physical and mental exertions to accomplish that which may add 



30 Essay on Female Diseases. [August, 



to our comfort as well as pecuniary advancement, but accomplish 
nothing more ; while the medical profession, in whose hands are 
placed the health, life and happiness of thousands, rest satisfied 
with the attainments already made in the u healing art ;*' although 
there has been so little accomplished for the relief of suffering hu- 
manity for ages past. We have but recently discovered that our 
predecessors in medicine were in error in some important parts of 
their practice, while we ourselves are unable to furnish a desider- 
atum in its place. 

Should not every physician feel it a duty incumbent on him to 
make some discovery or improvement in medicine, and never dis- 
pense with former discoveries without the best reason for so doing, 
and then only after proposing at least something which promises 
more certain and permanent relief? 

I presume no one would assert that in all cases of uterine and 
vaginal displacements, a Pessary should be used, and that without 
reference to the condition of the parts as to metritis and other af- 
fections ; nor would any judicious practitioner prescribe or intro- 
duce a Pessary without first ascertaining as nearly as practicable 
the condition of the parts, and then determining as to the time 
for application, the size and nature of the Pessary to be used ; and 
even then he should not resolve to continue its use at all hazards, 
but be governed by the effects produced and either remove or 
continue the Pessary for the time being as circumstances may 
direct. 

In several cases of prolapsus uteri which have come under my 
care (one of which has been within a month past) I have directed 
the use oi the Pessary, believing at the same time the patient 
prepared lor its use. But when on trial, it produced great uneasi- 
ness, I have then had it removed for some days and directed its use 
again when the irritable state of the parts shall have subsided; 
and my hopes and expectations have been fully realized. 

I am not at all surprised that many physicians have imbibed 
prejudice againsl the use of the Pessaries, who acknowledge they 
have never used them in practice, but have removed them when, 
after having been introduced by others, they were doing great in- 
jury to the parts. This is nothing more nor less than I should 
expect, from the solid unyielding nature of many Pessaries now 
in use, and highly recommended by some of our best physicians, 



1837. J Essay on Female l)'is(<< 31 

and from- the length of time they direct them to remain without 
beixur removed. 

But I presume none will make the foregoing assertion in rela- 
tion to the sponge Pessary, when prepared of good line sponge, of 
proper size, well introduced and removed twice a day. 

When I commenced this essay, my design was to present my 
views on the Pessary audits use in displacements of the uterus, 
&c. in a concise and condensed form ; hut professional and other 
business so frequently interrupted my progress, that to give 
some general idea of uiy opinions I have necessarily been more 
prolix than I anticipated. 

In conclusion, I would observe that several of the reasons 
offered by the essayist at the close of his essay, why " Pessaries 
ought now to be abandoned, 1 ' would never have occurred to my 
mind, nor can they (in my opinion) have any weight, when the 
sponge Pessary is used as I direct. The patient herself can in- 
troduce and remove the Pessary, nor is it indispensable that it 
should remain when in bed ; as the recumbent posture will be 
sufficient to keep the parts in site ; but introduced before or when 
she rises. The use of the Pessary may be suspended (as I al- 
ways order it to be) during the catamenial discharge ; at which 
time the patient should avoid great bodily exertion and keep as 
much as convenient in a recumbent posture, nor should I appre- 
hend any demoralizing influence from the use of the Pessary. 



Note. — Dr. Meek seems to have, in common with some of 
the most respectable authors, used the terms prolapsus and pro- 
cidentia somewhat differently from their general acceptation at 
the present day. It is true, that the application of the terms either 
way is arbitrary ; and consequently Dr. M. as well as those from 
whom he adopted his nomenclature, had a perfect right to apply 
them as he might please. Still a fixed nomenclature for these 
cases is not of trivial importance ; as the want of it has tended to 
unsettle the minds of pupils, and cause disagreements and mis- 
understandings amongst practitioners. Some authors have spun 
out. the nomenclature for this displacement to express several 
different degrees thereof: as Parr, who by relaxatio, means a de- 
scent of the womb down to the middle of the vagina. By proci- 



32 Essay on Female Diseases. [August, 



dentia, he characterises its descent to the labia ; and by prolapsus, 
its falling through the labia pudendi. Charles Mansfield 
Clarke says procidentia uteri has also been called prolapsus 
uteri and descensus uteri ; the latter term being used to express the 
minor degree of the disease — the former, that in which the uterus 
has fallen out of the body, through the external parts. Dr. Good 
seems to use the terms procidentia and prolapsus uteri as synony- 
mous with protrusion of the uterus into the vagina, and falling 
down of the womb. It is one of the species of his germs, " geni- 
tal prolapse, and includes three varieties, the first of which he calls 
simplex. He then gives different degrees of this variety, thus : — 
" If the descent be only to the middle of the vagina, it is called 
relaxation as by Parr ; if to the labia, procedentia ; if lower 
than the labia, prolapsus, &c. There appears however no need, 
either for practical or theoretical purposes, of making a distinc- 
tion between the small variations of this displacement. It is 
therefore now, almost by common consent, divided only into two 
degrees, between which there is a plain and definitely marked dis- 
tinction ; and which differing degrees in their nature afford fur- 
ther distinction in occasional difference of treatment. According 
to this plan, prolapsus uteri expresses any descent of the uterus 
from its natural site, wherein it still remains above the os exter- 
num; and procedentia, any greater descent in which any portion, 
or the whole of the uterus is protruded through the vulva. 

There is in favor of this nomenclature, at least some appear- 
ance of propriety in the proper and (slight) distinctive acceptation 
of these two words, which is not alike favorable to the other ap- 
plication of them. The former, or prolapsus, from prolabor 
means to slip, glide, incline, (fee, whilst the latter is from npowiima — 
procido, to fall down flat, <fcc. which is at least, a stronger expres- 
sion, and measurably implies a greater degree. It is true that the 
etymological ground for distinction of one from the other by these 
words is slight ; but slight as it is, we think the nomenclature 
had better be fixed on that little which may fix it, than continue 
to fluctuate with authors to the great inconvenience of pupils 
and practitioners, and of patients themselves. We should not 
have felt so deeply the importance of this nomenclature, but for 
a strong case, which often presents the fact of the ruinous tenden- 
cy of different names for the same thing in pathology. Although 



1837.] Essay on Female Diseases. 33 

our note is much protracted beyond what was intended, we feel 
it a duty to give a brief statement of this case, in this place. 

A lady, on the eve of her marriage, ascended a chair placed 
on a table for the purpose of fixing her parlour window curtains, 
from which, by some unfortunate movement, she fell in such a 
manner that her nates first struck the floor with great violence ; 
and a very severe flooding was the almost immediate conse- 
quence. This was, by various means, gradually moderated until 
she was enabled to be brought to town. I was consulted on her 
case, and decided, by the full current of external symptoms the 
existence of prolapsus. Some female friends more nice than 
wise, insisted that she should consult another physician, before 
she consented to the diagnosis. This was accordingly done, and 
the latter informed of my opinion. On being assured that the 
womb did not protrude, but that the external appearance was 
perfectly natural, he decided most positively that the former opin- 
ion was incorrect, that no prolapsus existed ; assuring the pa- 
tient that if it did, the womb could not fail to be visible externally. 
It was therefore concluded that her distresses were only the re- 
sult of that debility which necessarily followed the hoemorrhage 
— that her complaints were chiefly hysterical, and that a course 
of tonic and antispasmodic treatment would speedily restore her. 
This being a much pleasanter suggestion to the patient and her 
husband, was accordingly adopted, and the patient remained 
subjected to it for some six or eight weeks. At this time I was 
recalled to her by her husband, who had discharged the attend- 
ing physician, in consequence of having himself made an inves- 
tigation which proved to him that the lower part of the uterus 
was just within the vulva, and the discharges from it copious and 
extremely offensive ; indicating the approach of the case to one of 
the termination of this unpleasant disease when neglected, to 
which I had directed his and his wife's attention. On the touch, 
I found the anterior part of the cuvix of the uterus immediately in 
the rear of the punctum urethras, where it was very firmly attach- 
ed by the inflammation which had preceded the ulceration. The 
posterior lip and half of the curvix, as high as the middle of the 
great cavity of the body was lost by ulceration, and an extensive 
ulcerated and suppurating surface presented, occupying the whole 
internal surface of the uterus. I caused the discarded physician 



31 Essay on Female Diseases. [August, 

to be recalled, in order that he might be convinced of his error; 
but he persisted in the opinion that there had been no prolapsus 
in the case, but freely acknowledged that he knew there was pro- 
cidentia, which he had hoped to cure by strict, attention to pro- 
per position in bed. The lady was greatly emaciated, and in 
that state of debility, and laboring under that dreadful train of 
nervous distresses, which generally attends the extremity of these 
cases when their proper treatment is too long delayed. By great, 
unremitting effort and attention, with the excellent conduct of a 
patient of good sense, the ulceration was perfectly healed within 
about two months. But before the progress could be arrested, 
not less than two-thirds of the whole uterus was destroyed ; 
and on healing, a smooth cicatrix covered the posterior face of 
the remaining portion. This was nearly five months after the 
occurrence of the accident. No menstrual return had ever taken 
place since the accident, nor had there been any sanguineous 
discharge from the part after the suppression of the first hemorrh- 
age, except at about two months after the accident, when the 
ulceration was at its greatest extent, and probably, from the re- 
turn of the menstrual impulse, a hemorrhage considerably copi- 
ous appeared for a short time, but which was, from its excess, 
promptly checked. The menstruating organization was destroy- 
ed, and as the process of healing progressed, dull pains in the chest 
acceded, with cough — abcesses and ulcerations in the lungs ; — 
and death closed the scene in the eighth month after the accident. 
All this was doubtless from the apparently trifling facts that the 
attending physician called a descent of the uterus without the 
vulva, jirolapsus, and that in which it does not appear externally, 
procidentia ; and that he depended, for the cure of this latter, 
solely on position in bed. 

The exact dates of this case I have, with very accurate colour- 
ed crayon speculum views illustrating the ulceration in its differ- 
ent stages, and the final appearance in healing. — Ed. 



1837.] The Young Mother's Guide. 



PART II. 
REVIEWS AND EXTRACTS 



The Young Mother's Guide, and Nurses Manual ; contain* 
ing advice on the management of Infants, and conduct to 
be observed by the mother before and after Child-birth. By 
Richard S. Kissam, M. D. Second edition ; Hartford : 
Belk?iap fy Hamersley — 1837 ; small 12 mo. p. p. 152. 

This is the title of a small volume which has issued from the 
Hartford press during the present year. Its title page at once 
attracted our attention, alike by the subject treated on and the 
name of the talented and experienced author. There has always * 
and every where in this country been a crying necessity for a 
much greater extent of knowledge on the part of young mothers 
and nurses, relative to the management of lying-in woman and 
infants, than has been accessible to the proper reader. We say 
proper reader, not because the contents of this rich little volume 
would be unsuited to the eye of the best practitioner, or any one 
else ; but. because, intended as it is for the instruction of mothers 
and nurses, relative to such matters as do not ordinarily demand 
the presence of the physician, its value would be measurably lost 
if not diligently read by those classes themselves to whom it is 
addressed. Indeed the want of so concise and judicious a col- 
lection of instruction — the result of long and extensive observa- 
tion under the guidance of ample science, cannot fail to meet the 
necessities not only of every beginning practitioner, but also of 
most of those who have passed many years in professional life. 
However closely general practitioners may have directed their 
attention to the discharge of their duties, it is but with a very 
small proportion that we find any thing like that thorough know - 
ledge of the female economy, and the physiology of the infant to 
enable them to reason correctly for the prevention of disease and 



36 The Young Mothers Guide. [August, 



the promotion of the best corporeal and intellectual develope- 
ments. And of the small proportion who do by experience, come 
to possess themselves of what may be, and is commonly consid- 
ered by the physician, minor science, and useful chiefly in the 
nursery, but a small proportion again of these are sufliciently 
communicative, conscientious, and at leisure to enforce instruc- 
tions on the too thoughtless and inconsiderate patients and 
nurses. But the great sum of necessity for such a manual is in 
the country generally, where even physicians cannot be conveni- 
ently consulted, and in southern towns where there are no nurses 
but such as are drawn from the rougher occupations of life by 
the temptation of wages, with but little experience and less men- 
tal cultivation. 

The little volume before us is probably as unexceptionable in 
all respects as is possible for a production of the kind to be. — 
The interest the practitioner takes in reading it may lead him to 
lament its brevity on some, and perhaps all the subjects, until he 
reflects that most of young married women and almost all nurses, 
have not that forecast which should lead them to much reading ; 
and if a volume of considerable magnitude, though replete with 
matter of great interest, and concisely written, be placed in their 
hands, it appears so great a task that it is entirely neglected, or 
so superficially scanned as to afford only a few disconnected facts 
and many of them of least importance — a knowledge not unlike 
that generally obtained by females and others who read treatises 
superficially; and is much more calculated to do harm than good. 
The reader then becomes satisfied that, as he could not consent 
to omit a sentence and scarcely to alter the arrangement of one, 
the plan of the work could not have been better laid for the great- 
est usefulness. 

Nor is the work a mere collection of precepts valuable in 
themselves ; for whilst these are concisely and beautifully set 
forth, the understanding is enlarged by an accurate and perspicu- 
ous developement of their necessity and their reasonableness, an 
example of which we give in the following extract. It will be 
also seen therein, that the author has not failed fully to under- 
stand a subject of greatest importance and generally neglected by 
physicians, (i.e.) the proper adaptation of mental exercise to age 
and constitutional powers, for securing the best mental and cor- 

ornal perfection which is attainable. 



1837.] The Young Mother's Guide. 37 

The "subsequent management of the chiloV he arranges 
under four heads : 

I. Of the child's food. 

II. Of the child's dress, 

III. Of the exercise proper for the child. 

IV. Effects of mentai cultivation upon the child's health. — 
The iii, and iv. of which we extract. 

III. Of the exercise proper for the Child. — As soon as the 
child commences walking, the proportions of its body begin to 
assume a more perfect character. Exercise strengthens the mus- 
cles, and reduces the quantity of fat ; the limbs become stronger, 
and the abdomen more flat. The child should not be forced to 
walk. It ought to be allowed gradually and voluntarily to take 
the erect posture. The legs may become crooked from too early 
walking. The hip joints are easily injured at this tender age, 
and I have no doubt that a large number of children laboring 
under " hip joint disease," became so by being urged to walk 
when too young. The exertion to their imperfectly developed 
joints and muscles must be immense. As soon as the child 
walks firmly, he should be taught to exercise carefully and to 
avoid jumping, especially from such objects as chairs, tables, &c. 

The open air is the only proper place for exercise. When 
the weather is mild, children should spend much of their time 
out of doors. The morning and evening air is to be avoided. — 
After the dew has left the ground in the morning, and before it 
is formed in the evening., are the hours best calculated for their 
exercise. 

All violent exercise should be prohibited, such as very fast 
running, jumping over fences, down steep banks, or climbing 
up trees. It not only exposes the child to severe accidents, but 
is positively injurious to the proper development of the frame. 

The bones of young children are tender, and easily bent or 
broken, and their joints are not fully developed ; hence any 
violent exercise tends to injure them. I do not mean to say that 
the free and unrestrained use of the limbs should notbe allowed, 
but that children should not be urged by competition to deeds 
beyond their strength. Let them frolic and play as much as 
they please, but do not permit them to risk their limbs and lives 
by "extraordinary feats of agility." Children accustomed to the 
air are far less subject to catarrhal and inflammatory diseases. 
They acquire a vigor of mind and body to which children im- 
mured in a nursery are strangers. Their muscles aje more ful- 
ly formed, their complexion more healthy, and their digestion 
more perfect. 

And again — 



38 The Young Mother's Guide. [August, 

IV. Effects of Mental Cultivation upon the Child's Health. 
The education of children cannot be too early commenced. 
Even in extreme infancy, the moral character begins to develope 
itself; and as man is naturally inclined to evil, so the first vol- 
untary actions frequently require correction. 

Childhood is the time for moral cultivation. It is the proper 
season to impress elementary religious truths. The mind, al- 
though naturally possessing a certain conformation peculiar to 
each individual, is greatly modified by early education. The 
sacred volume says, '-Train up a child in the way he should go, 
and when he is old he will not depart from it." 

This direction alludes to moral and religious cultivation, rather 
than to mental discipline. No one who receives the word of 
God as our unerring guide in duty, can doubt the importance of 
thus early impressing the minds of children with religious truth. 

It is otherwise with regard to mental cultivation in its more 
extended sense. The brain, which is the apparatus of the mind, 
does not arrive to complete organization until about the seventh 
year. Before this period therefore, no task which requires any 
great degree of mental effort should be imposed. Children have 
a certain aptitude for learning the elements of all kinds of know- 
ledge, far superior to the adult. This, no doubt, is the provision 
which the God of nature has instituted to prevent, or render un- 
necessary, a long continued effort of the child's mind. When 
we consider the utter ignorance and helplessness of the infant 
when ushered into the world, we are led to suppose that we can- 
not too early commence giving it instruction, and urging it to 
mental exertion. Children learn principally by imitation du- 
ring the first few years of their existence, and the exercise of this 
part of the mind dose not appear to produce any bad effects. If 
the reasoning capacity of the child be urged to action, before the 
mind has acquired facts to reason upon, then the exercise of the 
reasoning faculty produces injury, because it is called upon to 
construct without materials, or in other words, to arrive at con- 
clusions without premises. 

Whenever the mind is called upon to act, an extra quantity 
of blood is sent to the brain ; and though this extra quantity is 
very small, still a long continued flow of it to the delicate and 
immature brain of the child, is apt to produce disease. A blister 
applied to the skin will cause an extra quantity of biood to go 
to the spot where it is applied, and this is caused by the stimula- 
ting quality oi the blister salve. Thinking acts on the brain in 
the same manner as the blister does on the skin. If a child be 
allowed to think too long, the blood which goes to the brain will 
produce a kind of irritation there, which is apt to lead to inflam- 
mation, sometimes terminating in dropsy of the head. But the 
irritation, even if it does not end in inflammation, if kept up 



1837.1 The Young Mother's Guide. 39 



a long time by the cause which produced it, dose not readily 
subside. The Consequence is, the brain is soon worn out. This 
is caused upon the same principle as blindness, when produced 
by looking at a very bright light. The eyes lose their power of 
vision, because their nervous energy becomes exhausted. They 
were used so fast, that nature was incompetent to supply the en- 
ergy as fast as it was lost. 

The food we eat is converted into blood, which furnishes the 
supplies necessary for restoring the lost energy of the system. 

It is imposible to lay down rules for the regulation of all chil- 
dren. The minds of all vary, and some come forward much 
earlier than others. 

Children generally prefer play to study ; and the reverse 
of this is very rare. I am inclined to think too much has been 
said on this subject of late, to induce parents to postpone their 
children's education. The mind is active ; it must be exercised 
on some subject. It cannot be folded in a napkin and laid aside. 
Its province is action, and act it must. 

Great care is necessary to direct this action into the channel. 
If the parent discourage the enquiries of his child for knowledge, 
he will seek it elsewhere. Knowledge he must and will have, 
and perhaps he will draw it from a polluted source. This will 
be destructive. It will encourage the passions to the detriment 
of his reasoning faculties. 

Those children who have a great desire for knowledge, 
are indisposed to muscular action. Great muscular action or 
continued exercise, is incompatible with much thinking, and 
hard study. This is owing to the fact that the blood is sent to 
the limbs, and retained there by exercise. The brain of course 
cannot have an extra supply. The best course, therefore to be 
pursued with children who are disposed to too much study: is to 
induce them to exercise freely ; and in addition to this, they 
must be furnished with simple food, and a hard bed. This will 
restore the balance of circulation. 

Children having a diseased brain, are very apt to exercise the 
mind too much ; when this is the case, the family physician 
should be applied to for advice. 

But we must deny ourselves the pleasure of any thing like a 
detailed analysis of the book before us, as we cannot republish 
the whole, and know not what we could omit. Its contents are 
arranged under four different parts. The first contains xxv. 
concise chapters, on the subjects of the qualifications necessary 
to constitute a good nurse ; engagement of a nurse ; her conduct 
in the sick room ; her duties during labor ; treatment of the 
mother immediately after child-berth ; treatment of the child 



40 The Young Mother's Chiide. [August, 

immediately after its birth ; washing the child ; dressing the na- 
vel ; of the belly-band ; dressing the child ; feeding the child ; 
putting the child to the mothers breast, &c. ; feeding the child 
when the mother affords no milk, or only a partial supply; 
management of the nipple before and after child-birth ; food of 
the mother ; her general treatment during the month ; temper- 
ature and ventilation of the room ; bed curtains ; management 
of the child at night ; wants of the child ; on crying ; general 
treatment of the child during the month ; on the mother's assum- 
ing the care of the child ; its subsequent management, and the 
conduct of the mother during lactation. 

Part II. treats on the " diseases of the child," 

Part III. on the diseases of the mother, and 

Part IV. on teething, weaning, administration of medicines, 
signs of pregnancy, and conduct to be observed during gesta- 
tion ; all of which are treated according to the soundest princi- 
ples of physiology and pathology. 

In concluding the pleasant task of noticing Dr. Kissam's 
book, we feel that we cannot say less than that it is a cheap little 
book, without the thorough knowledge of which no woman 
should come to the bed of travail— no nurse to the lying-in room, 
and no physician commence, or (if he has commenced,) continue 
the practice of his profession with females or infants. 



Thymic Asthma* of Infants; a disease hitherto but little 
knoivn, and imperfectly understood. 

The thymic asthma of infants is a much more common dis- 
ease than is generally believed. Every one has seen infants 
born with a difficulty of respiration, and die in a few weeks, or 
even months, without ever having been relieved, and without 
their death being accounted for. Indeed, life is so uncertain in 
the early ages of infancy, that the victim has been rather regard- 
ed as a tender plant unable to take root in the new soil to which 
it has been removed. 

It was however, evident that the cause of death, whether re- 
mote or proximate, was to be traced to the respiratory apparatus, 
and that the disease partook of the character of the asthma de- 

* Asthma Thymiquo. 



1837.1 Thymic Asthma of Infants. 41 

scribed by Millar, although more slow in its progress and 
presenting paroxisms of greater frequency and shorter duration. 
March, of Dublin, having seen an infant suddenly expire from 
suffocation, attributed its death to spasm of the glottis ; but it 
was a mere conjecture, which he did not attempt to verify by 
autopic inspection. He did not think of the thymus, which, be- 
ing subservient to foetal existence alone, should subsequently 
dwindle away. March was in error, for Hood having opened 
six infants who had perished from this spasm, found the thymus 
preternaturally enlarged. The publication of these cases awak- 
ened the attention of observers — authors were consulted, and it 
was found in the works Reicha and Vedries, published a 
century ago, that the asthma of new born infants is frequently 
caused by hypertrophy of the thymus. More recently, Dr. 
Frank taught that infantile asthma is often occasioned by an 
extraordinary enlargement of the brouchial glands and thymus. 
In 1810, Dr. Brera confirmed this ascertion in an infant who 
was suddenly suffocated when but a few weeks old. Such was 
the analogy of this case to those related by Millar, that it would 
have been considered the same had not the examination been 
made ; but most of what we know satisfactorily of this disease, 
we owe to Koop, who has collected a large number of cases in 
his own practice as well as in that of his friends, in a memoir on 
the subject, read before the Academy of Heidelberg. He gives 
the following characteristic symptoms: 1st, periodical suspen- 
sion of respiration, attended with piercing shrieks and anxiety ; 
2d, a return of suffocation when the child awakens, cries, or at- 
tempts to swallow ; 3d, the habitual projection of the tongue, 
the extremity of which remains between the lips ; 4th, the tris- 
mus which supervenes and produces death. Such are the phe- 
nomena presented in infantile asthma. Koop looks upon the 
main diseases as located in the thymus, whose enlargement 
obstructs the air passages and the freedom of circulation. 

Brera fully concurs with Koop, appreciates the symptoms, 
details the organic alterations, and enumerates the remedies pro- 
posed by clinical practitioners. He states that thymic asthma at- 
tacks infants three weeks old, though more frequently those from 
four to ten months, and sometimes even eighteen months of age. 
It is indicated by either one or more pathognomonic signs. The 
inspiratory sound is analogous to that of pertussis, but more 
sharp and piercing. Five or six inspirations will be heard before 
an expiration ; the latter is noisy like that of a violent paroxism 
of asthma, and respiration remains entirely suspended ; should 
the infant not perish immediately, the sharp cries will be contin- 
ued at each short and interrupted inspiration, until free respiration 
be restored. 

Collateral symptoms. — There is nothing peculiar in the other 



42 Thymic Asthma of Infants. [August, 

symptoms attendant on this disease. They partake of the im- 
peded state of respiration, and resemble those of hysteria, asthma, 
and other suffocations. For instance, the chest is thrown back- 
wards, the countenance is anxious and oppressed, the face passes 
from the livid to a state of paleness, the nostrils are in motion, the 
eyes fixed, the hands cold, the thumbs contracted, and the excre- 
tions sometimes involuntarily discharged, the paroxism continues 
from thirty seconds to two or three minutes. After the paroxism, 
the infant again moans and feels uneasy ; but soon returns to his 
natural state. He nevertheless remains for sometime pale, lan- 
guid, and disposed to drowsiness. On comparing one of these 
infants with others in the enjoyment of good health, he will be 
distinguished by the projection of his tongue more or less between 
his lips, and by the indistinctness of the heart's action between 
the paroxisms. Whenever the child exerts his organs of respira- 
tion, either in crying, laughing, becoming in a passion, swallow- 
ing with avidity or gaping, he will be threatened with suffocation. 
In the beginning the attacks recur every eight or ten days ; but 
they subsequently increase, become daily, and have even been 
known to return twenty times in four and twenty hours. It is 
not unusual to see the little patient fall, as though stricken by 
lightning, at the moment he begins to laugh or to cry ; yet infan- 
tile asthma most commonly assumes the chronic character, and 
terminates in convulsions of an epileptic character. The lum- 
brical muscles of the hands and the adductors of the thumbs, are 
always contracted ; the period of danger may continue from 
three weeks to twenty months ; and the signs of approaching 
death are those of apoplexy and of asphyxia. 

What then is the nature of this asthma ? Its symptoms alone 
would never have revealed it without the scalpel. All the phe- 
nomena of life proceed from the circulation of blood, respiration 
and innervation ; the encephalon and its dependences exercise 
an intimate influence on the heart and lungs at the same time 
that it is itself subjected to the influence of these. These three 
organs exercise their functions in a state of subjection to each 
other ; they are united by compact. 

Let us for a moment suppose the vital power to be located in 
the encephalon ; it will be from this centre transmitted by the 
nerves to the heart ; the blood thrown by the ventricles may be 
considered the vehicle of life ; and the lungs provide air for the 
renovation of this blood. Thus these three prime organs 
produce and sustain life ; each calls into action the two others T 
and neither can act of itself. If therefore the air of the lungs, 
the blood of the heart, or the nervous fluid of the encephalon, be 
lacking, death is the immediate consequence ; the' being may 
pass from life to death without gradation of transition. The 
practitioner might then have predicted, on seeing an infant die 



1837.] Thymic Asthma of Infants. 43 

suddenly on awaking or attempting to laugh or to gape, that 
either tiie primary or secondary cause of death wou.d Le iound 
in the brain, heart, or lungs, The skin is livid, the bleed is 
found stagnating in the 1 rain ar.d lungs ; the heart is flaccid, and 
sometimes still perforated Lyihe foramen ovale; Lut the piinci- 
pal and the most, constant lesion ishypeitrcphy of the thymus. — 
Here is the seat of the disease; the excessive development of the 
gland extends longitudinally, laterally, and usually in thickness. 
The lungs are compressed by it thrown back against the arterial, 
venous, and nervous trunks, with which they contract adhesions 
more or less extensive in the neck and chest ; the thymus has 
repeatedly been found spreading like a fringe and firmly embia- 
cing various parts. The tissue of this gland is sometimes nor- 
mal, though most frequently hardened, reddened, more fleshy, 
without being manifestly indurated, inflamed, nor carnified. ncr 
indeed transformed in any way. When cut through its centre, 
a mi ky humour is seen to flow. Its weight varies from six cr 
seven drachms to one ounce. Dr. Brera has seen the thymus 
two inches wide, and extending from the thyrcid Lcdy to the 
diaphragm so as to compress the trachea, lungs, heart, vessels, 
nerves, &c. in its way. In another instance be iound it adhering 
to the thyroid gland and covering the whole heart in such a 
manner as seriously to impede and almost prevent its action. — 
In a third child, the thymus presented prolongations entwined 
around and compressing the jugular veins and carotids as well 
as the arteria innominata. 

The predisposing causes of this disease are constitutional de- 
bility of the infant, diseases of the uterus previous to r.nd during 
pregnancy, predisposition to glandular affections peculiar to cer- 
tain families; there can be no doubt that bronchial catarrh, den- 
tition and al dominal diseases, complicated wilh enlargements of 
the mesenteric glands, may favor the development of thymic 
asthma. 

The prognosis is always alarming. There are no means of 
prevention, and the disease left to itself is always fatal. The 
author thinks however that by timely and diligent attention its 
progress may be arrested. He indicates the course to be pursued 
during the paroxysm: the chi T d ehou'd 1c seated and inclined 
forward, whe l slight thumps should be made en his back to fa- 
cilitate respiration; if the pulse is imperceptible, endeavors 
should be madi to restore the circulation by the horizontal po- 
sition and sprinkling the face with cod water; if the train be 
congested, leeches are to be app'icd to the sides of the neck and 
over the superior intercostal spaces. After the raroxysm, the 
remaining spasms may be combatted with small closes of laurel 
water, tincture of assa'feetida, musk, or cyanuret of zinc. 

The radical cure of the disease may be attempted with some 

F 



44 Cataract — Dislocation, $-c. [August, 



hope of success when the infant is robust, by resorting to repeated 
local depletion, active cathartics, alternated with laurel water or 
hydrocyanate of morphia. The depletion and purgatives will 
be more cautiously used when the patient is less robust, and anti- 
spasmodics more relied on ; for instance, the twentieth part of a 
grain of musk and as much of acetate of morphia may be given 
three or four times a day. Regimen constitutes the main part of 
the treatment for the reductiou of hypertrophy of the thymus, 
but should be aided by revulsions and discutients. In this man- 
ner good effects have been obtained from the ointment of tartar- 
ized antimony applied over the sternum ; unctions made with the 
muriate of barytes are still better ; whilst either of these oint- 
ments are used, the arms should be alternately blistered, but not 
with cantharides, antimonials combined with mercurials, iodine, 
animal carbon, extracts of hemlock and of the garden marygold 
(calendula officinalis, of L.) and the preparations of gold may be 
administered internally. The Milanese physician cites three 
cases he cured by this practice, two in 1831 and one the present 
year. The title of this memoir should then express that the 
thymic asthma though known was reputed incurable previous 
to Dr. Brera's publication. — Journal des Connaissances Me- 
dico- Chirurgicales* 1837, p. 73. 



Cataract. 



During the last three years, M. Serres, of Montpellier, per- 
formed the operation for Cataract seventy times, of which sixty- 
two were successful. M. S. prefers the displacement of the lens, 
and operates on but one eye, usually the left. The subsequent 
inflammation has always been either very slight, or readily sub- 
dued by depletion. The ascension of the lens has sometimes 
necessitated a second operation, which has been equally easy 
and successful as the first. M. S. recommends the anterior 
portion of the capsule to be carefully lacerated before removing 
the lens, for the partial or complete opacity of this membrane is 
an occurrence he has not always been able to prevent.— lb. p. 80. 



Modification of the usual method of reducing Dislocation of 
the lower jaw. By M. E. Bernard. 

A man about fifty-five years of age, having dislocated his low- 
er jaw by gaping, called in a physician who endeavored in vain 
to replace it. The next day he went to the hospital, and submit- 



1837.] Metoniioea, or Uterine Discharge. 45 

ted again to new efforts without relief. It was endeavored to 
overcome the muscular resistance by bleeding, when M. Ber- 
nard was called and at first failed. He however determined on 
a new method ; the patient being seated on the floor with his 
head between the knees of an assistant, the surgeon sat in front 
of him and placed his left knee under the patients chin. His 
thumbs were then introduced into the mouth for the purpose of 
depressing the condyles at the same time that the chin was ren- 
dered immovable by resting on the knee. The resistance was 
overcome, and the condyles carried backwards at the same time 
that the chin was elevated by the knee. The dislocation was 
thus readily reduced, although the usual methods had proved 
unsuccessful. — Journal Hebdomadaire, T. iv. p. 30. 



M. Moreau's Report on M. Chassinat's work on Serous 
Metorrhaia, or Uterine Discharge. 

1st. Serous metorrhoea occurs at various stages of pregnancy, 
and constitutes a real disease. 

2d. In the great majority of cases, the fluid discharged is 
secreted between the inner surface of the uterus and the foetal 
membranes, after a separation of these membranes from their 
attachments. This is invariably the case when the flow is 
abundant and repeated. 

3d. The most common causes of this secretion are geneal ple- 
thora, and uterine irritation, such as most frequently succeeded 
external violence. 

4th. The pathognomonic symptom of the disease is a discharge 
from the vagina of a fluid usually limpid and tenacious, of a cit- 
rine colour, and sometimes attended with painful contractions of 
the uterus. 

5th. This disease leaves no anatomical lesion visible. 

6th. This flow is usually dangerous neither to the mother nor 
child. Pregnancy goes on as usual, and the liquor amnii is not 
diminished in quantity. 

7th. With regard to the treatment, there is usually nothing to 
be done, unless the plethora should be excessive, in which case 
vinesection should be resorted to. In no case should the pro- 
gress of pregnancy be interrupted or labor be interfered with 
from this cause alone. Parturition will not be affected by it. — 
Journal Hebdomad aire. T. iv. p. 29. 



46 Remarks on Itinerants. [August, 

Remarks on Itinerants — Mercury. 

We extract from the Boston Midical and Surgical Journal 
for March. 1S37, the following remarks on Itinerants, as being 
evicbntly the fruits of observation. We have only to regret that 
the author did not append his name, that the weight of his cha- 
racter for the experience we judge he must have had, might have 
added its force to the power of the truths detailed. 

"Pison Marcury done this,'" said the puffed-up empiric, while 
dealing out his care-ail for the sore legs of a poor old man, who 
had not been sparing in his younger days of the cup that ma- 
keth the heart glad ibr a little while, but bringeth sorrow in the 
end. « Pison Marcury done this,"' said the aunts and cousins, 
as they each in their turn came in to pity the old man for his 
pain and inability to walk. « Pison Marcury " and Mother Eve 
have a great many sins to answer for, which they never knew 
anything more about than the rock in the quarry, or the child 
unborn. 

We consider ourselves an exalted people, and a civilized peo- 
p'le ; but we are not half so far in advance of barbarism as we 
think. Tne eastern potentate, who makes it penal for his phy- 
sician to meet with ill success in practice, is as reasonable as 
we in many respacis are. Tne natives of the interior of 
Africa, when they murdered Mungo Park for not being par- 
ticular enough in his veneration to a particular kind of tree, 
which they worshipped as a deity, were not more superstitious 
and inconsistent than we in some instances are. Notwithstan- 
ding we have light to direct us, we will not be guided by it. 
Like some idolatrous nations, who deify and worship the most 
loathsome reptile, we place confidence in persons of the least 
acquirements, of the most mistaken confidence in their own 
abilities, and the most ill-deserving of public confidence, allow 
ing their knowledge to be as great as they would have people 
think, it to be. 

' ; Pison Marcury," which there is so much said about, in skilful 
hands is one of the best remedies which the medical practitioner 
has hitherto become acquainted with. It is, like a great many 
other things, denounced partly because it has merits. We sel- 
dom behold a man of sterling merit without enemies. As those 
are the best fruits which the" birds have been picking at, those 
things are often the most worthy of being confided in, which 
have the most strongly been spoken against. 

The very persons who bestow so much contumely upon mer- 
cury, if they know enough to distinguish one medicine from an- 
other, use it themselves when they think they can do it without 
detection. They slander it to bring themselves into notice. Like 



1837.] Remarks on Itinerants. 47 

the thief who mingled with the crowd, and cried "stop thief," 
thsy sometimes abase it to screen themselves from suspicion . 
From some such way ; and fcr this mere than for the benefit they 
intend by it. they create for themselves a hobby upon which 
they too often ride triumphantly over the heads of their more 
observing brethren of the medical art. 

I once knew a man by the name of Sprague, who was so 
boastful a quack, that many people thought he was almost a 
prodigy in the art he pretended to understand. One of his idol- 
izers, after having vented his spite at "pison marcury" and 
"poticaries," showed me a weed that Dr. S. used as a substitute 
for "macury." I told him there was no virtue in that, and that 
I could eat a hat full. " To make it more vartuous," said he, 
"he adds a leetle corrose of sublimate." Corrosive sublimate, 
you mean, said I. How much do you call a leetle? "Why 
about five grains, or as much as you could take up on the pint of 
a jack knife." That is enough to kill a dozen persons, said I. 
Calomel, the preparation of mercury which is most generally 
used, may be given in tea-spoonfuls without danger. Corrosive 
sublimate, if given in the quantity of a grain of sand, would en- 
danger a man's life. He was astonished. He could scarcely 
be persuaded that I was not trifling with him. " Dr. Sprague 
use marcury? It could not be. He talks more against it than 
all the doctors lever know'd." He had a terrible load upon his 
mind, until he saw Dr. Sprague, who made him believe that cor- 
rosive sublimate was a vegetable. 

We never see a person, good, bad, or indifferent, and the re- 
mark is frequently made, who has not some friends. "Mercu- 
ry," as those who are opposed to its use call the various prepara- 
tions used as medicine, has its friends, and I am willing to be 
ranked as one of them. Though anathematized by quacks and 
their unconscious dupes, it is a valuable medicine, and could not 
well be dispensed with in general practice. By those persons it 
is asserted to be a poisoner of the blood ; but there is more evi- 
dence of its being a purifier than a poisoner of this important 
fluid. When a person is afflicted with an obstinate humor, the 
common supposition is that the blood is in a bad state. Mercury, 
in some form, is the best remedy of anything which has been 
discovered. Syphilis is supposed to poison the blood. There 
is, in all varieties of this disease no certain specific but mercu- 
ry, and this seldom fails. In affections of the liver, which with 
much propriety may be said to injuire the blood, mercury is 
generally the best remedy that can be administered. 

By its susceptibility (power ?) to operate upon every viscus and 
every gland, it may almost be said to be a universal purifier. 
When the bowels are loaded with impurities, it very readily 
evacuates them. When the stomach wants cleansing, as it is of- 



48 Remarks on Itinerants. [xlugust, 

ten called, it is more effectually operated upon when calomel is 
used in combination with some other emetic* (Cathartic?) In 
combination with diaphoretics, it operates upon the skin, produ- 
cing a most salutary diaphoresis. The biliary vessels are more 
effectually emptied by calomel than they possibly can be by 
anything else. Even the salivary glands, much to the sorrow of 
the patient, if not to the physician, are very sensibly, perhaps too 
sensibly, operated upon by mercury .t In fact it operates upon 
every part, and all other medicines belonging to the Materia 
Medica cannot be made to effect so many salutary purposes as 
this abused and despised article. It has, to speak figuratively, 
a sort of saponaceous quality, calculated to cleanse every part. 
I have used it in several thousands of cases, and were I put upon 
my oath to testify whether it had done good in every case, I 
could not pick out a single case where it had done hurt, or left 
the system injuriously affected at any time afterwards. 

One case in which I used it was that of a little girl, five years 
of age, so interesting on account of her beauty that she might 
with propriety be compared to arose bud. She used it after all oth- 
er remedies had failed, in doses of a teaspoonful heaped up, once 
in six hours, for a week, as a vermifuge. The result was, the 
worms (taenia) were expelled, to the almost incredible number of 
one hundred and twenty-five ; restoration to perfect health fol- 

*The propriety of the author's expression here does not strike us clearly, in say- 
ing " in combination with some other emetic." This would seem to declare Mer- 
cury to be an emetic. If so, it requires correction, because emetic operation is not 
the characteristic power of the mercurial preparations in use in practice. The pro- 
to-chloride (calomel) and the black oxyde (in the form of blue pill) are the forms 
the operation of which is alluded to by the author. Again: If he mean the com- 
bination of these with some emetic, which would have been better expressed by the 
omission of the word " other," we must object to the correctness on another princi- 
ple. Combinations of brisk cathartics with emetics are often very happy in their effect 
— first evacuating gently and to a limited extent by emesis, by the emetic, the quick- 
er operating power; and then by purgation — effected by the cathartic in combin- 
ation with the secondary tendency of the emetic power. Such is the operation 
of the very common emeto-cathartic of salts and tartar. But calomel, the favorite 
cathartic form of mercury, is not generally more desirable as a brisk cathartic than 
other hydragoge purges, (for this is one in large doses.) But the greatest excellence 
of calomel is not in its brisk purgative operation or its action as a cathartic on the 
first passages, which I have called its primary operation ; but in its secondary or 
action on the liver whereby this viscus is made to throw an unusual quantity of its 
secretion into the intestines which (secretion) pro\es cathartic. And again: If 
the author has used the word "emetic," for "cathartic," the combination is not so 
applicable to the "cleansing" of the stomach, as the former part of the sentence 
would lead the reader to suppose. — Ed. S. M. 4/ S. J. 

tLong and close observation lias brought me to the conclusion that the action of 
mercury in any form on the salivary glands is of very little curative value. 1 am not 
able to believe that it has ever shortened a fever one hour. Its only utility then, 
(which is more than counterbalanced by the severity of distress afforded) is limited to 
its serving as an index to the state of mercurial excitement, which may be as well deter- 
mined by other indices ; and were it in my power to deprive this invaluable medicine 
of its sialogogue, without injuring its other powers, 1 should have no hesitancy in 
doing so. — Ibid 



1837.] Pathology and Treatment of Dysentary. 49 

lowed, and she has since grown to maturity and is now an amia- 
ble young lady of exquisite beauty. 

In two cases of melancholy, occasioned by hepatic affec- 
tion, mercury effected a cure, when other remedies which had 
been resorted to produced no benefit. In the most violent case 
of mania I ever saw, after making use of all the more common 
remedies to no purpose, I gave calomel, first in large doses to 
produce catharsis, and then small ones, often repeated, to produce 
ptyalism and effcted a cure. A very remarkable feature in this 
case was the state of the skin. Without being affected with any 
supernatural heat, it was dry, husky, and scaly. The scales 
were large, sharp-edged, exhibiting, when the patient was enraged 
a bristling and erect, form, reminding one of the quills of a por- 
cupine. This affection was perfectly changed by the calomel, 
and the skin assumed the pliability and softness of a little child's. 
When the glands were restored to a healthful state, the mania was 
perfectly removed, and since that period, which was three years 
ago, the patient has remained hale in body and mind. 

From the prejudice existing against mercury, and from its lia- 
bility to affect the glands when this is not desired, I use it at no 
time when any thing else will answer as well; and never, 
unless the patient or his friends are willing. Like fire, water, and 
everything else which has been subsidized to useful purposes, it 
may do hurt, and ought not to be resorted to by those who do not 
well understand their profession ; and not by those who do, when 
anything else will do as well. 

All that is designed or intended by these remarks is the remo- 
val of the prejudices which ignorance and empiricism have pro- 
pagated and fixed upon the minds of well-meaning people. One 
thing is desirable in regard to it, and that is, that its effects upon 
the salivary vessels could be prevented when desired ; but then 
it would be too valuable a medicine for mortals to enjoy. 



Pathology and Treatment of Dysentery. 

[The following observations are from the pen of J. G. Davey, 
M. R. C. S. L,j as taken from a late foreign journal by the Boston 
Medical and Surgical Journal^ 

The prevailing notion is, that dysentery essentially consists 
in an inflammation of the mucous membrane of the intestines, 
more particularly the large intestines. This condition is look- 
ed on as the cause of the symptoms of the disease, and the treat- 
ment is directed to the removal of inflammatory action. In 
protracted examples of the disease there are to be met with un- 



50 Pathology mid Treatment of Dysentery. [August, 

doubted evidences of the existence of inflammation, and inspec- 
tion, post-mortem, very unequivocal] y demonstrates its usual 
disorganizing effects ; Lut I fee: disposed to lock on the phlegmon 
of tile mucous tunic of the alimentary canal as the resuit of a 
continued and efficient cause, operating locally. 

The presence of acrid, unwholesome, and indigestible sub- 
stances in the primes vice excites an undue and irregular peristaltic 
action of the muscular coat of the intestines, accompanied with 
increased secretion, for the purpose of carrying off the offending 
matter, and thus allowing the parts concerned'to re-acquire their 
normal condition. Such are nature's efforts to relieve herself, 
and in some mild cases it is possible that she will succeed without 
any medicinal interference, but, in the greater number of cases, 
the symptoms will become aggravated. "There will be a trouble- 
some diarrhoea, loss of appetite, and general indisposition, which, 
after continuing for a few days unrelieved, or being unattended 
to, will often be succeeded by those of a dysenteric"character. — 
In the majority of cases, at the commencement, there will he little 
or no febrile disturbance of the system, or local pain. If the ab- 
domen be examined, no unusual sensibility of its parietcs, or 
increased temperature, will be found. In those cases where the 
quality of the ingesta has been of a highly offensive and irrita- 
ting character, the symptoms will be proportionately severe, even 
at their approach, and will, in a very short time, assume all the 
characters of acute dysentery. An untimely saline, or a drastic 
purgative, I have known to establish, very quickly, the severest 
type of the disease; and thus are we led to trace the analogous 
effects of different irritants on the mucous membrane of the in- 
testines. 

The treatment which I have so successfully adopted in a great 
number of cases of acute dysentery has been this : On my first 
seeing my patient I direct the following formula. R. Powder 
opium, half a scruple ; blue pill, six grains ; tartarized antimony, 
one grain; mix. Make six pills, of which one is to he taken 
every alternate hour, in very severe cases — more commonly every 
four hours, and never without the greatest benefit. If the tenes- 
mus, or strangury, be very urgent, an opiate suppository, or an 
enema, may be prescribed, with much advantage. Alter some 
hours the patient will invariable express himself as being much 
relieved, and at the same time he may very properly take a tea- 
spoonful or two of the milk of sulphur, or a small dose of castor 
oil. The sulphur I have found to answer the purpose better 
than any other medicine. A moderate perseverance for a couple 
or three days, with these means, I have invariably found sufficient 
for every purpose. 

The daily administration of a mild laxative is highly necessary 
and judicious, throughout the course of the disease, in order to 



1837.] American Medical Association. 51 

excite the functions of the excreting organs, and to evacuate such 
morbid secretions as may have collected. 

That the pathology of dysentery, in its early stage, embraces 
something else than inflammation, is established, I think, by an 
unprejudiced review of its symptoms, and by the particular treat- 
ment above specified being so singularly efficacious, which few 
would consider as other than extremely unlikely to combat acute 
inflammatory action, occurring in any portion of the intestinal 
canal. 

If the disease have been, from its commencement, unattended to, 
or ill-treated, we shall then speedily find inflammatory action set 
up within the abdomen, and which, if not subdued, will lead to 
incurable disorganization of structure. 

We are much pleased with the above remarks, because they 
comport well with observation. We have long practiced on the 
same principle, as far as the primary inflammatory nature of 
this disease is concerned. Formerly the dover's powder or 
opium was our first prescription ; but latterly, opium and calomel. 



PART II J. 

VI IN T H L Y P ERISCOPB 



imerican Medical Association 

By reading an account ofa convocation at Southampton, Eng- 
land, for the purpose offorming ;i southern branch of the Provin- 
cial Medical andSurgical Association, it brought strongly to mind 
the importance of forming a great National Medical Society, 
which we have repeatedly urged through the pages of this Jour- 
nal, upon all true friends ofmedical science, in the United States. 
If some manifestations of interest towards the accomplishment of 
this desirable object are not made within the present season, we 
shall be compelled to acknowledge that there is no spirit or en- 
ergy remaining among us. Nothing could contribute so erfec- 

G 



52 American Medical Association. [August, 

tually to a perfect system of professional good fellowship as 
this ; and the good influence which would be exerted through- 
out the union by a National Medical Society, cannot be calcu- 
lated. — Boston Med. and Surg. Journal, for March, 1S37. 

We have been pleased to sec the anxiety of the editor of the 
Boston Medical and Surgical Journal for the establishment of 
a great National Society. It proves not only a laudable, but an 
honorable zeal for the true interests of the profession and of hu- 
manity. Our profession has always been too little fostered in this 
country. It has been left by the state to work its way onward if 
it could, through any embarrassments ; and not only so, but diffi- 
culties of insuperable nature have been cast in its way, and its 
benefits when on its own footing and responsibility, dragged from 
it by state power. These influences have tended so to curtail 
the income of the practitioner, as to cause him to seek fortune or 
renown in some other occupation. 

If we cast our eyes over France, we behold her, by virtue of 
state patronage, now the medical emporium of the world, with 
her thirty or forty thousand medical students from all parts, and 
this in the face, and under the frowns of her ancient neighbors 
who formerly led the van of mccical science. This state of 
things is not only calculated to add to her fame an imperishable 
nature, but to prove a source of wealth — a fountain of plenty, 
continually teeming into her metropolis the treasures of the world. 
But it is altogether probable that whatever of value is to be effect- 
ed for the profession here during the present generation, must be 
commenced by individual effort, and continued and accomplished 
by combination ofthesame. 

It is strange that the cause of humanity should not be more 
studied by legislators ; for then they might be able to see the pro- 
priety, (the necessity, if they would preserve themselves from 
the crime of being accomplices in the work of death and destruc- 
tion,) of refusing to legalize manslaughter by a parcel of swindlers 

the wmsi of swindlers, who can venture to strike in the dark, 

for gain, the delicate nerves of life,in the hardihood and cool- 
ness of then- perfeel ignorance of them, and of the force tiiey use. 
We mean those who call themselves » botanic doctors."* Our 



*A title truly, which no numan being on earth would commit a more unjust. 
usurpation in assutuing than steam doctors, as there are none who know less of the 
of Botany. 



1837.] American Medical Association. 53 

estimate of the human intellect must be considerably lowered, 
before we can be made to believe they are not sensible of their 
high moral error. What " boots it" then, whether the blow be 
struck with the dirk of the cold-blooded assassin, who is bribed to 
kill, or by a poison, or a ruinous course practised on the powers 
of life under the name of botanic medicines, of whose true power, 
as well as of the structure and vital powers to which they are ap- 
plied, the administrators are in absolute ignorance. Better — more 
noble it were to steal — far more so to rob on the highway, or to 
pirate on the seas ! Here man would meet man in some way — 
and risk immediately, retributive justice. 

Legislators we say might not only see the necessity of refusing 
such a cruel gratuity — legalizing so horrible a crusade against 
human life ; but also that of extending a fostering hand to true 
science, and the true means of state independence. They might 
come to remove obstaclest — offer inducements, and patronize in 
many ways those institutions which are truly necessary, and 
thus make their country the boast of scientific, as it is of civil in- 
stitutions. A country free of national debt, and able to pour forth 
her golden streams of wealth from her overflowing treasury, back 
to every tributary state, knows no limit to her means. What 
indeed might she not accomplish? A grand National Medical 
College, at any expense, would be but a handsome plaything for 
her treasury — but glory and independence would crest its lofty 
domes, and wealth turn back its course from foreign lands. 

Here should be the mark set before us — a National College, 
which alone should confer the Doctorate ; all other institutions 
subsidiary ; limited in their honors to the first degree ; and com- 
pelled to continue their annual course eleven or twelve, instead 
of three or four months. But this cannot be done until the mem- 
bers of the profession exert, by the resistless impulse of high worth, 
an influence proportioned thereto. They must go on. Zeal 
and enterprize must urge them onward in the sure road to pro- 
fessional worth. 

In its common details, the profession is a solitary one ; one which 
favors but little association in the ordinary course of business. 
The philosophy of it is boundless ; but each practitioner is limited 
to what he knows when he first sets out, and what lie can alone 

tThe suppression of practical anatomy. See Penal (\u\c of Georgia 



54 American Medical Association. [August, 



gather on his solitay way. Let us then plant our general associ- 
ations in every state and territory, to be made up of representatives 
from every society ; and if you please, a grand national conven- 
tion made up of a suitable rate of representation from the state 
associations. Or, if this be thought not advisable in connec- 
tion therewith, let the results of the state associations be circulated 
by the proper organ for disseminating the recorded intelligence 
collected by these associations of the chiefs of medical science. — 
Such a plan adopted could not fail to organize speedily the whole 
land into one beautiful, complete, and profitable system, whose 
operations for the good of humanity would be incalculable. — 
Zeal would be awakened in every direction, and every state sup- 
plied with " an able and faithful medical faculty ;" and the real 
interest the public "have in the qualifications and character of 
medical men' 1 promptly secured. 

The beginning point would be the establishment of associations 
in every state and territory. This done, a periodical channel of 
communication to every individual possessing one spark of pro- 
fessional zeal would at once spring into existence and be perpetu- 
ated ; and individual societies would be established in every set- 
tlement where half a dozen practitioners could be found. And 
if journals should be found insufficient for communication be- 
tween states, let the association be represented in annual con- 
vention after each meeting of the slate associations. 

There is profit derivable from state associations, or national 
conventions for our profession, which primary, local meetings, as 
tin- individual societies would he. cannot afford. There is some- 
thing in the pride, or self-love of men, amountingtoa party-spirit 
view of sell' interest in this land of freedom of opinion, which for- 
bids the profession, and even the practitioner, to succomb to the 
voice of reasonand plainest demonstration. It often amounts to 
a gross want of magnanimity. This self-party-feeling when 
possessed, blinds one to the loudest voice of reason, and engross- 
es every care u>v victory, even at the expense of true philosophy. 
Unteachableness and sordid views of personal fame and fortune 
are engendered, ami each retires to Ins home or desk of instruc- 
tion to pursue his own errors with redoubled vigor, as if in proof 
of the truth he advocated. This could not. at Least in any thing 
Like the same degree, reach into state associations. Here the spirit 



1837.] Thomsonitui Surgery. 



of enterprise which would impel to the meeting would be found- 
ed on the interest derivable from a fair exchange of scientific 
commodities, the purpose of giving small and receiving great 
gain, exchanging the solitary and domestic productions of each 
individual alone, for that of all others collected, at par value. 

We have had some experience in demonstration of the truth of 
these remarks. In our state we have had for nine years a central 
society which has had annual meetings. It was composed of 
members of the state board for the time being, and such others 
as pleased to meet with us. It is true that, there being no coun- 
ty or primary associations, the meetings were never very numer- 
ously attended; but the annual sessions generally occupied two 
or three, and sometimes four or five long December evenings. — 
There was no envy — no pride — no conflicting interests to serve. 
Arguments were fair, liberal and respectful ; and each seemed 
anxious to improve, by the opportunity thus afforded, his fund of 
useful theoretical and practical knowledge. Such was the steady 
character of these meetings. But not so with the primary society 
of which I have long had the honor of being a member. Here 
each too generally espoused to the last, the position he first ad- 
vanced — deaf alike to reason and absolute fact. 

It would seem only necessary to suggest the thought, to give 
wings to the grand enterprise, which would enable it at once to 
survey the whole land — metamorphose the present confined, dan- 
gerous and disgraceful state of things at once into a system, mov- 
ing on with the regularity and brilliancy of the solar, and illum- 
ining every spot with the lights of true science. 



Thomsonian Surgery. 

It has for some time been our purpose to notice the late repeal- 
ing act of the Georgia Legislature in favor of Thomsonian prac- 
tice ; but the delay of publication consequent on a change of 
printers, and the accumulation of matter of more importance to 
the profession have combined to enforce a procrastination of that 
duty. We may attend to it on a future occasion. 

We arc well aware of the fact that, on a former occasion when 
the Thorns. >n mil memorials were laid before the legislature of 



56 Thmnsonian Surgery. [August, 

Georgia, praying a repeal of the license law, some of the most en- 
lightened and respectable physicians of the state who were mem- 
bers of the legislature, favored the bill. This was however on 
account of the supposed necessity of such a course for bringing 
the citizens to a due estimation of the gross fraud and imposition 
which that practice exercises on them ; saying at the same time 
that they had not failed to use all other means in their power to 
save the people therefrom, not only without success, but to no 
better effect than to draw upon themselves the illiberal charge 
from those they would preserve, of acting from the impulse of 
pecuniary views and of a persecuting spirit. 

Although we were far, very far from admiring the humanity 
of such a measure, by legislators who had in trust the sacred 
rights of the citizens, we must in charity, hope and believe that 
those who were in the last legislature who favored the bill, were 
actuated by the same motive. We sny, " in charity we must 
hope" so, for we cannot hope and believe otherwise without be- 
lieving that they were actuated by a wrong principle, as we know 
of no other which is more charitable to the honest and scientific 
physician. 

If then, such was the purpose of the more intelligent portion 
of the legislature, now that the plan is adopted, it is important 
for humanity that the desired end should not be retarded by the 
fastidious silence of those who have facts in point. 

As it is not less our duty to prevent than to remove evils 
when produced, we therefore cheerfully insert the following let- 
ter from Dr. Miller, not because the facts contained therein ex- 
cite in us the sense of novelty or surprise, but because we conceive 
that those developed in the operations of this blind, bold, danger- 
ous imposition, should be laid before the public as speedily as 
possible: for such facts have power that no logical demonstration 
can display. "We give an instance in proof. Recently, Mr. A***** 
of this place, a journeyman saddler and harness maker of Broad st. 
who had been a most i and open advocate of Thomsoniari- 

ism for some months, "and had indeed obtained the epithet of 
"Doctor'' and was daily expected to Leave town for practice on 
the country people, as some of our hatters^ gilders, constables, 
&c\had before done, came to us in great distress. He stated to 
us thai after havinsrso strongly advocated the steamers as he had 



1S37.] Thouisoidan Surgery. 57 

done, he felt ashamed to come to us for medical aid, but his ne- 
cessities compelled him to do so. He stated his case as follows : 
That on complaining a little of slight colics from bilious habit, 
he had submitted himself to a steamer's prescription and had ta- 
ken in systematic order some six or eight prescriptions — princi- 
pally lobelia, composition tea, No. 6, &c. and that he then found 
his strength so exhausted, with abundant increase of his disease 
that he felt that the treatment must, if persisted in, kill him. He 
then labored under^a furred tongue, highly jaundiced skin, with 
distressing nausea, great feebleness and severe colic pains. He 
requested to submit himself unreservedly to our prescription, and 
accordingly received 40 grs. calomel and 5 of aloes, made into 5 
pills, of which 1 was to be taken every 3 hours, and effectually 
carried off within the same 24 hours. Three days after he call- 
ed to return his thanks for the signal benefit he had derived, de- 
claring himself in as fine health as he had ever been, and utterly 
astonished at the vast amount of black secretion which had been 
constantly passing since taking the pills. He remains a thorough 
convert, and is now greatly ashamed of being charged with ever 
having advocated the Thomsonian practice. He was the other 
day called on by one of the Thomsonian clan to subscribe for a 
Thomsonian journal. His reply was that he " found error enough 
in the world without reading for it."' On being asked if he had 
ever tried the practice, he replied that he had to his sorrow ; 
and that it must certainly have taken life had he proceeded fur- 
ther. It was returned that regular practitioners sometimes kill 
by an injudicious administration. " If then,' said he, ' even those 
who have labored so much for safety and success in practice, are 
found to kill sometimes by injudicious prescriptions, what better 
is to be expected of those who have spent no pains in the acquisi- 
tion of knowledge, but that they must be guilty of a fatal issue, 
much more frequently ?" "But,' said the steamer, 'we do for the 
best, and put our trust in Providence." "So,' he replied, 'do the 
physicians. This is what any old woman in the country does 
in all her undertakings with the sick. Pray sir,' continued he, 
'tell me now if you think you could take this old saddle and repair 
it as well as I can V " No, sir," replied the steamer. '• Why, sir ?" 
" Because I have never made it a matter of thorough study." 
The features of Dr. Miller"* case are perfectly familiar to 



5y Thomsonian Surgery. [August, 



any one who has taken the trouble to reason one step from the 
premises. Such an one could only be surprised by a correct dis- 
tinction of disease, or a correct, or even innocent prescription 
deduced in any way from such a compilation of deficiency and 
falsehood as makes up the compound known by the name of "The 
Thomsonian System." 

We speak not only in allusion to the operations of this practice 
in the hands of the most experienced ; but to its various influen- 
ces on the common people themselves, who are assured that all 
regular science is a humbug and that on paying $10 or 20 they 
are the best physicians in the world ; the consequences of which 
are abundant and ruinous, not only to patients, but to operative 
dupes themselves. I here allude to the inducement offered to 
weak minds to decline a regular, creditable trade or occupation of 
any kind which is honest, and whereby they have competence, 
and sometimes wealth at command ; and which is at any rate, a 
business quite coextensive with their genius and mental improve- 
ments. But this they do, and give themselves up to practice a 
daring, dangerous speculation on their lellow men, which is to be 
worked out in darkness, on human life ! Our intercourse with the 
sick has led us to the knowledge of frequent, and the worst of dis- 
asters, from the use of several of the members as they are called, 
or Thomsonian medicines. We have known of an instance in 
one country neighborhood, and of recent date, wherein, by the 
use of composition tea, or oilobcUa^ within three miles distance, 
and in the short space of five or six months, three excellent wives 
and mothers were torn from their affectionate husbands and 
little children ; an industrious and affectionate husband and father 
from the excellent companion of his bosom, and his numerous 
and beloved offspring — the young and tender bride but just 
entered the blooming mead of early connubial bliss— and the 
tender infant, at once the joy and hope of fondest parents, and 
but just weaned from maternal nurture, sunk into an untimely 
grave ! 

But we hasten to give the account of Thomsonian Surgery 
contained in Dr. Miller's letter, and which is from the mouth 
of the father of the patient, who was himself a steamer. 

It should be recollected thai surgical errors are external — ob- 
vious. Hence it is that they never attempt any thing in that 



1837.] Thomsonian Surgery. 



way ; and contend against the propriety of the most important 
surgery because* attention to it would necessarily require some 
philosophy which they have not at command, and the want of 
which would be too palpable to keep up the sale of the twenty 
dollar book. The business of internal administration, and simple 
medication any way is done under such circumstances as 
prevent detection by the vulgar eye. The cause of trouble is 
hidden — the arguments advanced are received as " moonum shi- 
num" latin was by the father from his promising son; and 
their effects as wonderful as the '-presto" of the conjuror, 
or the "open seceme" of the bandit Hassarac. But although 
not so obvious ; — although the facts of the case have not power 
to speak so plainly to the vulgar eye, still their common prac- 
tice is, like their surgery, groundless, reasonless guess-work, as 
it originates in the same ignorance and error. 

Letter from H. V. M. Miller, M. D. 

Cassville, Ga. 20th July, 1837. 

The repeal of the law prohibiting the practice of empirics in 
Georgia was not occasioned I conceive by any change in public 
opinion in relation to them, but by the consent and by the direct 
influence of the medical gentlemen throughout the state. They 
well knew the great advantages which opposition to empiricism 
in the form of statutes would afford to those who practice it ; 
and believed that the sure and more speedy method of allowing 
them to sink into the neglect, and contempt to which they are 
destined, would be to place them upon equal ground with phy- 
sicians, when from a succession of mismanaged cases the com- 
munity would become convinced ol the absurdity of their theory 
and the destructiveness of their practice. Hence a large propor- 
tion of the medical public not only withheld their opposition to, 
but strongly advocated the repeal of the statute of 1825, so far 
as it had relation to the Thomsonians (or self-styled Botanists.) 

Against the wisdom of these views of the physicians of the 
state, or their ultimate advantage to the profession, I have noth- 
ing to urge. The step has been taken and now we look to its 
effects regardless of the inhumanity of the policy which dictated it. 

But the anticipated end to be answered by the repeal of the 
law will not be so early accomplished if we allow the account 
of their murderous doings to spread only from neighbor to 
neighbor by oral communication, and permit cases, the treatment 
of which ought to heap unmeasured censure not only upon the 
individual who manages it, but upon the whole system under 

H 



60 Thomsonian Surgery. [August, 

the direction of whose false aphorisms he acts, to produce only 
a local effect in the section where they may cljance to occur.— 
Let every physician contribute so much at least to the cause of 
science and humanity as to publish a few of the cases which are 
constantly occurring and must fall within the observation of 
every one ; and but a short time will elapse before the people by 
common consent, if not by legal enactments, will free themselves 
from the curse which is now spreading its blighting influence 
among them. 

There are not many Thomsomans in the portion of the state 
where my residence is ; but I recently met with the subjoined 
case, which if the editor of the Journal concur in the above 
views, he can submit to his readers. 

In December last, a youth 14 or 15 years old, was riding rapid- 
ly through the forest in company with some other boys, when 
his horse took fright and he was thrown to the ground, from 
whence he was quickly taken up and removed to the house in a 
state of insensibility. His father, Mr. A., is himself a steam 
doctor, as the phrase is ; but not liking to trust his own skill in 
this instance, he called in his neighbor the Reverend Dr. Q., 
who examined his condition, and finding some deformity about 
the shoulders, pronounced it a dislocation of the os boachii — in 
other words, he had "slipped his shoulder," and proceeded after 
his own method to replace it. But alter every variety of pulling 
and twisting which his invention could suggest, had been tried, 
and the deformity still remained, he came to the conclusion that 
he had erred in his diagnosis, and it was now unquestionably a 
fracture of the humerus very high up. Again his surgical know- 
ledge was held in requisition to bandage the limb and place the 
bone in its proper position ; but again he was doomed to experi- 
ence a failure. Immediately he transferred the fracture from the 
humerous to the scapula or "shoulder blade/' and treated it as 
such for a day or two, when he finally came to the conclusion 
that (I use his own words) "the hour which joins the arm tothe 
back heme had been knocked out of place, and he did not know 
how to get it back again." So he threw off all his bandages and 
directed his attention to the general treatment. 

There was great pallor of countenance and oppressed breath- 
ing soon after the injury ; to relieve which, or to "bring him 
too," as the Doctor had it, stimulants were administered in large 
quantities, as No. 6, brandy, &c. In a short lime the pulse be- 
came full, the face Hushed, the patient frequently breaking: forth 
with wild and incoherent expressions. This was regarded as ve- 
ry favorable progress and certain indication ofhis being "brought 

to." But ass • days passed without the restoration of reason, 

the Doctor thought that he oughl to take "some more No. 6, 
some diaphoretic powders and be sweated ;" all of which was 



1837.] Thomsonian Surgery. 61 

done and Ihe same plan persevered in, subjecting the patient to 
repeated " courses of medicine," as they bombastically term it, 
for about three months — keeping him all the while under the 
influence of stimulants and sudorifics, alternately. Through- 
out all this period, after the boy recovered from the stupor occa- 
sioned by the fall, he was a raving maniac, continually singing, 
halloing, swearing, biting and otherwise injuring those who 
attended him ; sleeping very little, and his eyes wearing a pecu- 
liar expression of wildncss and terror. 

About this time the father of the boy began to entertain doubts 
of the infallibility of his system — and soon after, a friend upon 
whom he relied persuaded him that it was necessary his son 
should be trepaned, to perform which operation I was requested 
to visit him. I addressed a letter to my friend Dr. Montgomery, 
to meet me the next day at the patient's house, when we found 
his condition as above described, and received the foregoing his- 
tory of his case. 

It was at once apparent that the deformity of the shoulder 
which had so greatly perplexed his lobclial attendant, was pro- 
duced by a luxation downwards of the scapular end of the cla- 
vicle. From the present appearance of the patient — from the 
history of the case and its treatment, which Mr. A., the father of 
the boy, was able to give us in detail, it was no less evident that 
his brain had suffered from concussion, and that his present situ- 
ation was the result of the improper treatment of that injury. 

As there had been no fracture of the skull and no symptoms 
of compression of the brain remained, we had of course no use for 
the trephine. My residence is near 40 miles from our patient ; I 
therefore left him in the care of Dr. Montgomery, who carried 
out what we considered the proper treatment to which he should 
then be subjected, viz. venesection, frequent purging, revulsive 
enemata, spare diet, shaving and blistering the scalp. In two 
weeks he was well. 

It is needless to say what would have been the termination of 
the case had he been sufficiently bled and an antiphlogistic treat- 
ment adopted immediately upon the supervention of reaction 
after the receipt of the injury. 

In most inflammatory diseases, the injury produced t^r the use 
of the Thomsonian remedies would be incalculable, did they not 
excite a profuse perspiration which in some degree counteracts 
their stimulant effect, but in the above case, from the situation of 
the organ effected, this salutary provision of nature could not 
produce its customary beneficial results. 



62 Medieal Colleges. [August, 



MEDICAL INTELLIGENCE. 



I 

Medical College of Georgia. — This institution is now settled in its steady 
course of usefulness, with an increasing class, and every facility which Europe and 
America could afford for giving interest and usefulness to its ample course of an- 
nual instruction. Its Museum and Laboratory are appropriate and ample — its Li- 
brary, now considerable and containing many of the most valuable and costly 
foreign works, will soon be greatly enlarged by the adition of an extensive cata- 
logue of works, selected from all parts of the world. Its splendid classical edifice, 
chastely finished in Grecian Doric, stands on a beautiful plain, retired, yet con- 
venient to the populous part of the city, and is so arranged as to afford convenient 
accommodations for every important purpose. Its Laboratory and Library Rooms 
are spacious, and its suite of Lecture Rooms is ample for the accommodation of 
250 pupils, and affords the student the comfortable opportunity of changing rooms 
between each lecture as constantly as the subjects will allow. 

Two large rooms are appropriated to the Museum, another to microscopic obser- 
vations with a Grand Solar, and a Superior Compound Microscope; and another 
suitably capacious, to the purpose of a preparation room for the lectures on Anato- 
my and Surgery. 

A suitable fire-proof building has been recently erected in the rear of the College 
edifice for the purpose of Practical Anatomy, whereby this business has been re- 
moved from the college building, and complete arrangements made for its being 
well supplied. 

Since the completion of its last course, two additional professorships have been 
created, and filled by gentlemen of the most approved qualifications. 

Medical College op the State of South Carolina. — The annual announce- 
ment of the Trustees and Faculty of this institution for the course of 1837-8 in- 
vites attention to the present state of its prospects, and justly urges the advantages 
of southern over northern and western institutions, to those who are destined to 
southern practice. After a somewhat minute statement of their preparation, &c. 
for profitable instruction, they conclude with an analytical view of the course of 
lectures by each professor. 

The Faculty of this rising institution consists of 

J. Edwards Holbrook, m. d., Professor of Anatomy. 

John Wagner, m. d., of Surgery. 

S. Henry Dickson, m. d., of Inst, and Practice. 

James Moultrie, m. d., of Physiology. 

Tiios. G. Prioleau, m.d., of Obstetrics. 

C U. Shepard, m. d., of Chemistry. 

Henry R. Frost, m. d., of Materia Mcdica. 

E. Geddings, if. d., of Pathology and Jurisprudence. 

Anotomical Demonstrations by F. Wurdemann, m. d. 

E. Geddings, Dean of the Faculty. 

Medical College of Louisiana. — We have received the circular of this institu- 
tion for the next course of instruction, which informs us that the course of Lee- 



1837.] Transylvania University. 63 

tures will commence on the last Monday in November, and close on the last of 
March, making a course of about four months. The following gentlemen consti- 
tute the Faculty : 

Dr. Stone, on Surgery. 

Dr. Barton, on Theory and Practice. 

Dr. Harmon, on Physiology and Pathology. 

Dr. Jones, on Obstetrics and Diseases of Women and Children, and Clinics. 

Dr. Mackie, on Materia Medica and Therapeutics. 

Dr. Stone, on Anatomy. 

Dr. Riddell, on Chemistry and Pharmacy. 
The circular is well written, and holds forth to the student great advantages 
from the location of the school for the attainment of " all that is practical in the 
profession;" particularly in practical anatomy and clinical instruction; and in ad- 
dition to these, " a position remarkable for its salubrity, during those months to 
which the lectures are assigned." 

Accompanying the circular, is the Introductory of Dr. E. H. Barton, on accli- 
mation. This lecture contains much wholesome advice on that subject. Dr. B. 
lays it down as a rule for safe and ready acclimation, to conform to the customs of 
those who are natives, or who have been acclimated. This is done by lessening 
the atmospheric temperature, or avoiding exposure to it, and reducing the calorific 
process. We regret not having room in our present No. for an extensive extract 
from this lecture, on the subject of Temperance, of which the Dr. proves himself a 
zealous and able advocate. 

Medical Department of the Transylvania University. — It appears from 
various newspapers and other publications on the subject, that about the close of 
the last course of instruction in this institution, a difficulty arose between the Trus- 
tees and Faculty, and between some of the professors themselves, which resulted in 
the entire dissolution of the Medical Faculty. 

On organizing a new Faculty, professors Cook, Caldwell and Yandell were 
excluded; and Drs. Dudley, Richardson, Mitchell, Eberle, Short and Cross, 
were appointed to the six chairs. 

Dr. Yandell's narrative of the dissolution and the causes which led to it is before 
us. From this we learn that the difficulty arose out of a proposition by the Profes- 
sor of Anatomy and Surgery to remove the school to Louisville, on account of the 
impossibility of procuring subjects for practical Anatomy in Lexington ; and the 
growing importance of the former place. In his address to the Chairman and be- 
fore the Trustees in answer to the 1st charge preferred against him by Dr. Dudley, 
which was for " secretly conspiring and perseveringly urging the removal of the 
Medical Department from Lexington, &c." Dr. Yandell holds forth the following 
language : " He (Dr. D.) has long complained of the ineligibility in many respects, 
of Lexington as a site for a Medical school. He had habitually declared that its 
prosperity was safe only so long as its present Faculty should live. It was his loud, 
oft-repeated and alarming complaint of the impracticability of procuring a sufficient 
supply of subjects, that caused his colleagues to think of a removal. Sir, he was 
in the habit of avowing to his colleagues that he was obliged to discourage dissec- 
tions — lest the pupils should discover his scarcity of subjects." And that "so 
effectually had he discouraged dissections,' that, as testified by his Dissecter be- 
fore the Board, only one pupil dissected last winter .'" &c. 



64 Jefferson Medical College. [August, 

Dr. Y. then proceeds to the proof of his assertions by the evidence of Drs. Cook 
and Short: the examination of the former of whom is given at length in an ap- 
pendix purporting to be an ample confirmation of Dr. Y's. statement; and Dr. 
Short's, which was verbal, is declared to be not less confirmatory. Much of the 
documents are the transactions with the Trustees during the investigation; and 
other parts declared to them with positive evidence or hast r fenmee annexed. 

We have not seen the statements of the other side on like authority, and will 
therefore decline locating the blame of this affair, — (a blame certainly of no trivial 
nature,) on either party. 

It is understood that the ex-professors Cook, Caldwell and Yaxdell. are indus- 
triously engaged in the purpose of establishing a new school in Louisville. 



Annual Announcement of Lectures, fyc. in Jefferson Medical College, for the 
Session of 1837-8, <$*c. 

This annual publication is just received. It contains a very brief, but just allu- 
sion to the late and present progressive improvements in the science of medicine, in 
regard to their bearing on the duties of teachers and colleges. It is true that in the 
former age. a brief course of collegiate instruction was sufficient to afford a general 
and somewhat particular view of the state of the science then. But such have been 
the changes and improvements in latter years, that no course of instruction by any 
set of men, or under any kind of system, can at present do justice to the science in 
the short space of three or four months — much less to the pupil, whose mind cannot 
in that time compass the matter which must now be taught. A ^reat variety and 
quantity must under such a system, be crowded on the mind of the pupil, beyond 
what he can comprehend or retain, or even have bodily powers to attend to. It fol- 
lows therefore that the instruction actually obtained must, either from a want of time 
to present in a proper manner the many topics which, should lie thoroughly under- 
stood; or the want of powers in the hearers to comprehend and retain the same, or 
both, be superficial in a very great and unnecessary degree. Hence the very con- 
spicuous necessity constantly observed, for young practitioners to learn most ofthe 
important practical details, as well as prove the truth or error of their theory, by ob- 
servation exercised on their first and best friends. 

We take leave, however, in our notice of this production, to correct one little error 
which we observe on the 1th page. Whetherthis has arisen from the mere circum- 
stance ofthe remoteness of our situation having prevented the Faculty of Jeffer- 
son Medical College from learning the \\w\< appertaining to the Medical College of 
Georgia, or whether they mean to affect a forget'fulness of a new institution which 
is just rising into competition with them; or whether from some other cause, we do 
not pretend to determine ; but the following language is found on the page above 
referred to: 

" The same cause — the progressive improvement of medical science — <had suggest- 
ed to the | extend their course of instruction from four months — the 
longest term in other institutions — to five." 

Whether the gentlemen of 1 1 1 : » t Faculty have chosen to receive the suggestion 
from "the progn ssixe improvement of medical science 1 ' alone 1 and primarily, or from 
the evidence of its utility and popularity with the most valuable members of th« 
class, who have experienced the salutary effects of a protracted course in the Medi- 



1837] Jefferson Medical College. 65 

cal College of Georgia, is not a matter of much moment. But we are perfectly 
familiar with the fact that this institution has, i'rom the first reception of its charter ( 
6ome seven oreiu go, tu the conclusion of the last season, felt and acted 

upon the necessity of extending its course of public instruction by lectures to the 
term of six months — viz. from the third Monday in October to the third Monday in 
April. This was done from the indispensable demand for that length of time for 
doing justice to their subjects, and meeting the capacities of students generally; 
and some of the Faculty have, in consideration of the actual benefit to students, 
and the absolute demands of science, desired and strenuously contended for its ex- 
tension to ten or eleven months. It is also a fact of notoriety that the pupils from 
this southern institution, who were thoroughly informed on the subject of the term 
of the lectures here, have annually visited both the schools at Philadelphia. Xor 
did it fail to be predicted that the northern institutions, although they refused to 
form the convention requested by this college for the purpose of more effectually 
regulating the study of medicine, would soon find themselves compelled to extend 
their course ; not only by the reasons which impelled to it here, but also for the pur- 
pose of continuing successful competition with the south. As it has been the cus- 
tom ot the Medical College of Georgia to continue its course heretofore, for the 
term of six months, and is now continuing the same, with only a reduction of a few- 
days, it is alienor in fact that four months is "the longest term in other institutions." 
There is another feature in this annual announcement which we would examine 
for a moment b> . u subject. It is contained in the following extract 

—continuing the quotation from the same page: 

" With this view, (ofthe progressive improvement of medical science,) lectures 
have been delivered during the month of October for the last three sessions, &c. — 
There are _ and valuable topics aj i to each chair, which can- 

not be fully discussed in the course of four months, but may be readily examined 
during the additional period. The professors wish it however, distinctly understood 
that the regular course of lectures will commence, as usual, on thefrst Monday in 
November, and terminate on the last day of February:'' 

This is. to be sure, somewhat better expressed than on a former occasion when, if 
our memory serve us, the Jefferson College advertised to commence lecturing on the 
first of October, for the satisfaction of those who might desire a longer course than 
four months ; but assuring the public that those who did not prefer attending until 
November, would lose nothing by so doing. This was to us, at the time, a perfect 
paradox. But in its present form it reminds us of those regularly instructed practi- 
tioners of medicine who have taken what is called ; a steamer's patent" which is 
nothing more nor less than the act of paying twenty dollars for Samuel Thomson's 
Narrative and Guide; then give notice that they will practice on either plan, accord- 
ing to thj desire of the patient. Xow this appears to be a very plain case to any 
understanding. If regular medicine be a rational science, founded on the impreg- 
nable basis ofthe truths of induction, then Thomsonianism which, like homoeopa- 
thy, puts induction at defiance, is its antipode: and, founded on falsehood in the 
very face and under the frowns of ail induction, cannot be used injustice to honesty 
and humanity. But, on the other hand, if Thomsonianism be correct, (and if it be, 
we bid adieu to inductive reasoning forever,) then it should not be foregone at the 
option ofthe patient who has no judgement to decide. If Thomsoniasm be correct, 
its opposite, or the inductive science must be the very extreme of error, and 
consequently inadmissible in practice. But there are in every neighborhood those 
who believe one correct, and others who believe the other only is; and still for the 



Jefferson Medical College. 66 

money of all, all shall be served out according to their choice: — holding out at the 
same time, to each, the distinct idea of his own correctness, whilst the two opinions 
must in the very nature of things, be extreme opposites as truth and falsehood. — 
Such practitioners " run with the hare, and cry with the hounds." But to the case 
before us. 

If the lectures of the month of October be, as they are said to be, " on interesting 
and valuable topics appertaining to each chair," they should never be omitted by any 
student, because they are essential to the course of instruction : nor would it be 
good faith to them to offer or afford them facilities for so doing. But if they do not 
belong to the "regular course," (and every thing belonging to a regular course 
should, as far as practicable, be in it.) they should not be offered as " interesting 
and valuable topics appertaining to each chair." Bnt there are many students who 
understand the merits of the six months course and arc perfectly familiar with the 
fact that it is immensely more valuable than any four months course can possibly be ; 
and these two are the most studious and valuable part of the class; with whom the 
protracted course is extremely popular. There are others also in every class who, 
looking at the end in view, and not at the means of attaining it, desire to arrive at 
the diploma point by any possible means, and especially the shortest route, and least 
study — sacrifice what else they may. If therefore, one of the two plans will not 
6erve some individuals, the other will : and whilst the October lectures are recom- 
mended to the one as being on "interesting and valuable topics appertaining to 
each chair," another is assured that if he omit them he will still have a " regular 
course," and consequently one calculated to meet all his demands; or that he will 
have lost nothing by so doing. This is well calculated to suit all classes, orders, 
genera and species, it is still a paradox. Now we have no doubt but that the lec- 
tures which occupy the month of October in that institution, are indeed interesting 
and valuable as said to be. The difficulty is to know how, when they are so, they 
may be about as well omitted as heard, if it be not merely the working of a plan to 
endeavor to please the fancy of those students who will, and those who will not 
atudy. 



SOUTHERN 
JOURNAL, 

Vol. II. SEPTEMBER, 1837. No. 2. 

PART I. 

ORIGINAL COMMUNICATIONS. 



ARTICLE I. 



Case of Anomalous Hemorrhage and Spasms. By Hon. 
Charles E. Haynes, M. D., of Sparta, Geo. 

The peculiarities of the following case, and the apparent ben- 
efit derived from two remedies not in very general use, (Extract. 
Hyosciam. and Extract. Belladonna,) have induced me to place a 
brief report of it at your disposal — to be published or not, at your 
discretion. 

Miss S.G. is now just seventeen years old; the child of a fann- 
er in moderate circumstances ; her constitution has been formed 
by plain living and active exercise. She is of middle stature, 
moderately muscular, without the round and perlect finish which 
gives grace and beauty to the female form; complexion brown 
and eyes dark. She began to menstruate early in the year 1S34, 
then in the fourteenth year of her age, and after two periodical 
returns, was attacked with spontaneous bleeding from the in- 
side of the metarcarpal joint of the right thumb. The bleeding 
continued about twenty to twenty-four hours, when it was final 
ly stopped by a compress and did not return. Her mother re 

A 1 



2 Anomalous Hemorrhage and Spasms. [Sept. 

presents that several quarts of blood were discharged, and that 
the blood flowed in a stream like that issuing from a vein when 
opened by the lancet. 

But a short time elapsed before spontaneous bleeding com- 
menced from the middle of the forehead and continued at short 
intervals for about three months. 

It is represented by the family that the whole quantity discharg- 
ed could not have been less than four or five gallons. While 
the bleeding continued, the lips of the orifice projected, perhaps 
the fourth of an inch, of the color of blood, until the discharge 
was suppressed by a compress. Since that time, no further 
spontaneous hemorrhage has supervened. Not the least re- 
markable circumstance is, that the catamenia returned with ordi- 
nary regularity and quantity during the whole period of sponta- 
neous bleeding. 

About last February, shortly before the menstrual period, small 
red ridges were observed upon her head and arms, which finally 
burst and left marks in the skin, resembling to the eye and the 
touch the scratches of briars, or of the claws of a small animal. 
These have continued to recur in connexion with that period, 
and always preceding it, until about the 24th of last month, 
when they made their appearance a few days afterwards, accom- 
panied with violent spasms and excrutiating pains of the wrists, 
knees and ankles. As she had occasionally suffered with spasms, 
and been relieved by moderate bleeding, anodynes, &c. the family 
resorted to these remedies, but without effect, and I was called to 
see her the day after. Here it may be proper to observe, that 
formerly, whenever the cutaneous affection above mentioned 
was fully developed, every other troublesome symptom subsided. 

When I saw her at 4 p. m. on the 25th of July, I found her 
laboring under violent and frequently recurring spasms, pain in 
the joints, and the cutaneous affection imperfectly formed, com- 
plaining at the same time of such gastric distress as usually at- 
tends a suddenly suppressed eruption. Ordered sinapisms to 
the stomach and extremities without any visible relief. During 
that night and the next forenoon administered opium in almost 
every form, Aqua amnion. Tinct. foetid, without any permanent 
alleviation — the large quantity of paragoric, laudanum, black 
drop, Dover's powder, &c. procured four or five hours quiet 



1837.] Anomalous Hemorrhage and Spasms. 3 

sleep in the course of the night, which was followed with pain 
and spasm as excrutiating as ever. On the morning of the 26th, 
apprehending the existence of spinal irritation, applied an epis- 
pastic ten inches long, which drew well towards the evening. — 
About 11 o'clock, a. m. took about twenty-four ounces of blood, 
which was sizy without any apparent benefit. Late in the 
afternoon, I left her with directions that I should hear from her 
the next morning. No message was received until the 28th, 
when 1 was informed that she was no better. 

I then prescribed extract, hyosciam. in doses of two grains and 
a half to be repeated every six hours, and an ointment made of 
two drachms of extract, belladon. and an ordinary tea-cup full of 
lard. I did not see, or hear directly from her until yesterday, 
when I called at her father's and was informed that the spasms 
ceased very soon after the first dose of hyosciamus was admin- 
istered, but that two others were given as directed, and no more. 
Although the spasms were relieved, she suffered severe pain in 
one of the knees which was immediately removed by a single 
application of the belladonna ointment. 

She is now in ordinary health, but somewhat paler than usual. 
The cutaneous affection has not returned. Not doubting that 
her anomalous symptoms were connected with the state of the 
uterine system, have placed her upon moderate doses of tinct. 
aloe cum myrrh, and camphor. 

Singular as her case has been, I should have forborne to state 
it to you, had it not been for the effect of the hyosciamus and 
belladonna. A single case does not furnish sufficient ground for 
safe philosophical induction, but I offer the facts for what they 
are worth. 



Surgical Cases. [Sept. 



ARTICLE II. 

/Surgical Cases. By Paul F. Eve, M. D., Professor of Sur- 
gery in the Medical College of Georgia. 

SERIES No. 3. 

Case 1st. Stangulated Hernia — Reduction by Taxis after 
11 hours duration. — The 26th of February. 1836, 1 was request- 
ed to see Adam, a negro man belonging to Mr. Samuel Clarke of 
this city, who had been ruptured many years. The hernia was 
a reducible bubonocele of the right side, and for which a com- 
mon truss had been worn. About 1 o'clock in the day, the pa- 
tient first experienced pain, and an inability to return the protru- 
ded intestine. It was 6 in the evening when I saw him, and after 
several unsuccessful efforts to reduce the hernia by taxis, I di- 
rected the part to be kept wet with sulphuric ether and a current 
of air to be applied with a pair of bellows. I returned at 8, renew- 
ed the attempts at reduction with no better success, and left the 
patient at 9. It should have been remarked, he was of intemper- 
ate habits, and that there was no constitutional excitement, or so 
little as not to require the use of general means for its reduction. 
I was again sent for near 1 1 at night, and failing to reduce the 
intestine a third time, desired counsel and assistance. Dr. Du- 
gas was called in ; his efforts were also ineffectual, and before 
resorting to other measures, he requested me once more to try 
taxis, observing that Lisfranc believed that there were few 
Oases of hernia that would not yield to it when properly applied 
and long continued. By gradual and increasing pressure upon 
the tumour with the fingers and hand in the direction of the en- 
guinal canal, I had the satisfaction to feel the intestine yielding 
and finally to slip up with the peculiar gurgling noise into the 
abdomen, and this too in less than 15 minutes by the watch. 

Remarks. Here is a case, offering it is true, nothing very 
peculiar, but happily illustrating the importance of perseverance 
in the application of our means for relieving diseases. Taxis, 
the first, the most i simple and most important agent for the re- 
duction ofhernia, had been employed in this case, and I really 
thought to its fullesl extent, at least I know, until the fingers and 



1837.] Surgical Cases. 



hand were benumbed. But appealing to the watch, we were sur- 
prised to find how soon we became fatigued by the operation, 
and thereby deceived as to the true length of time it was contin- 
ued. It is certain if taxis had been protracted a few minutes 
longer when first applied in this case, it would have proved 
successful. A little more perseverance then, would have saved 
time and suffering ; and without it, the patient would in all pro- 
bability have been subjected to a painful and hazardous opera- 
tion with the knife. Do we always derive the full benefit from 
remedial agents, that can be obtained by a judicious persever- 
ance in practice ? Or are we not apt to become fatigued, and to 
cease our efforts before carrying them to the proper extent 1 We 
are pleased to contribute even one fact in support of the spirit of 
the age, which is, « whatever thy hand findeth to do, do it with 
thy might." What may we not promise for medicine and sur- 
gery by industry and perseverance ? 

Case 2d. Peritonitis and Cystitis following an extensive 
injury to the hypogastric region — Death on the fourth day. — 
Jumba, an aged negro, then belonging to Judge W. W. Holt of 
this city, while engaged in pulling down an old house, was 
thrown upon his back by a piece of timber striking hirn across 
the lower part of the abdomen . This occurred on the 28th of 
February, 1837; and Dr. Cunningham was first called to see 
him. The patient had eaten his dinner about an hour before 
the accident ; and about an hour after it he complained of pain 
in his back, and was unable to walk. There was no want of 
sensibility in the skin of the lower extremities ; his feet were cold 
and pulse rather weak. A dose of castor oil was ordered, he vo- 
mited however, before taking it and had two dejections. On the 
next morning, March 1st, the pulse was still very feeble, the pa- 
tient had violent pain in the back, and the lower extremities were 
cold. More opening medicine was given, which operated well, 
and the loins and extremities were rubbed with a stimulating lini- 
ment. At night he complained of strangury and had hematuria 
— by the use of the catheter a little bloody urine was drawn off. 

The next day, March 2d, I saw him with Dr. C. at 3, p. m. — 
The patient was in a half bent posture, and complained of great 
suffering in the hypogastric region. As he had passed no urine 



Surgical Cases. [Sept. 



for several hours and percussion strengthened our suspicions that 
the bladder was distended, a catheter was introduced with great 
difficulty, but no water flowed through it. Suction was applied 
to its external extremity, still no urine was discharged — we then 
tried to inject warm water into the bladder, but could not succeed 
in throwing in more than half an ounce. The bladder was ex- 
amined per anum, but no distention remarked. We agreed to 
give the patient an anodyne, and to make him as comfortable as 
possible — believing his death inevitable. He died the next day 
at noon. 

Examination 3 hours after death. — The muscles of the ab- 
domen and left thigh were very much contused and enfiltrated 
with blood and serum. The peritoneum was extensively inflam- 
ed, and in the pelvic region of a violet colour. The bladder 
presented the same colour throughout its coats, which were thick- 
ened and contracted to the size of a walnut. There was sufficient 
effusion into the peritoneum and infiltration in the tissues of the 
soft parts, to account for the deceptive sound of percussion. 

Remark. — We see by this case, that even the physical sign 
of a distended bladder, the dull sound emitted by percussion over 
the hypogastric region, (so often relied upon almost exclusively,) 
may lead to error in diagnosis. 

Case 3d. Death in ten minutes from a blow of the fist. — At 
8 o'clock in the evening of the — of May. 1837, 1 was requested 
with Dr. Dug as to examine the body of a man who had been 
killed a few moments before. The evidence at the Coroner's 
inquest was, that the deceased, Burke, and another Irishman, 
while drinking in a grog-shop, began sparring, and he received 
a blow just below the left ear, which knocked him down. A 
vein in each arm was immediately opened by a by-stander, but 
no blood flowed ; and in about ten minutes after he fell on the 
floor and expired. 

Examination an hour after death. — A slight bruise was bare- 
ly perceptible under the left ear. No dislocation of the cervical 
vertebrae — no external wound on head — but extensive effusion of 
blood on and in the brain, more particularly at its base on the 
left side, but reaching also to, and filling the lateral ventricles. 

Report of Coroner's Jury. — " That the deceased came to his 



1837\] 



Surgical Cases. 



death by a blow inflicted directly below the left ear, which rup- 
tured a blood vessel in the head." 

Case 4th. Laceration of the Liver from the kick of a horse 
— Death in less than 24 hours. — We are indebted to Dr. Cun- 
ningham for the particulars of this case, in whose practice it 
occurred ; and by whose request the post mortem examination 
was made. 

Wm. Maddox, aged 25 years, of short stature and of intem- 
perate habits, while engaged in his vocation, as ostler, received 
the kick of a horse in the left hypochondriac region, on the af- 
ternoon of the of May, — 1837. He vomited soon after the ac- 
cident, chiefly the dinner he had taken. Dr. C. saw him three 
hours after it, and found him in great agony, with cramps and 
spasmodic actions in the abdominal region, his pulse rather 
weak, and upon examination no external appearance of injury 
could be perceived. The patient directed the Doctors attention 
to a hernia of the right side of some years standing, but which 
could be even now easily reduced. He was ordered a drachm 
of laudanum and an enema of salt and warm water. These were 
repeated several times, the laudanum being invariably rejected 
by emesis, and the enemata returning without fecal matter. Half 
a grain sulph. morphine, and a mustard plaster quieting him, he 
was left for the night. The next morning at 6 o'clock, he was 
still suffering, though he had not vomited for some hours. The 
pulse was very weak, and the abdomen quite tense. He took a 
dose of castor oil, but did not retain it many minutes. At 9, he 
was suffering much from cramp and spasm — took 5l laudanum 
and applied 2 dozen leeches to the epigastrium. At noon, as the 
leeches had not bitten, he was cupped over the abdomen in four 
places, but not an ounce of blood could be obtained. Two 
drachms of tr. croton oil were now given, and at 4, p. m. a large 
quantity of salt and water was thrown up the rectum to encour- 
age evacuation. These afforded no relief — he had no discharge 
of fecal matter from the bowels. Slight delirium now superven- 
ed, the breathing became short, the pulse ceased at the wrist, the 
head and neck were bathed in perspiration, a livid colour was 
observed about the anus, and the patient died about 5 o'clock — 
twenty-three and a half hours after receiving the kick. 



8 Observations on Nepeta Catarla. [Sept. 

Examination 19 hours after death. — There was considera- 
ble lividity about the head, neck, chest and back. The abdomen 
was very tense — signs of the scarificator and of the mustard 
plaster were the only remarkable appearances upon its surface. — 
We could not define the print of the horse shoe or foot. Crepi- 
tation was felt over the whole abdominal region, and the scrotum 
of the right side was greatly distended with gas. Upon opening 
the abdomen a large quantity of thin grumous blood rapidly 
flowed out, and I mentioned my suspicions that the liver was 
lacerated. 

The quantity of blood effused into this cavity must have been 
near a gallon. In pursuing the examination, a rent in the mid- 
dle of the left lobe of the liver was discovered. It extended from 
the anterior edge into the substance of that gland for about three 
inches on its convex, and near four on its concave surface. — 
There were also two or three small fissures on its concave surface 
distinct from the extensive laceration. The hernial sac contained 
nothing but gas — portions of the intestines were highly inflamed. 



ARTICLE III. 

Observations on Nepeta Cataria, by M. Antony, M. I). 

j\rp—Catncp — Catmint — Mentha, Felina, sen Catarla. CI. 

Didynaniia—Ord. Gijniiinspermia. Gen. Nepeta. tSj). Nc- 

l>c/a Oatariai 

This plant is a native of most parts of America, as well as 
Kniopo, and is not confined to chalky or gravelly soil, as J ias 
been said, but flourishes well in almost any situation ; but affords 
a stronger aroma (in which probably its virtue resides,) in dry, 
gravelly and chalky situations. It is well known to the com- 
mon people throughout the I 'nited States by the familiar name 
( atnip, by its peculiar fragrance, by the attraction it has for cats, 
which attack, cat, and otherwise destroy it ; and also as a com- 



1837.J Observations on Ncpeta Cataria. 

moii domestic herb used in the complaints of females and infants. 
It is brought to the southern states in compact cakes of the leaves, 
and sometimes of the leaves and flowers, as preserved by the 
shakers; many parcels of which have lost alike their peculi- 
ar odour and virtue ; whilst others retain a valuable power. 
Whether this difference is attributable to its age, the time of 
gathering it, or its being packed whilst too moist, or some other 
cause, is not determined. But the fresh herb, which is from a 
perennial root, may be had in almost any neighborhood, if pro- 
tected from cats, or where they do not generally abound. In 
the country, in old fields, along roadsides and fences it is found 
in lafge quantities. It grows in bunches or clusters of bunches, 
and is often passed for hoarhound, which it very much resem- 
bles, when seen at a little distance. It blooms in the southern 
states in July and August, and should be gathered when in full 
bloom — the leaves and the flowers stripped from the stalk, and 
carefully dried in the shade. It should be kept closely packed 
in a jar or a drawer and in a cool place. 

My observation on its medical virtue assures me that the cat- 
nep is entitled to much more consideration than has been bestowed 
on it by the profession. It is an article in almost universal use in 
amenorrhoea, and dysmenorrhoca ; and as an anodyne antispas- 
modic in the diseases of infants and children jrcncrally. Its 
nervine power is very decided and appears to consist in a purely 
anodyne operation of the paregoric or hypnotic kind, without 
the deleterious stimulating effects of opiate narcotics, It assua- 
ges pain as other anodynes, and in increased doses, procures 
profound and delightful sleep, from which the patient awakes 
refreshed, instead of exhausted as from narrotic powers v, hich 
stupify by their excitement. 

It is used in the form of weak infusion, with infants from birth, 
onward, as a light carminative aromatic with which they are 
freely fed by the teaspoon. But when the tea is made stronger, 
either from a better preparation of the herb, or a larger propor- 
tion in the infusion, it proem. p of a profoundness and du- 
ration in proportion to the medicinal power taken, with as much 
certainty as opium. It is not, however, an apoplectic > • ep, even 
from Large quantity s ; but is ind with an appa- 
rently entire suspension of volition . and, although it may last for 

b2 



10 Observations on Nepela Cataria. [Sept. 



many hours, or one or two days, its manner is still that of a sleep 
into which a person of the best health has just fallen. I have 
often been called to patients from a few days only, to one or two 
years old, on account of the alarm of friends from a continued 
sleep and entire suspension of voluntary power from this cause.. 
The sleep is often so profound that the patient cannot be aroused 
to capability of sucking, or of performing any other voluntary 
motion until the effect of the anodyne has ceased ; and if aroused 
in any degree, the instant the awakening means are suspended, 
the sleep returns with all its completeness of character. 

I have seen an infant only two weeks old, on being fed with 
strong catnep infusion at five o'clock in the morning, for the re- 
lief of gripings which had troubled it through the night, sleep 
from a few minutes after taking the portion, until nine o'clock 
of the following day — a period of 29 hours. The alarm of the 
mother, in consequence of not being able to get the infant to 
nurse, or to arouse it from its sleep at all, caused me to be called 
to it when it had slept 15 hours. The mother had given the 
child seven drops of Bat email's drops at bed-time the previous 
night with the effect of composing it for about 3 hours, after 
which it became wakeful and afforded manifest symptoms of 
griping distress until the catnep was given. By the profound 
sleep the mother was induced to think the dose of Bateman's 
drops had resumed its narrotic operation to a great and danger- 
ous extent, and for which she wished a remedy. Knowing that 
the catnep is commonly in domestic use, and believing the sleep 
was of that character, 1 enquired if any had been given, and 
was informed that the servant had been directed to prepare 
some in the morning, of which the infant had taken freely. 
On inspecting the tea I found ii containing an unusually large 
proportion of the herb, and what had been given was ad- 
ministered at one time. The symptoms of the child did not 
seem in demand any prescription, and I made none; but advised 
licit the little patienl be allowed to sleep until he awoke, which 
was not until ( .) o'clock the next morning, when he did so, as after 
an ordinary sleep, took \\w br< as! freely, and remained well. 

Another case is present in my mind whilst writing on this 
subject, in which the child (IS months old) slept about fifty 
hours: in the lattei pari <>f which time hi lie had been 



1S37.] Remarks on the Cases of Br .E. H. Macon. 11 

often aroused, by the anxiety of the mother, but never so as to 
exert volition enough to drink or take nourishment. To this 
child I was called after a sleep of about 30 hours. On finding 
it to be the catnep sleep, 1 only recommended the use of a dose 
of castor oil, and that the child be allowed to rest. She awoke 
at fifty hours after the dose, with no other trouble following her 
long sleep than a little apparent exhaustion, which was soon re- 
lieved by nourishment which she took with good appetite. 

As an herb tea it is a pleasant diaphoretic, for which alone it 
is often used. But in those varieties of menstrual irregularity 
which wetermdysmenorrhoea, deficient, suppressed and retained 
menses, it is found fully equal, if not superior as an emmena- 
gogue power to pennyroyal and savin, articles also in extensive use 
in such cases. And in its entire adaptation to the case, especial- 
ly of dysmenorrheoa, it is peculiar suited by its anodyne powers. 
For this purpose it is used by females at and a little before the 
menstrual periods, in the form of a pretty strong infusion, pre- 
pared of two or three drachms to the pint of boiling water, and 
this drank warm and freely. 

I have no doubt but that the peculiar and valuable powers of 
this plant might be retained in a spirit, distilled in the manner of 
making essences of mint arid other fragrant herbs; and in a 
syrup, the form most desirable, as it would be the more conveni- 
ent lor administering to children, and exempt from the stimulus 
oi alcohol. 



ARTICLE III. 

Remarks on the eases of Dr. E. II. Macon. By Paul P. 
pvE 3 M. 1). Professor of Surgery in the Medical College of 
Georgia. 

In tlie 1 ;t numb ir oJ the 2nd volume of the Southern Medi- 
cal and Surgical Journal just received, at the conclusion of an 



12 Remarks on the Cases of Dr. E. H. Macon. [Sept. 



interesting article from Dr. E. H. M acon, information is request- 
ed concerning three important surgical cases. Although much 
occupied at present, still as these cases may be considered more 
directly addressed to my attention, I cannot permit them to pass 
unnoticed ; and would therefore, respectfully submit the follow- 
ing brief remarks : — 

Case 1st. "A clergyman of Oglethorpe, whilst leading his 
horse by the foretop* was by a sudden effort of the horse, caused 
to suffer great pain at the insertion of the deltoid muscle. He 
has almost entirely lost the use of the limb, being unable to raise it 
higher than his breast, or move it in any other direction except 
forward. The limb has been examined by several physicians, 
none of whom can detect luxation or fracture. All ordinary 
topical applications have been made in vain." 

From the very few particulars here published relative to this 
case, it is difficult to arrive at a very satisfactory diagnosis. 
There is a want of facts concerning it, from which to deduce a 
clear and rational conclusion. Several important particulars are 
omitted in stating the case, arising undoubtedly from the brevi- 
ty with which it has been presented. For instance, it would be 
necessary to know in what direction the force was applied to the 
arm ; what is now the actual state of the whole limb ; has its 
sensibility been affected by the accident ; can the elbow be 
brought to the side of the body ; is there any difference in the 
upper extremities, in their length, &c; what is the history, pro- 
gress, &c. of the case ? 

But notwithstanding the few particulars given of this case, we 
will venture in our very concise examination of it, to apply the 
doctrine of exclusion. In the absence then of more direct and 
positive evidence to the contrary ; 1st, it is not a disease of the 
nerves of the arm, because the patient can. at will, still use it to 
some, though it be to a very limited extent. 2nd, it cannot be an 
affection of the muscles, because the limb can be raised ashigh as 
the breast and moved lor ward — an injury of the deltoid would 
prevent any elevation of the humerus. 3d, it is not a fracture 
of the humerus, because of its immobility — it can be moved in 
only one, or at most but two directions. If the injury in this 
case be sustained and located in neither the nervous, muscular, 
nor osseous systems, and we may safely conclude that the tegu- 
mentary arid vascular, are not concerned in producing the symp- 



1837.] Remarks on the Cqses of Dr. E. H. Macon. 13 



toms as described, what then must be its true pathology? 1 am 
inclined to the opinion that the shoulder joint must be affected. 
The articulating surfaces, or the os humeri itself may be diseased, 
but then motion ought in either supposition to be as free in one 
direction as another. I am therefore brought to the conclusion, 
that in this case there exists a dislocation at the scapulohume- 
ral articulation. And moreover, I am strengthened in this de- 
cision, from the three following circumstances, admitted in the 
short narration already quoted. 1st, the arm at the time of the 
accident was extended (leading the horse by the fore-top,) its most 
favorable position for luxation. 2nd, the pain at the insertion 
of the deltoid, may have been produced by that muscle having 
been stretched by the elongation of the limb — and 3rd, the abili- 
ty to raise the arm as high as the breast, and to move it forward, 
are the very movements which can be peribrmed, when the dis- 
location is one of the head of the humerus into the axilla. It 
may be only a partial luxation — such cases are recorded. 

Case 2nd. " Mrs. L**** in this vicinity, whilst stretching out 
a hank of cotton yarn, suddenly felt pain about the middle of the 
humerus. In a few weeks the biceps flexor cubiti became much 
contracted and still remains so, bending the fore-arm up to the 
breast. The limb is painful and almost useless. No dislocation 
or fracture can be detected." 

Similar remarks with respect to the want of particulars, &c, 
in relating this case, are as applicable to it as to the one al- 
ready noticed. The fore-arm must have been extended upon 
the arm, u whilst stretching out the hank f the " sudden pain 
felt about the middle of the humerus," may be referred to 
the origin of the brachialis interims muscle; the contracted 
state of the biceps flexor cubiti, and the flexed position of the 
fore-arm, would induce me to suspect in this case, a dislocation 
of the ulna and olecrannon process backwards upon the humerus. 
If since the accident it be impossible to flex or extend the fore- 
arm to its fullest extent, and should there also be an increased 
ihicknes observed in the elbow joint in an antero-posterior direc- 
tion, with a corresponding diminution of its latteral diameter, 
then the diagnosis would be clear. By a singular coincidence 
of circumstances, I have seen within the last ten months, no less 
than four such dislocations as I suspect to exist in this case — the 



14 Remarks on the Cases of Dr. E. H. Macon. [Sept. 

olecranon process of the ulna removed backwards from the greater 
sigmoid cavity existing between the condyles of the os humeri. 
The fourth case was presented yesterday in the person of Mr. J. P. 
•of Barnwell district, who received the injury by wrestling a year 
ago, and who came to town to submit to an operation for a disease 
of the eyes. 

Case 3d. " In October a negro girl was struck by the falling of 
-a tree in such a manner that her scalp was considerably lace- 
rated and her left shoulder bruised and violently strained. ISo 
fracture of clavicle, scapula or humerus, nor dislocation, could 
be detected after the most careful examination. All topical ap- 
plications from the use of which benefit might be hoped for, 
were used to no good effect. Six weeks after, the arm was en- 
tirely useless,but moved in any direction without the least pain. 
The motion of the shoulder joint was free and without crepitus. 
The paralyzed state of the parts about the joint afforded a free 
examination of the head of the humerus, which was always in 
place with the glenoid cavity. The force which injured the 
shoulder was applied from above." 

This case is stated more fully, and we have a greater number 
of facts from which to make out an opinion. Its diagnosis too, 
ought to be more clear and satisfactory, and if I have hesitated 
in expressing an opinion concerning the nature of the injuries 
sustained in the two cases already referred to, I feel much better 
prepared to give a decided judgment on the one now under con- 
sideration. This girl, from the falling of a tree, received a lace- 
rated wound of the scalp and a severe contusion of the left 
shoulder. The arm is now entirely useless, the parts about that 
joint being paralyzed. The case I think a very plain one. The 
nerves supplying the arm have evidently sustained a lesion from 
the accident. The only question about it is, what part of these 
nerves is affected — does the paralysis of the left arm arise from 
the injury which the head received or from that of the shoulder, 
for both were struck by the falling tree and that too at the same 
time. For this state of the arm to have been produced by the 
blow upon the head, it must necessarily have been on the right 
side, or in other words the lesion of the brain must exist in the 
right hemisphere. In this event too, the intellect of the patient 
ought to have been disturbed, and in all probability, the paralysis 
would have amounted to hemiplegia. The cranium may have 
been fractured, its internal table for instance driven in upon the 



1837.1 Remarks on Debiliianis and Sedatives. 15 

brain, or the nerves (the axillary plexus,) may have been com- 
pressed or injured by some displacement, &c. near the shoulder 
joint, without its being detected by the attending physician. Be 
this as it may, we must admit, in this case a nervous affection. 

I have thus briefly noticed these interesting surgical cases, and 
I trust, in the spirit with which the information was requested ; 
but whether I have been so fortunate as to point out their true 
diagnosis from a correct pathological view of them, remains to 
be determined. 

Augusta, September, 1837. 



ARTICLE IV. 



Remarks on Debiliianis and Sedatives. By Joseph A.Eve, 
M. D., of Augusta, Ga. 

Inasmuch as in nearly every case of disease, in almost every 
aberration from health, irritation or excessive excitement is pre- 
sent, of higher or lower degree, of greater or smaller extent, in- 
volving one or more of the tissues or organs, the most important, 
the paramount indication in the practice of medicine, is the re- 
duction of excitement, the depression of morbid action. It is 
therefore of primary importance to know what the means are 
that cause this depression and the principles on which they act. 

The position first advanced by Brown, that all vital pheno- 
mena are called into existence and maintained by stimuli or 
excitants acting on the excitability of the system, is now, we be- 
lieve, universally admitted and regarded as the fundamental 
principle of all sound reasoning and correct theory in medicine. 
Assuming then that the manifestation of the phenomena of life, 
or in other words, excitement, is the result of excitants acting on 
the excitability, we readily perceive that it must always be de- 
depressed or diminished by abstracting the excitants or rendering 
the system less excitable — that is to say. to depress excitement, 



Sept.] Remarks on Debilitants and Sedatives. 16 

the agents employed must act negatively by abstracting orwith- 
holdingthe stimuli that maintain it, or positively by diminishing 
the susceptibility of the system to be excited. The first we would 
denominate negative depressants of debilitants. the second posi- 
tive depressants or sedatives. Besides debilitants and sedatives, 
there are other means which, though primarily excitant, by an 
indirect mode of operation conduce to the same end ; these are 
revulsives and local excitants — the former cause a depression 
or diminution of excitement in one part by increasing it in ano- 
ther of less vitality — the latter, by increasing the action of the 
secretory organs, lessen the amount of fluids in circulation and 
thus secondarily produce depletion. We shall not, however, at 
present consider those indirect methods of reducing excitement, 
but proceed to institute an inquiry into the nature and mode of 
operation of direct depressants ; these we have already said are 
divisible into two classes: negative, or those which depress ex- 
citement by withholding or abstracting stimuli, and jJositive, or 
those that deprive the system of its excitability and render it less 
susceptible of the action of excitants. 

No therapeutist whose writings I have seen makes the proper 
distinction between positive and negative depressants ; the term 
sedative is applied indiscriminately to both, or if debilitant be 
employed, it is in the same comprehensive sense, without regard 
to any difference between them. But when we examine more at- 
tentively the modus operandi, and the effects of the two kinds of 
depressants and consider the different circumstances and states of 
the system to which they are applicable, it is certainly very im- 
portant that they should not be thus confounded together under 
the same head. 

Opposed to irritation or super-excitement, there are three states 
of depression, resulting from very different causes : 1st, direct 
debility which is produced by the ab I of stimuli : 2nd, 

indirect debility, or exhaustion from overaction a, state in which 
the excitability has been exhausted and will not respond to the 
impression of stimuli: and 3rd. sedation depression induced by 
die action of direct sedatives -a state in winch the excitability is 
diminished or temporarily destroyed, of these, three varieties 
of depression, it is the lirsl and thud only, that we endeavor 
to induce artificially, in the tr< atmenl of disease . thai is, we en- 



L837.1 Remarks on Debilitants and Sedatives. 17 

deavor to reduce excessive excitement and control inordinate 
action, either by abstracting stimuli or by lessening the excitabil- 
ity — the means employed for the first purpose we designate by 
the term dcbilitants ; those used to effect the second we style 
sedatives. 

The general indication for the employment, of debilitants or 
sedatives will be determined by the nature of the excitement, 
whether it depends on redundancy of stimuli or excess of excita- 
bility ; thus in some cases and stages of inflammatory diseases, 
we observe the excellent effects of blood-letting and other meth- 
ods of abstracting stimuli, and in other cases and stages the 
greater utility of opium and other sedatives, and of revul- 
sives which are ; as already stated, indirect means of producing 
sedation. 

Debilitants are generally more applicable to the treatment of 
the first, sedatives to that of the latter stage of diseases of ex- 
citement ; but there are many exceptions to this rule, for the in- 
cipience of some cases is characterized by symptoms ordinarily 
observable only in the concluding periods of similar affections 
In the commencement of febrile and inflammatory diseases, the 
system is usually replete with blood and the other natural exci- 
tants, debilitants are therefore indicated — the indication is evi- 
dently to reduce excitement, by withholding or abstracting all 
the excitants that have produced it or that may tend to main- 
tain it. There is, however, one physiological fact involved, that 
should ever be borne in mind in the administration of Debili- 
tants — which is, that excitability always accumulates in propor- 
tion to the privation of stimuli, hence the reaction, often violent, 
necessarily consequent on the abstraction of blood,of caloric, etc.— 
the excitement thai succeeds the depression caused by all debil- 
itant means — to this principle is attributable the extreme excita 
bility of the stomach in persons from whom food has been long 
withheld, rendering perilous the ingestion of the very mildest 
nourishment — the very <*reat excitability of parts that have been 
frozen or long exposed to intense degrees of cold and the danger 
of suddenly admitting to them the ordinary temperature — the 
excessive sensibility of the eyes to light, after it has long been 
excluded from them — &c. &c. 

When debilitants are not timely employed, and morbid excite- 

■ 3 



18 Remarks on Debilitants and Sedatives. [Sept. 

merit has been allowed to rage unrestrained, the natural result 
is indirect debility or exhaustion, a condition in which neither 
debilitants nor sedatives can be employed to much advantage, and 
our chief reliance must be placed in the use of revulsives, and 
those means that are most efficient in equalizing excitement. If 
on the contrary, debilitants have been freely employed and se- 
dative means entirely neglected, there will most probably ensue 
a state, in which there is present high excitement with great de- 
bility — that is, we will find, although the patient's powers are 
greatly reduced, and he cannot tolerate farther depletion, still 
the excitement is excessive, not at all in correspondence with his 
exhausted energies — the case has assumed a typhoid type. 

It is only by the judicious administration of sedatives and re- 
vulsives, that we can hope to recover a patient from a state so 
critical ; it is only by the employment of debilitant and sedative 
means in proper association or succession, that is by repressing 
the excitability as well as abstracting stimuli, that it can always 
be prevented. It is upon this principle, by diminishing excita- 
bility, that the preparations of opium wisely prescribed, manifest 
such wonderful effects in inflammatory diseases, and are with 
propriety ranked amongst our most valuable resources — it was 
for this property that opium was so highly esteemed by the saga- 
cious Sydenham and our own illustrious countryman, the vene- 
rable Rush — and it was from observing its happy influence in 
such cases that the late and justly celebrated Armstrong declared 
that, if the lancet be termed the right hand of practice in in- 
flammatory diseases, opium in combination with calomel should 
be termed the left, so nearly do they correspond in efficiency 
and applicability, in the management of such cases, the correct- 
ness of which declaration the subsequent experience of the pro- 
fession has most satisfactorily established. We shall now pro- 
ceed to treat summarily of 

DEBILITANTS. 

The privation or abatement of the excitants that are essential 
to the production and maintenance of vital phenomena — viz ? 
aliment solid and fluid, blood, caloric, oxygen, light, electricity 
and the exercise of the organs, constitutes the class of Debilitants : 



1837.] Remarks on Debilitants and Sedatives. 19 

under this head therefore, are included abstinence, blood-letting, 
cold, a deoxygenized atmosphere, exclusion of light, the means 
of abstracting or diminishing the quantity of electricity in the 
system or part affected and rest. 

Abstinence — The suppression or regulation of diet is of all de- 
bilitants, indeed of all therapeutic resources, the most important ; 
it is that by which we are enabled to accomplish most, in our en- 
deavors to remove disease and reinstate the organs in the healthy 
performance of their functions. Without being in the least degree 
disposed to undervalue the efficacy of medicine, in which I have 
the highest confidence, I do not hesitate to say that we may, by 
the proper management of this mean alone, effect more in the 
treatment of disease, without medicine, than by the whole ma- 
teria medica, without due attention to diet. Diet must consti- 
tute the basis of every remediate plan — the judicious treatment 
of no case can be commenced, until the quantity and quality of 
the patient's diet has been determined. 

"Aliment (says Professor Jackson,) furnishing the materials of 
the animal solids, and differing so very greatly in its nature, in 
its properties, and in its effects over the actions of the economy, 
offers to the practitioner the most effective means of modifying 
the condition of the organs. Of all the remedial agents at his 
command, no other enables him with so much certainty to ac- 
complish extensive and radical changes in the actual state of the 
organs, as the aliment, directed on a thorough knowledge of its 
properties, and mode of influencing the organic or nutritive ac- 
tions. He is enabled through its agency, assisted by the various 
regulations embraced in regimen and hygiene, to revolutionize 
completely the whole organism, and to effect deep and lasting 
mutations in the physical and even moral nature of man. This 
result he can operate, by having at command the material ele- 
ments of our composition, derived from external supplies, and 
withholding, supplying or regulating them according to the ex- 
isting indications." 

Our design at present is merely to consider the modus operan- 
di of abstinence in reducing excitement, with which view it 
must be examined, with reference to its effects upon the stomach 
and upon the general system. 

The stomach is one of the most highly Vital of the organs and 
enjoys the most numerous sympathetic connexions with the rest ; 
hence when the stomach is excited or depressed, the whole sys- 
tem participates in the excitement or depression : food is the natu- 



20 Remarks on Debilitants and Sedatives. [Sept. 

ral excitant of the stomach, which in health stimulates it to the 
performance of its appropriate function — but when irritable or 
inflamed, food produces morbid excitement ; whereas abstinence, 
on the principle of withholding stimulus, reduces the excite- 
ment of the stomach, down to the healthy point when excessive, 
and when previously normal depresses it below it, which de- 
pression is by sympathy extended to the whole system.* It is 
thus that much of the beneficial influence of abstinence is proba- 
bly often displayed, before the system feels the need of fresh sup- 
plies of chyle. But when alimentation has been suppressed a 
sufficient length of time, the blood becomes impoverished — less 
nutritious and stimulating — if aqueous fluids have been allowed ; 
but if water be withheld during long continued abstinence, the 
blood becomes morbidly thick and surcharged with effete and 
noxious elements, in consequence of the expenditure of serum, 
in cutaneous and pulmonary exhalation, and the consumption of 
the more bland and nutritious particles in secretion and nutri- 
tion ; the result of which is a low typhoid fever which always 
ensues in those from whom aliment has been long withheld. 

The plentiful use of diluent drinks is therefore necessary, all 
the time the patient is subjected to severe abstinence, to supply 
the absorbents with water, wherewith to dilute the blood which 
being despoiled to a great degree of its stimulating and nutritious 
qualities, becomes less excitant to the heart and all the organs 
through which it passes — the act of nutrition which takes place 
in the areolar structure of the organs, the parenchymatous cir. 
dilation and the intimate molecular movements in allthe tissues, 
are reduced in energy and activity — the consequence of which 
is a lower grade of organic action generally throughout the sys- 
tem. 

[t is also necessary to relieve the pain of hunger when pre- 
sent, by mucilaginous drinks and the least stimulating articles of 
food, for if unappeased, it will not only irritate the stomach but 
prove a powerful exciter of the brain. Those physicians who 
push the starving system too Far, defeat their object, by subject- 
ing their patient to [he stimulus of hunger, until it produces 
excitement equal to or greater than that intended to be relieved. 



Ventriculo lantfuido omnia languent." 



1837.] Remarks on Debilitants and Sedatives. 21 

The excitement thus produced is some what comparable to the 
reaction that follows blood-letting and the depressing effect of 
cold; both result from the accumulation of excitability conse- 
quent on the abstraction of stimuli. 

During the continuance of acute diseases, digestion is gene- 
rally suspended, the sensation of hunger is not peiceived, and 
abstinence may be advantageously borne a length of time that 
would destroy life, in persons previously in good health. The 
following rule will perhaps be found subject to few, if any, ex- 
ceptions — whilst the general excitement is above the normal 
point, abstinence from food, with the free use of diluent drinks, 
will prove beneficial, as long as the patient is not distressed with 
hunger* In chronic affections, the same rule will not perhaps 
so generally apply — in cases attended with much debility, it may 
be necessary sometimes to administer nourishment, although all 
sense of hunger may be absent. 

The modes of operation of abstinence as a remedial mean 
may be summed up as follows : 

1st. By a direct effect in reducing gastric excitement. 

2d. By the sympathetic influence the stomach exercises over 
the other organs, as the brain, heart, &c. 

3rd. By suspending assimilation, thereby reducing and impo- 
verishing the blood, the same effect being produced as by blood- 
letting, only by a more slow and gradual process. 

It would be an agreeable task, did our limits permit, to consider 
these different modes of operation of abstinence, in its applica- 
tion to the remediate management of various diseases ; but we 
must hasten to the examination of other debilitant means. 

Bloodletting— -Next to abstinence in importance and extensive ap- 
plicability as a remedial agent and superior in power,is bloodletting; 
of all therapeutic resources it is the most potent ; it is that by which 
we can effect the greatest immediate, and often the most happy, 
results ; but its use is at the same time fraught with most dan- 
ger. Its administration requires the most thorough knowledge 
of physiology and pathology, and the exercise of the most acute 
discrimination and profound judgment : when timely and judi- 
ciously employed, it is mighty to the subduction of the most terrific 
and overwhelming violence of disease, and the rescue of life 
from impending death ; but when practised indiscriminately and 



22 Remarks on Debilitants and Sedatives. [Sept. 

and imprudently, without the guidance of correct principles, 
it is the weapon of destruction, dangerous as a two-edged sword 
n a madman's hand. Blood has been very appropriately styled, 
life's sanguine stream, for it imparts strength and conveys nou- 
rishment to every part of the system, and with its flow or ebb 
life flows or sinks with equal pace — it cannot therefore be safely 
trifled with, or with impunity wasted. 

While the remediate process of abstinence is slow, gradual 
and safe, the changes wrought by the abstraction of blood are 
rapid ; sometimes the most disorganizing excitement is instanta- 
neously reduced, and perfect ease afforded from intense and ex- 
crutiating agony — this frequently occurs in peluritis and other 
acute inflammations, while the blood is flowing from the arm ; 
but by imprudent and excessive deperditions of blood, the pow- 
ers of life may be irrecoverably depressed, or the consequent 
re-action become violent and beyond control. 

The proper employment of the lancet is one of the most diffi- 
cult and embarrassing subjects in medicine ; for high excitemen- 
is not always accompanied with exaltation of power, or com- 
patible with the loss of blood, nor is a depressed state of the vas- 
cular system always an evidence of debility, or a counter-indica- 
tion to the farther abstraction of blood. Our prescribed limits 
will not allow us to institute an inquiry into all the principles in- 
volved in this interesting subject : — our design is simply to make 
a few cursory remarks on blood-letting as a therapeutic mean, 
in which respect it must be contemplated, with reference first 
to its influence over the heart and arteries, and secondly to its 
effect upon the system in general. Blood is the appropriate 
stimulus of the heart that excites it to contraction and maintains 
the circulation ; its abstraction consequently, on the principle 
of withdrawing stimulus, diminishes the force with which it is 
impelled through the arterial system which is under the immediate 
influence of the heart ; and as every part is pervaded by arteries 
the effect is therefore felt throughout the whole organism, but most 
conspicuously in those organs that are most abundantly sup- 
plied with those vessels a and accordingly general bloodletting is 
most efficient in subduing inflammations of the brain, lungs &c; 
whereas when the menbranaceous viscera, as the stomach intes- 
tines, &c, that abound in capillary vessels, are inflamed, the 



1837.] Remarks on Debilitants and Sedatives. 23 

same beneficial results do not follow the use of the lancet, and 
local or capillary bleeding is found most efficacious. 

The therapeutic agency of blood-letting is readily comprehend- 
ed, by contemplating its effects upon the different organs and 
systems. Its debilitating effect on the circulatory system is evinced 
bythe pulse becoming feebler, softer, smaller and slower until syn- 
cope takes place, during which it is nearly or entirely suspended ; 
this state continues until it is relieved by the supervention of re- 
action — when, for a time, the excitement becomes as high, or 
higher than before the bleeding. 

The brain and nervous system very soon experience the de- 
pressing influence of blood-letting — the nervous centres failing 
to receive a sufficient quantity of blood, the functions they ex- 
ercise are performed with less energy and activity until they- 
are suspended in syncope. The muscular system being un- 
der the immediate influence of the nervous, muscular con- 
tractability is very promptly and conspicuously diminished 
by blood-letting. During the abstraction of blood, the ac- 
tion of the lungs becomes more free and their secretion more 
abundant, and as it continues to flow the inspirations be- 
come more profound and less frequent. The stomach and in 
testinal canal are greatly affected, either directly from not re- 
ceiving their accustomed supply of blood, or by sympathy with 
the heart, brain or lungs — nausea and vomiting are of frequent 
occurrence and sometimes diarrhea results — hence the propriety 
of the precept to avoid bleeding directly before or after a meal. 
The effect of blood-letting on the liver, though not apparent 
when that organ is in its normal state, is very conspicuously 
manifested during inflammation, by the speedy cessation of pain, 
and by the promptness with which its secretion is produced, all 
though cholagogue medicines had previously been exhibited 
without effect. The warmth of the surface and of the whole 
body is reduced. The skin becomes relaxed and covered with 
copious perspiration ; and most of the secretions are for a time pro- 
moted. The action of the absorbents is increased — the activity of 
absorption being always in inverse ratio to the fullness and force 
of the arterial system. By thus contemplating closely the influence 
blood-letting exercises over the organs in their normal state, we 



24 Remarks on Debilitants and Sedatives. [Sept. 

will be able to appreciate correctly the beneficial effects to be de- 
rived from it in disease. 

Blood-letting operates immediately in reducing the excitement 
of an organ, by lessening the quantity of blood sent to it, and 
the momentum with which it is impelled into it by the heart — 
which reduction or depression is in proportion to the amount 
lost and the suddenness with which it is abstracted. 

It has been long remarked that the system is affected more by 
the sudden abstraction of a small quantity of blood, than by the 
protracted withdrawal of a much larger amount ; this is general- 
ly accounted for, on the supposition that time is thus allowed for 
the vessels to contract and accommodate themselves to the di- 
minished volume of blood ; but this appears too mechanical and 
not in accordance with correct physiological principles — it is 
much more rationally explicable, on the principle of the ac- 
cumulation of excitability always consequent on diminution 
of stimulus. We would explain it thus — when the stimulus 
of blood is withdrawn slowly, the excitability accumulates so 
fast, that the excitement is maintained or subsides very slowly 
and imperfectly, sometimes not until frightful losses of blood 
have been sustained : whereas, when blood is drawn rapidly, 
time is not allowed for the excitability to accumulate — the 
heart, deprived of its accustomed stimulus, contracts feebly and 
ceases to afford the brain an adequate supply of blood to main- 
tain its functions — hence syncope, which continues until the ex- 
citability accumulates and reaction is established, when the ex- 
citement, as stated above, becomes as high or higher for a time 
than before blood-letting was practised — which temporary exalta- 
ation of excitement* inexperienced physicians are liable to regard 
as an indication to repeat the use of the lancet, which repetition 
is generally injurious and sometimes fatal. We observe then 
if blood be abstracted slowly, the proportional increase of ex- 
citability maintains the excitement, or at least prevents the de- 
bilitating effect from being so fully and promptly evinced, and if 

♦ This should be carefullj distinguished from the permanent rise and develope* 
merit of the pulse, often observable in congestive diseases during the abstraction of 
blood— this indicates prompt and copious depletion. An oppressed pulse always 
becomes fuller and stronger as the blood flows from the vein, but an attentive ob- 
server will never mistake thir, fur the excitement consequent on reaction. 



1837.1 Remarks on Debilitants and Sedatives. 25 

drawn rapidly, although debilitation is very speedily produced 
reaction soon supervenes and causes the excitement to rise as 
high, or higher than before. The plan by which the best re 
suit shall be ensured from the employment of the lancet, the plan 
by which excitement may be most promptly and effectually re- 
duced, is to abstract blood rapidly, to incipient syncope or until 
sufficient depression is produced, and then to administer a seda- 
tive which shall, by repressing the accumulation of excitability, 
prevent reaction which, as we have seen, often obviates or great- 
ly retards the good effects of bloodletting. 

After the subsidence of reaction, that is, after the accumulated 
excitability has been expended, the excitement will generally 
be reduced in proportion to the amount of stimulus lost ; for al- 
though the amount of fluid abstracted may be soon replenished 
by external absorption, it is principally with water that serves to 
dilute and render the blood less stimulating ; and even when 
assimilation is not interrupted, the serous portion is renewed 
long before the crassamentum is restored — still time is always 
required for reaction to subside, when bloodletting is practised 
without the conjoint administration of sedatives, and the depress- 
ing effect is much more slowly and imperfectly realized. 

Professor Dunglison, in his '-General Therapeutics," appears 
to estimate very correctly the importance of combining debili- 
tants and sedatives in reducing excitement, although in his clas- 
sification he does not make the proper distinction between them. 

" The advantage," says Professor D. " attending a union of 
copious bleeding with sedative doses of opium can thus be 
readily appreciated. The abstraction of blood reduces the 
amount of stimulus in the sanguiferous system, whilst the opi- 
um keeps down the excitability of the nervous system." 

And speaking of bloodletting in irritable habits, he observes : 
" It is in such irritable habits, that we find the advantage of adopt- 
ing other sedative agents : it is in such, that a combination of 
bloodletting, short of producing syncope, with a full sedative 
dose of opium, is often so serviceable ; the bleeding diminishing 
the exaltation of the vital manifestations, by acting on the nerves 
through the bloodvessels ; and the opium preventing the subse- 
quent developement of the nervous excitability. This, I say, is 
advantageous in irritable habits ; and, in strong individuals, the 
same plan pushed to a still greater extent, is equally successful 
and not the less philosophical, when employed for the removal of 
4n 



26 Remarks on Debilitants and Sedatives. [Sept, 

internal inflammations. It is the plan, which, as I have before 
observed, is adopted with so much success, in acute peritonitis ; 
the bleeding being carried so far as to make a decided impression 
on the system, and the opium administered in a full dose ; a se- 
dative influence is thus exerted on the body generally, and on the 
inflamed tissue in particular, under which the hyperasmia is 
effectually subdued." 

By thus employing debilitants and sedatives together or in im- 
mediate succession, by abstracting blood and exhibiting the salts 
of morphia at the same time, we will be able to depress action and 
reduce excitement, much more effectually, more promptly and 
with much less expenditure of vital power and waste of blood, 
than by the employment of the lancet and other debilitant means' 
alone. But we do not contend that this combination is always 
necessary or proper — there are cases in which it is not required 
and others in which it may be counter-indicated : yet the most 
excellent and happy results may frequently be derived from it. 
The secondary, but more permanent and important mode, in 
which bloodletting operates in depressing excitement is ascrib- 
able to its effect in diluting the blood, depriving it of its nu- 
tritious qualities and reducing its exciting power, in consequence 
of which the vital phenomena throughout the whole organism 
are manifested with less energy and activity, a general reduc- 
tion of exctiement and depression of action being affected in all 
the organs and tissues. The same effect is produced which we 
spoke of as resulting from abstinence long continued, only in a 
shorter time and to a greater extent. And to cause this dilution 
of the blood, the liberal use of diluent drinks is equally requisite 
to furnish the absorbents with aqueous fluid, when bloodletting 
is frequently repeated as when abstinence is long enforced. 

We have now concluded our remarks on bloodletting, short 
and imperfect indeed, but it was not our design to treat the sub- 
ject in all its details which would require volumes, instead of a 
few pages which was all we proposed. 

Note. — In a future number we will continue our remarks on 
debilitants and sedatives. 



1837.] Case of Retained Menstruation. 87 



ARTICLE VI. 

Case of Retained Menstruation, with anomalous symptoms. 
By Dr. D. F. Bailey, of Barnwell District, S. C, in a let- 
ter to the Editor. 

Mr. Editor : — As your Journal is one of the most useful 
organs in the Southern states, for the dissemination of medical 
knowledge, I transmit to you the following interesting case 
which occurred in our practice a few months ago. We were 
called to this case on the 10th of May last. It was complicated 
with a derangement of the uterine system. There was at first 
no obvious cause, though on inquiry, we learned that it was 
consequent to a fall, in which the gluteus maximus and latissimus 
dorsi muscles sustained considerable injury. A bubo, about as 
large as a common walnut, was discovered in the ingunial re- 
gion, which in the course of time became so troublesome as to 
require medical assistance! Dr. Tesser was called in, and 
believing the statement above related, did nothing else than 
treat it as an inflammatory swelling of a sympathetic nature. — 
Having relaxed the tumor, and suspecting from the softness of 
its feel that pus had formed, he made an incision into it, in a 
longitudinal direction with the glands, which gave issue to a 
thick kind of pus mixed with blood, but did not answer the pur- 
pose he anticipated. After trying various remedies and meeting 
with no better success, he abandoned the case as incurable. In 
the deplorable condition which < : a Dr's. desertion implies/' she 
was carried to Professor Ford, who examined, but did not do 
any thing for her, nor report her case. In this condition, she 
was brought from Georgia to us. She gave us the same state- 
ment as to cause and effect, and from the silence of those two 
preceding gentlemen, we were much perplexed to discover the 
pathology,* and apply curative means. On examination, we 
were from circumstances, induced to believe its origin to have 
been from a syphilitic taint ; but there was one circumstance 
which militated against this supposition, and that was, how she 

♦The patient was a girl, about 16 years of age, and owned as the property of Mr. 
Brigham, of Georgia, Burke county. 



28 Case of Retained Menstruation. [Sept. 

possibly could have contracted that complaint at the early age of 
twelve years. This is possible, I admit, but it is rare. The 
complaint was one of three or four years' standing. Giving full 
scope to our opinions, as regarded the cause and nature of the 
complaint, we modified our remedies accordingly ; but mercury 
did not the least good ; after continuing its use for an indefinite 
length of time with no advantage, we altered our prescriptions, 
substituted more active cathartics with a view to diminish the 
plethora of her system, as well as to remove gastric impurities ; 
with these we were more successful. Observing that she la- 
bored under a suppression of the menses, we combined those 
medicines with emmenagogues, with greater advantage, and it 
is here the nature of the disease developes itself. Before the ad- 
ministration of emmenagogues, the secretion from the ulcer in. 
the groin was of a fetid pale colour, adhering to the sides of the 
wound, and very rosy ; but after the system was brought under 
their influence, the discharge became more copious, more healthy 
and thinner in consistence ; and this was observed in three suc- 
cessive trials. But as soon as they were laid aside and their in- 
fluence suffered to wear off, the discharge would be greatly dimin- 
ished in quantity and deteriorated in quality. Hence I ask, may 
not the menstrual secretion have become absorbed and eliminat- 
ed through this orifice, which may have become a vicarious 
passage for it ? What manifestly renders this more probable is 
the phenomena observed in the augmented or diminished dis- 
charge of pus, in proportion as the dose of emmenagogues was in- 
creased or diminished. 2ndly, other medicines, of a different 
nature, not possessing this specific influence over the discharge : 
3dly, there being no evacuation of any kind per vaginum, nor 
ever having been, until within a short time after the bubo was 
observed in the groin, when there was a slight show : 4thly, the 
increasing dcvclopcmcnt of the mammae and pelvis, which was 
still more perceptible at each period. The patient told me that 
she had noticed some of the circumstances just enumerated for 
two years, especially the increased size of breast, the augmented 
quantity of the discharge from the sore at each menstrual peri- 
od ; but stated that the discharge then, differed from that which 
appeared to be occasioned by the emmenagogues, owing pro- 
bably to the imperfect state of the secretory process at that time. 



1837.] Case of Retained Menstruation. 29 

She also said, she never suffered any inconvenience from her 
menstrual periods which were attended with as little trouble 
as any other period of her life. From the progressive and uni- 
form enlargement of her breasts and pelvis, she incurred the 
suspicion of being in a state of pregnancy. But on examination, 
this suspicion was found to be incorrect, besides her breasts had 
preserved their fulness for three months, varying in size only at 
the time already mentioned ; and it is well known, that after the 
breasts are distended tooether with the other symptoms of la- 
bor, it will not be long from that period, before a new being 
is ushered into life. Her breasts have been, and still are much 
distended, without any of the symptoms of pregnancy. She 
is remarkably healthy. This sore must, by its long continu- 
ance, have become an habitual drain to the system — the menses 
must have been evacuated by a secretory process, through that 
source, or they certainly must have presented themselves per 
vaginum while the system was under the influence of the most 
powerful emmenagogues. But having very little time to dis- 
cuss those points, I will proceed to notice some of the peculiari- 
ties of the disease. When first brought to us, she was laboring 
under a severe cold and debility. The ulcer was situated about 
an inch and a half below the superior spinous process of the 
ilium, and just over the femoral artery. It was three and a half 
inches deep(?)4 inches long, and about 4 inches in circumference; 
it presented 4 fungus protuberances — one turned anteriorly, an- 
other posteriorly, and the 3d and 4th laterally, with indurated 
margins and of a highly phagedenic character. From those 
protuberances, there sprung a great number of small papilla or 
vesicles — containing as it were, a semi-transparent matter, and 
from these or the subjacent parts, there was continually exuding 
that ropy irritating matter mentioned in a proceeding place. The 
first indication in the cure of the local complaint was the remo- 
val of those fungi so essential to the cure by the second intention. 
We therefore resorted to ihe use of the most powerful caustics, 
which in the course of a month or such a matter improved the 
looks of the ulcer and entirely removed all those morbid growths 
for a while. Believing the ulcer would now heal favorably, we 
left off their use and endeavored to heal it up as a common sore, 
but no sooner was the caustic discontinued than they would 



1 1 Case of Retained Menstruation. [Sept 

spring up with surprising rapidity. These we constantly re- 
moved, and believing them to arise from a morbid state of the 
basis of the ulcer, we had recourse to " tents ;" by tents, I mean 
in this instance, a kind of bongie of a conical shape and with a 
passage communicating from one extremity to the other. These 
we introduced daily as low down as the ulcer would admit and 
through them we poured in the caustic. This had the desired 
effect of removing them almost completely. We then desisted 
from their use. ISot long after their discontinuance, the patient 
complained of a severe pain in the hip. This happened in the 
evening. Next morning she sent for my father, but before his ar- 
rival she had drawn from the ulcer a number of gland-like 
bodies connected together by filaments all of which together were 
4 or 5 inches long, round and excavated ; the hollow continu- 
ing from one end to the other. The patient was much relieved 
by their expulsion, but the discharge for 3 or 4 days was of a 
reddish color resembling somewhat the washing of flesh. How- 
ever she mended very fast, and in 3 or 4 weeks after it came out, 
she was discharged perfectly cured. It having healed up very 
favorably and without any ill consequences from the suppression 
of the discharge, she is now performing her accustomed duties. 
The most remarkable circumstance in this case, is the suppression 
of the menses with such little inconvenience to the system, and the 
healing up of the ulcer being attended with no danger together 
with the spontaneous discharge of the gland. On examination 
of the parts of generation, we discovered a laceration of the clitoris, 
together with a displacement of the hymen, and this is all that 
favors the suspicion of its being syphiltic. The passage from 
the os externum to the uterus was unobstructed, which proved 
undoubtedly that the menses must have been evacuated by a se- 
cretory process through the orifice in the ulcer. 



1837.} An Examination of Phrenology. 81 



PART II. 
REVIEWS AND EXTRACTS 



An Examination of Phrenology, in two lectures, delivered to the 
Students of the Columbia College, District of Columbia, 
February, 1837, By Thomas Sewall, M. D. Professor of 
Anatomy and Phisiology. Published by request. Wash- 
ington city ; B. Homans printer, 1837. 

This little volume of seventy pages, octavo, comprises two 
lectures on the subject of Phrenology, a topic which has for many 
years occupied much of the time and efforts of both the learned 
and unlearned. Perhaps few individuals labored more zeal- 
ously in the cause of true science during the last age than did 
Drs. Gall and Spurzheim of Germany for the establishment 
of the truth of Craniology and Phrenology. Nor should the 
world be ungrateful to them for the benefits bestowed on the 
neurological department of anatomical science ; for it is a truth 
beyond controversy, that these determined and persevering in- 
vestigations have given and preserved an impulse to anatomi- 
cal research by which more truth has been developed relative 
to the brain and nervous system and their connexions with the 
phenomena of animal life, a part of science hitherto far in the 
rear, than had been previously. Nor has the impetus thus given 
lost its force even at the present day. We will say more — that 
we believe it will not be lost until the light of truth which now 
glimmers in the vista with attractive beauty shall lead on the 
lovers of physiology to the knowledge of the whole philosophy 
of the nervous system in all its relations to and connexions with 
human life. If, without this grand object mainly, or in any de- 
gree in view, they shall have contributed that to this end, with- 
out which, it might never have been accomplished ; or if ever, 
certainly not so soon, Gall and Spurzheim will merit the grati- 



32 An Examination of Phrenology. [Sept, 

tude of all future ages. Indeed the anatomical truths which 
they have established, in connexion with their favorite topic, are 
contributions to science which can never be forgotten. Here ends 
the meed of praise we purpose rendering to these indefatigable 
pursuers of scientific research. But it was not our purpose to 
review the works or the opinions of Drs. Gall and Spurzheim 
as such, and we therefore turn to the consideration of Dr. Se- 
wall's lectures purporting to be an examination of opinions 
mainly set up, and circulated through the world by them. 

Of the hundreds, perhaps thousands of essays and volumes, 
some of which are ponderous tomes, which have been written on 
this subject, we are decidedly of opinion that Dr. S. has in the 
narrow limits of seventy pages, done more for the cause of true 
science, on the subject of phrenology, than the whole of them 
together. When we consider the proneness of human beings to 
error and the intoxicating love of novelty, and the vigor with 
which they seize whatever appears to them on a superficial view 
to be a pretty thing ; and then their obstinate pride which forbids 
retrenchment of opinions and sayings, we can venture to assure 
Dr. Sewall, that with the most unequivocal demonstrations of 
truth — make it if he please, as plain as the axiom that " things 
which are equal to the same, are equal to one another," he 
cannot succeed in changing at once the current of popular 
opinion which has been established. And now, truth has to war 
not only against erroneous teachings, the attracting force of no- 
velty and the pride of opinion, but also against a party spirit 
which is almost wholly arrayed against her, winch often re- 
quires an age in science, as it does in politics to cure. At least 
time must roll on until some new tack can be found to cling to 
with one hand, until the hold of the other can be gradually and 
somewhat unobserved let go. Who ever heard of a disunionist 
or a consolidationist quitting his ultra position and betaking him- 
self to the medium ground of common sense and prudence, un- 
til he found means of riding the hobby of abolition, or of rcgu- 
Lating the exchan gi \ or some such thing. But party spirit mere- 
ly is not the end of the gauntlet. Interest, an obstacle scarce- 
ly less in the way has i<> be met and vanquished. The 
books of writers and the tickets of lecturers, which are yet to 
be sold, come up with fearful odds, to say nothing of the phre- 



1837.] An Examination of Phrenology. 33 

nologizing offices, and the fees thereof and the implantation of 
a spice, if not a pungent sense of self-estimation in what of mind 
occupies each cranium whose eminences and depressions are 
subjected to the craniometer or the callipers, or the supposed sa- 
pient touch. It is a species of fortune-telling which has curren- 
cy given to it, not only with the vulgar, but also with the super- 
ficially scientific— the skimmers of science, by the virtue of a 
gloss of science, which covers it as does the plate the base coin. 
They do not set out with the recollection that " all is not gold 
that glitters." 

And there is another thing in addition to many others too 
numerous to be named ; which is, that it has become introduced 
into the parlour ; and here, in the dearth of science of all kinds, 
as well as of valuable sentiment, which is but too common in 
most circles at the present time, it is too great a convenience at 
the command of vacant minds, for the entertainment of the ladies 
to be readily surrendered. But we presume that the inculcation 
of truth in all faithfulnsss to his class was the purpose of Dr. 
S. and not that of at once changing a world from error to truth. 

In his first lecture Dr. Sewall gives us first a brief but faithful 
history of the subject, ascribing its origin, however, much to an- 
tiquity, instead of the latter half of the last century. As this 
may not have been made a subject of research by many, we will 
give his own words : 

" Whether he (Dr. Gall) was the originator of the science, or 
derived his first intimations upon the subject from some previ- 
ous writers, is a question which I shall not discuss. Certain it 
is, that ideas, in many respects similar to those of Dr. Gall, were 
entertained and promulgated long before his time. 

Aristotle, the Grecian philosopher, who wrote more than three 
centuries before the Christian era, considered the brain as a mul- 
tiplex organ, and assigned to each (part its appropriate functions, 
in the fore-part of the cerebral structure, he places common sense ; 
the middle portion he assigns to immagination, judgment and 
reflection ; the back part he makes the great storehouse or seat 
of the memory. 

In the 13th century we are informed that the Archbishop of 
Ratisbon mapped out the head into regions in conformity with 
the divisions of Aristotle and others. -In the 10th century this 
5e 



34 An Examination of Phrenology* [Sept, 

was done more fully than ever before by Ludovico Dolci, a ve- 
nitian. On this point the Dr. refers also to a work of Jo. Bap- 
tists Ports, published in 1586, and which is now in the library 
of Harvard College, " containing" so many of die principles and 
illustrations of the phrenology of the present day, that it may 
well be questioned whether hints have not been drawn from this 
source by later writers. He proposes to discover the intellectu- 
al and moral character of man, by his physical organization, 
color," &c. 

After coursing down the line of history through centuries and 
ages, shewing the greafdoubt of the justness of Dr. Gall's claim 
to originality in this matter, he comes at length to say ; 

" Whatever may be the truth with regard to the origin of 
phrenology, it is through the writings of Dr. Gall, supported by 
the untiring labours of his pupils and disciples, that the science 
has been widely spread through the civilized world." 

We pass hastily over the remaining part of this lecture, in which 
Dr. S. gives so faithful and liberal a detail of all that phrenolo- 
gy claims, that we were on reading it, fixed in our opinion that 
he was going to prove himself an able advocate of the justice 
of those claims — claims which the advocates of phrenology have 
the vanity to tell us dignify it into a science so important to the 
well being of society, that it looks down with compassion on the 
shallow distinctions, and peurile speculations of Locke, Hume, 
Berkley, Hartley, Reed and Stuart ; and that the disco- 
veries of Newton himself were comparatively insignificant, &c. 
Next, the principles on which the doctrines of phrenology rest 
their claims, are briefly but fully given — then a faithful de- 
tailed account of the propensities, the sentiments and the intel- 
lectual faculties, which with their thirty-four sub-divisions, or 
particular organs make up the principal machinery of phrenolo- 
gy — all of which with a view of the craniomater and its appli- 
cation to the head, are beautifully illustrated by a plate intro- 
duced as a frontispiece. 

Lecture 2. Having acquitted himself in the first lecture most 
generously towards the claims of phrenology, Dr. S. here be- 
comes the able advocate of true science, by proposing to show 
how far phrenology is reconcilable with the anatomical struc- 
ture and organization of the brain, the cranium, and other 



I837v] An Examination of Phrenology. 35 

parts concerned. This he does from two considerations : 1st. 
" From a belief that the anatomy of the parts concerned is 
the proper and only standard by which to ascertain its truth. 
2d. That the metaphysical arguments on the subject, whilst 
they have been urged with great power, have too often been 
evaded, and that the public mind has not been enlightened 
as to the real merits of phrenology, by the usual methods of 
investigation — even the lash of ridicule under which it has been 
left to wither, having done but little in arresting its progress, or 
exposing its errors." After thus advancing his purpose and the 
considerations on which this purpose is founded, the doctor be- 
gins his assault by removing the rubbish out of the way, that he 
may fairly seize the metal and try its purity by unerring tests. 
He notices the extent of the ground phrenologists assume the right 
of occupying, and the numerous outlets for retreat with which 
they have provided themselves, in order that they may plausibly 
evade almost any objection to their science which may be ad- 
vanced upon the common principles of reasoning. The ground 
of these outlets is fully laid open and the sophistry brought clear- 
ly to view. We have not room on the present occasion for a full 
detail of their just exposure, but cannot deny ourselves the plea- 
sure of presenting one or two. 

"If an individual has a large head connected with unusual 
powers of intellect, the case is brought in proof of phrenology ; 
but if the manifestations are very feeble, it is said that the great 
size of the head is attributed to disease, or that the brain is not 
well organized, or that other circumstances have tended to dimi- 
nish its power. If a small head is connected with a powerful 
intellect, it only proves that the brain, though small, is well organ- 
ized, and acts with uncommon energy, &c." Again. 

" There is a celebrated divine now living in Scotland, equally 
distinguished for his amiable disposition, gigantic power of mind, 
and great moral influence which he exerts upon the christian world. 
This individual, it is said, has the organ of destructiveness very 
largely developed ; and not having any counteracting organ very 
large, it is contended by those who are acquainted with the fact, 
that he manifests his inherent disposition to murder, by his 
mighty efforts to destroy vice, and break down systems of error. 
In this way he gratifies his propensity to shed blood." Again. 

" By a recent examination of the skull of the celebrated infi- 
del Voltaire, it is found that he had the organ of veneration 
developed to a very extraordinary degree. For him it is urged, 



36 An Examination of Phrenology. [Sept. 

that his veneration for the Deity was so great, his sensibility 
upon the subject of devotion so exquisite, that he became shocked 
aad disgusted with the irreverence of even the most devoted chris- 
tians, and that out of pure respect and veneration for the Deity, he 
attempted to exterminate the christian religion from the earth ! !" 

Many such are the miserable subterfuges to which he shews 
phrenologists are bound to resort in order to sustain their cause. 
He next proceeds to an examination of the principles of phre- 
nology on the following five grounds : 

1. How far phrenology is sustained by the structure and or- 
ganization of the brain. 

2. How far facts justify the opinion that there is an established 
relation between the volume of the brain and the powers of the 
mind. 

3. How far it is possible to ascertain the volume of the brain 
in the living subject by measurement or observation. 

4. How far it is possible to ascertain the relative degree of de- 
velopement of the different parts of the brain by the examina- 
tion of the living head. 

5. Notice a few facts which have been used in support of phre- 
nology, and conclude with some general remarks. 

Under the first of these heads our author gives a brief and 
accurate view of the anatomy of the brain, noticing in passing, 
the fact that the weight of the brain, which is generally about 
three and a half pounds, varies greatly, not only in different 
heads, but in heads of nearly the same size — that the mamma- 
lary eminences and accompanying depressions of the convolu- 
tions of the brain do not, in any respect, correspond in size, form 
or position with the bases of the phrenological organs as mapped 
out — that the external part is pulpy, the internal fibrous ; and 
that the brain is more vascular than almost any other part of the 
body. It is to be remeeibered that professor Sewall is at least 
one of the first anatomists of our country. We will give his 
conclusions from the enquiry, is phrenology sustained by the 
structure and organization of the brain? 

" Neither," says lie, " the central (pulpy) or fibrous part of the 
brain reveals, upon dissection, any of those compartments or 
organs, upon the existence of which the whole fabric of Phre- 
nology is based. No such divisions have been discovered by 
the eye or the microscope. The most common observation is 



1837.] An Examination of Phrenology. 37 

sufficient to shew, that there is not the slightest indication of 
such a structure. Indeed, no phrenologist, after the investiga- 
tions which have been made upon the subject, from the fir? ' 
dawn of the science to the present time, not even Gall v x 
Spurzheim themselves, venture to assert that such divisions of 
the brain have been discovered." The absurdity of the idea of 
the organs as described by phrenologists is illustrated by the 
horizontal membrane, the arrangement of the lateral ventricles, 
corpus collosum, fornix, and other parts. " The notion, then, 
of the division of the brain into phrenological organs, is entirely 
hypothetical, is not sustained by dissections, and is utterly incon- 
sistent with its whole formation." 

In the second place, he proceeds to substantiate the fact, that 
there cannot be any proportion between the volume of the brain 
and the mental powers. In proof of this position, he gives a 
tabular summary of Baron Cuvier's investigation on this subject, 
which shews that several species of monkeys have a considera- 
bly greater proportion of brain to the whole body than man : 
and if his opinions of the proportion of man's brain to the body, 
which is less than Cuvier's, be correct, and that it is, we appre- 
hend any anatomist will determine most easily, then all the nine 
species of monkeys tested by Cuvier would be found more 
intellectual than man, some having one pound of brain for every 
twenty-two of the body, and none less than one in forty-eight ; 
whilst man's proportion, according to Cuvier is one to thirty, and 
according to our author one to forty or fifty. Again. The ele- 
phant, remarkable for his sagacity, has but one pound of brain 
to five hundred of body, the carp fish one to five hundred and 
sixty, and the shark only one to two thousand four hundred and 
ninety-eight. This tabular view shews that not only four 
species of monkeys, but three kinds of birds, and the dolphin, 
exceed man in the proportion of brain, <fcc. Other proof is 
drawn from observations on the brain of men, by which the 
fact is established, the number of large and small brains of men 
of equal enlargement of intellect are about equal. 

3d. Here our author controverts most completely, the possi- 
bility of ascertaining the volume of the brain in the living 
subject, by measurement or observation. In proof of the cor- 
rectness of his position, Dr. S. presents views of the skulls of 
different individuals, from one eighth of an inch to that of an 
inch and a half in thickness, causing a difference in the central 



51,72 


u 


46,21 


u 


34,79 


u 


25,33 


it 


4,50. 


oz, 


10,01 


it 


21,43 


a 


31,89 


a 



38 An Examination of Phrenology. [Sept. 

cavity for the volume of contained brain in skulls of the sa me 
volume, apart from the contents by measure of the skulls con- 
taining, as follows : brain. 
Plate ii. A thin skull, (though of a sturdy wa- 
terman,) 56,22 oz. 
" in. The skull of a delicate female, but 
double the thickness of the former, 
" iv. Very thick,compact,and well organized, 
" v. Averaging nearly three quarters of an 

inch, 
" vn. A model from Spurzheim's cabinet, 
making a difference in these five skulls, as follows : 
Between n and in of 

" II « iv « 

« ii « v " 

u n u VII u 

making the greatest " difference in the volume of brain contained 
in two skulls, of the same external dimensions, 31,89 oz., 
something more than one half." These experiments have been 
most fairly made, in the presence and with the assistance of 
" Dr. Thomas P. Jones, and Prof. William Ruggles, gentle- 
men whose high scientifflc character insures the utmost accuracy 
in the results. Nor were they confined to these, but were 
" extended to a great variety of Crania," all tending to " show 
that the external dimensions of the skull furnish no indication 
of the amount of brain. The following conclusion is then 
considered inevitable, « that no phrenologist, however experi- 
enced, can, by an inspection of the living head, ascertain whether 
an individual has a skull of one inch, or one eight of an inch in 
thickness ; nor whether he has 56,22 ounces of brain, in 
volume, or only 25,33." 

The fourth enquiry of our author is, « how far it is practicable 
to ascertain the degree of developement of the different parts of 
the brain by measurement, or examination of the living head. 
He here again reminds us, that phrenology and craniology are 
professedly sufficient to enable the experienced phrenologist, to 
judge of the natural amount <mdge?ieral character of the intel- 
lects of individuals from an inspection of their heads. The 
amount of intellect being estimated by the size of the head, 



1837.] An Examination of Phrenology. 37 

while its character is determined by the form? Here again, 
i Anatomy interposes numerous obstacles to the practical phre- 
nologist," only the more important of which he notices. Of 
these, the separation of the internal and external tables, forming 
sinuses is particularly noticed ; and his eighth plate is a view of 
a horizontal section of the skull of an individual, well known 
to the author, who had often remarked his head as eminently 
displaying the external developement of the perceptive faculties. 
" Hiseye was deeply ensconsed under a full projecting brow, and 
the organs of form, size, weight, color, order, number, individu- 
ality and comparison, were uncommonly well developed. His 
locality was uncommon," and our author would, "upon the 
principles of Phrenology, have pronounced him a Rubens in 
painting, a Humboldt in arrangement, and in form, size, and 
weight, a Wren, a Douglas, or a Simpson;" whilst "his 
comparison and individuality would have placed him by the side 
of Dean Swift, and the Earl of Chatham ; and his locality 
represented him as quite equal to Columbus, Newton, Volney, 
and Sir Walter Scott. But most unfortunately for phre- 
nology, as well as for the individual, Prof. S. discovers, as he 
clearly illustrates by the horizontal section of the skull, that 
" the frontal sinuses extend over the organs of individuality, 
form, size, weight, color, locality, order, time and comparison," 
by the separation of the two tables of bone at some parts to the 
extent of an inch, and the cavity thus formed, so capacious as to 
measure one and a half fluid ounces. So that instead of cerebral 
dev elopements, it is most evident that there were depressions. 

Having far transcended the limits which we intended occupy- 
ing; by this article, we regret that we cannot accompany our 
clear and rational author to the end of the second lecture, which 
becomes constantly more and more conclusive, and finally settles 
the matter, by the tests of the stern facts of anatomy, that had the 
depressioriSjinstend of the eminences of the cranium,been declared 
by phrenologists as the evidences of peculiar faculties &c, the 
science would have been at least not less true than it is at present. 
We will conclude this article by a recommendation that all 
who are desirous of knowing truth and avoiding error on this 
subject, if they have not time nor talent, nor opportunity for 
investigating for themselves anatomically ; or even if they have, 



W Royal Academy of Medicine. [Sep* 



that they will read professor Sewall's two lectures, comprized 
in seventy octavo pages. For ourselves, we have ever withheld 
our confidence in the justice of the claims of phrenology, from 
our conviction of its incompatibility with the stern truths of 
anatomy. And we are, since reading Dr. Sewall's book, more 
than ever convinced that there is no more difference between a 
time and a tune bump, than there is between a " wine and a 
brandy bump" — both being about the same thing in cause? 
conditition and consequence. 



Royal Academy of Medicine. 

Session of twenty-third January. Extraction of a tooth 
during magnetic sleep. A Medical Journal had mentioned the 
fact of the extraction of a tooth during a magnetic sleep, in the 
case of a woman twenty-five years of age, feeble and so impressi- 
ble that the least cause produced with her palpitation and synco- 
pe. M. Oudet, a member of the Academy, and who had been 
the operator, was interrogated on the fact. M. Oudet said that 
he had extracted a great molar carious tooth of a woman who 
appeared in a profound sleep ; that the operation had not caused, 
nor seemed to cause any pain : at least she manifested no external 
sign of it ; and, on awaking, appeared astonished at the question, 
whether she had suffered, during the extraction of her tooth ? 
thinking she yet had it. 

The operator, however, declined drawing any deductions from 
the fact which he merely stated. 

This communication provoked, on the part of a great number 
of academicians, energetic protestations against animal magnet- 
ism. — Archives General de Medicine. 

Session of thirty-first January. Amputation of a breast 
during the Magnetic Sleep. M. Jules Cloojuet, whose 
name had been mentioned at the last session with respect to a 
woman from whom he had excised a cancerous breast, during 
the magnetic sleep, repented to the Academy the same details 
which had been before submitted to it. In this woman, there 
existed not only a cancerous mamma, but the axillary glands 
were- found to have become affected. Two incisions, of from nine 
to ten inches in length were made to circumscribe the tumour, 
the vessels were ligatured, and the axillary glands extirpated. 
The operation was long and severe, as great care was necessary 
to protect the axillary artery from injury. The woman did not 
utter the least complaint. M. Cloquet could not observe in the 



1837.] Royal Academy of Medicine 1 1 

expression of her features the slightest trace of emotion. When 
interrogated at different times, she replied that siie did not expe- 
rience any pain. The wound was healing, when in conse- 
quence of a ride that had been recommended by the magnetiser, 
she was seized with, a pain in the side, symptomatic of an effu- 
sion, and died the twenty-eighth dry after the operation. During 
all tliis time, the magnetic sleep had been interrupted but once, 
and was then promptly re-prodi^-.d, the patient having, during 
her state of freedom from the magnetic influence, expressed the 
most intense astonishment at the results of an operation which 
si le had unconsciously undergone. Tl e dressing had been made 
without her knowledge. T.jc ride had occurred while she was 
immersed in sleep ; and, in fine, it may be said with rigorous 
truth, that she died while sleeping. — Ibid. 

Session of fourteenth February. Animal Magnetism. M. 
Berna communicated to the Academy, that he was prepared to 
shew the phenomena of animal magnetism to those who might 
desire to observe them. After some opposition, the Academy 
decided that a committee should be appointed to witness the 
experiments of M. Bern a. This committee will he composed 
of M. M. Bouillaud, Emery, Oudet, Roux, Cloquet, and 
Frederick Dubois. — Ibid, 

Influenza. M. LAPELLETiERde laSarthe, occupyinga dou- 
ble medical capacity, the one at the central Bureau, and the other 
at the Hotel I3ieu, has had an opportunity of observing a great 
number of persons affected with influenza ; the number amount- 
ing in twenty days to one thousand and fifty. Besides the 
occult cause, the epidemic predisposition, he recognises atmosphe 
rical vicissitudes, and particularly cold humidity ,among the causes 
of influenza. The disease, according to him, consists essentially 
in an inflammation of the bronchial mucous membrane, but there 
is a nervous element which distinguishes it ; it is a spasmodic 
bronchitis. Influenza may assume different forms, but the same 
characteristic symptoms may be always easily detected. M. 
Lepelletier does not admit a benign and a malignant influ^ 
enza. In itself, it is always benign, and when serious accidents 
occur, it is in consequence of some complication. In two hun- 
dred cases, M. Lepelletier observed twenty-five complications 
of pneumonia ; two of pleurisy, three of gastro-enteritis, two of 
acute rheumatism, and two of parotiditis. He has seen a 
phthisical patient suffocated by the invasion of the spasmodic 
bronchites, and die in a state of asphyxia. He has made similar 
observations in catarrhal old men. Influenza may also be a 
very serious affection in apoplectic subjects, not only on account 
of the cerebral congestions which the cough provokes, but also 
in consequence of the general proscription of blood-letting. 
6 f 



42 Royal Academy of Medicine. [Sept, 

Pneumonia or pleurisy is the complication that is most frequently 
fatal, especially because venesection does not exert its usually 
beneficial effects. He has found that the plan of Rasori, who 
combines emetics in large doses with sanguine evacuations, is 
the most efficacious. He has also derived advantage in catarrhal 
old men from the administration of the white oxyde of antimony. 
M. Lepelletier has remarked particularly the capacity to resist 
the action of emetics. In eighteen patients, two only vomited. 
M. Louyer Willermay, also regards influenza as a mild 
disease, and has^ derived advantage from the employment of 
venesection where the pulse was full and developed, and the 
respiration oppressed. The duration of the disease does not then 
exceed three days, the blood presents a consistent coagulum and 
sometimes a buffy coat. M. Recamier refers to the epidemic 
of influenza that occurred in 1803, and which was very fatal. 
The progress of the disease was then marked by a cutaneous 
phlegmasia. He regards influenza as a disease of the nature of 
the eruption fevers, and for this opinion he relies not only upon 
the coincidence 'of the cutaneous phlegmasia which character- 
ised the epidemic of 1803, but also upon the totality of the 
symptoms which he has found to be analogous in both cases. 
The catarrh of influenza is,, in reality, similar to that which 
occurs in scarlatina ; if, in 1837, the cutaneous eruption was not 
general, erysipelatous redress was frequently observed, and 
pustules of the lips almost invariably. It is known that even in 
eruptive fevers, the eruption does not always exist, and that the 
nature of the disease is not thereby chano-cd. Besides, this erup- 
tion may be internal, for in 1803 it resided not only in the integ- 
uments, but also in the digestive mucous membrane, and the 
intestinal eruption possessed all the characters of the lesions so 
well described by Roederer and Wagner. Whenever an 
epidemic rages severely, it leaves indelible traces behind it. 
Thus M. Recamier observed, that intestinal eruptions were 
multiplied after the epidemic of 1803. After cholera, are not 
algid symptoms and those of cyanosis observable ') He distin- 
guishes in the phenomena of influenza three principal forms. 
In the first, the (inflammatory form,) the individuals affected 
being generally strong and robust, present a full and resisting 
pulse, the cephalalgia is intense, the respiration, is embarrassed, 
and a sensation of constriction as if by a bar exists at the base of 
the chest. In this form, venesection is indispensable. He has 
repeated it four or fl vo times, and has seen the blood become 
more coagulable in proportion as the evacuation was renewed, 
a character different from what is observed in pleurisy or pneu- 
monia, and which to be peculiar to influenza. In the 
second form (the bilious) the mouth is bitter, the tongue white, 



1837.] Royal Academy of Medicine. 43 

partly covered with mucosities, the pulse without strength or 
resistance, and the morbid action transpires in the digestive 
apparatus. Emetics are here indicated, and their effects are 

immediate. M. IIecamier has seen all the symptoms disappear 
in twentyfour hours alter this medication. Purgatives are much 
less efficacious, which is easily explicable since emetics, besides 
the evacuations which they occasion excite a diaphoresis, the true 
crisis of influenza. The third form is called nervous by M. 
Recamier, the nervous suffering is extreme, the patient enjoys 
no sleep, fugitive pains traverse the extremities and the trunk, the 
pulse is small and depressed, and the agitation considerable. In 
these cases the lancet is absolutely contra-indicated. In this 
form, the disease is very serious, and the patients sink before 
any means can produce reaction. In these cases, the employ- 
ment of baths has been most successful in his practice. M. 
Piorry admits two phases in the epidemic ; he has seen the 
pulmonary phlegmasia extend more and more profoundly, and 
being confined at first to the first broncheal divisions, it reaches 
in the end their ultimate ramifications. M. Piorry has employ- 
ed, but without success, emetics in large doses, in those cases 
complicated by pneumonia which he has particularly observed 
in old men. 

The loss of blood, even when practised copiously and at short 
intervals, was not more successful. M. Bouillaud without 
rejecting the idea of a special epidemic cause, finds in the exist- 
ing condition of the atmosphere a sufficient explanation for the 
disease and its propagation. He does not deny that epidemics 
impress their character upon all the intercurrent diseases ; but 
this opinion, however, has been exaggerated. He has not yet 
seen a sufficient number of cases to authorize him in pronounc- 
ing an opinion upon the nature of the pneumonia which is 
developed in influenza ; but he is in the possession of some facts 
which tend to prove that venesection repeated after his method 
must be equally successful in pneumonia attendant upon influ- 
enza, and in the more uncomplicated pneumonia. M. Bouil- 
laud cites especially the case of a physician of sixty ei 
years, in whom venesection repeated at short intervals, caused 
the very rapid disappearance of the mischiefs of a very serious 
pneumonia. He confesses, however, that since the invasion of 
the epidemic, more deaths have occurred. in his wards, than had 
taken place in the preceding eight months. — Archives Gen 
de Medicine, for Feb. 1837. 

Spontaneous perforation of the left Ventricle of thi 
Autopsy by M. Medic j, professor of physioloay in the Un 
sity of Bologna. A saddler, aged sixty, of a good constitution, 
robust, and enjoying habitual good health, was admitted April 



44 Royal Academy of Medicine. [Sept* 

21, 1830, into the hospital of Bologna, to be treated lor hemiple- 
gia of the leftside. Energetic contra-stimulating remedies such 
as copious sanguine depletions, drastic purgatives, alcoholic, 
extract of mix vomica, (from a quarter of a grain to five granis 
per diem,) antiphlogistic enemata were employed, but with very- 
little advantage ; the half of the body remained paralyzed ; the 
entire head turned toward <>ne side, speech embarrassed, &c. 
Dr. Baccialli, who replaced M. Medici, seeing the inutility 
of this medication, employed ammoniacum internally and ex- 
ternally, blisters and moxas between the shoulders, but the 
patient grew worse and worse. The 31st December, 1831, it 
was necessary to have recourse to the lancet, and the next day 
the patient was seized with an intense precordial pain, and upon 
the ensuing day, he died in a state of general debility without 
agitation. — Autopsy. — 1st. In the cranium, a pound of sanguino- 
lent serosity between the dura mater and the right lobe of the 
cerebrum ; the cerebral vessels were turgescent and full of bloody 
the pulp of the same lobe very red anteriorly, yellowish, almost 
diffluent, and without circumvolutions for the extent of half a 
dollar. 2d. In the thorax, the pericardium was distended like a 
bladder filled with urine, it was transparent and through its 
substance a red liquid was discernible ; when opened, this liquid 
was found to be composed of sirum and fibrine, mixed together 
to the quantity of three pounds. The walls of the sac presented 
no appreciable lesion. In the midst of this fluid was seen the 
heart, whose volume, structure, figure, and color presented 
nothing anormal. At its anterior and middle part, however, was 
observed a spot of a reddish colour, and in the centre of which 
existed a small hole, through which a .probe and afterwards a 
writing quill were freely passed into the left ventricular cavity 
by a pretty long passage. This passage was smooth and red. 
The left ventricle was health I y throughout, with the exception 
of its inferior part towards the point which presented a red colour, 
like that, of the pomegranate. The other parts of the heart were 
perfectly healthy. No softening, no ulceration or appreciable 
lesion, except the perforation. — Annali Universali di Medic'ma 
{Gazette Medicate.) 

After the exposition of the details of these interesting facts, 
the learned physiologist of Bologna searched for ibe cause of 
such a terion of the heart; but not finding it in the details, nor 
in the traumatic cause, nor in remollisscmcnt, nor in ulceration, 
he is obliged to declare that in the actual state of our knowledge, 
the lesion he has discribed remains unexplained. The coinci- 
dence, nevertheless, of the disease of the brain, and thelingcring 
death of the subject, renders the observation worthy of the 
consideration of the physiologist. — Gazette Medicate. 



y$7.1 Animal Magnetism. 45 



Animal Magnetism. 



6 



The evidence in favor of animal magnetism accumulates on 
all hands. Events which have lately transpired in a neighbor- 
ing city, leave to ridicule no excuse to amuse herself with facts, 
which reason cannot comprehend. The question is now, not 
how to change the laws which govern human belief, but to show 
how these surprising phenomena do not contravene anything 
heretorforc known of the functions of the brain and nervous 
system ; — a necessity the more imperious, since, if the obsolete 
notions that the soul leaves the body and wanders through the 
earth, as in the Stygian shades, be revived, as there is reason to 
fear from the tenor of some articles in the periodical press, it is im- 
possible to foresee what may be the consequences, even in th 
enlightened age, to the very constitution of civil society. 

With the hope of removing the grounds of such an assump- 
tion, and, in some degree, of obviating other difficulties con- 
nected with this subject, the subjoined observations are offered. 
Whoever is disposed to examine them attentively, though he 
may think that a simpler and less abstruse method might be ta- 
ken to account for the phenomena, will admit, it is believed, both 
that the conclusion follows directly from the premises, while the 
premises are the least exceptionable of any that can be adopted. 

Supposing the nervous system to be the chief medium of a 
subtle and elastic fluid, to which it maintains a relation analogous 
to that which obtains between glass or any transparent medium 
and light, regulating its vibrations, the white substance serving 
as a conductor, and the grey and white together serving as an 
excitor, when stimulated by the blood, all the phenomena of the 
mind, as external sensations, internal ideas, and volitions, maybe 
as readily conceived to be attended with an undulatory motion 
in that fluid, as any other state of the brain. This ethereal fluid 
would -then constitute the mind or soul, the brain being in all 
animals but the material condition necessary for its manifesta- 
tion. The existence of such a fluid has been rendered almost 
certain by the experiments of physiologists. But I hope it will 
not be considered out of place to add here a few considerations, 
which appear to me new, and strongly confirmatory of the 
hypothesis. 

When we observe the image formed upon the retina by an 
outward object, we are led to'infer that the image, thus painted 
has some connection with the impression produced on the mind ; 
but the inversion of the image overturns the hypothesis. When 
we compare the eye of the eagle with the eye of man, in order to 
discover on what depends the superiority of vision of the first, 



46 Animal Magnetism. [Sept* 



we perceive no essential difference, except that its retina consisJ 
of a number of folds or lamellae, giving it a great extent of surface 
compared with man's. Nor can we imagine a reason for this 
structure, on the supposition of the image impressed on the retina 
being the cause of the sensation or perception of the outwaid 
object. But when we take into view the wonderful effects pro- 
duced by the galvanic machine, owing simply to extent of 
surface (supposed to enable it to accumulate a great quantity of 
fluid,) by supposing a similar fluid to accumulate on the retina, 
the harmony between the structure and function of the part is 
evident. One class of philosophers say that the mind is in pro- 
portion to the size of the brain ; another, that it is in proportion 
to the number and depth of its convolutions. Both assertions 
coincide with the opinion that it corresponds with the extent of 
its superfices.* 

It is an established fact, that the nervous chords of sensation 
and volution increase in size in proportion to the function they 
have to perform in different animals, and in different parts of 
the same animal. The brain, the organ of thought, is larger in 
man in proportion to the nerves that issue from it, than in any 
other animal. The optic nerve is the largest in the human 
body, and has the greatest number of filamentous threads. Man 
is the most thinking animal, and vision is the highest and most 
intellectual of the senses. Whatever sense is most acute, its 
nerve is largest. Where muscular action is strongest, and often- 
est called into exercise, there the muscular nerves are largest. 
Mow a small nerve might transmit an idea, sensation, or volition, 
as well as a large one, for anything that we can see to the con- 
trary ; but when we see an electro-magnet increase in power 
according to the number of wires that are wound around it (fac 
similes of nervous filaments,) and arc told by the natural phi- 
losopher that they serve to accumulate the fluid, the adaptation 
for a similar structure in the nerves, to transmit a similar fluid, 
is obvious. 

Should we infer that this was the true function of the nervous 
tissue, our inference would be confirmed by the fact, that the 
powers of the mind, of sensation, and muscular action, are 
strengthened by being tasked, as the strength of the magnet 
increases by having weights attached to it. This fluid may also 
vary in density, as well as quantity; or the number of particles 
within a given space may increase, as well as the extent of 



* Some assert that, the grey matter is the matrix or generator of the white ; 
others, that it is I . the mind ; hut has not the attachment hetween the 

two its analogy in the copper and zinc plate of the gaWanic battery; and may not 

the extent of the superfices be for the purpose of exciting a great amount of fluid? 



1837.] Animal Magnetism. 47 



surface, giving rise to an accumulation of the fluid of the same 
density ; and if so, the phenomena would correspond with the 
effects of what is called, in electricity and galvanism, increased 
intensity and increased quantity. What can be a more striking 
evidence of the circulation of a fluid, which, if its existence 
were presumed, would be invisible, than the state of Somnam- 
bulism affords ? Here, one set of nerves act with unwonted 
energy, while another is almost as inert as dead matter. 

Believing, from such an accumulation of evidence, that we 
are justified in assuming this hypothesis as a ground work of 
reasoning, I would now proceed to show how far it is necessary 
to presuppose the existence of an analogous fluid without, and 
will first refer to the following paragraphs from Brewster's work 
on Optics. 

" In the undulatory theory, an exceedingly thin and elastic 
medium, called ether, is supposed to fill all space, and to occupy 
the intervals between the particles of all material bodies. The 
ether must be so extremely rare as to present no appreciable 
resistance to the planetary bodies which move freely through it. 

" The particles of this ether are, like those of air, capable of 
being put into vibrations by the agitation of the particles of 
matter, so that waves or vibrations can be propagated through 
it in all directions. Within refracting media it is less elastic 
than in vacuo, and its elasticity is less in proportion to the refrac- 
tive power of the body. 

" When any vibrations or undulations are propagated through 
this ether, and reach the nerves of the retina, they excite the 
sensation of light, in the same manner as the sensation of sound 
is excited in the nerves of the ear by the undulations of the air. 

" Differences of color are supposed to arise from differences in 
the frequency of the ethereal vibrations. * * * 

" The theory of undulations has made great progress in mo- 
dern times, and derives such powerful support from an extensive 
class of phenomena, that it has been received by many of our 
most distinguished philosophers." 

Every step made in the progress of science tends farther to 
generalize the laws which regulate the motions and affections of 
matter. Gravitation, electricity, magnetism, light, heat, chemical 
attraction, have approximated so far towards unity, that it is 
easier to say in what they resemble each other, than to point out 
in what they differ. Laplace demands but a plastic ether to 
mould the nebulous matter, floating through space, into all the 
conditions which his Celestial Mechanics require for their appli- 
cation ; while Lamarck and Sir Humphrey Davy, by a simi- 
lar agency, people the earth with all the forms of animate and 
inanimate matter. 



48 



Animal Magnetism. 



[Sept, 



The number of undulations of an elastic medium, or of 
different elastic media impinging on each other, in a given time, 
increases in proportion to the density of the medium ; in the same 
proportion, the extent of each undulation diminishes. If the 
undulations of a fluid in immediate contact with the retina, of 
which 37,640 occur in the space of an inch, and 458,000000,- 
000000, occur in a -second of time,* create the sensation of 
redness, the density of the undulating fluid without the eye may 
diminish indefinitely, so long as that within increases in the 
same ratio, and the same number of undulations be made by the 
one medium impinging on the other, and consequently the same 
sensation be excited. What is true of one is true of all other 
sensations. 

Now if we suppose thatetheral fluid, which Newton thought 
the cause of gravitation, to be identical with that which Huygens 
thought the cause of light, it must act through opaque as well 
as transparent bodies ; but as its density is less in opaque bodies^ 
or its undulatory power weakened, the reason why it exhibits 
the phenomena of light in one case, and the phenomena of weight 
in another, would be, because the number of undulations in a 

*The following table given by Mr. Herschel, contpms the principal data of the 
undulatory theory. 



Colors of the Spectrum, 


Lengths of an Undu- 
lation in parts of an 
inch in Air. 


Number of 
Undulations 
in an Inch. 


Number of undulations in a 
Second.t 


Extreme Red - - - 


0.0000266 


37040 


458,000000,000000 


Red 


0.0000256 


39180 


477,0000011.000000 


Intermediate - - - 


0.0000246 


40720 


495.000000,000000 


Orange ».--■- 


0.0000240 


41G10 


506,000000,000000 


Intermediate - - - 


0.0000235 


42510 


517.000000.000000 


Yellow - - - - 


0.0000227 


44000 


535,000000,000000 


Intermediate - - - 


0.0000219 


45600 


555,000000.000000 


Green 


0.0000211 


47460 


577,000000.000000 


Intermediate - - - 


0.0000203 


49320 


600.000000.000000 


Blue 


0.0000196 


51110 


622,000000,000000 


Intermediate - - - 


0.0000189 


52910 


611,000000,000000 


Indigo ----- 


0.0000185 


54070 


658.000000.000000 


Intermediate - - - 


0.0000181 


55240 


672,000000,000000 


Violet 


0.0000174 


57490 


699, 000000.000000 


Extreme Violet - - 


0.00001 G7 


59750 


727.000000,000000 



"From tliirf table," says Mr. Herschel, "we see that the sensibility of the eye is 
confined within much narrower limits than that of the car; the ratio of the extreme 
vibrations being nearly 1.58 : 1, and therefore less than an octave, and about equal 
to a minor sixth. Tnat man should be able to measure with certainty such minute 
portions of space and time, is not a little wonderful ; for it may be observed what- 
ever theory of light we adopt, these periods and these spaces have a real existence, 
being in fact deduced by Newton from direct measurements, and involving nothing 
hypothetical but the names here given them. — Brewster's Optics, page 119. 

tTokingJthe velocity of light at 192,000 miles per second. 



1837.] Animal Magnetism. 49 

given time were fewer in the latter, than in the former instance. 
But admitting a fluid to occupy the interstices between the par- 
ticles of the retina, or to cover its surface, on which the ether 
impinges in its vibrations, giving rise to a second series of vibra- 
tions on which the sensation immediately depends ; if its density 
be increased (as we believe takes place in somnambulism), the 
number of vibrations, as we have seen, will be increased in the 
same ratio, and there is no inconsistency in supposing that the 
slow undulatory motion of gravitation without, may produce 
that precise number of vibrations within, which excites the sen- 
sation of redness, or any other sensation. Since, then, gravita- 
tion extends from Boston to Providence, with a power (like the 
law of illumination) inversely as the square of 40 miles, when 
it is asserted that a somnambulist in the latter place has the 
panorama of our city before her, and can direct her attention to 
any part she chooses, and describe it minutely, the fact may be 
explained by combining two theories, which, if not established, 
are at least regarded as the most plausible in physics and phys- 
iology, viz. : that which assigns light and gravitation to the undula- 
tions of a fluid pervading all space, and all matter, and that which 
supposes a similar fluid to circulate in the nervous system of ani- 
mals. For by the nature of the fluid without, its undulatory power 
must be diminished, by diminished density, or what has the same 
effect, by the irregular collocation of the particles of opaque mat- 
ter, requiring, to produce the phenomena of light that increased 
density and consequent vibratory power of the fluid within, 
which all the appearances in the state of somnambulism compel us 
to believe actually exist. It does violence to no established law, 
but to our preconceived notions. And it is necessary that either 
our preconceived notions should give way, or a mass of evidence 
be rejected, the most positive and authentic in kind, and con- 
stantly accumulating in degree. 

It should be borne in mind, that animal magnetism is not the 
only subject that is inexplicable on the common notions of the 
animal economy. An extensive variety of facts, linked togeth- 
er under the terms of sympathy, of fascination, of antipathy, of 
irritation and counter-irritation, concerning which there is little 
or no doubt of their authenticity, point to the nervous system as 
the source of some unrevealed mode of affection. Nor should 
hereditary predisposition be overlooked in this connection ; nor 
even the question of embryotic influences, against which the on- 
ly substantial argument is our own ideas how Nature ought to 
demean herself in our presence, rather than the careful and 
humble observation of what she does. These words are but gen- 
eral terms, and, like the term inflammation, are expressive of 
something that lies deeper. As they are now used, they con- 
7 G 



50 Animal Magnetism. [Sept. 

vey no more real knowledge than do the names of the genera 
of plants, of their properties. If we could forget these terms, 
when reasoning about the conditions to which they refer, and 
imagine the nervous chords to circulate a fluid, for which their 
structure is as strikingly adapted as the vascular to circulate 
blood, we could lose nothing of what we already know, and 
might, possibly, learn something additional. 

Will the adoption of the electro-galvanic fluid explain these 
mysteries ? To assert that it will, unerringly and immediately, 
would perhaps ht*ve no other effect than to expose one to ridicule. 
The reasoning on which such an hypothesis must rest, is very 
complex in its nature. Facts are abundant, but their relations 
are intricate. Every argument must be grounded not on cer- 
tainty, but on the greater probability. And at first, it will be 
next to impossible to make due allowance for disturbing causes j 
still, an approximation may be made towards estimating its bear- 
ing on most, if not all of the functions of the animal economy. 
The heterogeneous mass of facts, which physiological experi- 
ments as well as pathology, have of late years brought to light, 
can be simplified and reduced to some sort of order, if not ac- 
tually reconciled, by this view. At present they are a " caput 
mortuum" serving no other purpose than to perplex and dis 
gust the student. Nor is he taught to regard them with a clearer 
or more favorable eye, by the disputes and not unfrequent recri- 
minations of different professors of the healing art. even in the 
same college. What can afford greater evidence of the want of 
a more comprehensive hypothesis as a guide to their researches? 

A great deal of ink has been shed to prove the danger of theory 
getting a-head of fact ; but comparatively little, to exhibit the 
evil of facts getting a-head of theory. And if, by hasty general- 
ization, science sometimes gels along too fast, can she not, from 
want of it, creep at too slow a rate? Let the speculations about 
ghosts, hobgoblins, witchcraft, disembodied spirits, and devils at 
six and sevens, which somnambulism is calculated to revive, 
if its phenomena cannot be referred to natural laws, answer this 
question. 

I cannot enlarge on these points. At some future time I may 
advance some reasons, why what is called the manipulatory pro- 
cess of magnetization is neither inconsistent with sound philoso- 
phy, nor without its analogy in other sciences. Before closing 
this communication, I would, however, add, that though what 
lias been said above presupposes the fluid to exist in the nerves 
only, it is not necessarily confined to that part of the system. It 
exists in all the solids and fluids of the body, the nervous sus- 
taining to the other tissues some such relation as the prime con- 
ductor to bodies around it, or as transparent to opaque bodies in 



1837.] Animal Magnetism. 51 

optics, — a medium for greater density of fluid, and greater free- 
dom of motion, — and the fluid itself may, like the cellular ti 
represent the image of the whole body: and oscillating from 
within outwards, and from without inwards (obeying in these 
motions, the laws which in crystals regulate reflection, refrac- 
tion &c. producing so many interresting phenomena,) may thus 
be the secondary agent, in the hands of the Creator, of the form 
of our bodies and bodily organs, as well as of the functions of 
the mind. On this hypothesis the equilibrum of fluids explains 
those experiments of Magendie, in which the crura of the cere- 
brum being cut, the animal moves forwards ; the crura of the 
cerebellum, backwards ; and the section of either one of them 
gives a tendency to a latteral motion. It may serve also to re- 
concile the views of Bell and Magendie on the one hand, and 
Bellingeri on the other, in regard to the function of the anterior 
and posterior of the spinal marrow. It accounts for the curvili- 
near course of the fibres of the brain, in the mutual action of 
counter-currents, and for the pons varolii, septum lucidum, for- 
nix, mamillary eminences, the decussation of nerves ; assigns a 
better reason for the ganglion of the posterior chord of the spinal 
nerves, than any hitherto given ; and taking the beautiful curves 
exhibited in crystals by polarized light as the analogical starting 
point, it tells why organized beings are rounded in form, instead 
of angular. In tetanus, palsy, catalepsy, and every variety of 
nervous disease, it will be found to go far towards explaining 
what heretofore has been considered inexplicable. Any one, at 
his liesurc, can verify these stal -. It is sufficient here to 

give them without tracing each individual fact to its relation with 
this hypothesis. But lest it might seem, at first view, that these 
are mere assertions, made without due examination, I will dwell 
for a moment on one, which both on account of its intrinsic 
beauty and because it occurred to the writer as an after-thought, 
may be considered almost as a crucial experiment of the whole 
theory. 

This fluid, it is supposed, by its undulations to and fro, and 
by its currents and counter-currents, moving through the parti- 
cles of organized matter, and exerting an attraction or exciting 
movement among them, disposes them in the forms of our bodily 
organs. Now let us imao-ine, after the optic bed i and corpora 
striata have been formed, two currents passing horizontally from 
the sides of the brain towards the centre, on the under surface 
of the corpus collusum; they would meet at the centre, and 
be deflected perpendicularly down ward, in the direction of the 
septum lucidum. Meeting with a repulsive surface on the optic 
beds, the fluid would there accumulate for a moment, from the 
fornix, fringing its edge by its vacillations against a counter- re- 



52 Animal Magnetism. [Sept, 

pelling fluid, with the fimbriated bodies, and be impelled as it 
were, most easily in the direction of its four crura. Passing 
down its anterior crura, and (ailing perpendicular upon another 
part of the fluid more dense, it would by undulating upwards 
and downwards, make a cupped depression, which would serve 
as a mould for the mamillary eminences. An idea of this mould 
one may have by blowing perpendicularly upon the surface of a 
fluid through a small orifice. In like manner the formation of 
the pineal gland, the infundibulum, the pons varolii, and the con- 
volutions themselves, may be traced with almost mathematical 
certainty. 

It is usual for the person who advances a hypothesis, to give 
his name in connection therewith. But as the publishing of 
my name would add nothing to the weight of the arguments 
which have been presented, I hope will not prevent their ob- 
taining a hearing. A systematic form will be given to the views 
which are here but indicated, as soon as time and circumstances 
will permit. In the meanwhile, at the expense of being re» 
gardetl as a visionary and enthusiast. I commit them to the can- 
did consideration of the medical public, with a firm conviction 
that while the art of medicine progresses uniformly, but slowly, 
by a rational empiricism, the science itself will be revolution- 
ized, and re-constructed on the basis of these hitherto disregarded 
phenomena : nay, more, that they will furnish a key to unlock 
the inmost recess of the labyrinth of nature, and unfold the rich- 
est field for scientific research that the mind of man has ever ven- 
tured to explore, — the one which is destined to lead him to a 
just estimate of his rank in the scale of being, and of his rela- 
tions to all things around him, and which will enable him to 
unloose the seals of the last volume of the series of Natural 
Religion, and read therein that Himself and the Polypus the Crys- 
tal and the Lily, the Earth and Chaos, the Stellar Heavens and 
the Nebulous Mass, are but links in one undivided chain of for- 
mation and casuation, of which the different physical sciences 
are but the names of its integral parts. — Boston Medical and 
Surgical Journal. 



1837.] Nitrate of Silver. 53 



PART III. 
MONTHLY PERISCOPE. 



Nitrate of Silver. 



This article which has been hitherto considered as belonging 
chiefly to the surgical pharmacopoeia has, of late been placed be- 
fore the public as a therapeutic agent claiming the particular 
attention of the general practitioner. 

Dr. Boudin has lately called the attention of the profession 
to it as an antiphlogistic of valuable powers in inflammation 
generally, and more particularly that of the mucous membranes 
He has also adopted its use with decided advantage in an 
:mic fever of typhus character with follicular enteritis. Of 
• ? of fifty patients treated by this medicine, only two died, 
a^> ■( i indeed. He considers that two important points 

have been established by post mortem examinations of these 
two fatal cases, viz. that the medicine did not add any irritation 
to the inflammatory action of the disease, but had promoted the 
cicatrization of the ulcers : and that on being administered by in- 
jections (which are generally considered as not passing beyond 
the ilio-caseal valve,) communicating its grey color to the lower 
portion of the ill in m. 

The formulae used by Dr. Botjdin was 3 or 4 grs. of the 
crystallized salt dissolved in 5 vi. of distilled water and admin- 
istered by injection : or crystallized nitrate of silver grs. vj. 
water q. s. dissolve and saturate with gum tragacanth, or starch, 
and make 24 pills. Dose 1 every half hour. 

He considers it a common error to suppose that the action of 
nitrate of silver is confined to the part with which it is in con- 
tact, inasmuch as the same greyish color which was produced, 
as its proper and ordinary effect in the large intestines with which 
it was in contact was also observable above the ilio-caecal valve, 
in the lower part of the illium. 



54 Nitrate of Silver. [Sept 



It is not less our pleasure than it is our duty to state thus the 
valuable results of Dr. B's. experience with this medicine, as of 
great importance in a certain kind and stage of action, with 
which the practitioner occasionally meets, and who has been com- 
pelled to trust in the virtues of means far more doubtful. 

Nor is it less our duty to object to the principle which appears 
to be claimed for the action of this valuable agent. Dr. Bou- 
din it will be recollected, speaks of and testifies to the remedi- 
al powers of nitrate of silver in " inflammation in general;" 
thereby making it truly and decidedly antiphlogistic, or capa- 
ble in small quantities, of weakening the system by diminishing 
the action of the vital powers. A misnomer in medicine is often 
productive of consequences over which humanity weeps. We 
could name some melancholy instances : but we will illustrate 
by a supposed example. 

Had Dr. B. prescribed arsnic tinder the belief that it was a 
febrifuge from its having the power of preventing the return of 
aparyoxism, under circumstanhes which needed an emetic or a 
bilious purgative, lie would have found his prescription fol- 
lowed by a continuance, or increase of febrile symptoms, or 
viscual obstruction, or hydropic disposition, or both — thereby 
proving at the expense of his patient, that he used a tonic when 
an operative portion was needed. 

Not less important is a misnomer in pathology. The exis- 
tence of idiopathic fever is denied, and a general febrile action 
called '-sympathetic fever,"' originating in lecal irritation of the 
stomach or intestines or both, is advanced as the true pa- 
thology of fever. The term gastritis^ or enteritis^ or g 
tro-enlcritis is therefore given to it — words which mean a 
phlegmonous inflammation in those parts. These names then 
as used of late in pathology make up the very Language which 
declares pathological truth. What are the unavoidable conse- 
quences of a fair reasoning from the premises thus settled? As 
surely as anyjusl conclusions can be drawn by fan ing, 

they are, nol only the careful and rigid avoidance of every effi- 
cient medicine, on account of the apprehension of increasing by 
it.> use, the gastric or enteritic inflammation; but a total neg- 
lect, of the secretions, in I lie expectation that on withholding 
from the pan, irritants of all descriptions, the inflammation will 



1837.] Nitrate of Silver. 55 

subside. Here, a word, as gastritis for instance, which means 
an inflammation of the stomach — neither more nor less. — char- 
acterized by symptoms of " pyrexia, anxiety, heat and pain in 
the epigastrium, increased when any thing is taken into it, vom- 
iting, hiccup, pulse small and hard, and prostration of strength, 
&c."' is used to mean an ordinary pyrexia, without any specific 
characters whatever : and which, when produced, exists for a 
few hours only, and then intermits so completely that the most 
powerful stimulants and tonics are comfortably borne in the sto- 
mach until the regular period of return arrives ; — a character 
perfectly incompatible with the term gastritis. Such is, in 
few words, the origin, and the sum and substance of ezpec l ant- 
ism: and who can calculate the vast extent of mischief thus ef- 
fected by the wide-spread and captivating doctrine of 'local origin ! 

Not less liable is a misnomer in therapeutics to lead to the 
most injurious prescriptions. We are satisfied of the fact, that 
the medicine under consideration is not, properly speaking, a 
sedative, or refrigerant power, — that is to say, it is not one of 
those very few active powers whose operation is to weaken the 
actions of the system by diminishing the activity of the vital 
powers. Most of the antiphlogistic means at the command of 
the practitioner are the withholding or withdrawing of the active 
powers. Yet there is good reason to believe in the existence of 
a few known powers which tend directly to the reduction of 
action, as prussic acid, laurel water, and (perhaps) antimonials 
&c. But all the phenomena of its operation on the living fibre 
from its severest cauterization, down to its valuable efficacy in a 
collyrium, tend to prove that nitrate of silver is uniformly an 
astringent or styptic power, being in common with others of the 
same class rendered corrosive when in a concentrated form. 

In its prescription, therefore, we should be careful to determine 
that state of the disease in which we may reasonably expect 
good effects from styptic, and not confound it with that which 
needs ' : antiphlogistic" operation. These states are extremely 
different ; the latter being the earlier, and the former the latter 
stage of the same disease, the remedial means must therefore be 
adapted to each with as distinct decision. 

We do not believe in the gastric or enteritic origin of ordinary 



56 Nitrate of Silver. [Sept, 

pyrexiae. Nor do we believe in the existence of a genuine gas- 
tritis or enteritis at all in ordinary pyrexiae, only as being them- 
selves symptomatic or secondary. We do believe that these 
inflammations can indeed exist primarily, from various causes, 
as the impression of cold, worms, chemical and mechanical vio- 
lence, as from worms, indigestibles, concentrated acids, alcoholic 
drinks, large doses of acrid, irritating medicines, as nit. potass. 
&c. &c, and that, these occuring in conjunction with suitable 
predisposition, may, and do involve the general system in febrile 
action. But when these do exist, their course is steadily, and 
often rapidly onward, in the true character of inflammation, 
until they arrive at some one of the various terminations of that 
kind of disordered action, without the least tendency to intermit 
or remit, more than a pleuresy or a pneumony uncomplicated 
with any degree of bilious character ; nor are they found, in a 
large proportion of instances, amenable to the most rigorous 
antiphlogistic treatment. 

Autopsy does, indeed, reveal much valuable truth — truth 
which should not, must not be disregarded ; but its develope- 
ments require to be reasoned on. When we find ulcerations in 
the mucous membrane of these, they do declare their antecedent 
or cause, inflammation, to have existed; but if these ulcera- 
tions are at the follicles they do declare an inflammation of these 
follicles, or follicular enteritis to have existed. This, then, is 
peculiar — not in the character of ordinary or genuine gastritis 
or enteritis, which extends itself with regular continuity to a 
greater or less extent of surface, and which may, indeed, be said 
to " radiate" from a beginning point in many instances, and 
extend over a considerable surface. Who ever saw the intes- 
tines of one who died from injuries inflicted on them by worms, 
but observed a regular and uninterrupted extension of inflamma- 
tion up and down the canal from each eschar. So it is with 
enteritis from other causes, as cold or any thing calculated to 
act on a greater extent of surface. But it is not so with the 
inflammation which is commonly the result of pyrexiae. This 
is follicular and the effect of other derangements of the system. 
One, then, is comparatively general, whilst the other is local, 
confined to the glands of the intestines. But both have their 



1837.] Hahnemannism and Thomsonianism. 57 

action and their declining or decreasing state of action as dis 
tinctly as conjunctivitis ; and who thinks of applying alum 
curd, or diluted alcohol, or solutions of the vitriols, or of nitrate 
of silver to this membrane in the early stage of an active inflam- 
mation ? Yet if we could be made to believe that cayenne is 
truly an antiphlogistic or a simple dimulcent, surely we should 
not hesitate to apply it. But in the subsequent stage, when the 
vessels are debilitated by the continuance of excessive action, 
and resolution is succeeding, or even passive congestion remain- 
ing, a styptic power, as some of those just named, is fonnd to 
greatly accelerate the cure. And if ulceration shall have super- 
vened, and remains chronic, from that debility of the part which 
is consequent to active inflammation, the same kind of power 
exerted on the part will tend greatly to the lessening of that 
deposition in the part whereby the ulceration is kept up. Hence, 
the use of catechu, kino, kreosote, and other astringent powers 
and hence the ulcers in Dr. B.'s two cases, which terminated 
fatally, were progressing to cicatrization under the application 
of nitrate of silver. 

Thus it seems evident that the nitrate of silver is not antiphlo- 
gistic, but phlogistic in its action, and that, as such, it is only 
admissible in that state of action which is benefitted by stimula- 
tion or styptic operation. 



Hahnemannism and Thomsonianism. 

In a late number of this work, we alluded to a recent meeting 
of the London Medical Society, at which a discussion took place 
on Dr. Uwin's paper in favor of the " homoeopathic doctrines." 
We now give below, the statements of Drs. Ure aud Addison: 

Dr. Ure had seen the practice of Hahnemannism in Germa- 
ny, at the very fountain-head of the "art," and it was not 
successful even there. The doctrine of " similia similibus 
curenlur" was almost as old as the hills. . Theophrastus was its 
advocate, but it fell into oblivion, and was only revived by 
Hahnemann, whose disciples blazoned abroad their "cures," but 
kept secret the deaths which occurred in their practice. Prince 
Frederick of Swartzenburgh.died under the care of Hahnemann 
though the " new light" gentleman said that his highness was 
8h 



58 Hahnemannism and Tkomsonianism. [Sept, 

guided to his last home by the allopathists. An old lady also 
died under^this treatment, in whom the globule of medicine was 
found in a carious tooth, which circumstance was considered to 
afford a reason for her death, the salvatory medicine not having 
reached the stomach. He thought that one point in the practice 
of Hahnemann had been overlooked — the rigid enforcement of 
diet. To many articles he strongly objected. Coffee was one 
which, in particular, he anathematized, asserting that Napo- 
leon and Byron both fell victims to the use of that beve- 
rage. 

Dr. Addison would not consent to argue on a subject which 
was so utterly beneath notice, but wished the world to know in 
what estimation that society held the practice of Hahnemann — 
that its followers were either fit for lunatic assy lums, or practised 
with the most sordid motives. He ( Dr. A.) was a very loyal 
man, and had always been so ; but he could not help saying 
he considered that the profession of this country had been gross- 
ly insulted in the highest quarters, by the preference there shown 
to the employers of this foreign mystery. Did the court ever 
send for lawyers who dealt out the law in Algebraic fractions, or 
bishops who preached by the square root? He did not mean to 
say that the blame was to be ascribed to the royol persons them- 
selves who set this example in medicine; but those who were 
about them deserved the severest censure, for aiding and abet- 
ting Hahnemannism in the palace. — [Boston Medical and Sur- 
gical Journal.) 

Hitherto we have said very little on this subject, 1st, because 
we had nothing good to say ; and 2ndly, because it seemed unne- 
cessary to say any thing bad or indifferent concerning such 
Utopian, not to say absurd notions ; for we would not dignify 
such stuff with the name of doctrines. But when such men as 
Dr. Uwins present to the London Medical Society a paper in 
favor of Homeopathy, and it is made a subject of serious discus- 
sion by such men as Drs. Ure and Addison, it is time to take 
sides on this subject ; for the London society is not without its 
influence. It is true that in the discussion, Drs. Ure and Addi- 
son gave the subject a good share of justice. But (en passant,) 
by our credulity we are forced to enquire if this Dr. David 
Uwins isthe same Dr. David Uwins who but the other year 
(1825) published a very sensible "compendium of theoretical 
and practical medicine ; comprising with the symptoms, diagno- 
ses, prognoses and treatment of diseases, a general review of phy- 



L837.1 Hahnemannism and Thomsoniauism. 59 



siology and pathology," <fcc. &c. If tie be, as we are inclined to 
believe, it may not be forgotten that he then declared that no one 
qpnld be more sensible of the respective merits of such authors, 
as Good, Gregory, Temple, and Thomas, than himself. He 
then spoke of each in terms of ample justice, saying of Dr. 
Gregory's Elements, " it is impossible to speak with undue 
praise" — of Dr. Temple's practice of Physic, it "has too long 
enjoyed a high reputation to need any enconium from my pen," 
&c. 

The principle claimed by Hahnemann is indeed, as Dr. Ure 
very correctly observed, " almost as old as the hills." Traces 
of it, have, in all times been found amongst practitioners as well 
as the common people. Our own observation' on this subject 
does not, however, go farther back than the last of the eighteenth 
century. The medical maxim then, was " the hair of the same 
dog is good for the bite." So strong, indeed, was the faith of 
the country people in its truth, that we have known great pains 
taken to procure the hair of the same dog ; and in some instances, 
the dog was killed when it could not be otherwise obtained. 
Even at different times in the present century, we have, on being 
called to wounds from a dog-bite, found them dressed with the 
hair of the same animal which had inflicted the wound. This 
has always seemed to us a relic of the days of the seventeenth 
century, when the wife of Wm. Hihbins was hung in Rhode 
Island for a witch. 

We have met, in later years with some (otherwise) respectable 
practitioners, whose fixed principle as far as they found it prac- 
ticable to carry it out, was "like for like," in all cases; as 
miotics always for the cure of miosis, cathartics tor catharsis 
bleeding lor haemorrhage, &c. &C. This was very good, "simi- 
liashiiilibus curantur" stuff, as to the kind of remedy. 

As to the discovery of the virtue of the inifinitissimal doses 
of the medicines this class of practitioners use, we have not the 
least objection, either on our own behalf, or that of any of our 
friends to leave the whole of its glory to Hahnemann, or any 
of his followers, now and forever. We can bear no testimony 
nearer disproving his claim thereto, than the occasional observa- 
tion in our early days, of pebble soup, for the cure of certain 



60 Hahnemannism and Thomsonianism. [Sept, 

diseases — a preparation, the formula for which was to collect a 
few white pebbles, wash them very clean, and boil them a certain 
length of time in pure spring water. The history of medicine, 
however, affords us some very near approximations to the imfin- 
itissimal doses, as in the ancient usage of drinking water out of 
a human skull for epilepsy — the amulets of yore, as the abraca- 
dabra, <fcc. This history affords us another approximation m 
the practice and principles of some of the ancient physicians, to 
a belief in the competency of nature to do all things necessa- 
ry ; an instance of which by no means inconsiderable, is found 
as late as the days of Stahl under the name of " Anima Medi- 
ca f and still later under that of the "vires natural medicatrices" 
and still later in the Diete absolnP and the " Medicine ExpectanteP 
These, however, were the productions of men of science, but they 
were erratic stars — a kind of monomaniacs. But when the 
totally illiterate attempt to display literature — when fools attempt 
science, we may well expect amonalies, prodegies, transcenden- 
tials, and lots of as curious things as are contained in the little 
old book called " Aristotles Master Piece," which, in our early 
day, we have occasionally seen carefully kept by old country 
matrons for their instruction in midwifery, and female com- 
plaints ; and from which, doubtless, Thomson took his know- 
ledge of the "four elements." We were not therefore in the 
least surprized at the forth-coming of what is called '• Thomso- 
nianism" or " Botanic Medicine ;" and which, had he pored 
one month over Corderii, or Nepos, the author would have 
called Contraria Contrariis. Our surprise in this case was ex- 
cited by that curiosity in human nature, in obedience to which 
it must always try a new thing ; and the more strange and 
unaccountable, the more sure the trial. That this disposition 
should have extended so far as to collect fifteen thousand memo- 
rialists in one state, and eleven to fifteen in another, to pray the 
Legislatures to legalize such stuff, already the most stupendous, 
and, at the same time, absurd system of imposition and quackery 
that ever pervaded the civilized world* — and that there should 
be occasionally a man found in the ranks of medical science, 

* Indeed we nrc assured by Thompson himself, that what he knew of Midwifery 
he learned in a few minutes conversation with ail old woman. 



1837. J 1 Ink nc mannism and Thorn sonianism. ' 61 

who should know better, and still is so lost to science, intellect, or 
honesty as to offer to practice for his employers on either " sys- 
tem.'' And still more, however, have we been surprised that 
the Legislature of an enlightened state should legalize the 
practice of such imposition and manslaughter on the unsuspect- 
ing citizens whom it is their duty to protect. But we were 
utterly astonished at the man himself ] with his character and 
opportunities, when Hahnemann openly promulgated his "sim- 
ilia similibus curantur principle and irtftnitissimalfoYmuiee. 
These two "systems," both the productions of the present 
century and age — one in Europe, and the other in America, 
we should consider, had we belief that their authors had knowl- 
edge of each other's views — the one, a counter-plot of the other. 
We should, had not humanity so much at stake, feel disposed to 
put them both together as great curiosities for the present age, 
and call them Risibles. But for humanity, surely we should 
not care how many thirty-cent books Thomsonians should 
impose on the foolishly credulous for twenty dollars each ;* for 
we should be perfectly content that those who are incapable of re- 
ceiving wit otherwise, and gratuitously, should buy it at any price 
they please. Bought wit is said to be the best, if not bought at 
too high a price. But we do hold that the tears wantonly wrung 
out of weeping humanity are worth too much for such a sacri- 
fice. 

But after all, it is said, and with much truth too, that they get 
a great many patients. This is however, not a strange truth, 
and the rationale of it is best explained in the brief dialogue be- 
tween the London physician and quack, which was about as 
follows : . 

Physician. Pray sir, what is the reason that without any la- 
borious study, or expense for education you are, thus unprepared, 
enabled to have, as you certainly do, so much more practice than 
I have? I have expended my patrimony, and the prime of my 
life in preparation for the correct and useful discharge of my 
professional duties. 

* Wc understand that the book can now be bought for ten dollars. Thus goes 
down this sinful Babylon ; and down — down it will go, until the printer nor even the 
porter will be paid for his labor. 



G2 ■ Inula Helenium in Leucorrhoea. [Sept, 



Quack. Why doctor, Fm surprised at you to ask so simple 
a question : surely you have not reasoned a moment on the sub- 
ject. 

Physician. Yes, I have often wondered at the fact, but could 
never account for it. 

Quack. Then I am the more surprised, and will make it per- 
fectly plain to you in one minute. We live here, you know, 
near together, and you are very well acquainted in our neigh- 
borhood. Now, sir, pray tell me, what proportion of the heads 
of families nearest around us do you consider both wise and 
prudent in determining a choice of medical talent. Do you 
suppose sir, that more than one in twenty is such? 

Physician. About that proportion, I should suppose. 

Quack. Very good, sir, you are about correct; the fact is that 
for this reason, where one would, by his good sense be able to 
determine on employing you, twenty would call on me l 



Inula Helenium in Leucorrhoea. 

This article (Elecampain) is spoken favorably of in the Revue 
Medicale, by M. De Lens, in the treatment of Leucorrhoea, as 
well as in some similar affections. He used it in a decoc- 
tion of 3ij to 3iv of the root to four cups of water reduced to 
three. Of this, the whole was taken a day, in three doses. M. 
De Lens thinks an infusion may be as efficacious. 

We should be pleased to find so simple and innocent an arti- 
cle as elecampain root, prove very successful in this case ; and 
hope it will be extensively resorted to ; as it may be tried in 
safety, even from the loss of time in cases of this kind, which 
are ordinarily not put under regular prescription, until the whole 
routine of domestic means have been unsuccessfully resorted 
to. Any definite successes with the remedy, accompanied with 
an accurate history of the case, its cause, duration, kind and 
manner of discharge, the menstrual condition, &c. &c, we 
should be particularly please to receive ; as such might be the 
means of giving us different views of the theory of those ca- 
ses, from those we now entertain. 



1837.1 Medical Intelligence. , 63 



MEDICAL INTELLIGENCE. 



Medical College of South Carolina. — We regret that by some cause un- 
known to us, the announcement of the annual course of Lectures in this institution 
did not come to hand prior to the publication of the August No. of this journal. It 
would have given us pleasure to have noticed it under our head of medical intelli- 
gence, with others. 

This institution is under the guardianship of the Medical Society of South Ca- 
rolina, whose president is ex-officio, president of the college and its government is 
vested in a board of trustees consisting of eleven medical gentlemen, who derive 
their appointment from the Medical Society. Dr. J. B. Whitridge is now the 
acting president. It has six professorships, filled as follows : 

B. B. Strobel, M. D., Professor of Anatomy, 

Elias Horry Deas, M. D., Professor of Surgery, 

Thos. Y. Simons, M. D., Professor of Theory and Practice of Medicine, 

Henry Alexander, M. D., Professor of Inst, of Medicine & Materia Medica, 

Wm. Hume, M. D., Professor of Chemistry and Pharmacy, 

Francis Y. Porcher, M. D., Professor of Obstetrics and Diseases of Women 
and Children. 
Demonstrations of Anatomy, by B. B. Strobel, M. D. 

Dean of the Faculty, Thos. Y. Simons, M. D., 

Clinical Lecturers. 
At the Aims-House, Edward Elfe, M. D. 

At Marine Hospital, Wm. G. Ramsey, M. D. 

In the " Announcement" by the Faculty, we are informed that the annual 
course of Lectures for the ensuing season will commence on the second Monday 
in November. 

In addition to a commodious edifice for the purpose, its Museum and Laboratory 
are said to be amply supplied, and a Library of about 2000 volumes, and opportu- 
nities for clinical instruction are afforded for the benefit of pupils. 

Medical Premium. — The New York Medical Society, at a recent meeting, 
passed the resolution that one hundred dollars be offered for the best dissertation 
on the following subject: 

" Diseases of the Spine, their causes, symptoms, and best mode of treatment." 

Drs. Jno. B. Beck, Jas. R. Manly, Richard Pennell, Jno. C. Cheeseman 
and Tho. Downing are appointed the Committee on Prize Questions for the ensu- 
ing year. , 

Dissertations to be sent to the Committee before the 1st of January, 1838. — Bast. 
Med. fy Surg. Journal 

Manslaughter by the steamers. — John Morgridge a kind of chief among the 
steamers, and the principal of a Thomsonian Infirmary at New Bedford, (Mass.) 
has been arraigned for manslaughter in the case of Mrs. Eliza Howland of that 
town. 



Gi Medical Intelligence. [Sept 

The unfortunate subject of this fatal quackery, was. with the exception of a pc 
nodical head-ache, in pretty good health. This chief administered his " numbers, 

lobelia, cayenne, &€. &c., in the usual rapid succession. The patient died appo- 
plcctic — the corpse remained heated a long time — was examined and every impor- 
tant organ found congested with blood. These facta are given in the N. Y. Ga- 
zette, the Evening Star, and the Saturday Evening Tost. The legal examination 
was expected to be long and tedious: and as it is but the beginning of these prose- 
cutions, may terminate in the exercise of mercy to the guilty wretch. But facts 
will multiply, and the observation of them, as they daily occur will be duly regarded 
and investigated. Then will the just indignation ot* an insnlted and injured com- 
munity burst with retributive vengeance on the heads of these reckless impostors . 

There are always those who, for a few shillings will step forward to " clear the 
guilty and to varnish crimes," but the reign of reason will come. Judges, jurois, and 
legislators will see the sad error of a toleration which spreads ruin on e\erv hand ; 
and as in England with Morrison's pills, so will convictions of manslaughter, be 
found after a little on every court docket. 

This case reminds us of one which occurred very recently in our own immediate 
neighborhood, in which death was produced in a very similar manner. The un- 
fortunate subject in this case was a very worthy young mechanic from Baltimore. 
He had been a little complaining from the effects of a slight cold and perhaps a 
somewhat billious habit ; but was about the house on the morning of the fatal day. 
The steamer prevailed on him to be taken through a " course of medicine" as he 
is pleased to call his treatment. The day was one of the warmest in July or Au- 
gust last — (the mercury rising daily to 93 or upwards.) Blankets, hot rocks &c. 
&c. were collected in abundance for the external "practice with caloric" in due 
obedience to the bill of rights granted by the legislature : and what they call " warm 
tea only," when the patient escapes death, (and which is well known to consist 
mainly of African cayenne,) for internal heating — also agreeably to their bill of se- 
cured rights. They were liberally applied and administered, in a small close room, 
a la mode de Thomson, during which the temperature of the room was considered 
to have afforded a " caloric" power of about 200 degrees for the skin and lungs, in 
addition to the internal administration of exciting means. In this state of things, 
and doubtless, when thesteamer was indulginga full hope that the " caloric" would 
operate to good effect, the unfortunate young man happened (strange to tell,) to take 
a violent appoplectic fit which continued a length of time and terminated in death 
We were summoned in great haste to him at 2 o'clock P. M. found him perfectly 
li\ id from appoplexy ; and gasping in death, he breathed his last before his arm could 
be bound for blecdin«r ! 



SOUTHERN 

MMIQ)3I(DA3L AM) STO©I[(DA3L 
JOURNAL. 

Vol. II. OCTOBER, 1837. No. 3. 

PART I. 
ORIGINAL COMMUNICATIONS. 



ARTICLE I. 

Observations on the Pathology and Treatment of Enlarged 
Spleen. By A. C. Baldwin, M. D., of Saint Clair, Burke 
County, Georgia. 

In those sections of the Southern states which favor the gen- 
eration of fever, the spleen is peculiarly subject to disease. As 
the result of neglected intermittent or remittent fever, its enlarge- 
ment to a greater or less extent is almost inevitable. Be the 
attack ever so mild, if the case is left to nature, the spleen will 
measurably participate in the deranged state of the system, and 
will be the last organ to recover a healthful condition ; and 
even, under the most judicious method of treatment, such a re- 
sult is by no means uncommon. Forming as it were the 
second link in a chain of morbid action, and bcin<r itself a con- 
sequence of prior disease, in its turn, it forms a foundation for 
other and more troublesome affections. Passing over those of 
minor importance, the number of dropsical cases which result 
from it are too numerous to have escaped the observation of 
practitioners generally. It is therefore a little surprising, that 

1 A 



132 Enlarged Spleen. [Oct. 

enlargements of the spleen have been so much neglected. Re- 
garding them as the effect of disease, physicians acting upon 
the principle that the cause being removed, the effect must fol- 
low, have contented themselves with merely prescribing for the 
original fever, without remembering that the consequent engorge- 
ment of the spleen is sufficient to keep up an excited state of 
the heart and arteries, and thus, whilst it lasts, intail upon the 
patient a perpetual state of fever. Of this last fact, any one 
may satisfy himself by examining the pulse of a person in whom 
there exists an enlargemsnt of the spleen. To the extent of 
my observation, and that has been considerable, it is always 
more frequent than in health. This condition of the pulse has 
often induced me to suspect the existence of enlarged spleen, 
whilst examining patients during the intermission or remission 
of fever, the excited state of which I could not otherwise ac- 
count for ; and the result of an examination has generally con- 
firmed my suspicions. 

Several varieties of enlarged spleen have been mentioned by 
writers, but it is not my intention to notice any other than that 
which results from intermittent or remittent fever, it being the 
most common, and the one which I have most frequently met 
with in practice. 

With some individuals, the power of the spleen to resist the 
incursions of disease, is much greater than in others, affording 
them a happy exemption in a majority of cases from attacks of 
the disease under consideration. Several persons of my acquaint- 
ance, thus happily circumstanced, pass through protracted at- 
tacks of fever, and finally recover without any consequent en- 
largement of the spleen ; whilst others less fortunate from com- 
paratively trifling febrile affections, uniformly have their spleen 
enormously enlarged. To account satisfactorily for this differ- 
ence of susceptibility to disease of the organ in the one and in 
the other instance, is perhaps impossible; although we may rea- 
sonably attribute the absence of enlargement in the one case, to 
an unusual small ncss of the artery which supplies the organ, 
thereby preventing an undue quantity of blood being forced into 
its vessels in a given time ; or to a more powerful exertion in 
the veins and absorbents in removing the supplies which have 



1337.] Enlarged Spleen. 133 

been furnished, and in this manner preventing accumulations 
which would otherwise take place, by keeping up an equilibrium 
in the circulation of the part threatened with disease. 

To explain the pathology of the disease, but few words are 
necessary. It consists in a simple congestion of the organ, the 
production of which may readily be accounted for, when we 
consider that the splenic artery is much larger than is requisite 
for the mere nutrition of the spleen ; and that, consequently, 
under a general excitement of the circulation, it must convey an 
undue proportion of blood to its place of destination, where it 
must remain producing congestion, or must be carried off by ves- 
sels destined to this office. So long as an equilibrium is kept up 
between the vessels collectively, no engorgement, or undue 
accumulation, can take place ; but, on the contrary, if the reple- 
tion is greater than the depletion of the organ, we at once have 
a case of the disease in question. 

The diagnosis is by no means difficult. The pulse and the 
general appearance of the patient, may induce us to suspect an 
enlargement of the spleen ; but, the most certain, and never fail- 
ing criterion to determine the fact, is the presence or absence of 
a hard body, commonly called a fever cake, in the left hypochon- 
drium, to discover which nothing more is necessary than a slight 
examination with the hand. 

In the treatment of enlarged spleen, various methods have 
been adopted. Emetics have been recommended by some, and 
for all I know to the contrary, may have proved advantageous ; 
but of this I know nothing from experience, never having pre- 
scribed them. Various external applications, as iodine oint- 
ment, mercureal ointment, blisters, &c, have had, and sail have 
their advocates ; all of which, with the exception of the first 
mentioned article, are more than useless, being calculated in 
themselves to produce more or less uneasiness, without the pos- 
sibility of their doing the least imaginable good. The same 
may be said of the blue pill and other mercurials given with 
the view of producing salivation; for no one, I am satisfied, has 
ever been cured of an enlarged spleen by a salivation only ; nor 
can I conceive of any case in which a salivation would be neces- 
sary or proper. It may be stated, and ample experience will 



134 Enlarged Spleen. [Oct. 

bear me out in the assertion, that nothing more is necessary in 
the treatment of this affection, than the judicious employment of 
purgatives. In my hands they have always proved successful, 
when fairly tried, and I can confidently recommend them to 
those who may not have been in the habit of prescribing them. 
I have known an enlarged spleen to become much softer, and 
nearly one fourth smaller, judging from the appearance of the 
patient, and an examination of the organ, from the free action 
of a large dose, (sij.) of the compound powder of jalap. It is 
not a matter of much importance what purgative is employed. 
In this respect, the practitioner may please himself, provided he 
selects an article which will purge actively, and causes its ex- 
hibition to be repeated at proper intervals for a length of time. 
With me no purgative is preferable to calomel. In all cases, it 
is the one which I first recommend, and from it I have experi- 
enced the most happy results ; giving it in doses of from ten to 
foity grains ; and following each dose in from two to four hours, 
with a large dose of castor oil, or some other certain cathartic, 
which not operating well is repeated again, and again if neces- 
sary. This purge of calomel and oil is directed to be repeated 
every second, third, or fourth day, as circumstances, and the 
strength of the patient may indicate, it being expected that the 
general health is to improve under this periodical purgation, 
which is to be kept up for weeks if necessary, or until the en- 
larged spleen has been so much diminished as no longer to prove 
a source of inconvenience. Although much attached to calomel 
as a cathartic in these cases, I by no means confine myself to it 
entirely. The blue pill in combination with aloes, using two 
parts of the mass to four of aloes,I have frequently prescribed; and 
this compound in doses of ten to fifteen grains, from its activi- 
ty, has often been used with advantage ; although in a majority 
of cases, it is necessary to follow it by some more prompt cathar- 
tic, as oil, or the sulphate of magnesia. As the size of the 
spleen diminishes, the interval between the exhibition of each 
cathartic may be prolonged, until once or twice a week will be 
often enough for their administrations. In many cases, the oc- 
casional use of a tonic in addition to the purgative plan of treat- 
ment is absolutely necessary. No tonic is preferable to quinine. 



1837.1 Oil Menstruation. 135 



It may be given on the days intervening between those of exhib- 
iting the cathartic. No particular attention need be paid to the 
diet — such articles of food as suit the patients' appetite, being 
generally allowable ; nor is it necessary to keep the house or 
bed to insure a recovery. 



ARTICLE II. 

On Menstruation by M. Antony, M. D.o/ Augusta^ Geo. 

" Propter solum uterum mulier est id quod est." — Hoffman. 

Passing by the special anatomy of the uterus, a brief account 
of which was given on a former occasion,* with which every 
reader desirous of comprehending the functions and diseases 
of that important organ should be familiar ; and in order that 
the pathology extensively connected with its structural and 
functional derangements may be better comprehended, I pur- 
pose considering in this place the character and phylosophy of 
its primary function under the circumstance of good health. 

The expression of Hoffman quoted at the head ot this article 
is most true, and when duly contemplated in view of its truth, 
becomes a most fruitful source of knowledge of the natural his- 
tory of woman as well as of her pathology. 

It is indeed to the uterus that woman is mainly indebted for 
her peculiarities of character ; even her peculiarity of configu- 
ration being determined in the latter part of the third epoch of 
her life, in part at least, by the developements preparatory to con- 
ception and child-bearing. Her peculiar softness and melody of 
voice, together with the child-like simplicity and abiding confi- 
dence which are part of the characteristics of her sex so calcu- 
lated to command the tenderest cares of man — the yielding soft- 
ness of her nature, all, as I shall attempt to shew, owe to uterine 

•See Southern Medical and Surgical Journal vol. I. page 171. 



I3G On Menstruation. [Oct- 

ane! other peculiar female developments their value ; whilst her 
peculiar acuteness of sensibility, exalted moral sense, and high- 
er order of refined taste are no less the products of that change 
•of proportionate developement whereby the female conforma- 
tion is mainly affected in the progress of the third epoch, and 
the genital developements are fully completed. 

But besides the concurrent peculiarities of the female, just al- 
luded to, her various succeeding healthy peculiarities will be 
found reflected on her natural character, by the structure and 
healthy functions of the uterus and the various derangements 
thereof. 

I shall in the first place offer to the reader some received defi- 
nitions in relation with the subject before us ; then proceed to 
give the healthy phenomena of menstruation, and lastly, to shew 
the phylosophy of the rise, progress and decline of this func- 
tion ; all of which afford extensive data for the reasoning of the 
pathologist. 

In thus pursuing my subject I shall use freely of such mate- 
rials as are before the profession ; and in some instances, (espe- 
cially in anatomical facts,) without stopping to make direct re- 
ference to the source ; as the facts which are known are made 
public property. 

I. Menstruation. This is a term 'which may be considered 
as generally used to include every thing relative to the cause, 
nature, appearance, duration, quantity, quality, use, successive 
returns, final cessation, &c., of the menstrual discharge. 

Menses. This word is used to designate that periodical, red 
discharge which healthy women afford from the genital organs, 
when not pregnant nor lactating ; ordinarily in temperate cli- 
mates from the age of fourteen, to forty five years. Turton* 
defines it the monthly purgations of women." Parr, "the 
periodical discharge of blood from the uterus or vagina, or 
both." Mm i: ici. Ac, "the menstrual is so called because it is 
evacuated periodically every month, when the female is of sui- 
table age and good health, if she is not pregnant nor giving 
suck." MagendIEj "a periodical sanguineous discharge which 

* Editor of the Linnacan system of nature, and author of the Medical Glossary. 



1837.] On Menstruation. 137 

takes place from the internal surface of the uterus, and is a true 
sanguineous exhalation? Baudelocque. " a periodical deple- 
tion which follows a sanguine phethora." J. Cloquet — " a 
periodical evacuation of blood from the female organs of gener^ 
ation, from the age of puberty to that of forty-five or fifty years, 
and which ceases to appear during pregnancy and lactation-." 
Mine. Boivin, " a sanguine excretion which women afford 
regularly about every month from the genital organs, from 
puberty to forty five or fifty years." 

Various other names have been given to this discharge, as 
catamenia, menstrua, e?nmenia r fyc. It has also been called 
menses, flowers, flows, monthly discharge, show 7 regular dis- 
charge, time, epoch, m,oons, affairs, fyc. fyc~ and is often allu- 
ded to with a nod. Before the days of Mauriceau, (seventeenth 
century.) this discharge was called " monthly purgations" be- 
cause, as was then believed, the whole habit of the body was 
thereby purged of its superfluity of blood. This old, but emi- 
nent practitioner and writer also informs us that it had, by a 
beautiful allusion to vegetable nature, received the name of 
" flowers of women." As trees do not bear fruit until preceded 
by flowers, so likewise women do not ordinarily become preg- 
nant of an infant before they have these flowers. 

Madam Boivin, a scientific female, having enjoyed the most 
ample opportunities afforded by her greater facility of access to 
females under all circumstances in society, by her general inter- 
course as a female practitioner in Paris, and by her situation as 
chief superintendent of the Royal Mansion of Health, with all 
desirable opportunities and capabilities for anatomical research, 
all of which were well embraced, I cannot do more justice to 
a statement of the phenomena of menstruation, than by giving 
her own on this subject. 

" Notwithstanding," said she. " I have sometimes seen infants 
of five or six years, and even younger, discharge by the vulva a 
sanguineous excretion more or less regular in its returns, still 
in the order of nature, it is not until puberty that this excretion 
is established in a regular and periodical manner. This epoch 
which generally announces and characterizes the aptitude to 
fecurdity, varies much, according to the constitution, climate, 
education, exercise, and various accessary circumstances. Most 
commonly, it is not until the age of fourteen or fifteen years, 



138 On Menstruation. [Oct. 

and when the mammoe begin to develope themselves, that the 
menstrual flux appears and is established. Derangements in 
the order and duration of this discharge commonly occasions 
disorder in other functions. 

" The quality of menstrual blood does not appear to differ 
from that which circulates through the whole system when the 
woman is healthy, well formed, and when she conducts herself 
according to the requirements of health and propriety. 

" The duration of this evacuation varies from three to six 
days. There are women who have this discharge only one or 
two days, and others, some hours only. 

u The menstrual flux is generally suspended during preg- 
nancy and lactation. When it does appear in the former case, 
it is ordinarily a symptom of disease, indicating a partial sep- 
aration of the ovum. Also when the blood does not appear at 
the stated period which corresponds to the time when the woman 
previously had her menses, it is a very good sign of disease, 
except in pregnancy." * * * 

" Causes of Menstruation. The opinion most generally re- 
ceived is that a plethora, general or local, causes this evacuation. 
Pinel said it would be found as difficult to answer this question 
as to explain the cause which made certain plants crown them- 
selves with flowers oftener than others. The causeof the peri- 
odicity of the menses is not better known. 

" Whatever may be the cause of menstruation, to it is gener- 
ally attributed the virtue (propriete) of preparing the cavities, 
which ought, in their turn, to furnish the blood destined to pass 
into the radicles of the placenta. But the developement of the 
placenta, and that of the fetus, without the uterine cavity proves 
that menstruation is not essential to the preparation of these 
cavities; or rather, that the placenta can do without (se passer) 
this preparation. It appears that the fecundated vesicle is capa- 
ble of developeing and enlarging itself every where when in 
contact with a vascular and nervous part. In the many cases 
of extra uterine pregnancy which we have seen, there was one 
at the term, at which the infant weighed eight and a half pounds. 

" Nevertheless, the influences of the menses on fecundation 
will not be denied, since before menstruation, after its cessation* 

* Not long since a case was related in the Boston Med. and Surg. Journal, in 
which a woman was delivered of a child about 24 years after the cessation, and du- 
ring the last year a case came under my own advice, in which the woman had 
ceased to menstruate some 20 years, and whose youngest child was about 24 years 
old. This woman had remained in health, and the wife of the same husband. 
She was in her 8th month when I was consulted on her case, and has since passed 
an easy and happy accouchment. 



1837.] On Menstruation. 139 

and even during any remarkable irregularity, conception does 
not ordinarily lake place. On the other hand, we remark that 
women are more apt to conceive at the approach of their menses, 
or immediately after, than in the middle of the term between 
the menstrual periods. 

" With those whose mestruation is interrupted, this excretion 
is commonly replaced by some unusual sanguine evacuation ; any 
part of the body being capable of becoming a supplementary emunc- 
tory for preserving the health of the individual/ Many examples 
are cited of women who have brought into the world well sup- 
ported infants, without ever having been regular, as well as others 
after having ceased to be. Finally, " a woman, who on the ap- 
proach of the menses proves to have pains in the head, and in 
the lumbar regions finds herself relieved that instant at which 
the menses appear, however small the quantity of blood which 
is afforded by the uterus : neither the application of leeches to 
the vulva, nor bleeding at the arm being able to produce an ef- 
fect so prompt and salutary.t" 

As I before observed, Madame Boivin's account of the phe- 

* See at p. 767, vol. I. of this Journal, M. Bourgeois' case of anamalous menstru- 
ation, in which it took place from the extremities of each of the ten fingers of a 
young lady. A case occurred "a few years since, under the observation of a medi- 
cal frL-nd, in which the discharge was vacariously effected through a sore on the 

Im- 
partial menstruation, in which the evacuation in the natural way is not so much 
as it should be, is perhaps always — 1 should say doubtless always compensated in 
another way by some other part. But the phenomena are not always discoverable. 
I now have a case under my direction in which the tonsels have so enlarged on the 
approach of each menstrual period for several months, that the former attendant on 
the ease contemplated the necessity of operating on them : but their enlargement 
has subsided after each period. On promoting ample menstruation, which was done 
by rectifying the prolapsed uterus, the enlargement has almost entirely ceased to 
manifest itself. 

I have another case of difficult and partial menstruation from prolapsus, in which 
a pustule has occurred every monthly period with great regularity for many months 
somewhere on the lips or face near the mouth. On the correction of the cause at 
the period before the last, so as to secure a pretty good evacuation, the pustule which 
arose was very slight, and did not mature itself, but passed off by resolution. At 
the last period none appeared. In both of these cases, the mammae became very sore 
and considerably swollen and hard on the approach of the period. This last phe- 
nomenon is of very common occurrence in tardy and difficult, or partial menstruation 
often affording a watery, and sometimes a milky discharge from the nipples. The 
varieties ot vicarious phenomena for menstruation arc innumerable. This teaches 
us the indispensable importance of investigating more scrupulously the condition oi 
this function in our research for cause as well as nature of disease in females. 

t See ars des accouchments p. 104. 

2b 



140 On Maiutruation. [Oct- 

nomena of menstruation is worthy of high confidence. In re- 
gard to the points in dispute amongst physiologists she, with 
that prudence which generally characterises her conduct, avoids 
entering into doubtful disputations, and has generally contented 
herself by setting forth the existing doubt, or giving some of the 
most respectable opinions on the subject in dispute. 

Most of the facts of menstruation are too well known to jus- 
tify the appropriation of much more time to them ; a bare reca- 
pitulation, therefore, of those mentioned, and a brief reference 
to a few not hitherto named, with some of the most common 
anomalies shall suffice. In the notice of those facts, however, 
it should be remembered that I describe the general course of 
nature in relation thereto ; and to these, as general facts there 
are exceptions, — wanderings from the regular order of things, 
which however, arise from very peculiar circumstances in the 
nature of the individual, or some existing morbid condition or 
propensity. 

In healthy young females in temperate climates, the discharge 
generally makes its appearance at fourteen years of age, or thir- 
teen to fifteen. Its first appearance is generally indicated by a 
sense of weight about the loins ; heaviness, and often more or 
less pain in the head, leaden color of the skin within the orbits 
of the eyes, pricking and pain in the nipples, shooting pains in 
the mammae, pain and more or less sense of weight in the hypo- 
gastric and inquinal regions. Some, if not most of these 
symptoms, ordinarily indicate the approach of the menstrual 
discharge. These, however, sometimes pass off for the present 
period without being followed by the actual red, but a more or 
less leucorrhaeal, or sero-mucous discharge,* and the subject re- 
gains her usual state of comfortable feelings, in the enjoyment 
of which she remains for about one lunar month, or twenty 
eight or twenty nine days ; when, probably, if not before, the 



* Those first sero-mueous discharges should he borne in mind, as they are, for 
the present, the proper men- inn] discharges for the present state of developement 
of the female proportions; and will serve to explain those cases of impregnation 
which arc said to occur before menstruation. There is also a like manner of dis- 
charge occasionally appearing after the final cessation of the dux of blood, which 
will nlr.o account for those cases of post-menstrual impregnations which sometimes 
take place early after cessation. 



1837.] On Menstruation. 141 

discharge called menstrual, makes its appearance from the geni- 
tal parts, and continues, with a gradual alleviation of those 
symptoms which have been named, for three, four, or five days, 
by which time they become pale, and finally cease entirely for 
another lunar month. Thus continues the woman, if healthy 
and unimpregnated, until the age of forty five or fifty, when, 
after becoming more or less irregular, they cease to appear 
forever. 

Besides the influence of climate on the periods of appearance, 
and final decline of menstruation, various anomalies are some- 
times observable, such as recurrence at a regular period of two, 
three, six, or eight weeks — the occurrence of a precocious peri- 
odical discharge as early as three, four, five, or six years — re- 
currence as late as sixty or seventy years — the limitation of the 
period of flowing to a few hours, or a day or two ; or its exten- 
sion, to eight, ten, or fourteen days — menstruating regularly 
during pregnancy and lactation as at other times — menstruation 
during pregnancy only* — menses never occurring in pregnancy, 
lactation, nor any other time.t &c. 

But notwithstanding these and many more possible and actual 
wanderings of nature, still, in good health, it is extremely regu- 
lar in the periodical returns, as well as the time of continuance 
and quantity of discharge at each period — lasting from three to 
six days, always the same in the same individual in health ; and 
so regular in its periodical returns, that the female, if intelligent 
and observing, can tell in some instances, not only the day or 
night, but even the hour at which it will return with the exact- 
ness with which the phases of the moon may be told, — all of 
which facts demand due consideration in the investig-ation of 



* Deventer in his arts of accouchment, gives a case of this kind — also other 
authors. 

t Gardien in his complete treatise on accouchments, says, that although some- 
times the discharge of red blood appears at the very beginning, still it is more com- 
monly the case that menstruation commences by a serous flux, and terminates in 
like manner. He says also that Roudelet mentions a woman who was delivered 
twelve times, — and Joubkrt another who bore eighteen children, neither of whom 
had ever menstruated. Doubtless these were cases of serous menstruation, similar 
to that first menstruation described, after which it is possible for conception to taka 
place. 



142 On Menstruation. [Oct. 

disease. Nor is it a matter of less importance in pathological 
investigations, that it should be borne in mind that the anomalies 
which have been mentioned are so rare that they are always to 
be regarded as morbid phenomena until a rigid investigation has 
demonstrated them otherwise. 

I have noticed the general characters of this function, and 
briefly referred to those anomalies which do occur and comport 
with good health, with the design of reminding the reader of the 
boundaries, or rather, the possible extent of physiology, in his 
research after disease ; and although the design of this essay 
was physiology alone, sail it may be well, by way cf applica- 
tion of the preceding pages to practional utility, to observe in 
this place that it is important to distinguish between the true 
physiology of the case before us, and its pathology. 

For instance, it may be a serious departure from health in a 
particular case to menstruate three or four days, when the natu- 
ral period was five days ; or five days, in one whose natural 
period was three or four ; the former being excessive if the flux 
be at the same rate, and the latter, deficient. Or five or six days 
may be a deficiency, when the natural durations of the period is 
seven or eight, &c. — Or the anomaly in which menses appear 
during pregnancy alone, or that in which they appear in preg- 
nancy as at other times, may be simulated by the occurrence of 
slight uterine hemorrhorage from other accidents than the physio- 
logical nature of the individual ; but which tend to, and may 
end in abortion. In this case, as in all others, we must observe 
with great caution the real boundaries of physiological function, 
not only generally, but in the particular case under investiga- 
tion. We must recur to the pristine state of this function in the 
individual, or its state at such times as her health was least ex- 
ceptionable; and thus find what constituted her regularity partic 
ularly. And, even by this index we may be deceived ; nor is 
this deception so rare as may be supposed ; but when suffered, is 
productive of no little perplexity. It is not unfrequently the 
case that a woman is found to menstruate precisely at the period 
of a lunar month, and have a continuance of the flux three or 
four days at the ordinary rate ; and it may be, that she enjoy a 
very satisfactory exemption from present pain of ally part : and 
still the foundation is being gradually laid for the destruction of 



1837.J On Menstrualion. 143 

health by hepatic, pulmonary, or other derangements. Here 
on the strictest examination of the menstrual functions alone, 
the practitioner is compelled to pronounce the patient perfectly 
regular. But there is a resort for the avoidance of this error in 
physiology and pathology, which is, to the philosophy of other 
morbid phenomena, to the thorough knowledge of which, the 
knowledge of the true causes and nature of the menstrual dis- 
charge is necessary. 

Tnus much have I thought proper to state relative to the 
facts of the primary function of the uterus. These facts are 
calculated to have their practical use, as all other physiology, in 
enabling us to judge, by a knowledge of healthy function, the 
existence, the kind, the cause and the extent of disease. But it 
was an additional purpose in commencing this essay, to attempt 
the further elucidation of some physilogical points in connection 
with this function. The enquiring mind is not content with 
composure in indifference to the truths of nature, when so much 
of the beauty of infinite wisdom is found at the end of all thorough 
investigation in natural history, and particularly in the human 
economy. We should not be satisfied with merely viewing this 
function as an isolated phenomenon in the history of the hu- 
man female. It would indeed be but a poor display of wisdom 
and benevolence — but a burthensome affliction intailed on those 
who are the subject of it, ever driving their delicate sensibili- 
ties to self-disgust ; and, were it not connected with the nobler 
ends of female construction — were it not arising in the first place, 
out of those peculiarities which woman, in view of being the 
mother of mankind is made to possess — were it not connected 
with her aptitude for that ripest perfection of organic sense by 
which she is lendered capable of conception ; and finally, were 
it not in connection with the support of the offspring in its most 
dependent state, that is to say, whilst in the womb and soon after 
birth, it would ever present a most loathsome phenomenon to the 
other sex. I shall now proceed to the physiological elucidations 
to which I have just referred. 

1st. Of the nature of the menstrural discharge. — Much has 
been said by physiologists relative to the nature of this discharge. 
The ways of nature are generally plain and simple when known, 
and it is a fact which abundant observation proves, that nature 



141 On Menstruation. [Oct. 

is strictly economical in all her purposes and operations — never 
requiring more causes than are adequate to the effect; or rather she 
seems to delight in effecting her purposes by the simplest and 
fewest means possibly consistent with their well-doing. We 
need not search for causes, the existence of which we cannot 
determine, when we have adequate causes, known and pre- 
sent. We should have to wander far indeed from the truth 
of anatomical demonstration, were we to declare this discharge 
a peculiar secretion. Yet such has been the course of some of 
the greatest physiologists, and even of the present day. It would 
be idle to occupy the time of the reader by repeating and con- 
testing every opinion which the imagination of man has brought 
before the world on this subject. It is thought sufficient to meet 
some of the arguments and opinions which have, more than 
others, withstood the withering blasts of reason and demonstra- 
tion so as still to retain a place in the schools at the present day. 
As such, we shall take for our review the doctrines taught by 
the highly accomplished and justly celebrated late professor of 
midwifery in the university of Pennsylvania, and which, so far 
as there is reason to believe, yet obtain in that respectable insti- 
tution. And I would here state once for all, that I know of no 
professor or author of the day, in whose statements of facts I 
have more, whilst there are many in whose I have not equal con- 
fidence. But however unequal the contest may seem, I feel 
bound to oppose his reasonings from those facts, and the conclu- 
sions to which he comes ; — resting confident in the power of 
truth, and trusting to the end of the contest for my justification. 
In all ages, from the time of Hippocrates and Galen, down to 
the present, the idea that the menstrual is a genuine sanguine- 
ous, (or in its less perfect state, a serous) discharge has found 
abundant advocates in the ablest physiologists of the day. And 
now it is plainly observable that all the most celebrated writers 
of France seem to receive this as a settled fact beyond controver- 
sy; and on this point, I would observe that when we consider 
the advanced state of medical sciences, and the habits of famil- 
iar intercourse the enquiring disposition and the facilities for 
anatomical and physilogical investigations which Paris affords, 
all of which combined t give opportunities for the acquisition 
of truth never before equalled ; these physiologists are entitled 



1837. J On Menstruation. 145 

to the highest respect. So much for long standing and high 
privileged authority. 

Still, however, the idea that the menstrual discharge is & pecu- 
liar secretion, has been taught by Haller, Hunter, Saunders, 
and others of former ages, and advocated by Dr. Dewees of 
the present age. 

In his preparation for the support of the opinion that the 
menstrual discharge is the result of a secretory process, Dr. 
Dewees attempts in the first place to draw preparatory support 
from the " structure and diseases" of the uterus,* thus : inde- 
pendently of considerations derived from tne structure and dis- 
eases of the uterus, &c." To this assumption, or rather suppo- 
sition, it must, in honest faithfulness be replied that the anatomi- 
cal facts in point not only forbid such an idea by completely 
demonstrating the want of appropriate structure, but actually 
display every necessary construction and arrangement for a pe- 
riodical discharge of just such blood as the menstrual flux ex- 
hibits. 

From his expression which we have just quoted, one would 
suppose that a regular glandular arrangement of the uterus was 
demonstrable, and that, so curiously supplied with sensibility, as 
to be competent, once in a lunar month, to take on suddenly its 
secerning action, and eliminate from the system from 3 to 6 or 
12 ounces of secretion within a few days, then close its opera- 
tion for a month, and so on ; and this too, to have its secreting 
energies increased by a relaxed and debilitated habit, — for it is 
a notable fact that delicate habits generally afford 3 to 4 fold 
more menstrual discharge than those of robust, strong and en- 
ergetic habits. But no such " structure" will be found. 

The Doctor next proceeds to derive " confirmatory sugges- 
tions from the appearance of the fluid itself. One of these two 
propositions he feels bound to receive : This discharge," he says 
11 must be either a portion of the common mass of blood as it cir- 
culates in the system ; or it must have undergone some change 
during its separation from the uterus." — If the former" he con- 
tinues, " it should exhibit the appearance of blood detracted from 
any other part of the body by opening a vien for the purpose ; 

*Sce his systems of Midwifery page 50. 



146 On Menstruation. [Oct. 

which it does not do. If the latter, it is probable that it has been 
eliminated by that process termed secretion." This last proposi- 
ton or avowed probability, he then considers strengthened by 
the following considerations of the physical properties of the 
fluid itself. 

1st. Its colour is between that of arterial and of venous blood ; 
being less brilliant than the former and more so than tne lat- 
ter. 

2d. It never separates into parts as blood drawn from any 
other part. 

3d. It never coagulates,* though kept for years whilst other 
blood, when free from disease and exposed to the air quickly does 
this. 

4th. Its odour is remarkably distinct from that of the circu, 
lating mass ; and it is less disposed to putrefaction." 

Here I would meet the doctor at the very foundation of his 
two propositions, and shew that by them he has only spoiled 
the truth by dividing it — that his probability which he assumes 
in the 2d proposition is but a petitio principii and which, when 
assumed, instead of deriving substantiation therefrom, it only 
tends to a false explanation of the four several physical pro- 
perties of the fluid. By only exchanging his distributive or 
for the copulative, and, we shall have a new proposition declar- 
ing the truth thus : This discharge mast be a portion of the 
common mass of blood as it circulates in the system, and it 
must have undergone some change during the separation from 
the uterus. This is, as a whole thus connected, a proposition, 
the substantiation of which cannot fail to refute that adopted by 
him and explain the phenomena of the "fluid itself" (by which he 
attempts in vain to strengthen his opinion,) in another and more 
rational manner. 

In the substantation of this proposition which I have thus com- 
pounded, I draw all desirable evidence, from the "structure" 



* "We too often see it escape in clots from women when they got unto walk 
about, after having been long in m sitting position, to be able to say with Dionis, 
that menstrural blood never coagulates. According to all appearance, it contains 
less fibria than that from other parte ol the body, but is not entirely without it. 
Brinjr mixed with the mucous and serous mutters naturally furnished by the inter- 
nal surface of the genetal organs, the menstrual blood is thus rendered more vis- 
cuous, and ought not to exhibit the same characters as that which escapes from a 
wound. — Velpeaus Midwifery p. 86. 



1837.] On Menstruation. 147 

of the uterus. It will not be forgotten that the various arteries 
which enter the uterus are very intimately connected with the 
ovaries, so that the removal of these by excision or their destruc- 
tion by disease, (which is said by the Doctor to destroy menstru- 
ation,) must necessarily injure, and that to a great extent, if in- 
deed it do not entirely destroy some of the most important 
branches : therefore nothing can be fairly inferred from the re- 
moval or other destruction of these organs. But the arte- 
ries which do go to the uterus terminate variously — as by anas- 
tomoses, by exhalent extremeties opening on the inner surface ; 
and « other branches," &c. "pass to the uterine sinuses" which, 
as I have before said in speaking of the lining membrane of 
the cavity of the uterus, open into the cavity by the most con- 
siderable openings which appear in the reticulated membrane. 
Here, then, is abundant anatomical structure to indicate plainly 
its purpose. 

I next come to explain, from the facts presented, the whole 
proposition which I have offered. The first member of the pro- 
position considers the discharge as being a portion of the com- 
mon mass of blood. Hippocrates, the most respectable author- 
ity in ancient medicine, whose close and correct observation has 
been constantly before the world — the most worthy example 
for immitation, and which has established so many truths which 
have withstood the relentless hand of time and the revolutions 
of centuries, says, " this blood is like to that of a victim, and 
coagulates promptly if the woman be well."* The most per- 
fectly healthy animals only were chosen foi the ancient sacri- 
fices ; hence this comparison. 

Maurice a.u, when Prevost of the company of Master Sur- 
geon Jurors of the city of Paris in 1672 had, and embraced the 
opportunity of examining the body of a woman who was hung 
for a crime, at the time of actual menstruation. All that portion 
of the cavity of the uterus about the fundus was plaistered over 
with coagulated blood, and the vessels here were much larger than 
those of the neck. He distinctly saw these coagula connected 



* il Proccdit autum sanguis velut a victim*, ct cito congelatur, si sana fuerit mu- 
lier." Vid. Oeuvrede Mauriceau, Tome 2 me, Deacrip. Anatoniique, &c. ; chap. x. 
page 47. 

3( 



148 On Menstruation. [Oct. 

with those vessels about the fundus, which disgorged themselves 
of the blood.* 

Madame Boivin, to whose excellent opportunities and capa- 
bilities I have before alluded, says she has had occasion to see 
the uterus of many young females who died during the men- 
strual epoch, in whom the internal face of the uterus was covered 
with a coat of bright red blood ;t and this fluid she caused to 
pass out of the vessels which afforded it, in small drops, by 
simple compression, or plunging them into warm water. These 
absolute facts should be considered highly satisfactory evidence 
of the truth that the discharge, as it passes from the vessels, 
which yield it into the cavity of the uterus, is but a portion of 
the " common mass of blood as it circulates in the system." It 
is caused to coagulate by the circumstances of the body in death, 
before it undergoes those mixtures which will be presently 
described. 

It has been observed in describing the vagina, as well as the 
neck and body of the uterus, that all these parts are generally 
moistened by a mucous secretion for the purpose of lubrication 
and the ordinary good condition of the parts for their functions. 
This mucous is not coagulable by any ordinary temperature, or 
atmospherical exposure. Nor is it readily susceptible of putre- 
faction. It is in considerable quautity — so much so that I have 
several times observed it passing after death, from the vulva even 
of girls, but a few years old, in consequence, as I presume, of 
the contractions of the uterus in death, from the -cessation of 
arteral action. 

In the sinuses into which the blood is poured by the arteries, 
those changes commence, which cause it to approach "more 
nearly to the color of venous blood." In this state it is poured 
during menstruation, into the cavity of the uterus, where'it enters 
inio immediate and complete mixture with the mucus of the 
jKirt. This mucus is so viscid that on ;m even mixture with 
[|, ( . blood, the latter will thereby be prevented from separating 
into parts. It is rendered incoagulable in like manner, by being 



* Ouvrc (k M.Hiii.v.m. 

t " Couvcrtc d'une couche do sang d'un rouge vif." Memorial de l'art des 
accouchemeiM. 



1837.] On Menstruation. 149 

in even mixture with this mucus, as it is in the usual healthy- 
menstrual flux. But should the discharge of blood exceed the 
usual quantity in proportion to the mucus, it then becomes coag- 
ulable because the proportion of mucus is not sufficient to pre- 
serve this quantity from coagulation. 

This mucus is coagulableby astringents, as alum, tannin, &c. 
So also is the menstrual fluid.* The peculiar odour which the 
mucous secretion possesses is combined with the blood, and this, 
added to the natural scent of blood gives the odour so " remark- 
ably distinct from the common blood." 

Here then are found unavoidable and competent causes for 
all the phenomena of colour, of inseparability, noncoagulability 
and odour ; the principal grounds on which the advocates of 
peculiar secretion have relied. Here is found an explanation of 
all the phenomena presented, in perfect and happy accordance 
with that simplicity and economy in which nature ever delights : 
and here, too, do we behold the kindness of Providence in the 
happy arrangement so well calculated to preserve from pain in 
ordinary menstruation, which would otherwise exist in conse- 
quence of constant coagulation. Believing this error needs no 
farther arguments for its final refutation to settle the true physi- 
ology of the function, I shall next proceed to the consideration of 
the causes of the beginning, the continuance, and final cessation 
of menstruation. 

Of the causes of the rise, progress, and final cessation of the 
menses. From the view we have taken of the nature of the 
menstrual discharge, we may well consider it as a periodical 
hemorrhage — the chief difference between hemorrhage and men 
struation being that the latter is natural — there being an organ- 
ization especially constructed for this purpose, and for ichich, 
when we consider the end for which woman was created, and 
that state of the system necessary to that end. there is from the 
beginning, a necessity : whilst hemorrage is unnatural and not 
from structure organized for that purpose. The latter is the 
effect of accidents which temporary causes create — the former 
the effect of wise design. 

There are, at least in the earlier part of human life, certain 

* These facts are constantly observed in the application of vaginal injections 
containing alum or tannin. 



150 On Menstruation. [Oct; 



periodica] changes which take place, the precise cause of which 
it would be dilficult to explain, unless it be merely a part of the 
order of dcvclopeinent established to suit the being; to the differ- 
ent relationships in life, to other beings of the species, and the 
other circumstances and periods of that life. These periods 
have been called septennial, as they have been observed every 
seven years. In man these epochs are marked, 

1st., By the dropping of the milk teeth at about seven years, 
and their replacement with new and more substantial ones. — 
During the first epoch, that of infancy, he has the roundness of 
form, softness of flesh, of voice, &c, which may be considered 
as belonging to this epoch. Both sexes run very much together 
in the marks of this epoch. 

2nd. During the second epoch, the roundness and thick- 
ness of childhood decrease, and the length of parts increases, 
and the whole stature becomes more spare. 

In early infancy, the head is much larger in proportion to the 
other parts — partaking still much of that extreme disproportion 
which in the early foetal state, gave to the head nearly half the 
weight of the whole ; and the proportion continues to decrease 
until fullest maturity. During the progress of the first epoch 
the body expands in greater proportion ; but in this, the second, 
the extremeties, particularly the lower, extend in a much greater 
ratio than the rest of the system ; and by the termination of this 
epoch, become, by their more rapid proportionate growth, in very 
good proportion to the other earlier dcvclopemcnts ; and, indeed, 
rather transcend, as those of some quadrupeds, the proportionate 
extent, and soonest acquire the proportion of the adult. By the 
end of this epoch, in consequence oft lie determination of growth 
to the lower parts, and the rapid accomplishment of the adult 
proportion of the lower extremities, thegenital organs of each 
sex become sufficiently developed to enable them to perform their 
functions; although so far from that maturity of strength and 
hardihood as to lender them, as yet, unlit for the exercise of 
function. 

3rd. The third epoch begins with signal changes. The 
sexes now begin to wander from c-<n-\\ other. The voice of the 
male begins to become more coarse and grave, whilst that of the 
female changes but little. The pilous system now begins to be 



1837.] On Menstruation. 151 

developed on the pubis of the male and female, and the downy- 
beginning beard on the former. The menstrual discharge of the 
female, and the growth of mammae go on. In man, too, the 
upper parts of the body — the thorax and shoulders begin to 
expand in greater proportion ; whilst the female growth is pecu- 
liarly directed to the lower parts of the body — the pelvs and 
thighs ; and these proceed on to that fixed difference of propor- 
tion which ever marks the two sexes during the period of matu- 
rity. The genital organs likewise go on improving in strength 
and full developemeut, the mammae increase in size, the pubis 
becomes well covered with hair, and the finest proportions of 
which the individual is susceptible are developed by the end of 
this epoch. The appropriating powers seem to continue their 
offices in the hips and mammas whilst they are mostly discon- 
tinued elsewhere, especially in the shoulders and the other 
standard masculine developements. Those parts grow and ex- 
tend, as if for a much larger stature than the woman will ever 
arrive at — particularly the hips ; so that her pelvis, nates and 
thighs are much larger in proportion than those of the male. 
Her cellular tissue becomes more filled with adipose matter, which 
gives to her the roundness and softness which perfect the beauty 
of her sex- The cessation of the developements peculiar to 
the male seems thus to leave the surplussage necessary to men- 
struation — to child bearing. 

u During this epoch the amusements of childhood yield to 
maturer enjoyments — rational inquiry begins to be developed. 
Capricious attachments give place to sincere, unaffected and 
permanent friendship ;''* all of which changes are making grad- 
ual progress to that maturity at which they are found at the end 
of this epoch, or twenty-one years of age, the earliest period at 
which Providence seems to have designed the union of the 
sexes, or at which that union seems rationably commendable. 
Theji, and not until then is woman that creature whose devel- 
opement of mind, and perfection and strength of organic con- 
struction combine to capacitate her for the efficient performance 
of the purposes, and the rational and prudent enjoyment of the 
pleasures of conjugal life. 



* Cuvier. 



152 On Menstruation. [Oct. 

Thus we observe the fact in human nature, that different parts 
are successively developed. We might have said that this is 
oped in like manner to the close of the second epoch, at which 
the developeing powers of the two sexes are differently directed ; 
those of the male to prepare him for that superiority of stature) 
that greater size and strength of muscle, that larger brain, 
stronger bone, stronger and deeper voice, coarseness and thick- 
ness of skin, and more full pilous developement, and that greater 
harshness, firmness, and independence which both characterize 
his sex, and fit him for the various purposes of his life ; whilst 
those of the female leave her skin, and muscles, and bones, and 
organs of voice, and hair, &c. &c, in all the delicacy, and soft- 
ness, and roundness, and flexibility of childhood ; being weak 
in body, comparatively feeble in mind and nervous energies, be- 
ing variable, credulous, subject to tne influence of the imagina- 
tion, and to nervous diseases ; whilst in disposition she is left 
soft, gentle, gaining by address rather than by violence ; all of 
which mark the peculiar sex. But in this we have only told 
that the developeing powers have failed to continue the devel- 
opement of some parts to that extent observable in the male. 
Still, however, the developing energies are not discontinued. 
They go on lastly to enlarge and perfect the organization neces- 
sary for pro -creation and the support of the race. The organs 
of generation are perfected. This done, the mammae, the organs 
for future support are developed, and the hips and lower parts of 
the body are brought out to that proportion which best suits her 
offices in life. This done, and the same power which effected 
the progressive developement of parts which we have noticed, 
still, by a rule of action peculiar to female nature, continues 
to bring appropriations, which constitute a surplussagc, which 
is now held in reserve, ready to be applied to farther devel- 
opements whenever conception shall render it necessary. — 
But such is the ratio of increase in the female system, as contin- 
ued after the full accomplishment of her personal perfections, 
that without conception, some kind of hypretrophy, or other form 
of constantly increasing disease would be the consequence of the 
retention of this surplussagc beyond a certain accumulation 
This we see threatened in the evidences of the near approach of 
the menstrual flux, which is indicated by head-ache, dullness of 



1837.] On Menstruation. 153 

most obvious from the earliest formation of the embryon. This 
continues until the whole body is formed, and both sexes devel- 
eyes, pain in the pelvic region, lassitude, whimsical appetite, 
&c., with or without a variety of nervous symptoms, as ringing 
in the ears, a sense of suffocation, palpitation, startings from 
slight and sudden noise, convulsive twitches, chorea, &c, and 
mournfully demonstrated in those organic diseases which seat 
themselves in the liver, lungs, brain, spinal marrow, &c, which 
we see constantly resulting from retained or suppressed menses 
without pregnancy ; and in those diseases, the full developement 
of which we witness at the critical period of female life. 

These then must, in the wise economy of nature, be prevented, 
which could alone be done by a timely elimination of this sur- 
plussage from the female system. If then this be not gradually 
and steadily done, by passing into the fcetal growth before its 
birth, or into the mammae afterwards, it so fills, gradually, the 
uterine vessels that they are at length obliged to yield it up front 
the outlets of the uterine sinuses constructed for its reservation 
for the nutrition of the offspring whilst in utero.* 

Thus flows the menstrual blood from the uterus until the 
evacuation is sufficient to relieve that local congretion which 
requires it, and which, without it, would go on to the production 
of disease in some other part, or the general system. 

A brief view of the manner in which the developement of 
the body is effected, may assist in exhibiting the rise, progress 
and decline of this curious function in a fairer ligrht. 

The vital fluid, it is truely said, is contained in corresponding 
vessels called arteries and vains ; but the former only are active 
powers. In the veins, the blood is propelled by the adventitious 
aid of other muscular powers, assisted and secured at each step 
by valves. It is evident, therefore, that for the necessary sup- 
port of the body, the action must bear a certain proportion to the 
resistance — otherwise, infarction would take place, or the arte- 
ries would be emptied. It appears to be a fact of observation, 
that the proportion of arterial action to venous resistance differs 
in different periods of life. Sir Clipton Wintringham has 

* The fact of menstruation in the human female is an evidence of the design of 
Providence that mankind should not be admitted to promiscuous intercourse as 
quadrupeds, &c. 



154 On Menstruation. [Oct* 

shown by actual experiment, that the density of the coats of the 
veins is greater in proportion to that of the arteries in young 
than in old persons. This proportion which these bear to each 
other is gradually changing, and after the acme of life, they are 
more equal ; or the resistance of the veins is little, in proportion 
to the action of the arteries. Now if we look to this curious 
fact, we shall find the true philosophy of the progressive growth 
of man for a certain portion of his life" his stationary condition, 
during the continuance of the lull perfection of manhood, and 
finally, his decline when the arterial power greatly preponder- 
ates over the venous resistance. 

This proportionate increase of power of the arterial system 
is to be accounted for on the principle of the increased develope- 
ment of muscular and fibrous parts by use — as in the muscles 
of laboring men. The moderate and prudent exercise of organs 
or parts, gives strength and energy of construction and function ; 
but the part or organ passively acted on suffers the overcoming 
of its resistance, and a loss of power and even substance. This 
is evinced in the increased powers of the muscles by their use, 
whilst the frequent pressure of their bellies during their action 
on the subjacent bone, flattens and attenuates the firm substance 
of the latter ; even to the production of apertures sometimes 
in the fiat bones. The arterial is the principally active organi- 
zation in the circulation — the venous, passive — hence by action 
and use, the former enjoys a perpetual increase of power and 
developement, whilst the latter suffers a decrease of its re- 
sistance. 

Nutrition is distributed to the general system — to each part 
by the arteries. The veins in early life are small and contracted. 
The resistance which they afford is sufficient to preserve the 
fullness of the arteries, and thus forces these to the continued 
elongation of their extremities, and the successive application of 
nutriment to the developement of parts. This predominating 
venous resistancs is no longer useful in man than during the 
increase of the body, and maturation of its powers : and in the 
wise economy of nature, it lasts until the whole formative pro- 
pensity, or the outlines of the design for manhood are filled, and 
no longer. Irteria] plethora, and venous resistance have thus 
far prevailed ; these now become equal. This done, or when 



1837.] Chi Menstruation. 155 



the venous resistance ceases to excel the arterial action , the parts 
cease to be developed, because the action and resistance are in 
equipoise. What takes place beyond this in the way of enlarge- 
ment, is only from the yielding of venous, and other soft and 
containing parts, as the cellular tissue, &c. Now however, 
arterial plethora no more exists, nor has venous plethora yet 
commenced. This balance of power and resistance continues 
for a time, during the prime of life, until at length the arterial 
power, by continuance of exercise, increasing, whilst the venous 
resistance, from being long acted on, gradually declines and 
yields to the former, and the venous plethora prevails, as is plainly 
evinced by the fullness and elevation of the superficial veins, 
&c. Such appears to be the philosophy of the developement of 
the bodily proportions and phenomena of mankind, without re- 
gard to sexual peculiarity of arrangement and function. But 
had such alone been the provisions of the human female, the 
race had never been perpetuated. Man's proportion of increase 
had only to be so arranged that his arterial plethora should effect 
his developement to the full stature of manhood and maintain 
it there. But to answer the functions so important to the per- 
petuation of her race, woman needed a provision not only for her 
own full developement to perfect womanhood, as displayed at 
the end of her third epoch, or 21 years ; but for a farther sur- 
plussage similar to that which prevails during the arterial ple- 
thora of early life, which should still exist for the support of the 
offspring. Instead, therefore, of that fullness of appropriation 
which, in man, goes to the support of his greater stature and 
other peculiarities, so expensive to the nutrition, and which I 
have before pointed out, it is withheld from these appropriations 
and kept as a reserve surplussage ready for use in her peculiar 
functions as a mother. This surplussage, ceasing io continue 
farther the developements of parts in woman, leaves her genital 
system with all those peculiarities which we have named as 
belonging to her sex, and is directed to the uterus, the place 
where it is destined to be appropriated. Such is the structure 
of the vessels and sinuses of the uterus, that they readily yield 
to delutation for a time, and a tropical plethora is the conse- 
quence ; which, when so great as to excite uterine resistance, is 
relieved by a gradual discharge from the uterine semises, of that 
4 D 



156 Rhinoplastic Operation. [Oct. 

blood which caused the topical plethora, and thus is menstrua- 
tion commenced. (" The idea of a topical congestion or plethora 
was suggested as far back as the days of Stahl, and had loosely 
floated in the minds of physiologists before the time of Cullen ; 
but to him are we indebted for its expansion into a system at 
once elegant and correct."*) 

Thus has nature wisely provided for and effected a union of 
the delicacy and softness — the roundness and flexibility — the con- 
fiding credulity and gentle yieldings of childhood, with the full 
developement of female perfection and beauty, as displayed in 
adult verginity : when, animated by the passions, emotions and 
sympathies which belong to her nature, and crowned with the 
sacred blush of modesty, woman is presented, full of charms and 
graces, which unite to render her a being the most enchanting — 
prepared by infinite wisdom to wear the golden chain of love, 
kneel at the hymenial altar, and become the mother of man- 
kind. 



PART II. 
REVIEWS AND EXTRACTS 



ARTICLE I. 

Rhinoplastic Operation, communicated to the Boston Medical 
and Surgical Journal, by J. Mason Warren, M. D. 

The history oi the patient who was the subject of this ope- 
ration, we shall give very briefly, as follows: 

J. T. 28 years of age. Three years ago last spring, while 
playing very roughly with one of his companions, he received 
a violent blow on the nose, which dislocated the cartilage, driv- 

♦Parr. 



1837.] Rhinoplastic Operation. 157 



ing it at the same time over to the left side. Some inflammation 
came on in the nose at the time of the accident, which very 
shortly subsided ; and as he was out of town, and at a distance 
from medical advice, nothing was done to replace the cartilage, 
which remained in the situation into which it had been driven 
by the blow. 

In the following spring, while pursuing his ordinary occupa- 
tions, a small red spot appeared on the right cheek just below 
the eye ; this very soon increased in size, the inflammation grad- 
ually spread, first attacking the lip, and from thence extending 
to the nose, which became red, swollen, and finally ulcerated. 

It will be unnecessary to go further into the details of the 
case ; suffice it to say, that in the course of eighteen months the 
whole nose, cartilages, septum, bones, &c. were successively 
attacked, and finally completely destroyed. The ulceration 
had also extended to the cheek of the opposite side. Subse- 
quently to this, cicatrization gradually took place, leaving the 
patient in the state in which I saw him, six months after his 
recovery from the disease. 

At this period, having accidentally come across a description 
of the Taliacotian operation in an old magazine, he applied to 
know whether anything of a similar kind could be done to 
remedy his frightful deibrmity. The following was his state 
as he appeared on the first examination. 

The nose, as described above, had entirely disappeared, leav- 
ing in the place it originally occupied an opening about an inch 
in diameter, bordered by a firm cicatrice ; the septum of the 
nostrils was destroyed, and the two nasal cavities thus thrown 
into one ; externally a small cicatrix descended from the lower 
and left edge of this opening to the angle of the mouth. In the 
course of the disease the four front teeth had been lost, and this, 
together with the absorption of the alveolar processes, had caused 
a sinking of the upper lip, which had fallen an inch below the 
level of the lower one. An opening also existed between the 
lip and upper jaw, through which a probe might be passed from 
the mouth into the nasal cavity. The sense of smell was quite 
lost, and he was subject to an occasional running of the tears 
over the face, arising undoubtedly from the too sudden contact 
of the air with the lachrymal ducts. 

A thorough examination of his case having been made, and 
finding there was no positive obstacle against the possibility of 
the success of an operation, the difficulties of such an operation 
as would be required were distinctly stated to him, the impro- 
bability of its succeeding so as to restore the organ in such a 
manner that the deformity should not be known, that the new 
nose might become very much flattened, and perhaps on the 
appearance of cold weather gangrene might take place, and 



158 Rhinoplastic Operation. [Oct. 

finally, that even his life might be endangered by it. I felt it 
my duty to state the case plainly, having seen all these accidents 
occur from the operation, and death in two cases being the con- 
sequence, from severe erysipelatous inflammation of the scalp. 

Notwithstanding all these objections, he said that he was 
ready to incur any risk which would give him the least chance 
of having the deformity under which he labored obviated, as life 
in his present state was hardly desirable. 

His case was certainly a hard one. A young man in the 
prime of life, in other respects of a good face and appearance, 
was, by this frightful calamity, not only entirely cut off from 
society, but prevented from gaining the means of subsistence. 

Having determined to submit himself to an operation, it was 
thought expedient to delay it a few weeks, in order to watch 
the case a little, and prepare him for it by a course of diet and 
regimen. 

At the end of six weeks his health had materially improved, 
and as he still persisted in the determination of having an ope- 
ration performed, preparations were made to do it as soon as 
possible, as on account of the approach of cold weather, no time 
was to be spared. At this period he was seen by my friend Dr. 
Peace, of Philadelphia, who was present with me at one or two 
operations of the kind practised by Uieffenbach in Paris, and he 
declared, as his opinion, that the appearance of the patient 
offered every chance of success. The favorable circumstances 
were — the healthy state of the integuments surrounding the 
opening of the nasal fossa, the great height of the forehead, the 
whiteness and delicacy of the skin, and, added to this, the good 
state of his health. All the preparations having been made, the 
operation was performed on the seventh of September. 

A piece of pasteboard, cut in the shape of the letter V, that is, 
of a triangular form, and with a projection from its base, corres- 
ponding to the columna of the nose, was placed upon the fore- 
head, and a trace made around it with the nitrate of silver ; this 
being used in preference to ink, as recommended by Lisfranc. 
in order that it might not be liable to become effaced by the 
blood. A trace was also made around the opening of the nasal 
fossa, at the points where it would be necessary to remove the 
integuments for planting the new skin taken from the forehead. 
This was done the night previous, in order to prevent any undue 
delay on the day of the operation. 

All unnecessary articles of clothing being removed, the pa- 
tient was placed on a table in a recumbent position, his feet 
towards the window, and the operator behind so as to have the 
full command of the head. The traces made by the nitrate of 
silver were about two thirds of an inch apart between the eye- 
brows, each side of the triangular portion of skin was three inches 



1837.1 Rluaoplastic Operation. 159 

and a quarter in length, with a base of three and a half inches, 
and the projection for the columna of the nose, which was to be 
taken entirely from the scalp, previously .shaved, was an inch 
and a half long and two tiiirds of an inch wide. 

The head being firmly supported by two assistants, the incis- 
ion was commenced between the eyebrows, and the flap of skin 
dissected up so as entirely to isolate it from the skin of the fore- 
head, except where, for the purpose of nutrition, it was left adhe- 
rent at the root of the nose. The incision on the left side 
between the eyebrows was extended a little farther down than 
on the right, the better to facilitate the twisting of the flap. This 
incision included the skin, subcutaneous cellular tissue, and a 
portion of the occipitofrontal is muscle, care being taken not to 
raise the periosteum, from fear of necrosis. 

The flap thus dissected and twisted round to the left side, was 
carefully wrapped in a compress of linen cloth, and before the 
the operation was proceeded farther in, attention was given to 
diminish the large wound made in the scalp. Little hemorrhage 
had taken place, and the temporal arteries which had been cut, 
very soon retracted and ceased bleeding. The angles of the 
wound were first brought together by the twisted suture, two 
pins being employed on either side. Its edges between the eve- 
brows were also approximated in a similar manner ; by this 
means the wound in the forehead was diminished at once to less 
than half its original size ; it was still farther reduced by the 
use of a few strips of adhesive plaister, and a little scraped lint 
filled up the remainder of the wound. Some lint spread with 
cerate was spread over the whole surface, a pledget, and the whole 
secured by a bandage round the head. 

The next object was to fix the borrowed skin in its place. In 
order to do this, it was necessary to freshen the borders around 
the opening of the nasal fossa, the traces of which, as stated 
above, had been previously made with nitrate of silver. For 
this purpose a short narrow knife, somewhat similar to a cata- 
ract knife, was used, and a strip of integument a third of an inch 
in breadth, removed, including all that portion which had been 
at all indurated during the cicatrization of the ulcerations. — 
The knife was also passed between the lip and upper jaw, in 
which existed, as before stated, an opening large enough to pass 
a probe, and the adhesions between the two, for the space of an 
inch, entirely cut away. This was done for the double purpose 
of giving the columna of the nose a more deep and firm adhe- 
sion, and, in the inflammation which would subsequently ensue, 
to close up the unnatural communication between the mouth and 
nasal cavity. 

The flap was now brought down into its place, its angles a 
little rounded with the scissors, the better to simulate the alee of 



160 Rhinoplastic Operation. [Oct. 

the nose, and the whole secured in its place by pins and points 
of the interrupted suture. From that portion of the skin which 
was to form the columna of the nose, the epidermic side was 
pared a little, so that it might form an adhesion not only under- 
neath to the jaw, but on its sides to the quadrangular wound 
made for it in the upper lip. 

A little scraped lint was now placed under the ends of the pins, 
and a strip of oiled lint introduced into each nostril to prevent 
adhesion ; another strip was placed upon the nose to preserve its 
temperature. The dressings were secured by a band of adhe- 
sive plaister fixed to the forehead above, and partially divided in 
the middle, so that it might descend on each side of the nose to 
the lip. 

During the whole of this long and painful operation the pa- 
tient kept up his courage, and not a cry was uttered, nor the least 
struggle made that could at all impede the motions of the opera- 
tor. Not much blood was lost, and his strength was so little 
exhausted that he was able to run up stairs to his chamber. He 
was ordered to go to bed immediately, to keep perfectly quiet, 
and a watcher left with him, who had directions, in case of his 
falling to sleep, to prevent him fiom either roiling over on his 
side, or raising his hand to the nose so as to derange the dress- 
sings ; also to wake him immediately should he breathe through 
the nose. To have arrow-root or gruel and lemonade, for nour- 
ishment. 

On visiting him in the afternoon he was found comfortable ; 
the new nose was warm, and had bled a little from the edges 
which formed the nostrils, both showing the circulation was not 
.at all impeded. 

Sept. 10. Passed a good night, slept well, pulse seventy-nine, 
-eomplains of no pain, the nose of about the natural temperature. 
The gentleman who watched with him thinks that the lint on 
-the right side of the nose was occasionally raised a little during 
expiration, when the patient slept soundly; he awoke him once 
or twice on this account. A purgative was ordered of the sol. 
sulph. Magnes. and liquid farinaceous diet. A piece of cork was 
confined between the teeth, so as to keep the mouth open, it being 
hoped that this might prevent him from closing his lips during 
sleep and breathing through the nose. 

11th. Quite as well, passed a quiet night, has a good appetite, 
pulse eighty. Watcher says that he occasionally made a motion 
to raise his hand to the nose, but, as if instinctively aware of the 
impropriety of it, withdrew it again without touching the dress- 
ings. The introduction of the cork into the mouth had entirely 
.effected its object, by preventing the passage of air through the 
nose. 



1837.] Rhinoplastic Operation. 161 

12th. The first dressing took place four days after the opera- 
tion, and the following was found to be the state of the parts. 

The dressings on the forehead, after being well soaked, were 
first removed. The angles of the wound were found to have 
united throughout, so that two of the pins were at once dispens- 
ed with. Union had also taken place in its lower part, just above 
and between the eyebrows ; the remainder of the wound, that 
is, its central part, in which union by the first intention could 
not take place, was suppurating well, and filled with healthy 
granulations. 

The nose was next attended to. Upon the lint being remov- 
ed, which had become very much hardened and caked in by the 
coagulated blood, it was found that entire union had taken place 
on both sides. The alae of the nose and lower edges could not 
easily be seen without making use of too much violence in re- 
moving the dressings, which at present was not thought neces- 
sary. The columna was curved inwards, and the sutures 
concealed. The nose was of the natural color and temperature, 
and the circulation through it seemed uninterrupted. 

Two strips of lint dipped in oil were laid over the cicatrix on 
each side of the nose, and no other dressings used. The patient 
was allowed to sit up a little, and to take any article of food of 
the liquid kind he might fancy. 

On the 13th he was quite as well, with the exception of a little 
oedema of the upper eyelids, arising, undoubtedly, from the pres- 
sure of the bandages and other dressings on the forehead. One 
of the pins was removed from the forehead on the 13th, and* 
another, the only remaining one, on the following day. The 
dossils of lint which had been placed in the nostrils still remained 
there, firmly caked in by the drying of the pus, blood, &c. — 
These were not removed until the 16th, when their places were 
supplied by two pieces of hollow sound. Some difficulty was; 
found in the introduction of the tube into the right nostril, which 
had become partially filled with granulations. 

On the 14th a quantity of hair began to appear on that por- 
tion of the skin forming the columna of the nose, which, as will 
be remembered, was taken from the scalp ; this hair, from time 
to time, required to be removed with the scissors. He was put 
upon a nourishing diet, with the caution to use the jaws as little 
as possible. He stated that occasionally, when he swallowed, 
he had a sensation as though he would "swallow his nose." 

15th. The remaining pins were removed from the side of the 
nose, and the two sutures which confined the alae ; and on the 
17th, ten days after the operation, the two ligatures, which con- 
fined the columna in its place, were also removed. 

At this period, the following was the state of the parts. The 
wound in the forehead, from the adhesion by the first intention 



162 Rhinoplastie Operation. [Oct. 

which had taken place, and subsequent contraction, had dimin- 
ished to a third of its original size, and the small triangular space 
which remained, together with that portion of the scalp from 
which the cplumna of the nose had been taken, was filled with 
healthy granulations. From the wound to the root of the nose 
was a linear cicatrix two inches in length, and continuous with 
the cicatrix on the left side. Adhesion of the integuments had 
taken place on both sides of the nose ; at the right alae, however, 
the union was not quite so perfect as at the left ; that is to say, 
the whole thickness of the skin did not appear to have united. — 
To assist the union, the skin of the face which lay under it was 
slightly scarified with the point of a lancet. 

The columna of the nose was a little curved backward, and 
its edges had retracted inwards upon themselves. The inside 
of the nose was suppurating well, and at its upper part adhesion 
seemed to have taken place between the two bleeding surfaces 
which had been opposed to each other. The tip of the nose 
was well defined, and its edges were curved inwards so as well 
to simulate the natural appearance of the alee, and just above 
the alse, apparently from atmospheric pressure, a depression was 
taking place, forming their superior boundary. This was assist- 
ed by the patient making an occasional pressure with his fingers 
at these points. He feels well, has a good appetite, and sits up 
all day. He breathes freely through the tubes placed in the 
nostrils, which require to be daily removed in order to clear out 
any obstructions which may collect in them. 

At the end of a month the wound in the forehead had con- 
tracted to about a quarter of its original size. Adhesion of the 
nose was perfect at all its points. The openings of the nostrils 
were regularly rounded, and simulated well the natural appear- 
ance. The lip ol the nose is well preserved, and a regular curve 
takes place from its root to the end of the organ. 

At the end of six weeks he was able to go out and walk about 
during the evening, but as the weather became cold he was ad- 
vised to confine himself to the house, as cold evidently had 
a very great effect in retarding the cicatrization of the wound 
in the forehead. By reference to the second figure on the plate 
which accompanies this paper, a pretty correct idea will be form- 
ed of the state of things six weeks after the operation. 

At the end of two months it was thought time to proceed to 
the second operation, which was required to remove the twist 
existing at the root of the nose. It will be easily conceived by 
referring to the plate, that underneath the pedicle which con- 
nected the nose with the forehead, a small portion of sound skin 
existed, and that of course no adhesion had taken place between 
this portion and the pedicle lying over it. The method usually 
adopted by operators has been to cut the pedicle, after sufficient 



1837.1 RJihwptasiic Operation. It3;> 



union oi* the nose has taken place below to justify the separation 
of it from its source of nutrition, and to fix it down at the root 
of the nose, in a transverse incision made for it at that point. 

To this method there arc some serious objections, first, the 
danger of inflammation in separating the pedicle; second, of 
sloughing of the organ on the vessels being cut which have 
hitherto supplied it witli blood; and lastly, the very perceptible 
transverse cicatrix left after the operation. The method resorted 
to in the present case is liable to none of these objections, except, 
perhaps, in the first one, in which the danger ismuch diminished. 

This operation was as follows. An incision was made, com- 
mencing at the internal angle of the eye, and extending to thai 
part of the base of the nose where adhesion had. not been able; 
to take place ; a corresponding incision was also practised on 
the pedicle. The skin being well dissected up from its adhe- 
sion, a small portion of integument was removed from the upper 
angle of the wound, where it had become wrinkled from the 
twist in the pedicle. The edges were brought together by three 
points of the interrupted suture. The same operation was to be 
performed at a future day on the other side, where, however, the 
opening was of about half the size, and not so perceptible. - 
Union took place, throughout, by the first intention. Some 
trouble was experienced, however, by the formation of a small 
abscess in the new cicatrix, which suppurated and discharged 
itself. 

The third drawing, executed four months after the operation, 
when the cicatrization had become complete at all points, ^ives 
a very good idea of his present appearance. He now declares 
himself entirely well, no secretion takes place from the nostrils, 
and on looking into those cavities a new skin is found to line 
them throughout. The nose itself has contracted gradually, so 
that by the first contraction of the integuments, and the subse 
quent contraction from suppuration, it has decreased to almost 
two thirds the size of the flap which was taken from the fore- 
head. Contraction also seems to be going on in its longitudi- 
nal axis, so that the distance between the tip of the nose and the 
mouth, daily increases. This will be much more perceptible, 
and the whole physiognomy of the nose much improved, when 
the four front teeth, which have been lost, are replaced. This 
will bring out the under lip, and at the same time raise the tip 
of the nose. The cicatrix in the forehead has become very 
small, and is gradually assuming the color of the surrounding 
integuments. The scalp from which the columna was taken is 
lost in the hair. The nose is quite firm, of a good form, and the 
cicatrix on each side hardly perceptible ; at the root of the nose 
on the left side, and at that portion which formed the pedicle, a 
5 E 



164 Rhinoplastic Operation. [Oct. 



small fissure still remains, which is for the present, concealed by 
a strip of court plaster. 

The health of the patient has never been better, his sense of 
smell is returning, and the tears no longer run over the face, and 
he, as well his friends, congratulate themselves both on the moral 
and physical effects of the operation. He is now able to make 
his appearance during the daytime, which he has not done be- 
fore during the last two years, and no person would observe any- 
thing remarkable in the nose, without a minute examination, 
when it would be difficult to explain the remarkable anatomical 
changes which have taken place. 

Remarks. — In an operation like the present, of comparative 
rarity in this country, it will not perhaps be considered amiss, if 
a few remarks are offered on some of the most interesting points 
connected witli its history, and of the chief difficulties which 
may occur to prevent its success. 

The operation of Rhinoplastie is originally of very ancient 
date. For various reasons, however, it had fallen into most un- 
merited disrepute until of late years, when it has been again 
revived in Europe by the brilliant successes of Graefe, Dief- 
fenbach, and Labat on the Continent, and Liston in Great 
Britain. Uieffenbach, in his late visit to Paris, where, with 
the accustomed liberality of the French, all the hospitals were 
thrown open to him for practising his celebrated operations for 
the restoration of parts, has, perhaps, done more than any other 
operator towards giving it its proper standing in surgery. 

In the most ancient operations of this kind, the lost organ was 
restored at the expense of the integuments in its immediate neigh- 
borhood ; advantage being taken of the extensibility of the skin 
of the cheeks, the integuments were dissected up on both sides 
of the nasal fossa, brought forward, and united in the centre by 
points of the interrupted suture. In case of the extensibility of 
the integuments not being sufficiently great, incisions were made 
on bothsides in front of the ears, so as to diminish the tension 
of the skin at these parts, the wounds thus made being after- 
wards allowed to fill up by granulation. This operation, how- 
ever, did not, as will be easily perceived, restore the form of the 
lost organ, and the only advantage gained was a flap of skin to 
coyer the existing deformity. 

The operation which was afterwards adopted, and which at 
present bears the name of the author, was that of Taliacotius, 
whicM consisted in taking the skin required, from the arm, or, 
in some cases, from the body of another person. The given 
shape of the nose being marked out on the place determined 
upon, the flap was dissected up, except at its base, and the inte- 
gument thus taken was confined in a place prepared for it around 
the nasal fossa. In this operation, it was required that the arm, 



1837.J RJiinoplastic Operation. 1G5 

in case it was taken from that part, should be confined in contact 
with the face, for the space of ten or fifteen days, or until union 
had taken place ; and it was not until then that the arm was 
released from its situation. The disadvantages of this method 
are at once manifest; the length of time required to keep the 
limb in this painful situation, so as in some cases to produce 
partial paralysis, and the danger that ensued in the too early 
separation of the transplanted skin from its source of nutrition, 
were, of themselves, reasons of sufficient weight to cause this 
method to fall into disuse. 

The operation which has attained the most celebrity, is that 
which goes by the name of the Indian Method, in which the flap 
is taken from the forehead. This has been most frequently 
practised in France and England, and it is this method, which, 
it will be perceived, has been adopted, with some modifications, 
in the present case. 

Having thus briefly referred to the history of the operation, 
some remarks will now be made on the chief difficulties which 
occur in the course of it, and the means taken to obviate them. 

No operation, perhaps, requires more attention to the nice 
points of detail, than that now under consideration ; and it is on 
these that the ultimate success of the operation, in a great mea- 
sure, depends. For information on this subject, we cannot do 
better, than by referring to the work of M. Labat, one of the 
most valuable monographs on rhinoplastie for reference yet pub- 
lished. The author, after having referred to the occasional 
trouble which he experienced from hemorrhage while dissecting 
up the flap of skin from the forehead, goes on to state, "But an 
inconvenience much more embarrassing, and to which it was 
necessary to be resigned, from the impossibility of remedying it, 
was occasioned by the great quantity of blood, which, entering 
the throat, was violently expelled from the mouth every time 
that the pain of the operation forced the patient to cry out. But 
what was much more troublesome still, was its being repeatedly 
received in my eyes, so as once or twice to oblige me to discon- 
tinue the operation for the space of some seconds/' 

The difficulty which the author here complains of, was reme- 
died in the present instance by a very simple means. Instead 
of placing the patient in an upright position, he was made to lie 
upon his back on a table, the operator behind him; the blood 
was thus conducted off on each side of the face, instead of pass- 
ing over the nasal fossa and mouth, and entering the throat. — 
To guard against any possibility of this accident taking place, 
plugs were confined in the opening of the nasal cavities, during 
the dissection of the flap, and the time occupied in closing up the 
wound on the forehead. When the operation was commenced 



166 Rhinoplastic Operation. [Oct. 



around this opening, and the entrance of the blood was unavoid- 
able, the patient, who maintained sufficient coolness throughout, 
was requested to keep the blood as long as possible in the mouth, 
and an assistant directed to clear out, with a small sponge, what 
had collected, as occasion required. 

We give the account of another trouble, in the author's own 
lively description, which, fortunately, was avoided in the present 
instance. 

"But an accident of much more gravity, and which placed 
me in a very critical position, presented itself at a moment, when, 
after having detached from the forehead the flap of integument, 
I was about to bring it down into the place it was destined to 
occupy. Previous to making this twist of the new flap, it was 
thought necessary, as I have before stated, to prolong the incision 
on the left side as far as the medium line of the root of the nose, 
in order to facilitate the torsion of the pedicle ; the patient expe- 
rienced, at this moment, such a violent pain by the inevitable 
division which it was necessary to make of some of the ramifica- 
tions of the frontal branch of the ophthalmic nerve of Willis, 
that he escaped from the hands of the assistants, rushed towards 
the door, and was determined not to undergo the remaining part 
of the operation. At this moment, the physiognomy of L. pre- 
sented a most frightful aspect ; his forehead covered by a large 
wound, the borders of wnich. retracted by pain, had greatly 
augmented its extent, and all the rest of the face, his neck, and 
garments, inundated with blood. But a sight which was much 
more horrible to behold was the flap of palpitating integuments, 
which at every moment were jerked from one side of the face to 
the other.*' 

In the present instance, no particular suffering was observed 
by the extension of the incision down between the eyebrows ; 
and incase of any difficulty of this kind, the complete command 
in which the patient was held, from the position adopted, would 
have prevented any of the evils complained of by M. Labat. 

One of the greatest difficulties of the operation, and that which, 
in its consummation, occupied the most time, was the passing of 
the pins which were to close the wound in the forehead, and to 
confine the new nose in its situation. To remedy this as much 
as possible, the pins to be employed, which were the long pins, 
generally used by naturalists, were previously sharpened; and 
for introducing them, a little instrument was constructed, some- 
what similar to the aneurismal forceps of Dr. Piivsick, made 
with a small groove to receive the head and upper third of the 
shaft of the pin. With this instrument the pins were readily 
seized, and pushed through the skin, and the ligature being ap- 
plied, their ends were cut off by the scissors or cutting pliers. 
At that part of the flap which was to simulate the alas of the 



1837.] Rhinoplastic Operation. 107 

nose, as it was necessary that the integuments should be directed 
inwards, the pins, of course, could not be used, and here a plan 
recommended by M. Lab at was adopted, which was followed 
by partial success. A thread being passed first through the inte- 
gument of the face, and then through the flap, at about two lines 
distant from the edges, the ligature was so tied as to produce, as 
it were, a fold at that point ; and the better to effect this object, a 
small piece of adhesive plaister, rolled up into the form of a 
cylender, was confined under the threads, so as to make a strong 
compression on the wound and to force the edges into their places. 
This succeeded completely on one side ; on the other, however, 
the union, at first, was not so entire, the skin adhering only by 
about half its thickness. 

During the whole of the treatment, it was necessary to keep 
the openings of the nostrils distended by small tubes. The sub- 
stance which seemed to answer the best lor this purpose, was a 
portion of the barrel of a quill ; the end which was to remain in 
the nose, being stopped up with a little melted sealing wax, and 
a small aperture cut in the side through which the air could 
freely pass. These were ingeniously constructed by the patient 
himself, who, after a time, was able to manage them without 
difficulty. The tendency to contraction at these points was very 
great, so that at one period, the tubes being left out during the 
night, it required considerable force to replace them. 

From the new nose being formed entirely oi skin, it will per- 
haps be supposed, that the integuments composing it are flaccid, 
and the form of it easily destroyed. This, however, from rea- 
sons easily appreciable, is not the case. The integuments of the 
scalp being naturally of great thickness, by the suppuration 
which took place from the inner side were made to assume a firm- 
ness almost similar to fibro-cartilage ; and at the root of the nose, 
the internal surfaces coming in contact, contracted adhesions so 
as to make the nose perfectly solid at that part. The size, also, 
of the columna, which doubled upon itself and contracting deep 
adhesions during the inflammation which took place, forms a 
round and solid pillar to support the tip of the nose. 

Great precautions had been taken to oruard against exposure to 
the cold, which, by stopping the circulation, might at once defeat 
the whole object of the operation. As soon, however, as adhesion 
had taken place, it was perceived that no danger from this source 
was to be apprehended ; and although during the winter he has 
slept in a room in which water has frequently frozen, and has 
been since repeatedly exposed during some of the coldest days, 
he finds that the temperature of the organ is never greatly dimin • 
ished. 

The cicatrization of the wound in the forehead was greatly 
retarded by the cold weather, and less than half the time would 



168 Broncholomy. [Oct. 



have been required, had the operation been performed during a 
warm season ; when it had diminished to a small size, and cica- 
trization, as frequently is the case in the filling up of large 
wounds, seemed to have been arrested, great benefit was found 
from the use of an ointment composed of six drops of creosote 
to an oz. of simple ointment. On the application of this to the 
wound, the effects were at once apparent. A small pellicle form- 
ed over its whole surface, which was shortly replaced by a firm, 
consistent cicatrix. 

In one or two cases operated upon by Dieffenbacii, much 
swelling took place in the new formed nose the day after the 
operation, arising from the difficulty of the blood, which had 
entered by the arteries, being conducted off by the veins. In 
one case the nose became so enormously distended, that it was 
feared the adhesions would be entirely destroyed, and it was only 
by the repeated application of leeches, 70 or 80 being employed 
in the course of 18 hours, that this danger was finally avoided. 
In the present case, from the extension given to the incision on 
the left side, Gare being taken that traction should not be made 
too forcibly on the part, so as to compress the pedicle at its base, 
the circulation was, from the first, unobstructed. 

In the account of the foregoing case, it has been attempted to 
bring forward some of the most important points which might be 
of service as a guide to future operators; and if the author has 
been so fortunate as to throw any new light, however small, on 
the operation, he will feel that he has rendered a service to sci- 
ence and to humanity. 

Boston, March, 1837. 



ARTICLE II. 

BRONCHOTOMY. 



This operation was successfully performed in December last 
by Dr. Calvin Jewett, of St. Johnsbury, Vt.* The necessity 
for the operation was caused by the lodgement of an eight-pen- 

-Boston Medical and Surgical Journal. 



1837.] llronehotomy. 160 

ny cut nail in the right bronchia, below the bifurcation of the 
trachea. The subject was a child, three years old. 

The symptoms manifested by the patient from the time of the 
accident had been frequent irritative cough ; sometimes, though 
seldom, approaching to suffocation. He continued to run about 
the house and out at the door for two or three days ; his cough 
and difficulty of breathing becoming now more urgent, it was 
concluded he had taken cold. His appetite failed him from the 
day of the accident ; and though he could now and at all times 
swallow either fluids or solids without the least difficulty, his 
principal diet was milk. Once, and once only, he had puked." 

This accident occurred on the evening of the 10th December. 
"Now," says Dr. Jewett, "full nine days since the accident, 
he is cheerful, though unable or unwilling to walk : pulse one 
hundred in a minute, breathing a little hurried, tongue clean, has 
frequent paroxysms of coughing, which last from a few seconds 
to one or two minutes. Breathing, or disposition to cough, not 
affected by posture, yet he chooses to have his head elevated, 
and to recline only on the right side. Sleep is frequently inter- 
rupted by coughing. Cathartics, expectorants and anodynes had 
been presented by Dr. Brown, the attending physician. Though 
very intelligent for his years, he complains of no pain, and when 
definitely inquired of, he acknowledges no pain or disagreeable 
sensation in any point you refer him to. Placing the hand over 
the region of the right lung, either anterior or posterior, it gives 
a sensation like crepitus ; to the ear it communicates a peculiar 
hissing sound, neither of which can be heard or felt over the 
left lung. These sensations were communicated both sleeping 
and waking, yet more distinctly when coughing." 

Drs. Jewett, Brown, Newell, and Spaulding, the whole 
consultation, concurred in the opinion that the nail had passed 
into the trachea, and not into the oesophagus ; and that it was 
below the bifurcation of the right bronchia. 

December 21 (continues Dr. Jewett,) I was again called to 
Mr. B.'s, where I met Drs. Brown, Spaulding, Alexander and 
Densmore. The little boy's strength fails ; he has become rest- 
less, and much more irritable than when I saw him before, not 
willing to have his pulse taken or to submit to any examination. 
All the physicians agreeing in opinion, the parents decided to have 
the child submitted to the operation. 



1^0 Bronchotomy. [Oct. 

Being provided with a pair of long and very small forceps, 
mad;' expressly for the purpose, of soft iron that could be bent to 
any desired curve, silver wire m loops, and all the variety of in- 
struments which it was thought possible might be needed, we pro- 
ceeded to the operation. On a table of convenient height, suita- 
bly covered, we placed the boy, his head being bent over a fold 
of cloth, and projecting beyond the table. From the bloated state 
of the neck, the smaliness of the trachea, and the enlarged veins, 
the direction of some being such that they could neither be avoi- 
ded or pushed to one side, some two or three ounces of blood was 
lost, and one ligature had to be applied. A long time was occu- 
pied in making the dissection and opening the trachea, of which 
three or four rings were divided down as Tow as possible. 

Should I say we were near one hour from the time of placing 
our patient on the table, until I cut through the trachea, 1 should 
not be far from the truth. Let those who think it a very easy 
matter, and quickly to be done, once have the trial em the little 
living subject, who has been breathing with difficulty, and 
coughing nearly to suffocation for ten or twelve days, and after 
such a trial they may speak with more certainty. 

Not expecting the nail would be forcibly ejected, as may be 
the case with light substances, a blunt probe was introduced 
down into the right bronchia, and the nail distinctly felt at the 
depth of about four and a half or five inches below the top of the 
sternum. I now tried the forceps, but before I could fix on the 
nail, the spasmodic action was so severe as to threaten immedi- 
ate suffocation, and I was compelled to desist and withdraw the 
forceps. Again and again I tried the long forceps, other forceps, 
the wire loop, &c. but tried in vain. Drs. Alexander and Spauld- 
ing ably seconded my efforts, and more than once and again tried 
with various forceps and instruments,, and with the like result. 

Near two hours had now passed since the little boy was pla- 
ced on the table, having been raised up frequently to take Ins 
drinks. During the whole process he made no resistance, and 
never cried, though often threatening to tell pa if we would not 
let him alone. 

Our patient now appeared much exhausted, and we desisted 
from any further attempts to remove the nail, for one hour, during 
which time he rested quietly and slept some. We again made 
repeated trials to remove the nail, but without effecting our pur- 
pose, and were compelled, most reluctingly, to say we could not 
remove it ; painful and humiliating as was this avowal, make it 
we must. 

When the opening was made into the trachea, considerable 
viscid mucus was thrown out through the wound; and the night 
following, I tarried with him and found his breathing much 
freer than before ; he coughed less, and rested better than usual. 
The dressings applied were simply strips of adhesive plaister. 



Bron< hotomy. Wl 



I now leave the history of this case, December 24th, expecting 
to learn, in the course ot'a few days,, of his death, and the dissec- 
tion, which will show the exact situation ofthe nail. 
Sequel to Bronchotomy, 

Under date of Feb. 6th, I received from Esquire Belden the 
history of his son's case from the time of the operation down to 
date. 

1 le says, " The air ceased to escape through the incision in 
thirty hours, and his breathing continued better than before the 
operation. About the 20th of January he had the appearance 
of having taken a cold ; his cough became more troublesome, 
with much phlegm. On the morning of January 23d, about 6 
o'clock, his cough was still more severe, giving a different sound 
from that of any time previous; it was harsher, sharper, and re- 
sembled the barking of a fox. I hastened to light a candle, but 
before I could do this and return to the bed, William says, ' Pa 
I have coughed the nail up/ I stepped to the bed with my light, 
and in a streak of phlegm and blood lay the nail, directly be- 
fore his mouth on the pillow, the head from him. I viewed it 
attentively before touching to see if I could discover any matter 
(pus.) but sow none." 

Since the above date of February I have seen both father and 
son ; the boy appears well and hearty, his cough has entirely 
subsided, unless when he is much irritated, he coughs a little. 
Contrary to what was the fact before, he now, since raising the 
nail, lays on either side, or on his back, with equal ease, and his 
head low : whereas, before, he could lay only on his right side, 
his head very high, or occasionally for a short time he would lay 
directly on his face. 

That there is not a similar case, as it regards form, weight, &c., 
o( a child so young, having received such a weight into his lungs, 
and thrown it up by coughing, I will not venture to assert, but 
if such a case has occurred, it has escaped my notice if reported. 

A few practical inferences may perhaps be drawn from the 
foregoing case, and its, thus far, result. 

Various instruments may, again and again, and repeatedly, 
for the space of one whole hour, be introduced through an arti- 
ficial opening in the trachea, into the lungs,. or rather into the 
bronchial tube, without taking life. 

It shows that a substance of most unpromising form, and great 
weight (in reference to its bulk) may be thrown up by coughing. 

It further confirms the safety, and expediency (because of its 
safety.) of the operation when light substances are received into 
the trachea, which being easily moved by air, would more likely 
produce immediate suffocation if remaining, and are almost cer- 
tain to be removed directly, when the operation is performed. 
6e 



172 Ccesarian Operations. [Oct. 



ARTICLE III. 

Ccesarian Operations, followed by success both for the Mother 

and Child. 

The following cases are of great interest, as they are fairly- 
calculated to assure us of a degree of safety not generally ac- 
corded to this operation in England and America. They also 
cite our attention to the cause of the frequent ill success which 
has attended them, and consequently enable us to avoid that 
cause, if we have the tact and decision which should belong to 
every surgeon -accoucheur. The compiler of these cases, Ven- 
derfuhr, has shewn us that in these cases of signal success, 
the operation has been performed early in the case, whilst the 
greater fatality of this operation in England he very reasonably 
ascribes to the delay of several days, during which the powers 
of the patients have been " exhausted by useless parturient 
efforts." This promptness cannot, however, be safely used 
without that thorough knowledge which is necessary to enable 
the operator to decide absolutely and correctly too, on the neces- 
sity of this operation by the facts which render it necessary, 
without awaiting the result of a long and unsuccessful labor to 
prove its necessity. We are, however, thus far, fortunate in the 
less frequency of its necessity in America than in England, or 
on the continent. And this good fortune Americans will con- 
tinue to have, until the American race is still farther deteriorated 
by luxury and vice. 

1st. Case by Yenderfuhr. — This is the third time, says the 
author, that in a practice of 18 years, I have had occasion toper- 
form the Caesarian Operation, and each time with success. The 
two first cases are contained in the Magasin de Rust of 1823. — 
In tliis, as in the other two cases, the operation was indicated by 
the narrowness of the pelvis and was performed at the instance 
of the mother. As in the other cases also I selected for the mode 
pf the operation, the incision on the linea Alba, which I consider 
the easiest and most advantageous. 

Gerti de Holzapfel, aged 24, born of healthy parents, was 
raised in extreme poverty. Affected with scrophula and rachitis 
she did nol begin in walk until theageoi nine. I [er general health, 
however, was tolerably good, and the catamenia appeared when 
she was 18 years of age. She became pregnant for the first 



1837.] CcBsarian Operations. 173 

time in her 24th year. Her pregnancy passed pretty well, and 
even during the last days she walked about seeking charity. — 
On the night of the 20th April, pains commenced, and I was call- 
ed on the 21st, near noon. 1 found the unfortunate patient in a 
miserable hut, clothed in rags and reposing upon straw. She 
was small, her limbs but little developed, the legs much curved. 
■She presented all the signs of the rachitis that had existed. By 
external measurement, 1 found eleven and a half inches between 
the great trochanters, and the antero-postenor diameter to be six 
inches. By the touch, the index finger soon discovered at the 
left; a projection which the midwife had at first taken for the head 
of the child, and which in reality had with the latter a deceptive 
analogy. This projection was formed by the promontory. The 
distance between the latter and the internal, face of the symphisis 
pubis could be easily filled by the index and middle fingers ; so 
that the antcro-posterior diameter which, according to the exter- 
nal measurement would be three inches, was reduced to two and 
a half in consequence of the projection of the promontory. — ■ 
The right side of the pelvis presented a greater width, but not 
however sufficient to admit the foetal head. The deformity was 
increased because the horizontal rami of the pubis were more 
elevated than the promontory. The head reposed upon the lat- 
ter, the neck of the uterus was dilated, the membranes were 
ruptured. Sanguinolent mucosity existed in the vagina. The 
pains were intense, and the violent motions of the foetus estab- 
lished its vitality. These circumstances induced me to propose 
the Caesarian operation, which received the sanction of some pro- 
fessional brethren. 

After having first emptied the bladder and rectum, I made an 
incision of five inches upon the linea alba, and soon perceived at 
the bottom of the wound the reddish blue colour of the uterus, 
A small incision was made in this organ at the place which 
seemed most suitable, and enlarged by cutting upon the index 
finger until it was four and a half inches in length. The pla- 
centa was not touched, so that the effusion of blood was inconsid- 
erable. The child, which presented its back towards the wound, 
was easily withdrawn, and by its cries proved its vitality. The 
after birth was delivered with difficulty, as the introduction of 
the hand and the separation of the placenta were embarrassed by 
the contractions of the uterus. I prevented the escape of the 
blood into the abdomen by applying the abdominal parities accu- 
rately against the surface of the womb, and thereby prevented 
also the protusion of the intestines, but not that of the omentum; 
a portion of which escaped during a convulsive paroxysm of 
cough. Having reduced this part, I united the wound by the 
twisted suture and strips of diachylum plaster in the intervals. 
The operation was protracted by vomiting which occurred seve- 



174 Crisarian Operation*. Oct.] 

fal thrfes. Tlie wound was covered with drycharpie and com- 
presses, and tire whole kept in place by a bandage around the 
body. The night passed without sleep, but without any other ac- 
cident except vomiting, which recurred several times during the 
first hours after the operation. The next morning the abdomen 
was neither swollen nor painful, the locheal discharges flowed 
regularly. The patient urinated twice without pain; the pulse had 
but little frequency ; thirst moderate, tongue clean alid humid ; 
the skin moist. Towards evening some fever and pain's in th6 
abdomen supervened, but these accidents subsided and were fol- 
lowed by some hours of repose. The following days the fever 
was only of moderate intensity, no sanguine depletion was ne- 
cessary, although the abdomen was slightly swollen and painful. 
The fifth day some diarrhoea supervened, and required the ad- 
ministration of opiates. The same day I removed the dressing 
and detached" the point of the suture. The wound had united 
in its superior third ; it was slightly open at its inferior part, from 
which a considerable quantity of Icetid secretion escaped. 'I'his 
secretion continued for some time ; the wound cicatrised slowly, 
a; circumstance which 1 believe to be advantageous, because it 
p'revents the accumulation of the secreted matter. The lochial 
discharge, so important in cases of this kind, continued more 
than a month. Fifteeii days after the operation the fever had 
entirely disappeared. From this period the patient began to re- 
cover rapidly. &leep and appetite returned', and at the end of 
two months, the mother and child were enjoying perfect health. 
With regard to the latter, I may remark that for fifteen days we 
entertained serious apprehensions of its safety. Born in perfect 
health, it took the. breast the second day as soon as the secretion 
of milk was established ; but the milk of the sick mother, though 
of good aspect and taste, did not agree with it. It was troubled 
by vomiting and diarrhoea, the mouth was filled with apthse, a 
great part of its body was covered by excoriations, and a fright- 
ful emaciation ensued. We were obliged to have recource to 
artificial lactation. As the diarrhoea persisted, we employed broth 
with yolk of e^gs, and some mucilaginous remedies. These 
means succeeded — the child recovered its strength, and at the 
end of three weeks was again put to the breast of its convales- 
cent mother. 

2d. Case by Meyer. To the above case we add another of 
Csesarian operation, remarkable for its success, in a, woman debi- 
litated bv previous disease, and whose case seemed desperate. — 
We regret that the author has left us in doubt, which diminishes 
the interest of the case, as he only remarks that the child was 
alive when taken from the womb, without informing us whether 
it continued to live. 



1837.] Cccsarian Operations. 175 



The wife of a shoemaker, aged 38, who had been healthy in 
her youth, had suffered for two years with rheumatic pains, and 
for the last year had scarcely left her bed, and could walk only 
when supported by crutches. She became pregnant, and in the 
evening of June 19 was seized with the first pains of parturition. 
The deformity of the pelvis, in consequence of the rheumatism, 
appeared to require the Caesarian operation, and the author being 
called in, visited the patient in company with two surgeons. 

The patient was in the most unfavorable circumstances : her 
abdomen much developed, was covered by an eruption ; the in- 
ferior extremeties were swollen up to the genital organs, and a 
painful cough, nausea and vomiting existed. The pubic and 
ischiatic bones were so much curved inwardly, that the finger 
could with difficulty reach the promontory advancing to the 
symphisis pubis. 

The 20th June the operation was proposed and accepted as 
the only means of safety. The patient was placed upon a table 
covered with cushions ; the thighs could scarcely be separated 
sufficiently to leave a free passage £o the hand, and in conse- 
quence.^' an anchylosis between the lumbar vertebre and be- 
tween these bones and the sacrum, the trunk could not be 
extended. In this semi-sitting position the abdomen was in 
near proximity with the thighs. Notwithstanding this unfavor- 
able circumstance, Meyer preferred the incision of the linea 
alba, because he had made it successfully in three other cases^ 
because the latteral incision is accompanied by loss of blood 
which it is important to avoid in a debilitated patient, and finely 
because in the incision of the linea alba the wound in the uterus 
always corresponds better with that in the abdominal parieties* 
The patient having been arranged for the operation, and assist- 
ants suitably placed, the surgeon made an incision through the 
skin from the umbillicus to the symphisis pubis, embracing an 
extent of four inches, the linea alba and peritoneum were incised 
to the same extent, a great quantity of serosity^ the result of an 
ascites escaped. The uterine parieties which the author had 
found thin in the proceeding cases, were firm, three lines in 
thickness and opposed some resistance to the instrument. The 
incision fell exactly upon the placenta, which caused an abun- 
dant sanguine effusion, and also diminished the space for the ex- 
traction of the child. The placenta was rapidly detached with- 
out producing hemorrhage, the child was found placed upon 
its back and presenting the right knee, the two feet were with- 
drawn, then the body, the arms, and finally the head, which 
offered some resistance. During all this time the uterus was 
kept fixed by an assistant. The blood and serosity were remov- 
ed from the abdomen, and the uterus was seen to contract to 
twice the volume of the fist. The lips of the wound were brought 



176 Ccesarian Operations. [Oct. 

together by the twisted suture. It was kept open in the space 
of ;m inch above the pubis. Compresses were applied and main- 
tained in place by a bandage. In half an hour the patient laid 
tranquilly in her bed. The child was alive, cried continually, 
but was feeble. Soon after the departure of the physicians, half 
an ell of intestine escaped through the wound, bat was easily 
reduced, and the opening was closed by compresses and adhe- 
sive strips. The consequences of the operation presented no 
peculiarities. The inflammatory phenomena which supervened 
were only of moderate intensity, and were easily subdued, the 
locheal discharge was regular, and the wound suppurated but 
little. The patient soon took food and entered upon convales- 
cence. The 15th July an inflammatory tumour appeared at the 
inferior part of the wound, an abscess was formed, and the 
wound which gave issue to pus, remained fistulous for some 
time. The 10th of August it was entirely cicatrised, and the 
patient completely cured. — Repertorium de Kleinert, 1836. 

3d. Case by M. Duchateau d' ] Arras. Stephanie Brassart 
aged twenty-two and a half, and forty-three inches in height. — 
All her extremities present the marks of rachitis. The verte- 
bral column is very convex at its anterior part. The scapulae, 
especially the right one, in near proximity with the pelvis. 

This woman whose menstruation commenced at the age of 
18, and continued regularly presented herself at the Hospice 
de la Maternite d' Arras to be bled in the 8th month of her first 
pregnancy. M. Duchateau ascertained that the crests of the 
iliac bones were placed in the same line, and that the distance 
from one anterior superior spinous prosess to the other was eight 
inches nine lines ; that the sacro-vertebral angle inclined towards 
the symphysis and a little to the right ; that the'superior strait had 
only two inches in its antero-posterior diameter. The 20th of 
April, 1836, this woman having arrived at the full period of na- 
tural gestation, returned to the hospital complaining of pain in 
the kidneys. No other phenomenon appeared until 24th, five 
o'clock, A. M. Then she began to experience more severe pains 
which succeeded each other, however, slowly. At six o'clock, 
the orifice of the womb presented itself turned to the right, and 
anteriorly with a dilatation of from ten to twelve lines. The 
membranes began to protrude, but no part of the child could be 
felt by the finger. (An enema and a general bath.) At nine 
o'clock she was in the same state. M. Duchateau and his col- 
leagues perceived the necessity of an immediate operation. A 
sound was introduced into the bladder, and this organ found to 
be empty. _ An assistant placed between the inferior extremities 
kept the womb fixed, while others exerted tension upon the ab- 
domen. The operator, with a convex bistoury, made in the 



1837.1 Ccnsarian Operations. 177 

skin an incision, which, commencing at two inches above the 
pnbes, was directed in the course of the linea alba, passing a little 
to the left of the umbillicus, and terminating two and a half 
inches from this part. The different aponeurotic layers were 
incised in succession. The peritoneum was raised by the dis- 
secting forceps and opened cautiously, and then divided in the 
length of the primitive incision with a straight probe pointed 
bistoury, directed by the index finger. The omentum which 
covered the uterus and intestines was raised and kept above the 
womb, as well as some coils of intestine, which the efforts of the 
patient had driven to the superior part of the wound. The 
uterus was found in the middle of the incision in the abdominal 
parieties. It was still kept fixed by an assistant, and an incision 
made in it with a slightly convex bistoury. The internal face 
of the womb being divided, a jet of black blood disclosed that 
the placenta existed at the place of the incision, which was di- 
lated with a probe-pointed bistoury. The membranes of the 
ovum being exposed to view were then divided like the perito- 
neum, using, however, the necessary caution to prevent the liquor 
amnii from escaping into the abdominal cavity. The placenta 
was then detached to a small extent, and the child seen in the 
first position of the head. The legs were seized by the right, 
and the trunk by the left, hand of the operator. It was extract- 
ed from the womb and uttered its first cry. It weighed six pounds 
four ounces. In three minutes the uterus began to contract. — 
The umbillical cord and the membranes, the coagula and the 
fluids contained in the womb were removed. The index finger 
was introduced through the wound into the neck of the uterus, 
which was soft and dilated to the size of a five franc piece. The 
finger of an assistant introduced through the vagina, touched 
that of M. Duchateau, proving that the fluids could escape, but 
that the promontory presented the projection which had led to 
the operation. 

The uterus having contracted, the lips of the wound were 
united by three points of the quilled suture, the parts were 
washed- with a decoction of mallows. Strips of Diachylum plaster 
were placed in the intervals between the sutures, and only a se- 
ton smeared with cerate was placed at the inferior angle of the 
wound. Charpie, compresses and a bandage completed the 
dressing. The operation lasted 20 minutes and was well borne. 
The patient was at first troubled by acute pain in the right iliac 
region, vomiting, and cough which were relieved by venesection, 
leeches, Cataplasms and mucilaginous drinks and enemata. The 
ninety-second day after the operation she had entirely recovered 
and the child was well. — Presse Medicate 1837, No. 7. 

A case analogous to the preceding, by Professor Stolz of 



178 Division of the Arm by a Sabre Cut — Reunion. [Oct. 

Strasbourg-, is contained in the Memoiresdc l'Academic Royale 
de Medicine, vol. 5, p. 91. 

Caesarian Operation repeated 4 times loitli success upon the 
same woman. By M. E. Charlton, President of the Medical 
Society of Edinburgh. This case, which occurred in Germa- 
ny, was seen by the author, who vouches for its truth. Cases 
have been cited in which the Caesarian operation has been re- 
peated six or seven times on the same woman, but these cases 
want the necessary authenticity and details to ensure entire coiir 
fldence. The subject of the case in question was a small rachitic 
woman, whose pelvis was greatly deformed. The operation 
was performed for the first time June 18th, 1826 ; the second 
time 21st January, 1830 ; the third time 28th March, 1832 ; and 
the fourth time 24th June, 1836. Ail these operations were per- 
formed in public, and by different modes. The patient was well 
with the exception of some fistulae at the place of the cicatrices. 

The author gives the details of these different operations, # and 
concludes by remarking that the Caesarian operation has very 
often succeeded on the Continent, while it is almost always fatal 
in England; the English, says he, do not operate till late, when 
the strength of the patient has been already exhausted by use- 
less parturient efforts for several days. — Gazette Medicate, No. 
25, extracted into } from the Edinburg Med. and Surg. Jour. 



ARTICLE IV. 

Almost complete division of the Arm by a sabre cut, re-union^ 
cure. By M. Stevenson. 

The following is the most remarkable authentic case of re-un- 
ion found in the annals of surgery : — 

An Arab, Abdoo Braheem, received a violent sabre cut in the 
arm, immediately below the external margin of the deltoid mus- 
cle, dividing obliquely all the tissues, the humerus and the entire 
body of the biceps muscle. The blood was projected forcibly 
to the distance of several feet. The assistants arrested the he- 
morrhage by exerting compression on the wound by means of a 
turban. Upon examination, M. Stevenson ascertained that the 
arm was attached to the rest of the body only by a single strip 
of skin at the internal part ; the bracheal artery had been divid- 
ed at the same time with the biceps muscle ; the pulse at the 
wrist had disappeared entirely. His first idea was to complete 
the amputation : but this was opposed by the patient, and it be- 
came necessary to attempt the re union, although but small pro 



1837. j Retroversion of the Tongue. 179 



bability of success existed. Assisted by M. Stevenson, M. 
Pearson first desired to ascertain if the bracheal artery could 
be tied ; this attempt was useless. A tourniquet was applied, 
left loose above the wound, and confided to an assistant with the 
injunction to tighten it if the hemorrhage reappeared. The 
wound was cleansed, the parts brought in apposition, and an ap- 
propriate apparatus with splints applied. 

No hemorrhage — the pulsation at the fist imperceptible until 
the third day. At this period the pulse began to reappear very 
slightly, and became more and more sensible. The wound was 
perfectly cicatrised the 26th day, but the fracture had not yet 
united. The arm was kept in the apparatus until the 45th day ; 
then the cure had been completed. The extremity, however, 
remained paralysed. 

This case is worthy of interest ; it leads to practical conse- 
quences of the highest importance. The reunion of a volum- 
nious limb, like the arm, may then take place after the division 
of its principal arteries and nerves. The contrary, however, 
has been laid down as a principle a priori. Dtipuytren had 
declared, (v. plaies d'armes de guerre,) that in the members whose 
vitality is confided to an unique source, (artery and nerve,) as in 
the arm and thigh for example, the reunion was impossible when, 
this source was concerned in the injury. Besides, added he, 
what would become of the divided artery without a ligature \ 
Thus he thought that the completion of the amputation was hir 
dispensable in this case. Reunion had, it is true, been attempted 
and obtained in an analogous case by Lamartiniere, but the 
bracheal artery and plexus had not been injured, which changes 
entirely the conditions of the lesion. The fact in question then 
proves the contrary of what had been presumed : reunion of the 
large members may take place notwithstanding the division of 
the principal vessels. The circulation may be re-established as 
after the operation of aneurism. Besides we can easily conceive 
how a large artery may be entirely obliterated- — Gazette M& 
dicale, No. 25, 



Retroversion of the Tongue, 

M. Cros3e, in a speech at the fourth anniversary session of 
the assembly of English physicians, at Manchester, mentioned 
that he had known a young boy who could swallow his tongue 
without any inconvenience, and that he frequently repeated it 
with the greatest facility. A very curious case of retroversion 
of the tongue has been recently published. A physician was 
called to visit a young infant that had been suddenly taken with 
7f 



180 Case of Triplets and of Locked Heads. [Oct. 

alarming symptoms of suffocation. Upon examining the mouth, 
he discovered a retroversion of the tongue, whose point was en- 
gaged in the pharynx. It was easily returned to its proper place, 
but the accident recurred several times. — La Presse Medicate, 
No. 49. 



PART III. 
MONTHLY PERISCOPE. 



Case of Triplets and of Locked Heads. 

A case of this kind occurred in the practice of Dr. Joseph A. 
Eve, of Augusta, on the 24th of September last. 

The woman was a delicate negress, aged about 35 or 40 
years. Her health had been bad during the whole period of ges- 
tation, and particularly about the time of parturition. 

The first birth was very easy and rapid ; the child having 
passed, before the Doctor's arrival. He found the woman on her 
knees on the floor, leaning upon a chair, ind the child suspend- 
ed by the cord. As soon as he had made the ligature on and 
cut the cord, she was put to bed, and he found, upon examina- 
tion, the feet of another child presenting. The labor progressed 
with the second child in this presentation until the body^ad 
passed as far as the armpits, when, in consequence of the pains 
becoming weak, and the fear of strangulation of the cord, the 
ergot was administered, with the effect of increasing the force of 
the p.uns. The next phenomenon worthy of remark was the 
indication of undue pressure on the brain of the second child, 
by convulsive contractions of its legs. At the same time the 
woman complained of severe pain and numbness in her right 
leg — the same side at which the head of the upper child present- 
ed. A farther examination was then instituted to discover the 
cause of compression, and of the arrest; for the pelvis was unu- 



1837.] Superfcetatiort. 181 

sually large, and the child rather small, though not much below 
the average size. On this examination the Doctor discovered 
the head of a third child below the superior strait, whilst the 
head of the second, whose body was delivered, was still above 
the same strait, constituting a case of locked heads. His first 
attempt was to dislodge the head of the third child ; but this 
was soon found impracticable ; for it was immovably fixed be- 
low the superior strait. Not approving the plan adopted by 
some, of delivering the upper child by the forceps, before deliver- 
ing the head of the lower, he determined to await the delivery 
of both together, as long as he might think it safe to the mother, 
and if necessary, ultimately to decapitate the lower child, press 
the head up from the superior strait, and thus a.*ow the upper 
one to pass, or assist it with forceps, as circumstances might de- 
mand. Whilst awaiting the issue of this plan, he requested a 
consultation ; but before the arrival ol another physician, and 
within little more than an hour after the discovery of the true 
nature of the difficulty, both heads passed. The superior child 
made some spasmodic movements after birth, but could not be 
resuscitated. Both heads were very much indented by the pres- 
sure of the other. 

Except the injury inflicted by the accident, the children were 
all well formed, and very little below ordinary size. Two of 
them were boys. The mother passed her accouchment as well 
as could be expected under the circumstance of her previous 
wretched health. 

M.wy cis33of diffbulty and psrplexity in child-bearing arise 
from the small dimensions of the pelvis ; but this was one which 
may be fairly attributed to too large a pelvis ; for had this been 
of ordinary capacity, the head of the third child could not, with 
the good developements of both, have engaged the superior strait, 
with the neck of the previous child engaged in it, and the head 
at or near the superior plane. 



Superfoetation in the Mare. — Horse and Mule Issue. 

Although supufoDtation is a thing of constant occurrence in 
the lower animals, and several well authenticated cases are given 
of women producing both white and mulatto children at the 



152 Thomsonianism and the LeRoy Physic. [Oct, 

same time, we do not recollect an instance before the following, 
reported to the Farmer's Reporter, by Gen. Thomas Emory, of 
Maryland, wherein both a mule and a horse colt were produced 
at the same time. 

Near Salem, N. J., June 6, 1837. 

1 hereby certify that I have a mare, which, this spring, pro- 
duced twin colts — one of which was a mule, and the other a 
horse colt, both having attained, before parturition, the ordinary 
size. The mule is still living, and the colt died without getting 
up ; having been] strangled by the caul or suck, from which the 
colt was not able to extricate itself. The mule is brown, of the 
ordinary appearance. The colt was a fine sorrel, with blaze 
face and white feet. This circumstance is regarded in this neigh- 
borhood as one of a very singular character in natural history, 
and was seen after the death of the colt by several persons, to- 
wit: my son Joseph, and Charles Slade. 

The mare ran in my stable yard to foal by herself; and it was 
next to impossible that the colt could have been brought into 
the yard by any other means than by the mare which foaled the 
mule. It was known last spring, that soon after the mare was 
served by the jack, that a two year old colt of my son's got to and 
served the same mare ; and as a further proof that this colt was 
the fruit of this act of coition, the colt was of the same color, and 
marked with white in the same manner as the supposed sire. 

JONATHAN BILDERBACK. 

Test : Thomas Emory, 

Robert C. Johnson. 

Salem, June 10, 1837. 
I hereby certify that Jonathan Bilderback is a respectable 
farmer in my neighborhood, and that I believe him to be fully 
entitled to credit as a man of veracity. 

ROBERT Y. JOHNSON. 



Thomsonianism and the LeRoy Physic. 

In the fate of the LeRoy Physic of France, we may see that 
of Thomsonianism in prospective. The LeRoy Physic has been 
out little known in America ; perhaps not much more than Thom- 
sonianism has been in France. It was that of which Thomso- 
nianism is, as near as may be well imagined, a true counterpart. 
We will give a brief view of its history. 

This LeRoy Physic, tolerated as it was by the state, had an un- 



1837.] Thomsonianisni and thi LeRoy Physic. 183 

paralleled run in France. It consisted of two books, and three 
different medicines, instead of six numbers ; one, an emetic, an- 
other a cathartic, and the third, we believe, was for a tonic. — 
Thousands and thousands of these sets of books and physic 
were sold off under state patronage, amongst the dense population 
of France. Its praises reverberated from the Pyrenees to the 
Netherlands, and from the banks of the Rhine to the I Jay of 
Biscay. That was the day of its glory. It was exalted to the 
sky ; but it was for a brief season. " Murder will out." Rea- 
soning from the facts of observation, will prevail. This noble 
faculty will be exercised when the force of novelty passes away. 
France was made up of a high minded and affectionate people, 
whose sensibilities rebelled against the insult offered to their 
understanding, and the injuries humanity was made to suffer. — 
She was a belligerent nation, and needed all her materials. She 
had a Napoleon, whose espionage reached every where and 
embraced everything ; and who himself had decision, always to 
the purpose. Novelty passed away, and the sober, undisguised 
facts were returned and accumulated at the Capitol, which 
proved its course was, like the/etreat from' Moscow, marked 
out by human victims on every side. The first step (with- 
out parley, without compromise at the expense of humanity, 
without the wretched policy of legalizing manslaughter for a 
time, for the purpose of drawing decision from the voice of the 
ignorant populace,) was the instant jjrohibition of its sale and 
use within the realm. 

The next manoeuvre of its proprietor was to try the imposition 
in other countries ; and it was consequently shipped in large 
quantities to America. It caught the eye of one in this place, 
who deemed the chance of making himself a notorious doctor 
too tempting to be unembraced. Its use was traced out by its 
multiplied, sudden and unexpected deaths. But fortunately, it 
had no friends more interested in its success than commission; 
merchants, and consequently its false praises were not sung. — 
The books too were in the French language, and, unlike Thom- 
son's, were a little too volumnious for the gulls and shallow- 
pated knaves to read, and it could not get a footing here. 

So let it be — so will it be with Thomsonianism. It is now at 
the zenith of its glory — sounding its own false praises from 



1S1 Thomsonianism and the LeRoy Physic. [Oct- 

Texas to Maine, and from the Atlantic to Missouri — the most 
stupendous system of quackery, and the most insulting offering 
ever tendered to the understandings of a free and enlightened 
people— littering its own banterin^s for proof of facts which 
nobody doubts, not even themselves ; for such facts are too fa- 
miliar to them. 

Now should Thomsonians look ont, and spread the parachute 
preparatory to the fall. We have no Napoleon; but we have 
schoolboys in great abundance who know well the ridiculous 
falsehood of their fundamental doctrine of the four elements. — 
We have women who know that the knowledge of midwifery, 
which could be obtained " in only a few minutes conversation 
with an old woman,"* will not answer the demands of humani- 
ty. And we have men too \vho know death when they see it — 
men who know very well when the tall, lean, long-necked man, 
is taken from his feet and subjected to a steaming heat of great 
degree, with a perpetual drink of African pepper, &c, and dies 
immediately in an appoplectic lit, what it was that killed. 

It is true that Americans are wonderfully fond of novelties; 
but they only need a little time for reflection on the observed 
truths. No sooner will this be had, than the steamers will be 
left as lonely as Sam Patch now is. This done, and they will 
know most clearly the cause of death when they see the ruinous 
effects of such a poison as lobelia, which, like arsenic, owes its 
safety only to its almost instantaneous rejection from the stomach. 

People who enjoy freedom of opinion and the right of action, 
will not have so gross an insult offered to their understanding — 
such injuries to weeping humanity. Reason and prudence lead 
to the sam3 results every where under like circumstances; con- 
sequently, the rational and prudent course of the Connecticut 
Legislature will be speedily adopted by other States, until the 
degrading stain ot Thomsonianism shall no longer disgrace the 
character of Americans. 

* See Thomson's Narrative and Guide. 



1837.] Diervllla Canadensis. 185 



Diervilla Canadensis. 

N. B. Pickett writes to the editor of the Boston Medical and 
Surgical Journal to say that a plant in the vicinity of Great 
Barrington, Mass. is held in high repute as a sped fide for the 
erythematic inflammation* produced by Rhus Toxicodendron, 
Rhus Radicans &c. An infusion of the bruised leaves and 
twiggs is applied. The writer also understands that it is used 
in calculous affections, and is known by the popular name of 
Bush Honeysuckle,! and is the Diervilla Canadensis of Eaton. 

We should be pleased to learn the sentiments of Professor 
Tully and Dr. Hooker, to whom reference is made for infor- 
mation. At the same time we feel it a duty to say, not only from 
our own observation, but more confidently on the abundant ob- 
servation and experience of a judicious medical friend, that there 
is perhaps no disease, the small pox itself, which is in its periods 
one of the most uniform of all diseases, not excepted, whose 
course is more certain to be run, despite of all remedies, than the 
erythematic or eruptive inflammation which arises from the dif- 
ferent species of Rhus — that it is uniformly stated in its periods, 
exacerbating for the three first days, and being well by the termi- 
nation of the seventh. The fact of its regular termination, as 
well as its regular period for decline not bein^ generally observ- 
ed, renders it probable that many articles have, from time to 
time, been named as remedies, only from the fact of their having 
been resorted to during the spontaneous decline, or termination 
of the disease. 

We have often observed, and for a long time believed that a 
lotion of strong salt and water, or an alkaline lixive. seemed to 
possess the power of gradually modifying, and promptly dispel- 
ling the inflammation with its attendant distressing itching, 
burning and swelling. But the character of the disease being 
considered, we are left in doubt whether the improvements ob- 
served, instead of being in the relation of effect, to the applica- 
tion as cause, it is not a mere coincidence. 

* See Boston Medical and Surgical Journal, vol. xv, p. 380. 

"t This is entirely different from the Azalea, or Honeysuckle, a shrub very com- 
mon in our forests, and spoken of in a former No. as a diuretic. 



186 Tic Douloureux. [Oct. 



In order then to deduce the truth as to the remedial virtues of 
Dier villa Canadensis, or any other supposed remedy for this 
disease, the period, and peculiar character of the disease should 
be carefully marked in connexion with the administration of the 
remedy. 

As to <•' specific" virtues, as understood in medicine — an infal- 
lible curative power, we have long doubted whether the term 
had properly a place in regular medicine. 



Tic Douloureux cured by the external application of Tartrate 
of Antimony. 

We are indebted to the valuable Electric Journal of Dr, 
Bell, (from Medicinisch Zeitung of 6th January 1836,) for the 
following interesting result, obtained by Dr. Hausbrandt : 

A woman, more than sixty years of age, had suffered many 
years from face-ache, the severity and long continuance of which 
almost reduced her to despair. As soon as the pain of the face 
ceased, the patient felt comparatively well : when the pain came 
on, which was always suddenly and without ostensible cause, 
the muscles of the face twitched, and the eye of the affected side 
was closed ; the whole face became remarkably pale, and the 
features indicated severe suffering. As no particular circum- 
stance capable of inducing the attack, excepting perhaps taking 
cold, could be discovered, the treatment was altogether empiri"- 
cal. A considerable number of remedies, such as are usually 
employed for this complaint, were tried, — especially frictions, 
vesicatories, narcotics, carbonate of iron, — but the paroxysms 
returned with greater frequency, and the patient not only lost 
flesh, but her condition seemed desperate. Dr. H. prescribed 
the following plaster, which was applied over the whole of the 
affected side of the face : 

R. Emplast. Resinse flavae, l\. 

Resin a3 flavae, §ss. 

Terebinthinae venetae, §iij. Liquat. adm. 

Tart. Antimonii, gjss. fiat Emplast. 
"When this had remained on the face twenty-four hours, the pa- 
tient experienced an itching, burning sensation throughout the 
spot covered by it, but the face-ache was relieved. At the end 
of several days the plaster was taken off, when the entire half of 
the face was found covered with pustules, which gave a good deal 
of pain, but which were very bearable in comparison to the former 
pains. The sores gradually healed by the application of simple 



1337.] Ijpuchorrhaca and Menorrhagia. 1ST 

dressing, and up to this time (three and a quarter years,) there 
has been no recurrence of the complaint. 



On Sulphur et of Lime hi Diseases of the Skin, by Dr. Sa- 

vardan. 

Dr. Savardan has employed the following ointment in chronic 
diseases of the skin, for the last twelve years, with very great suc- 
cess : eight parts of lard are intimately mixed with one part of 
sulphuret of lime ; and one drachm is directed to be rubbed into 
the palms of the hands for one quarter of an hour night and 
morning. Dr. S. has given short notes of thirty cases of chronic 
diseases of the skin of various kinds affecting different parts of 
the body, all of which gave way to this ointment, used in the 
manner specified. All were cases of long continuance, and the 
treatment was of course protracted ; one or two yielding in rather 
more than a month, others in three, four and seven months ; 
whilst in others the frictions' were persevered in for one or two 
years. — Journal des Connaissances Medico-chi?'urgicales,Jan 
vier, 1836. Eclectic Journal. 



Leuchorrhosa and Menorrhagia. 



b 



In a late communication to the Boston Medical and Surgical 
Journal, Dr. Thomas Close bears testimony to the use of ni- 
trate of patassa, sulph. alum, and kino in Leuchorrhcea and 
Menorrhagia. The basis of his prescription, taken fromDEu- 
ees and Eberle, consists of ten grs. of nit. of patassa, and five 
of alum, to which he has been induced by successes therewith, 
in cases of failure of the above alone, to add a grain and a half 
of kino. This dose is given three times a day, dissolved in a 
sufficient quantity of water. He asserts, that for several years 
he has « not met with a single case of Menorrhagia or Leu- 
chorrhcea which did not yield promptly to this remedy." 

As these two diseases usually alternate with each other, Dr. 
C. thinks that there is little difference in their nature — leucorr- 
hoea being commonly the mere sequel of menorrhagia — " the 
serous discharge escaping after the vessels have so far contract- 
ed as no longer to give passage to red blood." With this patho- 
logical view, he thinks it "not strange," (nor would it be, if 
8g 



1S8 Leuchorrhcea and Menorrhagia. [Oct. 

the view were correct,) " that the same remedy should be found 
to possess an equal control over them both." 

But the interest of this prescription is not limited in his prac- 
tice to ordinary cases of these diseases ; but extends with equal 
advantage to leuchorrhosa accompanying gestation ; cases of 
transparent discharge occurring before puberty ; to the most 
aggravated cases of profuse menstruation, and great flooding in 
child-bearing, &c. One case is given of overwhelming hoe- 
morrhage recurring once in two or three weeks, afterwards with 
a serous discharge so profuse, that the patient believed that more 
than a pint a day escaped her, and sometimes, after a few hours 
retention, that quantity was discharged at a gush." " So great 
had become the morbid determination of fluids to the pelvic re- 
gion" (in this particular case,) " that a serous discharge took 
place several times a day from the rectum, while the sufferer 
was constantly harrassed with a sense of weight, distension, and 
bearing down, and often with great pain — fullness in the lower 
part of the abdomen, alarming prostration, skin leaden color and 
countenance expressive of such great suffering and imminent 
danger, that he became fearful of carcinoma, and proposed ex- 
amination per vaginam." During some delay, however, this 
prescription was ordered, but with little confidence in its ade- 
quacy to the demands of the case. In this he was agreeably 
disappointed, and in a few weeks these profuse discharges were 
brought " within the limits of moderation and safety — the leu- 
chorrhcea in two months ceasing altogether." "It is proper 
here to remark," continues Dr. C. "that the morbid current 
which has been so long determined to the pelvic region, contin- 
ued still to flow that way, after its outlet had become obstructed ; 
causing at first such a sudden and violent distension of the ute- 
rus, as to produce intense pain and soreness, and requiring the 
loss of a considerable quantity of blood from the arm, with fre- 
quent fomentations to relieve it. Before the recurrence of the 
next menstrual period, however, the equilibrium of the circula- 
tion had been so far restored that no farther difficulty arose, and 
the patient was at length restored to firm health." 

" It is difficult for me to believe that success so uniformly can 
have been accidental ; and although others may not be equally 
fortunate with myself in prescribing this formula, yet I think 
that, upon a thorough trial, it will be found to possess a greater 



1837.1 Medical Intelligence. 189 



control over morbid uterine discharges than any other means now 
in use." 

We have long used, with very good success in suitable cases, 
a kindred preparation — the Pulvis Stypticus, or compound pow- 
der of alum and kino — in uterine haemorrhage. This we have 
found succeed many times, when taken dry, after the acetate of 
lead had failed, but we have never added the nitrate of potash. 

We should be pleased to learn that Dr. Close's practice suc- 
ceeds as well in other hands as in his own ; and we hope the 
successes will be returned to us in connexion with exact his- 
tories of the cases. 



MEDICAL INTELLIGENCE, 



Death by Tiiomsonian Practice. Indictment founded on evidence before 
the Coroner's Inquest. — We learn" by the Journal of Commerce, the Evening 
Star of New York, and other papers, that T. G. Fkexch, a young man 18 years 
old, and teacher in the grammar school of Columbia College, being afflicted with a 
slight cold, went to the Infirmary and put himself under the treatment of Richard 
K. Frost, a Thomsonian, or Steam Doctor in New- York. 

It appeared in evidence that he was then provided with an apartment, and a dose 
of " composition tea ;" and on the following day, " a regular course" of Thom- 
sonian practice, commencing with lobelia and steam baths, which, on the 5th day 
resulted in the death of the unfortunate and deluded young man. The body was 
disinterred, and a Coroner's Inquest empannelled. Drs. CiiEESEMANand Rodoers 
made a post mortem examination. Dr. Chilton, an eminent chemist in Broad- 
way, analized the contents of the stomach, and one yard of the intestines, where 
he found two teaspoonfuls of powdered lobelia ; and from a number of experiments 
made with it, it was found to have the same active principle with tobacco. A vast 
deal of testimony was adduced to shew the mode of treatment, and description of 
medicines used, which, in a few words, consisted of vapor baths, washing the 
patient with cold water immediately before he came out of them — administering to 
him large and repeated doses of lobelia in pills, emetics, and injections; and cover- 
ing up the patient in bed with a great number of blankets, to keep up the perspira- 
tion caused by the medicines. Physicians who were examined, testified that the 
powers of lobelia are similar to those of tobacco — tending to create great prostra- 
tion of both mental and bodily faculties ; and in large quantities, most likely to pro- 



!90 Medical Intelligence. [Oct. 

duce death. All the physicians on evidence concurred in the opinion that the de- 
ceased had been most improperly used. 

At the end of a tedious and deliberate examination of the abundant evidence in 
the case, the Jury returned the following verdict : — 

" It is the opinion of the Jury, that the death of the deceased was occasioned by 
a general congestion of the internal organs — a complete prostration of his natural 
functions and nervous system, produced by the administration of deleterious medi- 
cines and other improper treatment, while in the infirmary and under the medical 
charge of Richard K. Frost." 

Frost was then arrested under a coroner's warrant, and held in a recognizance 
of $5000 to answer an indictment against him for murder. 

It appeared on farther acquaintance, while detained in the police office for giving 
bail, that this great Thomsonian doctor, was, by apprenticeship, a lock smith, but 
had become manager of a Thomsonian Infirmary. 

A circumstantial account of the death of Sylvanus B. S. Rhodes, which was 
briefly alluded to in the last No. of this Journal. 

About the 20th of July last, Sylvanus B. S. Rhodes came to my office desiring 
to be bled, on account of headache, which he thought it would relieve. He had 
no fever, but a pulse of healthy fulness and frequency. I advised him to take in 
preference, a dose of calomel in divided portions; but he said he would be bled, 
and do that afterwards if he did not get better. I opened a vein in his arm. He 
had said he dreaded the operation very much, and immediately after opening the 
vein, he appeared somewhat faint, and was reclined on a chair a few minutes, until 
he felt better. He then went away, having lost not exceeding 6 or 7 ounces of 
blood. The next day I saw him about his boarding house door, and was informed 
that he went out to the workshops at the Rail Road Depot. I heard no more of his 
case until I was requested to visit him at his lodgings, on Monday the 24th, when 
I found him complaining of some headache, with a slight fever. His pulse was 
about 90 to 95. Believing he was suffering the effects of a slight cold only, I pre- 
scribed him a few portions of febrifuge mixture of acet. amnion, spt. nit. and ant. 
wine in diaphoretic doses ; with a warm foot bath at night if the headache and dry 
skin continued. Next day I saw Mr. R. passing the piazza of the Hotel, consider- 
ed him relieved, and paid him no farther attention. 

On Saturday, the 29th of the same month, at about 2 o'clock P. M. I was told 
that Rhodes was dying, and my attendan % e demanded. I immediately attended 
the call, and on arriving at the bedside where the unfortunate victim laid, and find- 
ing him in the last moments of life which was evidently being terminated by a 
profound appoplexy, I enquire! of those present, what had the patient taken, or 
what had caused the present state of things ] On this enquiry, the person who 
seemed to be endeavoring to serve him with care and assistance, and who was to 
me a stranger, replied, : ' I have civen him nothing, sir. but a little warn lea, and 
a footbath.' 1 '' " You have given," said I — " are you a steamer, sir V " I own the 
patent," he replied. 

Knowing that this treatment alone was not sufficient cause of the phenomenon 
which was before me, (for Rhodes was the extreme opposite in all his habits and 
bodily conformation to those things which dispose to apoplexy,) I pressed the en- 
quiry. I knew that with steamers, when a patient, who had taken lobelia recover- 
ed, it was No 1 which he had taken, which is lobelia; but when the powers of 



1S37.J 



Medical Intelligence. 10 1 



life wen Irrecoverably destroyed by this dangerous articl i, il was only il a v*.ry r< 
e?netic" that had been given; and. in like manner, composition tea is composition 
tea, if the patient recovered; but "a little warm tea" when he is killed, and that 
a steaming process, is in like manner a "steaming" or "a simple foot bath." On 

pressing my inquiry, I was informed by Mr. J. M. Moom . who by this time I ob- 
served at my side, and who was then serving as Bar-Keeper in the Hotel, that, in 
the morning, Mr. Rhodes had been about the house — that the steam doctor had 
been telling Mr. R. of some of his great success in the steam practice, which had 
induced Rhodes to conclude that, as he was not very sick, and the steamer had 
cured himself of t; just the same kind of troubles" very quickly, he would submit 
himself to his treatment — that he had consequently had R. under his treatment for 
some two or three days previous; and that on that day he had taken him up to his 
room, (which was a small, close, well-ceiled room, about 8 or 10 feet square,) and 
put him on the use of composition tea, and No. 6,* and applied a number of hot 
rocks to him, and covered him well with -1 blankets. — That on lying a while under 
this treatment, the patient sprang up from his bed and exclaimed, " I am shot 
through my head — that the external heat and internal stimulation were then in- 
creased on account of the aggravation of symptoms. The room was closed ; and 
fearing that Rhodes might sutler from the want of something, he attempted to en- 
ter his room; but on opening the door, found the heat so intense that he was unable 
to enter. That soon thereafter, it became known that Rhodes was laboring under 
a fit, and he (Moody) was dispatched for another steamer — that on his return, he 
found him in the large adjoining room where I saw him, whither he had been 
brought for the benefit of fresh, cool air. 

Mr. Moody made this statement openly, and in the presence of several persons 
who had collected around; and again subsequently and fully at the house of Mr. 
Dever, the nearest friend of Mr. Rhodes, and who had indeed brought him 
from his friends in Baltimore, to this place. 

Mr. Dever entered the room a few moments after me, with feelings of ardent 
friendship, and a sense of responsibility to his friends at home ; and finding his 
friend a livid, lifeless corpse, vented his distracting grief by alternately throwing 
himself on the dead body, and shrouding it in his embrace; and briskly pacing the 
room with all the extravagant manner of strongest grief: so that at this time, Mr. 
Dever was incapable of attending to the circumstances above detailed. 

I felt it a duty I owed to my fellow beings, to remark to the man who had con- 
ducted the treatment above described, (and who still stood by the corpse vainly en- 
deavoring to make the dead arm retain its position on the side of the corpse as if 
alive,) that before him laid the lifeless body of one of the most estimable young 
men in this community — deprived of life by his ignorance and cruel temerity — but. 
that I need say no more, as the Legislature of the state had placed him at liberty to 
go forth in the commission of such deeds as often as he could find subjects. I 
then left the scene. 

During the afternoon, Messrs. Deaves and Dever came to my office manifes- 
ting great dissatisfaction with the management and result of the case, and asking 

" Composition tea is made of composition powder; and composition powder [s made of Bay-berry 
root bark, inner bark of hemlock, ginger, cayenne and cloves, all finely powdered and welt mixed 
No. 6 is made of fourth proof brandy, or mostly of alcohol, myrrh, and No. 2 which is cayenne- Thom- 
son directs them to be given during the steaming process, and previously to raise the inward heat 
.(See Thomson's guide, p. 26.) This cayenne is an African pepper of peculiar powers. 



199 Medical Intelligence. [Oct. 

advice as to what they, as the friends of Rhodes, should do; desiring at the same 
time that I should open the body and see if the injurious effects of the treatment 
not so obvious as to sust.iin a prosecution against the man who had conducted 
the treatment. I replied that the in my estimation, sufficiently plain, 

from the facts already well known — that there could be but one opinion on the 
subject; but that if they insisted, I would request some half dozen medical gentle- 
men to meet me, and make an anatomical examination if they should think it ne- 
cessary to their judgment — stating, however, that a proseeution would avail noth- 
ing, since the Legislature had passed an act sanctioning that kind of practice ; and 
that as yet the community had not learned enough of its ruinous tendencies, to en- 
able them to get a special jury who would give a verdict of "guilty," however 
plain the facts might be in a particular case. They insisted, however, that I should 
call the Gentlemen's attention to the case. I then sent a written request of the 
attendance of Drs. Ford, Dugas, P. F. & J. A. Eve, and Robertson — only the 
two last of whom however attended. These gentlemen visited the hotel, and made 
for themselves the necessary enquiries into the facts of the case ; and felt bound, 
from the facts ascertained, without dissection, to fully confirm the opinion I had 
given. These gentlemen will not swerve from the opinion there deliberately made 
upon the abundant evidence which was present. 

It may be well to state in conclusion, some facts of Mr. Rhodes' person and 
character, to which all who knew him will testify; and which tend to show that 
there was nothing in his habits, disposition, or personal conformation, in the least 
calculated to favor the production of appoplexy : and that such an event could only 
have come from extraneous influences. Mr. Rhodes was a modest, pliant, intelli- 
gent and interesting young man, of unimpeachable moral character, and habits of 
the strictest temperance. His person was tall and slender, but very genteel and 
well proportioned ; his eyes and hair were very black, and his complexion brown. 

Augusta, 4th Nov., 1337. 

I hereby certify, that on the 29th day of July last, (the time of the death of 
Syxvanus B. S. Rhodes,) I was living in the Western Hotel as bar keeper — that 
the said Rhodes had been complaining for some days of slight indisposition — that 
on his being told, by a steam doctor who was also boarding at that time in the Ho- 
tel, of the great cures he had made of himself and others, Rhodes was induced to 
tell him that he might take him through a course of his treatment, as he was so 
successful and expeditious — that the steam doctor then commenced with Rhodes 
such treatment from day to day as he thought proper — That on the forenoon of the 
day of his death, he was, as usual, about the house, and was taken up stairs by the 
steam doctor to undergo the treatment for this day. That a number of hot rocks 
and bricks, and four blankets were provided, and Rhodes put in bed and the rocks 
and bricks placed about him, and all covered with the blankets; whilst the compo- 
sition tea ;\nd No. (i were administered internally — that the room wherein he was 
placed was a small one, not exceeding, as I should suppose, eight or ten feet square — 
that the door and window were closed, which, with the close ceiling of the apart- 
ment, rendered it as close as possible, and that the day was one of the warmest in 
the month of July — that after having been subjected to this treatment for some time, 
I attempted to go into the room, to see if he needed any thing, and found on open- 
ing the door for this purpose, the heat so intense, that I was unable to enter the 
room. 

Not long after this. Rhodes sprang up in his bed, and exclaimed, " lam shot 



1837.1 Medical Intelligence. 193 



through the head." Whereupon some alarm for him arose, and i was dispatched for 
anot'i 'tor. On my return, I found him removed to a bed in the large 

adjoining room, pulseless, and apparently i\\ Tel of water was then 

provided andplaced in the small room from which he had been brought, and Rhodes 
i backand placed therein : after a few breaths he seemed to die in the bath — 
was then removed again to the large room, alter which he gasped a time or two, and 
breathed no more. 

The above is the substance of the facts I related to Dr. Antony, who had just 
been called in, and was enquiring what had been done to Rhodes. All of which 
is substantially correct, as I attended to the administrations of the steam doctor when- 
ever he needed assistance. 

Dr. A. had visited Rhodes only once, which was on the [Monday previous to the 
Saturday on the afternoon of which he died. On Tuesday, the day following Dr. 
A.'s visit, Mr. Rhodes was better, and went out to the Rail Road Depot. Dr. A.'s 
prescription on the above visit was a viol of fever mixture, which I administered in 
broken doses, according to directions ; and a warm foot bath at bed time, in the 
event of his head ache continuing with dry skin; but the circumstances not de- 
manding it. the foot bath was not used. The next and only treatment which Rhodes 
e v er received after, was that of the steam doctor as described above. His death 
was on a Saturday, which was the 29th of July last. 

JAMES M. MOODY. 

Augusta, 4th Nov. 1837. 

I hereby certify, that on the day of Sylvanus Rhodes' decease, which I think 
was on the 29th day of July last, on hearing that said Rhodks was dying, I went 
to the Western Hotel to see him. and found him dead. This was a little after 2 
o'clock P. M. On looking into the room in which he had been lying, I saw a large 
vessel, being a half hogshead, containing water. There were rocks and wet blank- 
ets lying about the place, which as I was informed by those present, had been used 
in carrying him through the steaming process ; during which he had complained 
suddenly, whilst in bed with the hot rocks and under the blankets, that he was shot 
through the head. That on thus getting worse under this treatment, and the internal 
use of composition tea and No. 6, these means had been increased — that the room 
had been closed as well as possible, and that whilst under this treatment he had taken 
the appoplectic fit of which he died. 

These statements were subsequently made several times to me, and in my pre- 
sence, by Mr. Maddison Moody, who was at that time Bar-Keeper in the Western 
Hotel, and who attended with the Steam Doctor to afford him occasional assistance 
on his administrations. 

A few days previous to this, the said Sylvanus had been to our house, and ob- 
served that he had a notion to put himself under the steam treatment, as he did not 
feel very well ; and asked me what I thought of it. I told him I feared for him to 
do so, lest he might be killed by the violence of that course. 

CAROLINE JANE DEVER. 

Augusta, 4th Nov., 1837. 

I hereby certify to the truth of what I state below, relative to the death of the 
late Sylvancis B. S. Rhodes, to the best of my knowledge and belief. 

I wa* called upon to visit Sylvanus B. S. Rhodes on the afternoon of Saturday, 
the 29th July last at two o'clock P. M., and on doing so, found him in the most ex- 
treme distress, and to all appearance dying ; and I expressed to Mr. Black, the man 



191 Medical Intelligence. [Oct. 

who attended him. my belief that he was dying. From my knowledge of facts re- 
lative to his indisposition, I unhesitatingly declare the opinion that he had been too 
much steamed ; for death was manifest in his countenance when Mr. Black remand- 
ed him back into his room to the bath. I expressed a wish to have Dr. Antony 
immediately sent for ; to which Mr. Black objected j saying there was no necessity 
for my doing so. He seemed almost lifeless, as I thought, from the effects of steam- 
ing and other treatment ; but I assisted Mr. B. in placing him in a bath, in which 
he died. Mr. B. then agreed that I should call Dr. Antony, who instantly came, 
and at once pronounced the man dead. 

I farther state that his body retained such a degree of heat, that it was painful to 
bear the hand on it three hours after life was extinct. It became putrid before in- 
terment on Sunday morning. 

1 farther state that Mr. Black seemed to have great reluctance to my calling any 
physician in to see the said Rhodes; but said he had sent " for a doctor himself." 
Rhodes was a young man of great worth, and unexceptionable habits and princi- 
ples. 

Witness mv hand. EDWARD F. DEAVES. 



A Cholegocge Pill. The following formula for the preparation of a chole- 
gogue pill has been sent us by Dr. E. Delony of Talbotton, for our opinion of its 
merit. His uncle and preceptor, the late Dr. John R. Lucas, and since, Dr. Del- 
ony himself have long used it, with the greatest success in chronic visceral de- 
rangements, particularly of the liver, spleen, and uterus; also in bilious rheuma- 
tisms, and all that train of indescribable afflictions so perplexing to the practitioner, 
which arise out of those derangements of function ; such as dyspepsia, nervous- 
ness or superscentiousness, ccc. &c. 

ft. Extract. Colocynth. comp. si 
Hydr. Sub-mur. 3ij 

Tart. Aritim. gt. iij 

Ol. Carui. gtt.j 

Sapon. Hisp. siss 

Make a mass and divide into 24 pills, common dose, 2 to 4 every night, or every 
other night, at bed-time in chronic cases, continued as prudence may direct. 

We have not used this formula precisely in any case, but have for the last twen- 
ty years used one very analogous in the essential medicinal powers, with results 
which have constantly tended to heighten more and more our confidence in its 
peculiar suitableness for the correction of such derangements as are alluded to 
above. We are, therefore, of opinion, that the formula is worthy the attention of 
practitioners, as we think, not only from the extensive experience of Drs. Lucas and 
Delony, two of our most respectable practitioners, but from the powers and propor- 
tions of the formula itself, that it would be ioum\ peculiarly valuable in such cases. 
We feel it a duty, however, to say, that the two leading ingredients, are of those 
which should ever beprescribed by practitioners capable of comparing the medicinal 
powers with the derangements of the functions to be corrected; and should never 
become articles of common-place prescription. 



SOUTHERN 

MMBHOAIL AMID) ©TffM©H©A3L 
JOURNAL. 



Tol. II. NOVEMBER, 1837. No. IV. 



PART I. 

ORIGINAL COMMUNICATIONS 



ARTICLE I. 

Remarkable case of Biliary Calculi. 

The following communication was addressed to Dr. Paul F. 
Eve by Dr. S. B. Cunningham, a highly distinguished physi- 
cian of East Tennessee : 

Jonesboro', Tenn., Oct. 18th, 1837. 

Dear Sir : — Accompanying this you will receive two hun- 
dred biliary Calculi, being a part of the number obtained on a 
post mortem inspection of an individual (namely, the late Judge 
E — .,) of this place. We have retained about fifty as specimens 
of illustration for the use of private students. I trust that what 
I send may be added to your collection of mormid specimens, 
and with your superior talents and opportunities, subserve in 
some degree the philanthropic intention expressed in the dying 
request of him who fell a victim under their influence. 

I am able to glean but a few prominent facts from his previ- 
a 1 



196 Remarkable case of Biliary Calculi. [Nov. 

cms history which bear relation to the disease, so as to aid in 
illustrating its pathology. 

First then I remark, he was by birth a Virginian, descended 
from a family of rank and influence, of but ordinary strength of 
physical constitution naturally, but endowed with uncommon 
strength and vivacity of intellectual powers, with devoted and 
untiring perseverance in literary pursuits. As a matter of course 
his habits were sedantery. Of a sanguine bilious temperament, 
and from his associations in life, he was tempted to partake libe- 
rally of the indulgence and luxury of the table, (a thing com- 
mon in his day.) The evils to be apprehended to such an one, 
under such circumstances, have been too often experienced and 
explained to need comment. He had suffered several attacks of 
intermittent fever whilst a resident of Norfolk, which left him 
with disease, (probably enlarged or indurated spleen,) from which 
I am led to suppose he never entirely recovered. Some where 
between the years 1815 and '20, he removed to Tennessee. He 
was at that time from 45 to 50 years of age, and had become 
quite corpulent — rather oppressed with obesity, which rendered 
him the more sluggish and inert. His superior talents soon de- 
signated him as a fit character for the bench of the Supreme 
Court. Looking over the geographical boundaries of the State, 
and considering the arduous duties ol the office, we can perceive 
at once that it must have been oppressive. Having to travel 
over a boundary of several hundred miles of mountainous coun- 
try, alternating with the confinement of official duties, it must 
have broken down his already weakened powers. It was in one 
of these travels that he was seized with the first of a series of 
spasms of the stomach, as was then thought, which visited him 
at irregular intervals until the close of life. These attacks were 
supposed, by his medical attendants, to be gout in the stomach, 
and the treatment corresponded with that pathological view. — 
The means employed were venesection, blisters, with a profu- 
sion of revulsives, anodynes, &c. &c, but all to little or no pur- 
pose — the pains and spasm still continued. The warm bath was 
the first application to afford relief, and this was his chief means 
of reliance for many years when the pains returned. The wri- 
ter was first called to administerto his relief in 1830, some years 
after he had retired from office in hopes of regaining his health 



1837.] Remarkable case of Biliary Calculi. 197 

on his farm. On this occasion he was seized with pains in the 
right hypochondrinm and with general abdominal tension, at first 
supposed to be cholic — further characterized by costiveness, full 
tense pulse, furred tongue, and some thirst. To subdue these, I 
find, by reference to my book, I had recourse to repeated and 
copious bleeding, warm bath and purgatives. The last of which 
measures had to be administered in unusually large doses ; about 
30 or 40 grs. of calomel, with a large pill of opium, followed 
by repeated and full doses of jalap and oil before they produced 
any thing like full action of the bowels. This was usually the 
case when he had occasion to take medicine at all ; but his 
dejections when procured were of a healthy aspect, presenting the 
appearance of a due admixture of bile ; and of healthy consis- 
tence. This was their quality too, when not taking medicine, 
which he rarely needed. But little gastric disturbance was ever 
manifest : he could retain the most nauseous medicine with- 
out vomiting, and eat heartily (if allowed.) when relieved of 
the severity of the pain, at any time during his illness. Of 
these first attacks, he complained much of debilitating sweats, 
for which he took freely of vegetable and mineral acids, quinine, 
acet. plumbi, (fee. without any advantage. About the first of Nov. 
1836, he complained of dull and obtuse pain in the region of the 
liver, with no other uncommon symptom, which was attributed 
to hepactic derangement, superinduced by close confinement to 
writing, &c. When describing it. he thought \\\p sensation referred 
more to the muscles of the abdomen, or side as the seat than to 
deep parts. Pressure produced little or no increase of the pain, 
a portion of equal parts of cal. rhei. and a'oes was administered, 
followed by oil, which brought away copious feculent stools, but 
afforded no relief. At this time, and for some time after, except 
when under the action of medicine or remedial agents, he was 
able to attend to the editorial duties of his paper which he was 
then conducting. Nov. 4th or 5th, he was bled and blistered, 
5th, 6th, 7th, — no better. Ordered to dress with tat. emet. oint, ; 
but it became so painful as to occasion its abandonment after a 
few hours. A poultice was now applied, and pills of cal. and 
rhei, and oil ordered every 2nd day : diet light, bread and tea, 
gruel and roasted apples. Sth, 9th, 10th, — the ointment has pro- 
duced extensive cuticular inflammation, and extended like ery- 



Ir98 Remarkable case of Biliary Calculi. [Nov. 

sipelas over twice the original surface. The pain and irritation 
is almost insupportable. He cannot be persuaded that any thing 
else now is the matter, as he can feel no deep seated pain in his 
side. 13th, 14th, and 15th, — The inflammation still extends, 
some pustules, but no mitigation of pain. Ordered to bathe with 
decoct, tan bark, and acet. plumb, two, three, or four times a day, 
and take a pill of ext. cicuta, and repeat if necessary in 3 hours. 
Next day no better, had no rest through the night. Thus it ad- 
vanced for 2 or 3 weeks ; presenting a most perplexing erysipe- 
las, until in the remedial search, a solution of lunar caustic in 
the proportion of 2 or 3 gr. to the oz. suddenly healed it, to the 
great comfort of both physician and patient, (for he verily thought 
this alone was killing him.) But by and by, after it had gotten 
well, the old pain returned with increased action ; he found out 
his mistake. We now had recourse to mercurials, in order to 
their full alterative effects on the system, stramonium, bella- 
denna, &c. &c. The only relief he now obtained, was from 
morphine. This article could not be substituted by opium, 
laudanum or black drop. So sensible of its superiority did the 
patient become, that he scarcely could be prevailed on at length, 
to make trial of^bther substitutes. December — He now under- 
went a variety of treatment suggested by different medical gen- 
tlemen. But as no regular journal was kept, and it was of the 
miscellaneous order of treatment, I think it unnecessary to detain 
you. Other organs within the circle of sympathy of the disease 
became involved. The tongue lost in part the thick mucous 
coat, and became tipped with red. The whole epigastric region 
was painful at times ; but a prominent symptom was acute pain, 
extending to the back — in describing which, he said he could 
cover it with his thumb or finger if he could reach it ; so much 
was this the case, that we were led to attribute all the symptoms 
to nuralgia of the spinal nerves. He could only lie on the back 
or inclining to the right side. About the last of December, there 
occurred acute pain in the region of the kidney, attended by 
strangury and micturation, for which camphor, mucilages, bu- 
chu tea muriated tinct. iron, &c. were used, and measurably 
relieved him of those symptoms. Dropsical swellings in the 
limbs, next followed, for which the bandages were applied which 
held that symptom at beyance. But it now became evident, that 



1837.1 Remarkable case of Biliary Calculi. 199 

nothing but a paliative treatment could avail any thing, and 
from henceforth it was nearly all that was attempted. He lin- 
gered on, greatly emaciated, until sometime in July following^ 
when death came, a much desired messenger, to relieve his 
agony. 
Aud now as to the post mortem appearances : 
On opening the abdomen, the first thing that occurred to us 
worthy of remark, was the omentum highly injected with blood, 
a part of which was thickened and of a dusky red colour, shewing 
established inflammation, the missentary about the duodenum, and 
the bowel itself was much inflamed externally, the stomach and 
upper bowels were much distended with flatus. But on open- 
ing the stomach or inspecting its outward coats, there was but 
little perceptible derangement. Everything almost presented a 
healthful appearance, excepting at its contiguity with the liver 
and as it approximated the duodenum. The peritoneal coat of 
the smaller bowels was filled with small vessels, but may this 
not have been the remora of the blood from the atony of disso- 
lution, their vascular capacity having been increased by previous 
excilement ? The colon and rectum presented less ambiguous 
marks of positive inflammation, but was accounted for, from the 
circumstance of his having used to a great extent, stimulating 
enemata, such as spirits of turpentine : solution of salts and soap, 
and even tobacco. This was expected to be the case, as evi- 
denced by slimy or mucous stools, tenesmus, &c. The left kid- 
ney was enlarged, and its capsule contained several ounces of 
whey colored lymph. The internal kidney was not farther ex- 
amined, as our time was limited. The spleen was uneven, hard 
and tuberous; but is it not fair to conclude that this was only the 
legitimate offspring of his former intermittents. There was sit- 
uated on the left crura of the diaphram or abdominal surface, an 
abscess or collection of sero-purulent matter, containing about an 
ounce, but could not be traced by any morbid connection to the 
original disease of the gall bladder. The gall bladder was 
completely impacted with the calculi even to the ductus commu- 
nis choledochus ; several of the smaller size had made good their 
way near the opening into the bowel, and others were lodged 
part of the way ; but the coats were so thickened, that the pas- 
sage seemed almost totally obliterated. The coats of the bladder 



200 Rem ark all encase of Biliary Calculi. [Nov. 



itself, were about the thickness and density of the cutis vera of 
the hand, having rather a callous than vascular appearance. 
Adhesion had formed pretty extensively around the neck and 
bowel with thickening and increase of substance. The bowel 
was still more extensively inflamed, involving most of its mu- 
cous surface: part of which exhibited patches of ulceration. 
There may have been about a teaspoonful of dark viscid bile, as 
it were, percolating the stones which presented surfaces of such 
perfect coaptation as to afford but very small interstices between 
them. The volume of the liver was enlarged and filled with 
grumous blood, and on the under surface considerably indurated. 
The lungs and chest were normal so far as examined. 

I have thus presented some of the prominent symptoms of this 
interesting case, and will now conclude with the following inter- 
rogations : — 

1st. Is it possible that the first attack was produced by calculi, 
which have remained there ever since, harmless for the most part, 
except on extraordinary causes co-operating and arousing tempo- 
rary inflammation ? or did the first formation pass off, and a suc- 
cession of them produce the different paroxysms under which 
belabored? 

2nd. Is it fair to presume that originally, there was but one 
large one : and that it became broken and comminuted, and 
smoothed by attrition as we see them ; or were they so many 
separate formations ? 

3rd. Could surgery afford any possible prospect of remedy in 
such cases, provided our diagnosis of them were perfect? 



Remarks on the foregoing case, by P. F. E. 

1st Remark. Assuredly the calculi were formed separately; 
each one, in all probability, having its own nucleus. 

2nd. No surgeon would be justified in operating in such a 
Case, though the diagnosis were clear. The gall bladder has 
truly been punctured, and hepatie abscesses are opened, without 
the loss of life; but to <u( for stones in the gall bladder, is an 
Operation certainly not recommended in the present state of 
medical science. 



1837.] Mcrcureal Preparations in acute Fevers. 20 1 



ARTICLE II. 

Employment of Mcrcureal preparations in acute Fevers and 
other diseases. By John B. Gorman, M. D., of Talkot- 
tou, Ga. 

Known to Paracelsus among the first, preparations of this 
metal in his hands, we are assured, succeeded in curing some 
obstinate diseases, irremediable before his time. It procured for 
this great, but eccentric man, a wide spread reputation, anticipa- 
ted him in the annals of his science a half century before his 
time ; and gave early to the world, indubitable proofs of its 
great medicinal powers. No article of the Materia Medica, ex- 
cept the Peruvian bark, has been written on and discussed with 
so much fierceness, as the subject of our paper ; and, on this 
account, our services may be deemed a superfluity. Climate, 
locality, whatever modifies constitution, must, however, modify 
the use of all remedies. In the middle country of Georgia, 
twenty years now we have been an eye-witness of the opera- 
tions of this remedy on the economy, gathering up its history 
and value. And the justness and truth of many of the remarks 
about to be offered must, we think, meet the experience of many 
of our cotemporaries. We know, however, that prejudice and 
inability inseparable from us, prevent men from seeing the same 
thing alike, and that there must exist difference of opinion. 

The fortunes of this medicine, have been various in the ex- 
treme. Its exploits in the field of disease, have caused it to be 
esteemed a Divinity, and procured homage. Again like Vulcan, 
it has been thrust down from heaven, and figured a tattered vag- 
abond on earth; — and more respectable, it has been received at the 
court of kings, and refused at the beggar's hovel. Blasphemed 
by some, adored by others, its friends and enemies warring 
throughout the world, it became, at the same time the phantas- 
Thagotia of human folly, monument of human weakness, and 
the Boanerges of the Materia Medica. Its checkered fortunes 
and history show the powerlessness of our art, and infancy of 
its science. At the present day, by some parties in France, its 
use is too much contracted ; in Italy, too much expanded by 



202 Mercureal Preparations in acute Fevers. [Nov 

the contra-stimulists, disciples of Professors Rasori and Tom- 
masini; — lavished in Spain, England, and the United States, 
and their dependences ; it languishes in Germany in the great 
shadow of the Imponderable Biotic of Professor Malthus ; 
and assumes a spectors form in the airy nothing of the great, 
but deluded, infatuated Hahnemann, and his busy book-noisy 
homoeopaths. A general discussion on this subject, is not our 
intention ; we have limited our observations to only a few dis- 
eases, in which among us, its use is amazingly liberal and diffuse. 

Since we have known the practice of the middle region of 
Georgia and South Carolina, and we believe it is pretty much 
the same in all the South Western States, in the form of calomel, 
it has been very bountifully employed in acute fevers. 

The character and essence of these fevers are esteemed bilious; 
and calomel as a remedy against, bile, has passed into a proverb; 
To this circumstance, in part, may be attributed the great and 
often imprudent use made of it. The people and patients expect 
calomel, and, at the peril of his popularity, should the case prove 
fatal, the Doctor must not refuse it. The people help to make 
Doctors. 

In the first stage of the disease, it is used as a cathartic. But 
should death threaten, the deck is soon cleared, all hands at 
work, and its salivating powers invoked, and put in fidl and 
desperate operation. 

The Doctor gives his last triumphant look ; — " if the patient 
can now live until salivation take place, he is safe." " The 
Lord send it," respond the weeping friends ; and the falling 
shower of tears is staunched. 

With aching hearts, they watch around the bed ; — the watch 
is set, — the Doctor, the busy Doctor, pours in the drug, and 
blacking the body with ointment, applies all his mighty art. sole 
dependence now, and pivot on which all hope turns. 

Night after night you behold the taper burning ; — stillness 
and silence reign, except a sob or a sigh unconsciously breaks. 
The ticking of the watch and beating of hearts are only heard, 
a w; tking a we and black fore ibodhi gs of death. The fai thful dogs 
seem to lie still, and participate ill mourning. 

By day, by night, on his cheek still burns this August's sun , 
the fever's dark red spot, thirst torments him; he sleeps — 



1837.] Mercurial Preparations in Acute Fevers. 203 



he dreams, frightful visions are passing before him — torment 
him; he half-wakes and mutters delirium, which is responded by 
a low, mournful groan. His virgin sister startles up, her beauty- 
more tormenting by her flowing locks and neglected dress ; — 
she grazes with all her touching force, upon his parched face and 
shrunken features, — and bursts away to weep. The next mo- 
ment her mother follows, but soon they both return to the seat of 
action and sorrow. The father's firmness is in his manly soul ; 
he feels, but remains as something firmly planted to the spot. 

The Doctor, as a benefactor from the sky, again arrives, the 
air is again breathed ; and joy springing, cramped by unsub- 
dued despair, waves slightly through their features ; and is seen 
through glistening tears. He examines very scientifically, and 
pronounces " the looked-for harbingers are present" — salivation 
has commenced, — his hope, his confidence, and safety ; " the 
fever must now vanish" " He has conquered at last." With ev- 
ery sinew they exert confidence. " The Doctor knows." But 
alas ! The words he pronounced with the lips of Satan, inspired 
by his own ignorance ; the promises he has made to sinking sor- 
row, the hope he has excited and upheld by unworthy confidence, 
soon reveal their reality, and his unblushing shamelessness. 
It is putrefaction commenced ; horrible putrefaction ; where 
health and recovery were sacredly promised and insured. Black- 
ness covers the teeth, the tongue is thrust far out, the mouth 
swollen ; the eyes, sunk deep and dewy : the throat, tumid ; 
the soul's fair expression, lost forever in palsy ; the features 
twisted, distorted, demon-shaped. Horrible stenchfulness and 
dark cold night gather round him ; and nothing remains now 
to distinguish the life, except the little dark red spot on the 
cheek, which is now growing paler for actual dissolution. The 
grave-clothes are finished — the lights are put out ; and frittered, 
exhausted nature drops into long and protracted sleep. 

In this last scene and struggle, the Doctor has not participated. 
His great work terminated in procuring salivation, — passed this, 
passed all hopes, except the grave. He meets, sees them again 
clad in the dark livery of their sorrow and misfortune. They 
press round him — shake his hands ; their looks express kindness 
and gratitude. "He did his best." "It could not turn as he 
desired." " No one could have been more kind, assiduo?is, and 
b2 



204 Mercurial Preparations in Acute Fevers. [Nov. 

faithful; — all his looks, his language showed his concern. 
Providence* had ordered it so." 

11 Gluomodo tacuisse Dii Immortales Possunt." 

The truths of this picture should excite horror for medical 
stupidity and un worthiness. And we remark: — than physi- 
cians, no people on earth enjoy, for the services they render, an 
equal weight of love, kindness and gratitude — the flower, beauty 
and loveliness of the human heart. 

To be ignorant and be a physician, none but souls fallen , 
from Adam a second time, low, dastardly with the stain of a 
second sin, can submit. Their whole life of practice can be no 
other than a black tissue of hypocrisy, falsehood and deceit ; — 
hypocrisy, to conceal their ignorance ; — falsehood, for they most 
constantly speak of what they do not know the truth ; and de- 
ceit, to keep up their trade. To be the means of ruin and death 
to their best confiding friends ; and, in return, receive thanks, 
gratitude and fortune inverting nature ; — to be the firm reliance 
of sacred hope at a holy hour between worlds, and, only its 
wicked mockery. The thing exists, for the people can never 
be correct judges of skill. O horrible ! — Shocking ! 

" His warm blood the wolf shall lap, 
The eagle, her wing shall flap 
O'er the false-hearted " Doctor." 

In the picture and case before us, the febrile excitement had 
reached its maximum under depletion by calomel, and, perhaps, 
some auxiliaries. The symptoms are unsubdued, the fever still 
rages, and loss of confidence ensues in the course pursued. 

Suddenly all depletion is stopped, and calomel combined with 
opium, or some astringent is given with a different view — to ef- 
fect salivation quick as possible. Often considerable quantities 
of opium are required, as the medicine is thrown in freely, to 
prevent its passing off. Here then, the whole system is sud- 
denly locked up, and at the very moment, when sedataion, cold 
sponging, local sanguine emission, cautious alvine depletion, 
free cooling diluent drinks, &c. are most loudly called for, and 
would do more to calm the raging malady, than at any other 
period before. But what ensues ? 



* Pardonable blasphemy to sage the Doctor. 



1837.] Mercurial Preparations in Acute Fevers. 205 

The liver is active from the disease, rendered infinitely more 
so by the constant stimulations of the previous calomel ; the 
bile, which before had a free passage, now is clamorous for evac- 
uation, and more opium must be given to save the salivatory 
from passing. 

A sudden and violent shock is thus given to all the systems, 
inducing a new order of movements. The mucous alvine secre- 
tions being suppressed solicits to action — the organisms con 
nected in dependence and subordination with this tissue — revul- 
sion. Shades of icterus tinge the skin ; copious exhalation 
takes place from the serous membranes, as is proved by tension 
and soreness of the abdomen, fulness and tightness of the chest 
with some cough, of those who recover. Some effusion escapes 
from the arachnoid, one of these tissues, and the brain is slightly 
compressed, as is proved by these cases almost always manifest- 
ing and terminating in what are called typhus symptoms. The 
urinary secretion becomes scarce, thick and higher colored. The 
skin is more parched, dry and rough, all manifesting a decided 
diminution of secretory, excremential elimination. 

Thus a new stimulus is offered to the circulating system. 
The blood arrives at the right side of the heart more heteroge- 
nous, loaded with more highly stimulating matters, which ad- 
ded to the stimulations of calomel and opium so freely given, 
augments its velocity of motion. Nutrition, so important* to 
life, is nearly suspended. The powers of the cerebrospinal 
functions, must participate in the exhaustion now inevitable — 
death horrible, or nature pitying, snatches tier tortured offspring 
from the barbarous hands of its persecutors, and saves by her 
own matchless skill. But to follow this practice out : 

By a law of diseased action, all the alvine secretions sup- 
pressed, the serous membranes are excited to secretion. The 
malaise of the chest and abdomen, are not noticed ; that of the 
brain, or slight compression of the arachnoid, engrosses all at- 
tention. It is considered an actual inflammation of the brain 
itself, the disease is changed into typhus, proved to be so by the 
lesion of the mind's faculties thus assidiously procured by my- 
opia, strabismus, $-c. The head is shaved, and a powerful 



* Physiologic Compare, Tiedemann. 



206 Mercurial Preparations in Acute Fevers. [Nov. 

blister applied ; if action be sluggish, blisters over the body. 
The patient rises from this typhus made and cured, as from 
the fangs of a hyena, or grasp of a vampyre, to a long and te- 
dious convalesence ; or disfigured, dilacerated, exhausted through 
accumulated ills, sinks to the " long rest of Osiatfs narrow 
house" 

In the first case, the patient is rescued from the new disease, 
typhus, unwittingly brought about by this hot, stimulating, in- 
cendiary treatment, exhausting all forces, producing derange- 
ment and congestion, calling forth secretions and compressions, 
which would have remained quiescent under different manage- 
ment, or nature left to herself undisturbed. But unfortunately 
for humanity, tins typhus is considered only as a stage, and 
natural part of the primitive fever, and never once is dreamed 
of, as the offspring of art. This is the fearful delusion ! 

Since the antiphlogistic and sedative treatment of fevers has 
increased in popularity, the annals of our science share and 
prove, that this sort of typhus is fast banishing the world ; and, 
as much warring as has been published on this subject, it has 
not had its weight, where it has been our lot to live and observe. 

Among us it seems to have been more or less confounded with 
the typhus of European writers ; and their stimulating plans 
have been employed. Yet nothing can be more distinct, than our 
typhus or cerebrospinal exhaustion of our pleurisies and au- 
tumnal fevers, and the typhus or jail fevers of Europe, propagat- 
ed perhaps, by a peculiar infecting principle, of which all the 
phenomena are the particular offspring. 

But to resume : — In the last case of our patient, he sinks 
through nature outdone, — the total subversion of the subordina- 
tion of his living functions. Let us now attempt our explana- 
tion of the mechanism of recoveries, in similar circumstances, 
from this mode of modification, which, to some extent, may ex- 
plain the prevalency of its continuance in use. 

Salivation is the ultraism of medicine in the geographical 
limits of our paper, and almost universally resorted to in all 
diseases grown desperate, after other remedies have failed of 
success. I believe we are very well established in this assertion, 
although there may be exceptions. It has been so now for 
twenty years, and how much longer before, is not known. 



1837.] Mercurial Preparations in Acute Fevers. 207 



Since, however, the introduction of quinine, many more cases 
are cut short ; and much fever, we may suppose, fail to chal- 
lenge its employment. Continued fevers chance the oftenest. 

It is the last, solemn, farewell ceremony the Doctor performs 
for his patient, — something that can be done always, when noth- 
ing else is known ; — a forlorn hope, to which ignorance, blnck 
ignorance, holds the torch ; — in repute three fourths of a century 
ago, whence our fathers came ; that long-since eradicated and 
driven hence, now in the New World, puts forth its autumnal 
bloom. 

Among us, however, as it is not taught in our schools, and 
has not the sanction of teaching, it is highly probable, it is born 
of false experience — the " experientia falax' of Celsus, who 
calls it the Demon of medicine. 

1st Resorted to, as it commonly is, in the latter stages of at- 
tacks ; and, often at the very moment when nature is preparing 
the crisis and sweet repose of the patient, being a stimulus of 
pretty high powers, its stimulations were sometimes not unwel- 
come, if of the right sort ; and the only material effect it will 
have, is to make the recovery long and painful, and upon fu- 
ture health. 

Here, unfortunately, the recovery is attributed to salivation, 
the only services of which, if any, were to stimulate at a press- 
ing and necessitous hour ; to entail afterwards, sorrow and a 
long catalogue of evils, especially if pushed in extenso. 

Flushed by supposed success, the deluded physician tries it 
again ; and, thus this idolatry — this Juggernaut of medicine is 
kept alive in the nineteenth century, against all the lights that 
burn. 

2d. It is administered when the case becomes desperate at an 
earlier period, and, before prostration. Now it has the opportu- 
nity of exerting its most deadly mischief, the prospect being still 
fair and possible, by proper treatment, or powers of nature, for a 
favorable termination. 

It commences its work by the improper stimulation of its own 
means ; by the opium combined with them ; by suppressing the 
secretions, source of new stimulations, before its own can take 
place ; by exciting, as we have said, revulsive secretions, which, 
without its interference, would not have existed in the natural 



208 Mercurial Preparations in Acute Fevers. [Nov. 

order of the disease ; by consequent arachnoidel secretion and 
compression, bringing about by the aid of hyper excitation thus 
procured. Cardiaco-cerebro- spinal exhaustion, or which is 
the same thing, this Georgia Typhus, and death, or something 
like a spectral resurrection from it. 

But it is never supposed, this salivation, deep, thrice deep, 
killed. Death is always attributed to the typhus, inflammation, 
compression, mortification, to any but the true cause, or the 
Doctor's trade and reputation would be spoiled. — Horrabile dic- 
tu — O luctum veritatis ! 1 

3. Salivation is resolved upon, when the disease has main- 
tained apparently its energy until a late period ; just before the 
forces are about giving way ; the vital unity of action growing 
weak ; and the system beginning badly to obey the helm of life. 
Under any circumstances or treatment now, the case is desper- 
ate. Salivation here must cut off all hope, and procure 
death- 
In this case the oxydizers or lungs are spending — hsematosis, 
imperfect, the circulatory enginery, exhausted, the tendency to 
capilliary stasis, universal, nervous irradiation, partial, natural 
chemistry, on the incipient failure of the vital, beginning to af- 
fect the whole fluids and solids : — life soon must flutter, strug- 
gle, salutary secretions from any quarter, impossible. 

The only effect mercury, as we have said, can have in such a 
case, is mortification, to which there is an universal proclivity 
and death. But it is given — lavished in proportion to the case ; 
its wonted secretions eliminating its force, impossible ; the tis- 
sues wont to elect and appropriate its action, ramolesce and 
blacken, — hideous putrefaction and stench threaten away from 
the couch, weeping sorrow, tenderness and love ; the pious 
spirit pure — clean — loathes the binding fetter, which breaks, — 
and it rises/a/r — the body sinking into a scathing mercurial Hell. 
I write no fable ; — again and again with the most pained sen- 
sibilities, have I been compelled to witness such cases, which 
I have said among us are common ; and a great number of 
which, from much and long experience, and practice, would 
have yielded readily to a different treatment. Our reasoning, 
and the coloring given to these cases, may be doubted ; but the 
facts must challenge experience and belief. 



1837.] Mercurial Preparations in Acute Fevers. 209 

\\ 'c remark on the fir.st of the three cases : Employed under 
these circumstances, we have often known the patient to recov- 
er, and get on his feet before the salivation came on. Now con- 
fined to his bed again by the medicine, he struggles long through 
suffering and horror more severe than his first attacks, to die 
from exhaustion at last, when the stimulations of the salivant 
begin to abate ; or rises from his bed exsanguinated, shrunken- 
eyed, hollow-featured, with a troublesome cough, to recover 
finally next year, or never regain completely his former health. 

In the 2nd case : To salivate the antiphlogistic and sedative 
treatment is abandoned, at a most precious time, when it could 
do its greatest work, and turn the doubtful scale on the right 
side. When the whole system has arrived at the greatest ex- 
citement, hot, stimulating salivation is employed, helping out 
disorganizing" inflammation already existing, dematurizing all 
action ; producing ut supra, typhus and death ; or — salivation 
and the fever run on together, as we have often seen. Nature 
triumphs over opposition at last, or mercureal exhaustion and 
death come apace. 

In the 3rd case : Salivation is open murder and death, as 
has been seen — tolerated homicide almost in the presence of na- 
tural death. But does this paliate the crime ? a high offence, 
against which there is no law, as if it were right to kill a man 
likely to die. 

If the patients die in China, the law puts all the Doctors* to 
death ; if they kill in Georgia, the law protects. Which is the 
most reasonable — rather absurd and abominable? 

In conclusion: In all acute fevers, salivation should never 
be employed. This practice has ever been absurd, wrong; 
arose from false facts and false experience at first ; and sustained 
afterwards by prejudice and ignorance. Its apparent good with 
a long train of evils, is most always, by its stimulations. But 
these, in a very superior degree can be promptly procured by 
opium, camphor, brandy. Could it be known and believed, the 
good of salivation arises from its excitements, the delusion would 
vanish forever ; and those of the opium, camphor, &c. substi- 
tuted in its place. 



* Staunton's Embassy to China. 



210 Mercurial Preparations in Acute Fevers. [Nov. 

What a renovation of good and comfort would it be to the 
present practice, so much and so extensively pursued ; a practice 
which has prostrated our art, and brought the whole of our 
Materia Medica into disrepute among a great portion of the 
illiterate world, which has mainly set up a new species of quack- 
ery, and given it the most convincing and revengeful argument 
against us, in the minds of the people. What but mercury and 
its odious, hateful salivations, have given rise to so much talk 
and noise about medicines purely vegetable ? and emboldened 
its makers and venders ? It is mercurial vengeance — the sin 
of its unholy use revisited upon us 1 

In final conclusion, we would consider mercureal purging, 
and the, secondary effects of this drug in its altei^ative use. 

Take now, especially about the approach of Autumn, the 
healthiest man, and give him daily purgative portions of calo- 
mel. Soon he will become quite bilious, throw it up of the 
natural color, and pass it copiously by stool ; and soon, derang- 
ing the natural healthy state, it will become turpid and black. 
Fever will be declared; still purge him as before. It grows 
desperate ; now touch him ; salivate him deeply \ typhus ut 
sapra is declared : shave his head and blister him freely, and he 
recovers. But he labors under the slight cough, feels the pecto- 
ral and abdominal malaise. After some time he is attacked 
with bilious colic. His liver is hypertrophied. 

Again : The patient has some fever ; is sick ; his physician 
carries him through as above. At length, he is troubled with 
excessive bile ; suffers from abdominal pains. His physician 
comes again, touches him now slightly to cure this bilious col- 
ic : and recommends him occasionally to take a dose of calo- 
mel when 'he feels it coming on ; and the more and the oftener 
it is taken, the more it will be needed. 

The drunkard wears his shame in the efloresence of his face ; 
but the intemperate in mercury, his scar deep hidden in the liv- 
er, the glands, the mucous and serous tissues. Thus, he who 
was once free, has made a thorough bilious constitution thus 
procured. His liver, etc., is hypervrophied ; he tends to dropsy 
and wasting death. Nothing but a change of climate and coun- 
try, and abandonment of the medicine which brought it on, 



1837.] Mercurial Preparations in acute Fevers. 211 

can redeem and save him from his own unconscious impru- 
dence, and his Doctor's folly. 

A great number of cases purely of this character now actu- 
ally exist within our knowledge, and some under our care. 

Again : The patient has fever, but not bilious. Calomel is 
lavished ; the quiescent liver becomes irritated ; its irritations 
may now operate with the original cause to aggravation, or sup- 
plant it entirely, and become itself, the focus of universal irrita- 
tion or fever, which will run on to destroy the patient ; or he 
recovers exhausted, making this of what would have been a 
very light and mild case, a mortal or desperate and frightful 
one. 

Again : The patient has fever, is bilious and of the bilious 
temperament. A large dose of calomel might be of great ser- 
vice and the best remedy ; but keep it up, and it is sure, like the 
rest, to become a bad one, but with a little more certainty. 

In any of the cases above, calomel might be admissible, nay, 
the very best for the patient, but must not be repeated or per- 
sisted in. But in the following, a single dose might ruin all 
hope and the brightest prospects. The patient, with great de- 
pression has repeated spontaneous bilious dejections ; his gastro- 
intestinal mucous tissues, highly phlogosed, the valvules conni- 
rentes developed, closing up greatly the passage. 

Now touch him with a good dose, (common practice,) and 
you may touch a magazine to blow him up ; or he escapes, a 
tattered relic of what he was, or of what, under other treatment 
he might have been. 

I will mention here a great truth : Calomel as well as the 
bile, is very apt, very commonly excites the developement of 
these valvules closing or narrowing up the passage ; which, 
now it is lavished to force, urging on ruin by ruin. 

We know from Moseley, Hillary, Jackson, Cleghorn, 
Johnson, Bancroft, from a host of such — from French and 
Spanish writers, from our own experience, that in tropical and 
citratropical climates, the liver figures and reigns the most con- 
spicuously — tyrannizes in this great theatre of disease. It is the 
same in our country. 

Why, then, in our treatment, have we considered, do we 
provoke wontonly and unmerciful I y the anger, and rage, and 
c 3 



212 Remarks on Debilitants and Sedatives. [Nov. 

opposition of the liver, — the lion, by universal consent, of this 
great austral hemisphere of sickness and death? Rather let us 
quiet it when it can be quieted, and as soon as possible ; when 
quiet and in its proper place of action, not provoke ; when out 
of place, torpid and the economy in need, arouse it to effort. 
As soon as possible — for it is true as we have said, by improp- 
erly exciting it, for it is generally and almost always too active 
under our autumnal sky, it can easily supplant the primitive 
febrile irritation, and become itself the burning focus of the 
fever leading on unquenchably to the tomb. Not to provoke it 
when its function is straight with the economy ; because we 
get rid of great perplexities, difficulties, and prospective danger. 
To arouse it, because its influence is natural. 

But we are not writing on practice. We avow it : we have 
no interest but the profession to serve. You ask for proof. We 
must refer you to the symptoms while living ; and the truth as 
it is recorded in the dead man's body, and we will not fear. We 
ask pardon of our coternporaries ; and by those who are making 
up their opinions, we would be heard. 



ARTICLE III. 



Remarks on Debilitants and Sedatives. By Dr. Joseph A. 

Eve. [Continued.] 

Cold. The abstraction of Caloric is the next subject that 
demands attention under the head of Debilitants. 

Of the stimuli that are essential to the production and main- 
tenance of vital phenomena, caloric is one of the most active, 
universal and constant in its operation ; hence its abstraction 
must be attended by a correspondent depression or diminution 
in the manifestation of those phenomena, or in other words it 
must necessarily lessen organic action and cause debility. 

Caloric is essential to organic action, the former appearing 
to stand with respect to the other, mutually, in the relation of 



1337.] Remarks on Debilitants and Sedatives. 213 

cause and effect, and of effect and cause : for we observe increase 
of action is always followed with augmention of heat, and de- 
pression of action with diminution, and on the other hand we 
invariably find elevation of temperature increases action, and 
reduction depresses it. It would certainly be superfluous to ad- 
vance arguments to prove that cold or the privation of caloric, 
in its direct effects, is most decidedly and eminently debilitating — 
its depressing and torpifying influence, on man and the whole 
animate creation, is too obvious to require proof— the actions 
both of animal and vegetable life are suspended without an ade- 
quate supply of caloric. Abstract caloric from the system, and 
immediately " this sensible warm motion becomes a kneaded 
clod." 

It is true persons feel stronger and are not so soon fatigued 
in moderately cold, than in warm weather ; hence some physi- 
cians consider a moderate degree of cold, as exciting and strength- 
ening : but this is unphilosophical, cold being nothing in itself, 
but simply the absence or privation of heat, cannot possess any 
stimulating property. The reason that we feel weaker during 
a hot. day, is becanse the excess of caloric stimulates too much, 
and induces indirect debility — it is because a moderate degree of 
caloric, not a moderate degree of cold, is more congenial to 
strength and muscular exertion, than the excessive degree of 
the former, which constitutes what we term a hot day. 

The temperature most conducive to strength, and compatible 
with active exercise, is altogether relative, depending greatly on 
the circumstances, habits,&c. of individuals; those recently accus- 
tomed to severe cold, feel oppressed and overcome by heat in 
weather which is at the same time distressingly cold to those 
accustomed to intense heat. 

"The effects of cold, (says Begin,) have been the theme of 
endless discussions, on which a proper study of the laws of the 
organism has alone been lble to shed some light. According 
to the state of vigor or debility of the patient, and the extent, 
intensity, and duration of its action, cold is either an useful 
tonic, a powerful irritant, or a great debilitant. Its impression 
may even cause death, by checking all motions in the organs." 

The action of cold as a tonic or irritant depends on the prin- 
ciple of reaction. When the body or any part of it has been 



214 Remarks on Debilitants and Sedatives. [Nov. 

exposed for a length of time to a very low temperature, the ex- 
citability accumulates to such a degree, during the privation of 
the accustomed stimulus of caloric, that on its sudden restora- 
tion reaction takes place with such violence, that intense irrita- 
tion and not unfreqently disorganizing inflammation is the 
result, as exemplified in frost-bitten limbs, &c. 

Reaction is always proportionate to the degree of subsequent 
depression. If the system be subjected to a moderate degree of 
cold, and restored to the natural or ordinary temperature as soon 
as reaction commences, the tonic effect will be evinced, as dis- 
played in the employment of the cold bath for its tonic influ- 
ence on the system. As the patient enters the bath he shivers 
and continues benumbed and torpified until reaction is estab- 
lished, when he experiences a sensation of warmth as though 
the water around him had suddenly become warm, and feels a 
genial excitement pervading his whole system : if at this mo- 
ment he should leave the bath, he will feel excited and invigor- 
ated, and enjoy in the greatest degree the tonic effect ; but should 
he remain in it longer, this pleasant excitement will subside, 
and the depressing effect of cold be again realized without any 
farther alternation of reaction. 

Cold depresses excitement by abstracting caloric, which as 
an excitant produces and maintains it : it is upon this principle 
that it is employed so extensively, and with such beneficial re- 
sults, both in medical and surgical practice, for subduing action, 
allaying pain and restraining hemorrhage. The operation of 
cold water, ice, and other cold applications in abstracting caloric 
depends on the disposition this subtle fluid has to diffuse itself 
equally through all bodies in contact or proximity — the warmer 
or those that have more caloric imparting to the colder or those 
that have less, until an equalization of temperature is established 
between them. When in the treatment of disease the abstrac- 
tion of caloric is indicated, availing ourselves of a knowledge 
of this principle, we fulfil the indication by means of cold ap- 
plications to the part or organ whose excitement we wish to 
reduce. For this purpose we usually employ water, ice or snow, 
because they are generally most convenient, but a great number 
and variety of means are practised for the abstraction ot calo- 
ric : exposure to cool air, cold cataplasms, mud, clay, cold metal, 



1837.] Remarks on Debilitants and Sedatives. 215 

evaporating lotions, &c. Nor are we confined to the external 
surface, in the administration of means to reduce excitement by 
the abstraction of caloric, the stomach and intestinal canal may 
with equal convenience be treated on this principle, through the 
medium of cold drinks and cold enemata, which often prove 
very efficacious resources, in high grades of gastric and intes- 
tinal phlogosis. 

The following paragraph from M. Begin's work on Thera- 
peutics, is most graphically descriptive of the effects and lucidly 
explanatory of the principles involved in the operation of cold 
applications. 

u The primary object, (or rather effect) of cold is to condense 
the tissues, draw their elements closer, and increase their thick- 
ness and solidity. The skin is clutched and covered with asper- 
ities occasioned by the projections of the bulbs of the hairs and 
that of the sebacious follicles. The parts covered with cold 
topics turn pale, owing to the contraction of the vessels which 
cease to admit as many red particles of blood, and in which the 
circulation becomes less active. iVccompanying these phenom- 
ena, the local nervous action is diminished, sensibility lessened, 
and a notable numbness felt in the parts that have grown cold. 
We must not think however, that this state is continued, during 
the whole time of the application ; for soon after the first im- 
pression has been received, and though it may still continue to 
act with equal force, a reaction always takes place in all the 
parts submitted to the operation of cold, the blood is propelled 
toward them with renewed and increased vi^or, the parts become 
more or less red and painful, and experience a sensation of in- 
tense and even burning heat." "But these sensations are not 
of long duralion ; they disappear gradually and the debilitating 
action is soon reproduced. Then the tissues remain pale, cold, 
and hardly sensible ; the action of the capillaries is diminished, 
the irritation is suspended and soon disappears entirely." » To 
the action of cold is then subjoined the emollient and relaxing 
effect of water which serves as a vehicle to the former. These 
changes produced by cold applied to the tissues or to the skin 
which covers them, appear diametrically opposed to those deter- 
mined by stimulants. In this respect, cold applications consti- 
tute one of the most efficacious debilitants we possess. They 
are employed in two opposite circumstances; the one where 
there exists no tumefaction nor irritation in the parts, and when 
it is only necessary to prevent those accidents, as in contusions, 
sprains, &c. ; the other, when the irritation and the phlegmasia 
have already made their appearance. In either case, we may 



216 Remarks on Debilitants and Sedatives. [Nov. 

cover the parts with pounded ice wrapped in a bladder, piece of 
parchment or oiled cloth — or rather plunge them into a vehicle 
rilled with cold water, if the shape, function or situation of the 
parts will permit/' 

From not properly understanding the principles concerned in 
the operation of cold as a therapeutic agent, there is much diver- 
sity of opinion on the subject, and much contrariety of report 
upon its efficacy. Some regard it simply as a debilitant, whilst 
others look upon it as a stimulant or tonic, and others again view 
it in the light of an energetic astringent ; whereas when we 
properly comprehend the true principles involved, all difficulties 
immediately disappear or admit of easy explication. 

We have already seen that the modus operandi of cold is that 
of a direct debilitant. acting on the principle of abstracting 
stimulus, and that its action as a stimulant or tonic is only sec- 
ondary and temporary, depending on the principle of reaction : 
little reflection will convince us that its effect in condensing the 
tissues is not attributable to any astringent property possessed 
by water, or by cold, which is nothing but the absence or priva- 
tion of caloric ; the condensation produced by the application of 
cold water is the result of depressed action, the excitement being 
reduced in the part, less blood is attracted to and retained in it, 
in consequence of which the capillaries collapse which renders 
the tissues more solid. Let us for a moment contemplate the 
modus operundi of cold water in arresting hemorrhage, which 
is generally, though erroneously, ascribed to its astringent pow- 
er. Under the influence of irritation, an afflux of blood is deter- 
mined to the organ from which the hemorrhage proceeds, cold 
water by withdrawing the stimulus of coloric reduces the excite- 
ment ; the blood therefore is no longer attracted to it in undue 
quantity, the vessels contract and the effusion ceases. 

We have the administration of cold so much under control, 
and can regulate its action with so much precision, the conjoint 
exhibition of sedatives is not so essentially necessary, as in the 
employment of bloodletting ; for reaction being always in corres- 
pondence to the degree of depression produced, it can always 
be regulated, by commencing with a moderate degree of cold 
and by making, after reaction has subsided, applications of more 
intense degrees which may be continued as long, or repeated as 



1837.] Remarks on Debilitants and Sedatives. 217 

frequently, as the case may require, without any of the remote 
dangers consequent on blood-letting. Hut the combim d admin- 
istration of sedatives is often productive of very marked benefit, 
as exemplified in the superior efficacy of cold saturnine lotions T 
solutions of morphine, of prussic acid. dec. to that of simple cold 
water, in subduing inflammation and allaying irritation. 

Bloodletting and the application of cold, both act upon the 
same principle, the reduction of excitement, by the abstrac- 
tion of stimulus ; their comparative advantages may be thus 
explained : In a violent fever or inflammatory affection, when 
there is redundancy of blood in the system, and the strength of 
the patient previously unimpaired, nothing can prove a substi- 
tute for copious sanguine depletion ; the lancet stands unrivalled 
in efficacy ; it is our chief reliance, the anchor of hope, the tal- 
isman of safety : until blood has been freely abstracted, the relief 
afforded by the employment of cold applications must be tem- 
porary and ineffectual, somewhat comparable to the temporary 
smothering of a flame by heaping fresh fuel upon it, which soon 
bursts forth and blazes more furiously than before ; thus the ex- 
citement allayed, not subdued, will reappear and rage with in- 
creased violence. But when, notwithstanding copious sanguine 
depletion, there is still violent action and intense pain, with 
determination to some part, especially if it be to the head, and 
the case do not justify farther loss of blood, cold may often be 
employed with signal benefit. It reduces excitement without 
expense of the vital fluid, the debilitation produced is conse- 
quently less permanent, though it may be continued long enough 
for a suffering or^an to recover its normal state. Bloodletting 
and cold act both on the same principle : — the difference in 
their effects depends on the difference there is in the nature of 
the excitants they abstract, both of which are equally essential 
to life and the maintenance of excitement. When blood is taken 
away, it is replaced slowly by assimilation, which process is often 
interrupted by the disease for which the bloodletting has been 
practised or by the debility consequent on the loss of blood, or 
it may be restored by transfusion which operation is attended 
with much difficulty and uncertainty; whereas, when caloric is 
abstracted, it is soon renewed by the system itself, or by external 
means if necessary. 



218 Remarks on Debilitants and Sedatives. [Nov. 



Inflammation acts as a stimulus, exciting the action of the 
heart and arteries, but excessive action always exhausts the vital 
powers, and induces indirect debility, so that when it subsides 
or is subdued, the energies of the system are greatly depressed. 
Now it is certain, if we can reduce inflammation and prevent 
the inordinate, exhausting action consequent upon it, by cold 
applications or the conjoint administration of sedatives, with the 
expenditure of less blood ; in the same ratio will the powers of 
the patient be preserved, and the typhoid type less likely to ensue, 
and the patient sooner recover his accustomed strength. 

When it is deemed expedient to employ a very intense degree 
of cold, it will be proper to avoid a sudden and vigorous reac- 
tion, by commencing with an application of moderate tempera- 
ture, and gradually reducing it down, even to ice itself if desir- 
able. 

The necessity of keeping cold steadily applied, or of renewing 
cold applications as often as maybe required to keep them from 
becoming warm, is too obvious to need even an allusion to it ; 
were it not that a neglect of this caution too often obviates en- 
tirely the good effects of this valuable remedy. It will of course 
be necessary that the application of cold be continued long 
enough, not only to extinguish the irritation in the parts to which 
it is applied, but to destroy their disposition to react against its 
impression, otherwise the consequent reaction will very proba- 
bly increase the irritation and congestion intended to be re- 
moved. Snow, ice, or a degree of cold as low as zero, which if 
general would soon extinguish life, may be applied to parts of 
more or less extent, constantly for days and even weeks, not 
only without danger, but with the happiest effects. 

Thus have I endeavored to explain the modus opearndi of cold 
as a therapeutic mean, and to set forth the most important prin- 
ciples that appertain to its employment ; it would be an agreea- 
ble task to elucidate and illustrate those principles more fully 
by a practical application to the treatment of disease, but that 
would be incompatible with the limits I have prescribed myself 
in my remarks on debilitants and sedatives. 
[to be continued.] 



1837.] Medical Statistics. 219 

PART II. 
REVIEWS AND EXTRACTS. 



Medical Statistics. 



The following paper, by M. Double, on the question of the 
inapplicability of statistics to the practice of medicine, contains 
much £ood sense and fair reasoning. The results at which he 
arrives are true and unavoidable, and it is most unfortunate in 
medicine that so few can come to realize these truths, and adopt 
"the only methods admissible in practical medicine, analysis, 
logic, and induction" in each particular case under all its present 
circumstances. 

We give the essay in full, as extracted from the London Med- 
ical Gazette by the American Journal, with the editorial of the 
latter. 

This question has been recently brought before the Royal 
Academy of Medicine at Paris, and been very elaborately and 
fully examined. The following paper read by M. Double, in 
the discussion, excited considerable attention, and we shall lay 
it before our readers, as the subject is one of great importance. 
For ourselves, we have already expressed our opinions on the 
subject, (see our No. for August 1836, p. 489,) and need only add 
that it is our continued conviction that until some new problem 
in transceudental mathematics shall be devised, the numerical 
method can never serve to guide us to a positive method of treat- 
ing individual cases of disease. At the same time we disclaim 
all wish to invalidate the general usefulness of statistics in med- 
icine. But we will not detain our readers further from the ob- 
servations of M. Double. 

" The science of statistics, is in these days, one of the most 
fashionable; and in the ardor of their zeal, its disciples have 
applied it indiscriminately to medicine. They have attempted 
to substitute mathematical for logical analysis — to make arith- 
metic take the place of induction — and calculation that of rea- 
son. Let us, then, consider what some expect from statistics 
d4 



220 Medical Statistics. Nov.] 

applied to medical practice. In mathematical analysis, the pro- 
bability of future events is calculated from the observation of 
preceding facts, but always under the rules of the universal 
laws of large numbers, and without any individual application. 
"In medical statistics, on the other hand, the numerical 
method is expected to determine from the observation of preced- 
ing facts, and according to their number, the best method of 
treatment in each individual case which may occur. This, 
however, is quite impossible ; and I may remark, that were it 
ever affected, medicine would cease to be either a science, an 
art, or even a profession ; it would become as mechanical as the 
employment of the shoemaker. 

" What is called in geometry the universal law of large num- 
bers, is the rule and the foundation of all calculations of proba- 
bilities. One of the conditions of this law is, that the causes of 
the events calculated, though some are constant and others vari- 
able, yet can in no sense be said to vary progressively. From 
this law it results, that all the differences and irregularities 
which balance each other disappear in the quotient : and in this 
way the calculations of lotteries, of maritime insurances, &c. 
are made. 

"But this is evidently not applicable to medicine : neither our 
successes nor our failures balance themselves in large numbers, 
as in the case of marine insurances. Each of our problems 
embraces but one individual ; and besides, diseases always have 
their prevailing character, varying progressively according to 
an infinite variety of causes. 

" M. Poisson, in his new work on the Calculation of Verdicts 
given by Juries, writes thus — "In most questions of eventuality, 
the a priori determination of the chances of events is impossi- 
ble, and it is only from observed results that we are able to cal- 
culate them. Thus we cannot a priori, calculate the chance of 
a vessel being lost in a long voyage, but we must compare the 
number of losses with that of voyages when the number is 
large, the result is pretty constant, at least in each sea and in 
each nation ; but if the calculation be founded on a small num- 
ber of facts, there can be no certainty in the reckoner's results, 
if it be founded on a large number, the results are almost sure." 
« Besides this, it must be remarked that mathematicians them- 
selves are not all agreed as to the value of mathematical analy- 
sis applied to the calculation of probabilities. 

"The calculation of probabilities, from its very nature and 
professed scope, only makes approaches to the truth; yet its 
results have often some degree of apparent certainty. Never- 
theless, the facts on which such calculations are founded, are 
so vague, uncertain, and variable, that the results are not to be 



1837.1 Medical Statistics. 221 



depended on, and sometimes the most inconceivable mistakes 
take place. 

" The numerical method at once supposes and sanctions one 
of the greatest errors in therapeutics — namely, the adoption of 
absolute and exclusive measures. The celebrated problem of 
Pickairn — "For a given disease to find the remedy" — is only 
reasonable when understood in this way — "For a given indica- 
tion, to find the best method of fulfilling it," Each individual 
malady is not a simple phenomenon that can be represented by 
unity ; it is not certain and fixed, but constantly varying. Thus 
the pneumony of to-day is not the pneumony of yesterday, and 
the pneumony of Peter is not that of Paul. 

As an illustration, consider how disappointed the young phy- 
sician is in passing from a lecture or a didactic work to the bed- 
side of the patient ; and this because he is transferred from dis- 
ease in the abstract to its reality. Take any large collection of 
cases: consider the epidemics of Hippocrates, the constitu- 
tions of Baillou, the letters of Morgagnj; the consultations 
of Hoffmann, the ratio medendi of Stork, &c. — how many 
cases will you find alike ? The universally admitted law of 
idiosyncrasy and of individuality, so infinitely variable, cannot 
be included in any calculation of probabililies. Let us first ex- 
amine how the numerical method applies to a man in a state of 
health. Let us take two hundred healthy adults, of the same 
sex, age, profession, and condition : how many shall we find in 
exactly the same condition, so that we may say, "this health 
and that health make two V Or let us take their powers of in« 
tellect or of digestion : how many are alike in their intellect? 
how many have identical digestive powers ? When the differ- 
ent series of uniform intellects and digestive powers have been 
made out, a separate and universal method of treatment for 
each series has to be invented; and how will you succeed in 
this? 

" Let. us again suppose that there are in childbed, under the 
same circumstances, say a thousand women, and that the news 
of some grievous calamity is brought them ; five of them may 
become deranged, and the other 935 not have their reason affect- 
ed. In calculating probabilities, it is an easy matter to deter- 
mine this. But will any physician be therefore satisfied that he 
may announce apiece of bad news to a lying-in woman without 
danger 1 Or let a thousand men, in a state of violent perspira- 
tion, drink a given quantity of ice-cold water : ten are seized 
with pneumony, five with gastritis, and five with dysentary, 
while all the rest remain in perfect health. 

" But from theoretical grounds let us come to facts, and take 
the typhoid fever, of which term, by the by, I do not at all ap- 



222 Medical Statistics. Nov.] 

prove ; for, under it, gastric affections, bilious fever, entero-me- 
senteric fever, mucous fever, catarrhal fever, &c. arc confound- 
ed. It was this that led to that inextricable chaos of difficulties 
in your late discussion on that subject. The mistake was, that 
by the name of typhoid fever was designated a certain peculiar 
morbid state, which may be a dangerous termination, or a trou- 
blesome complication, of almost all other diseases. Thus pneu- 
monia, appoplexy, peritonitis, uterine phlebitis, phthisis in adults, 
surgical operations, &c. occasionally terminate with typhoid 
symptoms. 

" Still more so is this the case with bilious, catarrhal, and 
inflammatory fevers, which, according to my experience, all 
commence the typhoid fevers ; and, though I have seen a great 
many cases, I have never seen typhus come on primarily, but 
always preceded by nervous or febrile reaction, such as bilious- 
ness, an affection of the stomach, &c. 

" And here I may remark, that I think it one evil of the pre- 
sent state of medicine, that our experience is too exclusively 
that of hospitals. We thus only see one condition of life, and 
the disease already established, and can seldom retain the pa- 
tient long enough to see all the steps by which health is gradu- 
ally re-established. It is in these patients, in whom we never 
see the commencement of the disease, that we meet with the 
most marked cases of typhoid fever. 

" Well, then, in this same typhoid fever, can any unique, ab- 
solute, and exclusive treatment be assigned ? If the practice of 
medicine did not already do so, sound logic would give a nega- 
tive reply. Wlp^nwe consider the infinite modifications of cir- 
cumstances, the degree of strength, the state of the nervous 
system, the moral condition, the idiosyncrasy, the age, the sex, 
the country of the patient, the nature, period, and prevailing 
character of the disease, &c. &c, we see how impossible it is 
that any employment of figures, any calculation, however nicely 
balanced, should lead to any uniform method of treatment- I 
have in another place shewn, that, in the opinion of Lacroix, 
Laplace, and Condorcet, reasoning, logic, and induction, are 
in medicine not less useful, or less certain, than numerical cal- 
culations : even in geometry, in almost all points, calculation 
has hitherto only proved what reasoning has already suspected. 
" Theory," said Laplace, "is only common sense applied to 
calculation.'' The different influences modifying disease, to 
some of which I have alluded, are no less numerous, for exam- 
ple, than the letters of the alphabet. Yet, consider the richness 
and variety of language formed out of these letters : by that 
you may form an idea of tin; variety of the circumstances attend- 
ing disease ; or, to push the analogy still farther, there are in the 



1837.] Medical Statistics. 223 



alphabet certain elements of more importance than the rest ; in 
like manner disease has, so to speak, its vowels and its co. 
mints. 

" For myself I must say, that the morel see of disease, the 
more does eacli case appear to me a new and a separate prob- 
lem. When they see a new case, how many physicians can 
put down in figures the number of cases exactly similar which 
they have treated? I therefore think, that the useful results to 
be obtained from statistical calculations, in the treatment of ty- 
phoid fever, must be reduced to this : that we may usefully reg- 
ister the relative indications in cases within our own practice, 
and under given circumstances, of blood-letting, evacuants, ton- 
ics, (fee. But the numerical method can never point out the 
treatment to be adopted in any one given case. 

" But the numericalists, finding the subject of typhoid fever 
difficult ground on which to fight, have taken the case of inter- 
mittent^. With regard to intermittent fevers, however, we must 
not judge by those of the capital: first, because cases are rare 
in this country; and, secondly, because they yield easily under 
almost any means that are employed. It is in countries to the 
south that they are violent ; and I may remark, in passing, that 
this is another instance of the complexity of disease in general. 

"But even in this country I have cured intermittents by the 
most different modes of treatment ! — by local and general bleed- 
ing, by emetics, by purgatives, &c. : and if we examine the his- 
tory of medicine, which, when well understood, is the best 
instruction that a physician can receive, we shall find that in- 
termittent fevers, whatever may be their type, vary constantly 
in nature and in character, and yield to many different modes of 
treatment. 

"From all this it by no means follows that there are not in 
medicine certain general views, and fixed principles ; on the 
contrary, in the treatment of every case we act upon them. 
They are precisely the views taught by the beautiful doctrine 
of indications, (inductions?) which can alone guide us in the treat- 
ment of fevers, and of diseases in general. The doctrine, then, 
to which I have been led by my own experience, and by the 
history of medicine, and which I have always held and advo- 
cated, is that of eclectism. 

" Its methods are analysis and induction ; its aim, the wide 
and complete interpretation of facts, its result, the understanding 
of indications, with the knowledge of the best modes of fulfill- 
ing them. In short, it is the logic of facts, enlightened by the 
logic of thought. Yet to many this method is unpalatable : 
some are too impatient, some too indifferent ; while others are 
incapable of pursuing continued trains of reflection. I am led, 



224 Imperforate state of the Uterus. Nov.] 

then, by my long and unwearied labors on this subject, to the 
following results : — 

« 1. Individuality is an invariable element in pathology. A 
disease is not a simple, fixed, and uniform entity ; it is a series 
of varied and changing actions ; therefore every exclusive the- 
ory is absurd in pathology, and every absolute method repugnant 
to therapeutics. 

"2. Numerical and statistical calculations, open to many 
sources of fallacy, are in no degree applicable to therapeutics. 

" 3. The only methods admissible in practical medicine are 
those of analysis, logic, and induction." — Gazette Medicale, <$* 
American Journal. 



Imperforate state of the Uterus. — Pregnancy at full period. — 
Delivery. — Cure. By Mr. Tweedie. 

Eliza P***, aged from 23 to 24, in the ninth month of her 
first pregnancy, entered Guy's Hospital the 14th November 
1836. xMr. Roe, the physician of the ward, saw her at 7 o'clock 
A. M. The preceding evening the pains of parturition had 
manifested themselves with great force, and remained very vio- 
lent at the moment of the visit. After waiting some hours, Mr. 
Roe touched the woman but was unable to discover the neck of 
the uterus. Mr. Tweedie was called at 2 o'clock P. M. Upon 
examination he found in the vagina a solid, uniform, globular 
mass, pushing this canal before it at each pain. No irregularity 
could be perceived upon the surface of this tumor, every attempt 
to reach the neck of the uterus was useless. The woman hav- 
ing been constipated for some days, a dose of oleum ricini was 
prescribed, and some hours suffered to elapse. 

In the evening the expusatory pains were of extraordinary 
force : the purgative had operated. Touching per vaginum 
was again practised, but without any result. At each pain, 
however, could be felt before the tumor above indicated, a glob- 
ular body forming a prominence like the head of a child in an 
imperforate uterus. By touching with great attention, a small 
point thinner than the surrounding parts, but smooth, uniform 
and without any orifice could be felt at the place which the 
neck of the womb should have occupied. By pushing the mass 
towards the abdomen, the head of the child was distinctly felt, 
by its movements in the liquor amnii. 

The previous history of the case furnishes the following de- 
tails. The woman was married the 4th February 1836 : from 
the age of 14 she had menstruated every three or four weeks ; 



1837.] Imperforate stale of the Uterus. 225 

the blood was always pale, in small quantity, and continued 
only two or three days. The menstruation had never been 
painful. From the period of her marriage, the catamenia had 
disappeared. The woman had always enjoyed robust health 
both before and after marriage, but coition had always been 
painful to her. Two or three days before the commencement 
of labor, she had experienced hemorrhages from the vulva by 
which she had been frightened. 

The following diagnosis was made : — pregnancy of nine 
months shewn by hypogastric auscultation, (the pulsations of 
the foetal heart doubly as frequent as those of the mother's,) 
complete absence of the neck of the uterus ; very violent expul- 
satory pains. 

In this state of things, Mr. Ashwell was called in. He con- 
firmed the preceding diagnosis, and thought it was necessary to 
practise immediately an artificial opening in the thinnest part of 
the tumor. The pulse was from 120 to 130 per minute and 
very irritable ; the pains violent ; the skin alternately hot and 
cold ; the countenance expressive of anxiety and despair. 

Mr. Ashwell operated in the following manner. The woman 
having been suitably placed and the bladder emptied, the ac- 
coucheur introduced the index finger of the left hand into the 
vagina, along this finger a curve pointed bistoury was glided. 
The tumor was first punctured at its thinnest and most promi- 
nent part, and then incised from below upwards, and next from 
above downwards, or from the rectum towards the bladder, and 
vice versa. After the latter incision, some drachms of fluid and 
black blood escaped, followed by the liquor amnii. The head 
was instantaneously presented to the opening that had just been 
made; this opening presented one and a half to two inches in 
diameter, and about one line in thickness. 

Mr. Ashwell was unwilling to incise transversely, from the 
fear of wounding the branches of the uterine arteries. After 
the operation, the pains were somewhat appeased, but soon re- 
turned ; the head, however, did not advance. Three or four 
hours afterwards a laceration of the opening occurred, and the 
woman fell into a syncope. (Ether, ammonia, opium, prescrib- 
ed.) In two hours the pains resumed their former vigor. By 
touching, it was ascertained that the laceration was confined to 
the uterus, that it did not affect the vagina ; the head engaged 
more and more in the opening, and the woman was delivered 
happily at 11 A. M., 24 hours after the operation. The child 
was of the male sex, and in a state of asphyxia, but was soon 
resuscitated. Abundant, uterine hemorrhage, extraction of the 
placenta, contraction of the uterus, cure. 

By touching subsequently it was ascertained that the neck of 
the uterus was entirely absent. At the superior extremity of 



226 Imperforate state of the Uterus. Nov.] 

the vagina existed after the operation, an orifice puckered and 
irregular at its circumference, soft, with thick margins, irregu- 
larly circular, denticulated ; it might be compared to the base 
of an apple, or rather to the summit of a pear, represented by 
the uterus itself. By passing the finger around the circumfer- 
ence of the orifice, three rays or seams like the lines of adhesion, 
could be felt, one directed anteriorly, toward the right ilio-pu- 
bic articulation, and reflected upon the vagina — the second di- 
rected posteriorly toward the left sacro-iliac articulation, and 
reflected also toward the vagina, and the third shorter than the 
preceding, presenting only an inch in length, was directed to the 
right and posteriorly. 

This case though not unique, is nevertheless rare and inter- 
esting-. The author remarks with propriety, that the artificial 
opening should be practised soon before the spontaneous lacera- 
tion of the womb occurs. By art we make an orifice in the 
most suitable place without invading either the vagina or the 
peritoneum, and the accouchment takes place successfully, both 
for the mother and child, while every thing is uncertain and 
dangerous if the formation of the new passage be left to the 
blind efforts of the pains, the woman would then be placed in 
the same perilous condition as in lacerations of the uterus in 
general. It would be curious to know what was positively the 
state of the womb before conception, and how the woman could 
have been impregnated without an uterine orifice. Whence 
came the menstrual fluid ? Was not the os uteri obliterated 
probably after conception ? These are doubts which the author 
has not sought to dissipate. — Gazette Medicate. 

Not having received the English announcement of the above 
case, we have extracted it from the Gazette Medicate. Al- 
though from the highest British authority in obstetrics — Roe, 
Tweedie, and Ashwell, we give it only as a possible case, as 
regards the actual occlusion of the os tincee; but it may be use- 
ful in demonstrating, in connexion with other similar operations, 
as well as those which have been frequently employed for dilat- 
ing the natural orifice of the uterus in cases of extreme and 
fixed ridgity, the safety of delivery by incision of the os, or 
cervix uteri. 

The editor of the Gazette Medicate seems to "be curious to 
know what was possitively the state of the womb before con- 
ception, and how the woman could have been impregnated with- 
out an uterine orifice ? Whence came the menstrual fluid ? and 
if the os uteri was not probably obliterated after conception ? 



1837.] Imperforate state of the Uterus. 227 

It is evident from the first of these inquiries, that the flimsy, 
irrational, sympathetic doctrine of conception, as well as that of 
the absorption of seminal matter from the vagina by absorbent 
vessels, which anatomy cannot demonstrate, are alike and justly 
without a footing in Paris. 

We cannot take to ourselves the right to deny things which 
rest on such human testimony as we would receive freely in other 
matters, however strange the alledged facts, merely because they 
were not presented to our own senses. Such an assumption, 
would, if adopted by men, always clog the wheels of science, 
so as at least to make it stationary if not retrogressive. But 
whilst experience and observation may in many cases prove 
fallacious, sound reasoning from well established premises is 
productive of mathematical certainty. We repeat, that we give 
this case as one which we will not deny as possible because we 
did not witness it, and if we had, we might have been deceived 
perhaps, more easily than the surgeon-accoucheurs of St. 
Gutfs. But we have many reasons for doubting the correctness 
of the diagnosis so far as relates to the occlusion of the os uteri, 
in any such case, and particularly in that which is before us. 
Amongst them are the following, which we deem sufficient to 
justify the view we have taken : — 

1. We consider the doctrine of conception now settled, at 
least so far as to establish the fact of the admission of the male 
element into the uterine cavity. This being the case, concep- 
tion could not have taken place without a competent opening 
from the vagina into that cavity : but conception did take place, 
therefore the existence of the os uteri at the time of conception 
is established. 

2. If the os uteri existed at the time of conception, and did 
not at the completion of gestation, it must have closed itself 
sometime during the pregnant state. But every one who is fa- 
miliar with the diseases of the uterus must be aware, not only 
of the want of tendency in the os uteri to adhere and close its 
opening ; but of its exhibiting, on healing, after wounds and 
ulcerations, something of a formative propensity, whereby it 
seems inclined, like the lips of the mouth, and indeed, like most 
parts, to re-develops itself more or less in its original character, 
This is a physiological fact, arising out of the office of the ap- 

e5 



228 Imperforate state of the Uterus. [Nov. 

propriating powers. It is however, an office sometimes over- 
ruled by certain peculiar circumstances, such as great extent of 
injury peculiarity of location, (fee. &c, an example of which we 
have in burns, &c. But the propensity tends to unite severe d 
parts which were naturally in contact, when well disposed, as 
in incised wounds; and by the assistance of art, parts originally 
separate may be brought to unite, as in the harelip operation — 
the Rhinoplastic operation, &c. And we should not doubt the 
practicability of uniting the denuded edges of the os uteri by the 
twisted suture if the percolation of secretions should not pre- 
vent, nor the practicability of joining two individuals together 
as effectually as the Siamese brothers, by the intervension of art. 
This indeed was formerly the plan of making Talliacotian 
noses. But parts originally and properly separate, unless influ- 
enced by some of those peculiar circumstances tend to reinstate 
themselves more or less perfectly to their pristine formation, and 
to heal separately. We have occasionally treated and cured 
ulcerations occupying a part, or the whole of the os uteri, both 
in the unimpregnated state, and that of pregnancy wherein 
there is always a supernormal, and in a certain sense, morbid 
degree of excitement : in no instance of which has there been 
the least manifestation of a disposition to unite and obliterate 
the natural cavity. Indeed the great difficulty with these ulcer- 
ations is that, either in consequence of the peculiarity of struc- 
ture, or the irritation common to the pregnant state, or undue 
irritation of the uterine substance from other causes, as prolap- 
sus, (fee, or from some or all of these jointly, there is a tendency 
to loss of substance during the continuance of disease. We 
have now in our notes, a drawing, taken from a speculum view 
of the cicatrix at the upper part of the vagina, where at least 
the lower half of the uterus had been lost by ulceration caused 
by prolapsus, before it could be healed. Even with this destruc- 
tion of the labiated part and cervix, the lower extremity of the 
remaining fragment of the uterus healed even with the plane 
of the vagina at that part, leaving a round hole in the otherwise 
smooth vagina, corresponding with the cavity of the neck, and 
about the size of a large swan quill — conforming itself very well 
to the natural opening at this part of the uterus. 

We have the drawing of another specular view of a case in 
which the posterior wall of the uterus was destroyed nearly to 



1937.] Imperforate state of the Uterus. 229 

the fundus, and the anterior, to about the middle of the neck; 
thus leaving 1 an eschar in an oblique longitudinal direction, from 
above posteriorly and near the fundus, downward and forward 
to the fore and middle part of the neck, exposing all the remain- 
ing portion of the uterine cavity. The fragment of the uterus 
healed over in this shape, leaving the inner face of the uterine 
parietes a little excavated, and assimilated to the adjoining healed 
edges of the parietes. It is therefore not in the least probable 
that the orifice was obliterated after conception and during ges- 
tation. The conclusion therefore appears to us very evident 
from the weight of these facts, that the occlusion declared, did 
not exist. 

3. The anterior obliquity of the uterus, in some degree, by 
which the axis of this or^an is thrown at an anele more or less 
considerable in that direction, with the axis of the superior strait 
of the pelvis, is one of the most common circumstances met 
with in the practice of midwifery. This is often in a very small 
degree ; but in most cases sufficient to retard more or less, the 
second stage of labor, and to render the correction of this obli- 
quity by drawing the os uteri forward, necessary to the most 
prompt and favorable result. But we often meet with cases in 
which the os uteri cannot be found by manual examination, be- 
cause it is too high in the posterior region of the pelvis, — ren- 
dered so by an extreme anterior obliquity ; and the head of the 
child, having descended low in the cavity of the pelvis, carry* 
ing before it the anterior paries of the cervix, greatly extended 
and attenuated by the powerful impress of the expulsive parturient 
efforts — giving to the touch a very good resemblance of a large 
pouch of the waters, or membranes covering the foetal head in a 
complete delatation of the os uteri. In such cases we have some- 
times been utterly unable to find the os uteri until the protrud- 
ing part of the uterus, and of the foetus were returned suffi- 
ciently through the superior strait, to enable us to find the os 
uteri about the sacro-vertebral junction. In this case, all the 
expulsory efforts are expended against the wall of the uterus 
which is presented to the cavity of the pelvis, instead of the os 
uteri which is turned towards, and against the upper and poste- 
rior part of the bony pelvis. This, in various degrees, is one of 
the most common causes of tardy labor, and of the loss of pains; 



230 Imperforate state of the Uterus. [Nov. 

and the correction of which will render almost any labor more 
expeditions, and preserve the energies of the patient from more 
or less unnecessary exhaustion. But with a proper understand- 
ing of its nature, and the condition of the parts it is susceptible 
of almost instant correction even in most of those cases in which 
it exists in an eminent degree, by drawing forward the anterior 
part of the os uteri and retaining it so with the finger until the 
bag of waters so protrudes as to supply the place ot the finger, 
which is generally soon the case. 

4. The appearances of the part after recovery, such as the 
absence of the neck, &c, afford pretty conclusive evidence that 
the part incised in the operation was that part of the parietes 
of the uterus which is so often protruded into the cavity, and 
even to the perineal strait by the head of the child in anterior 
obliquities. 

Much more might be said on this subject, but we trust the 
present will suffice to guard practitioners against the hasty per- 
formance of a dangerous section of the substance of the uterus, 
when both safety and expedition are better secured without it. 
This is another of those cases, but too common in hospital 
practice which tend to assure us of the great inhumanity attend- 
ing that hasty and generalizing practice commonly pursued in 
extensive infirmaries. 

Since preparing the above article for our pages, the November 
No. of the American Journal has come to hand, detailing the 
same case from Guys Hospital Reports. We cannot repeat the 
article, although it may possibly be more correct in some partic- 
ulars. But we give below an extract from the London Medical 
Gazette, subjoined to the above case in the American Journal, 
which is valuable and interesting. 

John North, Esq., in an interesting article in the London 
Medical Gazette of the 10th of June, 1837, expresses some 
doubts of the real nature of the above case, as there are so many 
cases on record in which the uterus has been supposed to be 
imperforate at the time of labor, but, upon subsequent examina- 
tion, it has been ascertained that the os and cervix uteri, had 
escaped detection, in consequence of their mal-position. In 
some of those cases after delivery had been effected by incisions 
into the uterus, upon the presumption that there was no os uteri, 
both the os and cervix uteri have been found in their natural 



1837.] Imperforate state of the Uterus. 231 



situation, and naturally constructed. Mr. North observes, 
"that tliere are some circumstances connected with this case, 
which I confess I cannot comprehend, and which seems to ren- 
der the assumed fact of the uterus being imperforate scarcely 
conceivable. The complete closure of the os uteri must of 
course have taken place after conception, and as far as 1 know 
could only result from some disease, some active inflammation 
of the os or cervix uteri at some period of pregnancy, which in 
this instance could not have existed, inasmuch as it is stated 
that the patient " both before and subsequent to her marriage 
has had robust health." The doubts that have been expressed 
by the highest obsterical authorities as to the fact of the absence 
of the os uteri in many of the cases in which this rare anomaly 
had been presumed to exist, apply exactly to this case, as far as 
can be judged from the report given of it. For example, Bau- 
DELOCQ.UE asks,* "A quoi pourroit-on l'attribuer, (l'obturation de 
l'orifice de la matrice) chez lez femmes ou l'on a cru la rencon- 
trer au moment de l'accouchement 1 a l'inflammation, sans 
doute, et a ^alteration du col de la matrice. Mais rien ne fait 
pr'sumer qae chez elles de telles affections aient lieu pendant 
lagrossesseP DesokmeauI says. " Pour que l'orifice de I 'ute- 
rus s"oblitare et s'efface pendant la grossesse, ilfaudrait qu'il se 
fat d jveloppa une inflammation assez vive, cequi ne pent arriver 
que tres rarement ; or dans la plupart des cas on ne parte pas 
d'inflammation." Lastly, VelpeauJ thus states his opinion upon 
the subject: "II n'y a evidemment qu'une maladie grave, une 
inflammation aigue, qui puisse fermer ainsi le sommet de la 
matrice entre la fccondation et le terme de l'accouchement. 
Dans ce cas, les parties sont necessairement le siege d'altera- 
tions concomitantes propres a lever tous les dontes. Les signes 
anamn stiques aur aient oVavance eveill- f attention. r In these 
quotations, I have taken the liberty of italicising the opinions 
of the distinguished writers which are directly opposed to the 
closure of the os uteri at the time of labor in a patient who 
" had not had a day's ill health," and who was always fit for an 
" unusual degree of laborious exertion." The report of the case 
states, that " for two or three days before labor came on, she 
noticed a rather copious discharge that continually drained from 
her." From whence, if not from the uterus, and through its 
natural opening, the os uteri, is it probable that this "rather 
copious discharge" proceeded '? 

" The whole description of the case," he adds, " is exactly 
similar to many I have seen, and to still more described by vari- 

* Journal General de Med. t. 25, p. 42. 

t Diet, de Med. t. 15, p. 190. 

% Accouehcmens, 2nde edit, t. 2, p. 216. 



9Q9 



Imperforate state of the Uterus. Nov.] 



ous writers, where the os uteri could not be detected by any ordi- 
nary examination, oreven by the introduction of the hand, until 
after many hour's duration of severe labor pains, in consequence 
of there being 1 so great a degree of anterior obliquity of the 
uterus as to throw tlie cervix and os uteri back towards the sa- 
crum, or even above the sacro- vertebral an^le. I confess that 
more than twenty years ago I was much perplexed by two of 
these cases that occurred to me. In the words of Velpe.Vu, 
"I dreamt of anomalies, and knew not what to think.' 5 In sev- 
eral such cases I have subsequently known other practitioners 
at fault, and who fancied from "the firm, uniform, globular 
mass forcing down into the vagina" upon which no orifice could 
be detected, that there really was no os uteri. By patience, 
however, and proper management, the efforts of nature, and 
sometimes, though very rarely, manual assistance, which in 
such cases is seidom required, the os uteri has been brought into 
a more favorable position, and the delivery has been safely, 
though very slowly terminated. 

" If the pelvis is large, the uterus is in such cases forced into 
its cavity by repeated and violent pains, which have little or no 
effect in dilating the os uteri, in consequence of its being out of 
the line of direction of the expulsive force. The anterior and 
inferior part of the body of the uterus may even approach the 
os externum ; the head of the child, or any other part that pre- 
sents, being distinctly felt through the thin and distended ute- 
rine parieties. In such instances, either of two mistakes have 
often been committed. In the first place, it has often been 
thought that there was no os uteri, because it could not be detected 
by any ordinary examination with the fingers, however carefully 
conducted. Secondly, it has as frequently been supposed that 
the labor would be speedily terminated when it had scarcely 
commenced, for the head of the child is felt so distinctly, al- 
though still covered by the thinly expanded uterus, as to lead to 
the belief that the os uteri was entirely obliterated, although it 
was little, if at all dilated. I will refer to a few authorities for 
the purpose of corroborating the opinions I have given ; of 
showing how cautious we should he in presuming the uterus' is 
imperforate, .and also of showing how completely the most ex- 
perienced practitioners have been deceived in their diagnosis of 
such cases. Denman* says, "Cases have been recorded, in 
which it was said that the os uteri was perfectly closed, and in 
which it has not only been proposed with a pair of scissors to 
make an artificial opening instead of the closed natural one, but 
the operation has been actually performed.'' " 1 am persuaded 
there has been an error in some of these cases, and that what 

* Midwifery, 7th edit, by Waller, p 341. 



1837.] Imperforate state of the Uterus. 233 

has been called a perfect closure of the os uteri has not been 
such, but that the practitioner has. at perhaps an advanced pe- 
riod of the labor, been unable to discover it by reason of its 
obliquity.'" Dewees* thus strongly expresses himself: ' ; Within 
onr own knowledge, this case (anterior obliquity of the uterus) 
has been mistaken for an occlusion of the os uteri, and where, 
upon consultation, it was determined that the uterus should be 
cut to make an artificial opeqing for the foetus to pass through. 
They thought themselves justified in this opinion, first, by no 
os uteri being discoverable by the most diligent search for it ; 
and secondly, by the head being about to engage under the arch 
of the pubes, covered by the womb. Accordingly, the labia were 
separated, and the uterine tumor brought into view : an incision 
was now made by a scalpel through the whole length of the 
exposed tumor, down to the head of the child. In due course 
of time the artificial opening was sufficiently dilated to give pas- 
sage to the child. The woman recovered, and to the disgrace 
of the accoucheurs who attended her, was delivered per vias 
naturales of several children afterwards, a damning proof that 
the operation was most wantonly performed.-' Desormeauxt 
gives evidence to the same effect. Kiliax? remarks, that in 
cases of supposed closure of the os uteri, the practitioner must 
be very much upon his guard, and very mistrustful of himself, 
for the diagnosis is by no means easy. Jorg,§ in commenting 
upon - der schief heit des gebarenden uterus," obliquity of the 
pregnant uterus, observes, that it often causes great perplexity to 
the practitioner, who, in consequence of not being able to feel 
the os uteri after many hours' duration of severe labor pains r 
commonly believes that the uterus is imperforate. Baudelocqe,!! 
in a very instructive paper on the subject, gives several cases in 
which mistakes were committed, and needless operations per- 
formed by experienced practitioners. VelpeauI says, that he 
has so frequently known tolerably experienced practitioners 
affirm that there was no os uteri, when it was merely raised to- 
wards the sacro-vertebral angle, that he has no difficulty in 
referring to this mistake the majority of cases of supposed ob- 
literation, and that for beginners the anterior obliquity of the 
uterus is very embarrassing ; '•'- ne trouvant pas de col, ils r vent 
des anomalies, ou ne savent que penser." He mentions the fol- 
lowing case, which is quite in point. It happened to one of his 

* System of Midwifery, p. 90. 

* Diet, de Medecine, t. 15, p. 189. 

i Die Operative Geburtshulfe. Erstf.e Band, 259. 
§ Krankheiten des Weibes, ZweTTI Acflaoe, 690. 
II Journ. Gen. de Med. t. 52, p. 34, et seq. 
IT Loc.cit. 216 and 229. 



231 Imperforate state of the Uterus. [Nov. 

friends, who had practised three years, " avec distiction dans la 
capitate." Tne account was transmitted by letter to Velpeau. 
I do not presume to offer this as the counterpart of any other 
case, although, no doubt, its fellow might be found. I will not 
spoil it by translation. "J'ai passe la nuit pivs Madame de 8.; 
le travail parait marcher regulierement ; m us je ne trouve point 
forifice ; j'ai porte le doigt vers le promontoire, puis du cote des 
fosses iliaques, puis en avant derriere le pubis; partout je suis 
arrive jusqu'au culde-sac forme par l'extremite sup.rieure du 
vagin ; mais je n'ai point trouve le col ; qu'ai-je a faire, qu'est-ce 
que cela veut dire?' 1 Velpeau thus clears up the mystery: 
" C'est qu'en erfet I'oriflce etait tellement porte en arrive et en 
haut sur la tumeur, que pour l'atlendre, il fallait recourber le 
doigt en crochet tout-a-fait en avant." 

" The patient whose case is related in the Guy's Hospital Re- 
ports was in labor with her first child. It is true that so great 
a degree of anterior obliquity of the uterus, as to lead to an er- 
roneous diagnosis at the time of labor, occurs much more fre- 
quently in women who have borne many children, in conse- 
quence of the abdominal p.irieties having lost their power by 
frequent distension, of supporting the gravid uterus. But it may 
and does happen occasionally in first labors, either from a 
natural fiaccidity of the abdominal parietes, from the brim of the 
pelvis being inclined more forward than usual, or from an un- 
usual convexity of the Jumbar portion of the spinal column. It 
is stated in the case I refer to that a careful investigation was 
made about a month after delivery, and that there was no cervix 
uteri. In a case related by Lauverjat,* in whicli he and many 
other practitioners fancied there was no os uteri, and in which, 
consequently, an incision was made into the uterus, neither the 
os nor cervix uteri could be detected for two months after the 
operation. « L'un et l'autre alors etoinet dans l'dtat le plus 
naturel." 

The doubts expressed by Mr. North, concerning the nature 
of Mr. Tweedie's case, may he unfounded ; but at all events, 
the facts mentioned by the former, may tend to guard young 
practitioners against hastily assuming that the uterus is imper- 
forate at the time of labor, and to impose upon their minds the 
difficulty of the diagnosis in a description of cases which are 
generally not sufficiently dwelt on by medical teachers. 

* Ncue M. thole den Cayserchnitt iu raachen, 188. Gtuoted by Baudelocque, 
loc. cit. p. 45. 



1S37.] Cancer of the Lung. 235 



Cancer of the Lung. By M. Heidelfer. 

Cancer of the lung is a very uncommon disease in compari- 
son with other affections of this organ. But of all the cases of 
this disease, none present more indubitable characters than the 
following. We believe that a taberculous infiltration, may be, 
and has been more than once mistaken for cancer of the lung ; 
in this case a similar error could not have existed. 

A peasant a^ed 24, strong and robust, who, except the diseases 
of infancy, had never been affected by any others except the 
itch, was attacked towards the autumn of 1834 by pleurisy, 
which yielded to an antiphlogistic treatment. In the month of 
December a similar attack occurred, of which he was not so 
completely relieved by the same means. 

A new exposure to cold and improper diet aggravated his con- 
dition. The left side of the chest became the seat of very intense 
and apparently electric pains, which the patient felt from the 
shoulder to the false ribs, and from the sternum to the vertebral 
column. Sanguine depletion, both local and general, revulsives 
and soothing means were once more employed. The following 
was his state at this period : decubitus upon the back ; the left 
side of the chest somewhat elevated ; frequent, dry and short 
cough — accompanied with dyspnooa ; the left side of the chest 
immovable in inspiration and expiration. The sternum was 
elevated and pushed towards the right side, a very observable 
difference existed between the right and the left s,ide of the tho- 
rax, the latter presented a considerable dilatation immediately 
above the mammilla ; sound upon percussion, dull on the left, 
and very clear on the right-side, no respiratory sound on the left 
side, where the pulsations of the heart were also inaudible, but 
were heard with great distinctness but unequally on the right 
side. The face of a livid color, with an expression of agony, 
the breath pure, or at least without any bad odor, the emaciation 
inconsiderable. 

A month later the state of the patient was greatly changed ; 
the anterior part of the left side of the thorax presented a con- 
siderable tumour, of the volume of two fists ; it was hard and 
tuberculated. The patient could not repose upon the right side ; 
the left was immovable during inspiration ; the color of the face 
still more livid, leaden, and the expression of agony more pro- 
nounced. 

Two months before death, the axillary glands of the left 
side began to enlarge and be indurated ; at the same time two 
tuberculated tumours were formed above the left clavicle ; the 
symptoms of general dropsy supervened and the patient died, 
having to the last a cough with a glairy expectoration. 
f 6 



236 Cancer of the Lung. [Nov. 

Autopsy, externally, a considerable arched prominence of the 
left side! anteriorly, and containing several tumours soft and hard ; 
the mammilla was engorged and mllated. 

Nothing remarkable m the Encephalon. 

The right side filled with water ; the right lung adherent to 
the diaphragm and pericardium contained no tubercules. The 
heart ratner small than large, was adherent to the pericardium 
in all its dimensions, was flaccid, softened, and almost orelati- 
nous. The left lung adhered to the ribs, presented no distinct 
lobes, but formed a single mass which filled entirely the left side 
and even a part of the right side of the thorax. The pleura 
could not be distinguished. This lung was transformed entirely 
into a compact, lardaceous mass, of a dirty white color, in which 
could be perceived no trace of bronchea or of vessels. Near 
the center this mass was softened, encephaloid, ol a greyish 
white color, and within it was seen an opening arising from the 
non-consolidation of a large broncheal tube. The arteries and 
veins were obliterated and transformed into ligaments as they 
proceeded from the heart. An incision in the external promi- 
nence of the left side presented besides the skin and a thin layer 
of cellular tissue, a compact and lardaceous mass, softened near 
the centre and converted into a soft and encephaloid matter, 
which communicated with the interior of the lung through the 
intercostal spaces, the ribs having been pushed from above 
downwards. Here existed no trace of pectoral or intercostal 
muscles and the ribs of the left side were in a state of complete 
atrophy. 

The liver, spleen, pancreas, kidneys and bladder were in a 
normal state, the mesenteric glands engorged, and through the 
digestive mucous membrane were disseminated red and softened 
spots, but without any ulceration. 

The left testicle and epididymis presented an incipient schir- 
rous induration. 

The author informs us that in the cases recorded by M. M. 
Andral, Velpeah, and Begin, the disease was not detected 
until after death. However, it seems to us, that the prominence 
of only one side with dullness of sound, the lancinating pains, 
the livid and leaden color of the skin, and the presence of two 
tumours above the clavicle should at least have directed the 
attention to the possibility of a cancerous affection of the lung. 
The author informs us that the schirrous state of the testicle 
and epididymis was not ascertained until after death. Is it ne- 
cessary to say with him that the etiology and treatment of this 
kind of degeneration are at the present day beyond the power 
of the art? Ed. of Gazette Hedicale de Paris.— Gazette Mid- 
icalc. — Archives de Medicine. 



1837.] Fisk fund prize Dissertations. 237 



Fish fund prize Dissertations of the Rhode Island Medical 
Society. — No. 1. — By Thomas H. Webb, M. 1)., Provi- 
dence. 

(Communicated for the Boston Medical and Surgical Journal.) 

What are the causes and nature of Rheumatism, and the best 
mode of treatment to be employed therein^ 

It is not a little strange that the credulity of men, and of phy- 
sicians particularly, should manifest itself in believing little evi- 
dence, or partial testimony, where the facts of multiplied and 
long continued observation are also in review. We are induced 
to attribute this result however, more to the present, unprecedent- 
ed reign of novelty mania, than to the operations of credulity 
itself; for this alone, we think would, from the very nature 
of things, although readily captivated by small or weak, be 
still mare easily, by greater or stronger evidence. But the 
operations of the rage for novelty, for we can call it nothing 
less, is most unaccountable, if we set out on the investigation, 
with adue contemplation of the natural organization, if we may 
so speak, of the human mind ; for here Are find such an ill pro- 
portionate relation between the perception and the judgement 
that, when sufficiently removed from the intellectual process of 
ratiocination to contemplate it abstractly from the interest we 
take in the result, we are forced to consider it within the proper 
scope of the term mania. 

We see this strange evidence of ill-balanced intellect exhibited 
in a thousand ways ; and in some way, by almost every body. 
We see it in the most common concerns of life, as in the servile 
following of fashion in the destruction of the beautiful sym- 
m3try of the female form, and the more valuable possession of 
the ruddy glow of fine health, by the criminal (if slow suicide 
be criminal,) use of corsettes — in the imbibition of wine and 
other form? of alcoholic drinks into the human stomach without 
necessity imposed by disease ; and all this, with the perpetual 
observation of the injurious effects of the former and the 
latter, and the ruinous— almost certain demoralizing tenden- 
cies of the latter. And when we witness these things, and 
reflect on the eventful and important nature of those legitimate 



238 Fisk fund prize Dissertations. [Nov. 

inductions to which the human mind is by nature entitled — the 
happy consequences of correct, and the ruinous tendency of 
incorrect or unfair ones from the whole promises, we are led to 
conclude that, in a science like that of medicine, every step in 
the correct theory, as well as the practical operations of which 
must, in order to be profitable, be at the expense of a fair and 
proportionable deduction from the whole of the real promises, 
there is no branch of study so essentially collateral, or perhaps 
we should say adjuvant or auxiliary as logic, or the correct use 
of the reasoning faculties. There is as due a proportion between 
effect and cause in the science of medicine, as in any thing else 
which comes within the perview of mental operations. But it 
is alleged that we may not know all the premises,,.. To this we 
reply that we should see a due proportion, which always exists 
between one set of phenomena and another which we have rea- 
son to believe stand in the relation of cause and effect, before 
we draw our deductions ; and if we do not see this proportion, 
search for it alone, or with assistance until we find it. And 
again : if in some matters, the whole elements of a process of 
reasoning cannot be precisely determined, still it is no less the 
duty of the physician, under the necessity of the case, when 
human powers ultimately fail, to use in his ratiocinations, all 
that are known, than it is not to neglect any part of the whole 
which may be well ascertained. 

It is not so strange that men should reason widely, or rather 
put induction entirely out of their catalogue of mental operations 
when they undertake to tamper with those sciences of which 
they know nothing from which to reason, as is unavoidably the 
case with imposters who attempt the practice of medicine with- 
out a knowledge of the anatomy, the principles of life, and the 
healthy and diseased functions : for there is no true reasoning 
but from true and well ascertained premises ; and " what can 
they reason from but what they know ?" And this, we may re- 
mark is constantly done by the impostors of the day, who mea- 
sure well the intellects of those whom they mean to gull, and 
calculate the success of the imposition as accurately as did the 
London Quack, who upon the same ground explained his own 
success. They know well that when men are drawn out to 
make actual conclusions on a topic with whose elements they 



1837.] Fish fund prize Dissertations. 239 

are perfectly ignorant, that the reasoning must result in error 
proportionate to the ignorance of the premises — then may they 
clearly determine their own chance of success, twenty, forty, or 
one hundred to one, according to the true intellectual character 
of the community with whom they seek favor. But with men 
of science, it is passing strange that a solitary, fallible man 
should make a'declaration in the very face of the best experi- 
ence and most enlightened observations of thousands — not of 
one age but of a hundred ages, and still this solitary declaration 
will be seized and tried. And not only so, but all must try ; 
and instead of reasoning fairly beforehand to determine what is 
right, they reason, if at all, afterwards to ascertain why the results 
were not according to desire. 

We have been led to these reflections by our deliberate con- 
templation of the Fisk fund prize dissertation on the nature and 
treatment of rheumatism, by Thomas H. Webb, M. D. This 
is a well written essay, and we have no possible objection to the 
manner in which it has been got up. We therefore pass over 
the whole of it until we come to the mode of treatment which 
is advocated by the author, the discovery of which stands to the 
credit of Dr. Cazenave. 

It is true that in all times, opium has been more or less used 
by practitioners in the form of opium pills, laudanum, Dover's 
powder, &c, and by the common people in the form of Bate- 
mans drop, (fee. &c; but it has remained for Dr. Cazenave to 
recommend to the world the use of pure opium hourly in large 
doses, and these persisted in to the end for the cure of rheuma- 
tism. It will be recollected by those who have read this essay, 
that the author adopts, in extenso, the bold, electic practice of 
Dr. Cazenave who, knowing well the physical effects on the 
system in small doses, presses its use to the production of those 
immoderate effects which have long been, to other men, beacons 
of danger from the exciting powers of opium — that is to say, 
doses which produce nausea, giddiness, headache, palpitation, 
<fec. But "these effects," said Dr. C. "are of course but mo- 
mentary, and should form no solid objection to the remedy if it 
be found beneficial in other respects, besides relieving pain." 
And he proceeds, " To the above effects of opium, (if it be con- 
tinued,) succeed others :— the patient does not sleep, but he expe • 



240 Fisk fund prize Dissertations. [Nov. 

riences a kind of delightful ecstacy,* forgets his sufferings, &c. 
The action is then excitant like wine. In some cases an abun- 
dant perspi ration is the result — but in both events, that is, with 
or without the sweating process, the radical cure of lhcuna- 
tism is effected." It is obvious here that the exciting powers 
of opium are carried beyond the sleeping point— even to the 
ecstacy — the stupor of intoxication, and the bold prescription 
persevered with until the rheumatic form of disease disappears. 
Electism, as well as system in medicine has its extremes, and 
consequently its dangers ; and we should be ever watchful of 
that disposition in man whereby he tends to extremes — to ultra- 
ism in whatsoever he embraces. These ultraisms in electism, 
generally arise from a process of reasoning instituted on partial 
premises; a fact which is finely illustrated in the case before 
us. We need not deny that Dr. Cazenave cured every case 
of rheumatism which came under his care at the foot of the 
Pyrenees, where no other form of disease is known — a location 
disposing to nothing but good— perfect health, but where tem- 
perature, nevertheless, has its effects, which are that assemblage 
of symptoms we call rheumatism. And we will venture this 
opinion, that under the circumstances inseparable from this loca- 
tion, the cases of this disease are much more alike, in male and 
female, old and young, sanguine, phlegmatic, or nervous temper- 
aments, &c. than in any other less favored place. Nor need we 
deny that Dr. Webb and his medical friends may have met with 
a like success in Rhode Island ; notwithstanding we should 
think it somewhat strange if none of the injurious chronic effects 
of opium, at least, were subsequently exhibited in those cases ; 
or if a mere mctastisis instead of a cure were ngt the result. 
But we may contend that the best observation of all ages, has 
been long since brought to bear on the too promiscuous use of 
opium, to which some practitioners have in all ages been in- 
clined ; and that, more especially since the days of Dr. Brown 
it has been necessarily a great point of duty with the profession, 
to bring the practice of medicine down to the point of prudence 
in the prescription of this drug. The principle will ho'.d good 
as long as opium continues to be an excitant, that its safe and 



* Dr. C. should have known that so far from this heing a uniform result from 
opium, it id only an occasional one in certain temperaments, states of systems, &c- 



1837.] Fish fund prize Dissertations. 241 



prudent prescription must always be subject to the various mod- 
ifying influences which c:innot be left out of the estimate. These 
modifying influences must then not be neglected, but taken into 
the calculation if found existing, in every individual case. The 
most es cntial of these are the temperament of body and mind ; 
the kind and degree of morbid action present, the organs most 
tenth ng, or liable to congestion, the operation of predisposing 
causation as found in occupation, age, sex, climate, particular 
location, (fee. (fee. Nothing, therefore, can be more obvious than 
that a general formula, consisting of opium, one grain every 
hour until the tendency to hilarity is produced, and the still 
farther exciting effects h:iv r 3 cirriad the patient, to the calm 
which folLow* this excess of excitement, and which is caused 
by still farther stimulation, must be extremely unsuited to cer- 
tain many cases, according to the influence of these modifiers — 
causes ol effects which must and will have their influence in 
the result. It should be recollected that it is not alone Xhe 
secrecy of quack medicines and ptactices that is objectionable. 
This alone might probably begotten over by practitioners when 
they come to see the result of the physical agent — what medi- 
cinal operation it is its power to effect on the system : but the 
worst part of quack medicines and practices, as for as they have 
safe and efficient physical powers at all, is the universality of 
application, regardless of the particular circumstances of the 
cases. Now the same objection is unavoidable in the case be- 
fore us. Hepatic derangements, impaired digestion, torpid bow- 
els, fatal congestions, appoplexy, (fee. (fee must result in a large 
proportion of such cases as ours in southern climates. Nor does 
it seem less evident to us, that upon the common acknowledged 
principles ol excitement alone, this valuable medicine cannot 
be alike applicable to the extremely different states of acute and 
chronic rheumatism. Here it will not be denied by the impar- 
tial, that the states of excitent are extremely different. This is 
too plainly evinced by the whole assemblage of symptoms pres- 
ent. Nor is it less evident from another source of truth availa- 
ble in pathology, which is a posteriori reasoning. No oue will 
deny but that in one case of rheumatism the most powerfully 
stimulating diaphoretics will prove beneficial, whilst in another 
these will prove injurious, and nothing short of depletion, local 



242 Fish fund prize Dissertations. [Nov. 

or general, will meet the demands of the case. If, therefore, 
there be any truth in the principles of excitent, it follows that 
the general excitement at least is extremely different in these 
two cases. 

But when we come to consider, and allow due weight in the 
reasoning process to the complicating influences of other modi- 
fiers, as occupation, temperament, &c. &c. we find still addi- 
tional physiological, as well as pathological phenomena which 
necessarily influence the deductions. Let us take for example, 
a climate not only as well calculated as that of the Pyrenees, or 
of New-England to cause simple rheumatism, but which also 
affords a long and hot summer with a moist, atmosphere. Here 
is an influence calculated to torpify the general energies of the 
body, and of the liver particularly. This is a truth of constant 
observation. If we reason from cause to effect, or from obser- 
vation of the facts generally presented, we shall find that, (in 
whatever way,) there is a greater or less predisposition to bilious 
disease, and consequently, when an occasional cause is applied, 
as cold, instead of a simple inflammatory fever or rheumatism, 
an inflammatory bilious fever or rheumatism is the result. And 
why, but that another cause has operated in the production of 
the phenomena; and to which, as well as to the other causa- 
tion, the resulting phenomena must bear a reasonable propor- 
tion. 

Now although the same causes must, under like circumstances, 
always produce the same results, still it does not follow that 
causes differing in name may produce phenomena not unlike 
each other. This is a fact of observation relative to the influ- 
ence of alcoholic drinks as brandy, wine and opium, as also of 
opium and heat on the biliary apparatus — that is to say, that 
opium readily induces, in a southern climate i hat state which 
the southern heat itself ordinal iry produces. Under these facts 
then it would be as absurd to think of curing a rheumatism 
which is most commonly, (though not always,) what southern- 
ers would call a bilious rheumatism, by a free use of opium, as 
it would be to remove a patient from Augusta to Mobile, or 
New-Orleans with the expectation of lessening the tendency to 
bilious diseases. 

willing to condemn with undue precipitation a practice 



1837.] Fisk fund prize Dissertations. 243 

so respectfully and so ably advocated, we determined, on read- 
ing the essay, to adopt the practice urged by it in the first case 
of rheumatism in which, as in not a few heretofore, we should 
be foiled in our ordinary course of treatment according to the 
best judgement on the true pathological condition. But before 
just such a case came to hand, we found a patient so severely 
affected with the excruciating pains incident to this disease that } 
in our absence, and over the head of our prescription, he was 
forced to resort to doses of laudanum to lull his sensibilities and 
lessen his pain. With the manifestation of this disposition, and 
with the hope of regulating the use of opium to a safer course 
than might be adopted at the impulse of his distress, we laid 
down the course in all respects according to Cazenave's plan. 
It was pursued until forty pills were taken. By this time we 
found great tendency to cerebral congestion from the direct 
action of the opium, with hepatic obstruction, evinced by 
sallow skin, brownish yellow tongue, with hard, frequent, con- 
tracted pulse. &c. amounting to a very complete and highly 
bilious rheumatism, had resulted. Unwilling to press further a 
plan which reason, as well as the experiment thus far condemn- 
ed, we discontinued the course, and in its stead adopted the 
use of a pill of six grains of calomel, one grain of aloes, and 
half a grain of kermes every six hours. This restored the 
wonted hepatic secretion, preserved a steady perspiration, and the 
patient was speedily restored to health. 

With these experiments then, and the reasonings which we 
have had on the subject, we have been brought to the language 
which Dr. Cullen appli?d to the use of cinchona, that we 
"hold it to be manifestly hurtful, especially in the beginning, 
and in the truly inflammatory state" at least; and probably gen- 
erally in southern climates and bilious temperaments. 

We will observe, in the conclusion of this article, already 
greatly extended beyond the intended limits, that depletion was 
liberally used, and in the early part of the case ; and that great 
spinal irritation existed in all the extent of the dorsal and lum- 
bar spine, and most severe in the dorsal. This received the 
counter-excitation treatment usually enforced for this symptom, 
but without being corrected. It disappeared with the rheumatic 
symptoms. 

g 7 



244 Clinical Observations on opening Abscesses. [Nov. 

Clinical Observations on opening Abscesses, delivered at La 
Pitie. — By M. Lisfranc. 

If you consult those books which treat of abscess, you will 
find it laid down as a general rule, that where the abscess is of 
small size, it ought to be left to nature to effect an opening, be- 
cause this, it is said, will be small, and consequently leave but 
an inconsiderable cicatrix. According to this view, small ab- 
scesses are to be left to themselves, provided they be not too 
indolent, and do not advance too rapidly. But I reject this 
method ; for if the aperture made by nature be small, why 
should not that made by art be made small likewise ? It is only 
necessary for this purpose that we use an instrument with a 
narrow blade, and that we make a simple puncture. 

Again, before opening an abscess, it has been thought that we 
must wait till the matter be well formed, or in other words, till 
the abscess be ripe, although to this some exceptions have been 
made, as with regard to abscesses in the abdominal and thoracic 
parietes, and those situated in the neighborhood of 'tendons and 
joints. I have opened such abscesses before they were well 
formed, and what has happened ? As long as I confined my- 
self to the method recommended in books, I did not reach the 
root of the malady. Convinced of its insufficiency, I attempted 
to combat the inflammation excited by the pressure of the pus 
on the surrounding soft parts, by fomentations and local bleed- 
ing. Immediately after opening the abscess. I applied leeches, 
which were more efficacious in proportion as the swelling was 
recent. 

This first satisfactory result soon led me to another ; some- 
times the leeches partly failed, and the induration passed into a 
chronic state. In conformity with the principles which I laid 
down in treating of white swelling, I allowed this state to re- 
main undisturbed three or* four days, after which I successfully 
attacked it by means of frictions with ointment of hydriodate 
of potass and ioduret of lead, as well as by compression, when 
necessary. 

One objection only remains to be refuted — that of the pain, 
which was supposed to be greater in this than in the ordinary 
method. It is true that the pain of the incision is a little more 
acute when an abscess is thus prematurely opened, but it only 
continues a few moments, and accordingly I hold that abscesses 
ought to be opened as soon as the existence of pus can be de- 
tected. I have followed this practice for fifteen years, and I 
need not remind you that you have yourselves been witnesses 
of its success. 

If you have to open an abscess of small size, as for instance 



1837.] Clinical Observations on opening Abscesses. 245 

that of an egg, and if the skin be thinner at the centre than any 
where else, yon must make your opening there for two reasons; 
first, because the integuments being thinner, the instrument 
passes through a smaller extent of integument, and consequently 
gives less pain, and also because the incision gives to the integ- 
uments a slight decree of stimulus which facilitates their ciea- 
trization : it is also very easy to prevent the pus from stagnating 
in the abscess by making pressure on its parieties. For larger 
abscesses it has become an established rule to open them at the 
most dependent part, unless there be some important blood-ves- 
sel or nerve in that situation. 

If, in order to arrive at the abscess, you have to pass through 
a muscle, the incision ought to be made in a direction perpen- 
dicular to the action of its fibres — that is to say, that when the 
muscle is broad, you must cut across ; but if, on the contrary, it 
be narrow, your incision must be parallel to the fibres, to avoid 
the risk of dividing it altogether. If in the case of a broad 
muscle, such as I first supposed, your incision were parallel to 
the fibres, it would almost always happen that the aperture 
would be completely closed by their contraction. You have 
lately witnessed a remarkable case, which I may quote here. A 
patient, in the ward of St. Louis, had a large tumor on the 
thigh, which not only afforded the ordinary signs of fluctuation, 
but evinced a distinct gurgling. I practised an incision parallel 
to the axis of the thigh, at the most dependent part : nothing 
was evacuated. I introduced a hollow sound into the wound, 
but still nothing came out. I then made another incision, at a 
point where the fluctuation was still more evident, but with the 
same negative result. The patient was very nervous, and his 
muscles contracted with force. Astonished at the circumstance, 
I next introduced a grooved sound along the blade of the bis- 
toury, which yet remained in the wound ; but still no pus made 
its appearance. My next proceeding was to make a movement 
with the two instruments, in such a manner as to separate them 
and prevent the contractile action of the muscular fibres : then, 
at length, the pus found an exit. I request yonr attention to 
this point, which is a very important one, for I am persuaded 
that it happens very often, particularly when the fluctuation is 
not very evident, that the surgeon, after having made his inci- 
sion, erroneously supposes there is no pus, merely because the 
opening having been made parallel to the direction of the mus- 
cular fibres, their contraction again closes up the aperture. 

Abscesses of the neck ought to be opened by means of a sim- 
ple puncture. I do not now allude merely to small abscesses : 1 
have opened, in this manner, purulent depots of considerable 
size, and, although the extent of the incision was not in propor- 
tion to the collection of matter, yet was all the pus evacuated, 



24G Cli?iical Observations on opening Abscesses. [Nov. 

while the cicatrix which remained did not exceed that of a leech 
bite. This precept is of great importance, not only to the wel- 
fare of the patient, bnt to the reputation of the surgeon, and. in 
this double view, merits your attention. The following is an 
illustration in point: — I was called, three years ago, to Belle- 
ville, to open an abscess on the neck of a young lady, which I 
effected in the manner above recommended. In the same house 
was a child, having an abscess similar to the other in situation 
and nature. A practitioner there opened it by an incision of an 
inch in length, and had reason to repent having done so ; for 
the comparison of the two children, after the healing of the 
wounds, was very disadvantageous to him ; the wound in his 
patient having healed slowly, and left a large cicatrix. 

In abscesses of the neck, owing to the small n ess of the aper- 
ture, the want of freedom with which the pus flows, and its re- 
maining about the cellular tissue, there may be a little lodge- 
ment at the lower part, forming a kind o{ cul de sac, whence 
compression is insufficient entirely to dislodge the matter. In 
such case it is necessary to make a small counter opening, cut- 
ting upon the grooved canula, so as to make a second incision, 
no larger than the first, and thus the two look like leech bites. 
The same precepts apply to those parts generally which are 
habitually exposed. In the neck, as on the forehead, the inci- 
sion ought to be transverse, — that is, in the direction which the 
folds of the skin naturally assume in those situations. 

In those parts, however, where the appearance of the cicatrix 
is not an object, modern surgeons make incisions of several 
inches where the abscess is large ; and experience has proved 
the advantage of this practice. The bistoury is to be held in 
the first position : the two last fingers, separated from each other, 
and extended, are to be placed, if possible, beyond the tumor, as 
a point (Tappiil : the tissues which are penetrated must be di- 
vided in a perpendicular direction : the middle finger, placed on 
the blade of the instrument, serves to rogulate the depth of the 
incision. This is very important, for if the instrument cuts i 1, 
or if the texture be hard, we are under the necessity of pressing 
mire strongly on the parts to be divided ; and without the pre 
caution of having the finger as I have described, we should 
incur the risk of plunging in the instrument too far. Besides, 
it is easy to push the bistoury farther in if necessary, by draw- 
ing back the finger on the blade of the instrument. We must 
do all gently : thus, when the blade arrives in the collection of 
pus, the hand will perceive the fact, because the knife is now 
passing through a less resistance than before. The only excep- 
tion to this is where there are muscular contractions of a nature 
to interfere with the resistance. I cannot well give you a mea- 
sure of the slowness necessary in this proceeding ; but always 



1837.] Clinical Observations on opening Abscesses. 247 

remember this fundamental principle in operative surgery — tnte 
is better than cilo. 

I have advised you to make the instrument penetrate the in- 
teguments perpendicularly : this rule applies to all such punc- 
tures, and it is proper that I should point out its nnpoitance. If 
the bistoury traverses the textures obliquely, it will have to pass 
through a greater extent of them, and hence, consequently, 
there is more pain ; hence, also, the exit of the matter is less 
free, and probably we may have infiltration of the surrounding 
parts in consequence. Besides, in abscess on the parietes oi the 
abdomen, there may be a hernia without any indication direct- 
ing our attention to it. 1 was called by Dr. Piorry to a wo- 
man who had received a kick on the belly, in consequence of 
which an abscess had formed there. The patient was carefully 
interrogated, and assured us that she had never suffered from 
any symptom connected with the digestive organs, — there had 
never been any thing indicative of hernia. However, I opened 
the abscess cautiously, when a gush of purulent matter es- 
caped, and I then saw that there was a knuckle of intestine 
floating in the tumor. What would have happened had I thrust 
the instrument into the tumor with that degree of brusquerie 
which some affect on all occasions ? 

An abscess deep in the parites of the chest or abdomen may 
be actually in contact with the pleura or peritoneum, while that 
in the neighborhood of a joint may reach to the capsular liga- 
ment. If,"lhen, you open abscesses of this nature with no more 
precaution than what is generally adopted — and especially if 
the muscular contraction prevents you from judging when you 
have passed from the more into the less resisting part — or, if 
the abscess be not entirely filled, I repeat, that under such cir- 
cumstances you incur the risk of penetrating the pleura or peri- 
toneum. It is therefore imperiously necessary to open the 
abscess as carefully as if it were a hernial sac. 

I mu^t not forget to add, that in proportion as the incision is 
made, the fore-finger being introduced into it, enables us the 
better to appreciate the depth at which the collection of matter 
is situated. I know that this is painful to the patient, but the 
suffering is not of a nature to have any effect upon his health, 
and we must above all attend to his safety. 

If the abscess be in the course of a large nerve or artery, you 
are told to make the incision so as to avoid it. But the tume- 
faction and induration of the parts are such, that you cannot 
recognise their relative situation ; and although anatomy tells 
us the natural situation of the vessels, yet the developement of 
an abscess often changes the relative position of the surrounding 
parts. If the artery and nerve in question always retained their 
wonted place, there would be no difficulty ; but, as I have said, 



248 ( finical Observations on opening Abscesses. [Nov. 

they are frequently displaced, and it' yon cannot ascertain their 
new position, what are you to do ? Certainly, not to imitate 
those practitioners who, in order to conceal their embarrass- 
ment, declare the abscess to be not yet mature, and so postpone 
opening it. This delay may be attended with the worst conse- 
quences. If, for instance, an abscess be situated in the neck, 
near the carotid artery, the jugular vein, or the eight pair of 
nerves, or great sympathetic, in the midst of the fine loose tissue 
of that region, the matter may find its way into the chest, or, 
according to Desault, even into the abdomen. It is, therefore, 
urgently necessary to open all such abscesses very promptly, 
and it is now twenty years since I have adopted this method. 
Take the neck as an example : I there make an incision parral- 
lel to its axis, and which divides layer by layer successively the 
skin, the cellular membrane, and, if necessary, the superficial 
aponeurosis. I next take a blunt probe, and limit the extent to 
which it is to penetrate the textures, by holding it between the 
thumb and fore-finger. I then introduce this to the bottom of 
my incision, and make it pass on by separating or rather push- 
ing aside, the fibres of the parts beneath. Whenever the instru- 
ment has entered the abscess, there is a cessation of resistance, 
besides which I perceive drops of pus oozing along the sides of 
the instrument. I then push it upwards and downwards, so as 
to enlarge the opening, and thus the matter finds a ready exit. 
Such is the result of twenty years' experience, and I have 
never yet met with any accident from hemorrhage ; I am there- 
fore inclined to believe that those surgeons, otherwise very able, 
in whose hands such occurrences have taken place, have either 
been ignorant of, or neglected, the precautions here laid down. — 
American Journal, from Gazette des Hopitaux. 



Cure for Drunkenness. 

A native of Norway, aged forty, who had from his youth 
been accustomed to dram-drinking, was attacked with delirium 
tremens. His medical attendant, to cure him of his dangerous 
propensity, prescribed the daily use of a mixture of two drachms, 
of sulphric acid and twenty-four ounces of whiskey. The result 
was remarkable : in three month s 1 time he got such a dislike to 
all kinds of spiritoUB Liquors, that he could not bear to swallow 
a drop of any thing stronger than beer. The dose of the above 
mixture taken was four wine-glasses daily, and the cure had been 
of a year's standing at the time of the communication of the 
case. —Eyt. Tiendc Bind, andet Hefte. — Eclectic Journal. 



1837.1 Belladonna in Ileus. 249 



PART III. 
MONTHLY PERISCOPE. 



Belladonna in Ileus. 



We have, on former occasions noticed some of the important 
uses of Belladonna. Its safety mid benefits continue to bemore- 
and more developed by the enterprizing practitioners of the pre- 
sent age ; and important and extended as they now are, it is still 
difficult for the mind to contemplate a limit to its application to 
disease. Nor is its worth to be estimated by considering it 
merely as a convenient substitute for other things, or as a gen- 
eral prescription, or one ordinarily resorted to in cases wherein 
other articles of less power or less danger under circumstances 
of abuse or misuse in any way, would answer the demands of 
the case ; but is most signally displayed when brought into use 
as a kind of forlorn hope — a dernier resort. It is in those cases 
wherein other medicinals fail of the desired end — wherein they 
have been used ineffectually ; or for purposes wherein their use 
is precluded by the circumstances of the case — it is in short, in 
the earnest demand of the otherwise hopeless necessity of the 
case, that its signal virtues are brought to the aid of humanity. 
A few instances amongst many such, are many rheumatic and 
neuralgic pains, constriction of the urethra and of the rectum, 
obstinate resistance of the os uteri in labor, inflammation of the 
iris threatening obliteration of the pupil, &c. with its use in the 
operation for cataract. 

The preparations in which this medicine is used are various, 
and afford great facilities in prescribing it. Indeed, the practi- 
tioner has little to be watchful of in its use, but to avoid exces- 
sive doses in internal use. Those mostly in use are the extract. 
(Extr actum Belladonna, U. S.) The leaves, however, are re- 
tained by most of the Colleges, and the root also by the Dublin. 
It is given in infusion, substance, and extract. The leaves are 



259 Belladonna in Ileus. [Nov. 

generally used when it is given in substance ; the leaves or 
root, when used in infusion, and the extract is given internally 
in substance or solution, and applied externally in solution, 
plaster, and ointment. This extract, (Succus inspissatus Bel- 
ladonna, Dub.) is a variable preparation, owing probably to the 
different proportional results of the preparation in different 
hands and perhaps at different seasons ; as in Brande obtain- 
ing four to six pounds of extract from one cwt. of fresh Bella- 
donna, whilst M. Recluz obtained nearly ten parts from one 
hundred. It is probable that the difference consists, not so much 
in the quantity of extract afforded, as in the other substances 
extracted with it from the Belladonna, making the increased 
result of the latter : consequently, until the particular prepara- 
tion used is well known, it becomes prudent to begin with under 
doses, as one quarter to one half grain three times a day, and 
increase to decided effect. The infusion is made of 3i of the 
leaves to §x of boiling water. The ointment, as first directed 
by Chaussier, and which has continued in use, is made of 3 i j 
of the extract to §i of simple ointment, (for summer, or gj pre- 
pared lard, for winter.) 

The plaster, (Emplastrum Belladonnae) is made of 1 part ex- 
tract, and two parts of soap plaster. 

We have again turned our attention to this valuable article, 
in consequence of noticing in the last No. of Dr. Bell's inval- 
uable Electic Journal of Medicine, a work which should be in 
the hands of every medical man, an interesting account oi the 
use of Balladonna in Ileus, with cases illustrative, reported by 
Dr. Wagner, district physician at Schlieben. We will give 
the substance of the cases, as they alone can best illustrate the 
decided power of the medicinal agent under consideration. 

" Case 1. On the 2 1st April, Dr. Lohrenz of Schonewalde 
visited a man aired 23, who had been complaining, since the 
19th, of violent pains in the umbilical region. Pains came on 
periodically, and were so excruciating on pressure that the patient 
screamed out when touched. Incessant retchings, belly hard 
and tense, and had been several days without an alvine evac- 
uation. Venesection, leeches, enemata and various other exter- 
nal and internal remedies were employed without any effect. 
Symptoms increased in intensity, and on the 22d, had subsul- 
tus, syncope, and vomiting of feculent matter. Belly tympani- 



1837.] Belladonna in Ileus. 251 

tic, hard and painful ; bowels obstinately costive, pulse scarcely 
to be felt, anxiety intolerable, and body covered with a clammy 
sweat. 

Under these circumstances, Dr. Lohrenz had recourse to a 
clyster of Belladonna. One half of this lavement was first in- 
jected ; and unlike the other enemata which were almost in- 
stantly rejected, this was retained, with a marked effect in calm- 
ing the violence of the symptoms. The countenance became 
more cheerful, and the abdomen softer, but the pupils became 
greatly dilated. Half an hour afterwards the second half was 
injected, and produced a most decided improvement. It was 
speedily followed by copious evacuations from the bowels, the 
pulse rose, pain and vomiting ceased, and next morning the pa- 
tient felt quite restored, and had no return of symptoms.' 1 

« Case 2d. On the 14th June, Dr. Wagner visited a labor- 
er's wife, aged 40, spare habit, but otherwise robust and healthy. 
She complained of a violent cutting sensation in the bowels, 
with obstinate costiveness, and incessant vomiting. She had 
had repeated attacks of the same description before, but much 
milder, and of brief duration. On examination there was found 
a hernial tumour in the right groin about the size of a walnut, 
and so excessively tender on pressure, that she could not bear 
the slightest touch. Belly tympanitic and tender, pulse small 
and rapid, face pale, body moderately warm. A large venesec- 
tion, and all the usual internal remedies, (except quicksilver,) 
tried without any effect ; as well as clysters of all kinds. Pa- 
tient refused to submit to a second venesection or the application 
of leeches, and rejected altogether the proposal of an operation. 
On the 5th all her symptoms were increased, thirst excessive, 
fecal vomiting, and suppression of urine. In this state of things 
Dr. Wagner had recourse to Belladonna clysters. He infused 
3i of the root of Belladonna and §i chamomile flowers, (he does 
not say how long,*) in §xij of water, and divided the infusion 
into three parts. The first part was administered by himself as 
soon as it was sufficiently cold, and produced very remarkable 
effects. Nausea and vomiting instantly ceased, and half an 
hour afterwards the belly was soft, and without much tenderness 
or pressure, hernial tumour much less tender, though still pain- 
ful. No secondary bad effects were observed. At noon she 
was found quite easy and contented, but with dilatation of pu- 
pils. She told him that she had been threatened with a repeti- 
tion of the attack about half an hour before, but that she had 
stopped it by drinlcing a few spoonfuls of the clystric mixture. 
In the evening Dr. W. found her complaining of a return of the 

* We consider this instruction sntTicient ; an infusion was made, and of course, 
according to the ordinary rules for making infusions. 

h8 



252 Belladonna in Ileus. [Nov. 

abdominal pain and tension ; and as there was no indication of 
the secondary effects of the Belladonna, except some dilatation 
of the pupil, he administered the remainder of the infusion. 

The patient passed a quiet night with the exception of some 
troublesome dreams, and, on the following morning the abdom- 
inal symptoms were mild and inconsiderable, except that the 
hernial sac remained extremely tender on pressure, and the in- 
carcerated portion of intestine could not be replaced. At noon, 
the soreness and tension of the belly increased again, and as no 
alvine evacuation had as yet taken place, and there were no 
apparent bad consequences from the belladonna, Dr. Wagner, 
repeated the infusion as before. The first dose produced the 
usual tranquilizing effect, but no farther change ; and as the 
constitutional effects were limited to some increase in the dila- 
tation of the pupils, with unpleasant dreams, he administered 
the second portion, and towards the evening the third and last. 
On the morning of the 7th, the hernial sac had disappeared — 
loud borborigmi were heard in the abdomen. But the patient 
after having been annoyed the whole night by frightful dreams, 
was suddenly seized with such furious delirium that several 
strong men ware required to hold her. Her eyes were fixed 
and sparkling, pupils excessively dilated, conjunctiva injected, 
cheeks of fiery red, pulse small and rapid and scarcely to be 
felt — deglutition impeded. She saw nothing but strange phan- 
toms, which she saught to drive away by abuse and threats, and 
searched for concealed enemies under her bedding, cloathes, and 
furniture — believed herself perfectly well, wished to resume her 
labors, pulled on her clothes with furious violence, and would 
have rushed out of the house but for restraint by force. Dr. 
Wagner ordered enemata of vinegar, (which were followed by 
copious evacuations,) and gave vinegar with strong coffee inter- 
nally, of which she drank large quantities with much desire. 
Cold lotions applied to the head, and the limbs washed with 
vinegar, an operation which the patient herself performed with 
much apparent satisfaction, washing herself with vinegar from 
head to foot. 

This state of things continued until the morning of the 8th, 
when the patient became rational and composed, but complained 
of flashes of light, and various other optical phantasms, with a 
sense of great weight and pressure in the head, and a general 
feeling of soreness and exhaustion particularly in the feet. She 
recollected distinctly every thing she had done during the pre- 
ceding day and nijrht, and said the horrible phantoms around 
her, compelled her to act as she had done. On the 9th, she 
complained only of weakness, which soon disappeared, and she 
recovered rapidly without any further unpleasant symptoms." 

" Case 3rd. On the third of July a smith, aged 59. was at- 



1837.J Belladonna in Ileus. 253 

tacked with enterodynia, vomiting, tympanitic swelling of abdo- 
men, and constipation. Dr. Wagner found an incarcerated 
hernia of the left groin, about the size of a hen's eff£, and ex- 
tremely sore to the touch. All external and internal remedies — 
repeated local and general bleeding and frictions over the abdo- 
men with extract. Belladonnae and ext. hposciami, proved 
wholly ineffectual. Every thing was instantly vomited up, and 
the clysters immediately returned. Patient would not submit 
to an operation. Dr. Wagner threw up an enema compound 
of a scruple of belladonna herb, and half an ounce of chamo- 
mile flowers in four ounces of water, which arrested the vomit- 
ing immediately, and produced such a diminution of pain, that 
the patient was able to enjoy several hours sleep. The abdomi- 
nal symptoms, however, returned every six or eight hours, and 
were four times allayed by the use of the same enema. On the 
5th, relieved of the pain and tenderness. Dr. Wagner was 
afraid to have recourse to the belladonna, as in addition to great 
dilatation of the pupils, frightful dreams, sinking and an altera- 
tion of pulse, and dryness of the tongue had taken place, and 
he prevailed on the patient to submit to the operation. This 
was performed on the sixth, and in fourteen days the patient was 
perfectly well. 

"Case 4th. July 5th — Dr. Wagner saw a woman, aged 
47, who had labored for two days, under violent pains in the 
abdomen, obstinate constipation and excessive vomiting. On 
examination he found an incarcerated hernia of the right side, 
about the size of a small walnut, which was excessively tender 
to the touch ; diffused abdominal tenderness, and tympanitic 
distension. Bleeding, leeching, frictions on the abdomen with 
belladonna and hyosciamus were employed without any effect. 
Patient refusing the operation, Dr. W. had recourse to bella- 
donna clysters, which produced the usual tranquilizing effects; 
but the hernia remained considerable. Patient exhibited some 
of the symptoms of the poisoning, as dilatation of pupils, &c. 
Blood was drawn from the arm, small doses of calomel and lax- 
ative salts given internally, and the belladonna clysters contin- 
ued until six lavements, (each composed of 3i belladonna and 
§iv water) were used. Hernia continuing irredecible, Dr. W. 
discontinued his visits on the eighth. On the ninth, however, 
the greater part of the hernial tumor had disappeared, the pa- 
tient had several copious stools, and in the course of two days 
found herself quite well. 



251 Ergot preventive of Uterine Hemorrhage. [Nov. 

Ergot administered in anticijjation of Uterine Hemorrhage. 

The Lancet of the loth of April last, contains some observa- 
tions from Dr. Bradley, on his successful administration of 
ergot of rye in a case of uterine hemorrhage, immediaely suc- 
ceeding the expulsion of the child, which he concludes by ask- 
ing whether, when such an event is apprehended, it might not 
be prevented altogether by giving the ergot immediately before 
the birth of the child ? 

In the subsequent No. of the same journal, (April 22nd,) T. 
Abraham, Esq. bears testimony to the successful administration 
of the remedy under the circumstances indicated, in six cases, 
and I. Kisch, Esq. states that he has been accustomed for some 
time past, to administer the ergot in similar cases, and with the 
most happy results. So satisfied is this last practitioner of the 
powers of ergot in preventing uterine hemorrhage, that he in- 
variably enquires, he states, whether the patient has been in the 
habit of flooding after delivery, and if so, of using the ergot as 
suggested by Mr. Bradley. 

The utility of this practice is unquestionable, but if it has 
any novelty on the other side of the Atlantic, as we suppose it 
has from the stress laid upon it in the communications just no- 
ticed, it certainly possesses no claim to such distinction here. 
The practice is pointed out by Dr. Stearns of New- York, in 
his pamphlet on the ergot, published upwards of fifteen years 
ago, and as employed many years since by our venerable and 
esteemed friend, Dr. Dewees, and is distinctly and strongly re- 
commended by him in his valuable system of midwifery. — 

American Journal. 

We refer ihe reader to the first volume of the Southern Med- 
ical and Surgical Journal, page 68, for our former notice of this 
article as a mean of controlling and preventing uterine hemorr- 
hage. We should have been more full on this subject, had we 
not been writing especially with another view, that is, to give 
our experience with this article in opposition to some opinions 
published about that time, impeaching the powers, and the safe 
use of ergot. In addition to what we then stated, we now say 
that for twenty-five years we have been in the constant practice 
of using ergot for the suppression of uterine hemorrhage, when 



1S37.] Vaccine and Variola existing concurrently : 2oo 

it occurred consequent to delivery in such a degree as to need 
internal administrations; and in all instances in which we have 
had charge of causes on account of the reasonable fear of he- 
morrhage, or cases in which there was any reason to apprehend 
this unpleasant occurrence. We have diligently adhered to the 
practice of administering ergot during the labor, even when not 
demanded on account of deficient parturient action, in order to 
secure safety from hemorrhage, and with the most satisfactory 
results, constantly confirming the propriety of the practice. 
We have used it in two of those cases of dangerous hemorrhage 
from attachment of the placenta to the os uteri. In one, the pa- 
tient being twelve miles in the country, was in art iculo mortis. 
On our arrival — cold and pulseless, neither the ergot nor any 
stimulant power could produce reaction, and she expired imme- 
diately on the delivery of the child by extracting force, which 
was done as soon as it was found that she was inexcitable. 
The other case was attended with happier results. Although 
the loss of blood had been very great before the administration, 
yet the system was susceptible of the action of the ergot — the 
hemorrhage promptly restrained, and the child turned and de- 
livered by the feet. It was a birth at eight months — the woman 
recovered. Our experience with the article in this relation, jus- 
tifies the assertion that we have no anti -hemorrhagic power for 
internal use, combining more uniform efficacy and safety than 
ergot. 



Vaccine and Variola existing concurrently. 

The following circumstances detailed to the Editor during 
the last summer, by Mr. S. B. Parkman of Savannah, seemed 
to afford such conclusive evidence of the fact of the concurrent 
existence of these two diseases, that the Editor was induced to 
request of Mr. P. a written statement of the particulars which 
evince this truth. Mr. Parkman's well-known character for 
veracity, intelligence, and minute and strict accuracy of obser- 
vation is sufficient to insure the fullest confidence in all the 
facts detailed. The following is the statement which Mr. P. 
politely furnished. 



256 Vaccine and Variola existing concurrently. [Nov. 

" Summersville, August 3rd, 1837. 
Dear Sir: 

The facts of the case I mentioned to you yesterday were, to 
the best of my recollection, as follows : — 

In the summer of 1830, we left with our friends in Savannah, 
three young servants who had all been vaccinated some years 
before at the same time. On our return about the first of No- 
vember, we found the small pox prevailing to a considerable 
extent, and that our three servants had been again vaccinated. 
On two of them the vaccine matter produced no effect — but 
one, a girl about fourteen years old, named Peggy, had a full 
vaccine pustule on her arm. On the second day after our re- 
turn, two negroes came to our yard from my sister's plantation 
on May River, and we had them both inoculated from Peggy's 
arm, though they had both been formerly vaccinated. 

On the third day after our return, Peggy, who had been very 
sick from the day we returned, broke out with an eruption, 
which the health officer* pronounced to be small pox, and she 
was removed to the public hospital at Cattle Park, where she 
remained until she recovered. 

On her return, I found a number of deep scars from the small 
pox — I think the number did not exceed twenty — a considera- 
ble portion of the pustules having disappeared without filling. 
Her symptomatic fever, and the progress of the disease, so far 
as I could learn at, the time, were all very similar to the ordinary 
progress of small pox by inoculation. There seemed to be no 
doubt in the mind of the health officer but that Peggy had the 
genuine small pox, although much modified ; for the general 
character of the disease was very severe, many cases confluent, 
and several deaths. 

Of the two negroes who were vaccinated from Peggy's arm, — 
on one, the matter produced no effect ; on the other a full 
vaccine pustule from which all the negroes on the plantation 
were vaccinated ; and from which nearly all those who had not 
been previously vaccinated received the genuine vaccine disease. 
The small pox was on the plantation adjoining my sister's — 
but none of her negroes took the disease. 

I think the vaccine pustule on Peggy's arm was full when 
the symptomatic fever commenced, and the eruption appeared 
as soon as the pustule began to dry. I have always believed the 
girl had the two diseases concurrently. 

An infant also had been vaccinated in Augusta, which failed. 
It was again vaccinated in Savannah on the arrival of the fam- 
ily, which took effect. Peggy was with the family four days 
before she was sent to the pest house — the small pox pustules 
not mature. The infant had kine pox, and not the small pox." 



♦ Dr. IIabf.rhu*m. 



1837.1 Medical Intelligence. 257 

This history goes to establish, as far as one set of incidents 
can, 

1st. That kine and small pox existed concurrently in the 
same individual. 

2nd. Small pox was taken in the natural way by Peggy, after 
kine pox had taken locally, but before the constitutional effects 
were developed. 

3rd. That when taken in this way the vaccine modified the 
virulence of small pox, (fee. 

4th. That (as evinced in the case of the infant.) the small 
pox is not communicable before the maturation of the pustules. 
These points tend to remove much of the doubt attached to the 
preventive efficacy of the vaccine disease. 



MEDICAL INTELLIGENCE. 



Wc arc often pleased by the evidences of the sound practice of our professional 
brethren throughout the interior of South Carolina and Georgia, and particularly 
in the latter, as our personal acquaintance is more extensive. Little of the fash- 
ionable fancies which float on the superfices of the profession finds its way to the 
bed-side in retired country practice, and the destructive waves of ultraism, raised 
and kept up by counter-currents and adverse winds in science, are not fostered by 
the safe moorings of country life. Here the mischievous ultraism into which be 
may have run, and the errors of some ephemeral theory he may have been taught, 
soon succomb to the facts of demonstration ; and the controling power of his only 
master, Reason, governs him henccfoith in the even tenor of successful practice. 
Thus it is, that with a good stock of medical science, he soon comes to that matu- 
rity of judgement which renders him a prize of high value to his community. 

Previous to theyear 1825, that, in which the license law, or medical bill of Geor- 
gia was passed, it was a rare thing to meet with a medical practitioner of real sci- 
ence in the interior. It is true that one of great merit was occasionally found in 
some of the more prominent towns ; but by the wholesome operation of this law 
during a short life of only ten years, quackery was scouted out from the whole 
country, and true science so pursued, that on the repeal of that law, (which was 
effectually done by the last Legislature by legalizing at one " fell swoop", a legion 
of imposters*) that in no section of the country where there was any considerable 



* An instance of retrograde legislation perhaps never equalled in the United States. 



258 Medical Intelligence. [Nov. 

population, was there a distance of more than a few miles, without a practitioner of 
true science. 

Every experienced and judicious Southern practitioner will see, in the comparison 
of the following formula; of scientific practitioners in different sections, the harmo- 
nizing and regulating influence of deliberate observation and reason on the southern 
country practitioners, A pill will be found to have become in general use in cer- 
tain bilious disorders, in different sections of the country, between which there is 
no professional communication — no consultation by which these results would be 
communicated from one to the other. Nor is there much disposition amongst our 
practitioners to follow the prescriptions of one another ; but rather to go forward 
on deductions from their own facts of observation, or those facts of others in whose 
impartial observation they can confide. 

We noticed in our last No. the cholegogue pill in use by Dr. Dhlony, and for- 
merly by Dr. Lucas. It is a pill, the good adaptation of which to the general de- 
mand of chronic bilious cases, every southern practitioner of much experience, and 
unbiassed by erratic theories will at once perceive. We now give an extract from 
a letter from Dr. Holloway of Warrenton, as follows, on the treatment of inter- 
mittcnts; — 



8 


Comp. ext. colocynth. 

Calomel 


gr. xxxvi 




Pulv. gumgaurboug. aa. 
Ipecac. 
Anise oil 
Spanish soap 


gr. xvnj 

gr- V J 

gttij 

gt. xxiv 



Syrup q. s. Make twelve pills — dose two or three at night ; or one every night 
as occasion may require. 

II. Precipitated ext. of bark 
Piperinc 
Sulph. quinine, of each equal parts. 

Make a mass, of which a pill of three grains is to be given every two hours. If 
the ague should return add one quarter of a grain sulph. of copper to each pill." 

With this course of cholegogue and tonic treatment, Dr. H. informs us that he 
rarely fails to cure the most obstinate intermittents ; and that they are " particularly 
beneficial on chronic, habitual cases." The formula for cholegogue pills, he has 
used for the last twelve years with great success. It is not a little remarkable that 
we find the cholegogue pill of both these gentlemen almost identical, not only in 
the ingredients, but the quantity to the dose. 

Dr. Hum, of Athens has for many years, when in full practice depended for his 
choWotTue, mainly on a pill almost identical with these, and with the most satisfac- 
tory success. The following is his formula : — 

ft. Ext. of colocynth 

Calomel aa 3 j 

Tart, antim. one eighth to one quarter gr. 

Mix and make twenty four pills. Dose thrc"! to four pills. 

From another source we have received another formula for a cholegogue pill, 
differing from this last only in the tartrate of antimony being three grains, instead 
of one eighth to one quarter, and the dose two to four pills. 



SOUTHERN 
JOURNAL. 



Yol. II. DECEMBER, 1837. No. V. 



PART I. 
ORIGINAL COMMUNICATIONS 



ARTICLE I. 

-4 paper on diseases mistaken for Hernia, with cases. Report- 
ed/or the " Southern Medical and Surgical Journal". By 
Heber Chase, M. D. of Philadelphia, Member of the 
Academy of Natural Sciences — of the Franklin Institute 
of the State of Pennsylvania, for the promotion of the Me- 
chanic Arts — Honorary Member of the Philadelphia Med- 
ical Society, fyc. fyc. 

Among those diseases most frequently met with and often 
mistaken for hernia, are varicocele, or a varicose state of the 
veins of the cord. Buboes, or glandular swellings in the groin 
from any cause. Hydrocele, or dropsy of the tunica vaginalis. 
Hydrocele of the Cord. Enlargement of the Cord from any 
cause, and Fatty Tumours. 

Variocele or Cirsoccle. Within the last three years I have 
been consulted in several hundred cases of hernia,* and by 



* A tabular statement of two hundred cases of hernia will shortly be laid before 
the profession. 

Al 



260 Chase on Diseases mistaken for Hernia. [Dec. 

many patients, who, upon examination, were laboring under 
varicocele, and frequently wearing trusses applied by trass-ma- 
kers and druggists. Patients of this description are constantly 
falling under my observation. It has heretofore been almost 
universally the custom for practitioners to send their patients to 
instrument-makers for trusses, and it is by no means uncommon 
to hear some of those gentlemen boast of the number of trusses 
they have u put on." Should they be able to distinguish an 
enlarged vein, a firm tumour, or a bag of water, from a bowel, 
the knowledge appears of little moment to them, provided they 
effect their object, the sale of a truss, even at the risk of the 
health and life of the patient.* 

It is not unusual for surgical writers to censure the profession 
for mistaking variocele for hernia ; and there can be no doubt 
that such mistakes do sometimes happen ; but it may safely be 
said that in those cases where trusses are thus improperly em- 
ployed, there is seldom ground for believing that they were ap- 
plied by those whose extent of surgical knowledge and acumen 
have equalled their desire for such acquirements. 

Glandular Swelling in the Groin. 
Tumour in the Groin mistaken for Hernia — age of patient, 6 
years — application of poultice to the part ; discharge of 
contents — cured. 

Case 1st. April 24th, 1837. — A lady called at my office ac- 
companied by her little son, aged six years, whom I had cured 
of an inguinal hernia of the right side. She informed me that 
she thought " the disease had returned." Upon examination I 
found a tumour about the size of a hen's egg located near the 
seat of the internal ring, but a little outward and upward there- 
from ; and upon further examination, I was convinced that it 
was not a return of the bowel. The mother fearing there might 
still be something wrong in the case, I requested Dr. R. Coates 
to see the patient, who coincided with me in opinion. I ordered 
the parts to be poulticed. In five days the abscess opened spon- 
taneously : the contents were discharged, leaving a smooth cav- 

* Truss. This is an instrument employed by Surgeons. — Surg. Die. article 
Truss. 



1837.] Chase on Diseases mistaken for Hernia. 261 

ity, the edges of which were drawn together by adhesive strips, 
and in ten days the patient was well. 

Not nnfrequently, fatty tumours are found to occupy the seat 
of crural herniae, which should not be mistaken for this disease. 

Femoral Hernia mistaken for an inguinal gland — age of 'pa- 
tient about 45 years — operation for Strangulated Hernia — 
death of the Patient. 

Case 2nd. — A few months ago I was requested to visit a pub- 
lic institution near this city, to apply a truss in a case of hernia. 
On examination, I found the patient laboring under irreducible 
femoral hernia. The tumour was of the size of a filbert, and 
could not be returned into the abdomen. The surgeon and at- 
tending physician of the house thought the existing tumour to 
be a lymphatic gland ; that the bowel had been returned, and 
wished the instrument to be applied. Satisfied that such was 
not the case, I refused to comply with their request.* 

On the third day following, the symptoms of strangulation 
came on. An operation was performed for his relief, but the 
patient died a few hours after.t 

Hydrocele, or Dropsy of the Tunica Vaginalis. 
Case 3rd. In the early part of the year 1837, I was called 
to visit the son of a clergyman of this city, who was supposed 
to be laboring under double inguinal hernia. He was wearing 
a single truss. On examination, I found that whatever might 
have been his former condition, he had at this time no protru- 

* I employed taxis to considerable extent in endeavoring to reduce the bowel in 
this case ; but had no opportunity for instituting other means. I could not learn 
how long the bowel had been protruded. 

See an interesting, and instructive case of strangulated hernia with the employ, 
mentof taxis ; successfully treated by Drs. P. F. Eve and Dugas of Georgia, with 
remarks by Paul F. Eve, M. D. in the September No. of this Journal for 1837. 

t This species of hernia is liable to strangulation, even before it can be felt ex- 
ternally. Hence it is obvious that we must establish our diagnosis principally on 
the preceding and concomitant symptoms of the case. Some fatal effects hare re- 
sulted from mistaking strangulated crural hernia for inflammation of someof those 
lymphatic glands which lie in the vicinity of the crural ring. The deep situation 
of the hernia, together with its very small size, hare contributed to render the mis- 
take more frequent. In some instances the difficulty of discriminating is consider- 
ably increased by an enlarged lymphatic gland lying anterior to a very small her- 
nia. — Cones' Surgical Anatomy. 



62 Chase on Diseases mistaken for Hernia. [Dec, 

sion of the bowel ; but he was laboring under hydrocele on both 
sides, which, by a superficial observer, might be mistaken for 
ruptures. 

This watery effusion could be readily returned into the abdo- 
men, showing that the necks of the sacs were not closed. Upon 
further examination, I found a general dropsy of the system, 
and that the patient had labored, not long before, under an at- 
tack of scarlatina, the dropsy being one of the sequelae of this 
disease. 1 requested that the family physician might be called 
in attendance, which was done. The patient died, however, of 
hydrothorax, in a few days. 

Hydrocele of the Cord. 

Case 4th. — On the 11th of August, 1837, a gentleman and 
his wife, from the interior of this state, called on me (by the 
advice of their physician,) with their little son aged three years, 
to consult me in relation to an inguinal rupture, to which it was 
supposed their child had become recently subject. 

After a careful examination, I found the disease to be dropsy 
of the cord. The fluid could not be returned within the ring ; 
but the tumour presented at all times the appearance of a her- 
nia. Under appropriate mild treatment, the affection disappeared 
in about a week. As the physician whose patient the child had 
been, thought there was at times a protrusion of the bowel, I 
furnished the parents with an instrument to be employed in case 
the bowel made its appearance, but under no other circum- 
stances. The parents returned home with the child, and I have 
heard nothing- further of the case. Dr. Warren of New- 
Orleans, has met with two similar cases.* 

• From the connexion which inguinal hernia has with the spermatic cord, vou 
must expect thai those diseases to which the cord is subject, will boar a resemblance 
more or less strong, to this form of hernia. Thus, when water collects in a cyst 
onthat part of the spermatic cord which lies in the inguinal canal, forming encysted 
hydrocele of the chord, the appearance and feel of the parts will not be such as to 
constitute a satisfactory distinction between these diseases. Wo must then depend 
a good deal upon the history of their origin and growth, and also upon their atten- 
dant symptoms. — Collet Surgical Anatomy. 

A sac of fluid formed upon the cord, or the cellular hydrocele of the cord, may 
be mistaken for this kind of hernia. If lar<je, t lie tumour may bo known from its 
transparency, its uniformity, and elasticity; it docs not receive the impulse from 
COUghing, as the hernia does. — SfrCHARLES BELL. 






1837.] Chase on Diseases mistaken for Hernia. 263 

Enlargement of the Cord. 

Case 5th. August 10th, 1837. — I was requested to see Mas- 
ter , aged five years, who had an inguinal hernia, which 

had passed only into the upper portion of the inguinal canal. 
This was easily reduced, leaving a tumour which resembled a 
bowel, and, on examination, was found to be attached to the 
whole length of the cord between the external ring and the tes- 
ticle. Strong efforts were made to detach the tumours, but 
without effect. The hernia being reduced. I applied the Ingui- 
nal truss, which perfectly retained the bowel, the tumour re- 
maining in the same situation. 

12th. — I requested Dr. R. Coates to see this patient. On 
examination his opinion corroborated my own. We judged the 
tumour to result from a deposition within the substance of the 
cord. 

13th. — The patient wears his truss without any inconven- 
ience. 

17th. — Since the application of the truss there appears to be 
an evident diminution of this tumour. 

Sept. 15th. — On a careful examination of this case to-day, no 
appreciable difference could be observed between the two cords 
by the eye ; and a very slight thickening could be felt between, 
the testicle and abdominal ring. 

Ventro-inguinal Hernia, which had passed into the scrotum ; 
occurred while fox-hunting — mistaken for Hydrocele — pa- 
tient objected to the operation for Hydrocele. 

Case 6th. January, 1836. — H. S , an English gentle- 
man now resident in Philadelphia, has been subject to ventro- 
inguinal hernia of the left side for ten years. This accident 
occurred in fox-hunting. 

This patient consulted Dr. Hartshorne, who referred him 
to me. The hernia was easily reduced, and was perfectly re- 
tained by the ventro-inguinal truss. He had never worn any 
instrument previous to this application. The tumour always 
retired at night, and reappeared during the day. About five 
years ago he consulted a Danish naval surgeon, then on the 



264 Chase on Diseases mistaken for Hernia. [Dec. 

West India station, and the case was pronounced hydrocele. 
Two different hours were appointed on different days, for the 
operation of tapping and stimulating injections ; but fortunately 
the fears of the patient in both instances prevented the execu- 
tion of the design ! No attempt at reduction had been made by 
the surgeon, as there was not even a suspicion of hernia in the 
case ; and the diagnosis was thought to be so perfectly plain 
that great offence was taken at the unwillingness of the patient 
to submit to advice ! The reading of a medical work at length 
convinced the gentleman that he labored under hernia, which 
induced him to apply to Dr. Hartshorne. 

Varicocele mistaken for Hernia — case of four years 1 standing 
• — application of Dr. Hull's Truss — afterward of Mr. 
Stagner's instrument. 

Case 7th. — A Y , Esq., a gentleman of high stand- 
ing, from one of the southern states, came to Philadelphia for 
the purpose of consulting me relative to a supposed "scrotal 
hernia," with which he had been induced to believe himself 
affected. 

About five years ago he consulted a gentleman, not of the 
profession, who acted for the sale of a celebrated truss invented 
in New- York ; who, under the belief that the case was one of 
genuine hernia, applied die truss. The patient continued to 
wear it for some time ; but finding the disease greatly aggra- 
vated under its use, he at length relinquished it. 

His disease still continuing, he applied for relief to a gentle- 
man in Washington, D. C, who furnished him with Mr. Stag- 
ner's truss. This instrument he continued to wear for several 
months, until the distress resulting from the complaint became 
al 1 ogpther insu p] >ortal >le, 

On examining the patient} I found that he labored under an 
unusually extensive enlargement of the veins of the spermatic 
cord ! He had cirsocelc, and there were no signs whatever 
th.ii hernia bad existed in the case at any time! 

This information being communicated to the patient, his joy 
and gratitude were as great as could well be imagined under 
such circumstances ; for he had been harrasscd and annoyed 






1837.] Chase on Diseases mistaken for Hernia. 265 

for years with even an exaggerated dread of strangulated her- 
nia and the knife 1* 

Inflamed Inguinal Gland mistaken for Hernia — age of pa- 
tient about 30 years — injury from the improper use of a 
Truss — Fistula — cure. 
Case 8th. March 25th, 1S37. — 1 was requested to see Mr. 

, from Virginia, a gentleman of a corpulent habit, good 

constitution, and who had heretofore enjoyed general good 
health. This gentleman's attention was first called to a tumour 
in the right groin, near the seat of the internal ring, about two 
years ago, when he consulted a physician, who applied one of 
Dr. Hull's trusses. This instrument gave him no material 
inconvenience. He wore it about two months, when, the tumour 
not disappearing, he threw it aside. Shortly after, he applied a 
second instrument, with a stronger spring, but with no better 
success. 

Soon after the trial of the last named truss, he met with the 
instrument called Semple's truss, (the late Dr. Hull's spring, 
with Price's leaden conoidal block.) This truss is now in my 
possession ; he wore it for a {ew days with the leaden conoid 
placed directly on the site of the internal ring, but was confined 
to his bed by the pain produced by that instrument. His tu- 
mour not disappearing, and his groin having received great 
injury from the pressure, he threw aside all trusses. 

I found him able to walk about, but with his right inguinal 
region very much swollen, of a bluish color, with two small 
suppurating orifices on a line with Poupart's ligament, and near 
the site of the internal ring. I ordered a large poultice to the 
groin, and left him in the recumbent position. 

26th. — On the removal of the poultice to-day, two more ori- 
fices were observed : one, above those before mentioned, and 
about an inch nearer the anterior superior spinous process of 
the ilium : the other was situated a few lines nearer the os 
pubis than those first spoken of. 

A communication could be traced between the first three 
mentioned, by which they were united from twelve to eighteen 
lmes below the surface. 

♦ I have more than once known a truss applied for this disease, (varicocele,) and 
in one instance, to the son of a medical man, by his father.— Cooper 1 !: Lectures. 



266 Chase on Diseases mistaken for Hernia. [Dec. 

The upper one communicated with still another orifice further 
to the right, and at the outer side of the thigh : while the lower 
one penetrated almost to the angle of the pubic bone. 

27th. — Dr. R. Coates was called in consultation. Poultices 
were removed, but re-applied. 

28th. — Poultices removed ; matter of a greenish color es- 
caped on pressure. Ordered injections of sulphate of copper 
grs. xxx. to the ounce of water ; enjoined rest in the recumbent 
position. 

30th. — The poultice re-applied. 

April 1st. — Professor Gibson met us in consultation this day. 
On the removal of the poultice, a fifth abscess was discovered 
situated a little below that last mentioned, extending down the 
thigh the distance of four inches. Injections were also thrown 
into this extensive opening. 

It was suggested that a seaton should be introduced from the 
upper orifice to that next adjoining, and that the remaining fis- 
tulous communications should be treated by the injection of 
sulphate of copper, reduced one half in strength. 

2nd. — Professor Horner met me in consultation this day. I 
now applied graduated pressure over the abscesses indiscrimi- 
nately by means of cloth of elastic webbing and compresses; 
attention was also paid to his diet, which was ordered to be mild 
and nutritious. Two grains of blue pill were directed to be 
taken every night, and mild laxative medicines when required. 

Cold applications to the parts were also occasionally employed 
where the heat of the parts was increased. 

12th. — Upon examination it was found that the abscesses were 
closing at the bottom ; treatment continued. 

15th. — No material change having taken place where the 
seaton was employed, it was removed, and the injection of 
sulphate of copper substituted. 

20th. — No material change. 

25th. — The abscess where the seaton was employed, is now 
uniting under the use of the copper. 

29th. — The part of the abscess extending towards the os pubis 
is now perfectly closed. 

May 9th. — The abscess which passed down the thigh is com- 
pletely healed ; the other fistulae admitting a probe to the depth 
of two or three lines only. 



1837.] Chase on Diseases mistaken for Hernia. 267 

18th. — Fistulas entirely closed ; patient permitted to rise and 
walk about the room. 

20th. — Patient rode out for the first time. 

25th. — Compresses removed. 

30th. — Mr. left the city for Virginia. 

We saw no indication that hernia had ever existed in this 
case. 

Varicocele mistaken for Hernia, after cure of hernia — age of 
patient 28 years — test of cure, two and a half years discon- 
tinuance of the instrument. 

Case 9th. — Common inguinal hernia of the right side. Mr. 

, a gentleman aged 28 years, accustomed to much exercise. 

Accident of more than two years standing. The patient had 
never worn a truss before he placed himself under my care. 

In January 1835, my common inguinal truss was first applied. 
I saw the patient frequently for the two first months ; after 
which he regulated the instrument for himself. He continued 
the use of the truss for two months longer, and then relin- 
quished it without my advice. 

June 10th. — I saw the patient again. There had been no 
protrusion in the interval, but he complained of slight pain and 
a sensation of weakness in the part, when he rode on horseback, 
or was driven rapidly over the pavement in a carriage. 

May 20th, 1836. The patient came to me stating that he be- 
lieved there was a relapse of the disease, and that the bowel 
was in the scrotum. I examined the parts very carefully, and 
found the cure complete. The rings were perfect, but he had 
labored under a slight cirsocele on the right side, which had 
been considerably aggravated by active exercise and the heat of 
the weather. 

July 20th. — The patient continues well of the hernia, and the 
cirsocele has been diminished under the usual treatment. He 
has never been examined by any other surgeon, having steadily 
refused to submit to such an exposure. 

* See on the 247 page of this volume, first paragraph, a case of abscess with 
hernia. The abscess was opened by M. Lisfranc before the hernial protrusion 
was detected. Editor. 

b2 



268 Observations on the state of oar Medical Epoch. [Dec. 



ARTICLE II. 

Observations on the actual state of our Medical Epoch. By 
John B. Gorman, M. D., of Talbotton, Ga. 

Error is natural and easy ; but truth, hard and difficult. 
The former seems to move by the impetus which originates in 
itself; while the latter passes from age to age with a heavy, 
draging, motion ; its tendency is to be stationary, and its trans- 
port through time, accomplished only by the hard toil, the com- 
bined efforts of the real thinkers of our species. Error moves 
through time noisy as down an inclined plane, generating its 
own velocity ; truth is pushed steep-upward, and disputes with 
obstinacy every inch of ground it is compelled to traverse. Its 
real friends in all times have been few, its false patrons, all our 
race : and its travelling place, far out of sight in the rear of 
error. 

In Egypt, Phaenesia, and Greece, the infant sciences wept 
over this unequal struggle between the two. To turn the scale 
of victory on the right side, they built temples to truth, called 
Hermes in bodily shape from Heaven, invoked Appoilo and . 
brought Minerva out of Jupiter's brain. But these temples are 
in dust, the tomb of Jupiter is in Thrace, Hermes is forgotten, 
and our sciences, in their old age, still mourn this unequal 
struggle against them. 

In no department of knowledge has this state of things been 
so deeply felt in all times, as in medicine. Religion has its 
teachings from the sky to guide and govern ; its fundamental 
principles, the ideas of another world. On a few infallible, self- 
evident propositions, mathematics has reared the edifice of her 
stupendous science. For the other sciences, we may say, the 
five senses labor with facility, and furnish materials. But for 
medicine, in many respects, their operations are embarrassed ; 
much that is essential lies beyond them ; they yield not their 
full product, and the mind arriving at the ultimate boundary of 
their lights, reaches the truth now lying before it, by a route of 
thick and perplexing darkness. But how deplorably often it 
has failed, the history of our science, but too plainly shows. Its 
essential ideas are scattered throughout the universe. Vast time 



1S37.J Observations on the state of our Medical Epoch. 2G9 



more than has yet transpired is necessary to collect them ; 
and, in the future history of our race, medicine must be the last 
to arrive at perfection. And we should think, if death be the 
greatest misfortune, and life and health the greatest blessings, 
all wise legislators ought to stimulate to its cultivation, supply 
the means ; and, on our part, however difficult, the neglect of 
its profound study ought to be esteemed profanity and blasphemy 
offered to human nature. This has been attempted in many of 
the older states of Europe. Medicine under the patronage of 
government there, for the last twenty years, has for outstripped 
all its flights in former times : and, in the actual epoch, never 
before have arisen so many illustrious professors in every depart- 
ment, nor the world deluged with an equal number of false 
pretenders. Let us discuss a little this matter. The happy in- 
fluence the modem sciences have exerted upon the arts in abridg- 
ing labor, and arriving at the desired results by short and inex- 
pensive routes, has contributed to it. The principal operation 
of this influence is upon vulgar, popular opinion, inducing the 
belief, that, since what was formerly accomplished by vast time, 
labor and expense, is now effected almost without any trouble 
at all ; and, that since the world has become generally enlight- 
ened, all this mighty study about medicine, if not an imposition 
upon the good sense of mankind, is, at most, but little better 
than useless, idle stuff. Thus upon the purturbed face of 
modern society, has been erected a vast emporium for empiri- 
cism, whose turrets outtop all the former world. Misled by 
their ignorance, judging wrongly what they do not understand, 
the people have opened a market for doctors of their own taste 
and stamp, and patronized a medicine they can understand ; — 
a medicine, which to nature, falls short even of the merit of a 
real mockery. Naturally enough physicians of this easy and 
spontaneous elaboration, incubated by the mere warmth of pop- 
ular breath have multiplied, of every shape and form, pleasing 
in the people's eyes, and crowded full up to the public demand.* 
In our own country, and otherwise happy epoch, men from 
all ranks and conditions of life, are clamorous to practice the 
divine art of healing; and, what few restraining laws existed 



* A most faithful description affile Thonnonian cohort.. En. 



270 Observations on the state of our Medical Epoch. [Dec. 

among us are blown away before the popular breath. To the 
eager enterprizers of this art, the gates are thrown wide open, 
and liberty reigns again.* 

When the laws banished all the physicians from Rome, t their 
art was entrusted to the hands of the Priests of Apollo. These 
Priests possessed the learning of their time, which places our 
medical nineteenth century behind the shadow of Rome, for 
our unlettered have become our Priests. 

But the most deplorable feature in this state of things is, 
among those who would regularly cultivate the profession, 
slight and superficial attainments are encouraged. For, if the 
people, among whom our art is to be practised, believe that la- 
borious study, profound research, have but little or no influ- 
ence upon its success, the most powerful stimuli to support 
the student's painful toil — the hope of fame and reward are re- 
moved. And this must ever be the case, since nature forms but 
few to be delighted only with the pleasure which study and 
meditation impart. The impulse, therefore, among the vast 
majority who study medicine, must ever supply the place of the 
inborn love of study. And if the people believe that all learn- 
ing is a humbug, and calculated only to give the profession an 
imposing air and aspect, and are willing, nay, prefer to patron- 
ize and support the illiterate, the short and the bye-ways to 
practice, must be the most frequented. Those who travel the 
route of study, will be the few, the scanty few, whom nature 
brings forth sparingly, and scatters through ages to think and 
speak of her, to whom she unbosoms herself, and whose thoughts 
she wings with fire to beat up, and grasps at the feet of her 
Creator. They are born in a sea of thought, and live only to 
think. On these hang all the hopes of medicine, and the other 
sciences. 

It cannot be denied, in many parts of our country, the opin- 
ion prevails, that much study in medicine is useless : it is an 

* Sec Oeuvres completes <!<• Cabanis, tome 1. ct Hietoire de la Medecine par 
Spreugel, for a lull account of this affair and the result? of it. 

+ In some of the states of the. German empire, in France, the laws are very bind- 
ing on the physician. If the patient suspects he has not. been treated correctly ac- 
cording to the regular rules of the art, and he has sustained injury thereby, he may 
sue hisrlortor ana" recover imprisonment and heavy damages. How different the 
government of Georgia and our country. 



1837.1 Observations on the state of our Medical Epoch. 271 

art which requires but little thought or preparation ; nay, that 
learning mystifies the mind, makes a foo 1 of its possessor, and 
disqualifies him for practice. Were such opinions and views 
entertained and cherished only by the weak and the vulgar, it 
would not be so deplorable. They infect and lay hold on strong 
natural minds, nay, many of the highest cultivation ;* and have 
for their prosperity and support the sanctions of information, 
strong, good, common sense, respectability and high standing 
in society. And there are not wanting those, a busy, restless, 
artful band, who with all their strength and ingenuity, dress up 
these opinions with pleasing, winning contours, teach the un- 
suspecting and strive for universal proselytism ; making of the 
world a vast work-shop, where their lortuues are to be manu- 
factured. 

" Flap on the skirt of night your raven wings, 
Ye black, ye fetid, hungry death's I'll feed, 
With entrails of a thousand living men, 
Yourcrops, if I but two pence gain." 

It is easy to believe what we desire ; if we could arrive at 
the possession of goods and fortune without labor, it is the way 
we would prefer. The subject before us is in the same predic- 
ament. Thousands would make a livelihood of medicine, did 
they possess the knowledge. In the distance, we may say, they 
behold its vastness, and the mighty acquisitions which it has 
recently gained. They are deficient in its auxiliary sciences, 
may not possess courage or abilities for its prosecution ; its 
boundaries appear frightful ; the space to be travelled over, 
great; it is a world which must ever be concealed from them 
and their enjoyment. They despise what nature, by placing 
beyond, has refused to their acceptance. Without sagacity or 
qualification to understand, they proscribe ; without reason, 
they condemn reasoning ; without knowledge and experience, 
they condemn the knowledge and experience of all ages. All 
libraries, all colleges, institutions — all the most august and 
venerable labors and monuments of our species are insignificant 
rubbish. " Et simulacra l magnai] temporum percussa, et 
statuce veterum hominam dejecta sunt." 11 

* In a conversation the writer once had with a professor of our University, he 
declared his belief that duaek Doctors frequently cured where the regular art 
failed ; and had placed his sick under a root monger, who professed to salivate with 
roots. Every one knows I. I. Rosseau has noised his contempt through all ages. 



272 Observations on the state of our Medical Epoch. [Dec. 



They affect to despise all wisdom, all teaching — every thing 
of the kind which existed before they began to think ; or rather 
a growth of mind without thought But all this would avail 
nothing, if the people who are to pay them for their services 
have no faith. The next labor is to make the people, who trou- 
ble themselves with but little thinking, except in their own line. 
They apostleize ; — every newspaper is their minister. They 
tell of their Arabian knight cures. If you doubt, they strike, 
and the rest cry out, " lay on Macbeth," shoot their porcupine 
quills, and make common cause. They are fond of trying 
their new-born skill on the old incurables — those mountain 
rocks that did not fall when the storms of other times were 
passing; which now, with a tremendous crush, are pretended 
to be swept away. 

" Ruat coelum, — terra de his cat." 

But is the world so weak, silly, credulous ? In religion, mor- 
als, the science and art of government, the social, domestic and 
industrious arts, in civilization, argentation, or money-making, the 
public mind has attained to a knowledge unknown to all former 
times. But in medicine, as in astronomy and some others, the 
superstitious bigotry and the midnight darkness of the worst, of 
the most barbarous ages, tyrannise over it, and hold it in fetters. 
It has made no advancement, never can : the general interests of 
mind will never be attended to on our planet. The views of 
Barthez,* Goodwin^ Helvetia's,} of the advocates of Iiu- 
man perfectibility, are but lonely dreams. The elegant arts, 
argentation — whatever administers to the organic wants, and 
the passions, will still advance. The causes are forbid in our 
discussion. Scientific, popular medicine is among those which 
must remain nearly stationary for all ages. It is true the unlet- 
tered, the uninitiated man might calculate an eclipse, but would 
be sure of detection ; while the same might prescribe a dose of 
medicine without detection ; nay, with success and applause. 
Not that he has more knowledge and skill of the one than the 
other, for this he is supposed not to have ; but because different 

• Nouveaux elcmens dc la science dc l'hommc. 
i Political Justice. 
t Traite de rhorarao. 



1837.] Obser cations on the state of our Medical Epoch. 273 

laws govern in the two things. All the aether co-dynamical 
movements arise from the operations of one great law or inex- 
haustible, changeless force, of whose modes of action he being 
ignorant, mi^ht calculate forever without hitting an eclipse. 
While in the dynamical system of living organology, where all 
nature conspires to modify not only the actions, but likewise 
the sources whence they arise, he might chance prescribe — that 
is, offer a modifier ', which affecting some of the systems, might 
superinduce a new order of living movements, and tend to san- 
ification. And were the laws which govern the two systems, 
the same, both straight onward, every sickness would be death ; 
and nothing but sheer skill, as in the eclipse, could save the pa- 
tient. Here, then, is the great fountain head of all empiricism, 
medical, irredeemable, popular ignorance. Here is what has 
cloaked the false pretenders of the art for all ages past from de- 
tection, and screened them from merited anathema and detesta- 
tion ; nay, in place, has enabled them to receive the good will 
and benedictions of those their wicked ignorance and audacity 
were stabbing to the heart. And, salarous illuctabile scriptu ! 
here will be forged chains strong enough to hold all our future 
race — a despotism where, unlike as in others, no rebellion will 
ever come to fling off the yoke. For mankind can never be 
enlightened generally on their health, disease and treatment. 
Our sublunary condition forbids it; these are topics of vast im- 
port, and demand great time and study to give but a moderate 
knowledge. The endless ramifications or departments of life — 
argentation with its thousand active streams must go on, must 
occupy the time, the thoughts, and industry of ninety-nine hun- 
dredths of our race, leaving no room for their study. These, 
therefore, and more who possess not the ability, must ever be at 
the mercy of the few who make, or pretend to make, a business 
of the art. 

There is no hope that knowledge can ever become so gen- 
eral, that mankind in mass may judge correctly of the skill and 
abilities of medical practitioners, and detect the dupery and 
falsehood practised upon them. And the more so, since it is 
undoubtedly true, the torches, which the other sciences holdup 
of themselves, although so essential, fling but a dim light on 
medicine. To be understood it must be studied with them, and 



274 Observations on the state of our Medical Epoch. [Dec. 



by their lights. Ignorance, bigotry, medical superstition and 
credulity will continue to be associated, and the tales of mar- 
velous medicines and cures, unknown to truth and to nature, 
will continue to be listened to, and read with interest and appro- 
bation. A reform, therefore, from the general diffusion of 
knowledge, can never be looked for ; and as it always has been. 
Empiricism must exist onward, a most disastrous evil and mon- 
ument of our common frailty. In proof: — While most of the 
other sciences have advanced, and a deeper and wider interest 
been felt for them, popular medicine has remained nearly sta- 
tionary ; in despite still, in the winter of barbarous times, stand- 
ing alone in the solitary horizon, whence all other knowledge 
has emigrated. There it stands, in the forlornness of a dila- 
pitated world, while among its cultivators, at the very moment 
we are recording this memoir of the actual epoch, it is shedding 
the most brilliant glories, that any part of its history has ever 
manifested. But this light falls only on the profession, in the 
people it meets a permanent barrier. And, at this period, even 
of its professional prosperity and brilliancy, public esteem and 
admiration for it seems rather to have retrograded than ad- 
vanced. For, we know the Ancients created it into a Divin- 
ity, associated it with the worship of their Olympic gods,* paid 
their homage to its most illustrious professors, and, to their 
memories after death, erected statues. But for its gift we wise 
moderns thank not God nor Providence, believe it the growth 
of our own minds — may flourish by the side of stupidity — that 
wisdom comes not from thinking and thought's materials, and 
conclude 

" Darkness enough to cover thrice 
This double hemisphered world." 

" Aevum miserabile /" in which the majesty of reason and 
truth can never hush the noise of quackery. Public incurable 
ignorance, we see, is the vital air it breathes, in which it is en- 
gendered and kept alive as infusory life. Of reptile vitality 
and prolific in the extreme, it deposits its germ in the shady 
places of men's minds, where it grows up to consume the orph- 
an's substance, it has made an orphan. Its footsteps are seen 

* Diodorus Siculus, Opera. Cudworth's Intellectual system. 



1837.1 Observations on the state of our Medical Epoch. 275 

about fresh graves ; in its intercourse affected by modest, cau- 
tious and circumspect ; and its voice is heard consoling amid 
the death screams of the unsuspecting, dying — a vampyre 
that clings fast to the revolving orb of generations, marking the 
whole clean web of time as it is unrolled with its filthy trail. 
It does not walk in the back-ways, \n the bye-paths, in the sha- 
dow of night ; — it does not ply its busy industry in the mean 
hovel, on the dirty, honest peasant, stretched on his sick bed. 
Charity freezes its efforts. It flies from poverty as from sin, ex- 
cept it can use it to deceive and make its trade. It loves to dec- 
orate itself and walk in meridian light, conscious that its hid- 
eous form is concealed. It is fond of splendor and show and 
noise ; loves high places, and the houses of the great and the 
rich. In its manners so affable, so accommodating, so subduing; 
it finds easy access, flatters vanity, and lulls suspicion. It is so 
artful, none but the medical learned are free from its attacks. 
Upon minds possessing all other sorts of science, it fastens as a 
deadly superstition ; and reigns and tyrannises almost over the 
universal mind of our species, furnishing extra width and depth 
to the common natural grave. — Power Incubus — Upas-born ! 
irradicable !! General scientific knowledge opposes to it but a 
feeble barrier, as experience shows ; its only efficient obstacle is 
the learning and teaching of real medicine, which, as before, 
must ever be limited to the few. And the pressing occupations, 
wants of life, natural inabilities again, must always restrain 
within certain limitations this diffusion of general information 
to contract or expand a little with the accidents of ages and 
governments. Therefore, we repeat, quackery is an enduring^ 
irradicable evil, flourishing in our age, hoarding up its millions 
which is its genius and instinct. 

" Le charlatan, au contraire, a besoin de hors qui frappent le 
peuple etqui previennent V examen. II," again says M. Biot, 
" y vante au contraire," meaning to the true physician ; "haute- 
ment, il y fait vanter ses pretendues decouvertes : il en parle 
continuellement avec assurance ;" and then the delusion is 
sustained. 

The lesson this fact should teach, the influence it should 
exert, ought to arouse honorable ambition, stir up to more vig- 
orous effort those in the profession and those taking it on, that 
c3 



276 Observations on the state of our Medical Epoch. [Dec. 

they may raise higher the standard and character of its excel- 
lence. And although they mast often honestly admit its insuf- 
ficiency, and cannot promise to cure always, yet, with all the 
perfection of which it is susceptible by effort, endeavor to ren- 
der it worthy and acceptable to the world. Excepting by gov- 
ernment, in this way only can effectually be ameliorated the 
horrors of the empiric's art. While our people have erected a 
tribunal for even the most trifling crimes, even for insulting or 
speaking evil of a healthy man : yet by abusing, maltreating 
and Jailing a sick one, no legal offence is committed, and, as 
in Europe, no tribunal erected. It is then a most heinous crime 
to become sick : and does a man by so doing forfeit the pro- 
tection, the right of law ? These are great questions, and much 
time must pass, being too much in infancy, before they will 
meet with a correct solution among our people. But in evolv- 
ing light, the day must come, when future legislators will erect 
in our country, an altar of justice, before which, the wrongs 
and abuses done to the sick and the dying, will be redressed. 

" Osccula! currite, currite 

' Nobis' regna referte ' medicinarum' 

Saturnia. !" 

To this great end, and to suppress the evils of empiriciuiSj 
we are called upon by every principle of honor, by all the vir- 
tues, by patriotism, by philanthropy, to make the effort. Quack- 
ery is the war of falsehood against truth, of dishonesty against 
honesty, of deceit and hypocrisy against sincerity ; of auda- 
cious ignorance and stupidity, against truth and intelligence ; 
of wickedness against uprightness ; of inexperience against ex- 
perience ; of foolishness against wisdom. On the one side 
stand arrayed all the vices and the great inconscions world ; 
on the other, the virtues and wisdom, born of time and experi- 
ence weeping. Unhallowed warfare ! 

Remark it, empiricism is not one ; it has its modifications to 
accommodate the assailable points of our nature ; has a color 
for every eye, excites curiosity, originates novelty to please. It 
imports the name of its medicinal agents from afar. They 
come perfumecTwith oriental sweetness — cure prodigiously ! 
The same remedy searches every avenue of the economy ; dis- 
ease is its game, and attacks any it may chance to perceive or 
meet. A thins: not at all incredible! 



1837.] Observations on the state of our Medical Epoch. 277 

It issues its proclamation. " Nature offers a vegetable reme- 
dy for every disease ;" and the Grecian mother and mistress of 
flowers is profaned to give the report dignity and acceptance. 
It is believed. But how was it ascertained that nature has 
deposited all the proper curing agencies in plants. Who knows 
whether the eleven millions of species on the globe will cure 
"all flesh is heir to ?" Why as well not believe she has en- 
trusted these sacred powers to minerals exclusively? All dead 
men are mineral substance. Why can she not medicate with 
such l Because they are all poison ; and are plants not poison 
far excellence ? But do not the Japanese, the Kiagou, and 
many of the Asiatic tribes feed largely on mineral food ? and 
are they all dead ? Has not experience ascertained and reason 
approved it, that every agent in nature, may act medicinally? 
But reason and experience are proscribed, for they would tear 
off this incubus which sticks, hanging to the Jugulars of na- 
tions. The reason is obvious. The regular practitioners use 
remedies derived from all the kingdoms of nature. This fact 
is generally known. These remedies, therefore, must be con- 
demned — will not answer the purpose. They are devoid of 
the charm of novelty; public opinion must be intrigued on this 
point: triggered up to suit the sale and employment of the arti- 
cle and its makers. 

" If to her children, the mute earth could speak, 
Through their crammed ears no sound would reach." 

But what is a greater calamity, we have said, that among the 
practitioners called regular, slight study and superficial acquire- 
ments, encouraged by the ignorance of the people, are the order 
of the day, constituting a species of quackery more full and 
destructive than the former. This may be considered in the 
light of a domestic enemy, the other a foreign foe. The one is 
supposed and trusted as going forth with all the panoply of the 
art, being regular ; therefore more universal and mortific. 
The other labors under suspicion, and its mischief is trammelled. 
Our science, great in the transatlantic schools, among us has 
dwindled down to the little blind art of a few simple manual 
operations — that of knowing how to purge, bleed, blister, and 
above all, how to salivate a sick man in a fever. Many of our 
practitioners — far too many, popular too, without the ability to 



278 Observations on the state of our Medical Epoch. [Dec. 

write their prescriptions grammatically, seem to aspire no farth 
er, than to be able to do this bit of druggery, as some machine, 
and possess only an ambition to do and receive, and not to 
know. They learn to pronounce a few hard names to distin- 
guish them from other men, talk a word or two about mortifi- 
cation to explain consolingly inevitable death, and support their 
name for skill. They cannot read to grow wise, for they feel 
every proposition is an overmatch for their qualifications, and 
reading growing disgusting, is abandoned. With these, physic 
is a mere trade, and is followed only because it is the easiest sort 
of work in proportion to the gains. 

Unfortunately for the interests of humanity, those who study 
and learn to bleed, blister, and salivate — this oligarchy of med- 
icine — of all who make a business of the art, are far the most 
numerous class. Their services are in demand : for egotism 
causes men every where, to place a high value on their own 
opinions and judgments ; and their medical ideas and views 
correspond exactly enough with those entertained by men gen- 
erally, to be approved ; and if there be outside crust enough to 
conceal the interior make of these mock doctors, patronage will 
be extended. Their services are always at hand, because of 
their cheap and easy manufacture and elaboration. A few 
days absence from any other trade less profitable, puts the aspir- 
ant in possession of all the craft, and there is a new doctor. 

" Tridente, sic, pulsat Neptunus." 

So with his mighty trident Neptune struck 
Thegellid earth, and from its bosom cleft, 
Sprung up the war-horse, — down Numidia's plains 
Thundered along. 

But do you assert what is credible, and allow common sense 
to mankind ? Exactly so. " Practice makes perfect ;" and 
experience is esteemed every thing in medicine. Here is the 
spell, the fatal delusion and throat of death unwittingly pro- 
cured. These venerable axioms so true in every thing besides, 
but in physic, as the good Zimmerman* long since remarked, 
exactly false. There is such a thing as " having ears, and hear 
not," " eyes, and see not." The eyes and ears of our science 
are the offspring of study and profound learning. Without 

* Treatise on Dysentery. See Jackson Prof. Inaugural Address, 1834. 



1837.1 Observations on the state of our Medical Epoch. 279 

them, experience is a dead power and can avail nothing. I 
assert it, from the nature of things, there can be no experience 
without theory. Behold him — the illiterate, unsanctified pres- 
ence and audience of nature, gazes on his patient, as she unfolds 
to him the mysteries of the morbid operations she is carrying 
on ; points out to him her remedies, beckons to him to look at 
her struggles. He listens, but hears not her consoling voice; 
he looks, but sees nothing tangible ; or if he sees, he knows not 
what. He is a blind man ; his mind is not informed, he cannot 
know and read the language of disease and nature. He is in- 
capable of experience, can never grow wiser by practice, must 
end about where he began his career, in utter darkness. For 
there can be no experience without theory, nor theory without 
learning. But the world supposes he has gained experience 
and skill ; thrice fatal delusion which fattens the sepulchre, but 
makes money and fame for the doctor. 

Again : Has the illiterate lover of star-light, who may have 
gazed on the heavens until he is old — before whose eyes the 
s<ime nature has been continually presenting the secrets, fair 
and fully, of her celestial motions, gained any thing ; and who 
has witnessed a thousand times all the most skilful astronomer 
ever saw ? Can he tread the zodiac round, walk with the stars, 
converse with them ? Does he know, tell me, the great cycles 
of time, the parallaxes, the relative weights, distances and magni- 
tudes of the sun's wandering train, their parabolic movements ; 
Luna's loop-formed orbit ; where Aquarius holds his court, 
where the head of Andromeda rests ; where wanders Orian 
holding the lion's head, and the horn of Monoceros ? Has he 
gained experience from what he has seen ? Can he foreknow 
what he will see? He has been present, but unconcerned. He 
has eyes, and has seen nothing ; his mind has not been fecund- 
ated ; he has no theory, therefore, can have no experience. He 
does not understand the Divine language in which Urania re- 
cords her history, that is, without theory. Therefore, he knows 
nothing, has been an idle spectator, and is where he began — 
in utter darkness ! 

I remark : — Nature makes only impressions on the senses ; 
her doings, her ways, and her truth she reveals only to our long- 
ing, our eager immortality within. And could this truth be 



2S0 Observations on the state of our Medical Epoch. [Dec. 

generally felt, it would operate the moral redemption of the spe- 
cies from all tyrrannies ! ! But let us resume in summary. This 
class of physicians is the most numerous, because of their cheap- 
ness ; are the most dangerous and mischievous, and the degrada- 
tion and dishonor of the real scieuce and profession. The most 
dangerous, because no distrust or suspicion bars them, while the 
painted quack may be distrusted, and kept at arms length ; and 
his attacks upon public health be restrained to certain limits 
The most dangerous, because they can get practice : their views 
be thoroughly understood, and easily gain acpess to the common 
people, whose taste they suit, and who believe every where the 
letheal error, " practice makes perfect? and experience is all. 
The most dangerous, because they profess to be what the peo- 
ple believe regular, clothed with all the powers of the art, are 
welcome guests, and the most desperate, and all diseases are 
readily committed to their charge and treatment. To get along, 
at first, they have sometimes to make wise faces, and put on 
great looks ; at last seem to fall dupes to their first deception 
and believe really, themselves, they are doctors. And consider- 
ing that talents are generally cultivated for towns and large vil- 
lages which possess the best physicians, the writer ventures the 
assertion, that these doctors do seven eights of the practice of 
the world. This holds pretty true as regards our states ; and 
according to the calculations of city and rural population by 
Malt De Biiun,* holds nearly true with the civilized world. 
Let us contemplate the real Peiysician. 

What are the views, pretensions, and advantages, which dis- 
tinguish him from these others ? He beholds the constitution of 
man as an integral part of the great surrounding universe ; not 
acting isolatedly, but participating in the actions, and general 
concern of universal existence. Beholds it under the government 
and dominion of laws especially adapted to it by its Divine 
Creator ; and, at the same time, subjected to be modified and 
influenced by the general laws. He looks on it as an individual 
thing, and, at the same time, as only apart of a greater design. 
He pulls at the chords which tie it to surrounding existence, 
and discovers that they extend through and interknit with the 
whole starry frame ; and, what he might have supposed to be 



* Physical Geography. 



1837.] Observations on the state of our Medical Epoch. 281 

one, is really a part of the whole. Now he invokes the aid, for 
he needs ir, of the universal mind, thought and experience 
which have lived before him, the life and being of which are 
in books. Now he is on the vast arena of medicine ; his tor- 
tured soul struggles by the dim taper of midnight ; the field of 
interminable thoughts before him ; and the turbid waves of half 
thought, half seen truth, or blackness of error dashing round 
him. Years pass, and he struggles up to the dawn of his Cre- 
ator's truth — the truth of all science. His soul has acquired 
a new and a more excellent shape ; the ideas he has felt, have 
created for him a new existence ; he has lost his local habita- 
tion ; and lives every where in the things he has seen. In this 
study, he examines first the actors or instruments of these special 
laws separately, then, as a whole ; anatomy ascertains their 
mutual relations and adaptations ; the sources whence move- 
ments spring ; their universal subordination and dependence, 
forming the mysterious circle of vitality. This is the human 
economy which he is now to consider no longer as a whole, 
but as a part, an inconceivably small part of another greater 
economy, that of things. Again he studies the relations, the 
universal dependence and subordination of the two which con- 
stitutes another circle, that of all existing entities, general phy- 
siology. He sees the eye formed in relation, and acting in 
concert with the millions of torches that burn above. The eye 
is now a part of the starry frame participating, nay, an actor in 
its action. The gravity, which binds his body to the earth, 
operates in the sun and earth to sustain their relative positions. 
The same gravity which produces motion in ail worlds, may 
produce frightful varicoceles and incurable dropsies, in the 
lower extremities of a man. Gravity, empiric, may be used as 
a successful remedy in asphyxia from too great loss of blood, 
and in other diseases where not all your vaunted vegetable 
stuffs, nor any other on earth could succeed, may be employed 
in various doses in the prevention and cure of disease. 

Next come under his review, the heterogenous or abnormal 
movements. He scrutinizes their phenomena and their order ; 
examines their effects on the tissues, indurescence, ramolles- 
cence — their propagation, irradiation and subsidence ; and, as 
before, their universal subordination and dependence, constitut- 



282 Observations on the state of our Medical Epoch. [Dec. 

ing a circle, admitting the denomination mortality. This is 
pathology, born in France. Here he learns that disease is noth- 
ing but movements of no new actors, but of the same whose 
tendency being unsuitable to their make and subordination is 
to destroy. His mind frets up no spectral form from beneath, 
which he is called upon to combat. He sees what is, and learns 
to interpret the awful language in which our common mortal- 
ity is exhibited and recorded by nature. 

Lastly comes the application of the modifiers, — therapeutics, 
leading in its train natural history proper, or mineralogy, bota- 
ny, chemistry. In his study of othe r beings, worlds, he saw in 
all their actions they did not exhaust their forces, which con- 
tinued always changelessly the same. Hence no disorder* or 
derangement can ever take place in them ; can be no disease or 
death but that they must ever act onward uniformly through 
space, in their own natural immortality. But, in the system of 
life, he has seen exactly the reverse is true. Living bodies in 
their actions, expend their force : they diminish, increase ; there 
is no uniformity, they are never exactly the same. Here, then, 
is the natural function of all disease, death and the chances of 
life. Immortality is impossible and unnatural ; and here origi- 
nates the necessity of all medicine to keep out these chances. 
What then, I ask, can the real physician do ? He can keep 
steady and regidate, to a certain extent, this ever tottering, 
vascillating scale of force, on which all life hangs, by prop- 
erly removing, supplying, diminishing its accumulations ; by 
diminishing, increasing, removing, varying its excitors. The 
ground alloted him by nature, it must be perceived, is extremely 
small, his interference vastly limited, yet of infinite value and 
importance to the human race. It is then entirely certain, if he 
know not these special laws, and the adaptations and relations of 
the modifiers to them, the chances of every interference he 

* Before completing his great instrument of calculation, the differential calcu- 
lus, we would remark, Newton made some slight blunder in estimating the apsides 
of the parabolic curve, and concluded the world would run into disorder every hun- 
dred years, and was preserved by Divine interference. With the same calculus af- 
terwards, La Place proved the world to be self indestructible and corrected the 
error. 

Vous, vou^ voiyezle Svsteme du mondc. 



1S37.1 Medical Magnetism. 283 



a 



makes, must tend equally to death as to life and health. But 
deplorable ! Mankind will remain forever incapable of this 
truth, rushing upon destiny and the winding sheet while aiming 
for life; their physician's services, their funeral sermons, mistaken 
by them for the banquet of health. 

Officious 

Man, death will be mad with thee. 
For doing in his absence what 
Was his own work to do. 

This is written for the younger part of the profession ; and 
should it excite one to study, the dearest object we had in view 
will have been accomplished. 



PART II. 
REVIEWS AND EXTRACTS. 

Medical Magnetism. 

Although mankind have availed themselves of the use of 
magnetism for purposes deemed of capital importance, as in the 
magnetic needle &c; and notwithstanding we believe in the 
discovery of a new faculty, or properly of that which we call 
magnetism, that is to say, a meridional, as well as a polar attrac- 
tion, which will become at some future day, subservient to the 
purpose of determining longitude on any parts of the globe;* 

*It is possible the reader may not be aware of the fact, that some thirty-five or forty 
years ago, Dr. Joel Abbot, a highly scientific physician of Washington, Wilkes 
County, Georgia, during a series of experiments in magnetism, relating to the dip of 
the needle, &c, discovered a new law of magnetism, whereby it was found to exert 
a Meridianal, as well as polar attraction. This discovery was so satisfactorily 
demonstrated, that he felt himself fully entitled to the premium of forty thousand 
pounds then offered by the Board of Admiralty, for the discovery of longitude, to 
which purpose it was at once evident that this new law was as subservient as the 
polar attraction before known was to the other purposes of navigation. But that 
scientific gentleman, like most men of deep science, was more negligent of the hand- 

d4 



284 Medical Magnetism. [Dec. 

still we venture the opinion that one of two results of first rate 
importance is yet to be arrived at relative to this agent. Either 
will it be discovered to be itself a non entity, as to its own indi- 
viduality as a thing of nature, and only a habitude, or mode of 
action, or the offspring or phenomenon of another principle of far 
greater universality ;* or that, if it be found to be an indepen- 
dent principle or agent, its powers are yet to be applied success- 
fully alike to purposes of humanity and convenience of even 
more importance than all its present uses. Of this we see evi- 
dence in the authentic truths below stated, displaying its reme- 
dial powers in some of the most intractible distresses to which 
the human body is subject. Tic Douloureux particularly, has 
never found a uniform remedy, unless it be in the magnet. 

some pecuniary reward than of the purpose of discovering a new law in philosophy. 
In addition to this, he had great -difficulty in procuring the mechanical construction 
of the simple little apparatus which was to subserve for the mariner the very im- 
portant purpose of a constant index of longitude at every day and every moment. 
During the embassy of Mr. Crawford to France, that gentleman was commis- 
sioned to procure a part of the mechanical construction fiom the hands of some 
competent artist in Paris, which, I think, from some cause never came to hand. It 
was to consist of a perfect globe of steel equally hardened, and impressed in one 
particular position with magnetism, and graduated with 360 degrees on the equa- 
tor, and inscribed with meridianal lines; and which when floated in quicksilver, in 
which it was estimated there could be no impeding friction, would turn relatively to 
the quicksilver eastwardly in travelling to the west, and vice versa. Around this 
was to be floated an artificial horizon, with a meridian attached with an index to 
point out the precise degree and difference of longitude, or distance sailed from the 
point of departure to that of observation. I am not certain whether it was or not, 
alike calculated to point out the latitude with the same precision by turning relatively 
to the quicksilver southwardly in sailing northwardly, &c. 

The globe of Dr. A. was subsequently substituted by a section of the globe con- 
taining its greatest diameter, or a wheel, alike impressed, with an index springing 
up from the frame which supported it. This was found to traverse well at sea for 
several clays after leaving Savannah lor England, under the management of a Capt. 
Stickney; and again on his return voyage, until he came in the neighborhood of 
the Banks of Newfoundland ; and again on his arrival at Savannah and travelling 
to Washington in Wilkes, the index pointed out with great definiteness the differ- 
ence of longitude. All these experiments proved the truth of the law of meridi- 
anal attraction, for tin- wheel did traverse; but from some imperfection in the con- 
struction, it did not continue to do so through the whole of either voyage at sea. 
This however, the doctor attributed to the influence of the cargo on the metallic 
axis, in one, if not both instances, and which he suggested the correction of, by 
substituting non-corrosive axe s as of glass or stone. 



* Electrhitv. 



1837.] Medical Magnetism. 285 

These facts were published in the London Lancet some time 
ago, when we had not the opportunity of laying them before the 
public ; but they are of such interest that we are unwilling they 
should be overlooked by the profession, at least until further 
experiments verify or condemn the power of the mineral magnet 
over sueh diseases. 

" Some experiments which seem to promise results of consider- 
able interest and practical importance in medicine, are at present 
being pursued in certain of the metropolitan hospitals on patients 
afflicted with neuralgiatic douloureux, tooth-ache, and other 
immediate affections of the nerves. We allude to the applica- 
tion of a magnet to the parts suffering pain from those diseases. 
We abstain from communicating to our readers at present, 
any thing more on the subject than we have had satisfactory 
means of ascertaining to be rigidly exact on the score of truth. 
Three instances only have, in fact, as yet occurred under circum- 
stances which enable us to speak without hesitation of the power 
possessed by the instrument alluded to, over diseases of the hu- 
man frame. These we shall give, observing, that the employ- 
ment of the magnet has nothing to do with the art denominated 
" animal magnetism." 

Our readers will remember the interesting case of neuralgia of 
the finger, at St. Thomas's Hospital, upon which Dr. Egleston 
stated in a clinical lecture, reported in our 48th No., that he had 
exhausted his store of remedial agents. A more severe case, 
probably, was never subjected to treatment. The man left the 
hospital for a time, totally unrelieved, but soon afterwards re- 
turned, when, in accordance with a suggestion, as Dr. Elliot- 
son has since observed in one of his clinical lectures, of a cor- 
respondent of this Journal, the colchicum autumnale was tried in 
the case, without, however, the slightest benefit being derived 
therefrom. The sedative powers of the lobelia inflata then sug- 
gested to the Doctor the propriety of giving the patient the 
chance of that medicine. The grounds on which it was em- 
ployed, proved to be in a great measure correctly founded. The 
man took the lobelia, in increasing doses, every hour, beginning 
with seven drops of the tincture, and adding a drop to each pro- 
gressive dose ; until as large a quantity had been reached as 
could be taken without deranging the functions of the stomach. 
Great amelioration of the affection followed this treatment. The 
patient who was before unable even to cross the yard, or bear 
the slightest cutting of his finger nails, and had become emati- 
ated to the extremest degree from pain and sleeplessness,was soon 
enabled to walk out of doors, and enjoy many hours of rest, re. 
covered his good looks, and became comparatively cheerful. 



286 Medical Magnetism. [Dec. 

The relief, however, was very far from being either perfect or 
permanent. The continued exhibition of the medicine was de- 
manded to secure any portion of rest. 

A short time since, however, anew remedial agent presented 
itself, in the form of the magnet. The hospital was visited by 
(we believe) Dr. Kyle first, and subsequently by a physician of 
the name of Blundell, a friend of the former gentleman, who 
followed up the application of Dr. Kyle. The lobelia infiata 
was allowed by Dr. Elliotson to be suspended, and the effect 
of the magnetic tried. That effect was, we learn, a very decided 
one ; the pain was on every application of the instrument, re- 
moved, and continued absent for several hours. The distance, 
however, at which the operator resided from the hospital, pre- 
vented, and still prevents, the daily use of the instrument, or, the 
impression on the patient's mind is that, it would perform a 
cure. 

On Tuesday last, the Dr. Blundell already mentioned, re-at- 
tended the hospital at the hour of Dr. Elliotson's visit, when, 
in the presence of the pupils and our reporter, he drew forth the 
magnet, and commenced its application to the patient's finger. 

The instrument is of the horse-shoe form, about ten inches in 
its long axis, and five in its short, composed of five layers of 
metal, the central being the longest, and the whole bound with 
stout riband. The patient wis at the time apparently suffering 
considerable pain, and unable to use his hand. The north pole 
of the magnet was gently passed five or six times down the sides 
and back of the middle finger, and then rested on the central 
joint. The result was, such a cessation of suffering that he 
could gnash his fingers into the palm of his hand with ease and 
comfort, and he declared himself to be entirely relieved. The 
power of the instrument, however, did not cease here. Dr. 
Blundell showed that it possessed the means of re-producing 
the pain in the most intense fcrm. The south pole of the mag- 
net was directed along the finger. At the third pass, the patient 
began to bite his lip and close his eyes with an expression of 
pain. At a few passes more his chin was involuntarily buried 
in his breast, and his wrinkled features evinced the acutest suf- 
fering. This was allowed to continue for a few seconds, when 
the north pole was again presented to the finger, and the agony 
speedily subsided. The spectators then left the man with a 
countenance perfectly tranquil. 

At the extremity of the ward lay an elderly lady, a martyr to 
tic-doulourcu.r in the lower jaw, extending to the ear, and affect- 
ing a large portion of the head. The disease, she stated, was of 
more than nine years duration, and had never ceased to afflict 
her for a day during that period, up to her entrance into the 



1837.] Observations on the Treatment of Typhoid Fever. 287 

hospital. Her appearance was proportionably miserable. The 
magnet had also been applied in her case, and with similar ad- 
vantage as she stated. On the present occasion, it was found 
on approaching her bed, that she was that morning free from 
pain, and the aid of the magnet was not needed. "But cannot 
you show its power by producing the pain V inquired a by- 
stander. The suggestion was acted on. The south pole of 
the magnet was passed from the centre of the chin along the 
lower jaw-bone up to the ear. At the third pass, the pocr wo- 
man indicated that the tic was commencing, and in a few seconds 
more the affection was experienced intensely. The process was 
then stopped, as the experiment was carried far enough to satisfy 
all present of its consummation, and after a brief space the pre- 
sentation of the north pole wholly freed the sufferer from pain. 
The operator subsequently stated that by continuing the passes, 
he could have carried the pain on to the production of delirium. 

There is a female patient in another ward, who had suffered 
intense tooth-ache for three months, when, a fortnight since, 
according to her own evidence, which we have no reason to 
doubt, it was instantly cured by one application of the magnet, 
through the medium of a key, and had not returned in the 
slightest degree up to the period of the visit on Tuesday last. 

These are very interesting facts. We present them to our 
readers unaccompanied by comment. The specific name given 
to this instrument by Dr. Blundell, is that of a " mineral 
magnet." How far its application to disease admits of exten- 
sion, we are at present ignorant. — London Lancet. 



Observations on the Treatment of Typhoid Fever by purga- 
tives. By M. De Larroque. — Report to the Royal Acad- 
emy of Medicine by the following committee : M. M. Louis, 
Bricheteau, Bouillaud, Double, Bailly, and Andral, 
Reporter. 

Gentlemen : — The committee charged by you with the ex. 
amination of the work sent to the Academy, by Dr. De Lar- 
RoauE, upon the treatment of typhoid fever, by the evacuating 
method, make through me, the following report upon the re- 
searches of that physician, and the results to which he has been 
led. If, indeed, the pyrexia, called at the present day in France 
typhoid fever, be only a gastro intestinal inflammation, if the 
numerous symptoms which occur during the course of the dis- 
ease be only the sympathetic effects of a primitive irritation of 
the digestive passages, the therapeutic question is most simple ; 



288 Observations on the Treatment of Typhoid Fever. [Dec. 

the antiploglestic method is the only one which should be em- 
ployed, more or less actively, according to circumstances which 
the experience and tact of the practitioner may enable him to 
appreciate. 

If typhoid fever having still its point of departure in a phleg- 
masia of the digestive passages, nevertheless presents this partic- 
ularity that the follicular apparatus of the intestines is the special 
seat of the inflammation, — if, in a certain time after the appear- 
ance of the lesion of the digestive tube, other symptoms super- 
vene which are not exclusively, as supposed by the preceding 
theory, the sympathetic result of the intestinal phlogosis, but are 
attributable to the circumstance that putrid matter within the 
intestines absorbed, and, like septic poisons, infects the mass of 
the blood, and consequently the entire economy ; then the thera- 
peutic problem presents a greater complication. Independently 
of the therapeutic treatment which would be still indicated, we 
should endeavor either to evacuate the injurious matter contained 
in the intestines, and then the utility of purgatives will be ad- 
mitted ; or, to contend against the infection of the blood, and for 
this purpose the chlorides, or even tonics might be employed. 

Lastly, if in typhoid fever, the intestinal lesion be considered 
only as one of the elements more or less indispensable, a disease 
which, differing from true typhus only by a less degree of inten- 
sity, attacks like it or like variola, the entire organism, then, the 
therapeutic questions occupies a new ground. Then, according 
to the time and the prevailing spirit, two sorts of problems will 
be formed. In one of these problems, they seek in the midst of 
the general disorder for some great modification from which 
they suppose that all the rest is derived ; they admit that this 
modification is always identical, and they consequently employ 
always the same treatment. Thus, according to some, a super- 
excitation is the predominant fact, and the debilitating method 
the only one which should be employed ; according to others, 
on the contrary, an asthenic state, primitive or consecutive, to 
use the language of Brown, is the chief pathological condition; 
the indication is to support the strength of the patient and the 
tonic medication the most powerful and certain. According to 
others, the disease consists chiefly in an alteration of the fluids, 
in the presence of a morbid principle in the alimentary canal, or 
even in the blood, and the most useful treatment is that by evac- 
uants to expel this morbid principle 

Others form for themselves an entirely different problem ; they 
do not seek to learn the intimate nature of the disease; but they 
ask if the symptoms which accompany it are not sufficiently 
distinct from each other to authorize us to unite them under dif- 
ferent groups, to each of which, we may be led by experience to 



1837.] Observations on the Treatment of Typhoid Fever. 289 

oppose a different treatment. They admit, consequently, an 
inflammatory form, a bilious form, and an adynamic form, each of 
which they recognize by the admirable features by which Pinel 
has depicted them. In each of these forms they employ a spe- 
cial treatment; they declare that, according to age, tempera- 
ment, constitution, according to the infinitely varying influences, 
whether physical or moral to which individuals have been ex- 
posed, or according to the epidemic character of different times, 
the one or the other of these forms may be more common than 
the others, and may require a special therapeutic plan. They 
observe also a certain number of cases in which from the ab- 
sence of the symptoms that seem to require an active treatment, 
they have confined themselves with suceess to the simple meth- 
od of expectation, and to the cases of cure thus obtained, they 
apply this fine passage of Sydenham, "Natura enim sibi per- 
missa negotium suum suo tempore exsequitur ut nostra ope, 
nostris artificiis a que auxilitis, non indigeat ; suis viribus op- 
time instructa, suis opibus locuples, suo denique in genio satis 
docta." 

It is always by following one or the other of the routes which 
I have just indicated, that physicians belonging to different 
schools have treated the different forms of pyrexia designated at 
the present day under the name of typhoid fever. During the 
last fifteen years, the disease has been almost exclusively treated 
by the antiphlogistic method which varied only in the degree of 
activity. However, some practitioners during this period, pro- 
tested against the universality of this practice, and they pro- 
fessed that there existed certain forms of the disease in which 
other modes of treatment could be employed with great proba- 
bility of success, and in the first rank they placed the treatment 
by emetics and purgatives. One of the most prudent and learned 
practitioners of the capital, M. Lherminier, employed very 
frequently this plan at the Hopital de la Charite. This was 
the commencement of a reaction which has since continued to 
increase, until returning to a truth whose abuse had obscured its 
importance, it was ascertained that the proscription of emeto-ca- 
thartics from the domain of therapeutics deprives the practitioner 
frequently of an immense resource, and that these agents may 
fulfill important indications which cannot be fulfilled by any 
other. 

It is in the midst of this prevailing spirit to return to a certain 
kind of ideas too completely abandoned, that Dr. De Lar- 
ROQ.UE generalizing in his turn the evacuating method, and not 
restricting it only to certain cases, employing it during the con- 
tinuance of the pyrexia ; taking no account of the diversity of 
symptoms, or of lesions, or of the difference of individual pre- 



290 Observations on the Treatment of Typhoid Fever. [Dec. 

dispositions, endeavors to establish as an invariable treatment in 
every typhoid fever, the daily use of an evacuant, first of one 
or two emetics, afterward purgatives administered every day 
from the beginning of the disease to its termination. M. De 
Larroque endeavors to explain the constant indication of evac- 
uants in typhoid fever, by attributing to the bile a great agency 
in the production of this disease. Collected in the intestines it 
becomes says he, a powerful cause of irritation to the mucous 
membrane, and thus the latter experiences phlogosis and ulcer- 
ations. If the most serious lesions ordinarily occur near the 
end of the ileum and in the caecum, it is because the matter 
accumulates especially in this part of the digestive tube, which 
may be shewn by the sound or gargouillement that may be pro- 
duced by exerting a certain degree of pressure on the ilio-caecal 
region ; if, at a more advanced period of the disease, those gen- 
eral symptoms supervene which seem to denote on one hand an 
alteration of the bowel, and on the other a profound derange- 
ment of innervation, it is because the bile and the other matters 
contained in the intestines have been absorbed, and like true 
poisons have infected the mass of the fluids, and consequently 
the entire economy. 

These ideas were professed by Stoll in the last century, 
ideas which he applied not only to the fevers which he called 
bilious, but also to a great number of other diseases, and hence 
he inferred the utility of vomits which he so frequently em- 
ployed. This theory once admitted, would justify perfectly the 
employment of evacuants as the general method of treatment 
in typhoid fever. But against this theory, several objections 
may be urged ; and in the first place, it has not yet been suffi- 
ciently demonstrated that the bile is so altered, and produces so 
much irritation as to determine the serious lesions which are 
revealed by anatomy. There are many diseases, during which 
the patients remain for a long period without any alvine evacu- 
ation, and in which although we observed some injurious conse- 
quences, we perceive nothing analogous to what occurs in 
typhoid fever ; it would be necessary then, to admit, that in the 
latter, the- bile and other secreted humours of the intestines pos- 
sess particular acrid qualities imparted to them by the disease ; 
but this requires demonstration. The intestinal follicles have 
been found swollen and diseased as early as the fourth or fifth 
day of typhoid fever. But at this early period of the infection, 
especially when a more or less considerable diarrhoea had oc- 
curred from the- beginning, we cannot suppose that the bile has 
remained in the intestine sufficiently long to be altered and pro- 
duce the disorders. In cases which terminate unfavorably after 
the daily administration of purgatives which do not permit the 



1837.] Observations on the Treatment of Typhoid Fever. 291 

bile to remain in the intestines, we find the same follicular lesions 
as in those cases which terminate fatally without the use of any 
means to procure evacuation. 

Thus, then, the theory of Stoll which refers to the presence 
of the bile in the intestines and to the alteration which it there 
experiences, either the fever itself, or the most serious acci- 
dents which accompany it, is at least very contestable. 

The cases contained in the different memorials which M. De 
Larrociue has sent to the Academy, are more than one hun- 
dred. They have been collected under his eyes, by the pupils 
attached to the Hopetal Necker; they present almost all the 
possible forms which typhoid fevers can assume from that in 
which it resembles a simple gastric derangement or embarrass- 
ment, or a slight enteritis to that in which it is accompanied by 
the most serious ataxic, or adynamic symptoms. In all these 
cases, a uniform treatment was employed ; at first he adminis- 
tered one or two grains of tartar emetic, which he prescribed in 
every form of the disease, and whether the tongue was moist or 
dry, red or pale, &c. The next day M. De Larroq.ue gives a 
bottle of seidlitz water, and repeats it as long as the febrile state 
continues. If the patients take a dislike to this kind of purga- 
tive, he gives cream of tartar, calomel or castor oil. Toward 
the end of the disease, when the febrile state has almost entirely 
disappeared, he gives tonics to support the strength, and is not 
very slow in allowing food to his patients. Barley-water or 
lemonade is the common beverage during the disease. No acci- 
dent induces him to modify this" treatment except it be pulmon- 
ary engorgement, when he employs kermes mineral. He de- 
clares that sanguine emissions should never be employed in 
typhoid fever, and that the cases which he has seen terminate 
fatally, notwithstanding the evacuant plan had been treated at 
first by more or less abundant venesection. The abstraction of 
blood according to M. De Larroque, places the patient in a 
condition the most unfavorable for a cure ; he cannot, however, 
be ignorant that many typhoid fevers are combatted by sanguine 
emissions, with an energy justified by incontestable success. 

As to the influence exerted by the evacuating plan repeated 
each day upon the mode of termination of the disease, it is in- 
dicated in a statistical table which he has annexed to his work. 
In one hundred cases, ninety were cured ; ten only had died, 
and among the latter the treatment had been commenced in 
several only under desperate circumstances, while others had 
been bled more or less copiously. This mortality of patients 
with typhoid fever treated by the plan of M. De Larroque, is 
certainly smaller than that of patients treated by any other 
method. This result is confirmed by the testimony of M. 

e 5 



292 Observations on the Treatment of Typhoid Fever. [Dec. 



Be all. We may observe that in England, the majority of 
practitioners treat- the continued fevers, which answer by their 
symptoms to our typhoid lever by the daily use of emetics, and 
particularly of purgatives. Lastly, M. Bretonneau, a few 
years ago advocated the use of saline purgatives frequently 
repeated as the best treatment of dothinenteiitis. M. Piedag- 
nel has treated by M. De Larroque's method, one hundred 
and thirty-four cases of typhoid fever ; he has not however, em- 
ployed this method in all its exclusiveness, thus sometimes he 
has practised venesection and has seldom provoked vomition. 
In these one hundred and thirty-four cases, he lost nineteen, or 
one seventh, a remarkable result, but not as satisfactory as that 
obtained by M. De Larrocuje. M. Louis has employed the 
same plan upon thirty-one patients manifestly laboring under 
typhoid fever ; twenty-eight were cured and three died, or about 
one death in ten. The reporter of your committee has subjected 
forty-eight patients to the same mode of treatment within the 
last three years. In all those patients, without exception, who 
at the beginning of the treatment presented only slight symp- 
toms, such as those which answer to the inflammatory bilious 
or mucous forms, the termination was favorable. The number 
of such patients was thirty ; eleven others were subjected to the 
same treatment. When they had already reached a very serious 
state, nine were restored and two died. Upon seven other pa- 
tients, the treatment was commenced when the ataxo-adynamic 
symptoms had acquired a high degree of intensity, and six of 
them died. Thus, then, in forty-eight patients, eight died, which 
brings the mortality to one in ten.* If we unite the cases of M. 
M. De Larroque, Piedagnel, Louis, and those of your 
reporter, we have a total of two hundred and thirteen patients, 
of whom forty died, making the average mortality a little less 
than one seventh. 

From the facts above exposed, we may say that many serious 
cases were benefited indubitably, while the evacuants were 
daily administered, and that in the light cases the disease did 
not get worse in consequence of the administration of the evac- 
uants. And, indeed, thus treated, all the latter cases terminated 
favorably. We must therefore conclude, that if the evacuant 
method have not a well demonstrated eflicacity in the cases 
which were already serious when the treatment was com- 
menced, at Least it does not most commonly transform the slight 
into serious cases. 'This would certainly not have been admit- 
ted a lew years ago, when most physicians believed that the 
administration of an emetic or of a purgative in typhoid fever 
would necessarily aggravate the disease, and hasten the super- 

* Nearly two in ten. Ed. Smith. Med. Jou. 



1837.] Observations on the Treatment of Typhoid Fever. 293 

vention of the adynamic and ataxic symptoms. We have how- 
ever, seen things occur differently under our eyes — we have 
seen during thedaily administration of seidlitz water, the tongue 
preserve its moisture, to be cleansed, the bad taste of the mouth 
disappear, the thirst diminish rapidly, the epigastric pain cease, 
the frequency of the pulse diminish, the cutaneous transporation 
diminish, the cephalalgia and vertige lose suddenly their inten- 
sity, the expression of the countenance revive, &c. 

We should therefore be indebted to M. De Larrogiue for 
having recalled attention to one of the most important therapeu- 
tical questions of which so many different solutions have been 
given. Your committee thinks that the work of this gentleman 
ought to be taken into serions consideration, but at the same 
time it believes that it would not be consistent either with the 
dignity of the Academy, or with the interests of the science to 
pronounce a definite opinion upon the treatment, employed by 
him in every case of typhoid fever. Before this treatment can 
be thus adopted as the best in all cases, it will be necessary not 
only to have collected one or two hundred cases which testify 
in its favor, but to have observed such cases for several years, 
and under those different atmospherical influences which by 
succeeding each other produce such remarkable changes in the 
gravity of diseases, and consequently vary the statistics of our 
success in therapeutics. Who does not know that in certain 
years all the cases of pneumonia arc mild, and recover, whatever 
may be done ? While another year they have a singular char- 
acter of gravity, and produce a frightful mortality. Who does 
not know that in some months all surgical operations succeed 
in our hospitals, while at another time they are all fatal ? Hence 
the danger of solving therapeutic questions by the numerical 
method, if we do not weigh all the cases at the same time that 
we count them, if we do not analyze scrupulously and minutely 
the value of each of the facts to which we are to give the value 
of a unit. 

To prove the necessity of precaution in apply i 112: statistics to 
therapeutics, permit me to cite another result published in Lon- 
don in 1780 by Clark, in a collection of cases of continued 
fever. From 1777 to 1779, he treated in # the Dispensary of that 
city, two hundred and three cases of continued fever, with all 
the characters of our typhoid fever, mild and severe. In this 
number he lost only six patients, or one in about thirty-three, a 
greater success than occurs in our modern statistics. 

How did he treat them? None were bled, except two 
of the three who had a complication of pulmonary phlegmasia. 
All took at first one or two emetics ; they were afterwards sub- 
jected to the use of simple diluent drinks, and subsequently all 
without exception took quinine. If we regard only the statis- 



294 On the Use of Digitalis in Dropsy. [Dec. 

tics, this, without doubt, would be the best treatment. But it is 
not reasonable to proceed in this manner. Although numbers 
should assert the contrary, we could not be convinced that the 
same mode of treatment suits all the numerous varieties of 
typhoid fever. We agree with most of the great masters who 
have preceded us in our difficult and laborious career, that in 
every malady, whatever may be its seat and whatever its nature, 
certain general states of the organism may supervene, which by 
changing the physiognomy, complicate the nature and modify 
the therapeutics. In each case wo may find special indications 
to be fulfilled. Thus there are cases, in which instead of treat- 
ing pneumonia by sanguine emissions, we may be led to the use 
of quinine or of opium ; in such cases, the disease remains the 
same for the scalpel of the anatomist, but not however for the 
physician, in whose eyes the anatomical lesion can be only one 
of the numerous elements, the notion of which directs him in 
the determination of the therapeutic means. Shall I refer to 
those different diatheses, those idiosyncrasies, those special modes 
of feeling and of reacting which each new patient in some sort 
presents. If this be true, if there be no morbid case which 
resembles absolutely all those which have preceded it, and all 
those which will follow, what precaution should be employed, 
and how much are we exposed to error, if to appreciate the value 
of this or of that treatment, we take as the only element of 
judgment, the more or less considerable number of cases in 
which it has been employed. We apprehend that in this cir- 
cumstance as in many others, the majority is not always right. 
By this mode we operate upon quantities which are not of the 
same nature, and if this circumstance be neglected will not the 
most complete deception ensue ? — Journal des Connaissances. 



On the use of Digitalis in Dropsy. — By Dr. Sigmond. 

Some years ago we read some remarks in the Boston Medical 
and Surgical Journal, (perhaps before its name was changed,) 
on the use of digital is,, with which we were greatly interested ; 
not less by the important information they contained as the 
results of experience, than by the noble ingenousness which 
dictated the plan of communicating that information. It is 
common enough for practitioners to tell of their brilliant suc- 
cesses with their plans of practice. Indeed, it is too often the 
case that the eye of observation is jaundiced — sees nothing but 
its own peculiar color ; or sees no beauty in any other, if it 



1837.] On the Use of Digitalis in Dropsy. 295 

perceive it at all. And we know of no worse promise of suc- 
cess — no more certain presage of a career of ill success, or no 
success at all, for a time, than that which is found in an unwil- 
lingness to be taught by the truths of nature and of experience, 
and in its stead, a determination to adhere to a previous opinion 
with an unwillingness to see it tortured by a rigid rational analy- 
sis. This becomes no age nor individual even in his own pri- 
vate business ; but is perfectly inexcusable in any business 
where the public weal is at stake ; and in none more so than in 
medicine. 

But in justice to the present day we must say that the spirit of 
eclectism now prevailing to some extent, if it go not to ridiculous 
ultraism as every thing else seems prone to, has in its elements 
the power, and thus far promises well for arresting the wild 
vibrations of science at a proper equipoise between erroneous 
extremes, and settling it, at least upon many points, on the firm, 
honest basis of truth. The author to whom we have related 
above, (and we regret, for his honor's sake that we have forgot- 
ten his name,) came to the conclusion that science and human- 
ity would be more benefited by his pointing out his ill successes, 
and candidly acknowledging their causes — thus serving the pro- 
fession, as a wreck, or beacon, or a chart does the mariner, than 
by a narrative of the most brilliant successes. We see a similar 
spirit now manifested in some of the greatest men of the day, as 
Andral, &c. But to the point. 

The writer to whom we have alluded, selected digitalis as 
the first article, on whose powers he should tell the tale of his 
misfortunes. At that time this article was lauded for its powers, 
(powers too, which every body wanted,) of depressing the pulse, 
directly (was the idea,) as a sedative power ; and it had become 
not uncommon to prescribe it for this purpose alone, instead of 
real sedative and antiphlogistic powers. In this state of things, 
and if our memory serve us, when used with these views, those 
observations went to prove that it was, in general use, a most 
hazardous power — that sometimes sudden deaths occurred from 
the first dose of ten drops of the tincture ; and that again, the 
dose might be increased to thirty or forty drops or more, without 
the least obvious effects of any kind, until, suddenly, and with- 
out any premonition, an accumulated power would be manifested 



296 On the Use of Digitalis in Dropsy. [Dec. 

overwhelming with sudden death, as if a tenfold dose of the 
poison had been taken at one time — all proving at least, that its 
powers, the most desirable in some (uncertain) circumstances, 
nevertheless in others, (and equally uncertain why,) were those 
of a most deadly narcotic poison. 

But gravitation, which precipitates the mighty cataract to the 
depths below, or the frozen . avalanche, or the floods of burning 
lava from the mountains' top to the plains below ; or the lighten- 
ing of the clouds, with power immeasurable, and which have 
produced so much destruction of human life — these have been 
tamed by the benign influences of science, and turned into life- 
preservers at the order of man. And who can tell but that lo- 
belia, the present great slaughterer which, like a ruthless torrent, 
is now running its devastating course over the whole land, may, 
in the course of time, become, under the auspices of true sci- 
ence, a safe antidote for many ills. But we have been pleased 
to see the following observations by Dr. Sigmond, on the article 
of digitalis, which we insert below from the Boston Medical 
and Surgical Journal. A spirit of perfect candor and honesty of 
purpose pervades them which cannot fail to please, and to excite 
the confidence of the reader, whilst they at least afford a rational 
discrimination of the circumstances calculated to favor the safe, 
and even useful employment of this active medicinal agent. 
We hope Dr. Sigmond has at least opened the way to observa- 
tion, that its injurious effects may be prevented, if he has not 
rendered it a safe and useful article in the hands of the pro- 
fession. 

" You must be made aware that dropsy is to be considered as 
the prominent symptom of some morbid condition of the body. 
It is not an idiopathic disease, but it is the result of some un- 
wonted action, into the nature of which, before you search for 
your remedy, you must carefully inquire. To obtain a relief 
from the discharge of the fluid is of course an object of anxious 
consideration, but beyond this you must ascertain what has been 
the predisposing, what the exciting cause, whether any other 
remedy may not be more effectual, whether the constitution of 
the individual is such that you may prescribe an agent which, 
when it does not produce good effects, may become the source 
of mischief, and, indeed, be more detrimental than the disease 
which you undertake to cure by it. 

Nosologists have applied the name dropsy too indiscrimi- 



1837.] On the Use of Digitalis in Dropsy. 297 

nately ; they have merely taken the striking symptom, and the 
locality in which the hydropic effusion has occurred, as the sole 
objects of their attention. The disease is, however, anything 
but uniform in its character, in the causes from which it arises, 
or in the effects which are consequent upon it. The states of 
the system in which it makes its inroads, the various diseased 
organs which produce it, the morbid conditions of which it is a 
sequela, the variations apparent in the urinary secretion, the 
diversities of tissues liable to its influence — all demand the most 
earnest attention, and must, in every individual case brought 
before you, be the subject of your inquiry before you can employ 
to advantage the remedies which have been placed in your 
hands. 

Since the days of Aret^eus, we have gained great experi- 
ence ; and we cannot, at the present hour, coincide altogether 
with the remark with which he commences his chapter on drop- 
sy, that " very few recover from this disease, and those rather 
by good fortune, and the kindness of. the gods, than by our sci- 
ence, for the gods alone watch over great events." 1 We must 
attribute all we know to a supreme power ; and it is by examin- 
ing and availing ourselves of all by which we are surrounded, 
that we best show our gratitude, and we have been taught that 
there are conditions in which relief can be decidedly afforded 
by the art that we have studied. 

To remove simple effusion, where no diseased viscus is pre- 
sent, is by no means a difficult task ; but we have other objects 
in view. Sometimes we are called upon to alleviate the most 
acute suffering, which arises from water in the chest and in the 
abdomen, where we know that no effectual cure can be contem- 
plated, and therefore we require to have in our possession varied 
means of action, to know when each is to be employed and when 
it is to be avoided. In some instances, a combination of medi- 
cines will materially assist us, and, as Dr. Ferriar has shown, 
a mixture of many liquid diuretics will be found eminently use- 
ful, and where digitalis is properly united, it is invaluable. It is 
one of those medicines which prove the fallacy of the homoe- 
pathic doctrine, for, prescribed with other drugs, its beneficial 
consequences are oftentimes more striking than when alone. Dr. 
Ferriar has upon this point somewhat a fanciful idea, but there 
appears, in the general principle, much soundness of judgment. 
He says, that he has been led by observation to suspect that there 
exists, in the relative effects of medicines, something similar to 
the harmony of colors and sounds, and that the impulse requisite 
to the living powers of the body, which cannot be produced by a 
single impression, may be effected by a concurrence or succes- 
sion of impressions, in some measure dependent on each other. 
His " Observations on the Treatment of Dropsy," and his com- 



298 On the Use of Digitalis in Dropsy. [Dec. 

parison of M The Remedies of Dropsy," two admirable papers, 
which are to be found in the three volumes which contain his 
medical reflections and histories, fully bear him out in his prac- 
tice, if they do not in his theory. His prescriptions are well 
combined, and discriminately applied. They are not, as Cra- 
shaw has very fairly termed some of those " farragos" which 
are occasionally seen in chemists' shops, " certain hard words 
made into pills," but they are compositions which deserve atten- 
tion and imitation. 

With regard to the peculiar state of an individual who is labor- 
ing under effusion, you will find that digitalis will not only, gen- 
erally speaking, be useless, but occasionally injurious, when 
there is great natural strength and vigor, which have been unim- 
paired by the ravages of disease, where the muscular fibre is 
tense, the skin hard and dry, if the individual be inclined to 
corpulence, if the countenance be at all indicative of determina- 
tion to the head, or venous retardation, or if the habit of the 
bowels be slow and difficult to be called into action." 

This last sentence of Dr. Sigmond is invaluable. It should 
be written in capitals across every treatise on digitalis. It is 
the only rational approach we have seen to correct therapeutics 
in the prescription of digitalis, and being observed in prescrip- 
tion is one great step in the first place, towards preventing the 
injurious effects of the article in question, and in the second, 
towards securing its valuable operation with great uniformity- 
In the next sentence, on the other hand, we find, alike perspicu- 
ously set forth, and again proving a clear discrimination, those 
states of the system in which the happy effects of digitalis as a 
diuretic, may be expected. 

"Dr. Withering first drew the distinction of the cases of 
hydropic effusion in which digitalis would be found unsuccess- 
ful, and. I believe, the great majority of medical men who 
have been in the habit of employing it, coincide with his view, 
and the experience of the most acute and intelligent practition- 
ers has, on the other hand, satisfactorily demonstrated that there 
are states in which it is pre-eminently efficacious. In weak, 
delicate, irritable constitutions, where they may be present much 
laxity of fibre, a thin, soft, smooth, pale skin, which in the anas- 
arcous limb seems to be transparent, when upon pressure by 
the finger on the surface there appears to be no elasticity what- 
ever, but the impression sinks in deep, and there is no evident 
power of resistance ; when the emaciation of the other parts of 
the body is very striking, where the countenance is pale, where 



1837.] On the Use of Digitalis in Dropsy. 299 

there is feeble or intermitting pulse, when the constitution has 
been much broken down, more particularly if it were originally 
strong, sound, and robust, where any indulgence in spirituous 
liquors, bad habits of life, the action of mercury, or any debili- 
tating cause, has produced the mischief — in such states digitalis 
will be indicated in preference to most of the diuretics, of which 
I shall hereafter have to speak. You must remember, however, 
that it is merely the evacuation of the hydropic fluid that you 
will effect ; but you have not advanced more than a step in the 
cure of disease, more particularly if that disease be connected 
with disordered state of the viscera, or if it be attended with 
paralysis. It, however, will do that which sometimes is of as 
much importance as any object you can have in view ; it will 
alleviate the most distressing symptoms, and you will gain time, 
during which the system may be enabled to rally, and then sus- 
tain the impression of well-directed energetic remedies. Many 
have been the contradictory statements made of the diuretic 
effects of digitalis, in consequence of the want of attention to 
these principles, which you will find to be of vital importance to 
you, and you will not fail in giving relief where you judiciously 
employ digitalis. You will frequently be astonished at the 
quickness with which the fluid is evacuated ; but you must not 
be surprised at the rapid accumulation which may again take 
place, when you remember what I have told you, that you do 
not influence the disease which caused it. 

The man whose name 1 scarcely ever venture to pronounce 
without expressing my admiration — Sydenham — gives, with 
that sincerity and love of truth which distinguishes every word 
that fell from him, a very happy illustration of prescribing for 
the name of a disease without inquiring into its causes. He 
was called on to attend Mrs. Saltmash, of Westminster, who 
had the dropsy in the greatest degree he had ever seen, her belly 
being swelled to an incredible size. He gave her an ounce of 
syrup of buckthorn before dinner, according to the custom of 
the time, and it brought away an almost inconceivable quantity 
of water, without causing any disturbance or faintness. En- 
couraged by this, he gave her, every day, interposing a day or 
two occasionally, a smaller dose until she recovered. He says, 
this was twenty-seven years before he wrote his treatise, and the 
lady was his first dropsical patient. Being young and inexpe- 
rienced, he could not help thinking that he was possessed of an 
infallible medicine for the cure of any kind of dropsy ; but in a 
few weeks he discovered his error, for, being soon after called on 
to attend another woman afflicted with the dropsy, which suc- 
ceeded an inveterate quartan fever, he gave the syrup, and re- 
peated it frequently, increasing the dose by degrees ; but having 



300 On the Use of Digitalis in Dropsy. [Dec. 

ineffectually attempted to evacuate the water, inasmuch as the 
medicine did not operate, and the swelling of the belly increased, 
she dismissed him ; and he adds, " If my memory do not fail 
me, she recovered, by the assistance of another physician, who 
administered more powerful remedies.' 5 

It is upon the heart and arterial system that digitalis acts ; it 
decreases the irritability of the constitution, it diminishes the 
frequency of action of the heart, and hence the circulation 
through the system is so slow, that the kidneys have more time 
to take from the blood the watery portion which they excrete, 
for we have no reason to believe that those organs are stimulated 
to any increased action by the herb. The physiological reason- 
ing upon the action of digitalis has been considered to be ob- 
scure, from its having been supposed that it diminished action 
in one instance, and excited it in another ; but I should attribute 
the apparently newly-acquired energy of the kidneys, not to any 
stimulus imparted to them, but to their having a longer period 
to act upon the fluid which is detained in the renal vessels. 
Some authors have contended that digitalis is a powerful stimu- 
lant, that it produces flushed face, hot skin, restlessness, and all 
the symptoms of febrile action: and this you will find to be the 
case where, from a diseased state of the kidneys, the due separa- 
tion of the fluid from the blood does not occur, or where, from 
pulmonary disease, the due transpiration does not take place ; 
for the system of circulation is slowly carried on at first, but if 
no elimination from the blood occurs, the whole frame is thrown 
into disorder, and a febrile state is produced. 

Some believe that digitalis only acts as an indirect sedative, 
and only when it accumulates in the system, and the experi- 
ments of Jorge, at Leipsic, are referred to ; the herb was given 
to individuals in a state of health, in doses of a quarter of a 
grain of powder increased to three grains. It produced upon 
the alimentary canal marked effects, and this also occurred to 
Sandra rt in his trials, when the digitalis was administered in 
powder ; but I have before observed to you, that, in this form, 
it is liable to produce considerable irritation of the stomach : it 
likewise influenced the brain, a state resembling intoxication 
coming on. Upon the generative system its power was strongly 
marked, even to the excitement of seminal excretion in the male, 
and symptoms similar to the premonitory sensations which 
females experience at particular periods. 

All these phenomena may depend upon the retardation, in the 
capillary vessels, of the blood ; Dr. Mossman, in the year 1806, 
was the first who drew the conclusion, from its influence on the 
minute arteries, and the diminution of vascular action, that it 
was strictly a sedative ; lie went so far as to state that he could 



1837.] On the Use of Digitalis in Dropsy. 301 

obviate pneumonic inflammation with as much certainty by it 
as he could arrest the progress of an intermittent fever by means 
of the bark of cinchona. To his other observations I may, in 
my next lecture, draw your attention when we come to notice 
the effects of digitalis in inflammation and in phthisis. 

I cannot, either with justice to myself or to this very impor- 
tant disease, detain you much longer upon the influence of this 
herb on dropsies, more especially as I shall hereafter have fuller 
opportunities of explaining to you the effects of diuretics, but I 
must observe that, in hydro thorax arising from any obstacle to 
the circulation, such as hypertrophy of the heart, when it is the 
termination of long protracted diseases of the thorax, if they be 
not accompanied by disordered conditions of the valves of the 
heart, digitalis may be employed. In ascites, in anasarca, de- 
pendent upon disordered states of the exhalent vessels, which 
throw out a larger quantity of fluid than can be absorbed, you 
produce good effect by diminishing the impulse with which the 
blood is directed to the capillaries, and you present that fluid to 
the kidneys for a greater length of time, in consequence of 
which they can take up more to excrete than would otherwise 
be the case. In ovarian dropsy it seldom is found that digitalis 
succeeds ; in hydrocephalus, in infancy, it is highly noxious. 
Few states of the system have had more diligent inquirers. 
Amongst them, Wells, Blackall, Parry, Abercrombie, 
Ayre, Yeats, Bostock, Bright, Golis, Cheyne, have most 
indefatigably labored, and the analysis of the urinary fluid has 
been of late years looked to with the hope of obtaining a fresh 
source of information. Many prefer ample depletion before the 
exhibition of this remedy, but I think you will generally find 
that when you must lower the system previously, other diuretics 
will be more serviceable, and I would strongly urge upon your 
minds, as I think it a matter of deep importance, to avoid, if 
possible, the junction of these two means of cure. It is true 
that after venesection digitalis is more diuretic, but the most 
fatal effects have occurred from giving the herb, where blood- 
letting has taken place. To use an expression which I have 
somewhere seen — " It kills the heart." 

During the action of digitalis for the cure of dropsy, the re- 
cumbent position is preferable, for, from the experiments of Dr. 
Baildon, detailed in the " Edinburgh Medical Journal," for 
the year 1807, we learn that it decreases the action of the heart 
most when an individual is lying down. He observed in his 
own case, and he repeated the experiment several times, that 
after digitalis had taken its effect, as long as he stood erect, his 
pulse, which was upwards of 100, had not lessened in frequen- 
cy ; when he sat down it became about 75 ; but when he lay 



302 On the Use of Digitalis in Dropsy. [Dec. 

upon his back, it fell very considerably, and became as low even 
as 40. Dr. Baildon found that the same effect was produced 
upon all those patients to whom he had thought it proper to 
administer the herb. This effect is one of the most astonishing 
facts in our history of this sedative; it is very singular that it 
has not excited more attention, and led to some decisive experi- 
ments. Although Dr. Baildon's trials of this interesting sub- 
stance have been detailed by a vast number of authors, there 
does not seem to have been drawn from them that result which 
minute investigations would most probably afford to us in our 
practice. 

There is almost always some degree of nausea, of hunger, of 
uneasiness, of general irritability present, whenever digitalis is 
given ; indeed it would almost appear to be necessary for its 
salutary influence to be produced, and Dr. Paris has a very 
judicious and a very practical remark upon this point, which I 
think will be fully borne out. by all those who use it, that every 
attempt to prevent these unpleasant effects, or to correct the 
operation of digitalis, by combining it with aromatic or stimu- 
lant medicines, seems to be fatal to the diuretic powers of the 
remedy : he has likewise quoted Dr. Blackall, who objects, in 
some cases, to the union of mercury, digitalis, and squill ; to 
the combination of the two latter, however, I do not think the 
same objections arise as to the first. 

In some individuals the miserable train of sensations that 
follow upon the employment of this remedy, precludes the pos- 
sibility of persevering in it, even when we perceive that it has 
been successful ; nausea, vomiting, excessive depression of spir- 
its, and fainting, often prevent us from proceeding further with 
it, and as any attempt then to combine it with any drug that 
might be supposed to obviate its bad influence destroys its effica- 
cy, we are obliged to abandon it altogether. 

There is a point at which we can no longer administer digita- 
lis ; this is generally ascribed to its accumulation in the stomach, 
but it seems to be rather dependent upon the very low tone to 
which the vascular and muscular symptoms have been lowered, 
for neither by vomiting nor by purging lias any portion of the 
digitalis been thrown off, and the same effects are visible if the 
endermic mode of acting upon the system have been pursued. 
It is generally at about the eighth dose that the baneful influence 
of the herb is visible, and this often happens whether the dose 
have been large or small, whether it have been diminished or 
increased, whether it have been given twice or three times in 
the course of the day ; some curious examples have been quoted 
by Sanduat in two papers which appeared in the "Bulletin 
G6n6ral de Thetapeutique," in the year 1 833. They present 
some very extraordinary results from its continued use; his 



1837.] On the Use of Digitalis in Dropsy. 303 

cases were principally diseases of the heart ; out of 57, 31 had 
maladies of that organ, 13 being hypertrophy without dilata- 
tion, eight hypertrophy with dilatation, and eight dilatation 
without hypertrophy ; they fully bear out the great necessity of 
caution which the wisest and most experienced men of our own 
country have so strongly inculcated ; he seems, with Dr. Hal- 
lor an, Dr. Hamilton, and others, to consider it as a narcotic, 
first stimulating, and afterwards acting as a sedative. When 
the poisonous effects are produced after the symptoms of disturb- 
ance of the alimentary canal (indicated by the vomiting and 
purging, then vertigo, drowsiness, and frequent faintings) come 
on, the skin is bedewed with a cold sweat, the tongue and lips 
swell, profuse salivation occurs, sometimes the action of the kid- 
neys is totally suspended, at others it is increased, with frequent 
desire to expel the urine, or at others inability to retain it is felt ; 
the pulse intermits and is slow, and delirium, hiccoughs, cold 
sweats, confused vision and frequent faintings follow, till death 
closes the scene. 

Dr. Henry gives us an instructive example, in the eighth 
volume of the " Edinburgh Medical and Surgical Journal :" — 
A female, laboring under dropsy, took an over dose of a decoc- 
tion which had been made by boiling two handfuls of the leaves 
in a quart of water, then pressing the mass so as to express the 
whole of the liquor. At seven in the morning she drank two 
tea-cupfuls, amounting to not less than ten ounces by measure. 
In an hour's time she began to be sick, and vomited part of the 
contents of her stomach. Enough, however, was retained to 
excite vomiting and retching throughout that and the whole of 
the following day, during which everything that was taken was 
rejected. In the intervals of sickness she was exceedingly faint, 
and her skin was covered with a cold sweat, the tongue and 
lips swelled, and there was a constant flow of viscids saliva from 
the mouth; very little urine was voided on the day she took the 
digitalis, and on the following days the action of the kidneys 
was entirely suspended ; when Dr. Henry saw her, which was 
48 hours after she had taken the poison, the tongue was white, 
the ptyalism continued, though in a less degree, and the breath 
was foetid ; the pulse was low, irregular, not exceeding 40, and 
after every third or fourth pulsation an intermission occurred 
for some seconds ; she complained also of general pains in the 
limbs, and cramps in the legs. By the use of effervescing 
draughts, and ether with ammonia, she gradually recovered 
from her imperfect health. Dr. Henry states that she had 
taken no mercury, and that the ptyalism was the effect of the 
digitalis. 

Professor Brande, in his " Elements of Pharmacy," gives an 
instance of that carelessness which is sometimes met with in 



304 On the Use of Digitalis in Dropsy. [Dec. 

our public institutions, where tfyose who order an important 
drug, forget to give the necessary caution, and the patient con- 
tinues to take daily, without having any one to watch its effects, 
an energetic poison as a remedy. He says that he knew an 
instance of a person who suffered under anasarca of the legs, 
and who applied for relief to a dispensary, where he received a 
box of pills, one of which he was directed to take three times a 
day ; on the evening of the third day, he complained of great 
debility and faintness, and in the course of the night vomiting 
and fainting came on ; in the morning he died upon attempting 
to get out of bed. This sudden death, from the influence of 
digitalis, is by no means an unusual event ; and hence, it is ad- 
visable, that when it has been administered for a short time, 
exertion should be avoided, and the patient kept in a recumbent 
position ; the slightest movement may prove fatal, for the pulse 
instantaneously quickens, the heart throbs and labors excessive- 
ly, and fainting occurs from which there is no recovery ; not 
only have there been such instances of sudden death during the 
administration of the medicine, but even two or three days after 
it had been discontinued. It has been very properly described 
by my late valued friend, Professor Burnett, in one of the 
best works on botany that we possess, his " Outlines of Bota- 
ny," — "as one of our most beautiful native plants, and one of 
our most active indigenous medicines and insidious poisons. 
Its influence over the action of the heart, and its power of 
reducing the rate of the sanguineous circulation, would alone 
render it an important remedial agent, but when to the above 
are added the collateral effects on the kidneys and salivary 
glands, and its peculiar characteristic of lying, as it were, for a 
time, latent, and accumulating the power of repeated doses, so 
that by one fell swoop the heart is in a moment palsied, and 
life at once extinct, it must be acknowledged that it is a most 
fearful as well as useful drug." 

Few medicines have been more fairly tried as an iatraleptic 
or cutaneous medicament in France, than this has been in the 
cure of dropsy, and it has answered the most sanguine expecta- 
tions that had been formed of its efficacy. Dr. Chrestien, to 
whom we are much indebted for his experiments, has given us 
a fair narration of the cases in which he was successful, and 
those in which he failed. He is borne out in his practice by M. 
Cros Rogery, of St. Geniez ; by Bernard, of Bezieres ; by 
Blavet, of Monthozin ; by Rougher, of Montpelier ; and by 
Archibold Aspold. Under M. Rogery's treatment by the 
friction with digitalis, a case of dropsy of the abdomen, which 
followed upon a repelled eruption, was cured. Under Dr. 
Chrestien, dropsy, the sequla of scarlet fever disappeared^ 
and dropsies consequent on vascular inflammation, and on splen- 



1837. J New Doctrine of Erysipelas. 305 

itis, after intermittent fever, have yielded to friction upon the 
hypogastrium, with tincture of digitalis, three times in the course 
of the day. The tincture is made by macerating, for a quarter 
of an hour, an ounce of the leaves in three ounces of alcohol. 
The method employed by Brera, which was the first intro- 
duced, and therefore somewhat rude, consisted in macerating 
the digitalis in saliva, and then applying it by friction on the 
abdomen. I drew the attention of the profession to what had 
been done in this way, in France, three years ago. I have tried 
the system, but do not find it as successful as the internal admin- 
istration. — Boston Medical and Surgical Journal. 



Clinical Surgery. — New Doctrine of Erysipelas. — By M. 
Blandin, Surgeon at Hotel-Dieu^ of Paris. 

In reasoning upon the nature of this disease we must inquire 
into its cause for it does not commence in the wards of the phy- 
sician in the same manner as in those of the surgeon. There 
exists then, an etiological nature. This may be internal, and 
then the disease exists in the entire economy before it acts local- 
ly — or may be external, and arises most commonly from a con- 
tusion, a wound or an operation. Here the affection is altogether 
local at its commencement. This cause is easily appreciable. 
It is not so with the other. We frequently see epidemics of 
erysipelas. These, for want of greater precision, have been 
referred to a miasmatic constitution. But we find also in the 
wards of the physician, isolated cases of erysipelas, which are 
truly sporadic, and for which no special cause can be assigned. 

These two kinds of erysipelas pursue a course whose differ- 
ence depends upon their etiological nature. The erysipelas 
which arises from an external cause, and which is at first local, 
has a tendency to become general. The fluids being altered by 
the disease, and having a concentric direction, are soon dissemi- 
nated throughout the economy, and excite a violent reaction. 

The erysipelas which arises from an internal cause, on the 
contrary, and which is at first general, tends to localise itself. 
It is a critical effort of nature which directs towards a single 
point, the disturbing element that had created a derangement at 
once in the entire system. Would it not result from this theory, 
that the febrile reaction should predominate from the commence- 
ment in the erysipelas of internal cause, and at a later period in 
the erysipelas of external cause ? It must be confessed how- 
ever, that as the latter occurs almost always in consequence of 
wounds, contusions, ulcers, operations, the traumatic fever must 
mask that which is excited by the erysipelatous complication. 



30(5 New Doctrine of Erysipelas. [Dec. 



Anatomical Nature. 

Most pathologists admit that erysipelas is an inflammation ; 
but this word, so vague in its nature, does not specify any thing 
with respect to the seat. It is a cutitis, say almost all authors. 
But there is much more than a cutitis ; the pre-existing, domi- 
nant element is an inflammation of the lymphatic radicles of the 
skin. 

Such is the opinion of M. Blandin. It had however, been 
surmised partly by other authors. Mr. Rtbes had perceived in 
erysipelas something of a capillary nature. He was however r 
more inclined to believe in an inflammation of the venous, than 
of the lymphatic radicles.* 

Dance has observed them in erysipelas of the head, nothing 
is more advantageous than the application of leeches over the 
lymphatic glands at the base of the maxilla. Was not this 
admitting in practice, that the inflammation affected more par 
ticularly the system of white vessels ? M. Chomel is still more 
formal. Whenever, says he, an individual is affected with chills r 
nausea, horripulatio, red lines under the skin, and pain in the 
sub-maxillary glands, he will have erysipelas of the head. The 
lymph itis then, not only predominates but it pre-exists. Another 
proof of the lymphitis is that in patients convalescent from ery- 
sipelas, there often supervenes an oedema, which must be the 
consequence either of a venous or of a lymphatic inflammation, 
or of the obliteration of the vessels which carry the lymph. 
We have then in erysipelas, first a capillary lymphitis, and sub- 
sequently a cutaneous inflammation. 

But these two elements are not in equal proportion. In ery- 
sipelas, which arises from an internal cause, it is the cutaneous, 
and in traumatic ersypelas, the lymphatic inflammation which 
predominates. It is this circumstance which determines the 
difference of their gravity. The former is most commonly 
produced by a miasm, which disturbs the entire economy, but an 
erysipelas like that of the face exhausts the morbid cause. 
Traumatic erysipelas, on the contrary, invades the organism 
instead of quitting it, and the lymphatic vessels convey to all 
the tissues, according to their course the fluids which have been 
altered by the influence of a violent phlegmasia, at first local, 
and afterwards concentric. These are positive facts, says the 
author, and how frequently do we see women die with the ute- 
rine, inguinal, and femoral lymphitis described under the name 
of phlegmasia alba dolens ! 



• M. Rims declares that he !';<* found pus in the venous radicles. But this 
fact is rarely met "'it' 1 '•> erysipelas, ami besides may it not bo attributed to imbibi- 
tion. Ed. of Journal des Connaissances. 



1837. 1 New Doctrine of Erysipelas. 307 

It is for this reason that erysipelas is generally regarded as a 
much less serious affection by physicians than by surgeons.* 

Erysipelas arising from an internal cause is most generally 
stationary ; the other, on the contrary, extends almost always 
concentrically towards the trunk, and when situated on the 
trunk, is directed sometimes superiorly, sometimes inferiorly. 

The phlegmasia extends in the lymphatic net work, follow- 
ing the direction of the vessels ; thus we see red lines, before the 
redness and tumefaction of the skin. 

There are however, some cases of traumatic erysipelas which 
pursue a course towards the extremeties, and the wards of M. 
Blandin recently presented an example of this fact. It is 
because lymphitis does not always proceed concentrically. The 
same is true sometimes of phlebitis. But these cases are ex- 
ceptions. 

Prognosis. 

This can be readily inferred from what we have already said. 
Thus traumatic erysipelas, or that arising from an external 
cause is much less serious than the other variety. There are 
some cases which are owing both to an internal and an external 
cause, as when the disease supervenes around the wound of an 
operation performed during an erysipelatous epidemic, the pa- 
tient will most commonly feel the effects of the lymph conveyed 
to all the tissues, and also the effects of the atmospherical con- 
stitution. This is a most serious complication, and was most 
probably the case in a man who died recently in consequence of 
an erysipelas which supervened after the amputation of a toe. 

Treatment. 

The treatment employed by M. Blandin is peculiar to him- 
self, and is based upon his theory. As to the erysipelas from an 
internal cause, little is to be done. We know not the nature of 
the miasm which has produced it. Every treatment directed 
against it is purely empirical.t But as we are acquainted with 

* May not erysipelas \rhich arises from a simple internal cause, be considered an 
an eruptive lever and treated as such, by respecting the eruption, by favoring it 
by means of moderate perspiration, by recalling it to the surface when metastasis to 
an important organ exists, by observing tne symptoms and employing venesection 
and baths to modi-rate them when too violent? Ed. of Jour. Conn. Med. Chir. 

t It is perhaps gratuitous to assert this pretended benignity of erysipelas which 
arises from an internal cause; for according to his own avowal it occurs almost 
always at the face, and too often terminates tatally. Besides, the extension of ery- 
sipelas from the face toward the neck, that is to say, along thocourse of the glands, 
is much loss serious than its extension to the scalp. 

Ed of Jour mil de& Conttaissances Med, Chir. 
u7 



308 New Doctrine of Erysipelas. [l^ec. 

the nature of the erysipelas which arises from external causes, 
we should abstain from all compression of the wound, from all 
irritating applications, and especially from the use of adhesive 
strips which exert a tonic and exciting action ; we should have 
recourse to the lightest and mildest dressing. So much for the 
local traumatic surface, and thus far all practitioners agree. 
But the same harmony of opinion does not exist with respect to 
the rest of the treatment. 

Some have thought it advisable to act upon the altered fluids 
by means of tonics. But this is pure empiricism ; for what 
proves that quinine, for example, corrects the alteration. Tonics 
seem much better calculated to increase the inflammation, and 
should be used only in cases of well marked adynamia. Others, 
and at their head are Cullen and Dessault, have advised 
emetics and purgatives. M. Blandin has not obtained much 
success. from their administration. Blisters have been recom- 
mended. Dupuytren sometimes employed them in the centre 
or at the margins of the diseased surface ; sometimes he used 
leeches, sometimes emetics. Expectation has also been advised, 
and chiefly by physicians. Such a practice may be justified in 
most of the cases which arise from an internal cause. But 
what surgeon would confine himself to simple expectation in an 
affection that would destroy three fourths of his patients. Unc- 
tions protect the inflamed surface from the air, they lubricate the 
skin, make it pliant, permit its free extension, and thus prevent 
the kind of strangulation caused by the inflammatory fluxioxi ; 
but they are only palliative. They cannot prevent the progress 
of erysipelas, and much less that of lymphitis, and never exert 
any considerable influence except in the simplest cases of ery- 
sipelas. 

M. Ricord and some other practitioners have extolled mercu- 
rial ointment moderately employed. M. Serres D' Uzes 
thinks it should be carried as far as to cause salivation. M. 
Blanden has used mercurial frictions only in seven cases of 
traumatic erysipelas. Three of these patients died, of whom 
two were salivated, and the fatal termination was most probably 
thereby accelerated. 

M. Velpeatj has advised compression upon the erysipelatous 
surface. This practice might be useful in the very incipiency 
of the disease, if there existed certain precursory signs before 
the eruption, and the red lines. But the rapid propagation of 
the inflammation to the lymphatic glands, makes it almost im- 
practicable. It is however, U3eful at tin; moment of the disap- 
pearance of the disease, when there is a tendency to oedema. 
Finally, cauterisation above (lie limits of the erysipelas has been 
proposed. This plan is powerless in arresting the cutaneous 
inflammation, and how then can we conceive it to have the 
power of arresting the lymphatic inflammation. 



1837.] New Doctrine of Erysipelas. 309 

M. Blandin's Treatment. If the lymphitis be the pre-exist- 
ing and predominating affection : if after its destruction only a 
simple phlegmasia of the integuments remains, it follows that 
the former of these affections should be first attacked, and as 
the disease is propagated to the lymphatic glands, it is here that 
we should first act. This mode of treatment is the more easy, 
as each gland is a point which serves to arrest the course of the 
inflammation, as well as that of the lymph, and we should profit 
by the sojourn of the fluid in this point, to attack it by leeches 
in order that it may be freed from all irritation when it resumes 
its course towards the visceral glands. If on the contrary, we 
apply the leeches to the erysipelatous surface, we debilitate the 
patient uselessly ; this is demonstrated by practice as well as by 
theory. M. Blandin has employed his method two years, and 
has scarcely lost a patient ; he has treated more than sixty cases 
during an erysipelatous epidemic, without losing a single case. 
He believes that this plan, though less imperiously demanded, 
is also useful in erysipelas, which arises from internal causes. 
It is also serviceable in erysipelas, both of the extremeties and 
of the trunk, but more in the former than in the latter case. 
Because the glands of the extremities are more simple, more 
sparsely situated, while lymphitis of the trunk may affect at 
once the inguinal and the axillary glands, and those of the 
intercostal spaces. The employment of leeches is here more 
difficult. That this therapeutic may succeed, it must be insti- 
tuted before the inflammation has passed higher than the supe- 
rior glands of the extremity as those of the groin or axilla, for 
how can we act upon those of the viscera. It must be confessed 
that this method is much less efficacious in those cases which 
depend both upon an internal and an external cause, for here 
the miasm acts necessarily, and we know of nothing by which 
it may be opposed. But even here leeches applied over the 
lymphatic glands constitute the most rational remedy. — Journal 
des Connaissances Med. Chir. 



310 Indigo. [Dec. 






PART ITT. 
MONTHLY PERISCOPE. 



Indigo. 

This article, hitherto of interest only in the arts, has become 
a subject of investigation in a therapeutic point of view. To 
this end it has been subjected to physiological and therapeutical 
experiment, and to chemical analysis. It is pleasing to see a 
course of investigation in progress, bringing to view a portion 
of the fundamental elements on which a rational practice must 
be based, or from which it must be deduced. We give below, a 
brief notice of the chemical analysis, shewing the elementary 
principles this substance contains, its operation on the different 
functionaries of the human body, and its influence in a curative 
point of view in cases of epilepsy, chorea, &c. We have often 
heard of its utility in croup, pertussis, and other coughs ; but 
the only scientific experience with which we have met, is of its 
use in epilipsy, and a few other spasmodic diseases. 

M. Duma3 presented to the institute a memoir, in which he 
states that he has repeated the analysis of Indigo, and has ob- 
tained exactly the same results as those obtained by him five 
years since : — 

Carbon 73.0 

Hydrogen 4.0 

Azote 10.8 

Oxygen 12,2" 

American Journal Pharmacy. — Jour, dc Phar. 

Physiological Operation of Indigo. In almost all patients, 
the use of indigo is succeeded first by squeamishness and vom- 
iting, though the substance itself be tasteless and inodorous. 
The violence of the emetic efforts appear to be regulated by the 
individual irritability of the gastric nerves of the patients. Fe- 
males vomit more readily than males. The vomiting is at first 
continuous, that is, during the continued use of the agent, and 
often so violent that the indigo must be given up ; but after sev- 
eral days it ceases. It has otherwise the peculiarity that the 



1837.] Indigo. 311 

contraction of the abdominal muscles and the diaphragm is 
much less violent, and the debility is less considerable than after 
vomiting induced by other means. The contents of the stomach 
present nothing unusual, even in respect to taste, only they are 
of a very dark blue color, and the fluid is intimately mixed with 
the indigo, from which it may be inferred that the gastric juice 
contributes very much to the digestion of the indigo. 

Diarrhoea, the second physiological effect of indigo, takes 
place in general first when the vomiting ceases ; yet from this 
many patients remain altogether exempt. In general, diarrhoea, 
when once commenced, continues as long as the patients take 
the indigo, and increases in intensity during the continued use 
of the remedy. The motions are generally soft, semifluid, and 
of a dark blue-black color. The vomiting and diarrhoea are 
frequently accompanied with slight colicky pains in the stomach 
and bowels, which, however, may be so violent as to require the 
indigo to be given up. Those patients who are exempt from 
vomiting, appear to be attacked with more violent colicky 
symptoms. By the continued diarrhoea there is formed a spe- 
cies of gastrosis (irritation of the mucous membrane of the 
stomach and bowels,) with a loss of appetite, headache, and 
giddiness, and sometimes the sense of dazzling lights in the 
eyes. 

The third physiological operation of indigo is seen in the 
urinary secretion. The urine assumes a dark violet color, 
deepest in the morning. On the quantity of the urine, the 
agent seems to exercise no influence. 

Dr. Roth did not observe colouration of the sweat. But it 
is remarkable, that one patient, after the use of indigo for several 
weeks, fell often into slight convulsions, similar to those which 
ensue on the employment of the nitrate of strychnia. — Amer. 
Jour. Pharm. — Edinburg Med. and Surg. Jour., from Neuc 
Wissenchoftliche Annalen. 

Therapeutic Applications of Indigo. This substance was 
first employed as a therapeutic agent in the treatment of epilep- 
sy, by Lenhossek, and afterwards by Grossheim and others. 
Its efficacy was afterwards tried by Ideler, a Prussian physi- 
cian ; and among twenty-six patients, in whom indigo was 
experimentally tried, six individuals recovered completely ; three 
were dismissed cured, who had after intervals of from eight 
to twelve months a relapse, under the operation of causes which 
might have induced epilepsy ; of eleven patients, the condition 
underwent an essential improvement ; and in six individuals no 
change took place. At first, the patients were wont frequently, 
though without effect, to vomit ; after some days this ceased, 
and in its place diarrhoea occurred, which at first caused 



312 Indigo. [Dec. 

from six to eight motions daily, and was occasionally accompa- 
nied with moderate colicky pain, but afterwards moved the 
bowels only two or three times daily, but with fluid motions, and 
continued so long as the indigo was used, but without impair- 
ing the appetite or digestion. The curative reaction of the 
nervous system upon the agent was principally indicated by 
this circumstance, that the epileptic symptoms in the first period 
returned more frequently, and attained a higher degree of inten- 
sity, but afterwards became less frequent, milder, and at length 
entirely disappeared. 

Most usually the indigo was exhibited in the form of electu- 
ary, with a proportion of the aromatic powder, because, alone, 
it is very disagreeable to the patient. At first it was administerd 
in the dose of one scruple ; this was quickly increased to a 
drachm and more, so that daily from half an ounce to one ounce 
might be used for a series of months without difficulty. 

In a paper in Graefe and Walther's Journal, entitled 
Contributions to Casuistics, by D. Moritz Strahl, of Berlin, 
are some observations on the operation of the same remedy in 
spasmodic diseases. In the trials made by Dr. Strahl with 
this agent, in ten cases of inveterate epilepsy, in which it was 
given in progressively increasing doses, of Irom one scruple 
three times a day, to half an ounce daily for the space of ten 
weeks, it produced not the smallest effect. During its employ- 
ment the stools became blue, and the urine assumed a dark 
green colour. Excepting slight inconvenience of the stomach, 
no operation of the remedy upon the organism could in general 
be observed. On the other hand, indigo, in four hysterical 
females, one of whom was already in the age of decrepitude, 
evinced the presence of very remarkable phenomena. In all, 
after about two drachms daily had been taken, violent pain in 
the region of the kidneys, like colic, took place ; the urine 
assumed a deeper intensity of colouring than in male patients, 
and at the bottom of the vessel was observed no trifling quan- 
tity of fine indigo powder. The intense renal pain continued 
for four days, and at length subsided under the continued em- 
ployment of an oily emulsion. In one case only did there ensue 
a remission of the spasms, and the patient was not entirely well 
three months after the cure was completed. The operation of 
the indigo, further, on the womb, was very remarkable, since, in 
two cases, an amenorrhoca was radically cured, while the spasms 
were throughout undiminished. In two cases of St. Vitus's 
dance, in a boy of twelve and a girl of nine years, the indigo 
was throughout unavailing. 

The different clinical trials made with indigo by Dr. Roth, 
furnished the following results. In epileptic cases, the remedy 
evinces almost always the same immediate operation ; but its 



1837.] Indigo. 313 

subsequent consequences are regulated by the degree of vitality 
of the nervous system of the patients, and the kind and duration 
of the epilepsy. These effects are beneficial in all idiopathic 
epilepsies, curative in those of this class which have not been of 
long continuance; and in very chronic idiopathic epilepsies, 
only afew are alleviated by the use of indigo, none are cured. — 
Amer. Jour. Pharm. — Edinburg Med. and Surg. Jour, from 
Neue Wissenchaftliche Annalen. 

It will be seen by the above that, thus far there is only an 
approximation towards the elements of rational prescription of 
Indigo as a remedial power. For, however conclusive these 
investigations may be, and for aught we know, or suppose, the 
chemical analysis may be perfectly correct and conclusive ; and 
the physiological actions, (so to call its operation on the stomach, 
intestines, kidneys and skin,) all the phenomena of its physical 
powers on the system ; still, all these are, as we before said, but 
a small part of the elements of rational prescription. Indeed, 
successful practice may be had by only a knowledge of the 
medicinal powers of a remedy, without knowing how the chem- 
ist prepares it, or what are its constituants when prepared, (e. g.) 
Calomel, known by its power of purging, promoting secretions, 
salivating, <fcc. may be used as a simple, untested article, as 
cinchona, ipicacuanha, &c. before they were subjected to analy- 
sis, with as good effect ordinarily, as with a perfect knowledge 
of all its chemical nature, &c. Yet these items of knowledge 
are necessary to the scientific practitioner, both for the known 
power of the constituents, or the neutralization of these powers? 
and for avoiding the impairing effects of incompatibles given 
simultaneously, or found in the system, &c* Whilst therefore, 
these have their importance, still the indispensible elements of 
rational prescription lie in the philosophy of the disease — the 
true pathology of the case to be subjected to prescription. Hence 
the importance of pathological anatomy. But in the prosecu- 
tion of this study, great care and good unbiased judgment are 
necessary to discriminate between morbid phenomena which 

* As lime water for example, an article whose affinity for the muriatic acid is 
greater than that of the mercury, the consequence of which would be the decompo- 
sition of the calomel and the formation of the muriate of lime, whilst the oxyde of 
mercury is left — a power materially different from calomel. So likewise, the carbon- 
ate of ammonia is found to decompose this muriate of mercury, and form muriate of 
ammonia, leaving again the oxyde of mercury, and so on. 



314 Indigo. [Dec. 



are merely the effects of disease in its approximation to fatal 
termination, and those which are causes ; the want of which 
dissemination has been of late, an error but too general. 

Here then is a field of enquiry which we desire to see occupy 
the minds of medical philosophers. The inquiries are, what 
is the intrinsic nature of those spasmodic diseases for which 
indigo is desired to be found a remedy? What predisposition? 
What exciting, what perpetuating causes ? Where seated ? 
What functions are disordered, and in what do they differ from 
the healthy? What is the tendency of the pathological state ? 
Does it tend to, and will it, with the powers of nature alone, 
return to health, and that as quickly and easily as with the 
assistance of science, and may therefore be entrusted to the 
medicine expect ante ? Or does it tend to idiocy, or other per- 
manent impairment of the functions, or to death, and therefore 
imperiously demanding the aid of science ? These are inqui- 
ries of paramount importance, and which must be answered 
before a radical treatment can be determined. We must know 
what causes are to be removed — the mode of operation of these 
causes — the extent of their effects. We must know the general 
physiological state of the system, as well as the physical powers 
of the medicinal agents, their adaptation to the removal of 
these certain causes— to the correcting of their remaining effects — 
the means for combining, or avoiding, (as need may be,) modify- 
ing influences, &c. &c. In short, the pathological, as well as 
physiological, chemical and therapeutic elements must all be 
known and duly appreciated in deducing, what many practition- 
ers think a very little matter, a prescription. 

It will be observed that the therapeutic researches herein 
noticed, seem to have partially determined one important point — 
the inutility of this article in other than idiopathic cases, or at 
most its only alleviating temporarily, some of those which are 
symptomatic, or attended with organic lesions. But here Ave 
are arrested by the want of pathology, for who can say that 
there are any such cases as epilepsy, chorea, &c. truly ediopa- 
thic — who say that they exert only as phenomena of organic 
Lesions. Indigo may not therefore be expected to be used to 
greater or more uniform advantage than many other remedies 
which have had their day of praise and fallen into disuse ; until 



1837.J Dr. Cooper on Chronic Bronchitis. 315 

the pathological elements of the spasmodic diseases, particularly 
epilepsy, to which the medical mind seems to direct this prescrip- 
tion, is more successfully studied. 

We should be pleased to see a generous premium offered for 
(not the best, but) an essay which should set forth the rational 
philosophy of this, too often, uncontrolable and mischievous 
disease. 



Dr. Cooper's Observations on Chronic Bronchitis. 

We insert the following observations which are going the 
Tounds of the newspapers, not with approbation of the manner 
in which Dr. C. has thought proper to allow his observations to 
come before the public; for such a plan is more calculated to do 
harm than good, by throwing into the hands of the public a 
valuable power to be ill-judged of, or rather, to be indiscrimi- 
nately used, without any judgment at all. Nor have we arrested 
it in its flight in company with the nostrums and catholicons in 
the gazette curricle, on account of our estimate of value we 
place on the observations on consumption which fill up the first 
two paragraphs; but because "the course of treatment is evi- 
dently one which ought only to be adopted and pursued under 
the direction of a skilful medical adviser ;" and because we know 
that the remedial power which is the leading article in the pre- 
scription is calculated, under such circumstances to deserve a 
better fate than consignment to popular and indiscriminate use. 
It will be recollected by the profession that the leading power in 
this treatment, the good success of which Dr. Cooper has said 
so much about, is also the leading article in the pill of Dr. Sen- 
ter,* which at one time possessed great celebrity as a dry vomit 

* The following is the formula for making Dr. Senteu's dry-vomit pill — 

ft. Sulphate of copper 

Ipicacuanha, each 7 to 10 grs. 

Make into a pill to be taken into the stomach in the morning fasting, without 
drinking any thing after, until the operation is free. He also used a solution of 3 
to 12 grains in 2 or 3 ounces of water. What has been called Senter's emetic, is the 
following : — 

ftf Sulph. cupr. gr. vi 

Pulv. ipicac. rad. grs. x., vcl xv. M. 

Dr. Marryatt was probably the first individual who made extensive use of this 

h8 



31G Dr. Cooper on Chronic Bronchitis. [Dec. 

in the treatment of pulmonary affections. Jt is also a kindred 
power to the " emetic mixture," or " vitriolic solution" of mosely,* 
which is given in nauseating doses, or as a dry vomit ; both of 
which we have occasionally used with decided success. 

" The late lamented death of Dr. Bushe from that form of 
consumption known as chronic bronchitis, painfully reminds 
the subscriber of a duty he owes to his profession and to society, 
of making known a simple form of treatment that has never 
failed him in curing this form of consumption, so destructive to 
the clerical and literary professions. This treatment is of 
nearly equal efficacy in catarrhal phthisis, and is a valuable 
remedy for consumption in all its forms when in its chronic 
stages, and free from any inflammatory symptoms. It is based 
on the pathology of consumption as the generic name for the 
disease. 

Under the name of consumption are included that variety of 
diseases of the lungs attended with expectoration of purulent 
matter from the breathing surface of the lungs, connected with 
emaciation, hectic fever, and its concomitants, night sweats, col- 
liquative diarrhoea, &c. All the powers of consumption act on 
the general health from one common cause — the presence of 
matter acting upon absorbing surfaces, and thus producing those 
symptoms known as hectic fever. It is the presence and vio- 
lence of this symptom of consumption that prostrates the pa- 
tient, until it more or less slowly ends in death. It is the con- 
sequence of hectic fever, and not the immediate disease of the 
lunjrs, causing it that forms the source of fatality from consump- 
tion. 

article as an emetic, and a nauscant in phthisis. He advised it combined with 
tartarised antimony as follows : — 

\l. Sulph. of copper 

Tartarised antimony, each grs. vij. 

Rul> well together and divide into '5 equal papers, one of which he gave every 2 
or '.\ days. The j»ill is, for several reasons, the must eligible form. 



* Dr. Mobeley'a emetic mixture, or vitriolic solution is made as follows: — and is 
also treated as a dry vomit when given as an emetic. 

iif Sulph. zinc. 3iij. 

alumin. 3i. 

Pulv. cocc. cac. gr. iv. 

aq. bullient. gviij. M. Dose 3fs every 
hour to vomit, or every 3 hours to nauseate. 



1837.] Dr. Cooper on Chronic Bronchitis. 317 

The treatment I now with reluctant diffidence submit, I have 
used successfully, and for more than twelve years; and during that 
period of medical practice, 1 am not aware of having lost more 
than four or five patients from all the various forms of consump- 
tion ; and these were mostly passed to that stage of disease 
where the structure of the lungs had become so extensively 
diseased as to preclude the use of more than palliative treat- 
ment. Cases of chronic bronchitis were, in every instance, 
cured by it, even when the purulent expectoration amounted to 
pints daily, with hectic fever, diarrhoea, cold sweats, and intense 
physical prostration. 

The treatment is the administration of sulphate of copper in 
nauseating doses combined with gum ammoniac, given so as to 
nauseate, but not ordinarily to produce full vomiting. The 
usual dose for this purpose is about half a grain, and five grains 
of the respective ingredients, in a teaspoon ful of water, to be 
taken at first twice, and in the convalescent stages, once a day. 

In cases of chronic bronchitis, a gargle of the sulphate of 
copper alone is superadded. In this latter form of consump- 
tion, this treatment almost invariably suspends the hectic symp- 
toms in a few days, and the disease rapidly advances to its final 
cure. 

In cases of the more proper forms of consumption, the treat- 
ment must be intermitted frequently, and again returned to ; and 
whenever soreness of the chest, or other symptoms of inflam- 
matory action exist, the treatment must be suspended : as it is 
in the chronic state alone that the remedy is indicated or useful — 
that state in which the condition of the general system, as 
sympathetically involved, becomes the more prominent symp- 
tom ; and the success of the treatment depends chiefly on the 
breaking up of the sympathetic action of the diseased lung, on 
the more healthy tone of the stomach, increasing the digestive 
powers, and likewise causing, during nauseating action, a more 
active and healthy circulation through the lungs. Its curative 
powers are more immediately attributable to these effects of its 
action. But theory apart, the treatment prescribed is based on 
more than ten years experience of its curative advantages, in 
the proper treatment of muco-purulent, and purulent expect- 
oration. 

Having left a profession that more nearly than any other 
approaches the pure duties of humanity ; but which has nearly 
ceased in this country to be honorable or profitable, I have 
little motive in exposing myself to that certain ridicule that 
follows the annunciation that consumption may be cured, but 
the assurance of practical experience, and the desire of making 
public, the means of saving life in one of its most frequent and 
unwelcome exits. EDWARD C. COOPER. 



318 Carburet of Sulphur. — Cantharidin Plaster. [Dec. 



Resolutive Effects of Carburet of Sulphur vpon indolent 

Tumours. 

Lampadius in 1826 extolled the employment of this com- 
pound, for rheumatism, chronic gout, paralysis, cutaneous erup- 
tions and burns. Since this period, this liquid has been fre- 
quently made use of in the north of Europe. Dr. Krimer 
has employed it anew with happy results in divers affections, 
and principally in the treatment of indolent tumours which had 
resisted all kinds of medications. Under this plan of treatment 
he has administered internally 16 grains of animal charcoal, 
mixed with the extract of cicuta ; whilst externally he has 
caused to fall from a certain height upon the tumour, from 40 
to 50 drops of carburet of sulphur, repeating it three times 
daily. The effected part was enveloped during the interval in 
wool or swan's down, and twice a week warm baths slightly 
alkalized were directed. This method of employing the car- 
buret of sulphur was completely successful in his hands. The 
external use of the same compound was equally successful 
with M. Krimer in the case of a young lady who labored under 
goitre. 

Finally, in several cases of strangulated hernia, the author 
found that no application so much facilitated reduction as the 
carburet of sulphur. Some drops applied to the hernial tumor, 
reduced it promptly without any manipulation. 

M. Otto, of Copenhagen, has also employed with success, in 
obstinate rheumatic and arthritic affections, the carburet of 
sulphur according to the following formula: — 

Take of Carburetted sulphur, 3 ii. 

Spirit of wine, §i. M. 

The patients are to take four drops every two hours, at the 
same time that frictions are made with the following liniment ; — 

Take of Carburet of sulphur, 5ij. 

Olive oil, l\. M. 

By these means a persistent rheumatic affection of the feet 
accompanied with swelling of the extremities and knees, was 
removed in a short time. — Amcr. Jour. Phar., from Jour, de 
Pharmacie. 



Cantharidin Plaster. Charles Ellis* & Co., druggists 
and chemists, No. 50, Chesnut street, Philadelphia, have pre- 
pared a new blistering plaster from cantharidin, or the active 

* Secretary of the Philadelphia College of Pharmacy. 



1837.] (/////in Capsules of Copaiva. 319 

principle of Spanish flies. It is spread upon silk, or glazed 
cloth. Being ready prepared for use on silk cloth, it is said to 
be exceedingly convenient and easy of application, possessing 
the adhesive quality, as well as cleanly appearance of court- 
plaster — that it will excite a blister with equal certainty with 
the fly ointment, without the unpleasant consequence of a por- 
tion of it adhering to the blistered surface. It is also said to be 
free from the liability to cause strangury. 

It is used by applying a piece of it, of proper size upon the 
skin, with sufficient pressure of the hand to make every part of 
it adhere closely to the surface. It must be allowed to remain 
in application the usual period of 10 or 12 hours, unless it 
should draw sufficiently in a shorter time. 

For taking it off, a wet cloth or sponge is to be passed over 
the back of it, after which it may be removed without pain. 
The blister is then dressed in the usual manner. 

In case of the plaster having become dry by age or exposure, 
a little sulphuric ether rubbed over the surface of the plaster, 
will cause it to act more speedily. In all instances of applying 
it, care should be taken to make the plaster stick closely to the 
skin. This article will be found particularly convenient for 
application in those cases of spinal irritation now so constantly 
observed, and to which it is very inconvenient to bind on the 
common blistering plaster with sufficient accuracy for its con- 
stant adjustment. 



Glutin Capsules of Copaiva. M. Gueneau Dc Mussy 
read to the Royal Academy of Medicine the report of the com- 
mittee appointed to investigate the merits of a new kind of 
copaiva capsules invented by M. Raquin, a pharmaceutist. 
The capsules were formed of a slight layer of pure gluten. The 
copaiva, before being made into pills, is incorporated with one 
twenty-fourth part of magnesia. The committee have seen 
them prepared, and tried them in many cases at the Venereal 
Hospital. They prefer them to the gelatine capsules of M. 
Mothe, which have already acquired the approbation of the 
Academy. This preference is founded upon the following rea- 
sons: — The size of the copaiva pills enveloped in gluten may 
be varied, which is not the case with the gelatinous capsules. 
In a small volume, the glutinous contain more copaiva than the 
gelatinous capsules; and do not, like the latter, allow the copaiva 



320 Urinary Calculi covered by a kind of gildtng. [Dec. 

to exude. When immersed in fresh water, or in some odorifer- 
ous water, the odour is communicated to them, and they are also 
more easily swallowed. The capsules of gluten can be taken 
in larger doses than those of gelatine, and without the nauseous 
eructations which the latter cause when dissolved in the stomach. 
The small quantity of magnesia combined with the copaiva 
prevents this inconvenience, and facilitates the digestion. — Ar- 
chives Generate de Mid., July, 



Internal Strangulation of Intestine, taken for Puerperal 
Perctonitis. One year after marriage, Madame N. was deliv- 
ered without accident, of a child which she did not suckle. 
The 10th day the mammae were not even swollen, but the 
lochial discharge existed. The 12th day she felt, suddenly in 
her right iliac fossa a severe pain — the next day she was pretty 
well. " On the 14th, hiccough, vomiting, (fee. The patient pre- 
sented an umbilical hernia which was soft, and without pain. 
No tumour could be perceived in the abdominal rings. An 
active antiphlogistic treatment was commenced, but the patient 
died in eight days — the 20th after delivery. When the body 
was opened, the ca3cum was found strangulated by the appen- 
dicula vermiformis which embraced the intestine. The uterus 
and peritoneum were in a normal state. " The error of diagno- 
sis in this case," says M. Baffos, " was unimportant, as the 
same treatment must have been indicated. — Archives General 
de Med., July. 



Urinary Calculi covered by a kind of gilding. M. Sega- 
los presented to the Academy three calculi, one as large as a 
bean ; the two others, smaller, which resembled gilt porcelain. 
The large one was found in the kidney of an ox ; the other 
two, in the bladder of a cow. By scraping with the nail, the 
gilding was removed from one point, and the calculus found to 
be white; but when the same point was rubbed with the pulp 
of the finger, it was again covered by a gilt coat. A chemical 
examination was to be made, in order to ascertain the principle 
to which this gilt envelope is owing. — Archives General de 
Med., July. 

We presume it would not take much of what Dr. Johnson 
calls " strong, hard, round-about common sense 1 ' applied as a 
test to these calculi to determine, that the " gilt envelope," is no 
envelope at all, and is but the hue which is reflected by the pol- 
ish which these calculi very easily receive. Let us see, when 
the chemical analysis is reported, what better will be determined 
thereby. 



1837.J Obituary. 321 



OBITUARY. 

It is with feelings of filial sorrow that we are under the ne- 
cessity of announcing the death of the venerable Father of 
American Surgery, Dr. PHILIP SYNft PIIYSICK, 

There is no section of our happy land which is without those 
who mourn his loss. Thousands unite to praise his merits, 
reverence his memory, and ascribe to him the honor of our 
Father in Surgery. — But we are only his episodes ; his 
higher praises are registered in the grateful hearts of tens of 
thousands who, during his long and useful life, have enjoyed 
the ameliorating influence of his superior surgical talents. 

He was not of those who are driven up by the force of cir- 
cumstances ; but persevering zeal, and originality in many the 
most important respects were peculiarly his. Like his cotem- 
porary Dupuytren, he justly possessed the credit, of his own 
growth to fame and usefulness. When his hand was first ap- 
plied, American Surgery had not even a name ! Now, what 
is it ! Behold a prolific tree which overspreads the whole 
land, and justly claims honors equal with the foremost ! It was 
a plant, germinated at his feet, cultivated by his hand, guarded 
by his care, and nurtured, pruned and extended by his counsel. 

But it is not our purpose to write an eulogy. With his own 

hand he has created an imperishable monument, and inscribed 

thereon, the unfading honor he has bestowed 

on his country, in giving dignity and 

true worth and usefulness to his 

profession. 



Tribute to the Memory of Dr. Physick. 

At a meeting of the Faculty and Students of the Medical Col- 
lege of Georgia, for manifesting their high respect for the late Dr. 
PHILIP SYNG PHYSICK, Dr. Milton Antony was called 
to the Chair, and Dr. George M. Newton appointed Secretary. 

On motion of Dr. Paul F. Eve, the Chairman appointed 
Drs. Paul F. Eve, Alexander Cunningham, Charles 
Davis, George M. Newton, and William L. Alfriend, a 
committee to draw up resolutions suitable for the occasion. 

After a few moments the committee made through their chair- 
man, Dr. P. F. Eve, the following report :— 



322 Obituary. [Dec. 

The Faculty and Students of the Medical College of Georgia 
having heard, with the deepest regret, of the death of the vener- 
able Dr. PHILIP SYNG PHYSICK, feel themselves called 
upon to give public expression of their sorrow at this afflicting 
dispensation of Divine Providence. 

Truly has a great man fallen in our profession. One who 
had, by his zeal, talents, and arduous devotion to our science, 
secured the entire confidence of the American public; and 
whose teachings and signal improvements in surgery can never 
be forgotten by his numerous pupils in every state and territory 
of our eountry. 

He was associated with Rush, Shippen, and Wistar, in 
establishing the first medical school on this side of the Atlantic — 
himself a pupil of the celebrated John Hunter, and by his 
fame as a scientific and successful surgeon, he attracted patients 
from all parts of our Union. 

If Dr. Rush was the father of American medicine, Dr. Piiy- 
sick is no less entitled to the appellation of the father of 
American Surgery. Appreciating then the great loss which 
has been sustained in the death ot our venerable Father, Dr. 
Philip Syng Physick, late of Philadelphia, be it therefore 

Resolved : — That we deeply sympathize with the community 
at large, mingle our sorrow with our professional brethren 
throughout the Uuited States, and offer our sincere condolence 
to his distressed family. 

Resolved: — That as a tribute of respect for the worth and 
character of the deceased, we will wear the usual badge of 
mourning for the space of thirty days. 

Resolved : — That we respectfully request that the next number 
of the Southern Medical and Surgical Journal be issued in 
mourning. 

Resolved : — That the Secretary transmit a copy of the 
proceedings of this meeting, signed by himself and the Chair- 
man, to the family of deceased ; and to the editor of the South 
crn Medical and Surgical Journal, and the editors of each of our 
city papers. 

On Motion of Dr. P. V. Bve, the report was unanimously 
adopted. On motion of Dr. Die as, the meeting adjourned. 

Milton Antony, Chairman. 

George M. Newton, Secretary. 






SOUTHERN 

mmmmML akb §hjie®ii® ail 

JOURNAL. 



Vol. II. FEBRUARY, 1838. No. VII. 

PART I. 

ORIGINAL COMMUNICATIONS. 



ARTICLE I. 

Remarks on the Pathology and Treatment of Bilious Fever, 
read before the Medical Society of Augusta, by L. A. Dug as, 
M. D.j Professor of Anatomy in the Medical College of 
Georgia. 

There is perhaps no subject connected with the advancement 
of science, of more importance than nomenclature, for, on the 
correctness of names, depends, in a great measure, the correct- 
ness of our ideas relating to the facts they represent. A name 
should, as far as practicable, always convey a correct, and distinct 
idea of the leading features or properties of the subject to which 
it is applied, and any deviation from this principle must tend to 
complicate the attainment of knowledge, by requiring of the 
student not only the recollection of unmeaning technicalities, 
but also the correction of their original interpretation. It were 
always better that a name convey no definition, than an incor- 
rect one. 

A 1 



383 Pathology and Treatment of Bilious Fevers. [Feb. 

The inappropriateness of the appellative at the head of these 
remarks is striking. The term fever is now applied to a peculiar 
assemblage of symptoms, without reference to cause; yet, when 
qualified by the adjective "bilious," it is assigned to an extensive 
class of diseases prevalent in our section of country and in most 
warm climates. We should, from the above designation, expect 
to find this class of diseases always characterized by a derange- 
ment of the biliary secretion; such, however, is not invariably 
the fact, as I shall endeavor to establish in the sequel. 

The system of localization, which has already accomplished so 
much in continental Europe, has been too much neglected in our 
country, and especially with regard to the diseases of this cli- 
mate. Still adhering to the theories of the humoralists and of 
those who look upon fevers as specific affections of the entire 
system, the great mass of our practitioners are found to direct 
but little attention to the condition of individual organs. 

When, fresh from the benches of the school of organic medi- 
cine, I was called on to examine and to treat cases of "bilious 
fever," I instinctively interrogated in succession every organ of 
the body, in search of the seat of the disease, or in other words, 
of the cause of so much constitutional disturbance. In some 
cases, despite of all my investigations, no trace of disordered 
function (the best evidence of a diseased organ) could be detect- 
ed elsewhere than in the stomach ; in others the bowels -were 
alone distempered ; other sets evinced the disturbance to be lo- 
cated in the liver, in the brain, or in more than one of the prin- 
cipal viscera. The bilious modification, implied by the name 
of the affection, though very frequently manifest, was often en- 
tirely wanting. Yet, each of these cases presented certain cha- 
racters peculiar to all. Their onset was always marked by loss 
of muscular power, by pains in various parts of the muscular 
system of animal life, &c; their early y inter mittency or 

decided remissions; their duration and termination presented a 
strong analogy ; in short, it. was evident that, although modi- 
fied by the affection of some, special organ, all these cases 
were under the predominance of an original and common 
affection. The seat of this original and common affection 
cannot be mistaken if we adhere to the principle already al- 
luded to, that of regarding vitiated function as the best indica- 



1S3S.] Pathology and Treatment of Bilious Fevers. 3S9 

tiou of diseased organ. If an organ be healthy, its function 
must necessarily be normal; consequently; if a function be ab- 
normal, the organ presiding- over it cannot be in a physiological 
condition. I am aware that it will be urged that certain secre 
tions may be vitiated by an altered condition of the fluid whence 
they are derived, without disease of the secerning organs. For 
example, the urine may present various aspects according to the 
.substances taken into the circulation ; or, the composition of the 
bile may depend on that of the blood. But this cannot affect our 
position, for, the condition of the blood itself, depends entirely on 
that of the organs which form it, and of those whose office it is 
to eliminate its impurities. If it remain impure, the cause must 
be found in the vitiated action of the emunctories. 

But, whether these principles of diagnosis be admitted or not, 
it is presumed that no one would, on reflection, refer the morbid 
condition of the contractility and sensibility of the muscular sys- 
tem, to any other locality than the nervous centres. We have 
already stated the earliest symptoms of our fevers to be lassitude, 
loss of muscular power, and pains in the muscles of animal life ; 
also, that intermittency, more or less complete, always marks 
their early stage. We are, therefore, led to the conclusion that 
the nervous system is the original and common seat of this 
class of affections. I trust I will not be misunderstood ; the 
term original being here used expressly to indicate that these 
fevers subsequently undergo rerious modifications, from the su- 
pervention of other derangements. It is to these complications 
we must look for the explanation of the various forms assumed by 
the fevers misnamed "bilious" so that the proper definition of 
them should be an original affection of the nervous centres, 
subsequently com plicated by j>hlogosis of some other organ or 
organs, which secondary disorder may either gain the ascen- 
dancy of the primary, or merely mask and modify it. 

Let us now examine some of these complications : and in do- 
ing so, it is scarcely necessary to premise, that, in point of fre- 
quency, they vary exceedingly indifferent seasons and in differ- 
ent years. The most simple may be classed under the head of 
hepatic, gastric, enteritic, cerebral and pulmonic ; the more 
complex forms are those m which there are more organs than 
one. implicated secondarily. 



390 Pathology and Treatment of Bilious Fever. [Feb. 

The Hepatic complication will, in addition to the general 
symptoms, already mentioned as common to all the forms of this 
class of fevers, present the characteristics of hepatitis, more or 
less acute ; and this is, perhaps, the most obscure form of these 
fevers, inasmuch as the indications of hepatic disorders are less 
marked and less understood than those of any other of the vis- 
cera. In the present state of our knowledge, an hepatic affection 
can only be inferred either from an increase or diminution of 
bile, from the volume of the liver (which may be determined by 
percussion) or from the mere absence of disease in any other 
organ, sufficient to account for the general disturbance of the 
circulation. Pain in the region of the liver, though occasionally 
pointing to the seat of the disease, can only occur when the pe- 
ritoneal investment is affected (the liver itself being insensible), 
and is too inconstant to be relied on. The quantity of bile can 
only be estimated by the appearance of the matters ejected from 
the alimentary canal, and by the colour of the eyes and general 
surface. To admit, on any other grounds, the existence of dis- 
ease in the fever, would be proceeding beyond the limits warrant- 
ed by our actual knowledge of the pathology of this important 
gland. If there be an increased secretion of bile, it will be found 
proportionably thrown from the stomach and passed off with the 
alvine evacuations. The yellow hue of the eyes and skin may 
accompany this state, as well as that in which the evacuations 
evince a decided paucity of bile ; hence, this cutaneous change 
indicates the mere fact, that the colouring matter of the bile has 
passed into the blood, without pointing out the cause of this oc- 
currence. It is well known now, that jaundice often results from 
duodenitis, without any affection whatever of the liver itself. — 
If these circumstances be home in mind in the investigation of 
these levers, it will he found that a large number of cases will 
present no trace of hepaiic derangement. 

The Gastric Complication is characterized by the well known 
symptoms of acute affection of the stomach : viz. loathing of 
food, nausea and vomiting. The pulse in this is never so much 
developed nor so resisting as in the hepatic complication, and 
yields more readily to venesection, which not unfrequently oc- 
casions syncope. The countenance is also more anxious and 
the face less flushed. Pain, on pressure of the epigastrium, 



1838. 1 Pathology and Treatment of Bilious 391 



though oflate much insisted on as peculiar to gastric irritation, 
would, perhaps, more properly be regarded as indicating disease 
of the subjacent peritoneum, whether lining this region, or re- 
flected over the stomach or the depending edge of the liver. — 
This membrane is known to be highly sensitive when in a state 
ot irritation or inflammation, whereas we may yet doubt that 
this is the case with regard to the other coats of the stomach. — 
The inflammation of the peritoneum in this region alone, how- 
ever, might be produced by an extention of disease from the other 
coats of the stomach or from the parenchyma of the liver, and 
should, therefore, always be considered in connection with the 
state of these organs. That the tenderness of the epigastrium is 
occasioned by the condition of the serous membrane, may, inde- 
pendently of the above considerations, be inferred from the readi- 
ness with which relief is afforded by revulsive applications to 
the cutaneous surface, whilst the other symptoms remain unmit- 
igated. 

The Enteritic complication is that in which the bowels are 
most obviously in a state of phlogosis. The mucous surface of 
the intestines pours out an immense quantity of thin muco-serous 
fluid, which, either passes off spontaneously, or is expelled by 
the action of cathartics. It will be marked by copious diarrhoea; 
or by the fact that the slightest laxative will be attended with 
excessive purgation, which, instead of subsiding with the effect 
of the remedy, as usual, will continue indefinitely. The small 
are much more frequently affected than the large intestines, and, 
consequently, diarrhoea is more common than dysentery. Pres- 
sure over the abdomen will be occasionally attended by pain, 
probably arising from the extension of the disease to the perito- 
neal investment, as already explained with regard to the stomach 
and liver. 

The peculiar torpor, or obstinate constipation of the bowels, 
so often observed in our fevers, is considered by some as indi- 
cating a degree of inflammation so high as to arrest the secre- 
tions of the mucous surface, whereas others regard this condition 
as induced by a want of the accustomed stimulus of the bile. 
Both of these explanations appear to me exceedingly objectiona- 
ble ; the former, because I cannot admit so high a degree of ex- 
citement simultaneously invading the entire length of the canal j 



392 Pathology and Treatment of Bilious Fever. [Feb. 

and also because all post-mortem inspections testify that in cases 
of death daring the existence of diarrhoea or dysentary, the mu 
cous surface may be found presenting every ^rade of disease 
from mere irritation even to destructive ulceration. Inflam- 
mation of the mucous membrane cannot then account for obsti- 
nate costiveness. nor do I think these two states can exist together. 

To admit that such a state of torpor can result from the want 
of biliary stimulation, would be to concede that the hepatic se 
cretion is more irritating than the most drastic cathartics in ma 
teria medica, for, we frequently find it resisting them, not only 
individually, but in the most potent forms of combination. — 
Again: the passage of white or clay colored faeces occasionally 
observed in jaundice, at trie same time that it proves indubitably 
the absence of bile in the alimentary canal, also establishes the 
fact that such absence does not cause obstinate constipation. I 
would look to the intestinal muscles, and through them, to the 
nerves which control their action, for the explication of the phe- 
nomenon. The peristaltic motion is arrested because the mus- 
cles do not act, and these are torpid, because of some derangement 
of innervation. This lesion of innervation may be traced either 
to the concentration of irritability in some organ seriously im- 
plicated, (the liver for example) as is most frequently the case, or 
it may be found to depend on the peculiar condition, probably 
congestion, of the nervous centre. The correctness of these 
views is most strikingly illustrated by the efficacy of the treat- 
ment of obstinate constipation, in the one case by copious bleed- 
ing, and in the second by revulsives to the spine. In the great 
majority of instances, a few cups or a blister to the spine will 
enable laxatives to act when the most active drastics have pre- 
viously failed. 

The Cerebral complication is one that occurs alone, much 
more rarely than those already described. It is always, however, 
recognized by a predominance of encephalic disturbance, as head 
ache, intolerance of light, tinitis aurium, delirium, wakefulness, 
and sometimes subsultus tendinum and coma. The symptoms 
developed in this form of the disease, and which indicate phre- 
nitis, should not be confounded with the slight manifestations 
presented in most cases of bilious fever. Head-ache, for exam- 
ple, will be found in the great majority of instances, but may, in 



1838.] Pathology and Treatment of Bilious Fever. 393 



many of them, be referred to some kind of sympathy implicating 
the nerves of the scalp which frequently becomes very sensitive 
to the touch, and in which the pain is certainly then located. 

The Pulmonic complication is still more rare than the last 
mentioned. Here the respiratory apparatus will be found more 
or less distempered ; pneumonia may sometimes be detected, but 
the mucous membrane of the bronchi is the most common seat 
of disease. .Respiration will be more or less impeded: expector- 
ation at first slight, but subsequently copious, and occasionally 
some soreness about the chest; coryza not un frequently exists. — 
This form usually occurs either in the spring, or very late in the 
season of our fevers, and is seldom fatal. 

I have thus far described the mildest forms of our fevers ; the 
simple complications of the original type. But there are double 
and treble complications, in which two, three, or more organs 
are simultaneously or consecutively diseased. If the diagnosis 
of the simple complications be well understood, that of the more 
numerous will be equally so, and consequently needs not be now 
dwelt upon. Indeed any considerations on these would lead us 
far beyond the limits assigned to this paper, for, the five forms 
enumerated, might, by various combinations, be carried to an 
immense number. The gastro-hepatic, gastro-enteritic, and 
gastro-entero-hepatic are by far the most common of the plural 
complications we encounter. 

Let us now turn our attention to the treatment of these affec- 
tions — We have already stated that neither of the above compli- 
cating phlegmasia?, alone or unattended with spinal disease, 
could produce the phenomena common to all the forms of our 
"bilious fevers," and we have furthermore stated the primary 
lesion to be that of the nervous centre, or, i 2 other words, of the 
spinal cord. If this primary affection remain uncomplicated, 
then we have a disease of the mildest form known ; one which 
retains its peculiar characteristics, its paroxismal form and its 
periodicity. In short, we have a plain case of ague and fever, 
such as we daily see. With these views of the pathology of our 
autumnal fevers, the treatment must necessarily be divided into 
that proper in the first or uncomplicated stage, and that required by 
the subsequent modifications, for, if the first stage be promptly and 
energetically met, the progress of the disease may be arrested. — 



3'J4 Pathology and Treatment of Bilious Fever. [Feb. 

So long as the nervous system is alone affected, our medication 
should be entirely directed to it, and such remedies used as are 
known to possess the most decided anti periodical properties. — 
Quinine, our most potent anti-periodical, should be given with 
a liberal hand during the very first intermission, and persisted in 
until the disease be vanquished, or its administration be prohibit- 
ed by the supervention of settled phlogosis of some organ, which 
fact will always be indicated by the continued form then assum- 
ed by the disease. It is as impossible that a complete intermis- 
sion should occur during the existence of inflammation in an 
important organ, as it is that the said inflammation should alter- 
nately invade and disappear suddenly from a tissue, without 
leaving any vestige of its existence, until the recurrence of ano- 
ther paroxism. Inflammations are always more or less perma- 
nent; they have their periods of progress, maturity and declen- 
sion well marked, and cannot suddenly disappear and reappear 
with intermissions of perfect health, as do our intermittent fevers. 

The action of quinine will always be most happily seconded 
by revulsive applications to the spine, which is frequently found 
painful on pressure or percussion. Indeed these will, alone, in 
many instances, be found sufficient to arrest the disease. For 
evidence of their very decided effect, I would refer to the inter- 
esting and able paper published by Professor Ford, in the sixth 
No. of the Southern Medical and Surgical Journal. 

But, although the treatment of our fevers at their onset, be of 
the utmost importance, the services of the physician are rarely 
requested before the localization of irritation in some organ of 
more or less importance. He is then called on to treat a disease 
much more unmanageable. Inflammation has supervened, and 
the whole antiphlogistic battery must be put in requisition. In 
so doing, however, too much care cannot be directed to the se- 
lection of agents. It is not a mere abstraction, inflammation, we 
have to combat ; but inflammation of special organs; audit is 
the neglect of this consideration which accounts for the wretch- 
ed routine practice inculcated in many works and followed out 
by the people at large. It is this neglect that causes irritating 
emetics to be given in the gastric form of the disease, drastics in 
the enteritic, and calomol in the hepatic, whether attended with 
increase or diminution of bile. 



1S3S.I Pathology and Treatment of Bilious Fever. 395 



The general action of the circulation must be reduced; but it 
must be brought down by those remedies best calculated to abate 
the local inflammation which keeps it up. Early and free de- 
pletion from the arm, from the spine, and from the vicinity of 
the affected or^an, will be proper in all cases ; emetics in all, 
save the gastric ; and cathartics in all, save the enteritic. Em- 
etics are most signally beneficial in the early stages of the hepa- 
tic and enteritic complications, not only by emptying the sto- 
mach, but also by their revulsive operation, and by the general 
relaxation and diaphoresis they induce. In the enteritic form, 
antimonial emetics should be avoided, from their strong tenden- 
cy to act on the bowels, and preference given to ipecac or lobelia. 

Of cathartics I cannot speak too highly in all those forms un- 
attended with enteritis. They, not only evacuate the contents 
of the intestinal tube, but also establish from this extensive sur- 
face an abundant drain, both depletory and revulsive. They 
unite all the advantages of local depletion and of the most pow- 
erful revulsives, a combination of results not to be obtained by 
any other medication. If energetically and repeatedly used, 
they may advantageously supersede the lancet, whose effect is 
merely depletory, whenever the intensity of the disease is not 
such as to demand a more sudden reduction of the circulation. 
In such cases their advantage will be explained by the fact that, 
if revulsion be added to depiction, the extent of the latter need 
not be carried so far, and, consequently, the resources of the 
system will be less impaired and convalescence rendered more 
speedy. Let the modus operandi of cathartics be properly un- 
derstood, and their high value will be justly appreciated. They 
excite to increased action and increased secretion the vessels of a 
great surface, situated in the proximity of and connected by 
vascular communication with the organs most frequently phlo- 
goscd ; the liver and stomach. Their derivative and depletory 
effects must, therefore, necessarily be immediately felt by the 
diseased organs : the morbid concentration of the fluids will be 
diverted from viscera, unable, from over-excitement, to relieve 
themselves, and directed to a surface prepared to throw off any 
superfluous accumulation. \ ion is often necessary in 

our levers, but it can never be carried sufficiently far to com- 
pletely subdue excitement, without seriously endangering the 
n 2 



39(3 Pathology and Treatment of Bilious Fever. [Feb. 

recuperative powers of the system. Hence the vast superiority 
K»f cathartic depletion in many cases, and their positive necessity 
in the great majority. 

In alluding to the treatment of "bilious fever/' it would seem 
unpardonable to take no notice of a remedy thought indispensa- 
ble by the great majority of our practitioners; a remedy which, 
according to them, possesses the wonderful property of adapting 
to almost every condition of thesystem and form of disease ; 
of all id regulating whether increased or diminish- 

ed, of correcting the tciting the al . 5, of 

equalizing the circulation, and, in short, of rectifying the iiuids 
and renovating the solids. An agent oi' such multiform 
virtues should certainly not pass unnoticed, in considering the 
treatment of any malady, and, especially, of that of which it is 
so generally regarded as the antidote. The limits of this paper, 
however, already extended beyond my original design, will per- 
mit but a brief allusion to calomel. I am, moreover, disposed 
to be brief, because I rarely use this agent in the class of diseases 
under consideration. If the excitement be great, I prefer more 
active depletory and revulsive means, and, when it is reduced, 
I still resort to antiphlogistics of a milder and less objectionable 
kind, confident that the secretions will be restored and the cir- 
culation equalized, without calomel, whenever the organs are 
restored to their normal condition. If experience be appealed 
to, I will fearlessly challenge a parallel of my success, with that 
of the most strenuous advocate of the mercurial medication, and 
endeavor to prove that "bilious fever" may, in genera], be more 
readily and more safely cured without, than with calomel. 
The above remarks, hastily thrown together, in reply to a 
I for discussion by the Medical Society, are ne- 
>id of those r s and acknowledgments usual- 

n an elaborate treatise. They contain the simple 

,! the subject of debate, and arc not in- 
claim to originality than may be 

:, ui liar with the literature of our pro- 

P. S j aarks on the use of 

calotni I, in Lhe above article, have U en misunderstood by som< 



L838.] Pathology and Treatment of Bilious Feper. 397 



of those present at the meeting of the society; 1 will be more ex- 
plicit. 1 have stated that "I rarely use this agent in the class of 
diseases under consideration/' and not that I never use it. Nor 
is my objection to it founded on the belief that it is an irritating 
or drastic remedy. So far am I from entertaining this opinion, 
that I give it the decided preference in such rases, as are attended 
with a disposition to enteritis, and whenever I wish merely to 
evacuate the bowels, without incurring the risk of occasioning 
debilitating purgation. Hence it is peculiarly adapted to the 
last stage of our fevers, and not to the early, when active deple- 
tion is requisite. In the last or convalescing stage of tire hepatic 
form of the disease, when excitement has been fully subdued, it 
may also have some tendency to relieve the liver by exciting it 
to secretion, but whether this be done by a specific action or mere- 
ly by revulsion on the contiguous duodenal surface, is yet a 
matter of doubt with me. My principal objections to its general 
use are, in the early stages, its want of energy, and in the latter, 
its strong tendency to produce salivation with its frightful con- 
sequences. None but those familiar with the practice in our 
southern and south-western states can form any idea of the ha- 
vocs of this useful but much abused remedy. It is scarcely cre- 
dible, yet 1 have ascertained the fact by special inquiry of our 
druggists, that there are annually vended in this small city no 
less than one thousand pounds of calomel, besides a proportion. 
ate quantity of blue pill mass, mercurial ointment, corrosive sub- 
limate, &c. ! — Is it then surprising that the steamers, the vegeta- 
ble quacks and nostrums of all kinds should find countenance by 
those whose loss of teeth and shattered constitutions have warn- 
ed them against the abuse of mercury ! 



39S Case of Fistula cured by Coffee, [Feb. 



ARTICLE II. 

Case of Fistula cured by Coffee. By .VI. Anthony, M. D. 

J. S. C, aged about 40, of medium stature, black hair and 
eyes, round make and active in body and mind, between 3 and 4 
years ago became afflicted with hcemorrhoidal tumours. The 
swellings were soon very painful, and were chiefly within the 
sphincter ani ; soon however, tumours arose as usual around 
the verge of the anus. The swellings were never as large as 
they are m many cases, but were so painful that on the failure 
of other ordinary applications, he was compelled to resort to 
warm bathing of the part almost incessantly for keeping the 
extreme pain in moderation for the present. The symptoms, 
after being palliated for a while, readily returned on taking 
cold, or on any cause of the slighest morbid excitement. After 
a few months, an aching induration was observed, extending, 
along the cellular substance on the right side of the anus in the 
direction of the ischiatic tuberosity, to the extent of about one 
inch ; at the outward extremity of which there appeared in the 
superficial integuments a little pimple, which finally opened 
and discharged a small quantity of matter. Soon after this, the 
subcutaneous induration on that side of the anus shrunk away 
until it appeared like a small cord about the size of one's little 
finger, and the hcemorrhoidal tumefactions all around the anus 
disappeared, except one small point on the left margin. This 
remained, subject to some 1 swelling and tenderness on any unu- 
sual excitement, but ordinarily »m pain or peculiar sensi- 
bility : only exhibiting the appearance of a small shot under the 
integuments of the part. Meanwhile however, the littleopening 
on the right continued steadily to yield a small discharge, not 
exceeding probably, half a I iful a day. The opening 
was so minute as barely to admit the end of a common probe. — 
This was however, used in the examination, and an incomplete 
fistula found, which was about one inch in depth. 

After inspection by a physician, it was operated on, so as to 
divide the septum between tbe sinus and the anus. After this 



L838.1 Case of Fistula ■ 399 



operation, the incision was regularly dressed bythe interposition 
of lint, etc. It soon healed, leaving a superficial ridge in the 
direction of the sinus, and a considerable tumefaction within. — 
After a few weeks the sinus again opened at the outward end of 
the incision. This opening continued to discharge about as h 
did before the operation. 

Mr. C. was as before stated, a very active man in business, 
often riding on horseback, and often walking much: All these 
habits have continued regularly to the present time. About 
three months ago he took boarding at the private boarding house 
of a relative, where he was served every night at 9 or 10 o'clock 
with a cup of coffee — about three gills in quantity. Mr. G. had 
been habitually a tea drinker at breakfast and supper. Thus 
continued the fistulous opening until three weeks since, when, 
having remarked that he felt no inconvenience, and that his 
cloathes had ceased to indicate any discharge from it, he then 
examined, and found that the fistulous opening had healed, and 
the eschar in the direction of the cut, shrunk below a level 
with the external integuments, whilst the cord within had en- 
tirely disappeared. 

The coffee used by Mr. C. was a cheap West India, and was 
kept standing in a tin coffee-pot from supper until 9 o'clock at 
night. 

Notwithstanding this is a solitary case of the kind, there is 
much reason to believe that it stands as a demonstration of the 
curative power of coffee in such a case. 

And whilst it is admitted that the recovery, and the use of the 
coffee, an unusual article of diet with this individual, may have 
been a mere conjunction of circumstances, or a coincidence, hav- 
ing none of the relation of cause and effect, still, observations on 
the use both of tea, which this patient had habitually used, and 
coffee, which was accidentally adopted, tend to encourage the 
idea that the use of the coffee was the cause of recovery from the 
fistula. 

Almost every mother has observed the different influences of 
tea and of coffee on the function of lactation ; and mothers 
abounding in excess ol this secretion have found that the liberal 
use of coffee has not only failed to produce, like tea, an increase, 
but on the other hand has with great uniformity tended to les- 



400 Case of l\ hy Coffee. [Feb. 



sen the quantity. So well observed has this fact been, that 
nursing women wishing to dry or to lessen their lactation have 
learned to adopt the use of coffee as a diet ; and on the contrary 
to live liberally on tea when they desire an increase. The fact 
of the influences of different articles of diet on this function, 
none will be disposed to controvert. If this be a fact, why may 
not this opinion among the people, founded on the observation of 
facts, relative to the use of tea and coffee be correct also? If 
this opinion be founded in fact relative to the use of coffee hi 
genera], it is by no means less probable, if not more so, that the 
use of the Cuba or Jamaica coffee 1 , much stronger in the peculiar 
powers of that article, is calculated to produce signal effects. 

It would be well for physicians to institute a course of exam- 
ination on this subject, which may enable them to determine if 
this article, in such universal use as a beverage, whilst its mod- 
erate use is both wholesome and agreeable, is not at the same 
time so medicinal as to entitle it to a place amongst the articles 
which promote absorption. Or, if they should not find thiib idea 
confirmed by observation, they may ascertain that as an article 
of diet, it is mainly valuable on account of its peculiar stimula- 
ting powers, and that it, apart from the sugar and milk com- 
monly used with it, is not calculated to afford nutrition. And 
on the other hand, they may find, what is probably the fact, that 
India tea with the usual accompaniments is both exhilerating by 
virtue of its peculiar stimulating power, and either fails to pro- 
mote absorption, or contributes more or less liberally to the end 
of nutrition. Observations in point may be made by investiga- 
ting the habits of diet of patients laboring under hceinorrhoidal 
or fistulous afflictions. The same may be extended to lactating 
females, dropsical persons, &c. 



Remarks on Snip kale q) ine. 40 I 



ARTICLE [II. 

Remarks on Sulphate of Quinine. By M. Antony, M. I). 

In the last number of this Journal we noticed the cure of a 
periodical hemorrhage by the Q,uinine: remarking at. 

thesame time, ma , not forthe purpose of having 

it immitated, but with the inten to it on a future 

occasion. We now proceed to give below the remarks which, 
but lor want of time, would have been appended to that article. 

Formerly cinchona was looked on as a kind of specifick for 
intermittent fevers ; and so, from its power of often arresting that 
form of disease, it may well have been. Now it has passed into 
disuse ; its place being occupied by the same active principle in 
the more elegant and convenient form of Sulphate of Quinine. 
As experimental medicine progressed, the important fact was 
discovered, that other afflictions, observing like periods with 
intermittent fevers, were but these in disguise, and could, with 
equal ease, be arrested by the same active principle. Amongst 
these afflictions were periodical hemorrhage, periodical head 
ache, rheumatism. &c. &c, and hence the Quinine, in the early 
days of this article, obtained some celebrity in France for the 
cure of Megrin ; and the French-American citizens who, from 
fear of calomel here, had become subject to sick head ache, were 
occasionally found returning from France with a parcel of Qui- 
nine powders, under the name of Megrin Powders. It is easy 
to conceive of very efficient causes of the perpetuation of this 
practice, however unreasonable in itself it may be. Most of the 
observations published on this subject, whether in periodicals or 
in standard works, have been the productions of cold climates, 
by the tonic effects of which, together with the less confirmed 
nature of those hepatic derangements in the higher latitudes, 
the system has, more frequently than in the south, possessed an 
energy sufficient to regulate the functions, the derangement of 
which had been the predisposing cause of disease, so soon as 
the peculiar morbid actions and phenomena, which constituted 
the i of dis< *3 By the ie greater 



402 Remarks on Sulphate of Quinine. [Feb. 

resources of nature, and the less degree of predisposition, there- 
fore, the sequela; which, under the other circumstances that 
obtain in warm or tropical climates are found to follow, have 
been prevented. Observers, however minute and accurate, 
have not probably therefore, had occasion to witness such fre- 
quent sequelce as jaundice, chronic hepatitis, bilious colics, dis- 
pepsia, dropsy, &c; or if these have followed, it may have been 
at so much later a period, that the previous form of disease had 
been lost sight of, and they have been (improperly enough, no 
doubt,) attributed to other, and more recent causes. Such over- 
sight, we may conclude, is very easy, when we remember how 
common it is for the most serious hepatic derangements and 
disorganizations to arise and continue for a long time, without 
even the suspicion of the patient, or of his physician. Such 
results are, in consequence of the low sensibility of the liver, 
not so uncommon as may, at first thought, be supposed. An 
illustration of this fact may be seen in Faitiiorn's treatise on 
the liver, in which a case is given of an enormous quantity of 
vitiated secretion, perhaps ten or eleven pints, being found in 
the biliary vesicle, and still the hepatic disorder had not, for a 
great while, been suspected by the patient or physician. But 
we need not go so far for an illustration : Every man's practice 
in a bilious climate, would afford to the close and experienced 
observer, perpetual demonstration of hepatic derangements, far 
beyond what might be suspected from any conspicuous external 
evidence. 

We have intimated that the practice of resting the cure of 
bilious intermittents on Quinine, or on bark alone, is unreasona- 
ble. We repeat that it is so, however well that practice may 
comport with the fancies, or the high authorities of the present 
time. Reasoning apart, facts demonstrate this truth ; but facts' 
must be observed, before they can be known. To reason ab- 
stractly on this point in therapeutics, would require space not 
afforded in this place ; and would demand the arraignment of the 
high-sounding theories, at present too much in vogue, and their 
subjection to a little sound logick — very little of which would 
be sufficient to shew that they are founded, 1st, On the subver- 
sion of cause and effect ; and 2d, On assuming the production 
and continuance of effects^ without competent causes. Under 



1938.] Remarks on Sulphate of Quinine. 403 

such circumstances, the quinine may only be expected to act 
on some of the effects of the combined predisposing and exciting 
causes, so as to produce a metastasis, leaving diseases far more 
serious, in their ultimate tendencies, than the primary form; for 
the intermittents should be considered the primary form of the 
whole train of abnormal phenomena, but the antecedent of those 
sequelae, which too often beset the patient, after a cure of inter- 
mittent by means only calculated to change Xheform of disease. 
But what are the facts to which we have alluded? Forty 
years ago, Jesuit's bark and port wine, red bark, Huxham's 
tincture of bark ; and, in some obstinate and inveterate cases, 
the shower bath, or the ague drop,* were almost wholly relied on 
for the cure of intermittents ; and what were the consequences ? 
Dyspepsia, with diarrhoea, or obstinate constipation, bilious colic, 
cholera morbus, jaundice, chronic enlargements of the liver and 
spleen, with general inturmiscence, and a long train of nervous 
symptoms, called by the common people, -cachexy- ; and 'cachexy 
drinks' were got up in turn for their cure. These were common- 
ly made of chalybeates, as sulphate of iron in water, acetate of 
iron, made of vinegar and iron, steel dust, scales of iron, &c. in 
powder or electuary — these, with some diuretic vegetable, when 
any oedema was observed, were next administered. This was, 
however, often six or twelve months after the primary form of 
disease had been changed ; and who then ever thought but that 
these were new diseases, entirely new, without the least connex- 
ion with any other. It was thought a very hard, though com- 
mon case, that a new, and more formidable disease, should attack 
the patient so soon after recovery from another — the previous in- 
termittent. The ' cachexy drinks,' used for these secondary dis- 
eases, had generally the effect of giving a little more energy to 
the appetite and the digestive powers for a time, which did not 
fail to perpetuate confidence in their use, until at length, another 
new disease supervened, which was called 'dropsy,' having, like 
the former, no obvious connexion with the antecedent series of 
evils, and to which the patient was most commonly, after all, to 
succomb. It was often impossible that he should withstand 

* Fowler's Solution of Arsenic, was, at tiiat time, ague drop, as Uuinine Solu- 
tion has since been. 

c 3 



404 Remarks on SulphateDf Quinine. [Feb. 

such a succession of the worst of ills — a new one always suc- 
ceeding the cure (as he thought,) of the former. 

Notwithstanding all this error in the history of disease, and 
the pathology too, it was indeed sometimes the case, that this 
energizing plan of treating what was called the 'cachexy,' (and 
which was nothing more nor less, than the assemblage of those 
symptoms which attend chronic visceral obstructions,) was found 
to impart such healthy vigor to the system, (as we have said, is 
sometimes done by colder climates.) as to enable it, by this re- 
newal of its energies, to perform the necessary elimination of 
noxious predisposing or perpetuating causes, so as gradually, 
but ultimately, to restore the system to good health ; especially 
with the help, which was ordinarily looked to, the invigorating 
and purer atmosphere of winter. But no old scientific and un- 
prejudiced practitioner, can now be found — (alas, few have 
withstood the practice of those days,) who observed the progress 
of diseases forty years ago. but can testify, that he then saw twenty 
or more cases of dropsy, from visceral obstructions, where he did 
one, ten years ago ! And Bulimia, and its kindred forms of dis- 
ease, which were then, almost as common as hernia is now, are, 
at the present day, rarely seen, at least, in the same location. 
And to what may this comfortable change of the lot of humanity, 
in the southern section of country, be attributed ? In order to 
answer this inquiry, let us look for a moment at the history of 
the pathological and remedial departments. 

Thirty yeare ago, calomel, with all its evils, became the com- 
mon-place medicine in families; and it was soon the case, that 
it was rare to find a family throughout the country, without an 
adequate supply ; which, by the way, we should remark, is an 
article that ought, elf, and humanity, never to be 

administered, but under the sound judgment of a competent 
medical man. Bui I vith all its evils, we say, 

which were not a littl by the combination of jalap, 

being brought inl :e in less- 

ening livers and an Dr. Rush's lancet did, in the 

treatment of fever in Phila ; and which was indeed, noth- 

ing mor?- nor less, than li is This medi- 

cine, in lessening, or rather prev< nting, I | ermanent visceral 

obstructions, lias likewise prevented their almost certain etfects, 



1838.] Remarks on Sulphate of Qui?ii?ie. 405 

in all their variety. And the dirt-eater, who was then soundly- 
castigated for the correction of this loathsome practice, when 
forsooth his father or his physician should have been, is now, if 
found at all, speedily cured by a due course of visceral correction. 
This is mainly effected by the occasional use of slow mercurial 
purgation, and a change of location to an atmosphere less dele- 
terious than those which continue perpetually to renew the pre- 
disposition to bilious disease. 

It will not be denied that bark, quinine, and other tonics, and 
counter stimulants, have, in injudicious, as well as judicious 
hands, cured bilious fever ; but the cases are rare in which these 
cures, if they may be so called, are not followed by more or less 
troublesome or dangerous sequelae. But the cases in which 
they have not, have, we think, been more common under do- 
mestic, than under physician's presumptions: and why, but that 
in domestic practice, the solution being looked on as the ague 
drop, its use has been often adopted, at the first intermission of 
fever ; whilst, on the other hand, the physician was rarely called, 
until the force of the disease had been for days impairing more 
and more the healthy condition, and functions of particular 
organs, and of the constitution generally. Those cases only 
will be found to yield to this course, and be followed by good 
health, wherein there are good reactive energies, competent, 
when the peculiar effects of the exciting cause are removed, to 
overcome finally the task imposed I fault of healthy 

function, and thereby remove ; predisposition. And 

this result will be the more pro! sted by the early 

accession of cold weather, removal to colder climates; or a per- 
petuation of tonic edect. until this auxiliary is available. But 
such is not in I, nor can be the tact, in regular practice, 

in safety from secondary diseases, worse than the primary, until 
physicians become to be called at the very onset of the disease : 
and only then, with energetic 1st it is well known, 

that these are not the most frequen cts of this disease, but 

the contrary. Let us suppose c of some, or several 

of the organic derangements, attached to, and made by some, 
the chief nature of biliou . Is it not, according to one 

notion, a phlogosis of the both ; or ac- 

cording to others, that of the cerebral, or the spinal centre, or 



406 Remarks on Sulphate of Quinine. [Feb. 

both ? These are contended for by some, as cause, by others, 
as concomitants ; and may be more reasonably by others again, as 
effects. But as to this, it matters not. Suffice it to say, that some, 
or all of these, do often exist with bilious fever, and make a 
part of its pathological nature, or condition. How then, can a 
direct and powerful tonic be admitted with this nature ? The 
stomach will reject it, the intestines will pass it off cathartically, 
or it will give headache, vertigo, &c, and aggravate the febrile 
and inflammatory actions. But Quinine and other tonics do, 
in good constitutions, arrest the progress of the present type of 
disease. It, therefore, follows that these local derangements do 
not exist, either as causes or concomitants, in the beginning 
stages of bilious fever. It is true, that these, or some of them, 
do not unfrequently complicate, and give varieties to bilious 
fever of any of the usual types: but it follows in course, that 
when this is the case, the patient is not a suitable subject for 
the tonic treatment, as will be found on experiment ; until 
the case is reduced to the simple state of bilious fever, which 
primarily existed; or the inflammatory phlogosis, so overcome 
as to exert but a local and partial influence, and allow, without 
detriment, the general action of the tonic. But these concomit- 
ants, or secondary phlogoses, are not all the difficult secondary 
lesions, whose natures are opposed to the action of tonics. Ma- 
ny others may, and do arise, and there are none so uniform, in 
genuine bilious fever, as either a phlogoses, or a functional tor- 
por of the liver, and the consequences of either of these on the 
spleen, &c. all of which alike forbid the hope of prompt and 
permanent benefit from the use of tonics. Indeed, the hydropic 
disposition finds here its principal causation ; and here, likewise, 
is the origin of most of the chronic nervous derangements. 
which so often follow tlie un philosophical treatment of these 
febrile diseases. 

It will be asked then, how does quinine, or the other tonics : 
or cutaneous exciters, as sinapisms, blisters, stimulating embro- 
cations to the surface, &c, ever cure bilious fever, if not by sup- 
porting the nervous energies, or deriving action from the seat 
of phlogosis, to the surface, and so forth ? We will answer, that 
they do operate by imparting that energy to the whole system, 
or to certain parts, whereby they are enabled to resist the acces- 



1S3S.] Remarks on Sulphati of Q 



sion of the introductory features of the bilious ; for 

it is not the stomach, nor the intestines alone, on nics 

act, nor the surface over the spleen, or the epiga: trium alone, 
on which the counter-stimulant powei it the wrists, the 

legs, the thighs, and many other parts, with equal benefit. So, 
also, will a stimulant draught, or an anodyne pill — so, likewise, 
the cobweb, than which, there is not to be found a surer iuter- 
cepter of bilious chill : and these two last, operate on very differ- 
ent principles, from simple stimulants and tonics. Again, we 
find that mental, as well as corporial impressions, as anx 
fear, surprise, anger, joy. and indeed, almost any thing; which 
shall counteract the tendency of disordered nature to bring 
around her train of morbid actions, may be used with a good 
degree of success, for the interception of bilious chill. Bi 
this is elfeeted, we have gained nothing but the overcoming the 
exciting cause ; the systemin genera!, as well as some particular 
organs, being left with all their original predisposition, and that 
actually increased bv the past existence of febrile paroxisms. 
For when these periodical actions are suspended, every one 
knows how easy it is, by subjection to the action of debilitating 
causes, at the period for the bilious chill, or even at some other 
period, to cause its return. 

A close observation of nature should be sufficient, whether 
it have the effect or not, to convince the most skeptical of this 
one fact, that there is a bilious chill, and a bit ions fever, of char- 
acter, type, and nature peculiarly their own. These peculiar 
characters should be familiarly understood by every practitioner. 
They are effects in direct and proportionate relation with the 
several causes concerned in their production, and like all other 
effects whose removal or prevention is desirable, call for reme- 
dies which are in good proportionate relation, in power and kind, 
with the noxious causes. This view cannot fail to reveal the 
nature of the deficiency which attached to the plan of cure 
above examined. We have seen that its tendency was at best 
only calculated to bring back the system to its state previous to 
the effects of the exciting cause — leaving it, however, with its 
predisposition, aggravated by febrile paroxism. Here then is 
the great error ; the obvious symptoms which certify plainly the 
existence of disease are overcome, but a fatal predisposition is 



tlphate of Quinine. [Feb. 

still I thus increased, to work out its disordering influ- 

nidation. The resulting phenomena will vary 
as exactty ir; proportion to the unity or the combination of mor- 
bid force; ,„ the production of then- effects, as in the direction 
o' « moving body from a single force, or a combination of for- 
,; ■ as m a ehe mical process in which sub. super, and neu- 
tral salts vary m proportion to the proportionate relation of the 
influencing ,■ or as a tripple sak m(]st be ^ ^ q{ 

certain otheK additions to the causation. In the first of these 
illustrations, if the single force be allowed to operate, the body 
ilfed thereby will move in a direct line wit!, that force • any 
rceptmg means must then : : : so in this same direction 

Mt te , nds U <j te »aHy different from those resulting from 

coummat.ons of . iUj in , Jl0 other illuEtr J ion , 

S ' Sl ' rei ' n a metallic salt will differ in its 

l n,m ' Ca 01 rencies, according to the circumstances of 

the coml : and ail these, again, vary exceedingly in their 

T ,f SUhm S P ! '« from t!ie chemical or physical powers of 

'b'ple elem mts of which thev were composed. The acids 
i or metals, have their own appropriate phe- 
nomena proportionate, in kind and extent, with their powers as 
ad their effects and to intercept their powers, then 
we may look lor brent phenomena, and meet them with 

agent, winch bear a reasonable relation to the natures of the 
•' a,! ' : e expect to correct an alkaline element 

•' n;l alkal,ne a S ent , merely because it would neutralise the 
d in the formation of a salt with that alkaline ele- 
' that the treatment peculiarly adapted to the 
ting cause, must correct also the predispos- 
ing- Ls the alkali, in this case, uncorrected, would continue to 
7" :v ' ;■ :li ™^™<* "> <"' the future chemical process, without 
t..e iimuence of its proper corrective, so does the predisposing 
cause of fi ver continue to work out its peculiar phenomena 
which are only correctable by proportionate means. The pre' 
d,Sr ' ; ' : '" ;,! ; * correction, as well as the exciting 

I the cure is incomplete, and never effected, unless by 
"P ■■"""'■< <>f nature, if this be ,|. And here is the 

pla<e for expec.anusm. When it is clearly evident that the 
tircesol the system are sufficient for the correction of the 



1S3S.1 Remarks on Sulphate of Quin 



morbid predisposition, tliis correction may be left tl 
no less sound judgment is necessary in determining this ] ■ 
than in determining the use of mercury or of arsenic, for it is 
not less dangerous to leave a work for nature to perform, out of 
proportion to her powers, than it is to give a powerful : 
not proportionate to the exact demands of the case. But when 
it is not clearly evident, that the system is capable with its 
own resources to he entrusted with the correction of predis- 
position, it should of course not be more readily confided to 
than to any other inefficient agent. Nor is it so often (he case 
as the friends of expectantism may be inclined to think or to 
hope. This truth is evident, not only in the observations of 
nature in such cases, but it may be logically established with 
great precision, thus: — 1. Here is a given human system in 
health, consequently in possession of all its natural physical and 
moral endowments. 2. Here are predisposing causes of bilious 
disease. 3. Here remark that, notwithstanding the primary 
good health in all respects, predisposition or a predisposing state 
of the system supervenes, proving the power of this cause to 
invade fhe system in defiance of all its vires naturae medicatrices 
in full perfection. 4. An exciting cause is applied, and the 
phenomena of a bilious fever developed, as the legitimate result 
of the action of these causes in the system. 5. The influence 
of the exciting cause is overruled by a powerful tonic, as qui- 
nine, steel, arsenic ; leaving the system with its predisposition 
actually aggravated by the existence of febrile paroxism ; or, if 
you please, without this aggravation. In the sixth place we 
will ask, how, if the law be true, which nobody disputes, that 
similar causation in all respects must be followed by like results. 
how, we ask, if these things be so, can it be possible for the 
resources of a system — the vires medicatrices, undoubtedly im- 
paired by the actual invasion of disease, effect the final extermi- 
nation of a cause whose invasion it could not. with all the 
advantages of fine health, prevent? As well might we expect 
the physical resources of a country might conveniently expel 
her invaders from her centre, after being beaten down and pros- 
trated by their superior force, when, with all preparation, and in 
the fullness of her powers, she could not at first repel the inva- 
sion. But if she form allies of sufficient power, she may be 



410 Remarks on Sulphate of Quinine. [Feb. 



expected to effect the expulsion, and restore the commonwealth 
to peace and safety. Just so is the reasoning in the case of the 
predisposition. Remedies only which can measure powers with 
the invader, will be able to secure the desired renovation of 
perfect health: whether they be such as shall increase the natu- 
ral energies permanently, and lessen the application of predis- 
posing influences, as winter, a better climate. &c, or such 
as shall more directly attack and exterminate the enemy by a 
physical force competent to the end desired. 

We will remark here, in conclusion, that periodical hemorr- 
hage, as here related to. is an accident, so far as its cause is con- 
cerned, of the same nature as topical congestion ; and is indeed, 
nothing more nor less than the effect of topical congestion in the 
part whence the hemorrhage comes, which is a part easily re- 
lieved by spontaneous topical depletion; or in some more distant 
part which cannot be thus relieved, but which determines an 
unusual afflux to the part which becomes the seat of hemorr- 
hage. Its cause is, therefore, the same with the cause of conges- 
1 ions, infarctions or engorgements of the spleen, stomach, 
intestines, and the parts generally whence the portal branches 
originate, as well as of the great nervous centres. These, 
however, are, like the hemorrhage, secondary, and have gener- 
ally for their cause, obstructed hepatic circulation, with conse- 
quent induration and tremefaction of liver and spleen — fruitful 
sources also, of those gastric and intestinal inflammations, 
which have received the names of gastrite and interite, so 
commonly believed to arise in bilious pyrexiae ; as well as the 
spinal congestion and irritation, which affords such a distressing 
variety ol* neuralgic symptoms. 

These hemorrhages are generally from the nose, lungs, stom- 
ach and intestines, hemorrhoidal regions, or the uterus. These 
parts are easily relieved temporarily, by spontaneous depletion. 
Not so with the spleen, mesentery, spinal and cerebral cen- 
tres, &c. Now, we consider all these caused by an unusual 
determination to, or retention of blood in them, in conscqence of 
some obstruction to its wonted and important circulation through 
some other parts of its route. The primary seats of dangerous 
obstructions, are generally theliver andthe uterus. This brings 
us to the point we had in view. No one will contend that 



1S38.] Report on the Radical Care of Hernia. 411 



Quinine is possessed of those deobstruent powers, which should 
justify our trusting to its operation for the removal of these 
primary visceral, or organic obstructions — now to become, unless 
removed, the cause of numerous sequelae, such as congestions 
in various parts, with or without irritations, hemorrhages, lym- 
phatic obstructions, &c. What then, we would enquire, is it 
calculated to do 1 Only, at best, by meeting the demands of the 
exciting cause of that state, with some energising influence, to 
change the periodic exacerbational tendency, and thereby check 
t n prj33it for/n )f t n.l:>)i^ ; and leave caii3S3 present, and 
still in operation, to prod ice their more serious effects, on other, 
more vita!, and less relievable parts. Hence then, a dread- 
ful train of afflictions too often follow, not all in the same case, 
but some of them sooner or later, in almost all thus treated; 
amongst which, we may name hemorrhois, fistula, follicular 
ententes, bronchitis, dyspepsia, constipation, diarrhoea, colic, 
hepatic derangements, with all their consequents; spinal irrita- 
tion, with all its numerous afflictions and mischiefs, &c. 



PART II. 
REVIEWS AND EXTRACTS. 



Report on the Radical Cure of Hernia. Extract from the Mi- 
nutes of the Philadelphia Medical Society. April 29th) 1S37. 

The valuable paper above named, is contained in the Amen 
can Journal of the Medical Sciences, for Aug., 1837, and should, 
injustice to its merits, have been noticed last year ; but we have 
rested in the hope of being able to see a specimen of the im- 
provements of Dr. Chase, that we might exercise a closer judg- 
ment on their merits, than we could by merely reading the 
n 4 



412 Report on the Radical Cure of Hernia. [Feb. 

several reports, and Dr. Chase's book on the radical cure of 
Hernia. We regret that although we have made no inconsidera- 
ble effort to effect that end, even to the present time, the truss of 
Dr. Chase has not, so far as we arc able to learn, reached the 
shores of Georgia. Dr. Chase's treatise on the radical cure of 
hernia, with a valuable essay by the same gentleman, which 
appeared not long since in this Journal, intended to guard 
against ^ho abuses of the truss, together with the preliminary 
report of the committee of the Philadelphia Medical Society 
afforded satisfactory evidence of the valuable talent concerned 
in the improvements and the examination of the same. And the 
final report, the document now before us, is as satisfactory and 
conclusive as couM be desired; still, in noticing the article, we 
have hoped to be able to speak from observation, in addition to 
the extensive and satisfactory evidence of the worthy committee, 
on the subject of this valuable improvement. We feel unwilling, 
however, longer to delay laying before the profession, a brief 
notice of its merits, as contained in the final report of the patient, 
persevering, faithful and talented committee. 

It will be recollected, that as lon^f asm as the session of the 
Philadelphia Medical Society in December, 1834, Drs. Coates, 
Parish and Ashmead were appointed a committee for the 
investigation of the merits of Stagner's Truss, and other 
proposed means of radical cure of hernia. This committee 
have faithfully labored in the premises, with experiments and 
observations on numerous cases in point, until the 29th of last 
April ; an instance of persevering zeal, industry and faithfulness, 
highly creditable to the gentlemen who compose it, and meriting 
the obligation of the community. After laboring one year in 
the discharge of the duties assigned them, they read a partial, 
or preliminary report to the society, at the sessions of the 5th and 
12th of Apri', 1835.. This preliminary report was published 
in the xvii. vol. ofthe American Journal of the Medical Sciences. 

In this preliminary report, aluahle conclusions were 

arrived at, which were all important; for the investigations seem 
to have been pursued with great care and accuracy, and the con- 
clusions not hastily drawn. Amongst the most important of 
them, we will name the following: — 

1. -That the nn-t ;< apparatus, is that which 

affords the strongest probability of radical cure; and that long- 



183S.] Report on the Radical Cure of Hernia. 413 



continued or considerable irritation in the parts, 'as contended 
lor in the use of Stagner's truss,' so far from being an advan- 
tage, in reality, opposes the successful treatment; that there are 
no tacts in 1 >n which tend to prove indisputably, 

that even slight irritations of the superficial tissues are trans- 
mitted to th of the abdominal muscles in such a man- 
ner as to accelerate the cure ; and that radical cures are some 
times effected without any other irritations than such as are 
altogether fugitive in character." 

2. "That the retentive power of .solid blocks exceeds, cceteris 
paribus, by considerable difference, that of pads composed of soft 
materials." 

To this, the final report adds, that " The whole current of 
the evidence since presented to them, most fully substantiates 
the corrrectness of this position ; as the number of cases has 
been large in which the various instruments with soft pads, 
have failed in effecting 1 accurate and permanent retention, and 
in which the more perfect apparatu leeks of proper form, 

have been substituted with complete cuccess." 

The committee have demonstrated, in their various investjga- 
gations, the impropriety of substituting even "firm, but elastic 
materials, for the absolute solids in the construction of the arma- 
ture of trusses: and the inadmissibility of caoutchouc, as a 
direct and permanent application to the skin," they consider as 
established by the well known fact, that "the irritating effects 
of this substance are so well known in the neighborhood 
of the caoutchouc cloth manufactory near Philadelphia, that it 
is extensively employed there, as a popular remedy in cases of 
chronic rheumatism." 

We remark, in passing, that this observation, relative to the 
fact of the irritating powers of caoutchouc, having brought it 
into popular use as a remedy in chronic rheumatism, is a valua- 
ble corroborative of Dr. Chase's essay on the caoutchouc as an 
endermic application for the purpose of counter irritation.* 

Excluding much of their investigations from the report, by 
their conclusions, that the most retentive means offered the best 
promises of cure; and that absolute solids offered the best arma- 
tures for effectual retention, the committee next proceed to 
consider onlv "the r rith solid blocks, now in use or 

recommended by inventers." These, they •• divide into twa 
classe 



9outhera Medical urnal, vol i. p 663 



414 Report on the Radical Care of Hernia. [Feb. 

"1. Those which are constructed for the express purpose of 
producing irritation, in order to effect a condensation of the skin, 
cellular tissue, and the fascia supreticialis, or the abdominal ten- 
dons about the hernial orifice, into one common mass of adhe- 
sion." 

" 2. Those which are designed to secure the constant, perfect 
and safe retention of the bowel, without the attempt to create 
intentional irritation in the parts pressed by the instrument." 

"The first class includes the truss of Stagner, and the various 
apparatus of Dr. Hood, for the treatment of common inguinal, 
ventro-inguinal, femoral and umbilical hernia; also Price's 
and Sample's improvements, of conoidal truss-biocks of lead, 
tin, and other metals." 

" The second cla=s contains the old and well known instru- 
ment introduced to the notice of the society by Dr. Perrine, 
during the debate which followed the presentation of the prelimi- 
nary report, in 1335. Tne specimen presented to the society 
was armed with a wooden block; and since making their pre- 
liminary report, the committee ascertained the fact, of which 
they were not before assured, that th j , wooden block had been 
in use twenty years, and probably for a much longer period 
before its improvement by Mr. Stagner. This class also 
embraces all the instruments invented by Dr. Chase, which are 
five in number, it will be spoken of in detail hereafter." 

"The arguments of the committee on the first of these classes, 
naturally arrange themselves under two heads. 1st. Comments 
upon the supposed establishment of adhesive inflammation; and 
2ndly, an estimate of the retentive power of the apparatus." 

On the first of these topics, the committee, after many, patient, 
and fair experiments and observations, necessarily conclusive in 
their nature, came finally to the following unavoidable result? 
that they "feel compelled to regard these facts" (their own 
experiments and observations.) "as conclusive against the truth 
of the doctrine, that the trusses, or blocks of the first class 
produce a real condensation of, or adhesion between the skin, 
the sub-cutaneous cellular tissue, and the fascia snperficialis, or 
abdominal tendons." They "therefore entertain decidedly the 
opinion, that the hypothesis of condensation and adhesion is 
mtenable." 

On this subject, the committee go further ; and being, very 
properly, unwilling to give heresay evidence, they give an in- 
stance which came under their own observation, (case xii,) veri- 
fying their fears that the continuance of the pressure of this 



1838.1 Report on the Radical i Urmia. \\ 



first class of trusses, might endi itegrity of the tendons 

themselves. In this case, this result had actually taken place; 
and the patient was still, at the time of the 6nal report, under 
treatment for this serious misfortune. While the bowel is, 
however, perfectly retained by one of Dr. Chase's large ventro- 
inguinal trusses, time alone can determine the ability of the 
the tendons to recover their original structure. 

The committee next '-proceed to examine the retentive power 
of the trusses of the first class, so far as this subject remained 
unfinished in their preleminary report ; alledging, at the same 
time, that whatever of retentive power trusses of this class may 
possess, to it alone is attributed the good attendant on their use. 
This brings us to the 2nd, and last head under which the argu- 
ment on the first class of trusses was arranged. 

For the purpose of testing the retentive power of this class pf 
trusses, the committee have again labored with great patience, 
fairness and perseverence, alt of which, together with their rea- 
sonings on the subject, result in the following conclusions: — 

" 1st. That the trusses of the first class d o not secure the 
complete permanent retention of the bowel with all the certainty 
which may be obtained by mechanical means/' 

"2nd. That although it is extremely probable that radical 
cures may be occasionally effected by the use of such instru- 
ments, it has not been proved that the success following their 
employment, exceeds that which has been obtai the better 

kinds of trusses previously in use." 

"3rd. That the action of these instruments is o r ten attended 
with serious and unnecessary inconvenience, uneasiness and 
pain," and 

"Lastly. That their employment for too long a time, when the 
degree of pressure exerted by them is considerable, sometimes 
produces absorption of the tendons, dilatation of the hernial 
orifice, and an extension ot the evils they are designed to re- 
move; and that any attempt to obviate this danger, while the 
support of the instrument continues to be required, will diminish 
the security of the retention." 

From all which reasons, the committee do not feel warranted 
in making a favorable report on the claims of this class of trusses, 
upon the confidence of the society. 

Eberle's, or the Rachet truss having been examined with 
the first class, the committee next pass to the only remaining 
part of their duties, which is the consideration of the six instru- 
ments of Dr. Chase. 



4 10 Report on the Radical Cure of Hernia. [Feb. 

In considering Dr. Chase's trusses, which make up the whole 
of the second class, the committee commence with setting forth 
their alledged claims. 

"The object of these instruments is to secure the perfect and 
permanent retention of the viscera in hernia, in order to permit 
the powers of nature to effect a radical cure, after the removal 
of the misplaced parts, which are supposed to offer the greatest 
obstacle to her success." 

They then proceed, in the first place, to investigate "how far 
they fulfil the all-important purpose of retention; leaving their 
effects upon the tissues, the modus operandi of nature in effect- 
ing the cure, and the extent of the results to be discussed in the 
sequel under distinct heads, which they subsequently proceed 
to do in the most thorough manner. 

"The inventions and improvements of Dr. Chase, many of 
which have been adopted since the presentation of the prelimina- 
ry report, extend to all pares of the truss and its appendages ; 
and his attention to minute, but highly important details, has 
been carried to an extent, never equalled by any of his predeces- 
sors in this branch of surgery. The complete instruments em- 
ployed by him, are — 1st. The inguinal, or common inguinal 
truss. 2nd. The ventro-inguinal truss. 3rd. The femoral 
truss. 4th. The umbilical truss. 5th. The umbilical belt. 6th. 
The double truss."' 

To each of these a separate section is given, in which each 
partis particularly considered, viz : The block ; the block at- 
tachment : the spring and strap-attachment ; and the appenda- 
ges, and all illustrated by wood cuts. After duly explaining 
every part of the inguinal truss of Dr. Chase, the committee 
have been pleased to say, that they 

"Feel bound honestly to state their convictions, that this in- 
strument surpasses all others known to them, in the accuracy 
and permanence of its retentive power in common inguinal her- 
nia; a conviction fully sustained by all their practical observa- 
tions on the action of trusses. The instrument is worn with so 
much comfort, that patients generally relinquish it unwillingly, 
and sometimes absolutchj refuse In do 80, even when pronounced 
well by the surgeon. The committee find themselves unable 
to suggest any improvement, or to point out any defect of prin- 
ciple or construction in this truss, as now employed by the 
in venter."' 

Of the Ventro-inguinal Truss of Dr. Chase, they say: 

"To the complete instrument, as it has been actually employed 



1S3S.] Report on the Radical Cure of Hernia. II 



during the last year, the committee may safely apply the same 
language used in concluding their remarks on the inguinal 
truss." 

Of the Femoral Truss. The committee having been very 
limited in their opportunities of testing its value, are not pre- 
pared to say much definitely on its absolute perfection. "How 
far it may answer the special purpose of its construction, by 
entering under the fold of poupart's ligament, and acting almost 
directly on the femoral ring, the committee will not venture to 
judge from a single case. The report of Dr. Chase as to its 
result in other instances, is favorable ; but neither that gentle- 
man, nor the committee, regard it as having acquired the highest 
degree of perfection of which it is capable." 

Jt is expected to undergo farther modifications. 

Of the Doublk Truss, the committee presented a new article, 
the invention of Dr. Chase since the preliminary report, and 
now for the first time laid before the society. 

" It is an association of two single trusses, so combined as to 
be perfectly independent in their action, without the slightest 
interference ; yet so associated by means of the straps and loose 
spring covers, that they present the appearance, and act with all 
the convenience of a single instrument. * * * The com- 
mittee cannot speak too highly of this beautiful invention, but it 
may be safely permitted to speak for itself." 

Of the Umbilical Truss. "This truss has secured the 
perfect and constant retention of the bowel in all the cases seen 
by the committee, two of which were of a peculiarly unfavora- 
ble character." 

u The committee deem it, therefore, almost unnecessary to 
state their decided preference of this instrument." 

The Umbilical Belt. The committee concluded their 
brief observations on this instrument in the following words: — 

"In condemning the umbilical belt of Dr. Chase, together 
with all its predecessors, the committee feel much pleasure in 
stating that after practical tests, which they did not deem neces- 
sary, it has been frankly relinquished by its inventor, although 
it has effected radical cures in two cases. (See cases xx. and 
xxix.)" 

In concluding their comparison of the two classes of trusses, 
and after amply testing the actual merits of each, they 

"Deem any further comment on the retentive power of the 
trusses of the second class (made up of those of Dr. Chase,) 



418 Report on the Radical Cure of Hernia. [Feb. 



altogether unnecessary. These instruments certainly fulfil to 
admiration the two grand requisites winch they consider neces- 
sary to bring the chances of radical cure of hernia to a maxi- 
mum.*' 

"After all that has been stated, the committee feel themselves 
fully warranted in the following conclusions : 

"1. The retentive power of solid blocks is. cateris j?aribus, 
superior to that of soft pads in the treatment of hernia, as has 
been already stared in the preliminary report. 

"2. The chances of radical cure depend upon the perfection 
and permanence of the retention. 

"3. The perfection and permanence of the retention depend — 
first, upon t.ie mechanical action of the instruments; and, se- 
condly, upon the power of the parts affected to hear that action 
without danger of physiological accidents of suliicicnt import- 
ance to interfere with the treatment. 

"4. Ail the instruments with so.id blocks contrived before the 
recent inventions of Dr. Chase, are decidedly liable to import- 
ant mechanical objections, and ail of them, with the exception 
of the Iiaehet truss, are moreover capable of producing physio- 
logical accidents ot sufficient impoitance to interiere with the 
treatment. 

"5. The construction of the Rachet truss is such as to render 
retention uncertain even in veatro-i 1 ruinal hernia, to which 
form of the disease alone, it is tolerably well adapted. 

" 0. The instruments of Dr. Ciia.se have elfected the perma- 
nent and accurate retention of the intestines in every case of 
hernia observed by the committee, without material inconven- 
ience to the patient, and often under trials more severe than are 
usually ventured upon by those who wear other trusses ; trials 
which would be imprudent witli any other apparatus known to 
the committee. 

u 7. If we except the femoral truss, these instruments have 
stood the test of much practical application without superindu- 
cing any physiological accidents of sufficient importance to in- 
terfere with the treatment. 

"8. The mechanical principles upon which the femoral truss 
^constructed appear highly ingenious and promising, and unless 
this instrument should he found hereafter to be productive of 
important physiological accidents, it must take precedence of all 
other modes of treating this variety of the disease. No such ac- 
cidents arc vet known to have been produced by its employ- 
ment ; but the committee have not. enjoyed the opportunity of 
personal inspection in a sufficient number of cases to determine 
general results, nor do they deem it proper to receive evidence 
from any other quarter in discharging the trust reposed in them 
by the society." 



1838.] Report on the Radical Cure of Hernia. 419 

The committee, on this important subject, consider 

"A cure is radical, when the tendinous and fascial barriers to 
the egress of the bowel are brought or restored to their normal 
or original firmness and power of resistance. The only means 
by which such a result can be tested, are the firmness and resis- 
tence of the orifice when placed where it is subject to examina- 
tion, and the absence of all appearance of protrusion after the 
truss has been relinquished for some weeks or months, and after 
the patient has pursued his usual avocations, resorting frequently 
to more severe exercises, such as coughing, leaping, fatiguing 
walks, swimming, lifting, dancing, riding on horseback, &c." 

" The time required ibr the radical cure of an ordinary case 
of ventro-inguinai or direct hernia, in the adult, appears to be 
from twelve to eighteen months. The common inguinal hernia 
is believed to become secure at an earlier period, and the umbi- 
lical, later; all varieties, however, recovering much more rapidly 
in childhood, in which cases the committeee have found, since 
their preliminary report, and contrary to the opinion then ad- 
vanced, that this class of trusses is "borne without inconven- 
ience in infancy." 

We have but one regret on the subject of this report, and that. 
is that it is not in our power to give it entire ; for it is so fair, 
conclusive and well drawn up, we feel that scarcely can a 
sentence of it be omitted without withholding something valua- 
ble from our readers, and doing injustice to the commitlee. 

We cannot now take our leave of it, however, without giving 
two or three more of the latter paragraphs entire. It wiil be 
remembered that the great object of the late improvements in 
this department of surgery was to effect radical cures in these 
cases, without resort to the knife. After all, then, 
the improvements must be determined by their practicability, 
their safety and their unequivocal success. It should be 
borne in mind that time, considerable time, only can deVel 
the final success. The following paragraphs give us the re- 
sults of the practice, so far as they could be accessible to the 
committee. 

"A variety of causes have tended to reduce the number of 
cases in which the whole history of the accident, the treatment, 
and the result have been placed within reach of the committee. 
Among the most important of these may be mentioned the ex- 
treme unwillingness of many patients to relinquish the use of 
the truss, even when urged to do so by the united advice of their 
surgeon and the members of the committee ; the removal of many 
i. 5 



420 Report on the Radical Cure of Hernia. [Feb. 

patients to a distance, alter having been a long while under 
treatment, but before it has been deemed perfectly sale to lay- 
aside the instrument; and the unwillingness of some persons to 
submit to the necessary examinations ; yet, notwithstanding 
these difficulties, the amount of indubitable evidence actually 
furnished on the question of radical cure has been considerable, 
though none has been relied upon as basis for conclusions, ex- 
cept such as has been furnished by the actual examinations of 
one or other of the members of the committee, and the testimony 
of the patients themselves. 

••VII the individuals who have relinquished the use of the 
trusses approved by the committee, after having worn them for 
six months or more, and who have been afterwards examined 
by a member, or members of the committee, have been subjected 
to the necessary tests, and are believed to be radically cured in 
Ike sense of the foregoing definition. A still larger number 
who are yet under treatment, give promise of a similar result, 
and those who refuse finally to'relinquish the instrument on the 
advice of their surgeon, present, in the firmness of the rings, and 
in the absence of protrusion under exertions performed when 
the trusses are temporarily removed, very strong grounds for 
believing the cure to be radical in them also. Two cases only 
of old ventro-inguinal hernia, occuring in persons of nearly 
sixty years of age, and so large that the orilices admitted of the 
free passage of two or more lingers within the reverted skin, 
have been deemed incurable ; but even in these, the contraction 
of the rings, and the resistance to protrusion when the trusses 
have been removed by the patient for a few hours, render the 
impossibility of cure by no means certain : and it is deemed 
improper ever to subject the patients to the tests necessary to 
determine the question. 

\n appendix follows the report, detailing upwards of thirty 
cases. Case xix in this appendix, which is an umbilical hernia 
of many years standing; enormous orifice, is completely retained 
by CfffSE's umbilical truss, with a block six inches indiamater. 
This patient is restored to usefulness, but is deemed incurable." 

Finally,it is d< clared, that "the cases observed include all the 
usual forms o Lai hernia, whether resulting from mechani- 

cal or ph; i! cjiuses: and also, some instances of double 

and triple hernia." 



1838.] Electricity. 421 



Human Electricity. 

Wc extract the following narrative, extraordinary in degree, 
hut not in kind, from Silliman's Journal for January, 1838, 
with the fullest confidence in its truth. We arc aware that 
the statement of Dr. Hosford will be looked on, by many 
who are at a distance from him, as a hoax, or at least as an ex- 
;e ration, or an unfair narrative of facts : nor do we suppose 
that Dr. Mussey's statement will have the power of wresting 
it from the fate of skepticism with some readers. In their full- 
ness of pride, human beings are wont to disbelieve, especially in 
philosophy and religion, that which they do not understand. — 
This is the case to almost as great an extent as the disposition to 
disbelieve whatever is counter to their party views or their pre- 
viously avowed notions. We know nothing of Dr. Mussey but 
his character as a professional man : the same may be said of 
Dr. Hosford. Professor Silliman, all the world know to be, 
in literature and philosophy, amongst the stars of the first mag- 
nitude. But, we are told that he is so credulous as to be very 
susceptible of tricks of imposition. Perhaps he may be. Hon- 
est men, and men of profoundest science, do often become so fa- 
miliar (so to speak,) with the wonders of nature, that, with the 
predisposition their own honesty gives them, it becomes easy to 
believe there aie still things which their own intellects can 
neither analyze nor comprehend. It is the effect of profound 
knowledge to humble the heart and generate reverence for that 
matchless wisdom which is found displayed in the heights and 
depths of Nature's domain: and to teach this truth, which seems 
to be neither known nor believed by all, that neither the know- 
ledge nor the comprehension of all things is yet given to man. — 
It is a very small part of the great golden rule of virtue which 
requires that « we should do unto others as we would that they 
should do unto us," to consider all men honest until found other- 
wise — all men true, until proved false. But. there arc other 
grounds for credence in this case. When human evidence which 
we should not dare to doubt in other matters is afforded, our 
own want of powers to analyze the subject, is no justification of 
our skepticism. 



Electricity. [Feb. 

- 

We are not content with less. than an entire extract of the 

ment made by Dr. Willard Hosford, at the instance of 

Professor Sjlliman : with the preliminary remarks of the latter 

gentleman, from the American Journal of Science and Arts, for 

January, 1S3S, page 394. 

Extraordinary case of electric excitement, with preliminary 
arks by the Editor. The facts stated below were, by my 
request, kindly communicated for this Journal by Dr. Willard 
Hosford, a respectable physician of Orford, New Hampshire, the 
place where the occurrence happened. Being in that place in 
September, and finding the belief in the facts to be universal, 
particularly on the part of persons of judgment and science, (as 
at the neighboring University, Dartmouth, at Hanover, eighteen 
miles south,) I became desirous of preserving a record of them. 
Dr. Hosford remarks in the letter accompanying his commu- 
nication, that abundant evidence from the most intelligent per- 
il; hand for the support of every point in the case. He 
( also, that the appearance of the aurora during which 

rical excitement of the lady took place, "was precisely 
the Jame as that described by some gentlemen at New Haven."' 
of it Dr. Hosford adds, that "the heavens were 
i a crimon aurora of such uncommon splendor, as 
no ordinary emotions in every observer, and we had, 
in addition, an electrical exhibition much less daz- 
ig, but more singular and to the parties concerned more in- 

A lady of great respectibillity, during the evening of the 25th 

of January. 1837, the time when the aurora occurred, became 

Suddenly and unconciously charged with electricity, and she 

hibition of this power in passing her hand over 

brother, when, the astonishment of both, vivid 

passed to it from the end of eacli finger. 
immediately mentioned, but the company were 
that each in succession required for conviction, both 
and feel the spark. On entering the room soon afterward, 
I'the company was not sufficient to coh- 
fact until a spark, three fourth of an inch long, 
nuckle to my nose causing an involun- 
tary recoil. This power continued with augmented force from 
i of January to tl f February, when it began to 

;iin< t by the middle of May. 

ted during sonic days was 
nt hours were often mark- 
red, that under favora- 
tanees, f] i January to the first of the 

following April, there was no time i hen the lady was incapi ble 
of yielding electrical sparks. 



L838.1 Electricity. 423 



The most prominent circjBftnstances which appeared to add to 
her electrical power, were an atmosphere of about 80° Fah. 3 mo- 
derate exercise, tranquility of mind, jind. social enjoyment; 
these, severally or combined, added to her productive power, 
while the reverse diminished it precisely in the same ratio. Of 
these, a high temperature evidently had the greatest effect, 
while the excitement diminished as the mercury sunk, and dis- 
appeared before it reached zero. The lady thinks fear alone 
would produce the same effect by its check on the vital action. 

We had no evidence that the barometrical condition of the 
atmostphcrc exerted any influence, and the result was precisely 
the same whether it were humid or and. 

It is not strange that the lady suffered a severe mental pertur- 
bation from the visitation of a power so unexpected and undesir- 
ed, in addition to the vexation arising from her involuntarily 
giving sparks to every conducting body that came within the 
sphere of her electrical influence : for whatever of the iron stove 
or its appurtenances, or the metallic utensils of her work box, 
such as needles, scissors, knife, pencil, (fee. &c. she had occa- 
sion to lay her hands upon, first received a spark, producing a 
consequent twinge at the point of contact. 

The imperfection of her insulator is to be regretted, as it was 
only the common Turkey carpet of her parlor, and it could sus- 
tain an electrical intensity only equal to giving sparks one and 
a half inch long ; these were, however, amply sufficient to 
satisfy the most skeptical observer, of the existence in or about 
her system, of an active power that furnished an uninterrupted 
flow of the electrical fluid, of the amount of which, perhaps the 
reader may obtain a very definite idea by reflecting upon the 
following experiments. WJren her finger was brought within 
one sixteenth of an inch of a metallic body, a spark that was 
heard, seen, and felt, passed every second. When she was seat- 
ed with her feet on the stove-hearth (of iron) engaged with her 
books, with no motion but that of breathing and the turning of 
leaves, then three or more sparks per minute would pass to the 
stove, notwithstanding the insulation of her shoes and silk hosie- 
ry. Indeed, her easy chair was no protection from these incon- 
veniences, for this subtle agent would often find its way through 
the stuffing' and covering of its arms to its steel frame work. In 
a few moments she could charge other persons insulated like 
herself, thus enabling the first individual to pass it on to a se- 
cond, and the second to a third. 

When most favorably circumstanced, four sparks per minute, 
of one inch and a half, would pass from the end of her finger to 
a brass ball on the stove: these were quite brilliant, distinctly 
seen and heard in any part of a large room, and sharply felt 
when they passed to another person. In order further to test 



4£4 Electricity. [Feb. 

the strength of this measure, it was passed to the balls by four 
persons forming a line; this, however, evidently diminished its 
intensity, yet the spark was bright.* 

The foregoing experiments, and others of a similar kind, 
were indefinitely repeated, we safely say hundreds of times, and 
to those who witnessed t\ie exhibitions they were perfectly satis- 
factory, as much so as if they had been produced by an electrical 
machine and the electricity accumulated in a battery. 

The lady had no internal evidence of this faculty, a faculty 
sui generis; it was manifest to her only in the phenomena of its 
leaving her by sparks, and its dissipation was imperceptible, 
while walking her room or seated in a common chair, even af- 
ter the intensity had previously arrived at the point of affording 
one and a. half inch spar) 

Neither the lady's hair nor silk, so far as was noticed, was ever 
in a state of divergence : but without doubt tins was owing to 
her dress being thick and heavy, and to her hair having been 
laid smooth at her toilet and firmly fixed before she appeared 
upon her insulator. 

As this case advanced, supposing the electricity to have 
resulted from the friction of her silk, I directed (after a few 
days) an entire change of my patient's apparel, believing that the 
substitution of one of cotton, flannel, &c. would relieve her from 
her electrical inconveniences,! and at the same time a sister, 
then staying with her, by my request, assumed her dress or a 
precisely similar one ; but in both instances the experiment was 
an entire failure, for it neither abated the intensity of the elec- 
trical excitement in the former instance, nor produced it in the 
latter. 

My next conjecture was, that the electricity resulted from the 
friction of her flannels on the surface, but this suggestion was 
soon destroyed when at my next visit I found my patient, al- 
though in a free perspiration, still highly charged with the 
electrical excitement. And now if it is difficult to believe that 
this is a product of the animal system, it is hoped that the skep- 
tics will tell us from whence it came.* 

In addition to the ordinary appurtenances of a parlor, it may 



♦ It is greatly to be regretted that the spark had not been received into a Leyden 
bottle until ii u ould accumulate no longer, and then transferred to a line of persons 
to receive the shock. — Ed. 

tThis could hardly have been expected from non-conductors; we are informed 
thai the lad) was relieved of the electricity by a free communication with the earth 
l.\ a ;u>«><! conductor, iii the manner of a lightning rod, as by touchingthe stove and 
inaction with the earth through the medium of the chimney. — Ed. 

t It appears to be Dr. Bo&jford's opinion, thai the electricity was not caused by 
the aurora thai was coincident with its first appearance, but that it was, in 
way, an appendage ofthe animal yst« m. Ed. 



1S38-] Electricity. 

be proper to add. that the lady's apartment contained a beautiful 

cabinet of shells, minerals, and for< ign curiositii 

This lady is the wife of a very respectable gentleman of this 
place; she is aged about thirty, of a delicate constitution, nerv- 
ous temperament, sedentary habits, usually engaged with her 
books or needle-work, and generally enjoying a fine flow of spir- 
its. 

She has. however, never been in sound health, but has seldom 
been confined to her bed by sickness even for a day. 

During the past two years she has suffered several attacks of 
acute rheumatism, of only a few days continuance, but during 
the autumn, and the part of the winter preceding her electrical 
development, she suffered much from unseated neuralgia in the 
various parts of her system, and was particularly affected in the 
cutis vera, in isolated patches ; the sensation produced being 
precisely like that caused by the application of water heated to 
the point a little short of producing vesication ; in no instance, 
however, did it produce an apparent hyperemia, but about the 
last of December a retrocession took place of this peculiar irrita- 
tion, to the mucous membranes of the fauces, oesophagus, and 
stomach, there producing a very apparent hyperemia, and at- 
tended, during the exacerbations, with burning sensations that 
were torturing indeed ; and it was for the relief of these symp- 
toms that medical means were used, but it was found no e 
matter to overcome this train of morbid action. 

It was nearly immaterial what medicines were used ; no per- 
manent relief was obtained, and no advantage resulted from the 
use of the alkalies, or their varied combinations. In a few in- 
stances, a dose of the acetate of morphine w to secure a 
night's rest, but she seldom made use of an anodyne. 

The effervescing soda draught being very acceptable was freely 
given — from which, in addition to a rigid system of dietetics, the 
influence of the opening spring and the vis medicatrix naturae, 
relief came of her electrical vexations, of most of her neuralgia, 
and other corporeal infirmities, and to this time, a much better 
state of health has been enjoyed than for many years. 

Orford, N. H., Nov. 16, 1837. 

The only strange fact in this case, is the coincidence (for we 
consider it nothing more) of the first displays of unusual electri- 
cal developments in the person of the lady, and the occurrence 
of the Aurora Boreal is. The Aurora Borealis we well remem- 
ber, as its beautiful displays were very obvious at this place. 
It was remarkable for its conspicuousness thus far south ; but 
we hold it impossible that the electricity afforded by the lady 
could have been owing to a charge from that electrical phenom- 



426 ctricity. [Feb, 

enon. It is a cause constantly occurring without the production 
of such effects : it is also a cause perfectly incompetent to 
their production, as is evident to any one familiar with the 
most, common laws of electricity. A charged prime conduc- 
tor, or a powerful electrical battery, would have been incom- 
petent. The phenomena clearly evince that the source of the 
electricity displayed was within the body. AVe are surprised 
that Professor IS i lliman did not give an unequivocal decision 
on this point instead of stating in a foot note that Dr. Hosford 
thought "that it was, in some way an appendage to the animal 
system/ 7 But great men are sometimes rather scrupulous of 
giving their own opinions on points, for the proper reception of 
which they think the world is not fully prepared. They are 
generally afraid to venture their belief in a fact, the rationale of 
which they may not be fully prepared to set forth. Such has 
been the case with many : ii is indeed generally with men who 
wish to be considered philosophers. AVe believe this to have 
been the case with M. Dupuytren when, on a certain occasion 
not long after the free introduction of acupuncture into France, 
lie introduced fifteen or sixteen needles into a rheumatic knee 
to the entire relief of his patient. He felt, on touching the end 
of one needle, a peculiar sensation which, by its strong resem- 
blance to a slight electrical sensation, attracted his particular at- 
tention. Determined to ascertain if possible its nature, he con- 
nected the ends of all the needles with a small wire, thus forming 
them into a kind ot' battery, and procured obvious sparks of 
electricity ; still, however, notwithstanding he was lbrced to 
acknowledge the fact that electricity actually passed off from the 
diseased knee in this case, he took care to pronounce the de- 
cided opinion that this discharge of electricity had nothing to do 
with the curative effects of the operation. And full of theorising 
without facts or competent causes as are some of the gentlemen 
of dignity at the great French metropolis, they have had very 
little to say of many palpable facts which have been before them ; 
such for instance as the relief of some acute pains and inflam- 
mations by simple acupuncture, and the reliefof chronic ones on 
infusing into the part, by the needle, the charge of an electric or 
galvanic battery. 

We arc pleased with the ease with which Professor Siluman 



1838.1 Electricity. 427 



has favored us, not only on account of our implicit belief in the 
truth of the facts declared, and our ad niration of the wonderful 
amplitude of Nature's resources which these facts reveal ; but 
because they offered a strong illustration of the truth of a doctrine 
which we have long entertained, and which we consider of par- 
amount importance in the science of animal and vegetable life 
and disease. It is. that the human system has within itself 
resources adequate to the generation of free electricity, com- 
petent in quantity, as well as to the proper insulation and ap- 
plication of (he sam physical agent; for the development of 
all the functions of life y and the phenomena of disease. 

This we consider no population, but the declaration of a doc- 
trine, the truth of which is as demonstrable as the circulation of 
the blood : and which, in its abundant resources, is calculated to 
render plain and intelligible, most, not to say alt of the phenom- 
ena of life, health, disease and death. This we are aware will 
also be viewed askance, and indeed rejected, because its truths 
are not. at first view, strikingly intelligible to those who may not 
have investigated them. But this matters not, when truth is 
concerned. 

We regret that some one of those friends who are in the habit 
of borrowing rare books and retaining the loan, has deprived us 
of the opportunity of giving, in connexion with this case, an ex- 
act extract from Brydone's Tour in Sicily and Malta, of a case 
precisely similar in its philosophy, and very much so in its lead- 
ing facts. In the absence of that volume of this little work 
which contains the statement alluded to, we will endeavor to 
give the leading facts of the case by memory, from a reading 
some eighteen or twenty years ago. This work has been little 
known, and less read, because early stamped with a want of 
confidence in its entire truth, which we consider chiefly or soleiy 
owing to the disposition to doubt the truth of this case. 

Somewhere amongst the Alps, we think, he met with a lady 
of rank, of high sanguine, or sanguineo-nervous temperament, 
who when in full dress, emitted sparks of electricity to any con- 
ducting body near her. as regularly as the charged prime con- 
ductor of an electrical machine. The displays were very evi- 
dent to the sight and feeling, the sparks passing a considerable 
distance. Her full dress amounted to a good silk insulation. 
f 6 



428 Compression of the Carotid 'Artery . [Feh 



Bat we need not <jo farther than our own firesides for evidence 
of the internal development of electricity. Here, without other 
insulation than common shoes, we find on a cold, dry morning} 
that oar children's hair is divergent, from the repulsive power 
of electricity, as if charged on an insulating stool. We find the 
same phenomenon in tiie tail and mane of our horses on a cold 
dry day. There are, it will be admitted, but two possible re- 
sources for this charge; these are either without or within the 
body. It is reasonable to conclude that it is net from without ; 
for the only exterior sources are electrical generators, or a char- 
ged atmosphere. In this case, the former of these is not pre- 
The latter, to have imparted it, would be of the same electricity 
and would, according to a well known law of electricity, that 
positive repels positive, repel, instead of attracting it. The con- 
clusion is then inevitable, that the electricity thus displayed 
arises from the animal organism. 



Of the compression of the Carotid Artery in the treatment of 
Convulsions: By A. , Physician to the Hospital 

St. Antoine, and agr< gt of the Faculty of Medicine at Paris. 

When a therapeutic fact is isolated, it possesses in general no 
value; bat vv i m of a new plan has been so 
evident that it is irnpi icacy, when this plan 
is of easy employment and does not produce the slightest in- 
convenience, it i the consCientous an to in- 
troduce it to the atte . ssional brethren, 

( >n Monday, 1 1th e did me 
the honor of j illation with Pro- 
fessor ( '. tor Toirac, : of a 
young • Oar y i nt had suffered 
much nd dentition. 
Towj rds thi iad an attack 
of scarlatina, wh ch > u d and required only hygienic 
regulati< the invasion 
of the e i d al thai time* in p< i 
health, requi • walk in the garden of the 
Thaileri's. The^ d the request granted. 

At first no injury rd day afterwards the 

weather became sudi child took cold and the 

following da) rhal swollen, especially in the 
ion oi the parotid gland. 



LS38.] Compression of the Carol id Artery. A2 l J 

An oedema, not however considerable, took place promptly in 
the entire body. At the same lime the urine was suppressed 

for sixty-two hours, and was al'terv. <l only in 

small quantity and of a deep brown colour. But as the patient 
lived near the Thuileries, he was frequently conducted to the 
garden for the purpose of recreation. The cedema bad some- 
what diminished on the 10th September, and in the evening the 
patient complained of a slight pain in the head. He passed a 
restless night, and on the following morning complained of a 
violent cephalgia and manifested an unusual loquacity. 

At 3 o'clock P. M. he was seen by M. Cerise, who observed 
in the patient so extraordinary an appearance and a pulse so ir- 
regular, that he remained in attendance three quarters of an 
hour, anxiously watching the progress of the symptoms ; when 
suddenly, the child felt a very intense pain in the head, carried 
his hand to the part with a cry of agony, and experienced a 
violent epileptiform convulsion which continued only a few mo- 
rn -iits and was followed at first by stupor and afterwards by a 
true delirium: it was then 3 3-4 o'clock. 

M- Cerise applied immediately 10 leeches behind the mas- 
toid process, and covered the arms, the legs and the entire abdo- 
men with large sinapisms. At half-past 4 o'clock another attack 
more violent and longer than the first, occurred. At quarter- 
past 5, a third epileptiform paroxysm. At three-quarters past 5 
o'clock, a fourth convulsion which remained continuous. 

M. Chomel had named 9 o'clock P. M. for the consultation, 
but as the symptoms became more serious I was sent for in haste. 
It was quarter -past seven when I saw the young patient. He 
was str :d upon the bed, the head carried forcibly backwards 
and towards the right side. ids, the eye-balls, 

the muscles of the neck, the a the right side, were 

agitated with convulsive mov a most frightful kind. — 

The muscles of the left side were in a stare of complete relaxa- 
tion. The head had been covered with ice. but the convulsions 
continued, cold water had been d in the face, a handker- 

chief wet in iced water had been applied to the cheeks, but the 
symptoms were not moderated. r: e, however, acquired 

an extreme frequency, 160 per minute, and was tumultuous. — 
The respiration was embarrassed and rattling, it was evident 
that an fngorgement was taking place 1 in the lungs and that the 
bronchial tubes were beginning to be filled with a spumous 
fluid — The pupils were excessively dilated. In this conjunc- 
ture I proposed an affusion of cold water, to continue only half a 
mmule. which was administered, thg child having been placed 
naked in a bathing tub. 

No change ensued, The child was enveloped in a blanket, 
put in bed and supported in a sitting posture, so as to keep the 
head in an elevated position. 



430 Compression *f tke Carotid Artery. [Feb. 



Tins convulsion had continued two hours, it seemed to us that 
life would soon he extinguished, when 1 conceived the idea of 
preventing the blood from passing to the brain by some mechan- 
ical means — and the only mode was that of compressing the 
primitive carotids upon the side of the trachea. 

It will be recollected that the convulsions existed on the right 
side. By a negligence scarcely excusable in such urgent cir- 
cumstances, I compressed the right carotid. The convulsions 
continued, and the compression had been made two minutes 
when L perceived my error. I placed immediately the index 
finger upon the left carotid, and belbre fifteen seconds had elaps- 
ed the convulsions ceased suddenly and the child fell into an 
apoplectic stupor. The compression was continued one hour 
without interruption, and not the slightest convulsion returned. 
The respiration, previously rattling and stertorous, became more 
and more regular and in a .quarter of an hour was performed si- 
lently. After half an hour the child opened his eyes, and the 
pulse had fallen to 116. The patient crave signs ol intelligence, 
by attempting to answer questions that were proposed. The 
sensibility was evident on all the left side of the body, but very 
obscure on the right ; no lesion of the muscular movements on 
the left side, but on the right the paralysis was complete. The 
pupils had returned to their normal state. We determined that 
compression should be continued through the night ; that a d»*op 
of Croton oil should be administered to produce a derivation 
to the abdomen, and that cold water should be used as a bever- 
age. We tiiud however the effect of remaining a minute with- 
out compressing the vessel ; the compression was then renewed 
for ten minutes, suspended anew for ten minutes, renewed for 
ten, suspended for five, renewed for ten, and we then allowed a 
repose of a quarter of an hour, hx half past 11 P. M. conscious- 
ness and voluntary motion had been restored. The child would 
not permit any further compression of the vessel, and demanded 
drink and food with a vivacity which evidently indicated delir- 
ium. 

The patient slept during the night, but with some restlessness. 
The convulsions did not re-appear. The next morning there 
was still some degree of loquacity, but the cerebral excitation 
ceased during the day and the convalescence proceeded without 
interruption. 

Remarks. — The influence which the compression of the car- 
otids exerted over the convulsions in this case cannot be doubted. 
The spasmodic movements had continued two hours, and by the 
compression they ceased in a few seconds as evidently as the 
same mean would have arrested an arterial hemorrhage. 

Let us endeavor to specify the cases to which this plan will 
probably be applicable. I believe that it will prove useful in 



J838.1 Compression of the Carotid Artery. 131 



iill cases of congestive convulsions, meaning thereby all those 
convulsions which have lor their cause only an afflux of blood 
towards the brain. I do not believe in the efficaciousness of the 
plan in those convulsions which depend upon an effusion of 
blood into the cerebral substance upon rainollisseinent, or lacer- 
ation or contusion of the brain. 

The congestive convulsion ^and, under this head we include 
the eclampsia of women in parturition, that of dentition, that 
which often attends the incipient stage of the acute diseases of 
infancy) the congestive convulsion, we say, has for its anatomi- 
cal characters an engorgement of the cerebral vessels, a slight 
infiltration of the pia mater and effusion into the ventricles; it 
may indeed happen that the cerebral substance may be lacerated, 
that effusions of blood may take place in the medullary sub- 
stance, that the parenchyma and membranes of the brain may 
be inflamed ; but these accidents are only secondary in the ca- 
ses of winch we now speak and will be averted if the congestion 
be prevented. 

The compression of one of the primitive carotids produces 
anemia (!) in the corresponding hemisphere of the brain much 
more rapidly and certainly than blood-letting or an application of 
leeches, and if it be continued lor some time the cerebral circu- 
lation will be almost entirely annihilated, and the local irritation 
which caused the sanguineous afflux will be extinguished by 
the absence of the blood, without whose stimulus every flux 
ionary irritation must cease. We may remark also, that if the 
cerebral congestion be the cause of the convulsion, the convul- 
sion becomes of itself a cause of the congestion with this differ- 
ence, that the congestion is active in the first and passive in the 
slecond case. 

The co npression of the carotid prevents then in the first place, 
the primitive active congestion, and opposes still more effica- 
ciously the secondary passive congestion. 

The immediate effect of this compression in a healthy person 
is very remarkable. The face becomes pale, a sensation of 
chilness is experienced, and sometimes a certain perturbation 
in the intellect occurs. — the>e disappear as soon as the blood is 
permitted to resume its course to the brain. 

Hitherto we have spoken only of the compression of one of 
the carotids. Indeed, it will not be necessary in <reneral to in- 
terrupt the cerebral circulation except in one of the hemispheres; 
for we know that convulsions, even epileptic convulsions, affect 
almost always only one side of the body, the other side experi- 
encing only very slight convulsive movements. Hut if both 
sides of the body were equally convulsed, together or alternately, 
would there be any inconvenience in compressing at the same 
moment both of the primitive carotids ? By making the cxper- 



432 Compression of the Carotid Artery. [Feb. 



iment upon ourselves we may be easily convinced that the sim- 
ultaneous compression of the two carotic \ will not be attended 
by the inconvenience which we might at ilrst apprehend. The 
experiment should be made while we are in the horizontal posi- 
tion. Vision becomes obscure, the ideas are somewhat confused 
— an indefinable sensation of nonentity, but by no means threat- 
ening life, is experienced : by degrees th se phenomena cease, 
because the anastomoses enable the vertebra] arteries to supply 
the brain with sufficient blood for the maintenance of its func- 
tions. 

"We should not then fear to compress the two primitive caro- 
tids simultaneously when necessary. It is not however necessary 
to do this immediately, and it is better to compress at first only 
the vessel of the side opposite to the one in which the convulsions 
are most violent, and interrupt the circulation a lew minutes af- 
terwards in the other hemisphere. 

It may not be necessary to mention the place where the com- 
pression should be made. I prefer the interval between the 
sterno-cleido-mastoid muscle and the side of the larynx: for at this 
point the artery is free and may be easily readied and pressed 
against the anterior surface of the vertebra! column, and if the 
artery should divide lower down the neck than it usually does, 
into the two principal trunks, no inconvenience would hence 
arise, as the internal carotid would then be compressed and the 
same effect produced. The compression should be made with 
the thumb or with the index and middle fingers united, the finger 
is placed parallel with the axis of the vessel or perpendicularly, 
the palm of the hand turned outwards so as not to press upon 
the larynx or trachea. We should commence by ascertaining 
the situation of the vessel by means of its pulsations, and it should 
then be pressed gently against the vertebral column, taking care 
that, it does not escape from the finger. 

I may ask if in acute hydrocephalus of infants, if in the inci- 
pient stage of cerebral inflammation, the compression of the 
carotids would not cure these terrible diseases I I would not 
be rash enough to advise the ligation of the carotid in an epilep- 
tic patient, whose life might be threatened ; bill ill were afflicted 
with this horrible disease, I would certainly demaud ihe opera- 
tion for myself — When a surgeon is applauded for applying a 
ligature around the carotid Tor the purpose of curing a tumour 
of the orbit, he should nol be accused of rashness if he were to 
employ the same operation for the cure of epilepsy. This is 
what I have to say respecting the comipression of the carotids in 
the treatment of convulsion. I hope sincerely that the plan may 
succeed in the hands of my professional brethren, for it is simple, 
of easy application, without inconvenience and does not exhaust 

[ike the energetic treatment to winch children and women who 
■ 

have attacks of ei lampsia, are generally subjected. 



1938.] / opia of the Aorta. 438 



If by sub experience the utility of this plan be estab- 

lished, it will be a happy triumph In therapeutics : if it be proven 
to be inefficacious, those who employ it will have no cause of 
regret, as the patients will not be thereby injured. — Journal des 
Con no issam -es . ! / klico Chirurgicales. 



Ectopia of the Aorta — reported by M. Key, of Bordeaux. 

In the following case the aortia arises from the right ventri- 
cles, the pulmonary artery is nearly obliterated, the two ventri- 
cles communicate, and the brachiocephalic trunk is inverted. 

A little srirl ( J yeans of aire, born of young and healthy parents, 
was brought from the village of Charente to the hospital of Bor- 
deaux. The skin of the whole body, as well as the conjunctiva 
and clerotica, presented a decided blue hue, and the nails and 
lips a deep blue colour. By auscultation the heart was found to 
beat against the sternum like a hammer : the pulse was small 
and not of a strength corresponding with the action of the heart. 
The chest was well developed, sonorous on percussion, though 
respiration was laborious and attended with constant anxiety. — 
The child was extremely irritable and provoked to violent pas- 
sion by the slightest causes, during which suffocation seemed 
imminent: indeed it was in one of these paroxisms, shortly after 
her admission to the hospital, that the patient suddenly died, as 
though some mechanical cause had arrested circulation and res- 
piration. 

The most remarkable peculiarities revealed by autopsy relate 
to the heart and its vessels. It should be observed, however, 
that the accumulation of blood in the cerebral vessels was suffi- 
cient to have induced a true case of congestive apoplexy. The 
lungs did not seem to be developed proportionally to the volume 
of the heart ; they had been however, when examined, some- 
time macerating in alchohol ; they were engorged and did not 
crepitate. 

The volume of the heart was greater than usual at this age; 
its globular form assimilated it to that of the heart of a Chelo- 
niau : the inter-ventricular groove was less oblique than usual ; 
its weight four ounces; the auricles presented nothing peculiar. 
There was no trace of the foramen ovale, save the slight depres- 
sion termed the fossa ova! is. and which was more evident in the 
left than in the right auricle. The right ventricle was some- 
what globular, not collapsed, and presented an excentric hyper- 
trophy of its walls, the thickness of which, at the base, was four 
lines.* Its coiumnae oarneae were so much enlarged as to re- 



• The thickness of the same region in an adult hearl is usually about 2j linos. 



431 Phrenology . [Feb. 



semble those of the left ventricle. The auricula- venticular ori- 
fice was natural, and gave attachment to a normal tricuspid 
valve. The aorta and pulmonary artery arose from the anterior 
andsuperior part of the right ventricle.' Theaorta very singu- 
larly arose from the left side of the right ventricle, and at about 
the place of the usual origin of the pulmonary artery ; it passed 
over and compressed the pulmonary artery, curving this vessel 
to the left ; it projected posteriorly an inch and a half, and then 
descended along the left side of the spine; its orifice was sup- 
plied with the semilunar valves. The order in which the 
branches were given off by the arch of the aorta was inverted, 
so that the innominata was situated to the left, the right carotid 
and subclavian having distinct origins. 

The pulmonary artery originated in the right ventricle, and 
was so much inclined to the left that it seemed, at first sight, to 
come from the interventricular septum. This vessel was nearly 
obliterated at its origin in the ventricle,* presenting a diame- 
ter of only a line; it was surrounded with irregular calcare<>u< 
calculi. Its sigmoid valves were found above the narrowed 
orifice and placed one above another ; at this point the vessel 
resumed its dimensions, but did not exceed the femoral. Its in- 
ternal and middle coats were softened and of a dark red colour ; 
it contained coagulated blood, and presented manifest evidences 
of artensis. This artery bifurcated as usual. No remains of 
the ductus arteriosus existed. 

The left ventricle appears to have diminished in muscularity 
in proportion to the increase of the right side, though its capacity 
exceeded that of the right; its auricular aperture and mitral 
valve were normal; its columhse carnese small ; and no aortic 
opening perceptible. An oral aperture existed in the upper part 
of the ventricular septum sufficiently large to admit the little 
finger. The circumference of this communication between the 
two ventricles was polished, indicating its congenital origin, and 
precluding all idea of an accidental or pathological perforation. 

Archives Generates, T. 11, p. 426. 



Phrenology. 

This name means, in strictness, the doctrine of the mind, and 
is far more applicable, according 1 to the principles of nomencla- 
ture, to metaphysics in the sense of some of the disciples oi the 



• This obliteration led to the examination of the bronchial arteries, "which were 
found iioi t<> be increased in ealiber. 



1S38.] Phrenology. 435 

Aristotellian school, than to the eminences and depressions of the 
brain or of the cranium. But the brain, being- the grand nervous 
centre, derives a capital importance from being at once the seat 
and organ of the mind, so far as the location of this important 
constituent of man can be determined, and so far as physics are 
concerned in its existence and operations. As such, this organ, 
anatomically and physiologically considered, is worthy of the 
strict attention of medical men. We have however, but limited 
means of locating the intellectual nature or constituent of man. 
They seem to be limited to a few facts — some positive, and 
others negative. These are mainly that the entire absence of 
brain is always accompanied by an entire want of intellect— 
that important lesions of this organ are often attended with in- 
tellectual impairment — that the detectable existence of intellect 
declares the existence of brain, &c. But the law of this relation 
does not prove itself by working proportionably to the amount 
of each ; for the intellect, and this part of the organization, rank- 
ing mind with matter, are not always, nor even generally co- 
ordinate. Nor does it prove itself by displaying an adaptation, 
each to the other ; for imperfection of intellect does not necessa- 
rily imply an obvious or ascertainable organic lesion of the brain, 
as that does often appear without any detectable existence of 
this. And if the existence of organic lesion is not obvious or 
ascertainable, we have not the right to suppose its existence. — 
Nor do even very considerable lesions of the brain always de- 
clare impairment of intellect. AVe are authorized by pathologi- 
cal as well as healthy anatomy, to assert that the vital import- 
ance of the existence and integrity of the brain to the animal 
economy, is not so definite and invariable as may be generally 
supposed ; as we have seen the human being live, pulsating and 
breathing sufficiently for the perpetuation of animal life for many 
hours, without one atom of cerebrum, cerebellum, or of the ra- 
chidian bulb ; but at the same lime, without the least manifesta- 
tion of intellect ;* whilst again, we have seen that some of the 



* A case of ancncephalus. noticed sometime since in this journal, which lived 27 
hours, in the possession of all the natural powers, so far as could be ascertained 
except the intellectual. And Ribes notes a case of the same kind, which was s*en 
by Bayle, which lhyd a week. 

G 7 



436 Phrenology. 



most severe wounds of the brain have not, of themselves, been 
accompanied by immediate intellectual impairment.* 

But it is net our purpose on the present occasion to enter upon 
a dissertation on the anatomy or the physiology of this import- 
ant organ whose good condition is generally essential to the 
well-being of the economy- We think it a subject for regret 
that the former name under which Dr. Gall commenced his 
investigations has not been retained. With the aid of physiog- 
nomy, it might have been used, under the name ofcraniology in 
peddnng around the country the pretended fortunes of the weak 
who are always ready to bestow their confidence on any novelty, 
and reward it with their (often) scanty means: without prostitu- 
ting a good nomenclature. And moreover, the assertions of 
cranial depressions, eminences and magnitudes, would have 
been truth ; whereas, we have seen beyond all fair controversy, 

* Case of Henry Singleton, a soldier, who in one of Gen. Floyd's battles, re- 
ceived a bail nearly as large as tbat of a musket, just above the right ear. tbrough 
the squamous portion of the temporal bone, which passed obliquely backward and 
to the left Idle of the cerebrum and lodged against the yaietal 

bone of the left side. This man suffered no other sensible impression than a feeling 
of percussion, which he thought was from his own gun, as it occurred at the mo- 
ment he attempted to lire. Tic staggered a little out of line, but resumed his place 
instantly and obeyed promptly the next quick command, or rather the latter part of 
the command to fire and charge t>,e enemy. He ran in the charge many paces and 
returned; never having suspected he had been shot, until subsequently, when his 
companion, observing a little blood about bis ear. told him of his wound. He then 
retired to the hospital for dressing, and the surgeon general, on examining the 
wound superficially on account of the absence dfi !1 severe symptoms, pronounced 
it a " spent-ball wound" and dr< Lly, or not at all. He remained bow- 

ever on the list of wounded until the measles appeared on him some ten or fifteen 
after the battle, out three weeks after the wound 

was receivi himself nor his surgeon ever having doubted but that the 

I. 

AUtei ign being near its close, and his 

health appearing \o ren ler him i!;i;i: forimm ■■. he rode on horseback to 

the interior, a di to rain, hig '.Mer getting 

home, lie soon i and a measle-likc eruption 

s increased for a Jew days and abated. 
After : • ubject to partial 

the who! bodj . and he 
died, som< turn. In: nation alter his return, and during 

histi reely, without the least 

irough the brain as far as the 
kind. 



1838.] Phrenology. 437 



in Dr. 8ewall's second lecture, as well as elsewhere, the inap 
plicability of the external cranial marks (and none but the ex- 
ternal can possibly be available for practical purposes,) to the 
end of determining with the least certainly the cerebral mass or 
its proportional part — saying nothing of the unsoundness of 
the notion of a proportionate relation between certain intellectual 
faculties or animal propensities, and the cerebral developements. 
On this subject, the common sense views which would avail 
much in regard to any matter not qtiite so well calculated to 
titillate the fancy or the vanity, have been again and again urged 
by the friends of truth; but these cannot avail much in the face 
of that -'self esteem'*' which prompts almost all men and women 
to desire to hear some comment on their peculiar virtues, ac- 
quirements or prowess. Whilst this subject rested as a mere 
quere, whether or not, phrenology was a science? it was a matter 
of little consequence whether any one believed the one or the 
other opinion. It was a mere physiological question, very ab- 
stract from medical practice or therapeutical utility, and its de- 
cision not calculated to damage any one. But when taken up 
as a practical science and retailed around the world under the 
declaration of its being a fair ' ; mirror of nature" in which men 
and woman may see reflected their animal, moral and intellect- 
ual faculties, and thus for the purpose of draining from a confid- 
ing community who cannot be supposed to know any thing of 
its inapplicability to the truths of nature, an unfair support from 
their well-earned competence, it is time for the community of our 
country to open their eyes to tne imposition practiced on them, 
and be brought to see the grossness of the insult which is offered 
to their understandings. But common sense will, sooner or 
later, bring out the community on the side of truth. 

We have been led to these remarks, on the present occasion, 
by noticing in the last No. of the lied. Chirug. Rev., p. 507 and 
following, an extract from the facts about to be published by Dr. 
Lelut* on the subject of the average and the proportionate 
weight of the human brain, and its relation to the development 
of intelligence. The following facts relative to the cerebral 
mass, arc a part of the contributions to the work of Lelut, as in- 

• NouY£«u'fl Rapporto du physique at thi nalfral." 



439 Phrenology. [Feb. 

serted in a late No. of the Gazette Medicale de Paris. We copy 
from the Med. Chirug. Rev. for October 1837. Dr. Lelut has 
neither declared himself an advocate or an opposer of Phrenolo- 
gy. Several useful views may be taken of these facts to which 
the truth must ultimately bow, after the intoxicating charm of 
novelty shall have subsided, and the ridiculous tricks of gliding 
over the palpable incompatibilities of the doctrine shall have be- 
come old things. These views are, the smaller average of the 
female brain, the equality of the encephalic mass in ingenious 
accomplices in high crimes, and the speechless and absolutely 
senseless idiot, &c. 

" The average weight of the encephalon (including the cere- 
brum, cerebellum, and tuber annulare or rachidian bulb,) after 
the meninges have been stripped off is, in the healthy adult male 
about 1346 grammes, or three pounds and a half,* of which the 
cerebri] m weighs 1170, and the cerebellum 176 grammes. In 
the female the weight of the encephalon is about l-13th less 
than in the male. The following are the measurements of the 
encephalon in certain individuals, "dont la triste celebrite a jete 
quelque jours sur leur psychologic" 

1. Lhuissier, who murdered his-, mistress, and then cut the 
body up and threw the pieces into the Seine. Intelligence be- 
low the ordinary standard, and not cultivated — 45 years~of age — 
middle stature. 

The encephalon weighed - 1496 grammes, 

cerebrum - - - 1305 

cerebellum - - 191 

2. Belard, murderer of one of his relations ; a tradesman in 
the Temple. Intelligence below the ordinary standard, and not 
educated — 29 years of age — middle stature. 

The encephalon weighed - 1290 grammes, 

cerebrum - - - 1130 

cerebellum - - 160 

3. Bardon, an accomplice in a murder. Intelligence ordi- 
nary, and not cultivated — 39 years of age — midd. stature. 

The encephalon weighed 13S4 gram, 
cerebrum . - 1204 
cerebellum - - 180 

4. Chandelet, the assassin of his uncle; a porter in the Rue 
de Charonne. Reason lively and exalted ; propensities brutal 
and licentious — 31 years of age— stature short. 

The encephalon weighed 1192 gram, 
cerebrum - - - 1010 
cerebellum - - 182 

• An English pound of avoirdupois weigh! is equivalent to 423 gramme*. 



1938.] Phrenology. 439 

5. Avril, the accomplice of the notorious Lacenaire. Intelli- 
gence ordinary, and not cultivated— 27 years of age — middle 
stature. 

The encephalon weighed 1310 gram, 
cerebrum - - - 1130 
cerebellum - - 180 

6. David, murderer of his sister-in-law, who was the wife of 
a servant at the Hotel des Invalides. Intelligence ordinary, but 
somewhat eccentric, and partially cultivated— 34 years of age — 
statnre rather tall. 

The encephalon weighed 1420 gram. 

N. 8. It has been preserved in spirits, and the weight of the 
cerebrum and cerebellum, separately, cannot be stated. 

7. Fieschi. Intelligence ordinary, but not cultivated, but ac- 
tive and proud — 46 years of as^e — middle stature. 

The encephalon weighed 1365 gram, 
cerebrum - - - 1200 
cerebellum - - 165 

8. Guerin, accomplice of Chandelet (No. 4). Reason rather 
acute, developed, and somewhat educated — 42 years of age — 
stature rather tall. 

The encephalon weighed 1384 gram, 
cerebrum - - - 1240 
cerebellum - - - 145 

9. Lemoine, the assassin of the chamber-maid of Madame Du- 
puytren. Intelligence developed and cultivated — 40 years oi 
age — middle stature. 

The encephalon weighed 1310 gram, 
cerebrum - - - 1140 
cerebellum - - 170 

10. Lacenaire. Intelligence developed and cultivated — 34 
years of age — stature short. 

The encephalon weighed 1355 gram, 
cerebrum - - - 1205 
cerebellum - - 150 

Remarks. If we cast our eye over the preceding ten measure- 
ments, it will be seen that the medium or average weight may 
be stated, as we have said at first, at about 1340 or 1350 grammes. 
The heaviest on the list is that of Lhuissier (No. 1), and the 
lightest is that of Chandelet (No. 4); the former weighing 1496, 
and the latter only 1192 grammes. 

If we endeavored to establish any relation between the mental 
development or character of these criminals, and the weight of 
their encephala and of its two great divisions, it might be re- 
marked that Bardon, Lhuissier and David, in whom the ence- 
phalon or the cerebrum was the most heavy, were not the most 



4-10 Phrenology. [Feb. 



intelligent ; that in Lacenaire, on the other hand, the brain 
weighed considerably less than in them, and that ifin Chande- 
let, with his brutal passions, the cerebellum was large, the ce- 
brnni weighed as low as it does in many idiots, and yet he indi- 
cated no want of intelligence. 

But we have no intention to discuss this most difficult question, 
as we most willingly admit that a number of considerations 
ouffht to be taken into account, in such an enquiry. It might, 
for example, be objected that we have not sufficiently attended 
to the size and weight of the whole body in reference to the 
weight of the encephalic mass; nor to the relative weights of its 
two great parts, the cerebrum and the cerebellum ; nor to the 
education ol the individuals ; and, even if we were provided 
with accurate data on these topics, phrenology might then step 
in, and remind us that we have forgotten to attend to the com- 
parative size of the different convolutions ; and, then supposing 
that we had done this, that we have neglected to take into ac- 
count the temperament oi each individual, and the activity of 
the cerebral functions. 

Our intention therefore at present is only to afford accurate 
observations of what we ourselves have examined and ascertain- 
ed ; and we now, in pursuance of this plan, shall proceed to 
give some other measurements of encephala, such as we have 
found them in idiots and lunatics. 

1. Gobinot, 24 years of age, and of middle stature, hliotlsm 
of the lowest grade ; no power of speech, but only inarticulate 
sounds and cries. He seemed not to have even the natural in- 
stinct of hunger, and would not eat, unless induced to do it. 

The encephalon weighed 1320 gram, 
cerebrum - - - 1135 
cerebellum - - 185 

2. Inconnu, deaf and dumb, 43 years of age. and of a, stature 
somewhat above the ordinary. Idiot ism of the lowest degree. 
No speech, and scarcely any sign of intelligence. 

The encephalon weighed 1370 gram, 
cerebrum - - - 1205 
cerebellum - - 105 

3. Darvoz, 39 years of age, and of middle stature, ldiotism 
which places the individual below the brute. No speech ; sen- 
sations dull ; a slight degree of memory ; incapacity of clothing 
himself, or of defending himself against any external injury. 

The encephalon weighed 1250 gram. 
cerebrum - - - 1064 
cerebellum - - 102 

4. Courtois, 46 years of acre, and of middle stature, ldiotism 
of the lowest degree. Physiognomy almost simian. Incapable 
•if answering to any question, or of faking care, of his person. 



183S.] Phrenology. 441 

The encephalon weighed 1045 gram. 

cerebrum - - - 907 
cerebellum - - VoS 
The anterior cerebral 

lobes - - - 226 

5. Boulot,37 years of age, stature rather tall. Idiotism of a 
very low degree. The intellect is almost quite abolished ; to 
all questions he answers, " ma tete, mot) front sont egarCs," or 
"dans la province de Joiny, on a fait do moi un pauvre fou pour 
me perdre." lie is often much excited and very turbulent. He 
has no regard to his animal feelings, and his life is almost entire- 
ly vegetative. 

The encephalon weighed 1380 gram, 
cerebrum ... 1188 
(its anterior lobes) 192 
cerehellum - - - 300 

6. Rollet, 46 years of age iind of large stature. Idiotism very 
confirmed. His intelligence was almost at zero. He said, for 
example, that he was only three years old, and it was only -with 
extreme difficulty that he could pronounce a few words. His 
physiognomy was quite idiotic. He was employed at the Bice- 
tre to turn the wheel of the great well there. 

The encephalon weighed 1025 gram, 
cerebrum - - - S96 
(its anterior lobes) 2.50 
cerebellum - - - 135 

7. Cresson, 23 years ofa^e, and of large stature. Imbecility 
very strongly marked. S;)3ech embarrassed and stammering 
— physiognomy dull and heavy; although capable of manual 
work, never cruld be taught any art. 

The encenhalon weighed 1105 srram. 
cerebrum - - - 920 
cerebellum - - 185 

8. Mallebranche, 54 years of age ; stature rather tall. Idiot- 
ism quite confirmed. Speech scarcely intelligible. Extreme 
chorea of all his limbs. 

The encephalon weighed 975 gram, 
cerelrum - - - 825 
(its anterior lohes) 240 
cerebellum - - 150 

9. Favel'.e, 57 years of age ; middle stature. ImbecelitywitK 
irregnlari/y of muscular movements. He was admitted into 
the Bicetre as an idiot at the age of 12 ; and the only work he 
was enabled to do, was to assist in turning round the wheel of 
the well. His speech and his walk were embarrassed and difri- 
cult. His arms were in a constant trembling. His intelligence 
was correct, but very inconsiderably developed. 



442 Phrenology. [Feb. 

The encephalon weighed 1235 gram, 
cerebrum - - - 1077 
(its anterior lobes) 300 
cerebellum - - - 15S 
10. Chambin, 67 years of age, middle stature, hnbecelity only 
partial. He was never however, able to gain his livelihood by 
any occupation ; and, in consequence of this, he was put into the 
Bicetre at the age of 24. His intelligence was very small, but 
correct as far as it went. His speech was stammering and un- 
certain. Being capable of considerable bodily exertion, he was 
employed at the hospital to assist the servants in various ways. 
The encephalon weighed 1365 gram, 
cerebrum - - - 1215 
cerebellum - - 150." 

Phrenology in the vulgar sense teaches that the brain is the 
organ of the mind, and that "in proportion to the volume of the 
organ, other things being equal, will be the power of mental 
manifestations." That the organic developements arise from 
the medulla oblongata, and radiate to the surface; and that 
there is, in the source of these developments a congenital tenden- 
cy to impart a vigor of growth in these several organs, which 
will in future manifest by their size the grade or power of mental 
developement, whether of propensities, sentiments or intellect. 

It follows therefore as an unavoidable consequence, the legit- 
imacy of which is not to be slipped over by phrenologists, that 
when all these sub-organs progress on, so as to afford an 
unusual developement of the whole assemblage of any one, or 
of all of these classes of functionaries, the faculties of these 
mental functionaries are consequently and proportionably 
developed. That is to say, if one developement be large or full, 
it indicates the possession of an unusual natural faculty of that 
name; as for example No. 11, or " love of approbation." But 
if No. 12, or "cautiousness" be also unusually developed, it 
cannot destroy or impair the former, but leaves it with all its 
powers or merits, adding to the mind eminent "cautiousness." 
So of "conscientiousness,"' "ideality," "hope,' 1 and so forth to 
all the cerebral developements ; each not actually impairing the 
former, but adding to it another and another, until the whole as- 
semblage of mental developements, including "propensities," 
" sentiments" and " intellect/' are brought up to an unusual dig- 
nity --an integnal organ which must needs partake of the whole 



1838.] PhrenMgy. 443 

nature and degree of its numerous integrant constituents. There 
appear to be but tew fundamental propositions proper to this 
doctrine, the otheis being simply anatomical or physiological 
facts, which cannot, of themselves, sustain the superstructure. 
Those fundamental principles however, which must exist to 
make phrenology a practical science, are the following: — 

1st. The shape of the skull must precisely correspond with 
that of the contained brain, in order that the size and shape of 
the brain itself may be at once absolutely determined by as- 
certaining those of the skull. 

2nd. The larger the brain, the greater must be its powers, with- 
out temperament being held as a modifier* 

3rd. The more active an organ is, the more conspicuously 
will it be indicated by the cranial proturberance supposed to 
cover it ; or, in other words, the more exalted the cranial pro- 
trusion, the more active will the faculty be found which it is 
supposed to cover. These are indeed necessary to its support ; 
they are its chief fundamental propositions; for unless they be 
true, there is no foundation to the science as a practical one. 

The unsoundness of the first and second have been abundant- 
ly proven by Dr. Se wall's second lecture. As to the modifying 
influence of temperament, this belongs to Physiology, abstractly 
from Phrenology. It belongs to natural language, if we may 
so speak ; being that by which individuals may discern the 
taste, disposition, propensities, &c, as if by intuition. It belongs 
also to Physiognomy, with more propriety, for this has an earlier 
claim to it. It is a petitio principii to say that the state of the 
body always corresponds with the quantity of the brain. It 
cannot therefore be allowed in support of Phrenology as a prac- 
tical science. It must therefore remain unmolested with the rest 
of Physiology, or be yielded up to Physiognomy ; a thing 
which has had its great day, passed its age of novelty and delu- 
sion, and is now settled down to the proper level of its own 
intrinsic merits. To the 3rd of these fundamental propositions, 
we apply the stubborn facts of anatomy, cerebral staticks, and 
their necessary bearing on psycological physiology. This must 
end in the total subversion of this proposition, and in establish- 

* Temperaments aro a separate ]>art of science, and are therefore unjustly brought 
into ai& phrenology and heal its dei cien '.■ - in i rtune telling. 

ii 8 



441 Phrenology. [Feb 



ing the fact, that there is indeed no fixed relation available for 
practical purposes, between the cerebral developments and the 
mental faculties and propensities. 

It will be borne in mind that the average nett weight of the 
healthy, ordinary, adult encephalon. (including the cerebrum, 
cerebellum and rachidian bulb) is 

1346 grammes. 
The cerebrum of which is 1170 
cerebellum - - - 176 
The first case given by J)r. Lelut was, in point of intelligence 
below the ordinary standard, without cultivation, and the per- 
son of medium stature. In this 

The encephalon weighed 1495, more than com. av. 156 gram. 

cerebrum - - •• 1305, 135 

cerebellum - - 191, 15 

The second case, guilty of the same crime, both being mur- 
derous, the same grade of intelligence, being below the ordinary 
standard — person the same, being of medium stature. 

The encephalon weighed 1290 less than com. av. 56 grain, 
cerebrum - - - 1130 ------ 40 

cerebellum - - 160 ------ 16 

Now, if we add the deviations both ways, above and below 
the standard of the cerebrum, the great seat of intelligence and 
sentiment, we have 175 grammes difference in the weight 
of the cerebrum of individuals of the same known character of 
mind, stature, and so forth. AVe are indeed not told the tem- 
peraments in these cases, but can no more allow the practical 
phrenologist to say that in one, the temperament was of one 
kind, and in the other, it was the opposite, merely because the 
brains were so different, than we could grant him gratuitously 
the main tiling he wishes to establish. It was as well to grant 
him one petitio principii as another. 

In the 3d case — Intelligence ordinary — medium stature. — 
Ihre the difference from each of the others is, that the intelli- 
gence is ordinary, instead of being below the ordinary standard. 
Crime the same. 

The encephalon weighed L384, more thanord. average 3S grm. 
cerebrum - - - 1204, ------- 34 

cerebellum - 1 80, 4 



1S38.1 Phrenology. 44! 



Here all the dcvelopements of the brain were over ordinary, 
particularly the intellectual, 34 grammes; still the intellect was 
ordinary. 

In the 4th case the reason of Chandelet was lively and exalted 
— the propensities brutal and licentious — stature short. In such 
a case can we expect from Phrenology that 

The encephalon will weigh but 1192, less than the aver. 154 
cerebrum, with lively and 

exalted reason, - - 1010, 160 

and the cerebellum - - - - 1S2, more than ord. av. (V? 

Remark here that the lively and exalted reason of the indivi- 
dual Chandelet has the extreme opposite in the organ to which 
it belongs, whilst his brutal and licentious passions have a deve- 
lopement of cerebellum of only 6 grammes above the ordinary 
average ; the first fact, (and but a nominal one, as it is only 6 
gram.) in favor of this proposition of Phrenology. 

We will now place by this case, Guerin, the accomplice of 
Chandelet, which is the 8th case of Lelxjt. These persons were 
engaged in the same crime, that is to say the assassination of the 
uncle of Chandelet. The reason of Guerin was acute and de- 
veloped, stature rather tall, and it is fairly presumable from the 
peculiar crime in which they were concerned, that their real sen- 
timents and powers of mind generally, as well as their propen- 
sities, were very similar. But instead of 154 grammes less than 
the ordinary weight of the encephalon, Guerin had 38 more, 
making a difference in their whole brain of 192 grammes. And 
instead of the 160 less of cerebrum, as with Chandelet, Guerin 
had 70 more, making a difference in the organ containing the 
reasoning faculties of which both might boast, of 230 grammes. 
And instead of the 6 grammes more of the cerebellum which 
contains the brutal and licentious propensities, which Chandelet 
had, Guerin had 31 less, which, added to the 6 more of Chande- 
let, makes a difference between them in this organ of37 grammes. 

We leave to the reader to make the same observations for him- 
self on the remaining 5th, 6th. 7th 9th and 10th cases, as they 
continue to illustrate the severe truth, that the assumptions 
of practical phrenology are not the science of nature. 

Dr. Lelut next gives ten cases of idiots. In the first, the 
encephalon was 26 grammes less than the average, ldiatism 
was of the lowest grade — no speech — and without even the 



446 Phrenology. [Feb. 

natural instinct of hunger, whilst his cerebrum was only 35 
grammes less than average. 

The 2d case was one of idiotism of the lowest degree. ]No 
speech, and scarcely any sign of intelligence. 

Encephalon 24 grammes more than average, and cerebrum 35 
more, whilst the cerebellum was about 11 less. 

We here take leave of the subject, leaving the reader again to 
examine the remaining eight cases of idiocy and compare them 
with the ordinary average. lie will find some above and some 
below ; bat the average of the idiots' heads given, is rather below; 
proving the proposition with which we set out to review this 
table, that " there is no fixed relation available for jjractical 
purposes, between the cerebral developements and the mental 
faculties and propensities. Whilst therefore, the subject is one 
which should be freely and fully investigated, in physiology, 
whilst, physiological speculations should be as free on this, as on 
any other subject, and whilst, like the " language of flowers.' 1 
it may be admissible for amusement in the parlour, and whilst 
its doctrines may, without impropriety, be thrown before the 
public for their investigation ; still not being consistent with the 
truths of nature, and consequently not being founded thereon, 
it is morally wrong for it to be applied to the purpose of gain, 
by its practical application for the end of divining or foretelling 
the intellectual or other fortunes of a mixed community, whose 
ignorance of a study so much out of their way as the anatomy 
and physiology of the brain stands as a barrier to their judge- 
ment on its truth or falsehood. 



1S3S.] Editorial Remarks on the Primitive Carotids. 4 AT 



PART III. 

MONTHLY PERISCOPE 



Nothing is received with more grateful salutations by the 
practitioner who duly feels the burthen of humanity, than the 
knowledge of efficient remedial means for those dangerous dis- 
eases over which he has been obliged to weep with folded arms, 
or exert himself often in the face of despair. The cheering in- 
fluences of hope are cast around him by even a solitary fact 
which creates confidence in something, for the benefit of human- 
ity, which has not before been found unworthy of confidence. — 
But we call the attention of the reader to the following subject 
on more substantial grounds than the mere fact of its success in 
the treatment oi one case. Reason has suggested and fact de. 
monstrated its proportionate adaptation to the etiology and pa- 
thology of the cases for which it is believed to be a remedy ; and 
its physiological action or influence is calculated to substantiate 
the opinion formed of its efficacy. In short, it is consistent with 
all the philosophy of the cases to which it is proposed to be ap- 
plied as a prophylactic or as a remedy. The subject to which 
we allude is the communication of M. Trousseau, on the sub- 
ject of the compression of the primitive carotids, as a remedy for 
certain convulsions ; which we have given in the II. part of the 
present No., from the Journal des Connaissances Medico-Chi- 
rurgicales. 

It will be remarked that the cases to which this remedy is con- 
sidered applicable are congestive convulsions, or those which 
have for their cause, an afflux of blood towards the brain : such 
are a large majority of the convulsions of women and children, 
as well as the epileptiform, and many of the apoplectic convul- 
sions of men, which we are called to treat. There are no cases 
which make such sudden and agitating demands on our prompt- 
ness and immediate efficiency, as attacks of this kind. This re- 
medy has two high recommendations, if accompanied with effi- 
ciency: these are its convenience and its safety. We trust that 



413 Blenorrhagia and Lcucorrhcea — Fractures. [Feb. 



n profession which is accustomed to writhe under the sudden 
dcstructiveness of these cases, will not hesitate to adopt a prac- 
tice, at once so safe and rational, and report the results for the 
benefit, of the community. 

It is most obvious that in the case given by M. Trousseau, 
compression of the primitive carotids relieved the active conges- 
tion most promptly, and then quickly subdued the remaining 
apoplectic, passive congestion. It should be remarked that both 
the primitive carotids may be safely compressed if necessary, as 
the anastomoses will enable the vertebral enteries to afford to 
the brain a sufficient supply ; but when the convulsions are en- 
tirely, or mainly on one side, the artery of the opposite side should 
undergo the compression. 



New injection for the treatment of Blenorrhagla and Leu- 
corrhoea. The aromatic tincture of gall nuts is employed with 
success in the treatment of the above named diseases, in the new 
hospital, in the Reu de Poursine. It is prepared in the follow- 
nner : — , 

ft. Nux. Gallae contus. lb. j. 
A. Pura ft. 
Maceriate 12 hours, and decant the fluid ; add to the resdue ano- 
ther pint of water ; and after 12 hours maceration it is also de- 
canted. Add to the liquor 2 pints rectified alcohol and gvj. com- 
pound alcoolate of citron, and filter. 

This tincture, diluted with 6 to 8 pints of water, is used as an 
injection. — Jour, de Pharm. — Am. Jour, for Feb. 1837. 



Treatment of Fractures. We find in the Archives Gem' rales 
(Tom. 11, p. 438, 1837,) an interesting article by M. Fleury, 
on the causes tending to the consolidation of fractures. The 
writer, after premising 1 that, the ordinary treatment consists prin- 
cipally of reduction and retention of the fractured extremities in 
apposition, remarks that the attention of M. Tobf.rt has been 
directed to the state of the circulation in the affected part. 

" It is," observes M. F., "to the blood we should look for the 
formation of cicatrices ; every one knows its influence on the 
surface of wounds, on the form, colour, consistence, dcvelope- 
inent, and vessels of false membranes. The researches of Du- 



1838J Medical Intelligence. 449 



puytren having established the correctness of the principle 
advanced by Duhamel, that the periosteum and cellular tissue 
are the principal agents in the formation of osseous deposits, it 
might have been inferred that the circulation was greatly con- 
cerned in the accomplishment of this work. Observation has 
fully confirmed the correctness of these deduction, and proven to 
M. Tobert that among the causes which oppose the consolida- 
tion of fractures, impediments to the circulation and a vitiated 
state of the fluids should be considered some of the most potent. 7 ' 
Mr. Fleury then expatiates on the evils attendant on the 
tightness with which the bandages and splints are generally ap- 
plied to fractured limbs, and cites several cases in which union 
had been delayed several months under the ordinary treatment, 
but readily took place on removing the compressing fixtures, and 
exciting the circulation by stimulating frictions. 



Auscultation for the detection of Urinary Calculi. Messrs. 
Moreau de St. Ludger & Behier had in 1836, proposed to adapt 
a stethoscope to the handle of the sound in exploring the bladder 
in search of calculi, but this was attended with some inconveni- 
ence, inasmuch as it was difficult to retain the ear well applied 
to an instrument which it was neeessary to move about consider- 
ably, especially in striking against the resisting body to detect its 
sound. M. Leroy, d'Etioles, has recently presented to the French 
Academy an instrument remarkably well adapted to this mode 
of examination. It is formed by the connection of the stethoscope 
and handle of the sound by means of a flexible tube of gum elas- 
tic kept open by a spiral wire within. With this simple contri- 
vance the ear may remain applied to the stethoscope, unmoved 
by the catheter, whose shocks against a calculus will be distinct- 
ly heard. 



MEDICAL INTELLIGENCE. 

Medical College or Georgia. At the late annual meeting of the Trustees of 
the Medical College of Georgia, several important changes were made in the course 
of instruction in this Institution. The Faculty of the College consisted of eight 
Professors; but believing that a reduction of the number would be for the interest 
of all concerned, Dr. Cunningham tendered his resignation of the Chair of the 
practice of Medicine. The trustees, coinciding with that opinion, accepted the re- 
signation; and Dr. Ford, the late Professor of the Institutes of Medicine and Medical 
Jurisprudence, was appointed Professor of the Institutes and Practice of Medicine. 



450 Medical Intelligence. [Fob- 

An exchange of Chairs was then made between Dr. Newton, late Professor of 
Physiology and Pathological Anatomy, and Dr. Di gas, late Professor of Anatomy ; 
whereby Dr. Newton was made Professor of Anatomy, with the duties of Demon- 
strator; and Dr. Due as, Professor of Physiology and Pathological Anatomy. The 
Faculty therefore now stand as follows: — 

Dr. L. D. Ford, Protessor of Institutes and Practice of Medicine. 
P. F,Eve, ' " " Surgery. 
G. JVI. Newton, " " Anat;> 

J. A. Eye, " Ci Materia Mcdica and Therapeutics. 

M. ANTONY, " " Obstetrics and Diseases of Women and Children. 
L. A. Dugas, " t: Physiology and Pathological Anatomy. 
C. Davis, " " Chemistry and Pharmacy. 

Dr. Newton will serve as Demonstrator. By connecting the Demonstratorship 
with the Anatomical Chair, there will be a free admission of the whole class to the 
demonstrations, without a separate ticket. 

The engagement of Dr Newton's superior abilities in the Demonstratorship > 
with the abundant supply ol materials for which ample arrangements are made, 
cannot fail to add greatly to the benefits of this Institution, in special and practical 
Anatomy. 

An alteration was made at the same meeting, whereby the term of the course of 
lectures was reduced to four months, the period announced by the other colleges. — 
This arrangement will cause the course to commence in future on the first Monday 
in November, and terminate on the first Saturday in March. 

It will be remembered that, several years ago, the Medical College of Georgia 
proposed to the other colleges in the United States, to meet a convention, for the 
purpose of adopting certain general regulations and plans for the improvement of 
the present system of medical education, and elcvatiug the standard of medical sci- 
ence in the United States : but the proposition was rejected by the otner colleges; 
each preferring to maintain its own peculiar views, and establish its own plans of 
operation for its individual interest. One of the most important purposes which the 
Medical College of Georgia had in view, was to urge the propriety of establishing 
throughout thecollegcsa longer term of annual instruction than had been generally 
adopted. That College had always acted on their opinion of the importance of this — 
their course having been six, instead of the common term of from three to four months. 
But their proposition not being met by the other colleges, the Georgia College found 
it impossible to compete successfully with the popularity of a short and cheap course 
with students. If there be error therefore in the adoption of four months as the 
term of annual instruction, the blame is fairly attributable to the retention of the 
short course by the other colleges, and to the ridiculous and disgracetul practice of 
some of them, of boastfully circulating in every neighborhood of the union, state- 
ments of the small amount of money required for attending a course with them. We 
speak freely on this subject, because we have known the truth of such decoying 
temptations put to the test of experience by some ofthe most prudent and economi- 
cal young gentlemen of Georgia, whose pari nts have been compelled to more than 
double the amount stated — cases wherein the items of expenditure were faithfully 
n .! and exhibited in good proof of the true economy exercised. 



SOUTHERN 

M3EBIKDA3L AMID) §¥M©II(DAIL 
JOURNAL. 



Vol. II. MAKCH, 1S3S. No. VIII 

PART I. 
ORIGINAL COMMUNICATIONS. 



ARTICLE I. 

Remarks on Fever, more especially that form of it usually 
denominated 'Yellow Fever. By J. B. Whitridge, A. M. 
M. D.j President of the Medical Society, and ex-officio, of the 
Medical College of South Carolina ; in reply to certain 
interrogatories by Chervin, D. M. P., a celebrated French 
Philosopher and Physician. 

The subject was thoroughly investigated by Dr. Chervin* 
for who.M the following epistolary essay was prepared, and by 
him deposited in the Archives of the Royal Academy of Paris, 
for the use of the French Government. 

Although the essay has been sometime written, the experi- 
ence which it embodies and which is confirmed by subsequent 
observation, may perhaps be useful, and the remarks which it 
contains, not uninteresting to some of the readers of the South- 
ern Medical and Surgical Journal. 



* Sec Petition addressee a la Chambre Des Deputes Par > T . Chervin membre 
titulaire del' Academic Royale de Medicine. 
A 1 



452 TMiitridge on Yellow Fever. [March 



INTERROGATORIES. 

u Have you ever seen any case of yellow fever which origi- 
nated from contagion ) 

"Do you believe this disease under any circumstances, to be 
contagious ? 

"What do you consider to be the most common causes of 
yellow fever ) 

"Hive you seen any person attacked with the yellow fever a 
second time ? 

« Do you believe the human frame liable to be attacked with 
this disease more than ouce? :, 

To Dec tor Chevik — 

Sir: — Fever is a unit— I have long been of opinion that 
there are various forms and modifications of fever, or in the lan- 
guage of the illustrious Rush, that there are various symptoms 
and states of fever, but, that there is in fact, but one fever. — 
Hence the nosological arrangement of levers, according to their 
various forms and modifications, is calculated to bewilder the 
mind and to mislead the unwary. 

There are three forms of fever, viz: intermittent, remittent 
and continued : theseare subject to various modifications, accord- 
ing to circumstances, and constitute what is commonly called 
tertian, quartan, quotidian, &c. The remittent and continued 
forms of fever, have also their characteristic symptoms, but 
which, it is foreign to my present purpose to detail. 

There are regular gradations of fever, from the simple inter- 
mittent, up to the highest grade of bilious or yellow fever. The 
latter is not confined to, but is more frequently found in, tropical 
climates. In the climate of Carolina and Georgia, the human 
constitution at some period of life, from infancy to decrepitude, 
is liable to every grade of lever. And these take place, accord- 
ing to the greater or less juscepitibility of the subject, or accor- 
ding to the greater or less intensity of the predisposing and exci- 
ting causes. Persons accustomed to warm climates, or to the 
atmosphere of those places which are surcharged with the 
mephitic gasses, which arc principally instrumental in the pro- 






183S.] Whitridge on Yellow Fever. 453 

duction of the higher grades of fever, are less susceptible than 
strangers. Persons from high northern latitudes, are more sus- 
ceptible than those within the tropics. In this climate. Europe- 
ans aro mare than Americans, and persons from the 
northern section of the United States are more susceptible than 
Carolinians. Strangers ii re much more susceptible than natives, 
or those who have been lomr resident. Native children, are 
more susceptible than native adults. 

That modification of fever usually demonstrated yellow fever, 
is what now claims our more particular attention, and this is 
generally of the continuous form. 

The yellow fever is not a disease sui generua This then 
being conceded, there are no diagnostic symptoms by which 
(in popular Language) the yellow fever can be distinguished from 
other fevers. It can only be known by a strict observance of its 
symptoms. 

The term yellow fever is objectionable, in as much as it does 
not express that particular modification of fever, which is usually 
described under that name, nor is a yellowness of the rete muco- 
sum a symptom which invariably attends this modification of 
fever. It depends in a great measure on the mode of treatment 
pursued. Probably in seven-eights of the cases which occur, if 
left to the operation of nature, this symptom would manifest 
itself; but if an active and vigorous mode of treatment, upon the 
mercurial plan, were pursued, in seven-eights of the cases, it 
would be prevented. The same may be said of the black vomit, 
which is generally considered a diagnostic symptom of yellow 
fever. 

The nosological arrangement of this modification of fever, 
under the name of typhus icterodes, is also objectionable, in as 
much as the word typhus, according to the Greek original, im- 
plies a disease of low action. If it admitted of any classification! 
it might with more propriety be arranged under the genus syno- 
chus of Dr. Cullex, in as much, as it is a disease of a mixed 
character, and in the southern section of the United States 
generally partakes of the nature of those modifications of fever, 
which he terms synocha and typhus. As the term yellow fever 
is familiar to all, and as the symptoms which characterize this 
modification of fever, are generally well understood, for the soke 






454 Whitridge on Yellow Fever. [March 

— ^ . 

of perspicuity, I shall adopt the term, in the subsequent remarks, 
according to its usual acceptation. The limits prescribed to 
these remarks, will not admit of my giving a description of the 
disease, nor is it necessary, as it has been so often and so well 
described by medical writers. 

This being premised, I proceed to answer your interrogations, 
in as cursory a manner as possible, and 

First. — * Have you ever seen any case of yellow fever which 
originated from contagion ?' 

I answer, from the experience of several years practice in the 
city of Charleston, where the yellow fever has frequently pre- 
vailed, no evidence has ever been presented to my mind, to pro- 
duce a conviction, that the disease is of a contagious nature. — 
I have often seen persons predisposed to fever, under all circum- 
stances of exposure to the yellow fever, — breathing the deoxi- 
genated atmosphere of close apartments, both day and night, — 
often in contact with the sick, the dying, and the dead, in the 
performance of the sad offices of duty or of friendship, — and this 
too without the least indisposition. To those subjects who are 
predisposed to the disease, breathing the impure air of a sick 
room, watching, fatigue and anxiety of mind, especially when 
conjoined with the debilitating effects of fear, — these may, 
and no doubt often have proved, the exciting causes of yellow 
fever. This combination of circumstances, will, in some meas- 
ure, account for the erroneous opinions of those, who suppose 
the yellow fever contagious. To those who have any experience, 
the real character of the yellow fever is too clearly developed, 
ever to be mistaken ; — and to those who have not, (if they are 
open to conviction, and will reason fairly and candidly on the 
subject,) the facts and arguments before them are incontrovertible. 

Second. — ' Do you believe the yellow fever under any cir- 
cumstances to be contagious V 

From the foregoing statement, I certainly cannot believe it to 
be so under any circumstances ; because, if it were contagious, 
it would be a different modification of fever, or in other words t 
it would not be yellow fever, but some other fever. 

Such, however, is the vague and uncertain use of language, 
especially in regard to the use of the terms contagion and ivfec 
Hon. — and these, though words of very different signification, 



1838.] Whitridge on Yellow Fever. 455 



are so often confounded ; in order that I may not be misunder- 
stood, it will be necessary for me here to introduce a few remarks 
for the purpose of explaining what I understand to be the true 
import and meaning of these terms, respectively. And this I 
will do by the adoption of the woids of a friend, — an accom- 
plished and elegant writer, — in preference to the employment of 
language of my own upon this long mooted and vexed question, 
which I trust, your laborious investigations, your indefatigable 
exertions, will erelong settle forever. 

Is it not remarkable, that the word contagion, a word of so 
frequent use in professional writings, and in books of science, 
should never have acquired a definite or precise meaning; that, 
instead of being stamped with technical precision, as its impor- 
tance demands, it should so long have been suffered to pass, as 
a fluctuating and uncertain currency of common language? 

From the indiscriminate use, the words contagion and infec- 
tion, contagions and infections, as applied to diseases, would 
seem to be synonymous or convertible terms ; yet no respectable 
philologist, I think, will admit that they really are so. It is true, 
we cannot resort to etymology, in all instances, for the best 
authorized acceptance of words ; because long use, or, perhaps 
it may be said, abuse, often renders that arbitrary. The particu- 
lar use of words and terms, acquires, in this way, a sort of secon- 
dary, and indeed, an obsolute legitimacy. But where this 
has not been fully attained, where words continue to be used 
in different senses, by different writers, and even by the same 
writers, at different times, it would seem desirable to limit 
their technical use, to accord, as nearly as possible, with their 
radical meaning. But to give technical precision to a term, it 
will often be found necessary to restrain its meaning, within 
limits, somewhat arbitrary. Thus, the word contagion, in an 
unlimited sense, might mean whatever, by coming in contact 
with the body, is capable of producing disease. And as there 
are probably few diseases which are not produced, either direct- 
ly or indirectly, by some noxious principle, foreign to the body 
itself, and applied either to its external or internal surfaces, it 
would follow that, in this loose sense, a large proportion of our 
diseases might be said to be contagious. A somewhat similar 
remark would apply to the word infection. Without technical 



456 Whit ridge on Yellow Fever. [March 

limitation, it would perhaps, be nearly synon ;mous with conta- 
gion ; except that the former would convey the idea of a poison 
mingled with, or attached to, or imbuing some oilier body. And 
as contagion must be supposed to be generally communicated, 
through the medium of some body which, in common language, 
is said to be infected with it, (for a body, in this sense, as well as 
the atmosphere, may be infected with contagion.) it is not cl i £11- 
cult to see the origin of the loose and indiscriminate employment 
of the terms, infections and contagious diseases. 

But, it appears to me, and I think it corresponds, in general, 
with the usa^e of the most correct modern writers, that, to give 
precision to medical language, the word contagion should be 
applied to such poisons only, as originate in a diseased animal 
secretion ; and are capable of reproducing themselves by exci- 
ting, in a. sound body, the same specific action, in which they 
themselves originated ', such poisens as were, originally, by 
Mr. Hunter, and subsequently by Dr. Adams, denominated 
morbid poisons. A contagious disease, the//, would be such 
only, as is produced by exposure to those morbid- emanations, 
which are generated by a specific vascular action, in one 
labouring under a like disease. 

"On the other hand, the term infection should be applied, I 
think, to such poisons as are produced by the changes taking 
place about inanimate matter, either animal or vegetable, during 
their decomposition. And the circumstances, which seem most 
to favour this process, are heat, moisture, and confinement ; 
though the latter may have no further influence than to give 
effective intensity to the poison. Infection, then, differs from 
contagion, in this, that although the former may occasionally 
arise from animal secretions, such as the matter of sensible, or 
even insensible perspiration, or from the accumulated filth of 
numerous individuals, crowded into small and uncleanly apart 
ments, yet there is not, as in the production of contagion, neces- 
sarily a morbid vascular action. Infection may be constituted 
by deleterious miasma or poisonous emanations from the surface 
of the earth, in certain situations; or it may arise from foul 
matter, at various depths beneath the surface, decomposing under 
the influence of long continued and intense heat, and thus, more 
or less extensively, impregnate or infest the atmosphere. So, it 



183S.] Whitridge on Yelloio Fever. 457 

may sometimes be generated locally, as even in an empty hold 
of a ship, or about, the persons and beds of the sick on shore, or 
ill filthy apartments occupied by the sick; yet healthy individ- 
uals, from abroad, who sicken by being- exposed to such infection, 
do not necessarily sicken of the same disease as that about which 
it originated. And of the individuals exposed to it, probably but 
an inconsiderable proportion will sutler from its influence; the 
relative number depending on the condition of body, and other 
circumstances, in which the persons 'exposed may happen to be, 
it the time. The same individual, therefore, will contract an 
infectious disease, by an exposuie at one time, which at another, 
precisely similar in all circumstances external to himself, he had' 
escaped with impunity. Not so with contagion, its source is 
uniform and certain ; of whatever kind it is, its origin is invari- 
ably a specific morbid secretion ; and of those coming within its 
active sphere, rarely one escapes its specific effect; this too, 
scarcely influenced by circumstances of health,- habit of body, 
temperature, or climate. It may be remarked, further, that in 
comparing infectious diseases, all of which are acute in their 
nature, with that class of contagions, which are also acute, the 
former appear at irregular and uncertain periods, after exposure 
to their cause ; whereas the latter are, in this respect, uniform 
and certain." 

Under this view of the subject, as well as from my own obser- 
vation and experience, I do not believe the yellow fever under 
any circumstances to be contagious. 

Third. — ' What do you consider to be the most common 
causes of yellow fever?' 

In answering this question, I shall divide the causes into two 
kinds, viz: remote and exciting, and briefly enumerate the 
principal. Under the first head, I shall include the predisposing, 
and to the last, I shall add the proximate. 

A combination of causes generally conspire to produce yellow 
fever, especially that aggravated form which sometimes becomes 
epidemical ; — these may be divided into two kinds, viz : general 
and local. I do not mean to be understood to say, that local 
causes alone are not sometimes sufficient for the production of 
yellow fever; but I do say, that a combination of both general 
and local causes produces a more aggravated form of disease 



45S Whitridge on Yellow Fever. [March 

than either separately, and this combination will generally, per- 
haps always, be found to exist in large cities and towns, when- 
ever the yellow fever prevails as an epidemick. 

The influence of the latter is limited, but the former spreads 
far and wide. 

Local causes may produce sporadic cases, and sometimes 
endemial diseases ; general causes may assist in the production 
of these, but a combination of both, or of the latter only, are 
necessary for the production of epidemical diseases. 

These observations are strengthened, by the fact, that when- 
ever the yellow fever makes its apppearance in any of the large 
towns and cities in the United States, (and the remark is particu- 
larly applicable to the city of Charleston,) it usually commences 
in the low, crowded, and filthy parts of the city, or wherever the 
local causes act with the greatest force. 

REMOTE AND PREDISPOSING CAUSES. 

1st. — Vegetable and Animal Miasmata. 

Either of these, in a concentrated form, is sometimes suffi- 
cient for the production of yellow fever ; but when combined, 
they produce a higher grade of fever, or a disease attended with 
more violent symptoms. 

2d. — Excessive Moisture. 

This is manifest from the well known fact, derived from the 
history of the diseases of Charleston, for the last half century, 
that in very wet and rainy seasons, the yellow fever has been 
more prevalent than in any others. 

3d. — Excessive Dryness. 

It has been observed also, that in very dry seasons, the yellow 
fever has prevailed much more, than in those seasons attended 
with a due degree of moisture. 

4th.— Cold. 

This may sometimes operate, both as a predisposing and ex- 
citing cause, according to the manner of its application. 

5th.— Heat. 

This may also operate, both as a predisposing and exciting 
cause, according to the manner in which it is applied. 

6th. — Bad regulated Police. 



183S.] Whitridgeon Yellow Fever. 459 



7th. — The prevalence of particular winds. 

As for instance, the prevalence of easterly winds, is one 
among many causes which conspired to produce that aggravated 
form of disease, with which the inhabitants of the city of Sa- 
vannah were scourged, during the season of 1811). This gene- 
ral cause, operated, by bringing into action a greater portion of 
the noxious effluvia from the swamps of Carolina and Georgia, 
than could have been effected, by the prevalence of any other 
wind. On the contrary, for the same reason, a general preva- 
lence of westerly winds, besides being hotter, are more mis- 
chievous in their consequences, and more productive of evil to 
the citizens of Charleston, than any others. To us in the city 
of Charleston, easterly winds in the summer and autumnal 
months, are not only a great luxury, but a genera] prevalence of 
them, is almost a sure guarantee of a healthy season. 

8th. — The debilitating passions of fear, grief and despair. 

9th. — All excessive evacuations. 

The two last may also sometimes act as exciting causes. 

10th. — A constitution unaccustomed to the climate, or to the 
remote and predisposing causes, tj'C. fyc. 

EXCITING CAUSES. 

1st. — Excessive stimuli of every hind, such as intemperance 
in eating and drinking, $*c. 

2d.— Cold. 

This is a very frequent exciting cause, especially at night, — 
it operates by producing a sudden check, either of the sensible 
or insensible perspiration, or both. The yellow fever ^has been 
twice excited in my own system by this cause. 

3d.— Heat. 

I have known several cases produced by exercise, under the 
influence of the intense heat of the noon -day sun. 

4th. — Unusual labor or exercise. 

5th. — Violent emotions and stimulating passions of the 
mind, tj'c. 

B 2 



460 WJiitridge on Yellow Fever. [March 

PROXIMATE CAUSE. 

A morbid excitement of the liver and stomach, producing a 
morbid, increased secretion of those organs, and a sympathetic 
action in remote parts of the systeiiv. 

This, I think, maybe supported by numerous facts and argu- 
ments — especially those derived from dissection, but which my 
present limits preclude me from advancing. I shall, therefore, 
proceed to your fourth and fifth questions, which may both be 
comprehended under one head. 

Fourth. — ' Have you seen any person attacked with the 
yellow fever a second time?' 

'Do you believe the human frame liable to be attacked with 
this disease more than once V 

In reply to these questions, I have only to observe, that, I my- 
self have twice had the yellow {ever, to-wit : in 1817 and 
1819. On both occasions, I suffered severely, under the cala- 
mities of this formidable disease, and to the energetic powers of 
medicine, alone, sitb providentia, I owe my life. My sufferings 
on the latter occasion, were to me a convincing argument, of the 
susceptibility of the human constitution, to receive the disease 
" more than once." And further, the idiosyncrasy which had 
been by four years residence in the climate of South Carolina, 
(to which in 1S15, I was a total stranger,) and by once having 
the disease, could not have been changed, because, I had not 
slept a single night out of the city of Charleston, during the 
two years which elapsed between my first and second attack. 

Several cases have come under my observation, of persons 
having the disease twice. Captain Boyle, late of the United 
States Army, told me he had had the yellow fever several 
years successively, in the city of New-Orleans; and 1 have no 
doubt of the susceptibility of the human constitution to repeat- 
ed attacks of this disease. But il must be admitted, that by a 
long residence in a climate or place subject to the yellow fe- 
ver, and especially by the disease itself, the constitution is ren- 
dered less susceptible of a second or third attack, than of the 
fust. It requires, therefore, a greater combination of causes, or 
the same causes concentrated, so as to act with greater inten- 
sity, to produce the disease in a constitution assimilated to the 



1838.] Whitridgem Yellow Fever. 461 

climate, than to a stranger, — more especially one assimilated by 
the disease itself. After the first, it requires an increase of force, 
to produce every subsequent attack, exactly in the ratio of the 
diminished susceptibility. 

Having briefly answered your interrogations, I will now con- 
clude my observations, which I cannot do without expressing 
the high sense I entertain of the noble object of your pursuit, 
and the pleasure it would afford me, could 1 contribute more to 
the advancement of science and of truth. 

Too much honor and too much praise, cannot be conferred 
on that man, who so nobly hazards life, and expends fortune, in 
the acquisition of truth, — who undauntedly exposes himself to 
all the dangers arising from an exposure to the remote and pre- 
disposing causes of the highest grade of fever, — who enters the 
abode of the wretched and the distressed, from city to city, in 
order to seek out the occult causes, and to ascertain the true na- 
ture and character of yellow fever. 

It is a pursuit important to the commercial, to the moral, and 
to the scientific world. 

It is a pursuit, in every respect worthy of the attention, the 
zeal, and the indefatigable industry, of the philanthropist and 
the philosopher. 

That your life may be long preserved, and that you may be 
enabled incontrovertibly to establish the true nature and cha- 
racter of the yellow fever, is the sincere wish of, 
Dear Sir, 

Your obedient. 

And very humble servant, 
[Signed] J. B. WHITRIDGE. 

Charleston. S. C. 



402 Essay on Cancer. [March 



ARTICLE II. 

An Essay, read before the Medical Society of . 1 ugusta, on 
the question, " What are the CI tar act eristic or Diagnostic 
Simptoms of Cancer, whether in the state of Schirrus or of 
open Ulceration." By Paul F. Eve, M. D., Prof of Surgery 
in the Medical College of Georgia. 

The importance of the above question, propounded to me at 
the last meeting of the society, will readily be acknowledged by 
every one at-all familiar with the various and very different 
morbid appearances, which have been confounded with schirrus 
and cancerous ulceration. It is confessedly no easy task, to 
determine how carcinomatous affections are to be distinguished 
from all other diseases. Even with the light thrown upon the 
subject by the recent investigations in pathological anatomy, and 
which has effected so much in the diagnosis of our diseases in 
general, still a dark and heavy cloud obscures the one now under 
consideration. 

In order to answer definitely the question before us, I propose 
a thorough examination of the different symptoms of cancer, as 
recorded by the most distinguished writers on the subject ; for 
it is alone by comparison that we can arrive at an enlightened 
conclusion. And that our judgement may be correct, and the 
views of no author misrepresented, I shall not hesitate when con- 
venient, to employ the language of each, to whom reference may 
be made. I do this the more willingly, as the opinion of 
foreigners will be quoted to illucidate the subject of carcinoma. 

Jt is proposed in the first place, to examine the symptoms of 
cancer, whether in the state of schirrus or of open ulceration, in 
connection with the pathological anatomy of these two condi- 
tions of the disease ; and then to consider what is its peculiar, 
characteristic nature. 

Cancer is a Latin word and derived from the Greek carcinos, 
signifying a crab, and is so called according to most authors 
from the distended or ^aricosed veins existing over a schirrus 
tumour, which the ancients compared to the claws of this animal ; 



183S.] Essay on Cancer. 163 

but some writers suppose it was employed on account of the 
disease extending" bv whitish bands into the surrounding soft 
parts, which resemble the feet of the crab. Without stopping to 
enquire into the etymological derivation oi" cancer, or of 
even questioning the propriety of the expression as applied to 
disease, I proceed at once to its symptoms ; employing it or 
carcinoma as a generic term, and intending by schirrus and 
cancerous ulceration, the two very distinct varieties of this affec- 
tion. So great indeed are the differences in the appearance of 
this disease in its two states, that it is necessary to consider each 
separately. In one we have a tumour, and in the other an ulcer. 

In the classification of tumours, Laennec has very properly 
admitted two distinct orders of accidental or adventitious produc- 
tions. In the first class, are embraced those which have an 
analogy to the natural tissues of the body ; and in the second, 
abnormal productions which have none. It is among these lat- 
ter tumours that schirri are placed. 

A schirrus tumour is generally considered the forerunner of 
open or ulcerated cancer. By the author of the article on this 
disease in the Dictionary of Practical Medicine and Surgery, 
published in Paris, 1830, schirrus is described as being compos- 
ed sometimes of a perfectly white substance, at other times a 
little blueish or grayish, slightly transparent, of such a consisten- 
cy that ordinarily when cut it grates, and which varies from the 
fat of pork to a hardness approaching that of cartilage. Com- 
monly homogeneous, this matter appears to be divided in masses, 
which are subdivided into loblues. united by compact cellular 
tissue of a very variable form according to Laennec, but some- 
times of a regularity like that of the honey comb. Many schirri 
moreover, have a great resemblance to the substance of the 
turnip, others to that of the chestnut. 

Boyer, both in his Surgery and in his article on the subject, 
in the 52d vol. of the Dictionnaire des Sciences Medicales, says, 
a schirrus is a hard, moveable, circumscribed, resisting tumour, 
ordinarily indolent or a little painful on pressure. Its almost 
constant termination is in cancer. 

Abernethy in the account of various tumours in his Surgi- 
cal and Physiological Works, states that schirrus sometimes 
condenses the surrounding tissues so as to form a capsule ; and 



404 Essay on Cancer. [March 

at other times the organ in which it originates seems to be a 
nidus for the diseased action. In either instance the carcinoma 
commences in a small spot and extends like rays from a centre. 
This, says he, is a feature that distinguishes it from other disea- 
ses, which generally involve a considerable portion at their first 
attack. Another distinction is, that schirrus does not recede like 
other tumours to medicinal treatment. It also destroys the skin 
before it acquires any great magnitude.' Abernethy agreed 
with Baillie in his pathological anatomy of the tumour ; parti- 
cularly in his discription of the peculiar hardness, and intermix- 
ture of the firm, whitish bands, having interposed between them 
a brownish substance, or cells containing a pulpy matter of 
various colours and consistence. As a carcinomatous tumour 
increases, it generally becomes unequal upon its surface ; and a 
lancinating pain is commonly felt, though it is not experienced 
in every case. 

Richter says, it is an inadequate and erroneous difinition of 
schirrus, to call it a hard and painful glandular swelling, having 
a disposition to become cancerous. He even denied the disease 
to be regularly attended with swelling. But Sir Charles 
Bell observes, that though the organ in which the disease 
originates, (as the mamma for instance,) may diminish, yet this 
is not true of the tumour itself. The general bulk of the breast 
may be contracted, still the disease is a tumour ; there is an in- 
creased mass, a preternatural growth, or new matter formed, cor- 
responding to the old definition, morbosum augmentum. 

Samuel Cooper, in his Surgical Dictionary, says, the puck. 
ering of the skin, the dull, leaden colour of the integuments, the 
knotted and uneven feel of the disease, the occasional darting 
pains in the part, its fixed attachment to the skin above, and 
muscles beneath and in the breast, the retraction of the nipple, 
form so striking an assemblage of symptoms, that when they are 
all present there cannot be the smallest doubt that the tumour is 
a schirrus. lie also states, that without risk of inaccuracy, we 
may set down the backwardness of a schirrus swelling to be 
dispersed or diminished, as one of its most confirmed features. 

When a section, said Sir Edward Home, is made in a schir- 
rus tumour in its early stage, the centre is more compact, harder 
to the feel, and has a more uniform texture than the rest of the 



Essay on Cancer. 465 



swelling, and is nearly of the consistence of cartilage. From 
this, in every direction like rays, are seen, ligamentous bands of 
a white colour passing to the circumference, as also others of a 
fainter appearance in a transverse manner : the whole forming a 
kind of net work in the meshes of which a softer substance is 
enclosed. In a more advanced stage of the tumour, the diseased 
part has a more uniform structure, and no central point can be 
distinguished. According to Sir C. Bell, it is these ligamen- 
tous bands which produce the retraction of the nipple in the 
breast, by extendiug between the ducts and destroying its spongy 
texture. 

Sir Astley Cooper says, the swelling of schirrus gradually 
grows from the size of a marble until it acquires two or three 
inches in diameter ; for it rarely happens that the true schirrus 
turbercle increases to a very considerable bulk, and this circum- 
stance is one of its criteria. 

In the article Cancer, by Bricheteau in the Dictionnaire 
des Sciences Medicales, the physical characteristics of schirrus 
are denned to be, a demi-transparent tumour, having a linear 
disposition, often lobular, of the consistence varying from lard to 
cartilage or fibro-cartilage, and composed of tissue which seems 
to be of celluar production penetrated with albumen of a white, 
blueish or greyish colour. 

Dr. Gibson, understands by schirrus a preternatural density 
or induration of the soft parts, not easily resolved and very prone 
to ulceration. It is also recognised by certain external marks, 
and by a peculiar internal structure. The whole tumour is 
unequal on the surface, and uncommonly heavy: the pain is 
vehement and of a peculiar kind — at first prurient, but after- 
wards lancinating and compared by many patients to the gnaw- 
ing of an animal. 

Besides these characteristic symptoms of schirrus, and the 
peculiar pathological changes in the tissues affected, hydatids 
are sometimes found existing in great numbers, and of different 
sizes. This circumstance has probably given rise to the theory 
ol the animalcular origin of carcinoma, which was entertained 
by the late Dr. Adams, and which is still insisted upon by Mr. 
( Jarmichael of Dublin. 

Mr. Pearson declares he has never vet met with an une- 



466 Essay on Cancer. [March 

quivocal proof of a- primary schirrus in an absorbent gland. — 

He thinks it always commences in the secretory glands, as the 
mamma, the pancreas, tisticles, &c. Should this idea be con- 
firmed by experience, it would assist much in the diagnosis of 
the disease in the state of schirrus. 

By a comparison now of the descriptions given by the distin- 
guished authors refered to, we find but little discrepancy in their 
enumeration of the symptoms of cancer in the state of schirrus, 
or of the pathological condition of the tissues affected by it. — 
All agree there is no one pathognomonic sympton or sign of it ; 
but they also concur in an assemblage of them, which when 
taken together, clearly and distinctly characterize a schirrous 
tumour. Thus Bayli? and Cayol state that out of a hundred 
tumours of the breast, all of which are hard, unequal, insensible 
to pressure, and which have existed for more than a year, about 
ninety nine are cancerous. Again, if a tumour presenting these 
signs of schirrus, has resisted a treatment for chronic phlegmasia, 
for scrofulous engorgement, &q. then is it certain that such a 
disease is cancerous. 

With respect to cancer in the ulcerated stale, it may be 
remarked that writers generally coincide in representing it to be 
an ulcer opening spontaneously, with hard, jagged and reverted 
edges, of a very disagreeable aspect, from whose surface there 
flows a foetid, acrid discharge, excoriating the surrounding skin, 
which becomes of a purple colour, that of the sore itself being 
M'a dark red. The patient complains of darting pain and of a 
burning sensation over the whole ulcer, and which when exam- 
ined presents no trace of cellular tissue, nor of vessel, nor of any 
other normal structure, whatever may be the organ attacked. 

Boyer however, . slates, that notwithstanding Che 

!if. inequality , rough irregular shape of the ulce- 

ration, the nature oft! tion and the pain, the indiscrimi- 

nate d ion of all tissues, &c. yet they do not exclusively 

chari It is only \ known by its return 

when once operated upon ; this says he, is iheonly circumstance 
which can remove all doubt on the subject of its disease.* 



An iliat when- 

ever pressed for a tlcci tal urc of a disease supposed to be cance- 

rous, his uniform reply w.i i, " ij it returns after I cut il out, thru il is a cancer." 



183S.] Essay on Cancer. 467 

A question has originated of some importance in connection 
with the characteristic symptoms of this disease, and which it is 
well to notice at this place ; it is whether cancer ought alone to 
be restricted to schirrus degeneration. Authors generally admit 
that certain ulcerations may become carcinomatous, without 
being preceded by the state of distinct tumour. The question 
too, is I think decided by the admission of two separate classes of 
cause producing cancer ; viz : an internal and an external. 
For if an external injury or impression can develope a schirrus 
tumour under the skin when entire, certainly a similar cause can 
the more readily produce a like effect upon an ulcer. Be this 
however, as it may, a genuine cancer in the state of open ulcera- 
tion, is generally preceded by o schirrus degeneration. 

As regards now the nature of cancerous disease, it may be 
stated that we have nothing very satisfactory on this subject- 
If it be an affection sui generis as it certainly is, this nature is not 
as yet well denned. It is however, a subject bearing too much 
upon the diagnosis of cancer, to be omitted, notwithstanding its 
difficulties, in the present essay. 

Cancer is to all intents and purposes a highly malignant 
disease. None destroys more indiscriminately all the tissues of 
the body, than it and fungus nematodes, with which it has often 
been confounded ; and they are even to the present day, consid- 
ered by nearly all French writers, as only a modification of one 
and the same disease. Cancer, and fungus are placed by them 
in the same arlicle, and treated as partaking of the same general 
characteristics ; differing only in one being in a state of crudity 
and the other in the state ot ramolissement. But this is certainly 
a very great error. 

Cancer, in its nature, differs essentially from fungus nema- 
todes, in its seat, its progress, the contents of the tumour, and the 
liability of the period of life to an attack. Cancer most fre- 
quently affects the female mamma, uterus, testicle or the secre- 
tory glands — fungus, the extremities, internal organs, &c. Can- 
cer is generally chronic in its course — fungus is rapid. Cancer 
commences with a hard, uneven, knotted tumour, which never 
acquires any great size before ulcerating ; and when opened, the 
contents are of a cartilagenous durity, even turning the edge of 
a knife— fungus is a soft, smooth, elastic tumour at its begin- 
c3 



46S Essay on Cancer. [March 

ning, generally attaining a great magnitude, and when opened, 
found to contain matter resembling the structure of the brain. 
Cancer has a central point harder than the circumference of the 
tumour — fungus has nothing similar to this. Cancer is almost 
peculiar to old age — fungus to no particular period of life. 
Cancer, in its progress, contaminates the neighbouring lymphatic 
glands — fungus never, but affects the internal organs, as the 
lungs, liver, brain, &c. Two diseases having such differences, 
cannot be of the same nature. 

Cancer differs from gangrene. This latter, as has been said, 
kills the parts it attacks, or deprives them of their vital proper- 
ties ; while cancer, on the contrary, consumes, devours the tis- 
sues still living. Abandoned to itself, cancerous disease never 
recovers. It often does remain stationary, but when it changes, it 
is always to increase and never to diminish. These general 
characters, with those already mentioned, would seem to prove, 
that cancerous disease is the effect of one and the same cause. 
In the language of Bayle and Cayol, it remains to be establish- 
ed, what is this cause. Is it black bile, according to Hippocrates 
— acid black bile, according to Galen — a coagulable lymph be- 
come acrid, after Boerhaave — a foetid oil, alkali or acid — or is it 
a gas, according to some modern writers ? The truth is, we are 
absolutely ignorant what is the cause of cancer. 

Boyer supposed that cancer is formed by lymph, arrested in 
its passage, and in the neighbouring cellular tissue, and that it is 
the product of an internal constitutional cause. Abernethy 
said it arose from a disordered state of health, and agreed with 
Hunter that there is always a predisposition first in the system, 
before the appearance of the diseased action. Bayle and Cayol 
declared the disposition to cancer or cancerous diathesis, is the 
true and only cause why the disease returns after an operation. 
According to Andral, the fibrine coagutatcd in blood vessels, 
constitutes, sometimes in the organs, a whitish mass, resembling 
tumours called cancerous. Velpeau having had occasion to 
observe some facts of this kind, concluded that cancer could be 
developed primitively in the blood. But all this is little satis- 
factory, and assists us very feebly in answering the question, 
what is the true nature of cancerous action ? Were it true, that 
cancer depended upon a constitutional diathesis, as these and 



1S3S.] Essay on Cancer. 469 

other authors, even Sir Astley Cooper, would have us be- 
lieve, no operation could ever be permanently successful. 

While I admit a predisposition to schirrus and cancer, result- 
ing chiefly from old age, still I cannot believe that carcinoma 
arises in all instances from an internal cause, or that like scro- 
fula, the constitution is primarily affected by it. I must still con- 
tend for the local origin of this disease, and that the system is 
only secondarily invaded by its progress. All that has been 
well established on this subject, the peculiar nature of cancer, 
are the chronic induration with hypertrophy of the parts at- 
tacked, the difficulty, if not the impossibility, to discuss or re- 
solve such a tumour, its great tendency to malignant ulceration, 
the destruction of all the tissues indiscriminately of the body, 
and the occurrence of these circumstances at the age of about 
fifty years. 

Of all diseases, schirrus is most difficult to be distinguished 
from inflammatory indurations and fibrous tumours. From the 
first, it has been remarked, that chronic indurations are more or 
less of a red colour, from the presence of blood invited by irri- 
tation, into the part inflamed. They are, moreover, preceded 
and accompanied by symptoms of inflammation. A fibrous 
tumour differs from schirrus, in being more isolated from the 
tissue of the organ affected ; in acquiring a large size without 
ulceration ; in its fibres passing in every direction ; in the fibrous 
disorganization being well supplied with blood, bleeding freely 
when cut into or torn, which is never remarked in schirrus ; in 
never giving pain, producing only inconvenience from its mag- 
nitude ; finally, in its never degenerating into cancerous ulcer- 
ation. 

The last peculiarity of the disease under consideration, which 
I shall notice, is its affecting chiefly the white tissues of the body, 
as the breast, testicle, &c. Now it is this very structure which 
approaches, in appearance, nearest the schirrus disorganization. 
Who, for example, does not know that the female mamma, in its 
healthiest condition, will turn or fracture the ed^e of the best 
tempered knife ; or who, after a minute examination of its ducts 
and anatomical arrangement, has not seen some parallel to the 
whitish bands, &c, of a true carcinomatous tumour ? 

In conclusion, I define the characteristic or diagnostic symp- 



470 Essay on Cancer. March 



toms of a schirrus to be, at its commencement, a small, hard, 
moveable, circumscribed, and indolent tumour, ordinarily lo- 
cated in a secretory gland, and occurring most frequently after 
the forty-fifth year of age. It may remain stationary for years, 
but cannot be dispersed ; generally in about twelve months the 
tumour increases in size, becomes heavy, unequal or knotty on 
its surface, forms attachments to the skin and surrounding 
parts, which are converted to a leaden colour, and the patient 
will experience darting, lancinating pain through the part affect- 
ed. So malignant is the disease, that before attaining a diameter 
of two or three inches, the tumour will have ulcerated. Origin- 
ating like a local affection, the system soon becomes involved in 
its progress. 

A true schirrus dissected, will present a centre of a cartilagin- 
ous hardness, with whitish bands seemingly composed of con- 
densed cellular tissue, proceeding towards the circumference, in- 
terposed by others passing in a circular direction, and the whole 
enclosing a brownish pulpy matter, which exudes or may be 
scraped from the cut surface. 

I define the characteristic or diagnostic symptoms of cancer in 
the state of open ulceration to be, an ulcer seldom less than two 
or three inches in diameter ; commonly the result of schirrous 
degeneration ; of highly malignant character, destroying every 
tissue which it invades, and uniformly progressing. The surface 
of the sore is very uneven, its edges are jagged, very hard, irregu ■ 
lar and prominent, the discharge is a foetid, acrid matter, and 
the pain is acute and lancinating, or described by patients as a 
burning, gnawing sensation. The neighbouring lymphatic 
glands are sure to become affected ; and the ulceration when 
removed is very apt to return, especially if it proceeds from an 
internal constitutional cause. 

The anatomico, pathological appearances of such an ulcera- 
tion are, an indiscriminate disorganization of all the tissues 
involved by it, and their conversion to an homogeneous, hard, 
greyish or red, irregular substance. 



IS3S.J Treatment of Anchylosis. 471 



PART II. 

REVIEWS AND EXTRACTS 



A new treatment in a Case of Anchylosis. By J. Rhea 
Barton, M. D. 

In the North American Medical and Surgical Journal for 
April, 1827, I published an account of a new and successful 
operation at the hip, which had been undertaken for the two- 
fold purpose of remedying a most serious deformity and lame- 
ness, and of establishing an artificial joint, as a substitute for 
the natural articulation, which had become obliterated by disease, 
terminating in true anchylosis. 

The principles upon whicn this operation was founded, as 
well as the circumstances justifying the performance of it, were 
fully detailed in the publication at that time. 

In prosecuting my views for remedying lameness and deformi- 
ty from the mal-position of limbs in cases of true anchylosis, I 
have been enabled to present another case successfully treated, 
under circumstances suggesting a practice of a peculiar char- 
acter. 

In the case of anchylosis at the hip joint, it is to be recollected 
that the neck of the femur was sawn through, and the distorted 
limb straightened. The wound of the soft parts was then healed, 
whilst the reunion of the divided bone was prevented by subjec- 
ting it, from time to time, to motion ; such as gentle rotation, 
flexion, and extension, abduction and adduction. After continu- 
ing this treatment for a few weeks, the ends of the bones lost 
their disposition to unite, became obtunded and smooth, and were 
held attached to each other by provisional bands or ligaments, 
and in this manner forming an artificial joint, whose move- 
ments were regulated by all the principal muscles by which the 
original joint had been controlled : thus fulfilling the ends of 
my operation, and rewarding my patient for his fortitude.* 



* The patient, upon whom this operation was performed, enjoyed the use of his 
artificial joint for six years; during which period he pursued a business (trunk- 
making) with great industry, earning for himself a comfortable subsistence, and a 
small annual surplus. Pecuniary losses, however, through the reverses of those in 
whose hands he had confided his means, sunk him into a state of despondency and 
desperation. followed by habits of intemperance. This. with all its train of evils, abuse 
of health, &c. was, no doubt, the cause of the change which afterwards took placo 
in the artificial joint. It gradually became more and more rigid, and finally all 
motion ceased in the part. With this exception, the benfitfl of my operation wrere 



472 Treatment of Anchylosis. [March 

In the case now to be described, no attempt was made to 
establish an artificial joint ; as the attending circumstances did 
not admit of such a consideration. The object of my treatment 
was to remove deformity, and to restore to usefulness a limb 
which had unfortunately been suffered to become anchylosed in a 
mal-position. The following will, I trust, satisfactorily explain 
the operation and the after treatment of the case, as well as the 
principles by which I was guided in the management of it. 

S ■ D 's, M. D., formerly of Charleston, S. C, but now 

a resident of Alabama, when a youth of about nine years of age, 
unluckily had his knee joint involved in inflamation and suppu- 
ration so extensively, as to occasion the destruction of the syno- 
vial membranes, the ligaments, cartilages, and, in short, every 
structure peculiarly appertaining to the joint. After a protrac • 
ted suffering he finally recoved with the loss of the joint ; the 
tibia, femur, and patella having become united to each other in 
the form ot a true anchylosis. The loss of the articulation of 
knee, however, though a misfortune, did not constitute the sad- 
ness of his case. It was caused by the mal-position of the limb ; 
th.3 leir having b^en flexed upon the thigh to a dagree somewhat 
less than a right angle. Hence the only alternatives of which 
he could avail himse.f to aid him in walking were, either to use 
crutches, or to employ a very high block-sole boot, and to lower 
his stature by flexing the sound limb in order that both feet 
might: reach the ground. The latter expedient lie adopted. — 
The long continued pressure and weight of the body sustained 
by this defective limb, acting under such great mechanical dis- 
advantages, had at length caused some projection of the instep, 
and other irregularities, which it is unnecessary to particularize. 
This supposed irremediable condition of his limb, with all its 
ills, the young gentleman endured during the period of about 
sixteen years. In the mean time he graduated in medicine, and 
became a successful and highly respectable practitioner ; but as 
his professional labours increased, he found the condition of his 
limb to be an obstacle not only to his further success, but also a 
source of unceasing annoyance and vexation. Whereupon, with 



retained and lull;, appreciated until the period of his death; for as the. limb had 
been freed from deformity and restored to a useful position, he had no occasion even 
for a cane t<> aid in walking. During an attack of the Asiatic cholera, he express- 
ed a desire thai I should be sent for, in order that In- i iiiuJi t renew his bequest to me 

ofthe parts interested in the operation, lie recovered from the cholera, but subse- 
quently died of phthisis pnhnonalis. The autopsy exhibited the parts as described 
in the published case, but with the artificial joint anchylosed; a change which had 
been effected within two years previous to his death. With ordinary care, in all 
probability, this would not have taken place. 

The final history of this case presents now the important fact, that benefit had 
resulted, which fully requited the individual foT the pains he had endured, and 
were considered by him, even after the closure of the joint, yet an ample reward for 
the operation he had undergone. 






1S38.1 Treatment of And tylosis. 473 

a resoluteness not surprising to those who knew the strength of 
his mind, the firmness of his character, and the abundance of his 
manly courage, he repaired to Philadelphia in order that some 
relief might be obtained, if it were possible. When consulted by 
him I found him fully prepared to learn that no benefit was to 
be expected from any heretofore known practice, and that if he 
could be relieved it must be by some novel expedient and treat- 
ment. 

After a candid and full disclosure of my views of his case, and 
of the means by which I thought he might be benefitted, his 
own judgment accorded with mine; and believing in the feasi- 
bility of the plans, he became urgent for the undertaking. It 
was accordingly commenced on the 27th day of May, 183o, and 
pursued as follows : 

Two incisions were made over the femur, just above the patel- 
la. The first commenced at a point opposite the upper and 
anterior margin of the external condyle of the femur, and, pass- 
ing obliquely across the front of the thigh, terminated on the 
the inner side. The second incision commenced also on the 
outer side, about two and a half inches above the first ; and pass- 
ing likewise obliquely across the thigh, terminated with the 
other in an acute angle. By these incisions were divided the 
integuments, the tendon of the extensor muscles of the leg, at its 
insertion into the upper part of the pattella, and some of the con- 
tiguous fibres of the rectus and crureus muscles themselves, a 
greater part of the vastus internus, and a portion of the vastus 
externus muscles. A flap, composed therefore of this structure, 
was elevated from the femur close to the condyles. The soft 
parts were next detached from the outer side of the bone, from 
the base of the flap towards the ham, by passing a knife over 
the circumference of it, as to admit of the use of a saw. The 
flap then being turned aside a triangular or wedge-like piece of 
the femur was easily removed by means of a small narrow bladed 
saw ; such as was used in the operation at the hip. This wedge 
of bone did not include the entire diameter of the femur at the 
point of section ; so that a few lines of the posterior portion of 
the shaft of the bone remained yet undivided. By slightly 
inclining the leg backward, these yielded, and the solution was 
complete. This mode of effecting the lesion of the bone was 
designedly adopted, and constituted what I conceive to be a very 
important measure in the operation. Important, because it ren- 
dered the popliteal artery free from the danger of being wounded 
by the action of the saw, and subsequently the interlocking of the 
fractured surfaces tended to retain the extremities of the divided 
bone in their positions until the harshness of their surfaces had 
been overcome either by the absorption of their angles, or by the 
deposition of new matter upon them— a change essential to the 



474 Treatment of Anchylosis, [March 

ety oi the artery during the subsequent treatment of the case. 
Not ;i blood vessel was opened which required either a ligature 
or compression. The operation, which lasted about tive minutes, 
being thus ended, the reflected flap was restored to its place, the 
wound Lightly dressed, and the patient was put to bed, lying on 
his back, with the limb supproted upon a splint of an angle cor- 
responding to that of ike knee previous to the operation. This 
position was maintained until it was believed that the asperities 
of the bone had become blunted, and were not likely by their 
pressure to cause ulceration of the artery beneath them " This 
iirst splint was then removed, and another having the angle 
slightly obtuse was substituted. In a few days a third splint, 
with the angle more obtuse than that of the second, supplied its 
place. Others, varying in degrees of angularity, in like maimer 
came in their turn to support the limb until it had attained a 
position almost straight. It was then unchangeably continued 
in that line until the contact surfaces of the bone had united and 
securely fixed the limb in this the desired direction. 

During the treatment of the case, especial care was bestowed 
in protecting the popliteal vessels against any injurious en- 
croachment upon them. With that view, all antagonizing pres- 
sure on the soft parts in the ham was carefully avoided. The limb 
was rested on two long bran bags, laid upon the splint, with their 
ends apart — a vacancy of four or five inches being left between 
them opposite the lesion of the bone. This interspace waslighly 
filled with carded cotton, so as to afford a safe support. Every 
symptomof pain or uneasiness in this part was promptly attended 
to. The occasional issue of a drop or two of blood from the 
corner of the sore, during the process of dressing the limb, 
caused me some solicitude in this case; whereas, ordinarily I 
should have considered it as a matter of no moment — it being so 
frequent an occurrence during the dressing of wounds, owing 
to the disturbance of the granulations, especially in compound 
fractures. The wounded soft parts finally healed and quieted 
his anxiety. The straightening of the limb having been very 
cautiously and by deg cted, the iirst two months elapsed 

during the accomplishment of this object. Having then reduced 
it to the desired position, means were carefully observed to retain 
it so until the re-union of the bone had been fully completed; 
which occupied two months longer. The constitutional symp- 
toms were such as usually occur in compound fractures — some- 
what severe, but at no time alarming. Throughout the whole 
treatment it was not found necessary to bleed him, or to have 
recourse to any very active constitutional measures. He was occa- 
sionally indisposed from irregularity in the digestive functions, 
but was always speedily relieved by resorting to mild and appro- 
priate remedies. 



183S.] Treatment of AncHylo 475 

At the end of about four months from the date of the operation 
my patient stood erect, with both feet in their natural position, 
and the heels resting alike upon the lloor, although a slight 
angle had been designedly left at the knee, in order that there 
might not be any necessity for throwing the limb out from the 
body in the act of walking, which is always the c. 
knee is quite straight. After this period, the use of shoes of the 
ordinary shape was resumed, and the limb was daily exercised 
with increasing strength and usefulness. On the 19th of Octo 
ber, the Doctor took his departure for the South, bearing 
with him the injunction to continue the support of a small 
splint and the aid of a crutch or cane, until he should ac- 
quire sufficient confidence in the strength of the limb to justify 
him in laying them aside. 

I was subsequently advised of his improvement ; but was 
resolved not to give publicity to the case until the full and entire 
benefit of the operation could be ascertained. The wide distance 
which afterwards separated us prevented me from obtaining the 
necessary and direct information until within a recent period. 
I have the pleasure now not only to afford this intelligence, but 
to present it in the most satisfactory manner. Having written to 
the doctor for the information, and to learn from him in what 
manner it might be agreeable that I should refer to him as the 
subject of the case the following clear, satisfactory, and well 
written answer was promptly received. As the letter is full 
of interest in the case, I must be excused if I publish it 
almost entire, even though it contains some flattering sentiments 
for the one to whom it is addressed. That part only has been 
omitted which is in courtesy to my family. 

Charlestox, November 6th, 1^ 
"My dear sir, — Your letter of the 8th October, directed to me 
at Mobile, has just reached me at this place, where I am on a 
visit to my parents. I received a letter from you last winter, 
some months after its date, and availed myself of the opportunity 
of a friend going to Philadelphia, and who promised me that he 
would see you, to send you a full communication of my situation 
then. I preferred this to writing by mail, as he had been with 
me, and could answer any particular inquiries you might make. 
On his return he mentioned that he had arrived in Philadelphia 
only a few days after you had sailed for Europe. Your letter of 
the Sth is the first information I have had of your return. I 
have the satisfaction and pleasure of savins: to you now, that the 
operation you performed on my leg has been completely suc- 
cessful, and has more than realized my most sanguine anticipa- 
tions. The small abscess, which you dressed the day before we 
parted at Norfolk, continued open, and threw out. from time to 
d 1 



476 Treatment of Anchylosis. [March 

time, small pieces of bone, until the August after, when the last 
piece was discharged ; the orifice then closed, and I have suffered 
no material inconvenience from it since. From the January- 
previous, however, I was going about and attending to my pro- 
fessional business; and early in the summer, when our sickly 
season commenced, I was on horseback daily, riding from thirty 
to fifty miles a day ; without more than the ordinary fatigue or 
inconvenience. I am at present well ; the wound sound ; and 
I feel no other inconvenience in riding or walking, than what 
arises from my knee joint being stiff, which was the case before 
you performed the operation. I walk without a stick or other 
aid, with the sole of the foot to the ground, and my friends tell 
me, with but a slight limp; and I have great pleasure in adding 
that the leg and foot have increased considerably in size, so as 
now to be nearly equal to the other. When I think of what I 
was, and what I am ; and that to your firmness, judgement, and 
skill, 1 am indebted for the happy change. 1 want words to 
express adequately all that I feel. I will not attempt it, but 
believe me, my dear sir, I feel it not the less. I shall remain here 
a week or two longer, and if you wish any further information 
on my case, do write me and I will give it most cheerfully. 
After that period I cannot say where a letter would reach me. 
Adieu. * * * * * 

and am, my dear sir, very sincerely, your friend, 

Seaman Deas. 
To Dr. J. Rhea Barton. 

P. S. In the statement you propose publishing of my case, I 
am quite willing you should refer to me in the manner you sug- 
gest, using my initials in the body, and my name at length in the 
note you propose appending to it." 

Remarks. — In the case just recited, several difficulties of a 
peculiarly embarrassing nature presented themselves as obsta- 
cles to the restoration of this disabled limb ; namely, the true 
character of the anchylosis, the extreme angle at which the joint 
was fixed, the changes of structure which must have taken place 
during the p