(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"

NATiOHAD 
UBRARniHOERKO 

' ■ ATUA?!TA ' 



SOUTHERN 



^^M 



MEDICAL AND SURGICAL 



JOURNAL. 



EDITED BY 

PAUL F. EVE, M. D., and I. P. GARVIN, M. D. 




Medical College of Georgia. 



Jc prends U hien oujele trouve. 



VOL. I.-1845.-NEW SERIES, 



p. C. GUIEU, PUBLISHER. 

AUGUSTA, GEO. 

PRINTED BY JAMES McCAFFERTY 

1845. 



SOUTHERN 

MEDICAL AND SURGICAL 
JOURNAL. 

Vol. I.] NEW SERIES— JANCiRT, IS45. [No. 1. 

r ■ . t 

INTRODUCTION. 

The -vvant of some convenient repo.sitory for the results of the observation and 
experience of Southern Physicians — some medium through which they can 
communicate with each other, and with the profession at large, has long been 
felt and deplored. In all the broad region occupied by the Southern and South- 
western states, there exists but one periodical devoted to the Medical Sciences, 
and that of recent origin, though in this section are to be found hundreds of 
intelligent and experienced practitioners, who are thoroughly conversant with 
the diseases peculiar to it, and with all those modifications which climate, 
physical constitution, and other causes produce in those maladies which are 
common to our v.'hole country. It is true that there are already established in 
the Northern cities .several Medical Journals which are conducted with distin- 
guished ability. But these cannot supply our peculiar wants — Of necessity, a 
large portion of the correspondents of these periodicals reside where many of 
our most common and serious disea.ses are but little knowai— Moreover the field 
of labor of the Southern physician is so di.stant, that he does not feel that incite- 
ment to prepare the results of his observation for the public eye, which he would 
experience if there were published in his vicinity, a Journal in which his com- 
petitors and his friends were earning distinction for themselves and extending the 
boundaries of the Science, From the want of such facilities for communication, 
a vast amount of valuable knowledge is lost to the profession, and its Iwnor and 
usefulness seriously impaired. 

In view of these, and other cogent reasons, the Faculty of the Medical College 
of Georgia began the publication of the Southern Medical and Surgical Journal 
in the year 1836, under the editorial management of the late Prof. Antony. 
The work was continued with constantly increasing usefulness and success 
until the lamented death of the Editor led to its suspension at the close of the 
third volume. Since that time, they have received from various quarters urgent 
appeals to revive the Journal, and in accordance with these requests several 
attempts have been made to re-establish it, heretofore however, without success. 



SI 



o 



INTRODUCTION. 

But arrangements have now been made which justify the revival of the work, 
and render certain its future continuance. 

The Journal has been jjlaced under the editorial management of two mem- 
bers of the Faculty. They would distrust their o^ti ability to carry on so 
laborious, and responsible an undertaking, but they are led to make the effort by 
the promise of the valuable aid of their colleagues, and of other distinguished 
members of the profession in this and the adjoining States. They have entire 
confidence in the ability of Southern physicians, to furnish matter which will do 
honor to themselves, and prove highly useful to the profession. We therefore 
cordially solicit them to furnish us with their communications, not only upon 
medical subjects, but also upon any of the collateral sciences, ,.^---; 

It is proposed to devote a portion of the Journal to Reviews of new works, and 
to such Extracts from these, and from other periodicals, as may be useful and 
interesting. Another part of the Journal will be appropriated to a general Sum- 
mary of the improvements and discoveries in medicine, which are being made 
throughout the world. The facilities of the Editors for this part of their task are 
ample, as they are now regularly receiving all of the most valuable European 
and American Medical Journals, 

The first number of the new series of the Southern Medical and Surgical 
Journal will be sent to the former subscribers to the work, and also to many 
other professional gentlemen, in the confident expectation that they will aid the 
undertaking with their patronage. No selfish feeling prompts this solicitation — 
for no pecuniary benefit is expected to accrue, unless it should be to the pub- 
lisher. An anxious desire to do something to advance the usefulness and 
respectability of Southern medicine, prompts the efibrt. The harvest is great, 
the laborers are few, and the Editors enter upon it, trusting that with the blessing 
of God, and the aid of other professional brethren, they may be in some degree 
instrumental in the improvement of a Science whose sole, unselfish aim, is to 
benefit the human race. 

The Journal will be issued puncUially on the first of every month— and will 
be forM-arded to subscribers by mail, unless some other mode of delivery is 
specified. 

Letters containining remittances should be directed (free of postage) to the 
publisher, P. C, Guieu. 

Communications intended for publication, must be accompanied by the name 
of the writer, and should be addressed to the Editors. 

Augusta, January, 1845. 



Part I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

Pathology of Intermittent Fever — By Lewis D. Ford, M. D., Pro- 
fessor of the Institutes and Practice of Medicine, in the Medical 
College of Georgia. 

The writer offers no apology for an article on the common and 
trite subject of Intermittent Fever ; for after all that has been written 
upon it and all that is known of it, it still remains a subject of the 
deepest interest, and one worthy the most thorough study. The 
philosophy of that physician is not to be envied, who rests satisfied 
with his knowledge of Intermittent fever, when he has learned to dis- 
tinguish it from all other diseases, and to treat it after the commonly 
received rules. That its pathology is still unknown, continues to 
stimulate the inquiries of those, whose ultimate object of research, in 
every disease, is to ascertain its primary location and the very nature 
of the physical changes in which it consists. The very act of tracing 
out the relations of its open phenomena with the hidden parts of the 
organization is interesting, if only for the gratification of a scientific 
curiosity — " Felix, qui potuit rerum cognoscere causas.^^ 

But the study of the intimate nature of a disease, which is well 
marked by external symptoms, and which has a specific and well 
known treatment, has a higher aim than this ; for however well 
known the physiognomy of Intermittent fever in its simple forms, and 
however certain its cure, yet, in its complicated forms it becomes 
most formidable and fatal ; and he who understands best the patholo- 
gy of the simpler form, will be best prepared to trace it in all its com- 
plications, and to vary his treatment according to its ever-changing 
accidents. Again, if the opinion entertained by Dr. Cullen be true, 
that this is the fundamental or model type of all fevers— that even 
the most continued fever consists of a repetition of paroxysms, then 
the true mode of studying all fevers must be to begin with the simple 
form ; and he who passes by this form, without getting a definite 
knowledge of its intimate nature, will scareely be able to comprehend 
fever in its more complex forms. We have no intention now, to 
examine the question whether there really does exist any form of 



4 Pathology of Intermittent Fever, [January, 

fever, which is truly continued, but only assert the fact, the result of 
our own observation of many years, that the fevers of this climate, do 
almost invariably, in their commencement and through the greater 
part of their course, present a decided paroxysmal character ; and 
that it is not until after the occurrence of those fixed, structural chan- 
ges, which inflammation produces, that they loose this character. 
To the physician of the Southern States then, whose great business 
is the treatment of periodical fever of various forms, an effort to 
illustrate the nature of simple Intermittent fever, may not be unac- 
ceptable. 

It is unnecessary to enter into a detail of the symptoms of Inter- 
mittent fever, these being so familiar to all. The problem with which 
the writer proposes to occupy himself is this : the symptoms of 
Intermittent fever being given, to determine the organic alterations 
upon which these depend — in other words, the diseased acts being 
given, to ascertain the diseased state; for, as already intimated, he 
fully recognizes that sound principle of medical philosophy, that the 
ultimate object in the study of disease is the knowledge of the dis- 
eased state — the physical state of the organ or organs suffering. 

If organic medicine had done nothing more than establish this 
cardinal principle, it had rendered an inestimable benefit to our 
Science; f()r although it must be candidly declared, that this high 
degree of knowledge, even in the most palpable diseases, is very 
imperfect, yet its pursuit is not chimerical ; in proposing to gain it, 
we are not in search of the unattainable. This great principle of 
organic medicine teaches the physician to study his Science with i\iQ 
Bame inductive method, that has so beautifully illustrated the physical 
Sciences, in the assured hope, that new modes of investigation shall 
make definite, that knowledge which is now so imperfect. It is a 
great polar star, v/hich will keep him in the right way, and that 
which he does not reach himself, after-generations, beginning where 
he left off, shall not fail to discover. Even at the present day, this 
principle steadily kept in view will lead to the coarser, but by no 
means unimportant knowledge of the organ affected, in any given 
disease. 

The physical changes in the organization, upon which simple 
intermittent fever depends, have not as yet been satisfactorily deter, 
mined ; because, in the few cases, in which after a prolonged course, 
it proves fatal, it can scarcely admit a doubt, that the appearances of 
inflammation in the stomach and bowels, and enlargement of the 



1845.] Patliology of Intermittent Fever, 



liver and spleen, are the consequences rather than the causes of the 
disease. These morbid states are by no means, uniformly discovered 
after death or manifested during the disease ; these enlargements, 
often do not exist nor any evidence of these inflammations ; and 
moreover, nothing is more common than their continuance long 
after the fever has disappeared. Besides this uncertainty, we believe 
another reason why these physical changes have not been discovered 
is, that they have not been generally sought for in the right direction 
nor with sufficient patience and minuteness. And although autopsic 
examinations of cases of complicated malignant Intermittents shew 
physical changes to have taken place in the central organs of the 
nervous system, very uniformly, yet the inference is not allowable, 
that it is upon this kind of organic disease, that s^mpZe Intermittent 
fever depends. So that simple Intermittent never proving fatal, 
pathological anatomy can furnish us no aid in determining its organic 
lesions ; and we are left to reason out its pathology, under the 
guidance of general principles. 

In considering the various functions of the body, during a paroxysm 
of fever, we find almost every one of them disordered — functional 
disease is absolutely omnipresent ; and as we can conceive of no 
functional derangement independent of organic changes, we infer 
that organic disease is as universally present. Upon this state of 
universal disease of the organs, we are obliged to conclude, that they 
did not contain within themselves an independent cause of irritation, 
acting simultaneously to produce their disordered action — this were 
an absurdity. We are compelled to regard this universal disorder 
as consequent upon disturbance in the action of those systems uni- 
versally distributed throughout the body, and therefore universal in 
their influence upon its organs — namely, the circulating and nervous 
systems. Each of these has its great central organ, whose varying 
degrees and kinds of action are quickly manifested by corresponding 
changes throughout the entire economy- And again, when, in a 
paroxysm, we observe the whole circulating system disordered in its 
action, this becoming either increased or diminished or irregular, we 
are equally compelled to attribute this disturbance, not to irrritation 
or disease developed simultaneously, in the various parts of this sys- 
tem, but to the increased, diminished or irregular action of its central 
impelling muscle — the heart. This is true of ever\' part of the arte- 
rial system depending directly for its action, upon that of the heart — 
and to a considerable degree of the capillary system also; for 



Pathology of Inter milt eni Fever. [January, 



although it possesses an independent action of its own, still that is 
undoubtedly modified to some extent by that of the heart, as illustra- 
ted by the opposite states of the capillary system in the extremes of 
high and low general action. Seeing then, that a vast number of the 
phenomena of a paroxysm may be dependent upon disordered action 
of the heart, it becomes an important enquiry — how, in fever, is the 
disordered action of the heart produced ? To aid in the solution of this 
question, let us first determine the various modes in which an organ 
may be disordered in its functions. Inflammation present in an 
organ does most signally disorder its actions; and this is a state, 
discoverable by palpable characteristic changes — structural changes 
in its organization. Besides this state of inflammation, the functions 
of an organ may be deranged by the state and quality of the blood 
circulating within it; thus too much blood or too little, or blood of a 
depraved quality produces deranged action. Again, besides these 
two, there is a third cause of disordered function of an organ — viz : 
the influence of other diseased organs upon it, through the medium of 
the nervous system — sympathetically disordered. 

Does this disordered action of the heart, manifested during the 
paroxysm of fever, depend upon inflammation? — Is the primary seat 
of fever in the heart itself ? This question may safely be decided 
upon the testimony of morbid anatomy alone : which does not dis- 
cover the evidences of inflammation of the heart, or any of its tissues, 
even in cases of fatal malignant Intermittents. Further, its inflam- 
mation is characterized by well marked symj)toms, not present during 
the paroxysm; — and, again, this disordered action of the heart is 
secondary to other afftjctions previously developed. As to the second 
source of disorder — too much or too little or depraved blood ; ahhough 
this class of causes must necessarily exert a powerful influence over 
its action, at various stages of the paroxysm, yet the diminution of 
the natural quantity, or its increase, belongs to a secondary series of 
phenonvena — the eflect of pathological states previously existing; 
and this varying quantity of blood in the heart is probably dependent 
upon the peculiar action of the heart itself. We are led therefore to 
conclude that the action of the heart is disturbed by the influence of 
other organs antecedently diseased. 

In determining which of the organs exerts this influence over the 
heart's action, we remark, that the inflammatory state of each and 
every tissue in the body and of each organ, has this power of disturb- 
ing the action of the heart, and thus of inducing fever. We have 



1845.] Pathology of Intermittent Fever. 



ample proof of this in the great number of the Phlegmasiae — such as, 
Gastritis, Enteritis, Pleuritis, Pneumonia, Phrenitis, d:c. But this 
pathological principle will not enable us to illustrate the nature of 
Intermittent fever — it cannot be called a phlegmasia of any of the 
organs ; because these local inflammations consist in radical altera- 
tions of the tissues, which cannot be promptly changed, and which 
therefore manifest themselves by continuous symptoms ; accordingly, 
these fevers of the phlegmasiae are not marked by intermission — 
they are nearly continuous. — So that the pathology, which would 
regard Intermittent fever as a phlegmasia simply, of some of the 
organs, leaves unexplained its most characteristic feature — its peri- 
odicity. Indeed, so far is this opinion from being correct, that on 
the contrary, the occurrence of positive inflammation in any one of 
the organs is sure to destroy the periodicity of Intermittent fever. — 
Moreover, after a paroxysm, the organs all return to their healthy 
functions, so that the symptom? of the paroxysm must have depended 
upon some pathological state of the organs less permanent than that 
of inflammation — a state capable of being cured by the very com- 
motions of the paroxysm. 

This, however, only settles the opinion, that Intermittent fever is 
not a phlegmasia ; and the question returns, what are the organs 
primitively affected ? The recollection of the symptoms and the order 
of their occurrence will suggest, that it must be some part or the 
whole of the central organs of the nervous system ; for among the 
very first, or premonitory symptoms, are those indicating disorder of 
their functions; for they are symptoms of disjordered sensation, of 
disorders in the muscular system, and of disorders of the intellect. 
Before interpreting these symptoms, however, it is proposed to estab- 
lish the general principle, that a diseased state of the brain and 
spinal marrow may produce a vast variety of functional deranf^e- 
ments in distinct organs ; and to specify the various kinds of derange- 
ment known to bo thus produced. To commence with those affections 
of the spinal marrow, about which there can be no doubt — affections 
that are accompanied with and leave behind them, structural disor- 
ganization, we take Myelills or inflammation of the spinal marrow. 
It is sometimes general — at others, confined to particular portions of 
the spinal chord. When it exists in the cervical region, there is local 
pain; wliich, however, is so obscure as not to command, forcibly, the 
attention of the patient, until after pressure upon the spinous pro- 
cesses; which is generally follov/cd by continuous ^nin • — *^^ 



Pathology of Intermittent Fever, [January, 



urgent symptoms, to which the patient himself refers, are pain in 
the upper extremities, with spasms of the muscles, numbness of these 
limbs, permanent rigidity of some of the muscles, followed by para- 
lysis ; the respiration is notably injured, becoming laborious and 
asthmatic ; and it is remarkable that death comes by asphyxia, from 
embarrassment of the respiratory function. When in the dorsal 
region, besides the local symptoms already mentioned, the most obvi- 
ous symptoms are those of disordered respiration and especially of 
disordered functions of the abdominal viscera, cramps of the stomach, 
cholic, constipation, contraction of the abdominal muscles. When 
seated in the lumbar region, its characteristic symptoms are mani- 
fested in the lower abdominal and pelvic viscera and in the lower ex- 
tremities — obstinate retention of fasces and urine, or incontinence of 
both, convulsions, rigidity and paralysis of the muscles of the lower 
extremities. Allusion is here made to acute Myeletis, with fever 
finishing its course in a few days, leaving marks of' unequivocal 
inflammation, which it is needless here to specify. Nor is it necessa- 
ry to do more than merely refer to the acute diseases of the brain, 
as exemplifying the principle, that primary disease of the brain or 
spinal marrow is manifested by symptoms in distinct organs. Physi- 
ological experiments upon living animals establish it equally. If a 
nerve be irritated at its origin in the spinal marrow, this irritation 
will be manifested by pain and muscular contractions in the parts to 
which that nerve is distributed; and if this connection between the 
irritated portion of the marrow and the distant parts be broken, by 
dividing the trunk of the nerve, these effects do not appear. 

But let us look at this principle, more closely, in reference to the 
common symptom of pain. If the finger be pricked by a pin, we 
feel pain. We are apt, without reflection, and even in the face of 
our positive knowledge, to conclude that this pain is produced by 
injury done to the nerves of the part, and to rest in this explanation ; 
but surely the sensation of pain depends essentially upon the action 
of a particular part of the nervous centre, with which the tissue 
injured is in connection ; for, do but cut off the part injured from 
communication with the nervous centre, by dividing its nerve, and 
no pain will be felt, from the severest violence. The action^ then, 
of some particular portion of the central nervous organ, is indispensa- 
bly necessary to the production of this pain ; and this action is the 
result of a peculiar modification of this nervous substance. Now it 
is fair to infer, that if from any idiopathic affection of this portion of 



1845.] Pathology of Intermittent Fever. 



the nervous centre, the same modification should be produced, the 
same kind and degree of pain would be felt in the finger, as was pro- 
duced by the pin. We may safely adopt the same explanation of 
pain from disease ; and yet there is the same stopping short at the 
part itself, instead of looking to the more far-off source. 

In pleurisy, for example, no doubt that if the communication with 
the nervous centres were cut off, no pain would be felt ; and on the 
other hand, if from any cause, the portion of the nervous centres bo 
similarly modified, the same kind of pain would be felt in the pleura, 
as is felt when it is inflamed. Now, we are not left to conjecture 
on this point, for this state of things actually occurs, in that disease, 
closely resembling pleurisy, in its violent and pungent pain, though 
unaccompanied by its inflammation, its characteristic effusion or its 
fever — pleuralgia ; dependent on spinal irritation, as we believe, 
both from the fact that it is accompanied with tenderness on pressin*' 

« r o 

some of the spinous processes of the dorsal vertebrcs, and that it is 
promptly relieved by revulsive applications to the spine — relieved as 
by a charm. We have proof of the dependence of pain in an organ 
upon the diseased state of the spinal marrow, in tlie almost instanta- 
neous relief o^ false pains in the uterus, by revulsive applications to 
the loins ; — indeed, so certain is this mode of relief, that the writer 
has long been in the habit of using a sinapism to the sacrum and 
loins, as a test of the nature of these pains, instead of a manual 
examination of the os tineas. 

But irritation in some portion of the spinal marrow not only deter- 
mines pain in distant parts, but we think it may be shewn to deter- 
mine those physical alterations in the tissues, in which inflammation 
itself consists. These physical derangements in inflammation, take 
place in the capillary system — its beginning is there; suppuration in 
which it often terminates, is evidently a secretory process carried on 
by its vessels. If we enquire into the mode in which these vessels 
perform their action in heahh — the mechanism of their action — it 
will aid in determining this question. There are two circumstances 
indispensably necessary to the production of the actions of these 
vessels, as of every other vital action — 1st. the living organized 
surface, endowed with the capability of feeling the impression of 
excitants, and 2nd. the agents to make this impression. Now, 
without going into the question in physiology, whether the actions 
of the organs are independent of nervous influence, we remark that 
this susceptibility of the tissues to impressions is dependent on their 



10 Pathology of Intermittent Fever, [January, 



organization, and the nerves are indispensable to this organization — 
and it is according to our knowledge at the present day, to say that 
the power of feehng impressions is dependent upon the nervous sys- 
tein. In determining what are the agents and stimulants, which 
making their impressions upon the susceptible capillaries, excite 
them to action, tlie remembrance that their functions — nutrition, 
absorption, secretion, &;c. are incessant, never interrupted, not even 
in sleep, suggests that these stimulants must be always in contact 
with them — that this agent is the blood within them: in this we 
recognize a beautiful provision, inasmuch as the fluid, which is to 
furnish the materials for the nutrition and secretion of the organs, is 
itself the stimulus to the actions, which separate these materials. If 
this be a correct account of the mechanism of the capillary action, 
then a change in the quality of the stimulus, the sensibility remaining 
in the natural state, will derange their action ; but, a change in their 
sensibility — an increase of this sensiljility, the blood remaining of its 
natural quantity and quality, will also derange their action. Lotus 
apply these principles to explain how inflammation may be induced 
by idiopathic disease of some portion of the nervous centre. Let us 
take the pleura : in its sound state, it is exercising all its capillary 
functions with regularity; these capillaries, constantly supplied with 
tlieir stimulus, the blood, by the action of the heart; their suscepti- 
i)iiity to this stimulus as constantly kept up, by the incessant action 
of that portion of the central nervous system, with which it is in 
commtinication, by intercurrent nerves. But suppose that this por- 
tion of the nervous centre becomes diseased, its healrhy action disor- 
dered, then this susceptibility of the caj)illarics must become changed 
also; and if increased, their ordinary stimulus will excite its capillaries 
to higher action — the first step in every simple inflammation. The 
writer would not be understood as aflirming, that pleurisy and other 
inflammations have their beginning in the central nervous system ; 
he is only explaining how a particu.ar moditicalion of some portion 
of this system may determine the first beginnings of inflammation. 

It must be acknowledged, that a j)hysiological argument to prove the 
possibility of the dependence of inflammation upon a diseased state of 
the nervous centres would be notliing worth, if observation did not 
discover the fact. Acute Rheumatism, with its local heat, swelling, 
redness, and excessive pain in the joints may be considered, at the 
present day, as proved to ])e dependent on a diseased condition of 
some portion of the spinal marrow — proved by the evidence of 



1845.] Pathology of Intermittent Fever. 11 



uniformly co-existing and antecedent disease ihcre, and by the fact 
of the great success of revulsive applications to the spine. We assert 
the fact, that absolute mucous gastritis is uniformly attended with 
spinal tenderness, in some portion of the upper dorsal vertebrae, and 
that of all the means for relieving this most distressing affection, 
none can compare, in promptness and efficiency, with leeches, cups, 
sinapisms, and blisters to the spinal column. Again, we have for 
many years, recognized the same connection, in acute peritonitis — 
it exists with great uniformity, even in puerperal peritonitis, and 
these topical applications to the lower dorsal and lumbar region of 
the spinal column, we have been accustomed to use as most important 
auxiliaries, in that affection, which so often taxes all the resources of 
the physician. The writer regrets that he cannot, here, illustrate 
these pathological facts, by carefully observed and recorded cases, of 
wiiich he has an abundance at his command. 

There is another pathological state, strictly dependent on original 
disease in some portion of the spinal marrow — ^pasm or convuL-^ions 
of the muscles of organic life, such as the heart, the muscles of res- 
piration, the muscles of the stomach and intestines, &c.; and if those, 
we are authorized to conclude the muscular tissue of the capillaries 
also: — thus, upon some diseased state of the spinal marrow are de- 
pendent nervous palpitations of the heart, some of the varieties of 
asthma, hysteria, colic, and cramp of the stomach. Tlie writer 
could adduce many instances of predisposition to this last mentioned 
disease entirely destroyed by a seton between the shoulders. The 
recent records of medicine abound with facts, shewing the de- 
pendence of ahnost every variety of disordered sensation, as also 
of disordered secretion, upon original disease in the spinal marrow. 
Thus has it been shewn that acute pain and almost every variety of 
disordered sensation, throughout the body, spasms of the muscular 
tissue, and those disordered actions in the capillaries which are man- 
ifested in inflammation, and disordered secretions maij depend on a 
diseased condition of some j)artsof the brain or spinal marrow — that 
is every variety of functional disorder which is observed during a 
paroxysm of Intermittent fever. 

We now proceed to an interpretation of the symptoms, with the 
aid of these principles — to show that thoy depend on lesions of the 
central nervous organs. Consider the premonitory symptoms of a 
chill; which certainly forma very important part of the disease. 
These are pain in the back, in the knees and other joints, together 



12 PaiJiology of Intermittent Fever, [January, 



with a feeling of general weariness in the muscular system, prompt- 
ing the patient to move his muscles, and an unwonted degree of 
faliguo, upon slight exertion ; so that the patient is tormented between 
two opposite states, the desire to move the muscles and to keep them 
at rest. For days, there is a loss of appetite and disordered digestion, 
with nausea and even vomiting. Pain in the back — On remarking 
pain in the region of any important organ, we hesitate not to attri- 
bute some disease to that organ ; why not in this instance, especially 
as this symptom is so invariable ] These pains in the joints are 
without the usual signs of local inflammation ; and those accustom- 
ed to treat chronic rheumatism of the joints, by applications to the 
spinal column, will confidently refer them to the state of the 
spine. 

The healthy sensations of the muscles are well known to depend 
upon a good condition of those portions of the nervous centres from 
which they derive their nerves, and of course disease in those portions 
must disorder them. And when we remember that the muscular 
tissue is not readily diseased, wo have another argument that the 
disorders already mentioned in their sensations and motions originate 
in the spinal marrow. 

As for the heaviness of the epigastrium, and the uneasiness there, 
with loss of appetite — they are symptoms clearly referable to spinal 
irritation, in other cases where they are not attended with fever — in- 
dyspepsia, for example — where repeated blisters to the spine often 
prove an effectual relief So much for the precursory symptoms. 

The chill itself is marked by irregular action of the whole mus- 
cular system ; producing rigors of the limbs, chattering of the teeth ; 
universal pallidness and constriction of the skin, and suspension of 
the secretions, that is disordered actions of the capillary system. We 
do not hesitate to account for these symptoms, with Dr. Cullen, 
by saying that they proceed from spasmodic constriction of the 
capillaries. If now, we consider how closely the muscular and 
capillary systems depend on the central organs of the nervous system, 
we shall find in a diseased condition of the latter, a sufiicient expla- 
nation of all these symptoms ; but as these are manifested in all parts 
of the body, we must suppose the whole extent of the central organs 
to be in a pathological state. These general disorders of the capil- 
laries become in their turn, causes which modify the action and con- 
dition of all the other organs, particularly of the circulating system, by 
accumulating the blood unduly in the large vessels, as explained by 



1845.] Pathology of Intermittent Fecer. 13 



Dr. CuLLEX, and thus, by exciting strongly, the action of the heart 
becomes the procuring cause, of the succeeding hot stage. 

But there are more positive reasons lor assigning the proximate 
cause of Intermittent fever to some lesion of the nervous centres. 
The first we shall mention is, the uniformity of the evidence of a 
diseased state of some portion of the spinal marrow. This evidence 
we find in the fact, that pressure upon some of the spinous processes 
of the vertebrae is accompanied with pain. Upon this point the 
writer begs leave to refer to an article on this subject in the 1st vol. 
Southern Medical & Surgical Jourual, in which this symptom is 
shewn to have existed, in nearly every case of Intermittent and Re- 
mittent fever, occurring under his notice, for one reason. His own 
subsequent observations, as well as those of others, have satisfied him, 
that this is one of the most constant of its symptoms. And, again, 
that this diseased point of the spinal marrow exerts a decided influ- 
ence in producing the phenomena of fever, we may infer from the 
prompt relief afforded to many distressing symptoms of the paroxysm, 
through revulsive applications to the spinal column ; in proof of which 
many of the same cases may be cited. Another good reason is the 
fact, that Intermittent fever may be cured, by repeatedly cupping 
over the tender points of the spinal column, without medicine, and 
even without dieting — a fact which the writer has repeatedly verified. 
- We may infer the nature of a malady, from the medical treat- 
ment, by which it is best combatted. That ordinary treatment, 
which experience has sanctioned as the best for Intermittent fever, 
harmonizes with this pathology. This theory enables as to account 
satisfactorily for the success of Emetics, Cathartics, Narcotics, Stim- 
ulants, such as alcoholic tinctures of aromatics. and tiie great specific 
quinine. Emetics are revulsives applied to the surface of the stom- 
ach, and operate by relieving the nervous centres — Cathartics, in like 
manner. Alcoholic Stimulants heighten the normal functions of the 
nervous centres and thus prevent the recurrence of those physical states 
which constitute the basis of the disease. With regard to the groat 
remedy, quinine, there are good reasons for thinking that its action 
upon the nervous system is a specific one — such at least is the fair 
inference, when we see decided doses of it producing blindness, deaf, 
nessand roaring in the cars; that is, phenomena of disordered sensa- 
tion ; and if so, its power as a febrifuge is best explained by supposing 
that tlie causes of fever are lodged in that svistem where its effects 
are most strongly produced. 



14 Pathology of Intermittent Fever. [January, 



The opinion of many distinguished pathologists, that the mucous 
membrane of the stomach is the true seat of the disease, and that this 
aiTection is inflammation of that membrane, is disproved by the very 
difTerent effects of the same remedies in Gastritis and Intermittent 
fever. What physician would administer emetics, or narcotics, or 
alcoholic tinctures in the former? — all which, yet, have their measure 
of success in the latter. Quinine, the grand remedy in Intermittent 
fever, is perfectly inadmissible in simple inflammation of the stomach. 
It is no answer to these objections to say, that gastritis is modified by 
being intermittent ; for this is not a modification, but an essential and 
distinctive difference. 

This opinion of the primitive location of intermittent in the mucous 
membrane of the stomach, seems, at first sight, countenanced by the 
general acknowledgment of the profession, that marsh miasma is the 
exciting cause of the disease. For if this be the cause, it must be a 
physical cause borne to the body, by the air, and therefore makes its 
first impression upon the skin and mucous membranes of the lungs and 
stomach. And, indeed, this objection has been made to the pathology 
proposed in this article. But, passing by the very obvious remark, 
that if this exciting cause must produce disease in the first tissues, to 
which it is applied, we would find the mucous membrane of the lungs 
to be the seat of the disease, seeing that this is the most accessible ; 
let us look at some analogies. — Strychnine and Cantharides taken 
into the stomach, tell, the one upon the spinal marrow, the other on 
the organs of generations; the latter will exert its specific efl^ects, 
even when applied to the skin. Alcohol in the stomach affects the 
brain — Ipecac injected into the veins tells upon the stomach. So, 
miasma, though applied first to the skin or lungs or stomach, may 
very well give rise to effects in a remote part of the system — and the 
specific action of morbific causes strongly persuades us that it does 
so. That miasma involves the nervous centres, is further shewn by 
the fact, that where it abounds, we find a great variety of neuralgic 
affections, all having the intermittent character, prevailing simulta- 
neously with Intermittent and Remittent fevers. 

The writer remembers with great pleasure, that the observation of 
this fact, first led him to a critical study of the pathology of Inter- 
mittent fever. It was a case of neuralgia of the knee, of the regu- 
lar tertian form, occurring in a boy, whom he had cured of a simple 
tertian intermittent fever. The patient had suffered three paroxysms 
of neuralgia ; on the day following the last, he was cupped, twice on 



1845.] Treatment of Gonorrhcea. 15 



the sacrum and loins, and twice on the day of the expected acces. 
sion, and local applications to the knee as well as medicine, were most 
studiously avoided ; the paroxysm was arrested and returned do 
more. 

In conclusion — if we find gastritis, determining such a number of 
sympathetic effects that, in the opinion of the physiological school, it 
is sufficient to account for all the phenomena of fever, how much 
more may we attribute them to idropathic affections of the spinal 
marrow, seeing its connection with the organs and tissues is vastly 
more extensive than that of the stomach, and that the diseased 
stomach itself can operate only through its medium. 

It was the intention of the writer to have noticed some of the most 
dangerous complications of Intermittent fever, and to have shewn 
how the pathology herein proposed points to their most successful 
treatment ; but this article has been already extended beyond its 
proper limits, and he reserves this subject for a future number of this 
journal. He will feel that he has not multiplied words in vain, if 
he fixes in the mind, more especially of the young practitioner, a 
principle, which will guide him to success, in that class of cases, 
which make up so large a part of his practice. 



ARTICLE II. 

The Abortive and Curative Treatment of Gonorrhcea by the Nitrate 
of Silver, with cases — By H. F. Campbell, M. D., Demonstrator 
in the Medical College of Georgia, 

In the October number of the Medico-Chirurgical Review, for 
1843, and also in a late number of the American Journal of the 
Medical Sciences, is an article on the abortive treatment of 
Gonorrhcea, by Lunar Caustic. In the two communications, tho 
reporters have applied it differently — Mr. Cuilds recommending its 
application in substance, while M. Debeney prefers it injected in a 
solution of strength, from viii, to xv. grs. to the ounce of water. 



1^ Treatment of Gonorrhaca. [January, 



Having in the treatment of Gonorrhoea, used Nitrate of Silver after 
hoth these modes of application, my experience goes to corroborate 
their testimony as to its efficacy under either form, though of the two, 
I prefer its application by injection. 

I have found that the strength of the injection prescribed by M. 
Dere^'ey, is not, generally, sufficient to relieve by the first or second 
apphcaiion, and that it was necessary, in most cases, to increase it 
to from XX. to xxx. grs. to the ounce of water, and I have applied it 
in even a more concentrated solution. This I find to be a good 
modification of the two plans, inasmuch as that, while we secure its 
application minutely to the whole extent of the diseased surface, we, 
by this increase in the strength of the injection, provide a sufficiency 
of the agent to produce more effectual cauterization. I have had but 
one case, as will be hereafter seen, wherein the application has been 
followed by a high degree of inflammation, and in that one, I have 
reason to suppose it to have commenced, before this means of treat- 
ment had been resorted to. Generally, I have found the patient 
recovering speedily from both the disease and the effects of the 
cautery. 

Case!, A carpenter, aged 80 years, general health, good; was 
exposed to the disease, and on third day experienced pain in urinating, 
and a continued burning for some time afier. He was relieved by 
one injection of Lunar Caustic, xxx. grs. to the ounce of water. 

Case 2. A young man aged 17. The discharge in this case had 
began to show itself. Treated by one injection of Lunar Caustic, xl. 
grs. to the ounce of water : there was a discharge of blood afterwards 
in small quantity, but in a iew days he was entirely well. 

Case 3. A recent case wherein the patient complained of tender- 
ness of the chord before treatment. One injection was made of 
nearly xxx. grs. to the ounce of water. The application was 
followed by pain in the testicle and orchitis. The patient was 
from that time treated by another physician ; of the result I have not 
as yet been advised. This is the only case wherein the Nitrate of 
Silver, applied by myself in this disease, was followed by unpleasant 
symptoms. 

Case 4. A negro man, a taylor, aged 26. A recent attack, relieved 
by two injections of Lunar Caustic, xv. grs. to the ounce of water. 

Case 5. A mulatto boy aged 20 years; of a Strumous Diathesis: 
first treated by another physician, and afterwards by myself, unsuc- 
cessfully, with various balsamic mixtures and astringent injections, 



1845.] Treatment of Gonorrhoea, 17 



was cured by one injection of the Nitrate of Silver, xxv. grs. to the 
ounce of water. In this case a whitish membranous eschar was 
voided while urinating a few days after the application. 

Case 6. A negro man aged about 23 years : a boat hand, had had 
the disease about ten days. One injection was applied of from xx. to 
XXX. grs. to the ounce of water. The balsamic treatment, before 
used without making any impression on the disease, was continued ; 
the patient was well in less than a week's time. 

Case 7. A white man aged 30, a team driver, a recent case, cured 
by one injection, xx. grs. to the ounce of water. 

Case 8. A male aged 33 years, a recent attack : discharge, abund- 
ant, commenced the day before — no pain. I applied one injection 
of Lunar Caustic, xl. grs. to the ounce of water. That day there 
was an increase in the discharge and much pain in urinating, with 
some blood at that time. On the second day, the discharge ceased 
altogether, though the pain and bloody urine continued for some 
days. In this case I Combined, during their treatment, a ^qw dosea 
of balsamic emulsion each day. 

Case 9. A male aged 20 years, treated on the third day after the 
discharge had commenced with one injection of Lunar Caustic, xxx. 
grs. to the ounce of water, together with balsamic emulsion. On the 
fourth day the patient was entirely cured. 

Case 10. Prof. P. F. Eve here kindly furnishes me with a case 
wherein the balsamic and astringent treatment had proved entirely 
inert, though persevered in for some weeks, till combined with 
injections of the Nitrate of Silver of from viii. to xv. grs. to the ounce 
of water. 

Of the application of the Nitrate of Silver in substance, I can adduce 
but three cases ; one of which occurred in the practice of Dr. Edward 
A. Eve, near this city — the other two came under my own observation. 

Case 11. A young man aged 26 years: sanguine temperament — 
treated unsuccessfully with balsamic emulsion and injections of sul- 
phate of zinc, and sulph. of morphine. Dr. E. applied the Nitrate 
of Silver in substance, by paring the end of a cylinder, and intro- 
ducing it for about a half inch or more, within the orifice of the 
urethra. This was done repeatedly, and the patient was relieved in 
a short time after this plan of treatment was adopted. 

Case 12. A male aged 30 years, a mechanic : bilious tempera- 
ment — general health good. In this case the Gonorrhcca was 
complicated by a stricture, the result of previous disease, at the dis- 

2 



18 Treatment of Gonorrhcea, [January, 



tance of about an inch from the orifice of the urethra ; it was at a 
point somewhat beyond this, that the urethritis appeared to obtain, 
the patient experiencing pain at that place, during manipulation, and 
the matter confined behind the stricture, on pressure would appear 
at the orifice. After dilating the stricture by bougies, I freely applied 
the Nitrate of Silver in substance, by means of a style and canula 
somewhat similar to those of Mr. Childs. The pain was not felt 
after the burning of the caustic had subsided, the discharge ceased, 
and in a few days the patient was well. 

In the female, I have found the application of the Nitrate of Silver 
in substance, preferable to the form of injection : it is more practica- 
ble, the locality of the inflammation not being invariable. Of this 
class is the following : — 

Case 13. A white woman aged 26 years: general health good, 
habits regular. Treated for some weeks with the usual balsamic 
remedies, using at the same time very strong astringent injections of 
sulph. cup. and sulph. zmc. a a viii. grs. and sulph. morphine 1 gr. 
to the ounce of water, applied once a day. Finding this treatment 
unsuccessful, I applied with a speculum uteri, the Nitrate of Silver, 
by means of a port-caustic, freely to the orifice of the urethra, 
mouth of the womb, and interruptedly to the sides of the vagina. 
The application was made but once ; it caused much pain and there 
started a few drops of blood from the posterior lip of the os trncae, 
which seemed very much congested. In this case I continued the 
balsamic mixture together with the above injection, diluted. The 
discharge, though undiminished before the cauterization, soon entire- 
ly ceased, and she was well on the fourth day. 

From the consideration of the thirteen cases given above, together 
with the well attested experience of Mr. Childs and M. Debeney, I 
think we may safely conclude with regard to this mode of treatment : 
Firstly, that the treatment of Gonorrhoea with Lunar Caustic, as 
proposed by them, is preferable to any other mode of treatment ; 
Secondly, that the form of injection is preferable, to its application in 
substance ; Thirdly, that in cases not relieved by the injection as 
prescribed by M. Debenet, of strength from viii. to xv. grs. to the 
ounce of water, it being perfectly safe, it is advisable to increase it, 
even far beyond that strength. And further, that in those cases, 
wherein of itself it does not wholly relieve, we should by no 
means reject it, but continue its use as a very valuable adjunct to any 
other plan of treatment we can adopt. 



1845.] Bilateral Operation of Lithotomy. 19 



ARTICLE III. 

The Bilateral Operation of Lithotomy — another successful case : By 
Paul F. Eve, M. D., Professor of Surgery in the Medical College 
of Georgia. 

Since the publication in the April number, of the American 
Journal of the Medical Sciences, of four cases of the bilateral opera- 
tion, I have had another opportunity of removing a stone from tbo 
bladder, by the use of the double Lithotome cache. 

The first and leading article in the last No. of the Journal referred 
to (Oct. 1844) is, ''On the Bilateral Operation of Lithotomy; and 
on Lithotrity in the Female : By John C. Wakken, M. D., Professor 
of Anatomy and Operative Surgery, in Harvard University, Boston." 
In presenting to the profession the four cases successfully operated 
upon by my friend. Dr. Ogieb, of Charleston, and myself, I stated 
my belief that they were the first, at least in this section of the 
country, wherein the double Lithotome of Dupuytren, had been 
employed ; and i also ventured to recommend this mode of operating 
as superior to the one in general practice. It is no small gratifica- 
tion to find this opinion defended by so distinguished a Surgeon as 
Professor Warren, of Boston — the very head of the profession in 
New-England. 

Dr. W. states that in the course of 40 years practice, he has been 
called upon to perform all the operations of Lithotomy in Boston. 
These amount only to 25 cases, 3 of which alone were natives of 
that city or its vicinity — of this number 2 died, one from suppuration 
in the pelvis. This was a patient of bad constitution, with stone 
adherent to the bladder; in the other case, death occurred the fifth 
day from general peritonitis, after the patient had indulged in eating 
heartily. This brief report furnishes two interesting facts — the 
success of the operation, especially as no selection was made of 
cases ; and secondly, the exemption from urinary calculi in the city 
of Boston. 

In explaining the immunity thus enjoyed by the inhabitants in 
and about the capital of New-England, Professor Warren is inclined 
to attribute it to the circumstance, that there exists no calcareous rocks 



^0 Bilateral Operation of Lithotomy. January, 



or soils near that city — an explanation, which, although it will not 
be admitted as satisfactory on the other side of the Atlantic, is correct 
so far as my observation extends in the Southern States of our Union. 
In a biographical sketch of the professional career of Joseph Glover, 
M. D., of Charleston, prepared by Drs. Bellinger, Whitridge, and 
PoRCHER, for the Medical Society of South Carolina, and published 
in the American Journal of Medical Sciences, we find the following 
sentences : — " Calculous diseases are so rare in this locality, that to 
have cut for stone in the bladder constitutes an era in the professional 
career of our Surgeons. As late as 1808, only three operations of 
the kind could be ' distinctly and certainly recollected as having been 
performed' in Charleston. ***** Up to the present time, 
(Dec. 1840,) continues the Committee, only seven operations for 
stone in the bladder have been performed upon persons who were 
natives, or who had been for many years residents of Charleston." 

The following extract from a letter of my friend. Dr. Kollock, 
an estimable physician of several years practice, gives a report on 
this subject from Savannah : 

" In compliance with your request, I have endeavored to obtain 
for you all the information which we possess on the subject of urinary 
calculi, and the operation of Lithotomy, in Savannah and its vicinity. 
I have enquired of our oldest practitioners, in regard to their obser- 
vations on this point, and all, without an exception, state that they 
have never met v/ith a single case in their own practice, nor ever 
heard of one in the practice of any other physician or surgeon who 
has lived here. 

" The advocates of the theory of the influence of miasmata in its 
production, will find it difficult to maintain their position in this 
region, and will probably be under the necessity of acknowledging 
that, if a residence in a calcareous district is not absolutely necessa- 
ry, and the sine qua non to the production of stone in the bladder, it 
is a very important link in the chain of morbid causes." 

From Norfolk, in Virginia, to New-Orleans, along the whole sea 
coast, so far as I have been able to obtain information, the occurrence 
of urinary calculus is quite rare ; and it is only as we approach the 
mountainous regions that we find the number increasing. But two 
cases, so far as ascertained, have originated in Augusta — one was 
operated upon in New-York, some years ago ; and the other is the one 
now about to be submitted to the reader's attention. My other cases 
already reported, were from abroad — that is from the upper calcare- 



1845.] Bilateral Operation of Lithotomy. 21 



ous parts of the country. So far, they corroborate the opinion of Dr. 
W. in relation to the origin of stones in the bladder — that they 
are rather the product of calcareous waters than of atmospheric vicis- 
situdes. 

Professor Warren says — " The particular object which I have in 
view, in this communication, is to direct the attention of the profession 
to the best mode of doing the operation of Lithotomy. I have till 
recently performed the lateral operation, formerly with the gorget, 
and latterly with the knife. In the two cases alluded to above, which 
terminated unfavorably, the gorget was employed. Accident led 
me, a year or two since, to examine the merits of the bilateral opera- 
tion more exactly than I had ever done before. In this investigation, 
I many times dissected the organs concerned in this operation, both 
before and after having been done on the dead body. The result was 
so satisfactory, that, in a case particularly adapted for this mode of 
operating, I ventured to do it on the living body, and found it to be 
comparatively so easy in the performance, and so successful in the 
result, that, in the next case which presented itself, I was induced to 
repeat it. These cases I ask leave to bring before the profession in 
this country, in order to invite their examination into the merits of 
this mode of extracting stone from the bladder." 

It is right to state that this distinguished Surgeon objects to the 
Lithotome, and makes the incisions in the Prostate gland, with a 
straight, short, narrow, probe pointed knife. He also states that the 
bilateral operation, called Dupuytren's, was originally proposed by 
Ihe late Professor Ribes, of the School of Medicine in Paris ; the 
former giving it character and stability by his descriptions and en- 
gravings. Dr. Warren concludes by remarking, that, although he 
should not feel justified in recommending the bilateral operation for 
general use, from his limited experience with it, yet, from the lights 
before him and his views on the subject, he feels disposed to employ 
it in most cases where Lithotomy is required, in preference to the 
lateral operation. 

In the October No. (1842) of the American Journal of Medical 
Sciences, will be found an article by Dr. Josiaii C. Nott, of Mobile, 
Ala., on the subject of Lithotomy ; in which the following paragraph 
occurs: — "It should be remembered that Dupuytren saved, by the 
bilateral operation in the foul air of tbo Hotel Dieu, (the larircst 
Hospital in Paris,) twenty-six patients in succession ; a success per- 
haps, even more astonishing than that of Prod-ssor DunLr.v, when all 



22 Bilateral Operation of Lithotomy. January, 

the circumstances ar^ considered." Doubtless my medical friend in 
Mobile believed, when he published this article, that his data for the 
above successful report was reliable ; but since then facts have been 
revealed, by which it is now ascertained, that the late celebrated 
Surgeon in chief of the Hotel Dieu, lost, at least, one in every six 
cases he operated upon for stone. This much is due to truth. 

Case. Lewis, a mulatto boy, 3 years old, had been laboring under 
the symptoms of stone for several months. Having satisfied myself 
of its presence, by sounding, and with the finger in the rectum, and 
having prepared the patient for the operation, it was performed on the 
8th of June last. The patient being secured in the usual way, the 
semi-lunar incision was made between the bulb of the urethra and 
anus, with its convexity to the scrotum, and down to the staff* in the 
membranous portion of the urinary canal, through which it had been 
previously introduced into the bladder. To the groove of the staff 
thus exposed, was adapted the beak of a double Lithotome, of a small 
size, which had just been received from Charriere, of Paris. This 
instrument was introduced into the bladder, the one in the urethra 
withdrawn, the Lithotome turned upon its own axis, so that its con- 
cavity was towards the rectum, and its blades being expanded it was 
drawn out in lowering the handle. A gush of urine indicated the 
opening made in the bladder, through which the finger introduced 
felt the stone, which was extracted by a small pair of forceps. 
From some little delay in the seizing the calculus, and the alarm of 
the patient, the operation lasted twelve minutes. 

This little patient, like the others upon whom I had operated 
for stone by this mode, had a remarkably rapid recovery- The 
urine in a few hours passed per ureihram^ and all the dressing applied 
was a small strip of plaster over the wound in the perineum. No 
catheter was introduced during the treatment. He had a little fever 
for the first forty-eight hours after the operation. He sat up in bed 
on the fourth day, and on the eighth was considered well. He did 
not, however, recover the full tone and control of the bladder for 
some days afterward. The calculus weighed about 3 iss., and was 
of the mulberry variety. 



1845.] American Journal of the Medical Sciences, 23 



Part II.— REVIEWS AND EXTRACTS. 

ARTICLE IV. 

The American Journal of the Medical Sciences — Edited by Isaac 
Hays, M. D., October, 1844. 

The present number of this quarterly, although not heavily freight- 
ed with such original matter as should be expected in a work of its 
pretensions, brings us the details of several cases of interest. Its 
first article is from the pen of the venerable Professor Warren, of 
Boston, who has recently become satisfied of the superiority of the 
Bi-Iateral over the lateral operations of Lithotomy. We are happy 
to find such high authority corroborating an opinion we have long 
since entertained, and feel surprised that this able surgeon should 
have been so tardy in testing a method long since adopted by manyi 
and possessing such obvious advantages. We cannot agree with him 
in the preference he gives to the knife over Dupuytren's Lithotome 
cache, nor can we perceive any force whatever in his objections to 
this instrument. It must certainly be by far the safest instrument 
with which the bladder can be opened, independently of the facihty 
and simplicity it imparts to the operation. 

The article contributed by John Watson, M. D., of New- York, 
on organic obstruction of the (Esophagus, contains the particulars of 
his case of (Esophagotomy, and fhe history of the operation, which 
has been very rarely performed. Dr. W.'s case in itself (independ- 
ently of the skill and ingenuity displayed in prolonging the life of the 
patient,) is calculated to throw but little light on the subject, and its 
result is not such as to encourage others to penetrate the QEsophagus, 
except as a dernier resort in cases ofimpending death. The Doctor 
suggests the propriety of making an opening into the stomach itself, 
in cases of insurmountable stricture of the (Esophagus with progress- 
ing inanition, and cites the repeated instances in which peiforations 
of that viscus have terminated favorably. It may be apprehended, 
however, that the operation performed under the only circumstances 
that could justify it, namely, impending death from inunition, wonld 
not be so apt to terminate favorably as when it harf been the result of 



24 American Journal of the Medical Sciences. [January, 



accident, and in a system not previously enfeebled by long suffering 
and insufficient nutrition. 

The article on Isopathia or the Paralleli-m of Diseases, by Dr. 
John M. B. Harden, of Liberty county, Georgia, is highly credita- 
ble, and evinces much research and correct views on one of the most 
important classes of maladies. The more we study the effects of the 
cause of Intermittent fever, the more convinced will we become of its 
power to give rise to phenomena the most discordant in appearance, 
yet all traceable by the enlightened physician to the same deleterious 
agency, and controled by the same class of remedial means. The 
ptamp of intermittency, either complete or partial, is the grand char- 
acteristic of all the morbid phenomena, however varied in other 
respects they may be, that owe their development to this unknown 
and widely pervading cause. 

Dr. Tabb's Statistics of Deaths in the Philadelphia Hospital during 
a period of twelve years, possess much interest, as must do all such 
papers when judiciously and accurately drawn up. As illustrative of 
the value of such documents, we will cite a few of the results obtained 
by Dr. Tabb. The treatment of Mania a potu has, it is well known, 
been generally by opiates, and during the first six years, included in 
these tables, when this plan was used, the deaths averaged 1 in 10, 
whereas during the latter six years, when alcoholic drinks were sub- 
stituted for opiates, there occurred but one death out of 223 cases. 
Again, in the Women's Asylum, in which neither opiates nor alco- 
holic drinks were resorted to in the treatment of this disease, there 
was also but one death in 128 cases. Such facts need no comment. 
We have long since entertained strong doubts of the advantage of 
opiates, and relied principally on the cold shower bath as the most 
powerful and prompt means of allaying the ravings of delirium 
tremens. The table of diseases of the Respiratory organs, shews that 
one fourth of the fatal cases of Pneumonia occurred in children under 
the fifth year of age, and of Bronchitis more than one third. Al- 
though these proportions are undoubtedly much greater in the latitude 
of Philadelphia than in Georgia, they are certainly much greater here 
than is usually believed, a fact of which the profession will become 
more aware as the use of the stethoscope becomes more general with 
pur practitioners. On the subject of the Exantliemata, it is found 
that the number of deaths from Measles is much greater than from 
Scarlatina. It is to bo regretted that the proportion of deaths to cases 
admitted of the same disease, is not included in these tables, with the 
exceptions given in relation to Mania a potu. D. 



1845.] The New- York Journal of Medicine^ iSfc. 25 



ARTICLE V. 

The New- York Journal of Medicine and the Collateral Sciences — 
Edited by Samuel Foeey, M. D. Nov. 1844. 

The periodical, the title of which is given above, is published every 
two months, and has now reached its ninth number, havincr fully 
realized and sustained the anticipations of all acquainted with the 
merits of its very able Editor. We are not of those who regard a 
multiplicity of medical journals or of medical schools as having an 
injurious effect on either medical literature or medical instruction. 
Indeed there is no proposition, the fallacy of which has been more 
fuliy established by experience. It is notorious that the number of 
contributors has uniformly increased in a direct ratio with that of 
periodicals ; and able observers who had never before lent their aid 
to the advancement of science, by publishing the results of their 
labors, have been incited to do so by the establishment in their vicin- 
age of a medium of easy access. Nor is the case dissimilar with 
regard to new medical schools. The ver\' appointment of individ- 
uals to Professorial Chairs acts as the most powerful incentive to 
exertion, not only on the part of those who must prepare themselves 
to teach, but also on the part of all who come under the reach of their 
influence and who possess sufficient professional pride not to permit 
themselves to be distanced in the race for scientific distinction. We 
therefore bail every new journal and new school as the sure precursor 
of a better state of things within the whole range of their respective 
influence. 

The profession in New-York are justly entitled to an organ of 
communication with our extensive country, and we sincerely wish 
the fullest success to the work now before us. Among the contribu- 
tors to the 9lh number, we remark the name of a distinguished 
physician of a sister city, all of whose articles that have come under 
our observation, evince a mind well stored with professional as well 
as literary lore, and a ready pen" to communicate the deductions of 
sound judgment. The article of J. Le C\>nte. M. D., of Savannah, 
is entitled, "Extraordinary Elfects of a Stroke of Li'^htnin*' ;" but, 
not confining himself to the mere narration of the circumstances 



26 The New- York Journal of Medicine^ iSfC, [January, 



attending the case, the writer takes occasion to touch upon various 
subjects of much interest. The function of menstruation having 
heen singularly affected in two of the individuals who received the 
electric stroke, the writer reviews the present state of our knowledge 
of this interesting peculiarity of the human female — the age of its 
occurrence and final cessation — its connection with the state of the 
ovaries and impregnation, &;c. He then passes to the consideration 
of the general and local effects of electricity on the human body, and 
its use as a remedial agent ; and concludes with many valuable 
remarks on meteorology. The whole article is highly creditable to 
the writer. 

Article II. is from the pen of the Editor, Dr. Forry, and is on the 
"Nature and History of Vital Statistics," than which no subject 
possesses more intrinsic value to society. Dr. F.'s attention has 
been for some time strongly directed to this kind of research — his 
contributions are therefore always interesting. With the following 
remark, the writer furnishes a few tables, which we cannot refrain 
from transferring to our pages. 

"All the phenomena of the human frame, but more especially the 
physiological acts connected with reproduction, the development of 
man's faculties, and mortality, when examined and measured in a 
great number of individuals, it has been proved by observation, 
furnish a mean result equally correct with that of any other physical 
phenomena." 

" As regards diseases, it will suffice to give a few instances from 
the Fifth Registration of Births, Deaths, and Marriages in England, 
as presented in the following table : 

1838. 1839. 1840. 1841. 



Pneumonia : — 










Total deaths. 


17,999 


18,151 


18,582 


17,997 


Deaths to a million living, 


1,219 


1,200 


1,209 


1,154 


Phthisis ;— 










Total deaths. 


59,025 


59,559 


59,923 


59,592 


Deaths to a million living, 


3,996 


3,939 


3,897 


3,822 


Child-birth ;— 










Total deaths, . 


2,811 


2,915 


2,989 


3,007 


Deaths to a million living. 


190 


193 


193 


193 


Violent Deaths: — 










Total Deaths, . 


11,727 


11,632 


11,594 


11,100 


Deaths to a million living, 


791 


769 


754 


712 



1845.] 



The New- York Journal of Medicine^ (S^'C. 



27 



But even the conditions which ^eem to depend wholly on accidental 
causes, have the same constant recurrence, as is shown in the follow- 
ing table in reference to the recruitment of the French army. 

NUMBER OF YOUNG MEN IN FRANCE WHO HAVE BEEN EXCUSED MILITARY SERVICE ON 
ACCOUNT OF BODILY INFIRMITIES.* 



Causes of Unfitness. 



Wanting fingers, 

" teeth, 

Deafness and dumbness, 

Loss of other limbs or organs, 

Goitres, 

Lameness, 

Other deformities, 

Diseases of bones, 

Short-sighted, 

Other allections of the eyes, 

Itch,^) 

Scald head, 

Leprosy, 

Other cutaneous diseases, 

Scrofulous affections, 

Affections of chest, 

Hernia, 

Epilepsy, (falling sickness,) 

Different other diseases, 

Weakness of constitution, 

Insufficient size of body, 

Amount of whole class of certain age, . . 



1831. 


1832. 


1833. 


75-2 


047 


743 


1,304 


1.243 


1.392 


830 


730 


725 


1,605 


1,530 


1,580 


1,125 


1,231 


1,293 


949 


912 


1,049 


8,007 


7,030 


«,494 


782 


G17 


GG7 


948 


891 


920 


1,72G 


1,714 


1,839 


11 


10 


10 


749 


800 


794 


57 


19 


29 


037 


983 


895 


1,730 


1,539 


1,273 


5G1 


423 


359 


4,044 


3,579 


4,222 


4G3 


307 


ai2 


9,108 


9,058 


10,28G 


11,783 


9,979 


11,259 


15,935 


14,902 


15,078 



295,91 



277,477 



285,805 



The reports of criminal justice in France show the same remarka- 
ble con.stancy as regards the annual perpetration of crimes, and their 
punishments, as appears from the subjoined tablef : — 





182G 


1827 


1828 

227 
GO 
8 
34 
31 
21 
42 

G 

21 

2 


1829 


1830 


1831 


Murders in general, 


241 
5G 
15 
39 
23 
20 
35 
2 
G 
28 

17 


234 
G4 

40 

28 

20 

40 

5 

IG 

12 

1 

1 


231 
61 

7 
4G 
24 
21 
45 

2 

1 
23 

1 


205 
57 
12 
44 
12 
11 
4G 
2 
4 
17 

*2 


2GG 


Gun and pistol, 


88 


Sabre, sword, stiletto, poniard, dagger, &c 

Knife, 


30 
34 


Cudgels, cane, &c 


21 


Stones, 


J) 


Cutting, stabbing, and bruising instruments, 

Strangulations, 


49 
4 


By })rccipilating and drowning, 


3 


Kicks and blows with the fist, 


2G 


Fire, 




Unknown, 


2 



These results assuredly merit the attention of the philosopher; for 
it is here seen that even moral phenomena, apparently the most acci- 



* Q,uetelet's Treatise on Man. 
tlbid., p. G. 



E'.linburg Edition, p. 109. 



28 The New- York Journal of Medicine, Sfc. [January, 



dental or fortuitous, are produced annually in the same numbers. 
Aye, even murders, wJiich are generally committed at the close of 
quarrels, without any premeditation, do not only present very nearly 
the same annual numbers, but experience further shows that the 
instruments used to accomplish the object bear like proportions in 
each year." 

These extracts are sufficient to show the importance of vital sta- 
tistics to science and to society at large. Facts are always valuable, 
but especially so when their bearing is on the social system of the 
human family. We would earnestly entreat all who have it in their 
power to contribute to this fund, to neglect no opportunity to do so. 
Europe is far in advance of us on this subject, and it is much to be 
regretted that the only attempt of our National Legislature to assist 
in the matter, has proven so complete a failure in many respects. 

Article III. is " On the Pathological Effects of Alcohol, by John 
C. Peteks, M. D." It contains a summary of post-mortem appear- 
ances of the bodies of seventy persons vvhodied trom intemperance. 
The most interesting facts are the following : — The substance of the 
Brain was unusually white and firm. 

" The Lungs were generally healthy, except that congestion of 
them was frequently met with. Where large quantities of spirits 
had been taken shortly before death, the lungs were often found in a 
state of extensive splenization ; they appeared perfectly saturated 
with dark blood, which soon changed to a florid red on exposure to 
the air, except that which flowed from the large, severed blood- 
vessels, for this remained thick, dark, and tar-like. The parenchyma' 
was heavy and semi-solid to the feel, but softened; for the finger 
could be easily forced through it. We must make particular men- 
tion of the infreqnency of phthisis in drunkards; never have we met 
a tubercular abscess in them, even of the smallest size, while a small 
number of chalky tubercles was frequently noticed ; and cicatrices 
also were often met with, and were marked by presence of puckering 
of the surface of the lungs, of solid bodies which were readily felt 
before the lungs was cut into, and when this was done, they were 
found to consist of lumps or stripes of callous fibrous tissue, arourd 
which we rarely discovered a few discrete, grey, crude, small, tuber- 
cular granulations ; in every instance these appearances were strictly 
confined to thp upper third of the superior lobes, and the rest of the 
lungs was entirely free from either old or recent tubercular disease. 
The hronciii were almost always found reddened, somewhat <lilated, 
and more or less filled with catarrhal secretions. 'J'he readers ot the 
London Lancet will remomber that T'jlarshall Hall has lately recom- 
mended the constant application to the chest of folds of linen or 



1845.] The New- York Journal of Medicine, c^-c. 29 



flannel soaked in alcohol, as a cure for incipient plithisis ; we should 

judge that this mif^ht prove serviceable. 

********* 

" The Liver, in moderate drinkers, was found a little larger than 
natural, somewhat softened, and its external surface spotted with 
patches of fatty infiltration, which extended but two or three lines 
into the parenchyma ; the color of the rest of the'organ was nearly 
natural, and the edges retained their normal sharpness. In higher 
degrees it was considerably larger, the edges more obtuse, and the 
patches of fat larger and more numerous. In old drunkards tho 
liver was very large, weighing at least six to eight pounds, often ten 
to twelve ; the edges were very thick and much rounded ; the paren- 
chyma almost white with fat, soft, fragile, and the peritoneal corering 
could be torn off in very large pieces with ease. Granular liver was 
found in four or five cases only. The gall bladder was always large 
and filled with bile; gall-stones were found in two cases only, and 
singularly enough, both on the same day ; cone were found either 

before or after. 

*********f 

"The appearance of the omentum is very peculiar; it is loaded 
with an ashey-grey slushy fat. Our attention was called to this 
sign in Vienna ; it is there regarded as so characteristic, that a man 
is often judged to have been a drunkard, from a glance at the omen- 
tum, when the abdomen is first laid open. 
********* 

"According to Rokitansky, Andral and Engel, the blood in tuber- 
cular cachexia is arterial and rich in fibrin ; while in the cancerous 
cachexia and typhus fever, it is more venous, it abounds in albumen, 
and is deficient in fibrin; hence alcohol would seem to produce a 
state of the blood opposite to that which occurs in tubercular disease, 
and is somewhat similar to that which obtains in cancer ; therefore, 
it may prevent the development of the former, and hasten that of the 
latter." 

Article VII. is from the pen of Dr. James Stewaht, who furnishes 
valuable hints on the diet of infants in aflTections of the bowels — and 
specially insists on the advantages of animal food in such cases. 
Dr. S. recommends the substitution of calfs-foot jelly, or isinglass 
jelly, in lieu of the preparations of arrow-root, sago, flour, &c. in 
common use. Dr. S.'s experience in the treatment of infantile dis- 
eases entitles his views to much weight. They coincide very tlilly 
with those of the writer of this notice. D. 



oO Dcbroync on Chronic Diseases, [January, 



AKTICLE VI, 

We extract lb6 following article from the Medico-Chirurgical 
Review. We regret that its length renders its division necessary. 
The remainder will be published in our next number. 

Thcrapeiiiique Appliquee, on Traitemenls speciaux de la pluparl des 
Maladies Chroniques. Par P. J. C Debkeyne. 2me, Edition, 
jfp, 332. Bailliere, 1844. 

This is really a very useful and instructive v^^ork. It contains the 
results of our author's experience, over a period of nearly thirty years, 
in a variety of those chronic diseases which are of most frequent oc- 
currence. Dr. Debreyne is evidently a shrewd and practical obser- 
ver ; he has learned to think and reason for himself; and seems to 
have had, throughout his professional life, a marked aversion for all 
the nosological theories which have occupied so largely the atten- 
tion of most of his countrymen during the present century. See, 
how he treats the chiefs of philosophical (!) medicine. 

" The Pinel-ists, the organicians, the anatoxno-pathologists, the Broussais-ians, 
the statisticians, the numerists, have all, by the exclusiveness of their particular 
doctrines and views, stood in the way of, and materially retarded the advance 
of sound therapeutic knowledge. Now, however, that the system of universal 
irritation and of a materialist physiologism has fallen to pieces, a new era has 
happily opened up to our view, and Kijipocratic vitalism has reappeared amongst 

us in all its primitive splendour The reign of -anatomism, that is 

to sa}', of necropsies and facts and figures, has nearly come to an end ; and 
medical men now long for something more tangible and more applicable to the 
every-day duties of a professional life ; in other words, they wish to have point- 
ed out to them useful rules of treatment and rational means of cure, instead of 
endless catalogues of statistic tables and of post-mortem examinations." 

Dr. D. is professor of practical medicine to the establishment of 
Grande-Trappe (Orne), and seems to have reared a number of pu- 
pils, who have contributed, for some years past, not a little to dissem- 
inate his peculiar doctrines and modes of treatment in different dis- 
tricts of France. He is, moreover, the author of several treatises — 
on Physiology, Hygiene, Moral Theology in its relations with Medi- 
cine, of which we gave a short notice in the last number of this 
Review. However much we may feel inclined to dissent from him 
on several points of practice, we have been decidedly pleased with 
the general tone of the present v/ork, which appears to be a faithful 
record of discriminating observation of disease at the bedside of his 
patients. There is nownere any parade of learned phrases ; no dark- 
ening of knowledge with a multitude of words ; no wearisome and 



18 i5.] Dehrcyne on Chronic Diseases. ?51 



most profitless description of very common cases ; no heaping toge- 
ther of other men's opinions and doings, with a hesitating announce- 
ment of his own. Instead of this, we have a plain unvarnished talo 
afwhat the author has seen and found in practice; and all this 
explained in as few Vv'ords as possible. In fine, this book is tho- 
roughly and essentially a practical one — a somewhat uncommon 
feature, by the by, of a French medical work in the present day. Its 
motto is experire : our readers cannot do better than accept the 
challenge and judge for themselves. 

The diseases which pass under review, are arranged in three 
[livisions — Neuroses or Neuropathies ; Chronic Phlegraasiee ; and 
AsthenisB. We begin v.'ith a short notice of 

Epilepsy. — The remedy, which Dr. D. has found by far the most 
successful in the treatment of this disease when it is idiopathic, and 
there are no symptoms of existing cerebral congestion, is the extract 
of Belladonna. He gives it in the form of pill; beginning with 
about one or two grains per diem at first, and gradually raising the 
dose to four or five grains, provided no affection of the sight or any 
other intoxicating symptom is induced. In some cases, he conjoins 
with advantage the use of a decoction or infusion of Valerian. But 
neither this latter remedy, nor yet the oxyde of Zinc, nor the nitrate 
of Silver — although all of them have been found occasionally use- 
ful — can be trusted to alone. In general, the more frequent the 
paroxysms are, the more hopeful we may be of making an impres- 
sion on the disease : it is when two or more months intervene between 
each attack, that this Neurosis is usually most obstinate and intract- 
able. In such cases, the Belladonna should be administered for a 
week or two before the expected invasion. When (his is preceded 
by a distinct aura Epilepiica, a strong dose of Ammonia will some- 
times serve to ward off the attack : the patient therefore will do well 
to carry a small phial of the volatile alkali in his pocket. In some 
cases, the paroxysms of Epilepsy may be arrested for several months 
by the use of the Belladonna; but nevertheless they ultimately re- 
turn almost as frequently as ever, in spile of the prolonged continu- 
ance of the remedy. It is under such circumstances as these that 
the decoction of Valerian root, or of Orange leaves, should be exhi- 
bited at the same time. 

Dr. Derreyxe does not conceal the fact that several writers havo 
recorded their opinion that his favourite remedy has utterly failed in 
their practice. He mentions particularly a report by M. Picard of 
22 cases that were treated with it by M. Fesrus, in the Bicetre 
Hospital, in 1837. He attributes its lailure in these cases — in part 
at least — to the injudicious manner in which the extract was given ; 
the doses being far too large, and carried to such an extent as to prove 
rather poisonous than sanative. This is certainly not the way to 
give a fair trial to the remedy. 

Our author remarks that, " if in symptomatic Epilepsy, after the 



33 Dehreyne on Chronic Diseases, [January, 



removal of the exciting cause, the paroxysms continue from a sort of 
nervous habitude, they will be best obviated by the Belladonna ; and, 
in the event of this failing, by the use of Quinine and Valerian." 

Ilijsteria. — The following formula is very highly lauded by Dr. D. 

in the treatment of this too common disorder. 

I^ P. CamphoroB ... § ss. 

P. As.saiixtidae ... § ss. 

Extr. Belladonnce . . 3 iv. 

Extr. aquos.' Opii . . 9j. 

Mix and divide into 120 pills ; commence with two at first per diem, 
and gradually increase the dose to six in the 24 hours ; they should 
always be taken before food. Occasionally a wine glassful of the 
infusion of Valerian or Orange leaves may be given with much ad- 
vantage along with each dose of the pills. 

Dr. D. is in the habit of administering them also for the cure of 
general or partial nervous Trembling, and of Chorea. SomtJtimes ho 
exhibits in the latter disease, the Belladonna by itself; and, he says, 
very generally with success. When it fails, he has recourse to cold 
bathing. No allusion is made to the use of Steel in the treatment of 
this complainft by our author ; an omission that seems the more 
strange, as we shall afterwards find that he is so partial to ferrugi- 
nous medicines in the treatment of many diseases of debility. Ac- 
cording to our opinion, the remedy for Chorea is the carbonate or 
sesqui-oxyde of Iron, especially when administered in any bitter 
infusion. 

Neuralgia.— ^^'' For the last fifteen year^, we have been in the habit 
of using with the greatest success, in all the forms of neuralgia, — 
Sciatica excepted — the Belladonna as an external application. Our 
favorite formula is this : 

'fy . Extr. Bell'adonnoe . . 1 ss. 

Opii pulveriz 9ij. 

Adipis suis § ss. * 

Olei thy mi Tt[vj. M." 

A portion of this ointment, as big as a hazel-nut, is to be well 
rubbed upon the affected part two or three times a day, or whenever 
the paroxysms of pain are severe. The rubbing should be continued 
for eight or ten minutes at a time, until the ointment is quite absorb- 
ed by the skin : a little saliva may be added every now and then to 
promote the absorption. Let it be remembered that the use of this 
ointment should be at once suspended, if the sight becomes very sen- 
sibly affected, or any unpleasant cephalic symptoms supervene. In 
very obstinate cases. Dr. D. conjoins the internal administration of 
the extract of Belladonna or Opium with the use of the above pom- 
made ; but in the majority of instances, this is unnecessary, as the 
pain will very generally yield to the outward application. We em- 
ploy it, he says, specially against facial neuralgias and other local 
painful affections of a nervous character, the Megrim» &;c. In one 



1845.] Debrei/ne on Chronic Diseases. 83 



very severe case of Neuralgia, which had lasted for nearly twenty 
years, and which had resisted our author's quasi-specific pommade, 
as well as a score or two of other approved remedies, the pain which 
was seated in the skin, over the lower left ribs, at length yielded to 
the a])plication of the Vienna Caustic paste, so as to produce a pretty 
large eschar upon the affected part.* With respect to the treatnient 
of Sciatica — which, as we have seen, Dr. D. separates, in a thera- 
peutic point of view, from the other forms of Neuralgia — his usual 
plan is first of all to order the application of several volanle blisters 
along the course of the affected nerve; and if these do not quickly 
succeed in relieving the pain, to have recourse to his terebinthinate 
mixture, which is only a modification of that recommended first by 
Professor Recamier, and subsequently by Dr. Martiivet. The 
formula is this : 

;^ , Aquoe lactucas .... §viij, 
Olei volat. terebinth. . . ^j. 
Gummi Arabic .... 3 v, 
Syrupi simpl ? iiss. M. 

The dose, a large table-spoonful in a glassful of rice-water, three 
times a day, upon an empty stomach. Dr. Debreyne recommends 
at the same time the external application of an embrocation — com- 
posed of Spirits of Turpentine, Ammonia, Camphorated Spirits of 
Wine, and melted lard, — with which the affected parts are to be 
vigorously rubbed night and morning. In still more intractable 
cases, he has recourse to the use of moxas, applied over the seat of 
the chief pain ; the best point generally for their application is imme- 
diately behind the great trochanter. In conclusion, he frankly admits 
that the use of his favorite Belladonna ointment is seldom efficacious 
for the relief of Sciatica. 

Paraplegia and Local Palsy. — "Before we were acquainted," 
says Dr. Debreyne, " with the special action of Nux Vomica on the 
spinal-marrow, we were in the habit of trusting almost entirely to the 
use of moxas, applied over the lumbar or sacral vertebra}, for the cure 
of Paraplegia. But, for the last twenty years, we have invariably 
commenced our treatment of this disease with the alcoholic extract of 
the Nux Vomica, exhibited in the form of pills, each containing one 
grain of the extract." He begins with one, and gradually increases 
the dose until six — two at three different times — be taken in the 
course of the tv/enty-four hours. Whenever the patient ex|)eriences 
cramps and spasmodic twitches or tetaniform rigidity in the limbs, 
the action of the medicine must be narrowly watched ; and it will be 
prudent either to diminish the dose, or even to suspend its use alto- 
gether, if these symptoms become excessive. The object should be 
to keep up the nervous excitement in a moderate and safe degree, 



Vienna Caustic. — Equal parts of vegetable caustic and quick lime, moi^stcncd 



with alcohol. Edts 



34 Debreyne on Chronic Diseases. [January, 



for a considerable space of time. If after a month or two's use of 
the Vomica, no decided benefit is obtained. Dr. D. advises the appli- 
cation of one or more moxas over the lumbar region- 
He very properly cautions his readers not to expect the same 
benefit from the use of the Nux Vomica in the Hemiplcgic, as in the 
Paraplegic, forms of Palsy. It may, indeed, prove serviceable in 
some cases of the latter, where there is every reason to suppose that 
the sanguineous coaguUim within the cerebral substance has been 
nearly or altogether absorbed ; but in no case of this description 
should we be sanguine of doing mucli good. 

For the cure of Amaurosis, our author relies chiefly on the repeat- 
ed application of small blisters in the neighborhood of the affected 
eye, first on the temple and then over the eyebrow. In obstinate 
cases, the blistered surface should be sprinkled with a powder com- 
posed of starch and strychnine — about a fifth of a grain may be used 
at first, to be gradually increased. When this treatment fails, a 
seton should be tried. Dr. D. has used with very decided success a 
collyrium, containing some extract of Belladonna, in a good many 
cases of day blindness or Nyctalopia. % 

He also mentions a simple remedy for nervous Deafness^ which 
may deserve notice. Let the patient fill his mouth with the smoke 
of Tobacco, or of any other dry aromatic plant — Sage, for example — 
and then make a forced expiration, while the mouth and nostrils are 
closed : this should be done several times in the course of the day. 
The smoke enters the Eustachian tube, and thus produces a slight 
stimulant effect upon the internal ear. The remedy can do no harm ; 
and this is saying a good deal in its favor, considering the nature of 
many of the means of acoustic medication. It is best suited to those 
cases where the deafness has supervened on some catarrhal com- 
plaint, and whenever we have reason to believe that the pharyngeal 
end of the Eustachian tube has become thickened or obstructed. 

Asthma. — "For the last twenty-five years we have seldom pre- 

scribed any other formula but the following: — 

^ . P. Inulae Elecam. ... ^ ss. 

Flor. Sulphuris . . . | ss. 

P. rad. Belladonnaj . . 9iv. 

P. rad. Scillse .... 3j. 

Kermes min 3j. M. 

To be divided into 90 powders, of which one is to be taken three times a day. 
Our author assures us that he has witnessed excellent effects from 
this remedy, not only in asthma, but also in a variety of chronic pec- 
toral affections, when they are unaccompanied with fever or inflam- 
matory irritation ; as, for example, in what has been called Catarrhal 
Phthisis, and so forth. To allay the cough in such complaints, he 
combines the use of the Iceland moss jelly with the anti-asthmatic 
powders. When these fail — which, according to his report, is not 
often the case — he advises a trial of the Stramonium inhalation, and 
also of a strong infusion of the Camphree of Montpelier (Camphor- 



1845.] Dthreync on Chronic Diseases. 85 



asina Monspeliaca) — with the medicinal virtues of which our author 
was first made acquainted by a writer in the Revue Medicale for 
March, 1821. Daring the paroxysms of asthmatic dyspnoea, he 
recommends a mixture containinij the extract of Belladonna, Oxymel 
of Squills, Kcrmes Mineral and Orange-flower Water. 

In Hooping. cough also he again mainly trusts to the internal use 
of the Belladonna, in the form of its powdered root. This remedy 
was employed with very marked success by Wetzler during a severe 
epidemic of this disease that prevailed at Augsburg in 1810; and it 
was about seven years afierwards that our author first gave an exten- 
sive trial to it. The dose of the powder must, as a matter of course, 
depend upon the age of the child, its constitution, the character of 
the existing symptotns, and so forth ; but, if we state that a third of 
a grain should be given to a child twelve months old, twice or thrice 
a day, it will not be difficult to apportion the doses to other ages. 
When the fits of coughing are usually followed by vomiting, the 
powder should be given very soon after this has ceased. W^e need 
scarcely say that, if symptoms of inflammatory irritation be present, 
these must be subdued by the appropriate remedies, before recourse is 
had to the use of the Belladonna powder. 

In accounting for the failure of his favourite remedy in the hands 
of several medical men, who have recently published the results of 
their experience with it. Dr. D. alludes with much judgment, to 
some of those causes or influences which should always be attended 
to, in estimating the virtues of a medicine in any epidemic disease; 
and the neglect of which, in the present day, has induced such stri- 
king discrepancy of opinion on various practical points among differ- 
ent writers, as is any thing but creditable to the sagacity of profes- 
sional men. 

" Before," says he, "any one can fairly and satisfactorily determine the med- 
icative virtues ofBelladoima, or indeed of any other remedy, inHoopin2;-cough, 
by tlie efiects which it may produce ia any particular epidemic, it i.s ab^^olutely 
necessary that he should imitate the example of such observers as Sydenham 
and SroLL, and have fust carefully noted the type and genus of the epidemic 
itself, in order that he may know vi Umhic whether it be inflammatory, or ca- 
tarrhal, or bilious, &c. in its nature. He should moreover have attentively 
ascertained the character not only of the medical constitution of the season, but 
also of the prevailing diseases of the preceding as well as of tlie current year, 
so that he may be able to determine, if possible, their cor-relations and mutual 
dependencies. If the existing epidemic proves to have an inllammatory char- 
acter, it is scarcely necessary to say that the use of antiphlogistic measure.^ is an 
indispensable preliminary in the treatment: whereas, if it has a bilious type, we 
must trust more to the use of emetics and purgatives, betbre having recourse to 
the exhibition of the Belladonna." 

Before dismissing the subject of Coughs, we may state that Dr. 
Debrey.xe very strongly recommends the internal use of the extra( t 
of Belladonna, in the form of mixture, in most coughs of a nervors 
nature occurring in adults. He mentions the case of a woman, who 
had been afflicted with a violent convidsive cough for upwards cf 
twelve years, that was speedily relieved by this remedy — d«^se, one 



^^ Debreyne on Chronic Diseases. [January 



grain two or three times a day. It is equally serviceable in the cure 
of obstinate Hiccup, and of any spasmodic constriction of the throat 
and larynx. 

An ointment, composed of four parts of the extract and twelve or 
fifteen of spermaceti ointment, may be most advantageously used 
with much benefit in many cases of contraction of the anus, and 
painful afFcctions of the cervix uteri : also in various neuralgic com- 
plaints of the bladder and urethra. 

We now proceed to notice some of the most common gastric and 
intestinal afTections, for the purpose of explaining our author's ther- 
apeutic views ; and first of all we take the subject of 

Vomiting. — In the vomiting that may be considered to be nervous 
or spasmodic in its nature — i. e. when it is not connected either with 
inflammation or any bilious disturbance of the stomach — he recom- 
mends very highly the use of Columba powder : it possesses, he says, 
a sort of specific virtue in such cases nearly as great as Bark does in 
Agues. He gives it in doses of from 15 to 20 grains in two or three 
spoonfuls of red (French) wine, before meals. The addition of a few 
grains of magnesia, or of a minute dose of opium, may be necessary, 
if much acidity or gastralgia be present; and, should the patient be 
feeble, and anaemic, the subcarbonate of iron may be very advan- 
tageously combined with it. Opium is freely used by Dr. D. in va- 
rious abdominal affections, afler the state of the intestinal secretions 
has been ascertained to be tolerably healthy. The following quota- 
tion will show how highly he rates its value. 

"We treat all internal pains ■whatsoever, and more especially those of the 
abdomen, with some preparation of opium — provided always they are not con- 
nected either with acute fever, or with inflammation, or gout. We may, indeed, 
make a still more general assertion, and say that it is to the use of opium — 
which is the antidote of pain — that we mainly trust for the relief of all painful 
chronic diseases. If along with the element "of pain, there should happen to be 
co-existing a rheumatic principle — whether this show itself externally or in some 
internal organ — we associate the use of rubefacients and other appropriate med- 
icines along with that of opium. Without this most valuable drug, there could 
be no possible medication for a multitude of chronic diseases. If we were de- 
prived of it, we should ourselves instantly abandon the practice of the healing 
art. Sydenham thanked God for His gift'of opium to mankind for the cure of so 
many of the ills to which we are liable; and we can safely affirm, as far as re- 
lates to our own practice, that never a day passes over that we have not occasion 
to exhibit opium in some form or another. How admirably it acts, almost as a 
specific, in most cases of Dysentery, not to enumerate a host of other maladies." 



1845.] Process of Secretion — Malformation of the Heart, 87 



PART III.— MONTHLY PERISCOPE. 

Process] of Secretion. — The greater number of the fluids, which 
constitute the basis of the different secretions — such as the gastric 
and intestinal juices, the saliva, tears, milk, mucus, wax of the ears, 
fat, &;c. — proceed from a gradual dissolution of the substance of the 
very glands which are generally supposed to eliminate them. The 
blood, no doubt, furnishes certain elements for each secreted fluid; 
but that which constitutes the characteristic constituent of each se- 
cretion, is the fluid contained in the microscopic cells, which enter 
into the formation of every gland : — this fluid is poured out in con- 
sequence of either the bursting, or the dissolution, of the cellular 
envelopes. The cells, which along with the blastema constitute the 
parenchymatous substance of glands, are developed within the minute 
secreting canaliculi. When they have attained to a certain degree 
of maturity, they detach themselves from the interior, and are car- 
ried along in the secreted fluid. — MandVs Manual of Gen, Anat, 
applied to Physiology and Pathology — fi-om Am. Jour. 

Case of Malformation of the Heart of a Child, who expired on 
the fifth day after Birth — The child was well developed, and appear- 
ed to be in perfect health. On the third day it became soporose, 
sighed and had hurried respiration. The skin became dusky, breath- 
ing increased in rapidity, no fever, respiratory murmur puerile, with 
moist crepitus behind ; the child died on the fifth day. 

Autopsy. — Tli«re was only one large artery given off from the 
heart, and from this the pulmonary artery sprang. The thus united 
aorta and pulmonary artery was considerably larger than the aorta 
of so young a child. It proceeded from a large ventricle, which 
appeared at first sight to constitute the whole of the ventricular por- 
tion of the heart. The systemo-pulmonic artery was separated from 
the ventricle by semilunar valve, and from a very large auricle by 
tricupsid valve. Into this auricle entered by three openings, three 
pulmonary veins. The large auricle communicated by a small open- 
ing with another auricle, about the size of a small horse-bean, into 
which entered the two venm cavce, each not above two lines in diam- 
eter. This small auricle communicated with a cavity of the size of 
a swan-shot, in a fatty muscular mass upon the side of the large ven- 
tricle, constituting with it the whole ventricular mass, and evidently 
being the representative of the right ventricle. The right ventricle 
and the right auricle were separated from each other by small cob- 
web-like membranes, representing the ventricular valve. 

The circulation of, in all other respects, an apparently well devel- 
oped child, was thus reduced to that of a reptile of the lowest order, 



38 Ope/» Foramen Oca^e^ ^-c. [January, 



very nearly resembling that of a frofr. The very small size of the 
venm cavce would lead to the supposition, that tiie circulation of the 
b^ood, enabling a child to live in the air, for five days \vilh so slight 
derangement for two days at least, could not be carried on with the 
adequate return of blood from tlie system which such veins would 
indicate, and that one of the three orifices by which the blood return- 
ed into the large auricle was that of a systemic vein. The auricle 
is of much greater capacity than that of the united auricles of a 
child of that age ought to be. It cannot even be conceived that extra- 
uterine life could continue with such an inadequate return of venous 
blood, as is indicated by the small proportion of the two ven(2 cavcD 
to the pulmonic systemic artery. — Dr. Carson in the Report of the 
Liverpool Pathological Society. Dublin Journ., for Sept. 1844. 



Period at which iJic foramen ovale, the ductus arteriosus and ductus 
vcnosus become obliterated. — It results from the investigations of M. 
Elsyesser, made on 144 children, that the oI)literation of these tem- 
porary circulatory channels, does not (ake place until a month or six 
weeks after h\x\\\.-^V Experience^ Aug. 24:th, 1843, from Heke's 
Zeitschreft, t. 42 — from Am. Jour. 



Open Foramen Ovale — no cyanosis — Dr. Woodiiouse exhibited to 
the Reading Pathological Society, a heart taken from a woman aged 
71, who died of apoplexy. The foramen ovale was patulous to a 
considerable extent — about half an inch ; the valvular portion of the 
septum auriculorum unusually lari^e. There were no symptoms 
during life, as lividity of countenance, deficient nutrition, <Sz;c to in- 
dicate such a condition. — Prov. Med. Sf Surg, Journ.,July24, 1844, 



It was but recently that the doctrine was taught in the Schools, 
that impregnation generally took place just after menstruation. It 
will be seen that a different theory is now advocated, and said to be 
sustained by facts, in the following Report, copied from the British 
and Foreign Medical Review : 

Escape of ova independent of fecundation, and the connection of 
this with menstruation. — Each act of menstruation is connected with 
the maturation and discharge of an ovum. Numerous cases in proof 
of this are related (in addition to those formerly recorded by him, 
and by M M. Ge>dki>% Negkier, and others.) by Dr. Robert Lee ; 
others by Mr. Girdwood. M. Raciborski has four times found 
that ova have been recently discharged from the ovaries of virgins who 
died at or near the period of menstruation ; arui I'isckoff has also 
four times foun^l Graafian vesicles, containing etnised blood, in gijls 
who have recently menstruated- 

This menstrual discharge of anovurn i~ "=^rii<! '>v R AfinmisiKi and 
BiscHOlF to bo followr-d by thp funn tin.) of a corpus iutf urn. siniihir 
to that which is formed when the o\uin ia iniprt gnaled and developed 



1845.] Escape of Oca, independent of Fecundation. b9 



[But in this i have no doubt they are mistaken. If it were so, one 
or more corpora lutea should be found in the ovaries of all who die 
while the habit of menstruation continues; for the corpus luteum 
which forms when impregnation has taken place, is distinct not only 
through the pregnancy, but for more — often much more — than a 
month after delivery. Neither are the cavities which are left after 
the menstrual discharge of ova. or the processes by which they are 
closed, at all similar to those found when impregnation has taken 
place. In many examinations of ovaries I have not yet seen a case 
in which, without impregnation, any thing has been found which 
could be mistaken for a corpus luteum formed afier an ovum has 
been discharged and impregnated.] Mr. Girdwood believes that 
the cicatrices left after the discharge of menstrual ova may be count- 
ed, so as to indicate the number of ova discharged and the number 
of times of menstruation. [But recently I have examined a case 
in which a girl of seventeen had not menstruated for four months 
before her death, but previously had menstruated regularly : the 
ovaries showed no cases of cicatrices. Probably, therefore, the cica- 
trices remain for a time distinct, but are gradually obliterated, as 
thev are in the nearly analogous case of the dischar<TC of the Fever's 
and solitary glands of the intestines.] 

3. The menstruation of women, in so far as the periodical matura- 
tion and discharge of ova is concerned, is analogous to the heat or rut 
of animals. The phenomena, according to Raciboeski may be most 
distinctly seen in the sow ; but in all the domestic mammalia at their 
period of heat one or more follicles attain their highest degree of de- 
velopment, project upon the surface of the ovary, and at length burst 
with hemorrhage into their containing cavities, and this whether 
copulation have taken place or not. Bischoff also has repeatedly 
found the same things occur in bitches and rabbits whose uterus and 
tubes have been extirpated : they have heat, the ova mature and de- 
tach themselves and pass into the remaining portion of the tube, but 
of course cannot be impregnated. 

4. The discharge of the ova and their passage along the tubes are 
independent of impregnation and the passage of the seminal corpus- 
cles. This is evident from the facts already mentioned ; and others 
are furnished by Bischoff. In one experiment he kept a bitch care- 
fully secluded till the period of heat ensued. She then copulated 
once, and immediately after he extirpated the left uterine horn, ovary 
and oviduct. The copulation had lasted a quarter of an hour ; and 
he found that the semen had penetrated to the upper angle of the 
uterine horn, but not into the tube. He found also five ova in the 
oviduct more than two inches from its abdominal orifice; a distance 
sufiiciently great to prove that they had not been detached in the 
copulation. Next day he killed the bitch, and found (hat spermato- 
zoa had reached about a quarter of an incli in the right lube; he 
found also five ova in the same tube, and as many corpora luica in 
the right ovarv, but none of the spcrmatd-na had come h\ contact 



40 Escape of Ova, independent of Fecundation, [January, 



with the ova. These cases proved the detachment of ova before copu- 
lation. In some others Bisciioff found that they were not detected 
till long after the act. In some he found that they were undetached 
twenty-tour hours after copulation, and that the seminal corpuscles 
had passed on towards them. In others also he found the independ- 
ence of the passages of the ova and the semen still more marked ; for 
example, several days after copulation, ova were found fecundated in 
one tube, but in the other spermatozoa alone, none of the Graafian 
vesicles in the corresponding ovary being either enlarged or fully 
developed.* 

5. Thus, according to the period of heat at which copulation takes 
place, will be the place at which the semen meets the ovum. If it 
be early, the ovum may not escape before the semen reaches the 
ovary; if late, the ovum may have arrived at the uterus; and proba- 
bly if it have arrived at the lower or uterine third of the tube before 
it comes in contact with the semen, impregnation is impossible on 
account of the chano;es which the vitellus has alreadv undergone. In 
women it is in like manner near the period of menstruation that im- 
pregnation is most likely to occur. It may take place just before 
menstruation if the ovum be just mature when the semen reaches the 
ovary ; or some days, the ovum after its discharge remaining impreg- 
nable till the semen reaches it. Or, again, as many analogous cir- 
cumstances in lower animals prove, an ovum may by the sexual ex- 
citement be hurried on to its maturity and discharged ; and so, in 
unusual cases, impregnation may take place at a greater than usual 
distance from the menstrual period. Still the most common time 
must be, as common ol>servation shows it is, either during or very 
near the menstrual perio<l. M. Raciborski has found that in one 
hundred women there are not more than six or seven in whom this is 
not the constant rule. 

6. All these circumstances prove a closer analogy than was sup- 
posed to exist between the discharge of the ova of mammalia and 
those of the fish, batrachia, and others in which the ova are discharged 
from the body and impregnated external to it. In all alike the dis- 
charge of the ova is an independent act ; the differences are in the 
distances from the ovaries at which the semen is usually brought into 
contact with it. 



* These facts bear on the question of the possibility of a woman conceiving by 
two diflerent men; and I fmd a recent notice of a case, often referred to, of a 
negress who having, as it was believed by herself and others, conceived twice in 
the' same night, first by a negro and afterwards by a European, bore twins, of 
which one was a pure negress, the other a mulatto. Dr. Hillk, a Dutch military 
surgeon in Surinam, where the delivery occurred, adds that the children were 
living in 1841, that they were eight years old, that the black child, which was at 
first the strongest of the two, retnained so, and that the mother had died .some 
time previously, and on examination was found tc> have normal) v formed genital 
or'^ans. {Camper's IVackcnsthriJr, Jan. 23, 181^2.) 



1845.] Age of Puberty in Girls, 41 



Age of Puberty in Girls. — Mr. Robekton,* of Manchester, in 
continuation of some former papers, the object ofwliich was to prove 
that the age of puberty is as early in the cold as in the tropical re- 
gions of the earth, and that the early fecundity in Hindostan and 
other warm countries is only the consequence of early marriages, 
proceeds now to show, that in ail countries alike, early marriages 
(and earls'- fecundity) are always connected with moral and political 
degradation, as exhibited in bad laws and customs, the enslavement 
more or less of the women, ignorance oi letters, impure and debasing 
systems of religion ; and that they bear no relation to the climate of 
the country. 

His evidence is extensive and very interesting; and the conclu- 
sions he arrives at are, 1. That in England, Germany, and Protestant 
Europe in general, early marriage, i. e. marriage about the age of 
puberty, is comparatively rare. 2. That early marriage prevails 
among the uncivilized tribes within the arctic circle, as it likewise 
does in all cold countries, the inhabitants of which are in a state of 
iirnorance and moral degradation. 3. That throughout European 
Russia, which is confessedly low in civilization, extremely premature 
marriage was the universal custom at no distant date. 4. That at 
the present day, in the most southerly countries of Europe, where 
the people are immersed in superstition and ignorance, marriage is 
early. 5. That in Ireland, which as to its moral condition somewhat 
resembles the last mentioned countries, the marriage union takes 
place among the Roman Catholic po})U)ation almost as early. 6. 
That in England, about two centuries ago, when debasing political 
and social circumstances combined to favor tlie practice, early mar- 
riages were general, at all events in the upper ranks. 7. That in 
all the countries to which reference has been made, juvenile mar- 
riage is invariabl}'^ seen as an attendant upon ignorance and moral 
debasement, and this without reference to climate. 8. That conse- 
quently it is allowable to infer that early marriage in oriental coun- 
tries (which has generally, but without any proof, been ascribed to 
precocious {)uberty.) depends solely on the same moral and political 
causes as produce it elsewhere ; more especially as those very causes 
are well known to exist at present in an aggravated degree in all 
oriental and intcrtroj)ical countries. 

These conclusions are probably in a great measure true; yet 
that the commencement of menstruation and of fecundity does bear 
some relation to the latitude and average temperature, appears to be 
proved by the following table, in which M. Raciborski gives his 
results as to the average age at which menstruation commences in 
different countries and towns : 



♦ Edinburgh Medical and Surrrical Journrd, October, 1832, and Julv, 
1812. 



42 



-*^^ 'i/ Puherly in Girls. 



[January, 



Name of Town. 


Lati- 


Aee at first 


Mid. Temp. 


No of Ob- 


Observer. 




tude. 


menstruation. 


of the year. 


servations. 




♦Toulon 


. 43^ 


. . 14-081 . 


. 15^ . 


. 43 . 


. Marc d'Espcne 


tMarseillcs 


. 43 


. . 14015 . 


. 15- . 


. 25 . 


Ditto. 


tLvons 


. 46 


. . 14-492 . 


. 110 . 


. 100 . 


. Bonchacourt. 


Paris 


. 49 , 


. . 14-405 . 


. 18-0 . 


. 200 . 


. Raciborski. 


Gotdngen , 


. 53 


. . 10038 . 


. 8- . 


. 137 . 


. Osiander. 


Warsaw 


. 52 


. . 15-083 . 


. 9-2 


. 100 . 


. Lebrim. 


J Manchester . 


. 53 


. . 15-191 . 


. 90 . 


. 450 . 


. Roberton. 


Skeen 


. 59 , 


. . 15-450 . 


. 0- . 


. 100 . 


. Fave. 


Stockholm . 


. 59 


.' . 15-598 . 


. 5-7 . 


. 102 . 


. Wistrand. 


§Sv\-edish Lapland 


. 05 . 


, . 18- 






Wretholm. 



In general, therefore, the period of puberty is later in nearly the 
same ratio as the latitude is higher; for each degree of the one the 
other is retarded about a month and a few days. And the lower the 
latitude^, the more frequent are the examples of precocious appearance 
of menstruation. 

A still more exact relation is bet\vcen the date offirst menstruation 
and the mean year's temperature; as may be seen by comparing 
Warsaw and Gottingen, Gottingen and Manchester, &c. M. Raci- 
borski adds that race often determines the period offirst menstrua- 
tion. The children of negroes born in England menstruate as early 
as their parents ; those of Europeans born in India as late as their 
parents. To determine how far circumstances of climate could coun- 
tervail the influence of race, M. Raciborski obtained information 
respecting the period of menstruation in Jewesses in Poland, from M. 
Lebunr, medecin-en-chef of a hospital in Warsaw, and found the 
mean period in Catholics 15'83, in Jewesses 15*89 ; (100 observa- 
tions of each race ;) showing that the influence of race remained after 
ten or more centuries. And in like manner the menstruation ceases 
sooner in Polish Jewesses tiian in Sclavonian women, lasting in the 
former on an average '29 23-83 years, and in the latter, 31 6-33 
years. 

There is a difiererice also, dependent, probably, on numerous 
causes, between the women of Paris and those of vilhiges a league and 
a half or two leagues t>om Paris, tiiough both have a similar soil, 
lemperature, ^c. In the villages the average age at first menstru- 
^jtinij is 15*020 years, in Paris 14-4G5,|| 

M. RaciborskiIF has also published an account of the age at which 
menstruation ceases. At Lvons the average ajie is between 45 and 
iiO ; at the Salpetriere, in 100 women, the average was 46*03: at 
Warsaw, 47'G5 : at Christiana, 48*07. As a general rule, the grcat- 



♦ Archiv. Gen. de Med. 1835. t Diet, des Sc. Med. 2mc edit. "Menstruation." 

: Edinb. Med. and Sur^. Journ. Oct. 1832. 

§ Eighteen years is only a general statement, it should prob?bly be less. 

II A. Raciborski, "Dc I'Epoque de la Puberte," &c., L'Expericnce, Juillet 20, 
1843, and many subsequent numbers. Numerous facts bearing on this and 
similar questions rnav be found in Brierre ucRoismont, "Dcla Menstruation," 
&c., Paris, 1S42. \ Medical Gazelle, Dec. 9, 18-12. 



1845.] Epidemic Inlermillancc of InUrmitlcnt Fever. 43 



er the number of children born, the longer is the continuation of 
menstruation; the earlier the commenceinent of mcnslrua(ion, the 
greater the number of children and the later the cessation. 

On the Epidemic InfcrmiUance of Intermittent Fever. — The de- 
velopment of Agues in marshy countries is by no means uniform or 
constant: it is itself suSject to intcrmittanccs. 'i'hus, at Antwerp 
and its environs, in 1S22 and 1823, these fevers be«^an to become 
more common and severe than they had been observed to be for some 
years before. Their intensity increased during the following seasons. 

"The periodical genius or type," says M. Gouzee, "arrived at its 
acme in 1826, the period of the memorable epidenne of Gronin'^en. 
During the three summer months of that 3^ear, which were remarka- 
l)Ie for an almost constant dry heat of from 20^ to 28*^ Reaumur, 
the number of insidious and malignnnt remittent fevers was consid- 
erable at Antwerp, among all classes of the population. During the 
month o( July, twenty-five, thirty, and even forty i'avov cases entered 
the military hospital daily. In 1927, this epidemic constitution, 
although very decided, was nevertheless not of so great violence ; 
after having suffered a little remission in the foliowiui^ years, it re- 
appeared, and prevailed again with considerable intensity in 1834, 
1835, and 1838. 

" During this long succession of years, more particularly in the 
first eight or ten, nothing was so common as marsh cachexias, leuco- 
phlegmatic inflammations and engorgements of the spleen. It wa.s 
notuncommon to meet with invalids in whoin the hypertrophied spleen 
occupied the entire left side down to the pubis. The frequency of 
malignant fevers at that time obliged the medical men to be constantly 
on the watch. In 1837, a rapid change took place all at once: the 
intermittent fevers ceased, and their sudcien disappearance coincided 
with the appearance of a severe epidemic of Influenza, v/hich pre- 
vailed from the middle of January to the end of tlie followinn- month. 
Diiring the entire pr(ivaler)C(5 of this new epidemic, we did not meet 
with a single case of intermittent fcver^ — a circumstance well worthy 
of notice. 

"From 1837 to 1841, that is to say, during an interval of five 
years, the paroxysmal fevers were so rare, and so slight, that the 
sulphate of Quinine, formerly tlie anchor of safety in the majority of 
cases, had then in a manner fallen into neglect. The niaii'niant 
remittent feverrf, the obstructions of the spleen and the marsh cach- 
exias had also almost entirely disappeared. At last the periodic fevers 
re-appeared in 1812 ; and, during tlie following y(>nr, in our localities, 
thi'v returned to sucli an extent and ol"ien with such gravity as could 
not fail to arrest the attetition of all our practitioners. During the 
months of August and Septemb^.r of this year, the appearance of a 
good many cases of pernicious fevers was noted at Antwerp; a cir- 
cumstance which, for more than six yearb before, had not been met 
with in practice.." 



44 Treatment of the Itch in Belgium. January, 



These variations proceeded, according to our author, from dry pro- 
longed lieats, without great agitations of the air, and cold nights. 

'*In our low and marshy countries," he observes, "it is not, as 
many physicians believe, the humidity of the atmosphere that occa- 
sions the development of intermittent fevers. There is no situation 
in vvliich fewer paroxysmal fevers arc met with when the seasons, in 
which they generally show themselves, are rainy and damp. If the 
humidity of the air is necessary to their development, it is in districts 
not so low as ours, in order to prepare the work of miasmatic decom- 
position, which it requires other conditions of the atmosphere to com- 
plete." — Jour, Beige, 

Remark. — From the tone of the preceding observations, our read- 
ers will perceive that medical men on the Continent are beginning to 
pay attention to a subject, connected v/ith the history pf diseases, 
which has been far too much neglected in the present century — we 
mean the nosological influences of seasons, atmospheric changes and 
so forth. We need not say that the writings of Hippocrates, Sy- 
denham, Baglivi, &c. are pregnant with allusions to this matter. — 
Med. Chlr. Review, 1844. 

Treatment of the Itch in Belgium. — The following circular has been 
addressed to military surgeons by the Inspector General of the Bel- 
gian army. 

"Each patient is supplied with an ounce or an ounce and a half of liquid 
sulphuret of lime in a small pot ; this quantity he is to rub carefully and slowly 
v.'ith his hands on every part that is covered vv ith papulse. If there be any papu- 
loe on the back, another patient is to rub the liquid upon that part. The opera- 
tion is to be repeated three times in the twenty-four hours, so that each patient 
consumes three or four ounces of the sulphuret daily. A bath is to be taken 
every alternate day; the frictions are to be suspended on that day. Fifteen fric- 
tions (or ten daj's use) are usually sufiicient for the cure of the disease, if the 
medical officer in charge sees that the remedy is properly used." 

The su'phuret is prepared thus: take of sublimed sulphur 16 
pounds, and of quick lime 32 pounds ; boil in 80 pounds of water 
for three-quarters of an hour. Let the mixture rest for some time 
until it settle, and then let the clear fluid be decanted off. Boil the 
residue afresh in about the same quantity of water, treat it in a sim- 
ilar manner, and add this decoction to the first. Usually 140 pounds 
of the sulphuret, at 12® by the areometer, are thus obtained. If the 
liquid be more dense, it should be lowered to this standard by the ad- 
dition of rain water. — Ann. de la Soc. de Med. d'Anvers. Med* 
Chir, Review. 

We give also Dr. Gibeet's, (one of the Physicians to the St. Louis 
Hospital, Paris,) prescription for the Itch : — Two parts of sulphur to 
eight of lard, to which is added twelve grains of the carbonate of 
potassa for each ounce. — Edits. 



1845.] Malaria. 43 



Malaria. — A Reviewer of Dr. M*Willia:vi's " Medical History of 
the Niger Expedition," in the xVthenasum, having doii'ottd the exist- 
ence of Malaria, attributing what are called malarious diseases to 
other causes, as the "ordinary accidents of climate, heat, and hu- 
midity," Dr. M'W. combats the Reviewer's scepticism by a paper in 
the same journal, for 21st Septemlier, 1844. 

We suspect that the reviewer had never practised in a tropical or 
in any malarious climate, else he would not have considered mias- 
mata, malaria, marsh effluvia, or whatever name we may give the 
poison, as a creature of the imagination. The following quotation 
from Dr. M'Williax's "reclamation," must be satisfactory to most 
of our readers, though ten thousand other instances and facts equal- 
ly stringent might be adduced in proof of a morbific emanation from 
certain soils, exclusive of heat and moisture. — Medico -Chirurg, Rev. 

" Heat and moisture are conditions of the atmosphere which readily admit of 
minute quantitative determination, by metliods in common u:.e : and if fever 
were caused by them alone, in Europeans within the tropics, it should prevail 
wherever their amount is the same. Now, by reference to the meteorological 
tables in my work, the temperature and dew point outside the Niger, where no 
fever occurred, and while in the rivers, were as follows: 

Temp. Dew point. 

3, P.M. 3, P.M. 

Pa.ssage from Sierra Leone to Accra . . .81 .13 74-03^ 

Outside Niger from 9th to 12th August . . . 7J.00 73.70 

In the Nun and descending to Aboh . . . 80.G0 74.00 

At Aboh, Iddiih, and the confluence of the Niger and 

Tehadda to Sept. 21 8-1.00 73.50 

Confluence ofNiger and Tehadda to Egga . . 86.00 72J0O 

" Thus, though the expedition was exposed from the 1st of July to the begin- 
ning of August, to air containing more moisture, and but little inferior in tem- 
perature at the hottest part of the day, to any experienced within the river, not a 
case of fever made its appearance until the" 4th of September, three weeks after 
it had entered the river, and had been exposed to the emanations from the ordi- 
narily recognised sources of malaria. Similar results have been observed else- 
where ; in Barbadoes, for instance, no fever occurred among the troops in the 
garrison, during August, September, or October, 18-11, and although in Novem- 
ber a very violent description of yellow fever broke out. the temperature of the 
air was lower than in August, and the dev/ point lower than in September; their 
means were as follows : — 

Temp. 3, p, m. Dew point, 3, p. m. 
August . . . 83.77 70.61 

September . . . 82.13 73.78 

October . . . 82.31 72.67 

November . . . 82.83 71.67 

" Hence the connection between ' heat and humidity ' of the atmosphere and 
severe remittent, or yellow fever, is by no means so clear as the reviewer v.-ould 
have us suppose. It is, in fact, one of those hasty conclusions which will not 
stand the test of comparison with observed facts, and could only have been made 
with a limited view of the history of disease in warm climates. 

*' At Barbadoes the fever was almost completely confined to one of the regi- 
ments composing the garrison, while the other, the men of which were equally 
exposed to 'heat and humidity,' and performed the same duties with their neigh- 
bors, was almost wholly e.xempt. The cau.se of the disease in this instance, 
was very obviously tiie effluvia arisini^ from a pool of water, immediately to 
windward of the building occupied by the regiment that sutfercd. 

" But to return to the west coast of Africa. In 1836, H. M. S. Sc&id, under the 
command of Capt. Robkrt Craigie, proceeded to the we.*t coast; and by a care- 



Malaria. [January, 



ful obs'^rvance of the stringent 'General Orders' of the senior officer on the sta- 
tion, ' that no sliip was ever to remain in port more than forty-eight hours at any 
one time,' and that Oilicers were so far as was practicable to avoid entering any 
of tlie rivers on the coast,' only two cases of fever occurred in her during the 
lirst )'ear, and these were traced to two days' stay 2t Sierra Leone. In the month 
of April, 1837, Capt. Cragjr was obliged to ascend the Bonny river, in the Scout, 
as far as King Peppel's tov\m, for the protection of the British mercantile inter- 
ests there. On this occasion he also took the Dolphin, a brigantine, with him, 
and left the Liinx, another brigantine, anchored at the river's mouth. The Sroiit 
and Dolpkln were detained nearly a week at Bonny town, and on leaving the 
river, fever broke out in both vessels, and their united loss by death amounted to 
live officers and seventeen men and bo3-s, while on board the Lynx not one was 
even attacked. Bonny town is only about six miles from where the Lynx was 
lying, consequently there could have been very little, if any, difference as to the 
. 'heat and humidity' of the atmosphere in the positions of the vessels that suffer- 
ed and that which escaped. 

"Capt. BRUNswrcK Popiiam commanded the PcZimw, with a complement of 
101 M'hite men, for four years and a half, on the east and west coasts of Africa. 
During this time, his loss by death amounted to three Europeans. He made it 
a rule to avoid rivers, his boats having on one occasion only been in the Bonny, 
and that for a. very short time. Capt. Popua.m was on the station during 1835- 
6-7-8, and part of"39, during which the mortality on the coast is but too well 
known. In short, it seems to me perfectly clear, from the evidence of many old 
African cruisers, non-professional as well as professional, and from my own 
experience, that, as a general rule, a ship will continue healthy on the west coast 
of Africa, if she is clean internally, and keeps at sea, and that disease will ap- 
pear if she remains much nearer the shore, or has intercourse with the rivers. If 
we admit the immunity in the one case, and the occurrence ofdisease and death 
in the other, surely the destructive agency must have been owing to something 
connected with the land, vrhich is acted upon by the same meteoric agencies as 
the sea, with this difference, that the land and sea breezes become more feeble 
as we advance into the interior. The sun is mainly effective /ra7/A bcJon- in heat- 
ing the atmosphere on land and v.-ater, both of which absorb" its rays and com- 
municate them to the air above. Theoretically, we would expect nothing per- 
nicious to be evolved from the sea. the surface of which is always in a state of 
greater or lesser agitation ; and practically we find the conclusion to be just. 
On shore, on the contrary, we have all varieties of soil, in many conditions of 
which we have a right to inler, that gaseous evolutions will take place by the 
action of heat; and experience but too plainly tells us, that wherever certain con- 
ditions are present within the tropics, there, in general, disease is mo^t rife. It 
will no doubt be said that we have, as yet, no chemical evidence of the existence 
of malaria. But because its precise nature is unknown to us, are we, in the 
face of such destructive results, to deny its being'? We may just as well say, 
small-pox and other exanthemata cannot be propagated through the medium of 
the atmosphere, although the constitution of their poisons has not as yet been 
recognised by any ' chemist or physiologist.' 

" Provided that men have not been for a considerable time exposed to the nox- 
ious exhalations within rivers, it seems abundantly evident that their effects are 
in a great measure counteracted by the air of the open sea. 

"In November, 1838, H. M. S.Piladcs, (a ship remarkable for her general 
salubrity,) under the command of Captain William L. Castle, had occasion to 
be in the Bonny about forty-eight hours ; several of her crew were attacked with 
fever, soon after leaving tlie river, but they speedily recovered on the passage to 
Saint Helena, to which island the ship was ordered. Capt. Castle has observed 
similar results in other ships during along period of service on the west coast. 
********* ** 

"From these and numerous other instances, it would appear that the action of 
miasma is quite analogous to that of other poisons, inasmuch as its injurious ef- 
fects is in proportion to the amount taken into the system. By remaining long in 
rivers, the quantity imbibed will be very commonl}' sufficient to destroy life, while 
a short stay in such localities will only produce a temporary disorder of the func- 
tions." 



ld-15.J Medical InicUigence. 47 



MEDICAL INTELLIGENCE. 

Death of Dr. Forry, Editor of the Nev:-York Journal of MjJicinc. — It is with 
deep regret, that we are thus early in the discharge of our Editorial dulics, called 
upon to record the death of one, who had promised so much to our Profession. 
Dr. Samuel Forry, the editor of one of the Journals reviewed in another part 
of this No., was no ordinary man. His position in our Army, and particularly 
his station at Washington City, though but for a brief period, gave him oppor- 
tunities, which he industriously improved, and subsequently enabled him to 
publish in quick succession, a work on the Climate of the United States, Statis- 
tical Reports, and many other articles. His last labors with the pen, were 
crowned by the Prize of the Eoylston Medical Committee of Plarvard Univer- 
sity, on the subject of vaccination and re-vaccination. At the early age of 
thirty-three, he has been called awa)^ from the busy scenes of life and usefulness. 

A meeting of the Profession, we see by the papers, was held in the city of 
New- York, and after the passage of Resolutions appropriate to the melancholy 
occasion, a committee was appointed to superintend the erection of a monument 
to his memory, and a gentleman of the profession selected to deliver a public 
Eulogy on the deceased. 



We offer no apolog}' to our readers, for inserting the following interesting 
letter, from our young and talented friend. Dr. Cumming, now of Amoy, (China.) 
This is an answer to a request to contribute to the pages of the Medical Journals 
of our country ; and we hope in a few months, to be in the regular receipt of 
valuable articles and information directly from abroad. 

"In your letter, 5'ou request me to send home accounts of our medical opera- 
tions. Up to this time there has been so little of order and method in my practice, 
that I have had few op^wrtunities of observing cases long enough and well enough 
for description. Of the history of the cases, there is often little or nothing known 
by the patients. They seem to forget the dates and peculiarities of their disor- 
ders with the greatest facility. But as we learn more of the language, this diffi- 
culty will be diminished, as we may do much towards refreshing their memories 
by pertinent questions. As yet, all description must be most general. The most 
common of all the disorders is Gastralgia (generally complicated M-ith PjTosis) 
— of 388 new cases received during February and March, there were G8 of this 
disease, 13 of simple Indigestion, 9 of simple Pyrosis, making 90 affections of 
the stomach. Of Coughs (principally Bronchitis) 50, Asthma 15, Rheumatism 
17, Pains (from falls, &c.) 18, of affections of the skin 20, and miscellaneous 
medical cases 23. Of Keratitis 32, Conjunclivitis 25, Blepharitis 18, Opacity 
of Cornea, 14, Trichiasis G, Iritis 3, Staphyloma of Iris 3, miscellaneous affec- 
tions of the Eye 7, (of whicfi one of melanosis) — Eye cases 108; Syphilis 17, other 
affections of the genital organs 5, Otitis 3, Ulcers 8, miscellaneous medical ca- 
ses 8. Of all these diseases, the acute inflammations of the eye and tlie affec- 
tions of the stomach are most frequently cured. For the former we cup, purge, 
blister and anoint. I have recently been much pleased with an ointment of Sul- 
phate of copper — I use from 8 gr. to 16 gr. per ounce of lard. For Gastralgias, 
«&c. we have almost a specific in a preparation of pepper 5 parts, and rhubarb 6 
parts: we make 133 pills of an ounce of this mixture, and give six pills daily, 
2 an hour before each meal; it has done admirablv thus far, (nearly two years.) 
For the Cough, we use Ipecac or Tartar oiii!^ti<' pill"^, with some success (12 gr. 



4S Medical In!clligcnce, [January, 



of the former or 3 of the latter, in twelve doses daily.) Many cases of Asthma 
are much relieved by Belladonna and Ipecac pills. For Rheumatisms we blister 
and give Dover's powders. For Syphilis, corrosive sublimate pills 1-6 gr. each, 
l)eginning with two a day and going on to ten. In cases of Opacity of Cornea, 
w^e blow into the eye a mixture of sugar candy and red precipitate, finely pow- 
dered — this is done" from two to six times daily. In these we are quite successful. 
Of Hydroceles, vre see a great many — I punctured two to-day, bat our patients are 
generallj' satisijcd with having it emptied, go away ver}^ much rejoiced and never 
comeback, AVe have quite a number of misceiraneous surgical cases, such as 
whitlows, abscesses, wounds (especially among the sailors) bruises, &c. &c, 

"1 suppo.->3 that yon have heard that Dr. HKPBURN,of the Presb}lerian Board, 
came here in November. He is fast picking up the language, and is a good deal 
interested in medical matters. We rented two houses in x4mo)^ about the end 
of the year, and I came over the 1 Dth January. Since the opening of our Dis- 
pensary here, we have many more patients than before. Since tlw beginning of 
February, Dr. H. and I have liad more than 5G0 new cases, averaging 10 dailj' — 
they are also of a more interesting kind than formerly, there being a far larger 
proportion of acute cases. Our Dispensary consists of a front room 42 by 21, 
in which the patients arc seated, and a back room 18 by 21, in which are our 
medicines and in which we carry on our operations. We have two Assistants 
{Chinese servants) who can cupj spread blisters, &c., make pills and help us in 
many ways, I am desirous of getting three or four youths trained as regular 
Assistants; with these, Ave could accomplish far more than at present. My 
teacher thinks of learning the business. Of medicines we have had a pretty 
good supply, and we expect that Mr. Boone will make permanent arrangements 
on this point. We are even now looking out for a stock just arrived from the 
United States. We have opened a Hospital also, principally for^ases of Cata- 
ract. We have room for 50 patients, but have now only eight. If we succeed 
in our first operations for cataract, I think that we shall have multitudes of cases. 
What v.^e need is skill, and if we acquire that, vv'c may do a great deal of good. 
In time, I have no doubt that we shall be able to send home some interesting ar- 
ticles, but it will take considerable additions to my knowledge both of medicine 
and Chinese, before such memoirs can have much value. 

" Our Missionary Medical body in China is increasing in number — A Dr. 
McCauter, of New- York, has recently arrived, sent out by the Presbyterian 
Board, with a Printer. We learn from home, tjiat Mr. Boone hopes to bring 
out a number of new Missionaries — they will be welcome, for they are much 
needed. Dr. MgGowan, of the Baptist Board, expects to settle at IN'ingpo — he 
was there during the winter, and had many patients. As soon as vve can have 
access to the neighboring cities, we shall have an immense field for medical 
practice; andl thinkit likely that we should be tolerated where no one else would. 
Within forty miles from Amoy, there are probably more than three millions 
of people — How fine a field for medical enterprise '/ Amoy might be made the 
central station, from which medicines, &c. could be forwarded from other places. 
In a few years there will be ample employment for scores of physicians. And 
if we hope to raise up men among the Chinese to practice the healing art, we 
cannot expect that three or four teachers, having their hands full of work, v.ill be 
able to do much. If those Christians who complain that they can find nothing 
to do as physicians at home, would come hither, their complaints would soon 
cease. And for men anxious to learn, here is a fme opportunity. If we had the 
funds for a large hospital, we could easily keep it full. By feeding the patients, 
we could keep them as long as v/e desired, and by judicious selection we could 
soon beat any hospital in Europe, for we have a population around us, and an 
absence of competition which would draw hither all, of medical importance for 
many leagues in the interior, so that La Charite and L'Hotel Dieu of Paris, 
would be completely eclipsed. May that day come." 

^;^ Subscribers to the Sonthcni Mcdicol and Sur^rical Journal, will recognise 
in this, (with the old scries) the commencement of the 4th Vol. and of the whole 
Nos. the 37th, 



SOUTHERN 

MEDICAL AND SURGICAL 

JOURNAL. 



Vol. I.] NEW SERIES.— FEBRUARY, 1845. [No. 2. 

PART I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

Remarks on the Pathology and Treatment of Convulsions, By 
L. A. DroAs, M. D., Professor of Physiology and Pathological 
Anatomy, in the Medical College of Georgia, 

The announcement by M. Trousseau of a new method of arrest- 
ing Convulsions,* furnished me with an opportunity of making a few 
remarks on the Pathology of those affections, in the second volume 
of the Southern Medical and Surgical Journal, p. 546, published in 
1838. The following article is designed as an extension of the views 
then presented. 

The term Convulsion, in its most extended sense, has been applied 
to all morbid contractions of the muscular fibre. Thus considered, it 
comprehends all the degrees of disordered action to be found between 
the two extremes of mere tremor and permanent contraction. And, 
Avere the etymology of the term not adverse to this acceptation, there 
would be a manifest convenience in its adoption, for, as will be seen 
in the sequel, all these degrees of disordered action, may be regarded 
as mere manifestations of as many degrees of the same condition of 
the nervous system, or rather of innervation. Being, however, in 
possession of no term adequate to the expression of all these phe- 



* JoTirnal de? Connaissanccs M^dico-Chinirgicalr^, 1837. 

4 



50 



Pathology and Treatment of Convulsions, [February, 



nomcna, and, looking to the true import of the word Convulsion, it 
should be restricted to designate all abnormal series of alter Ji ate con- 
tractions arid relaxations of the muscular fibre. It is in this sense 
we shall use it. 

Distinctive appellatives have been assigned to convulsions, accord- 
ing to the various circumstances under which they may occur ; hence 
we have convulsions termed infantile, puerperal, hysterical, epileptic, 
hydrophobic, d:c. It is evident, however, from our definition, that we 
comprehend under the denomination of convulsions, all abnormal 
series of alternate contractions and relaxations^ without regard to the 
number of muscular fibres implicated, nor to the degree oi violence 
with which they are afTected. We therefore recognize as convul- 
sions, local as well as general contractions, and tremors as well as 
epilepsy. Indeed, when examined with the lights furnished by 
modern physiology, they arc, as already remarked, really but difTer- 
ent degrees of the same modification of innervation. 

Of the classifications of the afTeciions of the motor system proposed 
by the several Nosologists, that of Sauvages appears the least objcc- 
tionable. I will therefore insert it here for the purpose of subsequent 
reference, and offer one of my own, in which it is simply attempted to 
supply the deficiencies of that of this distinguished Nosologist. 





Classificatio^^ 


BY Sau^ 


"AGES 






m Class- 


-Spasms. 






\st Order- 


— Partial tonic spasms. 
Strabismus. 
Trismus. 
Wry-neck. 
Muscular stiff-joint. 








Pandiculation. 

Apomyttosis. 

Trembling. 

Palpitations. 

Claudication. 




Cramp. 


ith Or^er— General Clonic spasms. 




Priapism. 








Rigor. 


ed Order- 


-General tonic spasms. 
Tetanus. 
Catalepsy. 








Eclampsia. 

Epilepsy. 

Hysteria. 


Zd Order- 


-Partial Clonic spasms. 
Nystagmus. 
Carpholog}'. 








Chorea. 
Beribery. 




Classification i 


3yL. 


A. 


DUGAS. 




Affections of the 


Motor 


Si/s 


'evi. 




lit Order- 


-Partial Tonic spasms. 
Strabismus. 
Trismus. 
Wrv-neck. 
Muscular stiff-joint. 
Priapism. 








of small intestines. 

" large intestines. 

" rectum. 

" urinary bladder. 

" uterus. 

" gall bladder. 

•' heart. 




Cramp, 










of voluntary muRcle*. 




" diaphragm. 




" »tomach.' 











1845.] 



Pathology and Treatment of Convulsions, 



51 



2d Order — General Tonic spasms. 
Tetanus. 
Catalepsy. 
3i Order — Partial Clonic spasms. 

N)'stagmus. 

Carphology. 

Gaping. 

Palpitations. 

Claudication. 

Sub-sultus tendinum. 

Twitching of facial 
muscles. 

Stammering. 

Hiccough. 

Sneezing. 

Pertussis. 

Vomiting. 

Spasmodic croup. 

Spasmodic asthma. 

Laughing. 



Sobbing. 

Sighing. 

Coughing. 

Abortion. 

Grinding the teeth. 
Uh Order — General Clonic spasms. 
Shudder. 
Rigor. 
Trembling. 
Jactitation. 
Chorea. 
Shaking Palsy. 
Raphania. 
Beribery. 
Eclampsia. 

infantile, 
hysterical, 



puerperal, 

hydrophobic, 

epileptic. 



The causes of convulsions may with great propriety ])e divided into 
the predisposing and exciting. The former are eitlier congenital or 
acquired. That the congenital predisposition to convulsions may be 
hereditary does not admit of a doubt, as the observation of all practi- 
tioners will attest. No children are so subject to these affections as 
those born of parents similarly predisposed ; hence the offsprings of 
hysterical mothers are singularly prone to convulsions. There are 
many instances of this peculiarity being transmitted to several succes- 
sive generations, and of mothers, all of whose children have fallen vic- 
tims to it. The congenital predisposition is, however, not always the 
effect of hereditary transmission, for it is not uncommon to find chil- 
dren extremely susceptible to convulsions, when no such susceptibility 
could be recognized in their parents. The undue. preponderance of 
the nervous system, and a general deficiency of tonicity or stamina 
may usually be observed in such individuals. According to Jolly,* 
*• all the physiological and pathological conditions that increase the 
susceptibility of the brain to respond to external irritations, are cffi- 
cient causes of convulsions." Baumes, who has certainly written 
the best practical work en infantile convulsions, holds the followin"" 
language:! "'Jhe mobility of the system is in a direct ratio with 
the feebleness, laxily and delicacy of the various parts of the living 
body. Upon these evident peculiarities depend the extreme reaction 



• Diet, de Med. et dc chir. Pratiques, art. convulsion.*!. 

+ Translated from p. 21 of the "Traits dcs convulsions dans I'cnfar.rr, par M. 

FisnnT'*!. Omp. r Htton Pan'?, lf^O.'>. 



62 Pathology and Treatment of Convulsions, [Februnry, 



of the sensorium, (lie great susceptibility of the nerves, and the undue 
mobility of the muscles." It is to this mobility of the system, conse- 
quent on the deficient powers of resistance peculiar to all newly 
formed tissues, that^vc may refer the greater susceptibility of children 
than adults to convulsions, and, in proportion to the difference be- 
tween the full development of energy and stamina in the male and 
female adult, will be found the disposition to such disorders. Femalea 
are, in general, therefore, more subject to them than males ; and 
those reared under the enervating influence of city life, of sedentary 
habits, &;c. still more so. 

It has been remarked, that it is during the period of the 
evolution of the body, when new tissues are being formed, that the 
system presents the greatest degree ofsusceptibility, and is therefore 
most liable to convulsions. This is no doubt correct ; but it is also 
urged by some that in females tliis period may be said to continue 
much longer than in males, inasmuch as even after the full develop- 
ment of her own system, the form-ation of new tissues is continued in 
the production of new beings — in the evolution of the fcetus in utero. 
This, however, can scarcely be adduced as a reason of their greater 
aptitude to convulsions, (or it isto the imperfect solidification or tonicity 
of newly formed tissues, especially the nervous, that this aptitude 
should be attributed, and not to the act of formation. At the same 
time that the mother contributes the elements of new tissues to her 
oflspring, her own tissues cannot be said to undergo any special 
modification, save in the uterus. Unless, therefore, the mere devel- 
opment of the uterus under impregnation be regarded as a process of 
evolution, similar to that of growth, the argument cannot be valid. 
Yet it is true, that females are more subject to convulsions during 
pregnancy than during any other portion of their adult life, and that 
they cease to be so after the cessation of child-bearing. It is a re- 
markable fiict that the disposition to convulsive afi^ections decreases 
rapidly after this period, and that the aged of both sexes scarcely ever 
suffer from them — Baumes says ihey never do.* 

The predisposition to convulsions may be acquired by any train of 
circumstances calculated to retard or to impair the solidification and 
perfection of the tissues, and, consequently, the acquisition of strength 
and stamina. Acute and chronic diseases, atmospheric vicissitudes, 
insufScient or unwholesome food and raiment, deficient ventilatioD, 



* Op. cit. p. 19. 



1845.] Pathology and Treatment of Convulsions. 59 



want of exercise, &c. are among the most common causes of this ac- 
quired habit. 

The exciting causes are as numerous as the agents capable of 
disturbing the function of innervation. These might, according to 
Hippocrates, be summed up under the head of repletion and deple- 
tion. Thus: " Convulsio fit, aut a repletione, aut ab dcpletione.'"* 
To which Galex, in commenting on this aphorism, very properly 
adds irritation. Convulsions, however, occur under circumstances 
that cannot be referred to either of these heads. They may be occa- 
sioned, for example, by peculiar odors, musical or harsh sounds, 
affecting sights, &c.; nay, even by the workings of imagination, as 
was strikingly exemplified by the fanatical sect of Convulsionisls of 
St. Mcdard, who, in their meetings, frequently went into violent con- 
vulsions. Indeed the same may be occasionally seen in our own 
time and country under a somewhat similar state of the mind. 

But direct or indirect irritation of the nervous system is by far the 
most common exciting cause of convulsions. In using the term 
irritation, it may be well to state that we do not thereby wish to 
designate one of the stages of inflammation, but merely an impression 
which, when perceived, is followed by a perturbation of some of ths 
acts of the economy. Now, whilst sensations are usually but tlio 
perception of impressions made on the tissues by some mechanical 
or physical agent, there are sensations developed within the system 
independently of any antecedent impression that we can detect. — 
Hence, the latter are denominated internal sensations, and their 
cause is said to be physiological or functional. Let the nostrils be 
titilated by a feather, the mechanical irritation is immediately per- 
ceived, or a sensation is produced, and this is followed by a sudden, 
convulsive action of certain muscles, constituting sneezing. The 
convulsions will then intermit and return again, until the cause of 
irritation be removed. Yet sneezing will as cff.ctually be produced 
by the irritation of the lining membrane of the nostrils consequent 
on a modification of its capillary circulation, as occurs in commen- 
cing coryza. Here we have an instance of internal or functional 
sensation, the irritation being independent of any mechanical or 
physical impression. In like manner, vomiting may be excited by 
irritating the fauces, and by functional disorder of the btomich ; 
laughing may be the effL*ct of tickling or of a physiological condi- 



♦ Aphor. 30 sec. vi. 



54 Pathology and Treatment of Convulsions. [February, 



tion of the brain, or of the morbid state of the system termed hyste- 
ria. What is true in those cases, is equally so with regard to more 
violent convulsions. These may likewise be occasioned by mechan- 
ical and by functional irritations, by thn pressure of a tooth making 
its way through the gums, by the presence of indigestible food in 
the stomach, by worms in the intestines, as well as by spontaneous 
gastric or intestinal irritation. 'J'raumatic causes as well as occult 
ones, will induce epileptic convulsions ; and intermittent fever, in 
which there is always more or less spinal irritation, may be attended 
by all the grades of convulsion, from the tremors of the cold stage 
to the most violent eclampsia. It is a singular fact that the violence 
of convulsions is by no means in a direct ratio to the violence 
of the apparent irritation, the slightest wounds occasionally giving 
rise to violent tetanus, and lesions so mild as to escape detection, 
causing epilepsy and eclampsia. 

'J'he tendency of the age is to the localization of maladies, and whilst 
we would be among the furemost in acknowledging the immense ben- 
efits which have accrued to the science of medicine by this course, we 
must confess that in the study of convulsions it has rather misled 
certain a ithorities, otherwise entiiled to much respect. The chief 
purpose of Buaciiet, in the preparation of his valuable monograph 
on infantile convulsions,* appears to have been the demonstration of 
the existence of lesions in the brain, and especially of its meninges 
in the great majority of convulsive alToclions. Among the various 
authorities he invokes in support of his views, we find Portal, who, 
in summing up the lesions of the encephalon, detected in cases in 
which convulsions had occurred,f enumerates 1st, the collection of 
air, water and gelatinous matter; 2J, congestion of the blood-vessels 
or sanguineous cflusions ; 3d, engorgements composed of various sub- 
stances; 4lh, inflammation; 5ih, induration; 6th, abscesses; 7th, 
ulcers; 8th, wounds; 9th, foreign bodies; 10th, increased or dimin- 
ished volume; ilth, change of color, &c. But Postal takes care 
to remark that those lesions are not peculiar to convulsions. Bka- 
ciiET also cites a niunber of cases from Morgagni,:j: LALLEJIA^•DJ| 
Abercrombie,§ Andral,^ &c., in many of which it is by no means 
demonstrated that the lesions were not ratlier the effect than tho 



* Traite Prat, des Convuls. dans I'enfance, par J. L. Brachet, 2me. 6cl. Psrip, 
1837. t Anatomie Medicale. T. iv. p. 69 et seq. 
X De sedibus et causis rnorb. Tome 1, epi^t. x. II Lcttrcss'.:r Tcncr-jhrJe. 
SDi.sGcises of the Brain, &c. U Clinique Medicale. 



1845.] Pathology and Treatment of Convulsions. 66 



cause of the convulsions. The congestions and effusions, for in- 
stance, so frequently found in post-mortem examinations, may 
assuredly be the fffect of the convulsions, inasmuch as these, when 
violent, always produce intense congestion of the organs contained 
in the cranium and spinal column. So far then from considering 
these lesions as the cause of the convulsions, we should expect to 
find them as a necessary consequence of such disorders. That the 
inference drawn from these cases is not always legitimate, will 
appear from the first of the series he adduces. It is taken from 

MoRGAGM, and is as follows ; 

* 

"Obs. xlvii. A girl five months old was taken with fever and 
looseness of the bowels. The following day the fever alone persisted. 
The third day she was seized with strong chronic convulsions of the 
upper extremities, extending with less intensity to the muscles pos- 
terior to the chest, and still less to the glutei muscles. Towards the 
end of the fifth day, the convulsions diminished, were manifested 
only at intervals, and were entirely suspended when the child slept. 
Universal jaundice now supervened. 

"After death, the entire surface, but especially that of the hack, 
presented dark red blotches. In the abdomen, nothing remarkable 
was discovered, save that the rectum was of a biaolc color. The 
pericardium was filled with yellow fluid ; the rigiit ventricle of the 
heart contained polypous concretions which extended into the pul- 
monary artery, and which resembled concrete mucus. The blood 
every where else was liquid, but slowly coagulated when exposed to 
the air. Within the cranium all was natural, with the exception of 
a seroili humour found between the dura mater and pia mater, and 
which had formed concretions around the blood vessels, in the form 
of gelatine." 

In this case, Braciiet thinks the convulsions were manifestly 
caused by meningitis. Was there not also in this case intense dis- 
order of the rectum and of the biliary apparatus? Was there not 
an effusion in the pericardium as well as in the cranium? And if 
effusions, (as our author seems to think, but to which we cannot ac 
cede.) be indicative of irritation, why not admit it also to have existed 
in the pericardium as well as in the meninges? 

If it be borne in mind that Braciiet derives almost all his cases 
from special works on diseases of the brain, the following passage 
will no longer excite surprise:* "I will not quote a greater number 



♦ Translated from op. cit. p. 345. 



66 Pathology and Treatment of Convulsions, [February « 



of autopsic examinations. Had I added even many more, tlic result 
would have been the same. They would all have presented the same 
lesions: congestions, inflammations, abscesses, membranous or gela. 
tinous productions, tubercles, hydatids, osseous deposits, &;c." Yet 
he unwittingly exposes the bias under which Morgagni's cases were 
drawn up in the following paragraph:* "This celebrated author 
(Morgagni) is so well convinced that convulsions depend on menin- 
geal irritation, that, wherever he does not discover traces of inflam- 
mation, he considers as a sufficient cause of irritation the small 
quantity of serous matter found in the ventricles, and announces that 
we are not to judge ofirritating causes by their quantity, but by their 
power, and finally admits that this serous matter possesses an acrid 
irritating property." 

Believing convulsions to be symptoms and not special diseases, the 
only advantage we can perceive in these attempts to localize it, ia 
the collection of facts that may be used to establish the relative pro- 
portions of the various exciting causes of those phenomena. The 
predisposition to convulsions might we think be regarded with much 
iftore propriety as a special disease than the exciting causes, for with- 
out that condition of the system, the same irritation will not excite 
convulsions. 

Let us now analyze the phenomena presented during a paroxysm 
of convulsions, and in order to do so the more eflfectually, let us select 
hysterical eclampsia, or epilepsy. The individual is, to all appear- 
ances, in the enjoyment of perfect health, when more or less sudden- 
ly, he falls to the ground with violent, though intermittent, contrac- 
tions of all the muscles of animal life, and with loss of consciousness. 
I say with loss of consciousness, rather because such appears to be 
the case, than from a settled conviction that consciousness is abolished 
at the onset of the attack. The mere facts that the patient cannot 
then manifest consciousness, nor remember after the paroxysm, v.'hat 
has occurred, should not satisfy us on this point, inasmuch as, in tho 
first place, he has lost the control of the organs (the muscles) by 
which he could express consciousness, and in the second we have 
continually instances in which circumstances taking place without 
any apparent deterioration of this faculty, are not remembered a 
short lime afterwards. Be this as it may — at the onset of a par- 
oxysm of epilepsy, the patient soon passes into a state of stupor, with 

♦ Op. cit. p. 329. 



18-15.] Pathology and Treatment of Co niuhions, 57 



stertorous breathing, full, strong and slo.v pulso, congestion of the 
superficial veins and complete relaxation cf the muscles. He is then 
unquestionably unconscious, and will remain so until the equilibrium 
of the circulation be restored. Frothing at the mouth, symptoms of 
asphyxia, priapism, defecation, <5cc. may occur or notduring the con- 
vulsion, according to the intensity of action in special muscles. If, 
at the moment the contractions cease, the case were seen by one 
unapprised of the antecedents, it would certainly be regarded as pre- 
senting all the characteristics of apoplexy, viz. loss of consciousness, 
stertorous breathing, perfect relaxation of m.uscles, and full, strong 
and slow pulse. The stupor gradually subsides, the patient breathes 
better, begins to swallow his saliva, groans, turns over or changes his 
position, and finally opens his eyes and asks the by-standers, what is 
the matter? lie is again a well man, with the exception of the las- 
situde consequent on the violent exertions, but which soon wears off. 
Such is, however, not the termination of all cases of convulsions. It 
not unfrequently occurs that as the stupor diminishes and conscious, 
ness returns, the patient v.iil open his eyes, look about as though 
intending to speak, and immediately be again seized v» ith convulsions 
as before ; or the return of the convulsions may take place after the 
complete restoration of intellect and voluntary motions, even after 
b\\ traces of the former attack had disappeared; or they may termi- 
nate Hitally. 

We have then, manifestly, in violent general convulsions, regard- 
less of their cause, two distinct stages or conditions of the system— 
the one a state of violent muscular action, and the other of tolal 
muscular relaxation — the one a state of high excitement, and tho 
other of torpor. Now, whence this change? Is the nervous 
system, or innervation in the same condition during these two 
stages? Certainly not. Can the same cause produce, directly, 
effects so opposite? I apprehend not. The explanation is found in 
the old maxim, that irritation causes convulsions, and compression 
paralysis. Whatever be the immediate cause of the first stage of 
the paroxysm, the phenomena are those that pertain exclusively to 
disordered innervation, to a modification of the functions of tho 
nervous system that may be induced by various agents, mechanical, 
chemical, or physiological, acting in almost any portion of 
the system. That it is only through the intervention of certain 
portions of nervous system that such phenomena can be developed, 
will be subsequently shown. Tho violent contractions then may bo 



59 Pathology and Treatment of Convulsions, [February, 



assigned to a modificalion in the supply of nervous influence to tlio 
muscles affected. But we have seen that violent and general con- 
vulsions are invariably attended by a stage of stupor, stertorous 
breathing, relaxed muscles, &;c. This, the second, or the apoplectic 
stage, comes on more or less early in the attack, according to its in- 
tensity, usually in from 2 to 5 minutes. The more violent and gen- 
eral the convulsions, the sooner will the second stage ensue, and 
consequently the sooner will the paroxysm be terminated ; whereas, 
if the convulsions be slight, less intense or partial, the apoplectic 
stage of stupor may be much longer in coming on, or may not follow 
at all. In such cases the continuance of the convulsions varies 
from a few minutes to hours, and even days. Partial convulsions or 
such as affect only a portion of the body, are those which usually 
continue the greatest length of time, and are very rarely attended 
with unconsciousness — never with the apoplectic state. Let me not 
be misunderstood : I am aware that in certain cases of Eclampsia 
and even of Epilepsy, followed by the stage of stupor, or apoplectic 
stage, it would appear that there is hut one side of the body affected. 
Such however is not strictly true in such cases, for, although the 
muscles of one side arc more violently agitated than those of the 
other, these are by no means in a state of relaxation, but will gen- 
erally be found quite rigid. I repeat, if one side only is affected, the 
other being in a normal state, there will be no apoplectic stage and 
the convulsions will continue for an indefinite time. These remarks 
recall to my memory a case I witnessed about two years since, in 
which the lady's entire right side, including the right side of tho 
face, was affected with strong convulsions for several hours, without 
being followed by stupor nor attended with impaired intellect. In- 
deed she retained the power of speech and deglutition during the whole 
time, crying out for relief and swallowing readily the remedies pre- 
sented her. Cases more or less similar to this are by no means un- 
frequent among hysterical females. 

If it be now asked why the apoplectic stage occurs in general a,nd 
not in partial convulsions, the solution is quite easy. Examine for 
a moment how the circulation is affected under these circumstances. 
It will be seen at once tliat whenever the muscles are violently con- 
vulsed, the blood contained in the muscular as well as intermuscular 
veins must be forcibly driven out and accumulated in those veins so 
situated as to be exempted from the compression. These are found 
in tho surface cf the body and wiihin the cavities of the chest, spine 



1815.] Pathology and Treatment of ConiuWior.s. 50 



and head, and observation demonstrates that the organs of the chest, 
spine and liead are precisely those that suffer the greatest degree of 
congcstiojj under such circumstances. Again, the act of respiration 
is materially impeded by the fact alone of its muscles and those of 
the laiynx being affected. This impediment then, taken in connec- 
tion with the congestion determined as remaiked above, will accouut 
sufficiently for the deficient aeration of the blood, and for the symptoms 
of asphyxia presented during violent general convulsions. It is well 
known that asphyxia is always attended with congestion of the ner- 
vous centres ; so that we have \\cvq two conditions of the system, each 
tending slrongly to accumulate blood in organs contained within un- 
yielding walls, and consequently where no such accumulation can take 
p'ace without compression of the soft pulpj material of said organs. 
The nervous centres are really and truly compressed in this manner, 
until their faculty of perception as well as that of dispensing nervous 
influence be materially diminished or even irretrievably destroyed. 
If these faculties are merely diminished, so that neither the cause of 
the convulsion can be perceived or give offence, nor the muscles be 
supplied with nervous power to contract, the convulsions will cease, 
and consciousness wdl gradually return as the congestion subsides. 
If the cause of the convulsion still continue, however, the return of 
consciousness will be attended with a return ot convulsions — thus 
constituting the alternations of convulsive action, apoplectic stupor, 
recovery and relapse already described. But if those faculties be 
entirely abolished, death will be the necessary consequence. 

In cases of slight or partial convulsions the phenomena of conges- 
tion above recited must necessarily be corresj)ondingly slight or 
partial. Hence the nervous centres retain the perceptive and dispens- 
ing faculties — the cause of convulsion continuing to act, continues to 
give offence to the nervous sensibilities, and innervation continues de- 
ranged. There are certainly many instances in which the cause of 
the convulsion not being apparent, we cannot perceive that it has 
been removed, and yet the convulsion ceases. May we not admit 
that the perturbation of the circulation consequent on convulsions 
may, of itself, so modify irritation or its cause as to lessen its inten- 
sity or bad effects? Many of our most efficient remedial agents act 
ill this way. The warm bath, cold afiTusion, diffusible stimuli, &c. 
may be regarded as modifying the capillary and general circulation. 
Emotics even in hysteria, and oth"r osas in which the stomach 
cannot be considered tho seat of irritation, constitute one of our 



60 Pathology and Treatment of Convulsions, [February, 



most efleclive means of arresting convulsjicns, and, doubtless, afford 
relief by the great perturbation of the circulation occasioned by the 
act of vomiting. 

The study of the pathology of convulsive affections demands an 
acquaintance with the physiology of the organs implicated. These 
organs are the muscles and those portions of the nervous system by 
which they are supplied with nervous iniluence. The muscles them- 
selves, being inert when cut off from the influence of the nervous 
eystem, it becomes highly important to deteimine the laws and cir- 
cumstances under which such influence is manifested. These have 
of late years been studied with great success by Magendie, Flour- 
ENS, Sir Chaeles Bp:ll and JMarshall Hall, and the conclusions 
to be deduced from their researches will be very briefly slated. The 
nervous system is now divided into three very distinct and well 
defined portions ; the brain, the spinal marrow, and the ganglionic 
system; and to each of these portions, ycry distinct functions are 
assigned. Tiie brain is the seat of perception or sensation, of voli- 
tion, and of trie mental faculties ; the spinal marrow is both a medium 
of communication with the brain, and an independent excito-motory 
apparatus; the ganglionic system presides over the functions of 
organic life, as nutrition, formation, secretion, &;c. To the brain 
then must be referred all the abnormal conditions of sensation, of 
volition, and of mind — pain as v/ell as paralysis, perversions as well 
as loss of the will, mental aberrations as well as idiocy. Lesions of 
the senses, acts of violence, insanity, — all have their origin distinctly 
in the brain. Vivisections clearly demonstrate that injuries inflicted 
on the brain, induce neither pain nor muscular contractions, and, 
consequently that this organ is endowed with neither sensibility nor 
the vis nervosa of Ilaller. But when the brain is irritated, delirium 
ensues, when it is compressed coma follows, and when destroyed 
paralysis or loss of voluntary motion is the consequence. According 
to Dr. M. Hall, if other phenomena accompany diseases of the 
encephalon, they arise ficm the extension of (he influence of these to 
the true spinal and ganglionic systems, through irritation or pressure^ 
counter-irritation or count er-fres sure. Let us here be permitted to 
quote the learned Doctor's own words on this interesting portion of 
our subject :* 



♦ Mem. on some Principles of Patiology of the Nervous system. 



1845,] Pathology and Treatment of Convulsions, 61 



" M. Andral speaks of irritation of the cerebrum ns <hc cause of 
abnormal muscular contractions. Now, in our investifjaiions into 
the nature ofcerebral diseases, we must remember one circumstance ; 
it is impossible to induce muscular action by any irritation of the 
substance of the ccM-ehrum itself. Vr'henever, therefore, there are 
s[)asmodic affections in diseases of the nervous system, we must 
conclude that the spinal system is involved, either primarily or 
secondarily, in the disease. Irritation of the cerebrum may induce 
delirium and other disorders of the cerebral functions; congestion of 
the cerebrum may iudijce co!na, paralysis, d:c. Bat if these morbid 
conditions of the brain be attended by spasmodic or other deranged 
actions, it is because the true-spinal system is involved in the dis- 
ease, or alTected by it \n the way of irritation, counter-irritation, or 
of pressure, or counter-pressure. Hence we observe the symptoms 
of spasm in various diseases of the encrphalcn, the condilion being 
not the nature of the disease, but that they produce these interme- 
diate effvicts. Time, as is well known, is a very important element 
in this problem ; and why is it so? The fact is to be explained on 
the same principles. The very same lesion occurring quickly, will 
produce efiects which will be tofally absent if It creep on slowly. In 
the former case, we b.ave the effects of irritation and pressure, or of 
counter-irritation and counter-pres-ure ; in the latter, the cerebrum 
has so accommodated itself to the new state of things, probably by 
the altered condilion of its vessels, as to avoid these eiiects, except 
towards the close of the disease. 

" We need not, therefore, now view with surprise the fact tbat the 
same lesions as found po^f-Z/'zor/PT??, had been attended by a totally 
different series of symptoms during life, any more than the other fact 
that, in the diflercntperiofZ^ of that lesion, the symptoms have been 
dillerent. 

'*The symptomsTrequcntly subside too and re-npprar. If the dis- 
ease be not regularly progicssive, the encephalon accommodates itself 
as I have stated, and the synjptoms disappear; if now the disease 
proceeds, the symptoms also return. At least all this may bo. 

"A rapid efiusion of serum may resemble haemorrhage or ramolis- 
sement in its effects; or slow effusion may merely obscure the intel- 
lectual faculties." 105. 

♦ ** *** *:j<+ :ici|(4i 

" It is well known from the experiments of M. Flourens especially, 
that irritation of the cerebrum has no influence in inducing spasmodic 
action. Whenever, therefore, spasmodic symptoms occur in diseases 
of the cerebrum, it must, as I have already stated, be on a principle 
different from that of irritation of tiie cerebrum itself; it must be 
from an impression made upon j)arts of the nervous system in which 
the property of exciting spasmodic .action on being subjected to 
irritation resides; thcso parts arc the tubercula quadrigemina, the 
medulla oblongata, the intra-cianial nerves. d:c. 

**That ///i<Z//f counter-pressure on the medulla oblongata may, and 



C3 ratho^ogy and TieaUnent of Convulsions, [February, 



nctually does, excite convulsions, is proved by tlic following facts : — 
In the interesting case, most anxiously watched and accurately de- 
tailed to me by my friend Mr. Toogood, of Bridgcwater, of his own 
little girl, aged tliirtecn months, the croup-like convulsions occurred 
repeatedly, until one day, when the bones of the cranium separated, 
and the convulsion ceased. In a case of spina-bifida, related to me 
by Mr. Herbert Evans, of Hampstead, there was a croup-like convul- 
sion vvhencver the little patient turned so as to press upon the tumour. 
In the case of an anencephalous foetus, described by Mr. Lawrence, 
convulsion was produced on pressing on the medulla oblongata. In a 
case of meninfTJtis, civen bv Dr. Abercrombie, the anterior fontanel'e 
became very prominent. Pressure upon it induced convulsion. Hy- 
pertrophy of the brain affords an argument of the same kind; it 
induces convulsion, except in the case in which the cranium grows 
with the encephalon. These and other facts lead me to think that 
convulsion arising from cerebral disease is thus to be explained." 107. 

We have stated that the spinal marrow is a medium of communi- 
cation v»ith {\\(i brain, and an independent excito-motory apparatus. 
That it is a medium of communication with the brain, is easily shown 
by sections of this cord, v.hich deprive all the parts receiving ncri-cs 
from below the section, of the influence of sensation and volition, 
and consequently of voluniary contraction. Yet contractility is not 
annihilated by such sections, in these parts — contractions may still 
be excited by irritatinfi causes applied to the nerves, or directly to 
the spinal marrow. Hence Vae theory of the excito-motory process 
so happily developed by Marshall Hall. His views may be glean, 
ed from the following paragraph : 

*' A peculiar set of nerves consti'ute, with the true-spinal marrow 
as their axis, the second subdivision of the nervous system. As 
those of the former subdivision (the brain) were distinguished into 
sentient and voluntary, these may be distinguished into the excifor 
and motory. The first, or the cxcitor nerves, pursue their course 
principally from internal surfaces, characterized by peculiar cxcita- 
bilities, to the true medulla oblongata and spinalis ;* the second, or 
the motor nerves, pursue a reflex conv sc from that medulla to muscles 
having peculiar actions concerned principally in ingestion and eges- 
tion. The motions connected with the former, or cerebral subdivi- 



* Dr. Hall includes the tubercula quadrigemina in the true-spinal system. 
He regards as excitor nerves of this system, the fifth, the pneumogastric, and 
the posterior spinal nerves; and as reflex or motor nerves, the fourth, sixth, por- 
tio dura of the seventh, the pneumogastric, tiie spinal accessory, the phrenic, 
the inferior external respiratory, and the spinal ner\*es. (Op. cit.) 



1845,] Pathology and Treatment of ConvuUions. C3 



sion, are sometimes, nay, frequently, ^pon^aneoz/y ; those connected 
with the true-spinal are, I believe, always excited.^''*' 

The muscles of voluntary motion then contract under the man- 
dates of volition emanating from the hiain, and also under the influ- 
ence of irritation director indirect of the sj)inal marrow, and this 
whether the communication of their nerves with the brain be cut ofT 
or not, — whether sensation be developed or not. Nothing is more 
common than to find a limb so j)aralyzGd as not to move in the least 
under the strongest efforts of will, and yet be affected with more or 
less violent contractions when a feather is passed over its surface, or 
it is otherwise irritated. In such cases, as has been justly remarked 
by Marshall Hall, the seat of the lesion must be that of volition 
— the brain ; for the persistence of the reflex actions indicate an 
unimpaired condition of the seat of involuntary motions — the spinal 
system. If on the contrary it be found impossible to excite motions 
in the paralyzed limb, the lesion should be referred to the spinal sys- 
tem. This is an important means of diagnosis. 

Seeing that voluntary movements emanate alone from the brain, 
independently of excitement or irritation properly so called, and that 
all involuntary movements are manifestly produced by mechanical, 
physical, or functional excitement or irritation, the true pathology of 
convulsions is perfectly plain. Convulsive contractions are involun- 
tary — therefore not produced by tlie organ presiding over the func- 
tions of volition, but by that organ which presides over motions 
susceptible of being excited by stimuli other than that of volition. 
Excite the nostrils, or the fauces, or the anus, and, despite of the 
efforts of the will, sneezing, vomiting, or contraction of the sphincter 
ani will ensue, and these sequences vviil obtain whether the irritation 
have been perceived by the brain or not, as may be demonstrated in 
vivisections in lower animals and in cases of paraplegia and hemi- 
plegia in man. If such things take jilace in localities exposed to our 
view, there is no reason why they should not in those more deep seated 
or hidden. 

In the physiological or healthy state of the system, these phenome- 
na of reflex action are essential to the normal performance of the acts 
of the economy. It is only when they occur under the influence of a 
pathological state of the system that they constitute convulsions. In 



♦ Lcclnrc^ on the Nervou>< System and its Discafcs, by M. Hall. London, 1K)6. 



CI Pathology and Treatment of Convulsions, [Fcbruarr, 



idiopathic convulsions tiie lesion is in (he centre of the true spinal 
system — and in sympathetic convulsions at its periphery. In tho 
former, the movements take place without the intervention of tho 
cxcitor nerves; in the latter they result from irritation transmitted 
hy these cxcitors io the centre. To the former class may be referred 
the trembling of the cold stage of intermittent fever, chorea, car- 
phology, claudication, &c. and sometimes hysteria, epilepsy, &:c. ; 
whilst to the latter class belong traumatic tetanus, and the great 
majority of the convulsions thrown under the head of eclampsia in 
the classification we have proposed, as the infantile, puerperal, hy- 
drophobic, d:c. 

"Tetanus," says Dr. Hall,* "is, in every respect, the most une- 
quivocal example of an aficction of the true-spinal marrow, through 
an incident and the motor nerves. All the functions of this sub. 
division of the nervous system are affected in the most violent form, 
whilst the cerebral functions are unaiTected : the dyspnoea, the dys- 
phagia, the constipation, the trismus, the emproslhotonos, the opis- 
thotonos, the extreme susceptibility to causes of physical impression 
and ngitation, and of mental emotion, — all mark an affection of the 
true-spinal system; vv'hilst the freedom from all afTections of the 
senses and of tho intellect, the absence at once of delirium and of 
coma, denote the normal condition of the cerebral system. Hydro- 
phobia is in the same cntegory." 

Again, according to Dr. Hall, "in Epilepsy the very first symp. 
tom is generally, if not always, one of the true-spinal kind. The 
first symptom is constriction about the throat, and closure of the 
larynx, more or less complete ; then follow violent expiratory efforts 
and convulsive movements of the trunk and limbs. Intermediately, 
and even without the convulsive movements, the cerebrum is affected 
with congestion, and a multitude of cerebral symptoms occur : flashes 
of light, tinnitus aurium, the aura epileptica ; a momentary oblivion ; 
a state of terror, of delirium, or of unconsciousness, &;c; as parts 
of the general convulsion, the tongue is protruded and bitten, the 
fcEces, the urine, or the semen expelled ; as consequences of that 
convulsion, the cerebrum is congested, and there is coma. If this 
state continues, another order of symptoms takes place ; the respira- 
tion becomes stertorous, and, at length, aiTected with mucous rattle, 
the true spinal and ganglionic systems becoming fatally involved in 
the disease. 

"It is the constriction about the throat which assimilates epilepsy 
to the state of things which exists in strangulation, and which distin- 



* Memoirs on some principles of Pathology- in the Nervous System, hy M. 
Hall, noticed in the Meilico-Chirur^ical Review — Januarv, 1843. 



1845.] Pathology and Treatment of Convulsions. 65 



guishes it from hysteria. It is this circumstance which associates 
epilepsy with the crowing inspiration of the convulsions of children ; 
all are laryngismal. In epilepsy, there is sometimes a crowing in- 
spiration and convulsion of infants are sometimes followed by epi- 
lepsy in subsequent years." 

Shall we be told now that convulsive affections are for the most 
part to be referred to lesions of the brain or of its meninges? that 
congestion of the brain and effusion are among the most efficient 
causes of convulsions? that involuntary movements emanate from 
the organ of volition? It is evident that those who entertain such 
views have mistaken the effect for the cause, in not duly attending 
to the order in which are developed tlie several phenomena presented 
before, during, and after a convulsive paroxysm. 

The main object of this com.munication has been to elucidate the 
true character of such affections, in order that correct views of treat- 
ment might be attained. If in certain cases the origin of the per- 
verted movements must be traced to the centre of the true-spinal 
system, whilst in certain others it must be found at the periphery of 
this system, all that is necessary will be to distinguish these cases 
from each other, and to localize the peripheral portion affected* If 
the excitation proceed from the gums, the indication is plain ; if 
from the stomach, the intestines, the cutaneous surflice, or even the 
encephalon, it is equally so. There can be no difficulty in the mat- 
ter, once that the tiue nature of the case is ascertained. Each case 
should be treated on its own merits- — due regard being paid to the 
consequences as well as to the cause of the convulsions. But there 
can be no question that the same degree of local irritation that will 
occasion convulsions in one individual, or at one time, will not have 
the same effect in another individual, or at another time. Hence, 
as has been already stated, there is a convulsive predisposition some- 
times existing in the system, that must be combatted as well as the 
paroxysm itself and its effects. The treatment of convulsive diseases 
should therefore be directed against this predisposition, against the 
immediate cause of the paroxysm, and against the effects of the con- 
vulsive struggles. 

To the predisposition must be opposed all the means calculated to 
increase the solidification of the tissues and the stamina of the system. 
Tonics, especially the anti-spasmodic tonics, wholesome diet, exer- 
cise, change of scene, diversion, regular habits, 6lc» will accomplish 
these purposes. The predisposition being known to exist, dueattcn- 

5 



66 Faihology and Treatment of Convulsions. [February, 



tion must be paid to the condition of tbe localities from which excita- 
tion most frequently proceeds ; and these will vary according to tho 
age and sex of the individual. In children, they are the gums, the 
stomach, the bowels, the encephalon ; in adult females, the uterus. 
These localities should therefore be maintained, as far as practicable, 
in a state of integrity. 

Should an attack nevertheless supervene, it must be treated accord- 
ing to the seat and nature of the exciting cause. Lancing the gums, 
emetics, cathartics, enemata, anthelmintics, emmenagogues, warm 
bath, revulsives, &c. will furnish us the means most generally needed. 
During the paroxysm of violent general convulsions very little can 
be done to moderate its intensity; the supervention of cerebro-spinal 
congestion will of itself arrest it. But the paroxysm of partial or of 
mild convulsions, may be mitigated, and the threatened return of 
violent ones prevented, by the use of the above means, and also, ac- 
cording to the suggestion of Dr. Hall, by titillating the fauces and 
the nostrils, and by dashing cold water in the face, so as to modify 
the condition of the respiratory muscles ; inspiration, &c. being pro- 
voked by such impressions. 

The effects of the convulsive struggles should not be overlooked. 
The most formidable are cerebro-spinal compression from congestion 
or effusion, and asphyxia from accumulated mucus in the bronchi, or 
from constriction of the rima glottidis. The means instituted to ar- 
rest the bad effects of the former must be proportioned to its intensity. 
Knowing that congestion is the necessary consequence of violent 
convulsions, and that it usually subsides, more or less early after the 
cessation of the struggles, without leaving any bad effects, we should 
not too hastily resort to depletion. The abstraction of a portion of 
the circulating mass should be reserved for those cases in which it 
may be deemed requisite for the removal of the exciting cause, or for 
the moderation of the determination to the cerebro-spinal centres. 
Now it is exceedingly rare that the exciting cause is such as to re- 
quire aciite depletion, if any; and I believe it perhaps equally rare 
that the congestion is such as to excuse the profuse waste of blood 
advised by most practitioners. The expediency of blood-letting, and 
the quantity to be taken, should be determined by the antecedent, as 
well as the actual condition of the circulation. If the exciting cause 
of the paroxysm, and the general state of the system, would not have 
warranted the abstraction of blood 5p/orc the paroxysm, such abstrac- 
tion can certainly be tolerated during or after the paroxysm, only in 



1845.] Pathology and Treatment of Convulsions. 67 



so far as it may be imperatively called for by the violence of the con- 
gestion of the nervous centres. How often have not children, (at 
which afre the loss of blood is always a serious matter,) and women 
in child-bed, when the process of parturition must of itself tax the 
system with loss of blood, how often, I say, have not patients of these 
classes been hastened to the grave by injudicious depletion ? Do we 
not continually hear of copious blood-letting having been practised in 
convulsions occurring after parturition, and consequently after the 
blood-vessels have already been more or less unloaded? — and all this 
in the very class of individuals whose constitutional peculiarities 
evince that general want of tonicity and stamina which predisposes to 
convulsions ! If the irritability of the nervous system be in a direct 
ratio with the feebleness, laxity and deficient tonicity of the tissues, 
should we not pause, should we not carefully weigh the case in all its 
bearings, before we resort, in convulsive affections, to the most direct 
method of impairing the strength and stamina of the body? lam 
persuaded that the indiscriminate and lavish abstraction of blood, 
recommended in convulsive affections by some authors, and instituted 
by too many practitioners, is most pernicious, and probably one of 
the most frequent causes of the fatal result. Opiates and narcotics 
in general have been too sparingly resorted to, owing to the erroneous 
apprehension of cerebral congestion. This class of remedies, by 
subduing the irritability of the nervous centres, accomplishes precise- 
ly what is most desirable when the patient is threatened with convul- 
sions. There can be no doubt that by their judicious administration 
on the first appearance of the symptoms denoting a convulsive ten- 
dency, a large number of cases of puerperal convulsions would be 
averted, and that if given after the paroxysm they would prevent their 
recurrence. Although these remarks are applicable to almost every 
convulsive affection, they are peculiarly so in those cases in which 
the spasms are induced both by pain and by irritation, as in those of 
the puerperal and traumatic state. Brachet recommends very 
highly in infantile convulsions a combination of Ext. Hyosciam. nicrer 
and ox. zinc. 

With regard to the tendency to asphyxia manifested in certain 
convulsive affections, as epilepsy, spasmodic croup and asthma, puer- 
peral eclampsia, hydrophobia, &;c. it demands our special attention, 
as it is in many cases the immediate cause of death. The riraa 
glottidis, being in such affections more or less closed, respiration is 
correspondingly impeded. It is particularly under such cir-cumstan- 



68 Pathology and Trealmenl of Convulsions, [February, 



ces that Marshall Hall recommends dashing cold water in the 
face, and tickling the fauces and nostrils, so as to induce inspiration. 
They have been proposed also in the asphyxia of new-born infants. 
The operation of tracheotomy under impending asphyxia in hydro- 
phobia was, I believe, proposed by Dr. Physick, since when its 
necessity in all similar spasmodic conditions has been strongly urged 
by Dr. M. Hall and others. Some years ago a patient, apparently 
dying from asphyxia, consequent on deep intoxication, was saved by 
the timely performance of this operation, by Mr. Sampson, of Salis- 
bury in England. 



article II. 
An Essay on Auscultation — By Wm. H. CumMing, M. D.* 

Since the great discovery which has so illustrated the name of 
Laennec, the subject of Auscultation has received more attention 
than any other in the whole range of medical science. The accuracy 
of its results, the important information which it gives concerning the 
nature and progress of a numerous and important class of diseases, 
often existing in an isolated state, and perhaps more frequently still 
intercurrent with other disorders, sufficiently account for the enthusi- 
asm manifested in the cultivation of this most important mode of 
observation. We shall attempt in this essay to show the falsity of 
the generally received theory of the production of the sounds per- 
ceived in the respiratory organs. Without devoting any time to the 
useless and therefore irksome task of stating preliminaries now com- 
mon in the science, we proceed at once to the consideration of our 
subject. 

In its examination, we shall pursue the following order :-— 1st. We 
shall state in all their simplicity the facts which present themselves 



* It is but justice to Dr. Gumming to state that this essay was drawn up before 
he left for China, two years ago. — Edts, 



1845.] An Essay on Auscultation* 69 



to the observer. 2nd. We will give the explanation proposed by 
Laexxec. 3rd. We shall offer various objections to this explana- 
tion. 4th. We shall conclude with an exposition of the theory of 
Mr. Beau. 

In ausculting the various portions of the respiratory apparatus of an 
individual in good health, different impressions are received by the 
organs of the observer. These sounds are generally admitted to be 
three in number. The first, which may be heard in the larynx and 
superior portion of the trachea has been called the tracheal soiijle. 
This division was not admitted by Laexxec who confounded this 
sound with the second — it is supposed to be produced by the friction 
of the air against the different surfaces of the pharynx and larynx. 
The second, which differs from it in some respects, though preserving 
the same general character, may be most readily perceived by apply- 
ing the ear to the back, between the scapulae opposite to the root of 
the lungs. This sound is too well known to need any description. 
It was styled by Laenxec the bronchial respiration. The third 
sound is more generally diffused, and may be heard on applying the 
car to any portion of the chest whose internal surface is applied to the 
lungs. It was said by Laexxec to resemble the deep inspirations 
which occasionally take place in quiet sleep. 

To the explanation of the causes of the bronchial respiration, 
Laexxec does not seem to have given much attention. It is evident, 
however, from one or two incidental remarks, that he considered it 
to be produced by the friction of the air against the internal surface 
of the bronchia. His attention was much more excited by the third 
sound, styled by him the vesicular murmur. He asserts that it may 
be readily perceived, and that it indicates the penetration of air into 
the pulmonary tissue and its subsequent expulsion. He says that the 
impression conveyed to the mind of the observer, is that of a fluid 
passing from a narrow canal into a more ample space. We will not 
here state the many peculiarities of this sound, and of the conditions 
under which it is produced. These we shall reserve for our chapter 
of objections, as we shall find in each one a stubborn fact refusing to 
pass under the yoke of this explanation. And as a theory is only 
valuable as a general expression of individual facts, we shall go fiu 
toward the destruction of the explanation of Laexxec, if we can show 
that most of the facts so well observed by himself and others remain 
still isolated and refusing to bo admitted into this unnatural gener- 
alization. 



70 An Essay on Auscultation. [February 



Before entering upon an exposition of the many direct and (as we 
think) unanswerable objections, we must present a few reflections on 
the indispensable prerequisite to the exactness of this theory, viz. 
the existence of the cellular structure of the lungs. This cellular 
structure once generally admitted, is now not only doubted but even 
denied by many anatomists. The latest researches on this subject 
seem to show that the lungs are nothing more than an agglomeration 
of brenchial tubes ever decreasing to their termination — lined by a 
mucous membrane in which ramify the terminations of the pulmona- 
ry arteries. These tubes are united by a tissue resem.bling the gen- 
eral cellular tissue of the body, forming however a smaller portion of 
the pulmonary mass than is generally supposed. Besides this con- 
clusion derived from actual inspection, there is a consideration drawn 
from the philosophy of anatomy which has presented itself to my 
mind with great force, probably because it has originated there. It 
is evident that the lungs were intended to expose an immense surface 
to the action of the atmosphere. Their structure must however oc- 
cupy but a small space that it might not interfere with the functions 
of the adjacent organs. A moment's consideration will show that 
the existence of vesicles at the extremity of the bronchia is not com- 
patible with the exposition of the greatest possible surface to the 
atmospheric air. Though this consideration may not be conclusive, 
it must have great weight with those who have carefully studied the 
structure of the body, and observed the wonderful wisdom every 
where displayed in our physical frame. These two considerations 
render the vesicular or cellular structure of the lungs highly improba- 
ble, and theretore tend to invalidate a theory based on that supposi- 
tion. But we go farther, and assert that we doubt not only the mode 
of formation generally assigned, but even the locality. We are 
disposed to deny that this respiratory murmur is formed at or near 
the termination of the bronchia in the lungs. Let us notice some of 
the peculiarities of this sound. One of those most worthy of remark 
is the superior intensity during inspiration. It is indeed heard at 
expiration, but is feeble and seems distant. This fact did not escape 
Laennec. It has been supposed that the explanation of this fact 
might be found in the introduction of a larger quantity of air than that 
expelled by expiration. But this difference is found to be very small 
if it really exist. It is also fully compensated by the increased 
quantity of watery vapour and carbonic acid, while at the same time 
the elevation of temperature which the air necessarily undergoes in 



1845.] An Essay on Auscultation. 71 



the lungs, must render the volume of gaseous matter expelled fully 
equal to that inhaled. It has been also urged in reply to this objec- 
tion, that the air enters the lungs with greater velocity than that 
with which it is driven off*. This is, however, a pure hypothesis, 
based on nothing but the determination to find a reason for an un- 
reasonable notion. The time employed in expiration is equal to that 
in which the air is introduced, and as we have shown the quantities 
to be equal, there is no reason for an increase of velocity. It has 
also been observed that this respiratory murmur is much more intense 
in women and children than in men. So uniformly does this exist 
in children, that an unusual degree of intensity in the murmur of 
adults has been styled puerile respiration. This fact had evidently 
puzzled Laexnec. He explained it by supposing that children 
breathe more largely than men, forgetting, as it would seem, that the 
same could not be true of women. But we know that there are found 
men in good health, of active habits, indeed differing in none of these 
respects from others, who yet exhibit this puerile respiration. In 
certain diseases, when a large portion of the lungs is affected, we 
frequently find this puerile sound. This was most readily explained 
by Laennec, who asserted that when a large number of cells were 
closed those which were pervious were more forcibly distended than 
>mder ordinary circumstances. But this triumph was short-lived, 
for it was found that in certain cases of violent pneumonia or pleurisy, 
when large portions of the lungs were unable to perform their func- 
tions, and when therefore the pervious cells must be much distended, 
no puerile sound was observed. To comprehend in its embrace tlieso 
tiiree apparently conflicting facts is above the power of the theory of 
Laennkc. It is also found that in certain animals, e.g. the horse, 
the ass, the ox, the camel, the camel-leopard, &,c. who breathe freely, 
whose lungs fully expand, the respiratory murmur is not heard in 
ordinary circumstances. If the force and frequency of respiration 
be augmented in these animals by rapid and violent exertions, wo 
shall succeed in hearing this murmur as distinctly as in the human 
subject. We have thus cited many facts observed and stated by 
IjAENNec which he was unable to explain. They are inexplicable 
by his theory. The last and strongest objection we shall reserve until 
wo shall have presented the theory of our adoption, for it acts at 
once on the offensive and defensive, overthrowing the old and estab- 
lishing the new <loctrine on a firm and immovable basis. We think 
that enough has been said to show that the theory generally received 



72 An Essay on Auscultation. [Fcbruarj, 



is opposed by many well-observed facts, which it cannot explain, with 
which it is inconsistent, and with which therefore it cannot be con- 
sistent. Shall the facts or the theory yield? We prefer the latter 
alternative, and as the former are universally admitted, we shall 
adhere to them. And before proceeding farther, we will present a 
few thoughts which seem to be peculiarly appropriate here. After 
considering the structure of the bronchia, lined as they are by a smooth 
membrane lubrified by a thin mucus, remembering at the same time 
the small velocity with which the air traverses them, we are surpris- 
ed that any appreciable sound should be produced. When we 
auscult an artery in the healthy state of the system, diflering as it 
does from the transient bronchia, by its superior size, by the density 
and velocity, and consequently by the momentum of the fluid passing 
through it, we find a sound far inferior in intensity to that perceived 
on ausculting the chest. 

Proofs. 
Is the sound more intense at inspiration than at expiration? 
What more natural or consistent Vv'ith every day's experience, than 
that a sound conveyed to us by a current of air should be louder than 
the same sound compelled to force its way to us against the direction 
of that stream? Is it stronger in women and children than in men? 
A knowledge of the comparative anatomy of the larynx in different 
sexes, and at the various periods of life, offers a ready solution. Do 
we not know that the cavity of the larynx undergoes great changes 
in males at the age of puberty — that the ventricles are dilated, the 
thyroid cartilage enlarged, the opening of the glottis increased ? Do 
we not know that in females this change is slight? What then more 
reasonable than that the intensity of the sound should increase when- 
ever the conditions favorable to this modification exist? And if the 
original sound be mere forcible, it will be more intense at each point 
where it is examined. But actual observation excludes all necessity 
for a resort to reasoning. If we auscult individuals of the different 
sexes and children, we shall find that the laryngeal sound of men is 
feebler than that of women and children. Do we find some men who 
present this puerile respiration ? On ausculting such we shall find 
an unusual intensity of the laryngeal sound. We shall find that their 
thyroid cartilage is not much developed, that their voice is high, and 
that this change which occurs in all men has been slight in these 
cases. Do we observe this puerile respiration existing in certain 



1845.] An Essay on AusciiUaiion. IIS 



diseases of the lungs? On examination we shall find the laryngeal 
sound proportionahly increased. Do wo fail to observe it in certain 
cases where the violence of the disease is the same or even greater? 
We shall find that these individuals present no sensible augmenta- 
tion of the laryngeal sound. In no disease can this fact be more 
readily observed than in pneumonia. We frequently see patients of 
this kind who produced great sound in ihe larynx. This should not 
be confounded with that formed in the nasal fossae. We find others, 
who, while breathing as rapidly, and with as great difficulty, present 
no increase of the natural sound. The position of the patient, the 
state of his nervous system will introduce remarkable modifications in 
his respiration, and by placing in supination an individual occupying 
the sitting posture, we may frequently augment the laryngeal sound 
and the consequent respiratory murmur. An objection must be met 
here. V/e have said that en ausculting the chests of certain animals 
we could not perceive the respiratory murmur. It will be asked, did 
not the laryngeal sound exist? We answer that it does, but is pre- 
vented from reaching the cliest by a peculiar circumstance. We 
have cited the horse, the ox, the girafie, the camel, as instances of 
this kind. Though differing widely in their organization, they have 
one thing at least in common, — a long neck. In many of them, the 
laryngeal sound is feeble, and is lost before arriving at the terminal 
bronchia, or is rendered so soft tliat it is not perceptible. It will bo 
noticed that these animals have low voices, proving thereby that tho 
aperture of the glottis is large. But if the laryngeal sound be much 
augmented by rapid and violent exercise, we are then able to per- 
ceive the respiratory murmur. So that this objection, apparently so 
formidable, readily enters with the others and acknowledges the 
justice of our generalization. In the third portion of this essay we 
mentioned the reservation of a powerful objection to the vesicular 
theory. We did so in order to bring it with more eficct to the estab- 
lishment of our adopted doctrine. It contains within itself the root 
of the matter, and is amply suflicient to answer all our ends of demo- 
lition and edification. It is the fact, that we all possess the power of 
diminishing at will the intensity of the respiratory murmur without 
aflTecting the plenitude or rapidity of respiration. The only condi- 
tion is an enlargement of the aperture of the glottis. So far from a 
necessity of diminishing cither the fullness or frequency of respira- 
tion in order to produce this effect, we may increase both almost 
indefinitely without endangering the success of tho experiment. 



-471 Essay on Auscultation. February, 



With a little practice any one will soon be able to respire largely and 
rapidly without producing an appreciable sound in the larynx or chest. 
To such a fact commentary is injurious. All possible inductions will 
readily be made by the feeblest intellect. For the information of 
those who desire to repeat the experiment, we shall give a few direc- 
tions. Three persons are necessary to its proper performance : one 
to auscult the trachea, another the lungs of the third. The diminu- 
tion of the laryngeal sound, as observed by the first, will be found by 
the second to coincide with the diminution of the respiratory mur- 
mur ; and when the former ceases to perceive the sound in the 
trachea, the murmur will he imperceptible to the latter. 

The arteries are frequently more favorably situated for the trans- 
mission of any internal sound to the ear of the observer, as they are 
far more superficial. We indulge therefore in a legitimate astonish- 
ment when we are told that so rare a fluid passing with so small a 
velocity, through so small a vessel and at so great a depth, should 
produce a sound so superior in energy. And under such circum- 
stances we are justified in demanding an explanation which shall 
solve all the phenomena. On finding that the generally received 
theory is thus at variance Vv'ith so many well known facts, we are led 
to inquire on what lias been founded the favorable reception which 
has been given to it by the members of the medical profession. It is 
the appearance of simplicity which it presents that has secured for it 
Kuch general support. Indeed, the first impression is that the sound 
perceived is formed immediately under the ear of the observer. But 
this is at best but a small probability. Nothing is more fallacious 
than the decisions of our minds in regard to the direction of sounds. 
Were we guided by them, we should suppose that the clifT addressed 
us, because the sound is reflected from it to our ears. We shall here 
conclude our objections to the former theory, and proceed to expose 
and dcvelope that whose defence we have assumed. 

In a preceding part of this essay we have examined the sounds 
according to the scholastic mode. We have gone to their study in 
the manner counselled by t!ie dogmatists of our science — we have 
studied them *^ sccundcm Grfrm :^' let us reverse the method, and 
trusting to the guidance of another leader, let us examine the same 
phenomena secunclcm naivrnm. And let us set out on this course 
assured that we are under the direction of a safer, if a less brilliant 
guide. Let us then follow the air as it penetrates the respiratory 
passages — The first point open to our investigation is the larynx. 



1845 ] An Essay on Auscultation. 



Here we find a sound of peculiar character and of considerable ener- 
gy. The cause is readily discovered. The slightest knowledge of 
the anatomy of the larynx convinces us that all the conditions neces- 
sary for the production of such a sound are present in that organ. 
The column of air, increased in diameter by the existence of the 
ventricles, is compelled to traverse the narrow passage offered by the 
glottis. If we examine it at inspiration and at expiration, we find 
that it does not vary much in intensity at these different times. This 
might have been admitted a priori, for the glottis is inferior in diame- 
ter to the trachea. The induction which we have made as to the 
cause of the sound is then entirely conformable to the physical laws 
of sound. Admitting that we have discovered the cause of the sound 
in the larynx, we follow the trachea down, ausculting it at short inter- 
vals. We observe a modification of the sound which has become 
very apparent before wo have reached the sternum. We are here 
compelled to leave the trachea in front: but, nothing daunted, we 
recommence our examination in the rear. On applying the ear 
above the spinal column, near the level of the superior extremity of 
the sternum, we perceive a sound very similar to that of the trachea, 
and yet differing in some respects. We now proceed either to the 
right or left from this point, and we find a decided but gradual change, 
until we arrive at the axilla, where we receive the respiratory mur- 
mur in all its purity. By this mode of observation, instea<l of three 
sounds, we have an indefinite number, which pass from the laryngeal 
to the tracheal, to the bronchial, and finally to the vesicular, by 
insensible gradations. What cause has effected these changes ? The 
changes are gradual, i.e. comi)osed of a large number of slight modi- 
fications, requiring for their production an equally large number of 
efficient causes. We may examine the trachea, the lar^re and smaller 
bronchia, but we find no anatomical condition capable of explaining 
these phenomena. We have found that each sound in the trachea 
is merely a modification of that heard in the larynx. We have traced 
the same relation between the tracheal and bronchial sounds. The 
idea then irresistibly suggests itself, that there is an original sound, 
and that it is the laryngeal. Where then arc the modifying agents ? 
for v,-c have admitted that they must exist in indefinite numi)ers. 
They are the diflerent distances of each successive point from the 
glottis. The sound is borne by the current of air, and is thus carried 
to the terminal ramifications of the bronchia, where, from the dis- 
tancc, and the small size of the tubes, it assumes the peculiar charac- 



70 An Essay on Auscultation, ^ [February, 



ter of the vesicular murmur. The increase of the aggregate diame- 
ters of the bronchia may also exert some influence upon the quality 
of the sound. Here is the conclusion of the whole matter. Are our 
proofs demanded ? We take the facts which we have before urged 
against the former theory. The reverse experiment will be still 
more readily performed. By increasing the sound of the larynx, the 
respiratory murmur may be made to surpass in intensity the loudest 
puerile sound. To our mind this experiment is satisfactory — It fixes 
every point which was before doubted, and bestows the fullest assur- 
ance of the truth of the theory which we here advocate. Before 
concluding, we beg leave to introduce an argument from analogy 
which must please, if it do not instruct. If we apply an ear to the 
chest of a person speaking, we observe a confused sound somewhat 
resembling the noises of a distant crowd. If on the contrary we 
examine the trachea, or bronchia, of an individual engaged in speak- 
ing, the sound is louder and more defined. We seem to have the 
tube under our car. We observe here the similarity of the modifica- 
tions impressed upon these different sounds. The seat of the voice 
is, without doubt, the glottis. But this similarity is still greater in 
morbid states of the pulmonary organs. In those cases where the 
minute bronchia are rendered impervious to the air, either by the 
extravasation of the blood or by external pressure, we find certain 
modifications of the respirator)^ and vocal sounds. And it is remark- 
able that the writer, to whom we have so frequently referred, has 
used almost the same language in speaking of these modifications. 
In these cases he says that the bronchial souffle is heard so distinctly 
that it seems as though some one was blowing softly into the stetho- 
scope. In speaking of bronchophony, he remarks that the voice ap- 
pears to be produced within the same instrument. In describing the 
higher degree of these two phenomena which exist in cases of exten- 
sive excavations, he observes that the respiration produces an im- 
pression similar to that resulting from the breathing forcibly in the 
stethoscope, the sound seems to reach the ear. This very remark is 
applied to pectoriloquy. The voice seems to rise into the tube, and 
in some cases appears even to reach the ear, and in a few instances 
resembles the sound produced by the act of speaking aloud in the ear 
of an individual. How striking is this unintentional tribute to our 
theory ! It could scarcely have been rendered more flattering. 
An important induction from these facts must here be noticed. 
In examining patients affected with diseases of the chest we 



1845.] ' Dehreyne on Chronic Diseases. 11 



are often uable to auscult the voice, either from its weakness or from 
the unwillingness of the patient to speak. We need never be uneasy 
on this account. Do we hear a souffle 1 There is bronchophony. 
Do we hear the cavernous respiration ? There is pectoriloquy. 
Have we a patient who is constantly talking? Allow him this privi- 
lege — It does not interfere with the auscultation of the rales, nor do 
you need any other information as to the state of the respiration. Is 
the voice indistinct and murmuring? Rest assured that the respira- 
tion is good. Have you bronchophony or pectoriloquy ? If the 
patient were silent, you would hear the bronchial or cavernous souffle. 
Does the voice assume an amphoric sound ? Believe that the ampho- 
ric souffle is not absent. Do you expect the existence of some com- 
pression on the trachea or large bronchial trunks ? Examine the 
voice. Formed, as it invariably is, during expiration, it is so much 
louder than the murmur of expiration that it will advantageously 
replace the latter as an object of examination. We are aware that 
other inductions may be made from these facts, but we are disposed 
to leave them to the ingenuity and reflections of the reader. 



Part II.— REVIEWS AND EXTRACTS. 

Therapeuiique Appliquce, ou Traitements speciatix de la plupdrt deg 
Maladies Chroniques. Par P. J. C. Debreyxe. 2me» Edition^ 
pp, 332. Baillicre, 1844. 

(C0^XLUDED.) 

Phthisis. — Although Dr. D. classes this too-frequent scourge of 
France among the chronic Phlegmasicc, he expressly says that he 
does not regard it as at all of an inflammatory character in its early 
stages. During the course of the disease, there is a strong tendency, 
as every one knows, to the frequent occurrence of a pneumonic and 
pleuritic attack ; but this is to be regarded only as an epi-phenojncnon^ 
and not as a necessary symptom. With respect to treatment, wo 
find that our author has almost entirely renounced — after the expe- 
rience of their utter ineflicacy — the employjnent of nearly all reme- 
dies, save and except the insertion of a scton in some part of the 



78 Dchreyne on Chronic Diseases, [February, 



chest, and the persevering use of Iceland-moss jelly in large quan- 
tities, not forgetting the Opium or Belladonna once or twice in the 
course of the 24 hours. He recommends the same line of treatment 
in those cases of chronic purulent Catarrh, the symptoms of which 
so closely resemble those of gemiine tubercular Phthisis; and, in 
not a few instances, has a cure taken place under their use, when the 
case had seemed to be utterly hopeless. 

From the Chest we pass on to the Stomach. After delivering some 
excellent remarks on the mode of distinguishing gastraJgic from gas- 
triiic pain, our author exposes, with no less truth than severity, the 
melancholy mistakes that have been committed of late years by so 
many of his countrymen, since the prevalence of the Eroussaian 
doctrine. He shows that the existence of an inflammatory state of 
the stomach may generally be diagnosticated by observing the effects 
which different kinds of food have upon the gastric pain. If, for ex- 
ample, farinaceous and milky substance can be taken well, while 
those of an animal nature give rise to a sense of uneasiness, we may 
very generally presume that there is a greater or less degree of actual 
gastritis. If the reverse be the case, and if light animal food, such as 
chicken-tea or mutton-broth, be borne best, we may feel assured that 
there is no inflammation, however troublesome the gastric uneasiness 
may be. The diet may therefore be regarded as a most useful explo- 
ratory means of diagnosis. 

"It often happens that the epigastric pain does not yield to leechings and low 
diet; and wo be to the physician who pertinaciously seeks to combat it b}^ con- 
tinuing the use of the same means, and who has not learned to modify his treat- 
ment according to the varying condition of each case. For the relief of the 
gastric pain, which resists the application of leeches, &e., opium is often an 
excellent remedy; a light preparation should always be preferred, and it will be 
well to exhibit it in some mucilaginous vehicle.* If, however, this does not 
succeed in the course of a day or two, we should then have recourse to a volant 
blister. Should this also fail, we shall have good reason to believe that the 
epigastric uneasiness is more or less dependent upon an atonic state of the 
stomach ; and this we can generally determine by having recourse to the explor- 
ative diet of which we have spoken. Should such be found to be the case, we 
must allow the patient more nourishing food, and we should try the effect of an 
infusion of Rhubarb or Columba-root, to which may be added a weak opiate, if 
deemed necessary." 

In Chronic Hepatitis, our author strongly recommends the use of 
emollient poultices on the hypochondriac region, applied every night, 
and also during the day, if the patient keeps his bed. They produce 



* A favourite formula of our author is this: — 

^. AqucC lactucae §^'iiij- 

Laudani Sydenhami . . . . ^\[\. 

Gum. arabic .5vj. 

Syrupi simpl §ij. 

Bicarbonat. sodaR .. .. 3ij. M. 
A labie-spoonlhl or two to be taken twice or thrice a day. 



1845.] Debreyne on ChrGnic Diseases. 



a local diaphoresis, which is often very serviceable in relieving the 
internal congestion. The occasional use of a tepid bath at the samo 
time will much promote the cure ; for the skin is orenerally very dry 
and lichenous in chronic liver complaints. Emollient aperient ene- 
niata are nlso very useful. Saline purgatives, dissolved in a large 
quantity of herb-tea, to be followed by repeated doses of rhul)arb — 
which has long had the reputation of directly promoting the flow of 
the bile — are always more or less necessary. 

In various chronic hepatic affections and visceral obstructions, the 
followinsr formula has been found bv Dr. D. to answer exceedingly 
well. 

5^. Pul. Aloes 5ij, 

Sapon Hispanic. 
Pulv. Rhei. 

Ferri Subcarbonat. . aa 3iv. 
Potassii loduretU . . 3ij. In pil. 120 divide. 
Dose — From two to six pills in the course of the day. 

If these pills do not prove to be sufficiently purgative, the patient 
should be instructed to drink some aperient mineral water to aid their 
action. 

Erysipflas. — "The treatment which we usually adopt in recent cases of this 
disease, before the formation of pus has taken place, is the abortive and empiric 
plan followed by Dupuytren, and which he derived from the practice of M. 
Petit of Lyons. This method consists in applying a volant blister to the very 
centre of the inflamed part. The object which we have in vie\v by this bold 
and seemingly not very rational mode of treatment, is to arrest the internal in- 
flammatory action, and to cause it, so to speak, to abort, by drawing to one cir- 
cumscribed spot of the skin all the violence and raptus of the existing disease. 
It is quite true that this powerful concentration and sudden localization of the 
inflammatory action may, in consequence of being excessive, induce gangrene 
of the blistered part; but this accident is of very rare occurrence indeed. Out 
of between thirty and forty cases treated by us, we have only met with a single 
instance of it; and this occurred in a cachectic patient, whose constitution was 
altogether unhealthy. The application of a blister to the knee was in this case 
followed by the formation of a gangrenous eschar in the part, and the eventual 
consequences were extensive detachment of the surrounding skin, and consider- 
able suppuration. Of late years, however, it would seem that this unpleasant 
result of the vesicatory treatment has been observed .several times in the Hotel 
Dieu, at Paris, and that antiphlogi.stic measures have been on the whole very 
successful; whereas during the years 1813, 1814, and 1815, it was remarked, bV 
all who followed Dupu^nren's practice, that bleeding, &c. produced but little 
benefit, while blisters seemed to be quite a. specific remedy." 

Chronic Cutaneous Diseases. — Our author, without troubling him- 
self with the divisions and subdivisions of these diseases adopted by 
most dermatological writers, groups them together under the general 
appellation of dartres, and lays down some general therapeutic direc- 
tion that may be applicable to all. A mild unirritating diet, more 

vegetable and milky than animal, emollient refreshing drinks one 

of the best of which is whey — and the more or less frequent use of 
warm-baths, should never be omitted. Dr. 1). throws overboard, as 



80 Dehreyne on Chronic Diseases, [February, 



being utteil^y useless, the farrago of what liave been called Jepwra/ire 
remedies, such as the infusion of Fumaria, Dulcamara, Bardanum, 
Saponaria, Scabiosa, *S;c. &c. and he supports his own opinion on this 
point by quoting that of Alibert. The only internal remedy that 
he uses is the following : 

"fy. Flor Sulphuris 5iv. 

Sulphureti Antimon. nibri. . 3j. 
Calomclanos ,.,"... gr.xij. M. 
To be divided into 40 pov.'ders, of which one is to be taken twice a day. 

The external treatment is, according to his experience, of much 
greater importance than any internal remedy. As a matter of course, 
as long as there is any irritation present, the more simple the baths 
and other external applications are, the better; but when this has 
been subdued, we should as early as possible have recourse to such as 
are slightly stimulant and exciting. Of these a sulphur bath — pre- 
pared by adding five or six ousices of sulphuret of potash to an ordi- 
nary bath — will be found very convenient. The use of this should 
be continued steadily for two or three months at least. If the darU 
rous affection is limited to the legs, as is often the case, it may be 
sufficient to use a partial sulphur bath to them alone : from one to 
two ounces of the sulphuret may be added to the requisite quantity 
of water. This is a far better application than all the ointments and 
lotions that are so generally in use. "If the local atonic dartres 
prove very obstinate, and will not yield to sulphuretted baths and 
lotions, we are in the habit of trying an ointment — composed often 
drams of the sulphuret of potash to six or eight ounces of lard, fla- 
voured with oil of thyme — and usually with good eflect: the strength 
of the ointment must be varied according to the degree of irritability 
in the affected parts." Dr. Debreyxe tells us that, for the last five 
and twenty years, he has made use of no other application than the 
sulphuretted ointment — weaker strong, according to circumstances — 
in the numerous varieties of Tinea, or Scalled-head. 

Of the Asthenic class or division of chronic diseases, none is of 
such frequent occurrence, and therefore so important in the eyes of 
the practical physician, as atonic Dyspepsy, or, as our author desig- 
nates it, Gasiro-atouy. The following remarks are picked out from 
the description which he gives of it. 

This disease is of very frequent occurrence, especially among 
women who are subject to leucorrhoeal and chlorotic afiections. Its 
most obvious symptoms are loss of appetite, uneasiness and sense of 
distention after eating, flatulence and often nausea and sickness, a 
feeling of sinking weakness and craving, more rarely of dragging, 
pain about the stomach ; constipation ; tongue white ; taste more or 
less depraved, but without being bitter or clammy, as in bilious de- 
rangements ; loss of muscular strength ; tendency to nervous ail- 
ments, and these usually accompanied with great irritability of temper. 
Very generally (and this remark, by the by, it is especially important 



1845.] Dehreyne on Chronic Diseases, 81 



to attend to,) an invigorating animal diet agrees better than a farin- 
aceous and vegetable one — a circumstance that is very significant, 
and obviously excludes the idea of any phlogistic or irritative element 
being present. The mere circumstance of there being some degree 
of pain in the epigastrium, even although this be increased on pres- 
sure, is by no means a sufficient reason for suspecting the existence 
of any inflammatory action ; for this pain may be truly called an 
atonic pain, and can be relieved neither by opiates nor antiphlogistics, 
but only by appropriate tonics. 

With respect to the treatment of Gastro-atony, the mere regulation 
of the patient's diet will often suffice to relieve the milder and less 
chronic forms of it. He should avoid the use of much vegetable or 
farinaceous food, and live chiefiy on animal meat and good bread, 
with or without an allowance of a light sound v/ine, according to cir- 
cumstances. The drinking of large quantities of hot drinks, such 
as tea, coffee, &c. is most injurious, Our author very pithily remarks, 
' pour les maladies chroniques apyrctiques, medicaments sees ; et pour 
les affi3clions aigues, medicaments liquides:' the remark would apply 
better to food than to medicines. Steel and vegetable bitters are by 
far the best remedies that we can administer, more especially when 
there is any leucorrhceal or chlorotic ailment. Rhubarb is the pre- 
ferable aperient medicine in such cases. If the patient be subject, 
as occasionally happens, to attacks of nervous or spasmodic vomiting, 
Dr. D. always has recourse to the Columbo powder. If much pain 
accompany this unpleasant symptom, a small portion of opium should 
be added to the Colombo. Ice too will often be both grateful and 
useful, not only in allaying the irritability of the stomach, but also in 
giving it tone. 

When LeucorrTi(Ba accompanies this atonic state of the digestive 
organs, Dr. Df-breyne recommends the use of the following pills : 

IJ;. Ferri Subcarbonat 3iv, 

P. Cassuvii (Cashew) . . , 5iv. 

P. Aloes 5j. 

Terebinth. Veneti . . . . q. s. ut fiat raassa in pil. 
cxx. div. 
Dose: one or two to be taken, along with some bitter tincture or infusion twice 
or thrice a day. 

A somewhat similar formula will be found very efficacious in most 
cases of Chlorosis. 

Dropsy. — The following extract gives a good summary of our 
author's views respecting the treatment of this disease, when it is not 
dependent upon any organic visceral lesion. 

"We should always make sure of one of the outlets, by which nature usually 
seeks to evacuate the .<;erosities elTused within the .«5planchnic cavities. Now, 
as in theciu-e of Dropsies, the serous evacuations most frequently take place by 
the bowels and kidneys, it will be prudent to act uix)n both of these emunctories, 
by combininj^ the use of diuretics with that of hydragof3;uc purgatives. At the 

6 



82 Dehreyne on Chronic Diseases, [February, 



same time, we should prescribe a dry and tonic diet, consisting chiefly of broiled 
or roasted meats, bread, and a certain allowance of light wine. The patient 
should be directed to take as little fluid food or medicine as possible, and he 
should therefore seek to quench his thirst with fruit, ice, and such like things." 

The favorite medicine of Dr. D. in dropsy is a medicated wine, 
composed of 

Rad. Jalapas contus 3 iiss. 

ScilltE contus 3 iiss. 

Pot. Nitratis 3 v. 

Vini Albi ibj. 

Dose : from one to three tablespoonfuls thrice daily. 

The number of alvine evacuations need not exceed six or eight in 
the 24 hours. The remedy acts in some cases chiefly on the bowels, 
in otliers chiefly on the kidneys, while in a third set of cases both 
emuncfories are powerfully affected at the same time. When patients 
object to the use of this wine, or when it appears to disagree with the 
stomach, we may have recourse to the following pills: — 

'fy. Pulv. Digitalis . . . 5jv. 
Pulv. Scammonice , . 5ij. 
Pulv. Scillac . . . . 5ij. 

Extract. Juniperi . . q. s. Ut fiat massa in piL 
cxx. dividenda. 
Dose: from one to two pills three times a day, washing them down with three 
or four spoonfuls of white wine, in a bottle of which half an ounce of nitrate of 
potash has been dissolved. 

Dr. D. says that he has found these pills especially servicable in 
cases of Hydrothorax and Hydropericardium. He is too experienced 
and candid a practitioner not to admit that we can seldom, or never, 
hope to effect a r)^rmanent cure in such cases ; still it is an important 
thing to relieve our patients for a time, and prolong, if it be not given 
us to save, life. 

In cases of Organic Diseases of the Heart, our author mainly re- 
lies on the internal administration of the nitrate in combination with 
tincture of Digitalis — given in much larger doses than are usually 
recommended — and on the api)lication of leeches and blisters over 
the cardiac region. He seldom varies his plan of treatment, and 
assures us that, with these simple means, followed out foi a due length 
of time, he has succeeded in relieving a great many patients, who 
had derived no benefit from a variety of other remedies. 

In the closing Chapter of his Work, Dr. D. lays down some excel- 
lent general rules for the treatment of disease in the members, male 
and female, of those austere religious orders, who insist so rigidly on 
the observance of numerous and prolonged fasts, in addition to other 
modes of penance. Of these orders the most conspicuous are the 
Chartreux and the Trappists, "whose establishments," we are told, 
"are now so numerous, and whose moral and religious mfluence, along 
with the benefits of agricultural improvement which they have intro- 
duced, are every day more and more felt and appreciated io many of 



1845.] Observations on the use of Blisters, ^c, 83 



the finest districts of France." A vast deal of harm has been done 
for nrianv years past lullietoo common ado|)tion of Broiissaian prin- 
ciples, by themedicnl praclitioners of the Provinces; but now, thank 
God, the errors of Physiologism are mosf fully acl<rio\vIedo[ed and 
repudiated. As a genera' truth it may he asser.od, that the diseases 
of austere religionisls will not bear well mui'-h depletion. 

Even in acute disf)rders, the lancet shotdd be sparingly used ; and, 
instead of repeated bleedings, recourse should be had to the internal 
use of antimonials. and to hhsters, &;c. In fevers, when there is no 
distmct inflammatory localization, general bleeding should very rare- 
ly, if ever, be practised. Of chronic diseases, by far the most com- 
mon among tlie Monastic Community are Gastro-atony and its 
usual concomitants of Dyspepsia, Colic, Gastralgia, general weak- 
ness, and so forth. 

As for Gaslrilis, the term might be erased from the peculiar 
nosology to which we are at present alluding. Opium, cither alone 
or in conjunction with other remedies, according to circumstances, 
is an admirable remedy in a vast number of the gastric and enteric 
disorders to which the Trappist brethren are liable. It would seem, 
from the statements of our author, that these monks are singularly 
exempt from the epidemics which prevail in the neighborhood of their 
establishments. Even the cholera in 1832, did not enter one of them 
throughout the whole of France. This exemption he attributes to 
the temperance of their diet, and the calm unruffled tenour of their 
lives. He paints in glowing terms the joys of the peaceful life of 
the pious Cenobiles. 

" How greatly mistaken," exclaims our worthy author, " are they who sup- 
pose that religious penitents are gloomy, melancholy and hsrd-hesrted men, or 
that they become the early prey of a tedious and painful death! IS'o; their life 
is one long and blessed repose; or rather, as the Prophet says, it is a river of 
peace which calmly bears them on to the everlasting rest of God. They seem 
to the eyes of the worldly, who are altogether absorbed with the frivolities of the 
passing scene, to languish and die; and yet they are full of health and life, for 
they taste a peace and happiness of mind whichthe world cannot know: Visi 
sunt oculis insipicntium viori ; illi aiUeni sunt in pace." 



Observations on the Use of Blisters in Acute Infammatory Diseases, 
and on the Effects of Bleeding, B'isters, and Mercury, on the 
Blood. By James 'Purnbull, M. D., Physician to the Liverpool 
North Disyensary. 

In the Lancet of the 31st of August, 1844, my attention was drawn 
to the treatment of acute inflammation by large blisters, from observ. 
ing some excellent practical remarks on the subject by Dr. Henry 
Bennet, in which he has shewn that they may be safely and benefi. 
cially used at an earlier period of acute inflammatory diseases, e^pe- 



84 Obssrvatlons on the use of Blislers^ tj'^' [February, 



cially of those of the ore^ans contained in the thoracic ravity, than 
they are generally employed. The kitid of cases to which blisters 
are best suited; as well as the period of the disease at which they 
may be most advantagcou^^ly applied, are matters of gr^at practical 
importance, owing to the extent to which they are used ; and I take, 
therefore, the opportunity of makin^f some observations on these 
points, as well as on the effects produced by bleeding, blisters, and 
mercur)', on the different constituents of the blood. 

My attention was first particularly directed to the safety and ad- 
vantage of applying blisters in the early period of acute inflamma- 
tory disease, from observing, when in Paris, nearly five years ago, 
the treatment adopted by M. Gendrin in pneumonia and other acute 
inflammations, and I am glad to find that the results of his mode of 
treatment have been made known to the profession by one who has 
had the opportunity of closely observing it while holding, during 
nearly three years, the office of house-physician under him. I ob- 
served, as has been already pointed out by Dr. H, Bonnet, that tho 
greater part of M. Gendrin's treatment consisted in the application 
of very large blisters, and that their repeated application, with a very 
moderate use of bloodletting, was attended with very successful re- 
sults in his practice at La Pitie. From having witnessed the safety 
and efficacy of this mode of treatment, which was different from 
what I had seen elsewhere, in the hospitals, either in this country or 
in Paris, I was led to entertain some doubt as to the correctness of 
the opinion held by most of our best writers, in regard to the injurious 
exciting efFects of blisters in all acute inflammations during the early 
period. I have in consequence made use of blisters more freely, 
and at an earlier period, than I would otherv^'ise have done, and have 
a high opinion of their value in the treatment of acute inflamma- 
tions, especially after general or local depletion- 

In robust and plethoric subjects, in whom the proportion of globules 
in the blood is, at the healthy standard, 127 in 1000, or above it, the 
treatment by general bleeding being found the speediest and most 
efiectual in cutting short inllammintion, has been almost universally 
adopted ; and there can bo no doubt of its superiority to every other 
in such cases, as it has been foundv'?d on the solid basis of practical 
experience. Locking, also, to the effects of general depletion upon 
the blood itself, though we are unable to trace clearly the mode in 
which it reduces the inflammation, w^e see no reason to doubt its su- 
periority, for thougii it does not directly lessen the quantity of fibrin, 
the increase of wiiich forms the essential change in the composition 
of the blood in acute inflammations, stiil there is reason to believe 
that it may indirectly prevent its increase, and in plethoric individu- 
als the removal of a portion of all the constituents of the blood is 
assuredly the most effectual means which we possess of reducing 
inflammation. 

Local depletion, by cupping or leeches, does not differ from general 
bleeding in its effects upon the blood, except in degree. It acts, how. 



1845.] Observations on the use of Blisters, i^'C. 85 



ever, less directly and powerfully upon the nervous system, and the 
action of the heart, from the blood being abstracted both more slowly 
and less copiously, but its less powerful aciion on the system is, in 
many cases, fully compensated for by its more direct effect upon the 
seat of the disease, and I agree with Dr. Stokes in considering it as a 
remedy of great importance, even in the treatment of pneumonia. 
Dr. Stokes has skited that he found the hold and repeated use of the 
lancet to be unnecessary in the great majority of cases, a single, or at 
most two bleedings, being sufficient ; also that he regards general 
bleeding as only a preparation for other treatment, and that he con- 
siders local bleeding as the principal remedy. A case lately came 
under my care at the Liverpool Nortli Dispensary, which may serve 
to illustrate the fact, that in large towns cases of acute inflammation 
of the lungs do occur, in which general depletion may be superseded 
by local blood-letting, assisted by blisters, and other antiphlogistic 
mean;?. A middle-aged man, of large and rather robust frame, em- 
ployed in a brewer's establishment, was attacked with well-marked 
acute indammation of the lower and posterior part of the left lung. 
He was treated by a single cupping to the extent of about ten ounces, 
and by two large blisters, and, as it was also found that slight effusion 
had taken place into (he ])lcura, the effect of mercury was pushed, so 
as slightly to touch the mouth. In this case, though general bleed- 
ing was not practised, tlie recovery was almost as rapid and perfect 
as I have ever seen it. 

The preceding observations apply to cases in which the quantity of 
globules in the blood is about the healthy standard, or not materially 
below it ; there are, however, especially in large towns, a numerous 
class of individuals also liable to be attacked with acute inflamma- 
tion, though of a lessactive kind, in wliom the proportion of globiiles, 
in the blood has fallen considerably below the healthy standard, from 
the operation of debilitating causes, such as sedentary occupations, 
the respiration of impure aii*, or deficient nourishment, as ^^'ell as in 
consequence of the presence of other disease, such as tubercles, or of 
imperfect recovery from previous disease, such as fever. I have 
satisfied myself, from very frequent examination of venous and arte- 
rial murmurs, which are indications of this ana3mic condition, that it 
is extremely common, and that it occurs, too, in ])ersons who are not 
always deficient in flesh, or remarkably pale. Now, it is in influm- 
mation occurring in individuals in such condition that blisters have 
been found most useful, for, in addition to their counter-irritant ac- 
tion, they produce local depletion, without, however, withdrawingthat 
part from the blood — viz. the red globules, which is already deficient, 
and the deficiency of which constitutes a state of disease which 13 
directly aggravated by the abstraction of a portion of the whole of the 
constituents of the blood. The correctness, therefore, of the treat- 
ment, which experience has establi.shed, ver}* generally, in such casesi, 
is confirmed by an examination of the cfi'icts of blisters on the differ* 
cnt con«tituents of the l)lood. 



88 Observations on the use of Blisters, <^c. [February, 



Dr. H. Rennet has shown that, "both in non-inflammatory and in 
inflammatory diseases, hlistcrs do not give rise to as nuieh ^enernl 
excitement as is gencraily believed ;" nnd in this I coincide wiih him, 
thoiif2;h I am dis[)osed to regard their exciting effects, and (he possi- 
hihty of their doing harm, as greater tiian he has estimated them. 
We must hesitate, too, before we conclude that large blisters aie 
devoid of injurious efl^ect when applied in the early, stnge of acute 
inflammations, except in very rare cases, when we find that such 
writers as Copeland, Stokes, and Alison, express themselves strongly 
against the use of blisters before vascular depletion; and when, too, 
we find that Andral has expressed a doubtful opinion as to whether, 
by their influence on the fibrin of the bleed, they may have a benefi- 
cial or injurious effect. 

Dr. Stokes, in regard to the treatment of acute bronchitis, observes, 
'*that counter. irritation may be considered inapplicable in the earlier 
periods of the diseases© long as the skin is hot, the pulse strong, the 
expectoration scanty and difficult ; in fact, so long as the first stage 
of (he affection continues, that stage in which bleeding and (ar{ar 
emetic are useful, blisters are inefficacious and ofien hurtfid. It 
may be laid down as a general rule, that the longer we can with safe- 
ty postpone the application of a blister, the greater certainty will 
there be of its favorable action." His views of their action in pneu- 
monia are similar; for in treating of that disease, he refers to the 
observations he had previously made as to the treatment of bronchi- 
tis. We have here, then, the experience of one of our best practical 
writers, supported by the opinion of others of equally high authority 
in this country, opposed to the treatment of M. Gendrin. 

Let us see what light is thrown upon the subject by investigating 
still further the effects which are produced upon the blood by the ac- 
tion of blisters. Andral has shewn (hat every local phlegmasia has 
the effect of raising the quantity of fibrin in the blood above the natu- 
ral standard of three parts in a thousand, and that this increase is in 
relation to the extent of the inflammation, and the degree of febrile 
movement excited in the system, averaging, in acute inflammations, 
from six to eight parts, but in inflammation of the lungs, rising higher 
than in any other disease, in one instance having been found as high 
as ten and a half, 'i'his ir:crease of the fibrin occurs, not only in 
inflammation of internal organs, but also in (hat of the skin as well 
as in burns, which most nearly resemble the eflects ofa blister. 

We have no experiments to shew directly how far blistei-s may 
have the effect of increasing the fibrin in the blood ; but from what 
has been observed in those cases of pleuritis in which a portion of the 
serum and fibrin have been separated from the blood, we have reason 
to think that the discharge of serum, or even of fibrin, at the stirface 
of the wound caused by a blister, tends less to diminish than the arti- 
ficial inflammation does to increase the quantity of fibrin. Andral 
has shewn that in two cases of pleurisy without effusion, the quantity 
of fibrin was 5-8 and 5*9, while in eight recent cases with effusion, it 



1845.] Observations on the use of Blisters, dfc. 87 



varied between four and six. It would seem from this, that no very 
decided diminution of the fibrin of the Idond follows immediately from 
the effusion in pleuritic. Direct experiment only can, however, de- 
cide how far the quantity of fibrin in the blood is affected by blisters. 
In treating of the effects of revulsive remedies upon (he blood, Andral 
expresses his opinion on this point as follows: "Thus, a large blister 
takes from the blood a certain quantity of its serum; hut besides, some 
fibrin is doposited at the same time at the surface of the wound pro- 
duced by the action of the cantharides. Where there exists in the 
blood a superabundant proportion of fibrin, would this be the means 
of diminishing the excess of this principle in the blood ? Or, on the 
contrary, if the action of the cantharides be exercised on a pretty 
large surface, if the inflammation which results from its application 
have a great intensity, if especially it augment the febrile movement 
already existing, may there not arise from this a new cause for the 
superabundant fornw\tion of fibrin, and may not this cutaneous phleg- 
inasia. artificially produced to diminish tiie intensity of another by 
the kind of influence which it may excercise upon the blood, have the 
effect of increasing the morbid condition, which represents in the 
blood the phlegmasius state, and from which its intensity is derived?" 
(Essai d ILMnatologie Pathologique, p. 12 4.) 

The same distinguished pathologist has himself furnished us with 
the means of pursuing this inquiry some degree further, in comparing 
the action of blisters with the effects produced upon the blood by 
mercury, when given so as to act upon ihe motith. He examined 
the blood in four cases in which the mouth was affected with different 
degrees of severity, and it is a sin^jular fact, that, instead of finding a 
diminution of the fibrin, as we should have expected, from our know- 
ledge of the influence of mercury in subduing inflnmmation, he dis- 
covered that tliere wasan increase in the quar)tity,w!)ich corresponded 
with the severity of the specific mercurial inflammation of the mouth, 
and the degree <»f febrile action excited in the system. 

In the first case, in which the pulse was 60, the inflammation of the 
mouth slight, but the salivation abundant, the quantity of fibrin was 
4"5. In the second, there was more inflammation, and more febrile 
action; the pulse was 100. and tlje quantity of fibrin 5. In the third, 
there was nxire intense inflammation; the febrile action was nearly 
the same as in the second case; the pulse was 9G, and the quantity 
of fibrin 0-4. In the fourth case, the face was greatly swelieil, and 
the mouth crusted with talse membranes; the pulse was 120, and the 
quantity of fibrin G-G. In the last case, the blood had been examined 
a few days beture, when the patient had been bled, on account of a 
slight attack of apoplexy, and only 3'o of fibrin had then been found. 
In all the other cases, there was no other disease present that could 
have affected its quantity. 

We see, from these cases, that mercury, by its specific effect upon 
the mouth, nets not from any power of causinu a state of dissolution 
of the blood, but as a counter-irritant or derivative, and that its power 



88 Paracentesis Thoracis in Acute Pleurisy, [February, 



of subduing inflammation arises from a local counter-action, similar 
to that caused by a blister. Both remedies produce more or less 
febrile excitement, both seem to exercise a similar effect upon the 
blood, and both cause more or less secretion of fluid. The similarity 
in their mode of action being such, we must inquire how far they 
agree as to the circumstances in which they are useful in the treat- 
ment of inflammation. In this, too, we find that there is a similarity ; 
for, in treating acute inflammatory diseases, we do not give mercury 
at once with the view of inducing its specific action on the mouth, 
but first make use of depletion, where it is admissible, with the 
double intention of reducing the inflammation, and of rendering the 
system more easily affected by the mercury. Both remedies, too, 
possess a powerful influence in causing absorption of the fluid which 
has been effused from inflam.mation of a serous membrane. 

For these facts in regard to the effects of bleeding, blisters, and 
mercury, upon the blood, we are chiefly indebted to the recent re- 
searches of Andral. They seem to confirm the common opinion, that 
abstraction of blood should, in all cases in which it is admissible, 
precede the use of blisters and mercury ; but while they throw some 
light upon the obscure but interesting subject of the eflects of reme- 
dies on the blood, they would scarcely justify us in drawing any 
other positive inference. — London Lancet, 



PART III.— MONTHLY PERISCOPE. 

Paracentesis Thoracis in Acute Pleurisy. — At the latter end of 
last year M. Trousseau communicated to the Paris Academy a case 
in which he had successfully resorted to paracentesis in acute pleuri- 
sy. He has just published two other cases in which the operation 
was performed under similar circumstances ; one of the patients re- 
covered, the other died. 

The first patient was a young woman, twenly-three years of age, 
who was attacked with acute inflammation of the left pleura on the 
9th of June. She was actively treated, but without any ameliora- 
tion taking place. The effusion was very considerable, the entire 
thoracic region on the left side being dull, the intercostal spaces dila- 
ted, and the heart thrown underneath the right cartilage. On the 
21st the menstrua appeared, but stopped in the evening. During the 
night the oppression increased to such an extent that M. Trousseau, 
who was consulted, decided on performing the operation of puracen- 



1845.] Paracentesis Thorasis in Acute Pleurisy. 89 



tesisas the only chance of saving the patient. A smiill incision was 
made in the skin, between the seventh and eighth rib, a little to the 
outside of the breast. Tije skin was then raised until the incision 
corresponded to the intercostal space immediately above, and the 
ordinary abdominal trocar was introduced tiie depth of about two 
inches. On the spear being withdrawn the fluid rushed forth impetu- 
ously. In order to prevent the air from penetrating into the cavity 
of the chest, M. Trousseau wrapped round ihe pavilion of tlie canula 
a strip of very thin skin, wliich the fluid raised easily in passing out, 
but wliich, falling on the orifice during deep inspirations, effectually 
closed it. An assistant compressed the abdomen, so as to push up 
the diaphragm, as also the parietes of the chest. Four pints of sero- 
sity were thus withdrawn. The canula was then rapidly withdrawn, 
the skin being pressed down at the same time. Tiie incision regain- 
ed its position, below the puncture, and was covered with a small piece 
of court-plaster. 

The heart immediately returned to its natural position, and all 
dyspnoea disappeared. The patient slept seven hours the following 
night, and rapidly recovered. A fortnight after the slight operation 
she was able to walk out ; the respiratory murmur had returned, her 
general health was good, and the only abnormal symptom which she 
presented was a certain degree of matity in the inferior part of the 
left thoracic region. 

The second patient was a young woman, twenty-five years of age, 
who, a couple of days after a laborious accouchement, was seized 
simultaneously with symptoms of pleurisy, enteritis, and peritonitis. 
She v/as bled, a blister was applied to the parietes of the chest, and 
calomel was given internally. The abdominal symptoms became 
less intense, but the thoracic increased in violence, and the effusion 
became so considerable on the twelfth day that death appeared immi- 
nent. The heart was displaced, and the intercostal spaces thrown 
out. The operation was performed as in the former case, and three 
pints of purulent serosity extracted. The patient became much ea- 
sier, but in the course of five days the fluid accumulated to such an 
extent as to render the operation again imperative. Four pints of 
serosity, containing an enormous quantity of pus, were extracted, to 
the great relief of the woman, but the skui not having been used, a 
small quantity of air entered the thoracic cavity. The following day 
there was pneumothorax. Four days later the puncture again be- 
came indicated, and about four [)ints of fetid pus were withdrawn. 
The patient died a few days afterwards. At the autopsy the lung 
was found firmly bound down by liaise membranes. The pleural 
cavity contained about three pints of fetid pus. Slight traces of 
peritonitis were found in the abdomen, and an abscess of the large 
ligaments. 

M. Trousseau remarks that the second case, one of intense puer- 
peral fever, with a purulent diathesis, was of so unfavorable a nature 
as not to give paracentesis a fair trial. In the first case the opera- 



90 Anasarca — Cinchona in Rheumatism. [February, 



tion gave immcdinte relief, and was followed by nearly immedialo 
recovery. He thinks it of great importance to keep the air out of 
the pleura in order to prevent the decomposition of the pus, and con- 
siders that the slate of his second j;>atient was aggravated by the 
omission of this precaution. In addition to the instantaneous relief 
produced by tlie suhtraction of so large a quantity of fluid, M. Trous- 
seau says that great benefit is experi'juced Irom the air, which imme- 
diately rushes down into ihe bronchi, breaking the adhesions which 
bind the luno: down. — Journal de Medicine. 



M. CASTEL>rAU on ihe Causes of Anasarca — IVI. Andral profesjies, 
at present, that anasarca is always occasioned either by disease of the 
liver, of the heart, by some other obstruction of the venous system, 
or by Bright's disease. This assertion is not the result of theory, 
but the expression of his clinical experience. He has, he says, al- 
ways found dropsies which do not depend on some obstruction to the 
circulation of the blood to coincide with albuminous urine. M. Cas- 
telnau questions the accuracy of this opinii^n, and founds his doubts 
on four cases of anasarca in which the urine was not albuminous, 
and there was no perceptible obstruction to the circulation in the 
heart, liver, or any other organ. In these cases the anasarca appear- 
ed to be th(i result of a state of anemia or chlorosis, demonstrated by 
all the symptoms which indicate the existence of such morbid condi- 
lions. — Archives. 



Observations on ihe Treatment of Acute Ilheumalism by Cinchona 
Bark. By John Popiiam, M. D. — The cases in which it was most 
successfully employed were those of fibrous rheumatism or rheumatic 
fever properly so called. When it appeared at all probable that 
either the pericardium or heart was affecfed, the bark was not exhib- 
ited, at least until the inflammatory symptoms were checked. In 
capsular rheumatism the bark seemed to disagree with the acute 
stages, aggravating the symptoms, but in very chronic cases it seemed 
of service. 

The conclusion at which Dr. Popliam appears inclined to arrive, 
with regard to the administratioii of this medicine, are these : 

" That it is iinportarit to procure due evacuations previous to the exhiliticn 
of the bariC, except the patient be greatly deteriorated by constitutional debility, 
or the protraction of the disease. 

" That it is more qidcldy successful when the disease is cnrhj combatted by 
depleting measures, than when inefiiciently managed at the onset, and allowed 
to take root in the system. 

"Hence that is more likely to extinguish the disease and prevent chronic in- 
firmity in ihe seqi-el of first attacks being uncomplicated, than when a habit has 
been termed by reason of repeated relapses. 

"That the periodicity of the symptoms either peculiar to the attack, or produ- 
ced by treatment, and the duration and apyrexia of the intervals, afford strong 
presumptive arguments for the use of bark. 

"That bark is especially called for in cases where there is complete atony of 
the cutaneous ve.^»els, so that the .skin is unceasingly pouring out acid colliqu2- 



1645.] Surgical Operations in Cutaneous Diseases. 91 



live sweats, giving it a dull end pcrlwiled sppearance. at tbesame time that the 
pains are abated, and the pulse small and inaicaiing debility. 

'•That to produce its eiTects, quantity is not by tny means so essential as in 
intermittent, and that large quantities,' especially of the sulphate of quinine, de- 
range the stomach in many cases, and bring back the fever. 

•'That it is judicious.to administer it at the periods of remission, and stop it 
at the return of the exacerbations. 

"That it is injurioi^s when important visceral disease co-exists, and is espe- 
cially contra-inaicated in cerebral or the acute stage of cardiac complications. 

"Lastly, that in the synovial variety, it is interior to other modes of treatment ; 
but in persons of a rheumatic diathesis, when, from the long continuance of the 
disease the strength has sulTered, and disfisruration of the joints has occurred 
without serious de.<;truction. a course of baik. combined with sulphur, iScc. of.en 
prevents the recurrence of subacute attacks, and promotes the absorption of the 
effused svnovia. — Dublin M^d. J^i.r. 



On the utility of Surgical Opera'ions in Cancerous Diseases. — 
The grand points of tiiis most innportant surgical question are to de- 
te mine — 1, if it be really true that Cancerous disease i^ primarily of 
a local nature, and subsequently dcgencrat(S into a constitutional 
malady; and 2, if e.xtirpaiion, performed at on early period, pre- 
vents the occurrence of this deg^norafion. With the view of elu- 
cidating these matters, .M. Leroy d'Etiolies his collected the followirg 
statistical ohsorvntions. Of 601 operations, 117 were performed 
within a twelvf-month after the first m.tnifp^tation of the disease. 

Of these 117 cases, there were 61 in which tlie disease had return- 
ed at the time when the reports reached me. It is more than proba- 
ble that this proportion would bo foun<1 to be still higher, if we knew 
the actually present state of these cases. 

The results of operations for Cancer of the Lip are curious ard 
worthy of notice, in consequence of the diltVrence in this respect 
observed in the two sexes. Of 6.*33 cnses of Cancer in the male sub- 
ject, 165 were examples of Cancer of the Lip: of these 114 were 
treated with the knife — 12 with caustics. There were 15 relapsesin 
all: that is, about an eighth of the whole. On the other hand, cf 
2,143 cases of Cancer in the female, there were only 34 instances of 
the disease in the lip; of these, 22 were treated by excision; and in 
seven — nearly a third — there was a return of the disease. 

This ditf(;rence does not hold good of Cancer of the Tongtie : for 
then the disease is equally fatal in both sexes. Of nine operations, 
in which a cancerous tumour of this organ was extirpated, thrco 
were performed within one twelve-month after the earliest appcArance 
of the disease. In the other si.x cases, the patients died, the disease 
having previously returned. 

As respects Cancerous diseases of the Mamma, we find the follow- 
ing data. Of 277 operations, 73 were performed within the last two 
years: as yet we cannot say positively what are the results. Of the 
remaining 204 cases, 22 of them proved fatal in the year after the 
operation, and in S7 others there was a relapse of the disease. 

M. Lcroy deduces tite followintr conclusions from bis researches: 

1. Extirpation does not arrest tho progress of Cancerous disease. 



92 Treatmerd of Hydrocele — Ovariotomy. [February, 



2. This operation should not \m resorted to, as a general method 
of treatment, except for Cancer of the skin and lips. 

3. There is no necessity to extirpate Cancerous disease of other 
organs, except when an alarming hcCinorrhage supervenes. — Compies 
rendus. 

The Acadeni}^ appointed ]\!M. Roux, Velpeau, and Serres, to report 
upon this communication of M. Leroy. — Mcdico-Chirurgical Review* 



Treatment of Hydrocele with lodiirettcd Injections. — In more than 
300 cases of this complaint treated with an ioduretted injection, 
(composed of tincture of iodine 4 parts, and distilled water 125 parts,) 
by M. Ve.peau, not a single accident or unpleasant symptom has ever 
occurred. One of the patients indeed died ; but the fatal result in 
this instance proceeded from a purulent inflammation of the cellular 
tissue of the pelvis, quite unconnected with the operation, and not 
having any communication whatever with the affection of the scro- 
tum. The average period for effecting the cure was 15 days. In 
one case only the injection found its way into the tissue of the scro- 
tum, in place of the tunica vaginalis : not withs-tanding this misadven- 
ture, no appearance of gangrene supervened, and the patient recovered 
without any unpleasant accident. — L^Experience, Medico- Ciiirur- 
gical Review, 



Ovariotomy — Dr. Ciiuhciiill. — Ovariotomy is, just now, a formi- 
dable rival for fame, with Mesmerism or Hydropathy. The two 
former, indeed, ought to go hand-in-hand ; for as ovarian tumours 
seldom grow in any but ihe patrons and recipients of animal mag- 
netism, it would be a great advantage to those who come under the 
scalpel, to have its pains and penalties annihilated by the passes of 
an adroit mesmerist. Be this as it may, the ovarian operation can 
be tested only by time and statistics — the advocates and opponents 
steering such opposite courses, and using such ingenious arguments, 
as to puzzle tlie practitioner. Statistics will settle the question. Dr. 
Montgomery has gone into considerable detail on this point, and 
collected from various points of the compass a mass of materials 
that may greatly assist our prognosis — perhaps even our diagnosis, 
in these dangerous cases. 

Dr. M. properly remarks, that, under the head of ovarian dropsy, 
are comprehended many swellings very different from dropsy. There 
may be a single — or many cysts — and the contents of the cysts may 
and do vary from clear serum to an almost wholly solid substance. 
The ovaries may consist of malignant deposits — and last, not least, 
they may be detached, or they may have acquired extensive adhesions 
to various adjacent parts, rendering a successful operation all but 
impos.sible. 

Mr. Southam has published the result of 20 cases of paracentesis 
— ten from Bright — five from Barlow — and five of his own. Out 
of these, 14 died within nine months after the first operation. Of 



1645.] 



Oi'ariotoiny, 



93 



the remaining six, two (.lied in IS months — and four lived for several 
years, from four to nine. 

Of eleven cases of ovarian dropsy admitted into Guy's Hospital, 
seven were tapped, three of which were unsuccessful. The proposal 
of injecting siimulatin-T fluid- into the emptied sacs, has, we believe, 
eiiher never been tried, or entirely abandoned. 

The following throe tables will exhibit a coup d'ceil of the results 
of almost all the cases on record. It has been constructed with great 
care and labor by the able and indefatigable author. 

Table I. — Cases of Extirpation of the Ovary. 



No. and 
Date. 


Operator. 


Age 


Incision. 


Result. 


Character of Disease, 


Adhesions. 


1 


L'Aumonier. 




4 inches. 


Recovered. 


Abscess of ovary. 




2—1809 


Dr. M-Dowal. 




9 tlo. 


do. 


Gelatinous matter. 




3-1816 


do. 




Long. 


do. 


Scirrhous ovary. 




4 


do. 

do. 

do. 

Dr. N. Smith. 






do. 

do, 

Died, 

Recovered. 


Cyst, fluid. 




5 








6 









7—1821 


33 


3 inches. 


Adhesions, 


8— 18-25 


-Mr. Lizars. 


36 


Long, 


do. 






9—1325 


do. 
Dr. A. G. Smith. 


35 
30 


do! 
do. 


D:e.'. 
Recovered. 




Adherent, 


10 


Cyst, fluid. 




11 


Dr. Qui.tenbaum. 




About 4 in. 


do. 






12-1829 


Mr. D. Ilo^MTS. 




About 3 in. 


do. 


Solid and fluid. 


Adhesions. 


13 


Dr. Grariville. 







Died, 






14 


Dr. Chrysmer. 


47 


Long. 


do. 


Cart, and lardaccous 
matter. 


Adherent. 


15 


do. 


38 


do. 


Recovered. 


Honey-like and green 
sanies. 


do. 


15 


do. 




do. 


Died. 






17 


Dr. Ritter. 


si 


do. 


Recovered. 


Cyst, fluid. 




18-1836 


Mr. King. 


57 


Short. 


do. 


do. 




19— 1SJ3 


Mr. JeartVeson. 




do. 


do. 


do. 




20 


M. Dolhoff 


23 


Long. 


Died. 


Cyst and fluid. 


Adhesions, 


21—1835 


Mr. West. 




Short. 


Recovered. 


' do. 




22 


do. 




do. 


do. 


do. 




23 


do. 


24 


do. 


Died. 


do. 




34 


do. 




do. 


Not cured. 


do. 




25 


Mr. Hargrave«. 


40 


do. 


do. 


Multilnc, cysts. 


Adhesions. 


26 


Dr. Clay. 


16 


27 inches. 


Recovered. 


Cysts, sol. and fluid. 


do. 


27 




67 


14 do. 


do. 


do. 


E t.adh. 


2^^ 




39 


28 do. 


do. 


do. 


do. 


29 




40 


14 do. 


Died. 


do. 


do. 


30 





22 


14 do. 


Recovered. 


do. 


Adhesions. 


31 





40 


14 do. 


Died. 


do. 


None. 


32 




43 


14 do. 


Recovered 


do. 


Ext, adh. 


33 




59 


16 do. 


DioJ, 


do. 


do. 


34 




46 


16 do. 


Recovered, 


do. 


do. 


.^5—1940 


MrB.'philifps.' 




2 inches. 


Died. 






3V-1S4I 


Dr. Stilling, 




6 do. 


do. 






37—184-2 


Mr.Walne. 


5M 


Long. 


Recovered. 


do. 


None. 


38-1843 


do. 


57 


do. 


do. 


do. 


do. 


39 


do. 


21 


do. 


D ed. 






40-1543 


do. 


20 


do. 


Recovered. 


do. 


do. 


4I-IS13 


Mr. Morris. 




do. 


do. 






42—1843 


Mr. Sontham. 




do. 


do. 


Cystic sarcoma. 


do. 


43—184 5 


Dr. F. Bird. 




3 or 4 in. 


do. 


<:yst and fluid. 


do. 


44—1814 


do. 




do. 


do. 


Cysts and solid mat- 
ter. 


do. 


45 


Mr. Atlec. 
Mr. Lane. 




3 inrhes. 
Long, 


do. 
do. 




Adhesions. 


46 


Cysts, fluid. 


None. 


47 


Mr. Key. 


19 


do. 


Died. 


do. 


do. 


48 


Mr. Grecnhow. 
Mr. B. Cooprr. 


L»9 
32 


do. 
do. 


do. 
do. 




do. 


40 







9i 



Ooariotomy, 



[February, 



Table II. — Cases of Ovarian Disease^ in which the operation could 

not be completed. 



Date. 


Operator. 


Cause of failure. 


Result. 


Incision. 


50 


Dr. M'Dowal. 


Adhesions to ])lad- 
der and uterus. 


Recovered. 


Long. 


61 


Mr. Lizars. 


Solid and very vas- 
cular tumoiir. 


do. 


do. 


52— 132G 


Dr. Granville. 


Firm Adhesions. 


do. 


6 inches. 


53 


Dr. Dieffenbach. 


Vascularitv. 


do. 


Long. 


54—1826 


Dr. Martini. 


Solid and fixed tu- 
mour. 


Died. 


do. 


55 


Anonvmous. 


Fixed tumour. 


do. 




56 


M. Dolhoff. 


do. 


do. 


About 6 inch. 


57 


Dr. Clay. 


Exten. Adhesions. 


do. 


Long. 


58 


Mr. Walne. 


do. 


Recovered. 


5 inches. 



Table III. — Cases in which ihe Operation failed from Error 



in Diagnosis. 



Date. 


Opera' jr. 


Result. 


Disease. 


59-1823 


Mr. Lizars. 


Recovered. 


No tumour found. 


CO— 183-1 


Mr. King. 


do. 


do. 


61 


M. Dolhoff. 


do. 


do. 


G2 


Dr. Clay. 


Died. 


Uterine tumour. 


63 


do. 


Recovered. 


Hvdatid. 


64 


do. 


Died. 


Pelvic tumour. 


65 


do. 


do. 


Uterine tumour. 


66 


Mr. Heath. 


do. 


do. 



Thus, the entire numhor amounts to 66, of which 42 recovered and 
24 died — or ahoiit 1 in 2^. Of the 49 cases in which the ovary was 
extirpated, 16 died, or 1 in 3. Of the nine cases in which the opera- 
tion could not he completed, four died — or 1 in 2:| ; and of the eight 
cases where the operation was unnecessary, 4 died, or 1 in 2. 

Age does not appear to have had much influence, heneficial or 
otherwise, and the same may be said of marriao;e. Adhesions render 
the result of the operation much more dangerous than freedom from 
the same, and yet not so much so as one would, a priori, except. 
Where other organic diseases co-existed with ovarian, the termina- 
tion was almost always fatal. It is strange that the operation should 
have been ever performed, where no tumour has existed ; yet the 
mistake has been made by eminent surgeons, and without any negli- 
gence on their parts. 

Dr. Montgomery mentions a case where he felt a distinct tumour 
in a female's abdomen, which suddenly vanished in the very act of 



1845.] Camphor a Preservative of Ergot of Rye. 05 



examin.ition ! The abdominal iniiscles, in fact, often act in such a 
way as to imitate organic enlargements of the liver, spleen, ovaries, 
&c.. and thus deceive even the most careful practitioners. After 
many jiiilicions remarks, cautions, and comparisons, our author comes 
to the following conclusions : 

"Even after the details I have given, it is very difficult to come to a definite 
and perlecily satisfactory conclusion, because 1, Ave have not sulliciently accu- 
rate data to' estimate the progress of the disease unaided by surgery. *2. The 
tible quoted from Mr. Southam is clearly too limited to aiford a fair average of 
the results of tapping, and it is not easy to obtain suiTicient facts to enlarge it. 
3. The cases in which ovariotomy has been performed are of such a mixed cha- 
racter, that it is impossible to i^le'ct with fairness those cases in which the opera- 
tion was demanded for the relief of urgent suffering, and suitable to the nature 
of the disease, v/ithout the appearance of partiality. And 4, from the obscurity 
of the diagnosis, it is too much, perhaps, to expect that our practice in future will 
be free from those drawbacks on the operation. 

" But bearing in mind these diiiiculties, and making allowance for those draw- 
backs, I think we may conclude that there are cases in v.hich the operation 
would be ju.stifiable; and on these grounds, — we find the general opinion is 
against the curability of the disease by medical means: — that after a time the 
patient will die from local disease or accident, or constitutional disturbance, and 
that meantime she suffers more or less inconvenience: — that tapping in almost 
all cases affords but temporary relief; — and that, as far as the limited statistics 
we have adduced are admissible as evidence, it is attended with great danger: 
i. e. 1 in 5 died of the first operation, and of twenty patients, fourteen (more than 
two thirds) died within nine months of the first tapping; whilst of the entire 
number ot those who underwent the operation ofovariotomy, about one half have 
absolutely recovered so far." 

The foregoing paper is very creditable to the industry, the talents, 
and the judgment of its author. — Dublin Journal, July, 1S44. 



FROM THE LONDON LANCET. 

Camphor a Preservative of Er^of of Rye. — Sir : I was not a 'itt'e 
surprised to read some remarks hy Mr. Rawle, stating that he had 
discovered camphor to be a preservative of ergot of rye. lean only 
say that I have been in the habit of using it for the last nine or ten 
years, but not exactly in the manner prescribed by him. I order the 
camphor to be mixed with the powdered ergot, in tiie proportmn of a 
grain in every scruple. By this tneans I think the camphor is more 
intimately diffused throughout the whole than can possibly take place 
by the plan proposed by Mr. Rawle. I do not give this either as a 
new, or, indeed, my own discovery ; for I adopted the method by 
having seen it in the practice of Mr. Spurgin, an old practitioner 
at Saffron Walden, and from whom I have every reason to believe 
that your correspondent also obtained the same information, he hav- 
ing been engaged in the same gentleman's practice. 

If you think the ahove worthy of notice, you will oblige, Sir, yours 
respectfully, 

John N. Si.MrsoN, M. R. C. S. dcr. 

Staines, August 28, 1844. 



00 Medical Intcllis^ence, 



Simple MetJtod of Preparing the Pihda Ferri lodidi. — Take of 
iodine 127 grains, iron wire, about the thickness of a thin quill, half- 
nn-ounce, distilled water 75 minims. Agitate them briskly together 
in a strong ounce-phial, provided with a well-fitted glass stopper, until 
the froih which Mirms becomes white, which will happen in less than 
ten minutes. Pour the liquid upon two drams of finely-powdered loaf- 
sugar in a little moriar, and triturate immediately and briskly for a 
few minutes ; add gradually a mixture of the following powders, viz : 
liquorice powder half-an-ounce, powder of gum arabic a dram and a 
half, and fjour one drain. Divide the mass into 144 pills. 

Each pill contains about a grain of iodide of iron. 

In operations on the large f^cale, the bottle ought to be wrapped in 
a strong towel, in case of an explosion being caused by the evolution 
of steam from the heat produced; and even on the small scale, the 
stopper must be hold firmly, otherwise it will probably be blown out 
and the materials lost. — Pliannaceulical Journal, Medico- Chirur- 
£rical Revieiv. 



RJiaiany in Chronic Catarrhal Oplitlialmia. — M. Reveillee-Parise 
strongly recommends the decoction, or a strong infusion, of Rhatany 
root, as a lotion with which the affected eyes are to be bathed. Be- 
sides acting as an astriii;rent, this remedy seems to have some other 
mode of operation; for we do not find that similar preparations of 
oak-bark or of gall-nuts — ailhough both of these contain a large por- 
tion of tannin — are equally efficacious, as Collyria in the Ophthalmia 
alluded to. The application should be used lukewarm, and a few drops 
of Goulard's Extract may be added to it, if deemed proper. — Medico- 
Chirurgical Rcvieiv, 



MEDICAL INTELLIGENCE. 

The January No. of the New-York Journal of Medicine, (just received,) con- 
tains a short biography of its late Editor, Dr. Samuel Forry; and also a history 
of his last illness, prepared by Charles A. Lee, M. D. Professor, &c., and enti- 
tled, "Epilepsy terminating fatally; with hypertrophy and induration of the 
cerebral substance, induced hy excessive mental application." 

"We are pleased to fmd that the Journal is to be continued, notwithstanding 
the decease of its late able Editor. 



FhJ:e Fvvd Prize Qnestionr — The Trustees of the FiskeFund, in Rhode Isl- 
and, propose the following questions for 1844-45: — 1. "The best mode of treating, 
and the best apparatus for the management of, fractures of the thigh." 2. " The 
character, causes and best treatment of bronchitis." For the best dissertation on 
each of these questions, the sum of fifty dollars will be paid — the dissertations to 
be sent, previous to Mfjy 10. 1845, to "Dr. L. L. Miller, of Providence, Dr. T. C. 
Dunn, of Newport, or Dr.Jabcz Holmes, of Bristol. — JN'. Y. Journal of Medicine. 



w 



SOUTHERN 

MEDICAL AND SURGICAL 

JOURNAL. 

■ ■ ■-* 

Vol. I.] NEW SERIES— MARCH, ISIa. [No. 3. 

» ■ ■ ■ ^ 

PART I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

Calomel — its Chemical characteristics and Mineral origin considered^ 
in view of its Curative claims. By Alexander Mea>'s, A. M., 

Professor of Chemistry and Pharmacy in the Medical College of 
Georgia, 

Few substances within the range of the Pharmacopoeia, whether 
we regard its history, the extent and potency of its therapeutic action, 
or the deep and inveterate prejudices in the popular mind with which 
it has often had to contend, can be considered as subjects of greater 
interest than that placed at the head of this article. 

Its claims to antiquity cannot, it is true, be compared to those of 
Opium, Antimony, Sulphur, and a few other remedies whose history 
may be traced to the days of Diagoras, Basil Valentine and Par- 
acelsus, but it has nevertheless been contemporaneous with each of 
seven successive generations past, and at the present day occupies a 
conspicuous and elevated rank among the articles of the ■Materia 
Medica. Loudly as its virtues have been proclaimed, and its employ, 
raent recommended by its friends, and vehemently as its properties 
have been decried and its use reprobated by its enemies within the 
known period of its history, still strange as it may seem, this profes- 
sional altercation has not yet led to the circumstances of its origin or 
the name of its discoverer. It is believed to have been long known 
to the retired and idolatrous inhabitanta of Thibet, but lay, like 

7 



93 Calomel, [March, 



themselves, hidden from the scrutiny and observation of the world, 
amid the deep seclusion of their own mountain fastnesses. Oswald 
Croll, in the beginning of the 17th century, is believed to have 
been the first European writer who mentions our medicine, while 
the first directions for lis preparaiion were given by Beguix in the 
*'Tyrocinium Chemicum," published in 1608. The energy of its 
action in the removal of formidable diseases, was, probably at that 
early period, well understood, as Beguin denominated it "Draco 
Mitigatus," or the Tamed Dragon. Other fanciful and cumbrous, 
but expressive appellations, which it afterwards wore, seem strongly 
to sustain this opinion: — e.g. Aquilla Alba, (the White Eagle) 
Manna Metallorum (the Manna, or Honey of the Metals,) Panchy- 
magogum Minerale (the Mineral Extractor of all Humors,) &c. &;c. 

Mercurius Dulcis and Hydrargyri Submurias, were names subse- 
quently given to the same preparation. The latter appellation (de- 
pending for its adoption and its currency, upon the theoretical views 
of the celebrated Bektkolet, and other French chemists, who de- 
nominated the electro-negative element of the compound. Oxygen- 
ated Muriatic Acid,) maintained its place in the Pharmacopoeia 
until the researches of Sir Hujipiirey Davy proved it to be a simple 
substance, which from its yellowish green hue, when in the form of 
gas, he called "Chlorine," (from XAw^oj — green.) Since that time 
the several synonyms, Protochloride, Dichloride, and Subchloride 
of Mercury, have been applied to it by different chemists. The pre- 
sent popular and familiar term, " Calomel," was first used in 1655 by 
Sir TouRQUET DE Mayeuxe, (from xaUs, good, and /^«^as> black,) 
prohahJy because it was regarded a good remedy, for the removal of 
black bile, which the ancients regarded so fruitful a source of disease. 

Adopting, with the latest writers and under the authority of Kane, 
Graham, &c. 101'43 as the chemical equivalent of Mercury, Calo- 
mel must be regarded as a Dichloride, containing 2 atoms of the 
base (Mercury) and 1, of the electro-ncgative element, (Chloride.) 
A chemical classification will rank it as a Bi-elementary compound, 
among the Haloid Salts ofBerzelius. Although Calomel is found 
natural in Germany and Spain, in white crusts as well as in the form 
of quadrangular prisms, terminated by four-sided pyramids, yet for 
pharmaceutical purposes it is prepared artificially either hy precipita- 
tion or sublimation. The intended limits of the present article, 
however, will not authorize a detailed account of the process of 
manufacture at directed by the several colleges. SuflTice it to say 



1S45.] Calomel. 99 



that by precipitation it is obtained from the Nitrate of the Protoxide 
of Mercury in contact with a solution of the Chloride of Sodium, by 
which an interchange of i)ases takes phice, and the Bichloride of Mer- 
cury and the Nitrate of Soda are the result. This process, carefully 
conducted, gives a pure salt. It is also procured by rubbing inti- 
mately 4 parts of the Chloride of Mercury (less recently the Bichlo- 
rifle) with 3 parts of metallic Mercury, and afterwards subliming. 
The first sublimation is not, however, sufucient to free the mass from 
the dangerous presence of adherent Corrosive Sublimate. It must 
be repeated and carefully levigated and washed wilh boiling water, 
until no white precipitate is observable on the addition of a few drops 
of Aqua Ammonia. All the British colleges, (varying, however, in 
the details of the process,) direct the trituration of metallic Mercury 
with the Bi-pcrsulphate and common salt, and afterwards sublima- 
tion and elutriation. The Hydrated Sublimate of Mercury prepared 
by Mr. M. O. Hexry's modification of Sn well's apparatus, by which 
the sublimed Calomel is condensed in the midst of steam, is in the 
form of a beautifully white and impalpable powder. The slight buff 
color, however, which frequently characterizes the ofiicinal prepara- 
tion, is favorable to the conclusion that it is uncontaminated by cor- 
rosive sublimate — although much of the pure white calomel, prepared 
as above, is also free from it. The color cannot therefore be re- 
garded as an infallible criterion of purity. 

It is extremely desirable that a medicinal agent to which is justly 
assigned so wide a range in the treatment of diseases, shoul I not 
only have the mode of its action upon the animal tissues thoroughly 
and patiently investigated, but that it should be readily distinguishable 
by appropriate and convenient tests, and its chemical incompatibili- 
ties wilh other remedies satisfactorily understood. The cxperiencG 
of centuries, it is true, has not secured uniformity of opinion as to its 
physiological effects, and its classification, therefore, as an article of 
the Materia Medica, has depended upon the peculiar notions of indi- 
vidual writers, or the prevailing theories of the day. That Calomel 
has been placed upon the list of SiaJn/^orrvs^ by Cullex, Chapmax, 
Eberle, and others; — among S/zmw/a/?/.^, hy Dr. A. T. Tho.mpsox, 
Vavasseur, 6cc. — among SecIatit)cSy by Urrtklr, Horx, d:c. ; whi'o 
by such men as Mlhiray, Begin and Giacomim, it has been severally 
arranged with Tonics^ Revulsives and Hyvosthetiics, and by others 
still, among the '■^incertcn sedis,'^ only argues the valuable and 
ficxile powers of the remedy, which iindcr modifipd cirrumstanrp«;. i^s 



100 Calomel, [March, 



capable of exhibiting such a great variety of effects upon the animal 
economy. A slight acquaintance, however, with Pharmacodynamics 
discovers similar characteristics in Opium, Antimony and other arti- 
cles, equally embarrassing to a settled classification. The mere 
question of its technical position on the roll of remedies is to us a 
matter of minor consideration, and may he safely left for the deter- 
mination of future pharmacologists, but its intrinsic energies and past 
achievements have certainly distinguished it as a powerful auxiliary 
to the ranks of restorative agents. Nur have its virtues fled, nor its 
claims upon a benevolent and intelligent profession been extinguish- 
ed, because interested ignorance, or popular charlatanism in their 
temporary ascendency, and within limited circles, may have defamed 
its character and withheld its rights. No, verily — the spirit of vir- 
tuous heroism glowed as brightly in the noble soul of the A erican 
Frenchman, when in the dungeons of Olmutz, and the sympathies of 
the generous and good clustered as warmly around him, as when he 
moved side by side with his great compatriot in arms, the immortal 
Washi^^gton, and received a nation's homage. 

We design, however, to indulge in no acrimonious invectives 
against those who honestly differ from the views here designed to be 
expressed. Far from it. We appeal to sober Reason, and in can- 
vassing the following questions, only ask an impartial decision at her 
bar. 

1st, then : — Is Calomel to be ranked in the category of poisons 7 
That Mercury in this form, under an ill-timed and injudicious ad- 
ministration — by unwarrantable exposures on the part of the patient, 
or unjustifiable indulgences on the part of the nurse — and still more 
rarely, by an unsuspected idiosyncrasy of constitution, may once, 
perhaps, in 500 cases, overpass the boundaries of its usual and healthy 
action, and leave traces of its violence long and deeply to be regret- 
ted, no reasonable advocate of its use will deny. But what other 
active remedy, vegetable or mineral, may not, under similar circum- 
stances, lead to like unfortunate results. Each, it is true, may ac- 
cording to its peculiar properties, act upon different organs, or tissues, 
but the morbid impression, or over-action generated, being equally 
injurious. What practitioner has not known, Gamboge, Scammony, 
or Podopyllum peltatum, in certain instances, to produce exorbitant 
and prostrating catharsis, from the effects of which the after admin 
istration of opiates or stimulants could with difficnlly save the patient ? 
How often, too, has the specific action of the Tartrite of Antimony 



1845.] Calomel. 101 



upon the coats of the stomach, resulted in excessive emesis, followed 
by dangerous, if not fatal exhaustion of the powers of life. And 
yet these remedies maintain their claims upon professional regard, and 
occupy a respectable position in the catalogue of medicines. Indeed 
the mere fact that diseased action, under given cu'cumstances, may 
follow the contact of solids, Jiuids, or gases, with either the internal 
or external portions of the human organism, is no proof of the poi- 
sonous effects of such agents. If this position be admitted, the thou- 
sand luxuries of modern tables must submit to the ostracism of pro- 
fessional authority, nor will even roast beef and pudding, be suffered 
to retain their places upon the landlord's bill of .^are ; for where tem- 
perament and diathesis have favored cerebral engorgement, many 
an apoplectic has met his fate by epicurean indulgence. 

Fruits, too, must be classed with the list of poisons. The grateful 
juice of the luscious plum, and the delicious nectar of the blushing 
peach, both fall under the ban of this decision, for imprudent gratifi- 
cation here, has been often succeeded by Cholera Morbus, Diarrhoea, 
or Fever. But the very water we drink must be proscribed; for 
large, cold draughts, taken into a heated and exhausted system, has 
often produced fatal effects. Nay, this is not all — the use of the 
h\a.nd atmosphere we breathe must be interdicted, for Catarrhal fevers, 
Croups and Pneumonia have often resulted from sudden and untimely 
exposure to its currents. Nor should indiosyncratic temperaments 
bo allowed to decide this interesting question. The writer is inti- 
mately acquainted with a gentleman who cannot, with impunity, par- 
take of one of the elements of the Holy Sacrament — the mere 
morsel of wheat bread, presented on such occasions, acting like 
poison upon his stomach ; and yet, surely the toxicologist, as well as 
the epicurean, would scout the philosophy which should atten)pt 
gravely to label the baker's loaf, with the alarming epithet ^^Poison.'" 
He has known another who was instantly sickened by the smallest 
quantity of the albumen of an egg. even when tasted in the coffee 
which it had been employed to clarify : — still this isolated caso of 
injury would never authorize the popular voice to sanction the expul- 
sion of so innocent and nutritive an article of diet from the list of 
aliments. These remarks are designed to be made too, in full view of 
the unfavorable reports made in former years by such writers as 
HoFF3iAN, Vagnitius, Hellweg, find others, where in a very few 
instances even small doses are said to have proved fatal, but whether 
under circumRtancos of neglect or aggravation, or by the administrn- 



102 Calomel. [March 



lion of aa improper article, cannot now be ascertained. It is at least 
a plausible conjecture, advanced, peri^aps, first by Dr. Christison, 
that where such cases have occurred the Calomel may have contain- 
ed Corrosive Sublimate, a conjecture warranted by the fact to which 
the reader will recur, that according to one of the formulas given 
above, the latter article has been long and largely employed in the 
manufacture of the former and can only be removed from it by 
careful and repeated edulcorations. Surely, however, the congregated 
testimony of hosts of intelligent physicians in later years, and the 
reports of multiplied thousands of cases, more than sustain our indi- 
vidual opinion long since formed, i. e. that " Calomel deserves to he 
classed with the mild preparations of Mercury. ^^ It has y)een amply 
tested that in small doses, either alone, or in combination with opium 
or other adjimct, it acts as a safe alterative, — checking violent pur- 
gatives — correcting hepatic derangement by promoting the biliary 
secretion, and overcoming obstinate chronic diseases of the cutane- 
ous surface ; — while in large doses, it often acts the part of a sedative 
— quiets gastric irritation — stops vomiting, and moderates debilita- 
ting catharsis in some of the most alarming and fatal forms of disease. 
At the Cholera Hospital, Bethnal Green, London, Mr. Charles 
Benxet had 18 cases of Cholera introduced to his treatment. The 
first administration was 160 grs. of Calomel, immediately given, and 
60 grs. at the interval of every one or two hours afterwards, until 
some effect was produced. The result was, that in 17 out of the 18 
cases, "vomiting and purging diminished, and the patients recover- 
ed." In the unsuccessful case just alluded to, " 53 drachms of Calo- 
mel," says Dr. Pereira, " were administered within 42 hours without 
the least sensible effect." To one patient (a female) 30-^- drachms 
(1820 grs.) were administered in 48 hours, producing only a moder- 
ate ptyalism and followed by recovery. iMr. Roberts, of London, 
reports a case where one ounce of Calomel was taken by mistake, 
and " retained on the stomach two hours before the error was dis- 
covered." The only unpleasant effects which supervened were 
** slight nausea and faintness, — but by the application of lime water, 
emetics and purgatives, the mass was thrown ofl*, and on the second 
day afterwards "the patient was quite well." 

Dr. Griffin asserts that in 1448 cases, when given in doses of 
from one to two scruples, every 30 or 60 minutes, and before the stage 
of collapse, "it proved a most successful remedy, controlling or arrest- 
ing the progress of this formidable disease in the ratio of 84 cases 



1845.] Calomtl 103 



out of 100.*' Dr. David M. Reese, one of the most successful prac 
titioners in the professional field during the ravages of this epidemic 
in the city of New York, in 1832, depended mainly upon the admin- 
istration of large doses of our medicine in connection with ice-water, 
for the numerous cures affected under his care. Indeed the conjoint 
testimony of almost all writers upon the spasmodic Cholera, as it has 
prevailed in India, Europe, or America, has sustained the use of 
Calomel as a safe and effective remedy, while, so far I know, no 
writer of any distinction, either cis or trans-atlantic, has ventured to 
charge upon it injurious consequences, much less to anathematize it 
as an "irritant poison." But its safe and efiicacious action in the 
disease above referred to, mny have been made unnecessarily con. 
spicuous. Its claims are equally strong and its triumphs equally de- 
cided in a large range of morbid affections, to which its diversified 
characteristics so happily adapt it. It cannot, must not be confined 
to the exercise of mere tetrarchical functions over a petty province in 
the vast dominion of medicine. It wears and wields princely preroga- 
tives, gives ample evidence of its power to rule, and consociated with 
a few other leading and active agents of the Materia Medica, cons^ti- 
tutes that Oligarchy of medicinal power, in which alone the profes- 
sion can confide for the suppression of some of the most formidable 
rebellions against life and health, which Disease has ever generated 
in the human system. Other valuable remedies have their intrinsic 
merit, and occupy important positions as auxiliaries in this grand 
allinement for constitutional defence, yet few are capable of occupy- 
ing so wide a field of action, or destined to accomplish so much. 
In contemplating the noble spirit and invincible heroism of the inde- 
fatigable Ney, the foremost in the achievements of the army upon 
the Rhine, and the " bravest of the brave" on the memorable field 
of riohcnlinden, my heart recoils with an honest indignation at the 
cold-blooded cruelty, which presents that manly bosom as the public 
target for the muzzles of a score of French musketeers, simply be- 
cause the Bourbons are inpower. Now, although from Ihe nature of 
the subject, similar sympathies cannot be involved, yet something like 
a kindred aversion is excited against that ruthless policy which (from 
motives best known to those who advocate it,) would strike forever 
from the roll of medicinal honor, an ng<Mit signalized so long for its 
energy and its success, and to which, under Providence, the writer 
has been, at least once, indebted f<^r h'\fi life. 

But again, in organic bodies fheUws ofchcmicil nfiinifv are held 



104 Calomel [March, 



in subordination and control by tho vital forces, and in the human 
body, although these affinities still exist, yet all combination with 
foreign elements, hostile to the health of the several organs and tho 
harmony of their movements, are steadily and successfully resisted, 
and it is only where the attraction between foreign agents and tho 
tissues of the living organism, is stronger than the resistance of the 
vital principle, that the equipoise is destroyed, and temporary or per- 
manent functional or organic derangements supervene. 

Medical substances therefore, whether organic or inorganic ;— 
whether acting topically or generally, and remotely — by mechanical 
irritation — by chemical combination with some of the constituents of 
the tissues, or in the production of what has been denominated "vital 
effects," apparently unattended by either " mechanical or chemical 
lesions," must always, we apprehend, to be safe and efficacious, be 
subordinate in their action to the existing affinities which bind toge- 
ther the elements of the corporeal organism, under the superinten- 
dency of the vital principle. While, however, on the one hand an 
increase of mass^ even of a mild agent, may compensate for the want 
of intensity^ and overcome the resistance of the vital forces, so as to 
terminate fatally; — so, on the other, minuteness oi (\\\^n{'\iY or high 
dilution is an equivalent for hlandness of quality in the agent employ- 
ed, and reduces its action below the force of the vital affinities, so 
that even acrid and virulent poisons, by only feebly disturbing the 
organic activity, of the parts, and establishing a new and different 
action for the morbidly existing one, may, under judicious adminis- 
tration, be made to subserve valuable purposes in the curative art. 
While, therefore, under the scrutiny of an enlightened medical phi- 
losophy, it would be deemed no less fruitless than futile to attempt a 
defensible line of contradistinction between those substances popular- 
ly denominated " poisons," and others, by common consent denomi- 
nated " medicines," yet, it is proper to remark, that there are many 
chemical compounds, both from the organic and inorganic kingdoms, 
which produce violent changes in the living organism, and which, if 
continued to a certain intensity, result in the death of the part or the 
whole. The action of inorganic poisons, as the salts of lead, copper, 
and several other metals, are only to be [satisfactorily accounted for 
upon the adoption of the views of Liebig, viz : that the powerful 
affinities which they manifest for some of the constituents of the 
animal organism, as muscular fibre, albumen, cellular tissue, &;c. is 
Buch as to break down the vital energies of the part, and form a new 



18-15.] Ccilomd. lOo 






and insoluble compound which henceforth refuses to '^suffer, or effect*' 
metamorphosis or transformation, and is tlierefore removed i)eyond 
the claims of animal life — no longer subject to its laws, and ihercfore 
no longer sustainable among the living tissues. Such are Arsenious 
Acid, the Corrosive Chloride of Mercury, Nitrate of Silver, A:c. 
either in solids, or in blood-globules, and if the calculations of the 
same celebrated chemist are correct, the very high atomic \vcight of 
these several animal products, or, in other words, the large amount 
of them vi'hlch it takes to constitute a single equivalent for a sjnaJI 
amount of the salts in question, indicates clearly how very few grains 
of the two former sa-lts especially, may prove fatal. He supposes that 
5 grs. of Corrosive Sublimate, unites as the lowest equivalent propor- 
tion, with 100 grs. of fibrine, and 1^- grs. of Arsenious acid with 100 
grs. of albumen. Ordinarily, however, the toxicologlcal effects of 
each agent is limited to their degree of solubility. In accordance 
with this physiological law, therefore, the timely administration of 
Sulphates (as Sulph. Soda, Su -ph. Magnesia, &c.) constitutes the only 
safe antidotal policy for poisoning by the soluble Salts of Baryta, (as 
the Carbonate, Muriate, &;c.) the play of affinities which takes place 
in the stomach, resulting in the formation of an insoluble Sulphate of 
the metal, at once preventing morbid action, and averting all danger. 
Indeed, the Hydrated Sesquioxide of Iron itself, the gieat modern 
antidote for Arsenious Acid, whose invaluable efficacy has been tho- 
roughly tested in scores of cases, depends solely for its success upon 
the formation (in the stomach) of the insoluble Arseniate of the Pro- 
toxide of Iron, which, refusing to enter the circulation or combine 
with the tissues, secures the system against a fatal result. Another 
class of substances, such, for example, as Sulphuric Acid and the 
Caustic Alkalis, which the distinguished Professor of Giessen has 
forborn to denominate "poisons," nevertheless, by a sort ofchemico- 
vital process act, firsts destructively upon the organization of the 
parts with which they come in contact, by their energetic affinity 
for wafer, which, according to Miller, constitutes " four- fifths of the 
weight of the animal tissues," and without which the vital phenomena 
dependent upon them, cannot be continued. And, secondly, — by 
instituting an inflammatory action in the adjacent surviving parts. 
Now under these authorized views of the action of inorganic poisons, 
we do not feel warranted lo class among them, the article under con- 
sideration : — 

Ist. Because, we have shown, we trtist, by referejice to sufficient 



lOe CahfiitL [March, 



written authority which might bo quadrupled at pleasure, and to 
which we now add the testimony of our own experience for the last 
18 years, sustained, as we believe, by thnt of almost the entire body 
of the intelligent and scientific members of the profession in the 
South, (to many of the peculiar and violent diseases of which our 
medicine has proved to be happily adapted, and where its powers 
have been most largely tested) — that the Siibchloride of Mercury, 
under the direction of proper professional skill, may be given in S7nall 
ov large i\oses, singly ov repeated, with equal impunity J*" 

2nd. Because, instead of acting as an irritant upon the mucous 
roat of the stomach, it is known to act like a charm, in allaying that 
gastric irritability which constitutes one of the most troublesomo 
symptoms in many of our autumnal diseases. 

3rd. It does not, like the Corrosive Chloride, &c. combine with 
{\\e organic elements of the tissues — overcome the vital affinities of 
the parts in which it acts, and generate inflammation in contiguous 
surviving parts. 

4th. Its great insolubility resists the process of imbibition, and 
consequently transfusion through the circulating mass — the ready 
medium through which inorganic poisons ordinarily act. So nearly 
insoluble is it, that according to Graham, of London, "when the 
Mercurous Nitrate" (Nitrate of Mercury) " is added to Hydrochloric 
Acid," (by which Calomel is generated,) "diluted with 250,000 times 
its weight of water, a sensible precipitate of Subchloride of Mercury 
appears." 

But, — "Are not mineral substances, unsafe and improper remedies^ 
and therefore to he prohibited in the treatment of disease ?^^ Perhaps 
with the enlightened and unprejudiced mind this question might be 
regarded as scarcely meriting a philosophical examination, and were 
it not that a class of professional teachers, differing from ourselves 
toto ccelo in the etiology and methodus medendi of disease, have re- 
peatedly prono-snced ex cathedra, as well as in private intercourse, 
their burninfj anathemas upon our hapless salt, — denouncing its pre- 
tensions to public confidence under the broad, ungenerous charge, 
that it could not boast a botanical ancestry, and spurning it, with 
every kindred article, of mineral origin, as an illegitimate, and mur- 



• Idiosyncratic CcTses are of conrse excepted, and from Avhat has already been 
said, should not subtract from the force of onr remark. 



1845.] Caltrmt!. 10" 



derous intruder into the taniily circle of remecliil n^ents — the pnliiic 
eye would not have been taxed with the penisal of the tollovvirjg re- 
ply. To the thoughtful and dispassionate, whether /Arore//r«//z/ with, 
or against us, the views which it presents are ingenuously submitted. 
However ph3'siologists may speculate upon the modus exislcndi ot' 
the vital principle, life itself must be regarded as a constant struggle 
against the operation of those physical laws which effe^rt matter in its 
inanimate and passive forms. The human body iiself, presents an 
instance of a temporary, but triumphant ascendenc}' of a vitalized 
organism over a thousand active and wklely pervading agencies, hos- 
tile to its perpetuity. The presiding Spirit of the living machinery, 
within the circumscribed range of its dominion, modifies and controls 
those chemical laws which give form and character to inorganic mat- 
ter, and makes them suljservient to her own high purposes, while the 
powerful momentum of the vital forces keeps at bay, for the time 
being, those multitudes of external assailants, v.'hich like the be- 
leaguering hosts of the Roman Titus, around the venerable walls of 
doomed Jerusalem, never raise the siege until the last energies of the 
physical constitution are exhausted, and its beauty and strength both 
fall victims to their merciless power. 

Our corporeal organization, then, i.i liable to assault from every 
quarter. The Earth itself, by tlie great law of the attrnclion of 
gravitation, continually tends to draw our bodies towards its centre, 
and our erect attitude is only maintained by the expenditure of a 
countervailing vital energy acting upon nniscular irritability. The 
stagnant lagoon evolves its invisible mephilic gases, and the ready 
winds, commissioned for the work of death, transport them to our 
lungs. The serpent, tlie tarantula, and the rabid mastiff, each injects 
its destructive virus to dislodge the vital principle. Botany too, often 
lends the agency of its juices, fruits, and foliage to disturb the ba- 
lance of the harmonious functions, and speed us to our doom ; — while 
MineraJo^jy but joins the general crusade against the human exist- 
ence, and furnishes her Acitls and Alkalis, ?.Ietals and Salts, which 
by careless or malignant administration, may break down the resist- 
ance of the vital forces, and destroy life. But this is not all : — The 
skies drenc!) us, — the lightnings blast ns, or the floods drown us. 
Shall then the wonderful and complicated structure of the human 
body — the organ of communication between an imniortal mind and 
the surrounding universe, and on whose soundness and preservation 
that mind depends for every eartlily minilb^tation of its powerful 



109 Calomel. [March, 



emotions, lofty conceptions, and far reaching energies, be thus sub- 
jected to injuries from earth, and air, and sea, and sky : — from solids, 
fluids, and gases — animals, vegetables, and minerals ; — from enemies 
visible, and invisible — living and dead, — and yet its hygienic 
and therapeutic resources be restricted to the narrow limits of any 
kingdom, or any condition of matter, much less to the exclusive 
and fanciful formularies of a/ij/ pr'ofessional dogmatist ? No, verily. 
No. The voice of Reason and the voice of Nature both unite in 
this response. Let aid come to suffering human nature then from 
the four v.'inds of Heaven. The world belongs to it, by merciful 
conferment. Earth's millionary treasures were made tributary to its 
use and comfort, and with this mundane system its very temporal 
being, happiness, and history are inseparably identified. We repeat 
it, then, let remedies come — no matter whence: — from forest, field, 
fen, or fountain ; — from mountain height, or ocean cave ; — from 
earth beneath or heaven above. Let them come — no matter how: — 
solid, liquid, or aeriform, — ponderable or imponderable, until they 
cease to present any appropriate characteristics for the rescue of hu- 
manity, and then and not till then, may they forbear. But to be 
more specific in the expression of our views upon the propriety and 
reasonableness of employing mineral agents in the cure of disease : 

1st. The same elementary substances, as (e. g.) Oxygen, Hydro- 
gen, Nitrogen, and Carbon, are found in organic, as well as inorganic 
matter, and are only combined, in each respectively, under different 
modifications. Now, inasmuch as no remedy, animal or vegetable, 
is taken in a living state into the human stomach, the power of the 
vital principle is no longer exerted in controling the chemical ar- 
rangements of its particles, and it then becomes subject to the laws 
which govern inorganic matter. 

2iid. Some minerals are known to be innocuous, when taken into 
the human stomach, as Magnesia, Chalk, Sulphur, &c. and ojie, at 
least, has become an article of such popular use in the preparation of 
human aliment, in every grade of society which is removed from 
downright barbarism, as to constitute a sort of national test by which 
to distinguish civilized from savage man. And yet who would de- 
nounce the Chloride of Sodium (common salt) — expel it from our 
tables — return to the rudeness of savage taste, and eat the half-broiled 
flesh from the reeking coals, unseasoned by this grateful condiment, 
simply because it is dug from the mines of Cracow, and crystalizcsin 
the form of cubes? 



1845.] Calomel, 109 



3rd. Calomel itself i^ an analogous compound : — nay, more, — for 
it is only necessary that the negative element ot^ the Chloride of So- 
dium, viz. Chlorine, should exchange its metallic ba^e {Sodium) tor 
another metal, (i. e. Mercury) — two equivalents of the latter base, 
being united to one of the ibrmer, and we have the important salt 
which has elicited this dissertation. 

4th. The animal fibre is powerfully impressible, and the various 
organs promptly and signally modified in their action, by mineral 
remedies. Now whatever agents are known to exert an efficient 
control over functional movements, may, under a judicious and dis- 
criminative administration, be made valuable auxiliaries in the work 
of cure. 

5th. But is it not a virtual impeachment of the Divine wisdom, to 
denounce this ichole class of substances as injurious to the animal or- 
ganization, when both the Jluids Rnd solids of that structure, furnish 
minerals as a portion of their elementary constituents? What intel- 
ligent physician has yet to learn that Lime (a mineral) in combina- 
tion with phosphoric Acid, is found in the cellular, serous and muscu- 
lar tissues, and in the brain itself? — that from the most careful 
ultimate analysis of the human blood, Magnesium, Calcium, Sodium^ 
and Iron, (all minerals — the last in the form of a peroxide and 
Phosphato) are constituent elements of that fluid, and going the con- 
stant rounds of the circulation ? — that the whole osseous skeleton of 
the human body consists of little else than inorganic salts, deposited 
for the time being in a cartilaginous network of appropriate confor- 
mation, and all of which may be removed by digesting bones in 
dilute Muriatic Acid, while the cartilage alone remains in situ. One 
of these circulating salts too (Carbonate of Lime) is the same which 
constitutes the bulk of many of our mountain ranges, and in the 
form of statuary marble, withstands the waste of ages and gives 
immortality to deeds and men. The renal secretion, also, as might 
have been anticipated, contains these saline impregnations, and some 
of the most common forms of urinary calculi consist of the Oxalate 
or Phosphate of Lime. 

6th. Nature seems to have imposed no interdict, preventive of a 
rigorous reaction and chemical union between the several elements 
of animal, vegetable and mineral substances, and we therefore ra- 
tionally infer, that the three hlngdoms were designed to contribute to 
the resources of the profession. 

The Chloride of Mercury (Corrosive Sublimate) combines with 



lit) Calomel. [March, 



Albumen {animal maltor) and forms an inert and /iarm?e55 compound, 
arid hence tlie while of an egg is the best antidote to the action of 
this virulent salt. 

The proximate principle of vegetables unite Avitli minerals, as the 
'J'jirtaric Acid with Antimony and Potassa, forming the Tnrtar Emetic 
of the shops: — the Citric Acid with Iron, making t)ie Citrate of Iron, 
and, as recently discovered, the still more complicated, but beautiful 
and valuable coiDpound, the Citrate of Quinine and Iron, in which a 
vege-ahie and mineral base, conjointly submit lo the action of an 
Acid from the organic kingdom.''^ 

7th. Ajrain, the mere fact that a medicinal agent is obtained from 
\\\e vegetable kingdom, is no guarantee for its innocence or usefulness, 
while the converse is eqtially true, i. e. that a mineral origin is no 
presumptive evidence of deleterious properties, and should not, there- 
fore, vitiate its claims to public confidence. For whi'e the Vegeto- 
Alkalis, Strychnine, Brucine, Veratrine, Conicine, Atropine, and 
Daturine, with a host of other organic agents, among which may be 
ranked Hydrocyanic Acid, and the active principles of Opium and 
Tobacco, furnish some of the most active and virulent poisons on 
earth, — many ?nincral substances employed for ages in medicine are 
knoirn to be exceedingly mild and harmless, as well as appropriate 
and useful in the cure of diseases. Such, for example, are Sulphur, 
Chalk, and Magnesia, with its compounds, i. e. the Carbonate and 
Sulphate : — Soda, in the forms of the Sulphate and Phosphate; — and 
Iron, as a Protoxide, or Carbonate, &c. &;c. 

8th. But" lastly. Nature has settled this great question, and from 
her own granite alembics in the base of the "everlasting hills," has 
distilled her own pure waters, and richly impregnated them with the 
healing properties of her own subterranean resources. Chalybeate, 
Sulphureous, and Saline springs, with their respective minerals in 
ready solution, gush freely from a thousand localities over the earth's 
surface, to heal the maladies of our afflicted race. 

In conclusion then, with these facts before us, and the powerful 
and effective energies of our mal-treated remedy freely acknowledg- 
ed, shall we, because in careless and injudicious hands, or in idiosyn- 
cratic temperaments it may have occasionally overleaped the pre- 



• This fine pnrpli5:h brown salt, in tabular crystals, with a vitreous lustre, 
maybe found in the Drug store of Mr. Marshall, the suoces.«or of Dr. Wray, 
At^jrusta, Cra. 



1845.] Calornd. Ill 



scribed bounds of its therapeutic action, and done violence to th3 
human constitution, — consent to cower to the otit-cry ofbliiid preju- 
dice, or ignorant and interested empiricism, a'ld, before the e\('S of 
the living myriads wiiom it lias rescued from the jnw.s of the grave, 
deliberately pronounce the blistering curse of Science upon iJs lioHd, 
and consign it to the reproach and malediclions of posterity? Xo, 
never! — Sooner let the fate of the laceratf;d and entruli)lH'd multi- 
tudes, who have fallen under the explosive power of unconlrciled 
Steam, and found their winding sheet in the ocean wave, authctrizo 
the utter expulsion of this great agent from the civilized world, whe?i 
ten thousand burning axles arc rolling under its impulse and bearing 
with the speed of the winds, the exchanges of intelligenee and com- 
merce to rising and expectant nations. And yet who is prepared lor 
such a national sacrifice? — None. The voice of Civilization is the 
voice of Reason, and the world obeys ; — hear it : — 

"Study more profoundly your science — strengthen your cylin- 
ders, — modify your machinery, and increase your circumspection, 
but, still retain THE MASTIDON IX HARNESS, to do iLe work 
of an AGE in a YEAR." 

NOTE. — Havine: concludod our c^^neral views in regard to this 

o o tn 

interesting article of the Materia Medica, it has been thought desira- 
ble to append a few practical observations which may be made 
available in detecting Us presence or asserlinrr ils parity. 

Properlies. Its specific gravify is about 7.2, i. e. its weight com- 
pared with an equal bulk of ira/er, is as 7.2 to 1. 

By exposure to light, even in closely stopped glass bottles, it 
hcquires a darkish tint — the chemical constitution of the change thus 
produced, not being well understood. We cannot believe, however, 
with Du3iAS, that it depends upon the formation of a small quantity 
of the Corrosive Chloride and the deposition of Metallic Mercurv, 
but should rather suggest (were our own opinions to be consulted, 
that from the chemical activity known to be imparted to Chlorine by 
the action of light, a portion of that negative element of the com- 
pound, was dismissed and minute j)articles of Metallic Mercury de- 
posited on the exterior stratum of the mass. 

Tests. To ascertain first, whether an article supposed to be Cal- 
omel, be a mercurial preparation, heat it with one of the vegetable 
alkalis, or their carbonates, and if mrrcury be present, small globules 
will appear. 



llvJ Cases of Episioraphy. [March, 



f)r: Digest il with Nitric Acid, and then rub it with a woollen 
rioth, or buckskin, upon a bit o^ clean copper — if tiie metal be there, 
a silvery stain will be left on the copper, removable by a red heat. 

Next, to ascertain whether the Mercnrous salt thus detected bo 
Cnlomel, ascertain first, whether it is insoluble in neater. 

Secondly, wiiethcr with Aqua Ammonia, or Caustic Potassa, it 
strikes instantly a blackish, or with Lime water, a blackish gray pre- 
cipitate — which if produced, is the Profoxide of Mercury, while the 
supernatant liquor containing the dislodged chlorine in alkaline solu- 
tion, with Lunar Caustic, will give a white precipitate (the Chloride 
of Silver.) 

Other tests might be added, — these we trust will suffice, and, to 
hhow the value of such tests in determining the chemical character, 
istics of the article under examination, I close by remarking, that my 
esteemed and lamented friend and former partner, Dr. Wm. P. Gra- 
1IA3I, of Covington, Ga. once purchased from a store in the village 
a considerable quantity, perhaps ^ lb. of an article labelled 'Calomel/ 
and which from a superficial examination, he supposed to be such. — 
Before attempting to use it, however, after returnmg to his office, he 
determined to subject it to the action of an Alkali. To his surprise, 
no blackish preripitate appeared. He saw me some days afterwards 
and requested me to examine it in my laboratory. I did so, and by 
the most decisive tests, found the white mass to be Arsenious Acid, 



ARTICLE II. 

Cases of Episioraphy.* By Jony Lake, M. D., of Edgefield 
District, S. C 

Having received, through my pupil, Mr. James Hill, now in at- 
tendance on the Lectures in the Medical College of Georgia, a request 
from the Professor of Midwifery, Dr. J. A. Eve, to communicate 



♦ Epibion, external labia ; and raphe, suture. — Edts. 



1845.] Cases of Episioraphy. 113 



for the Southern Medical and Surgical Journal, two cases, in which 
I had performed successfully the operation of Episioraphy, I will 
with pleasure place them at the disposal of the Editors; although in 
presenting Mr. Hill, fiom my journal, a rough sketch of these cases, 
to assist him in preparing a thesis which, as a candidate for gradua- 
tion, he would be required to present to the Faculty, I little thought 
my cases would be regarded, in so flattering a light, as to call forth 
a desire to have them laid before the public. 

When about to enter the practice of medicine, which is now four- 
teen years since, as is common with all young men, I commenced 
with sanguine expectations, thinking the profession had approxima- 
ted much nearer to perfection than I now conceive it to be : I figured 
to myself, that nothing was more certain than that success must follow 
the theoretical views of the celebrated authors which I had read, 
when applied to practice : but as much as I respect the profession, 
and as high as I think medicine deserves to stand among other estab- 
lished sciences, I still recollect the mortification I felt, when I first 
became practically acquainted with the many cases which baffle the 
best directed eflTorts of the attentive and well read physician, and in 
this catalogue, to my astonishment, the case of prolapsus uteri as of- 
ten presented itself as any other. 

Professor Dewp:es, to whose memory the ladies of Philadelphia 
justly owe the monument, which they proposed to erect as a feeble 
tribute of respect for the able counsel and prompt aid which he was 
ever ready to render to their sex, taught in his lectures, which I 
always attended with unusual interest, and his works, which I have 
ever since continued to consult, that this malady is certainly control- 
lable by the common metallic concavo-convex pessary. 

As much as I think Dewees merits the reputation which he has 
acquired as an author, and as unsafe as I conceive it to be to differ 
from him, upon topics generally connected with the subject of mid- 
wifery and the diseases of women and children, yet I must enter my 
humble protest against this proposition. Admitting what is true, that 
his views on its pathology are correct, I must yet contend that his 
treatment based thereon is improper: for if a relaxed or weakened 
vagina bo the proximate cause of a large majority of displacements 
of the uterus, the reasonable inference is, and a considerable practice 
in this line has convinced me the idea is correct, that any hard body 
placed in the cavity of the vagina, with a view to support the uterus, 
muRt be sufficiently large to distend, very considerably, the parietes 

R 



1 1 4 Cases of Epislorayhy. [March, 



of the vagina, which distonsion, if persisted in, must eventually lessen 
the tone of an already debilitated organ, so as to render the probabili- 
ty of a radical cure at least doublfui, without an operation. 

With this view of things, my treatment for a length of time has 
been to enforce rigidly tlie horizontal position, if necessary, for weeks 
or months, and at tlio same time to persist in cold and slightly stimu- 
lating lotions to the vagina, and such constitutional measures as have 
a tendency to impart tone to the system generally. With this treat- 
ment I am entirely satisfied. 

As for those extreme cases which cannot be greatly improved or 
entirely cured by the above treatment, I have reason to believe they 
Avill not be made better, by any treatment short of the operation which 
Dr. Dewees denounces in such unmeasured terms, and which I will 
give as performed in two instances in my own practice. 

The first case is that of Mrs. D., who, when the operation was 
performed, was about forty-three years of age. She had, for at least 
twelve years previous to that time, been the su'DJect of prolapsus uteri, 
the latter half of which time she had been confined to bed. The 
constitutional derangement growing out of this disorder, frequently 
seemed to require more attention tiian the prolapsus itself; for her 
sufferings from nausea, gastrodynia, cardiaigia, a sense of weight in 
the stomach and very evident distension of the bowels, almost unin- 
terrupted fetid eructations, jiyrosis, a sensation of sinking or flutter- 
ing at theheart, &;c., were so great as frequently to induce the belief, 
not only with Mrs. D. and her friends, but with her physicians also, 
that under this state of things she could not long survive, and sincerely 
do we believe that death by her was looked to as her best friend. 
Mrs. D.'s case was successfully and no doubt correctly managed, by 
several intelligent physicians. During the illness of the last physician 
in attendance, we were consulted and requested to prescribe for her : 
we in turn recommended the usual treatment, such as the application 
of the pessary, accompanied wiih astringent washes, at the same 
time combatting the constitutional disturbance which had supervened, 
Avith no better success than our predecessors ; we became chagrined, 
almost ready to look upon procidenJia uteri as belonging to the op- 
probria medicorum, and we were about to pronounce it a hopeless 
case, when the operation termed by some Episioraphy, was suggested 
to us by a friend, as a last alternative- \Ye proposed it (though we 
confess, with little hopes of success) to our patient, who readily sub- 
mitted to the operation; which was performed, by denuding the ex- 



1 "? 45. ] Cases of Ep isioraphi/. Ho 



ternal labia, cornmenciRg something more than a finger's breadth 
below the superior comsnissure and also about the same distance from 
the margin of the labia, extending the incisions which were at least 
half inch in breadlh, to the fourchette which \ras included. The 
raw or cut surfaces were then kept in apposition by the quill suture. 
For the first few days after the operation, the urine was drawn off by 
the catheter, which it was apprehended, if passed in the natural way, 
might prevent adhesion of the parts. In a few days after, our most 
sanguine expectations were more than realized ; for notwitlistanding 
from want of action in the system generally, adhesion did not take 
place to the extent we wished, yet there was a degree of rigidity 
brought about, in the parts, which effected a radical cure in a short 
time. Her general health began to improve, the symptoms of dys- 
pepsia were gradually removed, and all the train of nervous affections 
attendant upon an aggravated case of prolapsus, was soon gone. In 
a few months she was so far recovered as to visit her friends in Ala- 
bama. Since when, (which was in the latter part of the winter of 
1S41,) she has enjoyed good health, and not suffered with a trace of 
her former complaint. 

The second case was a negro woman, who had been confined to 
bed for the space at least five years. She had had the benefit of 
the judicious application of the different pessaries in vogue, none of 
which offered her sufiicicnt relief to enable her to follow any kind of 
business : in fact she was completely bed-ridden, and had been for 
the time already specified. She was regarded by her owner as a 
nuisance. Encouraged by my success in the case of ]Mrs. 1)., and 
wishing to give the operation a still further trial, I proposed to her 
owner to take cliarge of her case, and if her situation was not greatly 
ameliorated, my attention should be given free of charge. He con- 
futed : her case was conducted in a manner similar to that of i\rrs. 
1). and the like happy consequences resulted; for in a few months 
(which is now near two years,) she was returned home and placed in 
the kitchen as a cook for a large family, which post she has occupied 
ever since. 



116 Lithotomy. [Marcli, 



ARTICLE III. 



Fifteen Cases of LUholomy, By P. H. Wildma>', M. D., Colum- 

bus, Ga. 

Within the last five years, it has fallen to my lot to operate in 
fifteen cases of stone in the bladder. 

One of these cases was that of a female about 30 years of age, 
from whom a calculus, measuring, in its longitudinal circumference, 
four inches, and in its shortest, two and three quarter inches, was 
extracted through the urethra, previously dilated. The instrument 
used for dilating, was made of steel, and constructed so as to open on 
the principle of the speculum auris — the blades standing at a right 
angle with the handles, and about three inches in length. It was 
constructed by a blacksmith in the village where I then resided. 
This instrument was passed through the urethra, and its blades sepa- 
rated with moderate force, for the space of ten minutes, every other 
day, during ten days, previous to extraction. On the tenth day the 
patient was placed on the table, a middling sized lithotomy forceps 
carried into the bladder, the stone seized and extracted easily. The 
patient had a rapid recovery — having had from the first hour, no 
incontinence of urine. 

By means of the dilator above described, dilatation of the female 
urethra may be carried to a much greater extent than sufficed in this 
case ; and if desirable, effected in the space of a iesv hours. In view 
of these facts, and when I reflect that incontinence of urine is a 
frightful, and almost inevitable consequence of laying open the female 
urethra, and that the high operation is both difficult and dangerous, 
I can scarcely conceive of a case of calculus in the female, in which 
I would not recommend the operation by dilatation, above any other 
which has been devised. 

The remaining fourteen cases occurred in male subjects, and the 
calculi in all of them, were extracted through bi-lateral incisions of 
the perineum and prostate gland. The following is the method in 
which I have executed the operation : 

The patient is secured as for the lateral operation. The bladder is 
injected with tepid water, unless the urine has been retained for 



1845.] Lithotomy. 117 



several hours. A staff, larger than that in general use, and with a 
deeper and broader groove, and also with a shorter curvature, is car- 
ried into the bladder, and its handle consigned to the right hand of an 
assistant, (standing on the left side of the patient,) who is directed to 
elevate the scrotum with his left hand. With three fingers of his left 
hand placed over the anus, and their extremities resting on the peri- 
neum just below the inferior border of the triangular ligament, the 
operator makes the first incision, through the skin and superficial 
facia, with a scalpel held in his right hand. This incision is made of 
a semilunar shape, its centre on the median line, its convexity looking 
towards the scrotum, and its horns resting on a point midway between 
the anus and tuberosity of the ischium on either side. The dissec- 
tion is continued in the line of the first incision, till tlie membranou:* 
[)art of the urethra is exposed, just below the bulb. An openintr, half 
an inch in length, is made into this part of the urethra, with a scalpel 
or bistoury, and the beakofDoct. Alexander H. Sfevexs's ^^pros^a- 
tic bi-sector' inserted through it into the groove of the staff. The 
handle f»f this latter instrument is now taken tVom the assistant, and 
the bi-sector gradually carried forward through the prostate into the 
bladder. 

The prostatic bi-secfor " in form resembles an olive, with a beak at 
its extremity, with cutting edges at its sides, parallel to its longest 
axis, and with a straight handle." I have, in my operations, usod 
three sizes of this instrument. The blade of the largest is one inch 
in its longest transverse diameter — of the smallest nearly throe quar- 
ters of an inch — the other is intermediate. Not more than one-third 
of the blade is exp(»sed — the remainder being covered, above and 
below, with bulbs of polished horn. 

It is not my intention or desire, to laud this method, or this instru- 
ment, above all others in the operation of Lithotomy : but merely 
to add my mite to the general experience, upon a subject so deeply 
interesting to the profession and to mankind. Still, I cannot refrain 
from expressing the belief, that the bi-lateral operation is safer for 
the patient, and easier for the surgeon, than the lateral. This opin- 
ion is sustained, no less by the anatomy of the parts concerned in 
the operation, than by my own experience and the testimony of 
othors. 

Of my fotirteon cases in the male subject, two were cut in tho 
month of January, two in April, one in May, one in July, two in 
Augu*t, four in St^ptembcr, one in Octol)cr and one in November. 



118 LUhotom?/. [March, 



The youngest was three years of age — the oldest, seventy-one ; nino 
were between three, and twenty — three, between twenty and forty. 
Seldom have my patients been subjected to any preparatory treat- 
ment. I have several times operated in the midst of a paroxysm of 
greater or less severity, and these patients have recovered as rapidly 
and as perfectly as the others. I have operated upon all who have 
made application to me, except one. This patient was confined to 
his bed and so much debilitated as to become pulseless under the 
operation of sounding. Besides this, I suspected that the calculus 
was encysted, or had lodged or been formed in the vesical extremity 
of the left ureter — about one-third of it only projecting into the cav- 
ity of the bladder. 

Of the fourteen patients, all have permanently recovered, except 
one, who died in five weeks after the operation. This patient was 
seventy-one years of age, corpulent, and had enlargement and indu- 
ration of the prostate gland. Eight friable calculi Vs'ere removed — 
two or three having been previously fractured in the bladder. The 
difliculty of removing these fragments through an indurated prostate, 
and deep perineum, from a bladder pushed high up into the pelvis, by 
an enlarged prostate, may be easily conceived. I left the patient in 
three or four days after the operation, and am not in possession of the 
subsequent history of his case, but am informed that the wound had 
healed. 

About a week since, and afler this paper had been prepared for 

publication, I extracted, by the bi-lateral operation, a small mulberry 

calculus, from a little boy about seven years old. He is doing well. 

Supposing the following case not devoid of interest, I transcribe it 

it in the words of Mr. Craig, one of my pupils : 

"J. U. W., aged 18, was wounded by an axe, Oct. 30th, 1844. — 
The blade, having first wounded the thigh, struck the scrotum, passed 
between the testicle, and penetrated the urethra. The family physi- 
cian introduced a catheter which was suffered to remain twenty. eight 
days. Eight or ten days after the accident the scrotum sloughed and 
exposed the right testicle. He was brought to Dr. Wildman on the 26th 
November. At this time he discharged his urine through a fistulous 
opening in the scrotum, and the urethra was nearly closed by a car- 
tilaginous stricture anterior to the fistula — it being impossible to pass 
the smallest bougie. Under these circumstances, it was resolved to 
cut down and lay open the stricture. The patient being secured in 
the position for lithotomy, and a large silver catheter passed down 



1845,] Lithotomy. ^ 119 



to it, the scrotum was laid open horn fop to bottom, on the 
median line. Continuing the dissection between the testicles, that 
portion of the urethra covered by the scrotum was completely expo- 
sed. The urethra was now opened upon the end of the catheter; 
but finding it impossible to pass a director from before backward, 
the urethra was opened in its healthy portion behind the stricture, a 
small director passed from behind forward, and the stricture slit open. 
The catheter was now carried forward into the bladder and confined, 
the wound closed, by sutures and adhesive straps, and a suspensory 
bandage applied. The catheter was suffered to remain only four days. 
When it was first withdrawn, the urine gushed, during micturition, 
from the whole length of the incision. The quantity, however, 
gradually diminished, finally ceased altogether, and the patient was 
discharged cured in three weeks." 

Remarks. — Wounds of the urethra should, if possible, be treated 
without a catheter. The urine has, if I may so express it, a strong 
natural ajfinify for the lining membrane of the urethra. This is 
evinced by the uniformity with which the urine retuYnoi] sponlaneoiisly 
to its natural channel, after the operation of lithotomy. In fact, 
judging from the cases of urinary fistula which I have seeD^ strict ure 
seems to be an essential precursor and concomitant of the disease; 
and the fistula invariably disappears spontaneously after the removal 
of the stricture. Thus it would seem that nothing short of mechani- 
cal obstruction, is capable of permanently forcing the urine from 
its natural channel. I object to the wearing of a catheter after 
wounds of the urethra: 1st, because, that, by putting the urethra 
upon the stretch, it causes the wound to gape; and 2ndly, because, 
by attracting the urine along its outer surface, it favors the escape of 
this fluid by the wound. A catheter is thought to prevent infiltration 
— I think it favors it. This accident is best guarded against by 
dilating: frcelv the external wound. 



120 Monstroslti/. [March, 



ARTICLE IV. 

A Case of Monstrosity. By S. B. Cunningham, M. D.^ of Jones- 

horo\ Tennessee. 

On the second day of July, 1843, Mrs. E*****s, of this county, 
was taken in labour with her twelfth child — a country midwife was 
in attendance, and the labour advanced regularly and slowly until 
the head was born ; when it ceased to make farther progress. After 
some effort, the attendant succeeded in bringing down the arms, but 
the body remained obstinately stationary. Eight or ten hours had 
been passed in fruitless efforts to effect delivery, when we first saw 
the case. The pains though enfeebled from exhaustion, were yet 
tolerably regular, and the delay under such circumstances and at 
such a stage of the labour, was unaccountable — gentle efforts having 
proved unavailing, the shoulders were grasped firmly with both hands, 
and by a pretty forcible zigzag traction, made during each pain, the 
foetus advanced until the abdomen passed, and the patient was quickly 
delivered of a still-born child. In due time the placenta came away, 
but it was fully three times the ordinary size. 

This foetus presented a very remarkable case of /m?w5 wa/wrcp, and 
congenital deformity, combined — The abdomen was unusually large, 
and contained two large tumors, like foetal heads — The circumfer- 
ence of the body, measured at the umbilicus, was twenty-three 
inches. The ribs and sternum were pushed up to make room for the 
abdominal viscera — Each hand was supplied with a thumb and five 
well tbrmed fingers, and each foot with six toes. The spinous process 
of the superior dorsal vertebra was wanting, and its place supplied 
by a spinal bi-fidal tumor, about the size of a small walnut. The 
internal surface of the tumor was covered with a sero-purulent fluid, 
the adjoining vertebrae were partially eroded — The occiput was per- 
foratcd below the upper crucial ridge by a hole the size of a shilling, 
with rounded edges, and surrounded by the lacerated covering of a 
sac which was ruptured by the manipulations oftlie midwife — There 
was hare-lip, the cleft of which extended completely through the 
palate bones, reducing the cavities of the mouth and nose into a 
single one. 

The appearance of the genital organs rendered the sex doubtful. 



1945.] Monstrosity, 121 



Superficially, the vulva appeared to be well formed, with deep com- 
missure superiorly and invaginated clitoris, alias penis, about half an 
inch in length, soft and without any appearance of corpora cavernosaae, 
gland or prepuce. There was a meatus, through which a knitting 
needle was passed into a kind of cwZ de sac, with thick and solid walls 
about one inch in length and of the diameter of a large straw. The 
labia when separated shewed no other opening, nor was there any 
appearance of nymphae. As the labia approached each other be- 
hind, the fissure rose more superficially until lost in ralher loose in- 
teguments posteriorlvf suggesting to the observer the idea of a scro- 
tum, or an abortive etfort of nature to make one. Internally there 
were some slight traces of spermatic chords, which were attached to 
vascular convolutions in the lower margin of the kidneys on both 
sides, which were easily unravelled, and more nearly resembled the 
plexus ciioroidts of the ventricles of ihe brain, than any llrirg else to 
which I can compare them. Yet I hey were located in tlie situ jjro- 
pria of the fcetal testes, and one was much larger than the other.* 
The kidneys were two large rolling tumors cf a rather spongy tex- 
ture, ii'ifi'.trated. of a pale color, and together weighing three pounds 
and three-quarters. The other viscera w ere natural — the lower ex- 
trerrfllies were unusually small — tiie foetus weighed between eight 
and nine pounds, the kidneys lurnisiiing one-half of the entire 
weight. A most singular circumstance connected with this case, is 
the fact, that of twelve children born of the same woman, five had 
nn abdominal and sexual organization similar to that just described, 
and were also still-born — the hydro-rachitic symptoms, however, were 
absent in these cases — The alternate children were well formed and 
healthy. During gestation of each monstrosity, the woman com- 
plained of unusual and anomalous symptoms, which enabled her in 
her last pregnancies to foretell tlieir issue. The families of hoth 
the parents were as healthy as others, and there was nothing in tho 
appearance of either, which could account for such a deformed 
progeny. 

I leave to others the province ot" comrneniing on such cases — 
Though nothing practical may be dirived from that just deiscribed, it 
furnishes an instance of a remarkable aberration of nature, which 
mav interest the curious. 



• Had this child lived, it doubtless would have been classed as r.i\ horma- 
phnxlite, as the parents and nfii:hl'ors were not able to determine tlie fox. 



12:3 Extirpation of the Mamma, [March, 



ARTICLE V. 

Extirpation of the Mainma of a female in the Mesmeric Sleep, with- 
out any emdence of sensibiJiiy during the operation. By L. A. 
DuGAs, M. D., Professor of Physiology^ S^c. in the Medical Col- 
legs of Georgia, 

On the 3rd of January, 1845, Mis. Clark (wife of Mr. Jessh 
Clark, of Columbia Co., Georgia) came to this city, for the purpose 
of Kettino; m.e to remo' a schirroiis tumor of her rio^ht mamma, 
which had been gradually increasing for the last three years, and 
which had now attaiii i, ihe size of a turkey's egg. The tumor had 
never caused any pain of consequence, was not adherent to the skin, 
nor did it implicate any of the axillary glands. Mrs. C. is about 47 
years of age, [las never borne a child, and her health, though by no 
means robust, was pretty good, and had not been impaired by the 
evolution of the tunior. The operation having been determined 
upon for the following day, Mrs. C. remarked to me that she had 
been advised by Mr. Kenrick to be mesmerized, but that as she 
knew nothing about it, slie v/ould like to have my advice, and would 
abide by it — to which I replied tiiat there were several well authenti- 
cated cases on record, in which surgical operations had been perform- 
ed, under mesmeric influence, without the consciousness of the 
patient ; that I would be happy to test the subject in her case, and 
that I would endeavor to mesmerize her, instead of operating as had 
been proposed, on the day following. 

On the 4th January, at 11 o'clock, A. M., I called on Mrs. C, and 
was informed that on the preceding evening she had been put to 
sleep by Mr. B. F. Kenricx (at whose house she resided.) I then 
mesmerized her myself, and induced sleep in about fifteen minutes. 
Finding my patient susceptible to the mesmeric influence, and re- 
flecting that it would not be convenient for the same person to main- 
tain tliis infliienceand to perform a surgical operation at the same time, 
I requested Mr. Kexuick to mesmerize Mrs. C. morning and even- 
ing, at stated hours, until insensibility could be induced. This way 
regularly done, with gradually increasing efi'ect, when, on the evening 
of the 6ih January, sleep was induced in five minutes, and the prick 



1 843. ] Extirpation of the Ma?nma. 1 '^'3 



of a pin was attended with no manifestation of pain. The sittings 
were continued, and the patient's sensibility daily tested by myself 
and others in various ways. On the 9Lh January, I invited Professor 
Ford to be present, and, after pricking, and pinching strongly the 
patient without evidence of pain, the inesmerizer was requested to 
leave the room, when we exposed the breast, handled it roughly in 
examining the tumor, and readjusted the dress, without the con- 
sciousness of the patient. We then held to her nostrils a vial of 
strong spts. of Hartshorn, which siie breathed freely for a minute or 
two, without the least indication of sensation, unless the fact tliatshe 
swallowed once be regarded as such, instead of a mere reflex action. 
On the 11th of January, in presence of Professors Ford and Means, 
in addition to the usual tests, I made, wilh my pocket-knife, an incis- 
ion about two inches in length, and half an inch in depth into the 
patient's leg, without indication of sensation. 

Fully satisfied now of our pov.'er to induce total insensibility, I 
determined to operate on her tha next day at i\oon, but carefully con- 
cealed any such design from the patient nnd her friends, who did not 
expect its performance until several days later. 

On the 12th January, at 29 minutes past 11, A. -\I., Mrs. C. was 
put to sleep in forty-five seconds, without touch or pass of any kind, 
the facility with which the mesmeric inHuonce was j)roduced having 
gradually increased at each sitting. At 1*2 o'clock, M., in presence 
of Professors Ford, Means, Garvin and Xewton, and Dr. IIalsee, 
the patient being in a profound sleep, I prej)ared her dress for the 
operatio!), and requested my professional brethren to note her pulse, 
respiration, complexion, countenance, cVc. before, during and after 
the amputation, in order to detect any evidence of pain, or niodifica- 
lion of the functions. As Mr. Kenricic had never witnessed a 
surgical operation, he feared he might lose his self possession, and 
requested to be blindfolded ; which was done. He now seated him- 
self on the couch near the patient, and held her hands in his during 
the operation. This was accomplished by two elliptical incisions 
about eight inches in length, comprehending between them the nipple 
nnd a considerable portion of skin, after which the integuments were 
dissected up in tha usual manner, and the entire mamma removed. 
It weighed sixteen ounce>\ The wound was then left open about 
three quarters of an hour, in order to secure the liloeding vessels, six 
of which were ligatcd. The ordinary dressing was applied, and nil 
appearances of blood carefully removed, ro ilmf tIiP\- niijjht nr)t bo 



124 Extirpallonof the Mamma. [March, 



seen by the patient when aroused. The amount of hemorrhage was 
rather more than is usual in such cases. 

During the operation the patient gave no indication whatever of 
sensibility, nor was any of the functions observed by those present, 
modified in the least degree. She remained in the same sound and 
quiet sleep as before the use of the knife. Subsequently, the pectoral 
muscle, which had been laid bare, was twice oc thrice seen to con- 
tract when touched with the sponge in removing the blood. About 
fifteen minutes after the operation, a tremulous action was perceived 
in her lower jaw, which was instantaneously arrested by the applica- 
tion ofthe mesmcrizer's hand to the patient's head. This phenomenon 
rrcurrcd in about ten minutes after, and was again in the same man- 
ner quieted. Professor Ford, who counted the pulse and respiration, 
states that before any preparation was n)ade for the operation, the 
pulse was 96, and the respiration 16 per minute ; — that after moving 
the patient to arrange her dress ior the operation, and just before 
this was commenced, the pulse was 9S,and the respiration 17 ; — that 
immediately a^ter the detachment ofthe breast the pulse was 96, — 
respiration not counted; and that after the final adjustment ofthe 
bandages and dress, which required the patient to be raised and 
moved about, the pulse was 98, and the respiration 16. All present 
concur instating that neither the placid countenance ofthe patient, 
nor the peculiar natural blush of the cheeks, experienced any change 
whatever during the whole process — that she continued in the same 
|)rofound and quiet sleep, in which she was before the operation, (with 
the exceptions above noted.) and that had they not been aware of 
what was being done, they would not have suspected it from any 
indications furnished by the patient's condition. 

The patient having been permitted to sleep on about half an hour 
after the final arrangement of her dress, the mesmerizer made passes 
over the seat ofthe operation, in order to lessen its sensibility, and 
aroused her in the usual manner, when she engaged in cheerful con- 
versation with Mr. Kexrick and myself, as though she had no suspi- 
cion of what had taken place. I then introduced to her the gentlemen, 
who had placed themselves so as not to be seen by her on awakening, 
nnd observed that 1 had invited them to come in during her sleep, in 
order that we might fully test her insensibility, preparatory to the 
operation. After a few minutes of conversation, I asked her when 
she would like to have the operation performed ? — to which she re- 
plied, the sooner the better, as she was anxious to get home. I 



lSi5.] Eitirpallon of the Mamma. 125 



added, " Do you really think tliat I could remove your entire breaist, 
when asleep, \^ithout your knowledge ?" Ans. " Why, Doctor, the 
fact is, that from the various experiments I am told you have madfe 
on me, I really do not know what to think of it." "Well, Madam, 
suppose I were to perform the operation one of these days, and to 
inform you of it when you would awako, would you believe me, and 
could you control your feelings, on finding that it had been done ?" 
Ans. " I could not suppose that you would deceive me, and of course 
I would be very glad, but would try not to give way to my feelings." 
*' Have you perceived, since your arrival here, or do you now perceive, 
any change in the ordinary sensations of the affected breast ?" " No, 
sir, it feels about as it has done for some time back." About^a 
quarter of an hour having elapsed since she awoke, I then told her 
that, as we found her in a proper state for the operation, I had per- 
formed it, and that the breast was now removed. She expressed her 
incredulity — said I was certainly jesting, as it was impossible that it 
could have been done without her knowing it at the time, or feeling 
anything of it now. She became convinced only on carrying her 
hand to the part and finding that the breast was no longer there. 
She remained apparently unmoved for a few moments, when her 
friends, approaching to congratulate her, her face became flushed, 
and she wept unaffectedly for some time. The wound healed by the 
first intention. 

In laying the above narrative before the Profession, it is due to the 
cause of truth to state, that it has been submitted to all the Physicians 
present at the operation, and that I am authorized by them to say 
that it accords in every particular with their own observations so far 
as they were present. I should also add that, having no other object 
in view than the establishment of the fact that a surgical operation 
may be performed under such circumstances without the conscious- 
ness of the patient, I have designedly avoided any mention of the 
various and interesting mesmeric phenomena manifested prior and 
subsequently to the operation. These have been carefully and judi- 
ciously recorded by Mr. Kknrick, whose well directed zeal has 
enabled him to collect a body of highly important facts from a field 
unfortunately explored too exclusively by ignorance and charla- 
tanism. 

Augusta, (Ja., 1st February, 1810. 



120 Cachexia Africana. [March, 



Pakt II.— reviews and EXTRACTS. 

Obsprvafions on the Cachexia Africana, or the habit and effects of 
Dirt-eaiing in the Negro race. By W. M. Carpenter, M. D., 
Prof. Mat. Med. in the Louisiana Med. College. (New Orleans 
Medical Journal, No. 8.) 

The nature and treatment of tlie diseases which seem to he pecu- 
liar to the Afrjcan race, present questions of deep interest to the 
the Southern physician. Among these diseases none is more worthy 
of the attention of the pathologist than that upon which Professor 
Carpexter has written, nor has any subject equally interesting re- 
ceived less attention from the physicians of our section. No Amer- 
ican physician, we helicve, has noticed it. But in the West Indiet?» 
where the habit prevails to a great extent, it has excited considerable 
interest, and a number of articles have been written upon the subject. 
We are much pleased that Prof. Caepekter has laid before the pro- 
fession the valuable results of his observations of this singular malady, 
and we very much regret that our limits prevent us from extracting 
the entire article. 

In the Southern Slates, dirt-eating is of frequent occurrence, par- 
ticularly on large plantations which occupy unhealthy localities. It 
is not so common however in this region as it appears to be in some 
of the South-Western States. We are informed by Dr. C. that in 
Louisiana, large planting establishments have been entirely broken 
up by the extensive mortality amopg the slaves, resulting from this 
pernicious habit. 

^^ Symptoms. — The initial and essential feature of (his disease, is a 
depraved appetite, causing an invincible craving for earthy substances, 
and so strong is this desire, that it generally triumphs over every effort 
to prevent the practice; and such is the i;idomilable force of the 
habit, that neither holts, nor bars, nor punishment, flor the certainty 
that it will inevitably end in death, can in any measure prevent 
their indulging in it — 'The only appreciable signs of mental activity,' 
says Dr. Craigin, 'exhibited during tlie course of this disease, are the 
crafty and cunning plans which the patient most subtily matures, and 
as stealthily executes, to procure his desired repast.' They usually 
fix upon one article, as preferable to the rest, but in its absence wiil 
readily indulge in those at hand. The iirticles most frequently eaten 



1840.] Cachexia AJ vicuna, 12" 



are clay, mud, dried mortar, plater, lime, d'.i>f, ashes, chalk, tobacco 
I'ipes, slate, bricks, sanri, rotten wood, rags, hair and some other un- 
ratural substances. iMr. Hunter states that, in Jamaica * thoy are 
Jondest of a kind of white clay, like tobacco-pipe clny, with which 
ihey till their mouths, and allow it to dissolve gradually, and express 
as much satisfaction from it as the greatest lover of tobacco could do.' 
lij Surinam, Dr. Craigin found (hey generally preferred to eat the 
fossil shells, of which a bed lay near the surface : and the streets of 
the towns were made and repaired with the same material. 

"As the symptoms, resulting from or accompanying dirt-eating, 
are trivial in the beginning, and very slowly progressive; and as 
they only come under the observation of the physician, in the latter 
stages, and after a considerable lapse of time, when they have assu- 
med a serious aspect, it becomes difficult to determine what is the 
order in which they apppar. On enquiry, however, it will generally 
be ascertained, that the first symptoms that attracted the notice of the 
patient, are those indicative ofmoreor less serious derangement of the 
digestive functions. The bowels are irregular in their action ; in some 
cases habitually constipated, in others the constipation alternates with 
spells of diarrhoea. Heart-burn and flatulency are common symp- 
toms at this stage ; and many patients complain of loss of appetite, 
or of vomiting after their meals. In some cases there is slight fever 
occasionally, or sensations of burning in the palms of the hands and 
fiiQt, The patient, at this earl}- stage, frequr^ntly begins to exhibit an 
inclination to avoid efl<)rt of any kind, skulks from work, and some, 
times pleads indisposition ; but as he conceals the true nature of the 
case, looks as well as usual, and can oidy designate a slight derange- 
ment of the bowels, or some other disorder, of an apparently unlm- 
portant nature, his plea is generally heard with suspicion, or rejected. 

This state of things continues for some time ; the disease pursues 
its insidioiis course ; the patient retains a degree of embonpoint which 
might easily delude the observer, in regard to the gravity of the case. 
A closer examination, howevei*, will reveal the extensive lesions that 
exist in the structure or functions of the vital organs. 

"The whole body has a full, and rather edematous appearance; 
and the skin is dry, sometimes smooth, but more frequently scurfy or 
furfuraceous, and it generally has a turgid or shining look. The 
face has a peculiar tumid but flabby fulness ; and those portions of the 
body which usually abound in fat, retain their full appearance, though 
they are wanting in their ordinary eias;tic resistance. The muscular 
])aits of the arms and legs still have their roundness, but feel soft 
and flabby. The feet, ankles, and hands are almost always cedema- 
tous, pit under pressure of the flnger, and retain the impression after 
the removal of the force. Dr. Craigin observed, in some cases, and 
in some parts of the body, a peculiar state which he compared to the 
condition of the tissues in elephantiasis, in consequence of the elasti- 
city of the integuments and of the sub-cutancous tissues. There is, 
however, one trait in elephantiasis that I have not seen in this discaijc; 



128 Cachexia Africana. [March, 



nnd that is, tlie hypertrophy of the skin itself; for thoufrh the sub- 
cutaneous tissues are otien hypertrophied without oedema, vet the 
skin in a great monsure retains its thinness. The eye is prominent, 
being rendered so by the abundance of the adipose tissue of the orbit, 
and tr.e lids are often pufTy or cedematous. The eye has generally a 
languid, unmeaning look, devoid of vivacity. The conjunctiva has 
generally a snouy v.hite or dirty yellow and jaundiced appearance. 
Dr. Craigin says, that in all the cases he saw in Surinam, it was 'of a 
peculiar snowy whiteness, untinged by a particle of red blood.' This 
condition however is by no means universal here, and the jaundiced 
appearance exists in a large number of the cases. The palms of the 
hands, and soles of the feet, are strikingly white and pale ; the lips, 
gums, and the whole mucous membrane of the mouth, are remarkably 
pale and anaemic, and the 'tongue which in health performs its duty 
with so much alacrity, lies bleached and bloodless, scarcely able to 
represent the motives of its owner.' 

'* These symptoms are referable to an ana?tnic condition, or rather 
to a condition characterized by a great deficiency of the red globules 
of the blood. In several cases, blood was drawn, and it always pre- 
sented the same characters, but varying in degree. In general it has 
a thin but turbid appearance ; the globules having a peculiar pur- 
plish colour, somewhat like that of pale claret lees ; and floating per- 
ceptibly apart, separate, or in little groups, in the large mass of serum. 
The proportion of clot to the mass of blood is remarkably small, 
though the organic solid matters of the serum, are, in quantity, as 
great, or even above, the ordinary standard. I regret, not to be able 
to give exact numerical data respecting the quantities of the ele- 
ments of the blood in these cases, as I only analyzed the blood in one 
case, and my notes on this analysis have been mislaid. In this case 
the solid matter of the clot was less in weight than that obtained by 
Andral and Gavarret from the blood of chlorotics ; the solid organic 
matters of the serum, to the contrary, were abundant, and the serum 
coagulated at a temperature of 153* of Fht. 

"The patient is excessively dull; sometimes stupid almost to 
idiocy; is very susceptible to the influence of cold, and 'delights to 
bask in the sun's rays,' or to hang over a fire, even in the hottest days 
of summer. 

"As the disease progresses, function after function becomes deran- 
ged, and soon the physiological balance is completely destroyed. 
Cutaneous transpiration is almost completely suspended, the urine is 
sometimes diminished, but in other cases greatly augmented in quan- 
tity, and there is often an irritable state of the bladder, which is ex- 
ceedingly troublesome, in consequence of its giving rise "to repeated 
calls -to urinate, which are so urgent and painful in some cases, that 
the patient has not time to walk a few steps, or even to get out of 
bed, before the urine is discharge. In two or three cases, that have 
come under my observation, this condition existed to such a degree 
as to amount to absolute incontinence, but apparently, without any 



1845.] Cachexia Africa na, 129 



paralysis about (he neck of the bladder, and depending solely on the 
intolerance of the bladder to the presence of urine. Some of these 
patients have assured me, that they were oblifjed to micturate twenty 
and thirty times in the course of the night ; others that they had calls 
of the same kind every few minutes, and being worn down by the 
disturbance, thev no longer got up, but had made provisions which 
prevented the necessity- of rising. In women there is generally sup- 
pression of the cafamenia, which, in some cases, however, are gener- 
ally re-established whenever there is for a short time an improvement 
of the general condition. 

" Instead of the constipation, which is the most common condition 
of the bowels in the earlier periods of the disease, we have in this ad- 
vanced stage, almost incessant diarrhoea. The stools are of variable 
consistance, and pale or yellowish, sometimes mixed with mucus or 
pus, or streaked v\ith blood. The abdomen is not generally tender 
when pressed, but is generally flaccid or tympanitic ; and the mesen- 
teric glands can rarel}^ be felt. 

"The disinclination to exercise now amounts to actual lethargy; 
and the slightest exertion, such as walking a short distance, or even 
rising up, produces an overpowering sense of fatigue and lassitude, 
attended by an oppression of respiration, painful palpitations of the 
heart, which are often audible to the bystander ; the carotid and tem- 
poral arteries beat strongly, and a distressing throbbing is felt in the 
head. 

"The patient is completely overcome by any attempt to walk up 
an acclivity, and when obliged to perform any labour that requires ac- 
tive exertion, or to walk briskly, particularly when it is hot, will some- 
times sink suddenly to the ground overpowered and exhausted, and 
sometimes in a state of sufibcation or of syncope. 

"When the patient is quiet, these painful feelings are relieved or 
diminished though the dyspnoea still continues to some extent, the 
heart's action remains laborious, and in some cases the painful throb- 
bing in the head, disturbs and almost prevents sleep at night. I havo 
seen cases in which this symj)tom causes more distress and complaint 
than in all others; and some, if not all, thus affected died suddenly, 
nt night, I suspect, from effusion upon the serous surfaces or in the 
ventricles of the brain. 

"Notwithstanding, however, that the visible signs of disorder, are 
diminished by rest; careful auscultation easily detects the important 
ftmctional or structural lesions which, according to my observation, 
invariably attend upon the advanced stages of this disease. The 
pulse is, in general, rather small, but tense, and varies in frequency 
from 90 to 120 a minute. In two or three cases, I observed pulsationa 
of the jugular veins which were synchronous with the pulse, and,' in 
these cases, thought that the signs afforded by auscultation, indicated 
hypertrophy of the ventricles and dilatation of the auricles : in one 
case, my diagnosis was confirmed by post-mortem examination : one 

9 



130 Cachexia Africana, [March, 



of the others is still living, and I hope to know the. condition in case 
of her death, which can scarcely fail to take place soon. 

"The derangements of the heart's action seem, in the early stages 
of the disease, to be sympathetic, or perhaps dependant on an irrita- 
ble condition of that organ ; but as the disease progresses, changes 
soon take place in the structure of that organ, and in the latter stages 
auscultation almost invariably indicates the existence of structural 
lasions of the heart or its appendages. Tn no one instance, have the 
post-mortem examinations failed to confirm the indications, afibrded 
by auscultation, of the existence of these lesions. 

"The examination of the respiration generally aflbrds no very 
decided results. The dyspnoea which in some cases amounts almost 
to an asthmatic state, is generally aggravated by a horizontal posi- 
tion, especially when laying on the back, and is sometimes so urgent 
as to require that the patient should be propped up in bed continually. 
This dyspna3a however seems to depend upon the cardiac lesion, and no 
correspojiding sign can generally be detected in the function of the 
lungs. The respiratory murmur is sometime^ wanting over small 
portions of the chest ; the mucous rale is frequently heard, but there 
seems to be nothing constant or definite in the condition of the lungs. 

"With the heart it is different. Its irnpulse'is generally very 
strong, and can be distinctly perceived in some cases, over the en- 
tire chest; and though its sounds and impulse are increased by exer- 
cise, they retain, when the patient has ]>een long at rest, a degree of 
energy much greater than in the normal state. The bruit de soujjlet 
is a common symptom, and indeed may be said to be rarely absent. 

"In liot weather, the symptoms are generally aggravated; the 
bowels are more deranged, the heart more irritable, and the disturb- 
ance of the circulation greater, the dyspnoea more urgent, the extrem- 
ities become cxjdematous, and menstruation in the woman ceases. 
It is consequently in summer, that the disease, when left to pursue its 
course, naturally tends to a fatal termination. This however is not 
the case, in, perhaps, a majority of the cases; for as far as my ob- 
servation extends, the greater number go offin winter; not from the 
immediate effects of the disease, hut from attacks of acute diseases, 
particularly acute pleurisy and pericarditis. 

"Cool weather is highly favorable in its effects on the general 
course of this disease, and I have seen several cases in which there 
appeared to be a complete restoration of the health in winter; the 
patient would seem well, be able to perform active work, and in wo- 
men the catamenia become restored. I have known several women 
thus adected, who became pregnant, and bore children during the 
existence of this improved condition. It is probable that, in cases 
in which the habit had not been continued so long as to produce im- 
portant lesions of the heart, and other organs, the amelioration of 
the symptoms, resulting from favourable weather, might become per- 
manent, if the habit could be broken. The respite, however, gener- 
al I v terminates soon alter hot weather sets in, the next summer ; the 



1845.] Cachexia Africana. 131 



symptoms soon assume a more formidable character than before the 
respite, and a brief period brings the fatal end." 

The diagnosis is oftentimes very difficult, as the cardiac derange- 
ments, and chlorotic symptoms which result from dirt-eating, may 
depend upon other causes. In these cases we have no aid in the in- 
vestigation from the patients, for in almost every instance they will 
most pertinaciously deny the existence of any such habit, and they 
often evince a degree of cunning in their attempts to evade detection, 
in remarkable contrast with the stupidity which usually characterises 
the subjects of this unnatural appetite. Dr. Craigin, and Dr. Car- 
PEXTER also, regards as pathognomic, the white and pallid appearance 
of the palms of the hand, and soles of the feet, but more especially 
the bloodless and blanched appearance of the inside of the lips, gums, 
tongue and lining membrane of the wiouth. 

"The tongue and gums often have the peculiar translucent and 
pallid hue of white wax. These appearances have never been absent 
in any case of confirmed and habitual dirt-eating, that has come 
under my observation ; and from these symptoms, if existing in the 
marked degree which is common in this disease, and accompanied 
by the general aspect of these patients, I feel safe in pronouncing 
unhesitatingly upon the existence of this habit. In numerous in- 
stances the patient, as well as the master, will positively deny the 
existence of any such habit, but if those signs are present it is a 
strong indication, and in such cases 1 have always been able, in a 
short time, to establish the fact to my own satisfaction, and generally 
to that of all parties. 

"As there are cases of chlorosis in which the apparent conditions 
of this disease are represented, it sometimes becomes difficult to dis- 
tinguish between them. Indeed, the condition arising from dirt-' 
eating," constitutes a peculiar variety of chlorosis, produced by a 
special cause, and characterized by highly aggravated symptoms. 
The extraordinary whiteness of the tissues of the mouth, may serve 
in some measure to direct us, tor thougii the general complexion, in 
chlori.sis, is callow, I have never seen a case of it in which the mu- 
cous lining of the mouth had the bleaciied aspect observable in the 
least marked of these cases." 

The prognosis is generally unfavorahu' — Without the habit is bro- 
ken up at an early period, which can rarely beeUccted, the treatment 
will consist in but little more than a palliation of some of the more 
distressing symptoms In the West Indies it is looked upon as equally 
fatal with phthisis. 

" Notwithstanding the possibilily of curing this affection, when 



133 Cachexia Africana. [March, 



treated under favourable circumstances, it must be admitted, that 
cases of cure are remarkably rare ; owing to the inveterate obstina- 
cy with which the habit is persevered in. But few cases have come 
under iny observation, in which the habit could be considered as 
eradicated, .and the patient permanently cured. Mr. John Hunter, 
states that, in Jamaica, 'a negro labouring under this malady, is 
considered as lost. On many estates, half the number of deaths, on 
a moderate computation, is owing to this cau^•e.' All other writers 
confirm his statements respecting the difiiculties encountered in treat- 
ing this affection in the West Indies, and it is to be regretted, that 
in this countiy, the results of various expedients, and modes of 
treatment, have afforded but little better results." 

"Tfie length of time required by this affection to run through its 
course to a fatal termination, depends upon so many circumstances, 
that no general rule can be applicable to all cases. I have seen 
negroes, who had been in the habit of eating dirt, occasionally, for 
four or five years, and who had only indulged so far as to induce the 
dyspeptic state which constitutes the premonitory stage of more ag- 
gravated cases. One case of this kind terminated in general anasarca 
of which the patient died ; others are still living. This, however, is 
by no means the usual course of the affection, lor it is rare that these 
patients exercise the slightest control over their inclinations : the 
habit becomes a passion with them, and the derangements resulting 
from it generally end fatally in a few years. M. Hunter says, that 
in Jamaica, when carried to excess, perhaps with a view of commit- 
ting suicide, it is sometimes very quickly fatal, and ' there are in- 
stances of their killing themselves in ten days.' " 

Considerable difference of opinion prevails as to the causes which 
produce this affection — Unwholesome food, prolonged abstinence, 
and irregularity in eating, have been mentioned as causes, but every 
^ one conversant with the disease must be satisfied that such opinions 
are erroneous, for in many instances it prevails among those who 
have an abundant supply of wholesome food, and at regular hours. 
JoHiv Hu^'TER considered the affection as being in its origin "more 
a mental than a corporeal affection." However true this may be of 
some rare cases, it cannot be so generally, for the disease is of frequent 
occurrence even among young children. The influence of example 
often causes an extension of the habit when once it has been estab- 
lished on a plantation. We are fully convinced that most cases 
depend upon a depraved state of the digestive organs, brought on by 
long exposure to a malarious atmosphere, for cases in adult negroes are 
rare in healthy localities. Prof. Carpenter considers an unwhole- 
some atmosphere as a predisposing cause. 



1845.] Cachexia Africana. 133 



"Flat swampy and insalubrious regions seem to predispose io this 
disease ; for tlioiigh we meet with occasional isolated cases on plan- 
tations of the higher and rolling lands of this State, the disease, in 
these districts, is rarely seen aflecting a large number of negroes on 
the same plantation, as is sometimes the case in low and unhealthy 
sections of the country. There are many plantations situated on the 
banks of the rivers and bayous of this State, on which so many ca- 
ses have occurred, as sometimes to create alarm, and, in one or two 
instances, to cause the desertion of the places. Instances of its ex- 
tensive prevalence on plantations are common on Bayou Lafourche, 
though they are said to have been much more so, some years ago. On 
the Bayou Boeuf, particularly in the parish of Rapides, it seems now to 
be causing great mortality, and on the banks of the Mississippi River, 
and the Teche, instances have likewise come to my knowledge." 
******** 

^^ Paihologrj. — In describing the appearances, 1 would be under- 
stood, not as desiring to establish upon these {qw observations, 
any general conclusions respecting its pathology ; but only as indica- 
ting the lesions which, in these particular cfises, appeared to me toariso 
from, or to have some relation to, the disease under consideration. 

*'The first thing that attracts notice in mnkinir post-mortem ex- 
aminations of these cases, is a peculiarly pale and anoematous appear- 
ance of the muscular tissues. The adipose tissues, so far from being 
much reduced in quantity below the usual standard, are generally 
abundant, filling up the spaces usually occupied by it, between the 
muscles and other organs, and giving to the body and limbs a rounded 
and plump appearance. 

'*The contents of the abdomen present the same pale appearance 
as the muscles, but even in a more remarkable degree ; the stomach 
being white and flaccid, the lining membrane appearing soft, but 
possessing in fiict its ordinary consistency, and is poorly supplied with 
blood vessels, excepting sometimes, a few sinal' distant patches, which 
are vascular and reddened, and sometimes slightly ecchymosed. The 
intestinal canal partakes throughout, of a similar gruoral aspect; 
is pale and thin, and sometimes prest^nts a rejiiarkahly diaphanous 
or almost transparent appearance. This cliaracter appears more 
striking in the small intestines, though it is sometimes equally so in 
the colon. Scattered at considerable distances apart, along the in- 
testines, the reddish patches are discernablc and in one or two cases 
I have detected ulcerated patches, which were more common in, 
though not confined to, the large intrstines. These ulcerated patches 
by no means correspond to the glands of Peyer and .Bninner, but 
appeared to be merely spaces fronj whic-h the epithelium was remov- 
ed. The glands above nn'ntioned, exhihited signs of irritation and 
engorgement in several cases, and it is probable that they may bo 
ulcerated in some. The mesenteric glands were enlarged in some 
cases, and in one case, several of them contained tuberculous deposits; 
in this case however, tubercles also e\i«^tpd in thi^ lunrr??. The liver 



134 Cacliexia Afrkana, [March, 



and spleen were each enlarged in some cases, but in others appeared 
nearly natural ; and the gull bladder vaiies as usual in chronic cases, 
in its dimensions, the quantity and colour of its contents, but presented 
nothing special or worthy of remark. The kidneys, which 1 expect- 
ed, from the symptoms of some of the cases, to find altered, were 
apparently of a normal size and consistence. The bladder, I have 
several times, found to exhibit traces of inflammation, about tho 
neck, and extending along the urethra. The womb, in the case of a 
woman who had only been delivered about a month before, was about 
three and a half inches long, and remarkably white and granular in 
its structure, and very friable (1.) 

"The earthy matters cannot invariably or perhaps generally be 
detected in the alimentary canal, which may be accounted for, by 
the circumstance that in many cases, severe diarrhoeas precede their 
fatal termination, and remove all of these matters which are not im- 
pacted in the intestinal pouches, or concretions which cannot readily 
pass through the narrow portions. In those cases however which 
terminate suddenly, in consequence of acute attacks or other acci- 
dents, without having been subject to severe diarrhoeas, the earthy 
matters are generally detected with ease. In some cases it is found 
in grains or fragments dispersed through the ftecal matters, but in 
others they are more or less agglomerated by mucus in different por- 
tions of the canal ; and in one case I found the earthy matter (alum- 
inous clay), occupying three or four of the sinuses of the colon, in 
the form of hard concretions, which fitted the shape of the pouches 
so nicely as not to be easily removed. The surfaces of these con- 
cretions, w hich presented towards the canal, w'ere smooth and cover- 
ed by an envelope of tenacious mucus, probably left by the faeces 
when traversing it, and this mucus seemed to be continuous into the 
substance of the concretions, which indeed appeared to have increas- 
ed in size by particles of earth lodging in, and being cemented to the 
masses by mucus. The abdominal serous tissues do not seem to bo 
generally the seat of any remarkable changes, though that cavity fre- 
quently contains more than the ordinary quantity of serum. 

"The contents of tlie thorax exhibit the most important pathologi- 
cal changes. The lungs themselves are not generally diseased, and 
we only find in them lesions, arising from influences in a great mea- 
sure independent of this disease, and such as are frequently found 
accidently co-existing with other diseases, such as engorgements, 
hepatization, tubercles, &;c. The pleura, however, very frequently 
shows marks of old or recent inflammation, and itscavity contains an 
unusually large, sometimes immense quantity of fluid, of a disagree- 
able odour, and with or without flocculi. The heart or its appendages, 
I have never failed to find diseased. One or both ventricles are gen- 

(1.) In this case the child was born at full term, it nursed well and was, be- 
Fides, fed with appropriate articles of food, but notwithstanding its gradual 
growth, it weighed at the age of four weeks, only three pounds. — It died a fpw 
days after the mother. 



1»45.J Cachexia Africana. 135 



erally found hypertrophled, sometimes enormously so; and the auricles 
are sometimes dilated. There seems to be no constancy in the rela- 
tions between the hypertrophied condition of the ventricles, and the 
dilatation of the auricles. The muscular tissue of the ventricles is 
always paler than natural, and even when hypertrophied has a fiabby 
look and feel, and there is an evident want of that firmness of struc- 
ture which naturally characterizes this muscle. Another singular 
condition, which existed in a remarkable degree in two cases examin- 
ed by me, in a somewhat less degree in one other case, and which 
may in fact be observed to some extent inmost of these cases, was the 
accumulation of fat about the heart, and in the tissues of the thoracic 
septum. In several cases, the fat has been abundant about the baso 
of the heart, occupying the tissues about the auricles and base of the 
ventricles, though not appearing, in any extent, to penetrate the mus- 
cular tissues, but lying over the surface or occupying depressions, and 
forming large bunches, which are sometimes connected round in such 
a manner as to constitute a prominent collar-like mass, surrounding 
the base of the heart, and partly enveloping the auricles. As this 
condition coexisted in each of the cases in which the developements 
of the fatty masses was greatest, with dilatation of one or other of the 
auricles it might be supposed to have caused this dilatation, by ob- 
structing the free passage of the blood from the auricles to the ventri- 
cles ; this however can only be established by a greater number of 
observations. It would perhaps be supposed too, tiiat this lesion 
should occasion some marked modifications in the cardiac sounds, but 
though careful auscultation was practised in each case, I was not led 
in either of them, to sus{>ect any thing more than a degree of hyper- 
trophy of the ventricles with more or less dilatation of the auricles. 
Of the eight well marked cases that I have examined after death, 
three exhibited hypertrophy of both ventricles ; two hypertrophy of 
both ventricles, dilatation of the right auricle, with a considerable 
hypertrophy of the adipose tissues at the base of the heart ; one, hyper- 
trophy of the right, and slight hypertroj)hy of the left ventricle, dila- 
tation of the right auricle, h\ |)ertropI)y of the tat at the base. 

1 have had no opj)ortunity of making examination of cases dying 
during the earlier |)eriods of tlie disease, but wotjld inf >r, from the 
indications obtained by auscultation, that the lesions of the heart are 
primarily, only functional, and that the structural changes arise at a 
later period. For in the earlier stages, though the heart's action is 
tumultuous, after exertion, it soon becomes composed by rest; where- 
as at a later period the heart labours incessantly, but issjlil! augmented 
by motion." 

As we have already rcjiiarkcd, the disease is most generally 
fatal. AH treatment must be unavailing unless the habit of dirt- 
eating is broken up, and this cannot often ho effected. Some 
persons resort to severe punishments in order to deter the patient 



13Q Cachexia Africana. [March, 



from his unnatural indiilgcncies. We entirely agree with Frof. C. 
in condemning this comse as cruel, because it is almost uniformly 
inefficacious. Others confine the patient in tight rooms; but as this 
course deprives him of proper exercise, and pure air, it is of course 
injudicious. The plan employed in the West Indies, and recom- 
mended by Dr. Cakpentj:ii, is to cause the patient to wear a close 
wire mask, secured by a lock, which prevents him from eating im- 
proper articles, and allows him at the same time to take free exercise, 

"One of the most important measures, not only in reclaiming the 
subject from the habit, but in relieving them of the cachectic state, is 
the establishment of an appropriate system of diet. 

"The nature of the diet should of course correspond to the stage 
of the disease in which each individual is seen. When the case is 
only so far advanced as to prevent the chlorotic condition, with a de- 
gree of functional disturbance of the heart's action, we may expect 
the most decided advantage from the use of fresh and easily digested 
animal food, well seasoned with capsicum ; and we may sometimes 
permit the occasional use of other stimulants, as a little wine, or even 
brandy, in fact a generous diet. When, however, we find the pa- 
tient laboring under the symptoms of organic lesions of the heart, or 
under diarrhoea or other symptoms of irritation or ulceration of the 
bowels, it will of course require a corresponding modification of the 
diet; and we may in these cases obtain good results from the em- 
ployment of bland, very easily digested, but at the snme lime very 
nutritious substances, such as animal jellies, or amylacious prepara- 
tions seasoned with cinnamon, or other appropriate spice. A fish 
diet has been insisted on most strenuously by some w ho have studied 
this affection and seen the various methods of treatment, in practice ; 
and it is easy to imagine, that when the bowels are in a condition to 
tolerate such food, it might answer a good purpose ; indeed, 1 have 
seen cases that have improved rapidly on this diet, though, as they 
were sent to the sea-shore, it would perhaps be nearer the truth to 
attribute the amelioration to change of air. 

"Next in importance to a proper diet, in these cases, certainly 
stands a change of air, to a higher region or at least to a healthy one ; 
and if a change to the sea-shore is practicable, if is to be preferred. 
In cases in which this has been practised, tjiey have almost invariably 
improved, and the improvement, in son^.e cases, seems to have been 
permanent. 

"Upon these means of improving the general health, our principal 
chance of cure depends; and in some favorable cases nothing more 
is required. Edwards, in his history of the West-Indies, says, 'the 
best and only remedy is kind usage and wholesome animal food ; and 
perhaps a steel drink may be of some service.' 

" In regard to the medical treatment, we must be directed by gen- 
eral principles, in the application of remedies directed against the 



1 845.] Extraction of Foreign Bodies from the (Esophagus. 1 37 



conditions which give rise to the groups of symptoms. Thus, with a 
view of removing the chh^rcsed state, tonics ^Yiil be proper, particu- 
lariy the preparations of iron ; and the aromatic stimuhints, especially 
cinnamon, canella alba, or winter's bark. The bitter tonics may be 
beneficial in some cases ; among these, the best will probably be 
quassia, simarouba, cusparia or gentian. If cathartics should be re- 
quired, rhubarb seems to fulfil the indications in this particular case, 
and has been most generally recommended. 

" The acute infianimalions which frequently attack the pericardium 
and pleura, generally yield promptly to local depletion, and the dis- 
tress arising from the tumultuous action of the heart is generally 
much diminished by the same means: indeed, notwithstanding the 
thin state of the blood, I have never seen small local depletions act 
more favorably than in these inflammations ; blisters may perhaps be 
applied in some cases with advantage, but it has appeared to me, in 
the one or two cases in which I used them, that they rather increased 
the effusions into those serous cavities, particularly into the pericardi- 
um. Hydrocyanic acid, and digitalis, hy allaying the inordinate 
action of the heart, greatly promote the comfort, and perhaps improve 
the general condition of the patient. 

"Both Dazille and Mason, laud the operation of emetics in this 
affection, and recommend that they should be followed up with brisk 
purgatives. Mr. Mason recommends, as atonic laxative, an inlusion 
of quassia, rhubarb, and ginger, and it is unquestionably well adapted 
to many cases requiring the action of purgatives. I cannot, however, 
see what advantage is to be gained by the use of emetics in any case, 
and should regard them as decidedly dangerous in many instances." 

We cannot conclude this article without an expression of our 
gratification, that the public attention has been called to this curious 
malady, and we trust that others will follow the example and lay be- 
fore the profession their observations of the modifications of morbid 
action which result from the peculiar physical constitution of the negro 
race. 



Extraction of Foreign Bodies from the (Esophagus. From Mr. 
List on s recent Lectures on the Operations of Surgery. 

How arc foreign bodies in the gullet to be got out ? ^ It will depend 
very mu^h on their sort and size and situation. You will not set 
about taking out needles or pins in the same way that you would 
large lumps of gristly meat, bone, coins, or any other hard body that 
may have lodged in the passage. 

Foreign bodies in the oesophagus and pharynx cause a great deal 



138 Exlraction of Foreign Bodies from the CEsovhagus. [March, 



of pain when the part is put in motion. If it be a hard and sharp 
body, there is a pricking sensation; if the body be of large size, the 
passage may be obstructed, the breathing may even be affected, as I 
have said ; at all events, the patient will be unable to swallow any- 
thing. A very small solid substance will obstruct the passage com- 
pletely when the patient is naturally very nervous, or the part is at all 
diseased. Patients who have a difficulty of swallowing become ner- 
vous : hysterical women are choked with very small substances, and 
patients who are laboring under stricture or organic disease of the 
oesophagus may have the passage closed from the lodgment of a very 
small portion of food. I have repeatedly seen cases of this kind. I 
recollect a woman, who came to me three or four times within two 
years, complaining that the passage to the stomach was completely 
closed. By introducing a small probang, the obstruction was disco- 
vered in the usual place ; a piece of meat vvas pushed through the 
contracted portion of the canal, and she was relieved. She would not 
suffer the introduction of instruments for any other purpose. 

Suppose that a large piece of gristly meat, or a large piece of 
tripe — oh ! indeed, you need not smile at this, for you will find in 
surgical books many accounts of persons who have been choked with 
tripe — gets entangled in the narrow part of the canal, immediately 
behind the cricoid cartilage, you must consider how \'ou are to re- 
move it. By introducing a probang you may, it is true, push it down 
to the stomach. A piece of whalebone, with a sponge at the end of 
it, will do very well. In introducing an instrument for any purpose 
into the pharynx or oesophagus, you must look to the position of the 
head, and bring all the tube, fauces, pharynx and oesophagus, as far as 
possible into a line with the month. For this purpose you throw the 
head very well back, depress the tongue with the finger of the right 
hand, and push the instrument back to the forepart of the vertebrae, 
where you guide and bend it suitably with the finger. Just as you 
get it behind the velum, and into the top of the pharynx, you desire 
the patient to swallow his saliva. By this action the instrument is 
drawn back into the throat, the rima glottidis is closed, and you then, 
with the greatest security, push the instrument downwards, certain 
that it will go in the right passage. You continue to push it onwards 
till you meet with some obstruction. But there are foreign bodies 
whir.h it would be very unsafe to push down, such as a piece of rough 
bone or cartilage, or hard gristly meat. You might tear the passago, 
or cause a rupture of it, and this would be attended with xary serious 
consequences. Infiltration in the loose cellular membrane, putrid 
abscess, and death, have not unfrcquently followed rash operations 
of this kind. If the foreign body is of such a nature that you cannot 
push it down safely, you must bring it up if you can. For'this pur- 
pose you must be provided with instruments of various forms. Here 
is a pair of forceps well suited for removing hard meat. You feel that 
there is something obstructing the canal ; you open the instrument- 
on the foreign body, seize, and extract it. I have taken out many 



1 b45. J Extraction of Foreign Bodies from the (Esophagus. 1 39 



lumps of meat in that way. If the foreip;:i body is hard — a piece of 
l)one or a piece of metal — you seize it with such forceps as these. 
The blades are made to open in diti'erent ways, according to the posi- 
tion in which the body lies. If a piece of metal — generally a coin — 
is fixed in the oesophagus, you may ascertain its position correctly, 
though you may well guess whereabouts it is to be found, by passing 
down a steel probe. This is the way to deal with large foreign 
bodies ; but you very often find small sharp bodies lodged in the 
pharynx — sticking deeply in the tissues composing it — pins, pieces 
offish-bone, and portions of the beards of barley. I have seen a 
great deal of irritation produced by a small husk of oatmeal stuck in 
the fauces or pharynx. These things will sometimes stick in the 
membrane for a Imig time ; but you must recollect also that these 
patients will often complain of a foreign body lodging in some por- 
tion of the passages long after it has got into the alimentary canal. 
The feeling of pain and uneasiness often remains a considerable time 
after the foreign body has gone away. The same takes place in the 
eye. A small fly gets betwixt the lid, for instance — no uncommon 
occurrence in riding or walking out into the country in summer — it 
causes intense pain ; you get a friend to raise the eyelid and pick 
the ^y out, but the feeling still continues, and does not goctf, perhaps 
for many hours. You must be quite sure that the foreign body is 
really lodged in the throat before you attempt to take it out. You 
bring the patient opposite a strong light, hold the tongue down, and 
then, perhaps, you see the substance : and by taking hold of it with 
small forceps, pull it out. Or, if it be low down, you hold the pa- 
tient's head back, and with your finger feel down by the epiglottis, by 
the root of the tongue on each side, and if your nail is a little long, 
you may entangle and bring up the foreign body between the finger 
and the nail. I have even taken pins and needles out in this way. 
But you may not be able to reach the foreign body in this manner, 
and you must then use the forceps. You will find a difiiculty in dis- 
entangling needles ; you are obliged to humor them, moving tiiem first 
m one way and then in another,arjd atlast you will succeed in extract. 
jf)g them. Pieces of wire, nails, ti^c, are sometimes lodged here, and 
great caution is required on the part of the surgeon in handling them. 

I should have stated that coins are sometimes extracted by means 
of forceps, and sometimes they are removed by a blunt bent hook. 

Occasionally you find very curious foreign bodies lodged in the 
throat. The following case came under my Jiotice years ago, though 
the patient was not under my care. A boy, engaged in herding cat- 
tle, was prc])aring his fishing tackle, lie had a hook for catching 
jack, which he |)nt in his mouth in order to repair it in some way. 
The cattle, meanwhile, wandering amongst the corn; he shouted out 
on observing them, and in recovering his breath, tilling his lungs 
again, the hook slipped back into the gullet, anil there it stuck. You 
are aware that in fishing for jack, there arc used three large hooks, 
tied back to b;uk, like a grappling iron, by means of brass wire. 



140 Extraction nf Foreign Bodies from tlie (Esophagus. [March, 



There was much fuss made about this case ; the boy was brought 
from a great distance to the Hospital, and he was kept as a show for 
some time. Every one suggested some plan or other for getting out 
the foreign body. It was a case in which, had it been in the hands of 
a very energetic surgeon, cesophagotomy ought to have been at once 
performed. There appeared but little chance of the three hooks 
coming out again, and the only apparent way of getting the boy out 
of the scrape would have been to make an opening below, and extri- 
cate them by pulling them downwards. The lad had a long chain 
hanging out of his mouth for weeks together, and at last it was pro- 
posed to use a bone proba ng, a large ivory ball with a hole in it ; and 
this was to be pushed down to disentangle the barbs. By this time, 
however, extensive ulceration of the pharynx had taken place, and 
the foreign body was gulped up, to the relief both of the patient and 
of the medical" men. In cases of this kind, you frequently find that 
practitioners are as much indebted to chance as to good management. 
Sometimes foreign bodies can neither be got down nor drawn out, 
and in those cases,' as in the one I have just related, the oesophagus 
ought to be cut into. The incision should be made, not in the medi- 
an line, but by the side of the windpipe. An incision ought to be 
made in the superior triangular space of the neck, of sufficient 
Jength to enable you to get cleverly to the obstruction. The larynx 
must be turned aside, and you will take care not to come in contact 
with the recurrent nerve, or to interfere with any of the other import- 
ant organs in the neighborhood. Guided by the foreign body, you 
cut through the parietes of the oesophagus, lay hold of it, and extract 
it with forceps, vulsellum, or hook, as may be. I think that Mr. Arnott 
had occasion to perform this operation in the i'liddlesex Hospital somo 
5'ears ago, but it is not had recourse to once in a quarter of a century. 

Where there is simple contraction of the gullet, you endeavor to 
restore the passage to its natural size. For that purpose you intro- 
duce instruments, day after day, till the parts recover themselves, 
and you can pass an instrument of full size without difficulty. You 
must be sure that there is really contraction, and from thickening of 
the walls of the tube, that it is not merely an hysterical affection ; 
and you endeavor to ascertain if there is organic disease, that it la 
not of a malignant character, before you propose a proceeding of this 
kind. You would not think of destroying the stricture by caustic, as 
proposed by Sir Everard Home; it is only by very gentle manage- 
ment that you can expect to succeed, or to benefit your patient. 

You require to introduce an instrument where persons have receiv- 
ed injuries of the neck, but you would not put in a tube and retain it 
there. In bad cases, where the pharynx or oesophagus has been 
wounded, this may be done ; but in the majority of cases all you have 
to do is, from time to time, perhaps two or three times a day, to intro- 
duce a common elastic catheter, such as is employed for the urethra. 
You pass it beyond the wound, and through it inject broths and jel. 
lies. Of all this I have already fully informed you. — London Lacet, 



1845.] Contributions to Therapeutics. 141 



Contributions to Therapeutics. By J. T^rooRE NELTGA^^ M. D., 
Physician to Jervis-slreet Hospital Lecturer on Materia Medica 
and Therapeutics in the Dublin School of Medicine, (^-c. 

On the employment of Conium in painful diseases. — In the follow- 
ing communication it is my intention to offer a few practical observ- 
ations on the anodyne -and sedative powers of the common hemlock, 
and to illustrate ifs niedicinaf properties by relating a few cases in 
which its employment has been attended with much benefit. Although 
much employed and highly extolled by the ancients, hemlock had 
fallen into complete disuse in modern medicine, until the latter end 
of last century, when it was again introduced, and very generally 
used, owing to the bigh terms in which it was spoken of by Baron 
Storck, who, in 1762, published an account of the physiological and 
therapeutical properties of this drug. Stt')rck ascribed two distinct 
therapeutical properties to the preparations of hemlock ; first, that of 
a powerful anodyne and sedative, and second, that of a deobstruent 
and alterative, especially in the treatment of glandular or visceral 
enlargements, of scrofulous affections, or of secondary syphilis, and 
of chronic cutaneous diseases. In the present day but little faith is 
placed in the deobstruent virtues of the drug, and much diff;renceof 
opinion exists even as to its anodyne properties, consequently it has 
again lost much of its reputation as a medicine, and is not nearly so 
much employed as it deserves to be. 

Since the discovery of the active principle of ihe plant, this almost 
universal discredit of its medicinal powers has been very satisfactorily^ 
accounted for, as it has been distinctly proved, that the application of 
even a moderate degree of heat, when continued for any time, causes 
it to undergo decomposition, and therefore that the extract (the pre- 
paration most generally cmi)loyed) when prepared in accordance 
with the directions of the Dublin and London Pharmacopceias, is, for 
the most part, inert, or nearly so ; that this is the easel have repeat- 
edly satisfied myself, by a|)plyinjr the potash test to various samples 
of the extract of our Pharmacocpia, obtained at the best shops. This 
potash test is of so simple a character, so easy in its application, and 
so certain in its results, that we should never omit its employment be- 
fore commencing the use of any of the preparations of hemlock. It 
consists merely in triturating in a mortar the preparation we wish to 
lest with a small quantity of strong cau^^tic potash, when the peculiar 
odour of the active principle, conia, is in a few moments emitted : 
care, however, must be taken not to confound this odour with that of 
the plant itself, from which it dillers most remarkably, the latter 
bearing a singular resemblance to the smell of mice, while that of 
conia is a peculiar, penetrating, very disagreeable, somewhat alkaline 
odour, an acquaintance with which may be easily acquired by applying 
the test to the fresh green leaves, or to the recently gathered ripe,fr»iit. 



142 Contributions to Therapeutics. [March, 



In commencinp;, then, any new investigation into the medicinal 
action and uses of hemlock, it becomes of much importance to take 
especial care that the preparations of the drug which we administer 
should have their energy unimpaired, and the peculiar properties 
which exist in the recent plant as little changed as possible. The 
preparation whicli I employed in tiie following cases, and which I 
have been in the habit of prescribing for the last two years, under 
the name of Succus Conii, is simply prepared as follows : Take 
of fresh hemlock leaves any quantity, express the juice in a tincture 
press, set it aside for forly-eight hours, pour off the clear, supernatant 
liquor from the fecula^and chlorophylle wliich it has deposited, and 
lastly, add to it a fifth part, by measure, of rectified spirit. This pre- 
paration I have found to keep well for two years, and its uniform 
strength, as well as t!ie facility with which we can increase or dimin- 
ish the dose we are administering, gives it a decided advantage over 
cither the extract or powder of the fruit or leaves. The best time 
for gathering the leaves is when the plant is in full flower, and previous 
to submitting them to expression the stalks should be carefully picked 
out and rejected, the leafy part alone being used. As in many in- 
stances it is often of great advantage to possess an active preparation 
of u remedy in a solid state, I have tried many ways of preparing an 
extract of hemlock which would retain unimpaired the medicinal 
powers of the plant, and the best I find is to be obtained by submitting 
the expressed juice, prepared as above, to spontaneous evaporation ; 
but even this extract, no matter how well and carefully preserved, soon 
loses all traces of conia. 

Hemlock, when administered in medicinal doses to an individual 
labouring under disease, appears to me to produce its beneficial 
effects by allaying nervous excitability, and diminishing muscular 
pain ; under its use also, both the force and frequency oi the heart's 
action are lowered, but in no instance have I seen it produce the 
least tendency to drowsiness or sleep. This is quite consonant with 
the account given by Christison of the action of hemlock when its 
poisonous effects are produced ; " that it does not excite convulsive 
spasm, or bring on insensibility, but that it exhausts the nervous 
energy of the spinal chord and voluntary muscles, occasioning mere* 
ly convulsive tremors, and slight twitches, and eventually general 
paralysis of the muscles, and consequent stoppage of the breathing." 
The active principle, conia, according to the same able authority, 
produces a similar remarkable action on the spinal chord, "a iew 
drops killing a small animal, such as a rabbit, cat, or puppy, in a few 
minutes, causing a gelieral paralysis, sliglit convulsive tremors, and 
death from the suspension of the breathing, without any alteration in 
the appearance of the blood." Such being the effects of hemlock, and 
its alkaloid, when given in poisonous doses, it can be readily under- 
stood that when administered as a medicine it will produce no very 
apparent physiological action, and that in producing beneficial results, 
it appears to act insensibly on the system. The only manifest effect 



1845.1 Contributions to Therapeutics. 143 



which I have seen it produce is where its use has been persevered in 
for some time, or the doses rapidly increased, when the patient gen- 
erally complains of a disagreeable sensation of dryness of the throat, 
with a feeling of constriction and difficulty of swallowing, amount- 
ing to actual pain, and which always compels us either to suspend 
the use of the medicine altogether for a few days, or greatly to di- 
minish the dose in w hich it has been given. 

The diseases in whicli I have administered hemlock with decided 
advantage are rheumatic affections, both subacute and chronic, par- 
ticularly when attended with severe pain, neuralgia, and senile gan- 
grene. And although I have employed it very extensively, both in 
hospital and private practice in those diseases, I have met with but 
very few instances indeed in which this remedy failed to afford relief: 
nevertheless, some cases occasionally occur, in which, as is the case 
with most other medicines, it does not appear to produce the least ben- 
efit. I shall now proceed to give a short abstract of a \ew cases in illus- 
tration of the therapeutical virtues of this drug, a perusal of which will 
show the precise character of the disease in which it proves most bene- 
ficial. 

Case T. — Obstinate rheumatic Pains from Exposure to Cold and 
Wet, Reported by Mr. ]ME^-I^0LD. — Lackey iM'Cormick, a labourer 
on the Dublin and Drogheda Railway, aged 32 years, of a strong, 
robust appearance, witli a sallow complexion, and sanguineous 
temperament, was admitted into Jervis-street Hospital, April 14th, 
1843. He complains of a dull, aching pain in tnc inferior dorsal and 
lumbar regions, stiffness in the shoulders and knee-joints, and occa- 
sionally at the fingers at the metacarpo-phnlangeal articulations, in 
short, he states that the only joints in his body which have been 
wholly exempt from pain and stili'Mcss (not even excepting the tempore- 
maxillary articulations) are the elbow-joints. Some puffiness is appa- 
rent in tiie shoulder and knee-joints, but there is no redness, nor is 
pain increased on pressure. 'J'he pains appear to be erratic, as they 
frequently disappear from one joint, and as suddenly seize another; 
they are more distressing in the afternoon, but are not aggravated by 
the heat of the bed, or by any increase of temperature. His pulse is 
at present slow and weak ; skin cool, not perspirable ; tongue clean ; 
bowels constipated; appetite good ; urine healthy, both in appear- 
ance and quantity. 

He has been cngngod as a labourer on the railroad for the last two 
years, previous to which time he had been at work in Scotland, but 
always enjoyed good h(««Jth until he came to Dublin. His occupa- 
tion has obliged him of late to be up fre(jucntly at night in the most 
severe weather, and to be exposed to the greatest vicissitudes of tem- 
perature. After a severe wetting on one of those occasions, about 
five months since, he was attacked w ith severe pains in nearly every 
joint in his body, but he continued to work without intermission, 
although sutfering severely, until the last few weeks, when, in conse- 
quencc of the pains and stilfnc^-^ o{'^^'< Ininis Inrrcusinfr so much, he 



144 Contributions to Therapeutics. [March, 



was compelled to give up work and apply for admission into the hos- 
pital. 

On the 5th of April, the day after his admission, he was ordered 
house medicine, so as to act on the howels freely, and on the follow- 
ing day he was directed to take 30 minims of the Succus Coniiihree 
times a day in a glassful of water. 

April 11th. Since last report M'Cormink has gradually improved, 
and is much freer from pain, which seems now to he principally con- 
fined to the shoulder-joints and to the small of his hack. The dose 
of the hemlock-juice v^as increased to 4(1 minims three times a-day. 
The bowels being confined, he was also ordered house medicine to- 
day. 

April 14th. Much freer from pain to-day, but complains of a dis- 
agreeable sensation of dr)'nessof ihe throat, accompanied with a feel- 
ing of constriction, and some difficulty of swallowing. The drops 
were omitted, and he was ordered saline cathartic mixture. 

April 16th. Since the omission of the drops the pains have again 
become more severe, but the unpleasant sensation about the throat 
has cjuite disappeared. To take a grain of the extract of hemlock 
(prepared b}- the spontaneous evaporation of the expressed juice) 
every night at bed-time. 

April 18th. Twenty minims of the Sitcciis Conii to be taken three 
times a-oay : the pill to be continued. 

April 24th. Much improved to-day, the pains l)eing now confined 
to the shoulder-joints, and not occurring until towards nightfall. 
The dryness of the throat and difficulty of swallowing have, however, 
again returned. House medicine, so as to eflect the bov/els : the 
drops to be omitted. To take one grain of tiie extract of hemlock 
three times daily. 

May 1st. Quite free from pain to-day. Ordered, at his own re- 
quest, a warm bath to-night. 

May 3d. McCormick was discharged to-day perfectly cured. 

I have given the details of this case pretty fully from the hospital 
case-book, as it illustrates well the form of the disease in which I 
found hemlock prove most useful, and also as it was one in which I 
found the peculiar constitutional eficcts, which I before referred 
to, were m.ost manifestly induced. The following cases are more 
condensed. 

Case II. — Severe chronic Arthritis irilh Sicelling and Deformity 
of the Joints. Reported by Mr. ]\IA^"DEVILLE. — John Nowlan,aged 
56, a cow-driver, was admitted into Jervis street Hospital March 8th, 
1843. He complains of agonizing pains in all the joints of his fingers 
and toes, as also in the shoulders and knees, which almost completely 
deprive him of rest day or night, and render him altogether incapable 
of following his usual occupation. All these joints are considerably 
swollen and deformed, the legs being semi-flexed, on the thighs, and 
the fingers forming an angle with the metacarpal bones, slanting out- 
wards towards the ulna. The swollen parts are slightly reddened, 



1945.] Contributions to Therapeutics, 145 



and the pains are aggravated by pressure or motion, but scarcely, if 
at all, by external warmth. The pulse is small : skin bathed in a 
clammy perspiration ; tongue loaded with a white fur ; appetite bad; 
bowels constipated ; urine high coloured; countenance indicative of 
much suffering. 

He states that his present illness commenced about twelve months 
ago, and that it was caused by his being compelled to sleep constantly 
in the open air at night, and t>equently on the wet grass. Since that 
time it has gradually increased in severity, attacking joint after 
joint, and for the last two months he has been so crippled that he has 
been scarcely able to move. 

On the day of his admission into the hospital he was ordered a saline 
cathartic draught, and on the 9th of March, the next day, he was 
directed to take 30 minims of the Succus Conii four times daily. 

March 13th. Pains remarkably relieved; swelling also, particu- 
larly of the knee-joints, considerably diminished. He got out of bed 
to-day for a short time, and states that he was able to move about with 
much more case to himself than he could for the last three months. 
To take 40 minims of the hemlock-juice three times a day, and to 
have house medicine to free the bowels. 

March 23d. The drops have been continued steadily since last re- 
port without producing the least apparent constitutional effect. He 
appears considerably improved, expressing himself tolerably free from 
])ain, and as possessing much njorc power of motion in all his joints. 
The articulations of the fingers and toes are now but s+tghtly swollen, 
and have, at the same time, regained much of their natural appear- 
ance ; the knees are, however, much enlarged and painful, particularly 
at night. The dose of the Succus Conii to be increased to 60 minims 
three times daily. 

March 31st. As Nowlan complained ofsomedrynessof the throat 
to-day, with slight diflTiculty of swallowing, he was ordered to take 
two cathartic pMls immediately, to omit the drops for this day, and to 
have a warm bath at bed-time. 

April 5th. The hemlock-juice was repeated on the 1st instant, and 
continued until this day, when the same symptoms having occurred 
as on the 31stofMarch, a repetition of the treatment as on that day 
was directed. 

A|)ril 15th. The same dose of the Succus Conii was continued up 
to this date, when Xowlan, was discharged from hospital, expressing 
himself quite free from pain, and, to use his own w'ords, able to walk 
almost as well as ever he was in his life. The swelling and stiffness 
of the knees are quite gone, and it is really astonishing how little de- 
formity remains in the joints of the fingei-s. Nowlan's wife came to 
the dispensary, about a month after his discharge, to say that ho re- 
mained quite well. 

Case III. — Suh-acufe Rheumatism confined to the muscular part of 
the Calves of both Legs, Jieported by .Mr. Bray. — James Barrett, 
aged 57, a gardener, was admitted mto Jervis-street hospital, .Tun«» 

10 



146 Contributions to Therapeutics. [March, 



29th, 1844, complaining of a dull, heavy pain in the muscular part 
of his legs, extending from the inferior termination of the po|)liteal 
space to within ahout an inch of tlio malleoli. The pain is rendered 
most excruciating by his standing, or placing his limbs in any other 
than a horizontal position: he was carried into the dispensary, and 
while there lay on the ground, being totally unable to stand. With 
the exception of his present attack, he states his health to be excel- 
lent ; the pulse is regular, tongue clean, bowels free ; he passes about 
three OjUarts of very pale urine in the twenty-four hours, which does 
not contain any albumen ; the whole surface of the body is constantly 
bathed in a clamm}^ perspiration. The countenance is indicative 
of much suffering. 

He states that about a fortnight since he was attacked with head- 
ache and obstinate constipation, accompanied with profuse perspira- 
tions, during the continuance of which he went to mow in wet grass. 
He remained at this employment for four or five days, when he was 
suddenly seized with an acute pain in the calves of both legs, which has 
continued since without intermission. For the last week he has been 
rubbing the parts with soap liniment, and has also taken some medi- 
cine, but from neither did he receive the least benefit. 

On admission he was ordered a dose of cathartic medicine and a 
warm bath, and the following day, June 30lh, he was directed to take 
15 minims of the Succus Conii tlirce times daily. On the 2nd of 
July the dose was increased to 15 minims every sixth hour. The 
report of the 9th of July states that he only finds a slight pain, when 
he stands, in the calf of the right leg, but that the left is quite well. 
July 13lh he was entirely free from pain, and could walk with ease ; 
and on the 14th he was discharged from the hospital cured. 

Case IV. — Acute Rheumatism. Reported by Mr. Bray. — John 
Egar, aged 36, musical instrument-maker, was admitted into Jervis 
street hospital, July 27th, 1844. He gives the following history of 
his illness. In working at his trade he is much suhjected to extremes 
of temperature, but, notwithstanding his having been a hard drinker 
all his life, was in the enjoyment of excellent health until lately. 
About six months ago he felt a shooting pain in his right breast, 
which used to shift to the same situation on the other side, and con- 
tinued thus alternating, hcing sometimes ahsent. Twelve days since, 
on getting up in the morning, he felt an acute pain in the left instcj), 
which, on examination, he found to be red, swollen, and excessively 
tender to the touch. This was treated by the application of eight 
leeches, which gave him some temporary relief, but on the same night 
the left knee was similarly attacked ; and in two days afterwards the 
ball of the left thumb, and, consecutively, the fingers, arm, and 
shoulder of that side. A pain in the small of the back, which was 
also present from the first, became much v\^orse, and after four days 
the disease spread to the hand, arm, shoulder, and breast of the left 
side. During this time he was attended by a physician, who treated 
him by the application of sinapisms to the affected parts, and put him 



1845.] Contributions to Therapeutics, 147 



under a course of mercury, which salivated him so severely that he 
has expectorated nearly a pint of saliva within the last twenty-four 
hours. 

As he now lies in hed he is free from pain, except in his right arm 
and shoulder, where there is a settled sensation of soreness ; but on 
the least movement in the noi«^hboring muscles, his legs and back, 
together with his left arm and breast, are seized with the most acute 
pain, while the soreness on the right side is likewise much increased. 
He is thus unable to use the least motion, and he cannot even stand, 
much less walk. The tongue is loaded with a thick white fur, yellow 
in the centre ; pulse 65, hard and incompressible ; bowels constipated ; 
whole body, particularly the head, covered with profuse perspiration. 

On the 28th of July he was ordered an active saline cathartic, and 
a gargle containing solution of chlorinated soda. 

July 29th, the following mixture was ordered ; 

IJi. Succi Conii, f. |ss. 

Mistuiac Camphorce, f, fvii. ss. 
M. Cochleare ampliim sextis horis. 

July 31st. Much improved. To take a table-spoonful of the mix- 
ture every fourth hour. 

August 5tl). The pains are all gone to-day, except in the ball of 
the thumb, and the wrist and ankle of the left side, which are somewhat 
swollen and red. Two table-spoonfuls of the mixture to be taken 
every fifth hour. 

On the Gth of August the dose was again diminished to a table- 
spoonful every fourth hour, as he complained of dryness of the throat, 
and some pain in the head. On the 8th he only complained of a little 
stiffness in the left ankle-joint, and of a tired feel in his arms. On 
the 9th the medicine was stopped, and he was ordered a warm bath; 
and on the 11th he w;is discharged from the hospital perfectly cured. 

I have now detailed four cases of rheumatism, none of which are 
precisely similar in character; and the hospital reports fur the last 
two years contain many others which were rapidly and effectually 
cured by the use of an efficient preparation of hemlock ; and that the 
recovery was solely due to the use of this remedy is sufficiently evi- 
dent from the fact, that it was the only medicine used in any of the 
cases. I do not, however, pretend to say that hemlock will cure every 
case of chronic rheumatism, a disease so intractable in its nature, that, 
to use the words of that eminent clinical physician. Dr. Graves, 
♦'there is scarcely any affection which tasks the ingenuity and tries 
the patience of a medical man more." The following case was one 
of those in which the remedy, at first, appeared to afford some relief, 
but afterwards liiiled to produce any benefit. 

Case V. — Chronic Rhcinndfisni caused by constant exposure to 
damp. Reported by I\Ir. Bkay. — John Diifly, aged 25, a labourer 
on the Dublin and Drogheda railway, was admitted into Jervis-strect 
hospital, June 21st, 1844, complaining of pains in both his Kgs-frora 
the thighs downwards, in both shoulders, in the back of his neck, 



148 Conlributions to Therapetttlct. [March, 



and in the right arm. The pains am intense, arc never ahsent, and 
are much increased hy the least muscular eff)rt. The right side is 
more afTectcd than the left, particularly the shoulder, and the left arm 
is, as yet, free from jinin. He states thnt for the last fourteen years, 
he h.as been constnntly cngngcd as a labourer in the construction of 
various pu])lic works, where, from the nature of his employment, he 
Avas much exposed to damp, having been frequently for hovirs together 
up to his breast in water; and also that from haliits of intemj)erance 
he has often l-iin out at night exposed to the inclemency of the wea- 
ther. He has, however, enjoyed good health until about five montljs 
ago, when the pains first commenced in his right knee and shoulder, 
since which time they have gradually increased in severit}', attacking 
in succession nearly every joint in his body. 

On his admission, the bowels being regular, the tongue clean, and 
the appetite good, he was immediately put under the use of the Succus 
Conii. being ordered to take 20 minims of it four times a day. On 
the 25th the dose was increased to 20 minims every fourth hour. 
On the 28th he expressed himself as being much relieved ; the dose 
was now incrcnsed to 25 minims every fourth hour. July 2nd, he 
complained of dryness of the throat, with some pain in the head, 
when the dose of the medicine was again reduced to 20 minims every 
fourth hour. On the 9th of July the following report appears in the 
case book : slight effusion is nov/ evident in the synovial membranes 
surrouiiding the right knee and both shoulder-joints, and on the whole 
the pains arc much worse than on his admission intt) the hospital ; the 
use of the hemlock was therefore suspended. This patient was af- 
terwards discharged from the hospital, July 30th, considerably relieved, 
but not cured ; the subsequent treatment adopted having been Col- 
chicum. Aconite, Dover's powder, and warm baths. 

I have also stated that I have employed hemlock, with benefit, in 
the treatment of neuralgin, and of senile grangrene. In the former 
of those diseases it will, like all other remedies, be found frequently 
to fail in affording relief ; and, on the other hand, it will often prove 
successful in cases which have resisted the use of numerous other 
medicines. The following short case will, I think, sufficiently illus- 
trate its beneficial influence in this disease : 

Case VI. — Facial Neuralgia. Reported by M. Fitzgekald. — 
Mary Fulton, aged 21, a servant, was admitted into Jcrvis-street 
hospital. May 13th, 1844. complaining of intense shooting pain in the 
left side of the face. The pain is not constant, but comes on in acute 
paroxysms, the intermission between whichj however, is of very short 
duration; it is most severe towards evening, and during the night, 
BO as almost completely to deprive her of sleep. She describes it as 
commencing in the cavity of the ear, and darting forwards towards 
the supra and infra-orbital foramina; sometimes it extends up to the 
forehead and head, and to the side of the nose, but it never passes 
the mesial line. During the paroxysm the surface of the face is pain- 
ful to the touch, and the least motion of the muscles of the jaw, 



1845.] Contributions to Therapeutics, 149 



even talking, produces intolerable anguish. Ker general health is 
good, and all the functions normal; the face is indicative of much 
suffering. 

She states that the disease occurred nbout eighteen months ago, 
since which time it has been gradually increasing in severity; ;it lir.st, 
intervals of six weeks, or two months occurring, duririg which she 
would be completely free i^rom pain, butof late tlie intervals have not 
been longer than IVom two to three weeks. The attack is always 
much more severe when the bowels are constipated ; prolonged con- 
stipation having been, she thinks, the original cause of the disease; 
at present the bowels are quite regular. Since the commencement 
of the disease she has been submitted to a gn?at variety of treatment, 
such as cupping, leeching, blistering, large doses of iron, mercury, 
bark, and turpentine; the latter of which, alone, appeared to afiford 
Iier the least relief. On the day of her admission. May 13th, she was 
ordered to take 20 minims of the Succus Conii, three times a day, in 
a glassfull of water. 

May 15th. Much improved; she says that she is completely free 
from pain for nearly an hour after she takes each dose of her drops. 
She was ordered to take 15 minims every four hours. 

16th. Bowels constipated, nevertheless the pains are less. To 
have two cathartic pills immediately; the drops to be continued. 

23rd. Expresses herself as being quite free from pain for the last 
two days, and feeling perfectly well. The hemlock-juice was con- 
tinued in the same doses since last report; it did not produce any 
dryness of the throat or difiiculty of swallowing. Discharged. 

July 30th. Fulton sent to the hospital to-day from the country, 
stating that she had remained perfectly (Vce from the least return of 
pain since she left the hospital, a period of more than two months, 
until within the last few days, when she had a slight attack ; and to 
ask for a small bottle of the drops. 

In two cases only of senile grangrene have I had an opportunity of 
trying the effects of hendock, and in both I have found it an cicel. 
lent adjunct to opiates. In one of those cases, which occurred in 
private practice, and in which the disease lasted from the 9th of !^]ay 
to the 29ih of June, 1843, the mortification having reached nearly as 
high as the knee before the disease t(;rminated fatally, the most dis- 
tressing symptom was a constant twitching of the tendons of the 
aflected limb. This unceasing cause of suliering was not in the least 
alleviated by the use of the opiates which were administered, but was 
at once removed by the use of the hcnilock-juice, and bv a per.^ever- 
ance in its employment was kept completely in check throu'diout the 
whole of the illness. — Dublin Journal. 



150 Epilepsy cured by Blisters, [March, 



PART III.— MONTHLY PERISCOPE. 

EpVepsy cured by Blisters. — TIio sn])JGct of this case was treated 
at the Hotel-Dieii, by Dr. Recamier, a bold and ingenious physician, 
who has made more than one discovery in the science of therapeutics. 
It is well known that a paroxysm of epilepsy is usually announced in 
some cases by a peculiar sensation in certain parts of the body, most 
frequently in one of the limbs ; a sensation to which we have applied 
the term aura epileplica. It has been thought that by preventing 
the aura we should arrest the epilepsy, and occasionally it has suc- 
ceeded. A tight ligature has been placed above the spot at which 
this awra starts; escharotics,setons, and even the actual cautery have 
been resorted to for the same purpose. M. Recamier sought to op- 
pose an effectual harrier to the passage of the aura, and thus prevent 
its reaching the head, by means of circular blisters; with this view 
he pursued it and attacked it with flying blisters at every point where 
it declared itself, and in one month, by means of eight blisters 
judiciously applied, he effected a radical cure of this intractable dis- 
case. It has nov/ been three years since this case was thus treated, 
and yet there has been no relapse. As this case is curious, and will 
suggest the proper method to be pursued, we will relate it. 

A tailor, aged 32, was seized on the 9th Nov., 1839, without any 
assignable cause, with an attack of epilepsy, and loss of conscious- 
ness. During the attack he fell into the fire and burned his right 
thigh, without being conscious of it. From this period to the 7th 
Dec, when he entered the Kottl-Dieu, (about a month,) he had eight 
such seizures, but less violent ; three of which were accompanied with 
loss of consciousness. The attack was ushered in by a trembling 
and a vibration which was felt only in one half of the body, and at 
the same moment the patient experienced a cramp in the let^t ankle; 
these premonitory symptoms continued for a few teconds, at the end 
of which t.me the attack was ushered in. After the first attack, the 
left leg, from the fjot to the middle of the thigh, remained benumbed 
and half paralyzed. Ij-^ to the 2 ith Dec. he had experienced two 
paroxysms — one strong, the other feeble. The seizure came on with 
cramps in the left ankle, then swelling and livid redness of the face, 
contraction of the muscles of the f^ice, which" becams hideous; froth- 
ing at the mouth, a hoarse voice, throwing the head tbrward and back- 
ward, tetanic rigidity of the trunk, convulsive respiration, coiitor- 
tions of the arms, &;c. The paroxysm lasted more than ten minutes, 
and the patient returned to himself ignorant of what had transpired. 
M. R. placed a circular blister about three fingers wide around the 
calf of the leg, above the spot where the cramp was felt. 

In three d lys the cramp was f^lt in the lower part of (he thigh, 
and was fjliowed by an attack of epilepjy; a second blister was 



1845.] C hronic Rheumatism and Neuralgia — Asthma, 151 



made to surround the thigh entirely. After the application of these 
two blisters, the paralysis of the leg was in a great measure removed, 
and the patient was enabled to walk with greater facility. On tho 
2nd of Jan. the left foot was numb ; a blister was ordered to the 
foot, and the numbness disappeared. On the 6th, had pains in the 
leg; circular blister above the painful spot ; the pain disappeared. 
On the 10th, patient felt, for two days, sliocks i\nd formica, extend- 
ing from the left hip to the mamma of the same side, with a tenden- 
cy to another epileptic attack : a blister was placed so as to engirdle 
t!ie lower part of the chest. On the ISlh the patient complained of 
a painful sensation of pricking, above the right mamma, and a painful 
numbness above the instep of the right tuot: a blister around the 
neck, and another belov/ the calf of the right leg. On the 22nd Jan. 
some shooting pains from the elbow to the left shoulder; blister in 
the form of a bracelet above the elbow ; besides, the patient was or- 
dered to take, morning and evening, the following pill : 

'fy Oxyd. Zinci. . . . 1 gr. 1 

Caniph i gr. > M. 

Ext. Belladon. . . i ?r. S 



On the 25th tlie patient thought the pricking sensation mounted 
from the foot to the left knee, and from thence to the groin ; the pills 
alone were continued. 2Gth, numbness in the back, and constipation 
for four days ; ordered a purgative lavement, which procured a free 
operation, and with it disappeared the numbness. Jan. 27th, the 
sensation of formication remains constantly in the left leg; the last 
blister was made to surround the thifrh, and all unpleasant symptoms 
disappeared. From this day up to March, at which time the patient 
quitted the hospital, no symptoms of the former disease were experi- 
enced ; the pills were however continued for about three weeks. The 
disease did not return. — Bulletin dc Therapcut. and JV. Orleans Jour, 



Useful hint on the Treahnent of Chronic Rheumatism and Xeu- 
ralgia: By Dr. James Johnsox. — A tea-spoonful of brimstone in 
a small cupful of milk, taken everv night at bed-ti:ne for a week or 
two together, is one of the best of all remedies that we know of, 
against old obstinate riieumatic aches, cratnp of the legs, the pains 
that aie connected with a varicose state of the veins, chronic sciati- 
ca, vScc. The well known nostrum — the '* Chelsea Pensioner" — thnt 
has so long had high repute in chronic rheumatism, is mainlv indebt- 
ed to sulphur for its virtues. It may be worth while to mention its 
composition- It is made thus : — ft. Flor. Sulphuris 5jj. Pot. Super- 
tartrat. gj. P. Guiaci 5j. P. Rhei 5jj. Spir. Nucis Myristic. 5ij. 
IMellis q. s. ut fiat clectuarium. 

The dose, one or two drachms every morninj* and cvenincr, 

[Med. Chir. Review, 

Iodide of Potn.rxium in Asthma, By W. H. Ca!«ey, M. D. — I havo 
now made use of the medicine in some twenly-fivo or thirty cases 



152 Pains of the Loins. [March, 



of Asthma, some of them very severe and afj^ravated ; and so far, 
in no one instance, \\ hen a fair trial has been made, has it failed to 
afford unequivocal and decided relief. As a general rule the patient 
is benefitted after a few days employment of tli« article, but some 
cases will require more time, perhaps weeks, before they impiove ; in 
one of mine, a very severe case of over twenty years duration, I 
persevered for nearly three months, before there was any decided 
amendment. In almost one-fourth of my cases, relapses have oc- 
curred after discontinuing the remedy; this occurrence however was 
in most cases owing to severe attacks ofcatarrh, or to errors in diet and 
consequent derangement of the digestive organs, which by the way 
should never be overlooked in the treatment of Asthma. From two 
to five grains of the Iodide of Potassium, given three times a day, 
dissolved in water or some syrup, as for mstance that of Sarsaparilla 
or Tolu, will generally be found sufficient for ordinary cases of the 
disease. Its continuance must be regulated by the circumstances of 
each case. — N. Y. Jour, of Med. 

Pains of the Loins. By Dr. Ore, Sovihampion. — Perhaps there 
is no symptom more commonly met with in practice than pain in the 
loins, which is usually and at once attributed to bile, gravel, or rheu- 
matism ; but as it may be also derived from other causes left out in 
a hasty decision, I shall enumerate them, and endeavor to point out 
the symptoms by which each may be distinguished. Pain of the 
loins may be derived from the muscles, from the liver, from the duode- 
num, from the kidneys, from the colon, from the uterus, from the 
aorta, from the spine, or from matter collected on the psoas muscle 
independent of spinal disease. In order to arrive at its true cause, 
we must endeavor to ascertain what function is principally involved, 
which will at once lead us to it. 

If the pain be rheumatic, it will be increased by pressure, and by 
the slightest action of the muscles affected. There will probably be 
also rheumatism in other parts of the body, the system will not 
evince much disorder, the urine will be high colored, and deposit a 
lateritious sediment. 

If derived from the he/patic function, the pain will shoot upwards 
along the splanchnic nerves to the scapulae; the alvine evacuations 
will be either deficient in, or exuberant with, bile ; or show a morbid 
quality of that secretion; the urine will have a bilious tinge ; there 
may be congestion of the haemorrhoidal veins; and the spirits will 
be depressed. 

If from the duodenal function, three or four hours after a meal the 
pain will be aggravated, shoot through towards the right side of the 
abdomen, and remaining till the tood has passed into the jejunum. 
Dyspeptic symptoms will prevail, and there will tVequently be painiul 
pustules breaking out about the face. 1 have lately met with a case 
in which the boils were extremely annoying. 

If from the kidneys^ the pain will shoot down the course of the 



1845.] Pains of the Loins. 153 



spermatic nerves towards the round ligament in the female, and to- 
wards the testis in the male, which will often be retracted by the 
action of the spermatic nerves upon the cremaster muscle. There 
will be more or less irritation communicated to thatoiucous membrane 
of the bladder. The urine also will be di;ignoslrc in this instance ; 
it may deposit mucus, calculus matter, blood, pus, or albumen, ac- 
cording to the nature of the case ; or it may be otherwise morbid in 
its constitution. 

If from the uterus, the pain of the back will arise cither from dis- 
ordered function or disease of that organ. In the former case the 
pain will be of a neuralgic character, will return in forcing paroxysms, 
extending around the hips and hypogastric region, will be attended 
with hysteria, and often with increased quantity of the menstrual 
discharge. In the latter case the pain will be constant and severe, • 
extending along the anterior crural nerve halfway down the thighs. 
There will be a thin, ofiensive discharge from the vagina. The coun- 
tenance will be wan and sallow, exhibiting ttie wear and tear of 
organic lesions. 

If from the colon, there will be constipation, and inflation in the 
course of the bowel, or the foecal discharges will be of small diameter, 
or there will be soreness of the intestine under pressure, especially 
at its ascending or descending portions, accompanied by mucus, 
or shreds of lymph in the form of boiled vermicelli, amongst the ex- 
cretions. 

If from arterial dilatation, an abnormal pulsation of the vessel 
involved — the aorta, for instance — may possibly be detected by aus- 
cultation, in the incipient stage of the disease, if such were suspected ; 
but in a large majority of cases, such a cause may reasonably escape 
the attention of the ablest surgeon, from there being no tangible 
BVmptom that might lead him to suspect it; and even after the dila- 
tation has considerably advanced, it may be sufficiently large to press 
upon and disturb the sj)ermatic nerves, but not large enougli to pro- 
ject and pulsate externally, and this may, at this stage, be confounded 
with diseases of the renal function. A few years ago I met with a 
case of this kind in a man of middle age. The pain had been con- 
stant and wearing, shooting from the loins down the course of the 
spermatic nerves, and for a considerable time was reasonably attribu- 
ted to the renal function, especially as there had been constant dis- 
turbance of the function. At length the aneurismal sac began to 
approach the surface, and then, of course, the cause became apparent. 
If from disease (f the sjnnal column, the pain will be aggravated 
by percussing the spinous processes at this part of the spine, or by 
suddenly striking the toes against an uneven surface. There will bo 
involuntary action of the muscles, especially of the llexors of the legs, 
diminished temperature, abnormal feelings, and more or less loss of 
power of the lower limbs. Should there be at the same time any 
unnaiural projection of the spinous processes, the disease will bo 
confirmed. 



154 AiUiJoles of Coirosive Sublimate, Copper, Lead, dfc. [March, 



If from a colJeclion of matter upon the psoas muscle, vnconnected 
V'ith spinal disease, the pain will be continued, dull, and deep-seated, 
extending iVorn the loins down the psoce, or in whatever direction (ho 
nuitlcr may have lakcn its course. The pain will be aggravated by 
flexing the thigh t<nvards the a!)donien, and there will be difficulty in 
walking ; moreover, tnere will be marks of a strumous habit, and 
more or less symptoms of hectic fever. Should any (iiictuating tu- 
mour present at the groin, or at any other point where the matter 
may t\m\ its way out of the body, it will be concluaive as to the na- 
ture of the case. — Prov. Med. Jour. 



Anfidofes of Corrosive Sublimate, Copper, Lead, and Arsenic, 
By MM. BouciiAKDAT and Saxdeas. — By means of numerous^ ex- 
periments, first made in the laboratory and then repeated on dogs, 
MM. Bouchardat and Sandras have arrived at many interesting 
results relative to the antidotes of corrosive sublimate, copper, lead, 
and arsenic. All these are, detailed at length in theirlong papers on 
the subject. Their conclusions were, that the following substances 
may be regarded as antidotes, and employed as such in medicine: 

As anlido!es for corrosive suhlimaie. — A mixture of zinc and iron 
filings; or powder of iron reduced by hydrogen; or the moist per- 
sulphurct of the hydrated peroxide of iron. 

As antidotes for copper. — A mixture of zinc and iron filings; iron 
reduced by hydrogen : porphyrized iron ; zinc filings ; or the pcrsul- 
phuretofthe hydrated peroxide of iron. 

As an antidote for lead. — The moist pcrsulphuret of the hydrated 
peroxide of iron. 

As antidotes for arsenic. — The moist hydrated peroxide of iron ; 
the dry hydrated peroxide of iron ; and the moist pcrsulphuret of the 
hydrated peroxide of iron. 

These experienced chemists add the following reflections : — This 
last preparation, the pcrsulphuret of the hydrated peroxide of iron, 
possesses this superior advantage over all the rest, that it changes the 
nature of all the four poisons above noticed, and is especially applica- 
ble in those cases where we have not had time to find which of the 
poisons has been taken. As to the manner of administering these 
antidotes, and the doses which it is necessary to administer, the sim- 
plest means appear the best. The powders of zinc and iron may be 
suspended in any electuary, or they may be swallowed in wafer pa- 
per. The magma of the hydrated preparations of iron may be swal- 
lowed in the form of jelly, in which they are procured from the 
druggists. Sever.il draughts of lukewarm water ought to follow the 
antidote, and the fauces be tickled with a feather, to excite vomiting 
Rnd the expulsion of the poison. The efforts at vomiting scatter more 
effectually over the stomach the antidote which is administered. As 
to dose, the experiments proved that 100 grains of the powder of iron 
or of zinc sufficed to prevent any bad effects from 15 grains of the 
acetate of copper. Fifteen drachms of the moist magma of the per- 



1845.] Albumen as an Antidote— Diseases of the Skin. 



155 



sulphuret were required to produce the same effect with the samo 
dose (15 rrrains) of.the acetate of copper. To act as an antidote to 
U grains of arsenious acid, 15 drachn.s of the moist magma of the 
persulphuret, or 30 drachms of the moist hydrate^ peroxide of iron 
or 20 drachms of the dry hydratcd peroxide of iron, were required. 
With regard to the time when these antidotes can be administered 
with advantage, in so far as the acetate of copper is concerned the 
lap^e of 40 minutes from the time of swallowing the poison ougnt not 
to be re'rarded as a sufficient reason for not administering the anti- 
dote ; but arsenic is more quickly absorbed. Nevertheless, the anti- 
dote should always be administered, because, though it will not 
neutralize what is absorbed, it will prevent its further absorption, by 
decomposing what remains in the sioinach.— Edinburgh Med. df 
Surg, Journal. 

Caution in giving Albumen as an ^yi/mVe.— Practitioners, in em- 
ployincr albumen as an antidote to corrosive sublimate, should be 
aware'that it may be given in too great quantity, as the compound 
formed is soluble'in an excess of albumen, and in the deleterious 
combination which enters the blood, producing the remote influence 
of the poison. So long as the vomited matters contain a white 
opaque material admixed, the antidote should not be withheld ; when 
the ejecta, on the contrary, become transparent, the further employ- 
ment of the remedy is generally useless, and may be injurious.— Atti. 
Jour. Med. Sciences, from Dublin Medical Journal. 

Selection from the Formulary of Biett on Diseases of the Skin. 
(From the work of M. Cazenave, translated by Dr. Burgess:—) 
Infernal Remedies. —SuhcvuUomxic of soda, half, to one drachm ; 
barley.water, one pint. Dose.— rour glasses daily. Use.— Lichen ; 
prurigo; chronic diseases with itching. 

Decoction of t/«/camara.— Dulcamara, lialf an ounce; water, a 
pint and a half. Boil down to two thirds. The quantity of the 
remedy may be increased to one ounce, or an ounce and a halt. 
Dose.— Half a glass at fust ; then a glass, morning and evening. 
Use. — Lepra vulgaris; chronic diseases. 

Decoction of orma.—Ovm;\ pyramidalis, four ounces ; water, tour 
pints; boil down to a half. Dose.— Two to four glasses a day. Use.— 

Scaly diseases. ^ . , • i r 

Syrup of fumaria, twelve ounces ; syrup of viola tricolour, four 

ounces; bisulphate of soda, two drachms. Mix. [M. B.ett oltea 

ompU^yed this mixture in cases of eczema, lichen, and several chronic 

disea.=:es of the skin.] Dose.— Two spoonfuls a day. 

Syrup of fumaria, a pint; bicarbonate of .soda, three drachms. 

Dose.— Two tea-spoonfuls; one before breakfast ; the other at bod- 

timo. Use.— Eczema ; lichen; prurigo. 

Pgarsons .^o/t/Zio;;.— Arsenite of Foda, four grains; water, four 

ounces. Dose.— From twelve drops to a drachm or more. U.se.— 



153 Diseases of the Skin. [March, 



Most chronic diseases of the skin ; eczema, impetigo, lichen ; but 
chiefly in squamous diseases, lepra, psoriasis, (Sec. 

Fowlej-'s solution. — Arsenious acid, and carbonate of pofass, of 
each seventy-Gin;h,t grains ; distilled water, a pint ; alcohol, half an 
ounce. Use. — The same as Pearson's solution. Dose. — Three or 
four drops, gradually increased to twelve or fifteen. 

31. BieAt's sohition. — Arsenite of amonia, four fjrains ; water, four 
ounces. Use. — Same as above. Dose. — Same as Pearson's solution. 

Larrey's Syrup. — Sudorific syrup, one pint ; bichloride of mercury, 
hvdro-chlorate of ammonia, and extract of opium, of each five grains ; 
Hoffman's liquor, half a drachm, Dose. — Half an ounce to two 
ounces. \jse.. — Syphilitic eruptions. Syrup of mezercon, two oun- 
ces ; balsam oftoiu, four ounces; subcarbonate of ammonia, half an 
ounce. Dose. — A spoonful, morning and evening. Use. — Consti- 
tutional syphilis. 

Van Swieten's liquor. — Bichloride of mercury, eighteen grains; 
water, twenty. nine ounces; alcohol, three ounces. Dose. — A tea- 
spoonful, daily, in a glass of decoction of sarsaparilla. Each ounce 
contains a little more than half a grain. Use. — Secondary syphilis. 

Powders. Pills. — Sul)limed sulphur, magnesia, of each half an 
ounce. Make eighteen packets. Dose. — One, daily. Use. — Chro- 
nic eczema; scaly diseases. 

Proto-ioduret of mercury, twelve grains; extract of lettuce, two 
scruples. Make lorty-eight pills. Dose. — One to four. Use. — Sy- 
philis. Or, 

Proto-iodurct of mercury, half a drachm ; extract of guaiacnm, one 
drachm ; extract of lettuce, two scruples ; syrup of sarsaparilla, q. s. 
Divide into seventy-two pills. Dose. — One, and then two,/ daily. 
Use. — Syphilis. 

Bichloride of Mercury. — Extract of aconite, six grains ; bichloride 
of mercury, two grains ; marshmallows |)owder, eight grains. Make 
eight pills. Dose. — One to four. Use. — Syphilis. 

Deuto-iod.uret of Mercury. — Deuto-iodurct of mercury, six grains ; 
marshmallows powder, half a drachm. Make thirty-six pills. Use. — 
The same. Dose. — Two or three a day. 

M. Sedillol's pills. — Strong mercurial ointment, one drachm ; 
soap, two scruples ; mallows powder, one scruple. Make thirty-six 
pills. Dose. — Two or three, daily. Use. — The same. 

M. Bietl's pills. — Mercurial ointment, powdered sarsaparilla, of 
each a drachm. Make forty-eight pills. Use. — The same. Dose.— 
One to four, daily. Or, 

Phosphate of mercury, half a drachm : extract of fumaria, one 
drachm. Make forty-eight pills. Dose. — One to two a day. Use. — 
As before. 

Aconite pills. — Extract of aconite, half a drachm; mallows pow- 
der, two scruples. Make forty-eight pills. Dose — One or two, 
morning and evening. Use. — Syphilitic eruptions ; nocturnal pains. 

Asiatic pills. — Arsenious acid, one grain ; black pepper powdered, 



1845.] Ulceration of the Cornea. 137 



twelve strains ; gum arable, two grains; water, q. s. Make twelve 
pills. Dose. — One or two a day. 

Ar senile of iron. M. Bieti. — Arsenite of iron, three grains ; ex- 
tract of hop, one drachm ; mallows powder, half a drachm ; orange 
flower syrup, q. s. Make torty-eight pills: each contains the one- 
sixteetith of a grain. Dose. — One, daily. Use. — The two preceding 
formulae are ciiiefly used in cases of chronic eczema and lichen; in 
the scaly diseases, lepra, lupus, and psoriasis. 

Arsenite of soda. M. Bieit. — Extract of aconite, one scruple ; 
arsenite of soda, two grains. Make twenty-four pills. Dose. — One 
or two, daily. Vs^. — As above. 

Hydrochloraie of iron. — Hydrochlorate of iron, twelve grains; 
gentian, in powder, twenty-four grains. Make twelve pills. Dose. — 
One to four, daily. Use. — Employed with success by M. Biett in 
scrofulous eruptions. 

Sulphate of iron. M. Biett. — Sulphate of iron, one scruple ; pow- 
dered mallows, twelve grains: syrup, q. s. Make twelve pills. \jsq 
and dose, the same. — Lond. and Ed. 3/. J. of M. S. 



UJceraiion of the Cornea. — The danf^er of employing certain col' 
lyria in diseases of the Eye. — M. Florient Cunier has recently called 
the attcnlion of practitioners to the evil effects of combining opium 
and its preparations with solutions of tiie meta'lic salts, such as zinc, 
copper, silver, &:c., in the treatment of opthalmia, and ulcerations of 
the cornea. When such mixtures are made, we have, says he, on 
the one hand, a sulphate, a carbonate, a nitrate, <Scc. of morphine ; 
on the other, an insoluble meconate of zinc, of copper, of lead, of 
silver, and so on, which is precipitated to the bottom of the phial. 
Before the mixture is instilled into the affected eye, the vessel is usu- 
ally shaken ; the meconate is thus suspended, and, in this form, 
brought in contact with the eye, and should there be any ulcers upon 
the cornea, the mixture will bo sure to lodge in such ulcers. In this 
way, we create a great number of specks — of supposed allougos, 
against which we may bring the materia-medica to bear, but in vain. 

These tacts M. C. corroborates by adducing a very striking in- 
stance, the principal circumstances of which we shall present to our 
readers. An English gentleman, in attempting to open n bottle of 
ammonia, received a few drops of the fluid into his eye. A physician 
being immediately called, prescribed cold fomentations, and the pain 
assuming more intensity in the evening, an opiate saturnine collyriuni 
was ordered. This treatment, aided by leeches and calomel, pushed 
to ptyalism, produced no relief. The patient consulted in succession - 
many London surgeons, who diagnosed an albougo. the result of a 
burn, and subjected the patient to every variety of treatment without 
any success. Three yeas afterwards, tliis man came to consult M. 
Cunier, who found him in the following condition : — The lids of the 
eye were spasmodically closed; when >f. C. attempted to separate 
them, a fiood of tears deluged his cheek : thf» pHttont suddenlv threw 



ICS Cure for Nccmhtj Croion Oil, [March, 



his head back, rose from his seat, linstened to his room and seemed 
to be agitated, alternately opening and shutting his lids, violently 
contracting the muscles of his face on the painful side, as persons are 
wont to do when any loreign body is admitted into the eye. After a 
few minutes the patient reseated himself, and M. Cunicr resumed his. 
examination. 

'J'he conjunctiva was highly injected ; the cornea, over three-fourths 
of its extent, presented a shining yellowish white appearance ; around 
its border were eight or ten large vessels, which terminated abruptly. 
The internal (ace of the lower lid, presented two or three small points 
of the same color, as the spot on the cornea. I\I. Cunicr, after ah 
attentive examination, and being well assured as to the nature and 
composition of the first collyrium, diagnosed an incrustation of lead 
upon the cornea, and at once proposed to remove it. 

After some hesitation and delay, the patient consented, and M. 
CuF)ier proceeded in the following manner to perform it. 

The patient was seated in an arm chair, the head resting against a 
pillow. Standing behind hirn the operator adjusted a blepharostat. 
The conjunctiva being seized below, and about two lines from the 
cornea, with a small pair of serrated pinchers, held in the left hand, 
he was thus enabled to carry the globe of the eye downwards, and 
thereby contract its movements. Then taking a proper instrument, 
(siich as Dentists use in cleansing teeth.) in his right hand, he placed 
itf^at on the lower and external border of the incrustation, thus act- 
ing from below upwards. The false membrane which covered the 
cornea offered no resistance, and the central plaque was readily de- 
tached in one entire piece. 'J'his operation, executed with great 
care, had the most happy success. The patient, who for three years 
bad lost the use of that eye, who believed vision completely destroy- 
ed, and had suffered beyond measure, saw now as well with this, as 
with the sound eye. M. Cunier received several communications 
from his patient at"ter his return to England, and was assured that the 
cure remained complete. Since that time, (3Iarch 1842,) 31. Cunier 
has had frequent opportunities of removing incrustations from the 
rorpea. In nineteen cases, the collyria used by the patients, were 
composed of a salt of lead, or of zinc, or of copper, either with or 
without the addition of opium. 

M. Cunier has then rendered a real service to opthalmic surgery, 
by pointing out the dangers and inconvenience of using these kinds 
r.f collyria, in the treatment of ulcerations of the cornea. It is there- 
fore apparent that the preparations of opium, combined with these 
metallic solutions may produce those incrustations, of which M. Cu- 
nier is the first to speak, and to which he has directed the attention 
of the occulist. — Annales cV Occidist, as quoted in Bull, Gen. de 
Therap.; 1844. 



Cure for Ncrin hy Croion Oil. — M. Lafarque states his method of 
curing Naevi, by inoculating with croton oil, as follows: Five or six 



1845.] The Liquor PotasscB — Fistula Lachryrnalis. loO 



punctures should be made on and around the tumour, with a lancet 
dipped in the oil, just as in vaccination. 

Each of the punctures causes immediately a pimple, which in 
thirty-six hours is developed into a little boil. These boils unite and 
form a rod, hot, painful tumour, covered with white crusts, and re- 
semblinrj a smnll carbuncle. Two days afterwards the scabs separatf, 
and in lieu of the neevus is seen an ulcer, which is to be treated on 
jreneral principles. It would be dangerous to make more than six 
punctures on a very young infant, as the irritation and fever are con- 
siderable. — Prov. Med. Jour. 



The Liquor Potasscc — Given in doses of from 15 to 30 drops, three 
times a day, is an admirable remedy in many cases of inveterate skin 
disease. Accordinf^ to our observations, it is far more effiracious, 
and perhaps, too, less injurious, than the potash in combination with 
iodine. The liquor potassoe may be given in milk, beer, decoction 
of sarsaparilla, &c. With respect to the sulphate of iron as an exter- 
nal application, in sycosis, menlagra, &c., we cannot believe that it 
possesses any curative virtues above those of the sulphate of zinc, or 
of the sulphate of copper, that are in daily use. The white vitriol is 
our favorite; and the best way of applying it is by dipping rags of 
soft lin^n in a tepid solution of the salt, and covering these with a 
piece of oil-skin. If used thus, the lotion will not require renewal 
oftener tiian night and morning. In some cases, a little hydrocyanic 
acid may be conveniently added to the solution with advantage. — 
Med. Chir. Review. 



Extirpation of the Lachrymal Gland for the cure of Fistida Lach. 
rymaJis. By *M. Paul Beknakd. '(Revue MedicaIc.)—8omo 
time ago M. Bernard communicated to the Academy of Scien- 
ces a case of cure of /f^/w/rt Zflf/<77/?;?rz//5 by means of the extirpation 
of the lachrymal gland. Thisgland had only been previously extir- 
j)ated on account of cancer ; and the simplicity of the operation, as 
well as the rapidity of tiie cure, induced him to remove it for fistula. 
A man, 30 years of age, subject to a considerable discharge of tears 
from the left eye, but without fistula, had been subjected to most of 
the usual remedies for the cure of that oisease. The ranula, colly ria, 
and ointments of various kinds, had been employed for a period of 
ten years, but the watering of the eye still continued, and rendered 
the vision very confused. M. Bernard then determined to remove 
at least that part of the gland which appeared to be hypertrophied. 
V vertical fold of the skin on the outer edge of the eye was raised, 
and a bistoury pushed through it. This exposed the palpebral cdgo 
of the gland. Tiiis portion was found to be hypertrophied ; it was 
drawn out by the forceps, and removed. The orbital portion of the 
gland also. No bad results followed : the wound healrd rapidly; the 
watering of the eye disappeared; in fact, a perfect cure followed. — 
{From EdinhurghMcd. and Sur". JonmnL Jan. l^lf).) 



IGO 



Cases of Fremalure Delivery^ <S^g 



Cases of Premature Del ivery- By M. SENLE^^ (L^ Experience, 
30th May, 1844 ) — M. Senlen has excited labour prematurely 13 
times in 7 women, in consequence of deformed pelvis. In three of 
these the deformity was produced by rickets; in 4 by malacosteon. 
Of the 13 labours in these 7 women, only 7 children were horn alive, 
and 4 of these died very shortly after birth. The antero-posterior di- 
ameter of the pelvis in these women was 2 inches in one, 2^- in another, 
2i} in another, and in the rest less than 3 inches. Labour was induced 
by puncturing the membranes, and, according to the contraction of 
the pelvis, wasljrought on from the 29th to the 38th week of pregnan- 
cy. The average period, however, was on the completion of the 30th 
week, or 7 calendar months. 



METEOROLOGICAL 0BSERVAT10^'S, for January, 1H45, al Augusta, Gj 
Latitude 33° 27' north— Longitude 4° 32' west. W. 





S.R. 


Ther. 
3, p. M. 


Bar. 


Wind. 1 




S.R. 


Ther. 
3, p. M. 


Bar. 


Wind. 


1 


'18 


72 


30 inches 


X. w. fair. '17 


56 


68 


296-10 in. 


s. rain. 


21 41 


63 


29 9-10 


s. E. fair. 18 


58 


57 


29 7-10 


K. w. fair. 


3 


40 


64 


" 


s.w. crdv.'19 


35 


37 


29 9-10 


N.E. rain. 


4 


43 


70 


(C 


'' fair. i!20 


36 


42 


" 


N. E. misty. 


5 


43 


71 


" 


" iiSJl 


38 


55 


« 


w. fair. 


6i 57 


64 


29 3-10 


s. E. rain, 22 


29 


58 


39 


X. w. " 


/ 


56 


56 


29 5-10 


w. fair. ;23 


42 


50 


29 9-10 


E. rain. 


8 


38 


60 


29 8-10 


" i;24 


49 


56 


29 6-10 


w. cl'dy. 


9 


32 


62 


29 9-10 


" ,25 


32 


54 


29 7-10 


N.w. fair. 


10 


33 


68 




s.w. " ii26 


31 


58 


29 8-10 


vv. " 


111 12 


58 


29 7-10 


V.-. " :27 


31 


67 


29 7-10 


s. 


12 


39 


55 


29 8-10 


x. w. " l'28 


31 


68 


29 8-10 


S. E. " 


13 


30 


61 


29 6-10 


s.w. '' 29 


37 


58 


30 


X. w. " 


14 


38 


60 


29 9-10 


w. " iSO 


32 


52 


30 9-10 


u 


15 


36 


59 


30 


variable. 31 


26 


59 


30 


IS (( 


16 


39 


70 


29 9-10 


S. E. cl%. 













22 Fair days. 



inches. 



At the annual examination of .he Medical In^'titntion of Yale College^ held 
on the 15th January, eleven candidates were admitted to the degree of Doctor 
of Medicine. 



ERRATA. — In Dr. Meaxs's communication on the subject of Calomel, on 
page 98, line 9th from boUom, for "(Chlorir/e)" read Chlori7ze, 

" 102, " 14th from top, for '-'purgatives" read purgation. 

" 103, " 8th " " for "so far 1 know" read so far ^5 I know. 

" 105, a whole line after the .5th from top omitted— insert as follows: "which 
unite vigorously in the librin Albumen, &C." — then follows next line, "either in 
solids," &c. 
page 105, line 8th from bottom, for "Miller" read Miiller. 

" 1 12, " 23d from top, for "t^Affe" read ithok. 



SOUTHERN 

MEDICAL AND SURGICAL 

JOURNAL. 

Vol. I.] KEW SERIES.— APRIL, lSi5. [No. 4. 



PART L— ORIGIXAL COMMUNICATIONS. 

ARTICLE I. 

Nolice of the Memoirs of 21. de Haldat vpon the Mechanism of 
Vision, By Joiix 'M. B. Harden, M. D., of Liberty County, 
Georgia. 

The object of the present communication is to bring before the 
readers of this journal the recent researches ofM. De Haldat upon 
the Mechanism of Vision, with reference more particularly to tho 
adaptive power of the eye. These researches, it appears, were ori- 
ginally embraced in three separate memoirs read at different times 
before the Academy of Nancy, and published among its transactions; 
but a complete analysis of them has been furnished by the author 
for the September number of the Annales de Chimie et de Physique, 
from which we have condensed the following account : — 

It is well known that, for the purposes of distinct vision, several 
nice adjustments in the structure of the eye are necessary in order 
to correct those aberrations which are dependent upon the laws of 
refraction and the properties of light. The modes of correction for 
spherical and chromatic aberrations, we believe, are universally 
agreed upon by philosophers : the former arising from tho structure 
of the crystaline lens by which its density increases from the circum- 
ference to the centre — the latter from the "adjustment of the powers 
of the different refracting media of which the globe fif the eye is 
composed, so as to give rise to wl»at is c;illed an achromatic comhina- 
Unn " Th« correction for parallactic aberration, however, or the 

n 



163 Mechanism of Vision, L-^P^'^* 



adaptive power of the eye by wliich it maintains tlic srime focal 
distance for rays from ditferejit directions, lias given rise to much 
controversy and has Ijecn made the subject of long and laborious 
investigation by Olbers, PoRTEitriELD, Hunter, Home, You^g, (1) 
and others. 

The theory which seems to have received most support is that 
which refers it to muscidar action ; but there has been, and still con- 
tinucs to be, great want of unanimity in regard to the modem which 
i\\\s action efTccls its object. Some have supposed that the contrac- 
tion of the muscles compressed the whole globe, and thus increased 
the convexity of the cornea ; while at the same time the axis was 
eloH'^ated and the retina removed farther from the lens: — others have 

o 

referred it to a change in the convexity of the lens itself, or a motion 
effected in it by the action of the ciliary body, or ligamenta ciliaria, 
by which its distance from the retina was either increased or dimin- 
ished. This last seems to have been the opinion of Dr. Youxg. 

The chief arguments in support of these views have been — first, the 
vague and unsatisfcictory one derived ex necessitate rei, and believed 
to be good and true, because sufficient to exjilain the iihcnomenon — 
the second, from the sensation of effort and fatigue of which we are 
conscious when we attempt to adapt the eye to the vision of near ob- 
jects. To this last our author replies, that "it is by no means certain 
that this sensation of fatigue has its seat in the muscles, but should 
rather be ascribed to the state of the retina, fatigued by an abnormal 
impression 1" To the idea of any change in the form of the cornea, 
he opposes — first, " the almost absolute incompressibility of the humors 
of the eye, and the extreme tenacity of the membranes which contain 
them — secondly, the difference of opinion among authors, some of 
whom attribute this power to the recti, others to the oblique, while a 
third class refers it to the combined action of all — thirdly, whether 
we admit the combined action of all these muscles, or the separate 
action of each set, it is necessary to prove that they can, by their 
contraction, change the form of the cornea; a power which cannot 
be admitted because of their unfavorable disposition, and particularly 
when we consider that the recti muscles, which are most powerful 
on account of their mode of insertion, cannot effect this change with- 
out exerting upon the posterior hemisphere njn'essvre which requires 
a point of support, (point d'appui,) or resistance which we cannot 

(1) Although denied by Dr. Young, our author follows Euber in believing the 
eye to be perfectly achrumaiic. 



1345.] Mechanism of Vision. 163 



find either in the flexibility of the optic nerve, or in the extreme 
softness of the fat which occupies the pyramidal interval which sepa- 
rates the recti muscles or which fills the base of the socket. As to 
the oblique muscles, which can only act in producing the rotation of 
the globe around the antero-posterior axis, we cannot see how they 
can efiect the compression necessary to produce the result supposed." 

But even supposing the muscular arrangement ever so favorable 
for the purpose, our author finds in the size of the muscles an insuper- 
able objection to the admission of a power in them sufficient to change 
the convexity of the cornea. By an experiment made upon the eye 
of a sheep, he found that a power sufficient to produce the least change 
in this membrane must be equal in pressure to three kilogrammes,* 
v.hereas, judging of the strength of a muscle by its mass, a rule 
adopted by all physiologists, the power of the muscles of the eye 
cannot exceed 500 grammes. 

Another strong argument against any change in the form of the 
cornea, is found in a fact accidentally observed by the author, viz : 
that when the globe of the eye is subjected to a pressure sufficient to 
effect a chanrre in its form, the cornea becomes fransJiicid, assuming 
a bluish gray tint, entirely incompafiblewith dislinctncss of vision. — 
"Hence," says ho, " it is evident that the hypothesis of compensation 
by a change in this membrane cannot be sustained." 

Not satisfied, however, by these indirect arguments, the author 
next proceeds to direct experiment upon the poin!, and, in the manner 
ofDr. YouxG, measures with great accuracy the curvature of the 
cornea, while the eye receives rays from difierent directions. For 
this purpose he uses a small micrometer telescope having a mao-ni- 
fying power of thirty diameters. The experiment may be conducted 
in two ways: In the first, the eye is examined in profile, and the 
visible part of the cornea is brought to the focus of the object so 
as to obtain a distinct image. The wires of the micrometer are then 
so applied as that one will be a tangent to its convexity, and the 
other will pass through the two extremities of the visible crescent, 
and thus its form can be satisfactorily determined while the person 
fixes his eye upon objects at different distances. In the second, the 
glass is directed obliquely towards the cornea, and receives the imaTe 
of any external object reflected by it. This image being broutrht be- 
tween the wires of the micrometer is accurately measured, while the 

• Kilogramme, a 1000 ^raniine-*. A grammft, 20 sjains. 



IW Mechanism of Vision, [April, 



person is directed to fix his eye intently upon an object by exerting 
all the force of the muscles. The constancy in form of the cornea 
was conclusively shown by the fact, that the rejlected image always 
preserved the same dimensions, and thus the experiment, according to 
our author, '•'■ completely deprives the cornea of the claim to the func- 
tion of a compensating instrument which has, for so long a time, been 
gratuitously ascribed to il.^^ 

Having satisfied himself upon this point, our author next seeks in 
the other structures of the eye the instrument of this compensation. 
The aqueous humor being as unalterable in its form as the cornea 
itself, cannot be supposed to have any agency in it. The iris, whose 
chief use seems to be to apportion the quantity of light to the wants 
of the organ, cannot be any better adapted to perform a part so im- 
portant. The vitreous humor, when separated from the crystaline, 
forms no distinct image upon the retina, and therefore we are forced 
to ascribe it to this latter, which unites all the properties of artificial 
lenses by which images are formed in onx instruments. But having 
determined this fact, the question recurs — what is the mechanism by 
which the eye adapts itself to objects at different distances? In de- 
termining this, the author again has recourse to the experimental 
method. The crystaline of an ox, fresh and sound in every part, was 
fixed by a suitable instrument in a camera obscura, and exposed to 
the rays of the sun, which were kept in a horizontal position by a 
heliostat-— the image of the sun, formed at the focus, was received 
upon rough glass, and was of course produced by parallel rays — the 
direction of the rays was then changed by the interposition of convex 
and concave glasses, and yet the image constantly retained its integ. 
rity, although altered somewhat in extent and Zi7v7/ia7?ry, proving that 
the crystaline lens has the property in itself, within certain limits, of 
forming at the same focus constant images for rays from different 
directions. 

The author has performed this experiment a great many times, 
both by iiimself and in the presence of those well acquainted with 
optics, and always icith the same result. lie has also varied the ex- 
periment by using the entire eye, with the exception of a small portion 
of the posterior hemisphere of a circular form, which he removes for 
the purpose of receiving the image which would have been formed 
upon the retina. This portion is replaced by a watch-glass, which is 
fitted into an instrument composed of a double hemispherical capsule, 
large enough, when united, to contain the globe of the eye of a sheep 



1845.] Mechanism of Vision, 165 



or ox. Each capsule is perforated \vith a hole in the centre, one of 
which contains the watch-glass above menlioneti, and is to be applied 
to the posterior part of the eye — the other to the cornea. They are 
brought together by means of a hinge, which unites the branches to 
which they are attached, and may be opened or shut at pleasure ; 
vvhen closed they leave an open belt or zone, surrounding the middle 
of the eye, where the globe may be compressed by the ends of the 
fingers. 

From all the experiments performed by the author, he thinks him- 
self warranted in drawing the following conclusions : — "1st. That 
all the possible changes in form which the cornea may undergo, do 
not give it that influence in the formation of the image which has 
been ascribed to it — since we may, by means of pressure upon the 
globe, swell it out, or diminish its natural tension, by removing a 
portion of the aqueous humor, or, what is still more remarkable, 
remove the whole cornea without destroying or even modifying the 
image. 2ndly. Tiiat we may replace the aqueous humor with at- 
mosplieric air, by means of a narrow oblique puncture ; showing that 
the use of the fluid is simply to give to the cornea that peculiar form 
which is natural to it. 3rdly. That the crystaline is the instrument 
essential to the formation of the image — since its removal, all the 
other parts being sound, renders it impossible, and, on the contrary, 
it takes place vvhen, the crystaline remaining, we remove the cornea 
and the aqueous humor, and even when isolated, the focus remaining 
constant for rays from diflerent directions. 4thly. That the crys- 
talinc, nevertheless, cannot alone form the image upon the retina, 
without the aid of the vitreous humor, because the focal distance of 
the crystaline is too short, as is proven by a comparison of its focal 
distance with that of the focal distance of the two fluids combined." 

The property of uniting into one focus rays from diflerent direc- 
tions, then, recognized in the cr?/.9/a/i'/Jc, the only remaining question 
to be solved, is in regard to the cause of a phenomenon so remarkable 
and apparently so much at variance with the laws of optics. The 
author acknowledges the difliculty ; but observes that, even supposing 
we cannot explain it, we must still admit the fact, as wo are obliged 
to do in a great number of cases where phenomena arc equally well 
knov.-n, whose causes are entirely hidden from our view. The con- 
clusion at which our author arrives, liowevcr, I.s that it must result 
from the form and intimate structure of the lens, and is probably 
connected with that urrargement by which wo know the aberration 



168 Mechanism of Vision. [April, 



of sphericity is corrected. Tliere is one fact in relation to this 
structure brought to view by the author, which he seems to think 
may have an important bearing upon the point, which is, that the 
elementary lamina, of which the lens is composed, gradually change 
their lenticular or ellipsoidal form as they approach the centre, until 
at last they assume the globular form completel}', so that the nucleus 
is a perfect sphere. 

The theory of our author recommends itself, not only on account 
of the stable basis on v/hich it seems to be founded, but because of its 
agreement with that simplicity in the operations of nature by which 
she accomplishes many objects by the action of one of her laws. 
Thus, as an illustration, by a modified motion of the earth, no less 
than four important phenomena are produced, all of which, at last, 
may be referred to the one law of vnicersal gravitation — and other 
instances of the same kind might be adduced. Another argument, 
not noticed by the author, whicii appears to us strongly in favor of 
his view, is found in the structure of the eyes of some of the lower 
orders of animals, as for instance, the insect tribe, where the eye is 
so immovably fixed in the socket that the adaptive power which they 
possess must depend upon the physical structure of the refractory 
media alone, and not on any muscular power which they can have 
in modifying their forms. 

Like every other theory, however, which may be advanced, it is 
by no means free from objections, two of which readily occur to our 
mind. The first is, that although the nearest distance, Ht which 
distinct vision is possible to the eye in a normal state, is about six 
inches, yet by looking through a pinhole made in paper, we may 
distinctly see an object at less than half that distance. Now, as the 
pinhole can act in no other way than by excluding light like the 
iris, it seems to indicate that the iris may have something to do with 
this property of the eye, as has been maintained by some writers. 
Again, it does not appear that the removal of the lens entirely des- 
troys the adaptive power of the cyo, although it ccv tii[n]y diminishes 
it to a very great extent. It was a practice pursued and recommend- 
ed by Sir William Adams, for what he calls " Conical Cornea,^^ to 
extract the lens entirely, and in the cases in which he performed the 
experiment, the result was, as he himself declares, " that although 
the patients were unable to see cither near or distant objects, imme- 
diately after the operation, without glasses, yet after a time they 
acquire a power to a considerable degree of perfection, if they have 



1845.] Mesmerism. 107 



the patience to do without tliem ;" and he gives us several cases 
illustrative of the fact, so that after all this faculty maybe connected 
with more than one structure of the eye. 

Our author has, it is true, adopted the inductive method in his re- 
searches upon this subject, but the truth or falsity of his deductions 
must rest upon the correctness of his premises. The inductive me- 
thod is good for nothing, without good observers and good observations. 
Lord Verulam himself, in his Essay upon the Nature of Caloric, for 
the purpose of illustrating his own doctrine, associated together, as 
concordant examples, //ze solnr rays and aromatic herbs; (1) and 
many a fine spun theory and logical argument have been based upon 
admissions equally groundless and untenable. 

January 31st, 1315. 



(1) No wonder he came to the conclu5lon that, '-Calor est moms expansionis, 
cohibetus, et nitens per partes minores" — although really it is about as good a 
definition as our modern philosophers can give. — Nov. Organ. Lib. 2, p. 164. 



ARTICLE ir. 

Mesmerism — A Lecture delivered in the Medical College of Geor- 
gia, {by request of the Students,) Feb. 18th, 1845. By Paul F. 
Eve, ^L D., Prof, of Surgery. 

The subject. Gentlemen, proposed for me to examine at this meet- 
ing, is Mesmerism, or Animal ^Magnetism. In the course of lectures 
on Surgery, which it has been my duty to deliver before you \\\\% 
winter, and which is now drawing near to a close, I took occasion 
to allude to it, incidently, once or twice. When recommending' the 
means employed to prevent or relieve pain during the performance 
of surgical operations, you will recollect this supposed agent mms not 
included among them. An operation having been performed by one 
of t!ie professors of this college, upon a patient in the "mesmeric 
state," without evincing consciour,ncs3 or pain, it was natural for 



168 Mesmerism. [April, 



you to desire to know why I had excluded it from the therapeutical 
applications in Surgery. 

In yielding to your solicitation, to give the reason of the faith tiiat 
is in me, and to present the evidence upon which I rely for an opin- 
ion on this subject, 1 do it with some reluctance. It is known, 
that as a faculty, the professors do not agree, and probably it is 
well we should not, upon a topic such as this. As an associate, like 
them, I am an humble searcher after truth, and this generally is 
best discovered by mutual and amicable discussion. And though 
we may differ, still there is no apprehension of the well known har- 
mony and good feelings which exist among us, being in the least 
disturbed by this investigation of an intricate and mysterious agency. 
In examining the subject, I hope to do so as a medical philosopher, 
to oflend none who may not share my own opinions, to violate in no 
instance propriety or courtesy ; and all I ask, is a fair hearing and 
an impartial judgment. 

No one at the present day can enter upon the terra incognita of 
animal magnetism, without some hesitation. The man who would 
give a decided opinion upon this subject, must expect to encounter 
opposition, and should bo prepared to fortify his position not only 
with good reasons and sound arguments, l)ut by indisputable facts — 
a point however much desired, not yet attained. The vantage ground 
is evidently that of silence or non-commitment, but however ditTicuit 
and arduous the duty, and whatever of reputation or character it 
may involve, I cannot now shrink from attempting to discharge it. 

In discussing the subject, I propose to endeavor to establish the 
three following propositions, viz : 

1st, That Mesmerism, or animal magnetism, was unanimously con- 
demned by the commission appointed in 1784, by the king of France, 
to examine and report upon it; and that it has never received any 
favor or approbation from any scientific or learned society whatever. 

2d, That Mesmerism is not a reality ; hut that the phenomena 
ascribed to it, are justly due to the imagination and excited feelings. 

3d, That the non-expression of pain, is no proof of its non-exist- 
ence, and that there are conditions of the body and mind, in which 
no suffering is evinced, and moreover that this state of the system is 
independent of Mesmerism. 

First, then, I am to prove that the cf)mmission appointed in France 
in 1734, unanimously condemned Mesmerism ; and that it has re- 
ceived no favor since from any scientific society. Tho first part of 



1S45.] Mesmerism, 1G9 



this proposition, one would suppose, would require no exposition ; but 
I have recently heard it denied, and this too by men of influence, 
that the French commissioners who examined Mesinerisn^ near the 
close of the last century, did report unfavorably to it. 

My second proposition, tiiat Mesmerism is not a reality, and that 
the phenomena ascribed to it, are justly due to the imagination, is 
so intimately connected with the first, that Ihcy will be considered 
together and not under separate divisions. 

It is said to be as difficult to define Mesmerism, or animal ma'jnet- 
ism, as it is to believe the phenomena ascribed to it ; and it has been 
observed by the same authority, that it ditTers from common magnetism 
as much as natural phenomena do from supernatural. It is not even 
decided whether it be a psychological or physiological subject, whe- 
ther it belongs to the clerical or medical profession. And if doctors 
have differed respecting it, so have divines ; for while, one* has 
published a sermon " on the Satanic agency of ^xlesmerism," another 
has recently, in England, issued a pamphlet entitled, " Mesmerism 
the Gift of God." 

Some believers have pretended to trace the history of Mesmerism 
to tlie remotest antiquity. Indeed, the miracles of Moses and those 
performed by our Saviour, have all been explained by reference to 
this agent, by some of the followers of jMesmer, in France. The 
holding up of the hands of the patriarch, when Joshua contended 
against the Amalekites, and the imposition of the hands of Christ 
upon the sick on some occasions, say they, were acts of V^'smcrism. 
Cut it is generally admitted, that animal magnetism took its origin 
about the middle of the last century, and somewhat after the follow- 
ing manner: — Paracelsus, Vax IIelmont, and others, having in- 
vestigated the singular properties of the magnet, it soon became 
famous as a curative means. A certain Jesuit, named Hell, after 
curing himself of rheumatism, as he supposed, by this agent, excited 
the ardent imagination of .Mesmek, then residing in Vienna. Mesmeii 
took his degree in that city in 177G, and wrote a thesis on the influ- 
ence of the planets on the human body. According to his theory, 
all the phenomena of life depend upon the movements of a mag- 
netic fluid ; and by |>ul)licly maintaining this opinion he incurred tho 
contempt and ridicule of his own coutitrymcn, which iiiduccd him, 



• The celebrate J Rev. Mr. T^eilf, of Liverpool. 



1"^ Mesmerism, [April, 



with other considLTationJ^, to quit Vienna and come to Paris. Hav- 
ing created a gvawi sensation in this latter capital and acquired an 
immense fortune, the king, Louis XVI. ordered in 1784, a commis- 
sion from the Academy of Sciences, from the Faculty of Medicine, 
and the Royal Society of I\[edicinc, to examine and report upon this 
new agent employed by Mesmek in curing diseases. From these 
three scientific bodies, fourteen persons were appointed, and among 
the number from the Academy, were Franklin, Bailly and Lavoi- 
sier, names inseparable from the annals of science. Mesmer refused 
to submit to this commission, and declined all propositions to have 
the subject investigated. They then had recourse to his acknow- 
ledged disciple, lAI. D'Eslon, who was a member of the Medical 
' Faculty of Paris, and was one of the first converts to the new doc- 
trine. 

Every week, for two or three hours, these commissioners experi- 
mented with EsLON, or Deslon, as his name is anglicised, and by 
themselves. M. Virey, a believer in Mesmerism, as any one may 
see in the 29th vol. of the Dlctionnaire des Sciences Medicales, 
states, tljat they felt nothing of this secret agent — they could not 
recognize the slightest sensation. Children did not experience any 
thing singular when experimented upon. When they bandaged the 
eyes of a patient, and then persuaded him he had been magnetized, 
but without doing it, he exhibited the same impressions as those who 
had been subjected to it. As trees were also magnetized according 
to Mesmer and Deslon, they bandaged the eyea of a young man, 
and conducted him towards one non-magnetized ; upon telling him 
it was magnetized, he was agitated by magnetic convulsions. All 
these etTcctsthen, ascribed to a secret pretended agent, they concluded 
were the result of the imagmation : and the commission from these 
learned bodies reported that animal magnetism was a chimera, and 
that the magnetic cures were the effects of the imagination. This 
report was confirmed by every member of the commission, except 
one, M. JussiEU, who did admit that there were some facts which in- 
duccd him to believe in the existence of a particular fluid, which ho 
compared to electricity rather than to magnetism. lie was however, 
but one, out of fourteen. 

J. BouiLLiAUD, a skeptic on the subject, and at present one of 
the Professors of Medicine in Paris, writes concerning this same re- 
port, that the ccmnissioners acknowledged that those who pretended 
to Mesmerize patients had great control over them. But this com- 



1845.] Mesmerism. ITl 



mission, of which the celebrated and i:i fortunate Bailly "vvas the 
reporter, concluded, from the experiments which they \vitnes.=^d and 
from those they made themselves — 1st, that there existed no particu- 
lar fluid which deserved the name of magnetic fluid — 2d, that the 
facts obtained were the result of a bewildered (frappee) imagination ; 
since from their experiments, they obtained these magnetic effects 
without magnetizing, provided the patients believed they had been 
magnetized, and that on the other hand, these effects did not occur 
when the patients were magnetized without their guspcctirg it — and 
Sd, that the crisis produced in the magnetic treatment might be dan- 
gerous and never useful. 

In the article, somnambulism and animal magnetism, written by 
Dr. J. C. Peicuard, of Edinburgh, in the 20th part of the Cyclopae-* 
dia of Practical Medicine, just published, will be found the following 
observations respecting this celebrated report of the learned societies 
of Paris: "The commissioners were men of the highest authority 
in science. '•'' * * They saw trees, bottles, glasses and cups mag- 
netized. * We cannot prevent ourselves,' say they * from recognising 
in these constant effects a powerful agent, which acts upon patients, 
subdues them, and of which the person who magnetizes them seems 
to be the depositary.' The commissioners soon discovered that it 
was very difficult to ascertain to what point the results produced 
were the cjj'ects of the imagination, to the excitement of which so 
many circumstances were adapted, and how far to any peculiar agen- 
cy. They resorted to private trials of the same manipulations. 
Some of the most interesting of these experiments were performed at 
Passy, at the residence of Dr. Franklin, who couM not be present 
at Paris at the public exhibition. Here Deslon tried his art in 
vain upon the obdurate American, as well as upon the members of his 
family, who, notwithstanding that some of them were ladies in del- 
icatc health, were found quite insensible to the whole ceremonial of 
magnetism. Neither cf the other commissioners could perceive anv 
effect in his own person." Dr. P. then relates the experiment upon 
trees said to be magnetized, with a boy having his eyes bandaged. 
This youth was purposedly selected by Dlslon, as an individual 
susceptible of the magnetic influence. This gentleman stood in the 
garden, with his cane pointed to the magnetized tree to keep it so, 
while the boy approached four trees successively. Under the first, 
he perspired great drops, coughed, expectorated, and felt pain in his 
head — being then 27 feet from the magnetized tree. Under the se- 



17\J Mesmerism, [April, 



coiid he felt stupor, dec; under the third, these symptoms greatly in- 
creased ; the youth believing he was a|)proacl)ing the magnetized 
tree, though in reality distant 83 feet from it. Under the (ourth, not 
magnetized, but 24 feet from the tree pointed at, he fell into a crisis. 
" He lost all consciousness, was carried to a neighbouring grass-plot, 
where Deslox scon reanimated him. The operator accounted 
for this untoward phenomenon by saying that the trees had probably 
become spontaneously magnetic. 'But, rejoined the commissioners, 
if trees are in the dangerous habit of assuming this state of their 
own accord, a susceptible person walking in a garden must incur 
the continual risk of falling into a crisis.' 

" The commissioners," continues Dr. Prichard, " having repeated 
and varied the experiments in every way that seemed to afford an 
opportunity ot arriving at the truth, at length came to the conclusion 
that the whole proceedings of the magnetizers were calculated in 
several ways to do injury; that they were devoid of any salutary or 
useful influence, and that the results were wholly to be attribu- 
ted to the imagination and other feelings^ which were excited by the 
performances. ]\I. Jussieu, however, refused to coincide in the re- 
port, and returned one of his own, which, though by no means favor- 
able to Mesnier, and explaining most of the results in the same man- 
ner as M. Bailly had done, yet admitted that in four particular ex- 
periments, he could not account for the results by attributing them 
to the imagination. He proposed an hypothesis of his own, viz. that 
animal heat, or, as he termed it, ' the electric fluid animalized,' direct- 
ed and accumulated on certain parts, may be the cause of the effects 
produced." 

It is proper to state, that in addition to this report, a private one 
was sent by these commissioners to the king, referring to the liability 
of abuse on the subject of Mesmerism. And indeed one would sup- 
pose something of the kind was necessary even thus early, as the 
following anecdote, known to all Paris at the time, will explain : *'Un 
satyriasis survint subitement a un monsieur, a la vue d'une jeuno 
demoiselle qui etait avec sa mere; les choses allaient si loin, que la 
merese leva pour y mettre ordre; mais M. d'Eslon s'ecria ; Laissez 
les faire ou ils mourront." To say nothing of this gross violation of 
decency and morality, we have here certainly a striking instance of 
sympathy on the part of the mesmeriser for the sensual acts of the 
mesmerised. 

You have now, gentlemen, the conclusions of this famous report of 



1845.J Mesmerism. 173 



the Royal commission of France, made in 1784, and in the very- 
words of three dififerent persons under different circumstances, viz: 
by ViREY, a believer in Mesmerism; Bouilliaud, a skeptic; and 
Prichard, who may be considered neither the one nor the other. 
If what has been stated respecting the decisions made by the scientific 
Societies of Paris be true — and that it is correct no one will pretend 
to deny — we find, in the first place, that Mesmer acted the part of 
all quacks and impostors, by refusing to have his pretended magnetic 
fluid examined by those most competent to judge of its virtues, and 
therefore, if true, to give it character; and, secondly, that after a 
patient investigation of the subject of Mesmerism, varying and re- 
peating experiments in every possible way which promised to arrive 
at truth, by fourteen individuals selected for the purpose from three 
of as learned bodies as then existed in the world, they pronounced 
animal magnetism a chimera. Not one made a report favorable to 
Mesmer, and only one, M. Jussieu, refused to admit that the opera- 
tions of the imagination could explain all they had seen. He classed 
all the phenomena which he had observed under the fo»ir heads: — 
1st. those general facts of which physiology could indicate the true 
cause with precision ; 2nd. negative or facts contrary to animal mag- 
netism; 3rd. those attributed to the imagination; and, 4th. facts 
which induced him to admit the existence of a particular fluid. He 
then states the case of a blind v/oman who was agitated when a rod, 
leading from a tub, which could neither generate nor retain magnet- 
ism or electricity, was pointed at her stomach, and which ceased when 
said rod was turned aside. Virey remarks, that Jussieu did not say 
whether the blind person was prejudiced in favor of animal magnet- 
ism or not, for this idea is often every thing in these delicafe obser- 
vations. Several other facts, continues he, analogous to this one, 
(viz. the agitation of a blind woman when her stomach was pointed 
at with an iron rod,) induced Jussieu to presume that there really 
did escape from the human body, under certain circumstances, a 
fluid, which he compared to that of electricity, rather than to a mag- 
netic fluid, tint yet demonsiraled. 

From this slender pretext, the impression is made that one of the 
members of the French commission was in favor of Mesmerism ; and, 
moreover, that ho was one of some (bur or five commissioners 
appointed by the King of France; whereas, the truth is, not ono 
believed that animal magnetism had been demonstrated, and there 
were not less than fourteen individuals who were associated in tlir» 



174 Mesmerism, [April, 



invcstlrration of the subject, and not from one, but from three difTcrent 
Societies. Notwithstanding these facts, strange as it may appear, 
some believers in Mesmerism are in the habit of referring to this very 
report, as authority fur their fliith ; because, say they, the commis- 
sioners acknowledged constant and powerful cfTects upon patients, 
the agency of which seemed to be deposited with those who liad 
magnetized them. I have cetected, however, that tl.e word seem, 
was very apt to be omitted; and the quotation itself not comi)leted. 
The commissioners expressly state, that this agent acting upon these 
patients was none other than the imagination. They never thought 
of attributing these effects to Mesmerism. They declared, unani- 
mously, they had never felt it — that it had net been demonstrated to 
them : they condemned Prliis^iER in fofo. 

Now Vr'hat were these efTects which this commission witnessed, and 
wliieh they, with so much unanimity, attributed to the imagination 
and other feelings excited by the performance of the mugnetizers ? 
Precisely those that are credited at the present day. Besides cough- 
ing, pains, tremors, convulsions, involuntary movements, &c. &c. — 
they say that every thing depended upon the will of the magnetizer ; 
were the patients in an apparently deep sleep, his voice, a look, a sign, 
(\ve\v them out of it. They also saw a young man, very impressible 
by the magnetic iniluence, who not only coughed, e::pcctorated, per- 
spired great drops cfsweat, felt pain in his head, had stupor, fell into 
a crisis, and lost all consciousness, and simply because he believed he 
was approaching a tree said to be magnetized. Having lost all con- 
sciousness, of course this youth was insensible to pain. A similar 
state, unconsciousness and insensibility to pain, is now produced by 
a look, or a few passes with the hands, for some seconds, or at most, a 
few minutes. In the former case, a Fr.AMiLiN, a I5ailly, a Lavois- 
ier, a GuiLLCTirf. a Jussief, and others of the highest authority in 
Science, attributed it wholly to the imagination and other feelings 
excited ; and as to the latter instance, Gentlemen, while others may 
difier, I really do not think we can do better, than follow their illus- 
trious example — two effects, so similar, cannot be very remote in the 
cause producing them. 

We now leave this report, of which so much of late has been said, 
and allow believers in Mesmerism to draw v.hat consolation or en- 
couragement they can from these undeniable and indisputable Hicts, 
for so far as its conclusions are concerned, I have, in all honesty and 
candor; given you the truth, the whole truth, and nothing but the truth. 



1845.] Mesmerism, 1T5 

In 1831, the subject of Mesmerism was agitated in the Royal Acad- 
emy of Medicine in Paris, and M. Hussox made a very favorable 
report respecting it — even admitting its extensive influence ; but 
wiiich was ably criticised by 31. Dubois, (D'Amiens). This, liowe- 
ver, had nothing to do witli the Academy of Sciences, or Faculty of 
Medicine, in that city : and even the report of M. llussox was not 
adopted by the Royal Academy of Bledicine, but simply read to that 
body. 

In 1841, appeared a work entitled the Academic History of Ani- 
mal Magnetism, and wriiten i)y Drs. Burbix and Dubois, members 
of the Royal Academy of Medicine of Paris. " These authors," 
says Dr. Ja^ies JoII^-sox, the celebrated Reviewer, "endeavor 
to establish a connection between all the leading juggleries which 
from one age to another have made their appearance in the 
world. They carry the reader, without any forced transition, 
from the oracles of antiquity to the witchcraft of the middle ages, 
from the devotees of London to the tremblers of Cevennes, from the 
convulsionists of St. Medard to the exorcisms of Gassner, and lastly 
to3Iesmerism, which the true believers point to us as the era of the 
doctrine of animal magnetism." They moreover declare that the 
report of M. Husson, already referred to, was neither discussed nor 
approved of by their learned Society. 

Tiie only other instance that I knov/ of since 1784, in which animal 
magnetism was alluded to in the Academy of Sciences, the most 
learned body in the world, occurred the 24th of June, 1841. It was 
contained in a report read by the distinguished physiologist, M. Ma- 
gendip:, on a case of alleged cure of a deaf and dumb woman, made 
by ?.r. DupoTET. As the exact condition of this patient, a female, 
was not ascertained before being subjected to this supposed agent, 
the commission could not vouch for the cure, even had it been com- 
plete — ''but unfortunately for both patient and doctor, it was far 
from being so." They took three inmates of one of the deaf and 
dumb institutions of Paris, and proposed to M. Dupotet to test the 
cflicacy of his treatment ; to this he consented. He asked for only 
eight days; they gave him fifteen. At the end of the eighth day 
M. D. represented them as cured, but the regular physician of the 
Institution from which they were obtained, told the commissioners 
that the amendment was in no respect dilfcrent from what mi'i^ht at 
any lime be atfocted, by proper exercise, v^c, of the organs of hearing", 
but which continues fur a sl.ort time. They then proposed to M. 



17»3 Mesmerism, [A.pril, 



DupoTET to send the three patients three times a week to his own 
liouse, to complete the promised cure, hut he declined giving any an- 
i^wer. The commission therefore concluded, the cure alleged to have 
heen efTected by animal magnetism on a deaf and dumb patient, is 
c uite without foundation. 

Dr. JoHXsox says that at a subsequent meeting of the Academy 
of Sciences, they resolved by a largemcjorify to have nothing more 
to do with the subject of Mesmerism. I\I. CLoauET, and even M. 
I>ouiLLiAUD, objecting to this summary dismissal of it, when M. 
BinisciiET stated that as that body had come to a resolution to pro- 
ceed to the order of the diy, whenever the question of the quadra- 
ture of the circle or perpetual motion was brought forward, tho 
Fui)ject of animal magnetism should be dealt with by them in the 
same way. This I believe was the final action of that most distin- 
guished Society on the subject of Mesmerism. 

On Sunday, tlie 1st April, 1829, M. Jules Cloquet, one of the 
Professors of Surgery in Paris, removed a cancerous breast from a 
patient, in that city, while in what is called the mesmeric state. She 
was a pious lady, of excellent character. She evinced no pain 
during the operation — indeed the Ilermcs, a journal of animal mag- 
netism, states that when the surgeon was washing the wound, the 
patient said merrily, "come, leave off — don't tickle me." She died 
a fortnight after the operation ; and a report having reached England, 
that while dying she confessed the whole had been a cheat. Dr. El- 
LioTsor^', who was ejected from a professorship in the London Univer- 
sity, for his belief in animal magnetism, wrote to Cloquet on the 
subject, and who replied, (so says Dr. ELLioTsorf's student in Paris,) 
he "is quite certain she never made the confession alluded to." 

On the 22d November, 1843, the subject of P.Iesmerism was in- 
troduced into the Royal Medico-Chirurgical Society of London, by 
Counsellor ToniAJi, relating the case of an amputation of the thigh 
of a laboring man, who was in the mesmeric condition. Lawyer T. 
was backed by Dr. Elliotson, and in the account published of it 
by the latter gentleman, it is stated that *'soon after the second in- 
cision, a moaning was heard from the patient, which continued at 
intervals until the conclusion ; giving to all present the iinpression 
of a disturbed dream. When the patient awoke, graduallj'' and 
calmly, — at first, he uttered no exclamation ; and for some moments 
seemed lost and bewildered, but after looking around, he exclaimed, 
' / bless the Lord, to find it '5 all over.'' When questioned, he observ. 



1845.] Mesmerism, 17' 



ed, he felt no pain, but once ' felt as if he heard a kind of crunch- 
ing.^ ^^ As all in the mesmeric state are poeti'-al, this last expres- 
sion has been interpreted to mean, he heard the sawing of the hone. 
But the proof that this man knew what was fjoing on at the time, 
the operator, a Mr. Ward, stated he designedly [)inched the sciatic 
nerve with a pair of forceps; and had the patient been even decapi- 
tated, Dr. Marshall Hall says his opposite limb would have been 
agitated — a fact which you, Gentlemen, saw illustrated a few days 
ago, in the partial amputation of a foot.* Dr. Hall concludes from 
this circumstance, that the quiescence of the man during the opera- 
tion was the effort of his mind to control his suffering. In the dis- 
cussion which ensued on the presentation of this case to the Royal 
Medico-Chirurgical Society, we find that besides Dr. Elliotson, 
Drs. Arxot, Oliver and Sysies, were the advocates of Mesmerism, 
and those who opposed it were Ja3Ies Joit^soN, Marshall Hall, 
MooRE, Blake, George Burrows, Copland, Grkgory, Evans, 
Merriman, Sir Benvamix Brodie, Alcock, Travers, Listox, 
Wakley, Editor of the Lancet, Cesar Hawkins, &;c. It need 
scarce be added, that animal magnetism was peremptorily dismiss- 
ed from the Society. 

In the two patients operated upon in the Mesmeric state, the one 
recently in this city, and the other in Europe, we notice this differ- 
ence. The one, when roused, and after collecting himself, said, " I 
bless the Lord to find that it is all over;" but the other, after she 
awaked, conversed concerning her amputated breast, " about a quar- 
ter of an hour," replied, when asked, that "it feels about as it has 
done for some time l)ack," and this, too, notwithstanding the Mes- 
meriser's passes over the scat of the operation, in order to lessen its 
sensibility, and yet "slie expressed her incredulity — said the operator 
was jesting, as it ^vas impossible that it could have been done without 
her knowing it at the time, or feeling any thing of it now. She be- 
came convinced only on carrying her hand to the part and findinrr 
that the breast was no longer there.' 'J'his surely is the most as- 
tounding part of the whole operation. That she was insensible to 
the knife is certainly nothing compared to the fact, that after beinfr 
aroused from the "Mesmeric state," and saying distinctly when 



♦ I know Dr. E. has attempted to deny this reflexed action in the opposite limb • 
but the profession need only be reminded of the fact, that the uniform practice^ 
until a lew years agjo, was to tie the opposite Urn!) to a le;^ of the table, to iircvent 
this very movement or agitation, during amputation. 

12 



178 Mesmerism. [April, 

questioned too, that the breast felt about as it had done for sometime 
back, admitted she did not perceive any change in the ordinary sen- 
sation oithe affected breast, conversoH about it for ^ifr.en rpinutes, 
and still did not know the opera:ion had baen periornied. With me 
this is the greater wonder of the two, and is proof positive of the ex- 
tent to which this patient was deceived by her own sensations. She 
declared she felt no Mesmeric influence in the breast, notwithstand- 
ing the passes had been applied, by a Mesmeriser; and then again 
while in possession of her natural feeling in the breast, did not know 
for about fifteen minutes it had been cut off, even after having been 
aroused from the Mesmeric state. If this be not proof of the effects 
of the imagination, or of the operations of the mind, in this instance, 
controlling the ordinary sensations, then I know not where we can 
find it. This lady was evidently in a trance, or reverie, brought on 
by the workings of her own feelings — just like the boy who lost all 
consciousness, from believing he was approaching a tree said to be 
Mesmerised. And yet this one case, has made hundreds of believers 
to Mesmerism. 

Who does not recollect the incident of an actor on the stage of 
Liverpool, falling dead upon uttering the words, in the play of the 
Stranger, " There is another and a better world ?" To what was 
this melancholy and unexpected event owing, but the yielding to the 
impulse and energy of his own feelings? How often have hysterics, 
syncope, &c., been brought on by patients themselves ? 

But not only by learned societies has Mesmerism been invariably 
rejected, it has almost universally met the same fate from distin- 
guished men in every country. With a few exceptions, such as 
CuviER, RosTAiv, Hussor^, Bertrand, &c., in France; Hufela^d, 
in Prussia ; Elliotson, in England, &;c., animal magnetism has 
uniformly received but little favor from scientific persons. 

Renauldix, says, "as to Mesmerism, animal magnetism, som- 
nambulism, real or simulated, or Perkinism and other modern inven- 
tions of charlatanry and of bad faith, if in some cases, these means, 
equally disavowed by reason and experience, have appeared to give 
some favorable influence to pain, it is evidently in individuals who 
have a blind confidence or a credulity without limit, and disposed by 
prejudice to receive an alleviation desired with ardor." 

We have already given the names of several distinguished men of 
Great Britain, and no doubt the list could be greatly augmented. To 
it we add the name of Sir Astley Cooper. And if in the British 



1845.] Mesmerism, 179 



realm there be one man who stands, more deservedly higher in char- 
acter, us a physician and a writer, it is Dr. James Joiixsox, of the 
Medico-Chiriirgical Review, and who has on every suitable occasion 
been the uncompromising and unremitting opponent of Mesmerism.* 
Brachet, a distinguished author in Paris, who has published 
largely on nervous affections, &c. writes, " from the magnetism of 
MssMERhas arisen that other jugglery, denominated animal magnet- 
ism. Twenty times beaten doum by science, and reason and facls^ 
every now and then it has again lifted up its head, more ridiculous 
and amusing, indeed, than dangerous. We do not, however, mean 
to deny the effects which may be induced in persons of highly nerv- 
ous constitutions, by the passes and other grimaces that are usually 
practiced, in the magnetic stupor of the animal energies that is 
sometimes induced, the entire nervous system is compromised ; and 
this influence may unquestionably appease pain and spasmodic con- 
tractions for a time, by acting pov/erfully on the imagination." He 
then states that although he has heard of such cases, he has not him- 
self met with any well-authenticated examples. "These distant 
voyages," continues M. Beaciiet, "without moving from off one's 
chair, these divinations, these transpositions of the senses, (kc , are 
only so many clever tricks, contrived to amuse the weak and entrap 
the foolish. It may happen that a poor silly hypochondriac, who is 
strongly prepossessed in favor of tliis culpable jugglery, appears for 



♦ Take but his last blow at this subject, and which is the last article in the 
last No. (99) of the London Medico-Chirurgical Review. Ridicule I know is 
not argument, and neither are opinions, facts. I grive this in proof of great 
men, in the medical profession, being opposed to Mesmerism. Let it pass for 
what it is worth. 

'' M sMf rism. — We do not know whether to congratulate, or condole with, the 
talented Heroine of Political Economv on the strange dream that has come 
over her soul. It appears that Mi.ss Martineau recovered her health and — we 
were nearly saying— lost her senses! But tliis is not the case — she hasacquired 
an additional sense — clairvovanck! Her maid, Bktty, placed her hand on her 
mistress's ivory forehead, and, presto, a Stkam-Tlu that was passing, became 
metamorphozei into a ship of celestial glory, fringed with gola and silver, and 
fit to be * a God-head's dwelling.' 

It's all in my eye, Betty Martin — eau. 
Betty, however, is no fool. She prescribed ale and brandy and water to her mis- 
tress, instead of opium eating, and the change resulted in the best efi'ect. Har- 
riet's Mesmeric dreams will prove a god-send to the animal magnetizers, and 
will command more attention among the old women of both sexes than her Po- 
litical Economy and her 'Preventive Checks.' Bin it won't do! 

" It will be the wonder of the day — perhaps of nine dayh — and then sink uito 
oblivion with the exploits of Mi^s Okcy." 



180 Mesmerism, [April, 



a timo to derive some benefit to his lirnlth ; but then it is only from 
his becoming the (iupc of his crediMous fancy, and not from any direct 
or actual sanative influence bestowed." 

In concluding the above transhilion from the French, Dr. Jonis'- 
soN says, that " we observe, in a recent number of the Medical Ga- 
zette, (a Journal of Paris,) a quotation to the same efTect, of the 
opinions of the celebrated riiiller, of Berlin, on the subject of animal 
mngnctism. How long will any men of education allow themselves 
to be imposed upon by the juggling tricks of clever rogues, and paid- 
for testimony of credulous women ? Medical men, at all events, 
should know better : for they must have studied the history of the 
nervous system and its functions only indifferently well, not to be 
aware that many startling, and not easily explicable, phenomena arc 
apt to occur during the progress of some of the neuroses."* 

It is licquently asked, and with an air of triumph, by believers in 
Mesmerism, will yon deny facts? No, Gentlemen, these are said to 
be stubborn things, and we do not wish to run counter to them. 
But what we do deny is, that all are not facts w hich are represented 
to be such, and this Mesmerists must admit themselves. Ask any 
one why he believes in animal magnetism, and he will tell you, be- 
cause I have seen so many facts I cannot doubt its existence. Request 
of this same person an explanation of the phenomena he has wit- 
nessed on this subject, and he will reply, I have observed so few 
facts 1 can give none. That is, he has facts enough for his senses 



♦ Benjamin Franklin's Estimate of Animal Magnetism. — Franklin Avrites 
thus, to M, De la Condamine: 

"You desire my sentiments concerning the cures performed by Camus and 
Mesmer. I think, in geneixl, maladies caui-cd Ly ol>tir.ciions, may le Heeled 
by electricity with advantage. As to the Animal Magnetism, so much talked 
of. 1 must doubt its existence till I can sec or J'ecl !-ome cficct ol it. ]None ol the 
cures said to be performed by it have fallen under my observation, and there 
being so many disorders which cure themselves, and such a disj-osition in man- 
kind to deceive themselves and one another, on these occasions, andlivinglong, 
has given me so frequent opportunities of seeing certain remedies cried up as 
curing ever}'' thing, and yet soon alter laid aside as useless, I cannot but fear 
that tlie expectation of great advantage from this new method of treating dis- 
eases will prove a delusion. That dehision may, however, in some cases be of 
use while it lasts. There are in every great, rich city, a number of persons 
who are never in health, because they are fond of medicines, and always taking 
them, whereby they derange the natural functions, and hurt their constitution. 
If these people can be persuaded to forbear these doings, in expectation ol being 
cured by only the physician's linger, or an iron rod pointing at them, they may 
DDSsiblvfind goodettects, though they mistake the cause. 

" I have the honor to be, &c. B. FRANKLIN." 

(nublin Med. Press, July 2\st, 1841.) 



1845.] Mesmerism. 1^1 



to admit a thinff, but not enough for him to exercise his reason. 
Now, upon what sense can we rely? Is it not true that courts of 
justice are chiefly sustained by errors of sight and hearing;, and that 
perver.ed sensation and imaginary diseases feed and clothe the med- 
ical profession ? How often iias even lithotomy been performed 
where no stone existed ? 

Another question often proposed by Mesmerists is, will you doubt 
your senses? If I receive an impression, by the exercise of one 
sense only, and this act be contradicted by reason and judgment, 
then I should not credit it, Ijecause I know how liable one sense is 
to deceive me. But if by the question so often asked, is meant the 
senses, then, I answer, no, I do not (in general) doubt them. And 
upon this very principle, I cannot believe in Mesmerism ; for it has 
never been presented to my mind through the senses. Like the 
commissioners appointed by the King of France, I have never been 
able to perceive any ertbcts in my own person or in that of another, 
which could not be otherwise explained. I have tried until satisfied 
that nothing unnatural could be i)r()di:ced. I have had professed 
magnetizers to labor by the hour on patients, and on some too very 
anxious to be put into the Mesmeric state, and still no relief or miti- 
gation of pain whatever was induced before the knife was employed. 
Some indeed have gone to sleep, but a word or j)rick of a pin has 
sulliced to arouse them. And I know and have heard of patient 
after patient, where ah the ceremonials of animal magnetism have 
been industriously employed, without producing the expected effects. 
Nor have the promise of my Mesmerising friends been at all realized. 
True, I witnessed on one occasion what produced extacies in some 
of them, until the Mesmerised boy by indication exhibited the organ 
of comhalii'cness^ from touching the tips of his shoulders. I have 
been asked several times since if I would like to witness the I\Iesmer- 
ic phenomena, and I have replied that I was a searcher after truth 
on the subject. I have heard, and that too very recently, of IMes- 
meric soirees or parties, at which I am told some of you were actors, 
as well as spectators, but as I was not invited, it is presumed the experi- 
ments were not satisfactory. Perhaps, indeed, my skepticism might 
have made me an unwelcome visiter. But this much is due to truth. 

But slill you may ask me, shall I not believe my senses? Cer- 
tainly, my professional brother, you are the best judge of your 
own perceptions. And pray, let me ask, whnt have you experienced 
on this subject ? Ilav.-^ yr.ii oven recognized it by any four, or three, 



182 Mesmerism, [April, 



aye, even two of the senses? If so, I beseech you relieve the world 
of the anxiety on the suhject — settle the question at once of its ex- 
istence, by telling what it is. But can animal magnetism abide this 
test? If not, and there are still difficulties in the way, mysteries and 
contradictory evidence, yet unexplained, it is the part of wisdom to 
scrutinize more closely and delay a decision favorable to its existence. 
In proportion to the improbability of a thing, should be our skepti- 
cism. The more extraordinary the phenomena, the more irrecon- 
cilable the fact, the greater the liability to error. Voltaire says, 
to believe a miracle, (and what is the conversion of water into wine 
compared to some of the so-called facts of Mesmerism,) it is not suf- 
ficient to have seen it, for we may be deceived. To be well established, 
it ought to be performed in the Academy of Sciences of Paris, or 
in the Royal Society of London. Now it has so happened that both 
these learned and scientific bodies, as we have already observed, did 
publicly and with great unanimity condemn Mesmerism. 

In accounting for the facts ascribed to animal magnetism, and in 
presenting my views on tliis subject, I adopt the opinions of J. Bou- 
ILLAUD, and reduce all phenomena that we observed to two classes 
or orders ; 1st, disturbed sleep, gaping, convulsive movements, deep 
sleep, somnambulism wilh insensibility more or less marked, shout- 
ings, laughters, &;c. These, says he, do not depend u'pon Mesmerism, 
since it is known that all these can be manifested by individuals who 
have not been subjected to that influence, and are the effects either of 
certain lesions of the nervous syslem, or simply the influence of cer- 
tain impressions or moral feelings. The second order of phenomena, 
continues he, cannot be classed wilh facts admitted at the present day 
— they are entirely contradictory to |)hysioIogifa! truths the most 
evident and clearly demonstrated — those are sight without the eyes, 
at the epigastrium, the end of the fingers, tlie occiput, the forehead ; 
prophecy ; divination; determining the seat and treatment of dis- 
eases by those, who have never studied medicine; the communica- 
tion of thoughts without any kind of sign ; the immediate communi- 
cation of symptoms of |)atients to the majjnetizcd with which they 
are in relation ; &c., &c. As these violate and are at variance to 
known and long established principles of anatomy and physiology, and 
are ojiposod by reason and judgment, and since it is not agreed what ex- 
actly they are by those who admit them, and moreover as this evidence 
is so conflicting as to destroy itself, they should be rc^jected as having 
no scientific value. If then the facts of the first class are explained 



1845.] Mesmerism. 183 



independent of Mesmerism, and those of the second are inexplicable 
by it, why, I ask, employ the term at all ? Why presume the exist- 
ence of a thing never demonstrated ? Why declare the presence of 
a new agent, when those known to the profession can explain all the 
facts that are well established ; and besides, to admit it, would neces- 
sarily involve the performance of miracles ? 

It may be said that all my arguments are chiefly directed against 
the name, and not to the denial of the existence of certain phenomena 
attributed to animal magnetism. I do admit that sleep, convulsive 
movements, insensibility, even mania itself, yea, death, may be pro- 
duced, and have been produced, by one person operating on the feel- 
ings of another — but these, in my humble opinion, are not the effects 
of an occult mysterious agent, called Mesmerism, but the legitimate 
results of the imagination, dec. And I am particularly strengthened 
in this opinion, by M. Bertrand, one of the most zealous advocates 
of animal magnetism at the present day, in Paris; and also by Dr. 
Prichard, of Edinburgh, who has written the last article on the sub- 
ject now before the profession in this country : and again, by Dr. J. 
K. Mitchell, one of the professors in the JelTcrsen Medical College 
in Pliiladelphia, whose views in its favor have been published, and so 
far as I know, he is the first and only one who has ventured in this 
country to do so. 

Dr. Prichard defines a somnambulator to be a dreamer who is 
able to act his dreams. " To tliis property," says Dr. Mitchell, 
"of artificial dreaming:, ^^y be referred the alleged miracles ofclair- 
voyance, intuition, and prevision. The subject dreams that he sees, 
and the questioner is deceived, by his confidence, his plausibility, and 
his ordinary character. He knows liirn to be honest, and he does not 
perceive that he is himself led astray by his uncorrected imagination. 
* * * The ra»/7o;'/, relation, or communication, supposed to have 
an absolute existence, dependent on the Mesmeric fluid, seems to bo 
entirely voluntary on the part of the patient, and rests on his know- 
ledge of its supposed necessity. It is, therefore, a delusion, but ono 
of the greatest convenience to the public exhihit«)rs of Mesmeric 
wonders. * * * Many of the feats of the clairvoyants are the 
results of the sharpened hearinjr, which enables them to detect objects 
by the sounds they make. 'J'h(»y really believe they see them, and 
so does the exhibitor, although he aids them by handling audibly tho 
various o))jects. (C«'rtninly very fltittcring.) Tims he opens and shuts 
a pencil, a |)en-knitV',or a s;!)r'cta<'!t'-rnso, .ind n;b-astick, or a sheet of 



184 Mesmerism, [April, 



paste-boaid. Ho always makes as much noise as possible with every 
thinoj. and he generally asks the producer of a marked card to explain 
the words or device to hitn. As we cannot believe in Mesmeric rapport, 
so we are not able to credit the existence of any peculiar sympathy be- 
tween the operator and subject. Untrained or ignorant patients never 
show syaipatheiic plienomcnn. I have been pinched, and hurt other- 
wise, a great many times, without ol)serving any suffering on the 
part of my subjects, until they were taught to believe thai such a 
relation existed; and then they honestly telt hurt, as people do in 
dreams — a kind of imaginary suffering. The phrenological phenom- 
ena of Me-merism, when rigidly examined, are found to consist, as 
do most of the Mesmeric wonders, of 'such stuff as dreams are 
made of.' The excitement of the brain is general, the direction of 
that excitement is given by the Mesmerised person's knowledge of 
phrenology. * * jMost of the phenomena of Mesmerism are a 
strange mixture of physical impulse and menial haUvcinafion." 
These are the words and language of the most distinguished believer 
of Mesmerism in our own country. 

With respect to the rapport, communication, or sympathy claimed 
to exist between the Mesmeriser and the Mesmerised, there is one 
remarkable circumstance, that has been overlooked. The person 
majznetized, it is said, experiences all the sensations, &;c. with the 
one with whom he may be placed in relation ; and he will feel pain, 
taste the same articles, imitate the act of swallowing, &;c. ; indeed, 
be in subjection even to the will of the Mesmeriser, and yet they 
never utter the same words. If this relationship be so intimate, this 
symj-.athy so close, why is it tiiat they do not speak alike — if one does 
what even the other only wills, thus having in reality an identity of 
thouirht and actions, why don't they use the same language. 

To prove too what can bo endured by practice, the Boston Medical 
and Surgical Journal states, that within a year two boys voluntarily 
called to explain the tricks and impositions of Magnetizers — one had 
been several months the wonder and admiration of hundreds of be- 
lievers. "Yet he positively declared that he had never been asleep 
in any instance, before an audience, nor was there ever a period 
when ho was not thorougliiy cojiscious in every respect, and obedient 
to command. l>y pradice, ho could hear to be pricked under the 
nails, tolerate tiie blaze of a candle within an inch of the eye without 
recoiling, allow heavy men to stand on his toes &c., and in short, be- 
came bv regular processof training, the best subject in New-England." 



18^5.] Mesmerism. 1S5 



But further in proof of the effects ascribed to animal magnetism, 
being nothing more than the operations ot the mind upon the body, 
all acknowledge its phenomena resembling very closely those of 
somnambulism — now it is certain, that the somnambulist sees only 
those objects which he seeks, or which are present to his imagination. 
A case of a female in this state is mentioned by Sauvages, where a 
lighted candle brought so near to the organ of vision as even to burn 
the hair of her eye-brows, a person unseen uttering suddenly a loud 
cry into her ear, brandy and a solution of ammoniacal salt placed 
under her eyes and introduced into her mouth, the feather of a pen, 
and afterwards the extremity of a finger applied on the cornea, Span- 
ish snuff blown into the nostrils, pricking by pins, twisting her ling- 
ers ; all these means were tried without producing the least sign of 
feeling or perception, and yet she perceived objects to which the 
current of her thoughts directed her. 

We have the authority of the celebrated commissioners appointed 
in France in 1784, to report on the subject of Mesmerism — they 
unanimously agreed that almost every fact they witnessed, was the 
resulc of the imagination and other feelings, to the excitement of 
which so many circumstances were adapted. " Dertkaxd main- 
tains that the effects, as well as all the results of magnetism, are to 
be attributed solely to the excited imagination ; and he declares that 
the effects produced within his experience haveaiways borne the most 
exact proportion to the conviction of the patient." He also supposes 
that the sense of weariness or numbness of the limbs, which persons 
experience when experimented upon, is occasioned by remaining 
long in one position. 

The theory of animal magnetism adopted by Rostax, Hussoxand 
others, and practiced upon by all believers, is that there exists a pe- 
culiar fluid in the human system which can be set in operation by 
certain movements, or looks, or even by the will of the Mesmeriser. 
This, says Dr. Pkiciiard, soars so far above the region of observa- 
tion and experiment, that it cannot be subjected to proof, and even 
were it conceded, or established, would not account for the phe- 
nomena of which the explanation is sought. " A much more proba- 
ble opinicni," says ho, " is that of M. Hkktkand, who, after surveying 
with calmness and discrimination the whole history of magnetism, 
and witnessing with his own eyes the proceedings of (bo operators 
in this art, and practicing them hijnstif with considerable efloct, 
comes at lust to tlie conclusion that all the results of these operations 



186 Mesmerism, [April, 



are brought about through the influence of the mind ; not by the will 
of the magnetizer, radiating forth his own vital spirit, and operating 
through this material, or immaterial instrument, on the vital spirits 
of other men, who are the passive recipients, but by the energy with 
which the feeling and imagination of t!ie latter act upon themselves. 

Abbe Faria boasted that he had j)ut more than 5000 persons into 
the Mesmeric state, simply by placing them in an arm-chair, and 
after telling them to shut their eyes and collect themselves, suddenly 
pronounced, in a strong voice and imperative tone, the word, 
"dormcZ;"' sleep. Bertrakd says that though this may be an ex- 
pggeration, he very often succeeded by this method — even upon a 
considerable number of persons, remoced from all suspicion of con- 
nivance. Here then is the imagination alone producing all the efliects 
ascribed to animal mag".etism, not in one case only, but in 5000 in- 
stances. What more can be required to prove my proposition — that 
Mesmerism is not a reality, but its elTects are due to the imagina- 
tion — than to cite ycu 5CC0 cases of the Mesmeric state, induced by 
placing these patients in an easy position, and crying out, sleep. "We 
have here a cause proved to be sufficient for the phenomena with 
which it is more philosophical to rest satisf.e:l, than to resort to the 
visionary hypothesis of the magnetic fluid radiated forth by the will 
of the operator upon surrounding persons and objects, or to confess 
the strange doctrine, that the volition of a human body is capable of 
exerting an immediate influence on other minds and bodies than his 
own." The co-operaticn of the agency of the will on the part of the 
magnetizer is even denied by Tertraxd, "v»'ho declares that in 
trials made by himself precisely the same results followed, whether 
he willed to produce them or not, provided that the patient was in- 
wardly persuaded that the whole ritual was duly observed." 

If animal magnetism be true, and Mesmerism a reality, where are 
the principles deduced from the facts o!)served even to the present 
clay ? T!ie whole v.orld has been engaged for 60 or 70 years col- 
lecting facts from any and every source, down to the present day, 
and yet not one established law — not one uniform rule exists, by 
which we may examine the subject, or by the exercise of which we 
can with any dogree of certainty produce a given phenomenon. We 
have invariable principles for electricity, galvanism, magnetism 
itself — yes, f(»r all other sciences, but not one for Mesmerism. In 
the selection too, of subjects upon whom to display its powers, animal 
magnetism invariably prefers the nervous female or delicate persons, 



1845.] Mesmerism. 187 



those especially in whom the imagination is most lively and active; 
while on the other hand, no man of science has yet been able to feel 
its influence. What the commissioners appointed by the King of 
France said more than 60 years ago, in reference to the fact, that 
not one of them could be made to experience the effects of Mesmer- 
ism, has descended to all other men of learning — none have yet been 
influenced or aflected by it. 

If the imagination have nothing to do with the production of the 
results ascribed to animal niagnetism, we should have thouglit ere 
this to have witnessed these upon the inferior animals. Operations 
are occasionally performed on the lior-?e, cow, dog, d;c. ; their organi- 
zation is similar to ours, and we claim for them, the sympathizing 
benevolence of our Mesmerising friends. Give us a series of opera- 
tions upon the inferior animals in the Mesmeric state, and our opinion 
is at once overthrown. Or if this be asking too much, then pray cite 
us the surgeon who has performed a series of operations even upon 
the human species while in this condition. But what is the fact on 
this point, a distinguished Professor of Surgery in Paris operates in 
one case, (Cloquet, 1819,) and for 16 years in succession, no second 
one is presented to him. Here we have an excellent, benevolent man, 
as all who know him will acknov/ledgn, a believer in IMesmerism, or 
rather who was, who is in the daily habit of operating, both in private 
and in the hospital, possesses, as is supposed by some, the means of 
relieving pain, and yet for 16 years he has not found another instance 
in which it could be applied. And still Mesmerism, this non est iw 
venttis for years together, is dignified with the name of Science. 
Can any one, I candidly ask, believe that, under these circumstances, 
animal magnetism even has an existence, v.'ithout admitting, it only 
di.sj)layK its influence by exceptions to general laws; and so do cata- 
lepsy, somnambulism, mental hallucination. And yet in this very 
city, I have known an operation made conditional in reference to 
the induction of the Mesmeric state, and tijat too upon a patient 
laboring under a cancerous mamma. V/e have thus a new science 
attempted to be built up, upon exceptions to generally received and 
well established princii)les — lor instance, that the knife gives pain in 
surgical operations. l>at with all the zeal and industry with which 
it is now cultivated and attempted to be applicil in every case, with 
one or two exceptions only, can i)atients be thrown into the insensible 
state — they will violate the Mesmeric condition by flinching when 
stuck with a pin. 



18^ Mesmerism, [April, 



Lastly : If Mesmerism be true, apply to it the test by which we 
have decided the existence ofa specific virus in hydrophobia. Give 
us instances of its effects upon inAmts in the cradle. Exhibit the 
Mesmeric state in the child before it exercises its imagination. I 
insist upon this test, and not in one, but in a series of cases. 

I am persuaded that Mesmerism has been alone continued to the 
present day, and believed to iiave an existence, from the circumstance 
of its supposed connection with the nervous influence, which itself 
has not been and cannot he defined. There are things in medicine, 
as well as in other sciences, which have not been demonstrated, and 
yet admitted to exist. Miasm or malaria is assigned as the cause of 
a large class of diseases, and still it has not been discovered. The 
effjcts, fever, &;c., are however, uniform and almost invariable, so 
that no one doubts the existence of a cause, although undefined. 
But this cannot be said of animal magnetism. Its phenomena are 
far from being certain, but on the contrary are exceedingly irregular 
and undetermined, and are moreover explained even hy believers 
themselves, as well as by men of the highest scientific authority, to 
be dependent upon another cause — viz. the imagination. Perkins- 
ism, e. i. the cure of diseases hy metallic tractors, which was only a 
branch of Mesmerism and founded upon its supposed existence, w^as 
at once exploded by Dr. Haygartii employing wooden tractors 
painted in imitation of metal, notwithstanding the wonders it was 
accomplishing both in this country and in England. Its sole effect 
was thus proven to be wholly attributable to the imagination. This, 
no doubt, will be the result of any treatment or system based upon 
the supposed existence of the agency under consideration. Mesmer- 
ism can neither be demonstrated nor abide the test of experience. 

My third and last proposition is, that the non-expression of pain is 
no proof of its non-exis;tence, and that there are conditions of the 
body and mind, in which no sufTering is evinced, and moreover that 
this state of the system exists independent of Mesmerism. That 
many capital operations have been performed without the patient's 
complaining, we have abundant testimony in the record of our pro- 
fession. We are convinced that there are few surgeons who have 
not met with such instances. I have seen several. 

Who need be reminded that a stoical philosophy once taught that 
it was beneath the dignity of man to complain ; that pain was not 
an evil ; that to cry was a shameful pusillanimity ? Who requires 



1845.] Mesmerism, 189 



to be told that savages, criminals and nnartyrs, have not only endured 
the greatest tortures without uttcrin"; a groan, but welcomed tlie hor- 
rors of death itself? Who does not know that at this moment there 
are religious fanatics in the East, whose bodies are voluntarily and 
cheerfully sacrificed to false gods — who have their persons suspend- 
ed in the air by great hooks stuck in their backs, d:c. 

Although pain is designed by nature to protect and preserve life, 
still, a contented mind, the consolations of religion, a profound medi- 
tation, delirium, fanaticism, mania, d:c., can suspend the action of 
our senses, and thus prevent the perception of pain. The mind at 
times has such control over the body, as even to extinguish life. At 
the siege of Bude, during the war of Ferdinand I. against the Turks, 
there was a young rnan who fought with such heroic valor, that he 
excited the admiration of both sides. At last he fell o\erpowered by 
numbers. He was sought out amonor the dead that be mijrht be recog- 
nized ; on removing his mask Raisciat de Souabe observed it was his 
son, he fixed his eyes intently upon him, and fell dead, without uttering 
a word. History furnishes us several such instances. The influence 
of the mind may be exerted only over a part of the body. Robert 
Boyle relates the case of a woman who, seated near a canal, saw her 
infant fall into the water and drown — from that moment she was attack- 
ed with paralysis of one of her arms, which attended her to the grave. 

The savages on the VVest coast of North America had long pieces 
of a broken bottle stuck deep into the soles of their feet, without pay- 
ing the least attention to the circumstance; and when spoken to on 
tbesuhjpct by the European sailors, they immediately cut their bo- 
dies with the fragments of the glass. 

Albucasis relates tliat on one occasion, he refused to amputate a 
hand from dread of hemorrhage, when the patient himself performed 
the operation. Count Mansfield submitted to amputation at the 
sound of the trum[)ets playing a charge. The daughter of Henry of 
Albert, for a splendid present promised by her father, gave birth to 
Henry the IV. of France, while singing a song. When Marshal 
De Muy was cut for stone, he uttered not a word or a groan. 

Baron Percy states that he removed a cancerous breast from a 
patient, who smiled and spoke tranquilly to a cross she held in her 
hand. At another time he operated upon a young man for aneurism, 
which was complicated and very painful, who remained silent with 
an imperturbable calmness, as if the surgeon were operating u|)oa 
another person. He assisted also in a c;ise of lithotomy upon a pa- 



100 Mesmerisin* [April, 



tient of sixty, wherein the operation was long, and accompanied with 
hemorrhntre, and alihoiigli he was advised by his surgeon to cry out 
wh(3n he suffared, he replied by saying the thing was not worth the 
trouble — he appeared scarcely to suffer. 

Surgeon Alcock says, "1 recollect a sailor astonishing Sir A. 
Cooper by not uttering the faintest sound while his leg was taken 
of!*, * *. No one will doubt the high courage of the Marquess 
of Anglesey. While his leg was amputated (at Waterloo) he uttered 
not a sound." 

Mr. Travers relates the case of a man, whose mind was unimpair- 
ed, but whose hands up to the wrist, and feet half way up the leg, 
were perfectly insensible to any species of injury, or catting, pinch- 
ing, scratching or burning. He passed a large needle into the ball of 
the thumb, down to the bone. Not the least degree of pain, or even 
of sensation, was produced. 

Mr. LisTON describes a case in the Edinburgh Medical and Surgi- 
cal Journal for April, 18C0, of a gentleman, who lost his sense of 
touch over nearly the whole surface of the body, and when Mr. L. 
cut away one of the bones of his foot, he felt no pain whatever, and 
he added, "nor would I now, I am convinced, were you to dissect the 
whole foot." 

Mr. Arnott says he has seen operations performed, without 
the knowledge of the patient, when insensible through opium or 
great loss of blood. 

Dr. Copland states that he had taken off, or seen taken off, a 
leg from a man who gave no sign of pain. 

Sir R. DoBsoiNT relates, that when the late Sir Tho3ias Thompson 
lost his leg in action, it is well known that he was singing during the 
time the operation was being performed. In the burial ground of 
Greenwich Hospital, continues he, is a monument to a seaman who 
was wounded at Trafalgar ; the epitaph relates that, " while the 
amputation was performing, he was exultingly singing the patriotic 
song of Rule Britannia." Another seaman in this hospital, while 
loosing his leg, said to the surgeon, "avast a-bit while I take a pinch 
of snuff," coolly took the box cut of his pocket, and after having of- 
fered a pinch to the assistant surgeon, took one himself, and the 
operation was finished without his having uttered a groan. 

Several surgeons had attempted to remove a small tumour from 
the eye-brow of a lady in London, but the moment the scalpel touched 
the tumour, the patient would scream out with pain. Wardrop bled 



1845.] Mesmerism, 191 



her to fainting, and extracted the tumour, which she would not believe 
until a glass was presented her to see her face. She too was deceived. 

The cojebraicd, but uafortunato. Gen. ?.Ioeeau. when wounded 
near Dresden, hesitated at first to have his limbs amputated ; but 
having made up his mind to submit, called for a segar, and while 
smoking, had both thighs cut off. 

Mr. Clever cut himself for stone, a few years ago in Paris. 

In November, 1832, Prof. Gibsox, aided by Drs. Horner and 
Bartox, of Philadelphia, removed a large tumour from the neck of a 
bdy 17 years old. It was for a fungus ha3matodes. The first incis- 
ion was seven inches long — one nerve had to be divided, the internal 
jugular tied; and another nerve, the par vagum dissected for five 
inches. "The operation lasted 34 minutes, and v/as most painful 
and diflicult. He (the patient) remained during the whole operation 
motionless, and neither complained, sighed nor gj-oaned." (See 6th 
Edition, Gibson's Surgery.) 

It is even said the late Sir Thomas Hardy of the British navy, 
was altogether insensible to pain. 

In the American Journal of T-Iedical Sciences for April, 1844, I 
related the case of a gentleman Oj.erated upon in Charleston for stone 
in the bladder, by my friend Dr. Ogier of that city. It is there 
stated that " he refused to be tied, and insisted upon it, that he would 
be able to remain perfectly quiet during the operation. He was told 
of the danger to which the least motion would expose him. During 
the whole operation he remained as motionless as a dead subject. Dr. 
O. in a note at the bottom of the page says, he was not Mesmerised. 

CuRLixG gives the case of a youth who performed sclf-castration — 
"he said he was not conscious of any pain in the operation." 

Two winters ago I operated upon an Irishman in our hospital, for 
a bloody tumour in the scrotum. At the first and only incision made, 
he called out, "cut away doctor, cut away." 

In June, 1842, 1 trepanned a man for a spicula of bone irritating 
the brain. The operation was necessarily tedious, lasting near threo 
quarters of an hour. Towards the close of it, I had to insist upon the 
patient checking his laughter, and to cease joking about the silver 
})late to be put over the hole made in the cranium. 

But why multiply examples of this kind, to exhibit the effects of 
the mind over the body, so as to induce insensibility to surgical oper- 
ations. These few, hastily collected, will sufiice. 

The work assigned me, Gentlemen, is now before you, and you have 



192 Mesmerism. [April, 



my views of Mesmerism. To what extent they are correct, is for 
you to judge, and future days to decide. I may have done the sub- 
ject injustice, as I iinow I hnve made a very feeble and imperfect 
defence of the opinions of those whose side I advocate; but I have 
acted conscientiously. And if by the explanations I have offered 
you, conflicting testimony can be reconciled, and you put into the 
right path to investigate this mysterious, all-absorbing topic of the 
day, your Lecturer has his reward. It will be perceived, I teach no 
new doctrine ; but those do, who reject the opinion of the imagina- 
tion being tlie source of the phenomena of animal magnetism. 

I know not how this subject is viewed by you, but with me, the 
existence or non-existence of Mesmerism, is a vital, a fundamental 
question. If true, you and I may close our books and retire forever 
from these walls, for by it, and through it, omniscience is come. 
Would you be wise in medicine — be put in relation wiih JoH^'30N 
and Velpeau, and your object is accomplished. Would you operate 
without inflicting pain ; would you know what remedies are now 
employed in London, Paris, or China; would you inspect the actual 
condition of the internal organs; would you predict the retuin of 
disease ; would you tell vvheiher that lady is pregnant with a boy or 
a girl ; or would you deliver this lady v»'ithout pain — Mesmerism be- 
ing true, study it. But, fsllow-laborer in the science of medicine,/ y 
these things are not so ; and I tell you whom you should rather con-// 
suit — the Author of all things. To the law and the testimony, what 
say they — intuition ! in the sweat of thy browshalt thou eat bread — 
divination! thou knowest not what a day may bring forth — no pain, 
no suffering! in sorrow shall thou bring forth children. 

That which was unanimous!}^ condemned by men of the highest 
scientific authority when it originated — that which is now classed 
with the quadrature of the circle and perpetual motion, by the 
Academy of Sciences in Paris — that which was abruptly dismissL^d 
from the Medico-Chirurgical Society of London — that which is ridi- 
culed by every Medical Journal of the day — that which has never 
been demonstrated, but which is opposed by reason and judgment — 
that which has never received favor with hut few exceptions from 
scientific men, of any age or country — that the belief of which cost 
Dr. Elliotsox his professorship in the University of London — that 
which at best exists but in a dreamy state — that which is explained 
not in one, but in thousands of cases, to be due to the imagination 
alone, cannot be, is not true. 



1845.] Dublin Journal. 193 



Part II.— REVIEWS AND EXTRACTS. 

ARTICLE III. 

Dublin Journal of Medical Science, No. lxvii. 

The January number of this valuable peiiodical contains its usual 
variety of interesting matter. The first article is the history of " a 
case of loss of Speech, &:c. — by William Edward Steele, A. B., M. 
D., &;c." The patient was a man aged about 25 years, and engaged 
in a laborious situation in a government oiiice. The attack was 
preceded by apoplectic symptoms, and paralysis of the right limbs. 
Under appropriate treatment, " he soon improved in all respects 
save in his power of speech, which, v.ith the exception of an occa- 
sional word or short sentence, Vv'as obliterated." Dr. S. relates many 
of the observations which were made during the progress of the 
case, for the purpose of determining the true nature of the mental 
disease. His conclusions we subjoin. 

•'These facts, I conceive, warrant us in making the following de- 
ductions: 1st. That there exists a faculty of the mind which presides 
over the expression of thought, by speech, writinir, and gesture. 
2ndly. That in the expression of our tiioughts, by these several 
means, there exists a considerable di (Terence in their perfcchon and 
complexity, as communicating media ; this difference being in the 
order enumerated : — speech, writing, gesture. 3rdly. That admit- 
ting these conclusions, it is highly probable that the defects exhibited 
in these actions, as a result of disease, arise not from any fault of 
memory, considered in itSL-lf, especially as in other respects (he me- 
mory is perfect; but that this may appear to be impaired by the 
destruction of one of the means it possesses, of inanilesting its ex- 
istence, ill common with it^ other mental attribu(es, percep{i()n, reten- 
tion, and association ; these being thus placed in the same position 
as is the retina in cataract or opaque cornea, — the |)ower of sigiit 
remaining, but the means, by whieh its exi&tence is manifested, des- 
troyed. 

*'As to the probable situa(ion of (lie cerebral lesion, in cases of 
this description, our knowledge is imporfect. Dr. Osborne believes 
it to be the upper surface of the cerebrum. In Abercroinbie, cases 
of brain disease are related, accompanied by los^ of speech, in whieli 
the central parts of the brain were those cliielly alfccted. In (his 
case, however, if it be (rue, us laid down by modern cranioioyists, 

1.', 



194 Dublin Journal, [April, 



that the double orgnn of language be seated at the back of the orbits, 
both organs niiist have been involved in disease, in order that the 
almost total loss of the power of expression may he accounted for. 
But the attendant hemiplegia would indicate the lesion (o be situated 
in one hemisj)herc only, leaving, at least, one-half of the double 
organ of language untouched ; a conclusion which is manifestly in- 
consistent with the total absence of the powers of speech, which this 
case at one time exhibited." 

Mr. Donovan furnishes a long communication, "on the physical 
and medicinal qualities of the Cannabis Indica, or Indian Hemp; 
with observations on the best mode of administration, and cases illus- 
trative of its powers." 'J'he remarkable effects produced by the 
Indian Hemp, and its value in the treatment of certain affections of 
an almost hopeless character, were first brought to the notice of the 
profession in an essay by Prof. O'Shaughnessy, of Calcutta. Mr. 
Donovan, who appears to have devoted considerable attention to the 
subject, seems quite enthusiastic in his Oj)inion of its value — "I 
indulge," says he, " in the expectation that this powerful agent, when 
physicians have fully developed its properties, will rank in import- 
ance with Opium, Mercury, Antimony, and Bark." 

It has been a question whether the Cannabis Indica and the Can- 
nabis Sativa, or the common hemp, were the same species. The 
experiments of 3Ir. Donovan shew pretty conclusively, that they are 
distinct, and that the domestic hemp is destitute of the principle 
which renders the Indian plant so desirable an excitant to the volup- 
tuous people of the East. 

The symptoms produced by the action of this agent, differ in many 
respects from those which follow the use of other narcotics. Among 
the remarkable effects noticed by Prof. O'Shaughnessy in some cases, 
was a well marked cataleptic state. In almost every case hunger 
seems to have been excited. Mr. Donovan made some experiments 
with this article upon himself, for the relief of a neuralgic affection. 
Vfc extract his history of its effects : 

"Having determined to try Indian h.cmp, I swallowed, during one 
of these attacks, five drachms of the same tincture of the herb which 
in a dose of three drachms, had formerly proved powerless. In 
twenty minutes, I was agrecahly surprised to find myself without 
pain ; although for the last four hours I had suffered severely. There 
was this peculiarity of the relief obtained, that I walked without 
much consciousness of the motion of my legs, or indeed of having 
legs at all : I felt as if they did not belong to me. 



1815.] Duhlin Journal, 195 



"In some months after, ^v;)l'o suffering under a severe attack of 
pain in the foot, I took nine grains of iccaJc resinous extract of hemp, 
which had not the slightest effect. Next night, I took six drachms 
of the weak tincture of the iierb, without ihc least hencfit. The 
third night, bring in exceedingly great torture, I took twelve grains 
of the same weak resinous extract: in twenty minutes! v»:is nearly 
free from pain, went to bed, and slept soundly four hours. The pain 
then awoke me, but it was much less severe. In the morning, there 
was neither headach, nor any other inconvenience. 

" Considerable pain having returned the fourth night, I took twelve 
grains of the same extract; soon fell asleep; and awoke, after two 
hours, free from pnin. The fifth night, the pain being somewhat 
troublesome, and wishing, more tor experiment than through neces- 
sity, to try the cfiect of a larger dose, I took fourteen grains of the 
same resinous extract. About five o'clock in the morning, I awoke 
to encounter a most extraordinary scene, — one, of which words can 
give but a faint description. I felt a rush of strange sensations 
through my head, accompanied with a crackling and singing noise, 
and a vibratory motion through my whole body. These gradually 
subsided ; and while dozing off, I thought an ex[)losion took place in 
my head, followed by the same rushing noise and vibration as before, 
and afterwards by a strange metallic sound. Various other noises 
succeeded. My sense of toucii and feeling had become more and 
more obtuse, until at length I lost all feeling, unless I pinched myself 
severely. The effects were now at their height, and the consequen- 
ces were surprising. I absolutely lost the consciousness of having a 
body, and my corporeal existence appeared to be comprised within 
my head, and a small portion of my chest, near the throat; in these 
spots, I felt as much alive as ever, but all other paits were without 
feeling, and to my perceptions annihilated. My intellect was not in 
the least disturbed; memory was as good as ever; I reasoned well 
enough ; was conscious of external objects as in perfect health : but 
I had some notion that if I gave way to sleep, I should never awako 
in this worKl; yet, strange to say, 1 felt perfectly resigned to this 
sudden termination of existence. 

"These sinmdarafK'ctions gradually pa-^sed off: on attempting to 
get out of bed, I could scarcely walk for giddiness ; my stomach be- 
came sicU,but on returning to bed I soon recovered, ate an immenso 
breakfast, and remained perfectly well, without having experienced 
any of these inconveniences wiiicb succeed relief obtained from 

opium." 

******** 

"The effect on the sensorium, prcduccd by the medicine, is gcner- 
ally alarming to the patient as well as to (he by-slandcrs, unless they 
were previously made aware of what was to bo expected- Scsme pa- 
tients evince great terror of death, but on recovering from the fit of 
narcotism, they laugh at their fears, and arc generally ready for 
another trial." 



193 Dublin Journal, [April, 



*' Riim[)hins says, tliat the kind of montal excitement produced by 
hemp depends on the temperament of the consumer. Professor 
0'Shau;^hnessy represents the inebriation to be of the most cheerful 
kind, causing the person to sin^^ and dance ; and adds, that in persons 
of a quarrelsome disposition it occasions an exasperation of their 
natural tendency. The aphrodisiac effects of hemp have been in- 
sisted on by all the oriental writers : Rumphius douljts that the herb 
possesses any such power ; for my own part I believe, that although 
it may powerailly excite Eastern voluptuaries, it has little effect on 
the natives of our own country; that when it does exert this influ- 
ence, it is only on the young, and on those of a sanguine tempera- 
men. In all the instances of its exhibitions to male patients, record- 
ed in the foregoing pages, one only was thus affected, and I made 
minute inquiry. In no case that fell under my observation, has it 
produced those rapturous ideas and ecstatic dreams described by the 
oriental writers. I knew but two or three whose ideas, while under 
its influence, were even pleasing, and some were singularly depress- 
ed, and under apprehension of immediate death." 

The Indian hemp has been employed in the treatment of various 
diseases, principally, however, of such as are of a painful character. 
It has been used in both the acute and chronic forms of Rheumatism. 
Prof. O'Shaugnessy, as quoted by Mr. Donovan, says, "In several 
cases of acute and chronic rheumatism, admitted about this time, 
half-grain doses of the resin were given, with closely analogous 
effects, — alleviation of pain in most, remarkable increase of appe- 
tite in all, unequivocal aphrodisia, and great mental cheerfulness. 
In no one case did these effects proceed to delirium, nor was there 
any tendency to quarrelling. The disposition developed was uni- 
form in all, and in none was headach or sickness of stomach, a sequel 
of the excitement." 

The powers of the article in tetanus are truly remarkable. Mr. 
Donavan refers to a number of cases of this fatal malady which were 
treated with the Indian hemp, and in almost every instance with suc- 
cess, lie also gives several cases of sciatica and other neuralgic 
affections, which were cured by this remedy. He declares that he 
has not made a selection of the successful cases out of many, but has 
faithfully recorded all which came under his observation, of which 
the termination was distinctly known. 

The resin of the Indian hemp is the form in which the article 
has been most frequently employed. The tincture of the resin, of 
all the preparations of the plant, is said by Mr. Donovan to be the 
only one on which reliance can be placed. 



1845.] Dublin Journal 197 



" I say the tincture, because the resin itself, being totally insoluble 
in watery liquids, is best administered in the state of solution : in 
the pillular form, it is likely to pass undissolved through the intestinal 
tube. Mr. Richard O'Shaughnessy found that a drachm of tincture 
which was only cqunl to three grains of the resin, had a much more 
decided effect than five grains of the latter. The strength which I 
employ, and of which I have made a large quantity, to guard against 
the variability of new samples, is two grains to one drachm of rec- 
tified spirit. The source of the variation of strength alluded to, 
would be a softer or harder consistence of the resin employed, giving 
rise to an enormous and dangerous difierence of power : other sources 
are the collection of the her!) at an improper season : the decay of 
the herb by long keeping; bad management of it in drying, d:c. 

"As to the modes of administration, I have tried many, and find 
the following to be the best : 

R Tinctura? resinae Cannabis Indices minim quindecim. 
Spiritus Rectificati minima quadraginta et quinque. 
Misce; fiat haustus. 

"The patient should be directed either to swallow the whole of 
this directly from the bottle to avoid loss, or to pour it into a little 
water, and ins fa ntly swallow it off. If not instantly, the resin will 
be precipitated, will adhere to the vessel, and thus escape being 
swallowed." 

The Indian hemp is doubtless a most potent medicine, and is des- 
tined to prove a valuable acquisition to the Materia Medica; but fur- 
ther observations are necessary, before we can arrive at any certainty 
touching its action and application to the treatment of disease. The 
interest which it has already excited will soon lead to ample cxperi- 
ment. In our Periscope, we publish the deductions of Dr. Laurie, 
drawn from his observations of its efTects, and it will be seen that 
these are not so favorable as those of Mr. Donovan. 

W. F. Montgomery, A. M., M. D., Professor of Midwifery, d:c. 
to the King and Queen's College of Physicians, in Ireland, reports 
" a case of a large Cauliflower excrescence successfijlly removed, 
together with the portion of the Cervix Uteri, from which it grew." 
This case presents nothing novel in its features, with the exception 
of its favorable termination, which circumstance we presume led 
to its publication. Such operations have heretofore so uniformly 
been followed by a reappearance of the disease, and a subsequent 
fatal termination, that medical men generally despair of atrordin"" 
any pertnanent relief, and therefore attemj)t lillle more than a pallia- 
tion of the more distressing symptonrMj. Prof. Montgomery's cage 



198 Duhlui Journal, [April, 



may serve to cncoun^gc dToits (o cfTect a radical cnie in such cases. 

The patient was a woman of forty-fivc years of age, and t!»e mo- 
ther of nine cliildren, the youngest of wliich was nearly four years 
of age. She had heen complaining of her present symptoms ever 
since she had weaned this last child. On examination, a firm, rough, 
lobulated tumor, was found, nearly filling the vagina — it apj^carcd to 
spring from the os uteri, as well as from the contiguous parts of the 
vagina, but the mouth of the womb could not be felt. 

The tumor bled readily on being touched. 

" By the speculum, the tumour was readily brou;;ht into view, and 
after wiping oliits surface, a layer tf ccagnlatcd blood with which it 
was covered, it appeared of a dull, dirty, whitish, or light drab color; 
its surface uneven and studded with a number of small tubercles, 
like the head of a cauliflower. Tiiis patient had been previous. y 
operated on in November, 1842. v»hen the tumour then existing was 
removed by ligature, in doing which, portions of it were broken off, 
which afforded Dr. Anderson the opportunity of making the micro- 
scopical investigation into tiic structure of this fundus growth, already 
alluded to: but it scon grew again, anil in the intervening four 
monihs had acquired considorable sizo. 

'•Saturday, .March 4. I included the whcde of the tumour in a 
ligature, which I placed as higli up as possible; its application gave 
no pain, and very little discharge occurred. After applying the lig- 
ature, I drew it up one inch, and ordered the patient an opiate. 

" The ligature was tightened every day, and in doing so was follow- 
ed by sharp abdominal pain, without any accompanying tenderness, 
or acceleration of the pulse; indeed pressure over the juibes gave 
her so much relief, that she constantly kept her hand firmly pressed 
over that part. Anodyne fomentations with draughts coiitainini; 
acetum opii, relieved her pain ; the jiulsc never rose above 80, and 
she was (juile free, throughout, from any constitutional disturbance. 

"On Sunday the 12lh, I found that I could not draw the ligature 
anv further, it had evidently come home to the top of the canula, 
and yet, neither it nor remains of tumour would come away; and 
being unwilling to allow the latter to remain any longer, I introduced 
a curved scissors, and removed the greater part of it. 

"Thursday IGlh. 1 exposed the u[5por part of the vagina by the 
speculum, and seized the remainiufj portion of the root of the tumour 
with a dressing ilu'ceps, when it came away completely, leaving the 
Burfacc behind it clean and healthy. lookin*: ; it sprimg from a s|)ace 
ahoiit tie diameter of a halfpenny, engaging the margins of the os 
uteri, and the vaginal mucous membrane, towards the left side. 

" On examining carefully the substance r.ow brought away, I found 
thnt I had removed, not only the morbid growth, which was now re- 
duced to a mere bundle of ragged filaments, but also the parts from 



1845.] Dublin Journal 199 



which it sprung, namely, the os uteri, and a portion of the vagina: 
— the bloody and serous discharges, and the peculiar abdominal pain, 
now ceased altogether, and a discharge of healthy pus took place 
from tlie exposed surface ; this, after a few days, threw up exuberant 
granulations, which I touched with nitrate of silver, and a clean and 
healthy cicatrization was completed in three weeks from the time of 
the removal of the parts. On the 7lh April, she menstruated natu- 
rally, and on tiie 17th April I examined her with the finger and with 
the speculum, and found her free from any remains of the disease. 

"1 have since seen and examined this woman several times, the 
last occasion having been on this day (Xovember 23lh). She has 
menstruated regularly and fully during tlic whole interval of time, 
amounting now to nearly twenty. one months. 

*-iIer general iiealth is pretty good ; she is improved in aspect, 
and increased in flesh: she complains of nothing except some pain 
in her back, especially at the lime of menstruation, which still con- 
tinues regular. 

"There is no projection of the cervix uteri into the vagina, and 
the OS uteri has entirely lost the defined m;irgins which are natural to 
that part in general ; it is very much closed, and gives to the finger 
the feel of a small puckered cicatrix ; but all the parts are quite 
healthy and sound." 

Dr. IMontgomery prefers the ligature for the removal of such tu- 
mors, and he states that the operation is more likely to be successful 
when the tumor has acquired a considerable volume, than when it is 
of a smaller size, because, though there may be more difiiculty in 
passing the ligature, it can be placed biirher up, and will more cer- 
tainly retain its position. Moreover, from its greater volume, it is 
probable that the portion of the cervix uteri i\o\u which it springs 
will have become elongated, and will thus be more readily and com- 
j)letely brought under the action of the ligature. After the extirpa- 
tion of the tumour. Dr. ?.I. recommends, "that the surface from 
which it has been removed should be freely touched with some active 
caustic, such as the strong nitric acid, fluid nitrate of mercury, ni- 
trate of mercury, nitrate of copper, or perhaps with the actual cau- 
tery, which, Dr. Johnson informs me, proved eminently useful in a 
case lately under his care." 

"Practical Observations on Phageda^nic Tlceralion, in connection 
witli its primary and secondary forms," is the title of an intcreslin;; 
article by John C. Egan, I\I. D., Licentiate of the Royal College of 
Surgeons in Ireland, and one of the Surgeons of the Westmoreland 
Lock Hospital. The term Phagcdagna, has been difTcrcntly employed 



200 Dublin Journal. [April, 



by authors. Dr. Egan bestows this appellation on " sores caused 
either by the process ofulceration or slougliing." As this species of 
disease is acquired by impure sexual intercourse, it has generally 
made some progress before medical aid is sought. 

"It rarely happens that we are consulted by a patient having re- 
cently contracted such a sore, and on this account are not always 
able to state what was the first indication of the disease. If we in- 
quire he will tell us it commenced either in a small black spot, re- 
sembling a grain of shot, or that a " pimple" was the first intimation 
of its existence ; that it rapidly increased in sizo, without cuusing 
much uneasiness :* and that his fears were first excited by a bleeding 
which took place from its substance. When we come to examine 
it, we find the surface of a dark-ashy colour, to which a bloody mat- 
ter tenaciously adheres; it neither exhibits granulations nor sur- 
rounding induration ; the edges are irregular and undermined ; the 
parts bordering on the ulceration are of a reddish hue ; the smell ex- 
tremely foetid ; and at this stage it is generally attended with con- 
siderable pain. In the male, the part principally engaged is the 
glans penis, from which it afterwards extends to the prepuce; in the 
female, the external labia pudcndi, in the first instance, from which it 
spreads with extreme rapidity ; and if not quickly checked, involves 
in its ravages the vagina, perinaeum, and anus, and sometimes even 
the bladder and uterus." 

Dr. Egan's essay is principally devoted to the treatment of the dis- 
ease. He deprecates strongly the employment of mercury, and in 
the condemnation of this medicine he is sustained by Lawrence, 
Carmichael, Ricord, and other distinguished surgeons. He admits, 
however, that there are a few cases in which mercury acts benefi- 
cially, but the indications for its use do not seem very plain. 

"According to one author it may be prescribed where there is 
nothing but ulcerative absorption, without any trace of inflammation 
in ihe surrounding parts, and where no constitutional disturbance is 
present ; according to another it should be used as a last resource, 
where every other remedy has failed to arrest the destructive pro- 
cess ; and on the authority of a third, its use is only admissible when 
the ulcer assumes an indolent character. I need scarcely say, that 
definite as these directions may appear to the theorist, they will prove 
almost useless to the practical surgeon, in the treatment of the dis- 
ease. Experience alone will solve the difficulty. As far as my ob- 



♦ The pain and constitutional disturbance, however, often keep pace with the 



1845.] Dublin Journal. 201 



servation extends, I may remark, that the cases benefitted by mercury 
are " few and far between," and it is with fear and trembling I resort 
to it, even where other remedial agents have proved ineffectual." 



The principal indications of cure are to subdue the accompanying 
fever — to allay irritation, and to check the sloughing process. To 
effect the first, Dr. Egan advises the use of the lancet, or of local 
abstractions of blood, and the employment of tartar emetic, when the 
condition of the patient will permit ; but in broken down constitu- 
tions such active treatment cannot be borne. In such cases it is 
advised to give small and repeated doses of the antimonial in combi- 
nation with opium. To allay the irritation the muriate of morphia 
is advised, to be given in pills at bed time. 

"The grand object to be attained, to which the foregoing treat- 
ment is merely preliminary, and in comparison of which every other 
indication must be looked upon as subservient, is the arresting of the 
ulcerative or sloughing process. I will not stop here to recount the 
various remedies that have been had recourse to at different times, 
and by different practitioners, for this purpose, the task would prove 
as useless as it would be uninstructive, as many of them have long 
since sunk into deserved oblivion, but at once proceed to a plan ot 
treatment, which is attended, for the most part, with beneficial re- 
sults, and which I have now employed extensively in the wards of 
this hospital, with the most complete success. I allude to the appli- 
cation of the strong nitric acid, which is to be used freely to the sore, 
and repeated until a clean vascular surface comes into view. The 
first or second application is not attended with any considerable de- 
gree of pain, as the disorganized material tends to protect the more 
sentient parts, but in proportion as the more sloughy matter becomes 
detached, the pain is increased on each successive application. I 
am in the habit of enveloping the parts in a warm poultice, immedi- 
ately after the employment of the escharotic, which is most grateful 
to the patient, and assists the separation of the disorganized mass. 
If the slough, as occasionally happens, should be reproduced, it will 
generally he to a partial extent, and at this period equal portions of 
balsam of Peru and castor oil will hasten its detachment ; |)oultice8 
subsequently encourage granulation, and promote cicatrization. 

"At the same time that active to|)ical measures are resorted to, 
constitutional remedies must not be neglected. The administration 
of dilute nitric acid, in combination with the compound decoction of 
sarsaparilla, acts favourably in the early stages of the disease, but at 
a more advanced period the preparations of iodine appenr to exert a 
considerable control ovrr this sj)ecies of ulceration. With this in- 
tention I prescribe the hydriodate of potnsh, commencing wiih five- 
grain doses, three times a day, and gradually increasing it to ten, 



20J French Journals. [April, 



which I seldom am obliged to exceed ; if pushed farther, the super- 
vention of colicky pains renders its discontinuance imperative." 

For the eruption which sometimes follows such ulcers, and which 
is generally of the runial form, Dr. Egan recommends, after the in- 
llammatory symptoms are subdued, the use of the Ilydriodate of 
Potash in doses of five grains, three times a day. 

" When I was first appointed to this hospital, I was in the habit of 
treating tiiesc cases with alterative doses of mercury in the form of 
Plummer's pill; but although the apparent cure wis in many instan- 
ces expedited by tliat remedy, yet the relapses were so numerous, 
that I determined to abandon it to a great extent, and seek some other 
rv'^modial agent ; and none appeared to answer the desired object so 
well as the hydriodate of potash. TTy reasons for giving it the pre- 
fM-ence are — First. It cures the eruptive and ulcerative disease. Se- 
condly. It is useful in these articular pains, so often accompanying 
ir. Tliirdly. It acts beneficially in the form of sore throat, which at 
a more remote period attends upon the disease: and lastly, it is par- 
tir-ularly applicable in the treatment of nodes, wdiich not unfrequently 
present themselves, especially after mercurial courses. As a local 
upp'icj'.tion, 1 have found the Unguent. Hydrarg. Nit. Oxyd., diluted 
with an equal proportion of lard, particularly usefid, first, in tending 
to soften the crusts, and subsequently as a stimulant in assisting to 
heal the ulcers." 

There are several other articles, of lesser interest, which our limits 
will not permit us to notice. 



ARTICLE IV. 



Gazette Medical e de Paris, No. 1 to 5 — 1845. 

Journal des Connaissances MeUco-CliirurgicaJes. 

Bulletin General de Therapeuiique Medicale ct Chiritrgicale, 

We have received several of the latest numbers of the Journals 
above named, and propose to notice briefly some of the articles which 
they contain. 

1. Tiie Medical Gazette of Paris is one of the most popular journals 
of the French capital. It has now reached its 13th vol. ; it is pub- 
lished every Saturday, in newspaper form, in numbers containing IG 
pages of double columns, and its chief editor is M. Jules Guerin, of 
orthopedic notor!e'y. The price per annum is about 60. 



1845.] French Joiirnah. 203 



The loading Article in the first and tiic three following Nos., is 
entitled the "Disease of the sternal and vertehral articulations of the 
Ribs, with or w^ithout tubercular softening and necrosis of the Bones 
of the spinal column." By A. Toulmoucho, M. D. &c., of Rennes, 
France. Althoiigii this is an excellent production, from the paucity 
of affections of bones, even of the vertebrcs, in this section of coun- 
try, we shall pas? over it with on!y a few extracts. Dr. T. commen- 
ces by acknowlcdiiing the difficullies in relation to the diagnosis in 
the affection. " Nevertheless," snys he, 'Mho works of ?♦!. M. Nichet, 
Nelaton, Parise, occ, have greatly advanced science, and dissipated 
in pnrt the indcfinitencss which obtains in the writing.-? left by Pott, 
Pouteau, Bra.sdor, and many other paliiclogists of the last centurj-. 
But they have not removed the uncertainty and obscurity which 
still reigns in the syirptcmalclcgy. Did the disease under consid- 
eration, begin by attacking tlie parts situated superficially, it would 
not be so diflicidt to recognize it ; but unfortunately, {\\c first lesion 
is in the bodies of the vertebra) deeplv lodged in the thoracic or ab- 
dominal cavity, and gives rise to collection of pus or soAcned tuber- 
culous matter, inacce.>si!)le to all means hitiierto employed for its 
early recognition. It is only when progress has been made by this 
affection in the advanced stages, and when paraphlegia or paralysis 
of the bladder, succeed to the pre-existcnce of pain in the spinal re- 
gion, or the detection of d"forinity in one or many spinal processes 
of the vertebra?, that we arc certain in our diagnosis." This memoir 
of M. T. comprehends three orders of facts — viz : 1st. those in which 
there is necrobis of the head of a rib in its articulation with the ver- 
tebral column, destruction of this part and symptomatic abscess; 
2nd. those where the same lesion has taken place, but with tubercu- 
lar softning, and necrosis of the neighboring vertebra); and 3rd. 
those comprehending the same morbid affections limited to the spinal 
column. Wc object to the word necrosis employed in this article, 
it should have been caries. 

There is an Article in Ophtalmology, and particularly directed to 
the three images reflected in the eye ; by Dr. Mngne, of Paris. This 
writer stales that since he addressed a memoir to the Academy of 
Sciences, relative to a black cataract upon which he had operated 
by couching, several of his professional brethren had called upon 
him fur explanations in reference to the imnges refierted in tho 
eye, and which induced liim to believe that the discovory of his pre- 
ceptor, the late Prof. Sanson, was neither acknowledged nor appro- 



204 French Journals. [April, 



ciated as it should be. He then states that, in 1835, Dr. S. com- 
menced to observe, and in 1837, demonstrated in his clinic, that 
when a candle was placed before an eye whose pupil was dilated, 
three images were seen, and succeeding each other from before back- 
wards. The first and anterior one, is the most evident, and is up- 
right or straight — the second or middle one is less distinct than the 
anterior, and the reflected image is reversed, or upside down — and 
the posterior is (he faintest of all, and is upright like the first. Sanson 
and his pupils arrived at the same results in their investigations on 
this subject; and the explanation of these phenomena is, that the 
first or anterior image is produced by the cornea ; the middle or 
reversed image is the reflection from the posterior segment of the 
crystalline capsule ; and the third or posterior straight, is due to the 
reflection of the light from the anterior segment of the capsule. An 
opacity of the cornea destroys all the images; opacity in the ante- 
rior capsule prevents the two posterior ; and that of the posterior 
capsule, the reversed image. In other words, in cataract of the 
posterior capsule, the middle or reversed reflection of the candle is 
not seen ; in that of the anterior capsule or capsulo-lenticular cata- 
ract, the anterior or first upright image is alone visible. In this 
catoptric examination of the eye, the two following circumstances 
must be remembered, viz ; to have the pupil well dilated and the 
room darkened. 

The Review of Journals contains a notice of the Surgical clinic 
of Fribourg, service of Prof. Stromeyer, from 1st November, 1842, to 
end of October, 1843, 414 patients were admitted, and 245 consulta- 
tions were held. There were 8 amputations, 6 of the leg and 2 of 
the thigh, 2 of this number died, 3 excisions of cancerous inferior 
lips, all cured, 4 cases of Lithotomy, all successful. We notice in 
one Journal, the case of a girl, aged 14, who in 17 days past 898 
lumbricoides. Except being pale-faced, she had enjoyed good health. 
Means employed to expel the worms, not indicated. 

At the session of the Academy of Sciences, M. Baldacconi pre- 
sented a specimen of petrified animal substance, produced by long 
immersion in a saturated solution of 12 parts of bi-chloride of mercu- 
ry and 1 or 2 parts of hydrochlorate of ammonia. 

M. Maisonneuve proposed a new mode of Cathetcrism — viz: first 
to introduce a very small bougie of gum-elastic into the bladder, and 
then slide upon it a catheter open at both ends. This latter instru- 
ment is rendered easv of introduction bv n thread of silk or metal, 



1845.] French Journals, S05 



tied to the external extremity of the bougie, after passing it previously 
through the catheter. This is now to be pushed gently upon the 
conducting gum-elaslic into the bladder. 

Dr. Roesch, who writes upon the subject, says, Goitre is the com- 
panion and precursor ofcretenism, wherever this disease is endemic ; 
at least there is always aujrmentation or deiicnorafion of the thvroid 
gland and of the surrounding cellular tissue, with a lymphatic tem- 
perament and a physical and moral apathy. 

M. Lereboullet, prot'essor at Strasbourg, communicated to the 
Academy a case of distinct inflammation, and of its usual efTocts, 
intense redness, exudation of plastic lymph, formation of false mem- 
branes, agglutination and purulent secretion in a coldblooded animal, 
(a species shark.) 

2. The Journal of Medico-Chirurgical Knowledge, is issued every 
month in loose sheets, containing 46 pages, and is accompanied each 
year with two Atlases containing six Plates of Anatomy of the natu- 
ral size, engraved upon steel. Price 82 50. 

The leading Article in the January No. is by M. Piorry, one of 
the Professors to the Faculty of ]\Jcdicine in Paris, and is on the 
effects of Sulph. of Quinine upon the Spleen. Given in 20 gr. dose, 
in 40 seconds this organ, which was enlarged, (hypersplenotrophy,) 
began to diminish ; and in five minutes the diminution was very con- 
siderable. Another similar dose on the next day reduced it to its 
natural size, and cured the patient. 

In the sitting of the Academy, 2nd December, 1844, M. Maison- 
ncuve proposed in cases of intestinal obstruction, to cut the intestine 
above, and secure it by sutures to another opening below. 

M. Valenciennes was elected on the 9th December, in the section 
of Zoology of the Academy of Sciences, in the place vacated by the 
death of M. GeoflVoy-Saint-Hilaire. 

The Journal states that 800 Students had entered the School of 
Medicine in Paris, being 51 more than the j)receding year. 

The plates of the Atlas for January, 1845, are 2 for the external, 
2 for the middle and 2 for the internal Ear. We need scarce add, 
they are most minute and splendidly executed. 

3. The General Bulletin of IModical and Surgical Therapeutics, is 
edited by Dr. Miquel, and is issued once a month ; each number con- 
tains 80 pages, and it is exclusively devoted to practice. Price §»4 50. 

Our limits will not, at present, permit us to notice the contents of 
this work, but we may have occasion to recur to it hereafter. 



20G Local Ilijsieria, [April, 



I\I. Dcvcrgie snys lie lias employed tho following recipe for an 
ointnicnt for Chilblr.ins for scveial years, and almost always with 
f ucccs :. 

R. Axiin^ia, sjss; Creosote, 10 drops; Liquor plumbi sub-acctali.s, 
10 drops; Thebaic Extract gr. 2. I\I. Make Ointment. Spread 
morning and evening a thin layer of this ointment upon the parts 
affected with chilblains, and maintain it by means of linen. 

We learn from tiie Bulletin, that the number of physicians in 
Paris is 1430, a pretty large regiment. Total, in France, 18,803. 
This, we think, is about the number in cur own Country. 



Local Hysteria. Bv R. B. Todd, ]\r. D., F. R. S.j Physician to 
King^s College Hospital, eye. 

It is difficult to assign a cause for the fixation of the hysterical 
phenomena in particular localities. We have, indeed, very much 
the same difficulty here, as in explaining other examples of general 
or constitutional disease exhibiting local symptomps. It may be that, 
in many cases at least, the local symptoms should be regarded as 
reflected nervous j)henomena, cither of sensation or motion ; some 
part of the great gasfro-intestinal surface, or some internal viscus, 
being the scat of a primary disturbance, which creates an irritation 
of a portion of the nervous centre, and this affects some sentient or 
motor fibres connected with it, which propagate their irritation to 
some peripheral region. Or, again (and this i)erhaps is of rare occur- 
rence), there may be some immediate irritation of a part of a nervous 
centre, not propagated from any sentient surface, but caused by some 
local disturbance of the circulation, and, consequently of nutrition. 
Or, lastly (and this is not unfrequent), the patient may have received 
a strain or hurt at some part, and her attention being strongly di- 
rected to that part, and her anxieties aroused respecting it, that part 
has become the seat of a fixed pain. And even if there has been 
no previous injury, there can be no doubt that a part may become 
irritable and painful, about which the patient's thoughts and anxieties 
have been occupied for a considerable time. I could quote to you 
many authentic instances of this power of the mind to create pain, as 
it were, or to perpetuate it, after it had been excited by some physical 
cause. But it m.ust suffice for me, at present, to direct your attention 
to the fact as one of which it is most important that the practitioner 
should be cognizant. I do not profess to give an account of«//the 
forms that local hysteria may assume, so many and so various arc 
they. I shall, however, briefly refer to the principal varieties that are 
likely to be met with in practice. 



1845.] Local Hysteria, 207 



Pain in the Side. — Amon2 the most common forms of local hys- 
teria are those pains in the riuht or left side ; of these I believe the 
most frequent is that on the leftside; the pain is referred to a spot 
immediately beneath the left mamma, corresponding very nearly to 
the situation of the apex of the heart. In m<i.st cases the pnin is in- 
creased on pressure: sometimes, however, firm and steady pressure 
gives case, and I have sometimes ohsorved patieiits to make pressuro 
themselves, in order to obtain some relief. It is quite extraordinary 
what a common symptom this pnin is, or that on the right side. If 
you watch the out-patients of this hospital for a day or two, you will 
find a large portion of the female applicants complainining of pain in 
the left or right side. It is very frequently (that on the left side 
especially) accompanied with leucorrhoDa or some form of uterine 
derangement, so much so, that now, after I have learned that a young 
woman of hysterical appearance complains of this pain, my next 
question invariably refers to the existence of leucorrhoea. In some 
instances this pain is always increased on inspiration, and is attended 
with a short but frequent cough, without expectoration. If there be 
any emaciation, or if there has been phthisis in the family, the fears 
of the patient's friends become excited, lest this cough and pain should 
be the forerunners of consumption. And it is not always easy to 
assure oneself that the irntaiion of nascent tubercles may not have 
some share in the production of the phenomena. Some time ago I 
was consulted in the case of a young lady of good family, who, from 
a long-continued pain in the left side and frequent cough, was con- 
sidered to be phthisical, and, in consequence, was kept in a regtilafed 
temperature for a considerable period. By several very careful ex- 
aminations of the chest, I teit myselfat liberty to pronounce her free 
from tuhercular disease, and prescribed an opposite mode of treat- 
mont, good air, carriage exercise, and tonics, with great advantage; 
and now I sometimes see this lady, who enjoys good health, but is 
subject to the occasional recurrence of this pain in the side and cough, 
whenever any anxiety occurs to excite her hysteria. 

IrrilubJe Spine. — The irritable sjiine is another form of local hys- 
teria, which, if treated on erroneous principles, or if its real nature 
be not detected, may lend to very serious consequences. This aflec- 
tion has been deemed of sufficient importance by some practitioners, 
to merit its being designated by the special name of spinal irritation, 
But this term is highly ohjectionable ; for it implies that the essence 
of the patient's mahidy is to be found in the spinal aflection, and that 
the treatment is chiclly to be directed to relieve the local sutferino-. 
And many who have written upon this suiijoct have striven, on very 
insufficient evidence, to show lliat the spinal cord itself is at fault. 
The truth, however, is that the spinal irritation is hut a svmptom of a 
general state, a local malady depending on a constitutional cause. 
These cases are often mistaken for actual disease of the vertebra?, 
and |)atients have been confined to the recinnbint posture for its cure, ■ 
a mode of treatment admirably calculated to perpetuate the real com. 



208 Local Hysteria, [April, 



plaint. It often happens that the patient has difficulty in walkinjr, 
and this is regarded as tlie consequence of the spinal afiection. She 
at first finds lierscif easily fatin[iied ; the pain in her back is increas- 
ed by walking or standinrj; she frradually becomes disinclined to 
move, and jiets accustomed to the horizontal position, and therefore 
readily yields to any sug-geslions in favor of quiet, or reluctantly 
obeys the advice which recommends an opposite plan. The most 
acute pain is felt over a particular spot on the back. Slight pressure 
will produce it, when the patient's attention is alive to it ; and firm 
pressure will often fail to create it when her attention has been di- 
verted from it. But there is always a good deal of tenderness in the 
whole course of the spine, and in other parts also. You will derive 
great assistance in your attempts to distinguish the real nature of 
thisatfection, by attending to the nature of the pain ; it is always of 
that exaggerated kind which I alluded to in my last lecture, as being 
characteristic of hysterical pain. It is much more acute than the 
pain which attends diseased vertebrae ; it is more superficial, so as 
often to appear, as I believe it is, seated in the skin that covers the 
spinous processes. We had one of these cases here not long ago, 
which very forcibly illustrated the importance of a right diagnosis. 
A young woman, of highly hysterical constitution, was sent here for 
pain in the back and weakness of the lower limbs; she declared that 
she was quite unable to walk, although she could move her limbs 
very well as she lay in bed. There was great tenderness over two 
vertebrae in particular, but the whole spine was tender also. She had 
been treated for some time by rest, and her spine had been cauter- 
ised. Vv'^e humoured her a little for a day or two, and then I thought 
it right to assure her that she could walk, and that she must walk a 
little every day. I had her taken up and supported between two 
women, and by making her move about the ward in this way a little 
every day, and increasing the walk each succeeding day, she soon 
began to find out that she had the use of her limbs, and ere long was 
enabled to walk to the shower-bath. 

I may remind you of another case still in the hospital, in which 
this plan of treatment was pursued with very striking success. This 
is the case of the woman named Collier, in Augusta ward, who has 
been so long under treatment. She was sent here completely para- 
plegic, and stated that she had been bed-ridden for ten years. On 
examining her I found some tenderness of spine, but no unnatural 
condition of it. The power over the bladder and rectum was unim- 
paired. She is highly hysterical and rheumatic also. The lower 
extremities, from disease, were completely wasted ; she could not 
stand, but as she lay could move about her limbs freely. I encour- 
aged her to expect a cure, and told her that she must exert herself. 
She was supported by the nurses and made to walk a little every day, 
and after persevering a few weeks in this treatment, she was able to 
walk a little alone ; by-and-by she got on with the help of a stick, and 
now she can walk up and down stairs without any assistance. Had 



1S45.] Local Hysteria. 209 



we treated this poor woman on the supposition of her having spinal 
disease, she would have been bed-ridden all her life. And, indeed, I 
attribute the slowness of her recovery (for she has been several 
months under treatment) to the extreme atrophy of her muscles, and, 
as we may fairly assume, of her nerves too, which was brought on by 
the disuse of them for so long a time. 

Pain in the region of the sacrum and in that of the coccyx are less 
common forms of local hysteria. They may probably be connected 
more directly with uterine irritation, and in some instances, perhaps, 
with imperfect action of the rectum, and accumulation of flatus in it. 

Local Pulsation. — We had lately a case in which this form of 
local hysteria was very well marked ; and it was accompanied with 
another symptom not uncommon in hysterical persons. This was a 
strong pulsation of the arota in the epigastric region, simulating 
aneurism. For some time the pulsation appeared so strong, and 
was so circumscribed, that had I not known the decidedly hysterical 
character of the patient's constitution, I should have felt considerable 
apprehension on her account. However, as her strength improved, 
and her catamenia became regular, those symptoms disappeared. 

Hyslerical Affeciions of Joints. — The profession is much indebted 
to Sir Benjamin Brodie fljr having directed attention to the frequency 
with which local hysteria manifests itself, especially among the higher 
classes, in the form of aliections of the large joints, simulating tliose 
diseases with so much accuracy that practitioners have frequently 
been misled by it. Sir Benjamin states the remarkable fact, which 
no one is so well able to ascertain as a surgeon of his great experi- 
ence, that four-fifths of the supposed cases of joint-disease which 
occur among the higher classes are hysterical. This statement ought 
to impress us strongly with the importance of being well acquainted 
with the peculiar features of these hysterical atrcctions of the joints. 

You will, of course, expect to find in these cases indications of 
the hysterical constitution; globus; perhaps occasional hysterical 
paroxysms; genera! irritability; enfeebled nutrition; pain easily 
excited on pressure at various parts of the body; irregular cata- 
menia, or some uterine disturbance. The joints which are most 
frequently afiected are the hip and knee. The patient keeps the 
painful joint quite at rest, being fearful of the least disturbance. 
When the joint is moved, she will call out with much more expression 
of pain than if there were actual ulceration of the cartilages. 
*' There is always exceeding tenderness," Sir Benjamin Brodie re- 
marks, "connected with which, however, we may observe the re- 
markable circumstance, that gently touching or pinching the intctuj. 
ments in such a way as tliat the pressure cannot allect the deep-seated 
parts, will often be productive of much more pain than the handlin"- 
of the limb in a more rude and careless way." As, however, in most 
hysterical atiections, if you can succeed in engaging your patient's 
attention about some other object, and lims directing her thou«>-|)ts 
from her own sufferings, you will iind that the joint can be moved 

14 



210 Local Htjslcria. [April, 



with comparatively little or with no pain. I need not, however, dwell 
U|)on this suhject, for you will tind it admirably discussed in Sir Ben- 
jamiu Brodic's "Treatise on the Joints," and in a very interesting 
and practical little volume on "Local Nervous Aflections," which I 
stronrrly recommend you to study. 

IrrilahJe Brcasl. — Another very serious form of painful hysterical 
afiection is the irritahle bueast. It is not generally attended with 
swelling or enlargement. The irritability is excessive, and the pa- 
tient shrinks quite as much from superficial as from deep-seated 
pressure, and even before she hns been actually touched at all. These 
characters, along with the evidence of hysterical constitution, are 
sutiicient to enable the attentive practitioner to distinguish the real 
nature of the afiection. 

Aphonia — I have alluded to various forms of hysterical paralysis ; 
you may have numbness in the course of particular nerves, or para- 
lysis of motion, in some cases putting on the features of hccmiphlegia 
— in others of paraphlcgia. Hysterical aphonia must be regarded as 
the same kind, the palsy or weakness aflecting the muscles of the 
larynx. The patient is unable to speak, except in a whisper, and 
even then not without eflbrt. It often begins and ends suddenly. 
Sometimes it remains after a severe hysterical paroxysm has passed 
away. This is a form of local hysteria of very common occurrence, 
and not likely to be mistaken lor any laryngeal disease, for respira- 
tion remains quite unimpaired. 

Paralysis of the Bladder. — Hysterical paralysis of the bladder is 
also common, and much mischief may arise from neglect of constitu- 
tional treatment, and too close attention to the local affection. Sir 
Benjamin Brodie lays down the rule, that in these cases the catheter 
should not be had recourse to ; and the only exceptions to it are in 
those extreme cases in which actual paralysis has taken place, and 
the bladder is likely to become diseased, if not artificially relieved. 
A similar want of pov/er over the rectum may occur in hysterical 
women. I have known women complain that they were unable to 
retain the contents of the rectum, although they were conscious of 
fajces having passed into it. With respect to many of these cases of 
hysterical paralysis, there is much truth in Sir B. Brodie's remark, 
*' that it is not that the muscles are incapable of obeying the act of 
volition, but that the function of volition is suspended." 

Spasmodic Affections. — Among the various forms of local hysteria 
we may class some singular spasmodic affections which often prove 
exceedingly trouhlesome ; for example — 

Laryngeal Affections. — In the woman Collier, whose case I have 
had occasion to refer to as an instance of paraphlegia, we had an ex- 
ample of a spasmodic affection of the muscles of the larynx, very 
much resembling the spasmodic croup, or laryngismus stridulus, 
which occurs in children. This attack was always preceded by 
depression of spirits and hysterical crying; the breathing became 
diiiicult, and both inspiration and expiration were attended with a 



1845.] Local Hysteria. 211 



stridulous noise ; there was also a loud barking cough, which could 
be heard at a considerable distance. The attack passed off as the 
temporary excitement disappeared. 

Hysterical Sobbing. — One of the most singular cases I ever saw 
was that of a girl named Howe, a3tat. 19, wlio was admitted in conse- 
quence of a peculiar spasmodic affection of the diaphragm, of a most 
severe kind, and which, while it lasted; was most troublesome and 
painful. This girl has been a long time in the hospital. At her 
admission, on the 28th of March, she stated that for the last three 
months she had been very sul)jcct to leucorrhcea. In other respects 
she was in good health. Her face has the aspect of hysteria; the 
full upper lip is very well marked. Four days before her admission, 
in taking down a bedstead, she fell and struck the right side of her 
abdomen. She suffered so much pain at the moment that she was 
obliged to rest for ten minutes; she then resumed her work and 
thought no more of the accident. In half an hour she was seized 
with a catching of her breath, and with pain in the right side of the 
abdomen. This continued for two or three hours, so as to interrupt 
her work, and then went off. Her bowels were open at the time, but 
she is of costive habit. In the evening the catching of her breath 
and the pain returned; it now continued sometime, so that she 
scarcely lay down during the night. Next morning there was great 
epigastric tenderness, and she was unable to bear the pressure of her 
stays. The catching of the breath and pain in the side continued to 
recur in fits till the morning of the 26th, when they discontinued, but 
returned in the evening, and have continued at intervals ever since. 
At our first visit we found her affected with this catching of the 
breath. It exactly resembled a violent fit of sobbing, unattended 
witli flow of tears. There is a jerking movement of the neck from 
side to side with each sob, but the limbs are motionless. Any ex- 
citement increases the sobbing. It was much increased by our visit, 
and subsided after we left. On the 29tli, whenever she was visited 
by myself, or by the pliysician's assistant, the sobbing was brought 
on. 'i'he pressure of the stethoscope in exploring the chest was 
sufficient to bring it on. The upper extremities are now thrown 
into jerking movements, resembling those of chorea, shortly after 
the soljbing begins. The slightest touch on the epigastrium or tick- 
ling the soles of the feet brings on the paroxysm, even when her 
attention has been directed to some other oi)ject. 

Her treatment consisted in free purging for the first few days, lest 
there should be any lodgment in the intestinal canal, and sub^•cquently 
tonics. On the 31st her attacks ceased, and as she remained quite 
free up to the 5th of April, and her health was inucii improved, she 
was discharged. She was, however, readmitted on the lOtli, with a 
recurrence of the paroxysms, without any a|)parent cause. They 
are accompanied with jerking movements of the upper limbs, and 
tremblings nf the lower ones, which give her an unsteady gait in 
walking. Pressure excites or increases the sobbing, particularly 



212 Local Hysteria, [April, 



when applied on tlie right side ; and if the pressure be continued, 
the sobhing becomes excessively violent, and the wl-olo boily is 
thrown into convulsive movements. The fits last lor three or four 
hours, during whicli time the nurse is obliged to wall; with her up 
and down the wards or passages ; for she cannot remain still, during 
the whole time she is affected with jerking, chorea-like movements. 
It is extraordinary what a slight pressure will excite the sobbing. 
If she accidentally press the epigastrium herself, it will come on ; 
the weigiit of the bed-clothes, the least pressure or even touch with 
the top of the finger, or even the near approach of the finger to the 
epigastrium, will excite it. She had followed a tonic treatment for 
a considerable time without any benefit to these paroxysms. I de- 
termined now to try a succession of blisters to the epigastrium. The 
first excited a very severe paroxysm ; however, by perseverance in 
the use of them, she has not only become able to bear them, but the 
paroxysms have considerably diminished in frequency and 5«everity, 
so that now she can bear a good deal of pressure without inducing 
the sobbing. 

Sir B. Brodie has recorded a case very similar to this. A young 
married lady, who was liable to ordinary attacks of hysteria, com- 
plained of a tender spot on the anterior part of the abdomen, a little 
below the ensitbrm cartilage. The slightest pressure of the finger on 
it caused excessive pain, and was followed by violent agitation of the 
whole person, bearing a nearer resemblance to the convulsive motions 
of chorea than to any thinfj else, and continuing for several minutes. 

Hysterical Sneezing . — Women are sometimes attacked with violent 
fits of sneezing, coming on at particular periods and lasting for a 
considerable time. Of my own knowledge I am aware of but one 
instance of this, in a newly married lady, in whom the fits of sneezing 
used to come on early in the morning. There was, I had reason to 
believe in this case, great disappointment that the signs of pregnancy 
did not appear about the usual time; and it was curious that these 
attacks should have come on chiefly when the morning sickness 
would have shown itself in the early stage of pregnancy. Women 
who are expecting pregnancy become very familiar with the ordinary 
symptoms of it. Sir B. Brodie relates two cases of this kind, in 
which the fits of sneezing were severe, and do not appear to have 
yielded readily to treatment. In the case to which I allude no relief 
had been obtained when I last heard of the patient. 

Lancet, July 15, 1843. 



1845.] Hooping Cough, 213 



PART III.— MONTHLY PERISCOPE. 

Hooping Cough. — The popular and professional catalogue of rem- 
edies for hooping-cough is both lengthened and varied, proving the 
usually obstinate nature of the disease- It cannot, however, he 
doubted that particular combinations have at times been attended 
with more than ordinary success; and it is the part of sound wis- 
dom to treasure up these evidences of remedial triumphs, since cir- 
cumstances may arise in the practice of all, where we are baffled in 
the application of our general principles, and are glad to resort to 
more specific and empirical means. There is, no doubt, a tendency 
in most minds to place exaggerated reliance on particular remedies, 
and to attach to them results which are attributable to the natural 
progress of the disease; but, on the other hand, it is possible to 
under-estimate their value, and to adhere too obstinately to imagin- 
ary principles. Success is, after all, the best test of being right, 
though it is often very obscurely obtained ; and in the practice of 
our art we are frequently compelled to be content with results apart 
from their explanations, and to submit to failure where our theory 
seems most complete. 

Dr. Thompson considers prussic acid his sheet anchor, gradually 
increasing the dose, and combining carefully regulated temperature 
with a milk and vegetable diet. He says the disease seldom resists 
more than four to five weeks. 

When the acute symptoms have subsided, the following extensively 
used formula of Dr. Beatty, of Dublin, recommended by Dr. Graves, 
has proved very useful : 

R'. Compound tincture of bark, five ounces ; tincture of lytta, tinc- 
ture of camphor, of each half an ounce. Mix. A tea spoon- 
ful three times a-day in linseed or barley tea. 
Above five or six years of age the dose may be increased one third 
daily until half an ounce is taken. 

The liquor arsenicalis, in decoction of bark, is favorably mention, 
ed; and in the second volume of the "Provincial Transactions," p. 
412, a combination of the tincture of lytta with the tincture of lobelia 
is stated to have proved successful. 

Belladonna, by liniment, plasters, and intornnrlly, is undo'.ibtedly a 
valuable agent. Dr. VValdeck, of Berlin (Bui. Cen. de Ther. 1838), 
gave from one-tenth to one-twelfth of a grain for a dose, and speak.-? 
very positively in its favour. Dr. Loujbard, of Geneva (French 
"Lancet," 9th June, 1839), mentions as a sure symptom of the de- 
cline of the disease, the greater frequency of accesses during the dav 
than night, and vice versa. He speaks highly of the sesquioxvde of 
iron in diminishing the number and violence of tlie fits, giving twenty- 
four (o thirty-six grains a-dny in divided doses. Dr. Steyrnann ("Bui. 
O.-^n. doThi^r." Plnrch, 1^:$-^). brings forward siiuihir evidence. 



214 Iloojnng Cough, [April, 



Dr. Crosslcy Ilnll's great remedy in all cases, was powdered alum, 
wliich he prescribed in a little water eight times a day, beginning 
with ten grains, to be increased two grains each dose till twenty are 
reached, which was then continued till the counh had coaled, which 
he states was tiic case generally in a week or less. The above doses 
arc for young persons, about Iburtecn ; adults may increase the dose 
to twenty. six grains. Infants are to begin with four or live grains, 
increasing two grains a dose to fifteen. No other medicine was giv- 
en ; milk to be avoided. 

Dr. Reecc strongly advises a warm irritating plaster to the chest, 
and the following medicine : 

R. Tincture of assafoetida, one drachm ; tincture of opium, ten 
minims; powder of ipecacuanha, ten grains; water, two oun- 
ces. Mix. A tea spoonful every three hours to a child two 
years old, increasing the dose ten minims for every year. 
When this fails, the two following formulae are (too) highly praised : 
Ft. Powdered leaves of conium, one scruple ; mint water, two oun- 
ces ; syrup, two drachms. 3Iix. A tea spoonful three times 
a-day to a child of any age, adding ten minims to the dose, till 
nausea and giddiness are felt. 
Br. Di-acetate of lead, four grains; syrup of poppies, two drachms; 
fennel water, two ounces. Two tea spoonsful to a child from 
two to ten years every five hours; half an ounce for an adult. 
It is said to cure generally in three days (?). There is other confirm- 
ative evidence in favour of lead in this disease, and a formula in 
combination v/ith conium is given in our report of the Reading Pa- 
thological Society for 1842. 

Mr. C. H. Chavasse(" Lancet," May 30, 1840), speaks highly of 
the following formula : 

R. Sulphate of coi)per, half a grain; syrup of poppies, half an 
ounce ; anise water, an ounce and a half. Mix. A tea spoon- 
ful to be taken every second or fourth hour, according to age. 
Sir William Watson's celebrated prescription was — 
R. Tartar emetic, one grain ; tincture of opium, twenty minims; 
distilled water, one ounce. Mix. A tea spoonful every, or 
every other night. 
Mr. Pearson, after premising an emelic, relied much on — 
R. Tincture of opium, one minim ; ipecacuanha wine, five drops; 
carbonate of soda, two grains ; water, halt an ounce. Mako 
a draught to he taken every four hours. 
Dr. C. Wachtl, of Vienna (vide Provincial Journal, Jan 21, 184a), 
has foimd Cochineal very useful in rapidly checking the paroxysms. 
R. Cochineal, ten grains; hitartrate of potash, one scruple; sugar, 
one ounce; water, six ounces. A tea spoonful every four or 
six hours. 
It is an old and popular remedy. 

The following is Roche's far-Himed enihrncation : 
R. Olive oil, one ounce; oil of cloves, half an ounce; succinum 
oil, half 0!i ounce. i»Iix. 



1845. J Acute Diseases in the Throat, 215 



We are not the advocates of one or all of the above, but think 
their occasional efficacy sufficiently attested to justifv their use in 
particular cases. — Prov. Med. Jour,, May 13, 1843. {Braithwaite's.) 



Cases of Acute Diseases in the Throat and Larynx. By Dr. James 
Arthur Wilsox, Physician to St. George'' s Hospital. 
There can be no doubt that many lives are lost by the above in- 
flammations for want of tracheotomy. In Nov., 1830, Dr. Wilson, 
with Dr. Xcvenson and Mr. Keate, attended a gentleman who died 
of cynanche supervening on erysipelas. On examination, the epiglot- 
tis and posterior membrane of the tongue were found to be highly 
vascular and thickened, and pus was iniiltrated in the cellular mem- 
brane of the fauces. The larynx below the cordas vocales, and the 
trachea, were fiee from disease or obstruction. Here was a case 
where tracheotomy would have saved life, almost to a certainty. 
The event made a deep impression on Dr. W.'s mind, and was of 
service thirteen years afterwards. 

Case. — Mr. W. C, aged 27, full habit, got heated at a ball, and 
caught cold going home. He was unable to sleep, from general un- 
easiness and sense of choking on attempting to swallow. Leeches, 
calomel, and other measures, were em))loycd; but the breathing was 
not relieved, even by the abstraction of twenty-four ounces of blood 
from the arm. In the evening of July 8, 1843, he was inextremis^ 
and xMr. Keate exposed the trachea below the thyroid gland, and 
made an opening into it, inserting a canula in the aperture. Instan- 
taneous relief was the consequence. 

"On the first rush of air into the trachea, the patient appeared to feel instant 
relief, and his countenance be2:an at once to resume its natural expression; but 
from this time not two minutes could have elapsed, when he was suddenlv at- 
tacked by most violent spasms of his whole frame, with a stru2:2:le for breath, as 
if threatening immediate suffocation. All consciousness directly ceased, the 
eyelids chx<ed, tlie face was livid, the features were distorted, the blood, still 
bubbling,' from the wound, became suddenly black as ink. The breath was 
drawn convulsively, and at Ions: intervals. All movement, excepting that of 
the pulse, had ceased, and the patient appeared, literally, at his last gasp. Du- 
ring this awful crisis of the young man's fate, which lasted for perhaps a minute, 
(seemingly tor a much longer time.) his head washeld forcibly bade, — the cr.nula 
was withdrawn. — and the orifice in the tracliea cleared from blood, and kept 
widely open. The breathing at length became more natural; the face, no long- 
er ghastly, began to resume the character and tint of life. IN'ot long after this 
most fearful convulsion, a large quantity of mucus, mixed in part witii bloo<l, 
v.-as rejected, in long viscid rojies, from the mouth; and it v.as then found that 
the patient again breathed through the larynx, Ujxm this, the canula was final- 
ly withdrawn. A profuse perspiration now burst forth from the face, neck, and 
chest of the patient, who gradually recovered his consciousne.<^<, and expressed 
by writing tliathis 'brealhin'.: was quite easy.' He slept at intervals during the 
night, and was convalescent from this time." 

Although, as Dr. Wilson remarks, the operation can linrdlv bo too 
Into, yet ihochnnce of succor's is preatlv los.^cncd bv dolav, bccniso 
the patient is bt'Iiiir poisont d by bis own b!r,«.fl. '!'!,. .r<^ i^ n good deal 



216 Effects of Indian Hemp — Chronic Diarrhcca. [April, 



of nianafTcmcnt necessary in preventing^ the blood from flowing down 
the trachea into the I'.'ngs. The operation of traclieotomy lias now 
been so often performed with success, that no patient should be al- 
lowed to be sutlucated by obstruction about the throat, without open- 
ing the vvind-pij)e. A gentleman of our acquaintance breathed more 
than twenty years through a tube. — Medico- Chirurgical Review, 



The Physiological and Thrrcfpeulical Effects of Indian Hemp. 
Bv. Dr. Lauuie. — The following arc the principal conclusions to 
which his experiments lead: — 

1. It seems to belong to that class of narcotics which rapidly in- 
duce excitement and intoxication, followed by sleep, neither sound 
nor refreshing. 

2. In a full dose it acts powerfully on the heart, causing palpita- 
tions, and rapid, weak, intermittent pulse ; and on the nervous system, 
producing delirium, coma, convulsions, and dilated pupils. 

3. Its eflects are generally transitory. In one case, however, the 
intoxication and dilatation of the pupils lasted nearly forty-eight hours. 

4. It is a very uncertain agent, in some cases producing the most 
violent and seemingly dangerous symptoms, in others being nearly 
inert. 

5. It very frequently causes vomiting, which, whether it occur 
spontaneously or from emetics, very speedily relieves its unpleasant, 
and perhaps dangerous effects. 

6. Applied around the eye, it does not dilate the pupil. 

7. It exerted little influence on the few patients to whom it was 
given in the form of enema. 

8. He does not think it is a valuable addition to our narcotic medi- 
cines. In very few instances did it act as an agreeable soporific and 
anodyne ; in none did it succeed when opium had failed ; and in one 
case only was it preferred to opium. 

9. So far from acting generally as an anodyne, its clTecfs was so 
disan-reeable, that the majority of those who took it once, only did so 
a second time on compulsion; and this is the more remarkable, as 
the patients on v/liom he experimented belong to a class to whom 
stimulants of all kinds are familiar, and who would greedily swallow 
opium and spirits to an unlimited asnount. 

10. It caused an immediate cravinjr for food, and, in a few, per- 
manently increased the appetite. — Edinburgh Monthly Journal, 

Nitrate of Silver in Chronic Diarrhoea. — Drs. Bertini and Bellin- 
ciere, in ol>stinate diarrhoea and dysentery, have found great advan- 
tao-e from the use of enemata and of cry!>talized nitrate of silver. 
These enemata are prepared by dissolvini: half a grain of nitrate of 
silver in half a pint of water. The patient sijould retain the enema 
for some hours. If necessary, the dose of nitrate of silver may be 
increased to three grains for each enema. — Terza Statistica Nosolo- 
fica, 4'^., 1843, p. 37, quoted in Annalcs de Thcrapeutiquej Nov., 
1843. American Journal of Medical Sciences. 



1845.] The Use of Pure Tannin. 217 



The Use of Pure Tannin. By Robert Druitt, Esq. — In any 
case in which a vegetable astringent is indicated, Mr. Druitt believes 
that the tannin ought to have the preference. A simple solution of 
it, in distilled water, he says, is much more easily and quickly pre- 
pared, as well as much more elegant, than the ordinary decoction? or 
infusions of oak-bark, catechu, &c. ; moreover, it may be prepared 
of uniform strength, and free from foreign inert matter, and is not 
liable to decompose quickly ; in fact, it has all the advantage which 
the other simple vegetable principles have over crude preparations 
from the herbs or extracts in which they are contained. 

The cases in which 3Ir. D. has employed it, are sore nipples, 
excoriations about the anus and scrotum, piles, leucorrhosa, atonic 
phagedenic sores, tooth-ache, aphthous sores in the mouth, severe 
salivation and relaxed sore throat. 

Vov sore nipples especially, Mr. D. has found it ''invaluable." 
Every accoucheur knows what a source of wretchedness and illness 
these are to the young mother, and how diincult it often is to find a 
decisive remedy ; but Mr. D. has never been disappointed in the use 
of tannin, except once in a neglected case, with deep irritable cracks, 
for which it was necessary to use the lunar caustic. The form in 
which he employed it, is a solution of five grains in an ounce of distil- 
led water ; this is applied to the nipple on lint, covered with oil silk. 

For the itching excoriations about the anus and scrotum, which so 
much infest old men, he has used it with benefit, but prefers lemon 
juice as a local application. For piles, with mucous discharge, he has 
also found it of use, but he cannot say much on this point from his 
own experience. 

"In one or two cases oflin^erins: atonic phagedena," says Mr. D., "I have 
found it of some service, sprinkled thickly on the sore; but more parlieiilarlj'so 
in those aphthous ulcers which sometimes occur in the mouths of adults, from 
acidity of the stomach, and congestion of the liver. I may say that I believe it 
the be.^t possible remedy for severe salivation, and for all cases of relaxed sore- 
throat attended with superabimdance of mucus. It coasrulates the mucus and 
enables the patient to get rid of it easily. Of course I do not use it to the exclu- 
sion ofcon.stitutional remedies; but of all the local means of making the mouth 
comforUihk, 1 believe it to be the l)est. 

"But of all the cases for wliich it is adapted, that common trou])lcsome com- 
plaint, tooth-aclie, is that in which I believe it is most to be depended on. For 
this piece of useful knowledge I am indebted to my friend Mr. Tomes, and I have 
te.sted it by ainj)le personal experience. It willofien l)e found, as Mr. Tomes 
told me, that the gum around a carious tootli is in a spungy, llabby condition; a 
little piece of it, perhaps, growing into the cavity. The ache, too, is often quite 
as much in the gum as in the tooth it.sclf. But, be this as it may. when the tooth 
aches, let the patient wash out the mouth thoroughly with a .solution of carbonate 
of .soda in warm water; let the giun around the tooth, or between it and its neigh- 
bors, be scarrilied witii di fine lancet; then let a little bit of cotton wool, imbued 
"widi a solution of a scru]»le of tannin, and five grainsof mastich, in two drachms 
of aether, be put into the cavity, and if the ache is to he cured at all, this plan will 
put an end to it in nine cases out of ten. 1 think that practitioners are to blame 
in not paying more attention to the cure of icoth-ache; 1 am convinced that, in 
most cases, it is as curable as a colic or a pleuri.sy ; the chief points being loopen 
the bowels, and put the .serreiions of the mouth in a healthy state, and to apply 
some gentle astringent and dcfcn?ative to the diseased tooth, till it is capable of 



•219 A Test for Bile — Medicinal Substances. [April, 



bein<3: stopped by some metallic substance. I say emphatically afiie lancet, be- 
cause llie coarse, round, blunted tools that are generally sold under the name ot" 
fum-lancets, only bruise the gum, and cause horrible pain. The lancet \vhich 
use is sickle-shaped, cutting on both edges and finely ground; and it guarded 
Avith the middle finder of the right hand, it may be used in the case of the most 
unruly children, without any possible i\\ icsu\C^-I'Vwii Am. Jour. Mtd. Sciences. 



A Test for Bile. — M. Pcttinkofttr, a German student, lias discov- 
ered a test for the presence of bile. It consists in addintr to the fluid 
supposed to contain bile, concentrated sulpliuric acid, until it becomes 
hot, and then dropping into it a solution of suj^ar (syrup.) the pre- 
sence of bile is manifested by tiie mixture becoming of a deep pink 
or red colour, varying in intensity with the amount present. 

*^* This seems to be a merely accidental discovery, the reaction 
being inexplicable upon any known relation or analogy between the 
substances. — London Lancet. 



On the passage of Medicinal Substances through the human econ- 
omy. — MM. Millon and Laveran, after going through a series of re- 
searches, witli a view to ascertain in what manner certain medical 
substances atiect the urinary secretions, have arrived at the following 
interesting results: — 

The substances experimented on were, principally, the double tar- 
trate of soda and potash, which was administered 208 times; the 
Hulphate of soda was administered fifteen times ; sulphur, four times ; 
and salicme, ten times. The tartrate of soda and potash was chosen 
in order to ascertain whether the opinions generally entertained re- 
specting the conversion of alkaline tartrates, citrates, and acetates, 
into carbonates, into the animal economy, are correct. So far from 
this being invariably the case, it was found that the transformation 
was very uncertain. Tiius, of the two hundred and sixty-eight cases 
in which the double tartrate was administered, in one hundred and 
seventy-five the urine was alkaline; in eighty-seven, acid ; and in 
six neutral. The mode of expulsion of the salt appears to depend 
nearly entirely on the mode of administration. If taken in large 
doses — ten or twelve drachms, for instance, in a limited period — 
its effect is generally concentrated on the intestinal canal, and its 
ingestion is Ibllowed by several liquid stools. Sometimes, however, 
no purgative effect is produced on the digestive tube, and then the 
urine is alkaline, the salt evidently l)eing absorbed and expelled 
through the urinary organs. When the same quantity is administered 
in fractional doses, duiing a period of ten or twelve hours, the effect 
produced is different. The salt docs not then give rise to purging, 
but is absorbed and eliminated as an alkaline carbonate by the urin- 
ary organs. In the first instance, indigestion follows its administra- 
tion, and it may be looked upon as an aliment; in the second, there 
are absorption, assimilation, and secretion, and it is then a medi- 
cine. In order to ascertain whether, when the urine was acid or 
neuter, alter the administration of the salt, the soda and potash might 



1845.] Medical Memoranda. 219 



not escape non-docoraposcd, combined with tartaric acid, or united to 
some organic acid, several experiments wore instituted, by which it 
was ascertained that the proportion of alkali contained in the acid 
or neutral urine was identically the same as that contained in normal 
urine. It thus became evident that the double tartrate did not escape, 
as such, along with the urine. 

Ro])ust men, slightly unwell, shewed the greatest aptitude to digest 
the tartrates. Tiicy occasionally digest part of the salt, even when 
given at once in large doses. Sometimes, although administered in 
fractional doses, the urine remained acid. This was the case when 
the patient was attacked with diarrhcea, or was in an acutely febrile 
state. But even ihen, by persisting in its use, the urine, at first acid, 
gradually became alkaline. On the other hand, absorption was fa- 
voured by constipation. 

The administration of the citrate, in absorbing doses, was tried in 
pneumonia and rheumatism. The blood of the patients thus treated 
was analyzed ten times. The fibrin was not found to have dimin- 
ished in quantity, and the bufi\' coat was as great as before it had 
been given. Although the alkaline carbonate was formed in the 
urine, these diseases progressed as usual. The increase of the 
powers of oxidation, rendered evident by the excess of urea, led to 
its trial in cases in which the nutrition was languishing ; and it was 
found useful in general debility, phthisis, albuminuria, 6^c. 

The sulphate of soda gave the same results as the double tartrate. 
Sulphur was never found in the urine, under whatever shape it was 
administered. — Ibid, 



MEDICAL MEMORANDA. 

Quinine in Ague. — Dr. Stratton thinks a single large dose in the 
interval, cures more rapidly than repeated small doses. 

Treatment of Neuralgia. — Dr. Jacques, of Antv.erp, recommends 
inoculation, by means of a vaccinating lancet, with a solution of 
sulphate of morphia. 

M. LafarfTue recommends inoculation in the same way, with a sat- 
urated solution of veratria ; and M. Roclauts, a Dutch physician, 
gives nux vomica, in doses of from three to ten grains in the twenty- 
four hours. 

Succinate of Ammonia in Delirium Tremens. — M. Scharn has 
Bcen the most lurious delirium overcome as by enchantment, and the 
disease removed in a few hours, by the use of this remedy alone. 

Arsenic in Peritoneal Dropsy. — Dr. Dc!)avay has treated a case 
successfully. One-twentieth of a grain was given twice a dav. The 
improvement was nolable in six weeks, and in six months all symp- 
toms had ceased, and the catamcnia, which had been suppressed, 
were restored. 

Mustard in the Convulsions of Children. — Dr. Tripler was led to 
the employment of this remedy as an emetic, and finding it arrest in 



220 Extensive Burn — Galvanism. [April, 



a few minutes an attack of convulsions that had lasted five hours, he 
has employed it in (liree other cases with complete success. 

Prophylactic Remedy against PtyaVism. — Dr. Schoepf recom- 
mends llic following tooth-powder during the administration of mer- 
cury, to prevent salivation. Dried alum, powdered, 3ij.; powder of 
cinchona, sj.; to be used by means of a soft brush, morning and even- 
ino-. — Ibid, 



We take llie following Extracts from a notice in the last No. of 
the Medico-Chirurgical Review, of a work entitled "Facts and Ob- 
servations in Medicine and Surgery. By John Grantham. : 

Extensive Barn. — A case of a burn from gunpowder is related, in 
which nearly the whole of the trunk and a portion of the extremities 
were involved, " the whole measured above 600 superficial inches, 
or four feet, 24 inches, and averaged a quarter of an inch in depth. 
Also the subcutaneous structure was completely lost, so that the ar- 
teries and veins were seen, as if neatly dissected, lying on the surface 
of the muscles and fascia." The successful issue of the case reflects 
great credit upon the author, especially as more than one untoward 
occurrence intervened. Three principles especially guided him, the 
due supply of nutritive food, the regulation of the animal heat, and 
the external and internal use ofantiseptic agents, such as the a|)plica- 
tion of yeast, the evolution of oxyminiatic gas into the apartment, 
the administration of alkalis, &c. During the extensive suppuration 
which occurred, six pints of milk in the twenty-four hours served to 
support the youth's (oet. 17) strength. A sphacelated wound over 
the sacrum, an attack of bronchitis, and an extensive re-opening of 
the wound by erysipelas, successively retarded the cure, and long 
rendered recovery apparently hopeless. It required several years to 
produce entire healing, during and subsequently to which th.ere has 
been much tendency to congestion of the brain, requiring small de- 
pletions and aperients, and attributable to the imperfect re-establish- 
ment of the functions of the skin over so large a surface. 

Galvanism. — We quite agree with ^[r. Grantham, that the appli- 
cation of galvanism in paralysis, and other chronic affeclions of ihe 
nervous system, has been too much neglected. Indeed, its adminis- 
tration seems to be confined almost to empirics, who apply it in all 
cases indiscriminately, and consequently do more harm than good. 
Why a full and fair trial of its medicinal powers should not be made 
in some of the numerous chronic cases which encumber the hospitals, 
we cannot imagine. Mr. Grantham relates some cases in which he 

o 

found this agent, carefully administered for a prolonged period, com- 
j)lctely successful ; and states the results of his experience in its em- 
ployment in these conclusions. 

" 1. Galvanism is identical with the vital action of the nerves of organic life, 
and the nerve? of volition. 2. Its action is determined bv the healthv condition 



1815,] Symvaihetic Nerve — Thymus Gland, 221 



of the brain and spinal marrow. 3. The skin must possess a normal sensation, 
as well as temperature, before the j^alvanic action can affect the muscular fibre. 
4. The positive plate or wire should be applied over the re;^ion of the origin, and 
the negative to the region of the termination of the nerve. 5. The galvanic 
influence, when passed along the spine, wilfbe most active in the paralyzed limb. 
(>. Galvanism is assisted by the alkalis and mercurial action. 7. It restores 
diminished temperature, decreased circulation, and lost muscular action, in the 
following order: 1st, temperature, 2d, circulation, and muscular action last. 
8. It has no effect in disease that alters the structure of nerves. 9. It supersedes 
manual friction. 10. It is assisted by immersion of the affected limb in a warm 
bath, into which, the negative plate or wire is placed. In passing a current from 
the head through one half of the body, the foot should be immersed in warm wa- 
ter. 11. It is injurious when much pain is caused in the muscles by its applica- 
tion. 1-2. It may be carried to an undue extent, so as to produce congestion of 
the brain." 



On Exlirpaiion of the Superior Cervical Ganglions of the Sympa- 
thetic Nerve, — M. Dupiiy (the Alfort veterinary professor) stated, 
that in 1806, along with Diipuytren, he had extirpated the superior 
cervical gan^rlions of the sympathetic nerve in the horse. The result 
of the experiment was redness, with infiltration, and swelling of the 
ocular and palpebral conjunctiva, and diminution of the volume of 
the globe of the eye. The horse was killed four months afterwards, 
and the ends of the nerve were found rounded and swollen. Thft 
sympathetic nerve is evidently insensible. When the branches of 
the fifth pair are cut or lacerated, a horse shrieks with pain, whereas 
nothing of the kind occurs when the sympathetic is divided. M. Du- 
puy repeated the experiment seven times, and each time with the 
same results. — London Lancet. 



On the Use of the Thymus Gland. — Dr. Picci, after glancing at 
the theories of his predecessors, suggests that the use of this Gland is 
chiefly of a mechanical nature ; viz. to occupy a certain space within 
the thoracic cavity, while the lungs remain unexpanded in the fcEtus ; 
and thus to prevent the ribs and sternum from flilling in too much 
upon these vital organs. The size of the Thymus is inversely as the 
volume of the lungs; and, when the latter become dilated afterbirth 
by the admission of air into their cells, the former immediately begins 
to shrink and become atrophied. In truth, it is only in the adult 
that the thoracic parietes are moulded completely upon the lungs; 
for, in infancy and youth, it is rather the Thymus gland that is, in 
their place, moulded uj)on the thorax. 

The situation of this gland in the anterior mediastinum and alonix 
the median line, the very nature of its tissue, and the greater expan- 
sion and development of its inferior half, are adduced as arguments 
in favour of the opinion now adduced. Besides the well-known 
circumstance that, in those new-born children in whom the thorax is 
very largely developed, the Thymus continues to increase gradually 
even to the end of the second year, it deserves notice that all those 
animals, in which the lungs are similar to those in the human subject, 
arc provided with this gland ; whereas, we find it to be entirely want- 



'-^ Crolon Oil Plaster— Castor Oil [April, 



ing in those which breathe by Branchiii? or membranous lungs. In 
h}bcrnaling animals, also, the Thymus exhibits altcrnations^of en- 
largcment and decrease, according to the state of the respiratory 
organs. In the Amphibia it attains its maximum of development. 

'J'he cu-cumstance too of the gland being usually rather larger than 
ordinary in phthi.^^ical patients maybe mentioned as lending somo 
prohabdity to tiie view wo have proposed.— yl/i/za/i Unkersali. Med, 
ChirurfT, Review. 



Crolon Oil Plaster.— M. Bouchardat recommends the following 
method of preparing croton oil plaster. Melt eighty parts of gum 
diachylon plaster at a very gentle fire, and, when it is semi-liquid, 
mix with It twenty parts of croton oil. The plaster which results is 
to be spread thickly on muslin. It will produce considerable irrita- 
tion of the skin, and may be employed in all cases where revulsives 
are required. It does not cause such severe pain as many other 
counter-irritants ; and it may be applied over an extensive siirface, so 
that a derivative action may bo established proportional to the irrita- 
tion which is to be combated, — an indispensable condition in the 
employment of these heroic remedies. M. Bouchardat is fully of 
opinion that the croton oil plaster will be found available in the treat- 
ment of many chronic diseases, both of the respiratory apparatus, and 
of the abdominal vkcera.—Anjiuairede Therapeuiiqite. Ameriean 
Journal Medical Sciences. 



MEDICAL INTELLIGENCE. 

Extract of a heller from Professor Mr.xss, to the Editors: 

Castor Oil, maxlfactured in Georgia.— AVhile the great staple of the South 
has become a drug upon the markets of the world, and its extensive cultivation 
IS discouragc<:I by the consequent reduction in price, the public mind has been 
fortunately constrained to direct its attention to other ample and, hitherto, unap- 
preciated facilities, completely within its reach— furnished bv our bold and 
effective water-falls, diversified soil, and delightful variety of climate, and pro- 
mising equal usefulness, and a better remuneration for an equivalent outlay of 
labor and expense. 

Actuated, as we suppose, with these views, our worthy and enterprising friend 
Mr. Joshua Willis, of Troup county, Ga.,has abandoned the cultivation of 
Co/ton, and most successfully commenced the growth of the nicijuts Communis, 
or Palma Cliristi (the Castor Oil Plant.) During the past 3'ear, he manufac- 
tured about 1500 gallons of oil, which Avere mostly (we believe) purchased by 
the druggists and physicians of Columbus, and the circumjacent country. % 

We were favored with a .'specimen of the article referred to, and cannot but 
regard it as a fair and beautiful oil— almost destitute of color, or smell, and 
with as liule of the unpleasant flavor, peculiar to the Castor Oil Bean, as is 
consistent with an unadulterated preparation— Clear, bland, free from rancidity, 
and without any foreign admixture, it constitutes an admirable article for do- 
mestic use, and in our hands, manifested mildly, but efTectivelv, its cathartic 
property. The East Indies have heretofore furnished probably seven-eighths of 
all the oil consumed in England, but for the last several years, American Oil, 
derived chiefly from the British Colonies and the Western States, has been ex- 



1845.J Medical College of Georgia, 2'2'd 



ported to that country, to the amount of perhaps, from fifty to eighty thousand 
pounds annually. The latter article, though confessedly of fine quality, and 
possessing a flavor superior to the East India Oil, has yet been regarded is ob- 
jectionable on account of the deposit (in cold weather) of a white, flaky matter, 
which some have supposed to be Margaratine — a flatty salt, consisting of the 
two i^roximate constituents, Margaritic Acid and Glycerine. Others have 
supposed it to be the result of adulteration from Olive Oil, which is knov^n, at 
low temperatures, to deposit what Pclouze and Soudet regard the Margarate and 
Oleate of Glyceril ^theHydrated Oxide of Glycerine) — an unlikely supposition 
however, in our estimation, as most of the latter oil isimportcd into this country 
from the south of Europe, and at too high a price to warrant the fraud of ad- 
mixture with the Castor Oil designed for exportation. 

We are rather inclined to the belief that such deposits, so frequently found in 
the American article, is from the liberal admixture of^nnimaloW (Adeps Suillus) 
which does not sustain its fluidity under from 78"^ 5' to 87'^ 5'. This ma v, perhaps, 
account for the rancid and acrid nature of some of the Castor Oil of Commerce, 
as the Oleine of the Lard, readily becomes rancid, i. e. acquires a disagreeable 
odor, and acid properties, by exposure to the Oxygen of the atmosphere. Indeed 
the deposite of Margaratine, from Castor Oil, if any, should be exceedingly 
small, as not more than .002 of the entire products of saponification, consist of 
Margaritic Acid. 

The oil manufactured by Mr. Willis, we believe, fully sustains the truth of 
this latter remark, and as a specimen of Southern enterprise, alike honorable to 
his skill and industry, commends itself to public confidence and popular use. 
Mr. W. Avill be prepared to execute large orders this fall and winter, and assures 
us that "it shall not cost more to druggists or other purchasers, whom he may 
supply, than the best article does from any other quarter," and all he asks is, 
that, other things being equal, home mamifacture mav have the preference. 

A. MEANS. 



Medical College of Gcor^rin.—HhQ Annual Commencement of this Institution 
wa.s held in the Masonic Hall, on Tuesday, the 4th day of March, when the 
degree of M. D. was conferred upon the following gentlemen :— 

Milton Antonv, of Georgia — Thesis ox Aneurism. 



A. F. Anderson, 


S. C. 


Circulation of the Blood. 


A. R. Bexley, 


Gco.- 


Congestive Fever. 


J. M. Bowers, 




Prolapsus Uteri. 


S. R. Caver, 


Ala. 


Gonorrhoea. 


G. M. Cade, 


Geo., 


Secale Cornutum, 


W. L. Cochran, 


S. C. 


The Liver. 


W. E. M. Cousins, 


Fla. 


Rheumatism. 


W. H. Davis, 


S. C. 


Intermittent Fever. 


W. H. Ellington, 


Ala. 


Cluinine. 


T. B. Gordon, 


Geo. ' 


Hs-pochondriasis. 


J. M. Galphin, 


s.q. 


Circulation of the Blood. 


Thos. Graves, 


" 


C}'nanche Trachcalis. 


J. S. Holliday, 


Geo, ' 


Dysentery. 


J. A. Harlov.', 


" ' 


Intermittent Fever. 


A. L. Hammond, 


i( 


The Blood. 


James Hill, 


S. C. 


Prolapsus Uteri. 


Taliaferro Jones, 


Geo. - 


Pneumonia. 


A. H. Jackson, 


1.1- 


Prolapsus Uteri. 


J. H. Jennings, 


S. c. 


Acute Rheumatism. 


W. W. Leak, 


Geo. - 


Moiins Ojx'randi of Modi( iiies 


J. T. Lamar, 


1. - 


RuN'ola. 



224 Medical College of the State of South Carolina^ ^c. 



Jesse Lowe, 


(( 


Dysentery. 


I. M. Morai^nc, 


S.C. 


Importance of Scientific Accoucheurs. 


R. M. Paries, 


Geo. 


Healthy Menstruation. 


H. W. Rutherford 


,S.C. 


Abortion. 


J. P. Ralls, 


Geo. 


Scarlatina. 


R. M. Stell, 


(( 


Uterine Hemorrhaj!:e. 


B. R. StronjT, 


Tenn. 


Pathology of Fever. 


E. A. Stribling, 


Geo. 


Phthisis Pulmonalis. 


J. W. Todd, 


(( 


Gastritis. 


T. A. Wakefield, 


S.C. 


Signs of Pregnancy. 


F. B. Wakefield, 


Geo. 


Congestive Fever. 



Medical College of the Sintc of South Carolina. — This Institution has conferred 
the degree of M. D, on seventy-four gentlemen : of whom, six were from Geor- 
gia — nine from Alabama — two from Mississippi — one from Florida — five from 
North Carolina — and the remaining fifty-one from South Carolina. 



We are highly gratified to learn that Prof. Charles A. Lek has assumed the 
Editorial management of that valuable periodical, the New York Journal of 
Medicine. We know no one better calculated to occupy the post and become 
the successor of the indefatigable and lamented Forry. 



METEOROLOGICAL OBSERVATIONS, for February, 1845, at Augusta, Ga. 
Latitude 33^* 27' north— Longitude 4° 32' west. W. 



^rj 


TilKKMOMI-T • '. 


Barometer. 


WlKD. 


Remarks. 




cr 


7, A. M. 


a, p. M. 


7, A. M. 


6, P. M. 








~I 


-2sr- 


51 


30 inch. 


29 9-10 


N. E. 


Variable. 




2 


31 


58 


29 9-10 


30 


N. E. 


Fair. 




3 


31 


45 


30 


29 9-10 


E. 


Cloudy. 




4 


50 


47 


•29 4-10 


29 4-10 


N. W. 


Rain 7-10 inch— high 


wind. 


5 


28 


42 


29 5-10 


29 7-10 


N. W. 


Hisrh wind night and 


day. 


G 


28 


51 


29 8-10 


29 9-10 


N. W. 


Fair, 




7 


28 


47 


30 


30 1-10 


E. 


Cloudy. 




8 


30 


02 


30 1-10 


29 9-10 


W. 


Fair. 




9 


31 


GO 


30 


30 


w. 


Fair. 




10 


32 


GO 


30 


30 


vv. 


Fair. 




n 


30 


73 


•29 8-10 


29 8-10 


.s. w. 


Fair. 




12 


48 


70 


'29 7-10 


29 7-10 


s. w. 


Fair. 




13 


40 


80 


29 7-10 


29 7-10 


s. w. 


Fair. 




14 


49 


52 


29 9-10 


29 9-JO 


E. 


Cloud V. 




\b 


54 


GO 


29 8-10 


29 8-10 


variable. 


Rain 3-10 inch. 




10 


35 


57 


29 8-10 


29 9-10 


w. 


Fair. 




17 


38 


70 


■29 9-10 


29 8-10 


s. w. 


Fair. 




18 


40 


09 


•29 8-10 


29 8-10 


s. w. 


Fair. 




19 


40 


72 


•29 8-10 


29 8-10 


s. w. 


Fair. 




20 


45 


70 


•29 8-10 


29 8-10 


S. E. 


Fair. 




21 


50 


75 


•29 8-10 


29 8-10 


S. E. 


Fair. 




22 


00 


74 


•29 8-10 


29 8-10 


S. 


Cloudy. 




23 


50 


02 


•29 7-10 


29 0-10 


P. 


Rain 1 inch 5-10 




24 


44 


08 


29 7-10 


29 7-10 


w. 


Fair. 




2.5 


40 


08 


29 7-10 


29 8-10 


w. 


Fair. 




20 


39 


70 


•29 7-10 


29 7-10 


w. 


Fair. 




27 


38 


59 


•29 0-10 


29 .5-10 


N. W. 


Fair — high wind. 




28 


33 


59 


•29 8-10 


29 8-10 


N. W. 


Fair. 





Glnantitv of Rain 2 1-2 inches. J9 Fair davs. 



SOUTHERN 

MEDICAL AND SURGICAL 

JOURNAL. 

Vol. I.] NEW SERIES.— MAY, IS15. [No. 5. 

PART I.— ORIGINAL COMMUNICATIONS. 

ARTICLE I. 

A Case exhibiting the good effects of Opiates in large doses in fre- 
venting Abortion. By Henry S. Levert, M. D., of Mobile^ 
Alabama* 

Mrs. , aged 24 years, was married early in April, 1842 : 

she was of delicate constitution, subject to frequent attacks of syn- 
cope, and for several years previously had suffered from severe 
pulmonary hemorrhage, unattended with cough or other symptoms 
indicating disease of the lungs. Her habit was constipated, having 
a discharge from the bowels, upon an average, once in six days. 

On the 20lh May, next after her marriage, she aborted. This was 
attributed to a slight accident, the overturning of the chair upon 
which she was sitting. Eight or ten weeks from this time a similar 
accident occurred, and in both instances the effect was so prompt that 
no treatment was or could be resorted to, to prevent the miscarriage. 
It was now observed that her general health began to decline rapid- 
ly. The hemorrhages were more frequent and alarming — syncopo 
of almost daily occurrence, and a slight cough added to her other 
symptoms, whenever she was exposed even in the slightest dcgrco 
to dampness or the night air. About the expiration of the second 
month, after the last abortion, she supposed herself to be again preg- 
nant, and fearing a similar accident, she consulted a medical gentle- 
man, who advised her to watch her symptoms carefully, and, if 
pfKSRihle, prevent a recurrence of the abortion. To do this, she was 



226 Opiates in preventing Ab,ortion. [May, 



directed to take opium in some form, and in doses sufficiently large 
to allay all pain. The opium was proscribed for each and every 
paroxysm of pain. Up to this period she had never taken opium in 
any form. As in the former instances, a few weeks only had elapsed, 
when she was again threatened, having pain and hemotrhage — with 
this difference, however — in this instance she had received no injuryor 
shock, as in the two former cases. The fourth of a gr. of the sulphate 
morph. was promptly administered, which gave immediate relief, 
checking the pain and hemorrhage at once. This occurred again and 
again at intervals of a few days, and always yielded to the same treat- 
ment; small doses of the sulph. morph. During one of these attacks, 
which was much more violent than usual, aggravated as it was sup- 
posed by mental suffering, she was attacked with convulsions for the 
first time ; and so severe were these convulsions, that upon three 
different occasions, during one night, her shoulder was dislocated. 
This was each time reduced as soon as the paroxysm passed off. 
She took at intervals of one hour GO drops of laudanum during the 
night, making in all 480 drops. Towards morning she grew better, 
and the attack finally passed off without abortion. As she advanced 
in her pregnancy, it was found necessary to increase the quantity 
of opium before the desired effect could be produced, each trifle 
causing an attack every two or three days. " When she was about 
six months gone," says her husband, "she had a severe fall upon her 
face — on the instant I did not hesitate to give her a much larger 
quantity of opiutn than she had ever before taken, for I knew that 
her pains would soon be very hard. I think I gave her 150 drops 
on this occasion, and repeated the laudanum in smaller quantities, 
say 75 drops, every hour for five successive hours: in addition to 
which I bled her." After a great deal of suffering the pains were 
moderated, but she was never entirely free frompain until after her 
accouchment ; nor was she again able to leave her bed until after 
that period. Opium was given daily, in doses gradually increased 
during the whole period of her gestation. She had frequent attacks 
of convulsions, similar in every respect to those first mentioned, 
which, when violent, were always relieved by bleeding in conjunc- 
tion with opiates. Her bowels, as may be supposed, were obstinately 
constipated during the whole of this time — never having an evacua- 
tion unless some artificial means were resorted to. 

At the expiration of nine months she was delivered of a healthy, 
full grown SOD, af\er a protracted labour of 14 hours, during which 



J845.] Opiates in preventing Abortion. 227 

time she had several severe puerperal convulsions. No opium w^s 
given after it was ascertained that she was in labour, nor was she 
bled. Immediately after her delivery, she began to diminish the 
doses of opium, and at the end of five weeks abandoned its use alto- 
gether, although she suffered much from its discontinuance. 

In October following she again aborted, and again in January, 
and so suddenly on each occarfion that there was no time to put her 
on treatment. 

In the spring following, (1844,) she again became pregnant. As 
soon as this was satisfactorily ascertained, every precaution was 
adopted to prevent abortion. But a short time elapsed before she 
complained of pain, d:c., and recourse was had immediately to 
opium. The same success attended its administration in this, as in 
the former instance. The only difference observable in this and the 
former pregnancy, was the more frequent recurrence of the parox- 
ysms of pain and their greater severity. It was not unfrequent for 
her pains to last 24 hours, returning at intervals of five minutes ; and 
so violent were they as to induce her attendants to believe that abor- 
tion would certainly be the result. Twelve or fil'teen grains of crude 
opium would be given during one of the paroxysms before relief could 
be ohtained. 

xVbout the fifth month these attacks came on periodically each 
morning at the same hour, and again in the evening. They were 
always subdued, by giving grs. x. of opium at one dose as soon as 
they were felt, both in the morning and at night. The opium about 
or a little after this time was laid aside, and the sulph. morph. u-ed 
in its stead. Of this latter article she took daily grs. iii. at two 
doses. It was soon ascertained that this dose did not suffice, and it 
was gradually increased, until she took the enormous quantity of 
grs. ix. twice a day regularly, and frequently three times a day, until 
her confinement. 

At 4 o'clock on the morning of the 121h February, (1845,) she felt 
more |)ain than usual, or rather than it was usual for her to have at 
that period of the 24 hours, and she took her accustomed portion 
(grs. ix.) of morphine, although it was four hours in advance of the 
hour when she had been accustomed to take it. This procured no 
relief, but on the contrary seemed to increase her suffering. I was 
invited to visit her at 8 o'clock on the same morning, and found her 
suffering a good deal from inefficient uterine pains. An examina- 
lion satisfied me that labour had commenced. The os uteri beinn^ 



228 Opiates in preventing Abortion, [May, 



slightly dilated and yielding, but the pains were too inefficient to 
effect the delivery. I came to the conclusion that, in consequence 
ot the large dose of morphine which she had taken four hours pre- 
viously, the pains had been subdued, and that after its impression had 
passed off'tlie uterine action would increase, the pains become more 
efficient, and that the labour would be terminated favorably. I left 
her, therefore, with directions to take no more morphine, but to wait 
patiently for the eflect produced by that already taken to wear off. 
At 4 o'clock in the afternoon I called again: her condition was 
pretty much as it was at my first visit in the morning — pains, perhaps 
not quite so violent, and the pulse more feeble. The os uteri 
being soft and yielding, I determined to give the ergot, and accord- 
ingly gave her grs. x., and repeated it at intervals of 15 or 20 
minutes, until she took 5jj. Not the slightest effi^ct seemed to bo 
produced by it. The pains were not increased, the pulse became 
more and more feeble, great jactitation, with sighing, &c., superven- 
ed, and I almost despaired of conducting the case to a favorable 
issue. Believing, however, that much of the restlessness, the feeble 
pulse, &c., resulted from the want of her accustomed stimulus, the 
morphine, and seeing that no good was to he expected from a continu- 
ance ofthe ergot, I determined to suspend the latter, and give her a 
decided dose of morphine. If it produced no good effect, it could 
only suspend the uterine pains for a few hours, and 1 should find her, 
after the impression of the anodyne had passed off, in the same situa- 
tion that she now was. I accordingly gave her grs. vij. of morphine 
at one dose. She took the morph. at 7-i o'clock, P. M. In 20 
minutes her pulse became fuller and firmer, the restlessnes materially 
abated, and the pains much more decided in their character. She 
continued to have pretty good pains until 10^ o'clock, when they 
ceased almost altogether. At this time I gave her another, though 
smaller dose, of morphine ; and in half an hour she was delivered, 
by a single pain, of a healthy, full-grown son. 

Nothing unusual has occurred since. She is now quite as well as 
other women after parturition — nurses her child and enjoys more than 
her accustomed heallh. 

Some four or five days after her delivery, I directed the morphine 
to be reduced ^ gr. at each exhibition making a ^ gr. daily. It is 
now reduced to one grain daily, and in the course of a few days 
more, she will have abandoned its use altogether. 

This case is iiiteresting in more particulars than oDe — Ist, the im. 



1S45.] Cough and Pleurodynia from Spinal Irritation. 229 



mense doses of morphine which it became necessary to administer, 
to prevent abortion — 2nd, the entire success with which it was given 
in tills and her previous pregnancy — 3d, the facility with which she 
has been enabled to abandon its use after each delivery — lastly, the 
non control which the morphine exercised over natural labour pains* 
III fact, its effects was indirectly that of the ergot of rye : by stimu- 
lating the system to that point which from long habit had become 
second nature, the uterus was enabled to perform its functions pro- 
perly. My conviction is, that had not this remedy been employed, 
the labour, to say the least of it, would not have been terminated so 
soon ; if indeed she could have been delivered at all. 



ARTICLE II. 

Cough and Pleurodynia from Spinal Irritation. By J. J. Robebt- 
soN, ?rl. D., of Washington, Ga. 

Whether we regard spinal irritation as an idiopathic affection, or 
ns a result from derangements in other organs exhibiting itself in 
this disorder, in the great nervous centre of reflex action, we must 
admit, that there arc few diseases in which a proper appreciation of 
cause and effect is of more importance in a practical point of view. 

The various and complicated symptoms ofan irritation of the medulla 
spinalis, simulate in their character, so nearly inflammations of other 
important organs, that were we to omit a manual examination of the 
spinal column, in connection with the consideration of other symp- 
toms, we would be subject to frequent error in diagnosis, and con- 
sequent injudicious application of our therapeutic agents. There 
are many affections, which were formerly regarded as inflammations 
or derangements of organs, remote from the spinal marrow, which, 
by more modern pathology, are clearly rclbrable to an irritation in 
some portion of this organ ; and notwithstanding, there are so many 
recorded facts, the result of careful investigation, which should im- 
press upon u-< the importance of nn examination of the spinal column 
in many diseases, yet there are n, numbor of practitioners, who 



230 Cough and Pleurodynia from Spinal Irritation, [May, 



cither from an ignorance of the important pathological relations of 
the medulla spinalis, or from a tenacious adherence to some favorite 
doctrine, altogether reject such an examination, and regard it onh', 
as "an empirical demonstration, or, at least, an insane manoeuvre." 
How they can satisfactorily and successfully treat many diseases 
which every one meets with, in a general practice, we are at a loss 
to divine. For ourselves, we should be subject to many frequent and 
perplexing difficulties, which otherwise are rendered comparatively 
clear. We do not contend, that a manual examination of the spinal 
column will in every instance give evidence of an irritation of that 
organ, when such irritation really exists, but we maintain, that in a 
large majority of cases, such a result will be found to follow. We 
do not wish to be classed among those, who without due considera- 
tion, are led off by every " wind of doctrine," for we deprecate the 
course of those who from an ardent zeal, or a morbid thirst for some- 
thing new, precipitately adopt every new theory and doctrine, and 
generalize from isolated f\icts ; yet, as is justly, and forcibly said by 
an able writer, "a too obstinate and inflexible adhcrance to doc- 
trines because they bear the impress of age, would as certainly retard 
the progress of true philosophy, as that laxness of reason that would 
allow every induction of sense, to be counted of equal weight with 
the most obvious and practical truths." 

Our attention was more particularly directed to the importance of 
this subject by the able Professor of the Theory and Practice of IMedi- 
cine, in the Medical College of Georgia, who at that time seemed to 
have advanced further in his investigations of this subject, than any, 
with whose researches we were acquainted. His pathology of Inter- 
mittent and Remittent Fevers, as recorded in the Southern Medical 
and Surgical Journal, for 1836, as well as his more recent article on 
the Pathology of Intermittent Fever, to be found in the first No. of 
the New Series of the same Journal, are worthy of a careful perusal, as 
having an application of this important doctrine, which of late, has 
become one of increasing interest and investigation. We would also 
refer the reader to an interesting article contained in the fourteenth 
No., seventh volume, of the American Journal, by Austin Flint, M. 
D., of Nev/-York, in which are collected a number of cases, exhibit- 
ing a diversity of distressing and alarming symptoms, all of which 
were referred to this common source, the treatment regulated accord- 
ingly, and the diagnosis fully and successfully sustained by theresull. 

Notwithstanding we have used the term "Spinal Irritation," which 



1945.] Cough and Pleurodynia from Spinal Irritation, 231 

in its common acceptation conveys the idea of the derangement to 
which we allude, yet it must be obvious that it is objectionable; for 
the true nature of the derangement, we must admit, in the present 
state of our knowledge, we cannot accurately determine. Various 
are the opinions respecting it ; and perhaps the appellation which 
now distinguishes it, is the least objectionable, until future investiga- 
tions shall have determined its true character. We are disposed to 
regard it, as a local, venous congestion. The peculiar anatomical 
arrangement of the vessels on the surface of the cord, as well as the 
fact which appears to have been demonstrated, that the spinal vessels 
are destitute of valves, and consequently have to perform their func- 
tions in opposition to the force of gravity, without the aid of these 
valuable auxiliaries, thereby rendering the blood exceedingly liable 
to be obstructed in its ascending course, — even bv slight and trivial 
causes: the fact of the suddenness of its invasion in most cases, and 
also that the remedial agents that usually give speedy relief, are of a 
character calculated to relieve this state of things; — all combine to 
favor this conclusion. We can readily conceive, how such a conges, 
tion can produce neuralgia, together witii all the evidences of a 
deranged inervation. Various other reasons might be adduced in 
support of this opinion ; but as it is not our purpose in this place to 
discuss the nature of a disorder that is involved in so much doubt, — 
and as we have already extended this portion of the article to a great- 
er length than originally designed, — we proceed to transcribe the 
following particulars of a case which we find recorded in our note 
book. 

We were summoned to see Mrs. J. at 5 o'clock, A. M., on 29th 
April, 1844. She was aged 23, and her health generally good previ- 
ous to her present indisposition. We received from her the following 
history of her case : Her digestive organs had been somewhat 
deranged for three weeks past ; two weeks previously she was at- 
tacked with pain in left side, of an intermittent character; a few 
days subsequent there came on a harsh cougii. unaccomj)anied with 
expectoration; the cough recurred during tlie day in paroxysms at 
irregular intervals, which aggravated the |)ain in the side ; she 
thought she had taken cold, and used the ordinary domestic remedies 
with no permanent amondment. Some days previous to our visit, 
she was advised to apply a blister over the scat of pain, with which 
we furnished her, having made no examination of her condition. 
The blister gave but transient relief; the symptoms recurred, and 



233 Cough and Pleurodynia from Spinal Irritation. [May, 



gradually increased until some time during Ihc night previous to our 
visit they became suddenly greatly aggravated. We found her con- 
dition as follows : — Pain in the left side, constant and intolerable — 
cough recurring in paroxysms, at intervals of about an hour, which 
aggravated the pleuralgia ; dyspnoea very great ; inability to keep 
the recumbent posture, which seemed to increase the dyspnoea, and 
favor the return of cough ; pain aggravated by every deep inspira- 
tion; pulse one hundred, small and soft; skin of a natural tempera- 
ture; tongue, coated with long white fur. We had no stethescopo 
at hand, and consequently made no auscultory exploration of the 
chest, nor did we deem such investigation necessary at the time ; 
because, from the history of the case, as well as from the slight con- 
stitutional derangement, we were not disposed to regard it of an 
inflammatory character. We proposed an examination of the spinal 
column ; when she informed us that she had no uneasiness whatever 
in that region, but she submitted to the examination. We proceeded 
to examine each separate vertebrae in the usual manner, without 
giving any uneasiness, until we peached the last cervical, which v.as 
found exquisitely tender on slight pressure; and in proceeding down- 
wards, we found the tirst fiVe dorsal equally so; but there was no 
indication of derangement iti any other portion. The result of this 
examination, together with the history of the case, afforded stron 
presumptive evidence that the present distressing symptoms were 
mainly, if not entirely referable to an irritation of the medulla spin- 
alis. W^e immediately ordered halfgr. of acet. morph. to be given 
immediately, and applied caustic ammonia to the diseased portion of 
the spine, which produced vesication in a few minutes. In half an 
hour she was somewhat easier. V/e gave another portion of mor- 
phine, placed her in a recumbent posture, and directed one-third 
of a grain of morphine to be given every half hour until relief should 
be obtained. 

At 1 o'clock, P. M., she was much easier than when we left her ; 
has taken during our absence two portions of morphine ; can keep 
t'.ie recumbent posture without aggravating the symptoms : dyspnoea, 
greatly relieved, but still troublesome ; intervals between the parox- 
vsms of cough much longer, and the cough unaccon)panicd with the 
distress previously produced. We gave morphine one-third ofa grain, 
and directed the vesicated portion of the spine to be rubbed with 
tart. ant. et pot. ointment, twice a day, until pustulation should 
take place. 



or 



1945.] Cough and Pleurodynia from Spinal Irritation, 233 

At 7 o'clock, P. M., the pleurodynia was but slight, and of an in- 
termittent character ; the cough not very troublesome ; the dyspnoea 
entirely relieved; the pulse ninety, rather fuller, but soft : she had a 
comfortable sleep of half an hour, since our last visit, and feels dis- 
posed to sleep. We gave the following pills, and left her for the 
night: 

R. Ext. Colocynth, comp. . . . x ij. grs. 

Blue Mass V " 

Ext. Hyoscyami, iij. " 

Mix, and divide into four pills. 
On the 30th, at 8 o'clock, A. M., she was much better than last 
evening; had slept some during the night; had coughed several 
times since our last visit, which somewhat increased the pain in the 
side; pulse and skin natural; tongue cleaning. The pills had pur- 
ged twice this morning. We left one-third of a grain of morphine, 
to be given in two hours. 

At 5 o'clock, P. M., we found her entirely relieved of her primary 
symptoms, except an occasional cough, which was but slight ; she 
complained of her back from the effects of the ointment. We left 
one-third of a grain of morphine, to be given should the pain in the 
side return, or the cough become troublesome. 

May 1st, 8 o'clock, A. M. She expresses herself as entijrely reliev- 
ed. She had slept some during the night, and thinks she would have 
slept all night, had not the pain in her back been troublesome, though 
the morphine left yesterday was not taken. We found a fine crop 
of pustules on the part rubbed with the ointment. It was ordered 
to be discontinued, and an emolient poultice applied to the back, to 
he followed with dressings of olive oil. As there was no operation 
from the bowels since yesterday, we ordered a dose of the same pills 
as on 29th. 

On the 2nd May, at 10 o'clock, A. M., we found her sitting up. 
She says she feels quite comfortable ; had rested well during the 
night ; the pills given on yesterday produced three evacuations by 
bed-time, and one this morning ; the pustules discharging freely ; no 
cough or pain, tongue cleaning, pulse and skin natural. 

She was now placed upon a course of the Siisq. Oxid. Ferri, to bo 
continued regularly ; the bowels to be kept soluble by mild laxatives, 
and her diet to be unirritating, but nutritious. This course she pur. 
sued with progressive amendment for three weeks: nt the expiration 
of which time, she discontinued the use of all remedial agents, her 
health being entirely restorejl. 



234 Cough and Pleurodynia from Spinal Irritation, L^^X' 

We were again called to see her July 4th, 10 o'clock, A. M., when 
we found iier suffering from pleurodynia of an intermittent character 
in the left side. She staled tiiat her digestive organs had again be- 
come deranged t'rom an imprudence in diet. Upon examination, the 
four first dorsal vertebrae were found to be tender on pressure, and 
although we regarded the pain, <kc., as purely neuralgic, yet, from 
an undue determination to the brain, a few ounces of blood were 
extracted before we ventured on the use of anodynes. The vene- 
section gave little or no relief to the pain in the side. We applied 
sinapsisms to the spine — gave a dose of pills, the same as in the pre- 
vious attack, only substituting ten grains of the submuriate of mercu- 
ry for the mass. 

We saw her again at 8 o'clock, P. M., when the pills had operated 
several times, entirely relieving the cerebral symptoms. The pain 
in the side still occurred at intervals. We gave a quarter of a grain 
of morphine, to be repeated every hour until relief was obtained. 

On the next morning she had taken two portions of morphine, 
with entire relief; had rested well during the night, and now feels 
quite comfortable. The same general course was directed as before, 
and was attended with the same happy results. She has since 
continued in good health, with the exception of a slight attack of 
gastralgia in January last, which readily yielded to appropriate 
treatment. 

The foregoing case has been selected from others before us, as 
possessing peculiar interest, from the exhibition of symptoms analo- 
gous to those usually presented in phlegmasia of the respiratory 
organs, but which have their origin, for the most part, if not entirely, 
in a lesion of the spinal marrow. 

In the treatment of this case, we made liberal use of anodynes, 
although we believe they can exert no other than a temporary influ- 
ence, while the derangement of the spine exists; still we always 
administer them in urgent cases of this character, when there is no- 
thing to contra-indicate the employment. Although we believe that 
the pain, &;c., may be relieved by applications to the spine alone, yet, 
when this lesion in the spinal marrow has existed for some time, the 
applications which produce vesication immediately, or even, the local 
abstraction of blood, will not always afford immediate and entire 
relief; and it is not until we establish a more decided and permanent 
revulsion, that the symptoms altogether subside : hence, the necessity 
of adniiiiistering opiates in such cases, to give some relief to the 



1S45.J Cough and Pleurodynia from Spinal Irritation* 235 



urgent symptoms, and allow time for the establishment of a decided 
revulsion. We have seen cases, that had existed for some time, 
which resisted all topical applications until a discharge of pus was 
established by tartar emetic ointment. It may be objected, that this 
is contrary to our reasoning in proof of its being o. local congestion. 
But not so; for as in the case just related, we believe the derange- 
ment to have been primarili/ a simple congestion ; but having existed 
for some time prior to our examination, it had assumed a new and 
more permanent character. Had we seen our patient in the onset 
of the derangement, doubtless the first application made to the spine 
would have proved adequate to the entire relief of the then existing 
symptoms. This fact we have verified in a number of cases; and 
when the neuralgic symptoms are not urgent, we always procure 
relief from topical applications to the spine. 

It would appear from the history of this case, that the spinal irrita- 
tion was symptomatic, from the fact that the pleurodynia, iScc, did 
not occur, until after the digestive organs had become deranged. 
We, however, had no opportunity of examining the spinal column, 
prior to the development of t'le urgent symptoms. The derange- 
mem may have existed, and produced the indigestion, and subse- 
quently, the cough and pleuralgia ; but we are not disposed to think 
so, from the fact that the patient could trace the disorder of the diges- 
tive organs to improper ingesta. Yet we do not believe, that a cor- 
rection of this disorder would have relieved the neuralgia, dsc. ; for 
there was a lesion in the spinal marrow, which required a distinct 
treatment. 

My friend. Dr. E. L^mar, of Lincolnton, has kindly oiTered to 
furnish me with some interesting cases of spinal irritation, which 
manifested itself in painful affections of remote organs, and was re- 
licved by treatment directed particularly to the spine. These, toge- 
ther with others that have come under our personal observation, we 
may report in some future number of this Journal. 



236 Remarks on a Lecture on Mesmerism. [May, 



ARTICLE III. 

Remarls on a Lcchire on Mesmerism, published in the Aih No. of 
the Southern Medical and Surgical Journal. By L. A. Dugas, 
M. D., Professor of Physiology, <S^'C. in the Medical College of 
Georgia. 

The Lecture on Mesmerism, by my esteemed friend and colleague, 
Prof. P. F. Eve, inserted in the last number of the Southern Medical 
and SurgicalJournal, being evidently designed to lessen the value 
that may be attached to Mesmerism as a means of diminishing or 
preventing pain during the performance of surgical operations, and 
having a tendency to invalidate the testimony I have borne of itg 
efficacy in the case published by myself in the 3d number of the 
same journal, I trust it will not be deemed inappropriate that I ex- 
amine the grounds on which rests the defence of the positions assumed 
in the lecture. And, before going any farther, I must assure the 
reader, in the language of my colleague, that " in examining the 
subject, I hope to do so as a medical philosopher, to offend none who 
may not share my own opinions, to violate in no instance propriety 
or courtesy,'- and to ask nothing moro than "a fair hearing and an 
impartial judgment." Differences of opinion in matters of scientific 
enquiry, wheti discu><scd in this spirit, can certainly lead to no un- 
pleasantness, and must redound to the benefit of >all parties. 

Prof. Eve endeavors to establish the three following propositions : 

" 1st, That Mesmerism, or animal magnetism, was unanimously 
condemned by the commission appointed in 1784 by the King of France 
to examine and report upon it; and that it has never received any 
favor or approbation from any scientific or learned society whatever. 

'•2d, That Mesmerism is not a reality; but that the phenomen.a 
ascribed to it, are justly due to the imagination and excited feelings. 

*' 3d, That the non-expression of pain, is no proof of its non. 
existence, and that there are conditions of the body and mind, in 
which no sufForing is evinced, and moreover, that this stale of the 
system is independent of Mesmerism." 

Now let us see how these propositions arc sustained. It is stated 
distinctly in the first proposition, that Mesmerism was vnajiimously 
condemned by the French committee; yet, as soon as the details 



1845.] Remarks on a Lecture on Mesmerism. 237 



of the Report are given, we find the statement that " the report was 
confirmed by every member of the commission, except one, M. Jus- 
sieu." "He was however, but one, out of fourteen." Was the re- 
port then unanimously confirmed? The names of Franklin, Bailly 
and Lavoisier, also are heralded as "inseparable from the annals 
of science." Why omit that of Jussieu, who was confessedly one 
of the most distinguished naturalists of the age? Is it because he 
was so indiscreet as to differ in opinion with them on the subject of 
Mesmerism ? In the paragraph, page 171, we find the following 
quotation from their Report: "We cannot prevent ourselves from 
recognizing in these constant effects a powerful agent, which acts 
upon patients, subdues them, and of which the person who magnet- 
izes them seems to be the depositary." They recognize then the 
facts, as does Jussieu, and only differ with regard to their explanation. 
They refcr them to an operation of the mind — whereas Jussieu thinks 
they may be attributed to some other agent. Admit the facts, and 
I care not a whit for the explanation. 

But I am really at a loss to perceive what bearing the decision of 
that committee can have on Mesmerism, as at present understood and 
practiced. The following extract from the Report of the majority, 
will show the process and phenomena upon which they were called 
to decide : 

" They saw in the centre of a large apartment, a circular box, mado 
of oak, and raised a foot or a foot and a half from the floor, and 
called the tub, {bacquel.) The cover of this box is pierced with a 
number of holes, through which pass bent and movable bars of iron. 
The patients are placed in several rows around the tub, and to each is 
assigned one of the bars of iron, which may be applied directly to 
the region affected. A cord, j)assed around their bodies, connects 
them with one another; sometimes a second chain of communication 
is established by their hands, that is to say, by applying the thumb 
between the thumb and index finger ofthe next person, and compress- 
ing the thumb thus held. The impression received from the left, 
passes to the right, and thus round through the whole. In one cor- 
ner of the chamber a piano is placed, upon which various airs are 
performed, and to which are added singinj^ and other vocal sounds. 
All those who magnetize, hold in their hand an iron rod 10 or 12 
inches long. This rod, which is the marriietic conductor, concen- 
trates the fluid towards its point, by which the emanations are ren- 
dered stronger. The sound of the piano is also a conductor of 
magnetism. The patients, placed in very large numbers, and in 
fleveral rows around the tub, therefore receiv(r magnetism atthrsame 
time from all these Hources : by tin; iron branches issuing from thv 



23S Remarks on a Lecture on Mesmerism, [May, 



tub, by the cord encircling the body, by the union of thumbs, and by 
the sound of the pfano. The patitMits arc moreover directly mag- 
netized by means of the fini^or and iron rod passed before the face, 
over or behind the head, and ahout the affected region ; hut they are 
es Kicially magnetized by the application of hands and by pressure 
of iho hy|)nchondriac and hypogastric regions, frequently continued 
for a longtime, and occasionally for several hours." 

The effects produced, are tiius related by the Committee : 

" In the experiments they (the committee) have witnessed, the pa- 
tients, being thrown into various states, present quite a singular spec- 
tacle : some are calm, quiet, and experience nothing ; others cough, 
spit, feel slight pains, a local or general warmth, and perspire ; others 
are annoyed and agitated with convulsions. These convulsions are 
of extraordinary continuance and violence : as soon as convulsions 
occur in one, they are manifested in many others. The committee 
have seen them continue more than three hours : they are attended 
with the expectoration of a turbid and viscid fluid, forced up by the 
violence of contractions, and in which may sometimes be detected 
streaks of hlood. They are characterized by rapid, involuntary 
movements of the linihs and whole body, by constriction of the throat, 
by tremors of the hypochondriac and epigastric regions, by confusion 
and wildness of the eyes, by piercing cries, weeping, hicough, and 
immoderate laughing; they are preceded or followed by a state of 
languor or of reverie, a kind of prostration, and even sleep. The 
slightest unexpected noise occasions trembling, and it was observed 
that any change in the tone or time of the airs played on the piano, 
affected the patients, so that a brisk air was attended with increased 
agitation and more violent convulsions. Nothing is more surprising 
than this scene of convulsions; one who has not seen it can form 
no idea of it, and, when witnessing it, one is equally astonished at 
the perfect tranquility of a portion of the patients, and at the agita- 
tion of the others, at the variety and repetition of the phenomena, at 
the sympathies established. Some of the patients seek each other, 
rush together, smile, converse affectionatply, and endeavor to soothe 
each other's feelings All are under snhjcction to the magnetizer ; 
however drowsy, a word, a look, or a sign from him, arouses them. 
We cann<it but recognize in these constant eflects a powerful influ- 
ence which acts u|)on the patients, subdues them, and of which the 
person who magnetizes them seems to be the depositary." 

How different are these procedures and effects from those of the 
present day ! Instead of a charlatanical and ostentatious display of 
causes and effects, the philosophic inquirer proceeds, without extra- 
neous parapharnalia, to the investigation of nature's truths. With 
perfect quiet around him, and nothing calculated to strike the ima- 



1845. J Remarks on a Lecture on Mesmerism. 239 

ginalion, he r.ses but his volition and a few passes of his hands along 
the person of liis subject. Yet how much more astounding the effects 
thus simply produced, than even those related above ! Even llie 
production of mere somnambulism, now so common as to have been 
\vitnessed by every one who has taken the least trouble to investigate 
the matter, was entirely unknown at the date of the celebrated Re- 
port. With what point then can the authority of this committee be 
invoked in an argument to disprove that of which they could have 
had no idea whatever ? 

In the second division of the lecturer's first proposition it is assert- 
ed that Mesmerism "has never received any favorer approbation 
from any scientific or learned society whatever." My friend must 
have forgotten several facts rather adverse to such a conclusion. In 
1815, the Emperor of Russia appointed a committee of able physi- 
cians to investigate the subject, who reported, that having ascertained 
that animal magnetism is a very important agent, they would recom- 
mervd that its practice be restricted to enlightened physicians. An 
Imperial edict was accordingly promulgated to that effect. In 1816, 
a similar law was passed in Denmark, at the instance of the College 
of Health. In 1817, the King of Prussia, by Royal edict, prohibited 
the practice of animal magnetism by any other than physicians. And 
in 1818, the Academy of Sciences of Berlin, which is confessedly 
one of the ablest bodies in Europe, offered a prize of upwards of $600, 
for the best work on animal magnetism, thus showing their belief of 
its importance. 

In 1925, a committee was appointed by the Royal Academy of 
Medicine, of Paris, to report on the expediency of appointing a sjland- 
ing committee for the investigation of facts relating fo animal mag- 
netism. The committee, consisting of Adelon, Marc, Burdin aine, 
Pariset, and Husson, reported that it ^cas expedient to establish a 
committee on animal magnetism; and, on the question being taken, 
35 voted in favor of the report, and 25 against it. The President 
then appointed the following gentlemen as that committee — viz: 
Lcroux, Bourdois de la Motte, Double, Magendie, Guersent, Laennec, 
Tnillaye, Marc, Itard, Fouquier, ami Gueneau de Musi-y. Lacnuec's 
health very soon became such as to necessitate his resignation, and 
M Husson was appointed in his place. During upwards of five years 
this able committee, with the exception of Magendie- and Double, 
who would not serve, were engngod in the discharge of the duties 
nsuigned them, proceeding with the circumspection and impartiality 



240 Remarks on a Lecture on Mesmerism, [May, 



of true philosophers, in the observation anil interpretation of facts. 
In June, 1831, their Report was read to the Academy, and concludes 
with the following coroihirics : 

1. The moans employed to establish relation, or, in other words, 
to transmit the magnetic influences of the operator to the magnetized, 
are the contact of thumbs or hands, frictions, and certain gestures 
made near the body, called passes. 

2. The external and visible means are not always necessary, for 
on several occasions, the will, or the eyes fixed on the patient, have 
produced the magnetic effects, even without the knowledge of the 
magnetized. 

3. Magnetism has acted on persons of different sexes and ages. 

4. The time required to produce the magnetic effects varies from 
half an hour to one minute. 

5. Magnetism does not usually affect persons in good health. 

6. It docs not affect all sick persons. 

7. During the process of magnetizing, there are sometimes man- 
ifested insignificant and transitory effects, which we do not attribute 
to magnetism alone, such as slight oppressiork, heat or cold, and other 
nervous phenomena which may be accounted for without the inter- 
vention of any special agent ; viz. by hope or apprehension, by pre- 
possession or the expectation of something unknown and novel, by 
the ennui resulting from monotonous gestures, by the silence and 
quiet attending such experiments, and by imagination which exerts 
such powerful influence on certain minds and constitutions. 

8. A number of the phenomena observed have appeared to us to 
depend on magnetism alone, and were not reproduced without it. 
They are well established physiological and therapeutic phenomena. 

9. The true effects of magnetism are various: It agitates some, 
and composes others; it causes most commonly temporary accelera- 
tion of respiration and circulation, slight convulsive actions of the 
muscular fibres resembling electric shocks, more or less numbness, 
drowsiness, sleep, and in a few cases what magnetizers term som- 
uambulism. 

10. The existence of a uniform feature by which the truth of this 
somnambulism can be determined, has not been established. 

11. Nevertheless the existence of this state may be certainly 
known, when it occasions the development of the new tacullies de- 
nominated clairvoyance., intuition, internal prevision, or that it pro- 
duces striking physiological changes, as insensibility, a sudden and 
considerable increase of muscular 'power ^ and when this state cannot 
be referred to any other cause. 

12. Inasmuch as ?ome of the effects attributed to somnambulism, 
may be simulated, somnambulism itself may sometimes be simulated, 
and furnish charlatanism with means of deception. 

13. The sleep induced more or less promptly, and more or less pro- 
foundly, is a true effect of magnetism, although not an invariable on©. 



1845. J Remarks on a Lecture on Mesmerism, 241 



14. It is demonstrated to us that it has been induced under cir- 
cumstances in which the magnetized could not see and were ignorant 
of the moans employed to produce it. 

15. When the magnetic sleep has been once induced, it is not al- 
ways necessary to resort to contact and to passes to induce it again. 
The look and will alone of the ma^netizer have the same influence. 
Not only an effect may then be produced on the magnetized, but 
complete somnambulism may be induced, and removed without his 
knowledge, beyond his sight, at a certain distance, and beyond closed 
doors. 

16. There are usually effected changes more or less remarkable 
in the perceptions and faculties of individuals thrown into somnambu- 
lism by magnetism. 

A. Some of them, in the midst of noisy conversation, bear only the 
voice of the Mesmerizer ; many reply correctly to questions propoun- 
ded by him or by those with whom they have been put in relation ; 
others will converse with any person present : yet it is rare that they 
hear what occurs about them. They are generally unconscious of 
external and unexpected sounds produced about their ears, such as 
the sound of brass vessels stricken near them, the fall of a piece of 
furniture, <S:c. 

B. Their eyes arc closed, their eye-lids resist efforts made to sepa- 
rate them with the hands ; this operation, which is not done without 
pain, shows the globe of the eye convulsed, carried upwards, and 
sometimes downwards. 

c. The sense of smell is sometimes abolished. Muriatic acid, or 
ammonia, may be inhaled without discomfort and even without their 
knowledge. The reverse sometimes obtains, and they are then sen- 
sible to odors. 

D. Most of the somnambulists we have seen, were completely in- 
sensible. We might tickle their feet, nostrils, and the corners of their 
eyes with a feather, pinch their skin so as to produce cchymosis, 
plunge suddenly and unexpectedly to a considerable depth a pin un- 
der the finger nails, without any indication of |>ain, and without their 
knowledge. Indeed one has been found insensible to one of the most 
painful surgical operations, whose countenance, pulse, and respira- 
tion, indicated no emotion whatever.* 

17. Magnetism is equally intense and is as readily felt at a distance 
of six feet as at six inches, and the phenomena are the same in both 
cases. 

18. It appears that those only who have been previously magneti- 
zed can be acted on at a distance. 

19. We have seen no one in whom somnambulism was induced at 
the first sitting. In some cases eight or ten sittings were required. 

20. We have always observed that natural sleep, which is the re- 



•Cloqilfitt'srasF. 



242 Remarks on a Lecture on Mesmerism. [May, 



pose of the organs of the senses, of the intellectual faculties, and of vo. 
luntary motion, precedes and terminates the state of somnambulism. 

21. Whilst in the state of somnambulism, the ma^rjelized \vhom 
we have seen, retain the exercise of their wakinjr faculties. Their 
memory appears even more faitliful and more extended, since; they re- 
inembi'ruhat occurred durinj: every previous slate of somnambulism. 

22. Whpn awake, they aver to have forgotten entirely all the oc- 
currences durinj: their somnambulism, and never recollect them af- 
teruards. On this subject our sole reliance must be on their veracity. 

23. The muscular ))oucr of somnambulists is sometimes benutjibed 
and paralysed. At other times their movements are merely impeded, 
and in walking they stagger as if intoxicated, avoiding or not obsla- 
cles in their way. There are somnambulists who retain complete, 
their powers of motion, and some of them are even stronger and moro 
active than when awake. 

24. We have seen two somnambulists distinguish, with closed eyes, 
objects placed before them; they designated, without touching them, 
Ihe color and suit of cards; they read words in hand-writing, or sev- 
eral lines in books opened at random. These phenomena occurred 
even when their eye-lids were kept perfectly closed with our fingers. 

25. We have met with two somnambulists who possessed the fac- 
ulty of foreseeing (prcioir) acts of the organism more or less remote 
and more or less complex. One of them announcrd several days, 
nay, several months beforehand, the day, hour and minute of iho 
the recurrence of epileptic paroxysm ; the other indicated the period 
at which he would be cured. Their predictions (previsions) wcro 
realized w ith remarkable precision. 'I'his faculty seemed to us to bo 
possessed only in relation to acts or lesions of the organism. 

20. We have met wilh but one somnambulist who indicated the 
symptoms of the disease of three persons wilh whom she had been 
put in relation [c7i rapport). We had however made experiments on 
a pretty large number of them. 

27. In order to establish wilh accuracy the relation of mngnelism 
to therapeutics, it would be necessary to observe the effects on a 
fjreat numher of individuals, and to make for a long lime daily exper- 
ifnents on the same patients. Tiiis not having been done, the com- 
mittee confines itself to the statement of what it has seen, although 
in too small a number of cases to venture on any positive conclusion. 

28. Some of the patients experienced no relief from magnetism ; 
others have been more or less manifestly benefitted by it ; for example : 
one was entirely relieved of habitual pains ; another recovered his 
strength ; a third had his epileptic attacks deferred several monlhs; 
and a fourth was completely cured of a serious and long-standing 
paralysis. 

29. Whether considered as an agent of physiological phenomena, 
or as a thera[)cutic means, Magnetism ousht to be included among 
medical studies, and consequently its practice and supervision should 
l>p restricted to physicians, as is the case in the Northern countries. 



1845.] Remarks on a Lecture on Mesmerism, 243 



39. The committee did not verify, for want of opportunity, other 
faculties which had been stated by mnjrnetizers to exist in somnam. 
bwiisls. But Ihey have collected and now communicate facts of 
sufficient importance to authorize them to think that the Academy 
ouglit to encourafiG researches on MajL^nctisfn, as a very curious 
branch cf psychology and of natural iiislory. 

The Report was listened to by the Academy with much interest^ 
received and ordered to be autographed, {auto graphic). Consisting as 
it did, of mere facts observed by the committee, it could give rise to 
no discussion without impeaching the veracity of those respectable 
men. Hence, although there were probably many members who 
still remained skeptics, as the Report was not objected to, it must bo 
considered as in accordance with the views of the Academy, or at 
least of a majority of that body. 

It is truly a matter of astonishment that, notwithstanding the gen- 
eral admission of the truths of Mesmerism in all the nations of con- 
tinental Europe, and tlie aclion of their respective governments and 
scientific bodies on the s bject, it should have attracted but little at- 
tention in England until a comparatively recent date. One would 
certainly suppose that a doctrine advocated in Germany by such men 
as Klugge, Sprengel, Treviranus, Weinhold, Hermstaedt, Meckel, 
Klaproth, Hufuland, Shiglitz, (Sec. ; and in France, by La Place, Cu- 
vier, Virey, Rostan, Orfila, Marc, Itard, Gcorget, Guersent, Husson, 
Fouquier, Andral, 6rc. was worthy of being at least listened to by 
the members of the Royal Medico-Chirurgical Society of London, 
even at as late a day as 1843 ! It should be remembered, however, 
that notwithstanding the indignity with which the great majority of 
this body treated the presentation of facts to them, there arc yet 
some in England, who, rising above the influence of blind prejudices 
and the fear of popular odium, have candidly investigated the sub- 
ject, and dared to proclaim their belief in Mesmerism. Among these, 
we find, Arnott, Oliver, Symes, Townshend, Elliotson, <Scc. — men 
whose abilities and standing entitle them certainly to as much consid- 
eration as the herd of opponents who "peremptorily dismissed Mes- 
merism from the society," without ever having taken any steps to 
verify its claims. That Dr. Elliotson, who had long been regarded 
as one of the ablest professors in the London University, whose clin- 
ical Lectures and Hospital success had won him the applause of the 
Profession and patronage of the public, who had been for years the 
respected President of this very Medico-Clnrurgical Society, that 



244 Remarks on a Lecture on Mesmerism. [May, 



such a man shoukl be "ejected from his professorship," dismissed 
from his Hospital, and compelled to resign his membership of tho 
society, merely because of "his belief in magnetism," are facts that 
so closely resemble the inquisitorial tyranny of the dark ages, that 
\\c can scarcely realize that they have occurred but yesterday, and 
in the Emporium of the civilized worki ! 

It is said that the Professor of Philosophy at Padua refused to 
walk into Galileo's house and look through his telescope, to see whe- 
ther the satellites of Jupiter really existed ; and that the Professor at 
Pisa delivered lectures to show that the facts could not be facts. 
Verily it would seem that we are not so fiir in advance of the age of 
Galileo as we had thought, and that human nature is still the same 
now that it was centuries ago — I hope, however, that for the honor 
of the age in which we live, I have sufficiently established that it is 
an error to suppose, that Mesmerism " has never received any favor 
or approbation from any scientific or learned society whatever," and 
that it h?.s on the contrary been recognized by learned medical socie- 
ties, legalized by governments, and advocated by a large number of 
the most scientific authorities of Europe. Fortunately for our coun- 
try, we have no society constituted for the purpose of determining 
ex auclorltale what we may or may not believe. Hence it is that 
since the subject of Mesmerism has been agitated amongst us, it has 
received the attention, not only of scientific men, but of observers 
of all classes, who, unbiassed by the vain phantom of authority and 
high sounding titles, have examined for themselves and become con- 
vinced that Mesmerism is "a reality." 

But my friend urges that the " phenomena ascribed to it (mesmer- 
ism) are justly due to the imagination and excited feelings," and that 
"the non-expression of pain, is no proof ofits non-existence." The 
latter of these propositions is so self-evident that I am surprised 
that so much labor should have been spent in the collection of 
cases to substantiate it. I might have furnished a goodly number 
of the kind which have come under my own observation; but I 
would add, that Mrs. Clark is the only person I have ever seen, 
who not only expressed no pain, but honestly averred having felt 
no sensation whatever during the operation. 

With regard to the first of the above propositions, I am happy to find 
that its phraseology contains no denial of the phenomena ascribed to 
Mesmerism, and that at page 183, my friend admits "that sleep, con- 
vulsive movements, insensibility. Ace, may be produced, and have been 



1845.] Remarks on a Lecture on Mesmerism. 245 



produced by one person operating on the feelings of another." True, 
in his opinion, they are the "legitimate results of the imagination," 
&;c. No one will deny that the phenomena have, and will give rise 
to differences of opinion in relation to the channel through which 
they are induced, as well as to the agency by which they are occa- 
sioned. Whether it be through the mind that wo operate on the bo- 
dy, or through the body that we operate on the mind, in the induction 
of mesmeric phenomena, are questions of minor importance in de- 
termining the great fact of our ability to place the body in such a 
state that a surgical operation may be borne without pain. Of what 
moment can it be to my patient, or even to her surgeon, that her in- 
sensibility be attributed to " a trance or reverie," or even to Mes- 
merism? Is it not to her a source of unspeakable thankfulness that 
a method has been discovered by which she has been spared the 
pangs of one of the most painfnl operations, and relieved from the 
presence of a loathsome disease without her consciousness, and as 
if by enchantment? And yet is she, and all who may be so unfortu- 
nate as to require surgical operations, to be told that this is all a farce, 
that it is the mere workinss of imairination, and that, in thelanfjun^e 
of Dr. Copland of the Medico-Chirurgical Society of London, ^^ihe 
fact is unworthy of consideration, because pain is a wise provision of 
nature^ and patients ought to suffer pain while their surgeon is oper- 
ating V or rather is it not more philosophic, whilst we may differ in 
opinion on points of theory, that we yield to the strength of facts, 
and endeavor, by multiplying them, fo to perfect our means as to 
render them available to ail sufferers, instead of being limited as at 
present to a favored few. That we cannot induce insensibility in all 
cases, is but too true ; may we not indulge the hope, however, that 
by becoming more familiarized with this mysterious agency, and the 
laws by which it is governed, we may ultimately be enabled so to 
control it, as to render it of general applicability ? 



240 A Case of Lithotomy in the Female. [May, 



ARTICLE IV. 

A Case of Lillwiomy in the Female — douhlc Calculus. By B. W. 
Gkoce, M. D., of Talladega County, Ala. 

During the month of April, 1843, I was called to visit Mrs. N. S. 
(aged 23 years, and of leuco-phlcgmatic temperament,) in consulla- 
tion witii Dr. Sumners, for the purpose of removing stone in tho 
bladder, by an operation. I found Mrs. S. in an extremely dcbil- 
itated condition. She informed me that she had been sufiering from 
the effects of the stone for several years. She iiad taken various 
medicines without producing any more than mere temporary relief; 
and was at this time laboring under the distressing effects of dyspep- 
sia. On further enquiry, she informed me, that in childhood she had 
been very much trou!)lcd with asthma, but which pretty much subsi- 
ded about the agc.ot *puberty. Siie did not, however, long enjoy 
the consolation of having gotten rid of this disease, before one of an 
cqiuilly distrcssingcharactcrmadc its appearance, to-wit,amenorrlioca; 
under wliich she labored until near the age of nineteen. Upon tho 
appearance of her catamenia she began to experience symptoms of 
gravel; which continued to increase in violence, until she was hap- 
pily relieved by an operation. On my arrival. Dr. S. represented 
the stone as being about three-fourths of an inch from the external 
orifice of the urethra. Upon making a minute examination, I dis- 
covered this to bo the case, and that the stone was so large as to 
prevent the passing of the finger up the vagina. Deeming dilatation 
impracticable, we immediately determined to <5perate ; which was 
performed by making an incision (with the smallest scalpel in tho 
dissecting case,) through (he vagina and urethra, immediately upon 
the stone. After completing the incision, the dressing forceps (in 
the pocket case) were introduced and the stone grasped; but dis- 
covering that it could not be extracted without considerable effort, 
the finger was inserted and the calculus raised from its bed, near tho 
internal orifice of the urethra, (for it had been so long in this situa- 
tion that it had become pretty firmly attached to the mucous mem- 
brane,) and then easily removed. 

In a few moments after the operation, the patient was attacked 
with rigors, but which subsided immediately upon the administration 



1845.] A Case of Lithotomy in the Female. 247 



of a little camphor water. She soon fell into a quiet and pleasant 
sleep, and rested well during the after-part of the day and that night. 
I visited her the second day after the operation and found her doing 
well: pu!s2 83, in no pain, the incision was healing by the f^.rst in- 
tention, and the urine passing ofT by the natural channel. 

1 heard nothing more of our patient (as I lived at some distance,) 
until about eight diiys afcer, when I was unexpectedly summoned to 
to sec her again. When I arrived, I found Dr. Sumncrs already in 
attendance, who stated that another calculus, fully as large as the 
first, had come down and occupied pretty much the same position 
as the one already removed. 1 was indeed astonished; but it imme. 
diately occurred to me that, we had neglected the imj)ortant and 
necessary precaution of sounding the bladder afier the oj)eration. 

We determined to make a second effort to relieve the sufferings 
of our patient, whose pains had now become almost intolerable. 
Upon making a vaginal examination, we found the previously made 
incision partly re-opened; this we enlarged, then introduced the for- 
tops, and removed the stone without difficulty. The bladder wag 
now thoroughly explored, and no other stone being detected, she was 
placed quietly in bed, and the strictest orders given as to her regi- 
men, (Sec. 

She recovered from this second operation, without a sirjgle un. 
favorable symptom, excej)t incontinence of urine, wliich, for somo 
time, threatened to be very obstinate. 'J'his however was finally 
relieved by astringent injections, bathing, <S:c., and I am now happy 
(o say, that she has since been delivered of a fine, healthy boy, and 
is at this time enjoying unusually good health. 

The calculi are of the mulberry character ; each half as largo as 
n pullet's og^^ and weighing something over an ounce. The one 
first removed is of an oval shape, with the upper surface smooth and 
polished; produced I suppose from the urine passing over it;* the 
other part of the stone is exceedingly rough. The second stono is 
round, and rough over its entire surface. 



• Most probably from friction of the second calculus which latter became rough 
over its entire surface in the eight days after the removal of tlie first. — Edits. 



249 Case of Procidentia Uteri during Labor. [May, 



ARTICLE V. 

Case of Procidentia TJieri during Labor, in which artificial means 
were necessary to effect Delivery, with subsequent replacement of 
the Uterus, and complete recovery. By John M. B. Harden, M. D., 
of Liberty County, Ga. 

The following case, the narration of which I have received from 
my friend Dr. Raymond Harris, of Bryan county, is so very curious 
and interesting, that I have considered it worthy of permanent record 
and therefore send it, with the request that it be inserted in the next 
number of the Southern Medical and Surgical Journal. Although 
not occurring under my own observation, yet, from the known char- 
acter of the gentleman who has furnished it to me, I have no hesi- 
tancy in vouching for the general accuracy of the details. 

In April, 1829, a negro woman belonging to Capt. George Rcntz, 
of Mcintosh county, was taken in labor — She was about 40 years of 
age, of good constitution, mother of several children, and so far as is 
known, not subject to any previous prolapsus or other disease of the 
womb. Something unusual and anomalous having occurred during 
the progress of the labor, Dr. Harris was sent for. He found her, on 
his arrival, in the following condition : — She was lying on her back, 
with the whole gravid uterus between her thighs, retained only by the 
ligaments, which were much stretched but not ruptured, and dis- 
charging from its external surface a serous or sanious fluid. The 
woman had been in this condition for about 24 hours. She had had 
no pain since the descent of the uterus, and was complaining of 
none at this time. The liquor amnii had been discliarged. After a 
careful examination, no motion or other sign of life in the foetus could 
be perceived. The uterus appeared to be in a perfectly quiescent 
state, without any disposition to contract. The os tincoe was barely 
dilated sufficiently to allow the introduction o^ two fingers. Finding 
it absolutely necessary to relieve her as soon as possible, the Doctor 
proceeded to deliver her by artificial means — He opened the head of 
the child with a suitable instrument, and then, having an assistant to 
hold and support the uterus, he introduced his hand, and by careful 
traction succeeded in removing its contents. There was very little 
pain during his manipulations. He now returned the womb, which 



1845. J Case of Procidentia Uteri during Labor, 249 



had scarcely contracted at all, and advising the recumbent position, 
left her. She had a very good ^^ getting vp," and two years ago tho 
Doctor learned, teas in good health. 

Re3iarks. — Cases of the above character must be of very rare 
occurrence. I have not been able to lay my hands on more than two 
bearing any resemblance to it — one is noticed in West's Report, pub- 
lished in the British and Foreign Medicat Review for April, 1844,* and 
occurred in the practice of Dr. Perfetti. In this case, however, the 
procidentia was not complete, the uterus only reaching "something 
more than six fingers breadth beyond the external parts. The woman 
had been subject to prolapsus "ever since she was fifteen years old." 
The other had been communicated to the Dublin Medical Press, by 
Dr. Darbey, of Droghedaf — The woman was 42 years of age, and 
had had prolapsus uteri for some years. This was her seventh preg- 
nancy. "On examination. Dr. D. found the uterus lying between 
the patient's thighs, pvcscnUn^ a livid appearance, and the os uteri 
having a dry feel and no symptoms of dilatation. The labor pains 
were strong, with violent cramps in the lower extremities.'' 

2. The treatment of these cases seems to have been governed by 
the circumstances attending them. In our first case, the os uteri was 
*' so hard and undilatable,'' that Dr. Perfetti deemed it necessary to 
malce incisions into it. He then introduced the forceps and extracted 
the child. Tho mother recovered. Dr. Darbey "took thirty ounces 
of blood from the arm, and administeied the following draught : — 
R. Aq. Menth. Pip. §iss; Tr. Opii. Acet. gtt. 4 ; Syrup Cort. Aur- 
ant. 3ij. I\I. — which procured rest, and checked the cramps and other 
bad symptoms. After a comfortable repose of two hours, labor 
pains returned, the os uteri gradually and steadily dilated, and a 
healthy, but small sized child^ was born. The placenta followed 
after a short time, and the uterus being replaced and suitably secured^ 
nothing untoward followed.'^ In our case, the dilatation was efTect- 
ed by the hand after having lessened the dimensions of the head ; 
and certainly this method should always be preferred to incisions ^ 
unless it be found impracticable. 

3. There is an important physiological fact to be gleaned from these 
cases: namely, the poorer o/'///e abdominal muscles in effecting de- 
livery ; and the case which we have now related shows plainly that 



* Am, Jour. Med. Scionces, N. S. vol. 8, p. 257. 
i Am. Jour. Mod. Sciences, N. S. vol. 9, p. 232. 



ii^O A Case of Uterine Hydatids. [May» 



parturition may he carriel through by the action of these muscles 
alone, mithout the c^nctrrencc rf uterine contraclicn, an! nn!uially 
suggests the question, which plays the most important part in Labor? 
Anyone who has ever had his liancl in the uterus during a labor jiain, 
must know that there is most powerful action of muscles somewhere, 
and he would no doubt be inclined to refer it to the uterus itself— but 
may not the most of this force arise from the abdominal muscles act- 
ing through the parietes of the litems? and may not the mechanism 
of labor, in this regard, bo similar to the mechanism of vomiting? 
For our part, we arc very much inclined to adopt the alfirmativc ; 
while at the same time we admit that the uterus has an independent 
action and jioicer of its own, nnd that in every healthy labor, this 
action and contraction march pari passu with the expulsion of its 
contents. 



ARTICLE VI. 

A Case of Uterine Hydatids. By George G. Smith, M. D., of 

Oxford, Ga. 

At the instance of some medical friends, who supposed that this 
case, from its novelty, might be deemed worthy of an insertion in 
your Journal, I place it at your disposal to publish or reject, as you 
may think proper. 

Cases like the following, may have frequently fallen under the 
notice of other practitioners, but as wilh me it was a novel one, I 
noted carefully its developments and progress, and preserved my 
notes. 

On the eleventh of November, 1843, I was consulted by the bus. 
band of Mrs. N., a lady about thirty years of age, respecting certain 
ascitic and anasarcous symptoms, with which she was aflected ; they 
bad made their appearance but a short time previous, and were 
increasing from day to day. 

She was represented to bo pregnant with her second child, nnd 
about four months advanced, having had the derangements of health 
usually attendant on gestation. 

Knowing the frequency of a hydropic diathesis, in females in that 



1845. J On the Action and Uses of Aloes, 251 



situation, I was indisposed to subject her to the operation of active 
remedies, until I saw her, when the alarming extent of her dropsical 
symptoms satisfied me that her condition would brook no delay ; and 
that active measures must be instituted immediately for her relief. 

The pulse being full and bounding, I bled her copiously, and put 
her on the use of active hydragogue cathartics — continuing them 
from day to day, and occasionally repealing the venesection, v.ilh 
evident benefit to her general healih. 

On the evening of the 22d, I was summoned in great haste to her 
bedside; profuse uterine hemorrhage, with occasional contraction 
of the womb, had occurred ; and about an hour after I arrived, a 
discharge of hydatids took place, consisting of innumerahle liltlo 
encysted transj)arcnt globules of various sizes, the largest about iho 
size of a pea ; they were floating in a reddish liquid, and intermingled 
with coagula — the discharge continued during the night, until a 
q'-iart or more were expelled, and finally an organized mass, as largo 
as the palm of the hand, resembling the placenta, came away ; the los3 
of blood was very great, and she was much exhausted by the cxces- 
siveness of the hemorrhage. I entertained some fears for her safety, 
but re-aclion soon occurred in her system, and on the next day, slight 
febrile symptoms supervened. 

A course of ferruginous tonics soon dissipated the remaining drop, 
sical symptoms, and she recovered her health, which has since con- 
tinued without interruption. 



Part II.— REVIEWS AND EXTRACTS. 

On the Action and Uses of Aloes. By John C. Pl:ters, M. D., of 

New- York. 

1. It is a specific purgative, for when applied externally to a b!i«5« 
ter, it operates in the same manner as when administered internally 
(Gerhard); tincture of aloes applied to a carious bone, has excited 
purging (Monro) ; an aloetic pill applied to an issue has had thesamo 
t-fll'ct (^Pereira); also, an aloetic salve, when rubbed upon the ubJo- 
mcn (Dierbach). 



25'2 On the Action and Uses of Aloes. [May, 



2. The part operated upon, however, is in dispute. Wood and Bache 
think it has a peculiar affinity for the large intestine; and ratlier to 
its muscular coat, than the exhalent vessels, as the evacuations pro- 
duced arc seldom very thin, or watery. Cullcn agrees with this, and 
asserts that it rarely, or ever, produces more than one stool, which 
seems to he merely an evacuation of what may be supposed to have 
been present in the great intestine, while hardly any dose under 20 
grs. will produce a liquid stool, which effect is always attended with 
pain and griping. On the other hand, the ordinary bulUy and rather 
liard evacuation ^nay in innumerable instances he constantly obtain- 
ed from 1 or 2 grs. The slowness of its operation has also been 
advanced by Lewis, as proof that it acts on the large, rather than on 
the small bowels, for it hardly ever operates under 10 or 12 hours, 
often not till 16 or 18, while even 24 hours may elapse ; but this may 
be attributed to its insolubility in the stomach. Finally, to be still 
more minute, Newmann conjectures that it acts especially on the 
circular muscular fibres of the colon. Whether given in large or 
small doses, it hardly ever causes a copious evacuation. 

3. On the other hand, aloes has been supposed to act upon tlio 
liver from times immemorial : Aloe blJem riiheam exveUit (Rhazes) ; 
Aloe ad inferiiifs inlestinum bihm diicAt (Aretaeus). According to 
Sigmond, its influence upon the liver is marked by the peculiar con- 
dition of the evacuations, the color and odor of which, and their 
peculiar pungent effect on the rectum, prove that an increased quan- 
tity of bile has been poured forth. Wedekind assumes that the oper- 
ation of the aloes depends on an increased secretion of bile, excited 
by its specific action on the liver, and asserts that, as long as the 
stools are white or grey, in jaundice, aloes will not purge even in 
large doses, while the purgative effect supervenes as soon as the faecal 
matter contains bile; — he even carries this opinion so far as to de- 
clare that if given when the quantity of bile is normal, or increased, 
aloes may induce bilious dysentery and hepatitis. Vogt, too, says it 
is not to be doubted that it has a special action on the liver, and 
tends more to restoration of a checked secretion of bile than any 
other drastic purgative. It never causes watery stools ; but the de- 
jections are always yellowish, greenish, or blackish, and slimy, and 
often have a peculiarly putrid smell (Dierbach). Antyllus counts it 
among the remedies which evacuate yellow bile. According to No- 
ack and Trinks, it causes aching and tension in the right hypochon- 
drium, bilious papescent stools, with heat of the whole body, and 
uneasiness in the region of the liver, while the evacuations produced 
are faecal, bilious, not watery or copious, and emit a peculiar putrid 
smell. Its effects are so distinct and characteristic, that, when added 
to other purgatives, they do not take place until some hours after the 
evacuations caused by the other purgatives, and its stools differ both 
in color and smell. 

4. A third set of physicians believe that it acts primarily and spe- 
cifically upon the vena porta system, and assume that its influence 



1845.] On the Action and Uses of Aloes 253 



upon the liver and bowels is secondary to this. Thus, Braithwaite 
says : "That it acts upon the vena portnrum, is fairly to be deduced 
frcMn the very peculiar state into which the haemorrhoidal vessel? are 
tiirown by the congestions which so rapidly occur after a dose of this 
drug has been taken, and also by the condition of the uterine vessels, 
which has led to its employment as an cmmenagoge." When fre- 
quently repeated, it is apt to irritate the rectum, giving rise in some 
instances to hcemorrhoids, and aggravating them when already exist- 
ing; it also has a decided tendency to the uterus, for its influence in 
promoting menstruation is by no means confined to cases in which 
its action on the neighboring rectum is most conspicuous (Wood and 
Bache). CuUen has seen haemorrhoids pryduced from large and 
frequent doses ; it acts specifically upon the rectum, and, in a full 
dose, is in some persons apt to excite heat and irritation about the 
rectum and tenesmus, while, in those troubled with piles, it is said 
not unfrequently to increase, but even to bring on the sanguineous 
discharge (Percira). Fallopius says, that of 100 persons who had 
used aloes freely as a purgative, 90 became afiected with a liaemorr- 
hoidal flux which ceased when its use was omitted; it causes a de- 
termination of blood to the uterus, and fulness of the bloodvessels, 
especially its veins, and thus uterine irritation and menorrhagia are 
apt to be induced or increased by it (Percira). Wedekind says it 
exerts a specific stimulant action on the venous system of the abdo- 
men and pelvis, and hence causes increased secretion of bile, irrita- 
tion about the rectum, and vascular excitement of the sexual organs; 
piles, strangury, immoderate flow of menses, and racking pains in the 
loins, like labor pains, are frequently induced by it (Fothergill). The 
congestive power of aloes may go so far as to cause a flow of blood 
from the kidneys, uterus and rectum (Soternheim). It readily causes 
stagnation and accumulation of blood in the abdominal vessels, and 
various aflbctions and consequences of Plethora Abdominalis ; some- 
times, even when given in small doses, it may cause congestions, 
anxiety, burning when urinating, urging to stool, increased pain in 
the loins (Vogt). It is a heating remedy, and in young persons read- 
ily excites febrile symptoms, quick pulse, troublesome sensation of 
warmth in the abdomen, &;c. (Dierbach). Finally the excited con- 
dition of the vena porta system may extend to the whole of the venous 
side of the circulation, and congestion, to the head and chest, but 
especially to the abdomen, may arise, attended with an unpleasant 
heat, anxious ieelings and throbbing, with increased sensibility and 
distension of the abdomen, frequent watery stools, mixed with blood, 
or bloody stools with violent and cutting abdominal pains, piles, vio- 
lent pains in the kidneys, scanty hot urine, burning when urinating, 
discharge of blood from urethra, drawing and burning in the sacral 
region, A:c. (\oack and Trinks). llarnisch says, alter the use of 
aloes ill very sensitive or plethoric persons, we notice burning when 
urinating, tenesmus, aching and heaviness in the pelvis, erections and 
pollutions, an excifpment of the hjemorrhoidal and uterine vessels. 



254 On the Action and Uses of Aloes. [May, 



and even a similnr action of the whole vascular system, so that the 
pulse becomes fuller and harder, the mouth dry with thirst, scanty 
discharge of red urine, increased sensation of warmth in the abdomen, 
tiirobbing and aching in the right hypocliondrium (liver), cnngeslioa 
of blood to the head and chest, with anxiety, bleeding from the lungs, 
and even apop'.cvy. 

To conclude the enumeration of the peculiarities of the action of 
aloes, we would slate that, an increased quantity does not produce a 
corresponding cathartic effect; it is alleged by Lewis that its effects 
are more permanent than any other purgative, allhough Cuilen con- 
tradicts this, and states that r)ot\vilhstanding the use of aloes, cos- 
tiveness will return at its usual period. Small doses often cccasion 
erections, and increase of sexual appetite (Wedekind). Greenhow 
asciibes a diuretic elTect to aloes, and IMoirond injected 4 drachms 
into a \c'n of a horse, with no other effect than producing the cvnc* 
I' ' on ofa liirge quantity of urine. It may cause emaciation, stric- 
ture of rectum and enteritis; and ifgiven during pregnancy, in largo 
doses, it may produce abortion (Vogl). If its use be long continued, 
it causes dryness of the intestines, paralytic-like rigidity of the mus- 
culnrcoat, esj)ecially of the colon and rectum, in consequence of 
which o')stinato constipation may result; in too large doses it causes 
violent cutting abdominal pains, watery and long-continued diarrhccn, 
tenesmus and inflammation of the lower portion of alimentary canal 
(Vogt). In Moirond's experiment of injecting 4 drachms into a vein 
ofa horse, the faeces were passed enveloped in a thin pellicle of al- 
tered intestinal mucus. It causes discharges of menjbranous-liko 
pieces of mucus from the rectum, and very large roUed-up pieces of 
intestinal mucus (Noack and Trinks). It has caused vomiting of 
blood. From very large doses, we at limes get a watery diarrhoea, 
with violent cutting pains, or a long-continued sanguineous diarrhoea, 
^vith tenesmus and even inflammation of the bowels. Cuilen says 
it was once a common opinion that aloes dissolved the blood, or in- 
creased its fluidity, and Lewis alleges that this is the condition of tho 
blood drawn from persons who are in the habit of using aloetics, 
although, accordinix toSchwenke, it seems rather to coajiulate than 
dissolve the blood when added to some which has been drawn from a 
vein. Itwasan old opinion that it proved emmenagogue from its 
power of dissolving the blood, and hence was hurtfid in scurvy, and 
all haemorrhages proceeding from a lax state of the blood and system. 
It acts as readily in substance as in solution (Cuilen). 

Therapeutical uses and effects. — 1. In disturbances of digestion 
dependent upon weakness of the muscular fibres of the stomach and 
1)owels ; in abnormal secretion of mucus, acid, gas, &lc. ; in anorexia, 
dyspepsia, fliitulent distension, and painful aching in the region of tho 
stomach, with acid, rancid eructations, sluggish digestion, and consti- 
pation, especially of hypochondriacal persons — (Sobernheim). It 
generally sits well upon the stomach, for its bitterness renders it an 



1815.] On the Action and Uses of Aloes, 



admirable stomachic, wiiich promotes both nppetite and dii^estion ; 
some think that it regulates the due secreiion of the gastric juice, 
while Ihe ancients tertrrjd it animn venfricuIL 

2. But its |)rincipnl use is in habitual coslivencss and obstinato 
constipation from a h^iig dilatation of ttie muscular fibres of the in- 
testine, witli dryness of the mucous membrane, diminished and ab- 
normal secretion of bile ; under such circumstances it is often iho 
only remedy wiiich may be used for years without injury. (Doses, 
1 or 2 grs.) 

3. In diseases of the liver, we have already alluded to Wcdckind's 
experience with it in jaundice; as long as the stools remain light 
colored, he pushed it in large doses, viz. half a scruple twice a day ; 
as soon as^bile began to aj>pear in the fseceji, he immediately reduces 
the quantity to one or two grains, and even omits its use for one cr 
several days. 

4. In affections of the menstrual hemorrhoidal secretions. The 
experience here is very curious ; in former times it was regarded as tho 
sacra anchora in the cure of hoDmnrrhoids of an asthentic character, 
although aloes produces active congestive piles. It was also used to 
restore the ha^morrhoidrJ flux, when troublesome nervous affections, 
such as hypochondria, melancholy, mania, cramp of the stomach, 
d:c., were induced bv their suppression. Five grains, several times 
a day, was then the usual dose. By restoring the lia3morrhoidal se- 
cretion, it has also relieved the sensations of aching and weight in tho 
p(dvis, the eruptions, pollutions, urging to stool, &;c., which are often 
felt as premonitory phenomena of tho occurrence of piles. At times 
these moliminal hacmorrhoidaloc pass over into flowing piles, under 
the use of aloes, while at others they cease without any discharge hav. 
iug been produced. Under the latter circumstances, Ilarnisch con. 
jectures that the tonic and stimulating efl'ects of aloes removes tho 
weakness of the vessels upon which tho preinonition of piles has de- 
pended, i. c., the active congestion produced by the aloes overcomes 
the passvc one, which previously existed in his o|)inion. Locseko 
also asserts, that ifaloes be given before the accustomed flow of piles 
comes on, tho flux will ensue; but, on the other hand, if given whilo 
they are flowing, a stoppage will be eflx^cted. Irregular ha;morrhoidal 
congestion to the head, chest, stomach, bowels, liver, spleen, kidneys, 
uterus, bladder, &c., with their attendant redness and heat ol the face, 
illusions of vision, threatened apoplexy, a constriction and anxiety 
about the chest, and even haimoptysis, or throbbing, aching, &c., 
about the stomach, with hematcmesis, or aching in the liver or spleen, 
with threatened dropsy, or hajmorrhage from the stomach or bowels, 
or aching in the region of the kidneys with scanty discharge of hot 
urine, or tenesmus of the bladder fnmi venous congestion of it, and 
luem ituria, or congestion to the uterus with menorrhagia, etc., have 
nil given way before the use of aloes (Ilarnisch). Eberle corrobo- 
rates the above in one paiticular (see Practice, vol. i., p. 572). Ho 
writes ; " Woubl not I>r. Dfnvey consider alots a vrrv improper rem- 



250 On the Action and Uses of Aloes, [May, 



edy in the menorrhagias of young, sanguineous and robust females? 
lie no doubt would; and why? because experience has shown that 
this arlicic is amonf; our most efficient means for exeiiinor the uterine 
vessels and directing the afTlux of blood to ihem. Yet ibis article, 
given in small doses, but frequent ones deserves to be accounted the 
best remedy wo possess for those protracted, exhausting, and obstinate 
bremorrhages from the uterus which occur in those of relaxed, nervous, 
and phlegmatic habits, about the critical period of life. When, 
therefore, we see a particular modification of this discharge arrested 
by a remedy which we arc accustomed to regard as decidedly calcu- 
lated to stimulate the vessels from whence the bleeding occurs: .in 
in other words, when \vc cure haemorrhage by stimulating applica- 
tions, the conclusion is irresistible that it depended upon debility." 

The above is a good example of the very numerous instances in 
which a very close symptomatic similarity masks a very wide patho- 
logical difierence. According to Andral, it is a law in pathology 
that very similar symptoms may arise from very different aflections. 
It is notorious that anccmia is often attended hy symptoms which 
render it liable to be mistaken for hyperaemia ; thus the pulse may be 
frequent, vibrate violently, be deceptively hard and tense, while the 
heart palpitates and beats forcibly as in active congestion or inflam- 
mation ; anjpmia of the brain and spine is often attended with pain 
and throbhing in the head, delirium, ringing in the ears, sparks before 
the eyes, and general convulsions; the npoplexia ex inanitione may 
be attended with the vertigo, stupefaction, entire loss of conscious- 
ness, stertorious respiration, &c., which attend true apoplexy with 
effusion ; bloodless lungs are dyspnoic ; the bloodless heart palpitates 
violently; the bloodless stomach is dyspeptic, tender to touch, nau- 
seated, (Sec. Bark and iron cure the above anaemic affections, antipa- 
thically, although they produce very similar symptoms, depending, 
however, upon the very opposite, i. e., a plethoric stats of the system. 

According to Symonds, the evacuations produced by the purgative 
which cures a diarrhcEa, are very different from those that constitu- 
ted the latter, and argue a dissimilarity in the state of the membranes 
that furnished them. The inflammation produced in the eye by the 
nitrate of silver is different in character from the inflammation 
which it is so useful in removing, &c. In Fletcher's "Elements of 
Pathology," p. 4S6, we learn that " In the first stage of inflammation 
there is constriction of the capillaries; in the second, there are re- 
laxation and enlargement of these, allowing an increased quantity of 
blood in them, causing redness, swelling, beat and pain in the part. 
Now, if in the latter state of the vessels, a stimulus be applied, it 
must produce constriction or contraction of the enlarged vessels, and 
hence remove one cause of the disease, viz., the enlargement and 
relaxation of the vessels. Examples of the utility of stimulants in 
this second stage of inflammation are familiar in the treatment of 
ophthalmia and gonorrhoRa." 

Constipation may be cured antipathically by drugs, (he marked 



1845.] On the Action and Uses of Aloes. 257 



action of which is to induce constipation. Thus, one of the most 
common causes of this state of the bowels, is a torpid, relaxed, dilated 
and enfeebled condition of the colon ; now iron, lime, lead, alum, all 
which cause a constipation depending on a dry and contracted state 
of the colon, may cure the first-described condition. Xux vomica 
causes constipation, depending on a spasmodic state of the bowels, 
and may cure antipathically a constipation arising from a sub-para- 
lytic state. Opium induces constipation by benumbing and stupify- 
ing the muscular fibres of the colon, and will cure constipation 
depending upon spasm, &c. 

Again, admitting that Peruvian bark causes chills, fever, and sweat, 
this by no means proves that this remedy cures fever and ague ho- 
mceopathically. For, in the first place, we have perused Hahnemann's 
description of the efTects of bark on the healthy, repeatedly and care- 
fully, and never have succeeded in finding any proof that it induces 
intermittent affections of any kind ; much less a fever characterized 
by regularly periodical exacerbations and intermissions. In the se- 
cond place, the bark-fever is an arterial congestive fever, while the 
intermittent is a venous congestive one. Professor Mitscherlich, of 
Berlin (see Mat. Med., 224), says, "From th^ long continued use 
of bark, we notice an increase in the quantity of the blood, which 
also becomes more arterial in quality, hence the pulse becomes fuller 
and stronger, the skin, especially of the face, becomes redder, con- 
gestions ensue, and a continued fever may arise." Dr. James John- 
son (see Med. Chir. Rev., Jan., 1837, p. 193), says: "If we watch 
the operation of Peruvian bark, we find that it excites the action of 
the heart and capillaries, increases the strength and invigorates the 
system. If pushed beyond a certain point, the bad efiects that fol- 
low are just what might be supposed to result from an excess of the 
same sort of action ; too much blood is made, and it is circulated 
with too much force. Sanguineous congestions or local infiamma- 
tions ensue, and the whole system becomes overloaded and oppressed 
with blood." How dilTerent, nay, how exactly opposite, are the ul- 
timate effects of fever and ague, viz., a cachectic, almost chlorotic, 
or leucophlcgmntic state, marked by paleness and sallowness of the 
surface, a deficiency of fibrin in the blood, which becomes more 
venous and watery, and hence predisposes to dropsical affections, 
starrnations, and infarctions of the blood in the liver, spleen, &c. 

Mercury produces ulcers and eruptions, but they ditfer widely 
from the syphilitic. The true Hunterian chancre, or indurated ulcer, 
against which mc^rcury is most serviceable, is rather small, nearly 
circular, deep, a!i(l excavated, the base and edges as hard as car:ila- 
ges, and is attended with little pain or inllammation, d:c. ; on the other 
hand, the mercurial ulcer is superficial, has a broad base, bleeds easily, 
is painful, and most nearly resembles a phagedenic ulcer, while, ac- 
cording to P(>reira, it is well known that venereal sores at times 
assume a- sloiighinrj (ilr.position from the improper use of mercury. 
Hence it ^ evident that mercury is most homccopathic to the phaga- 

17 



258 On the Action and Uses of Aloes, [May, 



denic variety of venereal ulcer." But in deciding on the use of 
mercury in syphilis, another point deserving attention is the condition 
of the primary sore ; if it be of ihc kind called phagedenic, or at all dis- 
posed to slough, mercury must be most carefully avoided, as it increases 
the disposition to sloughing," (Pcrcira, Mat. Med., vol. i. p. 597.) 

Mercurial eruptions are as rare as the syphilitic arc frequent : of 
these, a vesicular eruption, the eczema mercuriale, is the most fre- 
qucnt and best known. On the otiicr hand it is ^vcll known that 
*'an eruption, having the vesicular form, and developed under the 
influence of a syphilitic cause, is unquestionably not a common oc- 
currence." (Willis.) Rayer, too, speaks of syphilitic eczema .is 
extremely rare, for in all his vast intercourse with skin-diseases, he 
met with two examples only. An acrous, or indurated tuberculous, 
is the most common syphilitic eruption. We can readily conceive 
how a drug which tends to produce broad, superficial, spongy, and 
relaxed ulcers, may change the action of a narrow, deep, firm and 
hard ulcer; a drug which tends to cause vesicular, i. c., serous erup- 
tions, may change the action of a tubercular one, which depends upon 
the pouring out of plastic and firm lymph from the blood-vessels, A:c. 

It is needless to multiply examples, for it is evident from those al- 
ready given, that renledies which act very similar to the action of a 
given disease, in reality exert an aJleralive action upon that disease. 
In the earlier stages of his discoveries, Hahnemann recognized the 
truth of this position, for he states in the 45th paragraph of his " Or- 
ganon," that "two diseases which differ grealhi in their species, but 
which bear a strong resemblance in their symptoms, always mutually 
destroy each other;" and volunteers the admission in his "Spirit of 
the Homoeopathic Doctrine," that "without this nalural difference 
between the affection arising from the disease, and that arising from 
the drug, no cure could possibly take place, but only an exasperation 
of the evil." At a later period, he became so blinded and infatuated 
as to overlook the above irresistible conclusion, and in his precepts 
and practice even virtually to deny it, and setup the law, ^^ similia 
similibus curaiitiir,^' is the only true law in therapeutics; but, strug- 
gle as he would, all his attempts at explanation resolved themselves 
into old school theories, as is again evident in his assumption, that 
every remedy has two sets of actions, viz., primary and secondary, 
the latter of which is exactly opposite to the former; whence he 
again assumes that, although the primary action of homoeopathic 
remedies is similar to that of the disease, yet their secondary one is 
exactly opposite, and is willing to admit that this secondary opposite 
action eflectsthe cure. 

" We have names, diseases, remedies, notions, theories and expla- 
nations difTerent from those of olden times; but the art of healing 
is still the same, nature is the same, and the same capacities are re- 
quired for becoming an adept in medicine, as at the time of Hippoc- 
rates."— -( Hufeland.*) 



♦ 5;e*i "LLchiridioL ^leJicim* 



1845.] Essay on Inverted Toe Nail, 259 



The preceding excellent article, we hfive taken entire from the 
original department of the March No. of the New York Journal of 
Medicine. The only omission we notice by its author of the action 
and uses of aloes, is that recommended a few years ago by Professor 
Trousseau, of Paris, viz., as revulsive to the rectum in cases of apo- 
plexy, &c. A suppository or injection of aloes bringing on in a short 
period, an attack of piles, or an effort that way. 



Essay on Inverted Toe NaiL By Dr. E. Zeis. 

The affection usually known as the "inverted Toe Nail,'' or, to trans- 
late the denomination employed by our author, '• the growing of the 
nail into the flesh," is one, when we consider the frequency of its oc- 
currence, and the severe suffering by winch it is attended, and the 
impediment to the use of the foot in walking which it presents, is 
one of no trifling importance. Every thing, therefore, that is cal- 
culated to throw light upon its true nature and causes, and the means 
by which it may be most certainly and etfectually remedied, becomes 
of interest. 

By almost every writer the entire afi'cction, the inflammation of the 
soft parts, their suppuration, the intensely sensible fungous granula- 
tions wliich shoot up from the lateral edge of the nail, and cover the 
greater part of the latter — together with all the attendant suffering 
and lameness — and which, in many cases, continue for months and 
years — have been ascribed to the cd^o of the nail pressing upon or 
penetrating abnormally the soft parts — either in consequence of the 
too great breadth of the nail, its too arched form, or the unnatural 
downward direction of its edge; and hence the remedy that is pro- 
posed by diirerent surgeons is either the destruction of more or less 
of the nail, the changing of its form, or the drawing out of its edge 
from the flesh, and the preventing its again embedding itself into it. 
They all consider that it is the nail whicii is in fault, and the whole of 
their attention is directed to correct its abnormal action upon the soft 
parts. 

Many of the operations proposed even by surgeons of a very late 
date, are painful and cruel in the extreme, and few of them afford 
any otiier than a temporary relief, while some are calculated ulti- 
mately to increase the very evil they are intended to remove. 

"If," remarks Dr. Zeis, "the cure of the affection, supposed to 
result from the growing of the nail into the flesh, was formerly too 
often attempted by the destruction of the nail, it is only since Du. 
piivtror. has counselled its entire oiitrooting, that the operation has 



260 Essay on Inverted Toe Nail, [May, 



been generally sanctioned and adopted. Me it has, in every in- 
stance, filled with horror, and I am happy to say that I could never 
be induced to perform it. I have had repeated opportunities of ob- 
serving those patients who had been operated on, according to Du- 
puytren's method, by other piiysicians ; and found them far being 
relieved from their sufferings. ?sotwithstanding the offending por- 
tion of the nail had, in each case, together with its root, most cer- 
tainly been torn out, as was evident from the separated portion, which 
they showed me, yet, they had again been supplied by the lateral 
growth of the remaining part of the nail, but without any connec- 
tion being formed between the new growth and the matrix, so that a 
probe could be passed freely from its upper edge to its root. The 
free lateral edge of this new unattached portion kept up a constant 
irritation in the soft parts, and re-excited an inflammation in them, un- 
less it was kept constantly cut short, and in such a manner as to pre- 
vent the occurrence of a thin sharp edge — by which the original af- 
fection would be liable to be reproduced. Now this repeated trim- 
ming of the nail the patient was unable properly to perform himself, 
but it required that he should call in, from time to time, the aid of 
the surgeon, if he would avoid the very suffering, for the removal of 
which he had already undergone a most painful operation." 

In the 14th volume of Graefe and Walther's Journal, (page 234,) 
the render will find an excellent essay on the invertion of the nail, 
by H. S. Michaelis, in which is contained a very complete notice of 
the several operations proposed for its cure — and, in the same jour- 
nal, (vol. xxii. p. 108,) there is a paper, by A. Sachs, on the same 
subject, in which the different plans of treatment that have been re- 
commended are examined systematically. 

In the medical journals, particularly those of France and Eng- 
land, we meet almost constantly with the recommendation of novel 
modes of treatment, which, however, are, in most cases, merely 
modifications of those thad had already been proposed 

The most cruel of these operations is that described by Neret, 
{Archives Generalcs de Med., June, 1838,) who directs a spatula to 
be forced down beneath the nail to its root, and then carried towards 
the offending edge, so as to separate it fully from all its adhesions; 
the nail being now turned towards the opposite side of the toe, is to 
be torn out. Dr. Zeis very properly remnrks. that the amputation of 
the toe would be a more gentle and preferrable operation to that of 
Neret. 

Larrey (CUnique Chirurgicale, 1836) recommends the nail to be 
divided, a short distance from the diseased edge, (one-third the 
breadth of the nail,) by means of a sharp-pointed scissors ; the divi- 
ded portion is then to be separated at its root from the skin by which 
it is there covered, turned back nnd torn out. As soon as the hem- 
orrhage ceases, the part from which the nail is removed is to be cau- 
terized hy a hot iron ; the dressings are then to be applied and kept 
on fourteen days, when the lunar caustic is to be freely applied. — 



1845.] Essay on Inverted Toe Nail. 261 



This differs from Dupuytren's operation only in the smaller portion 
of the nail that is removed. 

Baudens directs the knife, which is to be held in the same manner 
as in cutting a pen, to be applied a few lines above the root of the nail, 
on its diseased side, and then carried down to the bone, when, with 
one sweep forwards, the whole of the inverted edge, together with the 
spongy flesh in which it is imbedded, is to be removed. 

Others advise the destruction of the whole nail, or a portion of it, 
by the application of caustics. Thus Payan, (Revue MtrL, July, 
1840,) after covering so much of the nail as is not to be destroyed 
with adhesive plaster, applies to the uncovered portion a caustic 
composed of equal parts of caustic potass and lime. The same 
procedure is recommended by Barbette and Bordes, (Journ. des 
Connaissances Med. Chirurg., Nov., 1839 — June, 1840,) by Al- 
bers, (Correspondenz hlatt Rhein. u. Westphdl. Aerzte, B. 1. N. 5,) 
and by Moreau, {Gaz. Med. de Paris, 1836, No. 52 ;) the latter, 
however, employed the caustic burnt alum, which required eighteen 
to twenty months to effect a cure. Labat, (Broussais^ Annates, 
1834, No. 9,) in order more rapidly to relieve the patient of his 
suffering, destroyed at once the root of the nail by the actual cautery, 
which is the treatment recommended, also, by the reviewers of 
Schregor's "Grundriss der Chir. Operationen," in \\\e Salzb. Med» 
Cliir. Zeitung, 1827, No. 55. 

'Dov\zc\\Essai sur VongJe incarne, etc., Strasbourg, 1836) directs 
the skin to be dissected back from the root of the nail, and the wound 
to be filled with charpie ; on the following day it is to be filled with 
pate causlique — the joint of the finger being first well dried and cov- 
ered with adhesive plaster. After the separation of the slough, the 
edge of the nail, which has been laid bare, is to be removed by the 
scissors. 

Others object to the destruction of any portion of the nail, either 
entirely or temporarily, and propose various procedures by which the 
nail may be kept from contact with the inflamed portion of the soft 
parts, until these have been completely healed. Sachs {Graefe and 
Wahher^s Journ., vol. xxii. p. 108) directs the general health of the 
patient to be restored by appropriate remedies, in conjuction with a 
proper diet and regimen ; the inflammation of the foot to be reduced 
hy the usual antiphlogistic means; and the pus which is formed to be 
discharged, and at the same time the loosened edge of the nail to be 
removed by means of a forceps and scissors, eitiier by a simple or V 
formed incision. If the swelling of the soft parts prevents this from 
being readily effected, a portion of compressed s|)ongc should be in- 
troduced beneath the edge of the nail and kept there until this has been 
sufficiently freed from iho spongy granulations by which it has be- 
come imbedded, taking care, however, at the same time, not to employ 
too great a degree of pressure, as this may increase the suffering ot the 
patient. The healing of the ulceration may be promoted, after tho 
excision of the nail, by the use of tonics. 



262 Essay on Inverted Toe Nail. [xMay, 



Martin {Recueil de Memoires de Med. de Chir. et de Pharm. 
Militaires, vol. '.]9, 183G) recommends a triangular portion to be cut 
out of the middle of the nail, the base being at the free edge ; and 
then the cut edges of the nail to be drawn together by means of a 
suture of brass wire, witli the view of rcmoviuir the lateral edges of 
the nail from contact with the inflamed portion of the toe. This 
operation, independently of being very painful, can afford only tem- 
porary relief, inasmuch as the constant growth of the nail will quick- 
ly counteract whatever advantage may result from the artificial 
reduction of its breadth. " 

Cooper and Buvncit (Land. Med. and Pliys. Journ., Ap. 1827, 
and Feb., 1829) simply recommend the inverted edge of the nail to 
be removed from the point to the root. 

Other surgeons have proposed to give to the nail a less arched or 
flatter form, so as to prevent, in this manner, its edges from pressing 
inward upon the soft parts. Houllon (Land. Med. Kcpos., Sept., 
1824) directs the nail to be shaved as thin as possible at its centre ; 
a triangular piece of cork is then lo be inserted, on each side, be- 
tween the nail and the toe — whether under or above the nail is not 
said — and a third piece, about one-third the breadth. and of the same 
length as the nail, upon the thinned portion of the latter, and over 
these a piece of adliesive plaster and a bandngc, which is to bo 
changed every three days. Biessy (Revue Mod., 1830, t. ii. p. 54) 
shaves the whole of the nail as thin as possible, and then touches it 
six or eight times with lunar caustic, until it shrivels up, and its edges 
are, in consequence, drawn out of the soft parts. This procedure 
cannot fail to produce the entire destruction of the nail. Rothamel 
(Zcitschrift fur die Ges. Heilk, etc., B. 1, Hft. 1) directs the nail, for 
the breadth of two lines, extending from the point to the root, to be 
scraped as thin as possible, by means of a piece of glass. Pressure 
being now made upon the central portion of the nail, the edges are so 
far drawn up as no longer to bear upon and irritate the inflamed soft 
parts. The scraping of the nail is to be repeated every other day. 

Petrequin (Archlv. de Med. Beige., March, 1841) thins the nail 
by means of a file, and applies pressure upon it by means of sponge 
and adhesive plaster; others, as Bonnet {Bulletin de Tlierop., Aug., 
1834,) propose to flatten the nail, and thus relieve its edges, by ban- 
dages and graduated compresses alone. Labarraque [Gazette des 
Hdp.f April, 1837) employs a thin plate of lead, bent in a particular 
manner, one edge of which is inserted beneath the edge of the nail. 
A somewhat similar plan is pursued by Lechler (Wartemh. Med. 
Correspondenz Matt, B. 8, N. 47). According to Vesignie, {Joxirn. 
Hebd., S. 34 — 3G, 1836.) the plan of Brachet consists in cutting 
away the soft parts; and when the nail requires to be entirely des- 
troyed, he prefers Dupuytren's operation, in conjunction with the 
cautery. In the generality of cases, he merely removes the superflu- 
ous portions of the nail, and then puts on a clasp composed of a nnm- 
ber of silver plates, which is elevated by means of a screw, and raises 
up with it the edges of the nail, by which means all pain is removed. 



1845.] Essay on Inverted Toe Nail 263 



*■ It is not," remarks Dr. Zeis, " merely the painful and cruel char- 
acter of the principal operations that have been proposed for the euro 
of the inverted toe nail, that renders them so disgusting to me — other 
operations are attended with much pain and sutiering, which excite 
in me no such feeling. But my opposition to* them is derived from 
the circumstance, of the whole of them being based upon erroneous 
principles, and their being all unadapted to afford any radical and 
permanent relief." 

In many, though by no means in the majority of cases, the cutting 
the nail too short is the primary cause of the atTection. The soft parts, 
being no longer kept down by the projecting free edge of the nail, 
are forced, by the pressure of the shoe or boot in walking, against and 
even over the truncated end of the nail, and, as this again increases in 
length, it may be made to even penetrate into them — giving rise thus 
to inflammation, swelling, ulceration and fungous granulations, with 
a decree of sufferinir, which often renders the slightest motion of the 
foot unbearable. The disease is most liable to occur in the great toe, 
in consequence of the greater amount of motion and pressure to which 
it is subjected in walking. The patient seeks to relieve his sufferings 
by constantly cutting away portions of the nail, but in so irregular 
and unskilful a manner as rather to increase than diminish the evil. 

The disease most commonly occurs at one or otlier of the lateral 
edges of the nail of the great toe — and in this case without the nail 
having been cut at all. Xo doubt, in numerous instances, it results 
entirely from the soft parts being pressed by too narrow or misshapen 
boots or shoes against and over the sharp edge of the nail. But 
cases frequently occur where it cannot, with propriety, be referred to 
this cause. Dr. Zeis believes, that under such circumstances, its 
production is to be attributed to that particular constitution of the 
blood, which, in certain persons, predisposes to furunculi and other 
spontaneous local inflammations. 

The inflammation once established, it is evident that the hard and 
sharp edge of the nail must act as a foreign body, and, by its constant 
irritation, keep up and aggravate the disease — ijiving rise to suppu- 
ration, ulceration and the production of luxuriant fungous granula- 
tions, of an intensely painful character, which rise up over the edge of 
the nail, and often cover it to so great an extent, that we are unable 
to obtain a sight of it, even by drawing them on one side. It is this 
that has favored the belief, that the whole of the evil has resulted 
from the too great breadth of the nail causing its edges to grow into 
the flesh; but there occur a greater number of broad nails uncon- 
nected with the aflection under consideration, than there do in con- 
nection with it. 

Micliaelis describes a condition of the nail, which he supposes to 
particularly favour its growth into the flesh. This is a very rounded 
form of the nail, so much so, that it resembles the half of a pertect 
cylinder. This condition of the nail Dr. Zeis has repeatedly observ- 
ed, but not always in cases of its so called growth into the flesh ; on 



264 Essay on Inverted Toe Nail. [May, 



he contrary, he has, in numerous instances, met with it in individu- 
als who had never suffered from this affection. Even when the dis- 
ease has been connected with an arched condition of tlie nail, it has 
been entirely healed without the destruction or flattening of the latter. 
Dr. Zeis considers that it is all-important, in every case, to attend 
to the condition of the patient's general health, which, in a largo 
number, will be Ibund to be more or less deranged. As the patient's 
health improves, tinder an appropriate therapeutic and hygienic treat- 
ment, the affected foot being kept at rest, and the toe guarded from 
all pressure, either in walking or from a too narrow boot or shoe, the 
local disease will be found, very generally, to diminish, and, in a short 
time, to disappear entirely. 

If, however, the disease has resulted from keeping the nail too 
short, the doctor considers it indispensable that it should be allowed 
to attain its proper length, which, with the simplest dressings, and the 
avoidance of motion and pressure, is sufficient to effect a perfect 
cure. So soon as the nail acquires the slightest projection, he is in 
the habit of introducing beneath it, by means of a fine probe, a small 
portion of charpie, and to prevent the falling out of this, he covers the 
end of the toe with adhesive plaster, spread upon gold-beater's skin, 
which adaptsitself l)etter to the parts, and produces a less amount of 
pressure than when it is spread on silk or linen. The toe is then to 
be bathed frequently, during the day, in warm water. 

If the soft parts, at the point of the toe, are in so swollen a condi- 
tion as to interfere with the dressing just directed, or completely to 
cover and conceal the edge of the nail, Dr. Zeis is in the habit of re- 
moving them by the knife. 

"Even in those cases," he remarks, "in which the nail has been 
cut so close as to be reduced to one half its length, under the above 
treatment, it will require but two, or, at the furthest, three months to 
effect a permanent cure, and to restore to the nail its proper length 
and natural shape. 

" Much more obstinate, however, are those cases in which the dis- 
ease affects, at the same time or is entirely confined to, the side of the 
nail. These are, especially, the cases in which the destruction of the 
whole or a part of the nail has been considered indispensable to the 
cure. I have, however, in such, seldom failed to secure the entire 
and permanent relief of the patient by rest, the frequent use of the 
foot bath, and the removal, by the knife, of the fungous granulations 
or spongy and morbidly sensible flesh, by which the edge of the nail 
becomes covered. I will not, however, pretend to deny," he adds, 
" that cases of a very aggravated character may occur, in which the 
unhealthy condition of the ulceration, seated beneath the nail, will 
require the loosened edge of the nail to be cut away, that our appli- 
cations may be applied directly to the ulcerated surface, and also to 
prevent the constant irritation which is kept up in it by the detached 
portion of the nail. It is never necessary to destroy the whole or 
any part of the nail, even under such circumstances." 



1845.] Essay on Inverted Toe Nail. 265 



The leading propositions which Dr. Zeis has attempted to estab- 
lish ill the essay before us, are thus summed up in the author's own 
words. 

"1. The so called growing of the nail into the flesh, is not, ex- 
cepting, perhaps, in a very few cases, the result of a too great breadth 
of the nail ; but is caused entirely by the inflammation and intumes- 
cence of the soft parts. 

"2. The arched condition of the nail, which is of frequent occur- 
rence, is perfectly natural, and neither can nor requires to be changed 
by shaving away the nail and the application of pressure. 

" 3. It is not, therefore, to the removal of any morbid condition of 
the nail that the attention of the surgeon must be directed, but to the 
removal of the inflammation of the soft parts, the healing of an ulcer- 
ation that may exist, and the destruction of the intumescence caused 
by the fungous flesh about the edge of the nail, which latter is best 
effected by cutting it away with the knife. 

'* 4. In the treatment of the local inflammation, in the affection 
under consideration, the frequent use of warm pcdiluvia is preferable 
to, and more effective than most other means. 

" 5. In a few cases, of infrequent occurrence, the temporary remo- 
val of the loosened edge of the nail will be required: in the majority 
of cases, however, even this will not be necessary. 

"6. The removal or destruction of the whole or any part of the 
nail, is in no case required ; and from its severity, and the mutilated 
state in which it ever after leaves the foot, should be considered as 
an unwarrantable practice, and one to be entirely banished from 
among the operations of surgery." 

We have given to the essay before us an extended notice, because 
the frequent occurrence of the affection of which it treats, the intense 
sufliering with which it is invariably attended, as well as the evident 
ignorance that exists in relation to its true character, as is evidenced 
by the severe and uncalled for operations which have been proposed 
for its removal, induce us to believe that a very full exposition 
should be given of the views of an author who has thrown much 
light upon its pathology, and presented a plan of cure as simple as it 
is effectual. 

The views advocated by Dr. Zeis in relation to the causes of the 
inverted toe-nail, we have entertained for many years; and have 
pursued a plan of treatment very similar to that which he recom- 
mends. In no instance have we had occasion to remove any portion 
of the nail, though we can conceive of cases in which the cutting 
away of the loosened edge of the nail may be necessary, as Astlcy 
Cooper remarks, to allow of the healing of the ulceration of the soft 
parts, by removing the irritation which the nail constantly keeps up. 
The success with which this plan of treatment has been attended, in 
the cases that have fallen under our care, emboldens us to recom- 
mend it strongly to the notice of the profession. — The American 
Journal of the Medical Sciences, 



2(56 Mercury and Iodine. [Way, 



Comparative value of the different Preparations of Mcrcvry and 
Iodine, and the best modes of administering them. Bv Edward 
OcTAvius HocKEN, M. D., &c., Pkyslciaji to the Blenheim-street 
Infirmary. 

Mercury is employed locally and generally, eilherto produce a local 
efTect simply, or, by its admission into the system, to bring the whole 
constitution under its influence. The mercurial influence is induced 
in the system by the introduction of mercurial preparations into the 
stomach, or by fumigation, or by inunction. In the first method we 
employ the chloride, bichloride, iodide, pil. hydrarg., d:c., dec. 

Chloride. — Calomel is chiefly useful when we wish to produce a 
speedy and powerful action on the constitution, as in venereal iritis 
or orchitis, but is less adapted to the ordinary symptoms. On the 
Continent it is extensively employed in tubercles of the labia, with 
or without ulceration, in various forms of creeping ulcers, and also 
in ulcerations of the throat and nasal fjsscc. Desruelles says, that 
he cannot too much recommend this preparation, which, united to 
opium, and an anti-j)hlogistic regimen, may produce the most bene- 
ficial results. Ricord employs the following pills in the treatment of 
enlarged testicle, which remains after inflammation of that organ : — 

Hyd. Chlor. 3i. Pulv. Conii, Sapon. Hisp. aa 3ij. M. ft. pil. xxiv. 

Bichloride. — 31. Dupuytren ordered this remedy in small doses, 
one-sixth of a grain three times a day, in constitutional syphilis, and 
on the Continent it still continues to be extensively used for this pur- 
pose. In some chronic cases of syphilitic skin disease, I have seen 
it used with advantage ; but as a general remedy in secondary syphilis 
it requires more care, is more dangerous, and altogether is a less eli- 
gible medicine than blue pill. 
^ Piliila Hydrargyri. — This medicine is the form most used and 
relied on in England, and as it is one of the njildest, safest, most 
certain, and most manageable preparations of mercury, it justly de- 
serves the preference given to it. In doses of five grains two or 
three times a day, it is applicahlc to nearly all those conditions which 
we have shown to be benefitted by mercury. 

Proto-iodurct. — MM Cullerier, Biett, Ricord and others employ 
this remedy in many forms of constitutional syphilis, especially where 
secondary and tertiary symptoms are combined, and in primary sores 
in strumous habits. Cullerier says, that it is chiefly in constitutional 
syphilis that the proto-ioduret of mercury is administered with success. 
Its effects are principally evident in secondar}- ulcerations of the mu- 
cous membrane, cutaneous tubercles, exostoses, and chronic affections 
of the joints, where the other preparations of mercury have had 
little effect. It should always be guarded by opium, and given in 
half ijrain doses twice or thrice a day. The deuto-ioduret is more 



1S45.] Mercury and Iodine. 287 



stimulating, and consequently its dose is smaller. Either of these 
may be employed in friction upon tumours and indolent buboes, after 
the removal of all acute inflammatory symptoms. 

Tiic cyanuret and deuto-phosphate of mercury are occasionally 
employed. The former is said to be preferable to the bichloride, 
being less apt to disagree, and less readily decomposed. It is an 
useful external application in some skin affections, allaying the violent 
itching and irritation of what M. Alibert terms herpes squamosus. 

Inunclion. — Inunction by the mercurial ointment was formerly 
employed to mercurialize the system more frequently than at the 
present day. In this way the mineral is less apt to disagree with the 
system, especially the alimentary canal, although, when used alone, 
it is less speedy in its effects. In buboes, I imagine that Hunter was 
correct in his opinion concerning the advantajies of making mercury 
]:ass through the affected absorbents. The Ung. Hydrarg. is used 
in the quantity of half a drachm to a drachm night and morning, to 
be well rubbed in, before a fire, on the more delicate portions of the 
skin. Culicrier prefers using mercury by friction in primary sores ; 
he orders fiorn a quarter of a drachm to a drachm and a halfof mer- 
curial ointment ateacli friction, leaving an interval between them of 
one, two, or three days, with the view of not irritating either the sore 
or the constitution, by bringing the latter suddenly under the influ- 
ence of the remedy. Ricord frequently orders the frictions to the 
axilla;, and they are employed in this manner by Cullerier, in certain 
forms of ulcerations of the mouth and fauces. He narrates two 
cases cured by mercurial frictions in this situation, which had resist- 
cd its employment on other parts. 

J'umigation. — Fumigation of the whole surface of the body is, at 
present, rarely used as a method of affecting the system, but the ap- 
paratus formerly employed is still to be found in some of our hospitals. 
It is very speedy in its action. The remedy is. however, employed 
locally, and with great advantage, in some affections of the throat 
anl nasal fos-ac, directed to the part by a suitable apparatus, and 
more generally in some obstinate diseases of the skin. For patients 
who have not strength to rub in mercury, and whose bowels will not 
bear the use of internal remedies, it has been esteemed highly ad- 
vantageous. 

Topical Applications. — As mere local applications, calomel, black 
wash (Hydrarg. Chlorid. x vel xv. grs., Aquae Calcis gi.), yellow wash 
(Hyd. Bichlorid. i. vel ij. grs., Aq. Cal. ^i.), solutions of the bichlo- 
ride in distilled water, the nitric oxide ointment, the nitrate ointment, 
the simple blue ointment, and the Ung. Hyd. c. Ammoniaco, are all 
of them occasionally applied. We select from these in proportion to 
their stimulating j)roperties, adapting to the condition of the svmp. 
toms we treat. Whatever preparation of mercury be selected for 
internal employment, it should always be combined with opium or 
conium, as a certain degree of constitutional irritability alrndst al- 
ways accompanies syphilis, which is most favorably influenced by 



268 Mercury and Iodine. t^^y» 



such medicines, and, in some cases where there is sthenic inflamma- 
tion or fever, antimony. M. IJiett's practice has constantly furnished 
numerous instances where these affections have disappeared under 
the influence of opium alone without mercury, and MM Ricord and 
Cullerier support similar views. Dr. Wallace says, that it will be 
always most prudent to combine the mercury with opium and anti- 
mony. No harm can result from this practice; and by it much in- 
convenience may perhaps be avoided. The combination of anti- 
mony and mercury has always appeared to him to render the influ- 
ence of the latter more nianageable, as well as more certain, while 
the addition of opium diminishes the irritating influence of mercury 
on the bowels, and subdues the disposition to an irritable state of the 
general system, or of the local disease. During its administration 
we must also carefully watch the health of the patient and the con- 
dition of his disease, and omit its further use for the time, should any 
unfavorable symptoms arise. The diet should be mild, and the state 
of the stomach and bowels attended to. Dr. Wallace recommends 
the patient to eat a few grains of allspice or pepper during the day, 
and to cover the abdomen with two or three folds of flannel. Mr. 
Parker says, that a nightly pill or draught of some preparation of 
opium with capsicum jnay be employed with advantage even during 
the period the patient is using mercurial frictions ; the former not 
only prevents those attacks of pain, griping, and diarrhoea, which 
sometimes come on during a mercurial course, and materially retard 
the healing process, but they contribute directly to the therapeutic 
effects of the mercury. 

The aspect of the sore is to be watched carefully, as it frequently 
points out when mercury does or does not agree with the system. 
Dr. W^allace says that it will be found a most important rule in prac- 
tice to omit all mercurial treatment wheneverthere appears an increase 
of inflammation or sensibility, to arise in the local disease during the 
employment of mercury ; for a perseverence in its use, under such 
circumstances, will almost invariably tend to some form of destructive 
action, determined in its character by the constitution of the patient. 
In such cases we must have recourse to emollients and anodyne ap- 
plications, purgatives, rest, abstinence, and diaphoretics, with or with- 
out narcotics, and, as soon as the morbid actions which have superve- 
ned have been removed, mercury, if necessary, may be again resumed, 
to be suspended afresh in case of a return either of inflammation or 
irritability. Should an indolent condition of the sore, and absorp- 
tion of the granulations, come on during mercurial influence, we 
must determine the cause and act accordingly. 

The quantity of mercury is always to be regulated with the design 
of deranging the system as little as possible, and patients should be 
abstracted from all causes of excitement : ptyalism, d:c., being con- 
sidered accidental occurrences. Dr. Wallace supports the opinion, 
that the greater the degree of excitement or of derangement in the 
functions which mercury produces, the greater is the danger of its 



1S45.] Mercury and Iodine. 269 



action being followed by tleletericus effects, or of its ceasing to influ- 
ence the sx'inptoms of syphilis in a salutar}' manner. We judge of 
the requisite quantity from its effects on the disease, and, in general, 
it is necessary to affect the gums slightly, and to produce a metallic 
taste in the mouth ; hut complete salivation is rarely if ever necessary 
to obtain all the good effects possible in curing chancres, or prevent- 
ing secondary symptoms. The cicatrization of the sore, without 
leaving a hardened cicatrix, should be the rule for discontinuing the 
remedy. When sores remain indolent, under the continued lise of 
mercury, it may be intermitted for some time, and then resumed in 
some other form. It is a mistaken notion to suppose that continuing 
the medicine after the sore has healed, and all induration of the cica- 
trix has disappeared, will protect the patient from secondary symp- 
toms; these will appear after the fullest course, and yet occasionally 
they will not appear when not a single grain of mercury has been used. 
Another point to be borne in mind is, to examine the condition of the 
mouth previous to the exhibition of mercury, as a state of inflamma- 
tion or ulceration, with foul breath, might lead us to attribute to the 
mercury what really depends on other causes. 

Iodine. — M. CuUerier thinks that the effects of the iodide of po- 
tassium are less prompt than those of mercury, and that, on this ac- 
count, more should be given, if the stomach will bear it. Reem- 
ploys grain doses of iodine with from two to four of the iodide of 
potassium in an ounce of water, given at intervals during the day; 
but he does not increase the iodine beyond two grains in the day, or 
the iodide beyond ten. I fully believe that the iodide is much more 
beneficial without the pure iodine, which disorders the stomach with- 
out benefitting the complaint. Mr. Stone, formerly apothecary to 
St. Thomas's Hospital, told Dr. Williams that he was called to pre- 
scribe for ten patients taking the compound of iodine and iodide of 
potassium for one that was taking the last medicine only. 

Dr. Wallace found by experience that the iodide of potassium 
was the only form of the remedy which agreed, that pure iodine was 
a very powerful irritant, very frequently occasioning severe symp- 
toms, whilst the iodide of potassium was perfectly harmless. Pure 
iodine, moreover, is converted into hydriodic acid in the stomach. 
lie has seen many cases in which the tincture of iodine, both simple 
and ioduretted, failed to produce any favorable influence, because 
the irritation excited in the stomach prevented its employment in 
such doses as were sufficient to act on the disease, and in tliese very 
cases the action of the iodide of potassium was subsequently most 
beneficial. In other cases, where pure iodine was em[)loyed. alihough 
the disease was cured, still it was at the ex|)ense of an injured stom- 
ach, and great emaciation. On the contrary, he asserts that he has 
never seen unpleasant cfl«jcls result iVom the iodide of potassium, 
except from mismanagement. 

Kicord employs the iodide of potas'^ium in gnuluallv increasing 
doses, commencing with ten grains dissolved in three ounces of dis- 



270 Mercury and Iodine. [May, 



tilled water, and given at intervals diirinfj .the day, in any suitable 
vehicle. Accordinfr to its ciTucts so must the dose be cither increased 
or diminished; — wiien the remedy n<rrees, which it always docs, if 
the stomach be healthy, the dose siiould be increased ten grains every 
two or three days, till it is earned to one or one and a half drachms, 
or even more, in the course of the day. The iodide of potassium, 
in full doses, when it agrees, occasions a sensation of warmth in tho 
stomach, imjuoves the api)ctite, accelerates digestion, so that many 
grow quite fit, and quickens the pulse. A constant cficct is an in- 
creased diuresis. 

When pure iodine is used, or the iodide given in excessive quanti- 
ties, or from idiosyncracy of constitution, unpleasant symptoms may 
arise. Sometimes those are slight, and resemble a common catarrh ; 
at others, ringing in the ears and pain in the head, or the skin may 
suffer from a slight pustular eruption ; occasionally it disorders the 
bowels, or produces j)ain or uneasiness in the stomach, having some 
resemblance to pleurodynia, but seated more deeply, and an acrid 
dryness of the throat. Mr. Mayo says that we may sometimes cor- 
rect these symptoms by adding a few drops of laudanum to each 
dose, and by administering aperient medicine. Authors assert that 
some patients experience ioditic intoxication, characterized by a slight 
uncertainty in the voluntary movements, some subsuhus tendbuim^ 
heaviness in tho head, a species of intellectual idleness, and some- 
times slight delirium. Soreness of the gums and ptyalism are also 
said to occur occasionally. Mr. Mayo has heard of effects resenibling 
mercurial erythismus. Should any of these symptoms occur in a 
severe degree, the dose must be diminished, or even abandoned alto- 
gather for a few days, and its exhibition re-commenced in smaller 
doses. 

Dr. Wallace found the urine to be the best test of the effects of 
the iodide of potassium on the system, by testing it with starch, &c. 
In some of his patients he remarked a great increase of perspiration 
— sometimes constipation, salivation, roughness of the throat and 
heartburn; he found that quinine controlled thc'^itate of the throat 
and stomach. Delicate females, he says, sometimes lose the power 
of sleeping so much as is natural — a state of wakefulness often ac- 
companied by peculiar feelings of the head, which is relieved by a 
purgative and interruption of the medicine. Emaciation, great gas- 
tric irritation, wasting of the mammae and testes, &;c., only occur 
from the use of free iodine. In two patients who had drachm doses 
of tho iodide of potassium administered by mistake for one day, 
there occurred in both sickness, soreness of the throat, colicky pains, 
vomiting and purging to a slight degree, frequent pulse, and exhaus- 
tion, quickly disappearing. Several patients, while under the full 
action of the iodide, were attacked with an acute pain in the anterior 
and lower part of tiie left side, precisely in the centre of the superfi- 
ces formed by the false ribs, accompanied by some cough, difficulty 
of breathing and fever. In all, the affection went off without much 



1845.] Mercury and Iodine. 271 



trouble. The medicine was omitted and subsequently resumed with- 
out inconvenience. In a private patient it produced severe indiges- 
tion, a rapid and quivering pulse, headache, and a peculiar condition 
of the eyes — the |)upils were dilated, and both eyes in a state of in- 
cessant motion. He was soon after seized with symptoms of paralysis 
on one side of his body, preceded by muscular tremblings, which 
remained for three weeks, but eventually passed ofT. 

Ricord stales that the good effects of the iodide of potassium have 
been constant in his practice, but not produced with equal rapidity, 
in this respect differing from Mr. Mayo, who says that no medicine, 
where it does good, produces amendment so ra|)idly ; therefore the 
propriety of continuing it is never doubtful. As far as I have observed 
myself, iodide of potassium nevergives rise to any serious symptom, 
provided that it be unmixed with pure iodine, and be administered in 
moderate doses. Apoplectic and paralytic symptoms sometimes como 
on during the existence of tertiary symptoms, and these are then at- 
tributed to the mercury or the iodine which the patient may be using 
at the time, but it is hardly fair that the whole blame should fall on 
the remedy. For an adult it is sufficient to commence with five 
grains of the iodide of potassium three times a day, and increase it 
gradually to seven or eight. Dr. Williams, while he admits that somo 
constitutions are aiTected even by one or two grains, thinks that the 
average dose should be eight grains three times a day ; for, says he, a 
smaller dose can hardly be recommended, for the patient's sufferings 
are so intense as to require immediate relief, and consequently wo 
ought to begin with as large a dose as his stomach will probably bear. 
This reasoning is not altogether conclusive, for if the dose be sufficient 
to excite or endanger unpleasant symptoms, we shall have to stop its 
use altogether for some time, and then finally resort to smaller doses, 
which, if used at first, would most probably have removed the com- 
plaint without any distress or delay. Dr. Williams remarks, that 
when mercury has been previously and unsuccessfully used, the quan- 
tity of the iodide necessary for the cure of the patient is often much 
greater than where none has been exiiibited. 

lleuiemof (he com-parative value of mercury and iodine in the IreaU 
ment of syphilis. — If we take a review of what has now been written, 
we can readily determine the comparative value of mercury and 
iodine in the treatment of syphilis — that mercury and iodine form the 
two main remedies on which the best and most unprejudiced treat- 
ment of the various symptoms and stages of syphilis mainly hinges, 
although neither of them should be regarded as a specific, nor can 
cither ofthem, to be used well and successfully, be exhibited empirical- 
ly ; — that mercury and iodine, when guided by observation, reason, 
and experience, and combined with such treatment and medicines as 
the profession would emf)loy were they to lay aside all notions of 
something specific requiring a blind and specific use of some reme- 
dial agent, they stand alone, and infinitely superior to all other medi- 
cines which the materia mcdica can furnish; that a modified use of 



272 Bibliographical Notices, [May, 



mercury is adapted to nearly all the forms, but especially the indura- 
ted, of primary syphilis; that in constitutional syphilis a modified use 
of mercury is almost a sine qua non m the preat majority of seconda- 
ry symptoms, -but is either hurtful or useful in the tertiary; that 
iodine is inert in almost all the symptoms of primary syphilis, with 
the exception of some forms of phan;odena. attended with great debili- 
ty and deranjrement of the health; that in constitutional syphilis it 
is a less valuable remedy in the majority of secondary symptoms than 
mercury, with the exception of some severe cases of pustular erup- 
tion, phagedenic throat, rupia, and secondary ulcerations of bad 
character, all of them marked by a cachetic and debilitated constitu- 
tion ; while in tertiary symptoms iodine is far more valuable than 
mercury, and its efiects more certain and decided than in any other 
set of symptoms ; — that mercury and iodine are most advantageously 
combined in cases presenting both secondary and tertiary symp- 
toms; — that many forms of mercury, having local or constitutional' 
actions, are applicable to the various symptoms of syphilis, but that 
the mildest constitutional effect, capable of overcoming the disease, is 
always to be preferred : — that the only form of iodine safely applica- 
ble to the treatment of syphilis, is the iodide of potassium, which 
should never bo carried beyond moderate doses ; hence, however 
valuable the iodide of potassium may be in seme forms of syphilis, it 
cannot be substituted with advantage for mercury in the great ma- 
jority. — Edinburgh JSled, Surg. Journal. 



BibUographical Notices. 



The First Lines of the Theory and Practice of Surgery; in- 
cluding the principal Operations. By Sami'el Coopek, senior, 
Surgeon to the University College Hospital, and Professor of Sur- 
gery in the same Colleoe, &:c. With Notes and Additions, by 
WiLLARD Parker, M. D., Professor of Surgery in the College of 
Physicians and Surgeons in the University of the State of New-. 
York, dec, d:c. In two volumes, pp. 540, and 531. Fourth 
American, from the seventh London edition. Published by S. S. 
& Wm. Wood, New York, 1844. 

Of the three Coopers, who have become distinguished during 
the first half of the present century in the city of London, not 
the least worthy is the veteran author of the First Lines, and 
Professor of Surgery in the London University. His great work, 
the Dictionary of Practical Surgery, containing, together with the 



1845.] Bibliographical Nuliccs. 273 

additions by Dr. Reese, in the American edition, nearly 2500 
pages of ordinary print, was sufficient to have transmitted his name 
to posterity. 

Cooper's First Lines of the Theory and Practice of Surgery, was 
originally designed as an elementary treatise on the subject, and as a 
text book for students attending his lectures. A^this is only an im- 
proved edition of a work long and favorably known to the profession, 
no review of it is expected at our hands. From an examination of 
the notes and additions by Dr. Parker, \vc are disposed to think, they 
have considerably enhanced the value of this edition. We commend 
it to all desirous of keeping pace with the improvements in Surgery, 
both theoretical and practical. 

The Principles of Surgery. By James Miller, F. R. S., C. 
S. E., Professor of Surgery in the Universily of Edinburg, Sur- 
geon to the Royal Infirmary, &c. &c. Philadelphia: Lea & 
I5la?>chard. 1815. pp. 519. 

This work is very favorably noticed by our exchange Journals. It 
was first issued last year in the city, in which the author is a professor, 
in 12 mo., pp. 710. It is gotten up in a very creditable manner by 
Messrs. Lea &; Blanchard, to whom the profession is so greatly in- 
debted for valuable publications, both original and re-prints. Prof. 
Miller's work commences with an historical notice of Surgery, in 38 
pages. Chapter i., is devoted to Perverted Action of the Blood ves- 
sels. Chapter ii., to Perverted Action of the Nerves. Chapter in., 
to Perverted Actions of the Absorbents. Chapter iv., to Suppura- 
tion. Chapter v., to Ulceration. Chapter vi., to Mortification. Chap' 
tor VII., to Perverted Action in certain Tissues. Chapter viii., to 
Perverted Action occurring in Bone. Chapter ix., to Diseases of the 
Joints. Chapter x., to Diseases of the Arteries. Chapter xj., to 
Aflections of the Veins. Chapter xii.. to Hemorrhage. Chapterxiri., 
to Afiections of the Lymphatics. Ciiajitcr xiv., to Aflections of 
Nerves. Chapter xv., to Tumours. Chapter xvi., to Wounds. Chap- 
ter xvii., to Burns and Scalds. Chapter xviii., to the Efiects of Cold.. 
CMiaptcr XIX., to Fracture. Chapter xx., to Dislocation. Chapter 
xxi., to Sprain and Rupture of Muscle and Tendon. Chapter xxii., 
to Bruise. 

The reader can now judge of the character of the \v#rk, and we 
fully accord with those who have recommendLd it, as the best book 
\ot published on Ihe Priiiripbv5i of Surgery. 

1« 



74 Blbliogrttphical Nutices. [May, 



A Treatise on the Diseases and Special Hygiene of Females. 
By Colomb.'it I)c L'Isero. Translated from the French, bv 
Charles D. ]Mei«rs, M. D., Professor of Midwifery and Diseases of 
Women and Children, in the Jefferson Medical College, Philadel- 
phia, &:c , d:c. Lea & Blanchard : 1845. 1 vol. octavo, pp. 720. 

The medical profession is much indebted to Prof. Meigs, for his 
excellent translation of this valuable work. Some idea may be 
formed of the immense labor and research of its author, when it is 
understood that he has cited more than one thousand authorities, and 
has given the opinions and practical methods of the most celebrated 
practitioners of ancient and modern times. • The notes of Professor 
Meigs, included within brackets in the body of the text, and consti- 
tuting nearly one-seventh part of the volume, impart additional value 
to the work, which we feel no hesitation in saying, should be in tho 
hand of every student and practitioner. 

A Practical Treatise on the Diseases peculiar to Women, illus- 
trated by cases, derived from hospital and private practice. By 
SAaiup:L AsiiwELL, M. D., London. With Notes by Paul God- 
DARD, M. D. Lea & Biianciiaed: Philadelphia, 1845. 1 vol. 
8vo. pp. 520. 

We are much gratified to see this complete edition, with notes, by 
Dr. Goddard. With no work arc we acquainted, in which the pleas- 
ant and the useful are more happily blended : It combines the greatest 
elegance of style with the most sound and valuable practical informa- 
tion. We feel justified in recommending it, in unqualified terms, to 
our readers, as a book from which they can scarcely fail to derive 
both pleasure and improvement. It is truly a model for medical 
composition. We are pleased to see that Dr. Goddard has not placed 
liis name on the outside of this book. It is humiliating to our na- 
tional pride to observe so many able and eminent American physi- 
cians, whose ambition might well have soared higher, attempting to 
ride to distinction, upon the backs of transatlantic authors. They 
should scorn, like satellites, to borrow light from distant luminaries, 
but in the noble strife for ffime, aspire to deck their brows — 

" With honors all their own." 

J. A. E. 



Remarks on the Influence of Mental Cultivation and Meiital 
Excitenmit upon Health. By Amariah Brigham, M. D., Super- 
intendant and Physician of the State Limatic Asylum, Utica, N. Y. 
Third edition. LeaA: Blanchard, 1845. 1 vol. 12mo. pp. 204. 

V/e are pleased to find that this useful work has passed to a third 



lS4o.] Malformalion of the Heart. 



edition. Its value is acknowledged abroad as well as at home, the 
work having been rc-piiblished in London, Edinburgh and GleLSgow. 
The facts and reasonings of Dr. Brighain shew conclusively that 
•'early mental excitement will serve only to bring forth beautiful but 
premature flowers, w hich are destined soon to wither away, without 
producing fruit." Vsc. commend the book as well to parents and 
teachers as to physicians. 



PART III.— MONTHLY PERISCOPE. 

Malformation of the Heart. — The Gazette Medicale of 15th Feb- 
ruary last, contains the description of an interesting case of malfor- 
mation of the heart, by M. Aug. Valette, of Strasburg. The subject, 
Julie Rieder, died at the age of six years and twelve days, from an 
attack of acute Bronchitis. During the first six weeks of her exist- 
ence her health was good, and notiiing indicated any malformation; 
but she was then suddenly seized with dyspnoea, accompanied by 
marked cyanosis of the skin. When six months old an attack of 
convulsions occurred, which left her right side paralysed. From this 
she gradually recovered, and enjoyed pretty good health subsequent- 
ly. Tiie cyanosed condition of the skin persisted till her death, was 
increased by active exercise, but was always more decided on the 
side afiected with paralysis. The dyspnoea also continued. By 
auscultation of the heart, a double bellows sound was heard. Intel- 
lect normal. 

Post-mortem inspection revealed the almost total absence of inter- 
ventricular septum, the orifices of the aorta and pulmonary artery 
being separated only by a small spur of the remaining portion of the 
septum. The aorta was about double the size of the pulmonary 
ar(ery. Tiie auricles communicated freely with each other by means 
of the unclosed foramen ovale and of another large opening beneath 
this. There was but one auriculo-ventricular orifice, which was 
large, protected by a triangular valve, and which consequently com- 
municated equally with both ventricles. This heart, therefore. 



276 Vaccine. ' [May, 



although prcscnliiig (he vestiges of a double organ, was in reality 
reduced to the condition of that of the Batracians. Notwithstanding 
the intimate admixture of the venous and arterial blood which must 
necessarily have taken place in this case, the individual's life was 
prolonged much beyond what is usually supposed possible under such 
circumstances. It is suggested by the writer that the increased 
cyanosis, manifested in the paralysed side, may be attributed to the 
slower return of venous blood from this side, and that this fact should 
probably lead us not to attribute cyanosis too exclusively to the mere 
admixture of the two bloods in the heart. D. 



Vaccine. — M. M. Dumiril, Magendie, Breschet, Roux, and Serres, 
having been appointed by the Academy of Sciences, of Paris, a 
Committee to investigate several questions relating to Vaccine, 
made a partial Report on the 24th February, 1845, from which we 
glean the following conclusions : 

1st- That rather more than one third of those attacked with small- 
pox in France had been vaccinated ; and that the proportion of 
deaths among these was very small. That the results are about the 
same in.England, Sweden, Denmark, Italy, Malta, Geneva, &c. 

2nd. That, in general, vaccination insures exemption from variola 
in a direct ratio with the recentness of its performance. The statis- 
tics derived from the various parts of Europe, show conclusively that 
until nine years after vaccination, children are rarely attacked with 
small-pox, and that this disease occurs most in such as have been 
vaccinated ten, fifteen, twenty, or even thirty. five years before. On 
the other hand, those who have been vaccinated more than thirty-five 
years, are rarely affected with variola, a fact that may be attributed 
to the diminished tendency to eruptive diseases in general at this age. 

3rd. That vaccination may be regarded as procuring complete 
exemption from variola for five or six, and even for ten or eleven 
years. That after this age, and especially during the prevalence of 
epidemics, a portion of the vaccinated, become subject to the small- 
pox. And that the majority of the vaccinated are permanently ex- 
empted. 

4th. That the intensity and protecting influence of the vaccine 
virus are greatest when it is most recently taken from the cow. And 
that exemption is not proportionate to the degree of local disease in- 
duccd. — Condensed from the Gazelle Mcdicalc of 1st March, 1845. 

D. 



1845. J Scarification of the Gums. 277 



Scarification of the Gums during Dentition. By Marshall Hall, 
M. D., F. R. S., &;c. — Tiiere is no practical fact of the truth and value 
of which I am more satisfied than that of the effect and efficacy of 
scarification of the gums in infants, and not in infants only, but in 
children. But the prevailing, 1 may say the universal idea on the 
subject is, that we should lance the gums only when the teeth are 
ready to pierce through them, and only at the most prominent parts 
of the gums, as the occasion to which I have referred may re- 
quire ; and no idea of this important measure can be more inadequate 
to its real value. The process of teething is one of augmented arte- 
rial action and of vascular action generally ; but it is also one of 
augmented nervous action ; for formation, like nutrition, secretion, 
&;c., generally, is always one of nervi-vascular action, and of this 
the case in question is, from its peculiar rapidity, one of the most 
energetic. Like other physiological processes, it is apt to become, 
from that very character of energy, pathological, or of morbid activi- 
ty. It is obviously, then, attended with extreme suffering to the little 
patient; the brain is irritable, and the child is restless and cross; the 
gums are tumid and heated ; there is fever, an affection of the gene- 
ral vascular system, and there are, too frequently, convulsions of 
various degrees and kinds, manifested in the muscles which move 
the eye-ball, the thumb and finger, the toes; the larynx, the parietes 
of the res|)iratory cavities; and the limbs and frame in general ; 
affections of the excito-motor part of the nervous system, and of the 
secretions of the liver, kidneys, and intestines; affections ^f the gan- 
glionic division of that system. 

What is the precise cause and source of these formidable effects? 
Can the mere tension and irritation of the gum situated over the more 
prominent part of the teeth be the cause of such extensive morbid 
Jiclions? I think not. The real source of these phenomena is in 
the entire dental system, in which actions of unusual energy and ex- 
tent are going on — sub-inffummatory they might be called, were 
they not in reality of an essentially different nature and origin. 
This undue action takes place in the fangs and sockets of the teeth 
in their whole extent, with their connections, vascular, nervous, and 
membranous. But the focus from which the nervous actions ema- 
nate is, I believe, not as is generally imagined, t!ie nerves of the mere 
gujns seated Qver the prominent j)arts of the teeth, but the nerves 
which may emphatically be termed the nerves of the terlhthcmscJrrSy 
the nerves which enter into the very fangs and substance of the 
teeth. It is to the base of the gums, not to their aycx merely^ that the 
scarification should be applied. The most marked case in which I 
hav(? observed the instant good effect of tcarilication was one in 
which all the trrfh had pirrrrd the gums! 

This view of tlie sui>je<t may assist in removing the iutile objection 
of sonio who have, wifluiuf dtu' <'onsid(ialioti I am convinced, ()j)])os- 
ed my \)\nn of rrcquiiit, ol'ien daily, scarificalion of the gums, to 
whi)m I would say, as niy sule reply — Better scarify the gums »//j/?c- 



27Q Sulphate of Quinine. [May, 



ccssarihj one hundred times, than allow the accession of one fit or 
convulgion from the neglect ot this operation, which is equally im- 
portant in its results, and trifling in its character. And it is not 
merely the prominent and tense frum over the edges of tlie tcelh which 
thould be divided; the gums, or rather the blood-vessels, immediately 
over the very nerves of the teeth, should be scarified and divided, as 
you would divide the vessels of the conjunctiva in inflammation of 
that membrane. 

Now, whilst there is fever or restlessness, or tendency to spasm or 
convulsion, this local blood-letting should be repeated daily, and ia 
urgent cases even twice a day. I would here repeat my maxim — 
better do this one hundred times unnecessarily than have one single 
^t frpm the neglect of so trifling an operation. A skilful person does 
it in a minute, and in a minute often prevents a most serious attack — 
an attack which may cripple the mind or limbs, or even take the life 
of our little patient, if frequently repeated. There is, in fact, no 
comparison between the means and the end, the one ko trifling, the 
other so momentous. 

I svould refer those who wish to prosecute this subject, to my work 
on the '* Diseases and Derangcnients of the Nervous System," but 
especially to my "New Memoir," which contains the most lucid and 
recent view of the whole subject of the physiology and pathology of 
the true spinal system, «^d plates which, for skill in the draughtsman 
(Mr. Simpson, of Stamford) both that of the artist and that of tho 
physician, and for interest in a practical point of view, have not been 
surpassed. Each plate evolves a principle of physiology or pathology 
cf great interest and value. 

1 have frequently thought the vascular condition of the gums during 
dentition might be ascertained by means of a thermometer properly 
guarded. The results of a series of observations on this point could 
not fail to possess much value, whilst they would probably suggest a 
means of diagnosis in some serious disease. I do not pretend, in the 
above proposition, to have advanced anything new ; but in the locali' 
ty chosen for the operation, and in the promptitude, repetition, per- 
severencc, and in the energy and steadiness of purpose with which I 
recommend the measure to be adopted— if these be fully apprehend- 
ed — I believe I do propose something new ; and when I repeat (hat 
since I adopted the plan o{ effectually removing all kritation of the 
gums, stomach, and intestines, in cases of crowing and other convul- 
sions of the same nature, early enough, I have not known or seen a 
fatal case, I am aware that I propose a plan of treatment at once new 
and invaluable. But half measures are of no efficacy. These re- 
marks do not apply, of course, to convulsive diseases of centric origin. 

• London Lancet. 



The effect of Sulphate of Quinine in diminishing the size of 
the Spleen. — About two years ago, it was announced by M. Piorry 
that the administration of a solution of 50 or GO grains (1 gramme) 



Is45.] Treatment of Diabetes . '^79 



of Sulphate of Quinine (in water and a small quantity of sulphu- 
ric acid) was attended wilh a considerable reduction of the 
size of the spleen, and tiint this effect could be detected as soon as 40 
seconds after taking the remedy. M Piorry has since repeatedly de- 
monstrated this singular phenomenon in his clinics. M. Gouraud, 
however, desiring to test the matter more fully, measured carefully 
by percussion the dimensions of the spleen, and then administered 
various liquids in the same quantity. He gave, for example, a cer- 
tain quantity of distilled water with a ^ew drops of sulph. acid, the same 
quantity of distilled water alone, of lemonade, of wine and water, of 
herb teas, <S:c., and in every instance obtained the same results as he 
did when giving the solution of quinine. M. Gouraud therefore con- 
cludes that M. Piorry is in error in supposing thnt the spleen is really 
diminished, and that the difference observed in percussing the spleen 
after the ingestion of liqiiids is to be explained by reference to the 
fact, that even a sniull quantit}" of tituJ taken into the stomach is at- 
tended with a considerable evolution of gas in this viscus, and conse. 
quently with a corresponding extension of the sonorousness of the 
splenic region, even amounting in some cases to the tympanitic sound. 
]M. Gouraud insists that this apparent reduction of the spleen mav be 
induced equally wliethcr the spleen be enlarged or in a healthy state, 
by the same process, a fact which had been stated by M. Piorry also. 
IM. G. has observed that it is only necessary that the patient shall 
have abstained from drinks for some hours previously, for if they havo 
taken liquids a short time before, the effect will not be induced. 

M. Piorry replies that he has repeated the experiments of M. 
(•'ouraud without by any means ohtaining similar results, and still 
insists on the correctness of his observations. The subject must 
therefore be investigated by other and impartial persons, and its im- 
portance is such that it is to be hoped that the truth may be accurate* 
ly established. — Condensed from the Gazette Mcdicale^ for March^ 
1845. D. 



Treatment of Diabetes — by Dr. Keith I^ikay. I have found 
tartar-ernelic of great value in the treatment of diabetes: it is prefer- 
able to James's powder, which, even in the largest doses, is uncertain 
and produces very liule eff*ect ; the former remedy given so as to ex- 
cite occasional nausea diminishes the desire for food, and has also 
consiflorable influence in moderating!; the thirst, and thus, bv dimin- 
ishing the iniipsta, is «if very ess'.Mitial service. It also has a greater 
tendency, than any other remedy that 1 havo tried, to promote per- 



'JSO Creosote — Croton Oil — Tic Douloureux. [May 



Hpiration, when its use is steadily preserved in for some length of 
lime. A much greater quantity of ihis remedy may be taken with- 
out producing sickness at stomach when combined with laudanum. 

Success in a few cases docs not authorihC me to draw a strong 
conclusion. Dut I am nevertheless much impressed with the belief 
that residence in a warm climate, when practicable, conjoined with 
l)ropcr regimen, will hereafter be found to possess greater influenco 
over diabetes than any other remedial means liitherto proposed. 
The powerful and continued operation of a warm climate, and its 
simplicity as a remedial agent, give it a decided superiority when 
contrasted with the many unscientific and uncertain remedies 
which have l)een hitherto used to overcome this obstinate and dan- 
gerous malady. — Edln. Med. and Surg. Journal. 



Creosote in a Case of Vomiting — by Dr. John M. Brewsi er, Jr. 
On Tuesday morning, February 25, 1845, C o'clock, I was called to 
visit a young man (a student in Amherst College) who had been 
taken ill about five hours previous with the most violent retchings and 
vomiting. I found the patient vomiting every ten or fifteen minutes. 
The matter ejected was mostly bilious. As to the origin of all this 
gastric irritability, I could not learn any suflicient cause. The young 
man retired the night before with his usual good health. But there 
was no time to be lost in vain speculations. The patient was rapid- 
ly becoming exhausted. What was to be done ? I ordered a strong 
counter-irritant, as hot as the patient could bear, to be placed over 
the stomach, and began immediately to administer creosote. A sin- 
gle drop of creosote to an ounce of pure water was the strength of my 
medicine. Of this I gave a teaspoonful every fifteen minutes till the 
vomiting was checked. After the fourth dose the intervals between 
llie vomiting began to lengthen, and continued to do so until the 
stomach bocame perfectly quiet and natural. The exhaustion and 
soreness of the parts consequent on such violent action have now 
nearly disappeared, and the patient is engaged in his usual college 
duties and calls himself entirely well. — Boston Med. and Surg. Jour. 

Croton Oil in Dropsij. — Dr. Fife has narrated in the Provincial 
Medical Journal, several cases of ascites, originating frem or com- 
plicated with, organic lesions, in treating which he derived great 
benefit from the sustained exhibition c.f croton oil, which, he observes, 
possesses one very decided advantage over elaterium, that even when 
its extreme action is manifested, it is not jollowed by the depression 
inseparable from the eiTective action of the latter; but that wljere the 
greatest vis inertia^, has prevailed, accompanied by absolute incapa- 
city for exertion, a sensible amelioration in these respects has follow- 
ed its continued exhihition. — .Y. Y. Journal of Medicine. 



Tic Douloureux treated hy Veratria. — Dr. Le CaUe cites two 
severe cases of this painful disorder, whicli were entirely cured by 



1345.] Epidemic Erysipelas. 281 



frictions with veratria ointment. The first is that of a person em- 
ployed as inspector of a telegraph, who, having exposed himself for 
half an hour to a very cold air, was a few minutes after seized with 
violent pains. They proceeded from the frontal branch of the oph- 
thalmic nerve, and radinted over the temple; the eye was injected, 
and there was considerable spasm of the eyelid, and dread of light. 
Dr. Le Calve immediate prescribed the veratria ointment. After the 
first friction, at the end of a few seconds, the pains ceased with ex- 
ceeding rapidity. The patient thought himself cured, and was soon 
asleep. At two in the afternoon a fresh attack came on, which 
yielded to a friction continued for fjur minutes. In the evening a 
preventive friction was made, and the patient passed an excellent 
night. The next day, about six in the morning, the pains re-appear- 
ed ; but this time they proceeded from the superior maxillary nerve, 
at the point where it issues from the infra-orbital foramen, and 
thence they spread rapidly to the posterior and superior dental 
branches. A friction which lasted five minutes caused this attack to 
disappear. It was fallowed by a few others which always yielded to 
the same means. From this period, for more than a year, the neural- 
gia has not re-appeared. The other case was that of a merchant's 
clerk, about fony-one years of age, of sanguine temperament, who 
was seized six days after a journey, during which he had exposed 
himself all night at the coach window, with a violent pam proceeding 
from the frontal branch of the ophthalmic, and radiating over the tem- 
pie of the right side of the back part of the head. Dr. Le Calve 
tbund his patient in violent agitation, and uttering piercing shrieks. 
The right conjunctiva was much injected, the eye was sufi*used with 
burning tears, and the dread of light was extreme. There was also 
a lancinating pain at the bottom of the orbit. The veratria ointm.nt 
was immediately applied, and the pain yielded to a friction which 
lasted sixty-two seconds. At two in the morning a fresh paroxysm 
occurred, which yielded like the former to a friction of two minutes. 
Ffteen months have elapsed without any rettirn of the neuralgia. In 
the preparation of the ointment, Dr. Le Calve gives the preference to 
rancid lard, as it favors the formation by its acidity, of acetate of 
veratria. — Med. Times. 



Epidemic Erysipelas. — Dr. Kognetta states, in the number of his 
Annales de Therapeutique M6 licale el Chirur^icalc^ for June last, 
that erysipelas prevails in all the hospitals of Paris. At the Hotel- 
Dieu, at Beaujon, at St. Louis, and at La Chariie, erysipelas, he says, 
is general. The slightest contusion, the least irritation, the punc- 
turo of an abscess, promptly give rise to erysipelas, which often runs 
a falal course. 

At the liopital Veneriens, the disease, in manv cases, affects the 
pcriloneiim, and terminates fatally. At La Chariie, it ctmstantly 
assumes the phlegmonous form, and is very formidable and frtqnent- 
ly falal. Of foui patients recently Iri iitcd in ihes^ervice of M. Cirdy, 



282 Treatment of Lupus, tSyc. [May, 



for contusion of the elbow, every one was seized with severe plilcg- 
inonpus erysipelas, with sphacelus of the subcutaneous cellular tissue. 
At St. Louis the epidemic has assumed even a still more terrible form, 
that of hospila] ga?)grcne. At the Hotel-Dieu punctures from bleed- 
ings, or from leech bites, inflame, suppurate and terminate in fatal 
plebitis; or they induce erysipelas, which extends to other parls and 
occasions very dangerous symptoms. Abscesses ol'liltle consequence, 
which at other times would heal in a few days, become a soured of 
phlegmonous erysipelas after being opened, which requires a long 
treatment and the |)rotracted stay of the patients in the hospital, 
ev(!n, indeed, if they do not fall vietims to it. 

The treatment has been antiphlogistic in all the hospitals. M. 
Gcrdy has employed deep scarifications; M. Blandin leeches, in 
great numbers, along the course of the vessels and over any engorged 
ghinds which may exist. M. Jobert treats the disease with frictions, 
with an ointment of nitrate of silver, which he regards as a powerful 
antiphlogistic, and M. Rognetta says that the disease is conslanfiy 
limited by it. M. Jobert employs the ointment of three degrees of 
strength, according to the intensity of the disease; the |)ropoilions 
are four, eight, and twelve parts of the salt, to thirty parts of laid. 
This ointment is copiously applied over the whole part affected with 
the disease, even the whole body if necessary, which gives to the pa- 
tient the appearance of a negro, but no injury has ever resulted. M. 
Rognetta says that he has seen, in the service of M. Jobert, cases of 
extremely severe erysipelas arrested and cured, as if by enchantment, 
solely by the use of this ointment. — Am. Jour, of the Med. Sciences. 



Treatment of Lupus, <^'c. By Robert Liston, Esq. — We have 
fo deal with ulcersofthe face, and they are of different kinds. We 
do not f)ften meet with simple ulceration here except from accident. 
Ulcers in the upper part of the body heal very rapidly ; the blood 
flows freely away, and this is very essential to the healing process. 
Wounds in the tipper part of the body heal in one-fourth part of the 
time that they do in the lower. 

Many ulcers here assume a specific clyii'«'^ctcr, and sometimes com- 
mence from very slight injury. A man has cut himself in shaving, 
and the wound has become poisoned, as the saying is, somehow. 
Some corrosive or irritating stuffhas been applied to it by accident or 
design, the oxide of some metal, such a panacea as brown soap and su- 
gar; or a small softish wart appears, or a little eruption, and from this 
ulceration takes place. These ulcers arise about the alaeof the nose, 
sometimes at the corner of the eyes, and sometimes on the cheek. 
Occasionally they begin as hard tubercles, and go on extending. 
IVrhaps the sore heals at one [dace and spreads at another. Although 
these sores are troublesome to the patient and intractable, they can 
scarcely he looked upon as thoroiifihly malignant. 'I'li^y may go on 
and destroy all the parts wilh which they come in contnrt ; skin, 
muscles, cartilages, ;ind bones all p( rish before them. Cases which 



1845.] Treatment of Lupus, i^^-c. l-'33 



are neglected may proceed from bad to worse for a number of years, 
until scarcely any vestige of the bones of the face or their covermfis 
is left. I have over and over again seen patients who had lost all 
their features, lips, nose, and eves ; nolhinf; remained but the bram- 
pan and tongue, and they required to be fed by a funnel introduced 
over the base of this organ and into the pharynx. 

These ulcers have a sharp edge; the integument around them >s 
sometimes slightly tuberculated, and the edges are now and then, as it 
were, worm-eaten, but there is noinflammation around, they are glaz- 
cdon the surface, and there is no api)earance of granulation in them; 
they may continue for a great many years, causing t^he destruction 
I lu'ive mentioned without the lymphatics being nt aii alTectcd, without 
the constitution suffering much, and without the disease appearing 
in other tissues or organs of the body. 

These sores, however, may be made to heal by proper treatment, 
however extensive they may be. We had a man in the hospital 
lately, an honest dealer in horses, from Yorkshire, who had lost a 
great part of the nose, the lips, the side of th#face, and one eye. 
Trie disease had been going on lor a great many \cars; when ho 
came in there was a sore on the cheek as large as the palm of the 
ban 1. extending in all directions, but he left with this sore not one 
quarter that size, and the ulceration was, to a great extent, healed, 
though not entirely, and it is doubtful whether it ever will be. There 
beinz such an excessive loss of substance the remaining soft parts 
could not come together, so as to assist in covering the void. 

Now, this affection, which has been termed lupus, or noli me tan- 
gore, or herpes exedens, &c., may be at once put a stop to by appro- 
priate treatment. It has been supposed that internal medicines do 
^rood; arsenic is said to be efTicacious, but it is by local treatment 
that you principally succeed. There may be some slight swelling 
in tlie part, and the parts underneath may be healed, but whenever 
you see the edges assume a sharp appearance they mtist be destroyed 
by an active escharotic. You may employ arsenical paste, but tho 
consiitiition is apt to bo dangerously affected by it. The best appli- 
cation i.s the chloride of zinc, mixed up dry, with an equal quantity 
<»f flour, and then moistened, by abiding a little water to it. It must 
be ixw^eA up to the consistence of bird lime, and you may spread it 
on lint; but the better plan is to put it on a spatula, dip your finger 
in water, and then lay it on with accuracy round the sore, and then 
over the whole of it- It subjects the patient to some pain, but that 
ceases after a time, and tiie paste becomes elevated at the edges. 
You then find that an extensive slough has formed, and immediately 
that separates, instead of the old eating ulcer you have substituted a 
healthy granulating surface, the part furnishes good matter, and 
there is soon the commencement of cicatrisation all around. This 
may be done in all stages of the disease; even where the greater 
part of the fei^tiires are destroyed you may in this way check 
the dlsi>:is(^ ; and wherc*lhc afleclion is not so far advanced you 



"N 



•jy-l Dangers of Surgical Operations — Lilhotrity. [May, 



may destroy it altogether, and obtain a healthy cicatrix without 
much deformity. 

'J'he chloride of zinc used thus is a most active and effectual reme- 
dy, but it causes, as might be expected, severe pain for some hours 
after its application. — Lancet. 



Dangers of Surgical Operations. — M. Ballard, Surgeon in Chief 
of the Military Hospital of Bosancon, read (to the Academy of Sci- 
ences) a paper in which he endeavors to show that the dangers and 
accidents consequent on important surgical operations, depend much 
less on the 7node of operating than on the treatment before and after 
its performance. He has observed also that although the regimen 
maybe various, the proportion of deaths does not differ materially ; 
but that in tliose cases in which a liberal diet and tonics were allow- 
ed, the deaths usually occurred from the fifth to the tenth day, whereas 
it took place betwe^ the thirtieth and fortieth day among those sub- 
jected to low diet and blood-letting. 

The autlior, in endeavoring to determine the causes of death after 
surgical operations, enumerates as the most common — the dread of 
the operation, the pain, the traumatic or suppurative fever, the des- 
truction of tissues by suppuration, and finally, the collection together 
of large numbers of sick, marsh efHuvia, defective ventilation, d:c. 
M. Ballard therefore looks to each of these causes in establishing the 
indications to be attended to. In the first place, the patient should 
be kept in ignorance not only of the time of the operation, but also of 
its necessity, prior to its performance. Secondly, the sensibility 
should be destroyed or diminished, so as to render the operation tol- 
erable ; and this is accomplished by the author by compressing the 
principal nervous trunks, and the use of narcotics in full doses for 
several days in succession. Thirdly, the supervention of inflamma- 
tion should be prevented, by obviating the increase of heat and pain, 
which may be done by surrounding the limb with bladders filled 
with water of such a tempei'ature as may be necessary. 

By means of these proj)hylactics, the author says he lias diminished 
the mortality to such a degree that of 28 amputations, (20 being of 
thelower extremity and 12 of the thigh,) ho succeeded in every in- 
stance, that is to say, that death did not occur in any case before 
complete cicatrization, nor during the year following. — Translated 
from the " Gazette MclicaJe," of U^lh Feb., 1845. D. 



Jjitliotrily. — ^I. Arthauit,of Paris, lia<;4Rvonted a new instrument 
by which he can irducc large urinary calculi into cxtrejiuly minute 



1845.] "Treatment of Syphilis — Immovable Bandages, 285 



fragments in a single sitting. An exhibition of this method was 
deemed highly satisfiictory by the enhghtencd persons present. The 
peculiarity of this instrument consists in the sui)stitution of files for 
the perforating and crushing agents hitherto employed. — Condensed 
from the Gazette Medicate, of22d Feb., 1845. D. 



On the Treatment of Syphilis by Tartar- Emetic. — Dr. Willebrand 
was induced to make trial of tartar-emetic in the treatment of syphili- 
tic complaints, in the military hospitals, from observing the rapid 
removal of a blenorrhoea in a patient who was using that medicine 
for an attack of rheumatism. On trying the efficacy of this medicine 
on a large scale, he found that urethral discharges were, in general, 
removed in from six to fifteen, or, at the most, twenty days. It was, 
however, in the cure of true syphilis that this medicine was found of 
superior efficacy. Cases of primitive chancre were cured by the in- 
ternal use of tartar-emetic alone, in from ten to twenty days, no ap- 
plication having been made to the sore but simj)ie water dressing. In 
a few cases, in which there was much induration of the base of the 
sore, a cure was not effi^cted. In fhirty cases of secondary affection, 
under thcform of ulcerations of the throat, &c.,all symptoms of the 
disease disappeared in from eleven to fifteen days. The tartar-emetic 
was, however, continued, as a precautionary measure, for five or six 
days longer, after which the medicine was discontinued ; and though 
two, and in some instances, three years have since elapsed, no relapse 
has occurred among all these cases. Most of the cutaneous affec- 
tions rapidly and easily yielded; but some of the more inveterate 
ones, as the pustular and squamous syphilitic eruptions, required from 
twenty to twenty-eight days for their removal. In some of these, 
from the antimony disagreeing, it was requisite to intermit its use. 

In all the cases, the tartar-emetic was administered internally in 
the same manner, viz., half a grain six or eight times a-day. The 
first doses generally produced vomiting; but by the second day tol- 
erance was produced. When this large dose seemed to disagree, an 
eighth of a grain was given in the same manner, but then it often 
failed to effect a permanent cure. Cleanliness, 'repose, an equable 
temperature, and regulated diet, were the only adjuvant means used ; 
and Dr. Willebrand thinks that these cases show, that, in very 
many cases, the tartar-emetic may be substituted with advantage for 
the more dangerous mercurial treatment. — Edin. Med. and Surg, 
Journ., from Gaz. Med. de Paris. 



Immovable Bandages of Starched Paper fur the Treatment of 
Fractures of the Limbs. By M. Laugikr. — Bands of starched 
jiaper are arranged as in Scultets' bandage, and form three super- 
imposed layers. The limb is placed upon these, and after the frac- 
ture is reduced, the bands are applied. Other bands of paper, also 
starched, are applied around the foot, and extending up the K'g so as 



:83 Encysted BronchoceJc — Copuiba Pills — Ointments. [May, 



to form a boot, accurately moulded to the^part. After drying, which 
is obtained in twelve hours in summer, and twenty-four hours in 
winter, by the aid of iicated balls or bricks, this apparatus forms a 
very solid and lijjlit mould, which allows the patient to move in bed. 
Before drying, this bandage is firmer than the ordinary Scullets' : 
the patient, however, must be perfectly quiet for some hours after its 
jipplication. It can never be too tight; it is suited to every stage 
of fracture, even to fractures complicated with wounds. But in the 
latter case, the limb must be first enveloped in gum-elastic cloth, in 
a single piece, to preserve the paper from the pus, which softens it. 
Surgeons who have used tiiis, are pleased with it. It may be errt- 
phiyed in all cases to which the immovable apparatus is applicable : — 
it cannot, however, be used for e fleeting compression: it is useful 
principally to secure the immobility of fragments, and painful parts. 
It commends itself by its lightness and its cheapness; the latter of 
some importance for poor patients, in the country, and in charitable 
institutions poorly provided with bandages. — U Experience — Ameri- 
can Journal Sciences. 



Encys'ed Bronchocele. — According to Dr. Bouchacourt, this dis- 
case is not seated in ttic thyroid gland, but in the lympha.tic glands 
situated near it. Of all the methods recommended, injection is, he 
j^ays, that w hich offers the greatest chance of success. A mixture 
of one part of the tincture of iodine with two, three, four, or five 
j)arts of water, is sufficiently irritating. It is not necessary to inject 
a quantity of the iodine solution equal to that of the liquid withdrawn ; 
c)ne-half or one-third is, in general, sufficient, and it may be left in 
the cyst without inconvenience. The hypertrophied thyroid gener- 
jilly diminishes from the excitation produced by the injection; should 
this, however, be insufficient, iodine may be given internally and 
rubbed in at the same time. An appropriate treatment must be ad- 
ministered, according to the constitution of the patient. — Bulletin 
ds Therapeutique. 



Pills and Boluses of Copaiba. — To form balsam of copaiba into 
pills and boluses, Dr. J. F. R. Simon recommends wax. He employs 
the following proportions, which have been very generally adopted : 
For pills: liquified white wax, one drachm ; balsam of copaiba, tw^o 
drachms; powdered cubebs, three drachms. For boluses: liquified 
white wax, one drachm; balsam copaiba, three drachms; powdered 
cubebs, six drachms. — Med. Times. 



Preparation and Preservation of Ointments. — M. Deschamps, in 
" The Journal de Pharmacie,^^ has thrown out a suggestion upon 
this subject which deserves attention. He made many experiments, 
he says, first, to ascertain whether the several varieties of fat may, 
in all cases, be used indiscriminately; and, second, whether any 
means can be devised to prevent fats from becoming rancid, which 



le lo.J To the Reader. 297 



must greatly impair their value. He found that an ointment, prepared 
by heating the buds of the poplar in melted lard, is subject to very 
little alteration by keeping; and it therefore occurred to him that, 
as this may depend vipon a portion of resin extracted from the poplar- 
buds, asuKill proportion of gum benzoin might answer a similar pur- 
pose. On preparing these ointments and keeping them for several 
years, he found they had undergone no change, no approach to ran- 
cidity. Iodide of |)otassium is a very cxcolicnt test of any acidity 
in fat. And by this test he found that no admixture with fat tends to 
preserve it from change so well as benzoin or poplar-buds ; the latter 
produces an orange-yellow colour, but its colour is not affected by 
lonix keeping, even mixed with acetate of lead. 

Fat or lard, thus prepared with poplar-buds, or gum benzoin, then, 
is the best possible basis for ointments containing melallic substances, 
red oxide of mercury, acetate of lead, iodide of potassium, &c.; with 
essential oils it makes lip-salve, and an application to blisters very 
much preferable to ordinary ointments. — London Lancet. 



TO THE READER. 

In the original department of this No. of the Journal, ^'\\\ be seen an Article 
from my respected friend Prof. Du?as, entitled "Remarks on a Lecture on Mes- 
merism." I here propose to close the whole discussion of this subject; thinking 
that the pages of the Journal may be more profitably filled with the consideration 
of matters coming more within the scop^ of scientific inquiry as conducted on 
acknowledged and well establislicd principles. Mesmerism is, with me, not 
worth a controversy, nor can I persuade myself to quarrel with my friend about 
the mere shadow of so doubtful a substance ; more especiallv as he would have 
so much the advantage over me; for by "his volition and"a few passes," his 
opponent might be thrown into a mesmeric state and mysterious condition. In 
the way oi belief too, l,would stand no chance with him. It is not my desire to 
enter into extended controversy in the Journal on this or anv other subject. 
Viewing Mesmerism in the light I do, I regret the space occupied by it in the 
Journal; but it was unavoidable— the Editors having been disappointed 
by the Gentleman who had promised an Article for the 4th No. I feel my- 
self bound, however, to make in passing a few brief notes where I consider 
the respected author of the Article to have incorrectly stated my meaning; and 
I do so the more trecly inasmuch as I have received from him a private commu- 
nication stating he does not object to my taking this course, 

1st. Jussieu did not, as I have amply shown in my Article, confirm tJie report 
of the majority of the commission; biit though he did not agree to every thing 
in that report, he did condemn Alrsmer. I do not repeal the proof of this undenia- 
ble fact, but refer to my Lecture inthe Journal. 

2nd. This whole matter is so shadowy and uncertain to our apprehension, 
that we arc never sure that we have a correct view of its outlines. It did seem 
to me, however, that the ghostly shape of modern Mesmerism, so far as it has a 
.sAr/;;^, does .so resemble that of the Mesmerism of sixty years ago, as to force 
iipon the mind of every common observer the idea of at least a paternal rela- 
tion, if not an identity. And, in truth. Dr. Dugas seems to have had some such 
idea himself when he wrote, "admit the facts and I care not a whit for the ex- 
planation." If the Mesmeri.sm ot 1784, istoto ccclo different from the Mesmerism 
of 184.5, how can the admission of the facts aUcsed in relatim. to the foimcr be of 
any avail tn him in the endeavoi to establish "/A^ laUer? We do sincerelv ac- 
knowledge that we have had great difficulty in geuing any definite notion of 
uluit Mesmerism ?.^, though we have found no difficulty in determining to our 
own satisfaction what it is. net. 



2S8 



Meleoroloskal Table. 



3rd. The RovrI Academy of Medicine, of Paris, in 1825, received a report, and 
ordered it to be published, but without r/isaissioji and idthout adoption. Surely 
Dr. Dugas is not unaware of the distinction between receiving imil adopting sl 
rei)ort. The Royal Academy did not snnctimi tkc things contained in that Report. 
But farther, this very Academy in 1S37, by a commission of MM. Roux,Bouil- 
laud, tl. Cloquct, Emery, Pellctier, Cavcnton, Cornac, Oudet, and Dubois con- 
doinied Mesmerism. The same inconclusiveness is observable in the other 
ir.cts mentioned by my friend. The Royal edictof the King of Prussia, in 1817, 
does not prove that he believed Mesmerism true. And so of the Academy of 
Sciences of Berlin — their offering a prize for " the best work on animal magnet- 
ism," is no proofthat they believed all its wonders. But even had the Emperor 
of Russia, the Kingof Denmark and the King of Prussia, put forth edicts assert- 
ing the truth of Mesmerism, what must be thought of the strength of an alleged 
doctrine of medical philosophy, that has to lean for support upon the authority 
of the crowned heads of Europe as they existed thirty years ago 1 

If this is all the extent of fact and all the force of argument that can be brought 
forward to disprove my positions, I thank my learned friend for the incidental 
support which I regard those propositions as receiving from his " Remarks." 
In truth, those propositions seem to me stronger than before. Truth is always 
advanced by fair and amicable discussion. 

P. S. — Those who may wish to pursue the .subject of Mesmerism, are referred 
to a full expose in the last No. of the London Lancet. PAUL F. EVE. 



METEOROLOGICAL OBSERVATIONS, for March, 1815, at Augusta, 


Ga. 




Latitude 33^' 27 


north — ] 

lEtER. 

3, p. M. 


jongitude 


4*^ 32' west Wash. 






Thermometer. 
Sunrise. 3, p.m. 


Baroj 
Sun rise 


Wind. 


Remarks. 


1 


33 


64 


29 8-10 


a) 8-10 


s. w. 


Fair. 




2 


44 


69 


29 8-10 


29 8-10 


s. 


Variable. 




3 


60 


77 


29 7-10 


29 8-10 


s. 


Variable. 




4 


68 


72 


29 8-10 


29 7-10 


S. E. 


Rain 2-10 inch. 




5 


56 


68 


29 6-10 


29 7-10 


W. 


Fair. 




6 


46 


73 


30 in. 


30 in. 


E. 


Fair. 




7 


52 


77 


30 


29 9-10 


S. E. 


Variable. 




8 


60 


80 


29 9-10 


29 8-10 


S. 


Variablv.-*, 




9 


58 


80 


29 8-10 


29 7-10 


S. W. 


Variable. 




10 


e-2 


v59 


29 6-10 


29 6-10 


N. W. 


Rain 3-10 inch. 




11 


42 


58 


29 7-10 


29 8-10 


N.W. 


Fair. 




12 


45 


55 


29 9-10 


29 9-10 


N. E. 


Cloudy. 




13 


47 


57 


29 8-10 


2i) 8-10 


N. 


Rain 1 inch. 




14 


49 


63 


29 7-10 


29 6-10 


W. 


Variable. 




15 


41 


57 


29 7-10 


29 7-10 


w. 


Fair. 




16 


38 


60 


29 7-10 


29 6-10 


w. 


Variable. 




17 


45 


76 


29 5-10 


29 4-10 


w. 


Fair — high wind. 




18 


47 


61 


29 5-10 


29 5-10 


w. 


Fair — high vvind. 




10 


37 


53 


29 7-10 


29 7-10 


w. 


Fair— high wind. 




20 


33 


56 


29 9-10 


30 in. 


N. W. 


Fair. 




21 


3:j 


58 


30 in. 


30 


N. W. 


Fair. 




22 


31 


60 


30 


30 


E. 


Fair. 




23 


39 


61 


30 


29 9-10 


S. 


Cloudy— rain at sun-set. 




24 


48 


52 


29 8-10 


29 8-10 


S. 


Rain to 3, p. m., 5-10 inch. 




25 


38 


60 


30 in. 


30 1-10 


\. F,. 


Fair. 




2<) 


33 


6f; 


30 1-10 


30 2-10 


f-'. E. 


Fair. 




27 


36 


72 


30 1-10 


30 1-10 
^0 1-10 


S. W. 


Fair. 




28 


Ai 


72 


30 1-10 


s. 


Variable. 




29 


51 


76 


30 1-10 


30 1-10 


S. E. 


Variable. 




30 


55 


74 


30 in. 


29 9-10 


E. 


Variable. 




31 


56 


61 


29 8-10 


29 8-10 


E. 


Cloudy. 





duantit.v of Rain 2 inrhes. 14 Fair d? 



SOUTHERN 

MEDICAL AND SURGICAL 

JOURNAL. 



Vol. I.] NEW SERIES.— JL\E, 1815. [No. 6. 



PART I.— ORIGINAL COMMUNICATIONS. 



ARTICLE I, 



Remarks on SecaJe Cornutiim in Obstetric Practice. By Joseph 
A. Eve, M. D., Professor of Obstetrics and Diseases of Women 
and Infants, in the Medical College of Georgia, 

It has been remarked of Digitalis by Dr. Ferriar, "If any person 
were disposed to write a satire on medical evidence, the different 
testimonies rcspoctinir the properties of this single plant would fur- 
nish abundant materials; 'It is a diuretic,' snys one physician; » It 
has no diuretic power,' says another ; » It is a stimulant,' says a third ; 
* It is a sedative,' cries another ; ' It has no properties at all,' exclaims 
a fifth." The opinions entertained by the profession with respect 
to sccale cornutum are equally various and contradictory. While 
by some it is extravaoranlly lauded as a powerful and valuable agent 
in obstetric practice, by others it is condemned as a destructive poi- 
son ; others again regard it to be a totally inert substance, and consi- 
der its chief merit to consist in its incapacity to do harm, and ascribe 
any apparent good results that may follow its administration, to mere 
coincidence, or to the influence that the mind exercises over the 
uterus, and profess to believe that any other substance, devoid of all 
active properties, if given with the same understanding, would an- 
swer altogether as well. Even among those who admit that it pes. 
scsses valuable powers, there is great contrariety of opinion with 
respect to the particular cases, conditions and circumstances of 

10 



290 RemarJiS on Sccale Cornutnm. [June, 



cases, to which it is applicable, and also with respect to the variety 
and extent of its application in obstetric practice. 

For the natural and medical history of this article and its pharma- 
ceutic preparations, we would refer, as to the best sources forcorrapt 
information, to the last edition of the United States Dispensatory, 
Pereira's ]\rateri:i Medica, Trai;e Theoriqiie et pratique de I'Art des 
Accouchements par P. Cazeaiix, the Diclionnaire des Sciences 
Medicales and the Dictionnaire de Medicine et de Chirurcie. 

Our design is to treat of the active properties of ergot and its 
employment in obstetric practice and only to mention, in passing, 
the modes of administration we have generally found most conven- 
ient and eflicient. Before proceeding to treat the subject as proposed, 
it may not bo uninteresting or inappropriate to make a hasty and 
cursory review of the opinions and views of the most distinguished 
recent obstetric writers. 

The late Dr. Gooch condoinncd ergot in the most summary man- 
ner, without a trial. This most reprehensible inconsistency does not 
comport with the superior judgment and discrimination evinced, by 
this highly talented author, on other subjects. 

"The Americans (says he) recomtnend the ergot of rye, in doses 
of a drachm or two scruples, and affirm that the uterus is almost 
immediately excited by it to a vigorous action. 1 never used it, 
neither do I credit what has been said respecting its efficacy." 

Dr. Hamilton of Edinburgh, than whom there is no higher author- 
ity in obstetrics, objects most decidedly to the use of ergot, after 
what appears to be a most fair, candid and thorough investigation of 
the subject, and arrives at the conclusion that "the evidence of the 
harmlessness of this medicine, when given in moderate doses, is sat- 
isfactorily established, that is, that it has no power either to do good 
or harm." Our limits will not permit us to state the facts he relates, 
or the arguments he advances, to support his position ; we refer the 
reader to his most excellent "Practical Observations on various sub- 
jects relating to Midwifery." 

Madame La Chapplle, after having instituted a series of experi- 
ments with the secale cornutum in the Hospice de la Maternite, at 
the suggestion of ?tIons. Chaussicr, says, ''the medicine has by no 
means realized the high expectations held out by its favorers, and its 
chief virtue consists in its producing no bad effect." 

Other respectable authorities might be cited who denounce it as 
inert and useless. On the other hand, in support of the high claims of 



1S45.] Remarks on Secale CorniUum. - 291 



this medicine, and in proof of its valuable properties, we nnight bring 
forward, were it requisite, a preponderating weight of authority ; 
indeed nearly all of the nnost recent authors who have written on the 
subject declare more or less in favor of its usefulness. The late Pro- 
fessor De wees was one of its most decided and strenuous advocates, 
although he employed it with much more caution and discrimination 
than Professor James who was accustomed toprej--cril>c it, with a free- 
dom and fearlessness which few at present would venture to imitate. 
Dr. Dewees was extremely particular, in limiting the use of ergot to 
certain specified conditions, and evinced great ar;umen and judgment 
in defining the rules and explaining the principles by which its ad- 
ministration should be governed; but notwithstanding he restricts 
its use so rigidly, he bears the following high testimony in favor of its 
valuable powers — " I am certain that I do not use the forceps now, 
where I formerly u-jed them ten times." " And the reason of this 
abatement, in the employment of the forceps, may I think be fairly 
attributed to the almost universal use of ergot, by every kind of 
practitioner of midwifery : and hence I presume that the secale cor- 
nutum now achieves deliveries that would have required the forceps 
formerly ; for were this not the case, I think I should be called upon, 
as formerly, to aid labours with these instrun}ents." 

Professor Meigs acknowledges its great powers, but appears to 
entertain such horror of the disastrous consequences to be apprehend- 
ed from its use, that he seldotn employs it except for its haemostatic 
properties. "Upon the wliole, (says Dr. Meigs.) I must say that I 
feel far more comfortable and free from apprehensions for the child 
and the mother, when I deliver with the forceps, than in waiting the 
result of secale cornutum." 

Professor Antony held secale cornutum in high estiniation. both as 
a haimostatic remedy, and a promoter of the parturient action of the 
uterus, but he exercised his wonted good judgment, in defining well 
the cases, to which he considered it applicable, condemning most 
severely the indiscriminate and incautious use of so powerful an 
agent. 

Although long known upon the continent of Europe, and, especial- 
jy in Germany and France, among the common people, as an ao-ent 
by which the action of the uterus njight be increased, and althoufrh 
Desgranges published researches on the subject as early as 1777, and 
Camerarius published on the same subject in 1709, it owes its gen- 
eral introduction into regular practice to American physicians, and 



292 Remarks on Sccale Cormitum. [June, 



principally to Dr. Stearns, of New-York, who first published a letter 
on the subject in 1808 ; and subsequently, but in a greater degree, 
to the great influence of Dr. Dewees. In our country there are, 
now, very few obstetric authors or practitioners who do not acknow- 
ledge its great power over the uterus, however much ihey may difier, 
with respect to its value and safety in practice, and the principles 
which should direct and govern its administration. 

Notwithstanding the great opposition and prejudice which it had 
to encounter in Great Britain, Ireland, and the continent of Europe, 
it has surmounted every impediment against its introduction into 
practice, and commended itself to the confidence of a large majority 
of the most distinguished obstetric practitioners, although there is 
considerable diflcrence of opinion among them with respect to its 
safety, utility and the principles that should govern its administration. 
Burns admits that ergot has occasionally a decided effect in 
accelerating delivery, but docs not appear to have a proper apprecia- 
tion of its properties. 

Campbell, in his "Introduction to the study and practice of 
Midwifery," speaks of it as one of the acknowledged resources of 
the art. 

Dr. Collins, in his valuable "Practical Treatise on Plidwifery,'* 
acknowledges the power of ergot in promoting the parturient action 
ofthe uterus, and remarks that he has been particularly struck with 
its sedative effect upon the circulation, in almost every instance in 
which he has exhibited it. 

The late Dr. David D. Davis, in his luminous and voluminous 
work entitled "Obstetric Medicine," acknowledges himself a tardy 
believer in its properties, but, contrary to his usual custom with other 
subjects, says very little about it. 

Dr. Blundell expresses himself decidedly in its favor. "In lin- 
gering parturition, (he says.) you will frequently find the ergot of 
invaluable use, for it has, in a high degree, the power of exciting the 
muscular efforts of the uterus." "After all that I have seen and 
heard respecting the action ofthe secale cornutum, I think there is 
no doubt that it has a specific power of stimulating the uterus, pro- . 
vided its muscular irritability be in a state well fitted to receive its 
impression." Dr. B. does not believe, though he is by no means 
prepared to deny, that ergot exerts any poisonous influence over the 
child in utero. 

Dr. Rigby acknowledges the great influence of ergot, and some 



1845.] Remarks on Secale Cornutum. 298 



other substances, over uterine contraction ; but he is extremely re- 
strictive of its use during labour and remarks, that "the chief value 
of these remedies is for the purpose of exciting uterine contraction3 
after labour, and thus to promote the safe expulsion of the placenta, 
when there is a disposition to inertia uteri, and insure the patient 
against haemorrhage." 

The testimony of Dr. F. H. Ramsbotham is decidedly in favor of 
the utility and safety of secale cornutum, when employed with proper 
caution and discrimination. "I have (says Dr. R.) given the ergot, 
in the doses recommended, every four or six hours, for many succes- 
sive days, on several occasions, and never knew it produce any bad 
effect upon the mother, except, occasionally, nausea and vomiting. 
Usually there is no more influence perceptible on the general system 
than would be obtained after taking a cup of tea ; but its effects upon 
the uterus in labour are often speedy, powerful and astonishing." 

Dr. Churchill says — "From repeated trials I can bear testimony to 
its efficacy, though it is somewhat irregularly exerted; but I must 
add that I have seen it do mischief." 

Dr. Robert Lee remarks of ergot, "there can be no doubt that it 
occasionally does act upon the uterus, and very violently ; but he ap- 
pears to be more impressed with an idea of the dangers to be appre- 
hended, than of the benefits to be derived, from its use: I have never 
ventured, (says he,) in either public or private practice, except in 
cases of accidental uterine haemorrhage and retained placenta, to 
administer the ergot of rye to a woman in labour." 

M. Velpeau expresses the most decided confidence in the power of 
ergot to re-excite and increase the contraction of the uterus. 

We have already referred to M. Cazeaux for the natural history of 
secale cornutum, and with equal propriety we might refer to his 
theoretic and practical treatise, for a most excellent account of its 
therapeutic action. His views are strongly in its favor, both as a 
mean to expedite labour, and restrain haemorrhage. 

Cazeaux, Chailly, Dubois, F. H. Ramsbotham, and some other 
authors, consider ergot not only capable of re-exciting, and augment- 
ing the contractions of the uterus, but of originating them at any time 
during gestation: hence they regard it as a valuable agent, when it 
becomes necessary to induce premature lal)our. 

M. Moreau, in his "Traile Pratique des accouchements," remarks 
of ergot, " we arc of opinion that it is far from being inactive, but that 
its action is neither so constant, nor so active as many suppose :" he 
iays, *• he is far from proscribing it — but riirely uses it." 



294 Remarks on Secale Cornulum. [June, 



We have now brought forward the opinions of a number of the 
most (listinguislied American and European Obstetricians on the 
subject of ergot; some ofwiiom wo find reject it as powerless, otliers 
condemn it as violent and dangerous, whilst others recommend it as 
an efficacious and invaluable agent in obstetric practice. 

In farther testimony of the useful properties of ergot in the prac- 
tice of midwifery and the treatment of the diseases peculiar to 
woman, were corroboration necessary, we might adduce the names 
of Baudelocque, Goupil, Roche, Gardien, Diiparcque, Ashwell, Lis- 
franc, Trousseau, Waller, Ingleby, and Colombat : indeed the 
catalofTue of hii^h authorities mif^ht be extended to an almost inter- 
minable extent. 

It appears to me, if any one were to approach the investigation of 
the properties of secale cornutum, unprejudiced, for or against it, and 
without any previous acquaintance with it, after carefully weighing 
and balancing all the discordant testimony and the various opinions 
of distinguished authors, he would come to the conclusion, that those 
who found it productive ol'no decided eiTect, were very unfortunate in 
the choice of the article they prescribed, or in the selection of the 
subjects to whom they administered it, and that as it is generally 
acknowledged to be a very perishable substance, it must have lost its 
properties, or the patients must have resisted its influence from some 
peculiarity of constitution ; that on the whole, it is neither so gener- 
ally dangerous, as some apprehend, nor so invariably safe as others 
seem to believe; that it undoubtedly exercises great power over the 
action of the uterus, and consequently, must be as capable of doing 
injmy when improperly used, as of accomplishing good when judi- 
ciously prescribed: and we cannot conceive how any person, after 
examining its properties experimentally, and carefully and candidly 
observing its eO(;cts, could arrive at any other conclusion. 

That ergot does possess a peculiar and powerlul influence over the 
uterus, is now too well established to be called in question — an influ- 
ence that may, with proper sliill, be wielded for the achievement of 
the most beneficial effects, but which, by ignorance and temerity, may 
be rendered productive of the most disastrous results. A powerful 
and safe medicine is certainly a solecism, most absurd and ridicu- 
lous ; the ability to eflect good imj)liosthe power to do harm. 

We will now proceed to give our own viewt of i(s tflJcts, and 
describe the cascis to which we consider it applicable, with due respect 
and deference always to the high auihorities from which we may 



1845.] licniarks on Secale CornuLum> 295 



occasionally differ — a difference which may however be considered 
pardonable in the most humble, as there is so little unanimity among 
themselves : If, however, amid so much diversity, and contrariety of 
opinion, so calculated to confuse and mislead the young, and inexpe- 
rienced, we may be so happy as to establish any principles, or lay 
down any rules that may, in any degree, assist our junior brethren, in 
the employment of an agent so energetic, and consequently so hazard- 
ous, our object will be fully attained. 

Whether ergot is capable of originating the parturient action of 
the uterus, before it has commenced, we cannot from our experience 
determine, never having prescribed it for that purpose, nor known a 
case in'Avhich that result followed its use ; but we can readily believe 
it competent to that effect, from what we have repeatedly witnessed 
of its influence over the unimpregnated, as well as the parturient 
womb, and upon the respectable authority, already cited in support of 
that opinion. 

This medicine not only puts into action the longitudinal fibres of the 
uterus, by the contractions of which, while the circular are passive, 
its mouth is dilated and its contents expelled, but it stimulates all the 
fibres equally at the same time to contract, and thus produce an 
equable and general condensation of the coats of the uterus, contrac- 
tion and diminution of its cavity, and compression, rather than extru- 
sion, of its contents. 

The ergotic contractions differ most decidedly from those of natu- 
ral labour, in havinsf no intermission between them, consisting in a 
permanent spasmodic contraction which admits only of slight remis- 
sions, but no distinct intervals of ease. This action is so different 
from the natural, liiat it is truly astonishing that any candid, intelli- 
gent observer could ever fail todistinguish between them and attribute 
the revival of labour, after its administration, to mere coincidence: 
It is true that there are exacerbations and remissions of pain, but the 
uterine globe continues permanently hard and contracted upon its 
contents : patients themselves readily recognize the difference be- 
tween natural labour and the action of ergot : it is usual to hear 
those who have experienced its effects before, when they take it 
again, say, "now I shall have no rest, nor peace, until the child is 
born." 

(Generally in ten or twenty niintites after it is tak<'n, its effect is 
maniCcsted; but ue nre contiiliMit, from repeated observation, (hat 
this is not invarial>ly the case. In some instances we have known no 



296 Remarks on Secale Cornutum. [June, 



effect evinced until an liour or more had elapsed. In one instance of 
abortion in which it was administered very liberally to restrain 
haemorrhage and cause the expulsion of the placenta, but without 
any apparent inllucnce, its action was so powerfully developed, some 
hours afier its discontinuance, that the placenta was ejected with 
force some distance below the patient's knee. We could account 
for this unusual spasmodic action of the uterus, in no other mode, 
than by attributing it to the influence of the ergot previously ad- 
ministered. 

Cazeaux says the action of the ergot decreases in an hour or an 
hour and a half, and soon ceases, and that it becomes necessary to 
repeat it, or resort to other means, if the object for which it was given 
has not been accomplished. This may be generally correct, but not 
uniformly ; it sometimes continues much longer, without any mate- 
rial diminution ; and when its influence upon the parturient action of 
the uterus has subsided entirely, its effect upon the tonic contraction 
continues with little or no abatement. Dr. Dewees was certainly 
right in assertino^ that the uterus is less liable to fall into a state of 
inertia after being excited to action by the ergot than by other 
means; an additional dose may indeed sometimes be necessary, after 
the delivery of the child, for the expulsion of the placenta ; but this 
will not be found generally requisite. 

From this view of the mode of operation of ergot, after having 
given what may be considered a full dose, (5i. to 3ij. of the powder, 
or from gi. to §ii. of the vinous tincture,) we deem it expedient to 
wait some hours before any farther administration, unless the indica- 
tion for its employment be urgent; but when it is clearly indicated, 
and the demand for it pressing, its administration may be repeated 
or carried to almost any extent, with as great or greater impunity 
than any other medicine of the same power. 

That it may have produced devastating epidemics, dry gangrene, 
narcotism, and convulsive diseases, when taken in enormous quanti- 
ties, or for a very long time, it would be presumption in us to deny 
in the face of so much respectable authority, although equally good 
might be cited for a contrary opinion ; but we do assert, after having 
employed it, in cases adapted to its use, very liberally, and witnessed 
its freer and more incautious employment by others, we have never 
known it produce on the mother any other bad effect than nausea 
and vomiting, and these much less frequently, when the wine has 
been exhibited, instead of the decoction. In this our experience cor- 
responds precisely with that of Dr. Ramsbotham already stated. 



1845.] Remarks on Secdle Cornutum, 29' 



The injurious consequences that may result to the parturient wo- 
man from the development of its specific action on the uterus, under 
circumstances unfavorable to its use, will be detailed hereafter. That 
it often exercises a deleterious influence upon the foetus in utero, 
when improperly used, is we believe generally acknowledged, but 
variously accounted for by different authors : some attribute it to a 
poisouous property absorbed, and conveyed by the maternal blood to 
the foetus ; and Dr. Beatty, in an excellent article upon ergot, pub- 
lished in a recent number of the Dublin Journal of Medical Sciences, 
goes so far as to lay it down as a rule that it should never be admin- 
istered, whenever there is a probability that the delivery will not be 
accomplished, before time may elapse, sufilcient for its absorption 
and transmission to the foetus through the utero-placental circula- 
tion, which time he defines to be about tuo hours. The death of a 
foetus, exposed for even less than one hour to the violent ergotic ac- 
tion of the uterus, might, we think, be reasonably apprehended and 
accounted for, without the supposition of the absorption and trans- 
mission of a poisonous property through the maternal blood. 

We have never seen any cause, nor heard any argument advanced, 
sufficient to induce a belief that ergot possesses any such property ; 
indeed our experience and observation have furnished us with the 
most satisfactory proof to the contrary. Formerly, when we em- 
ployed it with less discrimination than at present, and more recently, 
when prescribed by others, we have frequently known ergot admin- 
istered for several hours before delivery, without the foetus having 
sustained the slightest perceptible injury. Were it necessary to for- 
tify our opinion, by the corroborative support of high authority, 
many of the most distinguished names might be invoked. That the 
foetus often perishes in consequence of the untimely and injudicious 
use of this drug, we would be the last to deny: but we consider it 
fairly attributable to the mechanical effect of the long continued, un- 
intermittent, violent pressure upon t[ie foetus and the placenta and 
umbilical cord, chiefly perhaps by impeding or suspending the pla- 
cento-fa3tal circulation, upon the regular performance of which life 
depends as essentially, during the fcetal state, as upon respiration 
after birth. But besides the suspension of aeration, it may be the 
consequence of congestion of the brain or lungs, caused by the pla- 
centa being so constantly and firmly compressed that, while it can 
receive little or no blood from the umbilical arteries, more than dou- 
ble the usual quantity is forced through the umbilical vein, thus pro- 



^''^^ Remarks on Secale Cornulum. [June, 



ducing dangerous if not fatal pletliora in the fcetal system. So much 
injury indeed do we consider likely in this way to accrue lo the deli- 
cate organization of the fojUis, that we are accustomed, as highly as 
we appreciate the powers of ergot, to abstain from its use, even after 
the birth of the child, until the cord has been ligated, unless imperi- 
ously indicated to prevent, or counteract some greater danger. In 
some cases, the death of the fa3tus may, as some suppose, depend 
upon the placenta becoming detached from the uterus; but we are 
disposed to believe, when not dependent on an interruption of the 
placento.fa3tal circulation, it results from the long continued and 
severe compression and contusion of important organs, as the brain, 
lungs, ik,c. Our views with respect to the effects of ergot upon the 
fcetus, summed up, are, that it possesses no poisonous property, but 
that, although the child may sometimes escape unhurt after its long 
continued and often repealed administration, it is always obnoxious 
to injury from it, at any time before the establishment of pulmonary 
respiration and ligation of the umbilical cord. 

We will now proceed to consider its practical employment, and 
define the cases to which it is applicable. The therapeutic virtues, 
and practical utility of this article are becoming ni(jre and more 
developed, and commanding more attention and higher respect 
from the profession, but more enlightened views of its properties 
have greatly restricted its employment during labour, while they 
have much extended its application to the remedial management 
of the diseases peculiar to females. In this place, however, we 
will only consider its employment, during the different stages of 
labour. Inasmuch as it acts equally upon the circular as well as the 
longitudinal fibres of the uterus, it is never proper in the first stage, 
that is, until the mouth of the uterus is fully, or nearly dilated, and 
very dilatable, except perhaps in some cases of excessive haemorrha- 
ges of the accidental kind, and in some cases of violent convulsions 
occurring early in, or anticipating the commencement of labour. It 
is a question, doubtful with us, whether even in these cases it is an 
a|)propriate prescription: at least we have never met with a case of 
haemorrhage, in which it appeared expedient to employ ergot, before 
the first stnge was completed, or considerably advanced, and we- are 
disposed to believe that, at most witii very rare exceptions, it would 
be preferable to defer its use, and endeavor to expedite delivery by 
rupturing the mcndirancs. and assisting mechanically, the dilatation 
of the OS lincir, and even if it should be deemed nccesciary, on account 



1845.] * Remarks on Secale Cornufum. 299 



of the extreme urgency of the symptoms to resort to it sooner, these 
methods should be practiced simultaneously as indispensable adjuv- 
ants. With respect to convulsions occurring during labour, or near 
the termination of gestation, inasmuch as delivery is always essential 
to a cure, and ever to be looked upon as the principal, if not sole, reli- 
ance for safety to the mother, it might be proper to administer ergot 
by the mouth if practicable, or in the form of an enema, to originate 
or promote labour anterior to, or at the very commencement of the 
process; but we leave the solution of the question to others. Our 
own practice has been to defer ils exhibition until labour was consid- 
erably advanced, when we have had reason to be pleased with ils 
effecfs. 

If the first stage be properly conducted, so that while, on the one 
hand no injudicious interference is practiced, on the other no impro- 
per expenditure of strength or waste of time is allowed, artificial 
assistance of any kind will seldom be required in tiie second : some 
cases however do occur, in which, notwithstanding the most skilful 
management, ergot may be most advantageously used, but many 
more arc to be found, wiiich result from the ofiiciousness of 
ignorant midwives. . Although there is doubtless too often a resort 
made to ergot, where time and patience are the appropriate 
remedies, it is equally certain that it has often superseded the 
employment of instruments to the advantage of mother and otT* 
spring. 

It has without doubt been prescribed too indiscriminately to expe- 
dite delivery in lingering labours. Il is certainly a difficult point to 
determine when to employ it for this purpose. We seldom find it 
necessary, at any rate, never venture to use it, while the uterus is 
acting with as much force as it appears capable of exerting; for il is 
certainly hazardous to excite it to still greater exertion, as rupture 
of the uterus itsfdf, convulsions, exhaustion, or some other dangerous 
consequence might very reasonably be apprehended : under such 
circumstances it is far more rational, if possible, to endeavor to over- 
come the resistance. If exhaustion should have already supervened, 
or the patient be approaching that state, from the long continued, 
ineffectual action of the womb, if it were practicable to re-excite the 
fatigued organ to renewed activity, it would only be to render the 
exhaustion more complete, and the fatal result more certain. It 
is more than probable that, before the supervention of exhaustion, 
the uterus has already exerted its utmost capacity toward the accom. 



300 Remarks on Secale Cornutum. [June, 



piishmcnt of delivery, and (hat instrumental aid furnishes the only 
hope of rescue ; but there are cases in which the womb, after acting 
feebly for a considerable time, brings the presenting part to rest upon 
the perinaeum, and all that seems required to terminate the labour, is a 
little increase in its action, a little more expulsive power. At such a 
juncture we can see no objection to the administration of ergot, and 
we believe it far preferable to tiie application of the forceps, safer for 
both mother and child. 

It is not uncommon at any period of the labour for the pains to 
subside, without any of the symptoms of exhaustion, afibrding the 
patient a temporary respite from suffering. Unless there be an ur- 
gent necessity for prompt delivery, it is generally better not to 
interfere, during this temporary suspension, but to allow her spirits to 
revive, and strength to become recruited. Should this cessation of 
the pains occur very near the termination of labour, the patient not 
exhausted, especially if she should have passed without difficulty 
through previous deliveries, we would unquestionably prefer the ad- 
ministration of ergot to the introduction of the forceps, or to permit- 
ting her to remain long undelivered. It must, however, be remem- 
bered that near the close of labour, alarm, or apprehension of the last 
throes, often frightens away the pains, when hope encouraged will 
recall them again, which expedient should always be fully employed, 
before resorting to ergot or any artificial assistance. 

Many accidents or complications are liable to occur during the 
second stage, in which ergot becomes a most invaluable resource. In 
accidental ha3morrhage, when uncomplicated with preternatural pre- 
sentation of the fcetus, or mechanical impediment to the delivery, it 
is a most precious agent, the efficacy of which very few at the present 
day would venture to call in question. It is equally efficacious in 
haemorrhage dependent on partial presentation of the placenta. In 
complete placenta previa, it is generally inapplicable, as the tendency 
would be to increase the separation of the placenta, and consequently 
aggravate the ha3morrhage. It is not proper until after turning 
(which is the indication in such cases) has been effected, after which 
it may be very advantageously employed to hasten delivery, should 
the uterus then not act with energy. We know of one case of pla- 
centa previa, in which, contrary to the acknowledged principles of 
practice, ergot was administered and succeeded most admirably by 
causing the expulsion of the placenta foremost, and the foetus imme- 
diately after it ; such a favorable result, however, could not be safely 



1945. J Remarks on Secale Cormilum. 301 



calculated on. In our own practice a case anticipated our intention 
to turn, by terminating suddenly and spontaneously in this way : the 
ovum was expelled entire, the placenta upon the fore-end, the foBtus 
alive and moving vigorously in the waters. These cases present 
rare exceptions to the general rule : the alternatives are usually turn- 
ing or death. 

The following case will illustrate the indispensable importance of 
ergot, in the management of uterine hsemorragc during labour. At 
our first visit to a woman on a neighboring plantation, July r2th, 
1842, we found her in a state of extreme prostration from flooding, 
almost pulseless, with cold surface, nausea and vomiting ; she was in 
the eighth month ; labour, the result of violent exertion, commenced 
on the 11th, with rupture of the membranes and loss of the liquor 
amnii ; the os uteri was considerably dilated, but the pains had near- 
ly ceased. Nothing except ergot afforded the slightest ground for 
hope : an attempt to deliver by turning would in all probability have 
exhausted the little remnant of life: the system had not energy 
enough remaining to accomplish delivery unaided ; the vital fluid was 
still steadily oozing away ; the stomach could scarcely retain any 
thing ; and there was reason to fear that the loss of blood would be 
increased by arterial stimulants. In this dilemma we prescribed the 
wine of ergot, of which her stomach appeared more retentive tiian of 
any thing else ; which form was preferred, because the sedative pro- 
perty of the ergot is counteracted by the menstruum. The ergot 
promoted the tonic contraction of the uterus, sufllciently to arrest the 
haemorrhage. By the most extensive and persevering application of 
sinapisms, reaction took place on the morning of the 13lh, and her 
strength being recruited, by some light nourishment which her stom- 
ach became able to receive and by sleep, in the afternoon the labour 
became re-established, and about 9 o'clock, a foetus, evidently some 
time dead, was expelled. This patient suffered severe head-ache for 
some days, in consequence of the excessive loss of blood, but in other 
respects had a very fiivorable convalescence. We verily believe with- 
out the liberal administration of the wine of ergot, this patient would 
have inevitably perished ; in such an exigency, all the other resources 
of the profession would certainly have proven wholly unavailing. 

When hfemorrhage of the accidental kind, or from partial pre- 
sentation of the placenta occurs, after the os tincse is even two. 
thirds dilated, ergot is always proper, unless the labour is progressing 
as rapidly as could be desired, or there should be malposition of ^he 



.T32 Rcmarhs on SccaJe CurmUum. [June, 



foBtus, disproporlion or some other mnchanical impediment to delive- 
ry. When there is no such counter-indication to its employment, if 
it should do no good, it can certainly be productive of no injury, 
for if the uterus be stimulated to vigorous contraction, the delivery 
\\\\\ be accomplished, the haemorrhage arrested, and the necessity for 
turning super:5eded. Should it fail to act, it will not render turning, 
which then becomes the alternative, any more difilcult. The ex- 
hibition of ergot should be accompanied with the artificial rupture of 
the membranes, should the liquor amnii not have been already spon- 
taneously discharged. 

In all turning cases, after the feet have been brought down and the 
version accomplished, should the uterus not act with energy, it would 
be much safer, both for mother and offspring, to stimulate it to re- 
newed action, than to empty it by manual traction, while in a state 
of inertia or feeble action ; for to the mother this would bring the dan- 
ger of haemorrhage ; to the fcetus the danger that, the uterus not 
pressing firmly on the vertex, the chin would leave the breast, and 
the arms remain above the superior strait and obstruct the descent 
of the head. 

In breech, knee, or footling cases, the life of the child may often 
be preserved, by administering ergot near the close of the labour, 
thus hastening the delivery, and preventing the too long compression 
of the umbilical cord by the head in its passage through the pelvis. 

In prolapsus of the cord, after re-position has been accomplished, 
or when it is found impracticable, or after turning, should that method 
be adopted, the expulsion of the fcetus should be hastened by ergot, 
so that the compression of the cord may be of the shortest possible 
duration. 

In instruniental cases, should the uterus not continue to act with 
vigor, the delivery should never be terminated without the liberal 
administration of ergot. 

In speaking of the employment of ergot in convulsions during the 
first stage, we have anticipated what we would have said of its use 
in the second. As respects the mode of administration in convul- 
fions, we prefer the powder in syrup or the decoction as an enema, 
l)ut after very copious depletion the vinous tincture is a very eligible 
form. 

Dewees, Antony, and some others, to whom the highest respect is 
due, speak of the excellent effect of the ergot in irregular or mis- 
placed labour, declaring that it often determines the action more 



184.J.] V Remarhs on Secale Cornu'iun. 303 



decidedly to the uterus, and renders the labour more natural and 
efficient, in the first, if wo understand them correctly, as well as the 
second stages. Though our own experience does not comport with 
theirs, we do not entertain a doubt but that they have met with cases, 
in which it had or appeared to have that effect ; but we have not, and 
we believe it far safer for the mother and off-spring to resort to other 
expedients, for relieving irregular action and determination of excite- 
ment to other orsrans. 

There may be some other occnsionsin which during the second 
stage ergot may be advantageously employed, all however are enu- 
merated that are recollected, but writing as we do in the midst of the 
hurry of professional business, we may have forgotten them, and 
would be gladly reminded of them, for we would not willingly make 
any omission. 

The third stage of labour is that in which ergot is most frequently 
required, and upon its effects in v.-hich its value chiefly depends. 
However useful it may sometimes prove as a parturient or promoter 
of the expulsive power of the uterus, in the earlier stages, it is far 
more valuable, not only for its effect in promptly expelling the pla- 
centa, (rendering the introduction of the hand into the uterus seldom 
if ever necessary,) but also as a hemostatic remedy, in this stage. 
Were this position not too generally acknowledged to need corrobor- 
ation, there would be no difficulty in calling to its support any amount 
of the highest authority in medicine. 

Many authors speak of the excellent effects of ergot Tn prevent- 
ing hajmorrhago in patients predisposed to it, or who have in pre- 
vious labours suffered from it, by administering it a short time before 
delivery. Whilst we do not doubt the success of this mode of cm- 
ploying it, we believe it would be equally successful in preventing 
flooding, and safer as respects the child, to give it immediately after 
the latter is expelled, unless hccmorrhage precedes its birth. We 
have never had cause to regret not having administered it sooner ; 
indeed so much have we been pleased with the effects of ergot, ad- 
ministered immediately after the birth of the child, when hiemorrhagc 
actually demanded it, and in cases in which it was apprehended, that 
we have, gradually, fallen into the habit of giving a few drachms of 
the wine of ergot after every birth, generally after the ligation of 
the cord for reasons already slated. A case which occurred to us, 
a few years since, had considerable influence in determining the adop- 
tion of this practice more generally : Mrs , healthy and robust. 



304 Remarks on Sccale Cornulum, [June, 



l^ctwecn 20 and 25 years of ajre, was delivered of her first child • 
after a labour in ail respects favorable for a first parturition. After 
the uterus had contracted down firmly, and the binder had been 
carefully applied, we left her with injunctions to keep perfectly still, 
and drink nothing: warm. As primiparae are less liable to 'flooding 
than others, no ergot was administered, but some of the wine was 
left, with the most positive direction to give a tablespoonful and 
tighten the binder, should the lochial discharge become too free : 
Our orders, with respect to moving at least, were disobeyed immedi- 
ately after we left the room, and flooding followed. A very intelligent 
and experienced relative who remained with the patient, would not 
believe that she was flooding, so uncommon is it after first births, 
until the patient became faint from loss of blood and, then in the 
consternation that ensued, our directions were forgotten, and so 
much time lost before we were summoned to her assistance, that 
her life was brought into the utmost peril, and required the employ- 
ment of the most prompt and energetic measures for its preservation. 
Since the occurrence of that case, we have never felt satisfied to 
leave any case, until an hour or more had elapsed after the expulsion 
of the placenta, without having given a portion of the wine of ergot, 
and no decided instance of secondary haemorrhage has ever occur- 
red, in our practice, since the adoption of this rule. Besides the 
prevention of flooding, and the expulsion of the placenta, ergot, 
administered directly before or after the birth of the child, by ex- 
citing permanently the tonic contraction of the uterus, regulates the 
lochial discharge, and renders the patient much less subject to after- 
pains. 

On the subject of ergot, Mr. Grantham says, " the ctherial tinc- 
ture I have found very valuable in suppressing uterine haemorrhage, 
and I am in the habit of giving one drachm, in a wine-glass of warm 
water, to mitigate the after-pains It relieves the patient better than 
ojiium, and without producing any ill efl^ect upon the sensorium com- 
mune." 

Our object in prescribing a portion of wine of ergot after delivery, 
is to prevent flooding, or excessive lochial discharge, but we have 
often observed the most decided influence over the after pains, in 
those who had generally suiTered very much from them, in some in- 
stances preventing them altogether, but more frequently mod,erating 
and rendering them more tolerable: In some few instances no per- 
ceptible effect has been observed, at least some patients have com- 



1845.] Remarks on Secale Cornulum. 303 



plained as much after taking if, as before, or as they could, if they 
had not taken it ; hut it might have been that they had not taken 
enough, or because some females express as much suffering from a 
slight, as they possibly could from an intense degree of pain. This 
effect upon the after-pains doubtless results from the firm and per- 
manent contraction of the uterus, after the expulsion of its contents, 
and the consequent prevention of the accumulation and retention of 
coagula within its cavity, upon which after-pains principally depend. 
After-pains may sometimes perhaps be caused by sympathetic irrita- 
tion or excessive irritability of the uterus, independent of any con- 
tained matter, when of course ergot would be inappropriate for their 
removal. 

In the management of abortion, especially when attended with 
Iiaemorrliage, ergot is an inestimable resource: Whenever it has 
proceeded so far as to have become inevitable, but is progressing 
slowly, it is far better to give ergot to hasten the expulsion of the 
ovum, than to leave the patient in a state of protracted pain and 
suspense, exposed to danger from the continuance or supervention 
of haemorrhage; but whenever the patient's life is endangered by 
the profaseness of the haemoThage, it is indispensably necessary in 
any stage of abortion, although the more advanced the pregnancy 
is, the more desirable it is that there should be considerable dilatation 
of the OS tmcsc, previoiisly to its administration. After the expulsion 
of the embryon in early abortions, there is frequently retention of the 
placenta with haemorrhage : whenever it can be hooked away with 
tl)e finger or conveniently seized and brought away by the placenta 
forceps, it should certainly be done ; but this will ofien be found im- 
practicable, and then ergot becomes an indispensable resource, always 
controlling the haemorrhage, and sooner or later causing the expul- 
sion ofthe placenta. 

In cases of moles, hydatids, polypi, and all morbid growths and 
depositions within the uterine cavity, ergot should he employed to 
effect their expulsion, whenever the diagnosis is satisfactory, or the 
attendant haemorrhage sufficient to excite alarm. 

Had we not already transcended our prescribed limits, it would be 
an agreeable task to notice the application of ergot to the treatment 
of various diseases, especially those peculiar to females. This" would 
itself constitute a theme for an interesting article, which we trust 
will be adopted, ere long, by some one more able to do it justice, in 
a communication to this Journnl. 

CO 



306 Scraps from my Case Book, [June, 



Wc have Hdw. in ;i huiriod iivmnor, and uruler many disadvanta- 
ges, ('.\|)rosse I our views of iho eiiiployiniMit of ergot in obstetric 
prattire, for the bciicKt of those whose opportiuiitifs Cur cxperienco 
mav have been ni )rc limited than our own. Should these remarks 
conduce in the sii;ih(est degree (o elucidate any of the diflicultics 
and doubts that may ernharrass the very youngest of our brethren, 
ojir object will be fully attained; but should the experience and oh- 
servation of others lead them to ado])t different opinions, it would 
afford us pleasure to see them expressed, and to have our own cor. 
rectfcd if wrong, it being always more gratifj'ing to us to receive* 
than to attempt to impart information. 

Note. — In proof that the foetus in utero is not easily affected by 
medicine civen to the mother, (specially narcotics, we would refer 
to a most interesting article, by Dr. Levert, of Mobile, published in 
the I\lny nunib(>r of this Journal, page 225; in which Dr. L. re- 
lates a remarkable case, wlierein enormous <loses ot the sulphate of 
morphine were given twice, and frequently three times daily, to pre- 
vent abortion, for a length of time before confine^^ent, with the hap- 
piest result both to mother and ofl^spring. 



ARTICLE II. 

Scraps from my Case Bonk. By Andrew R. Kilpathick, M. D., 

of Woodville, 3Ilss. 

The object in writing this paper is not to shew any new theory of 
disease, or any peculiar mode of treating it; but simply to record 
facts in pathology, and elicit similar contributions from practitioners 
of more experience and possessed of better opportunities for obser- 
vation. 

Ascaris Lumbricoides. These animals are so familiar to every 
person, and particularly every medical man, that the question may 
be asked, why say any thing on so trite a topic? It is true we are 
familiar with them, and this familiarity has lulled that watchfulness 
and hostility which should be exercised towards them. Some physi- 
cians look upon the management of such cases with contempt : 



1815.] Scraps frommy Case Book, 307 



npjLlK^cf ihfm ns iriwortliy a fl;»rt fron tluMr quivor ; leave lliein to 
the care of oltl woriK-n, <ir to riot on liie-vHais of tetuler jrnhjeels, 
until ihevfiestrov life. And there are persons to he f<jtind, c^ven in 
the medical ranks, who look upon wornis as heneficial to the human 
economy and "blessings in disguise." I. for one, can never view 
thf^m in that li^ilit. But it is also true tliat there are others who 
ascribe nearly every distemper to which the juvenile system is liable, 
to worms, and this hohliv causes ihetn to employ i>nlhe!u»iiit»r-s in 
excess, thereby superinducing fatal disease in cases which were 
at first simple an(i curable. 

Cask 1st. IGth Nov. 1340, I was called to see a negro jtjrl 9 
years of ajre, of small and delicate^frame. She complained first on 
the lOlh; on the 121) an emetic had been «riven. which acted par- 
tially. On the nl^^ht of the 14tli calonjcl and rhubarb each x. ^^rs. 
was given, producing four operations and liie discharge of four large 
lumbrici at once. 

When I first sa XV her ibe skin was hot and dry, pulse quick and 
freqr»enf, though compressible; tongue coated wilh a thick, yellowish 
brown fur; some apj)etite ; eyes dull and heavy. She had complained 
of \>n)n in the unibilic il re;iion, but evidenced no uneasiness or ten- 
derness, either by flintthing or speaking, or changing of countenance, 
wh(!n the abdomen was |)ressed by the band. Prescribed s'atim ol. 
ter«^b. X. gult,, ol. rieini §<s. and an enuHic of ipecacuatiha in the 
morning. Nov. 17th: Ves|H»re ; the oil had acted only once ; the 
emetic thi< morning threw up two large lumbrici; fever continues 
without remis^;ion ; pulse quick, freqinuit and feeble ; warm and dry 
skin; tongue slill f««ul and ibitkly coated, ('ontinue the ol. tereb. 
in ten drop dose s four linns a Hay. and cal« mel x. ;irs. at b(d-time. 
Did not see her on the ISih. and was called in haste to her early on 
the morning of the 19ih. Extremities cold ; in attempting toswal- 
low lea, she coJighed, strangled, and threw it back. Sl)e began to 
sink last night ; vomited frequently a dark brown fluid, exact- 
ly like the black vonjil of yellow ^KiXQr. She continued to call for 
tea and chicken water not half an hour before she died. She was 
repeatedly questioned as to the seat of pain during the two past 
days, but persisted in saying there was none. She died about 8 
o'clock, A. M. 

Post Mortem. Cadaver not much emaciated; abdomen fidl. 
When the cavity of the abdomen was first entered by the scalpel, a 
large qtiantity, fully three pints, of a light straw-colored serum, 



308 Scraps from my Case Boole. [June, 



giishrd out ; on layini; aside the walls of iho abdomen, the entire 
contents were (♦♦mid to he afiirliilinated in one common mass by coap- 
iilable lymph, and some porti< ns were quite firmly attached to each 
other. Omentum and mesentery inflamed and gannrrenous in places ; 
alimentary canal in its length, exrcrnally, highly inflamed, and in 
many places gangrenous and softened; internally it was inflamed in 
patches, and the colon not so much as the small intestines. Inspect- 
ing these closely, I found in the ileum an orifice about the fourth of 
an inch in diameter through which the faeces had escaped into the 
peritoneal sac. I suspected the worms had made this, and on ex- 
amining further I found two large lumhrici, one at the base of the 
spleen and the other under the stomach. Here was the cause 
of disease and death. I discovered eight other worms in other por- 
tions of the canal; three in the stomach and two in the oesophagus, 
which accounts for the choking and strangling in attempting to 
swallow. The liver and spleen were sound: stomach externally 
white; filled with the ahove mentioned "black vomit ;" heartsound; 
pericardium distended with serum ; lungs healthy. 

I was astonished at the extent of disease here present, when I 
called to mind the fact, that f.ressure on the abdomen caused no pain. 
On counting up all the worms, we found she had discharged twenty- 
four, and twelve were found in her, which make thirty-six in. all. 

This case gave occasion for her master to detail to me, 

Case 2d. In the summer of 1837, a negro woman of his fell 
down in the field "in a fit," as it is commonly termed. She was 
taken to the house in a state of insensibility, from which she was 
roused with difliculty, by venesection, stimulants, &:c. For some 
days she continued in a dull, moping condition, quite feeble, with oc- 
casional nausea and vomiting. He charged her with "dirt-eating;" 
she denied, and one morning exhibited a lumbricus which bad es- 
caped from her mouth while vomiting. This was a new feature in 
the case, and he proceeded to treat it for worms, administering 
ol. tereb. 5iij. and ol. ricini ':., which caused the expulsion per anum 
of 86 lumbrici in a few hours; next day the same dose was repeated, 
and upwards of 70 were discharged. She was much relieved, and in 
a few days was able to wo'k in the field. The next summer she was 
similarly attacked and similarly treated with the like results. It is 
often the fact, that accident, as in this case, reveals the true cause 
of disease. 

Cases 3d and 4th. 1844, Aug. 14lh.— Called this dav to sro 



1345. J Scrays from my Case Book. 809 



two cases of fever, in a negro woman aged 2G, and her son aged 10. 
Both had been seized with fever on the 10th with the same symptoms, 
and emetics of ipecacuanha were administered to them, followed by 
submur. hydrarg. and ol. ricini.: and sniph. quin. during the remis- 
sions. There was no severity in the symptoms until the 13th, when 
they both were suddenly taken worse, and at nigiU a passing physi- 
cian was called in, but discovered that they were beyond the reach of 
medicine, and told the owners so, although at their solicitation he 
prescribed for them. When I saw them at 10 o'clock, A. IVl., 14th, 
they were moribund, and died within a few minutes of each other, 
about 12, M. During the afternoon I opened both bodies, proceeding 
f.rst with the boy's. 

Cadaver not much emaciated. On laying open the abdomen 
the omentum mnjus was found q-iite small and as it were wadded 
down in the lumbar region. Stomach small, empty and apparently 
crowded into the left hypochondrum by the liver, which was very 
large, of leaden color, soft and easily torn and broken up by the finger. 
Spleen was double the natural size, very deep blue color externally, • 
soft, easily ruptured by the finger, and internally presented the ap- 
pearance of " blood-pudding." Stomach, kidneys and bladder, 
healthy. The small intestines, jejunum and ileum, were almost emp- 
ty, containing a little frothy mucus, thin faeces and dead worms, either 
extended at length or rolled in knots. Theprmcii)al features in this 
case were the intussusceplions, and to which I wish to direct tho 
thoughtful attention of the reader. There were ten places where ono 
portion of the small intestines and mesentery had slipped into another ; 
some were as much as eight inclics, and so firm as to require some 
force to draw them out. At every one of these places there were two 
and three worms rolled up in a ball lying at the upper part of the 
orifice. The canal or passage through these places was so small as to 
allow only a probe to pass. Tho small intestines were inflamed in 
their whole length, and gangrenous in spots. Thoracic viscera pre- 
sented nothing remarkable. 

Post morlem of the woman. The small intestines were the parts 
principally diseased, being highly inflamed and gangrenous in places ; 
they were also thin, and worms were easily discovered in them ; they 
were also nearly empty. Intussusception was also here in five places, 
where from two to eight inches of bowel were crowded into itself, 
and a cluster of worms was found at each obstructed place. Nothing 
of conHt'quiMKO in th<* othtT abdominal vif^cora or those of the thorax 



810 A Case of Procidentia Uteri. [June, 



wri<? spi^n. WliPii the intus<:n!«(.-o|)tocl j)I;iccs were extricated (hey 
W; r? ftiirifl com;)l 'ti'ly Hisi»ru;uii/cil. 

Ni»\v the qiicsliou arises liow was ll»i> indi^sinception prouiincd ? 
Was it ONviii;; to the knots of uorins joinin;^ ihemselves ti«;htly in 
the howels, inercasin«r the vermiciihir action of those phices and 
causinjx the stiperior porti4»ii of the t)o\vel to s\vai!o\v the lower? or 
were the parts placed in this mal-povition hy some other eatise, and 
the w«)rrns in traversing the canal met ihetse barriers and had there 
collected ? I confess my inahility to decide in this case. I «.bserved 
in many parts of the intestines inequalities in circumference, there 
being spaces of from one to three inches much smaller than tl»o 
balance, and it is j)ro])able that >iniilar contraciions had existed at 
the intussuseepted places of a more marked character than tliose I 
saw, an 1 the superior portions could easily envelope them. 

I purposely omitted myilioning the condition of the colon in these 
four cases, because I wish to mention a fact which I observed in all 
of them, and also in the cadaver of a case of marasmus in a ne«;ro 
child I optjned in 18^^9, and that is. {])>' coniroctcrl conilition of that 
gut. In all oi* these cases, the colons were sn»alh-r than the small 
intestines, lor)kin<r like ropes, all their convolutions and rujjosifies 
bad disappean-d. and the canal was so small as to admit with diffi- 
cu'tv the little finj:er. I have examined many authors, to discover 
their opinions on the matter, but Abercrombie is (he only one who 
even mentions it. If any one else can account for it, and will do so 
throujih this Journal, he will confer a favor on me, and peMhaps others. 

Another time I will give cases of a different character. 



ARTICLE III. 



A Case of Procidentia U.'eri fermanently cured by excision of the 
Vaginal folds — wilh remarks. By H. V. Wooten, M. D., of 
Lownlesboro', Ala. 

On the 12!h of July. 1?3S, I was called to Retty, a negro woman, 
nged a!ouf loif y.five. I found her greatly emaciated, and so feeble 
a«! (o be iinald!' to assume the silling posinre without as^isfjinre. Her 
features were shrunken, her countenance anxious, her pulse extremely 



164.''xJ A Case of Procidentia Uteri, 311 



frequent and iVebie, and as hor romnlaint was represented to be diarr- 
hcE.i, I viewed it as a ho|)eloss case. Her owner had njisnnderstood her 
case, and on rurlher examination I ascertained that she was affliet(d 
with procidentia uteri, wliich for six weeks past had been ailrndtd 
with profuse leucorrhoea. She stated that for eleven years she had 
"falling of the womb,'' that during all this time she had been subject 
to recurrences of the leucorrhoea, and that her general health had 
sufK.red much, until she now seemed reduced to the lowest extremity 
of existence. 

On ins])eclion, I found the uterus and everted vagina protruded 
entirely without the vulva, and forming a tumor of about live or six 
inches in length. Its surface was generally of a blanched and re- 
laxed appearance, but there were on each side, and nearly opposite 
each otlier, two projections or tumors, about the size of a man's 
thumb and about as long, with a slight swell in the middle, one ex- 
tremity of these ridges arose within half an inch o^the os uteri, and 
one of them ran a ccjurse slightly diagonal to the main tumor. They 
were very hard, with a glossy surface and of a livid hue. They 
seemed to be composed of the fdds of the vaginal mucous mem. 
brjine and their irjter-cellular tissue in an advanced stage of inflam- 
n-ation. On the posterior surface, and about an inch from the 09 
uteri, was an ulcer of oblong shape and about the size of a half 
dollar, and of an indolent appearance. 'J'he patient stated that about 
four days previous, a "lump" similar to those described, had sloughed 
from the seat of this ulcer. 

I attempted a n placement of the prolapsed parts, but found it 
impracticable. I ordt red the application of sol. lunar caustic to iho 
ulcer, an emolient poultice to the [larts, th(» free use of nourishing 
liquid diet, and carbonate of iron in large doses three times a day, 
with a view to promote general streisgih. 

I saw the |>alient agim on the 14:h — Condition about tho same aa 
at the first visit, except that the ulcer had a more healthful appear, 
ance, and the general strength of the patient was slightly improved. 
Still the prolapsed parts were irreducible. The propriety of excising 
the folds ofthe vagina, as reeoumiended by Dietfenhach, was forcibly 
suiTgr'stcd by the pecliar state of the case ; so I proceeded at once 
to the operation. After making the necessary preparations of po.si. 
tion, (kc, I excised the tumors above deseri!)ed at tlu ir bases, aiininf^ 
to remove the entire fold wuh the engorged ctllular tissue, and at the 
sanu^ ti(u.' avoid wnnnding the oiUuard c^nt of the vH<rinn, which I 



312 A Case of Procidentia Uteri, [June, 



found no difilculfy in doin^^ The operation gave scarcely any pain, 
and the ha?inorrhan[e was inconsiderable. 

Afier removin«jj botli folds, or tumor*, and hathint; the parts with a 
strong sohition of chloride of soda, I returned the uterus to its proper 
place without further difficulty. I used no sutures, as I could see no 
necessity fur them. I had the patient placed in a recumbent position 
with the hips elevated, ordered a continuation of the nourishing diet 
with carbonate of iron, and a solution of cidoride of soda to be 
thrown into the vagina twice a day. For this purpose I used a large 
gum elastic catheter, attached to a small enema syringe, fearing that 
the size of the common female syringe would interfere with the pro- 
cess of cicatrization. This course was continued with regular im- 
provement of the patient fur six days, when, the leucorrlioeal dis- 
charge continuing, an infusion of nut-galls was thrown into the 
vagina once a day in addition to tlie chloride of soda. The patient 
was kept in the recumbent position, strictly, for four weeks, when, 
with a compress to tlie hypogastrium and bandage around the hips, 
she was allowed to get up. By this time she had measurably regained 
her flesh, and was very soon able to attend to domestic business, with- 
out any symptom of her old complaint. 

I saw her in March, 1845, when she stated that she had not had 
the least trouble with the disease since the operation. 

I have had but two opportunities to perform the operation sinco 
this case, and they were in women within the child bearing period, 
and I refrained, lest it might interfere with the process of parturition, 
should the patient become pregnant. Ail authors who have recom. 
mended this operation, have, so far as I have seen, observed this cau- 
tion ; but Mr. Crosse mentioned that Dr. Fricke had reported a case 
to him in v/hich the patient had become pregnant, after the operation, 
and "was delivered by the forceps without the artificial bridge 
giving way." After the child-bearing period, however, there can be 
no doubt that this will be found a safe and highly successful operation. 

By reference to writers on this operation, I notice that there are 
two plans proposed and practised for performing it — for in principle 
they are but the same operation — the one to excise the folds of the 
vagina high up, and the other to cut and produce adhesion at the 
base of the labia. It seems to me, that in most cases the former 
would be preferable, because the "artificial bridge" or cicatrix is 
higher up, and belter calctilatcd to support the uterus in its natural 
position, and becau.-se ibe part (^pcialtdun is k>s sensitive, giving the 



1315.] Hogs Lard fur Obstructions of the BoLceh. 313 



patient less pain in the operation, and subsequent treatment. 

I used no sutures in this case, because I expected the edges of the 
denuded surfaces to approximate spontaneously, and moreover, the 
object of the operation, as I conceive, is not so much to contract the 
vaginal canal, as to lessen its dilatability. ^riie smallness of the va- 
gina would ofTer but little obstacle to the descent of the uterus, if the 
dilatability remained excessive. A cicatrix is the in)portant object 
in this plan of treatment, on account of the firmness it imparts t*) 
the support of the uterus, and this I expected to obtain as well without 
ss with the sutures. The first case of permanent cure which sug- 
gested the operation to Dietienbach, was by sloughing of the vaginal 
fold, where of course, no sutures were used, and he says that, in hia 
operations he frequently used none at all, as " the edges of the wound 
frequently came in close contact with each other, after the reposition 
of the uterus." Whilst the sutures can do no harm, except a slight 
increase of irritation, there can be but liitlo doubt, that operations uf 
this sort will generally do as well without them. 

The greatest possible caution should always be used to prevent the 
descent of the uterus while tiic heaiiu'Z l)roccss is jjoincj on. 



A2TICLE IV. 

Hogs Lard a Remedy for Obstruct ions of the Boicels. By J. A. 
Mayks, M. D., of Bradlcyville, Sumter District, S. C. 

The aim and object of the medical profession is the relief of human 
suffering; and, as this object can be best accomplisiied by individual 
members of the profession freely communicating to each other, tho 
results of their experiments with the resources of our art, and there- 
by placing the knowledge of one at the disj)osal of another, no other 
apology, it is hoped, will be required for the obtrusion of this article 
upon public notice. 

The bowels frequently become so mucb obstructed by indurated 
faeces, that the best directed elForts of physicians to overcome tho 
obstruction, often prove useless, and even worse than useless, since 
the means we use for relief, if they fail, are apt to aggravate the mis- 
chief, by producing inn.nnuvjtlon, and con<iqiirntly, the chance of 



314 Hogs Lard for Obstructions of the Bowels. [Ji\nc, 



savirifT the life ofonr |)aticnt is lessoned. For such conditions ofthe 
bowels we h;ivc mariy reini^iies nlieady, anrl the list is rrradually 
lentrthenin^; but, occasionally, all the iK^ual resources of art within 
our reach have been used, and yet our patient has not oh aiiied relief. 
Such a case as this occurred in my prsjctice a few days ago. Every 
means in my power had to be called into requisition i"n this case; 
and my patient recovered, at last, under what I believe a very unusual 
course of treatment ; at least, a plan oftreatment which must be very 
rarely employed, as I see no mention made of the successful remedy 
in medical works in such cases, and have never heard of a similar 
practice being adopted by any one. I, therefore, make this commu. 
iiicalion, believing that a sli<:ht addition will be made, by it, to the 
general stock of mi.>dical knowledire. 

Casi:. George, a negrri man, aged 30, a tailor by trade, was, on 
Thursday lOlh A|)ril, 1815, attacked wiih very violent pains in the 
bowels, resem!)lin<^ spasmodic colic. For his relief. Dr. Mwldrow, 
his owner, prescrihed purnalives ccunbined with opiates, blisters, 
enemata, (Sec, without much benefit. Very small discharges from 
the bowels could be (obtained, and these, not without repeated 
enemata. His symptoms being more severe on Saturday morning, 
the 12th. I was requested to visit him. I found him suffering very 
acute pain throughout the abdomen, but especially severe on the right 
side; his abdomen was timiid and hard; com|)Iaincd very much of 
the slightest pressure; breathing, hurried: pulse, soft and regular ; 
has had no fever since his atlack ; pain occasionally remitting, but 
soon returning wiih as much secerily as ever ; had vomited a great 
deal : for twelve months past has been rather costive, and had had 
two or three attacks of colic lately, but none of much severity ; being 
soon relieved by purgatives. The existence of enteric inflammation 
in this case was thought probable; but the symptoms and the history 
of the case were such as to incline us to the opinion that spasmodic 
colic was the cause of his sufTerings. In consultation, it was deter- 
mined to administer calomel 10 grs., Dover's powder 20 grs., every 
three hours — mucilaginous drinks to be used freely, and purgative 
enemeta to aid the operation of medicines. 

Sjuday morning, 13:h. George does not complain so much of 
pain this morning; the medicines taken by the mouth had caused 
V(.mi iug of fluids in very large quantities, mixed with some stercora. 
ceous matter. The enemata had the ctK-ct of cleansing out tho 
lower l)owc'3 only ; the two or three last having been discharged in 



1815 ] Hogs Lard for Obslrucfious of the Bowels. 315 



the same s'nte as \vh?ii injected. His p..l.s(} still remains soft and 
re«rM!ar, with a litllc iidness — no fever; constant iiiccup. Directed 
{\^\}, calomel and Dover's powder to be continued ; eneinata of castor 
oil and spts. turpentine everv two hours: to be kept in the warm 
bath tip to his chest until his pulse becomes afijcted. 

Sunday evening. Constant slercoraceous vomitinf^ through the dny 
— no discharge at all downwards, the enemata coming away without 
even a faecal odour; the pulse and other symi)toms the same as in 
the morning. As purgatives by mouth seemed to increase the ster. 
coraceous vomiting, the Dover's powder alone, in doses of 10 grs. 
eve y Iwo or three hours was directed. 10 or 15 grs. tartar emetic, 
(ii.ss(»lv(.'d in a pint of warm water, was directed as encrnata, to be 
repeated -pro re nMa. 

Monday morning, 14th. The stercoraceous vomiting slill contin- 
ues, and is worse than ever, the matters vomited being large in quan- 
tities and of a pea green color ; no discharge downwards — the tartar 
emetic enemata were several times repeated, hut had no perceptible 
efTcfCt. Other symptoms as before. Directed 4 grs. ext. hyosciaun 
every three hours — infusion of tobacco as enemata — cataplasm of 
tobacco over the blistered surface on the abdomen — the enemata to 
be repeated fro rr nata. 

Monday evening. The vomiting has ceased since 10 o'clock ; but 
the tobacco, twice u<ed, producerl no other (fleet than very great 
prostraliim ; not much pain in the bowels and the di>tention of the 
abdomen not so great. Directed inject iorjs of C(dd water, to 1)0 
frequently repeated until nine or ten pints should be thrown into the 
bowels. Ext. hyosciami as ben)re. . 

Tuesday morning, 15lh. Has had no return of the vomiting — the 
injection of cold water had come away scarcely colored: pulse arid 
other symptoms about the same as before — a small quanlitv of sol. 
veratrini was injected into the rectum, to produce, if possible, a de- 
termination downward, but with no perceptible effect. As no instru- 
ment for passing fluids high u()the inlvstines, could be procured, we 
were at some loss how to proceed.* In consultation, it was agreed 

♦ We have been in the habit for some years of passinc^a ^nm elastic stomach 
tube into the colon, in all cases of colics, throu'^h which a lar^^e injection of salt 
and water, or other flui-J, may be easily thrown up into the lari^e intestine, 
with a common syrin2:e. There is neither ditncidty nor d; nj?er in the introduc- 
tion of the lube, ;.nd in no instance have we ever known .':n enema administered 
ill this male tj f..il in ;2:ivin .j prjfnpt and elL'clual relief. So uniformly suc- 
cesslul is this ino.lc ol tie.tmetit, ili;.t we have pretty much ceased to give any 
jiieJicines by the month in such c:.sefi. — Enra. 



1310 Ilogs Lard for Obstructions of llie Boicels. [June, 



to fill his bowels, by mouth and hy rectum, with some bland oil, and 
afterwards administer some drastic purgative. For this purpose, 
none seemed to be better adapted than melted hogs lard. A largo 
tea cupful of melted lard was immediately administered, and directed 
to be repeated in three hours — with eneniata of one pint melted lard 
every hour. The ext. hyosciami to he continued as before. 

Tuesday evening. Has had no return of the vomiting, but the 
stomach seems oppressed by the lard swallowed ; no pain, pulse very 
good. The last enema of lard had a very strong faecal odor w hen dis- 
charged. Directed the lard enemata to be repeated every hour — 
another tea cupful to be taken at night — a pill of morphia at night. 

Wednesday morning, IGlh. We were, this morning, agreeably 
surprised to find a large discharge from the bowels; the stomach no 
ioDger opprcssetl by the lard swallowed; no hiccup ; our paticnt'd 
countenance brightened very much — no longer the sunken eye, tho 
hagnjard look, the image of despair. We resolved to push our remedy 
still further — another tea cupful was adnjinistered and the lard ene- 
mata repeated every two hours — with morphine in small doses every 
three hours. 

Wednesday evening. Very large quantities of fccces mixed with 
lard are now discharging (Vom the bowels ; no uncomfortable symp- 
toms about tho bowels at all ; a small dose of caster oil was now 
given, directing it to be followed by a lard enema, if it does not 
operate in four hours. JMorphine to be continued. 

Thursday morning, 17th. The castor oil operated largely, in two 
hours afcer beirtg taken, biinging away much ra3cal matter and about a 
quart of lard. Directed nothing more to day than light nourishment 
with mucilage of slippery elm — morphine as ben)re. 

Friday morning, 18th. Faeces mixed with lardare still beingdis- 
charged from the bowels, but not in such abundance as before. A pill 
of morphine was directed night and morning for a few days — light 
nourishment, aromatic tonics and aperients when necessary. 

After this my attendance upon George ceased, and he was left un- 
der the management of his owner. lie is now rapidly convalescent, 
and will soon regain his former henllh. 

It is the opinion of Dr. INIuldrow and myself, that (he favorable ter- 
mination of this case was brought about by the hogs lard, when 
nothing else would have been of service. The details of treatment 
have been given, to convey some ideaof the nature of the case ; and 
whoever sludio?; tho case with attention, must arrive at the same 



1845.] Tubercular Development in an Infant. 317 



conclusion. Other moans, it is possible, may have been used with 
success; but none, \\c venture toaOlrm. could have acted so ofTectu- 
ally as the hogs lard, without producing some inflammation of the 
bowels. Being a mild aperient, and, at the same time, a suitable 
article for lubricating the bowels, nothing could have been better 
adapted to the case. Our patient took altogether, by mouth and by 
cnemata, a gallon and a half or more of melted lard, without any in- 
convenience at all resulting from the use of such a prodigious quantity 
of oil in his bowels — a circumstance, which could have resulted from 
the use of no other remedy in similar quantities, and which, the writer 
believes, will cause hogs lard to be elevated to a more honorable 
position in the materia medica than it has liitherto occupied. 

In conclusion, I would respectfully invite the attention of practi- 
tioners generally, to this subject; and hope, should cases similar to 
that reported occur in their practice, the remedy here treated of may 
have a trial. One case does not establish the utility of anv article — 
several are required, and I hope soon to hear of hogs lard being used 
successfullv in several cases of obstructions of the bowels. 



ARTICLE V. 

Report of a Case of Tubercular Development, occurring in a Child 
under one year of age. By H. F. Campbell, M. D., Demonstra- 
tor in the Medical College of Georgia. 

Inasmuch as there are comparatively but few cases on record 
wherein tubercular disease occurs in subjects under a year old, as is 
shown by all tables of mortality from phthisis, (the majority of au- 
ihors estimating the disease as occurring in subjects over fifteen years 
of age and upwards.) 1 would subjoin the following one simpiv 
with the view of corroborating the principle that consutnption can 
occur at that early age, by adding one more to the small number of 
cases now on record. Dr. Cless, of Stuttgart, in a recent publica- 
tion on the presence of tubercles in the diflerent organs, it) a January 
No. of the Gazette MeJicale de Paris, cites twenty children with 
tubercles in the lungs, but one was under three years of ngo. The 
fables also of Baylc and Louis show their estimates to have been taken 
from subjects between 15 and 70 years of a;:c. 



318 Tubercular Development in an Infant. [June, 



'I'lie case now tiiidor cnusicIiMalioti wnstliatofa mwl.ilto f* mrilcj 
child, the oir>|)iiii<; of parents very young, tlio mother being si niulal- 
to pirl ahont 15 years of age, of a strninons habit. Ti)C child from 
birth had been unhealthy, evincing a remarkable susceplibility to cold, 
manifested by rcj)eated attacks of pneumonia and plouritis — its di- 
digestive organs were also frequently deranged — Siomc months pn vi- 
ous to its death it had been alibcled with opj)ressed respiration which 
together with hectic and other marked symptoms of pulmonary dis- 
ease, led Dr. Joseph A. Eve, the attending physi<:ian, lodiognoslicate 
the existence of tubercles. 'J'hroughout its whole existence the above 
symptoms were accompanied by an irritative, feeble cough, without 
much expectoration, and by the manifestations of the child, he had 
reason to suspect on certain occasions that it suffered an acute pain 
in the region of the right lung. Pulse feeble and very rapid ; within 
from 25 to 30 days of its demise, there could be distinctly felt 
through the abdominal parietes many rounded projections o( variable 
dimensions, apparency attaehed to the posterior wall of the abdomen 
— its bowels had been, and from the present till its death were, affect- 
ed by a colliquative diarrhoea. On the of February, 1845, it 
died in a typhoid state, from exhaustion and suffocation. Autopsy, 
made in presence of Drs. J. A. Eve, Low, and others, about 14 hours 
after death. Emaciation extreme. 

On opening the thorax, I find the Irft pleura very nearly sound 
and of natural color, there being no adhesions and but litile effused 
fluid in its cavity. The lung though crepitant, not entirely free from 
disease, there being at its base innumerable greyish points of various 
magnitude, the radicles of crude tid>ercles, some of which are (is- 
distinguishable through the pleura pulmonalis opposing the supiyior 
surface of the diaphragm. 

The right vlrura pulmonalis adherent to the pleura cosfatis and 
pleura diaphragmatica throughout their whole extent by half organ- 
ized lymph, being in some places one-fourth of nn inch in thickness 
while in f)thers the adhesions of the pleura are immediate. 

The right lung, throughout its whole extent, is occupied by tuber- 
cles in every stage of development, and in the lower lobe is an 
abscess about three-fourths of an inch in diameter, filled with pus, 
there being also a smaller one in the n)iddle lobe. 

Only at the apex does there exist the least crepitus whatever, while 
the remainder of the lung is in a state of complete tubercular hepat- 
ization. Heart and pericardium natural. 



1845.] Tubercular Development in aji Infant. 319 



On opening (he cavity of the abdomen, the stomacli is found in a 
normal condition. 

Sma'l in'estines at particular places somewhat contracted, though 
no intussiiscrption. 

Large intestine, sound. 

Mescn'erlc gland'i,{\\vo\\^\\o\\i t' e whole extent of the mesentery, 
enormously enlarged, many of them to nearly the size of a walnut, 
while in some few I can plainly recognize matter hearing a close 
analogy to tubercular degeneration. Liver sound, wi.h gall cyst 
empty. Spleen atrophied. Kidneys sound. Pelvic viscera unex- 
plored. 

Remarks. The development of tubercles in the above case, was 
favored by two circumstances to the predisposing influence of which 
is due perhaps more important consideration than is in general ac- 
corded them — namely : the extreme youth of the child's parents, and 
sfill more, the fact that it did not claim its being wholly from either 
the Caucasian or African race; either of which, daily observation 
inculcates, is by far better calculated to resist pulmonary and stru- 
mous disease than the truly unnatural being, the mutual offspring of 
these two races so eminently ditfering from each other in many essen- 
tial particulars of habit and constitution. 



Note. — In corroboration of the paucity of cases on record of 
tubercular development in infants producing death, we observe in the 
9(h vol. of the Mcdico-Chirurgical Transactions, London, a tabular 
view of the seat of tubercle in 180 cases of children, of which num- 
ber not one was under 19 .nunlhs. — Edts. 



320 ' Treatment of Sypluliiic Discis'is. [June, 



Part II.— REVIEWS AND EXTRACTS. 

Treatment of SijphiJitic Diseases by Iodide of Potassiu7n. By 
H. jGouRAUD. From the Journal des Connaissances Medico- 
Chirurgicales, March, 1815. (Translated for this Journal.) 

Doctor Coindct, of Geneva, who first introduced Iodine into thcra- 
peiitics, (after its discovery, in 1811, by M. Courtois,) published, in 
1820 and 1821, three articles in wlijch the use of this substance was 
recommended in j^oitre, scrofula, and in some other diseases. M. 
Coindet even foresaw from the beginning the probable utility of the 
new medicine in certain forms of syphilis. 

Twenty-five years only have elapsed since the therapeutic origin 
of iodine, and at the present day it is extensively employed and forms 
one of the principal agents in the practice of a great number of phy- 
sicians. All are acquainted with the excellent researches of M. 
Lugol upon the powerful action of iodine in scrofulous afTections, and 
know the immense extent of this class of affections in all their 
visible forms, and in their more or less appreciable transforma- 
tions. Ifto the great class of scrofulous diseases and of their numer- 
ous degenerations, we add that of syphilitic affections with their 
different varieties in which iodine produces so many marvellous 
effects, we embrace at once the majority of cases in which the use of 
this medicine is irioicatcd. Formerly Bordeu considered scrofula, or 
at least certain forms of it, as being primitively of a syphilitic na- 
ture : this opinion has been recently revived by M. Ricord, and 
certainly deserves consideration ; it does not exclude the important 
opinion of M. Lugol respecting the very great power of hereditary 
influence, nor that of M. Baudelocque, who, without denying its 
hereditary character, places first among the causes of scrofula the res- 
piration of vitiated air. These opinions do not conflict, but all of 
them seem to be true in practice. Rordeii, believing in the syphilitic 
origin of scrofula, sometimes cured the disease by a mercurial treat- 
ment ; and does not the success which at the present day so frequently 
attends the treatment of scrofula and of syphilis by iodine, prove an 
affinity between these two affections? 

Iodine is now very frequently employed as an anti-scrofulant, an 
anti-syphilitic, a tonic, a sfimnlanf, an alterative, <^-c. Docs it not 



1845.] Treatment of Syphilitic Diseases. 321 



occupy at the present day the position formerly erijoyed by mercury? 
For some time a great numher of poisonous effects were attributed to 
its use, and the Germans have even described a particular disease 
produced by the administration of this substance: but at the present 
day it is employed without fear, and in considerable doses. We 
believe that the reputation of iodine is now permanently established. 
We have seen it act so beneficially under desperate circumstances, and 
derive so much advantage from its use in our daily practice, that we 
regard it as an heroic and special medicine : we also think that it is 
generally well tolerated by patients, (with some rare exceptions,) 
and that it may be given in large doses provided the general laws of 
therapeutic toleration are observed. We^do not however design to 
write at this time the therapeutic history of iodine — we only desire to 
call the attention of our readers to a very interesting work of Doctor 
Gauthier, of Lyons, upon the treatment of syphilitic diseases by the 
iodide of potassium. In 1823, M. Ricord Des Brus employed the 
tincture of iodine in blennorrhagia and in buboes: subsequently M. 
Eu>eSe de Salle made similar trials; and also M. Lallemand, of 
Montpelier, in 18'26. It is, however, to Doctor Wallace, of Dublin, 
that belongs the honor of having first employed the most suitable pre- 
paration of iodine — the iodide of potassium: of having administered 
it in doses much larger than those formerly given, and of having dis- 
tinguished those cases of syphilitic affection in which this medicine 
is most efficacious and in which it should be preferred to mercury. 
lie made his experiments from 1832 to 1836, and disclosed the results 
in his clinical lectures which were published in 183G. Subsequently 
other English physicians, viz: Doctors Robert Williams, Judd, A. 
Saville, Winslow, and Bullock, have verified the results announced 
by Doctor Wallace. In Germany, Doctor Elbers, of Breslaw, and 
Doctor Kluge, of Berlin, have recommended the same practice. 
Finally, in 1839, l\I. Ricord, in France, published upon this point a 
very interesting article. The use of this medicine is now universal ; 
facts abound in its fiivor, and the iodide of potassium may be cited a» 
a specific in the obstinate cephalalgia dependent upon syphilitic 
exostoses, in the same way that quinine is cited as a specific in inter- 
mittent fevers. 

We believe that pure iodine miited with the iodide of potassium, 
and administered according to the method of M. Lugol, is more easily 
tolerated than some physicians pretend, and that the toleration is 
^reafpr in thos'' ri^p> in which it is properly pr^escribed. It must be 

CI 



322 TrealmeiU of Syphilitic Diseases. [June, 



confessed, however, that some patients either will not bear the article, 
or will not tolerate a gradual increase in the dose. It is also true 
that it exerts upon the testes and uj)on the mammary glands an atro-^ 
phic action which must be regarded as an inconvenience. But the 
iodide of potassium administered alone docs not produce these bad 
cfFccts. Wallace, in 1836, ascertained by experiment and by clini- 
cal observation that the irritating quality of iodine does not ex st in 
the iodide of potassium, or at least only in a very feeble degree. "If 
we introduce," says he, "pure iodine into the stomoch of a dog, the 
mucous membrane is soon found inflamed, altered in its color and 
ulcerated, but if we introduce an equivalent or greater quantity of 
iodide of potassium, the stomach undergoes no alteration." 

The same thing is true with respect to its atrophic action. Wal- 
lace, M. Ricord, and Doctor Klugc, of Berlin, have never observed 
the absorption of the mammary glands; nor of the testes, nor emacia- 
tion, although they have practiced in large hospitals. The observa- 
tions of Doctor Gauthier have for several years confirmed upon this 
point the experience of the physicians of Dublin, Paris and Berlin, 
whom we have just cited. We believe that this fact is established 
by daily practice, and we hear fewer complaints against iodine and 
its preparations, since the exclusive administration of the iodide of 
potassium has been so generally adopted. 

The augmentation of the urinary secretion is one of the most re- 
markable and constant effects produced by the use of the iodide of 
potassium. This phenomenon arrested in a particular manner the 
attention of Doctor Wallace, who derived practical inferences from 
it. The iodide of potassium is found in considerable quantity, not 
only in the urine, but also in all the excreted fluids, and this explains 
the reason why it may be administered in large doses without pro- 
ducing injurious consequences. 

M. Ricord has described in a very complete manner the eirccts of 
the iodide of potassium upon the economy. In a memoir published 
by him in 1841, he says that this remedy produces frequently upon 
the skin different kinds of eruption which resemble psydracia, acne 
or ecthyma, and which are sometimes simple erythemoids ; that it 
frequently causes a species of salivation ; that it increases the urinary 
secretion; that it causes often a vascular injection, with tumefaction 
of the conjunctiva ; that in many cases also may be observed, under 
its influence, ti peculiar kind of coryza, and a bronchitis characterized 
by a well marked embarrassment in rcsj)iralion. M. Ricord ali^o 



1845. J Treatment of Syphilitic Diseases. 323 



includes among the phenomena caused by this substance, cerebral 
congestion^and a species of intoxication, and also spasmodic move- 
ments and tvvitchings of the tendons. 

Some of the phenomena mentioned by M. Ricord have not been 
observed by M. Gauthier, but he administered the iodide in smaller 
doses than those used by M. Ricord. Almost the only phenomena 
which he perceived to obtain with constancy were, increase of the 
appetite and of embonpoint, the coloration of the tissues, and the 
more abundant secretion of the urine. 

The iodide of potassium has been employed, and with good suc- 
cess, in the primary symj)toms of syphilis by several physicians, but 
as these primary symptoms disappear sometimes only by the observ- 
ance of cleanliness, and by an antiphlogistic regimen, facts of this 
kind arc rather deficient in value. But it is especially in the second- 
ary and tertiary symptoms that the curative powder of the iodide of 
potassium has been recognized. The patients treated by Doctor 
Wallace were affected with iritis, testicular engorgements, nodes and 
other affections of the fibrous, synovial and osseous systems, with 
cutaneous eruptions, and with diseases of the mucous membranes. 
M. Ricord insists much upon this distinction, that mercury is more 
suitable in the secondary symptoms, and the iodide of potassium in 
the tertiary symptoms ; and that in general, in proportion as syphilis 
comes to be transformed and its symptoms become tertiary, mer- 
cury loses and iodine gains in cfiicacy. 

31. Gauthier has found the iodide of potassium useful in the tertia- 
ry and secondary symptoms of syphilis : he has seen the most intoler- 
able pains of the bones cease in a few days; he has seen caries very 
promptly modified — ozena, with caries of the bones of the nose and 
perforation of the palatine arch, almost always cured; the gummy 
tumors, the deep seated tubercles of the skin and mucous membranes, 
and periostitis, also cured. The iodide of potassium has not appear- 
ed to him to be suitable to all cases of the syphilides. " In the exan* 
thcmatous, papular and squamous pyphilides," says he, "its use has 
produced, in general, no effects, or those which were only slightly 
advantageous ; but in the ulcerated tubercular syphilide, in that espe- 
cially which is called by !\I. Cazenave perforating tubercular syphil- 
ide, in the vast ulcerations of the skin which had destroyed the 
« cllular tissue and a portion of thesub-jacent muscles, I have obtain- 
• d from its employment the finest cures, and that too in cases »n 
which mercurial preparations- had l»ecn rather injurious thaij useful. 



324 Treatment of Syphilitic Diseases. [June, 



1 have also seen it cure syphilide accompanied with larj^e pustules 
and ecthyma. It may be said, as a jijeneral rule, that in the syphilides, 
whatever maybe their primitive forms, the iodide of potassium pro- 
duces advantageous effects, whenever they become ulcerous. Mcr- 
cury may doubtless cure also in such cases; but when it has been 
already employed by ihe patient, the iodide of potassium deserves 
the preference. Whatever may be the secondary or tertiary syphil- 
itic symptoms in which this remedy is employed, it may be remarked 
that, in general, it succeeds with the greater certainty whenever the 
constitution of the patient is deteriorated — in contrary cases it is less 
efficncit)us, and even sometimes fails." 

The last remark of M. Gauthier has its importance; for it was in- 
tended for certain anti-syphililic modes of treatment, particularly that 
of Dzondi. Beside? it corroborates the opinion of M. Ricord upon 
the kind of curative affinity which the iodide of potassium has for the 
tertiary symptoms, and for scrofula, which he regards as a tertiary 
syphilitic degeneration. The physician then knowing the admirable 
therapeutic resources which the healing art places at his disposal, will 
be no more discouraged by the cachectic state of his patients, than the 
surgeon will be deterred by the great debility of his subjects from the 
performance of amputations, when he recollects that very frequently 
wounded persons exhausted by suffering, by suppuration and by fever, 
present the best chances for successful operations. 

The physicians who have employed the iodide of potassium, vary 
much in the doses in which they have administered it. For several 
ye.ir«, only 4 or 5 grains were given in a day. Wallace employ, 
ed a mixture, composed of 2-h drachms of iodide of potassium and 

2 ounces of water, of which he gave a tea-spoonful four times a day, 
which was equal to near 40 grains daily, and administered always the 
same dose during the entire treatment. This is a faulty method, for 
experience has shewn that doses increased during the course of the 
treatment are much preferable. 

M. Ricord administersthe iodide of potassium in much larger doses; 
be commences with 20 to 40 grains a day, and pushes it rapidly to 100 
or 120, and has even given 160 or 180 grains. He administers the 
medicine in a ptisan ofsoapwort, or of hops, or in the syrup of sarsa- 
parilla. In cases in which there is a combination of secondary and 
tertiary syphilitic symptoms, M. Ricord prescribes the proto-iodide of 
mercury at the same time that he uses the iodide of potassium. 

M. Gauthier commences the use of the iodide of potassium in a 



I.,. 



1845. J Treatment of Syphilitic Diseases. 325 



small dose, such as 5 grains, or even less. Ee regards this prac- 
tice as necessary to avoid the occurrence of accidents. As far 
as we are concerned, we have seen in general the medicine tolerated 
easily, in doses much larger than those employed by M. Gauthier. 
It is true, however, that in some patients more caution must be ob- 
served. The physician of Lyons increases rapidly the dose to several 
scruples, and finds it useful to give the medicine in a mucilaginous 
ptisan. The ptisan which he prefers is composed of 2 scruples of 
salep and 2 ounces of gum arable boiled in 6 tumblers of water. 

In ulcerations of the throat, M. Gauthier touches the ulcers with 
charpie, saturated in the following mixture: 

R Iodide of Potassium, . . . gr. 12. 
Tincture of Iodine, . ... 32 
Distilled Water, .... g 6. 

When it is necessary to administer mercury at the same time, ho 
prefers M. Boutigny's syrup of the d^uto-iodide of mercury. 

The iodide of potassium ought to be continued for a certain time 
after the complete disappearance ofevery symptom. Besides, accord- 
ing to the remark of x\I. Ricord, there is no inconvenience in continu- 
ing a remedy which increases in the most energetic manner the 
activity of the digestive functions, and the appetite and embonpoint of 
those who make use of it. The work of M. Gauthier concludes with 
thirty-four cases in which the iodide of potassium cured, more or less 
rapidly, deep seated ulcerations, caries, syphilides, ulcerated tubercles, 
pains of the bones, &c. We think that some of these cases will be 
interesting. 

Cask 1. Vast ulcer of the pharynx with destruction of the soft 
palate, in a woman who had never taken mercury. Administration 
of iodide of potassium — Cure. 

The widow G , aged 60, came to consult me in the early part 

of April, 1844; she had a very large ulcer which had destroyed en. 
tirely the soft palate and the uvula, and which extended over all the 
posterior face of the pharynx. All these parts were the seat of a 
very abundant suppuration. This woman could utter a few words 
only with the greatest difficulty. For a long time she had been able 
to swallow only milk and soup for her nourishment. I informed her 
that she had a venereal disorder, and that she could be cured. She 
made the most positive denial : asserted that she had never had such 
an affection ; that she had been a widow for several years; that she 
could not hope for a c\ire, and only desired some relief from her suf- 



326 Treatment of Syphilitic Diseases. [June, 

ferings. A physician, deceived doubtless by her denial, had simply 
cauterised the ulcerated parts with nitrate of silver, without employ- 
ing any anti-syphilitic treatment. Having interrogated this woman, 
she informed me, however, that siie had been troubled about 15 years 
before with white discharges from the genital apparatus, and that she 
had also experienced deep seated pains during the night in the head 
and limbs. She had been told that it was a rheumatic aflection. I 
prescribed immediately the iodide of potassium in the dose of 4 
grains per day. I exhibited it in the syrup of Cuisinier, diluted 
with a mucilaginous ptisan. I ordered at the same time an iodine 
gargarism, and recommended the patient to touch several times a 
day the ulcerated parts with charpie, saturated in the gargarism. 
The dose of the iodide was gradually increased ; it sometimes dis- 
tressed the stomach; in which case I added a little syrup of poppies. 
After the expiration of eight days the change was very appreciable, 
the suppuration was much diminished, and the deglutition more easy. 
In a month the ulcerated surface was entirely cicatrised. The pa- 
tient took, however, only 1 scruple of the iodide a day, and it was 
sometimes necessary to suspend the use of it. The treatment was 
continued for two months. At the present time the patient enjoys 
very good health, has a good appetite, but there is much difficulty 
in eating, as the food and drinks enter into t!ie nasal cavities; her 
voite also is much affected. 

Case 2. General perforating tubercular syphilide; pains of the 
bones ; extreme emaciation : the iodide of potassium in very large 
doses effects a cure. Relapse after some months ; pains of the bones 
and hydarthrosis: new cure by the iodide in much smaller doses 
than at first. 

Claudine J , aged 32 years, of a lymphatic temperament, was 

attacked, in April, 1842, with ulcers on the genital parts, which were 
cured by cauterisation and mercurial pills. Three months after this 
cure, there supervened a tubercular syphilide over the whole body, 
which was treated with sudorific ptisans, the liquo«* of Van Swieten, 
the syrup of Cuisinier, &;c. The alimentary canal soon became irri- 
table, cough supervened with hectic fever, the menstrual discharge 
ceased, and the syphilide, instead of improving became worse and 
worse. She was admitted into the hospital of Antiquaille, April 
18th, 1842, in the most deplorable state: large ulcerated tubercles 
exist over the entire surface of the body, some of them upon the fore- 
head, the cheek, and behind the enrs. are ns Inrgo as a qtiarter 



1!=?45.] Trcalment of Sypli'dilic Diseases. 327 



dollar, some of them are covered with a thick scab, and from others 
exudes an abundant serous pus ; they penetrate very deeply; the 
largest ulcerations occupy the left leg; this affection presents the 
aspect of the perforating tubercular syphilide of M. Cazenave. The 
patient is in a very cachectic state, the ulcers are very painful, and 
when in a bath they bleed : cough, epigastric pains, tongue red, ces- 
sation of the menstrual discharge for five months, hectic fever, ex- 
treme emaciation, complexion livid, nocturnal pains in the extremilie.'^, 
which cause an obstinate want of sleep. 

After having subjected this patient for a month to mucilaginous 
drinks, to milk, and to opiate potions, I ordered the iodide of potas- 
sium in the dose of 2 grains per day, which I gradually increased 
to the doso of 1 scruple. Some amelioration then ensued. When 
the dose reached 3 scruples the condition of the patient remained 
stationary. I thought then that the proto-iodide of iron would be 
more suitable, because of the amenorrhoEa and of the cachectic state 
of the subject. I was deceived in this opinion. During the admin- 
istration of the iodide of iron, 1 scruple of which w^s given each 
day, the ulcers became more extensive and painful. The iodide of 
potassium was then resumed. As the condition of the ulcers had 
remained stationary while she was taking 3 scruples, the dose was 
now increased. When it reached 4 scruples per day, I perceived 
that the patient tolerated it well, and that her condition slightly im- 
proved. The dose was increased until 7 scruples per day were 
taken. I accomplished a cicatrisation of all the ulcer.?. The men- 
strual evacuation returned, after having been suspended for a year, 
and the patient left the hospital in a tolerably satisfactory condition. 

Having been exposed to cold and damjmess she was taken with 
very acute pains in the articulations, and was admitted into the Hotel 
Dieu, of Lyons, where she was treated with the extract of aconite. 
She left that Hospital much relieved, and was admitted into that 
of Antiquaille the 22d of August, 1844. She was then troubled 
with nocturnal pains in the bones of the head, there existed upon the 
arm one tubercle covered witii a scab, and besides she was affected 
with hydarthrosis of the wrist and of the fcxit. I doubted at first the 
syphilitic nature of these symj)tonis — I emjiloyed vesicalories, fumi- 
gations, and vapour baths, but unsuccessfully. I had recourse again 
to the iodide of potassium. I commenced the 22d of September 
with a dose of 10 grains ; on the 4th October she took 30 grains. 
Tlif nocturnal pains of the brad had alitady disnppenrel. On 



328 Diseases of the Heart. [June, 



the 8th October, 35 grains of the iodide were administered ; the 
hydartlirosis of the wrist and that of the foot have greatly dimin- 
ished. On 15th of October, 2 scruples of the io(Hde ofpolnssium 
were taken; the hydarlhroses have disappeared, and the patient has 
a good appetite. The treatment was continued to the 1st of Decem- 
ber, and the patient left the hospital on the lOlh of that montii The 
menstrual discharge at that time had not re-appeared. N. 



S(me of the Diseases of the Heart. By C. J. B. Williams, M. 
D., F» R» S., Professor of Medicine in the University College, t^c. 
London. 

Sounds of the Heart. — The sounds or murmurs accompanying the 
systolic action, as also the impulse, must be modified greatly by the 
force of the current out of the ventricles. There are several cir- 
cumstances to be taken into consideration in reference to this subject ; 
for instance, the blood may flow in the usual direction, into the aorta, 
the murmur being caused by some irregularity in the orifice; or the 
sound may depend on regurgitation thrcjugh the aortic, the mitral, or 
the tricuspid valves. It may also be prodiiced by perforations of the 
heart, and communications with the sac of the j)ericardium, or open- 
ings existing between the two ventricles, etc. Again, the murn)urs 
which are heard during the diastole of the heart, are produced by a 
flowing back of the blood into the ventricle; and they are chiefly 
regurgitant aortic, regurgitant mitral, or else obstructive sounds. 

Now, with regard to the distinction of the situation of soimds, we 
find them chiefly produced or propagated in those parts of the chest 
which form the best conducting media ; as also in those parts corres- 
ponding to the direction in which the current flows. The obstructive 
aortic sound is heard best when the heart and the aorta are brought 
near to the surface of the chest, as is sometimes the case in conse- 
quence of enlargement of the heart. Jt may be heard most j)iainly 
about the middle of the sternum or at its lower part, though some- 
times more on one side, sometimes more on the other. There is no 
certain rule with regard to position. You find obstructive aortic 
disease sometimes occupying one position, and sometimes another. 
But it is not the mere position of the sound that distinguishes the 
disease. It is heard where it is produced; but it is also |)ropagated 
in the direction of the great arteries, and extends alon^ tiie aorta 
behind the steiniun, up the course of the innominata, the left sub- 
clavian, and along the carotids. On the other hand, it may be heard 
pretty distinctly downwards towards the apex, but is by no means so 
loud nor so long as over the course of the arteries. Then, again, 



184.3.] Diseases of tlie Heart. 329 



the obstructive pulmonary sound is heard much in the same position : 
it is a very small miirmui, and may be produced by constric'.ion of 
these arteries. The piibnonary artery and the aorta lie so close to 
each other, that there is some danofer of confi)undinfr these sounds. 
There is this difTiircnce, however, between them. When you find 
the murmur very loud, and when it extends along the carotids, you 
may ireneraily sJispect it to be seated in the aorta. The obstructive 
aortic, and the regur<i[itant mitral, are the most common murmurs 
accompanyincr the sounds of the heart. The regurgitant mitral is 
produced in the mitral valve. It is heard, not so much immediately 
over the seat of the valve (about half way between the mammilla 
and the margin of the sternum) as it is at the apex of the heart, or 
a little bf'low the left breast. 

Functional Maladies. — I now pass on to the consideration of tho 
diseases of the heart; first noticing the functional diseases which 
imply disorder of the proper function of the heart's action. Disor- 
dered action of the heart may be divided into increased action, de- 
tective action, and irregular action. Inordinate action of the heart 
is engendered by various causes, and may be j)rodured by different 
pathological states. For example : undue irritation of the heart, by 
an over stimulating property of the blood, as when a person has taken 
stimulating liquors inconsiderable quantity. It may also arise from 
other causes than I he state of the blood itself: from something extra- 
neous to the heart — some mechanical cause interfering with the 
heart's action, as the stomach being overloaded — or from reflex irrita- 
tion through the medium of the nerves, caused by various irritating 
matters in the stomach; also it is produced by increased irritability 
of the muscular fibres of the heart itself, which may depend either 
on a greater flow of blood through the structure of the heart, or on 
a determination or inflammation of the lining membrane of this 
organ. Palj-itation of the heart may be defined to he that amount 
of inordinate action which is perceptible to the patient himself, and is 
productive of more or less distress. The distress produced by the 
violent action of the heart is sometimes very great; the patient is 
conciousofthe beating, which is accomj)anied by a hurried and vio- 
lent motion, as well as by a feeling of sutibcation. There may. how- 
ever, be inordinate action to a considerable amount, without the patient 
being aware of the existence of ihe disturbance; many such persons 
being merely subject to short breath and a feeling of faintness. It is 
a remarkable fact, that with regard to junctional diseases, generally 
speaking, the patient is conscious of the palpitation ; but in cases of 
structural disease, wliere there is inordinate action, the patient is not 
invariably conscious of the existence of palpitation, 'i'he reason of 
this is, that in cases of functional disease, the affection is intermit- 
tent, varying in its degrtM; at different periods; and it is durirjg this 
increase in degree that the palpitation becomes distressing aiui un- 
comfortable. In these cases there is an exalted sensibility, a nervouR 
excitability, existing in a high degree — an undue sensibility of tho 



.*i30' Diseases of the Heart. [June, 



nc-rves that renders the patient conscious of these inordinate motions 
of the heart. On the other hand, in structural disease, the inordinate 
action is developed gradually, until at last the patient becomes ac- 
customed to it. 

Physical Signs Accompanying Palpitation. — The physical signs 
of mere palpitation, without any structural disease, are fin increase 
of the impulse, as well as of the natural sounds of the heart, exactly 
like that produced after violent exertion; violent exercise, in fact, 
picxluces palpitation, hut it subsides with the cessation of the cause. 
Wifii tills augmented force of pulsation, the heart may be felt vi^jor- 
ously heatinjx against the chest, and there is increased loudness of the 
first sound, in consequence of the greater vigor and abruptness with 
wliich the muscular tension is produced ; but there is not augmented 
loudness in thesecond sound : there is not enough biood forced into 
the arteries, at each beat, to cause a sudden increased recoil upon the 
valves. In addition to the greater strength of impulse and abruptness, 
there is an absence of the signs of enlargement of the heart, which, 
although beating violently, is still in its proper place. 'Jhe signs on 
j>ctcussion are not materially modified. If there be any triflinjj 
amount of disease at tlie root of the aorta, or in the aortic valves, so 
that there is a regurgitation of hlood into the ventricle, these sounds 
become exaggerated during palpitation. In violent palpitation, the 
phenomena are strongly marked at the top of the sternum, in the 
carotids and arteries whiceare near, and in some cases (^i" this kind 
the jugular veins may be seen to pulsate. Attacks of palpitation 
often terminate with eructation of wind, and when the palpitation 
subsides there is a free flow of urine. In some cases palpitation is 
excited by temporary plethora. Large quantities of fluid being 
drank, become absorbed into the vascular system, and cause palpita- 
tion and a great flow of urine which is thus an index of the system 
having got rid of this excess. Sometimes perspiration takes place, 
and the thing subsides in this way. I'liere are various causts for 
congestion wliich may produce palpitation ; the heart is sometimes 
active, but does not contract fidly on its contents, and then it is exci- 
ted to violent palpitation. This occurs not unfrequently in connex- 
ion will asthenic plethora ; and in this case there is increased dulncss 
of sound at the region of the heart, and this organ is actually distend- 
ed by the quantity of l)lood which it is unable to get rid of. This 
likewise, often co-exists with defective action of the excretory organs, 
a condition which thus induces great plethora of the vascular system. 
Palpitation is sometimes produced by other causes which bring about 
internal congestion: such as long cx|)osure to cold; insufiicient 
clothing; or even the opposite extreme, great heat. It is very com- 
monly produced by extraneous causes; such as pressure over the 
region of the heart ; flatulence; accumulation of fu;ces in tlic intes- 
tines; iui})n)pcr food ; the tJ)rmation of tumors near the heart or 
^Mcat arteries ; and disordered uterine fvinction. In all these difPe r- 
rnt cases, the 'lalpitation is only sympathetic; it may be only tein- 



1845.1 Diseases of the Heart. ''Y^i 

porary ; but if it continue, it becomes very distressing, and tends in 
some instances to produce further disease, by throwing the blood 
irregularly into different parts of the system. Long continued pal- 
})itation, accompanied by plethora, may cause permanent disease of 
the heart or of the great arteries (either hypertrophy or dilatation). 
This is owing to the activity of the plastic process. In cases in 
which it is accompanied by congestion or inflammation, it tends, by 
its coulinuance, to the production of organic disease ; on the other 
hand, as I have said, it is produced in the opposite state from merely 
nervous causes; by an anemic state, or a deficiency of blood in the 
whole system ; and this may go on for a long time without producing 
any structural disease, merely accompanied by considerable func- 
tional disturbance. 

Treatmenl of Palpitation of the Heart. — The treatment of inordi- 
nate action of the heart must depend on the cjuise. It may some- 
times be relieved by stimuli, which seem to restore the natural action 
of the heart, and remove the nervous palpitation. Etiier, aromati<! 
waters, ammonia, and spirits, will give great relief in some cases of 
palpitation, restore the balance of the heart's action, and check th(3 
nervous irritability. These are only temporary measures. Incases 
in which it depends on congestion, the removal of the cause of this 
congestion must be considered as of essential importance. In all 
cases in which plethora exists, it is useful to employ local depletion 
to relieve the heart, and take away the increased load. Bleeding 
from the arm is, under some circumstances, serviceable; and it is 
desirable to produce increased action in the excretory organs, by 
purgatives, and various diuretics. It is, of course, necessary in cases 
of palpitation, accompanied by plethora or fulness, thai the patient 
should be abstinent ; and doses of calomel, for awhile, and Dover's 
powder, are of great efficacy ; but they njust bo used in a moderate 
degree. The best means of acting on the urinary secretion is by 
colchicum, digitalis, and nitre. If the disease occur simply from ner- 
vous sensibility, without the plethoric stato I have been mentioning, 
sedatives should be used in combination with other medicines ; hydro- 
cyanic acid, hyoscyamus, opium, and quinine, are the renunlies. 
Sedatives, however, are but temporary measures, and for permanent 
good tonics are chiefly to be depended upon, 'i^hc most useful is 
iron, where it can be borne; bismuth, nitrate of silver, and sulphate 
of copper, are also good remedies. In all cases, country air is essen- 
tial, an abstinence from sedentary habits, regular exercise, and the, 
use of cold water, either by drinking it, or sponging the whole sur- 
face, which tends to improve the capillary circulation ; also a cold 
plunge bath; these are the means which are mf)st efficaciou«J. 

Irregular and defective action maybe classed together. Irregular 
action is defective in its actual r(\sult. Irregularity in the rhythm 
of the heart is very common in weak and nervous subjects, both 
young and old. It consists in an interruption of the boat, or a r»"- 
tardalion, or clso in too great an accel ration ; so that insload fif re- 



832 Diseases of the Heart. [June, 

• 

cnrrint; at rogular intervals, one sometimes occurs sooner than the 
other, then thore is an intcrruplion, and then it goes on again. A 
constrain(ui posliire will .sometimes proHuce this condition, as a^so ir- 
regularities of diet, and so forth ; this state, moreover, is usually 
comhined with other symptoms of weak circulation, such as cold- 
ness of the ext rem i lies ^r a conijestive appearance of the face. Ir- 
regularity and inequality of the heart's pulsation are more commonly 
the efTect of struetiual disease ; but the palpitations I have been men- 
tioning, as accompanying asthenic plethora, are often attended by 
irregular action, altliou^h there may be no organic disease. 

Hypertrophy and DUntion. — It is desirable, first of all, to notice 
hypertrophy, dilation, and disenses of the mulcular structure, because 
these require to be carefully distinguished in the treatment. Now, 
the muscular structure of the heart is scarcely liable to inflamma- 
tion in itself, and carditis in the surrounding coats is extremely rare. 
The muscular structure of the heart is nevertheless liable to remark- 
able changes, and these appear to have relation more to the immedi- 
ate derangement of its functions than to inflammation. 'I'here are 
many cases of structural disease in organs, in which direct inflam- 
mation is produced ; but it is not so with regard to the heart. We 
find the origin of structural disease of the heart to be more particu- 
larly depending on disorder of its functions; audit may be stated, 
as a general fact, that circumstances which interfere with the func- 
tion of the heart, which over-excite it or tax it in various ways, tend 
to produce diseases in its structure. Now, inordinate action and de- 
fective action may both lead to structural disease of the heart. On 
the other hand, we sometimes meet with eases in which tre structu- 
ral aff'eclions will go on for an almost unlin)ited period, without lead- 
ing to great functional derangement. These are principally cases of 
angemia. in which the quantity of blood is insufHcient. Again there 
are cases in which an over-quantity of blood may have an influence 
in producing disease; where there is a })lethora or fullness of the 
vessels. In some, this is accompanied by a peculiar activity in all 
the functions connected with the circulation, secretion, and nutrition; 
this is comprehended under ihe term sthenic plethora. In the other 
kind, there is an absence of power in the blood to nourish and in- 
crease the muscular substance of the heart, arising from some defi- 
ciency in the quality of the blood, or from some other cause; and 
this comes under the head of asthenic plethora. Now, in relation 
to these two cases, we may observe the developement of two oppo- 
site conditions of the muscular structure of the heart. Sthenic 
plethora, inducing an excitement of the heart, will lead to hypertro- 
phy of this organ, and an increase of the muscular structure. On 
the other hand, the increased or irregular action — which you wdl fre- 
quently find connected with asthenic plethora — a state in which 
there is a distention of the heart, without a corresponding increase 
in its nutrition, leads to a lesion called dilatation of the heart. These 
aro the two modes in which these lesions are produced, and they 



1845.] Diseases of the Heart. 333 



comprehend the various exciting causes. The nnatter, however, may 
be stated in another point of view; and this leads us to an explana- 
tion as to the modes in which various exciting causes act ; as, 
when the heart is ex<Mted by continued obstruction — when there is 
some difficulty to the passage of the blood through the heart, either 
from weakness in the walls of the heart, or from positive obstruction 
in the vessels leading from it. Either of these causes excites the ac- 
tion of the heart, and leads cither to dilatation or hypertrophy, ac- 
cording to the preponderance of the elements hitherto considered. 

N<jvv we come to hypertrophy. This is a somewhat rare disease. 
But, when the heart struggles long against an obstacle to the circu- 
lation, at the same time that the nutritive function is active, and the 
muscular strength is kept up, hypertrophy does take place. The ex- 
citing causes of hypertrophy are several: excessive muscular exer- 
tion, more particularly during the continuance of growth, when the 
nutritive function is active, and there is sthenic plethora in the sys- 
tem ; that condition in which the blood is rich in nutritive matter, 
and ready to deposit its fibrine; when the heart is strong, and great 
excitement is given to it, it then grows in an inordinate degree. It 
is not, however, enough thr.t the muscular exertion is occasional, it 
must be habitual. Again, in structural diseases, which are accompa- 
nied by so much obstruction as to impede the circulation, and excite 
the action of the heart in an inordinate degree, as the various ob- 
structions that arise in the course of the large arteries, such as aneu- 
rism. dsc, or any cause interfering with the current of the circula- 
tion, as emphysema of the lungs, and all those various circumstances 
which overtax the heart ; in all these cases the muscular fibres of the 
heart are enlarged and hypertro|)hied. Obesity, too, when it is ac- 
companied by sanguineous plethora, has a similar effect ; and you 
find many cases of obesity attended with hypertrophy. This always 
manifests disorder of the circulation. Whenever a person is inclined 
to be corpulent, there is naturally more work for the heart, accor- 
ding to the necessary order of things; an increased task for the 
heart requires increased power and exertion. But in a State of ca- 
chexia, this increase in the substance of the heart does not take 
place; apd we find symptoms of weakness of the heart, tending to 
palpitation, and other things undor the head of defective action; 
and though the heart is not diminished in size, yet it has become too 
weak for the work it has to perform. These are the only two ele- 
ments required for the production of hypertrophy which it is neces- 
sary to bear in mind: namely, sanguineous plethora, and excessive 
and continuous excitement of the heart. Any circtimstances con- 
tributing to these two things, usually lead lo a greater or less amount 
of hypertrophy. 

The physical signs of hypertrophy are very distinctive. There is 
an increased developement of the muscular fibre, and this renders 
the contraction stronger, and consequently the impulse is more per- 
ceptible ; but it is slow and more heaving. The fibres do not con- 



334 Diseases of the Heart. [June, 



tract with the same abruptness and suddenness, as in the normal state, 
and the sound is more or less modified. Where there is simply hy- 
l)ortrophy, unaccompanied hy dilatation, the sound is usually dimin- 
ished ; whereas, in cases of dilated iiypertrf^^ihy — where dilatation 
and hypertrophy are combined — there will be an increased loudness 
of sound, together with an increased strength of impulse. But the 
chief characteristic, distinctive of hypertrophy without dilatation, is 
an increase of impulse with a diminution of sound, just as in dilata- 
tion there is an increase of sound with a diminution of impulse. In 
some cases, the tirst sound is very indistinct at the region of the 
heart, and the inipulse is strong and heaving ; but near the large ar- 
teries, the first sound is hoard more plainly. Where the increase of 
the substance of the heart is consideral)le, and the dilatation great, 
we then have a remarkable kind of motion produced during the dia- 
stole. In the normal state of the heart, the diastolic motion is 
scarcely perceptible; all that is felt is the apex of the heart coming 
in contact with the ribs, with the motion of the ventricle to the left of 
the sternum. But in these cases, during the diastole, we have a kind 
of heaving up of the walls of the chest, and that to a great degree ; 
but there is a sudden collapse or pulling back of the walls at the mo- 
ment of the contraction. This diastole Dr. Stokes called the back 
stroke, and it is frequently met with in cases of dilated hypertropliy. 
Now, besides this, the impulse is stronger and more extended ; but 
the degree of this extent will vary according to the form of the hyper- 
trophy. If it be simple hypertrophy, without any great enlarge- 
ments of the cavities of the heart, the beat will be found but little 
lower than usual, and the impulse will seem to be directed down- 
wards, without exteding beyond its usual locality. But, in hypertro- 
phy, with enlargement of the left ventricle, the impulse will vary ac- 
cording to the degree. The apex will be felt beating to a greater or 
less extent below the left breast. On the other hand, this dilated 
hypertropiiy may sometimes assume the globular form, and then the 
impulse is felt mostly higher up, and has not that striking or lifting 
character usually accompanying it. This is a curious phenomenon 
of this species of hypertrophy. Ordinarily, the whole heart is lifted 
up, as it were, duiing the diastolic action, and at the time of the con- 
traction, the apex is forced towards the walls of the chest. This is 
the reason why there is a sort of heaving swell felt in the region of 
the heart, when it is considerably hypertrophied. This is chiefly 
felt in the neighborhood of the sternum, and sometimes as low down 
as the epigastrium. Now, when the heart is very much enlarged, 
and the impulse is felt oi^er a very great extent of surface, we shall 
find the sound on percussion considerably modified. The stetho- 
scope is an invaluable instrument in these cases, and may be appli- 
ed with great certainty to measure the dimensions of the heart in 
contact with the walls of the chest. And in cases of greatly en- 
larged heart, where there is not only hypertrophy, but dilatation of 
the walls of the heart, you will find that this vi?cus occupies a great 



Diseases of the Heart. :^>35 



part of the front of the chest, from tlie upper margin of the second 
rib, extending to the epigastrium ; also, around the left side, and the 
axilla, and passing two o^r three inches to the right of the sternum. — 
This is particularly the case in young subjects where the chest is nar- 
row. 

The effects of hypertrophy vary very much. You may find the 
enlargement of the heart accompanied by a more extended impulse 
than usual, but with little increased dulness of percussion, in some 
individuals scarcely amounting to disease; while in others it may 
occur to the extreme degree I have just been describing. Indeed, I 
believe that, in some cases, hypertrophy may be considered almost 
as a corrective of disease, and sometimes little inconvenience i*5 felt 
from an enlarged heart. You find enlargement of the heart accom- 
panying other diseases — diseases of the lungs and visceral alfections, 
and in the greater number of instances of this kind, the progress of 
the disease is rather retarded than otherwise. There is a constitu- 
tional state in which there is a diminution of energy in some func- 
tions, at the same time that others are more active. Where enlarge- 
ment of the heart accompanies emphysema of the lung, you do not 
have the dulness over the region of the heart, nor the impulse usually 
manifested, in consequence of the lung standing between the walls of 
the heart and the chest ; but you have the signs of enlargement at the 
epigastrium, and you have also increased pulsation in the arteries. I 
have had cases of emphysema of the limg under my care, in which 
nature has overcome the obstacles in which the enlargement of the 
heart had originated. 

Treaimcni of hypertrophy of the heart. — You must remember that 
hy|)ertrophy, although it may exist to a great extent, is not always a 
disease against which remedies can be directed. In fact hypertro- 
phy is to be considered as a condition which may terminate in dis- 
ease. When, by the application of auscultation, we find the heart 
larger than usual, this indicates the necessity for precautionary treat- 
ment, but not for inferring the actual existence of disease. Accord- 
ingly, the treatment will vary very much. In extreme cases, where 
there is increased strength in the heart, and the circulation is very 
strong, there will be sometimes determination of blood to the head; 
and arising out of this there will be disorder t)f the secretory organs, 
and of the system generally, which may thus act secondarily on the 
lieart itself, the violence of its action producing pain, and other sen- 
sations of discomfort. Now, we cannot expect to remove such a 
state as this altogether by bleeding. In severe cases, where there is 
an extraordinary amout of congestion and pressure in the system, 
there is no doubt of the expediency of blood-letting. In cases where? 
there are symptoms of congestion of the brain from iletermination of 
blood to this organ, blood-letting may be resorted to in {iroportion lo 
the strength of the patient. You must not, however, lake too much 
blood at one tmie, but rather take a small (juantity, and repcait the 
(tperation if necessary. Use cvacuants, and such medicines as will 



336 Diseases of the Heart, [June, 



reduce the quantity of blood, without much impairing its quality. 
Also, sc'dfiiivcs of various kinds ; such as digitalis, hydrocyanic acid, 
&c., to diminish the irritability of the heart's action, which is not to 
ho knocked down at once, hut to be reduced in a gradual manner. 
Where there is much pain and oppres>ion, with a feeling of uneasi- 
ness at the chest, there is reason to suspect something of an irjflam- 
aiatory character, either accom|)anying the hypertrophy, or produced 
by the increased efforts of the enlarged heart. In this case, not only 
the depletory measures I have alluded to should he employed, but 
mercury should be administered, and cupping, blisters, and setons, 
may be used. The diet should be sparing, and irritating liquors 
should be avoided. The object is not to carry the antiphlogistic mea- 
sures to the highest degree, but to produce a more moderate and equal 
action. 

The physical signs of dilataiion of the heart require care to be 
distinguished from those of hypertrophy. If the walls of the ventri- 
cles are thin, the contractions take place very abruptly and quickly. 
The result of this is, that the contraction ceases with the first impulse. 
There is a smart jerk with the first impulse, but it is a very short 
one, having nothing of the heaving character of hypertrophy. There 
are several points in which the impulse and the sound differ from the 
natural ones: the impidse is short and abrupt, possessing very little 
strength or duration. In the natural condition it is chiefly centered 
nt*theapex, and extends but a slight distance around; that of the 
right ventricle is inferior in strength to that of the left; but when 
there is considerable dilation of the right ventricle, so as to make it 
extend to the anterior part ofthe chest, you then no longer have the 
beating effect, located between the cartilages ofthe fifth and sixth 
ribs. Under these circumstances, you have somewhat more of the 
impulse under the region ofthe sternum. It is very brief and slight 
in its force, and is accompanied by a short, abrupt sound. If the loft 
ventricle is not dilated, the natural obtuse sound may still" be heard 
below the left breast. But when the heart is not in direct contact 
with the chest, you cease to have the impulse, which is naturally 
communicated, because the dilated right ventricle pushes aside the 
left ventricle., Under these circumstances you do not h'lve symp- 
toms of weakness in the circulation. There is considerabh' strength 
in the impulse ofthe arteries in the neck, and at the top of the stern- 
um, though there may not be the natural amount of impulse at the 
region of the apex. When the left ventricle is dilated, there is a 
change in the condition ofthe heart, and its shape is altered. The 
heart is altogether more globular, and there is a diminution in the 
natural impulse. It is far less distinct, and is diffused over a larger 
surface ; where dilatation is conjoined with hypertrophy, the impulse 
often extends over ten or twelve square inches, over the whole ofthe 
front ofthe chest and the left side. The sound is otherwise different 
in Its character. It is a short first sound, extremely like the character 
ofthe second sound ; so that the two sounds following each other are 



1815.] Diseases of the Heart, 337 

/ ' 

not to be distinguished in character, but only by their succession. On 
placing the hand on the region of the heart, there is found to be an 
increase of the impulse as far as extent is concerned ; but it does not 
lift up the ribs at all. If it does that, we may be pretty sure that 
there is hypertrophy, combined most probably with extreme dilata- 
tion of the auricles. We have, however, no certain means of deter- 
mining this at present, and we are not acquainted with any peculiar 
pathological conditions which it tends to produce. Laennec thought 
that dilatation of the auricles produced modifications in the second 
sound ; but he seems to have had a mistaken notion as to the sound 
produced by the contraction of the auricles. 1 have very distinctly 
seen the pulsation ofthe auricles alternate with that of the' ventricles. 
Sometimes a double pulsation is seen in the veins; this is especially 
observable in the jugular veins, and the superficial veins ofthe thorax. 
The treatment of dilatation is very much the same as that under 
the head of defective action. It proceeds essentially from weakness ; 
a want of (one and of strength, or, perhaps, of both ; and accordingly 
the treatment most generally applicable to the dilated heart is strength- 
ening by means of tonics. But there are different circumstances to 
be taken into account in the application of this form of treatment. 
Sometimes the blood is more than the heart can propel, and we have 
here to enable the heart to propel this load : it is some time before we 
can give sufiicient strength, but we may give temporary relief. 
When the dilated heart is palpitating much, and obviouslv struggling 
\vith a load of blood which we cannot propel, we should apply blood- 
letting and cupping, or leeches over the region ofthe heart. Some- 
times, in asthenic plethora, where there is much lividity, or a bloated 
appearance of the countenance, there is more blood in the system 
than the heart can propel, and it is useful to withdraw blood to re- 
lievo the heart. This is only a temporary expedient. There is 
another circumstance that indicates the necessity of a modification 
of a general tonic treatment : you must remember that there is a 
weak circulation throughout the whole system, and at the same time 
a weakened state of the secretions; and, therefore, it is important, 
while we are using tonics and stimulants, also to em|)lov measures to 
increase the action ofthe secretory organs. This is an indication that 
should always be attended to. Evacuants, aperients, diuretics, and 
dietetics, may be used at the same time that you are giving tonics 
and stimulants freely. The treatment should be as strengthening 
and as nourishing as the patient can bear. iMineral tonics, especial- 
ly iron, are highly calculated to restore the strength ofthe heart, and 
to diminish the irritability of thesystem. It is desirable to vary the 
use of these from time to time, at the same time giving mineral acids. 
It is difficult to say how. these tonics act on the animal frame and the 
contractile powers, but it is certain that some tonics have the effect of 
tightening up the muscular fibres: alum also might be useful in these 
cases. I have seen this remedy so far useful as to diminish the con- 
gestion of the liver. 'J'onics, however, arc slow of action, and in 



338 The Spleen and its Functions, [June, 



cases of weakness stimulants may be given, especially where any ex- 
ertion is required — ammonia and so forth may be used. It is very 
desirable to keep down the mass of the blood, and to prevent it be- 
coming too bulky, at the same time that we improve its quality, and 
make it as rich as possible. In doing this, we must attend to the 
state of the secretions, keeping them quite free, more particularly 
those of tlie kidneys and skin. Warmth of the extremities, and so 
forth, is useful to relieve the accumulation of blood towards the heart, 
and to promote circulation towards the surface; keeping the diet of 
as nourishing a character as possible. See that the digestive organs 
are well managed, and avoid excess of liquids, as these arc often ex- 
tremely injurious, and not only by interfering with the digestion, but 
likewise by encumbering the organs of secretion. When a great 
quantity of water is taken into the system, it must be absorbed and 
carried away into the vessels. If the heart is weak, too great a quan- 
tity of liquid will encumber it still more. There are many reasons 
for adopting a diet of a dry nature, though not absolutely so. The 
diet should be as nourishing as it can be borne, and 4here should be 
abundance of animal food taken two or three times a day, if the diges- 
tive organs will bear it. A little gentle exercise is highly desirable, 
as much as can be taken without fatigue, varying the exercise with 
rest in a recumbent position. Where the patient is too weak to bear 
exercise, friction may be substituted, so as to promote the circulation, 
and thus aid the action of the heart. Great advantage is derived 
from cold bathing, which tends to improve the cutaneous circulation, 
and ultimately increases the vigor of the system. 

(To he concluded in next numher.) 



PART III.—MONTHLY PERISCOPE. 

The Spleen and its Functions. — The observations on the func- 
tions of the spleen have elicited the following facts. 1. The greater 
part of the water, received into the body, is admixed with the venous 
blood of the spleen in a few minutes, by which means a great disten- 
sion of this organ is effected. 2. The splenic veins leading to the 
vena portEe, are filled during the digestive .process with a darker 
blood than the other veins of the body. 3. The spleen has been ex- 
tirpated in some animals (chiefly herbivorous), without any peculia- 
injury to the system, with the exception of a slight derangement in 
the process of chylification. 4. The spleen, por.sessing no edu"tory 



1S43.] Oljservat ions on the Mysteries of Generation. 339 



canal, can have no influence on the formation of chyle. 5. The 
periodical accumulation of blood in the spleen, particularly during 
digestion, makes it appear to be a mere reservoir of blood for the or- 
ganism, favoring perhaps chylification by its pressure on the stomach. 
G. The lymph, passing from the spleen, is redder and more coagula- 
bie than that of other organs. After the extirpation of the spleen, the 
lymph, as it passed into the thoracic duct, was white, thin, slightly 
coagulable, and, only at^ter it had been exposed some time to the air, 
did it assume those properties of redness and greater coagulability, 
usually communicated through the influence of the spleen. 7. After 
the extirpation of the spleen, a more abundant urinary secretion takes 
place, the urine being thin and watery. 8. The bile has, in this 
case, a much darker color and an altered taste. 9. The volume of 
the spleen is enlarged, and the texture relaxed, by intermittent fever, 
as well as by typhus abdominalis. In explanation of the above facts, 
it is shown that the larger viscera of the body, and particularly of 
the abdominal cavity, have a specific attraction or relation to the 
elements of which the organism is chiefly composed, and by which 
it is reproduced : i. e. oxygen, hydrogen, carbon and azote : the lungs 
to oxygen, the kidneys to azote, the liver to carbon. Now, hydrogen 
alone remains, which is not always found combined with oxygen, in 
the form of water, in the organism, but also (pathologically) with 
other gases in the blood. The spleen seems to form the point of at- 
traction for this hydrogen, a view confirmed by the fact, that in all 
countries in which an excess of hydrogen is found in the air, and thus 
received in the blood, affections of the spleen are chiefly produced. 
Thus, we may say, that the spleen has a specific relation to hydrogen, 
separating it from its combinations, in order to elaborate it for its pe- 
culiar organic purposes. Thus, water undergoes a decomposition in 
the spleen ; the hydrogen is carried with the blood of the splenic 
veins to the liver, and used for the secretion of bile. This accounts 
for the dark color of the venous blood of the spleen, during digestion; 
therefore, the bile becomes changed in character, and the urine wa- 
tery, after extirpation of the svleen. The oxygen of the water is 
absorbed by the lymph, and produces the color and coagulability 
proper to this fluid. In intermittent fever, the spleen becomes en- 
larged and softened, in consequence of the hydrogen collected in it. 
In perverted, or obstructed, function of the spleen, the water is left 
in the blood circulating through the body, and produces abnormal and 
morbid phenomena in consequence. The, so called, splenic vertigo^ 
appearing under the form of a derangement of the functions of the 
brain, seems to be produced by this abnormal reception of hydrogen 
into the blood. — Dr. Frank of Berlin in Casper^s Wochenschrift. 

[N. Y. Journal. 



Ohservalions on the Mysteries of Generation. By M. Moeeau, 
{Bulletin Gen. de Therupeui. Med. Ckirurg. 1644.) It is not our 
object to write a dissertation upon the various systems by which the 



340 Observations on the Mysteries of Generation, [June, 



mysteries of generation have been attennpted to be explained; we 
wish sinnply to state an opinion of the pre-eminence of one over 
another, which we have heard advanced by our learned professor of 
midwifery, M. Moreau. This view of the act of generation presents 
to the physician an important practical question, which should attract 
his attention. It may not be peculiar to Professor Moreau, but 
these observations assume much more weight in our estimation as 
emanating under the patronage of a name so respectable as his, and 
more particularly as they are strengthened by a great number of ob- 
servations taken from his practice. 

Every one knows that all the systems proposed and discussed, from 
the earliest period to the present day, may be reduced to two — the 
ovarists and the epigenesists. The former maintain that the new 
being exists e/i germe in the female ovary, and man only contributes 
in the act of generation by vivifying the germ. With the latter, the 
individual is formed entirely by the materials furnished by both sex- 
es, each taking a more or less active part in the product of conception. 

M. Moreau believes in the doctrine of epigenesis. He thinks it 
incontestable that the individual who is the strongest, who enjoys the 
best health at the moment of conception, will have a pre-eminence 
over the other, and that the sex of the child will be determined by 
this pre-eminence. It has been ascertained by M. Moreau, a num- 
ber of times, and every one can appreciate the truth of the remark, 
that in families where the man is vigorous and robust, and the woman 
is feebte and delicate, the males predominate ; and where, on the 
contrary, the woman is very young and robust, and the man is sickly 
or old, the females outnumber the males. In some families we find 
all boys; in others, all daughters. In such cases, the predominence 
of one sex or other is constant — it is, in some measure, constitutional. 
But the predominence of the man over the woman, or of the woman 
over the man, arises from the state of the physiological foices — 
from the vital powers of each, at the moment of reproduction. 
If, then, the husband, although the most vigorous, is enfeebled, 
is suflering from any depressing cause, the wife, although apparently 
more feeble than he, will have the pre-eminence, and vice versa. 
In a word, it is not always from the exterior — from appearances, that 
we ought to judge of the physiological state of the reproductive for- 
ces. The state of the organism at the moment of copulation, exer- 
cises an immense influence, and the sex of the child will be determined 
by the relative state of the parties concerned, at the time of coition. 

From these considerations it follows that we may, at pleasure, in 
some degree determine the production of one or the other sex This 
fact, which sometimes possesses a high degree of social importance, 
is indisputable, according to M. Moreau. He is convinced that he 
has, in a number of cases, influenced by the above considerations, 
determined the production of a boy or girl. M. Moreau reduces to 
practice the well established rules of hygiene ; which consists in 
tonifying the one and reducing the other; this is all. A captain of 



1845. J Diseases of the Negro Fopulatioii. 341 



huzzars, of some renown, about 34 years old, having led a dissipated 
lite lip to the period of his marriage, espoused a young girl of 22 
years, strong and in fine health. His first and second children were 
daughters. He was anxious for a son. M. Moreau, being a witness 
to his despair, promised him a son if he would consent to change his 
habits. He renounced a mistress whom he kept; he took tonics and 
a substantial diet, and drank Bordeaux wine to recruit his strength, 
enim in vino Venus; he observed the most absolute continence; and 
during this time, his young wife was subjected to the use of prolonged 
tepid batl'.s, and to a light vegetable regimen. He seized for the conju- 
gal embrace the moment when his wife was languid, and mala Vaise; 
a third pegjnancy followed, and behold a son was born unto him ! — 
N. O. Med. Jour. 



Diseases of the Negro Population. By Daniel Drake, M. D., 
in a letter to Rev. Mr. Pinney. 

Medical Institute of Louisville, Nov. 15, 1844. 

Dear Sir : Smce our interview in Cincinnati, 1 have been so much 
engaged in entering on my duties for the winter, as to be unable till 
now to comply witli your request, for some notice of the diseases of 
the colored population of the South and West. As I told you then, 
my inquiries were chiefly made in Alabama, Mississippi and Louisi- 
ana, in the spring and summer of 1843 and '44. Of the diseases of 
which I am about to mention, I witnessed most of the varieties, but 
the greater and better part of my information was derived from con- 
versation with physicians, planters, and overseers, carefully noted 
down at the time. By referring to these, I give you the following 
statement : 

1. Many infants die of trismus, or lock-jaw, when they are but a 
few days old ; after that early age, convulsions, and summer sick- 
ness, (cholera infantum.) and worms, carry off quite a number. 

2. They are liable to measles and scarlet fever, both of which 
were prevailing (but especially the former) on many plantations 
which I visited ; which diseases seem to be as fatal to them as to the 
whites. 

3. Scrofula or kings-evil is of frequent occurrence ; and consump- 
tion, or cachexia Africana, as it has been called, is prevalent and 
always fatal. 

4. On many plantations the strange habit prevails of eating dirt 
or clay, the common soil of the fields, particularly that of the Mis- 
sissippi bottoms, producing serious and fatal diseases. I was told of 
one estate in South Alabama, on which fourteen slaves had died from 

■<his cause, and visited another in Louisiauii, on which I saw nearly 
half that number unable to work from the same practice. 

5. A disease of the heart, conjectured to arise from dirt-eating, 
destroys quite a number. I met with several cases, and heard of a 
plantation on Red River, where more than thirty died from this 
maladv. 



342 Diseases of the Negro Populalion. [June, 



6. Tetanus or lock-jaw from wounds, is extrennely common and 
almost uniformly fatal. Some cases occur without previous wound. 
A physician in Alabama told me he had, in fifteen years, met with at 
least tifty cases, nearly all colored people, and all but one mortal. I 
met with several young physicians in the smaller towns, vv'iio had, 
respectively, met with more cases than have occurred in Cincinnati 
from its first setliernent. 

7. Diarrhoea and dysentery, of frequent occurrence, are often fital. 

8. Where the cholera was epidetnic, in 1832, '33 and '34, it swept 
off" great numbers; was more destructive, in fact, to the colored than 
the white people of the Southwest. 

9. Epidemic erysipelas, or black tongue, has prevailed on many 
plantations within the past year. I was told of one, in Mississipi>i, 
on which seven had died of it. 

10. The colored people are not proof against the cause of yellow 
fever, but as they are not numerous in the cities and towns, where 
only it prevails, the mortality from this disease is not great. 

11. Acute inflammation of the lungs is among the most destruc- 
tive diseases of the colored population. These are catarrh, croup, 
bronchitis, pleurisy, and pneumonia, or inflammation of the substance 
of the lungs, which is the'most frequent and fatal of the whole. These 
maladies often destroy life in a few days ; but sometimes the patient 
recovers with his lup.gs rendered permanently unsound. I saw many 
cases of this kind. This group of diseases, produced by changes of 
weather in winter and spring, occasions more deaths than any other, 
except the next. 

12. Intermittent, and remittent fevers; simple, and malignant or 
congestive, are the greatest outlets of human life among the people 
of whom I am speaking. They return every year in the latter part 
of summer and in autumn, and one attack is no security against a no- 
ther. When they do not prove fatal, they leave behind them diseases 
of the spleen, and dropsy. In the following winter those who were 
down in the autumn, are tender, and often die of inflammation of the 
lungs. 

In addition to the diseases I have named, others occur now and 
then, with considerable frequency, of which I may mention rheu- 
matism, epilepsy, colic, hysteria, and several infirmities peculiar to 
women. 

From this catalogue you will perceive that the colored population 
of the Souttnvest are by no means exempt from a variety of formida- 
ble diseases. As we come further nortli, tetanus and autumnal fever 
get less, but consumption and inflammations of the lungs increase. 
All over the region of which I have spoken, the greatest part of tho 
practice of every country physician is among the colored people. A 
gentleman in Louisiana told me that he received a salary of Si, '200 
a vear for attending on a sinfrle plnntadon. From all I have read 
and heard of the diseases of Liberia, my impression is, that if half 
the colored population of a S.ailhwestcrn phinlalion were sent to the 



lS4o.J Htmicianiuy J^'c. — Discharges froiu the Ears. 343 



colony, they and tlicir descendants, in ten years, would number more 
than those left behind. — New Orleans MedicalJournah 



Treatment of Hcmicrania and Tic Douloureux hy Cauterizing the 
Palate. — Wy Al. Duckos, of Marseilles. — In the most intense hemi- 
crania, and in the most obstinate /ic douloureux, whether fronto-facial 
or temporo-facial, the pain disappears instantaneously on the appli- 
cation ol'ammonia at 25'^,* to the palatine arch, by means ofa [camel's 
hair] brush; the brush being allowed to remain on the part till a co- 
pious flow of teajs has been excited. I have tried this for the last 
three months in a very great number of cases, and the pain has 
always ceased. If the pain returns, a fresh application again pro- 
duces a cessation of the neuraliiia. — Gazette Medicale. 



Discharges from the Ears. — Mr. Wilde, of Dublin, has written 
\ Dublin Journal of Medical Science, January, lS44,]-a most excel- 
lent treatise on the causes and treatment of otorrhoea, chiefly 
dwelling on the aflections of the external tube and external surface 
oftlic membrana tympani. There are few diseases which are more 
frequently neglected and carelessly treated, than those of the external 
car; and few which, when allowed to proceed, entail more incon- 
venience on a patient during the remainder of his life. In simple 
otorrhcea, Mr. V/ilde paints over the surface with a solution ofnilrato 
of silver, ten grains to the ounce, applied with a fine camel's hair 
pencil, either to the wbole or a portion of the surface, according to the 
extent of tho disease. This is repeated every third day, and in tho 
interval ihe ear is syringed night and morning, and oftener if the dis- 
charge is copious, with plain tepid water, by means of a gum-elastie 
hag, which, when used by friends, is much preferable to the usual 
piston syringe, and at night a slightly astringent lotion is dropped into 
the ear till Jt fills up the meatus, and allowed to remain there for a few 
njinutes. For tills purpose we mayuseliq. plumbi diacet. one drachm, 
to an ounce of water or rose water ; or weak solutions of alum, copper, 
or chloride of lime. But otorrhcea is often exceedingly difiicult to 
cure, owing to its being caused by morbid vascular growths, such as 
granulations on the membrana tympani, which are allowed to pro- 
ceed undiscovered. In such a case the part aj)pears quite red and 
vascular, and Mr. Wilde recommends the application of the solid 
nitrate of silver, rubbed over the part about every second day, or of- 
tener if necessary; and for this purpose he uses a very neat little 
instrument which is five and a halt inches long, consisting ofa silver 
tube, cut spirally for three-fifths of its length, and having an aperture 
on the side near the extremity. In using this port-caustir, a little 
nitrate of silver is melted over the lamp on a small platina ladle, and 



* A solution of ammonia, showing 23° on Baumf's hydrometer,= a specific 
^rravity of .900. The liquor ammonice fort, of the London CoHege is of the sp. 
m. -8^2. — Tran^to/o/^s nri!(: in Md. Guz. 



344 A Sharp 'pointed Body in the Intestines. [Juno, 



then, when about cooling, the end o^ the port-caustic, is dipped into it 
till the aperture and extremity are filled and coated over with the 
caustic. We often find, however, that discharges from the ear are 
kept up by polypi, which it becomes necessary to remove; and for 
this purpose Mr. Wiide recommends a little instrument, first recom- 
mended, we believe, by Mr. W Robertson, surgeon to the Kelso 
Dispensary. It is a small snare-like apparatus, consisting of a fine 
steel stem, with a movable bar sliding towards the handle. It is so 
constructed that a noose made of fine silver or platina wire may be 
pushed down to tlie polypus, so as to surround and ensnare it. The 
morbid growth may thus be safely and cautiously taken away, either 
in part or wholly, and by the regular application of the armed port- 
caustic from day to day, all trace of the growth may ultimately be 
extiniruished. 



A Case in which a sharp pointed- body was swallowed by a child, 
passing the bowels vithont injury. By Dr. B. W. Avent, of Murfrees- 
b 'ro', Teiin. — On Thursday evening, 8th July, I was requested to visit 
a little girl, 4 yt^ars old, who, whilst engaged at play, had accident- 
alh' swallowed a sharp-pfjinted instrument, about two and a half 
inches long. This instrument was originally the handle of a long- 
bladed knite, the jaws of which had Leen filed off' about its centre, 
leaving the back spring, which had been ground very sharp at its 
point. 

I saw the patient an hour after the accident occurred, and, as 
might have been expected under such circumstances, found the fami- 
ly in great alarm, and in the act of pre])arintj an emetic, with a view 
to cause the stomach to eject this foreign body. 

The little girl was suffering no pain at all, and on examination I 
was satisfied that the instrument had passed the cardiac orifice with- 
out producing any injury in its passuge. Aware that the point of 
this instrument was sufficiently sharp to pcnetrnle the stomach, should 
it come in contact with it during any contractile action of that organ, 
I at once explained to the parents the great dnnger of any medical 
interference, and advised that the unassisted efforts of nature should 
be relied upon for relief, at least until some unpleasant symptoms 
sh< uld arise. With this advice, I left the patient about as comforta- 
ble as f nothing unusual had happened. 

On the following morning she complained of some pain in the epi- 
gastrium, but it was not of sufficient violence to excite much alarm. 
She took her breakfast as usual, and was permitted to engage in her 
accustomed amusements. After the morning, the pain in the stom- 
ach subsided. Sometime during the day her bowels were evacuated, 
without presenting any unusual appearance in the fteces. On the 
next (Saturday) morning, she was still well, had no fever or visceral 
excitement whatever, and had complained of no pain since the morn- 
ing of the |)revious dav. Through tins d;iv she continued to be 
plavful, :uul sufft'red no inconvenience, 'i'lie bo^^els were once 
moved without medicines. 



1845.] Treatment of Strictures of ihe Vrcthrd. .'M.') 
-. .4..^ 

Sunday morning. — Patient still (red from all excitement. At 9 
o'clock this moininj;, just 64 hours after the occurrence of the acci- 
dent, the instrument was discharged from the bowels, enveloped in 
iaeces, without any pain or inconvenience whatever. But little, if 
any visible impression had been produced upon it during its passage 
through the bowels. 

In the management of this case I applied no medical treatment, 
though often solicited to do so. I advised that the little patient should 
be permitted to engage in her customary amusements, and to take 
her ordinary diet, hoping by this course to kee|) her system, as nearly 
as possible, in a normal condition, the nalural action of the aliment- 
ary canal undisturbed, and that thus, as happened, the "unwelcome 
visiter" might be expelled. 

Medical interference, in this case, M'ould have consisted either in 
vomiting, with a view to the ejection of the contents of the stomach, 
or in the use of purgatives, more speedily tp evacuate the contents of 
the bowels. In either plan of treatment there would have been great 
danger to the patient. The contraction of the stomach, necessary in 
vomiting, would undoubtedly have endangered the wounding its 
coats, by coming in contact with the sharp point of the instrument, at 
every effort of that character, to say nothing of the great improbabili- 
ty of effecting the object desired ; whilst, on the other hand, cathariics 
would not ordy have ()roduced irritation of the bowels, but by carry- 
ing off too hastily their liecal contents, might have left the foreign 
body behind, in a condition to wound them at every peristaltic motion. 

Two circumstances existed in this case which favored the safety of 
the patient. First, the instrument was swallowed with the handle or 
blunt end downwards, which prevented its wounding the parts in it3 
passage; and, secondly, its length prevented its taking a transverse 
])osition ; either of which circumstances might have greatly endan- 
gered, if not destroyed, the life of the patient. — V/estern Med. Jouriu 



Treatment of Strictures of the Urethra. By Dr. J. Benique. — The 
author prefers dilatation to every other mode, but employs it in a 
manner more convenient to patients. He introdnccs into the urethra 
a bougie whose volume varies accordinj; to circumstances. As soon 
as it has penetrated, it is withdrawn and a more voluminous one in- 
troduced. Thus in succession three or four bougies, each larger than 
the other, are employed in the space of two or three minutes. The 
next day, he introduces the bougie which had been last used on the 
preceding day, and several others, increasing in size in the space of 
some minutes : thus he continues every day until he succeeds in the 
introduction of the largest bougies, which are not permitted to remain 
in the urethra for a longer period. Experience has demonstrated to 
M. Benique that this mode of producing a gradu;il dilatation succeeds 



IHG Surgical Cases. — Cause of Error in Diagnosis. [June, 



as well as that of leaving bougies in the urethra for several hours or 
the entire day; it has the advantage of not disturbing the urinary- 
passage, and of not keeping the patient from his ordinary occupation. 
(Trans, from Archives Centrales de Med., March, 1845 ) N. 



Surgical Cases. — Case I. Fracture of the Femur, Fibula and 
Radius. — A young man, ml. 23 years, was thrown from the top of an 
omnibus, which caused a fracture of the femur and tibula of the rigi)t 
side, and of the radius of the left. He was brought in the Hospital 
and kept perfectly quiet until the second day after the accident, when 
Dr. Mcrcier npplied the starch bandage to the whole injured leg. — 
Simple dressing with splints and ordinary bandage were applied to tho 
arm. The patient is free from irritation, lying quiet and doing well. 

Case H. Simple Fracture of the Femur ; of about four weeks 
standing ; still ununited — The subject of this case is a vigorous young 
man, aged 20, apparently of fine constitution ; entered the Hospital 
llth ^Tarch last. Dr. xMemier found him in the ward when he took 
charge of it. Heat once applied the starch bandage from the toes 
to the hip. Seven days afterwards, the young man left his bed and 
walked out into the yard with the aid of his crutches. He appears to 
l;e recovering rapidly. 

Case III. Fracture of the Humerus, of six weehs^ standing; 
ununited. — Dr. M. found this case also in the Hospital when he 
commenced duty. He applied the starch bandage immediately. It 
is now nearly three weeks since, and the patient is perfectly com- 
fortable — the cure nearly completed. 

Dr. Mercicr's Treatment of Ulcers. — An immense number of 
chronic ulcers are admitted into the Hospital, and quite a variety 
may generally bo seen in the surgical wards. The subjects, for the 
most part, belong to the poor class of Irish laborers, whose habits 
are bad, who are very mu(di exposed to the inclemencies of the 
weather, and who are proverbial for their disregard of all the dictates 
of prudence. Their constitutions are generally very much injiired 
by intemperance, and it is almost impossible to establish the healing 
process when any injury is inflicted upon their shins, for this is the 
most comnion seat of ulceration. Dr. Mercier has found the follow- 
ing plan of treatment to succeed better than any other : — He gives 
iodid. potass. 5ss.,and iodine gr. i, dissolved in decoc. sars., §vi daily. 
When sujipuration is copious, he has the sore washed clean with 
chloride of soda, and dresses it with lint wet with vin. aromat. — 
when the discharge is moderated and granulations spring up, hn 
covers the sore with narrow strips of adhesive plaster; with the triple 
view to counter-irritation, compression, and exclusion of the air. — 
N. O. Med. Journal. 



Singular cause of Error in Diagnosis of Affections of the Knee. — 
In the last Concours for the chair of Clinical Surgery in the Facully 



1^'45,J On tht Medicinal Properties of the Bebccrine. .'UT 



of Paris, a singular case occurred, the diagnosis of which gave rise 
to a difference of opinion both amongst the competitors and judges, 
and in which, moreover, had an error been committed, the result 
might have been a serious operation. M. A.^erard, the actual nomi- 
nee to the chair, thought that he recognized the existence of a f()r- 
cign body in the knee-joint of a patient aliectcd with hydarthrosis, 
and which had fallen to his lot as the subject of lecture. On exam- 
ination he found, besides an effusion of serum, a distinct circumscribed 
t jmour, of the size of an apricot stone; it rolled under the r)nger,and 
was situated at t!ie external side of the knee, above the i)atelia. M. 
Mdrio\'ii),jiige dc concoitrs, did not coincide with this opinion, nnd 
jitrirmed that what was considered as a foreign body was nothing 
niore than an adherent tumour, very often found in those afft-cted with 
hyciarthrosis: he was ignorant of its nature, never having hud an 
opportunity of dissecting one. M. Malgaigne, one of the competitors, 
and who, like M. Berard, believed in the existence of a foreign body 
within the joint, hastened to examine this tumour on two patients 
afft'Cted with hydarthrosis, then under his care in the Bicetre, and ho 
Ibund it exactly the same as in the patient of M. Eerard. One of 
these patients died shortly after ; he thus had an opportunity of de- 
termining its nature, and found that the apparently foreign body w.is 
nothing more than a pellet of fat, of a perfectly healthy appearance. 
M. M. next inquired whether this tumour was entirely the result of 
inflammation, or whether, previously existing in the natural state, it 
only acquired an increase of development in consequence of disease? 
To determine this point he opened a number of healthy knee-joints; 
in almost all of which he found the above-mentioned tumour, gener- 
ally on the external side of the articulation, but sometimes on the 
internal. Its normal existence is no way connected w ith hydarthro- 
sis ; but it appears to increase in size under the influenqp of the pain 
and articular inflammation: it is not found in all subjects aff'ecled 
with hydarthrosis; but when it does exist during the course of the 
disease, it continues after the disappearance of the latter; pain or 
pressure continues longer over the site it occupies than anywhere 
else, as if the irritation disappeared more readily when the synovial 
membrane alone is affected than when it spreads to the adjoining adi- 
])ose tissue. — Lond. and Edin. Month. Joiirn. Med. Sci., Oct., 1841, 
from Encyclographie Med. , June, 1644. A7n. Jour. Med. Sciences. 



On the Medicinal properties of the Bebeerine — In the April No. 
of the Edinburg Medical and SurgicalJournal, Dr. Maclagan reports 
a number of cases of intermittent and remittent fever treated with 
the Sulphate of Bebeerine, the active principle of the Nectandra 
Rodiei, a tree found in British Guiana, and so called in honor of Dr. 
Rodie, the original discoverer of its medicinal powers. "The cases 
of fever treated with bebeerine, " snvs Dr. !»[., "with which I am 



348 Anlidote to Poisoning. — Placeiiia Free via. [June, 



ncquainted, amount to about 40. In all of them it appears to have 
inunifested more or less of anti-periodic action. In 6 cases, or nearly 
one in 7. it does not seem to have acted satisfactorily. Of 26 cases, 
the details of which are given, 5 only, suffered from any unpleasant 
effect, and this seems not to have gone beyond a little ^i/2/ii/i/5 auri- 
t/m." The bebeerine has also been used with benefit in neuralgias. 
Dr. M. states that the bebeerine d i fie rs from the quinine in not being 
so liable to excite the circulation, or affect the nervous system. He 
gives it in the form of pill, made with conserve of roses, in the same 
way and doses of quinine. It can also be given in the liquid form, 
the addition of a few drops of diluted sulphuric acid sufiicingto form 
with it a perfect solution. 



Inhalalion of Oxygen Gas an antidote to poisoning with carbonic 
acid. — An individual, in the course of some pharmaceutical experi- 
ments, itiiialed a large quantity of carbonic acid. Removed into 
another chamber, he lay motionless, the eyes closed and the face a 
pale vellow, the cheeks, together with the lips, tongue and hands, 
were livid ; the pupils were fixed and somewhat dilated; all the sen- 
ses had entirely disappeared ; the carotids beat violently ; the action 
of the heart was frequent but weak, the pulse scarcely perceptible, 
and the breathing weak and irregular. The cold douche, bleeding 
and other means were unsuccessfully had recourse to. A quantity of 
oxvgen gas was then prepared, and this he was made to inhale, to the 
extent of two quarts and a half. In about fifteen minutes be rallied, 
as if from a deep sleep, and recovery was progressive. The use of 
the oxvgen gas is in this case sufficiently evident. We have seen 
the chlorate of potass, which contains a lai'ge amount of oxygen, ad- 
ministered under similar circumstances, with a most beneficial result. 
This case is recorded at length in the Xorthern Journal of Medicine. 



On Detaching the Placenta in cases of Placenta Prcevia. By 

Radford, M. D. — Since my observation on galvanism in uterine 
ba?morrhage, published in the Provincial Medical and Surgical Journal, 
I liave had letters from many gentlemen, inquiring whether I confined 
lhe|)ractice to detaching the placenta in cases of placenta praevia to 
those of exhaustion alone. In order, then, to supersede the necessity 
of writing to each correspondent, I make the reply through the same 
channel. In my paper I stated that I had detached the placenta in a 
case which occurred in 1819, but did not then state that it was un- 
attended by exhaustion. From this and other cases then alluded to, 
I conclude that on a complete separation of the placenta, the heemorr- 
hagc is ini mediately and completely suppressed, provided the uterus 
is in a condition to so far contract, as to torce down the head with the 
placenta upon the uterine openings. V>y this practice it may be said 



1845.J Placenta Prajcia. 'MO 



thnt the life of the child is sacrificed : but tliis will not al \vn ys hnppen. 
We find from hospital and individual reports, that the child is usually 
dead when the case has been treated by the present recooriiized means. 

In nearly all cases which I have collected and referred to in my pa- 
per, of expulsion of the placenta by the natural elForts, we find that 
the mother recovered ; and when this fortunate event did not hnppen, 
it depended upon the serious impression made upon the vital powers 
before the placenta was completely detached. 

It may also be stated that uterine phlebitis takes place more fre- 
quently in cases of placenta praevia, when the ordinary practice is 
adopted, than we observe in the same numher of cases of accidental 
hicmorrhage. This result, in the opinion of the writer, arises from 
the contusion and slight lacerations which are consequent upon ;i 
forced delivery. 

From the above statement, I consider lam justified in recommend- 
ing a modified practice ; but I shall not enter fully into the details of 
the plan, as this brief communication will not allow of it. 

First. Then, as neither delivery, nor detaching the placenta, ought 
ever to be attempted until the cervix and os uteri will safely allow the 
introduction of the hand, rest, the application of' cold, but, above all, 
the use of the plug, must never be omitted in cases where they are 
respectively required. 

Secondly. If there are unequivocal siorns of the child's death, the 
placenta is to be complete!}' d('tached, and the membranes are to bo 
ruptured. The case is then to be left to the natural efforts, provided 
there be sufficient uterine energy ; if otherwise, the ordinary means 
are to be used, and, in addition, galvanism. 

Thisdly. When the narrow pelvis exists in connection with placen- 
ta praevia, the practice is to detach the placenta and to remove it, then 
to perforate the head as soon as the condition of the parts allows, 
and to extract it by means of the crotchet. 

Fourthly. When the os uteri is partially dilated, and dilatable so 
as to allow the easy introduction of the hand, when the membranes 
are ruptured, and strong uterine contraction exists, the practice is to 
detach the placenta completely. 

Fifthly. In all cases of exhaustion, as already referred to in my 
paper, the practice is to draw off the liquor amnii, by perforating the 
placenta, as then recommended, then to detach completely this organ, 
and apply galvanism. 

Sixthly. In all cases of partial presentation of the placenta, the 
artificial rupture of the membranes v\ill crenerally be found sufficient 
to arrest the haemorrhbge, but if that should prove ineffectual, then 
we must apply galvanism. 

The practice of detaching and removing the placenta was adopted 
by some of the older writers ; and as I have mentioned in my paper 
*'0n galvanism applied to the treatment of uterine haemorrhage, " I 
detached this organ in the year 1S19, although it was not my custom 
to do so. 



350 Expulsion of Fceius throvgh Abdomen. [June, 



Early in October, I received a letter from my respected friend, Pro- 
fessor Simpson, in whicii he stated he removed the placenta in a case of 
nnavoidable haemorrhage. Ho "had the placenta on a plate two hours 
before the baby was born." The mother recovered. Dr. Simpson 
has collected a great number of cases of expulsion of the placenta 
before the child, and has come to the conclusion, that the practice of 
its removal, in some cases of i)lacenta prsevia, is calculated to save 
the parent's life. 

I am glad to have my views on this most important subject corrobor- 
ated by an authority so deservedly esteemed as Dr. Simpson, to whom 
I am disposed to award every degree of merit which really belongs to 
him, as having by observation and research accumulated materials to 
bring him to the same conclusion at which I arrived myself. Although 
I feel thus gratified in having the authority of Dr. Simpson in support 
of this practice, I must confass that it is to be the late Mr. Kinder 
Wood, who for many years was an active and deservedly respected 
colleague of mine at (he Lying in Hospital, that the merit (if there 
be any) is due for the first, as a modern obstetrician adopting this prac- 
tice, and also recommending it in his lectures. 'J'he practice I allude 
to, is that of detaching and removing the placenta in cases of una- 
voidable haemorrhage, attended with exhaustion. In the foregoing 
ohservations I have ventured to recommend this practice as applica- 
ble to cases in which tliere exist different conditions, convinced that 
there are many mothers sacrificed by the rash manoeuvres consequent 
on a forced and indiscriminate delivery. — Provincial Medical and 
Sur(^ical Journal. 



a' 



Successful Case of Expulsion of the Fcrius through a rupture of the 
Uterus and Abdominal Parietes. By Dr. Prael of Hildesheim. 
(Allegemei?ies Repcrtorium, June, 1844.) — A woman, 28 years of 
age, deformed by rickets, and the largest diameter of whose pelvis 
did not exceed two and a half inches, was delivered by the Caesarean 
section on the 11th of January, 1842. The child was a female, and 
alive, but died of trismus the ninth day. The mother made a tolera- 
bly good recovery, notwithstanding the feverish symptoms induced by 
the suppression of the milk st^cretion from the death of the iniant. 
It was a couple of months, however, before the cicatrization of the 
\vound was complete. She again became pregnant in January, 
1843, and about the fourth month a small ulcerated point made its 
appearance on the right side of the abdomen, about a hand's breadth 
from the cicatrix. It daily increased till it attained the size of the 
palm, when the feverish symptoms, &c., induced her to. apply for 
medical a^stance. When raising herself on the 18th July, a slight 
cracking noise was heard, and the abdominal parietes gave way, as 
well as the uterus itself, allowing the fcEtus, still surrounded with its 
envelopes, to project through the rupture. Before assistance could 
be procured the infant was dead ; a midwife cut through the chord, 
and got the woman put to bed. Dr. Schroeder, who arrived about 



1845. J Transylvania University and the Navy 351 



an hour after this, separated the placenta, and removed some clots 
trom the uterus. He could not ascertain the direction of the rupture 
through the walls of the uterus, but that through the abdominal parie- 
tes was transverse, and crossed the line of the Caesarean cicatrix. 
The edges of this wound were sv/ollen, soft, oedema tous, and unequal, 
and as they seemed as if unable to bear stitches, adhesive straps were 
used to bring the edges in contact. The fever of reaction which fol- 
lowed was slight ; a considerable quantity, however, of bloody sanies 
flowed out eacli lime the wound was dressed. Acute pain was short- 
ly after complained of at each extremity of the wound, which assum- 
ed a gangrenotis appearance, and discharged a very fetid sanies. 
Under quinine the state of the wound gradiially improved; but she 
was again thrown back by a rheumatic affection, and then by the 
formation of an abscess in the left inguinal region, accompanied with 
oedema, and partial paralysis of the corresponding limb. Under ton- 
ics and generous diet the wound slowly healed, though the old ulcer- 
ation of the surface continued to be the seat of painful sensations. 
By the 5th of October, the cicatrization of the wound was complete ; 
she suffered no pain ; had recovered her usual appearance ; her 
menses had reappeared ; and she was able to resume her household 
duties. The transverse cicatrix was situated four inches below the 
umbilicus, and measured four inches one line in length. It was very 
uneven and presented many unequal dilatations. The parietes over 
it, and the seat of the old ulcer, were very soft and thin. — Edinburgh 
Med, and Surtr. Journal, 



MEDICAL INTELLIGENCE. 

Transylvania University and Hie Navy. — The "Observer and Reporter," pab- 
bshed tit Lexington, Ky., has been sent us, containing a reply from the Dean of 
the Medical Faculty of Transylvania University, to an article in the New- York 
Herald, of April 7th. The Herald published a letter in which the writer assert- 
ed, "that at the last examination of applicants for the appointment of Assistant 
Surgeons for the Navy, out of thirty examined, only sixteen Avere found quali- 
fied, and that the fourteen rejected as incompetent, \\^re graduates of the Medi- 
cal Colleges of Lexington, and Cincinnati." In answer to a communication 
from the Faculty of Trans3^1vania University, Surgeon Harrington of the Navy 
Board, says, "it gives me pleasure to state, that of the candidates for admission 
into the Medical Department of the Navy, rejected by the last Board of Naval 
Surgeons, not one was a graduate of either Lexington or Cincinnati. Nor has 
any graduate of the Transylvania University yet presented himself before any 
Board, of which I have been a member." 



832 UtilccrsUij of Pciinsyhania. — Obiluanj. — Meteorology. 



University of Pernisylvania. — At the Commencement of the University of 
Pennsylvania, held April 4th, 1845, the degree of Doctor of Medicine was 
conferred upon one hundred and sixty-four persons — two of whom were from 
Georjria, and three from South Carolina. 



Obituary. — We regret to have to record the death of Professor Thomas Sewall, 
M. D., of Washington, D. C, which occurred on Monday, the 10th instant, in 
the fifty-ninth year of his age. Dr. Sewall was a native of Augusta, in the 
State of Maine. He graduated at the Medical School of Boston, and about the 
year 1820 removed to the City of Washington, where his talents and acquire- 
ments, with an upright deportment and great urbanity of manners, soon procur- 
ed for him the respect and patronage of a large portion of the inhabitants. He 
Avas appointed Professor of Anatomy in the Medical School of that place on its 
first organization, and continued to discharge the duties of the Chair, with dis- 
tinguished ability, until the time of his death. By the public prints we observe, 
that the members of the profession of the city in which he resided, and the stu- 
dents of the College to which he was attached, adopted suitable measures to 
express their grief for his loss. Ee.«ide tliese, his remains were followed to the 
grave by a larife concourse of people, including a number of eminent statesmen, 
and the distinguished citizens of the place. — Medical Examiner. 



METEOROLOGICAL OBSERVATIONS, for April, 1845, at Augusta, Ga. 
Latmide 33'^ 27' north — Longitude 4^^ 32' west Wash. 



> 


Thkrmomrter. 
Sun rise. 3, p. m. 


B.\ROMETER. 

Sun rise. 3, p. m. 


Wind. 


Remark-s. 


~1 


58 


70 


29 7-10 


29 8-10 


s. w. 


Cloudy to 12, M. 


2 


41 


79 


29 9-10 


29 9-10 


w. 


Fair. 


3 


4-1 


82 


29 9-10 


29 9-10 


.s. 


Fair. [thunder. 


4 


50 


85 


29 8-10 


29 8-10 


s. w. 


Fair — some drops of rain, and 


5 


50 


81 


29 7-10 


29 6-10 


^\'. 


Fair. do. do. 


6 


58 


60 


29 (5-10 


29 7-10 


w. 


C 1 oudy — spr i n kle , 


7 


51 


68 


29 7-10 


29 7-10 


w. 


Fair. 


8 


45 


64 


29 8-10 


29 9-10 


N. W. 


Fair— windy. 


9 


37 


62 


30 1-10 


30 


N. E, 


Fair. 


10 


39^ 


76 


29 9-10 


29 7-10 


s. w. 


Fair. 


11 


54 


84 


29 7-10 


29 7-10 


N. W. 


Fair. 


12 


56 


78 


29 9-10 


29 9-10 


E. 


Fair. 


13 


44 


81 


29 9-10 


29 8-10 


S. W. 


Fair. 


14 


50 


84 


29 8-10 


29 7-10 


s. w. 


Fair. 


15 


59 


88 


29 7-10 


29 7-10 


S. E. 


Cloudvj* 


16 


62 


84 


29 7-10 


29 7-10 


s. w. 


Cloudy to 12, 'SI. 


17 


65 


86 


29 7-10 


29 7-10 


s. w. 


Fair. 


18 


60 


85 


29 7-10 


29 8-10 


s. w. 


Fair. 


19 


60 


88 


29 7-10 


29 7-10 


w. 


Fair. ^ 


20 


64 


88 


29 7-10 


29 6-10 


w. 


Fair. 


21 


58 


83 


29 7-10 


29 7-10 


N. W. 


Fair. 


22 


55 


83 


29 7-10 


29 7-10 


N, W, 


Fair. 


23 


62 


82 


29 8-10 


29 8-10 


S. 


Cloudy. 


24 


62 


87 


29 8-lQ 


29 8-10 


S. E. 


Fair. 


25 


64 


84 


39 8-10 


29 7-10 


S, W. 


Cloudv. 


26 


64 


87 


29 7-10 


29 7-10 


£. 


Variable. 


27 


68 


90 


29 8-10 


29 8-10 


S. 


Fair— thun. and light. at9, p.m. 


28 


64 


86 


29 8-10 


29 8-10 


S. 


Fair. 


29 


60 


88 


29 9-10 


29 8-10 


S. E. 


Fair. 


30 


58 


86 


29 9-10 


29 8-10 


S. E. 


Fair. 



23 Fair days, auantity of Rain, none. We had no rain from the S^lth of 
March to the 12th of May — a period of 49 days. 



SOUTHERN 

MEDICAL AND SURGICAL 

JOURNAL. 

Vol. I.] NEW SERIES.— JULY, 1845. [No. 7. 

PART I.— ORIGLNAL COMMUxMCATIONS. 

ARTICLE I. 

Reworlis on the use of the Sub-Nitrate of Bismuth in certain gastric 
derangements. By I. P. Garvin, M. D., Professor of Materia 
Medica^ (Sfc, in the Medical College of Georgia, 

The utility of the Sub-nitrate of Bismuth in certain painful affec- 
tions of the stomach, has been known to the profession, ever since 
the publication of Odier, of Geneva, who was the first to employ it 
internally. In presenting the remarks which follow, we are therefore 
not to be understood as claiming any originality, either as to the 
mode of its action or application. Our sole object is to invite atten- 
tion to a most valuable remedy which we think is too much neglect- 
ed. Notwithstanding the length of time which has elapsed since the 
remedial powers of the sub-nitrate were made known, and the numer- 
ous facts which prove its value, some of the best writers on the 
materia medica have failed to notice it at all. Under these circum- 
stances we have thought that a few cases illustrating its beneficial 
effects, would not prove unacceptable to the readers of the Journal. 

Bismuth has been employed with benefif, in the vomitings of chil- 
dren which are connected with dentition, in the diarrhoeas which 
attack feeble infants upon slight causes, and in those which follow 
acute diseases, but are unattended by fever ; but these and some 
other applications of the article we do not intend now to notice, but 
shall confine our remarks to its effects in some of thooe nervous dc- 

23 



354 RemarJcs on the use of Sub-Nitrate of Bismuth, [July, 



rangements of the stomach, which prove so distressing to the patient 
and harrassing to the practitioner. Our observation has satisfied us 
that such nervous affections of the stomach, and indeed many other 
nervous diseases, are of more frequent occurrence in malarial regions, 
than in such as possess a salubrious atmosphere. Nor is this fact at 
all surprising, when we consider that it is upon the nervous system 
that malaria exerts its principal morbific influence as is proven by its 
agency in the production of intermittent fever — a disease, confessedly 
of nervous origin. These diseases of the stomach, like most nervous 
affections, are usually paroxysmal, and whilst relief is most urgently 
demanded during the sufferings of the paroxysm, the patient, and 
sometimes the physician, neglects the radical treatment, which can 
only be carried on during the intermissions. 

Case. The first case in which we obtained very marked benefit 
from the employment of the bismuth, was in that of a female, of a 
spare habit, nervous temperament, and about forty years of age. In 
the early part of the summer, she had an attack of fever in Florida, 
from which she seemed to have entirely recovered. In the month of 
September she had a succession of violent paroxysms of gastralgia, 
occurring at irregular intervals, sometimes of one or two weeks. 
During the three or four earlier attacks, she was from home, and the 
care of the case devolved upon another physician, but we learn- 
ed that she had taken morphine, chloric ether, and other similar 
remedies for the agonizing pain. Between the paroxysms she was 
directed to use the sulphate of quinine, in doses of several grains 
each day. This article, however, appeared to have exercised no 
beneficial influence, for though it had been regularly taken, the dis- 
ease had renewed its assaults. The first attack in which we saw 
the patient lasted about three hours : her face was pale — the skin 
bathed in a cold sweat — the pulse soft, small, and but slightly accel- 
erated — there was an occasional vomiting of a fluid resembling very 
much the black vomit of yellow fever — and there was pain in the 
epigastric region of a most distressing character. A large dose of 
the acetate of morphine was administered, and as tjje last matters 
ejected from the stomach were mixed with blood, to the great alarm 
of the patient, with the morphine was combined four or five grains 
of the acetate of lead. The relief aflx)rded by the combination was 
almost instantaneous, so much so that the patient expressed some 
curiosity to learn what she had taken. At first we were disposed to 
attribute the usual promptness with which the anodyne acted, to 



1S45.] Remarks on the use of Sub-Nitrate of Bismuth. 355 



some modification of the condition of the stomach produced by the 
hemorrhage, but from subsequent trials of the combination of the 
acetates of morphine and lead, in this, as well as in other cases of a 
similar character, we are satisfied that the acetate of lead was also 
an efficient agent in the production of the beneficial effects, probably 
by virtue of its sedative action on the irritated mucous membrane, 
and by restrainining the acrid secretions from the gastric surfaces, 
thereby preventing the irritation which they must excite on these 
morbidly sensitive parts. After the paroxysm we have just noticed, 
our patient continued the use of the quinine for some days, when she 
was again violently attarked. We should have mentioned before, 
that these attacks did not seem to depend at all upon the ingestion of 
food, either in too great quantity, or of an indigestible quality. In 
this instance, a small quantity of rice was the only article which had 
been taken into the stomach. On this occasion, as before, the com- 
binations of the acetates of lead and morphine gave prompt relief. 
The patient was then put upon the use of small doses of blue mass 
in conjunction with quinine, but the paroxysms continued to return. 
Having employed the bismuth in some other gastric derangements 
with benefit, and knowing that in the hands of others it had been 
found useful in cases very similar to the one under treatment, we 
abandoned the further use of the mercury and quinine, and put the 
patient upon the use of the sub-nitrate in doses of two grains three 
times a-day, increasing the dose one grain every two days. From 
the day on which she began the \Xse of this remedy she had no return 
of the disease. Her general health improved, and she remained free 
from this complaint up to the time of her death, which occurred about 
a year subsequent to the cure. 

The next case was one very similar in its general features to the 
foregoing. The patient was a female of a corpulent habit, and about 
thirty.five years of age. Her health had been good up to the latter 
part of the summer, at which time she had an attack of intermittent 
fever, from which, however, she soon recovered, but was soon after 
attacked with paroxysms of gastralgia, occurring at uncertain inter- 
vals, and lasting from one to eight or nine hours. The duration, 
however, was generally two or three hours. As the earlier par- 
oxysms were short, and as she lived at a considerable distance, she 
did not apply for medical aid until the attacks had become of very 
frequent occurrence, and more protracted in their duration. When 
we first saw her she had been laboring under a very violent paroxysm 



356 Remarks on the use of Sub-Nilraic of Bismuth. [July, 



for some hours. Her skin was cold and bathed in sweat, the pulse 
feeble and very slightly accelerated, and she vomited frequently con- 
siderable quantities of an acrid and nearly colorless fluid. The ace- 
tates of morphine and lead were administered, and relief of the pain 
promptly followed. As there was loss of appetite, with a sallowness 
of the skin, and a deficiency of bile in the evacuations, she was put 
upon the use of small doses of blue mass. Her skin soon became 
clearer, and her appetite and general health improved, nevertheless 
the paroxysms of gastralgla continued to return, though they were 
neither so frequent nor so violent. She was then put upon the use 
of the bismuth, and from that day to the present time she has had no 
retvrn of the comp la in t . 

The third was one of a different character. The subject was Miss 

, of a rather spare habit, and about thirty years of age. For 

a long period she had been subject to attacks of vomiting, which 
would continue from two or three hours to as many days. During 
these attacks the stomach would be thrown into the most violent 
contraction by the introduction of the smallest quantity of even the 
blandest fluid. Her skin was cool and moist, and her pulse feeble, 
though not at all increased in frequency. In her most violent at- 
tacks she was affected with spasms. Upon the subsidence of the 
vomiting, a rash, very much resembling that of scarlatina, generally 
appeared upon the skin. Slie had gone through the whole catalogue 
of anodynes and antispasmodics. In one paroxysm an article would 
give relief, which would fail entirely in the next, but it not unfre- 
quently happened that all failed. The dread of the return of the 
vomitings embittered the life of this lady, and led her to practice an 
almost entire abstinence from all the common articles of food, except 
those of the most digestible kind, and in very small quantities. After 
a trial of various medicines, (quinine among the number,) she was 
put upon the use of the sub-nitrate of bismuth, which was continued, 
with occasional intermissions, for a considerable length of time. 
After discontinuing the remedy, she had a slight return of her old 
complaint, but with this exception she has remained fr^e from the 
disease ro the present time. 

We are informed by Dr. Joseph A. Eve, that he has also employed 
the bismuth in several cases of gastric disease of a painful character, 
with the most marked benefit. He generally combines with its use, 
the employment of small doses of blue mass. The mercury he dis- 
continues in a short time, but increases the doses of the bismuth regu- 
larlv. 



1 S45. J Remarkii on the use of Sub-Nitrate of Bismuth. 357 



Dr. Dugas also informs us that he has used it frequently, and 
with almost invariable success, in those annoying sensations of 
oppression or pain in the epigastric region, so common with ladies of 
a delicate constitution and sedentary habits. In such cases he pre- 
scribes tive or six grains to be taken about an hour before each meal, 
until relief be obtained, and then morning and night for a few days 
longer. 

We have also used the article in several cases of dyspepsia, but 
have not witnessed any very marked benefit from its employment, 
except in those instances where pyrosis was present. In such cases 
we had mucl\ reason to be pleased with its effects. 

If the mode of action of bismuth were well understood, it is proba- 
ble that it would be found useful in other diseases than those in which 
it is now employed, but its modus operandi is exceedingly obscure. 
"If we endeavor to ascertain," says Trousseau, " the action of the 
Eub-nitrate of bismuth, we will be much embarrassed ; no intermedi- 
ate effect between the employment of the medicine, and its curative- 
results, can be perceived. Notwithstanding the attention we have 
given to it, we have not been able to perceive the least influence on 
the general functions. When an individual in good health takes the 
sub-nitrate of bismuth, the only phenomenon to be noticed is consti- 
pation, but the nervous functions, the animal heat, the movements of 
the heart, the urinary and cutaneous secretions, are not influenced in 
an appreciable manner." We can therefore only infer the nature of 
its action, from the character of the derangements in which it oper- 
ates beneficially. As these are characterized by an exaltation of the 
nervous sensibility, the medicine is supposed by Trousseau to possess 
sedative properties, and to be also somewhat astringent. Meratand 
De Lens rank it as a sedative, acting directly on thesurface to which 
it is applied, and not as the opiates. Dr. Wood considers it as tonic 
and antispasmodic. We think that it is an error to attribute to it 
any astringent property. Its effect in constipating the bowels, and 
in arresting certain diarrhoeas is evidently due to its property of re- 
ducing the nervous sensibility. 

Considerable fear is entertained by some lest poisonous effects 
should follow the use of bismuth. It is true, that v.hen imperfectlv^ 
prepared, it may contain a small portion of arsenic in the form of an 
arseniate of bismuth, and to the presence of this substance must any 
ill consequences be attributed which may follow ordinary doses, for 
when the sub-nitrate has bt.-en prepared from the pure metal, precipi- 



S^ Strangulated Omental and Intestinal Hernia. [ J^'y 



tated and well washed, no danger need be apprehended though 
the dose should be carried to half a drachm, or even more. Howe- 
ver, in over doses, even the pure sub-nitrate may produce alarming 
effects, such 98 great gastric distress, vertigo, drowsiness, 6z;c, 



ARTICLE 11, 



Strangulated Omental and Intestinal Hernia — operation 'and recovery/. 
By Charles West, M. D., of Wayneshoro\ Ga, 

On the 17th September, 1841, I was called at midnight to see a 
'^egro, (John,) in consultation with Dr. S. I found the patient suffer- 
ing from a tumour in the left scrotum, very painful on pressure, red, 
"dhining and elastic. The attack came on about twenty hours previ- 
ously when in the act of throwing a heavy piece of wood from a 
wagon. He has had constant nausea for six or eight hours, with 
frequent vomiting, and one or two scanty stools without relief. The 
paroxysms of pain were intense, extending over the whole abdomen, 
with an increase of nausea at each return of pain ; the pulse was 
100, strong and corded. He says, that about twelve years ago, he 
had a similar accident, which was relieved only after great efTorts, 
and aided by the use of the tobacco enema. He has always felt a 
considerable thickness in the scrotum since that attack, and has had 
frequent returns of the enlargement coming on gradually after ma- 
king any great effort — but he has always succeeded in relieving 
himself by sitting in cold water — this relief occurring gradually 
during two or three hours, and never suddenly. At the present time 
the presence of an ancient omental, and a recent intestinal hernia, is 
clearly perceptible. 

Perseverinn- efforts at the taxis alone, and then the tobacco enema 
producing great relaxation, followed by renewed efforts, were used 
for several hours without success. Venesection and the warm bath, 
both carried to fainting were then resorted to, with as little success. 

After exhausting every means which was thought capable of avert- 
ing an operation, \^e latter alternative was advised at 8 A. M. — 
Thiough the opposition of both master and servant, the operation 
was postponed till night, about forty hours after the beginning of the 



1845. J Strangulated Omental and Intestinal Hernia. 359 



attack. At this time the tumour was red, glossy, hard, and very 
painful, the whole abdomen very sensitive on pressure, the paroxysms 
of pain extremely severe — tiie pulse 140, small and feeble. There 
was nausea, but no vomiting. 

The cremaster muscle was found to have lost its fibrous appear- 
ance entirely, and seemed confounded with the serous membrane 
beneath. The division of the hernial sac permitted about an ounce 
of serum to escape, and brought into view a portion of omentum. 
This was found closely adherent to the tunica vaginalis, the false 
membrane being very strong, and requiring the use of the point of 
the knife te detach it. When dissected from its adhesions, it mea- 
sured six inches in length, four in breadth, and one in thickness. 
Beneath this, a fold of intestine was found of a dark red color, so 
closely strictured, that it was impossible to draw out any portion, or 
to return it. At the external ring there was no stricture, though the 
omentum had formed close attachments to the whole inguinal canal, 
and seemed sufficient to compress strongly the intestine. At the in- 
ternal ring, a stricture was found so rigid and clo;se, that the finger 
nail could not enter. From the presence and adherences of the 
omentum, the stricture was with difficulty divided, by using a small 
conductor, and a sharp pointed bistoury; the probe-pointed bistoury 
and Sir Astley Cooper's hernia knife, being both too thick to pass 
between the intestine and fibrous cord, thouf^>» repeated efforts were 
made to effect it. Having returned the intestine, the omentum was 
next cut ofTclose to the abdominal fascia with little or no hemorrbao-e. 

o 

The wound was dressed with four sutures, and adhesive strips. Four 
hours afterwards, a blister was applied over the whole lower abdo- 
men, though complete reaction did not take place until several hours 
had elapsed, and about the time of the drawing of the blister. 

A saline cathartic was then given, which did not operate till eight 
hours after. The wound cicatrized without difficulty, and on the 
twenty.first day the patient was discharged. For three months after 
he suffered severe colic pains after eating indigestible substances, but 
these gradually disappeared. There has been no return of hernia. 

This case has been recorded, not for any thing remarkable in its 
history, or the operation, but as connected with some reflections 
which it suggests. 

1st. The necessity of carefully examining every case of hernia 
after the reduction has taken place, so as to avoid, if possible, leavinij 
any portion of omenluni in the sac unreduced, since it will render 



An Essay on the Abuse of Diuretics. [July, 



an operation at some future day inevitable, and by prolonging and 
complicating the operation, increase the danger of the patient. 

The presence of an unreduced omentum, though small, renders 
the use of a truss highly dangerous, and if large, doubly so, from 
concealing the presence of a small nucleus of intestine from even a 
careful observer. The irritation produced by that instrument always 
causes a thickening of both omentum and intestine, and renders 
reduction without an operation a matter of impossibility. 

2d. The diagnosis of this case was materially aided by attention 
to its history since the previous accident. The constant presence of 
something not intestine, in the scrotum of that side, its volume fre- 
quently increased by bodily effort, and always relieved, not by pres- 
sure, or favorable position, but by the use of cold water, not suddenly 
with a gurgling noise, but gradually, seemed to point out the exist- 
ence of an old omental hernia, which was confirmed in the sequel. 



ARTICLE III. 

An Essay on the Abuse of Diuretics — some of the morbid conditions 
of the Urinary Organs arising therefrom, and their Treatment, 
with Cases : — Read before the Medical Society of Augusta, June 
7th, 1845. By H. F. Campbell, M. D., Demonstrator in the 
Medical College of Georgia. 

In the selection of a subject for this essay, the above particularly 
urges itself upon my attention — first, from its great importance 
in a pathological and therapeutical point of view ; and secondly, 
from the fact that, I have recently had occasion to deplore the 
pernicious eflfectsof the abuse of this class of medicines, in several 
interesting cases. 

In the relation of the few following cases, every practitioner may 
recognize, perhaps, many similar coming under his own observation, 
wherein the empirical efforts of the patient to relieve himself, have so 
complicated his primary disease, as to render the treatment very 
unsatisfactory to the physician, and ultimate cure almost hopeless. 

Diuretics are that class of medicines, which increase the secretion 
of the kidneys, and the term owes its etymology to the two Greek 



1845. J An Essay on the Abuse of Diuretics. 3G1 



words Sia, by or through, and ovpeio, I pass the urine. All agencies 
which, directly or indirectly, exert an influence on the urinary 
organs, producing an increase in their secretion, may with propriety 
be termed dmretics ; hence these agents have been classed under two 
heads, direct and indirect diuretics: the direct are those substances 
that produce a specific action upon the kidney through the circulating 
fluid, and which if injected into the blood in proper doses, would by 
selection, exercise their specific influence upon these organs ; and 
secondly, the term is applied to any agency which under certain 
peculiar circumstances has in any way become the cause of diuresis ; 
among these are diluents which by increasing the amount of the cir- 
culating fluid, will consequently produce an increase in the urinary 
secretion, any diminution in the amount of the cutaneous or pulmo- 
nary exhalations will, from the antagonism existing between these 
great depurators, result in a proportionate increase in the urinary 
secretion ; in exemplification of this we see cases daily, many indeed 
have come under my own observation, wherein the patients had 
been subject to irritability of the bladder, and invariably on the ad- 
vent of inclement wet weather the disease became aggravated, even 
producing haematuria, from the increase in the urinary secretion con- 
sequent upon the diminution of the cutaneous exhalation. 

Depletion and other antiphlogistic means, under certain circum- 
stances, become powerful diuretic agents ; when there exists an 
inflammatory condition of the kidneys, interfering with their secre- 
tion, blood-letting, by removing this condition, re-establishes the 
normal functions of these organs ; nauseants also act in this way 
beneficially by controlling the circulation in nephritis ; indeed the 
means and circumstances which, in certain conditions of the system 
may induce an increase in the urinary secretion, are multifarious 
and innumerable. 

While I have deemed it proper, thus at the beginning of this essay, 
to glance briefly at the normal modus operandi (if I may use the 
term) of this class of therapeutic agents, it would perhaps be super- 
fluous to enter into further detail of such action; I will therefore now 
consider their improper application, and the morbid conditions in the 
urinary organs thus superinduced. 

On a review of distinguished authors on urinary diseases, the abuse 
of diuretics stands among the first on the list of causes producing 
derangement in this set of organs, of which the proper exercise of the 
functions is so eminently important, and the morbid condition or im- 



362 An Essay on the Abuse of Diuretics. [July, 



perfect action, so surely entail a life of misery upon the patient. 
M. Chopart, in his valuable treatise on the diseases of the urinary 
passages, has occasion more than once to deplore the sad havoc 
caused by the improper use of diuretics, and relates at length cases, 
wherein some of the most obstinate affections of the kidneys and 
bladder have been the direful result of the injudicious use of this class 
of remedies. He deprecates their abuse by empirics, and by pa- 
tients themselves ; indeed there is scarcely a disease of the kidneys 
or bladder reviewed by him, wherein he does not cite this as an occa- 
sional cause of that morbid condition of those organs upon which it 
depends. In his chapter upon the vices in the secretion of the urine, 
he mentions the abuse of diuretics first, among those causes which 
superinduce the diseased states giving rise to such vices. In nephri- 
tis it is often the cause of the inflammation, by too actively 
promoting the flow of blood to the kidneys, impeding their functions, 
and giving rise to ischuria and all its attendant evils. I have fre- 
quently found this a cause of simple retention of urine from the 
violent irritation of the neck of the bladder, producing either tume- 
faction or spasm at that portion of this organ ; but what I have found, 
and this is the case in most of the reports on this subject, the most 
frequent r'6sultof the abuse of diuretics has been an irritable state of 
the bladder and kidneys, attended with incontinence of urine and 
hsematuria; and it is more especially to this particular condition of 
the urinary organs that I wish at present, most respectfully to call 
the attention of the Society, adducing a few cases with the treatftient 
found most efficient for their relief. 

There is perhaps nothing more common, and yet nothing more 
trying, to practitioners in their intercourse with patients, than 
the empiric treatment to which they almost invariably subject 
themselves in venereal diseases, before submitting to the advice 
of a physician. More than two-thirds of the cases we are called 
upon to treat, have perhaps run the gauntlet of all the alleged rem- 
edies the patient has ever heard of, and when at length, application 
is made to a physician, the 'primary affection forms but a part of the 
difficulty to be surmounted. 

Case 1st. Not long since, I was called upon to treat what the 
patient called a very obstinate case of gonorrhoea. Mr. K. said that 
notwithstanding the most active treatment, his disease had increased in 
violence, until he became alarmed and bought four ounces of balsam 
copaiba, and took the whole of it in two days, and in spite of all, the 



1845.] An Essay on the Abuse of Diuretics. 363 



burning and discharge continued, and when he urinated, (which was 
very often) he passed apparently all blood — and indeed he was in a 
deplorable condition : the bladder was so irritable as not to retain an 
ounce of urine ; the haBmorrhage so abundant as to be rapidly ex- 
hausting his strength ; and he at the same time complained of severe 
pain in the lumbar region — the discharge, it is true, still existed, but 
it was only of minor consideration in the sum total of his ills. Ho 
was treated with rest in the horizontal position, and a styptic powder 
of alum, kino and opium, to be repeated more or less frequently accor- 
ding^ to the amount of hoemorrhaire, with demulcent drinks and an 
occasional dose of camphor water, to allay irritation at the neck of 
bladder. After the haemorrhage was somewhat checked by this 
treatment, the buchu and uva ursi were steadily applied in the form 
of the compound syrup repeated three times a day, and the cure was 
complete in less than a week. The gonorrhoea was afterwards re- 
lieved by a lunar caustic injection followed by mild diuretics. 

It is remarked by Dr. Willis, in his learned and concise Treatise 
on Urinary Diseases and their Treatment, "that, in certain morbid 
conditions of the kidney, the increase in the quantity of urine pour- 
ed out by that organ, is followed by unusually frequent calls to relieve 
the bladder, and these calls have been Observed to have this peculiar- 
ity about them, that they are singularly urgent when they supervene" 
— a remark that the following case, which is one like the above, of 
irritable bladder with hsematuria, supervening upon the abuse of di- 
uretics, will go in some measure to corroborate. 

Case 2d. Mr. B A , a young man, aged 18 years, 

contracted gonorrhoea, and applied to an apothecary, who furnish- 
nished him with a balsamic emulsion, which he applied with all dili- 
gence, till he had the disease as he thought, pretty well subdued : as 
he had anticipated, while taking the balsam and nitre, his urinary 
secretion was very much augmented, but a short time before apply- 
ing io me, these calls had become so frequent and required such 
prompt attention, that he could not go into company at all, being 
obliged to void his urine with scarcely a premonition, after which he 
also passed a few drops of blood. 

When I saw him, he was not laboring under haematuria, but com- 
plained of a constant uneasiness in the perineum and a very frequent 
and painful voiding of scant, highly colored urine ; he also had a 
dull pain in the lumbar region and a sense of fatigue in the thighs 
and knees. The gonorrhoea had ceased, but in its place, he had su- 



364 An Essay on the Abuse of Diuretics. [July, 



perinduced a nephritic condition of the kidneys and an irritable blad- 
der. Under the antiphlogistic treatment, with rest in the horizontal 
position, followed by the full exhibition of buchu and uva ursi,. with 
occasionally a little camphor and opium, he slowly recovered the 
the tone of his urinary organs. 

Case 3d. Simon, a boat hand, had had gonorrhoea for some time, 
and been treated with balsam copaiba, of which he says he has taken 
a great deal. The Agent of the Company, supposing that the disease 
was slight,* as there was no discharge, and as he could not well de- 
fine his feelings, referred him to me for examination, previous to 
sending him with the boat. When I saw him, he had a dull, fatigued 
look, said he felt tired and heavy, and when asked where he had 
pain, complained of a vague feeling of uneasiness in the region 
of the bladder and in the perineum, and said he felt bruised in the 
lumbar region. The discharge had ceased : the pulse and respiration 
were natural — urine scanty and attended with slight burning. 

Treatment — I applied a tartar emetic plaster to the lumbar region 
and gave an active cathartic — after its operation, he took half an 
ounce of syrup of buchu and uva ursi, three times a day, under 
which treatment he recovered in a week. 

Case 4th. Mr. M. Z ^ aged about 35 years, had gonorrhoea, 

and took an emulsion of balsam copaiba, with oleum cubebae, oleum 
pimentaB, and several other essential oils, making in all a very stim- 
ulating prescription; — this he had taken for a week, and the disease, 
though somewhat checked, was still very troublesome. When he 
applied to me, he was in the greatest distress, from the highly irrita- 
ted condition of his urinary organs, in consequence of the almost 
destructive diuretic course, to which he had subjected them; he com- 
plained of severe pain in the lumbar region, which evinced much 
tenderness on pressure ; pulse rapid and full, respiration somewhat 
hurried ; his whole appearance indicated intense suffering. He 
voided his urine about every ten minutes, in small quantities, and 
very pale — for an hour or two belore I saw him, he was unable to sit, 
from the severe pricking sensation in the perinaeum which that po- 
sition produced — his bowels were constipated, and had been so for 
several days. Treatment. — The patient objected to being bled, and 
to relieve his immediate distress, I administered §ij. of camphor wa- 
ter, with half a grain of sulphate of morphine ; a short time after, four 
ounces of the compound decoction of buchu and uva ursi ; — to relax 
the bowels I gave four comp. cath. pills. He afterwards continued to 



1845.] An Essay on the Abuse of Diuretics. ^Qo 



use (he decoction ofbuchu and uva ursi every three hours, with an 
occasional dose of camphor water. The effect was immediately and 
decidedly beneficial — he was well in three days. The gonorrhoea 
was afterwards successfully treated with the carbonate of potassa, 
dissolved in the syrup of buchu and uva ursi, to which was added a 
small portion of balsam copaiba. 

The above cases I have adduced with the view of showing, as I 
have found them, the particular train of symptoms attendant upon 
that pathological condition of the urinary organs, superinduced by 
the improper use of di