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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.

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-

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

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.

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

749

800

794

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

1829

1830

1831

Murders in general,

241
5G
15
39
23
20
35
2
G
28

234
G4

231
61

7
4G
24
21
45

1
23

205
57
12
44
12
11
4G
2
4
17

2GG

Gun and pistol,

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

Knife,

30
34

Cudgels, cane, &c

Stones,

Cutting, stabbing, and bruising instruments,

Strangulations,

49
4

By })rccipilating and drowning,

Kicks and blows with the fist,

Fire,

Unknown,

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.

-*^^ '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.

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.

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,

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-

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

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,

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.

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.

do.

Dr. N. Smith.

do.

do,

Died,

Recovered.

Cyst, fluid.

7—1821

3 inches.

Adhesions,

8— 18-25

-Mr. Lizars.

Long,

do.

9—1325

do.
Dr. A. G. Smith.

35
30

do!
do.

D:e.'.
Recovered.

Adherent,

Cyst, fluid.

Dr. Qui.tenbaum.

About 4 in.

do.

12-1829

Mr. D. Ilo^MTS.

About 3 in.

do.

Solid and fluid.

Adhesions.

Dr. Grariville.

Died,

Dr. Chrysmer.

Long.

do.

Cart, and lardaccous
matter.

Adherent.

do.

Recovered.

Honey-like and green
sanies.

do.

Died.

Dr. Ritter.

do.

Recovered.

Cyst, fluid.

18-1836

Mr. King.

Short.

do.

19— 1SJ3

Mr. JeartVeson.

do.

M. Dolhoff

Long.

Died.

Cyst and fluid.

Adhesions,

21—1835

Mr. West.

Short.

Recovered.

' do.

do.

Died.

do.

Not cured.

do.

Mr. Hargrave«.

do.

Multilnc, cysts.

Adhesions.

Dr. Clay.

27 inches.

Recovered.

Cysts, sol. and fluid.

do.

14 do.

do.

E t.adh.

2^^

28 do.

do.

14 do.

Died.

do.

14 do.

Recovered.

do.

Adhesions.

14 do.

Died.

do.

None.

14 do.

Recovered

do.

Ext, adh.

16 do.

DioJ,

do.

16 do.

Recovered,

do.

.^5—1940

MrB.'philifps.'

2 inches.

Died.

3V-1S4I

Dr. Stilling,

6 do.

do.

37—184-2

Mr.Walne.

Long.

Recovered.

do.

None.

38-1843

do.

D ed.

40-1543

do.

Recovered.

do.

4I-IS13

Mr. Morris.

do.

42—1843

Mr. Sontham.

do.

Cystic sarcoma.

do.

43—184 5

Dr. F. Bird.

3 or 4 in.

do.

<:yst and fluid.

do.

44—1814

do.

Cysts and solid mat-
ter.

do.

Mr. Atlec.
Mr. Lane.

3 inrhes.
Long,

do.
do.

Adhesions.

Cysts, fluid.

None.

Mr. Key.

do.

Died.

do.

Mr. Grecnhow.
Mr. B. Cooprr.

L»9
32

do.
do.

do.

Ooariotomy,

[February,

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

not be completed.

Date.

Operator.

Cause of failure.

Result.

Incision.

Dr. M'Dowal.

Adhesions to ])lad-
der and uterus.

Recovered.

Long.

Mr. Lizars.

Solid and very vas-
cular tumoiir.

do.

52— 132G

Dr. Granville.

Firm Adhesions.

do.

6 inches.

Dr. Dieffenbach.

Vascularitv.

do.

Long.

54—1826

Dr. Martini.

Solid and fixed tu-
mour.

Died.

do.

Anonvmous.

Fixed tumour.

do.

M. Dolhoff.

do.

About 6 inch.

Dr. Clay.

Exten. Adhesions.

do.

Long.

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.

M. Dolhoff.

do.

Dr. Clay.

Died.

Uterine tumour.

do.

Recovered.

Hvdatid.

do.

Died.

Pelvic tumour.

do.

Uterine tumour.

Mr. Heath.

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.

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

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

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

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«»

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.

'18

30 inches

X. w. fair. '17

296-10 in.

s. rain.

21 41

29 9-10

s. E. fair. 18

29 7-10

K. w. fair.

s.w. crdv.'19

29 9-10

N.E. rain.

'' fair. i!20

N. E. misty.

" iiSJl

w. fair.

6i 57

29 3-10

s. E. rain, 22

X. w. "

29 5-10

w. fair. ;23

29 9-10

E. rain.

29 8-10

" i;24

29 6-10

w. cl'dy.

29 9-10

" ,25

29 7-10

N.w. fair.

s.w. " ii26

29 8-10

vv. "

111 12

29 7-10

V.-. " :27

29 7-10

29 8-10

x. w. " l'28

29 8-10

S. E. "

29 6-10

s.w. '' 29

X. w. "

29 9-10

w. " iSO

30 9-10

variable. 31

IS ((

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

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

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.

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

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

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,

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.

7, A. M.

a, p. M.

7, A. M.

6, P. M.

-2sr-

30 inch.

29 9-10

N. E.

Variable.

29 9-10

N. E.

Fair.

29 9-10

Cloudy.

•29 4-10

29 4-10

N. W.

Rain 7-10 inch— high

wind.

29 5-10

29 7-10

N. W.

Hisrh wind night and

day.

29 8-10

29 9-10

N. W.

Fair,

30 1-10

Cloudy.

30 1-10

29 9-10

Fair.

vv.

Fair.

•29 8-10

29 8-10

.s. w.

Fair.

'29 7-10

29 7-10

s. w.

Fair.

29 7-10

s. w.

Fair.

29 9-10

29 9-JO

Cloud V.

29 8-10

variable.

Rain 3-10 inch.

29 8-10

29 9-10

Fair.

■29 9-10

29 8-10

s. w.

Fair.

•29 8-10

29 8-10

s. w.

Fair.

•29 8-10

29 8-10

s. w.

Fair.

•29 8-10

29 8-10

S. E.

Fair.

•29 8-10

29 8-10

S. E.

Fair.

•29 8-10

29 8-10

Cloudy.

•29 7-10

29 0-10

Rain 1 inch 5-10

29 7-10

Fair.

2.5

29 7-10

29 8-10

Fair.

•29 7-10

29 7-10

Fair.

•29 0-10

29 .5-10

N. W.

Fair — high wind.

•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.

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-

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.

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

•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.

29 8-10

a) 8-10

s. w.

Fair.

29 8-10

Variable.

29 7-10

29 8-10

Variable.

29 8-10

29 7-10

S. E.

Rain 2-10 inch.

29 6-10

29 7-10

Fair.

30 in.

Fair.

29 9-10

S. E.

Variable.

29 9-10

29 8-10

Variablv.-*,

29 8-10

29 7-10

S. W.

Variable.

e-2

v59

29 6-10

N. W.

Rain 3-10 inch.

29 7-10

29 8-10

N.W.

Fair.

29 9-10

N. E.

Cloudy.

29 8-10

2i) 8-10

Rain 1 inch.

29 7-10

29 6-10

Variable.

29 7-10

Fair.

29 7-10

29 6-10

Variable.

29 5-10

29 4-10

Fair — high wind.

29 5-10

Fair — high vvind.

29 7-10

Fair— high wind.

29 9-10

30 in.

N. W.

Fair.

3:j

30 in.

N. W.

Fair.

29 9-10

Cloudy— rain at sun-set.

29 8-10

Rain to 3, p. m., 5-10 inch.

30 in.

30 1-10

\. F,.

Fair.

2<)

6f;

30 1-10

30 2-10

f-'. E.

Fair.

30 1-10

30 1-10
^0 1-10

S. W.

Fair.

30 1-10

Variable.

30 1-10

S. E.

Variable.

30 in.

29 9-10

Variable.

29 8-10

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

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.

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

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.

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.

29 7-10

29 8-10

s. w.

Cloudy to 12, M.

29 9-10

Fair.

4-1

29 9-10

.s.

Fair. [thunder.

29 8-10

s. w.

Fair — some drops of rain, and

29 7-10

29 6-10

^\'.

Fair. do. do.

29 (5-10

29 7-10

C 1 oudy — spr i n kle ,

29 7-10

Fair.

29 8-10

29 9-10

N. W.

Fair— windy.

30 1-10

N. E,

Fair.

39^

29 9-10

29 7-10

s. w.

Fair.

29 7-10

N. W.

Fair.

29 9-10

Fair.

29 9-10

29 8-10

S. W.

Fair.

29 8-10

29 7-10

s. w.

Fair.

29 7-10

S. E.

Cloudvj*

29 7-10

s. w.

Cloudy to 12, 'SI.

29 7-10

s. w.

Fair.

29 7-10

29 8-10

s. w.

Fair.

29 7-10

Fair. ^

29 7-10

29 6-10

Fair.

29 7-10

N. W.

Fair.

29 7-10

N, W,

Fair.

29 8-10

Cloudy.

29 8-lQ

29 8-10

S. E.

Fair.

39 8-10

29 7-10

S, W.

Cloudv.

29 7-10

£.

Variable.

29 8-10

Fair— thun. and light. at9, p.m.

29 8-10

Fair.

29 9-10

29 8-10

S. E.

Fair.

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-

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.

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 diuretics, and also to offer my own experience,
though limited indeed, in a remedy to which many ascribe but little
specific influence over the urinary apparatus. With regard to the
curative effect of uva ursi in urinary diseases, there exists among au-
thors even at the present day, the greatest discrepancy ; some claim-
ing for it all the sanative power usually ascribed to a favorite remedy,
while others contend that it is wholly devoid of any action whatever,
save perhaps a slight tonic effect upon the system. Alibert, in refer-
ence to this article of the Materia Medica, says: "All that can be
said of this remedy is that, its action is, under certain circumstances,
manifestly diuretic," and he denies it any influence whatever over
nephritic and other diseases of the urinary organs. Dr. Farriar
speaks favorably of it, in some few instances, and reports twelve out of
sixteen cases of urinary disease relieved by it, though the value of the
deduction from these cases is somewhat impaired by the fact, that
he combined its application with other acknowledged, and very effi-
cient remedies for the same affections.

M. Biett, in his valuable contribution to the Dictionnaire des Sci-
ences Medicales, on this subject, evinces but a feeble belief in the
specific virtues of this plant, in diseases of the urinary organs, and
advances in close relation with his own views, the experiments of
Dr. Alexander, which tend to prove that it is scarcely endowed with
diuretic properties, and coinciding with him, he further cites the high
authority of Werlhof, Acrel and Dr. Fothergill, who, he says, contest
(he question of its efficacy with some degree of reason ; and later, we
have the opinion of Sir Benj. C. Brodie, who in his excellent Prac-
tical Lectures on the Diseases of the Urinary Organs, confesses with
his wonted candor, his comparative want of success, with the remedy
in question, in the following words : "The uva ursi has the reputation
of being useful as a remedy for chronic inflammation of the bladder.
I must say however, that this remedy has generally disappointed me

303 An Essay on the Abuse of Diuretics. [July

in these, and that I have not seen those advantages produced by it,
which the general reputation of the medicine had led me to expect."
And in another lecture, whila- he extols the other article in the
combination used in the above cases of urinary disease, the diosma
crenata or buchu, he again expresses his unbelief in the virtues of
the uva ursi.

Indeed with such decided, adverse testimony, from the very exalt-
ed authority above quoted, it would appear even unscientific to hold
an opinion very favorable to the specific action of uva ursi, in certain
diseases of the urinary organs, could we not, on the other hand, ad-
duce a weight of authority equally as respectable, Galen, it is ra-
ther suspected by Dr. Murray, in his treatise on this subject, recom-
mended the uva ursi under the name o^ apKov srai-X/j, as a remedy
against haemoptisis. The physicians of Montpelier, and more recently
De Haen, as M. Biett remarks, have singularly contributed to spread
the use of it in these modern times, and since them we have the tes-
timony of Model, Gerardi, Joseph Quer, and Dr. Murray — all of
whom speak in the highest terms of its efficacy, and Joseph Quer
more especially in his "Dissertation on the Nephritic Passion," pub-
lished at Madrid, 1765, lauds it as "the veritable specific. ^^

A'though the majority of the above cited authors have valued the
uva ursi, more particularly for its supposed virtues as a lithontriptic,
a class of medicines which were since exploded by the chemical ex-
periments of M. M. Vauquelin and Fourcroy, on calculus, and which
now are but little esteemed by the profession; still I have deemed it
expedient to adduce them, inasmuch as, in their hands, the remedy
invariably exerted a decidedly beneficial influence over the urinary
organs in certain states of disease. Later we have the favorable
testimony of Dr. Farrair, Dr. Eberle, and Dr. Chapman, and lastly,
we may quote Dr. William Prout, perhaps the highest practical au-
thority on diseases of the urinary organs now extant. This
author, in his justly styled "elaborate and profound" treatise on
"the stomach and renal diseases," recommends it in terms of the
highest praise for its astringent and tonic effect, in many diseases of
the kidney and bladder, among which are the secretion of serous
urine, suppuration and abscess of the kidney, chronic inflammation of
the bladder, with cystorrhosa, &c.

In the cases given above, of disease of the urinary organs from the
abuse of diuretics, the uva ursi has been administered in combination
with buchu, which latter is rendered a very proper and efiicient addi-

1845. J , A Case of Hydrocele. 367

tion in such cases, from its demulcent and slightly balsamic charac-
ter, which last principle is said* to act topically upon the secreting
organs, as it passes through them, while it adds materially to the tonic
effect of the bear berry upon these diseased surfaces. The forms in
which I have applied the remedy most frequently, have been in that
of the decoction of the uva ursi and infusion ofbuchu, given three
times a day, in portions of two ounces each ; but a preferable prepara-
tion is the syrup, prepared from the leaves of these two plants, with a
sufficiency of sugar to prevent fermentation. This mode of admin-
istration, while it combines all the virtues of the two plants, is not
obnoxious to the almost invariable objection made to their employ-
ment in substance, or even in decoction, their liability to nause-
ate : indeed Dr. Lewis complains that in all the cases wherein he
has administered the uva ursi, it has produced the most distressing
nausea.

I have used the buchu and uva ursi in one or two instances, in
other affections of the urinary organs than those, the result of the
abuse of diuretics, but with indifferent success; and its effect was
only appreciable after a long continued administration ; but in the
above named cases, where there was but little organic lesion, and also
in the dysuria and violent irritation, attendant upon the absorption
of cantharides from a blister, their action has appeared to me, gener-
ally prompt and effectual in removing the most distressing symptoms.

* Pereira's Materia Medica and Therapeutics, Vide Art. Diosma Crenata.

ARTICLE IV.

A Case of Hydrocele iwenly-iTiree and a half inches in circumference
and containing thirty-seven ounces of serum — cured hy Iodine
Injection. By Paul F. Eve, ]\I. D., Professor of Surgery in
the Medical College of Georgia.

In November last, as will be perceived by the following extract of a
letter from my friend Dr. Wm. J. Johnson, an intelligent practitioner
of Fort Gaines, I was consulted in reference to a case of hydro-scarco-
cele. "I write you this at the request of a friend of mine, Barnett
Cody, of this (Early) county. He is a worthy citizen and most estima-

SG3 A Case of Hydrocele, [July,

bic man, somewhat past fifty years old, and the father of several chil-
dren. Some four or five years since a small tumour was detected at
the bottom of the scrotum, which has continued gradually to enlarge
to the present time. The old gentleman being very modest felt a great
disinclination to consult a physician, and would doubtless have con-
cealed his condition until now, or even longer, if he could, had not the
tumour increased so much in bulk as to have attracted the notice of
his friends and annoyed him greatly by its w^eight. Yesterday he visited
this place for the purpose of consulting me, and I made a thorough and
critical examination of the tumour. It is now quite large, and would
weigh, I have no doubt, could it be extirpated without loss of blood, at
least five or six pounds. It is attended as yet with no pain. It feels
hard and unyieldmg. There is no discoloration of the integuments,
no ulceration, no abrasion of surface. The veins at the bottom of the
scrotum are quite enlarged, and appear turgid and full. The SAvelling
v» ithin the last year has progressed upwards, towards the abdominal
ring, and the spermatic cord with its tegumentary envelope are prodi-
giously enlarged. I should say the track of the cord w^as as large as
my arm. Mr. C. informs me that he was many years ago a hernial
subject. The hernia occupied the right side, but he has been radical-
ly cured of that affection for at least twenty years. The tumour which
he now has, is confined to the right spermatic cord and right testicle —
the penis and left testicle being perfectly healthy.

I cannot detect the presence of the testicle as a distinct body in the
tumefaction. The tumour does not feel uneven or rough or knotty or
doughy ; but is quite even and possesses considerable elasticity. May
it not be an hydro-scarcocele ? I suppose it will require a surgical
operation, and have advised my friend to visit you as soon as possible."

In December last, Mr. Cody arrived in Augusta, and on the 30th of
the same month, he was prepared for the operation. I found the case
so accurately described by Dr. Johnson, that I have not a word to add
to it. The tumour measured twenty-three and a half inches in its
longest circumference, and having punctured it with the trocar, I drew off
by the canula thirty-seven ounces of straw colored serum. The testi-
cle on this (right) side, was now found to be twice the size of the
other. My patient experiencing some pain and being threatened with
syncope, was placed in the recumbent position, and drank some water.
In from five to ten minutes I injected tr. iodine six drachms to eight
ounces of water. The pain was felt to be increasing in a minute or two,
and the injection wa? allowed to escape. IMr. C. suficred considera-

1845.] A Case of Hydrocele, . 369

bly for two hours, to moderate which, morphine was given and a warm
poultice applied over the scrotum.

Dec. 31st. Had not slept — the patient attributes it to the morphine.
Very little pain was experienced. Diet, absolute.

Jan. 1st, 1845. Patient is doing well. A little more tumefaction,
though no increase of pain in scrotum.

2nd. Ordered a dose of oil. Diet, gruel, tea and bread.

3rd. Patient doing well.

4th. Tumefaction of scrotum considerable ; feels doughy. Punc-
tured the cicatrix of the trocar with lancet, and it bled freely, nearly two
ounces of venous blood. Swelling greatly abated.

5th. He feels well, and now thinks the operation will succeed.
Diet increased. The patient up, dressed, and moving about the room
for the past day or two.

6th. Started home (a distance of 300 miles,) by easy stages, in his
carriage.

The following letter, addressed to me by Dr. Johnson, two months
and a half after the operation, will give the result :

"Fort Gaixes, 14th March, 1845.

"Dear Doctor, — I have purposely postponed writing to you in refer-
ence to the case of my friend, Bamet Cody, Esq., on whom you oper-
ated for Hydrocele, in order to ascertain whether the operation has
been successful in effecting a permanent cure. I saw Mr. C. on last
Tuesday, and made inquiiies concerning the result of the operation.
He informed me that his affection first made its appearance about five
years ago. The tumour for the first two or three years enlarged
gradually, but for the past two it increased rapidly, reaching nearly to
the knees, and being so bulky and unwieldy as to incommode him in
walking or sitting; and the deformity occasioned by its presence
caused him to shun society and confine himself to his house. The
swelling upwards towards the abdominal ring, along the course of the
spermatic cord, commenced only a few months before he consulted me,
and was very rapid. You know the shape, form, dimensions, &c., of
the tumour, when he presented himself to you in December last, the
amount of serous fluid evacuated, the treatment pursued, d:c., up to the
time of his leading Augusta. Upon his return home, 'Mr. C. was under
the fearful apprehension that the operation had been unsuccessful, but
he is now thoroughly convinced that it has succeeded in effecting a
radical cure. You wrote me that one of the testicles was enlarged to
about t^^icc the uHial -izc . that enlargement ccntinue:, and I -uppc.-e

24"

370 Diseases of the Heart. [July?

will be permanent. The cavity of the sac is entjjrely obliterated, and
the scrotum is but little larger, if any, than in its normal state.

" I informed Mr. Cody that yoru had written me requesting to know
the result of the operation, that you might make a report of the case for
the Southern Medical and Surgical Journal. He expressed a de-
sire to have it made out and published, even giving hi^ name, resi-
dence, &c." * * *

I heard of Mr. C. a few days ago, and learned that he was well and
attending to his ordinarj^ business.

PART II.— REVIEWS AND EXTRACTS.

Some of the Diseases of the Heart. By C. J. B. Williams, M. D.,
F. R. S., Professor of Medicine in the University College, <^c.
London, (Concluded.)

Now, we come to a subject of much more frequent occurrence, and
more important in a practical point of view : — Disease of the valves
and orijices of the heart. We have hitherto considered diseases of
the muscular fibres and of the membranes covering them, and we have
now to attend to the lesions of the mechanism by which the circulating
current is directed and conductedfrom the heart. We now come more
especially to the diseases of what may be termed the hydraulic appara-
tus of the heart, in contra-distinction to that of the muscular structure,
or the dynamic apparatus of the heart.

Now, it is desirable to divide the diseases of the orifices and valves
into two great classes. First, there are the obstructive lesions — where
there is more or less obstruction to the current of the blood in its pro-
per channel ; and secondly, those that occasion the blood to take a
reverse direction, or a backward course, and these may be called re-
gurgitant diseases. Now, the lesions that produce these different
affections are very numerous, and I will describe the chief of them
under different classes.

First of all, those which are allied to the affections we have already
considered, as connected with endo -carditis. Istly. Under this head
may be mentioned a thickening of the endo-cardium, causing a similar
condition in the valves. Sometimes this resembles a deposit of l}Tnph,
as in cases of recent endo-carditis — a sort of fibrous matter on the sur-
face. This may occur in various parts. * It is found at the semi-lunar
valve, giving rise to a tlilrkciiirig" of ihp niargin of the valve?, and often

1S45.J Diseases of the Heart. 371

taking a peculiar shape from the contact of one valve with another.
It very commonly happens that there is a thickening of the membrane,
deposited in the shape of a festoon, or what is called a scutiform thick-
ening of the valve. The pressure of the valves against one another,
modities the appearance of the deposition ; generally, the valves are
thickened to a considerable extent, there being little vegetations round
their margins : the orifice of the valve is also sometimes a little fringed.
In one case that I witnessed, there were as many as eighteen of these
fibrinous tumours, connected with the cords of the tricuspid valve.
Another effect of this deposition is adhesion of one valve to another :
this is a very common lesion. It is very common to find two of the
aortic valves adherent to each other; so that instead of having three
A'alves, you have but one valve entire, and the other two adherent, the
intermediate portion forming a sort of projection between them. The
effect of this is to cause an obstruction to the passage of the blood.
The same thing may occur in the mitral, and more rarely in the tendons
of the tricuspid valve.

2dly. There is another class of lesions included in some of the depo-
sitions I have already mentioned. Besides a deposition of fibrine on
the endo-cardium, there is a thickening of the fibres and texture of the
valve beneath this membrane, and the formation of a tense yellowish-
white structure, so that the muscular portion becomes so altered as to a
great degree to present that peculiar appearance which constitutes hy-
pertrophy of the texture. This appears to be a deep-seated lesion,
connected with a change in the muscular structure, besides an affection

of the endo-cardium. Well, then, this probably arises fi'om the forma-
tion of a sub-serous coat or texture, most commonly in the laminmof
the valves, and the tendinous cords ; and in connection with this hyper-
trophy, there is very commonly a sort of elongation in the fibres ; and
I have often found that where these deposits have taken place, there is
an imj)aired elasticity, and a disposition to contract at one time, and to
elongate at another, and, on that elongation, to break ; thus producing
great irregularity in the apparatus of the valves, and interfering with
their proper functions. Sometimes this may lead to rupture of the
heart. Frequently, in addition to this, there are small osseous deposits
in the thicker portions of this fibrinous matter ; and sometimes the
tendons arc quite thickened in this way. There may be various de-
grees of this. There may be a mere thickening — not interfering with
the action of the valves, which is comparatively rare. Then there is
a thickening with shortening of the valves, causing a partial closure of
the orifice ; and thickening with elongation, causing irregular enlarge-
ment of the opening. For instance, suppose thickening with elonga-
tion to take place, it has the effect of rendering the affected side of the
valve quite loose, so that it never becomes tightened, and it cannot act
perfectly at each systole ; the blood gets behind it. and is forced by re-
gurgitation backwards into the different cavities. This will, ovrntual-
Iv, produce lesions ofthe heart itself

MHly. Another ihinjr to be c(msidpr«"d is that aficrtion of the orifice?^.

372 Diseases of the Heart, [July,

in which there is an osseous or cartilaginous rigidity, especially at the
aortic orifice, causing thus an obstruction to the circulation. Deposi-
tion is extremely common at the root of the aortic valves, causing ob-'
structive disease, without any actual projection of these processes.
The most remarkable form of deposition of osseous matter is a cohesion
of the valves, causing almost a complete closure of the orifice, or so
reducing it as to make it only capable of admitting a tube of the size of
a crow-quill. The same thing occurs with regard to the left auriculo-
ventricular opening. This adhesion of the laminae of the valves redu-
ces the orifice to one-fourth or one-fifth of its natural size, causing
obstructive disease. This state is always combined with regurgitant
disease. You seldom see this without some regurgitation into the
ventricle, or auricle, through this narrow orifice.

4thly. There is another kmd of thickening, attended with a sort of
disposition to ulceration, or at least, to rupture. This usually affects
the aortic valves, and is one of the most serious diseases to which the
heart is liable ; in which the valve is broken down, leaving only a rim
or a sort of cord across the orifice of the artery ; the other valves are
here very much diseased likewise: it is generally the result of a de-
gree of acute inflammation, involving not only the membranes, but also
the deeper-seated structure. Persons addicted to habits of intoxication
are subject to this form of disease.

5thly. There is atrophy of the substance of the valves ; this may
take place simultaneously with thickening of their lower portions ; and
if it is extensive, it must produce serious results, leading to considera-
ble regurgitation. Shortening and atrophy of the valves is not a very
common disease. It may, however, vary very considerably in extent,
the laminae, in some cases, being much longer than in others. With
vahailar imperfection, there is generally hypertrophy, or dilatation of
the heart, or both. I have already mentioned that this combination
has been usually considered a great aggravation of the mischief; but
I am quite sure, in many cases, it is so far from being an aggravation,
that it is rather a compensation ; and the effect of this, at least of hy-
pertrophy, and, perhaps, partly of dilatation, is a sort of counteraction
to the imperfections of the valves. When there is obstructive disease,
the blood is not forced with freedom through the orifice, and increased
force is required to propel it with sufficient power. On the other hand,
when regin'gitation takes place, the same thing may be said. When
there is obstruction to the passage of the blood from the auricle to the
ventricle, dilatation is the morbid consequence. If there were no re-
ceptacle for the blood to regurgitate into, it would press on the affected
parts, and rupture would be the consequence. The same sort of thing
is found to take place, naturally, in diving animals. There is no
doubt that hypertrophy is a great cause of evil in many instances, and
it does not compensate for the mischief occasioned by the increased
violence of the circulation. Dilatation, too, may be said to have a bad
result in many instances, because it is accompanied by weakness of
action. All the lesions I have been considering affect the left side of

1845. J Diseases of the Mean. 373

the heart infinitely more than the right side, at least, generally speak-
ing, and the reason for this has been variously ascribed. It has been
attributed to the stimulating quality of the arterial blood. But there
are several causes ; — first of all, there is the more active function of
the left side of the heart ; this increased activity, therefore, predisposes
to disease. 2nd]y, there is the different stnicture of the left side of the
heart ; the left side is altogether stronger and thicker than the right ;
but this very strength and thickness oiler a greater facility to the in-
crease of disorder, when it is once induced in the walls, ^rdly. ^ e
must consider the more extensive relations of the left ventricle, lou
cannot disturb any part of the body, without the left ventricle bearing a
portion of the disorder. Violent exertion, sudden chill, or any check
to the circulation, all bear more on the left ventricle than on the right ;
and the resuk of this frequent exertion or interruption imposed on the
left ventricle, renders it more liable to disease than the other.

The Physical Signs of Valvular Diseases. — These are highly
characteristic. I have stated, that what are called muiTuurs, or abnor-
mal sounds produced in the region of the heart, are most generally
caused by some modification of the current passing through the orifices
of the heart; and it is by these sounds mainly that we distinguish the
character of the lesion and its seat. But we must observe that it is not
every modification of the orifices of the heart, that will produce a
murmur; it is only those that fulfil or complete the elements of sound,
and give a vibrating lesistance to the current as it passes. Hence you
will understand, that where the obstacle in the orifice is very small, it
does not inteifere materially with the current of the blood, and it may
give no \'ibratory resistance. With some pulsations, there is no mur-
mur, but during strong pulsations there will be a munnur produced.
Sometmies the aortic valves may be closely pressed together, so that
the blood is forced out through a small orifice ; in this case, the vibra-
ting resistance may not be enough to produce a murmur. Again, the
thin state of the blood in anaemia may produce a murmur, though rich
blood may not. It may happen, if the vahiilar disease is considerable,
that the murmur is not heard in the weak pulsations, but it will be
heard when the heart beats more strongly. In the tricuspid orifice,
there is frequent regurgitation, so as to produce pulsation, not only in
the auricles, but in the great veins, as the jugular. This is not accom-
panied, in most instances, by any murmur ; and the reason of this is,
because the laminae of the tricupsid valve are placed fiat against the
direction of the current, and being rather light and yielding, they do
not aftbrd enough resistance for perfect vibration.

The murmur is then, generally speaking, a certain rule and indica-
tion of some vahiilar disease. But the amount and degree of murmur
is far from being proportioned to the amount of the lesion. You may
have a very loud murmur indeed produced by a very slight lesion ; this
is more particularly the case with those lesions that are called regurgi-
tant. The loudest murmurs are what are called musical murmurs,
where the vibrations produced by the current, are not only noisy but so

374 Diseases of the Heart. [July,

regular in utterance as to constitute a prolonged musical tone, the
vibrations being equi-distant. The quality of the murmur is the best
guide to the amount of the lesion, though even this is not a sure one.
Those which are uniform, whether of the blowing or the whistling
character, generally announce slighter lesions than the murmurs that
are gratmg, or more deep-toned. This is a general iTile. The musi-
cal sounds, when of a simple blowing or uniform character, are mostly
caused by regurgitation through the smaller channels ; on the other
hand, the deep-toned murmurs mark the larger currents, and a harder
kind of obstruction. Laennec, Drs. Hope, Wilson, and others, have
thought the rough murmurs indicative of a rigid state of the orifices.
Now the contrary is the case, for where this state exists, there is a
great amount of looseness in the sound ; and one of the harshest mur-
murs lever heard, was in a case where there was no ossification at all.
The breaking down of one of the valves caused a vibrating obstacle in
the direction of the current. The intensity of the sound is not at ail
in proportion to the loudness, but it depends rather on the capacity of the
obstacle for vibrating. There are, as I have mentioned, some obsta-
cles which do not vibrate at all.

Natural sounds superseded by the murmur. — There is another
character about the murmur, and that is the degree in which it supplants
or supersedes the natural sounds, whether the first or the second.
Whenever you have a murmur so intense and loud that you hear no-
thing at all of the first sound, you may be pretty sure that the lesion
which produces it is very considerable, not merely as to the anatomical
condition, but as to its effect on the constitution. On the other hand,
when you have a murmur added to the natural sounds, there is a certain
degree of proof that the natural actions are going on well ; accordingly,
when there is extreme disease of the mitral orifice, you find, towards
the apex, that you can scarcely hear the first sound at all, but merely a
prolonged blowing, not only obscuring by its loudness the first sound,
but actually overpowering it. But if you apply the stethoscope over
the right ventricle, you hear the sound. It modifies the suddenness
and the character of the tension on which the first sound depends, and
converts it into one which takes its character from the murmur itself.
And it would appear in these cases, as if the vibrations naturally pro-
duced in the walls of the heart were converted into vibrations of the
murmur — a conversion of the one into the other. We find these
sounds arrested under various circumstances. If we throw a string
into vibration, and while it is vibrating bring it near to another string
also in vibration, and hitherto incapable of vibrating an octave, the
octave sound will be very loud indeed ; and you find that the second
string, instead of responding a lower note, responds an octave ; one
vibration therefore supersedes other vibrations previously existing; and
it appears that the murmur, to a great extent, not only mufi^es, but en-
tirely destroys the natural sound of tlie heart, and converts the simple
obtuse sound that naturally arises, into a prolonged blowing. .Again,
with regard to the second sound, the same thing is ))articu!arly observ-

1845.] Diseases of the Heart. 375

t'd. There is sufficient reason for this, for where the disease is con-
siderable, you have not only the second sounds superseded, but the
tension of the valves, oa which the second sound depends, may be
-entii'ely destroyed. In the musical murmur I mentioned just now, the
natural sound was not entirely superseded, showing that the amount of
disease was limited. The patient did not die of disease of the heart,
though there was a certain amount of li)-pertrophy of its walls ; but he
died of a fever.

The two chief classes of vahoilar disease are the obstructive and
the regurgitant. The signs of the obstructive aortic being connected
with the first sound, and the regurgitant aortic with the second sound :
but regurgitant mitral is, in some measure, connected with the first
sound. The distinction between the obstructive aortic and the regur-
gitant aortic is obvious. The mode in which it is distinguished, is by
the manner in which the sound is propagated to the walls of the chest ;
the regurgitant mitral being transmitted most distinctly, and chiefly at
the part corresponding with the apex and surface of the left ventricle;
it is not heard so much in the upper part of the chest; whereas the
sound of the obstmctive aortic is above that, and is chiefly heard from
the middle to the top of the sternum. Speaking of the symptoms
produced by disease of the aortic valves connected with arterial excite-
ment, there is almost always hypertrophy of the heart, and the arteries
become the seat of an unusual impulse, a jerking kind of motion ; and
the symptoms, if the hypertrophy is considerable, are rather those of ar-
terial excitement than of venous obstruction. On the contrary, mitral
regurgitation and mitral obstruction produce especially the signs of ac-
nous obstruction in various parts of the system; in the vessels above
the left auricle, and in the lungs, producing pulmonary congestion, pul-
monary apoplexy, bronchial flux, sometimes hydrothorax, and bronchial
congestion, with a liability to inflammation and congestion of all the
other viscera, to a great degree. Thus the whole venous system is
affected ; the right side of the heart is dilated, and regurgitation
takes place, and the veins of the neck and brain become congested.
The regurgitation produces, sometimes, lethargy and stupor; and the
other organs, more particularly the liver, are affected.

We find that a long continuance of this disease causes structural
changes to take place in the different viscera ; the lungs are more hy-
pertrophied than usual ; the liver, more especially, is enlarged, net
merely under the influence of congestion, but a species of hypertrophy ;
and sometimes there is a transition to a state of subsequent contraction
and degeneration. The same thing takes place m the kidneys ; and
thus diseases of other organs are superadded to the disease of the
heart, and this superaddition of other diseases is really a common
cause of the fatal termination of regurgitant disease. The difierer.t
valvular lesions I have mentioned may be combined together ; in some
subjects you will have murmurs in both situations, referable to the mitral
valves and the aortic orilice. The mode of distinction here, is by the
loudness and the distinctness of character of the murmur in both situ-

376 Diseases of the Heart, [July,

ations. Under these circumstances, you may have the aortic murmur
heard in the middle of the sternum, and transmitted, as usual, to the
arteries ; but yet you hear also a loud distinct murmur at the apex, as
loud as'at the mid-sternum.

I have already mentioned that there are some cases of aortic mur-
mur transmitted to the apex of the heart ; but the character is usually
different in this and in mitral disease. The sound of the latter is
shorter than in the murmur which is produced at the aortic orifice.
The aortic murmurs are never so superficial. The blowing or whistling
sounds are likewise difierent in character in these two cases ; there is
a deep, grating, hoarse murmur in the aorta, whereas the murmur at
the apex is loud, whiffing or blowing. This distinction is very useful
in our prognosis, more particularly if these murmurs supersede the nat-
ural sounds. Then, you know, in conjunction with these, the other
signs of the disease may be different ; and the great reason why these
signs of heart-affections are sometimes so complicated, that we cannot
determine the position of the murmur at any one particular spot, is, as
I before stated, because the enlargement of the difierent parts of the
heart causes great displacements and alterations of position ; and the
only constant relation which is preserved, is with regard to the direc-
tion of the current into the arteries, or its direction backwards through
the auricles.

The general treatment of a diseased heart, in the first place, is to be
directed according as excessive or defective action predominates. —
There are cases in which excessive action, connected with h}'pertrophy,
is predominant, and the action of the heart and neighboring arteries
very strong. Moderate sedative and depletory measures should be
here adopted. The same thing is to be said in case of inflammation :
the treatment must be more or less antiphlogistic, although w^e have
not the same means of knocking down the inflammation altogether, as
>ve cannot w ith impunity reduce the system to too great an extreme in
these cases. Another class is that in which the action is altogether
defective, as shown by faintness, weakness in the circulation, and irreg-
ularity of the heart's action. This is generally benefited by stimula-
ting means ; but remember, there are some instances of defective
action, where the heart has already got such a load that it cannot propel
it, and we shall here give more relief by taking away some of the blood.
This is the congestive form ot the aflection; and in congestive affec-
tions, as well as in increased excitement, it may be useful to use deple-
tion to a moderate extent, and as a temporary measure ; on the other
hand, where there is a deficiency of blood in the system, and a tendency
to ansemia is obvious, from the pallidity of the countenance, and the
extreme tendency to dropsical effusions, this generally speaking, will
be benefited by a treatment of a more or less stimulant character.

We must consider, likewise, the different kinds of lesions as modi-
fying, in some degree the treatment. As a general rule, it may be sta-
ted (from which however, there are some exceptions), that diseases of
the aortic orifice, connected with a considcrabie amount of" hypertrophy,

1845] Diseases of the Heart.

commonly require a great amount of depletion, and an antiphlogistic
treatment. I question if the same treatment should be observed, with
regard to medicine and regimen, in lesions of the mitral valves also.
This is the general rule ; but, still, all is to be done in a gentle way,
not carrying the depletory measures to an extreme. The diseases con-
nected with the mitral orifice are more commonly attended by weakness
of the system and the circulation, by which the pulmonary organs may
be greatly congested : and mild tonics should be administered at the
same time, or subsequently to other measures. When the structural
disease is considerable, these medicines should be reserved for the pe-
riods of intermission. We may divide the exacerbations into t\\o
classes : 1*^ They may take place from mere nervous excitement, men-
tal or otherwise ; attacks of violent nervous palpitation, referable to
mental anxiety, or something disturbing the digestive organs. Here,
palliatives, such as hydrocyanic acid and opium, with mild aperients,
will often prove means of relief. There are effects produced by these
exacerbations that require attention; when the heart is healthy, the
effects will pass off without any remedies ; but when the heart is dis-
eased, we have not only to remove the immediate consequences of this
excitement, but also the previous morbid efiects ; thus, if the lungs be
congested, means should be adopted to act on the circulation, and keep
up the action of the blood ; if the liver is affected measures should be
taken to act on its secretion, as doses of mercurial medicines. It is a
very usefiil practice in all these cases, to give diuretics, combined with
mercury, for a short time, after any attack of this kind. I do not know
that any thing better can be suggested. In combination with blue pill,
henbane and squill, with a little digitalis, if the action of the heart is
not very weak, may be given ; two or three grains of blue pill, the same
quantity of extract of henbane, one grain of quinine, one grain of squill,
and half a grain of digitalis, are the best constituents for a pill, and
form one of the most useful combinations that I know of, not only for re-
moving congestion, but also the low inflammatory states that are some-
times produced.

2"^ Besides these nervous cases, there are exacerbations of a sub-
inflammatory character, produced by exposure to cold, over-exertion
and the occurrence of rheumatic affections. Under these circumstan-
ces the chief remedies are : moderate antiphlogistic measures ; gener-
ally local depletion at the region of the heart, by cupping or by leeches,
followed by blisters, and mercury and opium are sometimes usefiil in
these cases, but the pill mentioned before answers extremely well.
Diuretics should be combined with these until the congestive and sub-
inflammatory s}Tnptoms are removed. When the patient is extremely
weak, so that we are afraid of withdrawing blood, dry cupping is often
usefiil. This is not, however, so saving a measure as is generally sup-
posed. I have found many physicians recommend dry cupping, mider
the idea that it saves the blood, but this is a great mistake. It causes
extensive effusion of blood in the cellular texture, and the blood is de-
composed, and is no longer useful ; it is formed into a clot, and must be

378 Diseases of the Heart. [July,

absorbed again, in an altered state. The exhaustion from dry cupping
is much greater than when the scarificator is used. Besides this reme-
dy, plunging the hands in hot water rendered stimulant by mustard, or
tiie application of a poultice is useful. If there is any thing like a
rheumatic tendency, the best kind of remedies are colchicum, and
iodide of potassium, as a means of acting on the secretions. When
these temporary exacerbations have subsided, and the circulation is
relieved, great benefit will be derived from tonics or mineral acids.
The most usefiil is nitric acid. Gentian, too, is used with benefit.
Mineral acids are serviceable where there is a disposition to dyspepsia.
In cachectic states, where there is a deficiency in the quantity or qual-
ity of the blood, stronger tonics are employed, particularly iron in its
various forms.

Complications of Heart Disease. — In cases of disease of the heart,
we have likewise to consider the morbid conditions that arise from a
defective state of the circulation. Dropsy is the chief of these con-
ditions, and it has to be treated, generally speaking, with diuretics
and purgatives. Those diuretics I have mentioned under the head
dropsy, are useful; acetate of potass is serviceable in inflammatory
cases, combined with digitalis or squills, and also sweet spirits of nitre,
and spirits of juniper ; tmcture ot cantharides is also allowable ; but
no diuretic has so good an effect, in such cases, as the pill I mentioned
bcf jre. Measures should also be adopted to relieve the congested
state of the kidneys, where their secretion does not go on. Cream
of tartar, &c., is useful. Elaterium is an admirable remedy forget-
ting rid of the dropsy, and improving the action of the liver. It,
however, is apt to cause great sickness, and a tendency to faintness,
and, generally speaking, cream of tartar, in large doses of from half
an ounce, to an ounce, taken in the morning, produces free watery
stools, to a great amount. It should be continued at the same time
that tonics are given. After this, it may be useful to give tincture
of digitalis, with the tincture of cantharides. When this dropsy
continues, it may be necessary to combine these diuretics with tonics.
Dr. Abcrcrombie recommends a combination of squills with sulphate
of iron ; but 1 am not so strongly impressed with its utility.- Tartar
emetic is very useful in cases where there is not too great weakness.
Chalybeates and tonic medicines do much towards promoting the
action of the excretory organs, as well as increasing the general
strenorth of the system. The treatment of diseases of the heart is
a very important subject. The chief object is to preserve a proper
balance in the system; to avoid extremes; and to try to adapt the
circulating powers to the existing defects, as well as to avoid all cir-
cumstances which overtask the organs of circulation. Gentle exer-
cise, or friction, greatly promotes circulation, and it is also much
benefited by the improvement of the excretory and digestive organs.
As a general rule, in organic diseases ol the heart, the diet should be
as nourishing as the digestive organs will bear, without producing
fulness or inflammation. T!ie starving plan, in organic diseases of

I;? 45. J DUcascs of the Heart. 379

the heart, is most prejudicial. I have seen many cases where this
plan has been adopted, and which, with scarcely one exception, were
invariably benefitted by a return to a moderate nourishing diet. The
diet must be proportionate to the digestive powers. There are some
few cases, it is true, in which the regimen must he abstemious.
These are when inflammation is present, and exacerljations arising
from inflammatory action ; or else, where there is a great amount of
hypertrophy of the heart, and continued increased action, <kc. Un-
der these circumstances, the diet must be extremely sparmg for a
time. But by far the greater number of cases of heart disease pro-
ceed from nervous irritability. One great rule, in relation to the diet
of a patient afiected with cardiac disease, is to take care that the
quantity of food taken is not too great in bulk, and, therefore, vege-
table food should be avoided as much as possible. This is one rjiason
why a moderate animal diet, in conjunction with farinaceous food, is
better than slo})s, or things of that kind, which distend the stomach
without giving it strength. It is neces^^ary, therefore, to avoid any
large bulk of liquid. Many patients find out by experience the utility
of modifying their diet, so as to make it of as dry a condition as is
consistent, taking scarcely more than half a tumbler of liquid at their
dinner. If the system becomes encumbered with a great quantity
of liquid, mischief results. Further, it is important to avoid any-
thing that will tax the heart, and excite it to excessive and undue
action. In severe cases, this should be particularly studied, and the
patient should not even be allowed to go up stairs, or ascend to any
apartment not on the same floor ; he should always walk on the same
level. Constantly lying down, or sitting in one position, should bo
avoided : and walking about, now and then, so as to enliven the sys-
tem, is desirable. Friction of the extremities, if the patient is too
weak to move about, should be employed, two or three times a day, so
as to promote the circulation. In many cases, moderate exercise is
highly usefu', not merely on account of promoting the circulation, but
also the action of the various functions of secretion and digestion.
Exercise in the open air, and on horseback, is highly desirable ; gentle
riding answers very well. In this way I have seen cases, that had
gojie on apparently to their last stage, completely recover. Mental
tranquillity is an important element towards recovery.

No absolute rule can be laid down with regard to stimulants.
They should be used in the smallest quantities. Malt liquors increase
the action of the heart to a great degree. Many persons are in the
habit of taking malt liquors, and a certain quantity in these cases is
essential to their common mode of diet; so this must depend very
much on the habits of the individual. Generally speaking, white
wine, with a little water, or weak spirits and water, are useful to act
on the kidneys. — Medical Times.

380 Punctured Wound, t^-c. [July,

Case of Punctured Wound, followed hy a remarlcahle train of
Symptoms. By Luther Ticknor, M. D., o/ Salisbury, Presi-
dent of the Connecticut State Medical Society, {with remarks by
the Editor of the New- York Journal of Medicine.)

Mrs. A., about the middle of November, 1844, in washing some
small articles of dress, pierced the end of the middle finger with the
head of a threaded needle which she supposed penetrated the ball of
the finger to the depth of from one third to one half inch. The first
sensation was that of numbness, instantly following the infliction,
extending up the arm to the axilla and front part of the shoulder.
This was followed immediately by numbness of the fingers of the
other hand, and next with faintness and vertigo, which brought her
pretty soon to her bed. Some mitigation of these symptoms was
procured by laudanum, so that I did not see her until severe pain and
febrile symptoms, oppressed respiration and gastric sinking, excited
some alarm for her safety, about forty-eight hours after the injury.
I found her with hurried anxious breathing, very frequent obscure
pulse, a moist surface, with temperature but little increased, almost
constant chilliness, and what the patient call faintness. These
two latter symptoms continued with very little variation five or six
weeks. A ditiused swelling not easily defined occupied the upper
portion of the " pectoralis major muscle," extending upward to the
articulation of the shoulder ; certain points on this tumefaction were
excessively painful and tender to the touch. These tender points
changed their location from time to time, so as to encourage the hope
that some improvement was going forward.

The local treatment consisted of dry cupping, epispastics, fomenta-
tions, anodyne poultices, anodyne linaments, &c., with very little
apparent benefit ; and yet anodyne poultices did the best. Internal-
ly, opium, in some form, and in large quantities, was indispensable
throughout her treatment. Profuse perspiration, subsultus and inci-
pient delirium, pretty early suggested the use of tonics, of which
sulph. quinine was preferred and freely used with advantage. About
six weeks after the injury a slight fluctuation was felt under the edge
of the tendon of the pectoral muscle, within the axilla. Forty-eight
hours after it was discovered, a spontaneous discharge of at least
eight ounces of rather thin purulent matter took place, and continued
profuse from this orifice, and one made subsequently a little lower
down upon the chest, for about two weeks, when constitutional and
local symptoms gave place to returning health. Immediately after
the fluctuation was discovered, Mrs. A. made free with London por-
ter, it being the only stimulus of the diffusible kind her stomach would
bear, and this it bore to good purpose. Mrs. A. is now entirely well,
I believe, though perhaps the shoulder droops a little from tl^e awk-

1845.] Punctured Wound, i^c, 381

ward position in which the arm was kept for a long time, rather than
from any imbecility of the muscles. A deep depression marks the
site of the abscess, showing a pretty extensive condensation or loss of
cellular tissue.

Now, sir, is or is not this rather an uncommon history of a ptinc-
tured wound ? Nothing like it has occurred within my field of vision,
but that is no proof of anomaly. Is there not some analogy observa-
ble in this case, with poisoned wounds? Will you be so good as to
furnish some remarks on this case.

Remarks. — We thank our old and honored preceptor. Dr. Ticknor,
for the above very interesting case, and hope he will favor our read-
ers with still further contributions of a similar kind. Although we
cannot hope to elucidate the pathology of this particular case by any
remarks of our own, still we feel obliged to comply with his request
by stating such suggestions as its perusal has given rise to in our
own mind.

The case is one of uncommon interest, both physiologically and
pathologically. We shall first notice the physiological deductions
which seem to flow from this accidental wound, which, for our
present purpose, we will view as one instituted for experimental pur-
poses.

The nerve which was punctured, was undoubtedly a branch of the
median, which is formed by the two lower cervical and the first dor-
sal nerves ; and is the largest of the brachial plexus, which latter
supplies two or three filaments to the phrenic or internal respiratory
nerve, and sends numerous branches to the external muscles of res-
piration, to the pectoral and deltoid muscles, and indeed to the whole
external part of the chest and neck; and to the serraius magnus, a
large branch is sent, called by C. BeW, the external respiratory nerve,
which is also connected by a filament with the phrenic.

It appears that when the wound was first inflicted, n. sensation of
numbness was felt running up the arm to the axilla and shoulder, and
immediately afterwards the same feeling was experienced in the fin-
gers of the other hand; as no mention is made of spasms or convul-
sions, it is inferred that none were manifested, except suhsulius,
which occurred at a later period of the disease.

This, so far as our reading and observation extend, is a rare phe-
nomenon, and one well worthy of consideration. According to Mar-
shall HalVs doctrine of the reflex function of nerves, which supposes
that a nerve is compounded of sentient and excitor filaments, and has
probably two origins, one in the cerebrum, the other in the medulla
spinalis, so powerful a stimulus applied to an incident or sentient
nerve, ought to have encited contraction instead o^ pain in other re-
mote parts of the muscular system. How are the phenomena of this
case to be reconciled with the doctrine of the reflex function, as ex-
plained by Mr. Hall ?

Again, Midler observes, that " the sensationtproduced by irritation

382 Puncturisd Wound^ (Sfc. [July,

of a hrancli of a nerve, is confined to the parts to which that branch is
distributed, and generally, at least, does not affect the branches which
come off from the nerve higher up, or from the same plexus.^^ In this
case, however, we find a similar sensation experienced by the corres-
ponding nerve distributed to the opposite side of the body; and not
only this, but painful sensations in the region of the axillary plexus,
and the parts which it supplies with nervous influence ; and also dis-
tressing sensations in the epigastric region, which would seem to
indicate irritation of the coeliac plexus and other portions of the gan-
glionic system of nerves. And yet MuUer states that irritation is
felt " only in the spot ichere the irritant is applied, and that it never
reacts upon the brachial plexus, and on the other nerves which arise
from it.^' One clear case, like the above, in contradiction of a state-
ment like this, is as valid in physiology as a thousand. Sensation,
we know, is generally transmitted from the periphery to the centre,
from the surface of the body to the source of all sensation, the brain.
In addition to this, we here find sensation transmitted from the brain
to the extremities, as well as to the vital organs of the thoracic and
abdominal cavities. Examples of radiated sensations, in the same
limb, or region of the body, are not uncommon, as the extension of
the pain of tooth-ache over the whole face, of pain in one finger to
the hand, arm, and other fingers. In the London Medical Gazette
for 1834, a case is related where, after amputation of the thigh, a
swelling formed in the ischiatic nerve at its extremity, where it was
also firmly united to the cicatrix and bone; after a short time the
skin of the entire stump, and sometimes even distant parts, as the
integuments of the abdomen, became aflJected with severe pain, with-
out any inflammatory symptoms ; but the trunk being amputated at a
higher point, the pains did not return. Muller states that these sym-
pathetic sensations do not occur in health, because of the isolation
of the nervous fibres in their course to the brain ; but there is no more
isolation in health than there is in disease.

The following case, which we find in Mr. Swanks " Treatise on
Diseases and Injuries of the Nerves,'''' has many and close points of
resemblance with the one reported by Dr. Ticknor. Mrs. E., aged
40, received a cut on the inside of the first phalanx of the left thumb.
Immediately after the accident she felt a numbness in the arm, and
a sense of fulness, as if the skin would burst; these sensations con-
tinued for a fortnight, and the wound healed very well. At the end
of this time, violent pain came on, when a tremulous motion could be
seen in the part which it occupied. The pain was termed startings
or spasms, by the patient, and was felt in different ways, but the mus-
cles were not affected. T/iCse spasms were felt all over the body,
though they were by far the most frequent in the upper half of it.
She frequently felt a great heat in the che^t and abdomen, but most
particularly in the latter, and the same startings as in other parts of
the body. The sensations were sometimes as if the flesh was pinched
u'ith hot i?-ons : sometimes a great heat, as if hot watcmvas poured

n45.] Puncture^ Wound, iSfc. 3^3

down her back ; sometimes she had frequent shakings of tlie whole
body, which were unattended with pain, and were most relieved by-
drinking hot water. The spasms were not confined to the left arm,
but she had them at the same time in the right, and /rf(^ue«//y in the
right when she had none in the left. The fore-finger was as painful
as the thumb, and ifany thing touched either of them the spasms were
produced, which continued many days. She had a good appetite,
her bowels were confined and her tongue furred. But she had no
thirst.

Sedatives and antispasmodics seemed to do her most good, though
nothing was productive of much benefit. At the end of six months
the spasms were less frequent, but were reproduced if the thumb or
fore-finger was moved or touched. Succeeding years brought each
some mitigation of her sufferings, but even after seven had elapsed,
extreme susceptibility of any impression still remained in the thumb,
and the fore-finger had not recovered its natural condition. Liftingj
a weight, or using the right arm much, always produced sensations
as if needles were running into it, and attempting to use the fingers
of the left hand, as in knitting, produced giddiness. She continued
to be affected with spasms in every part of her body till her death,
which happened nine years and six months after the occurrence of the
accident, when she seemed to die worn out.

The following are examples of a similar kind. Dr. Wollaston
states (Sir B. Brodie on Nervous Affections) that he ate some ice-
cream after dinner, which his stomach seemed to be incapable of
digesting. Sometime afterwards, when he had left the dinner table
to go to the drawing room, he found himself lame yVom a violent jpain
in one ankle. Suddenly he became sick; the ice-cream was rejected
from the stomach, and this was followed by an instantaneous relief
of the pain in the foot.

" A gentleman consulted me," says Sir Benjamin Brodie, " con-
cerning a pain in one instep. The pain was severe, causing lame-
ness, so that he walked with difficulty ; but there was neither swel-
ling, nor, except the pain, any mark of inflammation. I prescribed
some remedies, which, however, were of no avail. One morning he
called on mfe, still suffering from the pain in the foot, and so lame
that he could not get out of his carriage and walk into the house
without the assistance of his servant. Now, however, he complained
of another symptom, he had a difficulty of making his water, and a
purulent discharge from the urethra. He had labored under a strict-
ure of the urethra for many years, and had occasionally used bougies.
Of late, the stricture had caused more inconvenience than usual ; but
he had abstained from mentioning it, thinking it would be better that
he should (if possible) be relieved of pain in the foot before any treat-
ment was adopted on account of the stricture. Under these circum-
stances I introduced a bougie, which penetrated the stricture, and
entered the bladder. Immediately on the bougie having been used,
the pain in the foot abated : and in less than a quarter of an hour he

334 Punctured Wound, Sfc, [July,

left the house free from pain, and walking without the slightest diffi-
culty ! This happened some years ago, but I have seen the patient
at intervals ever since; and from a most careful observation of his
case, he and 1 are both satisfied that the pain in the foot is connected
with the disease in the urethra, and we have never found any thing
to relieve it except the introduction of the bougie."

The following may also, perhaps, be regarded as cases illustrating
the tortuous or anomalous route sometimes pursued by sensation: as
when pain is felt in the testicle, from the passage of a calculus along
the ureter from the kidney into the bladder, on the same side ; or pain
on the outside of the hip, from inflammation of the testicle. The
former may perhaps be explained, by the circumstance that many of
the nerves of the testicle derive their origin from the renal 'plexus,
which also supplies the kidney, and which is formed by branches of
the great sympathetic nerve. Now the calculus operates, in the first
instance, on the nerves of the kidney, by which its influence is trans-
mitted to the renal plexus, and thence reflected to the nerves of the
testicle.

In the latter case, the nerves which supply the scrotum and cord
have the same origin, viz. the lumbar plexus, as the cutaneous nerves
of the outside of the hip. The irritation of the former is thus com-
municated to the latter and referred to the parts to which they are
distributed, — attacks of gout in the foot from the presence of acid or
other irritating matters in the stomach, are also examples to prove
that irritation in one part of the body may cause pain in another and
remote part.

Instances are common enough where irritation at one extremity of
a nerve is felt at the other, or at its origin : as when pain is experi-
enced in the back, from injecting port wine, &;c., into the tunica
vaginalis testis, head-ache from irritating matters in the stomach
(which is instantly relieved by an emetic).

Now, how are we to explain these facts from recognized physiolo-
gical laws ? Is an impression conveyed to the sensorium by one
nerve, and transmitted by it to another nerve? Is it possible to de-
.termine, in particular cases, why a. particular route is taken by sen-
sation ? Is it, in short, reflex action from the brain or spinal cord, at
all? Muller has asked, whether a current, in such cases, passes from
the cerebral or spinal extremity of the nerve in a retrograde course,
to its peripheral extremity ; or, if there is no current, but merely
oscillation of a nervous principle? whether the impression conveyed
to the brain by the nerve primarily excited, gives rise to a reflex oscil-
lation in another nerve, from its cerebral to its peripheral extremity ?
It seems altogether improbable to us that either currents or oscilla-
tions are propagated in a retrograde direction from the brain ; nor is
it necessary, in explaining the phenomena in question, to suppose the
existence of any such law, or mode of action; it is more rational,
and certainly more philosophical, to suppose that the irritation is
transmitted to the origin of the nerve, in the bram or spinal cord.

1S45.J Punctured Wound, ^-c. 3S5

which supplies the part aOected, and tJiere affects the origin of other
nerves, going to other parts, and thus giving rise to sympathetic sen-
sations in those parts to which such nerves are distributed. As when
a limb has been amputated, sensations are ai)parently felt in the
limb that has been removed ; and, in epilepsy, an aura is experienced
in the lower extremities, although we know that the cause and true
seat are not in those parts, but in the spinal marrow or brain ; being,
in fact, nothing more than the first symptoms of the affection of the-
spinal marrow and brain, which show themselves during the attack.

In alTections of the spinal cord, moreover, the sensations are felt
in the peripheral ])arts of the body, as in inflammation of the cord,
we feel violent pains in the limbs. In this manner, we apprehend,
are sensations sometimes radiated to different and remote parts of
the body.

In the case of Mrs. A., the function of^ rcsjnraiion nnd circulation
was seriously affected, and that immediately upon the infliction of the
wound. Our first inference from this fact is, the phenomena were
manifestly the result oi" irritation, and not inflammation, as sufficient
time hftid not elapsed for the processes of the latter to have been in-
stituted. Hence, the opinion of some, that all phenomena that arise
in consequence of injuries to the nerves are owing to inflammation, is
erroneous, and should be abandoned.

The symptoms also indicate, that that portion of the spinal cord
and medulla oblongata, that gives origin to, or is connected with, the
par vagum, sympathetic, phrenic, and other nerves that minister to
the functions of organic life, was profoundly affected ; and it is a re-
markable fact, that an impression of so grave a character was chiefly
confined to that portion of cerebral or medullary matter that is con-
cerned in sensation, and did not involve the tract concerned in motion.
The cold and moist surface shows a suspension of capillary circula-
tion— a function well known to depend on the integrity of the nervous
power. The sensation of "faintness" may perhaps be referred to
the deranged function of the nerves which constitute the cardiac and
solar plexus. The sensation of " rigor," or constant chilliness, is an
attendant upon local irritation, under a great variety of forms — ex-
pressive of a sympathy of the circulating with the sensorial organ —
of the heart with the brain. It may arise from fear, from cqld, from
suppurative action, from a direct nervous impression, as syncope,
from the prostrative character of severe irritation, as a severe shock
or blow; and in general, perhaps, it indicates returning animation
and reaction. Another remarkable feature in this case, was the for-
mation of an extensive abscess beneath the pectoral muscle. When
we take into consideration the state of the system at the time, the
low state of the circulation, and the imperfect manner in which all
the vital functions were performed, we arc certainly forced to the
conclusion, that suppurative inflammation does not, at least, always
indicate a high grade of arterial action, and that it may be sometimes
combat tod most successfully by anody nei and tonics — remedies to

386 Punctured Wound, t^c. [July,

allay irritation and support the integrity of the vital powers. The
effect of the remedies will, also, clearly lead to the same conclusion.
May we not hence derive a useful lesson? and, when we meet with
local inflammation, with deteriorated condition of the general health,
and symptoms of irritation present, in one or more organs, whether it
be the brain, the stomach, or the urinary apparatus, instead of gener-
al or local bleeding, resort, with advantage, to a cordial, supporting
plan of treatment?

Mr. Travers, in his excellent work on " Constitutional Irritation,"
has pointed out with great clearness, the distinguishing marks between
inflammation and irritation, which the reader may profitably consult
in connection with this subject. This case proves very conclusively
that if much may be said as to the •' constitutional origin of local dis-
eases," much may also be advanced upon the local origin of constitu-
tional diseases.

Dr. T. has inquired whether there is not some analogy in this case
with poisoned wounds ? So much so, we would say, that had the
same symptoms occurred from a dissecting wound, few would have
doubted that they were occasioned by the absorption of morbid mat-
ter. Mr. Lawrence thinks it very doubtful, whether " any thing that
can be called virulent or poisonous, is introduced into the human
frame by dissecting wounds," but imputes the efl^ects to the mechani-
cal injury inflicted. Such cases as the above would seem to lend
considerable support to such an opinion. Th6 instantaneous occur-
rence, however, of some of the gravest symptoms, may serve to dis-
tinguish such a case from one where poison has been absorbed, as,
in the latter instance, some time would be required for the develop-
ment of the disease. It depends, we believe, entirely on the state of
the general health at the time, whether such accidents ever lead to
any serious result ; certainly in a very large majority of cases, no
unpleasant symptoms whatever follow such wounds. During our ap-
prenticeship in our younger years, as demonstrator of anatomy, we
often met with these accidents in dissecting, but never experienced
the slightest injurious effects, although we used little, if any precau-
lion. In some instances, we believe the effects produced are such as
Would arise in wounds considered in themselves, without any refer-
ence to ihe absorption of morbid matter; in other cases it is more
probable that a poison is introduced into the system, to which the sub-
sequent phenomena are to be attributed. We here close our dis-
course, with many thanks to our friend who has furnished us with
our text.

1S45.] T^atment of Sciatic Neuralgia, ' 387

On the employment of Vesicatories in ilie treatment of Sciatic Neural'
gia, according to the method of Cotugno. By I. Gari^^ translated

from the Bulletin General dc Therapeuiique,

The facts which I am about to relate are not very important either
for their rarity, or for the obscurity of the diagnosis, or for the de-
ductions which might be drawn from a greater number of cases.

Sciatic neuralgia is an affection which if not always well determ-
ined as to its nature and the kind of lesion which causes it, is at least
generally well known by its symptoms ; and the rare cases in which it
may be confounded with incipient coxalgia, or with neuritis, are the
only ones in which the diagnosis presents some difficulty.

It is especially with regard to its treatment that this affection has
arrested the attention of practitioners, and they have exhausted means
of every kind in their attempts to remedy the cruel pains, of which it
is the prolific source. Thus the number and the variety of the means
employed, prove the great difficulty and uncertainty of the treatment,
and are at the same time but little calculated to encourage new re-
searches. In a therapeutic view, however, the following facts may
possess some interest. Without extending the already long page of
the treatment of sciatica, they will disclose the peculiar employment
of a known remedy, and they will shew that there is a proper mode
of employing topical applications, as well as of administering medi-
cine internally, and that both fail, unless upon certain conditions,
which ought to be well appreciated.

Case 1. A carpenter, aged 37, sent for me April 7th, 1844. He
was of a strong constitution, and of a sanguine temperament, had
lived at Lyons for ten years, and had never been sick — eight days
before, while working in a shop exposed to currents of air, he experi-
^enced in the left thigh, a sensation of pricking, and of numbness,
which attracted but little attention. During the night the pain be-
came more severe, and the next day, and the two following days, it
})egan to embarrass his movements, and although it seemed to be
less acute during action, than when in a state of repose, the patient
discontinued his work, believing that tranquility would be sufficient
to restore the use of his limb. In this he was disappointed, as the
pain hccamo morn and more developed. It occupied the posterior

388 Treatment of Sciatic Neuralgia* [July,

part of the thigh, from the gluteal region, to the popliteal hollow,
without extending below the knee. For two days, the patient em-
ployed frictions with camphorated oil, without any relief. On the
fourth day, he applied a blister upon the thigh. The pain, instead of
diminishing, increased, and extended below the knee, along the ex-
ternal margin of the leg to the external malleolus and the instep,
following the course of the external popliteal nerve. The limb be-
came very sensitive upon the slightest motion, so that the patient
was obliged to send for a physician. T was called.

On the 8lh of April, the ninth day of the disease, the pain was very
acute — the patient had not slept, the face was red, the head of a burn-
ing heat, no appetite, intense thirst, the tongue white and the pulse
hard and frequent.

Prescription. — Bleeding of about sixteen ounces ; barley ptisan ;
gum syrup, with one grain of the watery extract of opium. Diet.

On the 9th, the patient having slept a part of the night, was free
from cephalalgia, and asked permission to eat. He continued to
complain however of pain, which was fixed — continuous, sometimes
of a crawling, sometimes of a lancinating character, and which was
occasionally aggravated ; two cramps had occurred during the night
— the leg was flexed, and motion impressed upon it caused acute pain.
The latter extended from the hip to the foot where it was especially
acute, and also in the gluteal region, but less severe at any interven-
ing point. There was no redness, heat, or swelling, along the
course of the nerve, but pressure at certain points increased the
suffering.

The signs of acute sciatica being indubitable, I resolved to employ
immediately the method of treatment by multiple vcsicatories, which
I had seen in Paris to be successful in the practice of M. Gendrin,
and which had appeared to me to be most expeditious. I applied im-
mediately three blisters, the first opposite to, and a little behind the
trochanter major, the second upon the external side of the tibio-femoral
articulation, opposite the superior extremity of the fibula, and the last
upon the inferior extremity of that bone, so as to cover the malleolus
externus, and the superior and external part of the dorsal face of
the foot. These blisters were applied simultaneously, and were of
the following dimensions : the first, six inches in diameter, the second,
four inches, and the third, five inches, as I had seen practised by the
physician of the Hopital de la Pitie. In addition, the same potion
and ptisan were renewed, and soup allowed.

1845.] Treaimcnt of Sciatic Neuralgia. 389

April 10th. The patient has had fever; ho has not slept; but the
sciatic pain is obscured by that of the blisters. Same prescription.

The 11th. The sciatic pain is less violent in the thigh, but very
acute in the foot. The blisters removed on the previous evening,
after an application of 24 hours, had produced a circumjacent eryth-
ema, upon which were placed compresses smeared with an opiate
cerate. Semi-regimen ; the same ptisan ; the opiate potion is sup-
pressed.

Three days afterwards, (the 14th,) the blisters have ceased to be
painful, the neuralgia is much less severe, and the patient complains
only of a very uncomfortable sensation of numbness. Same prescrip-
tion. Tiie blisters shewing a tendency to dry up, are excited by an
epispastic pomatum of cantharides.

The 17th. The patient, who had been previously unable to place
his foot upon the ground, got up without any increase of pain ; but
the limb is weak, and scarcely able to support the weight of the
body. From this time, I did not see him until the 23rd, when I
learned from him that he could walk without difficulty, and without
pain. I advised him to make dry frictions upon the extremity, every
morning and evening, and to resume his ordinary occupation.

This is a case of acute sciatica, which presents nothing peculiar,
except its rapid termination. The duration was about twenty days,
and the cure was accomplished by the employment of blisters in the
course of twelve days. The following case of chronic sciatica pre-
sents the same success.

Case 2. A plasterer, about 44 years of age, had been affected
with sciatic neuralgia of the right extremity for two years, for which
he had been treated from the beginning, at the Hotel Dieu of Lyons,
by oily and aromatic frictions, by vapour baths, and sudorific drinks,
whose nature he could not specify. This pain was very acute for a
month, and ceased gradually during summer.

September 18th, 1844, he came to me with a new sciatic pain of
the same extremity. The pain presented the peculiarity of having
commenced at the foot, thence extending progressively along the
fibular margin of the leg, without ascending above the knee. The
general healtii of the patient is not good, his constitution is feeble,
he is emaciated and pale. The pain of tiie leg is deep-seated, dull,
and seems according to the expression of the patient, to occupy the
marrow of the bones. Pressure along the course of the external
popliteal nerve increases the pain, and transmits it to the hip, the

390 Treatment of Sciatic Neuralgia. [July,

same result is not obtained by compressing the sciatic nerve near its
origin.

Prescription — Two blisters, one upon the malleolus externus, the
other upon the head of the fibula, with the respective dimensions in-
dicated in the preceding case.

On the following day, the pain which had been fixed in the leg
was experienced in the thigh, and in the gluteal and lumbar regions ;
the patient has not slept, the pain having kept him constantly awake,
and it was with great difficulty that I could persuade him to permit
the application of another blister of six inches in diameter on the
gluteal region.

Prescription — Two pills with half a grain of opium ; ptisan of the
flowers of the orange tree ; soup.

Sept. 20th. The patient suffers lancinating and lacerating pains in
the thigh, which upon pressure or motion, are increased and propagated
to the gluteal region and to the scrotum. He has slept but little, the
suffering is greater during the night than in the day. The prescrip-
tion is continued ; the regimen is slightly increased.

The 22d. The pain has diminished ; pressure not so painful, but
every movement renews the suffering.

The 25th. The blistered surfaces are revived by a cantharides po-
matum.

The 27th. The neuralgia has nearly disappeared ; the patient can
perform the movements of flexion and extension, without pain, but
is still unable to walk or to get from bed.

The 30th. Pain is no longer experienced ; the patient can turn in
his bed, and begins to walk about in his room. Six days afterwards,
he resumed his occupation, which has not been interrupted up to the
present time. This was a case of sciatica, in which pressure dis-
closed with precision the extent of the phlegmasia. It extended
upward along the course of the external popliteal nerve, as high as a
point at which pressure ceased to be painful. We may here also ob-
serve the same fact which may be remarked in the preceding case,
viz., the exacerbation of the pain, and its extension to the entire
nerve immediately after the application of the blisters. This is a
phenomenon which I have constantly observed, and which is explain-
ed by the vivid irritation caused by vesicatories applied to a large
portion of the cutaneous surface.

Case 3. The employment of multiple vesicatories is not only very
advantageous in cases of simple sciatica, as in those which I have

1345. J Trealmcnl of Scialic ycuraJgia. 391

just reported, and which are the most common, but these powerful
derivatives may also be very successfully used in chronic lumbago,
which is sometimes accompanied by a double sciatica, as the follow-
ing example proves:

One of my friends, aged 42 years, of a good constitution, and of
a nervous temperament, has been subject from his infancy to head-
ache of the most violent kind, and very frequently repeated. It is
the only affection with which he has been troubled, except the one
about to be described.

For about fifteen years, he has experienced almost constant pains
in the lumbar region, which he attributed to the accidents of the
chase, for which he had a great passion in his youth. He has suc-
cessively employed every variety of treatment, shower baths, vapor
baths, sand baths, sea bathing. He has visited Aix, Cette, Balaruc ;
but nothing had been successful. The pain seemed on the contrary
to have increased, and from the lumbar region, it had extended to the
thighs, to the legs, and even to the plantar surface of the feet, which
were particularly painful, so as sometimes to prevent walking or even
standing.

I had frequently advised, but not very urgently, the employment
of blisters on a large scale, being doubtful whether they would pre-
vail against an affection of so old a date, and which I regarded with
other physicians as an inflammation of the medulla spinalis. Tired
of the means which had been previously employed without success,
he determined in the month of September last, to try this last chance.
I will not enter into the details of a treatment which continued for a
month, and during which the patient remained constantly in his bed,
or in his room. I will only state that at three different times blisters
were applied upon all the joints of the inferior extremities, and upon
both sides at once, and also that four different applications were
made upon the lumbar regions. All these blisters had the dimensions
which I have already indicated, and those upon the loins were even
seven inches in length and eight in width ; so that it might be said
that the body was but one vast wound, judging at least by the enor-
mous quantity of linen which was daily stained by the suppuration,
by the excessive pains of the patient, and by the rigorous immobility
to which he was condemned. From this extensive vesication, I had
no accidents to combat, either with respect to the urinary bladder, or
the genital organs, or the head ; ptisans of barley and flaxseed, emol-
lient injections, and some opiate potions, were the only internal
remedies cmploved duiinji the treatment.

392 Treatment iyf ISciafic Neuralgia. [-^uly,

Six months have elapsed since this treatment was adopted, and ever
since tlie patient has remained in the possession of good health ; the
loins and the inferior cxtr^iities have regained their strength, and
are competent for ordinary exercise. Long continued walking, how-
ever, or tolerably great fatigue, causes weakness, without re-exciting
the pain,

I could take from my old notes of the clinic of M. Gendrin, many
facts in support of the treatment which I have just detailed, but they
would add nothing to the single inference which I wish to draw from
the preceding cases, viz., that blisters in the conditions which I have
indicated, having been successful in the cases just reported, and in a .
great number of analogous cases, we should hasten to employ a
method which is so easy, and is preferable to others that have been
more vaunted ; such as the employment of morphine, incision along
the course of the sciatic nerve, and the application at the bottom of
the wound of a belladonna pill, a treatment which is imprudent and
which I have seen to fail, and finally the worst method of all, the
section of the sciatic nerve, advised in extreme cases by Galen, and
practised without success by Mareschal, Louis, Sabatier, and more
recently in 1828, by M. Malagodi, who is mentioned by Velpeauin
his Operative Surgery.

If vesication, employed in the particular case which now occupies
our attention, has been sometimes unsuccessful, these failures must be
attributed rather to the mode of application than to the inertness of
the remedy. Thus to speak only of the ordinary blisters of canthar-
ides, they are employed most frequently singly, and of the dimen-
sions of two or three inches, and applied only over the great troch-
anter. Some go so far as to renew them from time to time, in order
to obtain a constant suppuration, but many abandon the essay after
the first application. This mode of vesication has most frequently
failed, for two reasons ; first, because it is too limited to act effica-
ciously upon the affected nerve which is siluated deeply in a case of
sciatica ; and secondly, because neuralgia, though sometimes limited,
is most commonly extended along the whole nervous trunk, and it is
not sufficient to act upon the nerve only at its origin, but it is
necessary also to operate upon it throughout its entire course to its
termination.

• That thiscxplanution of the insufficiency ot' a single small blister,
is true, rannot l).; tlonbted; observation and txperience testifv this
insufficiency, to be almost constant when fhe neuralgia is of some

I"? 13. J Treaimtn! of Scialic yvuralgia. ;^U3

extent and importance. This was perceived by M^. Velpeau, ^vhen
lie employed blisters in strij)s along the entire course of the sciatic
nerve, and of the external popliteal nerve. I know not if these
strips were too narrow, or if the &ui)puratron was not maintained
sufTiciently long, but it seems that this plan was unsuccessful, since
it has been renounced by its author.

The method of vesication which I have employed, after the exam-
pie of r>I. Gendrin, is not new; but the physician just cited has
added some modifications to it. It is the method of Cotugno, and
is also recommended by Hufeland, in his Manual of Practical Medi-
cine, with this single difference, that the Italian physician and the
physician of the Prussian king, gave to their blisters equal dimen-
sions, and applied them only at intervals of one day, fearing
doubtless to produce erysipelas, and a too vivid irritation of the cuta-
neous surface. But we know that if blisters have been able to fix
erratic erysipelas, they rarely determine its production. As to my-
self, I have never seen the least inconvenience result from their
multiple application. I conclude, then, that monstrous blisters, if
they may be so called, though still larger are employed, are :

1st. The best mode of treatment for sciatica, whether dependent
upon an inflammatory or upon a rheumatismal cause, experience
having shewn that they succeed in both cases.

2d. That these blisters having the dimensions above stated, ought
to be applied upon the three articulations of the inferior extremity,
with this exception, that we apply only two when the sciatica is con-
fined to the thigh or to the leg, but. the third one is to be applied, if,
as sometimes happens, the neuralgia invades the entire limb after
the first application.

3d. That these blisters do not have the danger of the employment
of morphine, whose effects cannot be calculated in the endermic
method, because of the difference of its action upon different
subjects. I heard, during my residence at the Hotel Dieu, that a
patient had died with symptoms of poisoning, after the application
of one grain of acetate of morphine, upon a denuded surface. While
in the service of one of the divisions of the Ward Quatre Rangs, I
saw a patient experience poisonous effects f.cm the employment
of half a grain of the hydro-chlorate of moipliine, and neverthe-
less, authors council us to trust to the absorption of even two
grains. Finally, as f;ir as inconvonionces arc concerned, these mon-
strous bliijters cannot bo compared with the section of the sciatic

394 Cons icier ulions upon Ataxic Pneumonia^ J^'c. L'^"b'»

nerve, which in the case cited by M. Velpeau, was followed by a
very slow cicatrisation, after the expiration of one year, and by de-
bihty of the limb which remained in a state of semi-paralysis.

4th. My fourth and last conclusion is, that blisters of large dimen-
sions have not produced erysipelas, or other accidents, and that ves-
ication, whose employment has been so frequently modified, and
which has been regarded alternately as an inoffensive remedy, and
as an heroic remedy, ought to be much used in sciaiica, not with the
view of endermic medication, but as an evacuant and a derivative.

Considerations upon Ataxic Pneumonia with Delirium and its treat-
ment by Musli — contained in a letter from Thibeauu, Professor
of Clinical Medicine at Nantes, to the Editor of the Bulletin de
Th erapeutique. ( Translated.)

I have just read in the January number of the Bulletin de Thera-
peutique, a case of j)eripneumony, accompanied with delirium during
its course, and which terminated fatally on the eighth day. The
disease had existed for five days before the patient was admitted into
the hospital, when he was affected with so violent a delirium that he
was unable to give any account of his condition. Pneumonia of the
light side having been recognized, several venesections were pre-
scribed without obtaining any amendment. Death occurred on the
third day after the admission of the patient — the delirium persisted to
the last, and so also did the signs of pneumonia ; the pulse presented
but a moderate degree of development.

To this case were appended the following reflections:

"The delirium, rather than the pneumonia, should have been the
source of indications after the failure of the venesections, and we
believe, after an attentive examination of the different elements
which this case presents, that the use of musk would most probably
have subverted the delirium which embarrassed the progress of the
disease," &c.

It is with the view, I^Ir. Editor, of corroborating your opinion, and
of insisting upon a therapeutic point of great interest, that I take
the liberty of addressing you this letter.

Most certainly there are cases of peripneumonia in which the pul-

1845. J Consider alio lis upon Ataxic Pneumonia^ iS^c. 395

monary inflammation, if we may so speak, occupies only the second
rank, and is eclipsed in importance by a superior element — the ner-
vous element. Indeed the doctrine of elements developed by the
physicians of the school of Montpellier is here eminently applicable.
Delirium, the form assumed in these cases by the nervous phenomena,
occurs under a peculiar aspect, and has been well appreciated by M.
Recamier, Trousseau and Pidoux. In the majority of cases it is
violent, accompanied by incoherent vociferations, and by unreasona-
ble acts. The features bear the impress of afTright, or of intense
pre-occupation, the patient has not an instant of repose — sleep aban-
dons him, and the room in which he is placed is disturbed by his
threats and his cries — most commonly it is necessary to confine him
in a straight-jacket. During this time the pulse is small, weak, fre-
quent, and sometimes irregular. The general and local signs of the
pulmonary affection undergo but little change ; auscultation announ-
ces generally a stationary condition. It is not then in the extension
or in the increased intensity of the j)ljlegmasia that the danger re-
sides. In such cases you have said, as has been also established by
Sarcone, Recamier, and others, that musk produces marvellous ef-
fects. This is no exaggeration, — this medicine becomes under such
.circumstances truly heroic. If the diagnosis be exact, if we have not
mistaken for this ataxic delirium^ which I have just endeavored to
describe, a sub-delirium without any particular character which oc-
curs about the termination of certain cases of pneumonia, or indeed
the delirium which, combined with other characteristic symptoms,
announces the existence of cerebral meningitis, we are almost cer-
tain to triumph over the threatening symptoms which make their
appearance. I am at the present time so well convinced of what I
have just advanced, that in my clinic I have frequently predicted to
my pupils the immediate and ulterior effects which were to follow the
administration of the musk. Indeed after a dose somewhat large of
this medicine, one scruple or more has been administered, the agita-
tion is diminished, the delirium is appeased, the superior eye-lids
become heavy, yawning and pandiculation occur, the patient seems
under the influence of an imperative desire to sleep, and which he
endeavors in vain to resist. This sleep soon supervenes, and is pro-
tracted for several hours, and during this time the pulse becomes
slower and incieases in force, a general perspiration breaks out, and
when he awakes the patient is restored to consciousness. If the de-
lirium returns it is only at intervals, and at length entirely disap-

396 Co!isideralioii8 upon Ataxic Pneumonia, dj^c. [July

pears. But although he has recovered his consciousness, the patient
remains soqietimes in a state of numbness which continues for seve-
jal days. The senses are obtuse ; audition, vision, and touch give
but confused perceptions, and the answers, although correct, resemble
those sometimes made b}*^ persons at the moment of being aroused from
slumber. However the local symptoms of the peripneumonia, which
until this time had remained stationary, change immediately. The
resolution of the phlegmasia which had been suspended by the dis-
turbance of the economy resumes its progress, and auscultation proves
that the pulmonary parenchyma is becoming pervious to the air.

Ataxic pneumonia is not very common, and hence probably the
astonishment which it causes in some practitioners, and the errors of
diagnosis committed by even eminent men. The opportunities of
giving musk as a specific medicine do not occur as frequently as is
supposed. Here I speak only of those cases in which this substance
produces evident effects, and which the most sceptical cannot deny.
At the present moment I leave out of the question certain acute, and
particularly numerous chronic affections in which musk has been
recommended. In such cases, new researches are necessary, and
it is perfectly legitimate to doubt. Thus, musk is one of those reme-
dies which is employed by one practitioner or disdained by another,
according to their different opinions or the nature of their studies;
but this is not the case in the disease which we we are now consider-
ing. I said that ataxic peripneumonia did not appear to me to bo
very common, thus in a service of more than forty beds, where the
admission of patients is pretty frequent, I have not observed more
than one or two cases of this kind each year ; and even sometimes a
greater interval elapses before such cases are received in my service.
I orivc musk therefore but rarely, and only under the above-mentioned
circumstances, being doubtful of its good effects in many other mor-
bid affections.

I will also add that, during the progress o^ pneumonia, with deliri-
um^ complications sometimes supervene and oppose an invincible
obstacle to the good effects of the musk. Two such cases, which I
cannot now report with all their details, and which were observed in
my clinic in 1841 and 1844, were especially very remarkable. In-
dependently of the hepatisation of the lung, as denionstrated by
autopsy, there existed in both traces of acute pericarditis, and in one
of them traces of cerebral meningitis. In both these patients the
delirium v.hicli occurred during the course of the peripneumonia

IS 15.] Considerations upon Ataxic Pneumonia, c^'C. 397

presented the characters above indicated, and yielded completely to
musk, which was given in a large dose. It was only secondarily
that a new phase presented itself, and that symptoms of another na-
ture occurred and occasioned the death of the patients. In one of
these cases, the pericarditis was not recognised; in the other, a re-
markable agony, and a great intermittence of the pulse, were the
only signs which induced us to suspect its existence.

These cases, however, are of a particular kind, and cannot invali-
date others now recorded in the annals of our science. Cases of the
latter kind are now well known, and their number increases daily.
In 1S39, in the 7th volume of the Journal desConnaissances, Medico-
Chirurgicalcs, we published ourselves such a case. The peripneu-
mony had occurred under the influence of a cold temperature acting
during the night upon a young soldier while on duty. It had reached
the ninth day without any appreciable change ; the most energetic
treatment had been adopted ; eight venesections had been successive-
ly practised, thirty leeches had been applied upon the thorax, and
subsequently two blisters ; kermcs mineral also had been administer-
ed. After several apparent and temporary ameliorations, a violent
delirium suddenly seized the patient, the pulse became small, feeble,
and frequent, (115 per minute,) respiration frequent, (40 per minute,)
the local signs of pneumonia persisted, the countenance was greatly
altered, the features cramped, and tlie delirium so great that it was
necessary to tie the patient to prevent his escaping from bed. In
this state of things, musk was administered in pills in the dose of one
grain per hour. Eight grains had been given, and already the deliri-
um was sensibly diminished, and the pulse had lost its frequency.
The following night, during which the musk was continued, a calm
sleep supervened. The second day, after the administration of one
scruple of the medicine, convalescence commenced, and during this
time the signs furnished by auscultation, announced a free solution of
the pneumonia.

On 13th May, 1844, M. Botte, a pupil of the Hotel Dieu of Nantes,
selected ataxic pneumonia as the subject of his inaugural thesis. In
the course of his researches, he reports several cases collected in the
different services of the hospital, and particularly in the clinical
wards. Two of these cases seem to me well calculated to demon-
strate the incontestible efiicacy of musk, and were prepared under
my direction.

A patient was admitted into the Hotel Dieu on the fifth day, of a

398 Considerations upon Ataxic Pneumonia, <^c. [July,

peripneumonia, for which two venesections and an application of
leeches had been rhade. On the third day he was taken with a vio-
lent delirium, which rendered it necessary to tie him, and in that
condition he was brought to the hospital. During the day, after a
third bleeding and the administration of a bottle of Sedlitz water, the
symptoms were aggravated to the highest point, the eyes became
brillrant, the expression of the countenance threatening, and the
straight.jacke't was used to prevent the patient from escaping from
bed. His strength declined, tongue and lips parched, pulse frequent,
concentrated, and depressible, the bladder distended with urine, and
requiring the introduction of the catheter. During all this time,
auscultation discloses posteriorly, and upon the left side a crepitant
rale, a broncheal souffl j, and bronchophony ; the expectoration of a
peripneumonic character. In the midst of this frightful array of
symptoms, musk was proscribed in a large dose, and in thirty hours
(counting from its administration) yawning and pandiculation took
place, followed soon by a quiet sleep, with a gentle moisture of the
skin, announcing the beginning of improvement. On the next day
some vestiges of delirium still persist, but soon disappear entirely.
The pulse loses its frequency, the signs of resolution are manifested,
and five days afterwards the convalescence is confirmed.

Another patient was admitted into the hospital on the seventh day,
of a peripneumonia, after having been bled three times, and after
the application of fifteen leeches upon the affected side. The steth-
oscopic signs of pneumonia were recognised, and two additional
venesections were practised the day after his admission. On the
following day, delirium suddenly supervened, and attended for some
moments by a kind of cataleptiform stupor. Consciousness is entire-
ly lost — the eyes immovable, seemed fixed upon any object before
the patient. The pupils are contracted ; deglutition difficult ; pulse
very frequent (1:24 per minute) and very depressible. At the mo-
ment of the visit, this condition suddenly gave way to a violent par-
oxysm of delirium, with a disposition to escape and to seize upon
the persons who approached him. After the administration of one
scruple of musk, the delirium is replaced by a kind of profound tor-
pidity, the pulse is pliant, of moderate consistence and less frequent
(92 per minute.) A chill, without any known cause, supervenes
during the day, and is followed by a return of the delirium. One
scruple of musk is again prescribed, and "kfter a calm night and
refreshing sleep, the intellect becomes clear, signs of the resolution

1845.] Venous Pulse. 399

of the phlegmasia are manifested, the appetite returns, and the patient
is convalescent.

Thus in certain cases of pneumonia, there may occur new morbi I
elements of such a nature as to arrest the resolution of the phlegmasia
and to threaten life. In such circumstances, appropriate remedies
ought to be substituted for the ordinary treatment. Ataxic, or deliri-
ous pneumonia, furnishes an instance of this kind, and in the same
way, that in pernicious fevers, although attended with phlegmasia,
the sulphate of quinine constitutes the fundamental plan of medica-
tion ; because a special element here predominates over the entire
affection ; so in like manner, musk is the heroic medicine to which
we should promptly have recourse in ataxic pneumonia accompanied
with delirium. Physicians have been so much fascinated by the
doctrines of exclusive organicism, that they can hardly comprehend
how very intense cerebral symptoms (such as those which we have
indicated in this article,) can exist without meningitis, and how con-
sequently any other than an antiphlogistic treatment can succeed
in such cases. The same thing is true in many other diseases. But
nevertheless, the accomplished physician, enriched by the knowledge
of modern discoveries, tends each day to resume the route which has
been too much abandoned, and to study morbid affections by means
of clinical observation, in preference to any thing else^ and not ex-
clusively by the light of Pathological Anatomy. N.

PART III.— MONTHLY PERISCOPE.

Venous Pulse. — M. Martin Solon read a paper on the Nature and
Causes of the Venous Pulse, which occasioned several animated and
interesting discussions. The term venous pulse is generally applied
to the pulsations which are observed in the jugular and subclavian
veins, in cases of great repletion of the cavities of the heart, or of
insufficiency of the tricuspid valves. The latter not closing when
the ventricles contract, the blood is expelled, as it were, into a third
artery, and venous pulsations ensue, more or less synchronous with
the arterial pulsations. M. Martin Solon, having lately observefl
})ulsations in the dorsal veins of the hands in two instances, in which
it appeared to him that the pulsations were evidently transmitted
through the capillaries, wished to draw the attention of the Academy
to this phenomenon. The patients on whom he observed the venous

400 ^ Venous Pulse. [July,

pulsations were both attacked with violent pleuro-pneumonia, had
been bled several times, and had taken tartar emetic in large doses.
The veins were prominent, rounded, of a bluish-rose colour, and pre-
sented a diastolic and systolic motion, easily appreciable by the eye,
and synchronous with the pulse. On a carefid examination being
made, it was evident that this motion was not communicated by any
adjacent vessels. When the fingers were pressed, the pulsations
ceased, but when ^he wrists were pressed, they remained as before.
When the brachial artery was pressed, the pulsations of the radial
and cubital arteries, and of the dorsal veins of the hands, all disap-
peared together. In both cases the patients gradually recovered.
In one, the venous pulsation appeared on the fifteenth day, and re-
mained seven days, the cardiac impulsion being strong; in the other,
the impulsion of the heart was weak, and the symptom was not of
so long a duration. M. Martin Solon thought t)iat the abnormal
fluidity of the hlood in these patients facilitated the passage of the
blood through the capillaries, and thus enabled it to retain the im-
pulsion communicated hy the heart. The same phenomenon, he
stated, had been observed by Dr. Ward, on a woman recently deliv-
ered, *and attacked with pneumonia, and by Dr. Graves, on a woman
labouring under peritonitis. In both instances the patients had been
bled largely. This symptom was of great importance in a patholo-
gical point of view, as it indicated a state of fluidity of the blood
which might render further bleeding unadvisable; he consequently
thought that the attention of practitioners should be directed to its
existence. In a physiological point of view, the fact of the arterial
systole and diastole being thus communicated to the veins, was of
great importance, as it proved that the entire circulation is under the
influence of the heart.

M. Cruveilhier stated that he had several times observed venous
pulsation in the veins of the bend of the arm, but never in the dorsal
veins of the hand. He thought it most probable that such pulsations
were the result of a shock conveyed to the venous column by the
neighbouring arteries.

M. Velpeau had seen venous pulsation in all the superficial veins
of the thoracic limbs, but attributed it to a kind of reflux, such as is
frequently observed in the jugular veins.

M. Blandin admitted fully the explanation of M. Martin Solon.
Harvey had stated that, in some cases, the heart was able to transmit
pulsations to the veins, and the experiments of M. Magendie, which
he himself had successfully repeated, showed that this was really the
case. If, on the dead subject, a part of the circulatory system having
})ecn previously cleared by an injection, fluid is injected into an arte-
rial trunk by successive jerks, it passes out in a jerk from an opening
made in a corresponding vein. If an interrupted flow of blood from
a vein can be produced in a dead subject through the capillaries, why
should not the same phenomenon be possible in the living?

M. Dubois d'Amiens remarked, that when the circulation is exam-

1845.] Venous Pulse. 401

ined with the microscope, it proceeds byjerks, until the blood reaches
the capillaries, when its flow becomes uniform ; it was, therefore,
scarcely possible to admit the interpretation which M. Martin Soloa
had given.

?.r. 3Iartin Solon replied, that he did not reason from experiments,
but from pathological facts. He had been careful not to be misled
by the proximity of arterial branches, and by the communication of
their shocks to the veins. If the pulsation had depended on reflux
from above, pressure above the veins ought to have arrested them,
which it did not. The valves of the veins would prevent the jugular
reflux from propagating itself far.

M. Poiseuille stated, that researches which he had recently made
with reference to this subject, would enable him to throw some light
on the question. When the capillary circulation of reptiles and
mammiferous animals is examined with the microscope, its flow ap-
pears perfectly uniform ; but this is not really the case ; for although
continuous, it is insensibly interrupted, jerked (saccade), a.s is proved
by the following experiment : — If a curved tube, containing a solu-
tion of subcarbonate of soda, to prevent the coagulation of the blood,
is adapted to one of the veins of a thoracic or pelvic limb, so as for
the opening to be turned towards its extremity, the blood enters the
tube continuously, but not uniformly. The flow is interrupted-co7i-
iinuous, [continu-saccade.) which would not be the case if the flow of
blood in the capillaries was uniform. This experiment is the same
on thelivinor as the one described by M. Blandin on the dead subject,
and the result is also the same. Careful examination of the jet of
blood in ordinary venesection, equally demonstrates the truth of this
fact. The amplitude of the jet is never identically the same, even
when the openings of the skin and of the vein remain perfectly paral-
lel, and the arm and its muscles are perfectly inactive. That this is
the case may be perceived by observing attentively the spot where
the blood falls ; it will be seen to recede or approximate alternately.
It is scarcely necessary to add that the greatest amplitude of the jet
coincides with a contraction of the heart, or with an expiration,
which increases the impulsive force of the arterial flow, and that the
smallest amplitude coincides with the diastole of the heart, or an in-
spiration. If this normal state is exaggerated, it may give rise to the
venous pulse, or uneven flow, which is sometimes observed in bleed-
ing, and which is usually attributed to the communication of arterial
shocks. In the mesenteric circulation of young rats and mice, no
intermittence is at first visible; but if blood is lost in any quantity,
the circulation becomes jerked (saccade) both in the capillaries and
in the veins. The heart losing its energy, a smaller quantity of
blood is thrown into the arteries, which being less dilated, contract
with less force, and thus lose their power of converting the intermit-
tent flow into a continued one, as is normally the case. This ac-
counted for the venous pulse having been observed by M. Martin
Soloji, Dr. Graves, and Dr. Ward, on patients who had lost much

2r,

402 Periodic Discharge of Ova, 4'^« U^^Yt

blood. M. Martin Solon attributed the phenomenon to the greater
fluidity of the blood. But his own experiments, as well as those of
M, Magendie, proved that the more aqueous the blood became, the
greater was the difficulty with which it passed through the capillaries,
owing to imbibition. He thought it, therefore, more correct to ex-
plain the influence which loss of blood evidently had in producing
venous pulsation, as he had done.

M. Priorry had seen jerks occur in bleeding patients who presented
obstructions in the right heart, when a pound or a pound and a half
pf blood had been withdrawn. At the same time the blood became
red instead of black, showing that the action of the heart had become, ,
momentarily, stronger. — Lancet

On the Periodic Discharge of Ova, and the Function of Menstrua-
tion.— The following propositions embody the most important con-
clusions that have been formed by the best authorities on this highly
curious subject :

1. Menstruation commences at the period of the maturity of the
ovules.

2. The final cessation of the catamenial secretion coincides with
the abolition of the formative function of the germs. 3. The ovaries
of women, who have ceased to menstruate, never contain the appear-
ance of any vesicles that have recently burst, or that are about to do
so (Negrier.) 4. At each menstrual period, the highly excited state
of the ovaries induces in the female a decided propension to coition.
5. The aptitude for fecundation is greatest on those days that imme-
diately precede the menstrual discharge. 6. In all the lower
animals, the ovaria become tumid during the season of rutting,
7. Women, in whom there is a congenital absence of the ovaria,
never truly menstruate, however perfect may be the structure of the
uterus and other parts of the generative system. 8. The extirpation
of these organs puts a complete stop to menstruation, in cases where
this function had been already established. 9. Women, in whom
there is a congenital absence of the uterus, but in whom the ovaria
are normally developed, experience every month all the phenomena
of menstruation, the sanguineous discharge alone excepted. 10.
The catamenial secretion ceases completely in women, in whom the
ovaria have become affected with organic degeneration. 11. It has
been asserted by some writers that lascivious girls have — in this re-
spect like the common hen — occasionally discharged ova from the
vagina, and that a mere voluptuous thought will suffice powr ehranler
these minute vesicles. 12. In very many women, the menstrual
period is preceded by severe colicky pains, attributable most likely
to the turgid and excited state of the ovaries.

13. In those who sufl^er much at these periods, the cavity of the
uterus sometimes becomes lined with a soft flocky membrane — a
genuine memhrana caduca — the formation of which isefttirely inde-
pendent of coition. 14. Lastly, in that singular case of monstrosi-

1845.] Epidemic of Erysipelas — Epilepsy. 403

ty — in which the two girls, Helen and Judith, were united to each
other hy the posterior and lower parts of the back — the catamenial
discharge took place in different quantities and at different times
from each subject, although there was a complete anastomosis between
the abdominal vessels of the two. — Memoire pour servir a V etude des
Maladies des Ocaires,par Achille Chereau. Paris, 1844. Medico-
Chirursical Review.

Epidemic of Erysipelas, in the Hospitals of Paris. Bulletin de
Therapeufique, April, 1845. — The surgeonsof the Parisian hospitals
have had frequent opportunities of observing epidemics of erysipelas.
At this moment, one of these epidemics prevails in several of the hopi-
tals of Paris. At the Hopital de la Pitie, the service of M. Lisfranc is
crowded with erysipelatous patients; in 198 patients, 25 are attacked
with erysipelas, occurring in the hospital and following operations
which had been performed upon them. M. Lisfranc has never seen
an epidemic more general and more intense. Six women, from
whom he had removed the mammae were all of them seized with
erysipelas, and with the bad consequences which thence ensue. A
simple ligation of haemorrhoids produced in a patient a very serious
erysipelas, which extended gradually over the whole back, and even
to the nape of the neck. This patient is in danger. The disease
has also been developed in patients who entered the hospital in con-
sequence of accidents from vehicles, falls, 6cc. A simple application
of leeches, the smallest operation, the slightest incision, are sufficient
to excite the disease. Some of the cases are very serious, and have a
tendency to terminate in a typhoid state ; no patient, however, thus
far has died. It appears that the same epidemic influence is equally
felt at the Hopital Beaujou. M. Martin Solon has also several ery-
sipelatous patients under treatment. In presence of such an epidemic,
surgeons who see farther than their bistouries, and who are governed
by general principles, will admit in this fact the incontestable exist-
ence of a particular medical constitution which should influence their
conduct. Under such circumstances, the prudent surgeon should
abstain from operating or performing only those operations which
are urgent. N.

Corrosive Sublimate in Epilepsy. — In an elaborate article upon
the Neuroses of the Ganglionic Nerves by M. Merat, Member of the
Royal Academy of Medicine, we find the following remarks : —

''Since the year 1810, I have been in the habit of administering
the Corrosive Sublimate in the treatment of several nervous diseases,

404 Treatment of Chlorosis — Cautery in Gangrene, [July,

and more especially of Epilepsy. I have witnessed decidedly suc-
cessful results from its use in a good many — but certainly it roust be
confessed, not in the majority — of the cases of this malady. The
formula, which I use, will be found in the Dispensatory of Bouchar-
daut (ed. 1840, p. 394.) A pill, consisting of a sixteenth part of a
grain of the Sublimate, one grain of Camphor, three fourths of a
grain of Opium, and half a grain of Musk, is given daily ; thisdose
is to be increased every eight days by an additional pill of the same
ingredients. Some patients have been able to take one or even two
grains of the sublimate in the course of the twenty-four hours. As
a general rule, I have never wished to exceed half a grain at most ^
unwilling to run the risk of inducing a black colour of the skin, as
has happened to some patients after a protracted use of the drug.

Revue Medicale,

Professor Cornealini on the Proximate Cause and Treatment of
Chlorosis. — From an extensive experience in the wards of thePavia
Hospital — to which he is attached as the professor of clinical medi-
cine— the author deduces the following conclusions respecting this
not unfrequent disease : —

1. The essential nature of chlorosis consists of two pathological
conditions, both of them appertaining to the solids; — the frst being
an inordinate excitation of the heart and arteries, and the second a
chemico-vital alteration of the assimilative functions of Chylification
and Haematosis. It is not possible to determine which of these two
conditions is the primary and causal one.

2. No plan of treatment is so certain and efficacious as the exhi-
bition of steel in $ome form or another : the preparations of this metal
acting curatively upon both of the pathological states now mentioned.

3. There is no very marked difference in the comparative efficacy
of different chalybeate preparations, except in so far as relates to
their solubility in the animal fluids, and perhaps also to their readiness
to become disaggregated by the process of digestion.

4. The addition of an acid decidedly increases the efficacy of
steel remedies.

5. Steel-filings become converted, in the stomach of chlorotic pa-
tients, into the lactate of iron.

6. It is useless — and not unfrequently it is unsafe — to administer
very large doses of ferruginous preparations.

Professor Corneliani has examined with great care the state of the

blood in chlorosis ; and most of his observations go to confirm the

accuracy of MM. Andral and Gavarret's statements respecting the

diminution of the normal proportion of red globules and hsematosine.

Annali Universalis Med» Chir. Review,

The Actual Cautery successfully employed in Gangrene of the
mouth. — The case occurred in a female child, five years of age, du-
ring the convalescence from, an attack of Typhus fever. The pecu-

1845.] Digitalis in Diseases of the Heart. 405

liar (by some deemed pathognomonic) offensive odour, that accom-
panies this species of gangrene, was remarked before any actual
appearance of the disease was discoverable. There were four
gangrenous patches on the upper and lower gums, besides one on
the inner surface of the right cheek. Dr. Weber determined to
apply the actual cautery to all the diseased spots, and the immediately
adjacent parts- This was done, not without difficulty, as may be
imagined ; and the mouth was directed to be afterwards washed out
every two hours with a decoction of Cinchona, to which some spiritus
cochlearecB was added The offensive smell ceased immediately after
the application of the cautery, and did not again return.

On the third day, the sloughy parts began to detach themselves ;
at the same time, a few suspicious-looking spots were touched with
the nitrate of silver. Several teeth remained ^^dechaussees,^' and
at three points the maxillary (upper) bone was exposed. These ne-
crosed portions, inclosing a molar tooth, and two smaller bits of the
lower jaw were subsequently detached. During the progress of the
case, an offensive purulent discharge took place from the ears, and
numerous small abscesses formed on different parts of the body.

Dr. Weber does not think that, in this case (nor indeed generally),
there was any reason to suspect that the gangrenous ulceration of the
mouth was in any degree attributable to the action of mercury upon
the system. He points out the analogy between this disease — which
he designates by the name of noma or corroding ulcer — and the
pustule ?naUgne, so actually described by Boyer and other continental
writers. — Gazette Medicale de Strasbourg, from Ibid.

On the action of Digitalis and its rises in Diseases of the Heart.
By Wm. Muxk. M. D. {Guy's Hospital Reports, 1844.)— This
practical paper is founded upon upwards of 400 observations, which
were made during five years of dispensary practice. The tincture
has been found the most successful form of preparation as regards
the effect produced upon the action of the heart, while the infusion
is incomparably superior as a diuretic ; and, from want of attention
to this distinction, discrepant opinions as to the utility of the medi-
cine have doubtless arisen. The powder, used alone. Dr. Munk
considers as worthless, an;! although in combination (with mercury
and squill) it forms a valuable diuretic, it cannot be so employed as a
sedative.

The action of digitalis upon the heart is manifested in two ways :
by the exertion of a depressing influence, and as an antispasmodic.
Hypertrophy of the organ, whether simple or complicated with other
disease, causing increased impulse, may be benefitted by the depress-
ing influence of digitalis, which is best obtained by giving the un-
combined tincture, in tolerably full doses, at intervals of eight, ten,
or twelve hours. The antispasmodic'in^uence, acting so beneficially
in the irritable condition of the heart manifested by palpitations,
irregularity, <5wC., is that which is usually sought from digitalis. Dr.

406 Digitalis in Diseases of the Heart. [July,

Munk does not agree with those writers who state the action of the
digitalis upon the heart to be uncertain. Its operation is as certain,
in properly-selected cases, as that of other medicines, and may be
maintained with safety.

There are, however, circumstances under which this medicine
cannot be exhibited usefully or safely. Thus, in a plethoric state of
the system, its employment must be deferred until bloodletting or
other evacuants, for which it is no substitute, have played their parts.
An inflammatory, or sub-inflammatory condition of the gastric and
intestinal mucous membrane, seems to prevent the action of digitalis
upon the heart ; and increased irritation results if it be persisted in.
Such complication of lesion of the heart and gastric derangement
is by no means rare, and in such cases prussic acid is the appro-
priate medicine. Quietude of mind and body much favor the action
of digitalis. The recunjbent posture is very adjuvatory to its de-
pressed action ; and Dr. Lombard truly observes, that it is rarely
efficacious in those who take much exercise, or whose attention is
much occupied during its use. Dr. Munk gives ^x. ad xxx.
every eight, ten, or twelve hours, and is rarely disappointed. He
does not reduce the pulse, which is to be carefully watched, below
60 in the adult, and thus derives the beneficial without risking the
production of the dangerous effects.

Digitalis rarely acts as a diuretic when its influence upon the heart
is marked, and vice versa. The author quite concurs in the high
opinion Withering entertained of its power of increasing the flow
of urine, which is seldom accomplished by any other drug after its
failure. It is not to the robust, fiorid, or wiry-pulsed, but to the en-
feebled, shattered, condition of the system, that digitalis is applicable.
*'If the pulse be feeble or intermitting, the countenance pale, the
lips livid, the skin cold, the swollen belly soft and fluctuating, or the
anasarcous limbs readily pitting on pressure, we may expect the
diuretic effects to follow in a kindly manner," These remarks were
penned, it is true, in reference to dropsy, from whatever cause
arising; but mutatis mutandis, they are equally applicable to all
cases in which the diuretic operation of foxglove is required. In
disease of the heart, a diuresis is frequently a valuable means of
preventing effusions by diminishing congestion, or of producing
their absorption if they have already occurred ; but whether digitalis
be the appropriate remedy or not, depends in chief upon whether a
sthenic or asthenic condition of the system prevail. Thus in the
case of hypertrophy, it is seldom apprf»priate, while in dilatation it
is usually the best of diuretics. Valvular disease is that in which
digitalis proves most useful, except in cases in which this is compli-
cated with hypertrophy. The infusion is to be given in doses of
§ss. to §j. every six or eight hours. With a view of preventing
the sedative operation of the drurj, moderate exercise, short of
diaphoresis, should when possible be taken. A moderate quantity
of drink may be given, and the loins must be covered with a double

KSl.j.J XcurJiria. • 407

roll of flannel, or, as recommended by Lombard, a stimulating plaster
may be applied to them.

Dr. Munk believes that untoward and fatal effects, resulting from
the continued employment of this medicine, are " exceedingly rare,"
and cites the opinions of Drs. Holland and Pereira as confirmatory
of his own.

"It has only occurred to me to see the slighter and less porten-
tous of these symptoms as a consequence of foxglove ; such as
inequality or intermittence of the pulse, loss of appetite, and frontal
headache : either or all of which have at once subsided on discon-
tinuing the medicine. I believe that such symptoms will only occur
when the drug fails to act in a normal manner as a sedative or a
diuretic. If cither of these effects are once obtained in a kindly
manner, I then consider my patient safe from the poisonous opera-
tion of the drug. If on the contrary, it does not evidence its usual
effects within a ^e\v days, the medicine, I believe, accumulates in
the system, and the patient is in danger of experiencing its poison-
ous influence. I am therefore in the habit of prescribing it for a
week : and, if within that period, I perceive neither sedative or diur-
etic effects, I then invariably desist from its administration. Let
these effects, however, be once kindly indiced and the medicine may
then be continued with safety for a considerable period. In no one
instance have I seen a bad effect follow'the use of digitalis where
the first consequences of its exhibition were the removal or material
alleviation of prominent or distressing cardiac symptoms, whether
this has been brought about by its operation as a sedative or as a
diuretic." — Med. Chir. Rev.

Neuralgia — Introduction of Medicated. Fluid to the Nerve. By
Mr. Ryxd. (Reported by Mr. Richard Gregory*) — Margaret Cox,
fEtat. 59, of spare habit, was admitted into the hospital, May'lSth,
1844. complaining of acute pain over the entire of left side of face,
particularly in the supra-orbital region, shooting into the eye, along
the branches of the portio dura in the cheek, along the gums of both
upper and lower jaw, much increased in this situation by shiitting
the mouth and pressing her teeth close tofiether, and occasionally
darting to the opposite side of the face and to the top and back of
her head. She states that about six years ago she fell from a wall,
and, in the act of falling, a stone struck her in the temple; that
twelve months after this she was much exposed to cold, and one night
was suddenly seized with the most agonizing pain in the si.tuations
above dosrrribod. "She thought her eve was being torn out of her
head," and her cheek fiom her face; it lasted about two hours, and
then suddenly disappeaied on taking a mouthtul of ice. Slie had
not had any return for three months, when it came back even worse

♦Menth Flospital zul County of Dublin Infirmary.

408 Neuralgia. • [July,

than before, quite suddenly, one night on going out of a warm room
into the cold air. On this attack she was seized with chilliness, shiv-
ering, and slight nausea ; the left eye lachrymated profusely, and
became red with pain ; it went in darts through her whole head, face
and mouth, and the parox)'sm lasted for three weeks, during which
time she never slept. She was bled and blistered, and took opium for
it, but without relief. It continued coming at irregular intervals, but
each time generally more intense in character, until at last, weary
of existence, she came to Dublin for relief.

She had been salivated three times, and had been so much in the
habit of taking laudanum that latterly half a drachm, three times in
the day, had no effect in lulling the pain, and was the quantity she
commonly took. She was a miserable, sallow-complexioned looking
creature, had been sleepless for months, and her face was furrowed
with constant pain.

On the 3d of June a solution of fifteen grains of acetate of mor-
phia, dissolved in one drachm of creosote, was introduced to the
supra-orbital nerve, and along the course of the temporal, malar, and
buccal nerves, by four punctures of an instrument made for the pur-
pose. In the space of a minute all pain (except that caused by the
operation, which was very slight) had ceased, and she slept better
that night than she had done for months. After the interval of a
week she had slight return of pain in the gums of both upper and
under jaw. The fluid was again introduced by two punctures made
in the gum of each jaw, and the pain disappeared. After this the
pain did not recur, and she was detained in the hospital for some
weeks, during which time her health improved, her sleep was restored,
and she became quite a happy looking person. She left the hospital
on the 1st of August in high spirits, and promised to return if she
ever felt the slightest pain again. We conclude she continues well,
for we have not heard from her since.

Case II. R. Dolon, a3tat. 28, a thin spare man, of middle stature,
was admitted into the hospital 9th September, 1844, and came under
Mr. Rynd's care on the 10th of November, complaining of acute
pain in the right hip, thigh, and leg, to the sole of the foot, along the
entire course of the sciatic nerve and its branches, but chiefly in the
main trunk of the nerve. He is unable to sleep from the pain, and
quite unable to walk. He is much emaciated, and the muscles of
the limb are attenuated and wasted. He has been ill for three years,
during which time he has been almost always confined to bed. He
has been frequently treated for the disease with calomel, to produce
salivation, cupping, blistering, leeching, &:c., all without any salutary
effect. Exposure to cold and wet is assigned as the cause of the
disease.

On the 13th of November, the fluid was introduced, ten grains
acetatis morphite to the drachm of creosote, one puncture behind the
trochanter, and one half-way down the thigh. He was instantly re-
lieved from pain, and walked steadily through the ward without any

1845.] yeuralgia. 409

pain or difBculty ; before, walking increased the pain. For about
half an hour after the operation he felt uneasiness from the puncture.

16th. Says he is perfectly well in the thigh, and feels only a slight
pain in the course of the anterior tibial nerve. The fluid was again
introdaced"to-day to the seat of pain by two punctures ; it disappeared
as before.

29th. Says he is perfectly well ; has walked every day since ; has
slight stiffness in the knee from previous want of use.

Ordered, camphorated oil to rub the knee with.

December 15th, Left the hospital to-day, saying he felt perfectly
free from all pain and uneasiness.

February 6th. He walked up to Dublin to-day (twenty miles), and
says that since the last operation, on the IGth of November, he has
never felt his old pain, and is perfectly well.

ADDITIONAL TESTIMONY.

Gentlemen, — I observed in the Medical Press, March 12, two
cases of neuralgia, treated by Mr. Rynd in the Meath Hospital, by a
new method of introducing morphine and creosote to the nerve
affected; the result proved most satisfactory. It had been my in-
tention long since to have sent you an account of some cases treated
by me during the last summer in a similar manner, and with most
happy results, but much occupation this winter prevented my doing
so. I hope, also, on a future occasion, to send you some cases of
other diseases, such as dyspepsia, hooping-cough, &;c., treated with
proto-iodide of silver — a remedy I believe hitherto little used.

Case. — Last summer, an elderly female, much emaciated, and
with countenance indicative of much pain and suffering, was sent
up by her medical attendant from the country for the purpose of sea-
bathing. She had had severe neuralgia of the nerves on outer side
of leg, shooting from her knee to her ankle and foot. She had been
subjected to a variety of treatment, such as leeches, blisters, an in-
cision down to nerve, and cutiing it across, &;c. She was quite
lame when I saw her, and it hurt her much to put her foot to the
ground ; she suffered greatly at night, and could not sleep. She had
been here some time, and had bathed without any benefit. I made
several small punctures along the course of the nerve affected. I
used a common lancet, armed with morphine, mixed in a little water,
about the consistence of paste, and operated precisely as is done in
vaccinating an infant; 1 did not use creosote with it. She felt slight
stinging and uneasiness for a short time after, but that night she
slept well, and next day stated that the pain, with the exception of
one or two spots, was quite gone. I punctured in these places again.
She again recovered.

On inquiring from her friends a short time since, I heard she has
continued in good health ever since — a period of nearly nine months.

I adopted the same mode of treatment in a case of sciatica with
similar success. In another bad case of neuralgia in the foot and
leg in a man who had been subjected to a variety of most active

410 Toolh-Ache — Jaundice — Febrile Periodicity, (^'C. [July,

treatment in hospital, and with very little benefit, I determined on
using creosote wilhout morphine. I had not heard of its being used
before until 1 read of it in the Press as used by Mr. Rynd, but in
his case he mixed it with morphine. It was of decided benefit in
my case, and the man has been able to go to his work, and has con-
tinued well to this time — a period of about seven months.

As neuralgia is a disease that so frequently bafiles the skill of the
physician, I think it is not unworthy of the profession to give this
mode of treatment a trial, and I should much like to know whether it
has as yet been much adopted.

I beg to remain, gentlemen,

Your obedient servant,

ARTHUR GUINxNESS.
Dublin Med. Press.

Caouichouc as a Remedy for Toofk-acJie. — Caoutchouc becoming
very smooth and viscous by the action of fire, has been proposed by
Dr. Rolfis as an excellent remedy for filling hollow teeth and allevia-
ting the toothache proceeding from that defect. A piece of caoutch-
ouc is to he put on a wire, then melted at the flame of a candle and
pressed, while warm, into the hollow tooth, and the pain will disap-
pear instantly. The cavity of the tooth should first be cleaned out
with a piece of cotton. In consequence of the viscosity and adhe-
siveness of the caoutchouc, the air is completely prevented from
coming in contact with the denuded nerve, and thus the cause of the
toothache is destroyed. — Brail hwaite's Retrospect.

Jaundice. — The Gazette Medicale (April, 1845,) contains a notice
of M. de Lonjon's researches on the diagnosis of Icterus, from which
it appears that he has ascertained that, besides the usual yellow tint
j)resented by the mucous lining of the mouth, this is strongly mani-
fested, even in the slightest cases of this disease, in the soft palate, or
velum pendulum palati, from its posterior margin to its juncture with
the bony roof of the mouth. D.

Febrile Periodicity, as influenced by the Sulphate of Quinine.
By Thos. D. Mitchell. M.I)., Prof. Mat. 3Ied. and Therap., in
Transylvania University. — But a few years ago, the therapeutical
application of th.s invaluable salt of Peruvian bark, was exceedingly
limited ; and with some, even at tliis day, it is held to be competent,
as a remedy, only to true intermitting ^ever, or ague and fever.

The doctrine, that all fevers and all diseases, are essentially inter-
mittent, has long been before the public; and while we are ignorant
of the nature and source of periodicity, theyV/ci of intermittence is
as well established, as any other in medicine. And although a latewri-
ter has asserted l^oltily, and without exception, that Therapeutics

1645.] Tracheotomy, in a case of (Edema of the Glottis. Ill

cannot be based on Pathology, we aver as po^itivel3\ that the direct
opposite is true. We believe, especially in reference to fevers, almost
without exception, that they are curable by sulphate of quinine,
simply and solely, because it is a remedy, al)ove all others, adapted
to diseases of an intermittent and remittent character; their terms
being substantially, and in fact, as to periodicity, the same.

In regard to the Pathology of Fevers, we know almost nothing,
perhaps nothing at all. that is practically of the smallest value, save
the naked fact of intermittence or periodicity. This is cognisable
when we can scarcely lix upon another point, that is worthy of notice
or remark.

We cure an ague and fever, by sulphate of quinine, no matter
whether it be a true and open ague, or a masked intermittent. And
we cure many diseases of genuine neuralgia, unattended by chill or
fever, at all perceptible, by the same agent. These are common
cases, with which all practitioners are familiar, and they clearly set
forth the adaptation of the remedy, on the ground of intermittence.

But if we look a little further, wesliall discover, that other fevers,
called by different names, merely to subserve the interests of theory,
possess one common property, which, confessedly under the control
of the sulphate of quinine in the case of common ague and fever, is
no less so in Typhoid, Typhus, Congestive, Yellow, and it may be,
all the fevers named in the books.

The position I assume here, is plainly and boldly this : there is hut
one feature or element in either of the fevers named, that is essential
ioi's pathology, and. that feature or property or element hows before
the potent sicay of the sulphate of quinine, and for this reason only,
we cure the patient. — Wesiern Lancet,

Tracheotomy, performed successfully in a case of Oedema of the
Glottis — translated from the Bulletin de Therapeutique. — On the 23d
March, 1845, Sageot, while in the Hopital du Midi, into which he
had been admitted on February 1st, was taken with a quinsey, appa-
rently slight, and which for three days caused only a slight difficuky
of deglutition. On the mornino: of the 27th, an inconsiderable
febrile movement occurred, with loss of appetite; soon dyspnoea
supervened, and increased suddenly in the evening to a frightful de-
gree. The patient, in a sitting attitude, makes unheard of efforts to
inspire air which penetrates with a whistling sound — the voice is
nearly extinct — expiration is easy; on inspection, a slight tumefac-
tion of the amygdalffi is found, with redness of the mucous mem-
brane. The finger carried deeply into the pharynx, discovers in the
vicinity of the arytaeno-opiglottic dnplicatures. a soft tumour, yielding
to pressure. This tumour is incised with the point of a bistour}'', and
from it only a few drops of blood escape. Suffocation becoming more

412 Gazenave on Caustics. [July,

and more imminent, M. Ricord is sent for at 10 o'clock, P. M.; finding
the patient with his face of a violet color, the extremities cold, the pulse
very frequent and very small, and the pupils enormously dilated, that
surgeon, after having again recognised the existence of the supra-
epiglottic tumour, determined to perform tracheotomy. The incision
was made in the crico-thoroid membrane and in the cricoid cartilage,
the lips of the wound were kept separate by hooks fixed by means of
a riband behind the neck. Respiration was immediately re-estab-
lished, and in an hour the patient slept quietly. The pulse having
risen three hours afterwards, M. Ricord prescribed twelve leeches,
six on each side in the vicinity of the jugular veins. April 4th, the
supra-epiglottic tumour presents but a very small volume, and the
canula, which on the 29th March had been substituted for the hooks
was withdrawn, and the patient was much improved after the extrac-
tion of the canula. On the following days the opening made in the
trachea diminished more and more in extent, respiration and deglu-
tition are performed without any pain or embarrassment, and on the
12th April the patient was perfectly cured. N.

31. Cazenave on the different sorts of Caustics. — The Poicder of
Dupuytren, is composed of one part of arsenious acid and 200 parts of
calomel. It is a mild and very manageable caustic, that is useful in
cases of lupus in women and children, when the ulceration is super-
ficial and of limited extent. If the diseased part be dry, it may be
necessary to denude it by means of a blister, and then to sprinkle the
powder upon the raw surface. A certain amount of heat and painful
swelling is usually caused by this application. When it falls off, there
is generally observed a decided modification of the diseased surface.
A few applications are sufficient to effect a cure in a great many
instances.

The Vienna power and paste are remedies of great power in cer-
tain cases of lupous ulceration. They are composed of equal parts
of powdered quicklime and potnssa cum calce. In using it, we take a
portion of this mixture, and add a small quantity of spirits of wine to
bring the powder to the consistence of a paste. A piece of adhesive
plaster, with a hole in it of the size of the intended eschar, should he
laid over the diseased surface, and the paste is then applied on the
exposed parts. It is to be \ei\ for ten or twenty minutes, according
to the depth of the eschar that is wished, and the ability of the pa-
tient to endure the pain.

The chJoruret of zinc paste is much used in the presenr day. It is
made by mixing one part of this substance with one or two parts of
flour, moistening the mixture with as little water as possible. The
pain produced by this application usually lasts for several hours. A

Id 15. J Cazenave on Caustics. 413

greyish-coloured eschar is formefl ; and this, in most cases, remains
attached for two or three weeks hefore it is separated. The surface
underneath is generally not ulcerated. M. Cazenave very frequently
has recourse to this caustic in certain cases of lupus, to destroy the
non-ulcerated tubercles.

For this purpose he applies only a very thin layer of the paste, so
as not to destroy the entire tubercle ; and in this manner he often
succeeds in effecting a complete resolution of it, without any scar
being left behind.

In very many cases of long standing and deeply-corroding lupous
ulceration, he gives the preference to the arsenical paste over the
two others which we have mentioned : its action is twotold ; local as
a caustic; and general by becoming absorbed, and exercising a po-
tent alterative or modifying influence upon the economy. The fol-
lowing is the formula which he invariably uses :

Take of White oxyde of arsenic, 2 parts.
Sulphate of mercury, 1 part.
Animal charcoal in powder, 2 parts.

When used, a small quantity of this powder is to be made into a
thin paste by the addition of a few drops of water ; this is put upon
the denuded surface — which should seldom or never exceed in extent
that of a franc-piece. This application usually produces not only
very sharp pain, but also a severe erysipelatous swelling, which lasts
for 24 or 36 hours, and is sometimes accompanied with grave consti-
tutional symptoms. GeneraMy these siibside very quickly ; and then
there remains on the cauterized part a hard brown crust which often
adheies for nearly a month, before it is detached.

Fluid Caustics. — M. Cazenave frequently makes use of a solution
of the sulphate of copper for the removal of those small warts that
"Dften form upon the shoulders and back, also of certain pediculated
horny productions, which occasionally appear upon these parts. A
stronger solution must be used for the latter form of cuticular excre-
scence.

In the treatment of favus and tinea, he recommends a weak solu-
tion either of this salt of copper, or of the nitrate of silver, or of
acetic acid.

Of fluid caustics, one of the most potent and useful is the acid nitrate
of mercury. When used to the surface pure and undiluted, it acts
as a mere caustic ; but when considerably weakened, and especially
when applied to a large surface, it is unquestionably absorbed, and
then it acts on the system.

It usually causes a good deal of pain and inflammatory swelling.
The cases most benefitted by its application are those of lupus, in
which the ulceration is extensive and not deep-seated.

The erysipelatous inflammation, which this as well as other caus-
tics— more especially the arsenical paste — are apt to produce, need
not be much dreaded ; nay, the effects of the cutaneous phlegmasia
seem sometimes to be decidedly salutary in the end. — AnnaJes ties
Maladies de la Peau.

414 Tuhercular Lip, ^^c. — Spasmodic Strictures. [Jiily»

M. Gibert has recorded in a recent No. (Oct., 1844) of the Revue
Medicale, a case of severe scrofalous lupus of the face, in which the
progress of the disease was arrested and the extensive ulcerated sur-
face became cicatrized under the employment, external as well as
internal, of cod-liver oil. The use of this medicine was steadily per-
severed in for a full year and a half. During this time not only did
the local malady become healed, but the general health — which had
formerly been very weak and ailing — was very decidedly improved.

The patient was a young woman, and the disease had existed for
nearly six years. On one occasion she had derived very considera-
ble benefit from the internal administration of the deuto-ioduret of
mercury, and the external use of the proto-ioduret ointment; but the
benefit was temporary only. She had been subjected to a regular
and protracted course of iodine treatment ; but certainly with no
advantajre. — Med. Chir. Rev.

Tuhercular ihicJcening of the Lip, successfully treated by Iodide
of Potassium. By Alexander Ure. — Mrs. H., aged 28, admitted
the 16th Sept., 1844. The upper lip is greatly enlarged and promi-
nent; its external surface is the seat of superficial ulcers, for the
most part covered with crusts. The afl^ection commenced six months
previously, as a hard round swelling in the right side of the lip, unat-
tended with discoloration. The swelling subsequently extended over
the whole lip, and is always most conspicuous in the morning. —
Several indurated tubercles can be felt imbedded throughout its sub-
stance. States that her general health is good. Her tongue is clean,
but the pulse is rather frequent, and she complains of thirst.

Ordered a solution of Epsom Salt and Tartar Emetic twice a day;
and to pencil over the excoriated surface every morning with a lotion
containing ten grains of Nitrate of Silver dissolved in an ounce of
pure water.

23d. Sores are all healed, but the swelling remains as before.

To take five grains of Plummer's Pill, night and morning.

27th. No change in the condition of the lip.

Ordered five giains of the Iodide of Potassium, dissolved in water,
twice daily.

Oct. 4. The swelling is considerably diminished ; the tubercles
much lessened in size.

To continue the Iodide of Potassium.

8th. Tumefaction quite gone; no tubercles to be felt.

The above case exemplifies, in a striking manner, the power of
iodide of potassium in promoting the absorption of a variety of tu-
bercular deposition, which seemed to bear some resemblance to ele-
phantiasis in its primal stage. — Med. Gaz.

Spasmodic Strictures of the Urethra. — The 'Archives Medicales'
for February, 1845, contains an able article on the subject of spas-
modic strictures of the urethra, by M. Gossclin, one of the 'agreges'

1845.] Stalistics — Mi J wives in Paris — Medical Intelligence. 415

of the Faculty of Paris. M. G. arrives at the following conclusions :
1st, That anatomy forl)ids the belief that spasmodic strictures can
exist in any other than the membranous portion of the urethra ;
2d, That the arguments of authors opposed to this view, are very
weak; 3d, That facts authorize their admission only in such cases
where already exists an organic stricture, or gonorrhoea. D,

Medical Statistics. — It appears from the Medical statistics of
France, published by M. Lucas Champoniere, that there are in that
kingdom 18,800 Doctors of Medicine, or one to every 1810 inhabit-
ants ; besides 8,088 sub-physicians termed •' officiers de sante." That
the number of the latter class of practitioners is diminishing whilst
that of the former is on the increase. In the course ol the last nine
years the Degree of M. D. has been conferred on 4,774 persons, and
2,616 "officiers de sante" have been licensed. D.

Gaz. Med., Afril, 1845.

Instruction of Midwives in Paris. — According to the new regula-
tions regarding the instruction of Midwives in Paris, it is required
that they shall present testimonials of good character, be at least
eighteen years of age, and be able to read and write correctly the
French language, before they nan be admitted to the clinical lying-
in hospital. It is only after having diligently attended this institution
for twelve months, and taken two full courses of lectures on the
Theory and Practice of Mid.vifery, that they can present themselves
as candidates for the Defjree. D.

MEDICAL INTELLIGENCE.

Extract of a Utter from John McLester, M. D., late Danonstrator of Anatomy in
the Medical College of Georgia.

Paris, March 30th, 1845.
Longei's lectures on the Anatomy and Physiology of the Nervous System,
with vivisections, are extremely interesting. He has devoted himself to this
branch of science for several years, and at this time, is unequalled in it. His
demonstrations are admirable, and by varying his experiments in almost every
possible manner, he has made sorne discoveries, and exposed the errors of
Majendie, Marshall Hall, Charles Bell, and others. I saw him demonstrate
the existence of an electrical current in the muscular tissues in the following
manner : — He stripped the skin off the inferior extremities of some frogs, decapi-
tated at the moment, then cut the thighs off close to the body, separating them

416

Meteorological Observations.

from the legs, by carefully disarticulating the knee joint. Five thighs thus pre-
pared, were arranged in a semicircular manner, with the lower end of one,
stuck in among the muscles of the upper extremity of another, and so on. The
battery being thus completed, he used bits of moistened paper, or wire for con-
ductors, and by operating on the sciatic nerve of another frog, contractions were
produced,, precisely similar to those caused by galvanism. This current runs
from the centre towards the extremities. These experiments, though cruel, are
extremely interesting. Most of them are easy of performance, and with proper
precaufions, are highly satisfactory and conclusive. Longet's dissections of the
brain, spinal marrow, and nerves, are superior to any I have seen. His work
on this subject is the best extant. ******* Foville is publishing
a work on the Anatomy, Physiology, and Pathology of the Cerebro-spinal Sys-
tem of Nerves, in three volumes, with an atlas of twenty-three plates. The
first volume and the atlas are published. It is said to be an excellent work,
*********** Ricord is publishing his cliniquc, accompa-
nied by fifty or sixty plates, in quarto, colored. The work is said to be nearly
completed, and will cost ninety francs. It is said he has changed his opinions
in some respects, since the publication of his former work.

METEOROLOGICAL OBSERVATIONS, for Mav, 1845, at Augusta,
Latitude 33=* 27' north— Longitude 4*=* 32' west Wash.

Ga.

Thermomkter.
Sunrise. 4, p. m.

Barometer.
Sunrise. 4, p.m

Wind.

Remarks.

30 in.

29 9-10

S. E.

Fair.

29 8-10

N. W.

Cloudy— thunder.

29 8-10

N. W.

Variable. o

29 8-10

s. w.

Variable.

29 8-10

s. w.

Variable— thunder and light'g.

29 7-10

s. w.

Cloudy.

29 7-10

29 6-10

Fair.

29 8-10

29 9-10

Fair.

30 in.

S. E.

Fair.

S. E.

Fair.

29 9-10

Cloudy. [1 5-10 inches.

29 8-10

N. E.

Commenced to rain at 4, p. m.,

29 8-10

N. W.

Variable.

29 8-10

29 7-10

s. w.

Variable.

29 5-10

Clear— rain last night 1 3-10 in.

29 6-10

N. W.

Fair.

29 7-10

Fair.

29 8-10

Fair.

29 8-10

.^. w.

Fair.

29 8-10

s. w.

Fair.

29 8-10

K. E.

Cloudy, and thunder,

29 8-10

29 7-10

S. E.

Misty in morning.

29 6-10

Variable.

29 .5-10

29 6-10

CJoudy — a little rain.

29 8-10

N. I-.

Variable.

29 8-10

Fair.

29 8-10

Fair.

29 8-10

29 7-10

Variable.

29 7-10

29 6-10

Fair — dry storm at 7, p.m.

6(\

29 7-10

29 8-10

K. E.

Variable.

30 in.

N. E.

Fair.

Fair

1 1. Qnantitv of Rain. 2 8-10 in.^hp'

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I.] NEW SERIES.— AUGUST, 1S45. [No. 8.

PART I.— ORIGINAL COMMUNICATIONS.

ARTICLE I.

Observations on Geophagy. By Johx Le Conte, M. D.,
of Savannahf Georgia.

MiRBEL has proposed to distinguish vegetables from animals by the
different nature of their yborZ. --^the former deriving their nutriment,
as he affirms, from inorganic matter, and the latter from organic : — ■
That plants transform dead matter into organized principles, and thus
prepare food suitable for animals. [Traiie d\4.natomie et de Physi-
ologic Vegetale, etc.) Another distinguished physiologist, M. Virey,
in the Nouveau Dictionnaire d^Histoire Naiiirelle, Article Alimext,
maintains, on the contrary, that plants as well as animals are sup.
ported by oro^a/izc food ; since, as he contends, it is the debris of
organized matter mixed with the soil, that furnishes vegetables with
their appropriate pahuhim, as likewise those animals, such as earth-
worms, the larvae of ephemerae, etc., which have been supposed to
live upon earth. M. Virey ingeniously endeavors to support this
hypothesis by the fact, that the fertility of a soil depends upon the
quantity o^ hmniis or vegetable mould, which it contains, and that
worms, etc., are not to be found in very barren soils. It appears,
however, from the masterly researches of Liebig and others, that the
so-called httmus, in the form in which it exists in the soil, does not
yield the smallest nourishment to plants; that it only tccelerateg
their growth, in so far as it serves as a medium of fixing the inor-
ganic elements around the spongioles or absorbing extremities of the

418 Observations on Geojphagy. [August,

roots, or of slowly extricating carbonic acid in the gradual progress
of decomposition. Moreover, it is universally admitted that humus
arises from the eremacausis or slow decay of plants. No primitive
humuSf therefore, can have existed ; for plants must have preceded
the humus. The first vegetables must have, consequently, derived
their carbon from, some other source than organic matter: — that
supply is furnished in the form of carbonic acid by the atmosphere.

There are satisfactory evidences drawn from geological considera-
tions, as well as a priori reasons deduced from the physiology of the
function of nutrition in the respective kingdoms of organic nature,
for believing that vegetable organization preceded the development
of animal life, in the physical revolutions which the crust of the globe
has undergone. Vegetables seem to constitute the intermediate
link in the scale of creation, between the Inorganic world and the
Animal kingdom ; and although in a few instances they are partially
dependent upon the latter for their existence, it cannot be doubted
that the general balance is greatly in favor of the supplies they afford.
The distinction laid down by M. Mirbel, based upon the character of
food, has, therefore, been confirmed as a general law in the two or-
ganic kingdoms.

Plants constitute an immense apparatus for reduction, in which is
habitually created true organic matters fit for the assimilation of
animals : — so that, in this point of view, we might justly and philo-
sophically say, that " all flesh is grass," without even imposing a
violently metaphorical character upon our language. On the other
hand, animals constitute an immense apparatus for combustion, —
reproducing the elements, which are returned into the air and the
earth. Thus it is in the vegetable kingdom that the great laboratory
of organic life resides; — there it is that the vegetable and animal
matters are formed, and they are produced at the expense of the air
and the inorganic constituents of the soil. From plants, these mat-
ters pass ready-formed into the herbiverous animals, which destroy a
portion of them, and accumulate the remainder in their tissues: —
From these, they pass unaltered into the carnivorous animals, who
destroy or retain some of them according to their wants: — Lastly,
during the life of these animals, or after their death, these organic
matters, as they are destroyed and resolved into their ultimate ele-
ments, return to the atmosphere and to the earth, — the reservoirs
whence they proceeded, — to be again used in perpetuating the myste-
rious cycle of organic life on the surface cf our planet. It is thus,

1845.] Observations on Geophagy. 419

that the grand "physiological balance" in organized beings, — so
eloquently illustrated by M. Dumas, — is maintained : — adaptations,
adjustments, reciprocal dependence of parts, and conformity of ar-
rangement, appear everywhere pervading both systems ; — checks and
compensations are perpetually in operation, which must maintain
the equilibrium between the kingdoms of organic nature, — just as
the masses of the planets, — the eccentricities of their orbits, — the
direction of their motions, — and the inclinations of the planes in which
they revolve, are all arranged so as, according to the beautiful theo-
rems of Lagrange and Laplace, to preserve the stability of the solar
system, by affixing limits, maxima and minima, between- which the
irregularities oscillate.

As there exists a close affinity between animals and vegetables in
the respective groups of Phy tozoa and Protophyta ; — so do we observe
an analogous gradation with respect to the sources of nutriment.
Some appear to be exceptions to the general law founded on the dif-
ference of food. The only class of Plants which seems to be depen-
dent for its support upon matter already organized, is that of Fungi, —
a group of peculiar interest, as presenting us with two curious analo-
gies with the Animal kingdom, in the extrication of carbonic acid,
and in containing /wTio^m, a proximate principle as highly azotized
as animal flesh. (Carpenter's Principles of General and Comp.
Physiology, 2d Ed. London, 1841. Paragraph 277, p. 217.) A re-
markable mode of obtaining nutriment is afforded by some species of
Parasitic fungi, which are found growing on the larvae of certain
coleopterous, lepidopterous and hymenopterous insects. One species,
which was sent to France by Father Parenin, is in high estimation,
as an article of the Materia Medica, among the celestial nobles at the
palace of Pekin. Dr. J. Pereira thinks that this fungus belongs to
the genus Sphaeria,and is closely allied to the Sphmria entomarrhiza
of Dickson. An analogous species has been found in New Zealand,
called the Spharia Robertsii, which grows from the neck of the cat-
terpillar, to the length of six or eight inches. (Phar. Journ., as cited
in the New-York Journ. of Med., etc., vol. 1, p. 128-131. 1843.)
Such growths are also found on coleopterous insects. The larvae of
the meloloniha, not unfrequently exhibit a vegetable sprout three
inches in length, proceeding from between the head and the under
part of the thorax. The larvae aj-e not only dead^ hut in a state of
decay, and the sprout rising from the ground indicates where they are
found. A species o^ciirculio, in the perfect state, from Mexico, has

420 Observations on Geophagy. [August,

also been mentioned as having long slender filaments attached to
various parts of the body, — and in one specimen, it had a sprout on
the rostrum or beak, which gave it the appearance of an additional
horn. A species of hymenopterous insect, made known under the
name of " vegetating wasp " by a Spaniard, named Father Torrubia,
inhabits the same country. He says, that in 1749, he found some
dead wasps in a field in New-Spain, from the belly of each of which
a plant germinated, growing about five spans high. Similar vegeta-
ting wasps are said to have been found in the Island of Dominica.
The parasitic plant, — considered to be a species of clavaria, — which
grows frofn them, bears several pods, which are supposed by the in-
habitants to "drop off" and become worms, and from thence flies."
The common wasp of this country, when dead, has been observed to
give origin to analogous vegetable growths, as likewise the pupae of
a species of cicada which is common in Martinique and Dominica,
Kirby and Spence mention one specimen of the last genus in their
cabinet, "with a kind of Sphseria with a twisted thickish stripes and
oblong head, springing up in the space between the eyes." Some
imago specimens of lepidopterous insects have been brought from the
tropical regions, covered with long slender filaments. They are
always in a very decayed state. (Vide. Natural History of Insects,
Harper's Family Library ; Second Series, No. 74, p. 260 to 265 :
New-York, 1840. 12mo. Also, Dr. Samuel L. Mitchell's letter to
A. P. De Candolle, in Am. Journ. of Science and Arts, vol. 12,
p. 21-28, 1827.) M. J. B. Ricord-Madianna, however, states, that
he has observed at Guadaloupe a nest of wasps, the greatest number
of which were encumbered with these cryptogamous excrescences.
As they quitted the nest, they fell to the ground, and could not rise
again on account of the weight of the plant, which had taken root on
some part or other of their body, particularly on the sternum. Hav-
ing observed the larvse contained in the cells, M. Ricord remarked,
that they also had this cryptogamous appendage, but then it was very
small. Of course the fungus was developed on the living insect,
although apparently in the last stages of existence, and seeming
about to perish from the influence of its destructive parasite. This
species appears to have been the SphcBria entomorhiosa of the Eng-
lish botanists. {Journal de Pharmacie, as cited in Brando's Quar-
terly Journal of Science, etc., New Series, vol.6, No. 12, p. 437-438 :
London, Jan., 1830.)

The singular epidemic disease to which the silk-worm is liable,

1845. J Observations on Geophagy. 421

called muscadine, and first described by M. Bassi, is occasioned by
a parasitic fungus, named the Botrytis Bassiana, from the discoverer.
The characteristic signs of the d^ease do not appear until after
death, when the body is bedecked with a white powdery efflorescence,
becomes dried up, and as it were, mummified. This efflorescence is
mould, the germs of which must have been nourished at the expense
of the silk-worm. According to Dr. Stilling, of Cassel, an analo-
gous disease is found in frogs, under certain circumstances. (Vide.
Fletcher's Elements of Gen. Pathology, Edited by Drs. Drysdale
and Russel, pp. 74 et 75. (note.) Edinburgh, 1S42.) In the majori-
ty of the above-mentioned cases, it is reasonable to presume, — from
the decayed state of the insects, — that the spores of the fungi found
a suitable nidus for germination in the mass of decomposing organ-
ized matter. The two last instances appear to be exceptions to this
general rule.*

When plants are made to grow in infusions of madder, the radical
fibres are tinged of a red color. From experiments made by Sir H.
Davy on the growth of plants in weak solutions of sugar, *gum, gela-
tine, the tanning principle, etc., in all of which they grew luxuriantly;
and from those of M. Biot, in which, a white hyacinth became red
after a few hours, when the earth in which it was planted was sprin-
kled with the juice of the Phytolacca decandra; — it has been con-
cluded that organic substances, do, under favorable circumstance?,
enter into the roots, and thence into the circulation, of vegetables.
It is to be remarked, however, that organic coloring matters, when

* A species of parasitic fungus discovered by Lewis D. De Scliweinitz, and
described under the name of Isaria Sphingum (S^-nop. Fung, carol. Sup. p. 100,)
is remarkable as being found proceeding in ail directions from the abdomen,
nerves of the wings, etc., of a sphinx resting upon a branch with expanded wings.
Although the insect was dead when thus discovered, yet the position in which it
is usually detected, and the other attending circumstances, afford a strong pre-
sumption that the fungus was evolved while the sphinx was 5-et in a state of ex-
istence. It may be doubted whether the vegetable ever predominates over the
animal life, while the vital principle of the latter is in full energ}'; but that the
larvae, in a feeble state, may have afforded a fit recipient for the seed of the fun-
gus, while their complete evolution was retarded by some cause, until the final
transformation of the insect, is certainly not improbable. In this respect they
may offer some analogy with the helminthoid entozoa, such as the ascaridcs,
tanice, hydatids, etc., which are most commonly observed to prey upon animals
of debilitated or languishing health. (Vide. Paper by Abraham Halsey, in
Annals of the Lyceum of Nat. IIii<t. of New- York, vol 1, Part 1st, p. 1'25-126:
18-24.)

422 Ohservations on Geophagy. [August,

thus introduced into plants, do not generally extend upwards to the
leaves and flowers. The madder does not usuallj' discolor the
leaves. The color imparted to tUe white hyacinth, in the experiment
of M. Biot, disappeared in the sunshine in the course of a few days.
Organic matters, therefore, undergo some chemical change either in
the stem, in the leaf, or in the flower. (Vide. Lectures on the Ap-
plications of Chemistry and Geology to Agriculture. By James F.
W. Johnson, M. A. F.' R. SS. L. et E. etc.— Am. Ed. Wiley and
Putnam: New-York, 1844. Part 1st, p. 64.) According to Mr.
G. T. Burnett, the pitchers of the Sarracenia and Nepenthes are
true sarcophagi, and constitute the nearest approaches, — the strong-
est adumbrations of a stomach in vegetables.* in them, a processs
very much like animal digestion goes on; for it appears that the
fluid they contain is very attractive to insects, which, having reached
its surface, are prevented from returning by the direction of the long
bristles that line the cavity. The bodies of those which are drown-
ed seem, in decaying, to afford a supply of invigorating nutriment
as favorable to the growth of these plants, as a similar process on the
leaves of the well-known DioncBa muscipula, to the health of which,
a supply of animal food appears to be essential. (Vide. Brande's
Quarterly Journal of Science, etc. ; New Series, vol. 6, No. 12,
p. 279 to 293 : London, Jan., 1830.)

Although such instances as these may seem to contradict the gen-
eral statement, that Plants derive the materials of their nutrition
from the inorganic world, yet they probably do so more in appear-
ance than in reality. In most cases where previously-organized
matter influences their growth, it is only whilst in a decomposing
state, during which it is separated into its ultimate elements or very
simple combinations of them. We find in the Animal kingdom also,
many apparent exceptions to the general statement which has been
made respecting the source of their nutrition. Thus the spatangus^
various species of holothuricB, the earth-worm, some kinds of heetleSf
many conchifera, and several cephalopoda, are known to swallow

* Rumphius has observed, that a certain small squilla or shrimp, is some-
times found living in these pouches; so that even this simple digestive appara-
ratus is not free from intestinal worms. The discolored spots occasionally
observed in the pouches of the Sarracenia have been supposed to indicate
serious disorganization, and the powerful and rapid decomposition of food,
when taken in too great abundance, has been fancifully likened to indigestion
from repletion, and then the occasional offensive odors may perhaps be symp-
tomatic of vegetable dyspepsia. (Burnett op. cit. p. 290.)

1845.] Observations on Gcophagy. 423

moist sand and comminuted shells ; but it is, probably, only in order
to derive nourishment from the innumerable animalculae and remains
of organized matter so abundant in it.* The stomach of many of
these invertebrated animals is provided with a thick, tough, coriace-
ous epithelial lining, to protect it from the dense inorganic substances
taken along with their food. (Vide. Outlines of Comparative Anato-
my, by Robert E. Grant, M. I)., F. R S., etc., London, 1841,
pp. 329, 331, 343, 366, 376. Also. Lectures on the Comp. Anat.
and Physiology of the Invertebrate Animals, by Richard Owen, F. R.
S., etc., London, 1843. Passim.)

Such being the general and broad distinction between the vegeta-
ble and animal kingdoms, as indicated in the sources of nutriment,
it is certainly an extraordinary physiological phenomenon that
Geophagists should be found among men,— the highest in the scale
of animal organization.

Geophagy, as a habit, prevails chiefly among savage tribes inhabit-
ing the intertropical regions. Alexander de Humboldt has recorded
some highly interesting observations on this singular physiological
phenomenon as presented to him in the tropics of South America.
The Otomacs, a tribe of Indians inhabiting the mission of Uruana on
the Orinoco river, were found to swallow every day, during several
months, very considerable quantities o^ earth, without injuring their
health. They belong to those most uncivilized nations of the savan-
nas, who have a decided aversion to cultivate the soil, and live almost
exclusively on hunting and fishing. They are men of very robust
constitution; but ugly, savage, vindictive, and passionately fond of
fermented liquors. They are omnivorous animals in the highest de-
gree ; and, therefore, the other Indians, who consider them as barba-
rians, have a common saying, "nothing is so disgusting that an
Otomac will not eat." While the waters of the Orinoco and its
tributary streams are low, they subsist on fish and turtles. At the
time of the periodical inundations of the Orinoco, which last two or
three months, it is extremely difficult to procure fish, and the Oto-
macs are in the habit of swallowing a prodigious quantity of earth.
The clay ig kneaded into balls, called poz/cr, of from five to six inches
in diameter. M. M. Hurnboldt and Bonpland found heaps of these

* The stomach of the Siren lacertina, — a species oi perennih-anchicde reptile
having only one pair of feet, which inhabits the Southern States, is usually
found to contain little else than mud. (Vide. Annals of the Lyceum of Nat.
ITist. of New- York, vol. 1, Part 1st, p. 53. 1824.

424 Observations on Geophagy. [August,

balls in their huts, piled up in pyramids three or four feet high. The
Otomacs do not eat every kind of earth indifferently; — they display
considerable epicurean skill in selecting the alluvial strata that con-
tain a very fine and unctuous clay, remarkably smooth to the feel, —
of a yellowish gray color. Being slightly baked in the fire, the hard-
ened crust has a tint inclining to red, owing to the oxide of iron
which is mingled with it. When about to be used, these clods aie
moistened afresh, and each individual consumes dail}', during several
months, three quarters of a pound of clay slightly hardened by fire,
without any sensible effect on the health. (Vide. Personal Narrati\ e
of Travels to the Equinoctial Regions of the New Continent, during
the years 1799-1804. By Alexander de Humboldt and Aime Bon-
pland. Translated into English by Helen Maria Williams, vol. 5,
Part 2, p. 639 et seq. London, 1821.) No trace of the mixture of
an organic substance, whether oily or farinaceous, could be detected
in the balls o^ poya, which Humboldt took to Paris. Neither is it
steatitic ; for, M. Vauquelin did not discover any traces of magnesia
in it. He found, that it contained more silex than alumina, and three
or four per cent, of lime. (Humboldt op. cit., vol. 5, p. 641-642.)
When questioned concerning the nature of his subsistence during the
two months when the Orinoco is the highest, the Otomac shows his
balls ofclayey earth. This he calls his principal food;- — for at this
period he can seldom procure a lizard, a root of fern, or a dead fish
swimming at the surface of the water. But he does not the less re.
gale himself with this species of aliment during the rest of the year.
Every day in the season of drought, when fishing is most abundant,
he scrapes his balls o^ poya, and mingles a little clay with his ordina-
ry food, (p. 642-^643.) What is most surprising is, that the Oto-
macs do not become lean by swallowing such quantities of earth :
they are, on the contrary, extremely robust, and are far from having
the abdomen tumid and puffed up. The missionary Fray Ramon
Bueno, assured IM. Von Humboldt, that he never remarked any alter-
ation in the health of the natives at the period of the great risings of
the Orinoco, (p. 648.) It has not, as yet, been possible to verify
with precision how much nutritious vegetable or animal matter the
Otomacs take in a week during the same period ; but it is certain,
that they attribute the sensation of satiety, which they feel, to the
clay, and not to the wretched aliments which they occasionally take
with it. M. Von Humboldt also *' found some traces of this vitiated
appetite among the Guamoes; and between the confluence of the

lS4o.] Observaliuns on Geophagy. 4*25

Meta and the Apure, where every body speaks of Geophagy as of a
thing anciently known. (Op. cit., vol. 5, Part 2, pp. G39 et 640.)

The same distinguished traveller observed every where within the
torrid zone, in a great number of individuals, children, women, and
sometimes even full-grown men, an inordinate and almost irresistible
desire of swallowing earth ; not of an alkaline or calcareous charac-
ter, to Mutrali/.e (as is commonly supposed) acid juices in the stom-
ach, hut a fat clay, unctuous, and exhaling a strong smell. It is often
found necessary to tie the hands of children, or to confine them, to
prevent their eating earth, when the rain ceases to fall. At the vil-
lage of Banco, on the river Magdalena, he saw the Indian women
who make pottery continually swallowing great pieces of clay.
These women were not in a state of pregnancy ; and they affirmed,
that ^'carth is an aliment which they do not find hurtful.'^ (Op. cit.
supra., p. 643-644.) In other South American tribes people soon
become sick, and waste away when they yield too much to this mania
of eating earth. The same excellent authority informs us, that he
found at the mission of San Borja an Indian child of the Guahiba
nation, who was reduced to a lamentable state of atrophy in conse-
quence of a disordered appetite, having refused during four months
to take almost any other food than clay. Yet San Borja is only
twenty-five leagues distant from the mission of Uruana, inhabited by
that tribe of the Otomacs, who swallow the poya without experiencing
any pernicious effects, (p. 644.) Father Gumilla asserts, that the
Otomacs mingle the flour of maize and the oil of turtles' eggs with
the clay, and that they purge themselves with the melted fat of the
crocodile, when the\" feel any gastric obstructions : .but the testimony
of resident missionaries, as well as the inquiries of 31. M. Humboldt
and Bonpland, have failed to confirm either of the above assertions
of this credulous traveller. As already remarked, the balls of po^a
which were taken from the winter stores of the Indians, contained no
trace of animal fat, or of amylaceous matter. (Humboldt op. cit.,
vol. 5, Part 2d, pp. 642, 645, 657, et 658.)

In the Indian Archipelago, at the island of Java, between Soura-
baya and Samarang, M. Labillardiere observed little square reddish
cakes exposed to sale. These masses, called tana-ampo, were cakes
of clay, slightly baked, which the natives eat with appetite. (Voy-
age in Search of La Perouse. English Ed. vol. 2, p. 333. Lon-
don. 1800.) According to M. Leschenault, (one of the naturalists
of the Expedition to the Southern Lands, under the command of

426 Ohservdlions on Geophagy. [August,

Captain Baudin,) the cakes of earth which the Javanese are fond
of eating, and which are sold in the public markets, are composed of
a reddish and somewhat ferruginous clay, which is spread on a plate
of iron, and baked. " This clay has a peculiar taste, which is owing
to the torrefaction ; it is very absorbent, and adheres to the tongue,
which it dries. In general, it is only the Javanese women who eat
the ampo, either in the time of their pregnancy, or in order to grow
thin ; the want of plumpness being a kind of beauty in this country.
The use of this earth is fatal to health ; the women lose their appe-
tite imperceptibly, and no longer take without disgust a vety small
q'lantity of food ; but the desire of becoming lean, and of preserving
a slender shape, can brave these dangers, and maintain the credit of
the ampo," (Letter from M. Leschenault to M. de Humboldt on the
kind of Earth which is eaten at Java, as cited by Humboldt, op. cit.
vol. 5, Part 2, p. 647.) Even in the most highly civilized countries
this habit is frequently voluntarily induced, — particularly among
exquisitely Hishionable ladies, — by a vain desire of improving the
beauty of the person, of giving a graceful slenderness to the form, or
a languishing fairness to the skin, through the medium of chalk, vin-
egar, slate pencils, and other empirical materials.* Without pre-
tending to passjudgment on a subject so delicate as the complicated
elements which are brought into harmonious action by the all-subdu-
ing manifestations of feminine charms; I am rather inclined to think
that, the leanness and etiolation, which is thus induced by the con-
sequent supervention of a chlorotic state of the system, is any thing
but attractive to the opposite sex! Among the Greeks,— who seem
to have distancec^ the most ambitious modern dandies in foppery as
well as in Epicurism, — this practice appears to have been more
common than even in our own day, and this too, among young men
as well as young women ; in consequence of which, their physicians
gave to this variety of the disease the name of iiaXada, softness, or
effeminacy.

M. Labillardiere informs us that the savage inhabitants of New-

* Dr. H. Nims has given an account of the death of a girl 17 years of age,
from eating large quantities of slate-stone, of which she passed nearly a pound,
in a short time, by enemata. On dissection, the slate was found lining the in-
testinal canal, from the stomach to the rectum, and in the stomach near the
pylorus, was discovered a perforation about the size of a goose quill, with the
usual marks of inflammation, evidently caused by a sharp portion of the slate.
(Boston Med. ct. Surg. Journ., vol. 25, p. 11.)

1S45.J Observations on Geophagi/. 427

Caledonia, eat great pieces of a friable steatite or lapis ollaris, which
were of a greenish color, very soft, and twice as large as a man's
fist, — to appease their hunger in times of scarcity. (Voyage in search
of La Perouse, English Ed., vol. 2, p. 213-214: London, 1800.)
3L Vauquelin analized specimens of the earth which were transmit-
ted to him by Labillard^ere. It was soft to the touch, composed of
small fibres, which were easily separated, and when incinerated lost
about four per cent, of its weight. He found it to consist of —

Magnesia, 37

Silex, 3G

Oxide, 17

Water, 04

Lime and Copper, . . * 03

Loss, 03 '

100
From which he concluded that it does not contain any alimentary
quality, and can only be considered a kind of mechanical expedient
to suspend the pains of hunger. (Vide. Notice of M. Vauquelin's
paper read before the Philomatic Society of Paris, in Tilloch's Philo-
sophical Magazine, 1st Series, vol. 11, p. 231 : London, 1802.)

Goldberry had seen the Negroes in Africa, in the islands of Bunck
and Los Idolos, eat an earth, of which he had himself eaten, without
being incommoded by it, and which also was a white and friable
steatite. (Goldberry's Voyage en Afrique, vol. 2, p. 455, as cited by
Humboldt, p. 648.) The Negroes on the coast of Guinea delight in
eating a yellowish earth, which they call caoiiac. The slaves who
have been taken to America try to procure for themselves the same
enjoyment ; but it is constantly detrimental to their health. They
say " that the earth of the West Indies is not so easy of digestion as
that of their country." Thibaut de Chanvalon, in his voyage to
Martinico, expresses himself very judiciously on this phenomenon.
" Another cause," says he, " of this pain in the stomach is, that sev-
eral of the Negroes, who come from the coast of Guinea, eat earth;
not from a depraved taste, or in consequence of a disease, but from a
Iiabit contracted at home in Africa, where they eat, they say, a par-
ticular earth, the taste of which they find agreeable, without suf-
fering any inconvenience. They seek in our islands for the earth
most similar to this, and prefer a yellowish red volcanic tufa. It is
sold secretly in our public markets ; but this is an abuse which the

428 Observations on Geophagy. [August,

police ought to correct. The Negroes who have this habit are so
fond of caouac, that no chastisement will prevent their eating it."
{Voyage a la Martinique, 1763, p. 84, as cited by Humboldt, loc. cit.
p. 646.)

M. M. Humboldt and Bonpland saw at Popayan, and in several
mountainous parts of Peru, lime reduced to a very fine powder, sold
in the public markets. This powder, when used, is mingled with
coca, that is, with the leaves of the erythroxylum peruvlanum. In-
dian messengers frequently take no other aliment for whole days
than lime and coca. In other parts of South America, on the coast
of Rio de la Hacha, the Guajiroes swallow lime alone, without adding
any vegetable matter to it. They always carry with them a little
box filled with lime, as some more civilized men do snuff-boxes, and
as in Asia people carry a betel box. It has been conjectured that,
the lime may he used for the purpose of blackening the teeth; as in
the Indian Archipelago, as among several American hordes, black
teelh are esteemed highly ornamental. According to the same ob-
server, in the cold regions of Quito, the natives of Tigua eat habitu-
ally from choice, and without being incommoded by it, a very fine
clay, mixed withquartzose sand, suspended in water. Large vessels
filled with this milky water, which serves as a beverage, were found
in their huts. (Humboldt op. cit., vol. 5, Part 2, pp. 648, 649.) It
is well known that the water of the Mississippi river, — which is usual-
ly surcharged with mud and dirt to the extent of nearly one fourth of
its bulk, — forms a favorite and healthy drink with our Western
people.

The banks of the McKenzie river, a few miles above the Bear
Lake, contain layers of a kind of unctuous mud, which the Indians
in that neighborhood eat occasionally during seasons of scarcity, and
also take it even at other times for an amusement. (Vide. Food and its
Influence on Health and Disease, by Mathew Freeman, M. 1).; Lon-
don, 1842, p. 67.) It is known, that great use is still made in the
East of the bolar and sigillated earths of Leranos, which are fat,
unctuous, aluminous clay, mixed with oxide of iron. The German
workmen employed in the quarries of sandstone worked at the
mountain of * Kiffhauser, spread a very fine clay upon their bread,
instead of butter, which they call steinbuiter, stone butter ; and they
find it singularly filling, and easy of digestion. (Freiesleben, Kupfer-
schiefer, vol 4, p. 118. Kesler, in Gilbert's Annalen, B. 28, p. 492,
as cited by Humboldt, op. cit. vol. 5, Part 2, p. 654.) According to

1845.] Observations on Geophagy. 429

Pliny, the Romans invented a broth or porridge called Allca, which
was made oift of a grain resembling spelt, which was also called Zea.
In order to make the AJica white and tender, it was mixed with chalk
t>om the hills between Naples and Puteoli. (Nat. Hist, xviii.,7, 10,
11, 29.) Mr. Medhurst informs us that, the Chinese use great
quantities of sulphate of lime, (gypsum,) which they mix with pulse,
in order to form a jelly, of which they are very fond. (China, its
State and Prospects, p. 39 : London, 183-8.) The fosil farina^
which, according to Stanislas Julien, {Cojnptes Rendus, 1841, 2 Se-
mest, p. 358,) is used in China, in times of great scarcity, as a food,
contains 13.2 per cent, of organic matter, (Payen, ibid p. 480. Vide
Pereira's Treatise on Food and Diet, Am. Ed., by C, A. Lee, New
York, 1843. p. 4, note.) The earth called berg?nehl, or flour of the
mountain, which has been employed at Degerfors, on the frontiers of
Lapland, in times of scarcity, admixed with flour "hnd the bark of
trees, has been shown by the microscopic researches of Prof. Retzins
to consist of the fossil remains of nineteen different forms of infu-
soria with ^liceous carapaces, yielding twenty per cent, of animal
matter by incineration. (Poggendorf's Ann., B. 29, p. 261, as cited
by J. Muller, in his Elementsof Phys., Am. Ed. Philadelphia, 1843.
p. 328. Also, Truman, op. cit., supra., p. &7.) In view of such
examples as the above mentioned, Dr. Trueman has been led to
affirm that, "all edible earths most likely contain portions of organic
matter, which is the reason of their being taken as food" (op. cit. p.
67) ; — an assertion directly at variance with the analyses of IVL Vau-
quelin, who could detect no organic matter either in the balls of clay-
eaten by the Otomacs, or in the steatite consumed by the New Cale-
donians.

Dr. James Copland once saw a robust seaman, who occasionally
would devour a whole wine or ale glass, having previously crushed it
in small pieces with his teeth, and yet no bad effects resulted, at least
for many months afterwards. (Lend. Med. Repos., vol. 1, 7.) The
only other instance on record, where this dangerous feat has been
performed, is given by Camerarius. (Memorab. cent. 5.) (Vide.
Copland's Die. of Practical Med., Am. Ed., Art. Appetite, vol. 1,
p. 123.) Indeed, the Ephemerides of Natural Curiosities from Ovid,
through Darwin's Zoonomia, down to the Dictionnairc des Sciences
Medicates, abound in examples of paniophagists or polyphagous
monsters, who have swallowed clasp-knives, musket bullets, stones,
billiard balls, gold watches, and Louis-d'ors ; and, what is still more

430 Observations on Geophagy. [August,

singular, generally passed them through their callous digestive tubes
a few days afterwards. In the case recorded by M. Fournier, in his
Cas Rares, the stomach of a galley-slave became gradually enlarg-
ed into a warehouse of all sorts of marine stores. But these remark-
able instances o^paniophagy do not come within the same category
M'ith the habits of Geophagy which I have noticed; for they are
comparatively rare, — are confined to isolated individuals, — and, so
far from being prompted by the cravings of a natural i , are

usually nothing more than exploits of reckless hardihood.

In the Southern States, Geophagy prevails to a considerable ex-
tent, particularly among the Negroes, in whom the habit is frequent-
ly indomitable, and almost invariably proves fatal, unless broken
before the morbid symptoms are manifested. I have before me the
Notes of a case of a Negro girl, aged seventeen years, who was pro-
bably more or less addicted to this pernicious habit from childhood.
General swelling and emaciation supervened, attended with loss of
appetite, difficulty of breathing upon the slightest exertion, drowsiness,
inactivity, and general debility, — despondency, with fondness for soli-
tude, together with the characteristic white and pallid appearance of
the nails, palms of the hands, and the soles of the feet, — the peculiar
bloodless, translucent and blanched hue of the inside of the lips, gums,
tongue, and lining membrane of the mouth, and glossy state of the
tunica adnata, with other signs of depressed vital power and deficient
assimilation. The cause of her difficulty being suspected, and being
now confined to her bed, a strict guard was kept to prevent the in-
dulgence of the vitiated appetite, while the certainty that a continu-
ance of the habit would inevitably result in death, was strenuously
urged upon her attention. But nothing could prevent the gratifica-
tion of the invincible craving for earthy substances ; — for the cunning
plans of the patient to procure her desired repast, eluded the utmost
vigilance. She at length sank under the joint influences of extreme
debility and inanition. After death, a ball of clay as large as a
man^s Jist, and partly eaten, was found under the bed-clothes!/
There appears to have been a complete arrestation of the reproduc-
tive functions. In her general appearance, she presented the char-
acters of a girl of only twelve years of age ; — there was no augment-
ation of the mammae, — no manifeslion of a catamenial discharge, or
any other indications of puberty !

According to Dr. Joseph Pitt, Geophagy prevails cndemically
among the poor white people, as well as the negroes, in North Caro-

1845.] Observations on Geophagij. 431

lina, along the borders of the Roanoke river. (New-York Med.
Repos., 2d Hexade., vol. 5, p. 340 : N. Y., 1808.) I have frequent-
ly observed the same habit among the poorer classes of white persons,
inhabiting the pine barrens and thinly settled portions of Georgia.
The influence of example, especially among children, doubtless con-
tributes materially to the perpetuation and extension of this perni-
clous habit, when once established in a community. The endemic
affection, called Dirt-eating, Mai d'Esiomac, Cachexia Africana,
etc., so well described by John Hunter, George Davidson, James
Dancer, John Ferguson, and other writers on the diseases of the Ne-
groes of the West Indies, as well as by Prof. W. M. Carpenter of
Louisiana, — appears to be the entailment of a habit contracted in
Africa. Whether the conjecture of Thibaut de Chanvalon, previous-
ly alluded to, that the indulgence of the habit in Africa, is not perni-
cious to health, be tenable or not, we have not the means of deter-
mining with certainty ; — but there are facts as well as analogies,
which throw considerable probability on the opinion, I have already
noticed the fact, that among some savage tribes, Geophagy is not
fatal to health.

According to M. Moreau de Jonnes, it has been supposed to be
observed, that the inordinate taste for eating earth autrments amonj^

' o o o

the African slaves, and becomes more pernicious, when they are re-
stricted to a regimen purely vegetable, and deprived of spirituous
liquors. (Obs. on the Dirt-eaters of the West Indies. Bullet, dela
Soc. Med., Mai, 1816, as cited by Humboldt op. cit., vol. 5, Part 2d,
p. 645.) With regard to the influence of spirituous liquors, my ob-
servation does not furnish me with the data requisite for giving a
decided opinion ; but I am quite sure, that a liberal supply o^ animal
food has, in many instances, removed the malady, and that a con-
tinuance of its use has, apparently, contributed much towards the
eradication of the habit from many plantations, ^noh ^ permanent
effect could be scarcely ascribed to a mere change of diet.

No physiological phenomenon being entirely insulated, it may bo
interesting to examine several analogous phenomena, which present
themselves in other departments of the animal kingdom. Kirby, the
distinguished entomologist, informs us that he found the larvae of
the Dermestes vulpinus, Fabr, feeding on a specimen oC amianthus,
and perforating it in various directions, and that they underwent
their customary metamorphoses. As this class of insects is not par-
ticular in selecting a place in which to undergo their metamorphoses^

432 Observations on Geophagy. [August,

it is not probable that they would have taken the trouble to perforate
the asbestus for that sole purpose: — but a further proof that this was
not their object, is furnished by the varying size of the holes perfora-
ted in the specimen. There were three, one of which was one and a
half lines in diameter ; another, one and three quarler lines ; and a
third, two lines: — from whence it seems to follow that the insects
that perforated it were in different stages of growth ; and consequent-
ly derived nutriment from that substance." (Vide. Tilloch's Phil.
Mag., 1st Series, vol 61, pp. 3 et 4 : 1823.) A large Spider of the
species Aranea scenica, Linn., has been supposed to be capable of
obtaining nutriment from devouring sulphate of zinc. Two ounces
of this salt were closed up in a box with the spider, of which it was
found, at the end often weeks, he had eaten a considerable quantity.
At the time the paper was read, the insect seemed in perfect health,
having in about six months eaten nearly four ounces of the sulphate
of zinc. Other metallic salts,— sulphates, muriates, and nitrates, were
also offered to the spider, but he would not touch them, even when
denied his favorite salt. From some experiments made on the yel-
lowish brown powder found at the bottom of the box, the author con-
cludes that the sulphate of zinc had been deprived of a part of its acid
in passing through the spider. (Tilloch's Phil. Mag., 1st Series,
vol. 53, p. 61 : 1819.)

Assuming that, in the instance recorded by Kirby, the Derraestes
had the power of resolving the amianthus into its ultimate elements,
let us inquire what were the sources of nutriment of this insect.
According to the analysis of Meitzendorf, asbestus consists of—

Silica 55.8G9

Magnesia, 20.334

Lime, 17.764

Protoxide of Iron, . . 4.309

Prot. Manganese, . . 1.115

99.391
(Vide. James D. Dana's System of Mineralogy, 2d Ed., New-York,
1844, p. 370.) If we grant these coleoptera the extraordinary power
of appropriating from the atmosphere, carbon in the form of carbonic
acid, — nitrogen either alone or in the form of ammonia, — oxygen, —
and hydrogen in the form of aqueous vapor, — perhaps, — with the
assistance of the elements of amianthus, — we will be furnished with
materials sufficient for the nutriment, growth, and metamorphosis of

1845. J Ohservatlona on Gfophagy. 433

(hem. Ktit tlie Aranea which luxuriated on sulphate of zinc, must
have been provided with still more extraordinary powers of assimili-
tion; — for the sources of his nutriment were attenuated to the ele-
ments of that salt, viz: sulphur, oxygen, and zinc, — together with
the materials furnished by the atmosphere. Great caution should,
however, be observed in generalizing from instances drawn from the
lower orders of animals, and especially from insects, with regard to
the sources of nutriment. The mere air, or that in conjunction with
the impurities usually suspended therein, appears to afford nourish-
ment enough for many forms of animal life. Snails and chameleons
have often been known to live upon nothing else for years. The
scorpion has been knowm to endure an abstinence of three months,
and the Melasoma, one of the beetle tribe, has lived seven months
pinned down to a board. Garman found that this nutriment is suf-
ficient for the support of the voracious spiders; and M. Latreille
confirmed the experiment by fixing a spider to a piece of cork, and
precluding it from any communication with every kind of food for
four months ; at the end of which period he appeared to be as lively
as at first. Mr. Baker in like manner confined a Scaraboeus beetle
under a glass for three years ; allowing him nothing but air for diet :
at the expiration of this period, he was fortunate enough to effect his
escape, and go in pursuit of a more substantial repast. Every ento-
mologist repeatedly sees insects living in their cases, although pinned
down for an incredible length of time. I have frequently observed
several of the larger species o^ EJaier to survive the transfixing of a
pin for many months. It is a well-established fact in the history of
fishes, that many species will live and thrive upon water alone in a
marble basin; although, it seems probable, that they may obtain
some nutriment from organic impurities, and from the numerous
animalculae which the microscopist reveals to us in the purest forms
of rain-water. Bruce kept two cerastes or horned snakes, in a glass
jar for two years, without any apparent food ; and they cast their
skins at the usual period. Lizards, toads, frogs, and many other
reptiles of the batrachian family, have dragged out anchoritic lives
of indefinite duration, imbedded in trunks of trees, and blocks of mar-
ble ; cut off from every kind of food except the moisture by which
perhaps they are surrounded, and the indirect communication of air
through the pores and crevices, which the experiments of W. F.
Edwards have demonstrated to be essential to the maintenance of
life in such ci; cumatances. Ht nee it is very clear, thaf, it is possible

434 Observations on Geophagy. [August,

that the Dermestes and the Spider above-mentioned, might have
lived without any ostensible nutriment, and might have consumed
the amianthus and the sulphate of zinc as a matter of amusement,
without abstracting any nourishment therefrom : — although it must
be confessed, that the varying size of the perforations and the regular
metamorphoses which the insects underwent in the example recorded
by Kirby, as well as the alteration of the physical characters of the
salt of zinc which had passed through the spider, appear to indicate
that these minerals subserved some more substantial purpose in their
unique system of dietetics.

Like man in a savage state, some animals also, when pressed by
hunger in winter, swallow clay or friable steatites ; such are the
wolves in the north-east of Europe, the reindeer, and, according to
the testimony of Patrin, the kids of Siberia. The Russian hunters
on the banks of the Jenisey and the Amour use a clayey matter, which
they call rock-hutter^ as a bait. The animals scent this clay from
afar, and are fond of the smell ; as the clays of bucaros, known in
Portugal and Spain by the name of odoriferous earths, have an odor
agreeable to women ; especially to those of the province of Alentejo,
who have acquired a habit of chewing it, and feel a great privation,
when they cannot indulge this violated taste. (Humboldt op. cit.,
vol. 5, Part 2, pp. 655, 656.) My uncle, Maj. John Le Conte, F. L.
S , of New-York, has kindly furnished me with the details of an ex-
traordinary example of canine Geophagy, which fell under his own
observation. This bitch, when very young, nearly killed herself by
eating the skin of boiled ham, and was ever after more or less trou-
bled with indigestion. She remained in New-York until she was half
grown, when he brought her to Georgia, where she killed herself in
about eighteen months, by eating clay. Although she was a remark-
ably large dog, and lived three years, she manifested no disposition
to breed, and never had any offspring. Her appearance was always
rather lank, notwithstanding she belonged to a variety distinguished
for stoutness and a tendency to be corpulent. She was very robust,
but seemed incapable of getting fat. The kind of clay which she
preferred, and which, it is believed, is always selected by every ama-
teur Geophagist, was a white clay which could be obtained in the
sides of newly-dug ditches and had a slight aluminous taste. Ho
likewise informs me, that in the mountains of North Carolina and
Tennessee, he has seen horses, horned-cattle, and hogs, eat a kind of
red clay, strongly impregnated with iron, which is not unfrcqucnt in

1S45.] Observations on Gcophagy. 435

that part of the country. The natives ascribed the habit to an inade-
quate supply of salt. Whether this practice was injurious to them,
or whether it ever degenerated into a disease, he was not able to
ascertain.

It is an unquestionable fact in the history of the crocodilian rep-
tiles, ihni fragments of stone are frequently found in their stomachs.
Humboldt and Bonpland dissected a crocodile eleven feet long, at
Batalley, on the banks of the Rio Magdalena, the stomach of which
contained fish half disrested, and rounded fra<j^!nents of ojranite threo
or four inches in diameter. (Op. cit., vol. 5, Part 2, p. 656.) M.
GeofFroy-Saint-Hilaire met with a quantity of small pebbles in the
stomach of the Egyptian crocodile, ^' the polish of which annaunced
that they had served for the trituration of the alimentary inatters.'^
(Annales du Museum d^IIisioire NatureUe, Xo. 7, as cited in Til-
loch's Phil. Mag., 1st Series, vol. 16, p. 440-441 : 1803.) Mr.
Richard Owen also found them in a Crocodilus acittus, Cuv., which
died at the Gardens of the Zoological Society. (Phil. Mag., New
Series, vol. 11, p. 63 : 1832.) I have repeatedly taken stony masses
of various sizes from the stomachs of our Alligators, (Crocodilus
lucius, Cuv.); and, in one case, an Indian arrow-head of hornstonc
was extracted, which was as beautifully polished as though it had
been in the hands of an accomplished lapidary. The savages of
South America believe that these indolent animals like to augment
their weight, that they may have less trouble in diving; while the
inhabitants of Ceylon and Luconia, seem to have a superstition that
the reptile swallows " a stone whenever he kills a human being, as if
to keep account of his misdoings." (Siliiman's Journal, vol. 38,
p. 319-320: 1S40.) The two prevailing opinions are, either, that
these sauria swallow stones only when they are going into a torpid
state, for the purpose of keeping up the action of the stomach during
the period of hybernation ; — or, that it is to appease hunger in times
of scarcity, by exciting an abundant secretion of gastric juice. But
I am disposed to think, that the true object in swallowing the inorganic
masses, is, to provide these animals with the means of accelerating
the trituration of the aliments in a muscular and thick stomach ; as
the Crustacea, insects, and many gasteropods, are furnished with
gastric teeth; — and as the graniverous birds take small pebbles, to
assist mechanically in the reduction of the food. The teeth of these
reptiles are exclusively prehensile organs ; consequently their food
is swallowed without mastication, requiring Fome other mechanical

436 Observations on Geophagy. [August,

power to reduce it to a mass fit for assimilation. The stomach of
this class of reptiles, like that of several phytophagous Chelonia, re-
sembles that of graniverous birds, in the thickness of its coats, and
the approximation of its two apertures. Its muscular character and
gizzard-like form, had long drawn attention to the analogy which it
bears to the true gizzards of birds ; but the propriety of this denomi-
nation has been questioned by M. Geoffroy-Saint-Hilaire, on the
ground of its wanting a cuticular lining. In a young Alligator
(Croc, lucius, Cuv.) which I dissected during the past spring, I found
that viscus in the form of an ellipsoidal, strong muscular gizzard, —
the villous coat being remarkably thick and highly vascular ; — the
muscles do not form a digastric mass as in gallinaceous birds, but
the muscular fasciculi radiate from an anterior and posterior central,
shining, circular, tendinous part to the margins, as in many species
of cephalopoda and rapacious birds. In short, the absence of an
epithelium appears to be the only reason for withholding from this
viscus the function of a true triturating organ ; while the muscular
character of its parietes, and the polished condition of the stony
masses found therein, would seem to indicate that it does actually
perform that office in the economy of this class of reptiles, without the
protection of a cuticular membrane.* According to this view of the
question, therefore, these sauria cannot, properly speaking, be regard-
ed as Geophagists.

When we reflect on the whole of the facts connected with the
phenomena of Geophagy, we perceive, that this disorderly appetite
for clayey, magnesian, and calcareous earth, is most common among
the inhabitants of intertropical regions; that it is not always a cause
of disease ; and that some tribes eat earth from choice, while others
(the Otomacs in America, and the New-Caledonians in the Pacific
Ocean,) devour it to appease hunger, and to give bulkiness to the
meagre supply of organic food which they can obtain in times of
scarcity.

That the habitual indulgence of an appetite, apparently so un-

* It is somewhat remarkable that Prof. Rudolph Wagner affirms, — contrary to
the observations of Geoffroy-Saint-Hilaire and Owen, — that, the stomach of the
Crocodile is ^^ lined loith a hard epithelium^ (Elements of the Comp. Anat. of
of the Vertebrate Animals. Edited from the German, by Alfred Tulk : London,
1845, p. 16-2.) A re-examination of the specimen taken from an Alligator,
w^hich I have preserved in spirits, does not show any appreciable development of
a cuticular membrane distinct from the villous tunic.

^45. J Observalions on Geophagy, 437

uatural, should not always result in the induction of a pathological
state of the system, is certainly an extraordinary physiological phe-
nomenon. Our knowledge of the physical and chemical properties
of the different kinds of earth which are eaten by various tribes of
savages, is not sufficiently accurate to admit of a definite conclusion,
with regard to what constitutes the deleterious qualities of some, and
the innocuous character of others. I am disposed, however, to ascribe
the diversity of effects, in a great measure, to the difference in the
mechanical states of the kinds of inorganic materials which are
swallowed. A careful review of the facts above collected, will show
that those tribes which indulge their Geophagous propensities tcith
impunity, always select a fat, smooth, and unctuous magnesian or
aluminous earth ; the mechanical condition of which, is precisely
such as would be least liable to produce gastric or intestinal irritation.
The clay consumed by the Otomacs without any perceptible injury
to health, which was analyzed by M. Vauquelin, appears to have
been a silicate of alumina and lime, analogous to that resulting from
the decomposition of feldspar, — possessing all the characters of a
fat, unctuous variety of clay. The steatitic masses swallowed by
the savage inhabitants of New-Caledonia, seem to be a silicate of
magnesia mingled with the oxides of calcium and copper, — present-
ing the same smooth, unctuous character. The white friable steatite
which Goldberry observed the Negroes on the coast of Africa to eat,
and of which he had himself eaten, without being incommoded by it,
was probably a serpentine or talcose variety of stone. Substances
so smooth and unctuous would not probably cause any gastric or in-
testinal irritation, even w^re they to pass unchanged through the
whole length of the alimentary canal.

On the contrary, it is not at all astonishing, that the ferruginous
clay called ampo, which the Javanese women eat, should produce
emaciation and loss of appetite ; since it is probable, that the angu-
lar silicious particles mixed with it, would speedily occasion some
visceral disturbance, merely from the mechanical irritation which
the presence of such materials must develop. Still less remarkable
is it, that the Negroes of the West Indies, who had been in the
habit of eating an unctuous steatite on the coast of Africa without
experiencing any inconvenience from the diet, should speedily become
sick when they consume the rough volcanic tufa of these islands.

A variety of physiological phenomena prove, that a temporary
cessation of hunger may be produced, without the substances that

438 Observations on Geophagy. [August,

are submitted to the organs of digestion being, properly speaking,
nutritive. This observation has been confirmed by the direct ex-
periments of two distinguished French physiologists, M. M. Hippo-
lyte Cloquet and Breschet. After long fasting, they ate as much as
five ounces of a silvery green and very flexible laminar talc. Their
hunger was completely satisfied, and they felt no inconvenience from
a kind of food, to which their organs were unaccustomed. (Hum-
boldt, op. cit. vol. 5, Part 2, p. 653.) Indeed, the experiments of
Dr. Beaumont and others, have demonstrated that bulkiness of ali-
ment, is almost as necessary to healthy digestion, as the presence of
nutrient matter itself. It is, probably, from this cause, that the
Kamschatdales and the Veddahs, or wild hunters of Ceylon, mix
earth or saw-dust with their train-oil and honey. Hunger is appeased,
the painful feeling of inanition ceases when the stomach is filled. In
vernacular phraseology, this viscus is said to stand in need of ballast ;
and every language furnishes figurative expressions, which convey
the idea, that a mechanical distention of the stomach causes an
agreeable sensation. We may readily conceive, that the secretion
of the gastric and pancreatic juices is augmented by the presence
of earths in the stomach and intestines of the Otomacs : — but how
does it happen, that such abundant secretions, which, far from fur-
nishing the body with new matter, only produce the elimination of
substances already acquired by other means, do not at length cause
emaciation and exhaustion? M.Humboldt thinks that "It can be
attributed only to a habit, prolonged from generation to generation."
(op. cit. p. 655.) The influence of habit is, without doubt, very
powerful: — we are able gradually to change the regimen of herbivo-
rous and carnivorous animals, to feed the former with flesh, and the
latter with vegetables. Spallanzani habituated an eagle to live on
bread, and a pigeon on flesh. {Experience sur la Digestion, c. 74,
et. 75.) Sometimes a long deviation from the natural food is follow-
ed by a change in the structure of the digestive organs : thus, Hunter
found that after a sea-gull has lived for a year upon grain, the strength
of the gizzard is vastly increased, (vide. Home. Comp. Anat., vol.
1, p. 354.) It is asserted that, the domestic cat, which eats bread as
well as flesh, has an alimentary canal considerably longer than that
of the wild-cat ; thereby presenting an approximation to the herbivo-
rous mammalia in the structure of the digestive apparatus, (vide.
Good's Study of Med., Doane's Ed., vol. 1, p. 24, New-York, 1836.)
Like many animals, man can accustom himself to extraordinary

1^43. J " Ob:iervaiioii6 on Geophagy. 439

abstineDce: — but we can scarcely ascribe to the effects of a habit
progressively acquired, the power which the Otomacs possess, not
only of living, but of enjoying vigorous healthy with no other appa-
rent subsistence, during two months of the year, than masses of
silicate of alumina and lime ! Assuredly it is more rational to sup-
pose, that the life of indolence and the almost complete cessation of
muscular exercise, which these savages have associated with the
periodical overflowings of the Orinoco, enables them to be supported
on the comparatively insignificant amount of organic matter w^hich
is occasionally taken with the clay. This view is strengthened by
the consideration, that in intertropical regions, where the tempera-
ture of the surrounding atmosphere is high, but a small amount of
the elements of respiration is consumed in the function of calorifica-
tion; and during the period of muscular inactivity, where there is
very little manifestation of mechanicaiybrce, a comparatively scanty
supply of materials is sufficient to maintain an equilibrium between
the supply and waste of matter in the system ; — especially when it is
taken in conjunction with other matters, which, while they afford
little or no nutriment to the body, yet serve to give that hulk to the
aliment, which is one essential condition of active and thorough
assimilation.

It cannot be doubted, that the great mass of substances, inservient
to the nourishment of man, is obtained from the animal and vegeta-
ble kingdoms ; but there seems to be no sufficient reason for excluding
those articles of the mineral world that are necessary for the due
constitution of different parts of the body. JMost of these inorganic
elements enter into the constitution of the vroteinaceous compounds
of animals and vegetables, as well as into other organic aliments, in
sufficient quantity to supply the wants of the system. When they
are not thus furnished in adequate quantities, it is by no means un-
reasonable to suppose that they will, — when presented in a form suit-
able for assimilation, — be appropriated directly from the mineral
kingdom. Such a deficiency of the mineral ingredients of the ali-
ments, may be the cause of the prevalence of Geophagism among
certain tribes of savages. I do not now speak of the vitiated appe-
tite for inorganic substances, manifested as a symptom of derange-
ment of the function of digestion, but of the habit f-s it prevails amonn-
apparently healthy individuals. All of the edible earths contain
more or less lime, — an element essential to (he proper nourishment
of the osseous structures.

440 Observations on Geophagy. '[August,

The essential constituents of the human body are thirteen — viz :
carbon, hydrogen, oxygen, nitrogen, phosphorus, sulphur, iron, chlo-
rine, sodium, calcium, potassium, magnesium, and fluorine; and the
same, therefore, must be the elements of our food. Several of them
are required in such minute amounts, that considerable time must
elapse before their want is manifested by derangement of the animal
economy; — but it seems certain, that no one of those primary or
simple substances can be wanting in the nutriment without the body
ult mately feeling the ill effects of its absence. From experiments
on the nutrition of a calf, and a cow in calf, M. Boussingault concluded
that there is a portion of the mineral substance taken in with the
food, which remains definitively fixed, to concur in the growth or in
the evolution of the individual. In an adult animal, it is to be pre-
presumed, that no such definitive fixation of inorganic principles takes
place, or that it is much less considerable. Nevertheless, it would
be a grave mistake to suppose, that an adult animal could go on for
even a very short period of time, upon food that contained no miner-
al matter. Precisely as in the case of organic matter, it appears
that a portion of inorganic matter is also fixed in the living frame,
where, for a time, it forms an integral element in the wonderful
structure ; and a supply of the latter kind is undoubtedly no less ne-
cessary, than is the supply of the former description recognized by all
the world. (Vide. Rural Economy, in its relations with Chemistry,
Physics, and Meteorology ; or. Chemistry applied to Agriculture. By
J. B. Boussingault, Member of the Institute of France, etc. Trans-
lated by George Law, Agriculturist : Am. Ed., New-York, 1845,
p, 410 et seq.) Were there an inadequate quantity of phosphoric
acid, of lime, etc., in the aliment, no question but that the body would
speedily feel the effects of the deficiency, and that disease and death
would eventually put an end to existence. So much, indeed, seems
demonstrated by the very interesting experiments of M. Chossat, in
which he kept graniverous animals upon a diet rich in azotized prin-
ciples and in starch, but deficient in lime. From previous inquiries,
M. Chossat had observed that pigeons even require to add a certain
proportion of lime to their ordinary food, the quantity naturally con-
tained in which, does not suffice them. Wheat, though it contains a
large proportion of phosphate of magnesia, yields very little phos-
phate of lime ; and pigeons fed on this grain, though they do per-
fectly well at first, and even get fat, begin after a while to fall oflT.
In from two to three months, the birds appeared to suffer from con-

1845.] Observatiuns on Geoyhagy. 441

stant thirst ; they drank frequently ; the faeces became soft and
liquid, and the flesh wasted, and in from eight to ten months the
creatures died under the effects of a diarrhoea, which M. Chossat
attributed to deficiency of the calcareous element in the foo(\. And
it is neither uninteresting nor unimportant to observe, that the same
thing occasionally occurs in the human subject during the period when
the process of ossification is usually most active. But one of the
most remarkable features of M. Chossat's experiments was observed
in the state of the bones of the pigeons; — they became so thin and
weak that they broke during the life of the birds with the slightest
force. (Chossat, in Compies Rendus, tom. 14, p. 451, as cited by
Boussingault, op. cit., p. 413.) From these instructive experiments
M. Boussingault very justly concludes, that "supplies of all the
elements of all the parts of the body are indispensable to the main-
tenance of health, to the continuance of life." (loc. cit.) A pigeon
will eat about 463.140 grains of wheat per diem, containing 9.725
grains of ash, in which analysis discovers 4.569 grains of phosphoric
acid, and 0.277 of a grain of lime. But this small quantity of lime
is incompetent to maintain the bones in their standard condition.
(Boussingault, op. cit., p. 413.)

The importance of the inorganic principles of food, has not been
sufficiently recognized : — it is not only indispensable that the allow-
ance of an animal in full growth be adequate to support, and even to
add to the soft textures ; — it must further contain the elements re-
quisite for the nutrition of the osseous system. While the ashes of
wheat contain about 2.85 per cent, of lime, that of maize or Indian
corn grown at Bechelbronn, yields, according to the analysis of M.
Letellier, but 1.3 per cent, o^ lime, to 50.1 of phosphoric acid, and
17.0 of magnesia. (Vide. Drs. Will and Fresenius on the Inorganic
Constituents of Plants, in Phil. Mag., 3d Series, vol. 25, p. 517.
1844.) Very probably the amount of lime contained in maize, may
vary considerably, according to the character of the soil in which it
is grown ; but the foregoing analysis seems to indicate, that this
grain usually contains less of it than wheat. Hence, M. Boussin-
gault remarks that, " in South America, where the animals have it
largely, I have observed that they frequently eat earth." " The hab-
it," he continues, " which certain tribes of the natives have of eating
earth, too, which has been particularly remarked upon by travellers
and missionaries as an instance of depravation of taste, presents itself
to me in quite another light, since I became acquainted with the

442 Observations on Geophagy. [August,

composition of the ashes of the ordinary article of diet (maize) in the
countries where it occurs." (Op. cit., p. 414.) The calcareous and
other salts necessary to nutrition are, however, not derived from the
food exclusively; the water that is generally consumed contains a
quantity which is hy no means to be neglected. Liebig seems to
think, that the habit of eating calcareous substances observed among
children, arises from an insufficient quantity of lime in their diet: —
the validity of which assertion, is questioned by Pereira, on the ground
that there is no evidence to prove, that in these cases the food is defi-
cient in its ordinary proportion of lime. (Vide. Pereira, op. cit.,
ante. p. 37.)

In confirmation of the importance of inorganic principles in the
food, I will here adduce a remarkable fact which has repeatedly fal-
len under my own observation. The cows which live on the exten-
sive savannas and pine barrens lying on the North side of the Alta-
maha river in Mcintosh county in this State, subsist upon very coarse
species of grasses, which are probably deficient in some of the phos-
phatic or calcareous ingredients essential to healthy nutrition ; for
these animals are constantly observed io chew hones: — frequently
remaining stationary for several hours, — with the head elevated at
an angle of forty.five degrees to prevent the saliva from escaping
from the mouth, — they will, by constant trituration, gradually reduce
the bony mass to a very small size, when it is rejected as an unman-
ageable morsel. The catile in this section of the State are usually
rather lean; and cows brought from the fertile plantations in the
neighborhood, — if allowed to subsist on what they can procure in the
savannas and pine-barrens, — in the course ofa year or two, become
equally thin, and ultimately fall into the habit of eating hones. I
have not been able to ascertain whether these animals indulge in this
habit to a greater extent when they are in a state o^ pregnancy and
when they are giving milk; but it appears reasonable that the in-
creased demand for mineral matters under such conditions of the
economy, would call for a proportionate supply. The intelligent
instinct which prompts these animals to seek for a diet so extraordin-
ary, must originate in an inadequate supply, — in their impoverished
aliment, — of some of the inorganic principles (probably the phospha-
tic salts) essential to a proper nourishment of the osseous structures.
The above-mentioned fact confirms the justice of the observation of
Prof. J. F. W. Johnson, who recommends upon theoretical grounds,
that bone-dust or bone meal be introduced as an article of general

1845. J Observalionson Geophagij. 4 13

food, for growing and pregnant animals, with a view of supplying the
large quantity of the phosphates required for increasing the osseous
system of the one, and for the healthy evolution of the foetus in the
other. (Op. cit., arite. pp. G03 et 605, Part 4.)

Such being the importance of mineral elements in the animal
economy, it does not appear either extraordinary or very astonishing,
that the dogs, geese, and other animals, which M. M. Magendie,
Tiedemann and Gmelin fed exclusively on sugar, or gum, or starch
and distilled water, should have gradually become extremely emacia-
ted and eventually died of inanition ; or that the unfortunate Dr.
Stark should have fallen a victim to a system of exclusiveness in
diet. It is scarcely to be expected that animals could subsist for any
length of time, on aliment which did not contain all of the constitu-
ents of their bodies, — which could not repair the waste of the system.
The necessity for variety in diet so clearly illustrated by the experi-
ments of M. M. Magendie and Burdach, is very probably owing to a
deficiency of one or more of the inorganic principles in the alimentary
substances which were given to the animals. Some articles of food
contain an inadequate quantity of some salts, w^iich are supplied by
others ; — and thus arises the necessity for variety in diet. In milk
nature has furnished a product perfectly adapted to sustain and de-
velope the young animal : — it contains all of the proximate principles
necessary for the increase of the soft textures, and, likewise, all of the
saline ingredients required for the consolidation of its bones.

Every fresh discovery in Organic Chemistry brings vital phenome-
na more within the grasp of physical laws, and, in so far, more within
the provinces of exact research. We have yet to learn what chronic
diseases are produced by restricting individuals to a diet deficient in
certain inorganic principles which are indispensable to healthy nutri-
tion. The importance of a good allowance of chloride of sodium in
the food, is universally acknowledged ; but the influence of the phos-
phates, of the salts of lime, magnesia, potassa, iron, etc., has not been
sufficiently investigated. Certainly it is not an irrational conjecture
to suppose, that the Geophagous propensity manifested by certain
tribes of savages, — not as a vitiated appetite resulting from a nervous
lesion of the function of digestion, but as an uncontrolable habit, —
maybe owing to a deficiency of some of the saline ingredients in their
ordinary food, which nature prompts them to supply in this remarka-
ble manner. This view derives confirmation from the fact, that an
indulgence of the appetite, does not always produce disease. Might

444 Volvulus and Strangulation of the Intestines. [August,

not a due admixture of bone-meal with maize and other kinds of
aliment, afford a cheap, efficacious, and palatable mode of furnishing
the saline materials required in the reparation of the osseous struc-
tures ? Might not such a plan contribute greatly towards the eradi-
cation of the Cachexia Africana from the Southern and Western
States?

Man can never devise a system of dietetics which will embrace but
one single alimentary principle^ for the obvious reason that his body
is composed of a number of such elements. It is highly amusing to
notice the great attention with which some persons regard the ver-
riest trifles in diet, and the hopes which they entertain of the advan-
tages to be derived from strict constancy in some particular style of
self-management. Some, like Sanctorious, measure with scrupulous
accuracy the prescribed quantity of their ingesta, — while others,
like Bouleau, religiously abstain from sitting near the fire, lest per-
adventure it should dry up their radical moisture. Notwithstanding
all this, man is not made to last forever : — it is scarcely reasonable to
imagine that he will ever, in the language of Dr. Fletcher, " instead
of sitting down, as at present, to his pound and a half of mutton chop
and pot of porter, will swallow for his dinner a fine grain pill com-
posed of equal parts of ovine and cerevisine, or some such matters of
which science has yet to be delivered ;" — but rather, that all attempts
to work miracles on himself, and render him unsusceptible of disease,
must be forever frustrated, and that he must always continue to exist,
the same "poor, bare, forked animal" that he was originally created.

Savannah, June 25th, 1845.

ARTICLE II.

A RemarJcable Case of Volvulus and Strangulation of the Intestines
within the Abdomen, By Jasies M. Gordon, M. D., of Law-
rencevillej Ga,

It is to be regretted that comparatively so few cases of mortality
have a place assigned them in our medical journals, notwithstanding
many of them might be productive of unusual interest. A large
majority of physicians who write, very naturally, entertain a predilec-
tion to report those cases only which have terminated in remarkable

l'^45.J Volvulus and Strangulation of the Inlesiines. 445

cures, or at least successful issues ; to the utter exclusion of those of
an opposite character, however advantageous to the medical profes-
sion. The following case, although it may avail but little practically,
may not prove wholly unacceptable to the pathologist.

D. P. C, of Gwinnett county, aet. 35, a respectable planter, and
a man of uncommon strength and vigorous health, was attacked on
the 18th of May last with the most excruciating pains in the abdomen,
which were attended with obstinate constipation of the bowels. As
he was supposed to be laboring under an attack of colic, various do-
mestic remedies were administered without effecting the slightest
abatement of pain, or relief to the confined bowels. A Thompsonian
physician of the neighborhood was requested to see him, and who
had charge of the case for the subsequent week, but without afford-
ing any relief. My partner, Dr. Russell, and myself, were then
requested to visit him, and found him the subject of most violent
paroxysms, of pain in the abdomen, with partial remissions of com-
parative ease. The skm w^as cool, tongue coated with a dark brown
fur, pulse nearly naturd, bowels constipated. Upon further exam-
ination it was discovered that considerable pain and tenderness were
evinced from pressure upon the lower dorsal and lumbar vertebra?.
Local revulsives were freely applied to the spinal column ; opiates
and antispasmodics were then administered, which had the effect
to allay all pain. An active cathartic was now retained till tibout
the time catharsis should have been produced, when the pain returned
with its full force of intensity. Laxative enemata were given in
such quantity as to distend the whole colon, but all to no purpose, the
stricture not being removed. The pain soon gave place to a death-
like sickness at the stomach, pallid countenance, cold extremities,
surface bedewed with a cold clammy perspiration, followed by vomit-
ing of an abundance of stercoraceous matter very offensive to the
smell. The most energetic means were adopted for his relief — yet
nevertheless without averting the fatal result of this unfortunate case.
For the few last days such remedies were used as were best calcula-
ted to allay pain and support the sinking powers of nature. He con-
tinued to grow worse and expired in the most intense agony at 8
o'clock, P. M., of June 1st, thirteen days after the attack.

Post mortem appearances twelve hours after death. On opening
the abdomen the ileum exhibited a dark red (almost black) appear-
ance, which extended through all of its coats, and also to the mesen-
tery. Upon examination it was ascertained that an infrosuscrpfion

446 Volvulus and Strangulation of the Intestines, [August,

of about an inch and a half in length existed about four inches above
the termination of the ileum. So firmly had the coats of the intestine
become agglutinated that they presented the appearance of a fleshy
tumour, blocking up its entire caliber. It was also observed that the
ileum had made a complete revolution upon itself, with the peritone-
um as an axis, so as to strangulate a knuckle of intestine five inches
in length. The first point of strangulation was immediately above
the introsusception, and the second twelve inches above the last.
They were twisted around each other so as to form a knot which was
with difficulty relieved after the morbid specimen had been removed
from the body. The incarcerated noose of intestine presented an
almost black color, and was greatly distended with gas. About
twenty inches of intestine were involved in the congestion. The
points where the intestine passed around itself were of a dull white
color, presenting a striking contrast with the surrounding parts.

Remarks. The above case presents several interesting peculiari-
ties : — First, the complicated nature of the disease ; secondly, its
length of duration ; thirdly, the attendant symptoms. So far as our
information at present extends we believe there has been no case in
which introsusception complicated with a linking oHhe intestine so
as to produce an additional cause of strangulation has been recorded,
although instances of either of the obstructions separately are upon
record. The most remarkable circumstance in relation to the case is
the great length to which it was protracted, and in our mind it can
he accounted for in but one way, and that is by the supposition that
the introsusception was the original obstruction, and the knotting of
the intestine a secondary legion, and a consequence of the great in-
crease of peristaltic motion of the intestines produced by the active
cathartic medicines administered or otherwise by the violent com-
motion of the contents of the abdomen in the efforts at vomiting. A
pretty conclusive evidence of the fact, that the introsusception must
have existed from the attack, is the firmness with which adhesions
existed between the intestinal folds — so perfect that the different lay-
ers could be but very indirectly traced. It is but reasonable to sup-
pose that the introsuscepted portion was not entirely deprived of
circulation, or the process of gangrene and sloughing, which was
slowly progressing, must have advanced much more rapidly. On the
contrary, the knot was so firmly made as to exclude all circulation,
and the noose of strangulated intestine actually in a state of incipient
iianfT^rcnc which could have only existed for the space of a few davs,

1845.] Jasminiim Revolutum in Syphilis. 44'

otherwise death must have ensued at a much earlier period. A re-
markable fact in regard to the symptoms is, that there was no vomit-
ing (except after a cathartic had been administered) throughout the
course of the disease. Had not the secondary lesion supervened, it
is not impossible but that there would have been sloughing and a dis-
charge per anum of the invagiuated portion of intestine, and a spon-
taneous yet complete cure.

ARTICLE III.

Jasminum Revolutum in Syphilis. By J. M. Gardner, M. D., of
Fort Gaines^ Ga.

The Jasminum Revolutum, commonly known as the Yellow Jas-
mine or Jessamine, is found in great abundance throughout the
United States. Its active principle resides in the root, particularly
the young root, which should be gathered in the spring.

The medicinal properties of this plant are very imperfectly under-
stood. When taken in a large dose, it produces the usual effects of
narcotics; such as stupor, convulsions and death.

In some cases of scrofula, I have used the Jasmine with success.
The late Dr. Garbel, of Columbia, Alabama, experimented very
largely with it, particularly in paralysis, but with what success, I am
unable to say. But it is chiefly in diseases of a syphilitic character
that it has been successfully employed.

The treatment of syphilis with yellow jasmine, was known anl
practised among the Indians living on the Chatahoochie. An Indian
negro, \^ho had become celebrated among them for curing this disease
*with roots,' is said to have made the profession acquainted with its
medicinal virtues. Dr. Johnson and the late Dr. Brown used it in
syphilis, and have spoken favorably of its powers. In the hands of
the latter it was signally successful. In my own practice, the action
of the jasmine has proved more effectual, where the system had been
first prepared by the administration of pil. hydrarg. until the gums
were slightly touched. But Dr. Brown, I believe, used it without
any previous preparation of the system by mercurials.

While under the influence of the jasmine, the patient should re-
main within doors, exposure to the sun producing vertigo and loss of

446 Dickson's Practice. [August,

sight. He should also abstain from greasy food, since it counteracts
the effect of the medicine upon the disease, without lessening the
danger to be apprehended from an over dose.

In cases of poisoning with the jasmine, we are induced from its
narcotic properties, to employ the same antidotes as are directed
against an excessive dose of opium. I know of only three cases of
poisoning with this article: one terminated in convulsions and death,
the other two were relieved by prompt medical aid.

The form best adapted for use is that of tincture, prepared by
taking of the jasmine root and cross vine, each a pound, proof spirits
half-gallon. Cut the roots into small pieces, and macerate for twenty
days in a warm place.

The dose for an adult is from five drops gradually increased to a
teaspoon ful.

In applying the yellow jasmine to the treatment of syphilis, I have
been guided by no other data, but what were gleaned from the In-
dians. I added the pil. hydrarg., which seemed to render the system
more susceptible to its influence. I hope that those who have a wider
field of labor than lias fallen to my lot, will test its properties, for I
feel assured that when they are better known, the yellow jasmine
will obtain a place among the articles of our materia medica.

PART II.— REVIEWS AND EXTRACTS.

Essays on Pathology and Therapeutics, being the substance of a
Course of Lectures delivered by Sam'l Henky Dickson, M. D.,
Professor of the Institutes and Practice of Medicine, in l^e Med-
ical College of the State of South Carolina. Charleston: 1845.
2 vols. 8 vo.

The well established reputation of Professor Dickson, cannot fail
to secure to the work before us an extensive circulation throughout

our country, and particularly in the Southern States, where the
author's abilities and professorial eloquence have long been familiar
to the profession. The first treatise on the Practice of Physic which
has emanated from a Southern pen, it will necessarily find a place in
the library of every Southern practitioner, and be regarded as the
exponent of Southern views in Medicine. Wo will nafurally turn

1S45,] DicJcson's Praclice. 449

to it for light, especially on the forms of disease most peculiar to our
latitude, and cannot but be disappointed if we find it at all lacking
on these topics, however full it may be on others. We are aware that
a preface is rarely read, yet it not unfrequently, as in the present in-
stance, deserves attention as an index of what may or may not be
expected in the body of the work. ' The author, after stating that
he has been repeatedly solicited to publish a "complete and system-
atic Treatise on the Practice of Medicine," adds : " But, I have
now, neither (not?) the ambition to attempt the task, nor do I ima-
gine, that the advantage to be attained by its performance, would be,
in any degree, commensurate with the sacrifice of time and labor
which it would demand." The confession is candid — yet may lead
to the regret that one who has ambition enough to publish so exten-
sive a work, and professional lore in abundance, should not have had
sufficient ambition to make the work "complete."

The ten first chapters of the work are devoted to general consider-
ations on the causes of disease, malaria, animal putrefaction, conta-
gion, endemics, epidemics, seats of diseases, tendency of disease,
symptomatology, diagnosis and prognosis. These several subjects
are treated in the usual felicitous style of the author, and in an off-
handed manner remarkably well adapted to their want of minuteness
and sometimes of accuracy. The following quotation will illustrate
this observation :

" Amidst the rank grass of Africa, the lion couches, and her forests
resound with the roar of her beasts of prey. The jungles of India
nourish the elephant and the tiger, and the thick foliage shelters
innumerable tribes of apes and serpents. In the swamps and bays
of America, the panther and the wild cat seek their food, and the
deer hides himself from the red Indian and the hunter. Animal as
well as vegetable life, luxuriates in heat and moii-ture ; hosts of reptiles
crawl abroad in the mud of each slimy pool, and countless insects
sport in every sunbeam that glances from its surface. To man — to
the white man alone, is this prolific combination unfriendly.

"But the structure and functions of the lungs and stomacn are
not obviously different in the black, or red, or tawny tribes ; like the
lower animals, they are chiefly distinguished from us anatomically
and physiologically, by the peculiarities of the cbtaneous integument.
We account then, most readily, for their remarkable difference as to
susceptibility of malaria impression, by reference to the structure of
the skin, which would therefore seem to be the surface primarily
acted on.

"It is true that negroei? born and constantly resident in healthy
positions, who have been housed and clothed delicately, will become

450 Dickson's Practice, [August,

in a certain limited degree susceptible of miasmatic influences. It
is possible, too, that animals long domesticated and carefully sheltered
and tended, may take on a like susceptibility, though this is not well
established. In this part of the world, where we have but too fa-
miliar an acquaintance with this subject, we are persuaded that our
negroes are comparatively little — our flocks and herds not at all,
liable to malaria diseases."

It may be that negroes are, in the neighborhood of Charleston,
"comparatively little liable to malaria diseases." Such is however
far from being the case in Georgia and in the upper districts of South
Carolina, as will be attested by every planter. It is well known that
one of the greatest objections to the settlement of our most productive
lands, is the fact that a large number of the hands who till them are
disabled by fever at the very time when they are most needed in the
cotton fields. We are not prepared to admit even that the fatality of
fevers is less in the black than in the white race. We hesitate not
to express the belief that by statistical researches, it will be demon-
strated that there is but little, if any, difference either in liability or
fatality between the two races under similar circumstances of expo-
sure, regimen, &c.

We fully concur with the author in the following views :

"Of these (intestinal worms) there are several varieties, whose
generation within the body is altogether unaccountable, and forms
one of the most plausible instances, among those alleged by philoso-
phers, of the spontaneous developement of life and organization. The
lumbricuS or round worm, so familiarly known to parents and nurses,
is indeed very rarely wanting in the bowels of children, and is fre-
quently met with in the alimentary canal of the most vigorous adults.
Parr, Rush and several other physicians, have regarded them, on ac-
count of their uniform presence, as intended for some useful or salu-
tary purpose in the animal economy ; perhaps aiding in the removal
of effete portions of the food taken. I am by no means disposed to
coincide in these views, although I believe that they very often bear
the blame of occasioning diseases in which they have had no share.
I do not believe them to be capable of producing any specific form of
disease; but they give impulse and efficiency to a great number and
variety of morbid influences. By inordinate increase of number,
they impair the constitution, preventing the free and due performance
of the functions of the intestines, whose surfjice thus takes on a diver-
sity of modes of irritation. Even when present in moderate number,
they may become, by a change in the condition of the mucous tissue
of the digestive canal, sources of severe additional excitement and
disturbance."

1S45.] Dickson's Practice. 451

It is indeed too frequently the case, especially with the unprofes-
sional, that diseases of a serious nature are overlooked in the anxiety
to get rid of worms. That their presence may aggravate certain
affections of the bowels and stomach, cannot be denied ; but that
they often occasion disease is extremely questionable. It is a matter
of daily observation that children in the enjoyment of fine health
will pass large numbers of worms on the administration of anthel-
mintics. This especially obtains among the negro children of our
plantations, who are unusually robust. There is a circumstance in
connexion with this subject that we do not recollect to have seen
alluded to by any writer, viz., that worms endeavor to escape from
the alimentary canal on the supervention of fever of any kind, and
that they are not, unfrequently, passed off lifeless if this state of the
system have existed for some days previous. How common it is to
see worms working themselves out of the rectum and even the stom-
ach, during febrile disorders of children, although their total number
may prove to be very small by the subsequent administration of the
most certain vermifuges. This may serve to explain the popular
disposition to attribute almost every attack of sickness in children to
the presence of worms. That extraordinary numbers of worms may
exist in the alimentary canal without producing any appreciable im-
pairment of health, is, as already hinted, well established.

We need offer no apology for introducing the following very hand-
some and appropriate extract on a subject worthy of attention :

" Would to Heaven that the good sense of mankind would lead the
civilized and christian nations to resume the ancient classical practice
of burning the bodies of the dead. There is surely something shock-
ing in the very idea of inhumation. It is, I confess, revolting to my
own mind in the highest degree, to remember that custom dooms me

•' To lie in cold obstruction — and to rot!
Tljis sensible, warm being to become
A kneaded clod!"

"But there is a much better argument than that derived from mere
feeling, against the mode now universally practised indisposing of the
human corpse. Upon the funeral pile we reduce to a heap of inno-
cent dust, that which in a few days will be changed into a mass of
putrefaction, tainting the air and spreading around it, if not taken far
away, horror and pestilence. What matters it that we are at present
able to remove it to such a distance, and to hide it so completely that
it affects our senses neither of sense nor smell ; although we have not
succeeded, if we may believe the statements of several respectable
writers, Walker and Chr.dvvick among them, in obviating the deleteri-

452 Dichson^s Practice. [August,

ous influences of its putrefaction upon the living, who breathe the
neighboring atmosphere affected by it. The mere concealment of
the decaying remnants of mortality, will not always be in our power.
The 'city of the tombs' is already more crowded with inhabitants,
than the busy streets of Constantinople ; the catacombs of Paris,
and the cemeteries of London, are filled to overflowing. Nay, cer-
tain facts stated recently, with regard to the burial grounds of two of
the cities of this new world, would lead us to doubt whether similar
evils were quite so distant from our apprehension, as might have been
imagined, from the comparative sparseness of population in our im-
mense extent of territory.

" How much better, then, for the cold and clammy clay, and the
noisome grave-yard, to substitute the polished vase, the marble urn —
in which we may preserve deposited, the relics of 'all that our souls
held dear,' and dwell upon the remembrance of our friends with
emotions of tender melancholy, mingled with no gloomy ideas of re-
coiling disgust. Their ashes may thus become the inmates and the
ornaments of our habitations; and their constant presence may serve
to over-awe us from what, being evil, would have been frowned upon
by them when living, and to encourage us to those good actions, which
we feel, would have deserved and met with their approbation.'*

Prof. Dickson's nosological arrangement comprehends seven divis-
ions or classes — viz: 1st. Dis. of the Circulatory System ; 2d. Dis.
of the Digestive System; 3d. Dis. of the Respiratory System ; 4th.
Dis. of the Sensorial System ; 5th. Dis. of the Motory System ; 6th.
Dis. of the Generative System; 7th. Dis. of the Excretory System.
Under the first of these divisions we find the various forms of fever —
intermittent, remittent, yellow, catarrhal, typhus, typhoid, pneumonia,
symptomatic. Without commenting upon the propriety of the above
arrangement, we hasten to more practical matters. On fever, in gen-
eral, the author expresses himself thus:

" You will not expect from me any additional attempt at promulga-
ting a theory, or striking out a definition of this Protean disease ; and
I cannot describe it to you better than by a familiar quotation from
Fordyce, which with all its simplicity and quaintness, is often refer-
red to as conveying more truth than is to be found elsewhere in the
same brief limits.

'* 'A fever,' says Fordyce, 'is a disease that affects the whole sys-
tem ; it affects the head, the trunk of the body, and the extremities ;
it affects the circulation, the absorption, and the nervous system ; it
affects the skin, the muscular fibres, and the membranes ; it affects
the body and likewise the mind. It is, therefore, a disease of the
whole system, in every kind of sense. It does not, however, affect
the various parts of the system equally and uniformly ; but on the

1845.] Dickson s Practice. 453

contrary, sometimes one part is much affected in proportion to the

atlection of another part.'

********

"I shall not hesitate to retain the long established distinction of
fevers into Symptomatic and idiopathic. My senses and my reason
both recognize an obvious difference between the febrile disorder con-
sequent upon, and produced by, a wound of soft parts, dislocation of a
joint, or fracture of a bone, and that which, however apparently analo-
gous, arises without the occurrence or manifestation of any notable
accident, or evident change previously affecting the body, or any of
its parts ; and there seems to me little risk of confounding exanthe-
matous fever, and that which is connected with inflammation of the
pleura, or of the brain, with any of the numerous types attributed to
malaria, and offeringat their invasion no constant injury of a special
organ, but rather dividing (as in the faithful sketch from Fordyce) its
disturbing influence over the w^hole constitution. Notwithstanding
these points of separation and contrast, however, which seem toaflbrd
safe and broad ground for a rational diagnosis, the weight of modern
authority is decidedly in favor of considering all fevers as symptom-
atic— the extension of general irritation and disorder from some local
aff*ection. There is much dispute, however, as to the point of local
origin. Clutterbuck fixes it in the head, and regards fever as nothing
more than the secondary or constitutional result of inflammation of
the brain and its membranes. Broussais attributes it to an inflam-
matory irritation of the mucous tissue of the digestive tube, and
especially the stomach. With vastly more plausibility others have
rejected these exclusive theories, and considered all irritated and
inflamed organs, as centres from which may radiate the different
modifications of fever. Thus Professor ^larcus finds in the brain the
original irritation upon which typhus is generated ; in the lungs that
of hectic; in the trachea, that of catarrhal fever, etc.

"I am not disposed to pursue this discussion, and shall therefore
hazard but one remark farther on this point so warmly disputed. It
is highly probable that no cause of disease possesses such indefinite
extent of impression, as to act at once upon more than a single part ;
and besides, it is consistent with all analogy to suppose that every
cause of disease is determined to, and fitted to act specifically, or at
any rate specially upon one organ or tissue. It follows, therefore,
or it is highly probable, that all disease is, to speak with logical pre-
cision, local in its origin.

********

" We may conclude here this brief discussion of the general subject
of fever, with an enumeration and cursory description of its conse-
quences, or th^ effects of febrile disorder upon the several organs of
the body assailed in its progress, as manifested in examinations post
mortem.

"The brain rarely fails to present the signs of vascular engorge-
ment, and very often shows the results of inflammation in greater or

454 Dickson's Practice, [August,

less degree in either of its.substance or membranes. This occurs so
generally that inflammation of the brain and membranes is considered
by a pretty numerous class of physicians with Clutterbuck at their
head, as the true proximate cause of fever. Numerous facts have
been brought forward to establish this conclusion, which has been
very plausibly advocated, and much ingenious reasoning employed to
explain away the difficulties and exceptions adduced by its opponents.
"Analogous marks of lesion in the mucous membrancof the stom-
ach and intestines, have occasioned this tissue to be in a similar
manner selected as the seat of an inflammatory irritation alleged to
be the proximate cause of fever, or rather fever itself, for such is the
doctrine of Broussais and his followers. Nor do the other abdominal
and pelvic viscera escape during the tumults of this pervasive malady ;
though as we shall hereafter inform you more in detail, they exhibit
these disturbances rather in derangement or suspension of their func-
tions than in anv material alterations of structure. Yet we can ob-
serve occasionally not only engorgement but inflammation with its
results in the liver, spleen, kidneys and bladder.

"The respiratory organs also sufler in fever, though not so gener-
ally or m so striking a degree as the viscera above spoken of. Pul-
monar}^ conjjestion is often one of the early symptoms of the attack,
but in a majority of instances it undergoes a spontaneous solution
during the successive changes of action and determination.

"It is admitted that these local febrile affections are usually of the
nature of i»iflammation, or display an almost irresistible tendency to
run promptly into that condition. The opinion certainly derives
strong support from the phenomena exhibited in fatal cases of pro-
tracted duration. In these we almost invariably meet with inflam-
matory disorganization. On the other hand, it is contended that
these are incidental and not essential results, as they are not found to»
take place in the most violent attacks if they terminate unfavorably-
after a brief course. Here no lesions are discoverable. In still more
numerous instances we find the determinations to and aftecfions of
particular parts to be clearly and simply congestive, and these are
among the most mortal and malignant of febrile modes of derange-
ment. Still faither, it seems to me reasonable to regard many if not
most of the determinations that occur in the course of an ordinary
attack of fever as simply irritafive, in contradistinction to inflammato-
ry and congestive conditions of parts. The numerous head-aches,
spinal and muscular pains, and gastric oppressions and annoyances
connected with fever at particular stages or periods, subsiding rapidly
and often disappearing altogether when these stages are past, are, I
should think, clearly of this character. In different seasons, climates
and localities, and in different types of fever, we find these several
local affections difl^ering notably. Some of these variations appear
to be incidental, while others are uniform and essential, occurring in
rnasses and showing little respect to individual peculiarities of con»
fttitution.

1845.] Dickaons Practice. 455

"Here we find a majority of the lesions presented, in the viscera
of the abdomen. The mucous membrane of the stomach and intes-
tines very rarely escapes injury in cases protracted to any length.

"The next greatest number is of the cerebral affections, and these
are met with in attacks that prove rapidly fatal, and such as run into
a typhous state. Comparatively few lesions of the pulmonary organs
take place in our genial climate, and though not absolutely confined
to the winter season, usually occur during cold weather."

We have thus drawn largely on the author, in order to place be-
fore the reader, in his own language, Prof. Dickson's views. We
do not object so much to what is expressed, as to what has been
omitted. Indeed, unless we can find enough of Pathology in these
quotations, we need look no farther, for, strange as it may appear, we
have in vain sought for it under the heads of Intermittent and Remit-
tent fevers. The interest at present excited with regard to the
pathology of these fevers is such, that as soon as the work was placed
in our hands, we immediately turned to the chapters treating of them,
in order to ascertain the views of so distinguished a Southern prac-
titioner. But to our utter surprise we found not a syllable on the
subject of Pathology ! In the chapter on Intermittents, the five or
six first pages furnish us with symptomatology, causation, and prog-
nosis. The treatment is then taken up and occupies the remaining
fourteen pages. The chapter on Bilious Remittents comprehends
about forty-two pages, equally barren on the important subject of
Pathology. Why this extraordinary silence? Can it be possible
that the teacher thinks it of too little consequence to occupy the at-
tention of the youthful and inexperienced student, (for it must be
remembered that these pages contain the substance of a Course of
Instruction to a Collegiate Class,) or, what is still more improbable,
can it be that the learned author has no fixed views on the pathology
of such common aflfections ? Foiled in our expectations on this point,
we turn to the treatment of Intermittents and Remittents, and find, in
relation to their most potent antidote, the following language :

♦' Thus you will hardly venture upon the exhibition of cinchona,
when the apyrexia is imperfect, and where there are present obvious
marks of local disorder of some important organ. The continuance
of headache, gastric oppression, abdominal pain and tension — these
symptoms demand farther general or preliminary treatment.

"Bark, in all its modes of preparation, even the sulphate of qui-
nine, is generally regarded as inadmissible whenever the apjTexia is

456 DicJison's Practice, [August,

notably incomplete, and when there are any prominent affections of

important organs. To such cases, fortunately, sulphur is perfectly

well adapted, and in such I have often found it productive of the most

obvious and lasting benefit.

********

"The obvious analogy of the remittent with the malarious inter-
mitlent, and of the remission of the former with the apyrectic stage
of trie latter, long since suggested the employment of cinchona in
protracted instances of autumnal fever of the present type. The
practice is becoming more and more common to resort to some one
of the preparations of this powerful febrifuge in the better and moro
marked remissions. Nay, some practitioners regarding quinine with
Bell as a f-cdative, do not wait long for an opportunity of this sort,
but administer it generally after premising such depletory measures
' as may be demanded. As yet I cannot but look upon both the theory
and practice as uncertain, yet the experiment deserves to be cau-
tiously made. If the sulph. quinine in ordinary doses be cfTensive
to the stomach, however, or determine to the head as it will some-
times do, with pain, dizziness, tinnitus aurium, I would desist and fall
back upon the less impressive but safer course already pointed out."

It is truly to be lamented that a work, destined to be the guide of
many young practitioners, should inculcate such obsolete principles.
We had thought it, long since, an acquired fact in practice, that
quinine could be given with impunity, not only during an intermis-
sion but also during a remission of our " malaria fevers," as the
author terms them. We have never known it to act otherwise than
beneficially under such circumstances, and this is the experience of
all who have used it similarly. Having been for a number of years
convinced that the sulphate of quinine exerts rather a sedative than a
stimulating effect on the system, that it blunts the nervous sensibilities,
and, regarding our Intermittents as well as Remittents as primarily lo-
cated in the nervous system, whose derangement may lead to disorder
in other organs, we have always made it a point to restore the nervous
system to a normal state, as early as our services were required, and
by so doing to arrest the development of the secondary phenomena.
This can always be done with entire safety by the applicction of
revulsives to the spine, and the free use of quinine during the periods
of intermission or remission, without regard to the condition of the
system or of any particular organ. We are aware that, even now,
most practitioners hesitate to administer quinine in cases presenting
a predominence of gastric or of rercbral affliction. Our case book
bears unequivocal testimony of the fallacy of such hesitation.

Having neglected the study of the Pathology of" malaria fevers,"

1S45.] DicLsoji's Practice. \h'

and misapprehended the effects of quinine, the author, instead of ar-
resting the disease at once, still adheres to the routine treatment,
such as it was practised ten or fifteen years ago. Wc find no allu-
sion made to revulsive applications to the spine in Interinittcnts,
and a mere incidental reference to them in Remittents.

•' V/Hile the sensorial energies are active, and the vascular excite-
ment high, tiie pain and inliamination of a blister will probably add
more to the general irritation of the disorder than will be compensa-
ted for by its revulsive impression. But when the case is protracted
beyond a certain point, the former eficcts do not follow, or are of less
relative importance — nay, the exciting as well as the revulsive influ-
ence of the epipastic becomes desirable. Ey the selection of proper
periods, we may make this class of remedies, however, entirely safe,
and far more valuable than if this be unattended to. If you use them
chiefly as revulsives, apply them in' the remission and in the vicinity
of the organs you desire to relieve; to the epigastrium or side for
the benefit of the stomach or liver; to the back of the neck or be-
tween the shoulders if the head be threatened ; along the spine or on
the sacrum to relieve congestion or irritation of the vertebral cord."

We have deemed it a duty to notice these omissions, because of
the great advance made of late years in the Pathology and treat-
ment of the class of affections we are most frequently called on to
combat, and because v.e think it inexcusable in an author of such
repute as Prof. Dickson, to have made no allusion to them, when so
ably advocated by Maillot in his work on fevers, and by others in our
country. We would refer with especial pleasure to an article on the
subject, published as long ago as 1838, by Prof. Ford, in the 1st vol.
of the Southern Medical and Surgical Journal, and which can scarce-
ly have failed to meet the eye of so near a neighbor as Prof. Dickson.

In regard to the use of the lancet in Remittents, Prof. Dickson
expresses himself thus :

" For myself, it is proper to avow, that in the practice of a quarter
of a century, I have bled as {ew patients in bilious remittent as any
physician who uses the lancet at all. I cannot presume to aflirm,
that I have always selected the cases proper for its employment, or
that I have omitted none in which it was indicated ; but the instances
are very few in which I have been satisfied of my having derived any
decided advantage from it ; nor have I been disposed, in reviewing
my course, to regret its omission in any.''

The author advocates strongly, and we think very judiciously,
cold affusion.

458 Dickson's Practice. [August,

" The cold bath, one of the most ancient and universal remedies for
fever, demands our early attention as specially indicated in the varie-
ty of it under discussion. The temperature of the season, the very
nature of the attack, the symptoms present, the condition of the pa-
tient, are all such as to prepare us to expect from its employment
tiio happiest results. Accordingly, I am disposed to rank it among
the most efficient of our febrifuge measures here — far above the lancet
both in the extent of its adaptation and in its degree of specific utili-
ty. All that we can hope or anticipate from [)loodletting may be
obtained in a majority of cases by the use of the bath, while the lat-
ter possesses this striking and obvious advantage, that we can repeat
it as often as the symptoms are renewed that require it. Nor can I
help expressing my surprise at the very limited resort of my profes-
sional brethren to it, when I consider how instinctively we desire it
as a relief from the burning heat that oppresses us, and how certain
and immediate a means it is of affording the relief.

"Of the three modes of employing it, namely, affusion-, immersion
and ablution, the first is the most impressive and efficacious, the last
the least liable to objection or risk in doubtful cases. The particular
indications which demand the resort to it unhesitatingly, are found in
the yeuth and general vigor of the patient and the heat and dryness
of the surface. The local determination which it controls most
promptly is that to the brain, shown by headache, flushed face, red
eye, delirium, etc., with a full, hard, bounding pulse. Seat your pa-
tient in a convenient receptacle and pour over his head and naked
body from some elevation a large stream of cold water ; continue
this until he is pale or his pulse loses its fullness, or his skin becomes
corrugated and he shivers. On bc-ing dried and replaced in bed, a
genial sense of comfort and refreshment will attest the benefits de-
rived from the process, which, as I said above, may be repeated
whenever the symptoms are renewed which it is so well adapted to
remove.

"If the shock of this shower bath or cataract be too great, immer-
sion, which fnany prefer, may be substituted. Few shrink from this,
and almost every one will evince the high gratification and enjoy,
ment derived from it. One of the pleasantest effects following the
bath, is the complete relaxation of the surface which it so often brings
on, attended with a copious and salutary sweat. I need not warn
you against the nearly obsolete practice of endeavoring to acceler-
ate or increase this by wrapping in blankets or shutting up the apart-
ment, or warming it artificially. 'J'he patient is to be covered agree-
ably to his sense of comfort ; and though I would not place him in a
current or draught of air, I would have his chamber fully and freely
ventilated."

We find nothinfj in the volumes before us on Malignant Intermit-
tents. The subjoined extract will show how summarily our author
disposes of congestive fever, malignant remittent, and country

16-15. J DicJisun^ Practice. 459

fo-ver ; forms of disease so interesting to Southern and Western
practitioners.

"It would evidently be futile to attempt to lay down rules for the
adaptation of details of treatment, to the several varieties of torm,
wiiich under diverse circumstances and in different constitutions,
may be assumed by our autumnal remittent. IMie principal of llu'se
is known, as 1 before said, by the title of "congestive fever." The
specitic peculiarity of this dreaded disease is the centripetal tendency
of the tluids of the body, the consequent enQ:orgement of the internal
organs, and the general oppression and obstruction of the vital func-
tions which result of necessity from this vicious condition of the cir-
culatory mass. Some bold practitioners employ the lancet here as a
revulsive, or for the purpose of resolving congestion ; and the meas-
ure is certainly an efficient one, and as well adapted as in Mcintosh's
use of it in the cold stage of intermittents. It is full of serious risk,
liowever, and I cannot venture to recommend it, though I can readily
imagine cases in which it would be very likely to prove serviceable.
And the same remark holds equally true as to cold atfusion. A far
sat'er course and equally promising, is the early resort to the warm or
even hot bath, which often rouses the patient at once from his sullen
languor, or relieves his sufferings from visceral engorgement. The
free exhibition of the stimulant diaphoretics should tbllow, with assidu-
ous application of external irritants, mustard and cantharides. Cam-
phor or ammonia may be combined with our mercurial, and free
doses of quinine administered. Indeed, our brethren of the south
and west have placed their principal reliance, within the last {e\v
years, upon the sulphate of quinine, almost exclusively exhibited, and
prescribed in immense doses. Congestive fever has been reported to
have been successfully treated by doses of twenty to thirty, and even
fifty grains of the remedy. I have heard authentically of an instance
in which one hundred grains were given, in little more than twelve
hours, and of another, in which half the contents of an ounce bottle
were administered during a similar period. I have as yet met with
no attack which required such enormous amounts. I will not dis-
pute their necessity or propriety; of which indeed time and enlarged
experience must constitute the true tests. Unless the drug, as thus
employed, is strangely adulterated, evidence enough has been offered
to prove that the danger of these large doses has been grievously ex-
aggerated. Turpentine and capsicum are used freely here by many,
and it is said with the best effect. The Dover's powder determines
well to the surface, and. unless where there is coma, seems appropri-
ate to our purposes. Many of these congestive cases resemble, from
the first, or readily run into a typhoid condition, with abdominal
irritation — diarrhoea, tenesmus, meteorism. I have found, in such
instances, denominated in some parts of our State ilictis, the nitrate
of silver productive of benefit. I prescribe the sixth or fourth part of
a grain every three hours, without allowing it to interfere with such
other remedial measures as mav be indicated.

4(iU Dickson's Practice. [August,

" In the malignant remittent, occasionally met with and formerly
described to you, the vital forces, rapidly crushed by the overwhelm-
ing intensity of the morbid cause, fail apparently to exhibit any
resistance or reaction. They must be sustained by every means
within our power, while we have immediate recourse to our most
impressive revulsives. The hot bath, sinapisms, vesicatories, must
1)0 quickly and assiduously applied, while we stimulate by the freest
use of internal remedies, carefully selecting such as are best adapted
to the circumstances presented. If, as is often the fact, the patient
suffers severely from pain in the abdomen or chest, large doses of
opium or morphine must be administered, while we keep up his sink-
ing strength by brandy, ammonia or aether. In your diligent super-
intendance of such cases, make it a rule rather to incur the risk of
over stimulating transiently, than fall below the requisite point of
excitement in your use of stimulants. I am fully persuaded that I
have seen more than one man die from the timidity of his physician
in this respect ; who, keeping at a cautious distance behind the, dis-
ease, would not venture on the exhibition of any excitant adapted to
the feeble excitability, until the vital energies upon which alone
stimulants can act, had become worn out and exhausted.

*' If the stomach will bear it, add to your formula some of the pre-
parations of cinchona. The sulph. quinine in full doses will be often
retained and do good. Alternate, combine, and recombine your
stimulants, which may perhaps be aided also by warm and nu-
tritious fluids, wine whey, arrow root with wine, wine alone or spiced,
brandy with milk or in mucilage. These energetic agents will
usually be found effective within a very short period, improving the
pulse and arousing the general powers of the system. Yet you must
not permit yourselves to be disheartened into inaction by their ap-
parent inefficacy or slowness of impression. Persevere not only
while there is a reasonable hope, but even after all hope seems extin-
guished ; and though your hearts will now and again be wrung with
painful disappointment, by the feebleness and inutility of your reme-
dies, yet you will feel yourselves ami)ly repaid by the gratification,
which will not be denied you, of saving more than one fellow crea-
ture from the destruction which seems inevitably to await him.
instances of such recovery do occur, though rarely, and bear honor-
able testimony to the skill and unv/earied humanity of the physician.
They display too, the excellent pov/ers of our medicaments, the capa-
city for endurance inherent in the human constitution, and show
forth above all, the unspeakable benevolence of the former of these
wonderful though frail frames.

"In the bills ofmoitality for the city of Charleston, you will find
every year a certain number of cases distinguished by the appellation
of 'country fever.' The phrase is employed to denote the febrile
attack which follows within a short time, and with appalling certainty,
an exposure to the concentrated malaria of the low country in our
immediate vicinity. To sleep a single night upon his plantation,

1S45.] Dickson's Practice. 461

involves the southern agriculturalist in the most serious danger ; nay,
he is not safe if he indulge himself in frequent visits, even by day, to
his rice fields, or inhale too often under any circumstances, the pes-
tilential air of our swamps and marshes.

"Country fever, using the term as above defined, is a very instruc-
tive and interesting variety of fever, exhihiting in a very striking
manner the tendency of the several types which have a miasmatic
or paludal origin to mingle with or run into each other. Through
the progress of a given case you may indeed have each of them in
turn presenting itself. An attack commencing as intermittent, or
single tertian, will thus become a double tertian, then a triple tertian,
then a remittent of greater or less distinctness and regularity ; if
successfully managed it may become again intermittent by restoration
of the apyrectic interval ; if otherwise it prove violent and tenacious,
it is not rare to see it degenerate into that low and typhoid condition
in which the remissions becoming irregular and uncertain, and in-
distinct, it approximates at least, if it does not assume the continued
form.

"As early as May, in ordinary seasons, attacks of country fever
follow the exposures above pointed out. I have known a few, even
in April, ascribable perhaps, to some uncommon contingencies. The
period of their appearance has, undoubtedly, a reference both to the
temperature of the past winter and that of the advancing spring — a
cold winter and a late spring being unfavorable to the invasion.
Much also, is owing to the habits and constitutional predisposition of
the subject exposed, who is especially liable to be assailed ifimprudent
or intemperate, or a subject of fever the year previous.

"It has been a long received opinion that a return to our compar-
atively healthy city atmosphere, the ordinary summer residence of
so many planters, during the latent period which ensues after efficient
exposure as above described, endows the coming attack in some
obscure manner with a peculiar violence and malignity. The type
assumed, as I have stated, is apt to be irregular, confused and com-
plicated. We meet frequently with the herosthesis of the ancients,
recognized, as I formerly mentioned, by Robert Jackson — an accu-
mulation of unexpected paroxysms or exacerbations one upon ano-
ther, or an exacerbation interposed at the most unlocked for period
of the day, just when a remission was anticipated, and both patient
and physician were congratulating themselves upon the prospect of
a brief but solacing respite.

"It is a most insidious modification of fever, requiring to be
watched with the greatest attention and assiduity. The sick man
will often make little complaint, his symptoms will appear mild, and
yet you will perceive that he gets steadily weaker and worse ; or the
remission shall have become very distinct, nay, shall amount to com-
plete intermission, and you flatter yourself with the hope that conva-
lescence is become, when some single paroxysm shall intervene with
such overwhelming violence, that prostration and fatal exhaustion
ensue in a few hours.

402 Dickson's Practice. [August,

" In the diffjculty of accounting for this strange assumption of
malignity under the circumstances, it has been argued that these
modifications were determined by the peculiar state of the city atmos-
phere in relation to its capacity for producing the more pestilential
grades of fever, as it is well known that cities are the exclusive sources
ofyellow fever and of the plague; and it is thus attempted to be explain-
ed why we also meet in the suburbs with similarly modified fevers. As
regards Charleston Neck, the remark holds good — fevers originating
in this mixed atmosphere very often partaking of the dreaded charac-
teristics of countr}^ fever. But there is an insuperable difficulty in
the way of (his suggestion, in accordance with which we should find
the bilious remittents of the city itself severe and fatal. The fact is
notoriously otherwise. Here, they are indeed both infrequent and
comparatively mild and manageable, as formerly stated to you.

'* Besides this, a similar aggravation of violence and danger is
affirmed to occur every where, when a subject efficiently exposed to
the influence of febrific miasmata, has removed during the latent pe-
riod to a pure and salubrious atmosphere. This is true, as Flint tells
us, of the upland prairies of the far west, and as I have more than
once had unhappy occasion to note, in our own lofty motmtain regions.

"The prognosis in such cases you will at once infer to be very
doubtful ; nay, it is hardly safe to regard your patient as better until
he is quite well.

"The treatment also requires to be managed with great diligence
and nicety. Frequent visits are absolutely necessary, and with all
possible watchfulness and assiduity, you will still be liable to fall into
serious errors. It is exceedingly difficult to distinguish in the early
stages the most unimportant attack from the most dangerous. Hence
it has become my custom to lock upon all such seizures with a jealous
eye, and to institute from the commencement such a course of treat-
ment as shall otier the best resources under any sudden development
of malignity or aggravation of violence. Under these circumstances
too, I watch anxiously for the first opportunity of administering some
preparation of cinchona — the infusion in some of its combinations,
or the sulph : quinine in proper and efficient doses. The system
sinks so readily under such exacerbations or such accumulation of
them as I have above alluded to, that I often venture upon the exhi-
bition of this class of remedies, even in remissions somewhat
indistinct and obscure, after the first vehemence of febrile action
has passed by, and the appropriate measures of depletion have been
premised.

"I have very rarely observed any evil results follow this practice ;
its worst consequence, if not most injudiciously timed, nor pressed
obstinately against contra-indicating contingencies, will be an in-
crease of violence in the next exacerbation ; but to compensate for
this, the succeeding remission will rarely fail to be more distinct and
better adapted for the use of our febrifuge, and thus the disease is
made to vield more readily than under any other course."'

1845.] Dickson s PracUce. 4G3

Chapter VII. treats of Yellow fever. The annexed corollaries
contain the author's views oi' the generation of this disease.

" 1st. This malady is the effect of a specific and peculiar cause.

"2d. In certain localities, this obscure cause is permanent and
always active; in others, it exhibits only an occasional activity, by
which alone its presence can be inferred. In Vera Cruz, Havana,
Kingston, it is perennially endemic ; it is occasionally so in New
Orleans, Mobile, Savannah and Charleston; which last city seems
to be placed upon its extreme northern limits of spontaneous pro-
duction.

" 3d. Its relation to season and temperature is equally well made
out; being efficient only during the hot months of summer and
autumn.

"4th. Yellow fever is contagious; in other words, a case of yellow
fever having been generated in favorable season and locality, by its
unknown and undetected cause, becomes itself a generating centre
productive of other cases, or of a morbid agent capable of producing
them.

" 5th. It is transmissible from any one centre to another, or from
any one of its generating centres to a healthy locality ; and this com-
munication or extension may lake place in two modes, — either by
conveyance of a portion of atmosphere in which is diffused its unde-
fined specific cause, as in the hold of a foul vessel, from any placo
where it prevails epidemically; or by the introduction of a sick body
or any fomites imbued with its contagion.

"6th. As a general rule, we may add that the contac^iousness of
yellow fever is limited by certain contingencies. This is Hosack's
doctrine of contingent contagion; but the same circumstances limit
the efficiency also of the generating cause, as indeed of all the al-
leged causes of yellow fever. Thus, high temperature is necessary
to its production, existence and extension. No matter liow it is gen-
erated, the fact is known that it does not exist any where in winter.
Hence it follows, that if carried into a cold region from a hot one, it
will not diffuse itselt". An exception to this rule is said to have oc-
curred in Halifax, N. S., whither the disease was carried from the
West-Indies, in May ; but the case is not satisfactorily made out."

AVe add Prof. D.'s opinion on the nature of black vomit.

"The majority at the present day regard it as a form of gastric
hemorrhage. Warren, of Barbadoes, calls it "mortified blood."
Bancroft says it is " merely effused blood altered in appearance and
darkened in color by the gastric juice, or by some chemical decom-
position. But this view is not altogether free from difficulties. The
change of appearance is not accounted for, as we know it takes place
in the vessels. We never meet with it in acknowledged hemateme-
sis, the blood being always recognizable in that hemorrhage by its

4G4 Dickson's Practice. [August,

proper qualities. Dr. Rhees, of Philadelphia, informs us that on in-
stitutincr a series of observations with the solar microscope upon
black vomit, he found it to contain innumerable animalculcer A
single drop exhibited many thousands, being indeed a mere congeries
of them. When recent fluid was examined, they were alive and in
constant motion ; if suffered to stand awhile, and when taken from
the dead subject, they were still and torpid. Comparative examina-
tions were made of the discharges from the stomachs of patients ill
with bilious remittent and other autumnal fevers, but no similar ap-
pearances were detected."

The author's treatment of Yellow fever consists principally of cold
affusion, revulsives, and the free use of calomel as a cathartic, and
\Mitha view to the early establishment of complete mercurialization.
His aversion to the use of venesection is thus summed up : "I re-
peat then, that while I propose to you no speculative objections
against the lancet, and admit that circumstances may call for its oc-
casional employment, the results of experience and observation^ are
unfavorable to the general or frequent resort to it." The whole
chapter is one of deep interest, although lamentably deficient in
autopsic research and pathological considerations.

The limits assigned to this paper will not permit us to review the
other diseases comprehended under the author's first division, and
which complete the first volume. We therefore proceed to notice
some of the contents of the second volume. Under the head of
" Diseases of the Digestive System," we -find the chapters on Dys-
pepsia, Gastritis, Enteritis, Milk-sickness, Colic, Cholera, Diarrhoea,
Dysentery, Cholera Infantum, Helminthia, Hepatitis, Icterus, Splen-
itis, Parotitis, and Pharyngitis.

•Affections of the spleen, although exceedingly common in our
latitude, have'hitherto received but little attention from the profession.
Nor do we find any new light thrown upon them, or upon their treat-
ment, by Prof. D. He makes the following concession in relation to
the treatment of splenitis :

" For my own part, I cannot recommend any particular formula
with great confidence, in this obstinate malady. I think I have
found most benefit from the use of iodine combined with mercury, as
in the deutiodide of mercury and potassium, while the patients
bowels were kept soluble by the employment of the blue pill with
rhubarb in such doses as were requisite, never pressing this matter
very far. Cups or leeches over the tumor relieve pain. Fomenta-
tions applied to the side are also useful."

1845.] Dickson's Practice, 465

It is to be regretted that the author's extensive experience has not
led him to test the efficacy of the use of quinine in large doses, as
recommended by the French, We have used it with manifest ad-
vantage in several cases of chronic enlargement of this organ.

Of. the " Diseases of the Respiratory System," the author notices,
Croup, Laryngitis, Bronchitis, Pleuritis, Pneumonia, Phthisis, Asth-
ma, and Pertussis. We are much pleased with the stress with which
is urged the exploration of the chest by physical means. The histo-
ry of auscultation and percussion furnishes a strong illustration of
the reluctance with which improvements are adopted, when industry
is necessary to the appreciation of their merits- Although the great
advantages of these physical means have been known upwards of a
quarter of a century, and made an essential part of a physician's
education in France, we still find that in our country, they are
totally neglected by the great mass of practitioners. Indeed it is but
a few years since they have been systematically taught in our medi-
cal schools. Justice requires, however, that we award to the Jack-
sons, to Morton, to Gerhard, &;c., of our own country, the merit of
having labored with successful zeal in the advancement of our know-
ledge of these means, and in the promulgation of their importance.
Nor should we omit the claims of Drs. Cammann and Clark, of New
York, who by the happy combination of simultaneous auscultation
and percussion, have made the greatest improvement discovered since
the days of Laennec. It is to be regretted that Prof. D. has not
availed himself of their valuable publication (in theNew York Journal
of Medicine and Surgery, for July, 1840) in his remarks on the
exploration of the heart. The author, however, is not singular in
this neglect of improvements made at home. We do not recollect
ever seeing the slightest reference to the paper alluded to, in any of
the periodicals or works issued from the Philadelphia press. How
different would it have been, had such an advance in our means of
diagnosis been made in Europe ! The American Journal of the
Medical Sciences, which claims to be "the organ " of the Profession
in America, would certainly not have passed it over in silent con-
tempt. Can it be that jealous rivalry precludes the notice in Phila-
delphia of anything done in the neighboring city of New York?
We do not for a moment impute such unworthy motives to the au-
thor before us, and must attribute his neglect of our countrymen to
the fact that this portion, at least, of his work was probably written

466 Dickson's Practice. [August,

before the publication ofDrs. Cammann and Clark, and has not
since been carefally revised.

The division of "Diseases of the Sensorial System" includes
Phrenitis, (acute and chronic,) Mania-a-Potu, Apoplexy, Paralysis,
Chorea, Epilepsy, and Neuralgia. The diseases of the " Motory
System," treated of in this volume, are Gout and Rheumatism.

Of the seat of Rheumatism our author entertains the following
views :

"For my own part, I am inclined to hold, with Craigie, that the
chief, if not the exclusive, seat of rheumatism, is the tissue which is
termed 'aponeurotic' — 'the aponeurosis, fascia, or tendinous ex.
pansion, which, invariably connected with the periosteum or capsular
ligaments at the articular extremities, covers or supports each mus-
cle to a greater or less extent, penetrates into the substance of the
muscle and passes at each joint from one part of a limb to the other,
and from the limbs to the trunk, forming a covering of the greatest
extent, next to the skin, in the human body.' "

Prof. D. admits the hereditary prexiisposition to Rheumatism, and
adds :

"Beyond this, and the fact that a second attack supervenes more
readily upon any given individual, owing not only to the building up
of a constitutional diathesis, but probably also, in some measure at
least, to obscure changes impressed upon the parts first affected — be-
yond this, we know little of the predisposing causes of rheumatism.
Muscular fi\tigue is, perhaps, the only one which we can affirm to be
definitely pointed out, and the malady is hence accounted for in its
aptness to attack the hard-working laborers of the lov.er classes. It
is also commonly believed, that a limb or joint which has been previ-
ously twisted or dislocated, or weakened by a blow or sprain, is ever
after more liable to be acted on by the several circumstances that
tend to give rise to rheumatic inflammation."

On the treatment of acute Rheumatism wo find that "Prof.
Mitchell, of Philadelphia, has discovered that counter-irritants of this
sort, are frequently more serviceable when applied to the spine, than
directly over the part. He selects the portion of the column whence
issue the nerves that supply the seat of the inflammation. The sug-
gestion is a valuable one, and deserves your attention." On the
treatment of Chronic Rheumatism no allusion is made to the spinal
applications. Yet, nothing is more satisfactorily demonstrated than
the efficacy of this plan of treatment in both forms of the disease,
but more especially in the chronic. The pathology of Rheumatic

IS 15.] On Ascites. 467

affections, as at present understood by many, would lead irresistibly
lothis, as the most efficacious treatment, even were it not substantia,
ted by the daily observations of those who resort to it. We would
refer to a paper on the subject published as long ago as 1836, in the
Southern ^Medical and Surgical Journal.

The " Diseases of the Excernent System " comprehend Variola,
Varioloid, Varicella, V'accinia, Rubeola, Erysipelas, Scarlatina, and
Dengue. The last chapter of the work occupies about twenty pages,
and treats in general terms of some of the affections of the "urinary
organs," as Diabetis, anuria, morbid urines, gravel, renal calculi,
nephritis, Bright's disease, nephralgia, cystitis, cytherismus, vesical
calculi, and lithic diathesis.

In concluding this very imperfect notice of the work before us, we
appprehend that we may incur the imputation of having dealt unfair-
ly with the author in presenting a picture rather of its defects than of
its intrinsic merits. We felt, however, in accomplishing the task,
that whilst nothing we might say could add to the deservedly high
reputation of the distinguished author, it was due to the Profession,
and especially to the Profession at the South, to notice some of the
most important omissions in a work emanating from so imposing a
source. Errors are baneful in proportion to the authority by which
they are sanctioned. We trust, therefore, that our strictures may be
received in the spirit by which they were dictated, and that a new
edition of the work will be brought up " au niveau de la science."

PART III— MONTHLY PERISCOPE.

On Ascites. By Prof. C. J. B. Williams, M. D., F. R. S., &c.—

We now go on, from inflammatory affections, to ascites, which is a spe-
cies of flux, or more properly, dropsy of the abdomen. There is an
increased secretion of serum, frequently to a great extent, and this we
have found to be sometimes the result of chronic peritonitis ; at other
times, however it is a consequence of disease, not of an infiammato-
ry nature. It may arise from the sudden suppression of another flux,
such as diarrhcea, or the stoppage of the ca4amenia. Sometimes,
ascites occurs as a part of general dropsy, from disease of the heart
or imperfect action of the kidneys, or a general cachectic slate. IMore
commonly, ascites arises from an obstruction to the return of the

468 On Ascites. ' [August,

blood from the abdominal vessels, as in disease of the liver. In such
case, it is frequently unaccompanied by any considerable swelling of
the legs or other parts of the body. The usual symptoms are : swell-
ing of the abdomen, attended by fluctuation, and a dull sound in the
most dependent parts, but the position of this varies; where there is
a slight degree of effusion, the fluid in the abdomen may be best felt
in the sitting or standing posture, in the pubic and iliac regions. It
may be felt by the usual process for ascertaining the presence of
fluctuation, by pressing the hand on the abdomen on one side, and
gently tapping on the other ; each stroke from the finger is followed
by a movement of the fluid, which is impelled onwards to the opposite
side. There must be some quantity of liquid to effect this. It very
frequently happens that the intestines, or some of the solid contents,
fall down to the middle part of the abdomen, and cut off'the commu-
nication between the two sides; and, therefore, though there is a
considerable quantity of fluid, you get no fluctuation. In that case,
you may ascertain it by pressing the hand on the lower part of the
abdomen, and adopting the process on a smaller scale. There may,
however, be a source of error here; the soft parts do not fluctuate;
but, where there is a solid tumor, there is a sort of fluctuation induc-
ed. I have been deceived in this manner, repeatedly, and no very
correct idea can be obtained by percussion. If you strike the abdo-
men high up, a fluctuation or tremulous motion is propagated to the
finger; the same thing is found with a tumor, such as the enlarged
liver or spleen, and, on one occasion, I was thus led to mistake an
enlarged spleen, of enormous size, for a tumor in the ovarium. The
same thing will occur when you try fluctuation between bodies at a
short distance ; and it isdiflficult to say, where the walls of the abdo-
men are thick, or where there is a considerable amount of soft or
fatty matter, whether such fluctuation is the result of the liquid or of
the solid matter. The best mode of distinction, therefore, for small
quantities of liquid, is, certainly, the sound on percussion, as I point-
ed out in speaking of chronic peritonitis. In this manner you may
readily displace a small quantity of liquid by pressure. You will find,
in these cases, the lower part of the abdomen to sound dull on per-
cussion ; but, if you press inwards, you get rid of a quantity of liquid,
and come in contact with the intestines; and, therefore, the diflfer-
ence of forcible percussion, and of gentle percussion, will enable you
to distinguish the presence of liquid. Hence, you find, when pres-
sure is not employed, that there is a dull sound on percussion, but by
pressing on the parts, and then percussing, there is a clearer sound,
and this is a pretty sure proof of liquid being present in the lower
part of the abdomen ; this may be ascertained by the patient stand-
ing; and, in order to get the liquid in front, the patient should be
desired to lean forward. This plan is also available for making fluc-
tuation more distinct, or perceptible in other cases. The same prac-
tice may be applied to the flanks, and I have been enabled, in many
instances, to announce this commencement of ascites, before many

i^lo.J On Ascites, 4ti9

others could detect it by fluctuation. Another mode of diagnosis
between ascites and ovarian tumor — between liquid in the peritoneal,
and liquid in the ovarian, sac — is important to be noticed ; its dis-
tinction is, however, very easy. Ovarian tumors begin low down, on
one side, gradually rising up, and, when they occupy a great extent
of the abdomen, the dulness will be found to be more defined, and
will extend higher up ; below, there is a sort of tympanitic sound of
the intestines, which are pushed aside by the tumor. In ascites, it will
be more in the dependent parts, that there will be dulness — towards
the pubic region ; and, if there is any resonance at all, it will be per-
ceived towards the umbilicus, and in the pit of the stomach. On the
contrary, in ovarian tumor, the chief dulness will be in the central
portion of the abdomen, whilst the intestinal resonance will be in the
flanks. In some instances, however, of very advanced ascites, the
fluid may be so extensive as to cover the intestines completely over,
so that the abdomen is dull in every region, both behind and before;
but, such cases are unusual; and, even then, by pressing inwards, as
far as the walls will allow, and using strong percussion, the tympan-
itic sound may usually be heard towards the umbilicus. There are
cases of adhesion ot the intestines to the sides, so that they cannot be
displaced by liquids. Under such circumstances, although dropsy be
present, there will be.a degree of resonance on percussion, along the
tract of the intestines. In most cases, ascites is accompanied by a
scanty and turbid condition of the urine, which is also high colored,
or else, in many instances, it is impregnated with albumen. It is,
not unfrequently, also connected with disease of the kidney; and
you must remember that ascites, or dropsy of the peritoneal sac, may
be dependent on some other causes, of which there will be found signs :
for instance, a person will be suddenly attacked with swelling in the
abdomen, on the suppression of some discharge. The disease is, here,
somewhat of an inflammatory character, and, not unfrequently, if it
remain unsubdued, anasarca will take place. In ascites from diseas-
ed liver, there is, generally, some local sign of hepatic disease. Some-
times attacks of jaundice, or bilious affections, occur, and the intesti-
nal and urinary evacuations show, more or less, symptoms of disorder.
The ascites must be diminished or removed, before we can determine
the exact position of the liver. In many cases of ascites, the enlarge-
ment of the liver may be felt by pressing the hand on the right side,
or using gentle percussion : this presses away the fluid, and you then
find some resisting body in that direction. Extensive ascites will
impinge on the region of the chest, and cause some of the signs of
disease of the thoracic organs ; the tumor, pressing up the diaphragm,
will produce imperfect respiration, or interfere with the due perform-
ance of this function. In other cases, there will be symptoms of
something like hypertrophy of the heart, this organ beina thrown
forwards against the chest. You judge of this by the amount of
swelling. There is yet another cause of ascites to be noticed, and
that is a curious one : it is — obliteration of the ascending cava ; in a

470 Treatment of Typhus. [August,

^Q\v instances, in which this has been observed, not only ascites of the
belly, but, likewise, dropsy of the lower extremities, have been re-
marked as a consequence ; obstruction of the vena cava inferior, or
of a portion of the venaportas, generally leads to ascites.

The irealment will depend very much on the cause. When it
arises from simply suppressed excretion, it may require general de-
pletion, or cupping over the region of the loins. The chief medicinal
remedy, in these cases, is eiaterium, in small doses; or cream of
tartar, in doses of from half an ounce to an ounce; taken the first
thing in the morning, and sometimes combined with jalap; after
this, diuretics may be given ; but the greater portion of these are of
no use, until the main symptoms are reduced, and, often, such medi-
cines are found merely to irritate, instead of doing good. Sometimes
a warm bath is useful, particularly where the disease is connected
with suppressed perspiration, and a dry state of the skin. In cases
of diseased liver, or diseased heart, or both, mercurials, combined
with diuretics, answer best : such as squills and colchicum, digitalis,
tincture of cantharides, cream of tartar, spirits of juniper, tincture of
horse-radish, acetate of potash, iodide of potassium, &c. ; these two
last may, sometimes, bo combined together. Blisters to the abdo-
men are also of great efficacy, in some cases of low inflammation of
these parts. If the ascites be extensive, and the above medicines
produce but little impression, hydrngogue purgatives sometimes
cause copious evacuations, but they exhaust, rather than relieve, the
system. Diuretics do no good ; and, then, we must have recourse
to tapping, which gives present relief, and is further useful, inasmuch
as other remedies are then enabled to act with more freedom.
It is on these occasions, that we are often, for the first time,
enabled to examine the abdomen clearly, and to make out the
diagnosis. In the same way, we may be guided to the use of
mercury, if the disease be in the liver; or of iodine, if there is
any enlargement of the general glandular system. After tapping
has removed the fluid, a tumor may still remain in the abdomen, and
this may then be found to depend on an enlarged ovarium. Some-
times it is the liver which is enlarged ; or, again, it may be the
spleen. In all these cases, iodide of potassium has been known to
exercise very good effects. — London Medical Times.

Treaiment of Typhvs. — Dr. Davidson, in the London and Edin-
hurgh Medical Journal, thus sums up the treatment of typhus fever.
He considers that, as typhus is a disease which cannot be checked
in limine, and is often tedious in its progress, causing great emacia-
tion and exhaustion, measures which may vitally lessen the powers
of life, such as bleeding, vomiting, and excessive sweating or purg-
ing, ought not to be used without very strong and special reasons.
The ordinary measures may be the following : — Place the patient in
a large, well-ventilated apartn)ent, on a mattress, with few bed-
clothes; let the head be shaved, and kept cool with an evaporating

1845.] Nitric Acid ill Purpura IliBmorrhagica. 471

lotion, give a gentle purgative every second or third day, let the skin
be bathed once or twice a day with tepid water, and this may be ac-
companied with small doses of tartarized antimony, antimonial pow-
der, or ipecacuana. The drmk should be liglit, cooling and slightly
diuretic ; and the diet nutritive, but light, and little liable to acescen-
cy. When there is a tendency to congestion in any organ, a little
calomel, or hydrargyrum cum crela, may be combined with the pur-
gative, or calomel with a small quantity of opium may be given every
six or eight hours. The application of two or three leeches to the
temple or nostrils is often useful in congestion of the brain, and also
where there is intense head-ache, which is often the forerunner of
delirium. Blisters are also often advantageous in such cases. De-
rangements of particular functions, or symptoms arising from
idiosyncracy of constitution, sometimes occur, and must be treated
accordingly. Mercury in small doses is frequently useful in pro-
moting several of the secretions, and in relieving the congestion of
internal organs. Opium is injurious in a large proportion of cases,
from its tendency to cause congestion in the head ; but where diarr-
hoea is a symptom, it ought to be administered with a view to check
the exhausting evacuations. Wines and other alcoholic liquors, as
they contain both stimulant and alimentary elements, are the most
to be relied on for supporting the strength, and are the least injurious.
The pulse, taken along with the general symptoms of exhaustion,
may be held to be the rule for its exhibition, both as to time and
quantity. Ammonia, camphor, quinine, and other similar tonics, are
not to be depended on in bad cases ; and when exhibited along with
wine, frequently cause the patient to refuse both. When the disease is
complicated with local alTections in the head, chest or abdomen,
they must be treated on the same general principles as the idiopathic
disease which they represent, with this important modification, that
evacuations of all kinds must be employed more sparingly, and with
much caution; and that even in these cases, if there be much pros-
tration of strength, and a very weak pulse, wine must be administer-
ed, although more moderately than in the simple disease. — New- Yoi^k
Journal of Medicine.

Successful use of Nitric Acid in a case of Purpura Hoimorrhngi.
ca. By J. J. Bradford, M. D., of Augusta, Ky. — On the 12th of
April, 1844, I was consulted by Mr. Cline in reference to the case
of his son, aged ahout 12 years. His health had been generally
pretty good, and he was free of scrofulous disease, either hereditary
or acquired.

For about two weeks prior to the attack, he had complained of
lassitude and pains in the inferior extremities. His appetite was
very little affected, and the alvine discharges had a healthy appear-
ance until a few days before his seizure, when he passed a good deal
of dark grumous blood, which greatly alarmed his parents.

472 Blisters in Children. [August,

At the time of attack his countenance was pale, the skin cool, the
muscles shrunken and flaccid, the pulse quick, feeble, and varying
from 120 to 140, on the slightest exertion of body ; fullness of the
abdomen was obvious, with slight tenderness in the right hypochon-
driacal region ; the urine was turbid and in diminished quantity. We
found the lower extremities completely covered with spots, varying
in bulk from mere scarlet points no larger than flea bites, to large
purple blotches, of the size of a fifty cent piece. The front part of
the abdomen presented numerous purple spots, quite large. On the
chest there were some also, of less size, while those on the neck, face
and upper extremities, gave the speckled appearance of the turkey

error.

There was a constant oozing of blood from the tunica conjunctiva,
from the schneiderian membrane, the gums, the tongue, the soft pa-
late, the fauces, and indeed from all the mucous membranes, except-
ing only the bladder and urethra.

The treatment of the case was at first by calomel and rheubarb, as
follows : — R. Cal. and Rhei. aa. grs. xv ; mix, and divide into three
parts and give one every night, with a dose of castor oil on the next
morning if the powders fail to give one or two good alvine discharges.

April 14. — The first two powders acted freely on the bowels, but
the symptoms were arrgravated. The third powder was not given,
but in its place the following prescription was administered : — R. Ni-
tric Acid 1 drachm, pulv. gum arable, white sugar, aa. 2 drachms,
water 5 oz. mix, and give balf a table-spoon full every six hours,
followed every third day by sulphate of magnesia, if the bowels
should not be opened.

April 17. — Symptoms rather better. Patient is not so weak. Less
blood passes from the stomach and bowels, and he has a motion with-
out resorting to the cathartic. The petechial appearance is stationary.
Continue the medicine.

April 19. — Evident improvement in all the symptoms. The ap-
petite increased. Pulse 112, and very little blood oozes from any of
the mucous membranes. Continue the medicine.

jVIay 1. — The medicine was renewed to-day for the last time, and
by the 20th of the month he was entirely restored.

From the success of nitric acid in this alarming case, 1 feel justi-
fied in recommending the remedy to the notice of my professional
brethren ; at the same time I resign to others all speculations as to
the modus operandi. — Western Lancet.

Blisters in Children. — Some discussion took place repecting the
use of blisters in children. Generally, their employment was looked
upon as only a choice of evils, and two cases were related in which
their application produced fatal results. The President had found, in
cases where blistered surfaces were healed with difficulty, that the
mixture of a grain or two of opium with an ounce of spermaceti
ointment was of great benefit. In cases in uLich morphia was em-

1845.] Valerianate of Quinine 473

ployed endermically, the difficulty often was, to keep the blistered
surface open. — London Lancet.

Valerianate of Quinine — its Therapeutic Employment — Mode of
Preparation and Adviinistration. (Translated froin the French —
UAheille Medicate.) — Dr. Francis Devay, Physician to the Ho'el
Dieii de Lyons, through an essay published in the Gazette Medicate^
directs the attention of practitioners to a new comhination of valeri-
anic acid with a vegetable alkali — quinine. We arc induced to
augur favorably of this union of the active principle of valerian to
the medicinal agent of the most powerful of our exotic products.
According to M. Devay, this provision is fully justified by clinical
verification: valerianate of quinine in small doses is anti-periodic,
very effectual, and superior to the sulphate by its nevro-sthenic pro-
perties.

Doubtless the gastro-intestinal accidents produced by this latter
salt have been much exaggerated; still, it is no less true that the
sulphate is much more irritating than the bark in substance; first, by
reason of its greater solubility; and again, because it has not the
corrective properties possessed by the Peruvian bark, viz — tannin.
It is not so with the valerianate. In this last product the quinine
is modified by its intimate association with a vegetable acid, which,
to a slightly perturbating action upon ihe nervous system, joins
those eminently characteristic of Peruvian bark. There is, in this,
a fact connected with therapeutic dynamics, concerning which we
cannot too much engage physicians to consider attentively. Thus,
as we said before, in our first memoir, valerianate of zinc is an anti-
spasmodic raised to its highest power ; so valerianate of quinine is a
medicine endowed with anti-periodic powers of the greatest energy.
This is a fact we have acquired through numerous cases zealously
collected several months since. But it is due to us to say, that the
administration of the valerianate will for a long time expose the
practitioner to mistakes, until the apothecaries generally become
experienced in its composition, and in all the minute and delicate
preparations required by it. M. Devay remarks, that to judge of
the therapeutic action of valerianate of quinine, it is necessary, first
of all, to satisfy ourselves of the excellence of its composition. His
experiments were made with valerianate of quinine, prepared under
his supervision by Mr. Guillermond, a skilful pharmaceutist of Lyons.
Characters. — According to the analysis of the Prince of Canino,
who was the first to prepare and describe valerianate of quinine, this
salt is formed of one equivalent of valerianic acid, one of quinine,
and two equivalents of water, of which one constitutes its water of
crystallization. The crystalline form of this salt is very difl^crent ;
it is octcedrical or hexsedral. We have ourselves obtained it in
hexaedrons, flattened on two faces, and forming rhomboidal tables
perfectly characterized. It is often agglomerated in light, silky
masses. Independent of this last fact, the crystals are hard and tol-
erably heavy.

474 Valerianate of Quinine. [August,

Valerianate of quinine has a slight odor of valerianic acid, and a
decided bitter taste, recalling that of cinchona. It dissolves with fa-
cility in water at a common temperature. Alcohol is a better sol-
vent; and olive oil dissolves it equally well, assisted by a slight heat.
The mineral acids, and most of the organic acids, decompose it.
Submitted to a heat of about 90°, crystallized valerianate of quinine
looses an equivalent of water, softens, and melts like a resinous sub-
stance. Depriv'ed of water, it is rendered insoluble in this liquid,
while, on the contrary, it is very soluble in alcohol. Exposed to a
bight r tempernture, it cannot be made to part with its other equiva-
lent of water, but is decomposed, and mono-hydrated valerianic acid
vapors are seen to escape from the resinous mass. The aqueous
solutions of this salt, exposed to the heat of boiling water, also
decompose, and oily drops are seen to float upon the surface of the
liquid, which cannot be made to redissolve in the water, except by
means of spirit of wine, and is nothing more than mono-hydrated
valerianate.

Preparation. — To a concentrated alcoholic solution of quinine add
valerianic acid in slight excess. Dilute the alcoholic solution with
twice its volume of distilled water; mix intimately, and evaporate in
a stove at a heat not surpassing 122'^ Fahr. After the evaporation
of the alcohol, the valerinnate is exhibited in the form of handsome
crystals, here and there grouped or isolated, which increase from day
to day.

The valeriannte of quinine may likewise be prepared by double
decomposition, in mixing sulphate of quinine with valerianate of
lime or baryta, both being d.ssolved in wenk alcohol. We have our-
selves obtained this salt in mixing an alcoholic solution of the neutral
sulphate of quinine with an alcoholic solution of valerianate of potash.

The process succeeds, after several successive tiials, to insure the
perfect decomposition of the two salts. These methods are only
good in saving time ; it is far better to act in a direct manner, so as
to have finer and purer products.

Whatever mode of preparation be adopted, it should always be
home in mind that the solution must be evaporated slowly, with a
gentle heat, and the crystals not bo separated from the mother waters
except to dry them in the open air.

Valerianate of quinine may be distinguished as follows :

1st. A concentrated alcoholic solution of valerianate of quinine
precipitates the concentrated neutral aqueous solution of nitrate of
silver: this ])recipitate is redissolved in a large quantity of water.

2d. An aqueous solution of valerianate of quinine does not pre-
cipitate one of chloride of barium.

3d. This aqueous solution, submitted to ebulition, allows some
oleaginous drops of melted hydrated valerianate to separate.

4th. If this solution be treated with acids, valerianic acid is dis-
engaged, which may easily be recognized by its odor ; and if this
decomposition be effected with crystallized valerianate of quinine

1845.] Copaiba with Purgalives in Gonorrhcea. 475

and a concentrated liquid acid, valerianic acid will be obtained in an
olean;inous form.

Mode of Adminisfratlon. — Like the valerianate of zinc, this of
quinine being very delicate, or more correctly speakinfr, easily de-
composed, it is best to administer it in the most simple form : in this
belongs a necessary condition to its successful use.

We mostly give it in a gummous solution. Five decij^rammcs ©f
the salt, (8 grs.) according to our experiments uith ^{r. Guiilermond,
dissolve easily in 100 ;i;rammes of gummous vehicle. One of the
great advantages of valerianate of quinine is to be able to dissolve
it easily in oil, and use it in this manner for frictions and embroca-
tions upon the region of the spleen. With this object we have made
use of the following liniment:

R Olive Oil 60 grammes.

Valerianate of Quinine, 1 gramme, (near 20 grs.)

For neuralgia we use commonly pills containing 6 centigrammes
each, prescribed in the simplest manner.

To appreciate the therapeutic value of valerianate of quinine, M.
Devay reports, out of many cases under his observation, 14, for the
most part severe and complicated intermittent fevers, which were
cured by the administration of valerianate of quinine, when the
sulphate even proved abortive. Each dose from 10 to 40 centigram-
mes (1^- to 6 grs.) a day, according fo circumstances. The author
cites no instances offliiluro, and mentions no inconvenience resulting
from the employment of this new therapeutic agent.

He concludes thus :

1st. Valerianate of quinine is a superior antiperiodic to the sulph-
ate by its nevro-sthenic properties, and because it acts in smaller
doses.

2d. Its pure and simple administration is of equal value with that
of cinchona and the nevriliques combined.

3d. In fevers of the worst character (ataxiquesmalignes) it is
thought to render the most eminent services by its specific proper-
ties. — Am. Jour, Phar.

Combination of Copaiba with Purgatives in Gonorrhma. — From
an account given by M. Jacquetant of the Hospital practice of M.
Diday, it would seem that the balsam of copaiba acts much more
energetically in the removal of gonorrhoea if combined with purga-
tives. The formula which ^I. Diday found most successful, was three
drachms of the balsam of copaiba, four drachms and a half of the
powder of cubebs, and forty-live grains of the powder of jalap, made
into an electuary, of which one half is taken in the morning and the
remainder in the evening. The treatment rarely lasted more than
five days, by which time a permanent cure was in general effected. —
Gazette Medicate de Paris and Edinburg Med. <S^ Surg. Jour.

476 Mammary Abscess. — Nervous Action, iS^c. [August,

Proposal to treat Protracted Mammary Abscess by the Breast-pump
and the Syringe. By Alex. Wood, M. D. — This proposal, which
appears to be a novel one, and to be well worthy of trial, is as fol-
lows:— "As soon as the indistinct fluctuation or rather the boggy
feeling, by which the formation of matter in these abscesses can be
defected, is distinctly ascertained, let a small bist6ury or abscess lan-
cet* (the common lancet will sometimes not penetrate deep enough)
be carried down until the matter begins to escape. After all that
can be squeezed out by pressure is removed, let the breast-pump be
applied over the orifice, and the rest of the matter be drawn out. The
sinus is then to be injected with some astringent solution, by means of
a small syringe. The syringe employed is the small glass one for
the urethra, sold by most apothecaries. The lotion I have hitherto
used is the one recommended by Mr. Hey, though it may be doubt-
ful if it possesses any peculiar advantages. R. aquae purae gxv; spt,
rosmarin. §i ; spt. lavandul. com. 5i; zinci sulphat. gr. xxx. — M.
Iiat lotio. The sulphuric acid lotion of Sir A. Cooper will probably
answer as well.

" A pledget of lint dipped in the lolion is then to be applied outside, and cover-
ed with oiled silk; over this a compress may be placed, and firm pressure main-
tained on it by means of adhesive plaster. In some cases the walls of the
abscess will unite at once, and all that remains to be done is to trust to time for
the removal of the surroimdiiig induration, or to attempt to discuss it by frictions
with camphor liniment, mercurial or iodine ointment, or the application of the
emplast. ammoniaci cum hydrargyro. »

"Where the surfaces do not thus unite, the falling in of the breast, produced
by the exhaustion of the glass, will be found to have disappeared; the cavity in
such cases has only to be injected two or three times a-day, which will serve at
once to keep the opening free for the discharge of matter, and will also tend to
arrest the further extension of the ulcerative process.

" The treatment of acute and more superficial abscess may be conducted on
the same general principles. The early evacuation of the matter saves the pa-
tient much suffering, and also enables the nursing on that breast to be resumed
at a much earlier period. The cicatrix is also much smaller than in cases
wdiere the matter is allowed to discharge spontaneously ; indeed, if the incision
be made in the direction of the natural folds of the breast, that is, radiating to-
wards the nipple, the cicatrix will in a short time be imperceptible.

"Dr. Wood has tried this plan in three cases, and with results which war-
rant him in suggesting it to the consideration of theproliession," — Northern Jcmr-
nal oj Medicine. From Am. Jour. Med. Sciences.

Re-establishment of Nervous Action after Autoplastic Opera-
tions.— M. Robert (de Lamballe) in a memoir read before the
French Academy of Sciences in February last, states the following
to be the results of his experiments on man and animals : — 1st. Im-
mediately after autoplastic operations, sensibility diminishes or dis-
appears in the flaps, the diminution of the sensibility being directly
in reason of the loss of blood. 2d. The section of the pedicle is
followed by complete loss of sensibility, but after a certain length of
time it reappears, and increases in the same proportion as the vascu-

* A subcutaneous incision-knife would answer well.

1845-J Injiammation of the Knee- Joint, — Hernia. ^11

larity; both sometimes increase beyond the limits of the normal
state, but always simultaneously. The anatomical examination of
the pedicle gives the following results: — 1st. After its section, the
flaps are separated from all parts of the economy by cicatricial tissue.
2d. The only means of communication that exist between the flaps
and the rest of the economy, arc the vessels, more or less developed,
which pass through the cicatricial tissue ; no nervous filaments are
ever met with. 3d. The nerves which existed primitively in the flap
become atrophied, and may end by disappearing. 4th. Those of the
neighboring parts stop at the level of the cicatrix. Sometimes they
are suddenly interrupted, presenting a kind of swelling of the neuri-
lemma ; sometimes they lose themselves in the cicatricial tissue, but
it is never possible to follow them into the flap. — Lancet,

Case of Extensive Inflammation of the synovial membrane of the
Knee Joint terminating in suppuration, without inducing ulceration
of eithet the hard or soft textures of the Joint. By Sasiuel Tyler,
M. D. — I was called on the 29th of October, 1844, to visit a patient
15 years of age, laboring, as it was then supposed, under a scrofulous
affection of the knee-joint. Upon inquiry into the history of the
case, I learned that some six months previous the patient had given
the limb a severe twist, whilst running over rutty, uneven ground.

Finding the joint excessively swollen, the leg so contracted as to
render it almost impossible to place the foot upon the ground by force,
I proceeded to treat the case in the following manner:

Commencing with the ap|)lication of a blister which surrounded the
joint, which was afterwards kept discharging by the use of warm
poultices, I gave on each alternate day the favorite purgative of Dr.
Physick, jalap and cream of tartar, in doses sufficient to procure free
evacuations.

Under thiff treatment the general system improved somewhat, but
the joint continued to swell, when on the IGth of November I made a
free incision upon the inner side of the joint, evacuating at least one
quart of pus. A continual discharge was kept up from this openmg
until the 29th of December, when I made use of "Chase's apparatus"
to overcome the contraction of the limb, which was perfectly eflfected
in less than three weeks' time, leaving the patient with a limb perfect-
ly straight, and entire mobility of the joint.

I consider the great peculiarity of this case to consist in the fact,
that where there should be so excessive and long continued inflamma-
tion of the synovial membrane, that it should terminate without in-
ducing ulceration either of the soft or hard textures of the joint.

Am. Med. Journ. of the Med, Sciences.

[Certainly a surprising case. — Edts.]

Statistics of Hernia. — M. Maisonneuve has made a statistical re-
port of 11,644 cases of hernia, which were examined during a period
of six years, at the Central Bureau, Paris; he thus distributes them :

478 Case of Ticins. [August,

Of 11,644 cases of abdominal hernia of every description, 8790
were observed in males; 2,854 were observed in females.

Of 8,790 cases of hernia ohserVed in males, 8.237 were inguinal
hernia; 307 were crural hernia; 246 were umbilical hernia.

Of 2,854 cases observed in females, 1,112 were inguinal hernia;
639 were crural hernia; 560 were umbilical hernia ; 543 were vagi-
nal hernia.

Of 8,237 cases of inguinal hernia observed in males, 4,483 occur-
red on the right side ; 3,733 occurred on the left side ; 16 not deter-
mined.

Of 1,112 cases of inguinal hernia in females, 542 occurred on the
right side ; 564 occurred on the left side ; 6 not determined.

Of 307 cases of crural hernia observed in males, 171 occurred on
the right side ; 125 occurred on the leftside ; 11 not determined.

Of 639 cases of crural hernia observed in females, 344 occurred
on the right side; 255 occurred on the left side; 40 not determined.

From these figures, Mons. Maisonneuve deduces the following
corollaries: —

First. Hernia in males are to hernia in females, as 3 to 1.

Secondly. In 100 hcrniae found in males, 93 were inguinal, 4
were crural, 3 were umbilical; whilst, in 100 cases of hernia found
in females, the proportion was 40 inguinal, 21 crural, 20 umbilical,
19 vaginal.

Thirdly. In men, inguinal hernia are met with as often on both
sides as on one only, and in the latter case, those of the right side
are to those of the left, in the proportion of 5 to 4.

But in women, inguinal hernia are met with on both sides, three
times out of Hmr, aiid those of the right side are to those of the left,
in the proportion of 5*42 to 5'64.

Fourthly. In men, crural hernia are met with on one side only,
three times out of four, and tho?e of the right side are to those of
the left, as 7 to 5 ; whilst in women, crural hernia are met with on
one side only, 4 times out of 5; and those of the right side are to
tho<?e of the left as 7 to 5.

Under the head, vaginal hernia, are included all tumours of the
vagina and uterus presenting externally, and requiring the use of the
pessary, as cystcceles, rectoceles, and prolapsus of the vagina and
uterus.

Under the head umbilical hernia, are included hernia of the linea
alba, and displacements referahle to the neighboring regions. — Med,
Times, from Gazette des Hopitaux.

Case of Twins ; tJiere being an interval of tliirty-iiDO days between
their Birth. — John IRVI^'E, a surgeon in the British navy, records,
in the Medical Times, (28lh Dec, 1844,) the following remarkable
case. Mary F., aged 35 years, was seized with labour pains, on the
1st of October, at the full period of utero-gestation ; and was deliv-
ered by Dr. Burleigh, of a healthy, but rather smalbsized female

1845.] Term of Pregnancy. — EvoIuUon and Delivery. 479

infant, Thr^e hours afterwards the placenta was cast off by tho
natural contraction of the uterus. Dr. Burleigh, on examining the
patient at this stage, clearly ascertained that the uterus was still in a
gravid state. After waiting some time for the renewal of parturient
efforts, he left, with instructions to be sent for when labour commenc-
ed. On visiting his patient three days afterwards, he found her out
of bed following her usual domestic affairs, and in good health. On
the 2d of the following November labour pains came on, and just as
Dr. Burleigh arrived, a large healthy male infant was born, and two
hours afterwards, Dr. B. extracted the placenta. The patient's re-
covery was as rapid as previously, for on the third day she was at-
tending to her family concerns. — Am. Jour, of Med. Sciences.

Term of Pregnancy exceeded by Four Weeks. — A pregnant wo-
man, who had already borne three children, was attended by Dr.
Hayn, of Konigsberg, for "gastro-nervous fever." The affection
was so severe that premature labour was threatened. Dr. H. mado
an examination jper vaginam, and felt satisfied, as well from this as
from the woman's account, and her other symptoms, that the natural
term of her utero-gestration would expire about the 23d of May,
1841. The patient recovered from her fever, and at the^above-men-
tioned date was seized with weak labour pains, copious mucous se-
cretion from the vagina, and remarkable sinking of the uterus into
the pelvis. After three days the pains wore away; and four weeks
thereafter the woman wns with difficulty delivered of an unusually
large child. — IS orlhern Journal of Med. ^ May, 1844, /rom Caspar's
IT oc/ien«cAri/i!, No. 47, 1843. Ibid.

Evolution and Delivery with Presentation of the Arm and Shouh
•^er. By Dr. Sussewind. — [We give the foilov.'ing case as we find
it quoted in the London Medical Gazette, 2()th December, 1844,
from Caspar's JVochenschrift, No. 23, the dimensions of the foetus
are not given.]

A healthy woman, who had already had several children without
difficulty of any kind, was taken in labour again, and besides the
waters, lost a considerable quantity of blood. When seen first, the
right upper extremity of the fcetus was found projecting from the
external parts of the mother : the pains at this time had almost ceased,
but on an attempt being made to introduce the hand, and turn, they
came on again with such violence that the attendant was on the point
of taking away some blood to moderate their force. The mother
now said she felt the child advancing, and in fact, the right shoulder
and collar bone were forced beyond the vulva : the lower extremities
and buttocks were at the same time forced into the hollow of the sa-
crum, and by and by the right ramus of the lower jaw came into
sight, the shoulders and arm having receded. But little effort was
required to disengage the breech, upon which the child was quickly
born ; but it was dead. The placenta followed, and an hour after-
wards the woman felt herself very comfortable. — Amcr, Jour.

480

Medical Intelligence, — Meteorological Table.

MEDICAL INTELLIGENCE.

We learn from a correspondent that a Medical Society was formed for East
Tennessee, at Knoxville, on the 7th May last. The name assumed is " The
Medical Society of East Tennessee." The object of the association "will be to
improve and elevate the standard of Medical Science within its limits — to elicit
information by reports of cases, epidemics, &c." At the annual meeting in May
next a prize will be awarded to the best essay on Erysipelas. S. B. Cunning-
ham, M. D.,of Jonesboro', is President, and F, Ramsay, M. D., of Knoxville?
Corresponding Secretary of the Society.

METEOROLOGICAL OBSERVATIONS, for June, 1845, at Augusta, Ga.
Latitude 33° 27' north — ^Longitude 4° 32' west Wash. Altitude above tide
152 feet.

Thermometer.
Sunrise. 4, p. m.

Barometer.
Sunrise. 4, p.m.

Wind.

ReMj^RKS.

30 in.

29 9-10

Fair.

9-10

7-10

S. E.

Fair.

9-10

s. e.

Fair.

9-10

s. e.

Fair.

• 87

8-10

Cloudy.

9-10

Flying Clouds.

9-10

S. E.

bo. do.

9-10

8-10

S. E.

Do. do.

9-10

8-10

S. E.

Fair — blow.

9-10

Showry 1^-10 in. — hot vapour.

9-10

8-10

Cloudy.

, 72

8-10

7-10

Blow— variable.

7-10

8-10

Fair. [1-10 inch.

8-10

Fair — storm of wind and rain

9-10

8-10

N. W.

Fair — shower 2^-10 inch.

9-10

Variable.

Rain 8-10 inch— storm.

8-10

9-10

s. w.

Cloudy — thunder, &c.

8-10

9-10

N. W,

Rain at 3, p. m., 1 inch.

30 in.

29 9-10

S. E.

Fair.

9-10

S. E.

Cloudy.

8-10

7-10

Fair.

7-10

Fair— stiff breeze.

7-10

Fair, do.

2^1

8-10

Fair, do.

8-10

7-10

Fair — thunder and lightning.

7-10

8-10

Fair— thund. and light. 9, p.m.

8-10

Variable — thunder, showery.

8-10

7-10

N. VV.

Variable — storm of wind.

7-10

5-10

Showery 3-10 inch.

9-10

8-10

Fair.

16 Fair days. Gluantity of Rain, 2, 6-10 inches. (Quantity of Rain for first
six months of 1845 — 14, 2-10 inches. During the last four months, less than 7i
inches. Julv 23d, at 4, P. M., Therm. 100°— in sun 131°.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I.] NEW SERIES— SEPTE)1BER, 1S45. [No. 9.

PART I.— ORIGINAL COMMUNICATIONS.

ARTICLE I.

Intermittent Fever — -its various forms — their treatment — with Cases,
By Lewis D. Ford, M. D., Professor of the Institutes and Practice
of Medicine in the Medical College of Georgia,

The writer of the present article comes to redeem the promise
made at the conclusion of a former one on the Pathology of Inter-
mittent Fever, in the 1st No. of this Journal, by noticing some of the
varied forms of Intermittent fever, with a view more especially, to
their treatment.

Under this head he proposes to take up Malignant Intermittent,
Remittent, and some forms of Continued Fever.

In the "Practice of Physic " of almost every author in our Ian-
guage, these forms of fever are considered as different species of the
same genus or as themselves distinct genera; and the doctrine too
generally inculcated is, that they have no common pathology, so that
it may be taken as the prevalent opinion, that each requires a dis-
tinct and peculiar treatment. In this state of things, the writer is
not without his fears, that to arrange these forms under one head — to
co-ordinate them by one general principle of pathology and of treat-
ment, may be regarded a presumptuous deviation from the beaten
track ; but he hopes to show that though different in manv of their
external features, yet they are fundamentally, of the same nature
and require the same general mode of treatment.

It is propped to give a brief description of these three forms io

482 Intermittent Fever. [September,

illustrate them by specific cases, and to deduce from these cases,
some general considerations as to their pathology and treatment.
We shall embrace in one view almost all the varieties of fever known
to this region of country, by whatever names they may generally be
called ; for it is well known to every practitioner of experience, that
idiopathic, endemic fevers of this climate of miasmatic origin, pre-
vailing in the summer and autumn, uniformly present at their begin-
ning, at least, a paroxysmal character — that cases of fever continued
from their commencement are extremely rare, this latter form being
the endemic of the winter season of cold climates and caused by
concentrated human effluvia.

Malignant Intermittent. — This form receives its name from its
great danger. If simple Intermittent fever claims our attention by
the interest of its pathology, this complicated form demands it on
higher grounds; for, whereas the first is a disease easily diagnostica-
ted, easily cured — cured, in the great majority of instances, as well
by the intelligent planter and by the ignorant doctor as by the most
skilful of the profession, and never fatal; the latter is insidious, rapid
in its progress, and without appropriate treatment, uniformly fatal in
its termination ; and yet, with all this, in competent hands, as man-
ageable almost as the simpler form.

This disease is known to the profession at large, by the elegant
standard works of Torti, Alibert and Bailly, as raging endemically,
at Rome and other localities within the influence of the celebrated
Pontine Marshes, s Subsequent to these, we have histories of the dis-
ease by some distinguished French army surgeons, as it occurs in the
north of Africa and in other situations exposed to malarious exhala-
tions of peculiar virulence. But it is a sad mistake to think that it ex-
ists only in such pestiferous localities. \The young practitioner of this
climate should know, that although his lot is not cast within the influ-
ence of the pontine marshes, he will be called upon to treat sporadic
cases of this disease, occurring in situations, where simple intermit-
tents and remittents are the prevalent forms. The lineaments, there-
fore, of this formidable disease should be known to him, its danger
appreciated, its pathology and its proper treatment settled, otherwise
liis sporadic cases will too often prove fatal cases, in his hands.

The forms of Malignant Intermittent are almost infinite ; but this
general description will apply to them all — viz : intermittents at-
tended with inflammation or congestion of some vital organ, so
extreme as to endanger its integrity and the life of the patient, during

1S45.] ^ Intermittent Fever, 483

the paroxysm ; at the conclusion of which, however^ there comes on a
perfect intermission of all the violent symptoms. This latter trait
is apt to deceive the inexperienced physician, leading him to a false
prognosis and consequently to an inefficient practice, when the most
prompt and energetic treatment is demanded ; for one of these vio-
lent paroxysms, whether the first of the attack or succeeding to milder
ones, is the sure harbinger of others still more violent — so that if
unchecked, the disease will prove flital at the third, fourth or fifth
paroxysm.

Torti, the distinguished physician of Modena, in his work, enumer-
ates seven varieties of this fever. Subsequently, Alibert, in his Inau-
gural Thesis, extended the number to nineteen, naming the varieties,
according to the prominent malignant symptom ; such as, the hepatic,
syncopal, algid, soporose, nephritic, &;c. They may all, however,
be embraced under three general divisions: — 1st, those cases in
which the cerebro-spinal organs are chiefly affected ; 2nd, those cases
in which the thoracic organs ; and 3rd, those in which the abdominal
organs suffer most.

The first division embraces the comatose, delirious, convulsive,
tetanic, tScc. — varieties marked respectively by coma with its accom-
panying symptoms, by delirium, convulsions, &c., these symptoms
becoming urgent during the paroxysm, and disappearing as it abates.
In the comatose variety, of the tertian type, it is not uncommon for
the intermission to pass without a trace of head-ache remaining ; not-
withstanding which a more violent paroxysm may confidently be
expected.

The second division embraces such as are marked,during the par-
oxysm, by symptoms of pleuritis, pneumonia, syncope, &;c.

The third embraces such forms as the cardialgic, peritonitic, chole-
ric, dysenteric, hepatic, &c.

The cardialgic is marked by excruciating pain at the epigastrium,
either continuous or intermittent ; in the latter case, grievous com-
plaints are forced from the patient, accompanied with great anxiety
of countenance, and vomiting, and often with general spasm of the
muscles. Thus too, in the choleric form, the paroxysm is marked
by all the symptoms of cholera morbus, the intermission being free
from them.

But there is a form of malignant intermittent, of more frequent
occurrence, perhnps, than any other, known by the name oi algid
fever, and marked by the following symptoms : — During the cold

484 ' Intermittent Fever, [September,

stage, which is unusually protracted, there is a great degree of op-
pression at the chest and abdomen, prostration of strength and rest-
lessness. There is an attempt at the formation of the hot stage,
which proves abortive ; for soon the skin becomes cold, pale and
shrunken, on the extremities, but cool elsewhere, and covered with
a cold, clammy perspiration, while only the central parts of the body
are very hot. The pulse is small, frequent and almost imperceptible
at the wrist, increased restlessness, jactitation, impatience of bed
covering, with complaint of oppressive heat, not only at the chest and
abdomen, but even on the cold extremities, so that the patient refuses
to have them covered. The intellect is generally undisturbed, and
the expression of the countenance quiet, even where the disorder of
the temperature and circulation is so extreme, that the tongue even
becomes cold and the pulse ceases. This irregularity continues
through the whole period of the paroxysm,andit isonly at theend of it
that the temperature and circulation are partially restored. When
we consider that the functions most conspicuously disordered in this
algid fever, are those of circulation and of calorification — functions
dependent on cerebro-spinal nervous influence, we are disposed to
place this form under the first division, and to regard these symptoms
as dependent on an aggravation of that peculiar lesion of these cen-
tral organs, which constitutes the fundamental character of intermit-
tent fever. At any rate, this algid state is not a prolonged chill ; for
almost universally, in such cases, the chill is separated from this
peculiar cold state, by symptoms of imperfect reaction. The two
states, moreover, are shown to be different by this striking fact, that
in the chill, the temperature is not absolutely diminished — at least,
not in proportion to the patient's complaints of coldness; whereas in
the algid state, the temperature, as measured by the thermometer, is
positively diminished, while the patient complains of burning heat.

In each of these forms, as will be perceived, there is combined a
local phlegmasia or congestion with intermittent fever, which latter
may be of the quotidian, tertian or any other of its types. What is the
relation of the local affection to the intermittent fever ? — a most im-
portant question, inasmuch as the decision of it must necessarily
determine our therapeutic measures ; for if it bear the relation of
cause to the intermittent fever — if it be the fundamental lesion, upon
which the whole disease depends, then the rational treatment is to
subdue this local affection ; and the antiphlogistic regimen becomes
the main part of the practice. If, on the other hand, it be regarded

11^45. J Intermiltent Fever. 485

only as an accident, complicating the intermittent fever, which latter
disease might continue, even if this were removed, then the indication
is to treat both the intermittent and the accident, each by its appro-
priate remedy. This latter view, it is believed, is the correct one.
The writer contents himself with merely stating this opinion here,
leaving the considerations, by which it is sustained, to be adduced,
when commenting upon special cases, hereinafter given. Let us
regard, then, this disease as consisting of two distinct elements — an
intermittent fever and a local phlegmasia or congestion, having no
necessary relation with each other ; at least the latter not the cause
of the former — let us regard the recurrence of successive paroxysms
as the true source of danger, inasmuch as they renew the local affec-
tion and push it to the degree of fatal disorganization. By this
view the intermittent fever becomes the main affection, and our ruling
indication must be, to prevent the recurrence of its parozysms; and
the local affection will rank only as ah accident, yet not an immaterial
accident, but one, the increase of which constitutes the final danger
of the case. Of course, another prominent indication, under this
view, will be to subdue the local phlegmasia, or congestion. Thus, as
in simple intermittent, the treatment will have respect both to the
intermission and to the paroxysm, and so will be both antiphlogistic
and antiperiodic. But how shall an expected paroxysm be met? —
May we venture, in such cases, to use the great antiperiodic quinine?
What ! administer quinine after a paroxysm, during which the
patient has manifested the symptoms of congestive apoplexy or of
pleuritis, or above all, of gastritis, and while there yet remains the
symptoms of gastritis or phrenitis, only a little moderated in vio-
lence,— what! in an hour or two after having depleted the patient
to the fullest extent that prudence could justify, urged thereto by
extreme violence of the local affection, shall we suddenly turn round
and administer the iowjc quinine? We answer, yes — for it is the
only hope of the patient — the sheet-anchor of the case, and if it hold
not, the vessel is a- wreck.

It seems proper here to specify two practical precepts of great
value — the one in reference to the dose of quinine, the other to the
time for its administration. As to the dose, the quantity given during
the intermission, is to be directly proportioned to the danger appre-
hended from the expected paroxysm, — if from the existing state of
the patient and the violence of the preceding paroxysm, we apprehend
that tiie coming one will prove fatal, the quantity given should be

486 Intermittent Fever. [September,

thirty-five or forty or fifty grains. As to the time for commencing its
use, this is immediately on the cessation of a paroxysm; even if the
case have the tertian type, this rule must not be violated, for we have
no security that it may not change into the quotidian. If of the
quotidian type, we should not wait for the entire cessation of the
paroxysm, but commence the use of the specific, with the sweating
stage, lest the complete intermission should not allow time enough to
bring the patient under its peculiar influence.

It need scarcely be added, that the treatment during the paroxysm
is that which would be appropriate to an idiopathic inflammation —
general bleeding and local by leeches, and cups and revulsives,
sinapisms and blisters.

This way of treating both elements of this compound disease, by
the alternate and sometimes even the conjoined use of active deple-
tion and quinine, is directed by an enlightened pathology, and sanc-
tioned by the highest authority.

The following cases from the writer's note-book will sufficiently
show the sporadic occurrence of this disease in situations remarkable
for the benign character of their fevers, and at the same time exhibit
its symptoms more in detail. Other cases from foreign authors are
added to illustrate its pathology and its appropriate treatment.

Case 1. T. H., aged about thirty-five, was brought to the City
Hospital on 28th Sept., 1840, at 5, P. M., with no account of him,
except that he was brought from Bridge-row, and was taken with fever
in Hamburg, two days before. At 6, P. JM ., this was his state ; Skin
uniformly hot. perspiring on the head and breast; face flushed ; abdo-
men moderately ful!, fsBces (yellow) and urine discharged in his
clothes ; pulse 105, full and strong ; respiration frequent ; tongue and
lips moist; breath very offensive ; eyes closed, the eye-lids resisting
attempts to open them, eye-balls turned upwards ; slight spasmodic
twitching of the muscles of the extremities, when the limbs are
moved ; no paralysis ; perfectly stupid, and not aroused by the loud-
est call ; shrinks and groans from pressure on the middle dorsal ver-
tebrae. (A ligature to the top of each thigh to produce distention
of the veins of the lower extremities; V. S. 20 oz. produced
diminution in the strength of the ^^w/^e, almost obliterating it;
gaping, diminished redness of the face and a relenting of the
current of blood from the arm. In this state, thefnger being upon
the pulse, the ligatures on the thighs, were simulianeously and sud-

Ib45.] Intermittent Ftcer. 4a7

denly relaxed; the current of blood from the open vein was renewed
and the pulse increased in strength. Scarifications to the dorsal
spine, with cups, yielded 3 oz. stupor unrelieved ; 10 grs. sulphate
of quinine, in solution, every two hours, as soon as the patient can
swallow.)

29th, 8, A. M. Pulse 90 and soft ; skin cool ; eyes still closed ;
resisting attempts to move him ; impossible to arouse him ; has taken
nothing, having remained stupid during the night. (10 grs. sulphate
of quinine, in solution, every two hours : one dose was forced down
him ; saline injection.) 12, M. Has taken the third dose of quinine ;
injection has procured stools. {Blister plaster 7 by 4 inches to the
dorsal spine.) 8, P. M. Still stupid; pulse 90 ; respiration not
hurried; opens his eyes, when loudly called. (Two blister plasters
to the legs ; water during the night, if called for ; two more doses of
quinine.)

30th, 8, A. M. No fever ; very deaf; asks for water; complains
of blisters. (Cold water and thin gruel.) 3, P. M. Met the patient
stalking about the entry, begging for water; skin cold; pulse ex-
tremely feeble from this effort. (Blisters to be dressed; water and
gruel.)

Oct. 1st, 9, A. M. Quietly in bed; no fever; senses entirely
restored ; hearing good ; asks for water. The case was transferred
to the Physician for October.

Note. — Intermittent fever at this time prevalent in Augusta and
Hamburg.

P. S. — The convalescence of T. H. was steady ; he was discharged
in a few days.

The facts with regard to this patient that he was taken with fever,
in Hamburg, on the 26th, and that on the 28th he was picked up in
Bridge-row, in Augusta, seemed to warrant the conclusion, that sub.
sequently to his attack of fever, he was so far recovered as to be able
to walk over the bridge, and farther — that he was laboring under par-
oxysmal fever — that he was, on his admission to the hospital, either
in the second or third paroxysm. Notwithstanding the depletion, gen-
eral and local, the coma continues through the whole period of a parox-
ysm, no abatement, until the following morning, and this improvement
coinciding with the abatement of fever. In the uncertainty as to the
type, whether quotidian or tertian, the q'jinine is ordered as soon as
the patjput can be rni'le to swallow it, lo«t by waiting for a perfect

488 IniermiUcnl Fever. [September,

recovery of the senses, the remaining time of the intermission should
not be sufficient to place the patient under its influence. It is worthy
of remark, that here is a case of the most malignant character, brought
to a happy and a speedy termination, simply by general and local
depletion and revulsion external, and one saline injection, without a
single dose of cathartic medicine. Would this antiphlogistic treat-
ment alone, without the quinine, have arrested the paroxysms? The
fact in this one case will not warrant us in answering — No ; but the
writer feels fully assured that the candid practitioner, who has had a
fair opportunity of contrasting the two modes of treatment, will an-
swer no, unhesitatingly. V But, who would incur the hazard of another
paroxysm in such cases, when he holds in his hand a remedy of un-
doubted power to prevent it, and this a safe remedy ? — for surely we
are warranted by the facts of this case, to draw the conclusion, that
quinine may be safely used in large doses, even in the comatose form
of Intermittent fever. Here, under the action of 45 grains of
quinine, the patient comes out from a profound stupor, and recovers
his senses, while under the full influence of the quinine, as his deaf-
ness proves. This case also, incidentally illustrates the value and
mode of operation of the tourniquet as a therapeutic agent.

Case 2. A. B., aged thirty-five, residence middle of Broad-street,
cotton-buyer — habits intemperate — full habit, plethoric. Oct. 19th,
1840.— On the 17th, at 11, P. M., had a chill, and on the morn-
ing of the 18th represented himself to have had fever and to have
passed a restless night — was not confined to bed on the 18th, but at
11, P. M., of the 18th had a chill, (as he subsequently informed the
family,) and two hours afterwards was found stuj)id ; on the afternoon
of the 18th was free from fever, and sat up for two or three hours.
Has taken no medicine. On the KJth, 2, A. M., first visit, find him
thus: — Head hot, face flushed, skin universally hot and dry; breath
very offensive; respiration hurried; breathing laborious; pulse full
and strong and 115; eyes closed, resists attempts to open the lids;
impossible to arouse him or to command his attention; the arms are
folded on the breast, the fore-arms rigidly flexed upon the arms, and
he resists attempts to extend them ; lower extremities extended at full
length, the legs crossed over each other; he resists every attempt to
change his position. (F. *S^. about 50 02., reduced the strength
and frequency of the pulse ; 30 grains Calomel, irhcn able to swaL
lo w ; s a I i n e i njectio n ; hot jfcdiluviu m . )

1845] Intermittent Fever. 489

19th, 8, A, M. Got neither the injection nor the pediluvium ;
took the calomel, with great difficulty, at 4, A. M. Muscles less
rigid ; unable to speak ; only opening his eyes slightly, on the great-
est efforts ; pulse 100, full and soft. {Saline injection; Infusion
of Senna, Salts and Manna.) 1,P. M. Head more clear ; muscles
relaxed ; has been up to stool ; three copious stools. (40 grains
quinine in solution — quarter every two hours.) 9, P. M. Has taken
40 grains quinine; pulse 105, soft and full ; his intellect, under the
use of quinine, has become entire ; three more stools ; roaring of the
ears. {Sinapis?ns, the whole length of the spine, at 10, P. M.) 11 ^,
P.M. No chill; very deaf ; no head-ache; pulse as before. {Cold
water and gruel. )

20th, 8, A. M. No chill, last night ; has slept a little; pulse 115
and strong; head-ache; is quite deaf. {V. S. 20 or.) 3, P. M.
Still head-ache violent; deafness somewhat abated. {V. S., Com-
pound Senna Infusion.) '

During the night of the 20th, his fever was light ; on the morning
of the 21st, he was without fever — he was salivated. His convales-
cence was slow, being retarded by an attack of mild delirium tremens;
which was due possibly to too free depletion ; it was relieved by
morphine. On the 10th November, he suffered a paroxysm of Inter-
mittent fever; which was followed by two others, of the tertian
type. This simple fever was arrested by moderate doses of quinine.

This is a case ofquotidian Malignant Intermittent, and shows strik-
ingly many of the characteristics of this affection : that paroxysms,
marked by the most malignant, dangerous symptoms, may yet be fol-
lowed by a perfect intermission — this patient being comatose in the
second paroxysm, is yet, before its access, sitting up and conversing
freely with the family, giving an account of his chill, &c. — that it is a
perfect Intermittent. It shows, too, a progressive increase in the vio-
lenceof the paroxysms; the second so violent as to warrant the opinion,
that another would prove fatal. It shows the safety of giving 40 grs. of
quinine a few hours after a state of cereljral congestion so great as to
require most copious bleeding to relieve it, and therefore commends
this medicine to our fullest confidence, under such circumstances.
To any one, who could possibly doubt if this were a case of Intermit-
tent fever, we have a corroboration in the fact, that at the third heb-
domadal period, it is renewed, in the simple form.

, Case 3. Nov. 22d. A. R.. aged fiftv-five ; residence on lower

490 Intermittent Fever. [September,

^ Broad-street ; of active habits : full habit, florid complexion, perma-
nently red nose and cheeks — a free liver and drinker. Three weeks
since, he had three paroxysms of quotidian Intermittent fever; for
which he took, by his own prescription, one active cathartic and ten
grains of quinine. Since then his mind has been harrassed by em-
barrassed business.

On the 20th, had a slight chill, about the middle of the day. On
the morning of the 21st, represented himself as having been crazy
during the previous night. On the 21st, a chill about 12, M. ; was
in his room alone, upon the sofa, during the afternoon, and slept alone.
On the morning of the 22d, was at the breakfast table, but was ob-
served to look very unwell, and represented his head as feeling very
bad, and that he had slept soundly, without waking, the whole night;
ate a hearty meal. At 10|, was suddenly seized with a chill ; free
vomiting, discharged the whole of his breakfast ; went to bed, com-
plaining of a violent head-ache. 22d, 1, P. M., first visit — this is
his state: face flushed ; skin hot, universally ; eyes staring, the eye-
lids frequently snapping violently; he answers to every question in
a hurried manner — Yes sir — and attempting further, to speak, but
splutters with his tongue ; the muscles of the extremities as well as
of the tongue are extremely agitated — fingers and toes being perpet-
ually in motion, and occasionally, one or other of the limbs convul-
sively agitated ; lies on his back, and resists every attempt to move
him ; the action of the heart excessive, and its impulsion against the
ribs fearfully violent ; pulse in the left arm very small, but tense;
{Note. — Anomalous distribution of radial artery of the left side.)
in the right arm, full, strong and utterly incompressible, elevating the
finger, when forcibly held upon it — 120. (F. S. 50 to 60 oz. ;
40 grs. Calomel; strong Saline Injection.) Bleeding was difficult,
on account of the restlessness of the patient, uncontrolable ; — by this
copious bleeding, the pulse was not entirely subdued, being still full
and strong. The calomel was greedily swallowed. The introduc-
tion of the saline injection increased his agitation extremely ; this
agitation seemed to depend on the effort to resist its rejection from
the bowels and that of attempting to get out of bed ; during this time,
he was pulling forcibly, at the penis and testicles ; was lifted from
bed and placed upon the easy-chair stool ; still he had not intelli-
gence enough to perceive that he was on the stool ; but forcibly closed
the spincter of the rectum, and continued to drag at the testicles, 6zc.
This resistance to discharging of the bowels wns finally overcome

1845.] Intermittent Fever. 491

only by filling his bowels with repeated injections. During this
manipulation with the patient, his linen was observed to be exten-
sively stained with urine, but now dry ; — during tiiis struggle, the
orifice in the vein bled an indefinite amount, saturating the sleeves
of two shirts and running down to the hand, before the accident was
discovered ; after discharging the bowels, he was removed to bed ;
the pulse now much reduced in fret[uency and strength ; muscles
composed; skin perspiring ; still answers but yes sir, to every ques-
tion ; same want'of control over the muscles of the tongue, on any
attempt to speak ; at 4, P. M., a compound cathartic of salts and
senna ; this produced three or four copious stools, in the beginning
af the night. 22d, 12 at night — pulse 100, soft and full ; skin soft ;
muscles not entirely quiet, but much less agitated ; still answers,
yes sir, to all questions, but with less vehemence and with more de-
liberation ; the attempt at further articulation, ends in a spluttering ;
I estimate that he does not know me. (36 grains quinine, in
solution, one-third every two hours, commencing at 2 o'clock.)
^ 23d, 8, A. M. Has taken 36 grains quinine, the last dose at six
this morning; he recognizes me; indisposed to talk — answering no
to some questions, but cannot command his tongue perfectly enough
to utter more than four or five words ; slight head-ache ; pulse 95,
soft; skin soft ; tongue soft and moist, not furred, trembles on thrust,
ing out ; has taken some gruel. [Sinapism to the whole of the sjjine—^
which is tender on pressure, at the third, fourth and fifth dorsal ver-
tebrae— to be kept on as long as it can be borne.) 12, M. No
chill; speech much improved; some remaining difficulty of utter-
ance; complains of difficulty in finding words to express himself ;
gives some account of the state of his health, previous to yesterday,
but remembers nothing of the transactions of yesterday. 10,
P. M. Still deaf; no head-ache ; improved in every respect ; two
yellow stools in the afternoon. (3 grains quinine every two hours,
from 12 to-night to 8 in the morning — equal to 15 grains.)

24th, 9, A. M. Has passed a comfortable night ; asks for coffee.
{No medicine — gruel and water.) 9, P. M. Very deaf; no fever.
{Pediluvium hot.)

25th, 9, A. M. Has passed a good night ; is sitting up, taking
coffee and toast ; hearing perfect; some soreness of the gums, the
more annoying from having a set of artificial teeth.

28th. Discharged, having improved steadily ; suffering only some
slight inconvenience from sore gums.

492 Intermittent Fever. [September,

Here is a patient, about the tiiird hebdomadal period from an at-
tack of simple intermittent, seized with intermittent malignant in its
very first paroxysm : yet that first not so violent as subsequent ones ;
for he retained, during the night of the 20th and the subsequent
morning, some recollection of his case, saying he had beei^crazy.
The second paroxysm, more violent than the first, passed without his
consciousness, as he represented himself to have slept soundly ; and,
moreover, the urine-stain on his shirt, and its dry state, warrants
the inference, that his coma was so profound as that Re, unconsciously,
discharged the urine in his bed. A quotidian Intermittent — a true
intermittent, for he is able, after such a violent paroxysm, to dress
himself, appear at the breakfast table, and even to eat a hearty meal.
The third paroxysm still more violent, the local symptoms so urgent,
as well as the general arterial action, as to warrant the opinion that
without the freest depletion, irrecoverable injury would have been
done to the brain — illustrating the necessity of treating vigorously,
the local affection, whether of the nature of congestion or of inflam-
mation. The question very naturally presents itself — what would
probably have been the course of this case, had it been trusted to the
antiphlogistic and revulsive treatment alone, without quinine? In
all probability, the paroxysm would have returned on the 23d, and
considering the degree of cerebral disease, which existed at 11, A. M.
of that day — the period of the expected paroxysm, is it not reasona-
ble to presume, that under the commotions ofa paroxysm, the brain
would have been disorganized to a fatal degree ? When it is remem-
bered that the brain, at 11, A. M., of the 23d, was in a state of far
greater disease than at 11, A. M., of the 22d, and the danger of that
paroxysm is remembered, we think another one would have proved
fatal, notwithstanding the most vigorous antiphlogistic measures had
been used. At any rate, where is the wisdom or prudence of sub-
jecting a patient to such imminent danger, when it can be arrested
by a safe remedy? — for surely this case confirms the opinion of the
safety of quinine in large doses, on the decline ofa paroxysm of cere-
bral malignant fever. This patient was not exposed to any peculiarly
virulent miasma ; for he was still living under the same circumstan-
ces as when he suffered an attack of simple intermittent, three weeks
before ; — one of the commemorative circumstances, however, sug-
gests to us the determining cause of the malignity of cases occurring
in ordinarily healthy localities. One of his organs (the brain) was
found prcdispoi;cd to become congested by the high general arterial

1845.] Intermittent Fever. 403

action of a paroxysm — predisposed by fatigue and over-exertion coin-
cident with an anxious state of mind. An analogous case is, at thij
time passing under the writer's notice — a case of chronic diarrhoea
of three months standing, from which the patient, a young man of 20,
was gradually recovering — when after a week's residence on the
bank of a mill-pond, an attack of a quotidian remittent fever renewed
the chronic affection of the bowels — the choleric symptoms increasing
and abating with the exacerbations and remissions of the fever, and
becoming more and more violent in each succeeding paroxysm, until
on the 5th, the patient seemed in imminent danger. The antiphlogis-
tic treatment alone, founded upon the opinion that the prominent
local disease is the essential cause of the fever, maybe demonstrated
by the records of practical medicine, to be not a uniformly unsuccess-
ful, but certainly a hazardous one — as hazardous as unphilosophical,
for well authenticated cases conclusively establish the principle, that
the Intermittent fever is independent of the local inflammation or
congestion. Impressed with the importance of this principle, the
writer here adduces a case from Bailly, with the remark that such
like cases could be multiplied indefinitely. /

Case 4. *"An Irishman, living at Rome, was attacked, in the »
month of August, 1822, with fever, and extreme pain in the belly. In
the morning, when I saw him, he was in a state of agitation, difficult to
describe — he was tossing himself upon the bed, with his hands pressed
against the belly ; screaming from the violence of pain ; his tongue was
a little white, but neither red nor dry; no thirst ; the pulse strong and
very full. He was bled 16 ounces from the arm, and twenty leeches
applied to the abdomen. In the evening, the paroxysm had abated
and a tranquil night ensued. The next day was passod without
fever or pain. The third day,^in the morning, a paroxysm com-
menced with a chill, and was marked by the same violent abdominal
pains as in the first paroxysm. Bled again to the same amount, and
twenty leeches applied to the abdomen ; diet and mucilaginous
drinks. This paroxysm is terminated as the first, in the evening ;
the night tranquil. The fourth day a complete intermission. On
the fifth day, the paroxysm returns in the morning, but with this
striking difference — although agitated as much as in the preceding
paroxysms, his complaints as desperate, his restlessness as great, in
short, seeming to suffer as much pain, yet he could not designate the

* BMLLY—Traitc Ficvrcs Inkrmiitcnfcs. 18C5.

491 ' Intermiltent Fever. [September,

seat of his suffering. As his intellect was perfect, I repeated fre-
quently the question — Have you pain in the belly? lie uniformly
answered me that he had not, and continued to refer his distress to
the general state of his system. Judging him to be free from danger,
without medication, he passes through the paroxysm, which termin-
ates as before, in a perfect intermission ; the calmness of which
contrasts strikingly with the anguish and distress of the previous par-
oxysm. I prescribed 15 grains sulphate of quinine, in three powders,
during the morrow. On the seventh day, he experienced a general
uneasiness, but not to be compared to the suffering of previous par-
oxysms. The sulphate of quinine was continued, for a few days, and
his recovery was perfect."

This case distinctly proves the independence of the fever upon the
local affection ; for by the judicious antiphlogistic treatment daring
two succeeding paroxysms, this abdominal disease is subdued so com-
pletely, that in the third paroxysm, no further antiphlogistics are
used ; yet the tertian fever continues — continues until arrested by the
specific. It shows also the insufficiency of the antiphlogistic treat-
ment, even when it entirely cures the local phlegmasia, to arrest a
paroxysmal fever. A case analogous to this is recorded by Morgag-
ni : — "A patient was first attacked with dysentery without fever —
then fever supervened, of the tertian type, the dysentery still con-
tinuing its course ; the intermittent ceased, yet the dysentery still
continued ; finally a continued fever comes on, with stupor, deafness
— death." We must infer from such like facts as these, that the
lesion upon which depends intermittent fever is a specific one of the
cerebro-spinal system ; and that whilst the local congestions of ma-
lignant intermittents are controlled by anti-phlogistic measures, this
is controllable with even greater certainty, by the specific quinine.

J Case 5. Oct. 11th, 1842. — A mulatto woman resides at the
Academy lot, aged 42, having borne many children, has now an infant
of 8 months. Represents herself to have had a chill, on the after-
noon of the 9th, followed by fever — was up and about her work on
the morning of the 10th ; but at noon was taken with a chill, since
which she has suffered, up to the present moment, with head ache,
vomiting, pain, &c. This is now (11th Oct., 9, A. M.) her state : skin
covered universally with urticaria^ itching extremely ; skin warm ;
intellect perfect, hut her communications are interrupted by violent

1845.] Intermittent Fever, 495

pain at the epigastrium, increased at intervals ; no cough except after
vomiting; respiratory murmur perfect, but respiration frequent and
irregular, rendered irregular by the violence of epigastric pain, urgent
thirst, the tongue of a natural color and moist, perfectly clear at the
anterior half, slightly furred behind, where the papillae are enlarged.
At the bed-side is a tin basin, nearly filled with matter vomited, con-
sisting of watery fluid and mucus in large flakes floating upon it,
and of a brownish black colour ; pain at the epigastrium increased
by pressure ; exquisite pain on pressing third, fourth and fifth dorsal
vertibrce ; one stool yesterday ; pulse extremely small, barely per-
ceptible and very frequent. 10 ne pint of Cold Water at a draught;
V. S. 16 oz.) Faintness, as was anticipated, followed the bleeding
and vomiting of the same dark colored mucus and some perspiration
over the upper part of the body. At 10, A. M., she took 16 grains qui-
nine, in solution, which being vomited, with more of the black mucous,
another dose was given and retained, and repeated at 11 and at 12
M., and retained At 12 M., two scarifications to the spine with
cups drew 4 ounces blood. Sinapisms over the whole abdomen and
spine to be renewed, llth, 9, P. M. Has retained all the quinine ;
has great distress at the epigastrium, with a desire to vomit, the pain
less violent than formerly; sense of suffbcation prompts her to find
relief by rising up to the erect position ; — is deaf, and has roaring as
of waters, in the ears — pulse more developed, 120 ; no stool. (Cup-
ping the dorsal spine to 3 oz. relieved her head-ache and epigastric
distress ; sinapisins renewed to the abdomen and spine ; saline injec-
tion. 10 grs. quinine, in powder, at 5 in the morning and at 7.)

12th, 8, A M. Has passed a comfortable night — injection produ-
ced two stools — has taken this morning the 20 grs. quinine, in two
doses. No vomiting during the night. Pain still, at the epigastrium,
but less violent — pulse 110, and moderately full ; nettle-rash has dis-
appeared— thirst still urgent. (10 ^r*. quinine, at 9. Cold toast-
water. Sinapisms to be renewed.) 1, P. M., no more vomiting — no
stool — less pain at epigastrium ; bat has a sense of fulness of the
abdomen ; pulse 120, soft and full ; skin warm and moist ; deafness
and sense of confusion in the head. (Saline enema^ at 2, P. M.
Chicken water.) 9, P. M. Has slept ; still pain at the epigastrium;
pulse 110 and soft ; skin warm ; has taken no nourishment, (1 oz,
castor oil, to-morrow morning.)

13th, 10, A. M. Has passed a tolerably comfortable night ; has
taken and retained the oil ; heavy pain still at the epigastrium ; pulse

490 Infermillent Fever. [September,

100. 4, P. M. Three stools extremely black, so reported by nurse ;
pain at epigastrium unrelieved, increased by pressure, which produces
also, a sense of suffocation. {Blister plaster 7 by 9 to epigastrium,)

14th, 10, A. M. Drawing of blister has relieved pain at epigas-
trium ; patient relishes cold water and has taken some gruel. Pulse
80, and quick ; tongue furred yellow, but moist ; several stools, du-
ring the night. (Gruel and cold water.)

16th. Convalescent.

Here is a case of quotidian Intermittent, simple in its first parox-
ysm ; — but the second continues nearly up to the time of access of
the third, with severe local gastric symptoms. At 9, A. M., the
symptoms being very urgent, and another paroxysm being reasona-
bly expected to supervene about 1, P. M., and it being apprehended
that great danger would arise if that paroxysm were not prevented,
the patient, for the relief of the local epigastric symptoms, is bled to
fainting, and at the moment of relaxation, the stomach cleansed by an
emetic of cold water, — and in anticipation of the period of access, to
this distressed stomach is administered 48 grains of quinine in two
hours. The effect of this administration is to moderate the vio-
lence— to break the force of the succeeding paroxysm, and that with-
out materially aggravating the local gastric symptoms. With con-
tinued revulsive applications to the epigastrium and spine, 30 grains
of quinine are administered, in anticipation of the paroxysm of the
12th, with the effect of preventing it and curing the Intermittent par-
oxysmal fever. But stilly the local, phlegmasial affection continues,
after the cure of the fever, until it is arrested by a blister drawn upon
the epigastrium.

The previous case proves the independence of the Intermittent fever
upon the local affection, inasmuch as the first continues under the use
of the antiphlogistic treatment, which cures the local affection. This
last case shows the Intermittent fever cured, by a treatment, which
did not reach the local inflammation, which latter continued until
relieved by the blister.

Case 6. * " Muller, asoldier, aged 22, of a good constitution, hav-
ing been discharged from the Hospital about a month previous, was
brought back on the 15th January, 1835, in the afternoon. He was in
the most profound coma ; the pulse full, large, soft ; the skin not hot ;

• Mali,ot — Trailc des Ficvrcs, Paris, 1836.

1^15.] Intermittent Fever. 497

respiration deep ; the physiognomy that ofa man asleep ; altogether
insensible to pinchingof the skin. No information on the course of his
disease. {Diet, lemonade; V.S,\boz. ; 2>0 leeches to the jugulars ; a
small starch, opiated hijection, with 60 grains sulphate of quinine, 40
grains quinine in potion, blisters to the thighs, sinapisms to the legs.)
At 8, P. M., the coma continues, but the insensibility less absolute, the
skin more warm. {Bleeding from the temporal artery from 8 to 10
oz. ; 40 grains sulphate quinine, in two doses, at the interval of two
hours. Cold fomentations to the head.)

16th. In the morning, the tongue is slightly gastritic, epigastrium
painful on pressure ; some remaining heaviness of expression of the
face, but the intelligence is restored ; during the night, a copious
sweat. The patient now relates that he has had five paroxysms of fe-
ver, each commencing about 3, P. M., daily — during the fifth he was
brought to the hospital — that the first paroxysm was accompanied
with violent head-ache and efforts to vomit. {Diet, lemonade, 4:0 grs.
quinine immediately, at one dose ; cataplasm to the epigastrium ; cold
fomentations to head continued.) Apyrexia was complete during the
day ; and in the evening, the state of the patient was very desirable.

17th. Morning — complete apyrexia ; no head-ache, no lassitude
of the limbs ; no stools for many days. {Diet, lemonade, 24 grains
quinine, enema emollient.)

18. Convalescent, &;c.

This case is worthy of consideration, as shewing the safety of lafgd
doses of quinine even in the comatose form of malignant intermittent.
Here the administration of quinine commenced at a time, when the pa-
tient was in the deepest coma, was continued to the extent o^one hundred
and eighty grains, in the course of ZQ hours. Such an administration of
quinine, the writer apprehends, would seldom be found necessary ini
this climate; but such cases are valuable, as fixing the general prin-
ciple of practice, that quinine may be used in such extravagant quanti-
ties, if necessary, and as dissipating that too common prejudice against
this heroic medicine, that it disposes to cerebral congestion — that it
produces head-ache, and therefore that the existence of heaid-ache
contra-indicates its use. It is curious to observe how much more
correct were the opinions of the master-spirits of the profession, as
to the effects and mode of operation of quinine, at the time of its
first introduction, than those of the great mass of the profession in
after times.. The reason of this, however, is sufficiently obvious,

498 Intermittent Fever. [September,

The attention of men, whose crancl dependance in the treatment of

malignant fever, was Peruvian Bark, must have been strongly arrested
by the high claims of the sulphate of quinine, and accordingly they
subjected these claims to the most severe and candid examina-
tion, under circumstances favorable to the establishment of a true
opinion as to its merits and its mode of operation. Bailly, e. g.
says of it — "If I do not regard quinine to be an antiphlogistic, I am
as ftir from regarding it a stimulant. At Rome, 1 have taken a hun-
dred grains of sulphate of quinine, in some days ; on an attentive
examination I have found no marks of irritation, which such dose
must have produced, were it an irritant. It is a specific, sui generis —
a sedative of the nervous system, and only of certain of its periodical
and intermittent functions, for it exercises no action either upon sen-
sibility or locomotion, it does not relieve pain or convulsions, except
these be dependent on an intermittent excitation of the general mo-
tions of the economy. It is the specific sedative of the abdominal
nervous system." Soon coming into universal use, the general opinion
of its mode of operation was naturally determined by the prevailing
doctrine as to the j^atliology of fever — debility being regarded as the
essential foundation of fever, and quinine being observed to cure it,
by inference, it was called a tonic ; its location in the class of tonics
seemed further, to be sanctioned, by the fact that cinchona was at
the head of the list. Too often is it thus, that the opinions of the mass,
founded in prejudice and ignorance, overshadow the exact and
carefully.formed opinions of the true philosopher. And such is the
influence of names with mankind, that it is to be apprehended, so long
as sulphate of quinine continues to be called a tonic, so long will
these unfounded prejudices against its use last. To the existence of
such prejudice against this valuable article of the materia medica, the
following sentence from Professor Dickson's recently published
''Practice," testifies — "Even the sulphate of quinine is generally
regarded as inadmissible, whenever the apyrexia is incomplete, and
where there are any prominent affections of important organs." He
specially instructs his pupils: "Thus, you will hardly venture upon
the exhihition of cinchona, when the apyrexia is imperfect, and when
there are present obvious marks of local disorder of some important
organs. The continuance of head-ache, gastric oppression, abdomi-
nal pain and tension — these symptoms demand farther general or
preliminary treatment."

1:^45. J Intermittent Fever. 499

Case 7. Oct. 3(1, 1844, Thursday— The pnlicnt, a l)oy of nine
years of ago, rcsiclos iintiicdiatc ly on (ho river, 9 miles ahovc (own.
On Saturday last, had tho ladiiis of the left fore-ann hrokcn ; is rep-
resented to have had fever on Monday iii<;htlast; heUer on 'J'liesday
morning; Tuesday night, restless wilh very hot skin; Wednesday
night, high fever with delirium, copious sweat towards morning. This
morning, Thursday, was out of bed, but complained of bead-ache;
had no appetite ; at 12, M. to-day, fever commenced ; at 2, P. M.
had a strong convulsion, followed by stupor, which lasted till moment
of first visit, about 5, P. I\I. ; after convulsion, a tea-spoon-ful of
ipecac was forced upon him ; since which time he has had several
involuntary stools. Now perfectly stupid, not aroused by the loudest
calling ; occasionally restless, mourning and screaming when moved ;
pulse 90, soft and full; skin perfectly natural in temperature,
except the extremities, which are cool, and the head, which is very
hot; pupils dilated; adnata not injected; bowels soft and supple.
(F. S. 12 oz. ; scarification beticecn ths slirnihlcrs, with cups, draW'
ing about 4 ounces ; hot mustard pediluvium, every two hours ; cold
affusion to head, erery two hours ; sinapism the whoJe length of the
spine ; two blister -plasters to the legs ; to-morrow morning at 5, four
grains quinine in solution, to be repeated every hour, for five doscSf
unconditionally.)

Left him at 7, P. M., still stupid, with no other marks of returning
sensibility, than groaning under tho hard pressure of the cu|)s, and
great restlessness under the first application of undiluted mustard to
the spinal column. Being une.'^iectcdly again in his neigliborhood,
at midnight, found his consciousness so far restored, that he asks for,
and drinks water.

Friday, 4th, 11, A. M. Perfectly conscious ; skin cool ; has taken
20 grains of quinine, and is deaf and complains of roaring in the ears;
fretful from pain of blisters ; no stool. (5 grains blue mass every two
hours, for four doses, commeneing at 2, P, M. ; enema saline, if
fever returns; hot pediluvium and cold affusion to the head; 12
grains quinine, commencing to-morrow morning at 5 o'clock, in
three doses ; oil -| oz. to-morrrow, at 4, P. M., if bowels shall not
have been freely moved.)

Was subsequently informed that be passed the night of the 4tb,
with but little fever ; since which bis convalescence has been rapid.

The accident of a simple fracture of one of the bones of the fore-

^00 Intermittent Fever. [September,

arm is not sufficient to account for the violent character of this case,
in a healthy robust boy. The following facts warrant the belief
that this character was determined by extreme virulence of the
exciting cause, peculiar to this and some other localities in the neigh-
borhood:— One month before the occurrence of this case, there was a
similar one in the same family, treated successfully in the same
manner, by Dr. Robert, of Columbia county. In July, 1843, a
boy of twelve years, from the city, was on a visit at this house; at
the end of two weeks, he was taken with light fever, consisting of
daily paroxysms ; which having returned for two or three days, it was
thought prudent to bring him home ; on the morning following a
night of severe fever, with delirium, he was so well, that he dressed
himself, and begged to remain — on the way down, in a carriage,
fever supervened; he arrived at home in a state of profound stupor,
in which state he died, notwithstanding the diligent use of appropriate
remedies. Two days ago, whilst visiting at the same house, the
writer incidentally saw a negro child about five years of age, in a
paroxysm of algid fever, which terminated fatally in two hours ; this
child had been slightly unwell for two or three days, and on this
morning had been playing in the yard. A negro woman at this time,
was convalescent from a similar attack of algid fever. There are
other well known localities in our climate, where the malignant form
of fever is endemic. The native of the city of Charleston, e. g. sleep-
ing but one night, in the summer season, in the neighboring country,
insures to himself an attack of much-dreaded " Country fever."
From descriptions of this fever, by friends professional and non-
professional, and the occasional notice of supposed cases occurring on
steamboats, formerly running between this city and C-harlcston, the
writer has long entertained and expressed the opinion, that this
" Country fever," of Charleston, was the Malignant Intermittent or
Remittent fever, of Torti, Morton, Bailly, d:c.; and that when the
profession of that city shall have adopted the uncompromising, uncon-
ditional use of cinchona and quinine, as recommended by such high
authority, this now formidable disease will be stripped of its terrors,
and be found as manageable almost as simple Intermittents. His
opinions are confirmed by Professor Dickson's description of Country
fever, which though very general, yet sufficiently shows the true na-
ture of the affection. "An attack commencing as intermittent or
single tertian will thus become a double tertian, then a triple tertian,
then a remittent of greater or less distinctness and regularity."

1845.] Intermittent Fever. 501

He says again, " Or the remission shall have become very distinct,
nay shall amount to complete intermission, and you flatter yourself
with the hope that convalescence is begun, when some single parox-
ysm shall intervene with such overwhelming violence, that prostration
and fatal exhaustion ensue in a few hours." The paroxysmal char-
acter is here assigned to it — -remittent and even intermittent — and
that peculiar insidiousness which it has been the writer's object to
illustrate, is fully set forth in the last quotation. The treatment
mentioned by Professor Dickson is not very exactly specified — he,
remarking that his custom is "to institute, from the commencement,
such a course of treatment as shall offer the best resources under
any sudden developement of malignity or aggravation of violence."
But upon the use of the great specific, he immediately adds, "under
these circumstances, too, I watch anxiously for the first opportunity
of administering some preparation of cinchona — the infusion in
some of its combinations, or the sulphate of quinine in proper and
efficient doses. The system sinks so readily under such exacerba-
tions, or such accumulation of them, as I have above alluded to,
that I often venture upon the exhibition of this class of remedies,
even in remissions somewhat indistinct and obscure, after the first
vehemence of febrile action has passed by an^l the appropriate mea-
sures of depletion have been premised." It is not such a use of
quinine, to which the writer alludes, but the early use of it, in full
doses.

Knowing sulphate of quinine to possess the power of preventing
the paroxysms of periodic fever, he would anticipate X\\e first expected
remission — estimating the time of its return, either from the previous
history of the individual case, or from "the general history of the
existing epidemic — by doses of 10 or 20 grains, pressing it " obsti-
nately against contra-indicating contingencies" — that is, acknow-
ledging no such contingencies to exist — seeing in the circumstances
generally considered such, only the stronger indications for its use;
fearing no danger so much as the danger of a repeated paroxysm.
This is the course of treatment, which the writer feels confident,
would offer the best security against those sudden developments of
malignity, so characteristic of the country fever of Charleston.

It is with reluctance that the writer, finding this article already so
extended, yields to the necessity of postponing his remarks upon
Remittent Fever, &c., to some future number of the Journal.

502 Acute Peritonitis, [September,

ARTICLE II.

Cases occurring in the Practice of Drs. Qgilhy dj- Robert : Reported
by W. H. Robert, ^I. D., of Madison, Ga.

Case No. 1. Acti'e Peritonitis. — Mr. J. L. Caverly, a school
teacher, aged 27, of tall stature and largo frame, gave the following
history of his case previaiis to our visit :

For several days he had experienced a general uneasiness of the
whole body, but more particularly of his lowels, locating the pains
about the region of the umbilicus, although even here they constituted
more an uneasiness than an actual pain. On Friday, seven days
previous to our being called to him, he had gone to the country, and
very imprudently, eaten heartily of muscadines, shortly after which
he was taken with a severe chill. He returned to town the next
day. On Sunday, being costive, he took a dose of epsom salts,
which operated mildly. The general symptoms not yielding, and
still complaining of the uneasiness of his bowels, he continued to
attend to the duties of his school, abstaining almost entirely from
food, until our visit, on Thursday:

September 19lh — when the following symptoms were present-
ed: Skin warm, dry, and of a pale yellow colour; tongue dry,
tip and edges very red, centre loaded with a brown fur; forcible
pressure upon the bowels caused very little pain, and that was princi-
pally about the region of tic ilio-crecal valve; the rest of the
bowels had a very knotty and doughy feel; pulse hard and wiry,
115 to the minute; stomach irritable; bowels had not been operated
on for the last forty-eight hours. 18 ounces of blood were taken
from the arm; li. Cah mcl 30 grs., opium 8 grs., mix, from mass and
divide into eight pills, one to be taken every three hours ; diluent
drinks, &c.

20th. Symptoms in almost every respect the same as yesterday ;
did not sleep much; complains of very little pain in the abdomen.
Castor oil given, and the operation promoted by cnemata. Had
several very offensive discharges, of rather a serous consistence and
cf an ashy colour.

Evening visit — Skin hot and dry; tongue, pulse, A:c., as hereto-
fore ; stomach still irritable. Calomel and opium pills resumed, with
soda powders in cold water.

1845.] Acute Peritonitis. 503

21st. Rested better; skin cool, but dry; tongue the same tis yes-
terday ; bowels a little tympanitic; complains of no pain and only
slight soreness on i)ressiiro of the abdomen. Calomel and opium
continued, with 20 drops chloride soda every three horns ; soda
water, &;c., also a large number of leeches to the abdomen.

22d. Had several small serous and offensive discharges from his
bowels during the night ; did not sleep well ; wandering and deleri-
ous ; tympanitic state of the bov/els has increased ; pulse 125 to the
minute ; treatment continued, with cups to the abdomen.

23d. No material change in the sym.ptoms since yesterday, except
an increase in the frequency of the pulse, which is now 140 ; tongue
very dry. Ordered castor oil, which operated twice: discharge
pale, thin, and very offensive. Evening visit, ordered following : —
R. Blue Mass, Dover's powders aa. 30grs., divide into 12 pills, one
to be taken every three hours; blister over the abdomen, and to be
dressed with mercurial ointment ; soda water continued.

24th. He is worse this morning : pulse feeble and 150 per minute ;
skin cooler ; hiccough since early last night, w-ith more constant de-
lirium ; tympanitis increased; no pain or uneasiness produced by
pressing the abdomen. Ordered, oil turpentine, to be given every
two hours, and sinapisms to the extremities. Continued to grow
worse, and died that night at 12 o'clock.

Autopsy, sixteen hours after death, in the presence of Dr. E. E.
Jones. Upon opening the abdomen, a large quantity of foetid gas
escaped, which dispersed some of the bystanders ; the intestines were
knotted together from contraction and adhesion of a very highly
inflamed peritonium ; every part of the peritcnium that covered the
intestines was in a high state of inflammation ; that which formed
the omentum was in a gangrenous state, and the right lower edge of
the omentum adhered to the peritoneal covering of the right iliacus
muscle: on separating these, we discovered a large ulcer of the peri,
tonium, to the right of the ilio-coecal valve — it measured an inch
wide by two and a half long, extending towards the pelvis, in which
we collected about one pint of pure pus. The mucous membrane of
the stomach and intestine was inflamed, but not so much as the peri-
tonium. The thoracic organs were not examined.

Here we have a case of Peritonitis progressing on to gangrene
and suppuration, and the patient complaining of scarcely any pain
indeed be attended to his school until a day or two previous to our

504 Paralysis. [September,

first visit. Could the pain have been controlled by the patient's for-
titude, or was it really not felt because of a morbid impairment of
sensibility? From the extent of the disease, I think it impossible
that any man with ordinary sensibility, could have borne it without
complaint.*

C4.SE No. 2. Paralysis, or Loss of Muscular Motion of the right
arm. — On the 12th of March last, we were called to see a negro boy
about ten years of age, the property of Miss D*****, and found him
laboring under complete paralysis of the right arm. The boy's mo-
ther gave us the following history :

Two nights previous to our visit, something like a noise caused her
to notice the boy : she found him somewhat stupid, partially blind,
and unable to move the right arm. He remained in this condition
until our visit, about forty hours after.

The patient then presented the following symptoms: — Stupor,
such as to render it difficult to arouse him ; pulse firm and slow ;
bowels costive; complains only of pain in the head. We bled him
generally and locally ; blistered the nape of the neck ; ordered mer-
curial and aloetic purges — his bowels v/ere all the time very difficult
to move. This treatment was pursued ten or twelve days, without
any improvement. We then put him under the operation of the
electro-galvanic battery, the operation of which was confided to his
young master, to be made daily.

April 12. I happened to be in the neighborhood, and called to see
the boy. I found him almost entirely relieved: he could throw a
stone about as far as he ever could, and the only difficulty was a
little weakness of the arm. The use of the battery was shortly after
discontinued.

June 17. The arm has been gradually improving, and there is
now scarcely any difference between it and the other.

* See Dr. Carr's Article under head of Extracts. Was this not a case of dis-
ease originally located at the CEecum 1 May there not have been some of the
muscadine seeds lodged in the Appendix ? — Edts.

1*^45. J A Case of Lumbar Ahscess. oOo

ARTICLE III.

A Case of Lumbar Abscess. By E. M. Pexdletox, ^^I. D.,
of Sparta, Ga.

• Aa extract in the March No. of the Southern Medical and Surgical
Journal, from Dr. Oke, of Southampton, defining tlie diagnosis be-
tween several disL^ases, which produce pain in the loins, has directed
my attention to a case, occurring in my practice during the last
autumn, and which strikingly exemplifies the difficulty, as well as
necessity, of a correct diagnosis in all such cases.

I first saw the patient on the 21st November last. He was a far-
mer, residing near this place, about thirty-five years of age, and was
in the following condition : — Countenance depressed, indicatinf^pain
and anxiety of the mind ; pulse very feeble and thready ; voice weak ;
great emaciation, &c., reminding one of the last stage of phthisis
])ulmonalis. He lay on his back, could not move himself except
when assisted, and then only with great pain ; his whole complaint
was referred to the lumbar region extending down the left hip to a
little below the joint ; he had severe diarrhoea, his stools indicating
considerable derangement in the bilary secretions. The urine was
passed freely, and without difficulty, and the appetite but little im-
paired. On examination, I found two small tumours occupying each
side of the lumbar vertebroe which evidently contained matter. There
was slight tenderness and fiuctuation also extending down the left
hip to the upper and outer part of the thigh. I could not hesitate for
a moment as to the nature of the case, and directed my treatment
accordingly.

The following is a succinct history of the case, as given by the
patient, and his attendants previous to this time : — Sometime during
the month of May, 1344, he was attacked with pain and weakness in
the lumbar region after considerable exposure to cold, damp weather;
he applied for relief to an experienced and skilful physician, which
was but partially afforded. A fresh exposure produced a recurrence
of the pain, and though subsequently treated for acute nephritis and
lumbago, only a mitigation of the symptoms was obtained for a time.
He continued to grow worse and waste away until the latter part of
August, when he became perfectly bed-ridden, suffering the most
intense pain, and giving up all hope of recovery.

506 A Case of Lumbar Abscess [September,

As a dernier resort, however, finding that science had failed, he
had recourse to empiricism. A notorious steam doctor was sent for,
who having exhausted the routine of lYo. 6, composition, lobelia and
steam-bath, gave up the case as utterly hopeless, declaring to the
alarmed and awe-stricken patient, that he could have cured him, but
one of his kidneys was entirely destroyed, and he could not make a
new one.

I will merely give the outlines of the treatment instituted in tno
case. My attention v/as first directed to the diarrhoea, which was
very exhausting. Tiiis I succeeded in checking in the first twenty-
four hours with powdered opium. I next corrected the bilary de-
rangement by blue pills and a large blister over the right hypochon-
driac region, where tliere was pain and tenderness on pressure, and
then directed my attention to strengthening the patient. Fearing
lest a too speedy abstraction of matter might be too much for his
extremely weakened state, I applied blisters over the tumours, and
upon the tender point dosvn the thigh, that external suppuration
might go on gradually, while I plied the exhausted powers of the con-
stitution, with wine and a nourishing diet, hoping to restore its recu-
perative energies, in some degree at least, before operating.

Night sweats supervening in a ^g\w days, I added about ten drops of
elixir vitriol to the wine, to be taken thrice daily. The blue pill was
continued until ptialism was produced, and the blisters applied and
re-applied with but little effect, except the one on the hip, which
seemed to suppurate considerably. Early in December, the tumour
broke at the upper and outer portion of the left thigh, and ran an
immense quantity of pus during several succeeding weeks. The ton-
ics were gradually increased, and my patient commenced to improve.
By the 30th December, (ray last visit,) the tumours had entirely dis-
appeared, and firm and healthy granulations taken their places, and
the issue on the thigh nearly healed up. He had also been able to
sit up a little. Subsequently he continued to invigorate very fast,
and was soon able to go about and attend to his business. He how-
ever complained of considerable weakness of the left side, no doubt
occasioned by the shrinking, from long inertia, if not partial loss, by
suppuration, of some of the cellular tissue, dsc, about the hip.

The chief points of interest in this case are, first, its Etiology. The
patient had received an injury in the loins a number of years since,
from a fall, which had produced weakness and occasional pain ever
since. I believe it is generally conceded, that exposure to alterna-

1S45.] A Case rf Lumbar Abscess. 507

tions of temperature, or any other cause which tends to produce
inlhrnmatory action in the system, will always attack the weak part
first. I regard, then, in this case, the injury as the remote cause,
inducing a preternatural weakness of the parts; and the exposure to
cold as the proximate caus? superinducing an inflammatory action
about the muscles and the cellular texture beneath, which, from the
fiiilure of antiphlogistic treatment in the outset, terminated in suppu-
ration and lumbar abscess.

Next, the Diagnosis. No scientific physician had seen tiie patient
for near two months prior to my being called in. Hence, I apprehend
the case to have been more difticult of diagnosis in the early stages
than when I first saw him. As the pain in each loin was immediately
over the kidneys, and psoas abscess is so unfrequentin this country,
the attention of the physician should have naturally been directed to
nephritis first. But v/ hen he ascertained that the secretion of the
kidneys had not been disturbed in the least, it would not be strange
for him to recur to lumbago or some spinal afiection for a solution of
the ditficulty. Had I formed a hasty diagnosis, founded upon pre-
conceived notions and a casual examination, the true pathology of
the disease would have remained undiscovered, and by consequence,
the treatment ofsuch a character, as to endanger the life of the pa-

tient. I first ascertained that the lungs, stomach, liver, kidneys, and
all the important viscera of the system were not materially diseased :
when by careful examination and pressure upon the loins, I detected
deep seated fluctuation, the problem was at once solved, and the
case made out. I was enabled to encourage the patient to hopo
for life.

The third point of interest, is the treatment. An immediate open-
ing of the abscess, (as a physician subsequently told me should have
been his course,) would, I am sure, ha»e effectualjy prostrated the
patient. However difficult maybe the rationale of the thing, facts
have established the principle in pathology, that a large quantity of
fluid, v/hether water or pus, suddenly abstracted from the system,
produces debilitating effects. The draughts made upon the vital
powers (already so much weakened by disease) to restore the lost
fluid to the system by the secretive process, produces a prostration
from which none but the strongest constitutions may hope to recover.
Such was the fact in a case which I saw while at Lectures, operated

on by Professor F — < . He mentioned his apprehension to the

class at the time, although the patient was able to walk about, and

508 Extirpation of a Schirrous Tumour, [September,

seemed to have considerable strength. A large quantity of matter
was abstracted, and in two days the patient was dead. This, and
another case of a similar character and history, decided me in delay-
ing the operation, (until the very last point of time,) and instituting
a course of stimulants and tonics, that I might strengthen, if possible,
the recuperative energies of the system, so as to aid nature in throw-
ing off the extraneous matter in a more gradual manner than could
have been effected by surgical interference. The blisters aided our
efforts considerably by their counter-suppurative effects. In review-
ing the history, pathology and treatment of the case, we are constrain-
ed to believe that the recovery of the patient turned mainly on the
constant administration of stimulants and tonics, and the refraining
from a sudden abstraction of the matter, while yet the system was
unable to sustain itself, under an exhausting issue, of a deep seated
and large abscess.

ARTICLE IV.

'IC

Extirpation of a schirrous tumor, the patient being in the Mesmeri
state, arid evincing no sensihiUty whatever during the operation.
By L. A. DuGAs, M. D., Professor of Physiology, <5'c., in the
Medical College of Georgia.

Mrs. Clarke, the lady whose mamma I removed in January last,*
enjoyed for several months afterwards an unusual degree of health.
In the month of May, however, she began to suffer almost daily with
slow fever, and perceived a small induration in the adipose tissue
surrounding the region formerly occupied by the breast. This soon
assumed the form of a distinct tumor, which was increasing in size
with some rapidity, and was becoming painful, when, in the early
part of June, I advised Mrs. C. to have it extirpated. To this pro-
posal she readily consented, remarking very philosophically, that she
would rather have such a tumor removed every six months, than
permit it to remain and grow on her. There was no evidence of
disease in the axilla.

I now requested Mr. Kenrick to ascertain whether he could still

♦ Ca^e published in the March Iso. of this Journa].

1845.] Extirpation of a Shir rous Tumour. 509

mesmerise her, and, if she were susceptible, to repeat the operation
a few days, so that we might test her sensibility in that state. Mrs.
C. was readily put into the mesmeric state, and found to be entirely
insensible during its continuance. Deeming it unnecessary to repeat
the tests, I determined to operate on the 13th June, several days
sooner than was expected by either herself or her friends. The
operation was performed in presence of Professors L. D. Ford and
Jos. A. Eve, Drs. L. Kennon and J. F. Hammond, the Rev. Mr.
Alfred Ford and Mr. F. J. xAIartin. The patient was mesmerized at
9 o'clock, A. M., and the extirpation effected at about 10 o'clock, by
making a semilunar incision along a portion of the circumference of
the tumor, turning over a flap, and dissecting away the indurated mass
and surrounding tissues, making up the volume of a hen's egg.

During the operation, Mr. Kenrick, being biind-folded to avoid the
unpleasant spectacle, sat by the patient, with her hands in his. Mr.
K. avers that Mrs. C. evinced no uneasiness by grasping his hands,
that her fingers did not twitch, and in short, that her hands remained
perfectly passive. Prof. Ford, whom I had requested to note the
pulse and respiratory act particularly, informs me that there was no
appreciable change in their character and frequency before, during
and after the operation. The countenance of the patient and the
hue of her cheeks presented no change whatever, nor was there iho
least indication of sensibility detected during or subsequently to the
operation, by those who were present and anxiously watching the
result. There was neither twitching of the pectoral muscle when
touched with the sponge, nor tremor of the lower jaw. Indeed the
patient slept on as quietly as an undisturbed infant, through the entire
operation.

The wound v/as left open about half an hour, a small vessel ligated
and the ordinary dressing applied. The patient was permitted to
sleep on, and awoke spontaneously at a quarter-past 1 o'clock, P. M.,
in the presence of Dr. Ford, the Rev. Mr. Ford, Mr. Kenrick and
myself. Dr. Kennon arrived a moment afterwards. She appeared
entirely unconscious of what had been done, and was much surprised
as well as gratified, on being informed that the operation was over.
She stated that she had not suspected our design, and had no recollec-
tion of having experienced the least uneasiness during her nap.

I will add on this occasion, as I did on reporting the former case,
that the above statement has been submitted to all the professional
gentlemen present, and that they fully concur in its accuracy. This

10 Diseases of the CcBcum. [September,

is perhaps the only instance on record in which avserious and painful
operation has been twice performed on the same individual in the
mesmeric state, a circumstance that may lend it additional interest
with those who are disposed to collect facts on an interesting subject.
Augusta, 1st Julv, 1845.

PART IL— REVIEWS AND EXTRACTS.

Cases ilJnslrotive of the Diseases of the Ccccvm and its Appendix^
By EusoN Caer, M. D.^of Canandaigiia, N. Y.

The c£scum has manifestly an individuality both of function and
disease — having otTices to perform in some respects quite pecuh'ar lo
itself, while it is subject to frequent derangements and fataldiseases,
m which no other portion of the digestive apparatus is implicated.

While the former have received fiir less consideration than their
relative importance would seem to demand, the latter can scarcely
be said to.bave a place in our systematic practical works.

A Monograph by Dr. John Burne, an article in Copland's Diction-
ary of Practical Medicine, and the cases which are detailed in Du-
])uytren's Clinical Lectures, embrace nearly all that has fallen under
Hiy notice upon this interesting class of affections ; with the exception
of sin"-le cases which occasionally appear scattered through our peri-
odicals.

If we take but a very superficial view of this organ, its situation
and capacity, its attachment to the parietes of the abdomen, so con-
fining it that its relative position admits of no change, and the
circumstance that its contents are moved forward in opposition to
the laws of gravitation, it must be evident that the alimentary sub-
stances were designed to remain here longer than in any other
portion of the alimentary canal.

These considerations have very naturally suggested the idea that
the caecum constitutes a kind of second stomach.

Aiiain. if we examine a little more carefully into its organization,
we find the caecum liberally furnished with large follicular glands,
evidently designed for the abundant secretion of important fluids,
while the entire organ, with its appendix, is more richly supplied with
arterial blood than any other portion of the intestinal canal. It
appears from the experiments of Tiedemann and Gmelin, that these
follicular glands ''secrete an acid, albuminous and solvent fluid,
which mixes with, and promotes the digestion of those portions of
aliments which have withstood the action of the stomach and small
intestines, or have been insufficiently changed by them.*' We may

1S45.] Diseases of the CcBcum 511

also remark that the contents of the alimentary canal first acquire
their peculiar fecal odor in the caecum. This, according to tho
researches of the same physiologists, depends upon an oily volatile
substance secreted by the mucous follicles. And we think it highly
probable that the appendix performs an important pan of this work,
since, when examined in its natural condition, it is generally found
to contain a portion of this material. Indeed, we think it would be
difficult to assign a more probable function to this organ; inasmuch
as its formation is such as to preclude ihe idea of the alimentary sub-
stances entering it, while the large supply of blood sent to it must
plainly bespeak for it a more important office than merely affording a
convenient retreat for such unlucky cherry stones and the like, as
may chance to escape from their destined course.

It farther appears probable from the experiments of Tiedeman and
Gmelin, that the ccecum performs the additional function of secreting
"chiefly from its numerous follicles, an unctious fluid for the protection
of the surfaces of the large bowels from the irritating eflects of the
fecal matters passing along them," and that the constituents both of
this and of the other secretions poured out from its surface, consist of
elements which require to be eliminated from the blood; so that, in
addition to its other functions, it is also a depurating organ.

We may reasonably infer from the foregoing considerations that
the caecum is an ipnportant organ, whose functions can neither be
suspended nor suffer material derangement, without serious detri-
ment to the animal economy.

My own observations lead me to apprehend that such disturbances
occur much more frequently than it has generally been supposed.
Such suspension or modified function may result from various causes,
as defective nervous stimuli, the unnatural stimulus of crude undi-
gested food, unhealthy secretions of theprimas viae, or sympathetic
relation Vvilh some other organ, in a pathological condition. The
following case will perhaps sufTiciently illustrate the most simple
form of such derangement:

Case I. Mrs. B., now thirty-seven years of age, experienced
slight inconvenience early in the summer of 1828, from dyspeptic
symptoms, which readily subsided under a regulated diet. From
early childhood to that period, she had never suffered from any serious
indispositi6Vi. She scon lost her ruddy complexion, her usual elasti-
city and strength began to decline, her lips and tongue became pale,
and a general disinclination to physical and mental exerti'on soon
followed. But the more remarkable circumstances manifested in
this case,are a slight uneasiness seldom amounting to pain, frequently
felt in the region of the caecum, and ascending colon, attended with
an evolution of gas which escapes entirely without odor, while the
fecal matters, which are quite natural in appearance, with iheexcep.
tion of perhaps being slightly softer than common, are generally
entirely wanting in fecal odor.

512 Diseases of the Civcum, [September,

This state of things has continued with but short intervals of in-
terruption for more than sixteen years. During this period she has
had a good appetite, with no unnatural thirst, and daily motions of
the howels without the use ofnaedicine. The uterine functions have
been uniformly healthy. She has borne four children during the
time. Menstruation has never been interrupted except diu'ing preg-
nancy and nursing. It has never varied materially in time, quantity
or quality, and has never been attended with pain or any appreciable
constitutional disturbance. She has never suffered from leucorrhoea,
or indeed from any other indisposition than the above described.

Several intelligent members of the profession have been consulted
in this case, and the functions of every organ in the body have been
faithfully interrogated and carefully watched, and yet no one has been
able to form a satisfactory opinion as to the cause of these peculiar
phenomena.

The observations of Dr. Copland upon the functional derange-
ments of the caecum, seem to throw some light upon this and similar
cases, and make it appear at least probable that these peculiarities
depend on such derangement. If the views which are entertained
in regard to the functions of the caecum be correct, there will be no
ditTiculty in coming to such conclusion.

I might here introduce several other cases which would seem to
confirm the correctness of the views above presented, but perhaps
this may be sufficient to direct the attention of other and more com-
petent inquirers to its investigation.

I will however remark, that I had an opportunity about a year
since, of making an examination of a case ift which the leading
symptoms had for a long time been similar to the one already descri-
bed. In this instance, death was occasioned by the sudden super-
vention of acute gastro-enteritis. The lower part of the ilium, the
caecum, and a small part of the ascending colon were found very
much hypertrophied, the parietes of the cascum measuring over two
lines in thickness, while the cavity of the appendix was so nearly
obliterated as barely to allow the introduction of a small probe.

Dr. Copland remarks, that " when the vital energies are weakened
and the alimentary canal debilitated, the caecum often betrays greater
disorder than any other part of the digestive system. Its situation
and functions will accoimt .for the frequency and importance of its
diseases. In some cases, the irritation produced by morfld or accu-
mulated matters in it are slight, and readily productive of sufficient
reaction of its muscular coats to propel them along the colon. In
other instances, the efforts made to accomplish this end, owing to the
obstructions occasioned by the lodgment of flatus about the right
flexture of the colon, or by irregular spasmodic contractions of this
bowel, are ineffectual, and give rise to colicky pains. If the inter-
ruption is removed, disorder soon subsides ; but if it continues for any
considerable time, the more violent forms of colic or ileus supervene."

The two following cases, while they corroborate the foregoing re-

1845.] Diseases of the CcBcum. 513

marks, have some points of peculiar interest as illustrating the
fact, that the bowels may be freely evacuated with active cathartic
medicine, while substances remain impacted in the caecum undis-
turbed.

Case II. On the 7th Aug., 1835, 1 visited Saugur Brockelbank,
a lad thirteen years old. who had complained for two or three days
with colicky pains. He had taken salts, castor oil and cathartic
pills, which had operated well, but without relieving the pain.

I learned that four days previous to this time, he had eaten freely
of choke cherries (prunus virginiana). On examining the abdomen,
he seized my hand as it approached the right iliac region, exclaiming
that it was very sore. Careful examination discovered a distinct
circumscribed fullness and hardness over the cajcum. He complain-
ed of thirst and head-ache ; pulse eighty-four, and rather hard.

Pres. V. s. gxv., calomel ten grs. to follow in three hours, with
castor oil. Warm fomentations to the bowels.

8th. His bowels have been freely moved several times. Soreness
over the caecum still continues; pulse ninety-two, v. s. repeated;
calomel four grs., with one-eighth gr. morphine to be repeated every
six hours. Blister to the seat of the soreness.

9th. Bowels have not been moved since yesterday ; pulse ninety-
two ; tongue slightly coated^vith a white creamy covering; pres.
calomel five grs., to be followed with castor oil in four hours. Blis-
ter to be dressed with warm poultice of slippery elm.

10th. Soreness rather increased; bowels moved, but slightly;
pulse ninety. four, small and quick ; pres. calomel and Dover's powder,
each three grs. every four hours, and fomentations to the bowels.

11th. Has had two slight motions of the bowels — without fecal
odor. Calomel and Dover's powders continued ; blister renewed and
to be dressed with slippery *elm poultice.

Evening. His bowels have been moved several times during the
day; no fecal odor; complains of thirst, tongue heavily coated but
not dark ; five grs. of Dover's powder every four hours.

12th. Relieved from pain by Dover's powder, but not otherwise
improved ; calomel and Dover's powders every four hours, blister
renewed.

loth. Tongue more thickly coated; pulse ninety-six, small and
quick; pres. cal. five grs., to be followed in three hours with salts
and senna, and in three hours the following enema to be administered :

R. castor oil §ij., spts. terebinth si., warm water one pint.

Evening. The bowels have moved freely several times during the
day. The evacuations contained what the mother termed "a hand-
ful of cherry stones, which had remained so long that they smelt
very bad."

From this time the soreness began to subside, and his recovery
was rapid and uninterrupted.

Can there be any doubt that in this case, the cherry stones were

514 Diseases of the CcBcuTn, [September,

lodged in the csecutn during the nine days which intervened between
the time of eating and discharging them?

Case III. At 1, A. M., August 17, 1S40, I was called to R. B.,
aged 20. He complained of excruciating pain in the abdomen, with
nausea, retching, anxious countenance, features much contracted,
pulse 110, quick, small and tense ; the whole abdomen extremely
painful to the touch. He had been troubled- for several days with
diarrhoea, attended with occasional griping pains. For the last
twenty-four hours, he had felt a dull aching pain in the bowels, which
was increased while in the erect posture, and greatly aggravated by
any slight jar, as in walking. But the severe pain came on sud-
denly on rising from his bed jus^ before I was called, at which time
he experienced a smart chill. I took from the arm thirty-six ounces
of blood, gave him fifteen grains of calomel combined with one-half
grain of morphine, and hot fomentations were applied to the bowels.
6 o'clock — pain and nausea slightly relieved, but the soreness of the
bowels continued. Bleeding repeated to twenty ounces, which oc-
casioned fainting: calomel ten grs. and Morphine one-half gr.: fo-
mentations continued, and a mixture of calc. magnesia 3ij, aromat.
syrup of rhubarb, i i ; to be given in three hours.

2 P. M., pulse 127. Soft and compressible, pain much relieved.
By means of a flexible tube passed into the colon, the following
enema was administered: — R. castor oil, §ij; spts. turpentine, §i;
warm water, three pints. This passed off in the course of three
hours, with some fecal matter.

9 P. M., pain much diminished and entirely confined to the right
iliac region, where a distinct circumscribed fulness and hardness was
perceptible. Calomel, three grs.; morphine, one-fourth gr.; to be
given every four hours.

18th. Morning. Pain, soreness and -swelling over the caecum,
considerably increased ; pulse 130, small and quick. An injection
of warm water and castor oil produced a small fecal evacuation,
without odor. Calomel and morphine continued ; about four oz. of
blood was taken from the region of the caecum by cupping, and fo-
mentations to the seat of pain.

2 P. M. Pain somewhat relieved ; blister applied to the scat of
pain.

9. Evening, pain much relieved. Injections repeated, but with
slight effect — calomel 3 grs., Dov. powder 4 grs, to be given every
four hours. Blister to be dressed with slippery elm poultice.

19th. Morning. Rested well : free from pain, pulse 120, soft and
compressible. Tongue slightly covered with moist white fur. A
mixture of castor oil, g i., and an equal quantity of aromatic syrup of
rhubarb, to be given directly.

2 P. M. Has had rather a scanty evacuation, tinged with bile,
with slight ftecal odor ; feels much relieved.

8 o'clock. Evening. Pulse 110, soft and compressible; bowels

1S45.] Diseases of the Ccecinn. 515

have been freely evacuated ; foecal odor, strongly marked. 5 grs.
Dov. powder to be given for the night.

20th. Morning. Has had a tolerable night's rest; pulse 110;
bowels acted freely ; complains of soreness, and some deep seated
pains in the region of the caecum. Blister dressed with mercurial
ointment.

Evening. Pulse 100; swelling and soreness still continues; cam-
phor and opium pill to ba given at bed time. Mercurial dressing
continued.

21st. Still complains of dull, deep seated pain ; pulse 100; cam-
phor and opium pill; mercurial dressings continued.

Evening. Pain continues; pulse more full and hard; tongue
more coated, with edges very red ; colon distended with §iv. castor
oil, in five pts. warm water. This brought away an apple seed, with
some flakes of hardened faecal matter which appeared as if broken
from a hard mass. Pres. Dov. powder and calomel aa 5 grs. to be re-
peated every four hours.

22d. Morning. Has had a quiet night ; pulse 100 ; tongue Iboks
belter; swelling and soreness much relieved ; skin has been in a
moist state during most of the night. Has had a large evacuation
of offensive foecal matter, with several hardened lumps in which were
found a number of whole, unripe blackberries. On inquiry, no fruit
of the kind had been taken since the Saturday, a week before his
illness.

Evening. Has had several evacuations during the day, with frag-
ments of hardened faecal matter, containing numerous seeds of black-
berry.

From this time he began gradually to recover, although it was
several weeks before the soreness and swelling had so far subsided as
to allow of his returning to business.

He has since had several slight attacks of pain and soreness in the
region of the Ccecum from error in diet, which have readily yielded to
prompt treatment.

We may remark that in both of these cases, during the time in
which foreign substances remained impacted in the caecum, although
the bowels had been repeatedly freely acted upon by medicine, there
was almost an entire absence of foecal odor in the alvine discharges.
I have noticed the same circumstance in several other similar cases,
and recognized the reappearance of the odor, as one of the earliest
symptoms of anything like permanent relief. ^

Case IV. On the evening of the 29tli of August, 1835, I visited
Miss , a young lady, 16 years of age. She had suffered from

slight headache, for two or three days. Four days previous, while
walking in the garden, she had taken several unripe plums, since
whicli lime she has had no motion of the bowels. I attributed her
headache to this circumstance, and directed castor oil and aromatic
syrup of rhubarb, of each one ounce.

516 Diseases of the C(Bcum. [September,

80th. She has had no motion of the bowels : headache continues ;
pres. R. Calc. magnesia 3i.; spts. ammon. aromat., 3i.; mintwater,
§i.; to be taken directly, and repeated in three hours if required.

Evening. Medicine has had no effect, and the following was or-
dered ; calomel 8 grs., com. ext. colocynth 12 grs., and should this
have no effect, it may be repeated in six hours.

31st. Her medicine has had no effect ; complains of pain in the
bowels. On examination, I discovered tenderness and slight fullness
in the right iliac fossa. V. S. sxvi. fomentations to the abdomen,
and an enema to be administered directly, and should there be no
motion of the bowels in three hours, the following mixture to be given :
castor oil, si, aromatic syrup of rhubarb, |ss, with the addition of
two drops of croton oil.

From this time to the third of September, being ten days from the
time she had taken the plums, although ordinary means have been
resorted to, such as bleeding, blistering, warm baths, enemas and
active cathartics, no passage of the bowels had been effected.

At the request of Dr. Bristol, who was now called in consultation,
the croton oil, warm bath and enema were repeated, but all with no
effect.

Sept 4th. The soreness and pain have increased during the night:
tongue loaded with a heavy white coat ; pulse 88, quick and small ;
calomel and Dover's powder each three grs. every three hours. About
noon she experienced a sYnart chill, which was followed by severe
pain and exquisite tenderness, which spread rapidly over the whole
abdomen.

Drs. Cheney and Bristol were now called in consultation. The
stomach had become sa irritable as to reject every thing taken into it,
and the rectum so sensitive, that enemas by an ordinary syringe
could not be retained, and it was proposed to distend the colon freely
by means of a long flexible tube. In attempting to pass this into
the colon, I met with a difficulty which I had frequently encountered
in similar attempts.

When the tube reaches the angle which the intestine makes, in
passing over the psosas muscle and common iliac artery, it meets the
side of the gut, nearly at a right angle, and after forcing the intestine
before it as far as its loose folds at this point will allow, the tube is
doubled upon itself, some two or three inches from its point, and
broken. That this is the nature of the difficulty, which frequently
occurs in passing a flexible tube into the colon, I have satisfied my-
self by laying open the abdomen of the dead subject, and introducing
it with the intestine exposed to view. Indeed, I think it requires espe-
cial good luck, as well as dexterous mancEuvering, to be able in all
cases to pass an elastic gum tube into the colon, although from the
representations of Mr. O'Beirn and some others, it seems quite other-
wise.

In order to satisfy myself whether there was any unnatural ob-
struction in this case, I took a common rectum sound, and passed it

1845.] Diseases of the Caciim. 517

into the colon without difficulty. It now occurred to me that a flex-
ible metallic tube, made in shape similar to the sound, might be
introduced without trouble. I accordingly prepared one the size of
a large catheter, with an egg shaped bulb upon the end, pierced with
several holes like the tube of the womb-syringe — passed it into the
colon, attached it to the tube of Reed's double valve pump, and
gradually distended the colon with a mixture of castor oil ^iv., spts.
turpfentine §i. and five pts. warm water. This soon passed off, and
with it a large quantity of dark fcEcal matter, containing several balls
of black, hardened faecal matter, about the size and in appearance
not unlike the black walnut. The evacuations were attended with
alarming fainting, but were soon followed by relief from all pain and
threatening symptoms.

The three preceding cases, I apprehend, furnish us with examples
of the most common causes of acute inflammation of the caecum,
viz. foreign indigestible substances, or hardened faecal matter, im-
pacted in the caput coli.

Mr. John Burne, Physician to the Westminster Hospital, in an
article published in the 20th vol. of the Medico-Chirurgical Transac-
tions, has given a_ history ofeight very interesting cases of this disease.
He tells us he has seen not less than twenty cases, in all of which he
has not seen a single example of the idiopathic inflammation of the
caecum from the ordinary general causes — exposure to the vicissitudes
of weather, &;c. "But every instance has been symptomatic of
some mechanical exciting cause, as the lodgment of undigested food,
of fruit stones or of concretions which the structure of the caecum
and appendix favors ; and hence the peculiar features of the disease."
It not unfrequently happens, that after an attack of acute inflamma-
tion of the caecum, induced by some foreign substance impacted in
its cavity, the natural powers of the organ are but slowly regained ;
hence it is subject to renewed attacks from any trifling error in diet,
or slight exposure to cold. Such cases often become exceedingly
troublesome and difficult to manage. The following is an instance
of the liabihty to a recurrence of this kind :

Case V. On the evening of June 13, 1843, Miss E. J. W.,aged
17, was seized with pain in the bowels, which was attributed to her
having eaten freely of unripe gooseberries during the preceding
afternoon. Lsaw her early on the morning of the 14th. Her coun-
tenance was indicative of severe suffering. She had taken a full
dose of Gregory's Mixture (magnesia, rhubarb and ginger), which
was rejected. The pain was referred to the umbilical region ; pulse
88, full and sharp ; pres. V. S. §xx. calomel gr. 10. Morphine gr. |.
Hot fomentations to the abdomen.

I saw her again in three hours. Her medicine had been retained,
although there had been some retching. Pulse 84, pain somewhat
abated; pres. calomel 5 grs. Morph. l-3gr. F'omcntations continued.

3 o'clock, P. M. She complains much less of pain. Skin moist ;

51S ~ Diseases of the CcBcum, [September,

tongue slightly coated with moist white fur ; pulse 84, soft ; pres.
half a Seidlitz powder, to be repeated ever}' hour, in hot water. Fo-
mentations to be continued.

9 P. M. Medicine has been retained, but there has been no motion
of the bowels. Slight pain still complained of in the umbilical region.
Abdomen soft; moderate pressure occasions no pain except over the
csBcum, where there is an evident fulness, quite tender to the touch.
Pres. an enema of castor oil and warm water, to be administered
directly. Cal. and Dov. powd. each grs. iii., to be given every four
hours. Fomentations to be continued.

15ih. Slie has passed a comfortable night; had a slight motion of
the bowels soon after the enema, with some dark Itecal matter.
TJhe pain has entirely receded to the right iliac fossa, where it re-
mains constant but not severe. Soreness not diminished ; tongue
more thickly coated, but white and moist. Pres, blister over the
caecum. Half a Seidlitz powder every hour and an enema to be
repeated every third hour, until free evacuations shall be procured,

Eveninii;. She has had several small evacuations of a greenish
ftuid with no solid faecal matter. Pres. 5 grs. Dov. Powd., to be
given every three hours. Simple dressing to the blister, over which
is to be laid a warm bran poultice.

16ih. She has had a quiet night, free from pain. Skin moist.
Pres. The follovv'ing enema to be administered directly : Castor
oil iij., spirits turpentine fij., warm water two pints.

2 P. M. In the course of the forenoon, she had several evacua-
tions of dark faecal matter in which there were several hard masses
containing portions of several partially digested gooseberries. Pres.
Hnlf a Seidlitz powder every two hours.

Evening. She has had several evacuations of greenish faecal
matter during the afternoon. Pres. 5 grs. Dov. Powder.

17th. Convalescent.

On the 8th of June, 1844, a similar attack occurred after eating
unripe, or but partially ripened cherries. Under a similar course
of treatment she got relief on the 4th day after the attack, but the
soreness and tumefaction subsided much more slowly than in the
first instance.

On the 14tb of Sept. following she was seized in the same way —
but the case proved much more obstinate than in either of the former
attacks, yielding to the treatment on the 15th day after its com-
mencement.

On the 3d of Dec. of the same year, she had a recurrence without
any knov.-n cause, except a bad cold, under which she had been
suffering several days. This lasted until the 21st, or eighteen days
from its commencement. From this time until the following spring,
she was constantly troubled with constipation of the bowels, attended
with flatulence, together with more or less tenderness and pain in
the caecum and ascending colon. Her general health suffered ma-
terially until the 28d of April, 1845^ when she had another attack,

1845] Diseases of the CcBCum. 519

attended with more acute inflammatory symptoms than either of the
former, involving the peritoneum to considerable extent. This
occurred in three or four hours after eating boiled cabbage. By
the use of an emetic most of this was thrown off from the stomach,
in an undigested state, together with a quantity of green bile. The
inflammation subsided, under active treatment, in the course of six
days, and the bowels slowly regained their natural powers so far as
to be comfortable under a carefully regulated diet, with the occasional
use of tonic laxatives.

We occasionally meet with instances in which the vermiform ap-
pendix seems to be the principal seat of the primary disease. This
is generally occasioned by the accidental intrusion of some small,
hard substance into its cavity, which its free communication with the
caecum readily allows; while there is no way of escape but by a
retrogade movement. Whether this oi-gan has the power of expelling
offending matter in this way or not, it is well known that they some-
times become impacted in this narrow tube, giving rise to irritation
and inflammation, which result in perforative ulceration of its coats
with most disastrous consequences.

Mr. Copland mentions having seen four cases of this description,
where the appendix was primarily and chiefly affected, owing to hard
substances having escaped into it. All of these cases terminated
in general peritonitis and gangrene of the appendix.

It appears from his description of this affection, that in the cases
which he has seen, the symptoms from the beginning were more
acute than in inflammation of the caecum itself..

Two well marked instances of this affection have fallen under
my observation, one of which was occasioned by the presence of two
l)iliary concretions lodged in the appendix. The symptoms in these
cases were less urgent than in those related by him ; although the
sequel was the same.

Case VI. This occurred in a young man about 17 years of age,
while attending school at the Canandaigua Academy. I first saw
him on Tuesday, June 6, 1837. He complained of sickness at the
stomach, and pain in the umbilical region. He attributed his illness ,
to the eating of oranges on the previous evening. I gave him calo-
mel and rhubarb, of each 10 grains in powder, and directed hot
fomentations to the abdomen.

I called again in four liours. The sickness had subsided and pain
somewhat abated ; gave him castor oil and aromatic syrup rhubarb
each 1 oz.; fomentations to be continued, and a copious enema to be
administered in three hours.

7th. The bowels have been freely moved ; still complains of pain
about the umbilicus. On carefully examining the abdomen, I dis-
covered tenderness on pressure deep in the lower part of the right
i'.Iinc fossa ; no febrile movement has manifested itself.

I applied a blister to the right ilio-inguinal region, and directed

520 ' Diseases of 'the Ccecum, [September,

calomel and Dover's powders, each 3 grains, to bo repeated every
four hours.

Evening. Several times during the day he has rejected from the
stomach small quantities of greenish watery fluid, which has left a
slight stain upon the tongue. The blister has filled well ; Dover's
powder and calomel to be continued through the night.

8th. Rested well during the night ; pulse 76, soft. Skin moist ;
thin white coat upon the tongue ; not dry ; no pain, but little sore-
ness ; blister looks well. I gave him ten grains of calomel to be fol-
lowed in three hours, with a draught of infusion of senna and Ep-
som salt.

Evening. His medicine has operated several times during the day.
The evacuations contain a large quantity of dark fcccal matter but
without faecal odor. He expresses himself as feeling relieved. Di-
rected Dover's powder for the night.

9th. Had a quiet night. No pain, but some soreness in the right
iliac region. Heavy white coat upon the tongue ; pulse 78, and soft,
and yielding readily to slight pressure. Has had a small evacuation
from the bowels. No faecal odor ; blister reapplied. A seidlitz pow-
der to be given every three hours.

Evening. Bowels have been moved several times, evacuations
not examined. Entirely free from pain. I spent more than an
hour with him, in company with some friends, who had called on
him. He left his bed and v/alked to his chair without assistance.
Conversed freely, and desired permission to ride to his friends the
next day — a distance of 10 miles — which I advised him to defer for
a few days. Everything seemed quite favorable, excepting a very
heavy, white, clammy coat spread entirely over his tongue. A
Dover's powder was the only medicine prescribed for the night.

10th. I was called to him very early this morning, and found him
in articulo mortis-

On post-mortem examination, assisted by Dr. Bristol, there was
found in the pelvis about half a pint of purulent matter. The vermi-
form appendix presented an opening about one inch from its attach-
ment to the caBCum, in which lay a bilary concretion about the size
of a common white bean, and nearly of the same shape. On raising
the appendix it separated from the caecum, and was found in a gan-
grenous state through its whole extent. About half an inch above the
ulcerated opening already mentioned, there was an enlargement of
the appendix in which was found another concretion of about the
same size and appearance. On carefully cutting open the concre-
tions, they were found to be composed of concentric layers of dense
bilary concretion around a common centre of the same material.
Marks of recent inflammation were traceable to a great extent, over
the peritonium as well as the small intestines.

The most remarkable feature in this case, is the amount of organic
lesion of so destructive a character, with no more urgent symptoms.

In the other instance of this description of disease to which allu-

11545.] Diseases of the C(BCU7n. 521

sion has been made, the s^^mptoms were more nearly allied to those
of strangulated hernia. The appendix was found imbedded in a mass
of omentum, greatly hypertrophied, and in a state of ulceration.
The cavity of the appendix was nearly obliterated by a thickened
condition of its mucous membrane which had assumed a kind of firm
pulpy consistence. Portions of the mucous membrane of the caecum
also presented a similar appearance.

Affections of the appendix are not generally distinguishable from
those of the csecum itself, during the life-time of the patient. We
may sometimes suspect them when the seat of the affection is deep
in the pelvis, as this organ is frequently found depending in this situa-
tion. This was noticed as detailed in Case VI. The soreness was
deep-seated in the pelvis, which led to the suspicion that the appendix
was the principal seat of the affection. Indeed the opinion was ex-
pressed before the post-mortem examination. But the situation of
the appendix varies so much in different individuals, that even this
sign can lead to nothing more than a mere suspicion ; nevertheless,
this fact is often very important in its practical results.

In the dissections which I have made, I have not discovered much
uniformity either in the size or shape of the appendix, or of its place
of origin, nor of the direction which it takes on leaving the csecum.
Among my dried preparations, I have one colon of common size, in
which the appendix measures six and a half inches in length, and
nearly half an inch in diameter; passing off nearly in a straight line
from the most depending point of the caput coeci, the extremity of the
appendix resting on the floor of the pelvis. I have another colon of
equal size, in which the appendix is less than two inches in length,
and no thicker than a crow's quill. This has its origin just at the
margin of the iiio-caecal valve, is coiled upon itself, and firmly bound
to the caecum by a fold of peritonium. In another specimen the ap-
pendix measures four inches in length; has its origin within half an
inch of the termination of the ileon and makes a turn round this intes-
tine, firmly embracing it. I have preserved nine preparations of the
caecum and appendix, all of which vary materially in their form and
construction, so that no general description will answer to any two
of them.

Dr. Burne observes, that "The confirmation and situation vary
much in different individuals — a fact not noticed by anatomists, but
which I have found to influence the phenomena and nature of its dis-
eases very considerably. The conformation of the appendix is
generally described as flcxuous, and its situation as depending into
the pelvis; but by some the situation is not noticed, further than that
the appendix arises from the caecum, and is bound down to it on the
right by a fold of peritoneum, the meso-appendix ; whereas the ap-
pendix is more frequently situated on the outer edge of the psoas
magnus, on the fascia iliaca, snugly curled up beneath the caecum,
and concealed by it — a fact which I have verified by many dissec-
tions, and one of great importance to the pathologist, as will be seen.

522 Diseases of the Ccscum. [September,

In the event of a perforative ulceration of the appendix, and a conse-
quent peritonitis or fcecal abscess, the parts involved will ditler entirely
according to the situation of the appendix. If it should happen to
depend into the pelvis, then the pelvic viscera will be implicated ; if
it should happen to bo situated on the iliac fiiscia, and underneath
the caecum, then the belly of the iliacus internus.and the neighboring
adipose cellular tissue will be involved, and the course of the abscess
be determined accordingly : so important is the relative anatomy of
even inconsiderable organs to the physician."

The foregoing cases nre selected from eighteen well marked in-
stances of this class of affections which have occurred under my
own observation during the last fourteen years. I met with several
other examples of this disease during the earlier years of my prac-
tice, of which no notes were made at the time. I have also occa-
sionally seen cases in consultation with neighboring physicians, so
that abundant evidence is afforded of their frequent occurrence, at
least in this section of the country.

They are spoken of by some medical writers as being obscure in
their origin, and often difficult of detection. Professor Albers, of
the University of Bonn, makes the following remark, ''That the
diagnosis of the disease of the caecum is attended with no inconsid-
erable difficulty appears from the well known circumstance, that very
often they have never been suspected to exist during the life of the
patient, and have been discovered only on dissection."

Dr. Burne remarks, that "A practitioner who witnesses one of
these cases for the first time, is satisfied it is not a common inflam-
mation of the bowels, although he does not know its exact nature —
he says the case is a curious one — he cannot make it out."

Dupu3'tren, in speaking of the importance of a correct diagnosis in
these affections, says, "I have seen this inflammation give rise to
the belief of the existence of internal strangulation, hepatitis, metri-
tis, and even peritonitis." That these affections are sometimes
mistaken for common inflammation of the bowels, or "Bilious Colic,"
I am fully aware, having been consulted in four well marked cases,
the true nature of which had been entirely misapprehended. One
of these terminated in the usual way by resolution — the other three
were allowed to pass on to suppuration, one of which terminated
fatally, the abscess bursting into the peritoneum. The other two
cases opened externally, a little above the crural arch, one of which
formed ill-conditioned sinuses which remained open more than a year
— and finally recovered.

The causes of failure in diagnosis are probably owing in part to the
mildness of the earlier symptoms, which attract but little attention
from the patient or physician; but principally to the fact, that the
pain attending ihem is generally described by the patient as a colic,
and is frequently referred to the umbilical region, or to the abdomen
generally. Indeed it is very rare that the patient directs attention
to the seat of the disease.

1S15.] Diseases of the CcBCum. 523

It is only by a careful examination that the nature and seat of the
difficulty are detected. By gentle pressure or percussion over the
surface of the abdomen, as you approach the right iliac region, the
patient shrinks from you, or perhaps instantly seizes your hand, and
betrays surprise at the discovery of such exquisite tenderness.

Hence the importance of carefully examining every part of the
abdomen, in these, as well as in all other affections of the abdominal
viscera.

If we take into consideration the situation of the ca)cum, fixed as it
is in the parietes of the abdomen, admitting of no considerable varia-
tion in its relative position with regard to the other viscera, it must be
evident, that \vith such an examination the disease under considera-
tion would seldom escape early detection.

The progress of the phenomena as developed in these affections, is
thus descubed by M. Dupuytren : " After some error in diet, a con-
stipation or diarrhoea, of longer ^r shorter duration, more or less hab-
itual colic ; sometimes without any of these causes, the patient suffers
from violent colic and pain in the bowels, with a tendency to concen-
tration in the right iliac fossa; it may also extend towards the large
intestine, or over the whole abdomen. This colic is generally ac-
companied by constipation, and sometimes vomiting; such are the
symptoms by which we may predict the occurrence of the tumor.
They are of very various duration ; sometimes lasting for a month or
more, sometimes for a few days only."

Dr. Hays, Editor of the American Journal of the ?»Iedical Sciences
(see Medical Essays, vol. 1, page 81, published by Lea and Blanchard,
1S41), says: "the disease usually announces itself by certain pre-
cursory symptoms, as coVic, with alternate constipation and diarrhoea,
occurring at longer or shorter intervals, and continuing for a greater
or less period. After a while the attacks of colic become more se-
vere, and appear fo centre in the right iliac fossa ; they may also
radiate in the direction of the great intestine, or spread over the whole
cavity of the abdomen. These pains are usually attended with ob-
stinate constipation, and sometimes with such violent vomitings as to
simulate an internal strangulation. In some cases the disease has
its origin, is attended with less violent symptoms, and commences
with pain the right iliac fossa. If this region be examined, it will be
found more tender to the touch, more resisting, and sometimes to
project more than in the natural state. It is frequently possible, by
pressing upon the abdominal parietes, to distinguish a circumscribed
tumor of variable size, of considerable firmess, more sensible to the
touch than any other part of the abdomen, and appearing to rest upon
the cscum ; the remainder of the abdomen is soft and indolent. The
patient continues at the same time t^ complain of colic and constipa-
tion."

Dr. Burne, ih the papers to which we have already alluded, gives
the follo\^ing graphic description of these affections: '• In all the ex-
amples of inliammation of the caecum, which I have witnessed, the

524 Diseases of the Ccecum. [September,

development of the symptoms has been in the following order : The
first sign is a sense of uneasiness, which soon amounts to an aching
pain, deep-seated in the right ilio-inguinal region, arising unexpect-
edly while the person was in health, and not preceded by rigor or
exposure. This pain increases progressively for twelve or twenty-
four hours, retains its character, is fixed and constant, never even
remitting. Then supervene gradually tenderness, fullness, and ten-
sion of the whole ilio-inguinal region ; the bowels are constipated
and do not reply to medicine, and the patient grows sick and vomits.
Some febrile movement now begins to manifest itself; the tongue
becomes white and furred ; the urine scanty; the appetite is gone;
the pulse is frequent, tight, and sharp, with increased volume, but
the stroke, though sharp, is not strong, nor is its impression on the
finger decided — it is a pulse of irritation and inflammation combined ;
the patient lies on the back quite still, slightly inclined to the side
affected, and the case presents a serfous aspect."

The above is certainly a faithful delineation of most of the symp-
toms which are usually manifested in these cases, but these phenom-
ena are most invariably preceded! bj' a series of ^^ precursory symp-
ioms,^^ as noticed by Dr. Hays.

By referring to the cases detailed by Dr. Burne, it appears that no
one of them came under his observation earlier than the fifth day
after the attack ; a circumstance which fully explains the cause of
his having failed to notice the symptoms, which usually precede what
may be considered as signs, peculiar to these affections.

Instead, therefore, of waiting for the development of local signs,
these symptoms should at once awaken our suspicions, and if we are
led by them to a careful examination of the abdomen, we may, even
before the attention of the patient has been directed to the part, dis-
cover a circumscribed fullness, well defined, and quite tender to the
touch, situated over the ccecum. It is during the prevalence of these
earlier symptoms, that a well directed treatment will often prove
most successful.

The course of practice which I have found most successful in these
cases, previous to the development of inflammatory action, is a free
use of calomel and opium, together with warm fomentations to the
abdomen. When the system is fully under the influence of opium
— pain and spasmodic action having subsided — an enema of castor
oil and spirits of turpentine, in a sufficient quantity of warm water
to freely distend the colon, will generally succeed in removing -the
offending matters. By thus removing the cause of the difficulty, we
may often avoid the more serious character of these complaints. If,
however, this course proves unsuccessful, and inflammatory action
supervene, it m.ust promptly but cautiously be met ; and here I cannot
do better than to commend as worthy of special attention, the follow,
ing judicious observations of Dr. James Johnson. '•' As the inflam-
mation is the result of a mechanical source of irritation, or, perhaps,
obstruction, it is obvious that depletion must not be carried to so great

1845.] Diseases of the CcBcum, , 525

an extent as in idiopathic enteritis. Another consideration which
should moderate the employment of depletory measures, especially
of local or general bloodletting, is the reflection that the patient may
have to go through an iliac abscess, and that his powers should be
husbanded for its support. The depletion, then, should be cautious ;
enemata, and such purgatives as the stomach will bear well, should be
administered; light poultices and fomentations are to be applied ;
and about the fifth or sixth day the bowels may begin to act, and the
symptoms to subside. Should they not subside, the physician or
surgeon must anxiously watch for the first appearance of an emphy-
sematous tumour, and make an early incision into it; foetid g^is
escapes, and the cellular tissue is more or less sloughy, or actually
sloughing. The patient must now, of course, be supported, and even
stimulated, to the necessary pitch."

There seems to be some difference of opinion among practitioners,
as to the propriety of opening these abscesses after suppuration has
taken place. M. M. Dupuytren and Dance recommend leaving them
to the efforts of nature, allowing the matter either to make its own way
to the surface, or to escape through some of the natural passages ;
while on the other hand, Drs. Hargrave and Kennedy, of Dublin;
Drs. Johnson and Copland, of London ; and Dr. Hays, of Philadelphia,
advise a free opening for the exit of purulent matter, as soon as a
tendency to the surface is evident. There can be no doubt that the
latter course will be sustained, when experience shall have decided
their relative advantages.

We occasionally, in these cases, meet with an exceedingly irritable
condition of the rectum. Under these circumstances, an enema, by
a common syringe, will not be retained in sufficient quantity to be
of much advantage. We may then resort to the use of an elastic
tube, passed high up into the colon, as recommended by Dr. O'Beirn.

I have during the last two years made use of the tube described in
connection with Case IV., which I have found in some respects
preferable to the common elastic tube. Its advantages consist in its
being of sufficient firmness to retain whatever shape or course we
may choose to give it, previous to its introduction, while the bulb at
its extremity is not liable to be obstructed in its passage by the loose
folds of the mucous membrane ; we consequently avoid all danger of
breaking the tube, or of injuring the coats of the intestine.

In detailing the foregoing cases, I have appended occasional re-
marks; not, however, for the purpose of offering to the profession
any thing new, but rather with the intention ofdirecting the attention
of the readers of your Journal to a class of affections which are
scarcely noticed in the systematic works which constitute the libra-
ries of most country practitioners ; and also of inviting their attention
to the articles from which I have drawn so largely in preparing this
paper. — Neiv-York Journal of Medicine, July, 1845.

526 Climate, Diseases, <SfC., of Middle Florida, [September,

Remarks on the Climate, Diseases, <^c., of Middle Florida— parti,
cularhj of Gadsden county, ^y Robeet Edmonds Little, M. D.,
of Quincy, {From Am. Jour. Med. Sciences, July, 1845.)

Gadsden, one of the most northern counties of Middle Forida, ex-
tends from the Georgia line on the north, to the Gulf of Mexico on
the south, a di.stance not far short of one hundred miles,— while its
eastern and western boundaries are the Apalachicola and Ockolok-
nee rivers.

The northern portion of the country (the part most densely popu-
lated) is watered by numerous streams of considerable magnitude,
the principal of which, beside the above named, are Little river,
Witlacoochce, Tellogee and Rook Comfort creeks. Their banks are
low and often so boggy as to cause it to be necessary for the road
over them for the distance of several hundred yards to be elevated,
so as to render the stream approachable. These waters are clear
and usually not unpleasant to the taste. The face of the country is
for the most part rolling— especially the rich portions of it in the
neighborhood of the hammocks,* while the pine lands are tolerably
level; the former fertile, producing in abundance all the great sta-
ples of the climate, — the latter are poor and little adapted to cultiva-
tion; unless manured, being principally used as ranges for cattle, of
which many of the planters possess an immense number. The ham-
mocks are covered with a growth of cane, oaks, hickories, poplars,
sweet gums, red bays, magnolias, g:c.. and vary in width from fifty
yards to a mile — the soil of which they are composed is a ])Iack loam',
based upon a bed of clay. In passing over the country the traveller
frequently meets with barrens, dotted here and there with stunted
oaks, pines and prickly pears, which, however, are soon forgotten in
beholdin^g beautiful plains, shaded by stately pines; now and then
green mounds, the receptacles of the dead — and not unfrcquenlly a
glassy pond, whose sparkling waters are so many mirrors reflecting
the beautit^ul verdure of the live oaks which dip their wide-spreading
branches far over its banks. In the early settlement of the country
when land v.'as easily obtained, no care was taken to prevent a dete-
rioration in fertility — hence many fields are now lying in a waste
condition, not worth cultivating, v*^hich will, however, in the course
of a few years be entirely renovated and capable of producing as well
as formerly, — no land in the world being more susceptible of im-
provement by rest.

* The word hammock is applied indefinitely in many parts of the territorv
m one quarter it is used to signify '-a thickly wooded place:" in another ''a
mound raised out of a swampy tract of land ;" and again it is supposed to be a
corruption of Tomaka, the Indian name for a river whose banks are covered
With hammocks or swamps. Webster derives it from the Spanish word hamucu
referj-mg to the beds used by sailors, and as the soil of which these hammocks
are composed seems to be raised above the surrounding water.

1345.] Climate, Diseases, t^Cf of Middle Florida. 527

The frvcai staple of Middle Florida is cotton — but since its depre-
riation in value, many of the planters are uirning their attention to
the cultivation of tobncco, a species of which is produced in many
portions of the district, almost equal to that of Cuba. Rice and sugar
cane grow well and are cultivated in quantities sufficient for domestic
use; — the latter mi;:jht be made an article of considerable revenue,
as the soil and climate seem to be peculiarly adapted to its cultivation.
The fig and orange arrive at perfection, and with care might be ren-
dered a source not only of luxury, but profit. From the slips they
bear fruit in a very few years, and the only attention necessary to
bestow on them, is protection from the frosts of winter until they are
matured. The apple, pear, cherry, grape, gooseberry and currant
are unsuited to the climate, -seldom arriving at perfection — while the
peach and melon flourish, affording during the summer an abundance
of agreeable fruit. The long continuance of warm weatber prevents
a proper attention being paid to gardening, yet so mild are our win-
ter and spring months, that almost every article usually found in
gardens in more temperate climes is capable of being produced in
profusion. The Irish potatoe, onion, and cabbage, degenerate after
the first year's cultivation — their produce being small and of unnatu-
ral flavour, while the sweet potatoe furnishes a considerable portion
of the population with an agreeable article of food, the soil being very
favourable to its production.

The flora of Middle Florida is peculiarly rich in the variety and
and beauty of species, the surface presenting one vast bed of flowers.
And no portion of the American Continent is so plentifully supplied
with insects and reptiles as in this "land of flowers." In rambling
through the woods scarcely a leaf can be turned, or brush disturbed
without breaking in upon the slumbers of some "creeping thing,"
whilst at night, during the summer season, our ears are assailed by
the buzzing of myriads of mosquitoes in their murderous attacks
upon those of us who are so unfortunate as net to have pr<J\ided
bars as a means ofdefence. So formidable are their stings, that cat-
tle and deer are often compelled to leave the swamps, and take up
their residence in the pine woods to avoid them.

In all parts of Florida is to be found a species of land tortoise,
called the Gopher {Goiiff re, French), (Testudo Polyphemus). Alli-
gators of large size are numerous, and on the banks of the Apalachi-
cola, on a bright day, hundreds of these monsters are to be seen
basking in the rays of the sun, ready to pounce on any prey that may
be so unlucky as to be accidentally thrown in their way or so hardy
as to approach them.

Of the feathered tribe we have a great variety — especially aquatic
— the most prominent of which is the large wood pelican; an awk-
ward bird in its movements on land, but when placed upon its conge-
nial element, graceful. Large droves of the paroquet are seen, a
noisy but beautiful bird, singularly graceful and rapid inflight.

As objects of greater interest to the sportsman, various quadrupeds

528 Climate^ Diseases^ (Sfc, of Middle Florida. [September,

are found in a wild state. Luxuriant in vegetation, the Territory af-
fords ample opportunity for the hunter to indulge in the exciting chase
after deer, and for the hardy woodman to hunt bears. Wolves and
panthers are numerous, frequently proving troublesome to the settlers.

Of the climate of our American Italy much has been said, and sit-
uated as Florida is, in the southernmost part of our great confederacy,
for years past it has been looked to with the hope of its possessing a
climate capable of affording relief to those afflicted with diseased
lungs, scores of whom annually leave their northern homes but to
languish and die on a foreign shore. Whether this hope is likely to
be realized or not, time alone can certainly determine.

Warm weather usually makes its appearance about the middle of
April, and continues with but little variation until the last of Septem-
ber ; when the mornings and evenings begin to grow pleasantly cool
— although the weather remains at mid day warm until November is
ushered in. During the last two months of the year, the days are
pleasant ; but few blasts of cold weather sweeping across the land to
remind us of overcoats or cause us to desire to exchange our pine
knot for the anthracite fires of our northern friends. Although hot
weather is of long continuance, the thermometer seldom indicates a
temperature higher than 95®, the mean heat of January being 55°,
of July and August 87^^ ; and of November and December 58°. At
this point (Quincy inlet, 30° 40',) a breeze from the Gulf of Mexico is
generally felt about ten in the morning — which continues until late
in the evening, thus mitigating considerably the heat of summer and
rendering our almost tropical chme not only endurable, but pleasant
at a time when the inhabitants of a more northern region are sighing
for the zephyr's breath to stir the dormant,' sultry atmosphere with
which they are surrounded. Our nights in summer are cool, especi-
ally towards the latter part, — so cool, indeed, as not unfrequcntly to
make it necessary to add a blanket to the usual articles of clothing.
In summer, droughts of long duration are not uncommon — much to.
the injury of the planting community. The spring months are those
most usually productive of rain, which falls not gently for a few
hours, but in torrents, and for whole days with such impetuosity as
to have gained the distinctive name of "Florida rains." As the banks
of the water courses are low they are easily overflowed ; the rush of
waters sweeping every thing before them, fences, bridges, &;c. noth-
ing being safe from their desolating influence. Such was the case in
the spring of last year. For three days the rain fell in such torrents
as to darken the atmosphere, rendering it almost impossible for a man
to be recognized at the distance of twenty steps. The streams were
carried far beyond their banks; lagunes overflowed; roads rendered
invisible ; in short, the appearance of the whole country was chang-
ed. Traveling was suspended for weeks; as well as intercourse
between neighbours ; all waiting for a subsidence of the waters and
rebuildingof bridges, many of which were swept away — all injured.
Rains are usually succeeded by pleasant weather, the surface of the

1845.] Climate, Diseases, <^c., of Middle Florida, 529

country drjing in the course of a few hours, the soil being very ab-
sorbent.

The summer winds generally come from the south and west, and
when these are accompanied by clouds, rain is pretty sure to follow ;
while northern winds seldom precede or attend rain. From our
proximity to the Gulf of Mexico, tornadoes are not unusual. The
one which occurred in the fall of eighteen hundred and forty-three
will be long remembered, because of its violence and the destruction
of property caused by it. Port Leon, St. Marks, and most of the
settlements on the Wakulla were destroyed. The gale commenced
in a gentle breeze, causing but a slight agitation of the waters and
rustling the leaves ; gradually it increased, the waves began to lash
the banks, and the trees to bend ; and after a time to be prostrated,
unable to withstand the fury of the enraged elements. Time only
served to add strength to the winds, and they ceased only when every
thing had fallen before them. Gales such as that alluded to seldom
occur in this region, although almost every spring and fall are at-
tended by storms of considerable violence.

Our coldest months are December and January. The past was
the most severe winter experienced in Middle Florida for the last
twenty years ; in several instances the small pools of standing water
caused by the hoofs of horses, were frozen over and remained so
until 9 o'clock in the morning. Snow has fallen but twice in the
last eighteen years, and then only in quantities sufficient to give the
ground here and there a white appearance. Atmospheric changes
are frequent, the mercury falling and rising again 15^ to 25'^ within
a few hours ; but fortunately the cold spells last but a few days at a
time and are succeeded by weather most delightful to the invalid ;
although the changes are sudden, there are but few days in winter so
unpleasant as to prevent the valetudinarian from taking necessary
exercise in the open air either on foot or horseback. As before
remarked, an opportunity is seldom wanting in winter to indulge in
the chase after deer, or less fatiguing sport of hunting wild turkeys.

In the villages, the accommodations for the sick are good — the
hotel tables being bountifully supplied with all the delicacies of the
season, a circumstance heretofore much complained of, to say nothing
of the exorbitant charges of the worthy Bonifaces of our land.

Separate and apart from the evidence of meteorological registers,
we are strongly inclined to the opinion that the climate of Middle
Florida presents inducements as a winter residence to those who are
predisposed to, or have already contracted tuberculous affections in a
northern latitude (provided they are not far advanced), equal to any
portion of the eastern division of the territory ; taking into consid-
eration the influence of good society — accommodations, &;c. To-
wards the permanent restoration of advanced cases nothing can be
done; such we would advise to remain at home and not to seek a
grave in a strange land.

A common opinion prevails at the north, not only among the un-

530 Climate, Diseases, <Sfc., of Middle Florida. [September,

informed, but even among physicians, that consumption is a disease
that rarely originates in warm cHmates, an opinion not more com-
mon than erroneous. In the southern country tuberculous diseases
are often met with, not the result of colds — but of the long continu-
ance of warm weather and the use of food almost entirely vegetable,
circumstances tending to produce a debilitated state of the system.
This cause is not liable to operate with the same force upon natives
of a northern as upon those of a southern region, the former, reared
in a climate whose tendency is to invigorate the frame and render it
capable of enduring for a number of years the debilitating influence
of Vvarmth, resist phthisis for a great length of time, while the latter,
subjected from infancy to a high temperature, early fall victims to
tuberculous cachexy upon the occurrence of even the slightest agent
in its production.

The prevailing diseases of this portion of the southern country
^re those which are supposed to have a relationship or connection
with that peculiar agent termed malaria, and our territory is rich in
all the elements favourable to the elimination of this poison, viz :
vegetable matter in a state of decomposition ; high temperature and
moisture ; a union of all these being necessary, or either alone being
capable of generating it, while a superabundance of the latter, moist-
ure, although the other constituents are in exact proportion, prevents
its formation. No fact is better known in the southern country, than
that for the first few years after the settlement of a particular dis-
trict, its inhabitants are more exposed to disease than in after years,
because of the evolution of miasm in large quantities, caused by the
felling of the forest and cultivation of the soil ; a greater amount of
the earth's surface being exposed to the action of the sun's rays, but
in subsequent years when it has been deprived of its superabundant
vegetable matter and well drained, its inhabitants are exempted in a
great measure from malarious diseases. The pine lands which are
dry and removed from the water courses, are always considered
healthy ; one of the malarial elements, moisture being absent ; a
fact also strikingly illustrated in the epidemics which annually devas-
tate Egypt, caused by the overflowing of the Nile, — ^the disease never
extending into the arid plains of the desert. An excess of moisture
tends to the destrifction of any poison which may have been in exist-
ence prior to its creation, for instance flat places in ordinary seasons
unhealthy, become healthy if completely overflowed, while, on the
contrary, high lands where sickness was never known to prevail
before, emit a miasm which sweeps every thing before it. The advice
of Lancisi to those travelling near the Pontine marshes, not to do so
after dusk or early in the morning, as the dew in their neighbour-
hood is largely adulterated with miasm in a concentrated state, might
well be given to travelers in Florida, where the dews are remarkably
heavy, and, from the great susceptibility of the system in warm
climates to the impression of morbific agents, capable of doing much
injury at that lime.

1345.] ' Climate, Diseases, i^c, of Middle Florida. 531

Dirt Eating. — Apart from the sickening influence of malaria, we
cannot refrain from noticing the degeneration, mental and physical,
of children reared in this extreme southern portion of the Union.
During our first months' residence in Florida, in passing through the
country, we often stopped boys on the road, not over ten or twelve
years of age, who presented the most abject state of degeneration
imaginable; with head and body large, limbs shrivelled and deform-
ed, eyes dull and of a bilious tinge, lips colourless, and features dis-
torted. This degeneration, by many, has been attributed to dirt-
eating, a propensity very general throughout the whole country.

Having completed a general and consequently incomplete descrip-
tion of the physical phenomena of a portion of the Territory, reference
will now be made to its diseases. If the remark made by Dr;
Macculloch be true, that the disorders produced by malaria include
more than half the number, prevailing at any moment throughout the
universe, it may readily be inferred from what has been said above,
that a majority of our diseases arc malarial.

Intermittent Fever. — There is no disease with which physicians are
supposed to be better acquainted than intermittent fever — but on the
other hand it must at the same time be confessed, there are few
which occur under so many different circumstances— modified by so
many causes, both malarial and geological, and so difficult to be re-
cognized in its anomalous forms. But few cases of an inflammatory
character are met with — they are usually adynamic and complicated
with visceral obstructions, and if suffered to go on, degenerate into
remittent or congestive fever, or assume the appearance of slight
apoplectic or epileptic attacks ; palpitation of the heart, toothache,
"sun pain," dec. — diseases Dr. Macculloch would have us believe
identical with intermittent fevers, because of their liability to slight
remissions — their alternating not unfrequently with it, and their be-
ing cured by the same remedies. Enlargement of the spleen and
night sweats are the most troublesome sequelae of intermittent fever.
When the disease becomes chronic, the intellect is impaired — which,
together with the physical degeneration, renders life a burden. Re-
lapses are frequent, and each succeeding attack increases the suscep-
tibility of the patient to another.

Remittent Fever. — Intimately related to intermittent fever, and
produced by the same cause is bilious remittent fever, the prevailino-
febrile disease of our summer months. So much do the two diseases
resemble each other, as to be considered by many as identical, or at
any rate modifications of the same disease, an opinion not destitute
of foundation, as their symptoms during life, and morbid appearance
after death, differ only in degree.

The disease is usually ushered in by a chill, sometimes severe,'
frequently nothing more than a cold sensation, (which occurs as a
general rule every twenty-four or forty-eight hours) followed by pain
in the back and limbs. The tongue in the early stages of remittent
fever is moist, and presents a white or yellow appearance, but as the

532 Climate, DiseaseSfi^c.t of Middle Florida. [September,

disease advances, it becomes dry and the colour changes to a dark
brown. Pain in the head is a common symptom, frequently contin-
uing through the whole progress of the case. During the stage of
excitement, the pulse is increased both in force and frequency, while,
during the remission, it is scarcely above the natural standard, fre-
quently below it. The bowels are commonly torpid, requiring the
most active cathartics to excite them. After the disease has con-
tinued for four or five days, epigastric tenderness is not uncommon,
attended by weight or tension, requiring for its relief the' abstrac-
tion of blood locally, blisters, <&;c. ,

The condition of the skin varies during the stage of excitement ;
its temperature is much increased, while it is not unfrequently les-
sened during the remission. In grave cases its colour is inclined to
be yellow; in slight and even in tolerably severe cases, its appear-
ance is not materially changed.

The intelligence of the patient being influenced by the violence
of the headache, it may be readily inferred that in the beginning of
both recovered and fatal cases where there is much pain in the head,
delirium is not an uncommon symptom during the exacerbation. In
fatal cases, towards their termination, there is generally low mut-
tering delirium or coma.

Remittent fever in this climate, as a general rule, terminates in
from three to ten days.

Congestive Fever. — Of all the diseases incident to a southern
climate, no one, perhaps, is so much dreaded by the profession, as con-
gestive fever, a disease which, unless arrested in the onset, is gener-
ally attended by the worst consequences. Its attack is preceded by
precursory symptoms, sudden and violent, and, unless the most
prompt measures are early used, it runs its course in from twenty-four
to seventy-two hours. For several days prior to an attack, the sub-
ject of it complains of general malaise with derangement of the
chylopoietic viscera ; finally a chill supervenes which ushers in the
disease in all its violence. The pulse is now exceedingly feeble;
breathing quick and laborious; the tongue moist; bowels usually
costive; they are, however, sometimes fully acted upon, and not
unfrequently there is nausea and vomiting. The patient complains
of internal heat and of a heavy load pressing on the epigastric; his
calls for water and efforts to throv/ off the load pressing him are fre-
quent. As the disease progresses the extremities become very cold
and shrivelled ; pulse almost imperceptible ; intellect clouded ; spit-
tle spontaneously flows from the mouth ; subsultus supervenes ; the
skin grows colder, is covered with a cold clammy perspiration, and
loses its natural colour, particularly that of the face, and finally it is
not uncommon for the case to terminate in convulsions, especially
if there be congestion of the spinal cord. Such are the symptoms
most usually observed. We have not attempted a full description of
them, as they are modified by a variety of circumstances — such as
seat of congestion, &c.

1 ?45.] Climate, Diseases, iSfC., of Middle Florida. 533

During the summer and fall seasons, cholera infantum, diarrhoea
and dysentery are very prevalent, as might be inferred from the tem-
perature of the weather and locality of the country, being produced
by nearly the same causes that give rise to intermittent and bilious
fevers. To a variety of other causes have they been attributed, as,
for instance — to eating fruit, to heat, &>c. Facts, however, seem not
to favour the supposition. That fruits in moderation are prejudicial
to health or productive of disease, we cannot believe, as, during sea-
sons of great scarcity these diseases are not uncommon, while it is
not ascertained that th|^' occur more frequently during seasons of
plenty than at any other time. A rigid proscription of them will not
prevent an attack of cholera infantum or diarrhoea, nor will a free
use of them bring on disease without the influence of other agents,
as is witnessed in families where no restraint is imposed on the chil-
dren in eating apples, melons, currants, and other fruits, even before
they are matured. That heat alone is incapable of giving rise to the
above diseases we are assured from the circumstance of this not be-
ing most prevalent during the warmest summers. Hence, we must
conclude that other causes than warm weather and the use of fruits
are necessary to their production. From the prevalence of febrile
diseases and of bowel complaints and disappearance at about the
same lime, it is altogether probable that they are engendered by one
common cause.

Diarrhoea and dysentery are not usually found uncomplicated with
other disease. They are, for the most part, sequels of obstinate or
badly treated cases of fever, and require for their removal a long
course of treatment.

In the tropical climate of the Southern States the liver is most genr
erally the suffering organ in disease, as the respiratory apparatus is at
the north ; as a consequence, the afiections to which it is prone are
numerous— often slow in their attack and progress, and liable to be
misunderstood from their obscurity. The organization of the liver,
its immense size in comparison with the other abdominal organs, and
the important office that it is called on to perform, force the belief
upon usthat any derangement either in structure or function must be
attended with consequences which will sooner or later, if not relieved
undermine the health, cause the patient to drag out a miserable ex-
istence, and finally end his career, a victim to delay and inefficient
or misapplied medical treatment.

As acute hepatitis is uncommon in this climate, except as a result
of the chronic form, a consideration of it will not be had, our object
being to speak more particularly of the latter, as it is a disease daily
encountered by the southern practitioner. In saying that acute
hepatitis seldom occurs except as a sequel of the chronic form,, we
wish it to be understood that the disease is scarcely ever a primary
affection itself, and that it usually supervenes upon or is rather an ag-
gravation of the last named variety. For years patients will labour
under a variety of symptoms, without being able to determine or even

534 Climate^ Diseases^SfC^i of Middle Florida. [September,

suspect their cause, when suddenly they are aggravated, or a new
one in the catalogue appears, and its true nature revealed. Such is
its insidious Protean character.

Middle Florida has been visited by scarlatina very rarely. Spor-
adic cases are occasionally seen, mild, however, in character. About
the first of January last, it made its appearance in the village of
Quincy, extending its ravages to some two or th>ee plantations in its
immediate vicinity. It was confined to a few families, several mem-
bers in each being attacked, varying in age from one to ten years.
The two first cases that happened were ma||^ed by a peculiar malig-
nancy and terminated, we believe, within thirty-six or forty-eight
hours from the commencement of the attack. They were for a time
supposed not to be cases of scarlet fever, hut subsequent cases, similar
in many respects, revealed to the attending physician the true nature
of the disease, which, in the course of the epidemic, assumed all ap-
pearances, from the mildest to the most malignant. The patients
were, as a general rule attacked suddenly, either with pain in the
head or vomiting. No two cases presented exactly the same ap-
pearance. In all severe cases the heat of skin was great from the
commencement, to the termination of the disease. The pulse was
frequent in some cases, whilst in others it was slow, respiration
difficult, and the thirst tormenting. In a majority of cases, there
was no affection of the throat complained of, while in others there
was soreness of the fauces and neighbouring parts for a month after
the fever had subsided. In two or three instances the glands of the
throat swelled and suppurated, giving rise to troublesome sores. The
absence of, and the singularity of the eruption when present, gave
rise to a doubt among some, whether the disease was scarlatina or
not. Its absence was no just ground for doubt, as it often appears
without the eruption being present, constituting the scarlatina sine
erupfione of some writers, and the scarlatina sine exanthemata of
others. The eruption, when it manifested itself, appeared simultane-
ously with the other symptoms, and presented a variety of appear-
ances— in some, it was papular, and in others miliary. The eruption
coalesced in a very short time, became pretty uniform over the whole
body, and faded or assumed a livid appearance in the fatal cases prior
to death. Vomiting and purging in the commencement of the dis-
ease were always grave symptoms, and, if we remember correctly,
both of the fatal cases which we witnessed had liquid operations for
a few hours before their termination. The determination to the brain
in manv cases was excessive ; when this happened, unless a decisive
plan of treatment was resorted to, convulsions would ensue, and the
patient die comatose. This was the case with a fine little boy of this
place, a son of Judge Allison. In the morning he was restless, and
seemed to have contracted a slight cold ; no attention was paid to
him, save the administration of a mild aperient; towards eVening,
while resting on his nurse's knee, convulsions came on, and, notwith-
standinf; an active course of treatment, he died comatose on the

Isio.J Bibliographical, 535

third day of his illness. Two or three cases were reduced very low
by the supervention of enteric symptoms, which were difficult to
relieve.

As before remarked, the disease was confined to a few families,
and these were either in the same quarter of the village or related
to each other, and in the habit of constant association. Its increase
was gradual. When it commenced it usually attacked all the young-
er members of a family in succession. Several had the disease who
held no communication with the sick or convalescent, while many
escaped who were often in the sick room. As to its contagiousness
or non contagiousness we are not prepared to offer an opinion.

Nearly all the recovered cases were afflicted with som.e one of the
sequela} of scarlet fever. The lips, mouth and cheeks in several
were ulcerated, whilst others had partial or general dropsy, which
was relieved by cathartics succeeded by tonics. Slight exposure to
cold, or irregularity in diet, would bring on a relapse with its attend-
ant consequences.

Belladonna as a prophylactic, was extensively used, but so far as
we know, without any good results, as a number to whom the bella-
donna was adrainisterecU had the disease in all its violence. From
the trial made, we are inclined to adopt the opinions of Pereira, who
says that whilst the facts brought forward in favour of the existence
of this prophylactic power are only negative, those which can be
adduced against it are positive, for twenty cases of failure are more
conclusive against it than one thousand of non occurrence are in
favour of it.

BIBLIOGRAPHICAL.

The Principles and Practice of Denial Surgery. By CHAriN A.
Harris, M. D., D. D. S., Professor of Practical Dentistry, in the
Baltimore College of Dental Surgery; Fellow of the American
Society of Dental Surgeons; Member of the Medico-Chirurgical
Faculty of Maryland, etc., etc. Second edition ; revised, modified
and greatly enlarged. Illustrated by sixty-nine wood engravings.
Philadelphia : Lindsay iSc Blakiston, 1S45. 1 vol. 8 vo., 600 pp.

We have been much pleased in looking over (though cursorily) the
above work. We feel warranted in saying that it imbodies more
practical information and less faults than any other work in the Eng-
lish language, consequently would recommend its perusal in the most
unqualified terms to the Medical profession generally and to the sci-
entific surgeon-dentist in particular. It is divided into six parts — viz.

1st. Anatomy and Pin siology of the 3Iouth.

536 Properties of Bile. — Cyanosis of Infants. [September,

2nd. Physical characteristics of the Teeth, Gums, Salivary Cal.
cuius, dec.

3rd. Diseases of the Teeth.

4th. Salivary Calculus — Diseases of the Gums, &c.

5th. Diseases of the Maxillary Sinus.

6th. Mechanical Dentristry. B. D.

PART III.— MONTHLY PERISCOPE.

Secretion and Properties of Bile. — "A series of experiments by
Schwann has led to the distinct conclusion of the bile being indis-
pensable to life. They consisted in removing a portion of the com-
mon bile-duct, and establishing an external fistulous opening into the
gall-bladder, so that the bile might be naturally secreted, but be dis-
charged externally, and not permitted to e»ter the intestine. Their
general result was, that of eighteen dogs thus operated on, ten died
of the immediate consequences of the operation, (by peritonitis and
other affections, aggravated, probably, by the want of bile;) and of
the remaining eight, two recovered, and six died. In the six which
died, death was the result of nothing but the removal of the bile ;
after the third day, they daily lost weight, and had all the signs of
inanition — e. g., emaciation, muscular debility, uncertain gait, falling
of the hair. They lived from seven to sixty-four days after the
operation ; and the inanition was the greater the longer they survived.
Young dogs appeared to die rather sooner than old ones. Licking
the bile as it flowed from the fistula, and swallowing it, had no influ-
ence on the consequences of the operation. In the two dogs that
recovered, the importance of the bile was equally well shewn ; for
in these it was found, when they were killed, that the passage for the
bile into the intestine had been restored, and the period of its restora-
tion was distinctly marked by their weight (which had previously
been regularly decreasing) being augmented, and continuing to in-
crease till it amounted to what it was before the operation ; and also
by the fistulous opening into the gall-bladder healing, and the dis-
charge of bile ceasing." — British and Foreign Review,

Cyanosis of Infants. — Gazette Medicale de Paris. Dr. Meigs,
Professor of Midwifery in the Jefferson Medical College, read before
the Academy of Sciences at its session June 16th, a note upon this
subject. Infants die in this case, said Dr. Meigs, from the presence
of a black, veinous, non-oxygenated blood in the encephalon ; it is in
the arteries and capillaries of the brain that this blood becomes des-

1S45.] Tartar Emetic in Hydarihrosis, 537

tructive to life, acting not as a poison, but simply because of its
incapacity to excite the innervation in this organ. The whole world
knows the anatomical cause of these phenomena — it is the persist-
ance of the foramen ovale.

The occlusion of this foramen being prevented because the san-
guine torrent coming from the vena cava inferior raises and keeps
raised, the inter-auricular valve which is thin and floating — Dr.
Meigs conceived the idea of placing infants labouring under Cyano-
sis upon the right side, with the head and trunk slightly elevated, in
order that the inter-auricular septum might become horizontal, and
that the blood contained in the left auricle might press with all its
weight upon the valve which would thus be closed. Dr. Meigs has
seen that at the very instant when infants were placed in this posi-
tion the blue coloration would disappear, proving that there no longer
penetrated into the arteries any thing but oxygenated blood. Dr.
Meigs affirmed that he had rescued from death from fifty to sixty
infants in an hundred by this method, while all the other means em-
ployed to the present day, as is well known, have been unsuccessful.

On the employment of Tartar Emetic in large and gradually in-
creased doses in Hydarihrosis, By M. Gimeiae. — Gazette Medi-
cale de Paris. The author has already published a memoir upon
the same subject, but the present work contains new facts entirely
confirmatory of the preceding ones. M. Gimelle has found the
medication which he proposes to be efficacious in all cases of hydar-
throsis, of however old a date, provided that the synovial membrane
had experienced no organic alteration, and that the fluid secreted by
it retained its normal character. In these twenty new cases the
absorption of the fluid was always accomplished in eight or ten days ;
the dose of tartar emetic was never carried beyond SO centigrammes,
(16 grains,) commencing with 20 and increasing 10 each day, when
the toleration was established. The age of the subjects varied from
27 years to 63.

As a model for the application of the method in all its details, we
think it proper to give one of these cases.

M. R., a Belgian magistrate, aged 34, had been affected with
hydarihrosis of the right knee for three years. The treatment by
leeches, blisters, caustics, by every kind of external irritation, by in-
ternal remedies, by the use of natural mineral waters, by baths and
compression had failed, in Belgium, in Prussia, and in a private

538 Acute Articular Rheumatism. [September,

hospital in Paris, where the patient had sojourned for six months.
Such was his condition when he came to consult M. Gimelle. The
volume of the right knee was 4 centimetre (near 2 inches) greater than
that of the opposite side, the patella was strongly pushed forwards,
and on each side of that bone existed a protuberance in which fluctu-
ation was perceived — the flexion of the limb was much restricted —
the whole extremit)'' was considerably emaciated, and the patient
could walk only with the assistance of crutches.

M. Gimelle commenced the 10th May, 1842, by prescribing tartar
emetic in the dose of 20 centigrammes (4 grains) in a potion of
100 grammes, (45.) with the addition of 20 grammes (f §) of the
syrup of poppies. Teb vomitions and six alvine evacuations follow-
ed. The same dose was administered the next day and produced
only two vomitions.

On the 12th, the same dose produced only one alvine evacuation,
but there supervened a very abundant perspiration which continued
during the entire night. On the following day the synovial mem-
brane was less tense.

From the 13lh, the dose of tartar emetic was increased each day
from 10 centigrammes (2 grains) to 20 (4 grains) until it reached
8 decigrammes, (16 grains.)

At this date the diseased knee presented a volume only 2 centimetre
(1 inch) greater than the sound one, and the fluctuation was scarcely
perceptible. From this period the emetic potion was continued in
the same dose every other day, until the 31st May, when the volume
of the right knee was only one centimetre greater than that of the
left one ; no fluctuation could be perceived ; flexion could be carried
to the extent of a right angle; the patient made use of only one
crutch. All treatment was arrested, and in the latter part of June
the patient left Paris.

During the entire treatment M. R. ate and drank to the satisfac-
tion of his appetite, and in a letter written in 1843, he informed M.
Gimelle that he had continued to improve — that the diseased limb
had regained its usual volume — that he still had some lameness, but
that he could endure standing or walking for several hours.

On the treatment of Acute Articular Rheumatism hy Sulphate of
Quinine in moderate doses. By M. Legeoux. — Gazette Medicale,
June 2lst, 1845. — M. Legroux having followed for some time the
cliniquc of M. Bouillaud has come to the conclusion that if the me-

1845.] Iodide of Potassium in Syj)hil is. 539

thod of bleeding at short intervals, as practised by the latter physician,
often arrests rheumatism at once, it nevertheless has the inconven-
ience of protracting convalescence, of increasing and of multiplying
internal congestions. Having tried the sulphate of quinine accord-
ing to the formula of M. Briquet, he has Jiiet with some serious acci-
dents; but regarding the sulphate of quinine as a powerful sedative,
he persisted in the employment of it, greatly reducing the dose,
however, according to the following formula: Sulphate of quinine
1 gramme, (20 grains,) or 150 centigrammes (30 grains) for the first
day, according to the strength of the patient and the intensity of the
rheumatic diathesis. This quantity is divided into six or eight por-
tions, one of which is administered every two hours. Immediately
after each dose, half a tumbler of sulphuric lemonade is given to fa-
cilitate the solution of the medicine in the stomach. On the next
day and the following days, according to the effects produced, the dose
is maintained or increased without passing, however, beyond 2
grammes (40 grains) in 24 hours. When the pain and fever disap-
pear the dose is gradually reduced. This treatment has been gener-
ally followed to the exclusion of every other mode ; in some cases,
however, bleeding, purgatives, and blisters have been employed to
combat complications which the sulphate of quinine could not reach.
By this treatment, rheumatism was cured generally with as much
rapidity as by the employment of sulphate of quinine in large doses,
or by the other medications so much vaunted in modern times. In
the majority of cases the duration of the disease was from ten to
eleven days, when the patients entered the hospital about the second
or third day of the affection. As to the infiuence of the quinine
medication upon the blood, it results from the experiments of M.
Legroux that the fibrine already superabundant in rheumatic pa-
tients is still farther augmented for forty-eight hours after the first
dose of the quinine, but that in ninety-six hours it is diminished by
one-third, and tends to become normal in quantity. On the other
hand, if the analysis be correct, the globules would follow an opposite
proportion, that is to say, that their relative proportion would tend to
decrease. These results may explain why in larger doses the sul-
phate of quinine often induces a kind of typhoid state. This point
is worthy of attention.

Employment of the Iodide of Potassium in the treatment of the
'primary symptoms of Syphilis, — Bulletin General de Therapeutique.
At the present day no one denies seriously the efficacy of the iodide

540 Iodide of Potassium in Syphilis [September,

of potassium in the tertiary symptoms of syphilis. This is one of the
few articles whose reputation has been as rapid as it was just. It
was but natural that the brilliant success obtained from its use in
consecutive syphilis should produce a disposition to make trial of it in
the primary symptoms. Such trials have been made, but with dif-
ferent results. While some have obtained only a very doubtful suc-
cess, others vaunt its efficacy in every period of syphilis, even in its
incipiency. We have before us a treatise by Dr. Mistier, in which
he adopts the latter opinion, and from considerations which seem to
us to be new and worthy of interest.

According to this author, every local and primary chancre, how-
ever small and mild it may be, when once developed, manifests itself
almost always after the lapse of a certain time, by the development of
consecutive symptoms, such as buboes, ulcerations of the throat, &c.,
although you may have employed all your efforts to prevent the ab-
sorption of the virus. The same thing does not take place when the
iodide of potassium is employed from the beginning of the affection
and conjointly with local treatment. In these cases, says M. Mist-
ier, the consecutive infection is as rare as it is common after the
ordinary mode of treatment ; and nevertheless, adds he, the iodine
treatment produces no very sensible effect, either for good or for evil,
upon the local symptoms, but it opposes the development of the con-
secutive, preserving the economy from virulent infection. The ra-
pidity of its absorption, far from rendering its action uncertain, as
has been supposed, constitutes on the contrary the preservative power,
which resides particularly in this property, of stimulating actively the
lymphatic system, and thus counterbalancing the action of the
syphilitic virus.

All this is perhaps rather theoretical, but the author affirms — and
this is the important thing for practitioners;— that when the iodide of
potassium is administered in sufficient quantity in primary syphilis,
it prevents infection and opposes the development of consecutive
symptoms.

When a patient with chancre applies to M. Mistier, he endeavors
to destroy it, to dry up the local affection, or treats it with the means
generally used ; but at the same time, in order to preserve the pa-
tient against the consecutive infection, he administers from 25 centi-
grammes (5 grains) to 1 gramme (20 grains) of the iodide of potas-
sium every twenty-four hours. It is but seldom necessary to go
beyond 1 gramme per day. This dose is sufficient in the majority

1945.] Ant i. Syphilitic Remedies^ 4'C. 541

of cases. He continues the use of this remedy not only until the
local symptoms have completely disappeared, but for some time after-
wards, until it appears to him that the secondary affection is no
longer to be apprehended.

This treatment, he says, has over others incontestible advantages.
It does not weaken the constitution like antiphlogistics — does not
act upon the mouth and salivary glands like mercury, and finally
docs not require the patient to protect himself particularly against
taking cold, as is necessary after the employment of sudorifics. It
imposes no restraint upon the diet or regimen of the patient.

Thirty-eight patients affected with chancre have been treated by
M. Mistier according to this plan — thirty-two have been preserved
from the secondary affection, and in the other six consecutive symp-
toms made their appearance, five of these were cured by mercurials
combined with iodine preparations, and only one resisted every mode
of treatment. He died in consequence of ulcerations of the larynx.

Anti- Syphilitic remedies and their therapeutic appplication. Prize
E^ay, by M. Payax. — Gazette Medicale. In this work, which ob-
tained the prize from the Medical Society of Bordeaux, M. Payan,
Chief Surgeon of the Hospital of Aix, expresses opinions nearly in
conformity with those of M. Ricord. His therapeutical experiments
have led him to believe that the old division of syphilitic spmptoms
into primitive and consecutive is insufficient, and to admit with M.
Ricord in the manifestation of these symptoms three successive
phases or periods. In the first, he ranges the symptoms called primi-
tive, without, however, considering them, with the Parisian Surgeons,
as the simple effects af a local disease : such are blennorrhagia,
chancre, bubo, or adenites. The second period comprises symptoms
which denote evidently a general infection, and affect principally the
skin, the mucous membranes, the eyes, the testicles : such are the
different syphilides, fissures, alopecia, chronic furuncles which ter-
minate in ulceration, cutaneous nodosities or tubercles, consecutive
ulcers or chancres, and different excrescences in the vicinity of the
sexual parts. In the third period he ranges the symptoms which
denote an infection of an older date, and which are more deeply situ-
ated : such as deep seated tubercles of the skin and mucous mem-
branes, tubercles of the cellular tissue, commonly called gummy
tumours, periostitis or nodes, caries, necrosis, &;c.

Each of these periods gives rise to peculiar therapeutic indica-

542 Diagnosis of Hepatitis and Hepatalgia, [September,

tions, and has a specific remedy which is not equally applicable to
the other two periods. Thus he regards mercury as the specific of
the first period, the iodide of mercury as the specific of the second,
and the iodide of potassium as the specific of the third.

M. Payan remarks that mercurial fumigations and baths are in-
convenient, inasmuch as we are unable to appreciate the quantity of
mercury absorbed ; he employs fumigations only in certain local
affections, as venereal testicle and certain excrescences ; he reserves
mercurial frictions for those cases in which a phlegmasia of the diges-
tive tube opposes the internal use of mercury ; with M. Ricord, he
esteems the proto-iodide of Mercury as much less irritating than the
deuto-iodide, and he recommends the cyanidide of mercury as an ex-
cellent preparation for delicate and susceptible persons.

He regards the action of the iodide of potassium as heroic in the
third period of syphilis, and that its efBcacy is proportionately great-
er in old cases, an opinion generally entertained by modern writers
upon this subject.

The Diagnosis of Hepatitis and Hepatalgia. — The following
summary, though it has nothing novel to recommend it, may be ad-
vantageously borne in mind : —

"Although the pains accompanying heptalgia, may be as intense
as those of heptatitis, and in many instances, perhaps more urgent,
they are not constant, but are at the outset, and frequently, also,
during the whole progress of the disorder, paroxysmal, affording in
the interval a complete immunity from pain. The pathognomonic
signs indicative of inflammatory action of the liver, are pyrexia, tu-
mefaction, great tenderness in the hypochondrium, frequent and
strong pulse, thirst, furred tongue, and vomiting, sometimes of a
bilious, and at other times of a dark-coloured secretion, as the sub-
stance of the liver more or less partakes of the invading disease.
The bowels are irregular in their action, the evacuations presenting
a great variety of appearances, according as the biliary secretion is
more or less afiected. and the urine is scanty and high-coloured. In
hepatalgia, on the contrary, these signs are invariably wanting;
there may exist, indeed, constant pain and tenderness over the region
of the liver, increased to a certain degree by pressure, but manifest
exacerbations, even in the worst cases, occur, which are sufficiently
indicative of its paroxysmal character. The functions of the organ
may proceed uninterruptedly as in its healthy condition. The tongue
may be quite clean, or sometimes, in the centre, there may be a
gentle creamy fur, and the urine is generally increased in quantity,
and is of a lighter color than ordinary." Treatment of Hepatalgia. —
*' Gentle purgatives, combined with colcliicum, ipecacuanha, and

IS 15.] Emetics in Bronchitis, 543

hyosciamiis, will seldom fail to work a speedy cure ; and if the con-
stitution have sufFcred from protracted, unmitigated pain, alkaline
vogetable tonics wiilcfloct that which we might in vain expect from
the rough, insoluble mineral preparation. — Dr. Allnatt. Medical Gaz,

Emetics in Bronchitis, By John Higgixbottom, F. R. C. S.,
Nottingham. — I have found an emetic dose of ipecacuanha a v«ry
valuable remedy at tiiat stage of bronchitis where a sudden, low, or
sinking state has come on with oppression at the chest, and the ex-
pectoration difficult, endangering suffocation. Vomiting with ipe-
cacuanha has not only soon relieved these symptoms, but has roused
the whole system, and has produced such a decided change, as to
render the patient convalescent in a few days. I have never seen
the same good effects in such circumstances produced by any other
remedy. The two following cases are of that description :

" 3Ir. D , aged 60, an inn-keeper, of a gross habit, but not con-
sidered intemperate, had been much reduced in consequence of a
neglected erysipelatous inflammation of the leg and thigh ; this had
in some measure subsided, but he had at the same time bronchitis,
attended with a troublesome cough, difficult respiration and expector-
ation. A sudden state of sinking came on, with increased dyspnoea,
and a feeble, quick pulse. I gave half a drachm of ipecacuanha in
a little water ; he vomited at different times for two hours ; the low-
ness and dangerous symptoms were much relieved ; he had no relapse
of the low or sinking state, and he gradually recovered under a
common mild treatment."

" Mrs. C -, aged 78, had an attack of the prevailing influenza ;

saline aperients, with diaphoretic and expectorant medicines, had
been given for about five days, when a low, sinking state came on,
with difficulty of breathing. I was inclined to give an emetic of
ipecacuanha as the most probable remedy to afford relief. I named
it to her daughter, fearing the old lady would object to it. I was
glad to find my patient would take it ; and I may here mention the
favorable idea patients sometimes have of an emetic, imagining that
vomiting enables them to throw up the phlegm. I gave her half a
drachm dose of ipecacuanha, which had the desired effect of com-
pletely relieving her. I was only required to visit my patient for
five more days, she being then quite convalescent."

The following observations in Dr. Johnson's Review, of April,
1844, are corroborated by the above case, and I have no doubt, will
hold good in a variety of diseases, both in the commencement and
in the sinking stage of disease : — " The use of emetics (I would say
ipecacuanha, from the great safety of its operation) is far too much
neglected in the present day, and most practitioners are unnecessarily
timid about using them to old patients ; a single emetic will often
effect more good in the course of a day or two, than other remedies
in a v/cck or two." — London Lancet.

544

Mesmerism. — Meteorological Observations,

True and False Mesmerism. — Dr. Charles Radclyffe Hall, of London, in a
series of Articles in the Lancet, on the Rise, Progress and Mysteries of Mesmer-
ism, in all ages and countries, deduces the following conclusions:

" Of the alleged results of mesmeric processes, I believe there are
Proved — Gluietude; composure; sleep.
Probable, but requirins: confirmation — Traction; muscular rigidity ; convulsions;

heightened sensibility ; diminished sensibility ; double consciousness.^
Possible, but not very probaile — Insensibility to severe pain, for a given length of

time, at pleasure.
Impossible, as far as amy thing can be so — Clairvoyance; intuition; prevision;

community of thought; involuntary and complete subjection of mind to the

mesmeriser.
And, lastly, I believe that we have not a shadow of evidence in support of the

existence of any new agency, whether designated mesmeric, magnetic, occult,

or by any other name."

Up to the present hour, we Imow of no Medical Journal, either in Europe or
in this Country, that looks upon mesmerism with the least allowance.

METEOROLOGICAL OBSERVATIONS, for July, 1845, at Augusta, Ga.
Latitude 33^^ 27' north — Longitude 4® 32' west Wash. Altitude above tide
152 feet.

Thermometer.
Sunrise. 4, p. m.

Barometer.
Sun rise. 4, p. m.

Wind.

Remarks.

29 74-100

Fair.

'' 74-100

" 75-100

Fair. (8-10 in.

'• 75-100

" 66-100

Cloudy— shower at 5, p. m.,

'' 66-100

" 66-100

Flying clouds.

" 75-100

" 80-100

S. E.

Variable.

" 91-100

" 86-100

S. E.

Variable.

" 94-100

" 86-100

Fair.

" 85-100

" 80-100

Variable— thunder.

" 77-100

" 74-100

S. E.

Cloudy.

'' 76-100

'' 74-100

S. E.

Rain 8-10 inch.

" 76-100

" 73-100

N. W.

Fair.

" 72-100

" 65-100

N. E.

Variable— showery— thun.-

" 70-100

«' 70-100

Cloudy — showery, do.

" 70-100

S. W.

Variable — showery, do.

'' 70-100

" 70-100

S. W.

Variable — showery, do.

" 72-100

" 75-100

s. w.

Variable, do.

" 76-100

" 78-100

s. w.

Variable — thunder, &c.

" 80-100

" 82-100

Fair.

" 80-100

'= 78-100

Fair.

" 80-100

N.W,

Fair— flying clouds.

'= 80-100

" 78-100

Fair, do.

100

" 69-100

'= 66-100

Fair, do.

100

" 64-100

«' 62-100

E. & W.

Fair — 12 m. change of wind.

" 67-100

" 69-100

Fair.

" 70-100

S. E.

Variable.

" 65-100

" 55-100

s. w.

Cloudv— blow, [dv, blow.

" 54-100

" 50-100

Th. &light. last night, clou-

•' 64-100

«' 67-100

N. W.

Fair.

" 65-100

" 60-100

S. W.

Flying clouds.

'• 52-100

" 45-100

s. w.

Do. do. thunder, &c.

" 58-100

" 66-100

Fair.

13 Fair days. Gluantity of Rain, 1 inch and 6-10.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I.] NEAV SERIES.— OCTOBER, 1S43. [^'o. 10.

PART I.— ORIGINAL COMMUNICATIONS.

ARTICLE I.

Observations on the Soil, Climate and Diseases of Liberty County^
Georgia. By John M. B. Hakdex, M. D.

Liberty county in Georgia is situated between *31° 38' and 32*^
north latitude and the 4th and 5th degree of longitude west of the
meridian of Washington in the District of Columbia. It extends
from the Atlantic ocean on the east, where it takes in the Island of
St. Catharines, sixty or seventy miles into the interior, where it is
connected with Tattnall county on the west. At this latter point it
has a breadth of between thirty and forty miles, but at its eastern
extremity it is narrowed to a distance of ten or fifteen miles. It is
bounded on the north by the Midway river, and partly by the
Canouchie, whjch touches it on the northwest, and on the south by
the south Newport river, and partly by the Alatamaha, and has a
superficial area of nearly 1800 square miles.

Soil. — In respect to its soil, Liberty county may be divided into
two distinct portions by a line parallel with the sea coast and equi-
distant from its eastern and western limits, extending along a ridge
of land which is the commencement of what is commonly known as
the '' Sandhills," \

♦ From two observations made in,1842,by means of two Gnomons of my own
construction, I found the latitude of Bull town swamp, at the southern terminus
of the county, to be 31° 38' after making corrections for Sun's semidiameter and
horizontal parallax.

546 Observations on the Soil, Climate and Diseases [October,

The eastern portion is intersected in every direction by many large
and dense swamps, which are the tributary branches of the Midway,
north Newport and south Newport rivers; taking their rise at the
ridge of the Sandhills in what are called " Spring Branches,^' and
continuing down to the head of tide-water ten or twelve miles from
the ocean. The surface is very level, with a gradual but impercep-
tible desf ent towards the coast. The soil is for the most part com-
posed of §^and* and clay in various states of intermixture, in some
places the sand, and in others the clay seeming to predominate. In
the neighborhood of the swamps the clay is very pure and tenacious,
and when mixed with much vegetable matter, it assumes a very dark
color and is known as ^^ Blue Clay.'" This blue cZaz/, with a rich,
vegetable mould, form our most valuable soils for the culture of Cotton
(Gossipium Barbadense) and Corn (Zea maize) — and when combi-
ned with Marie, it seems to be inexhaustible.

The western portion at the ridge has a very evident, and in some
places, a very abrupt rise of from 10 to 15 {eet, and then with a
gradual ascent towards the west, it assumes the same level aspect
with the eastern portion, until it reaches the limits of the county.
The soil here is mostly sandy and barren, except in the immediate
vicinity of the branches which are given off by the Alatamaha on
the south, and the Canouchie on the north. The sand varies in
depth from 4 to 8 Ceet, and probably even more in some places ; and
in reflecting upon the appearance presented, we can hardly resist the
impression that this ridge was at one time the limit of this part of
our continent, and that these sands were the downs cast up by the
waves of the ocean. In the midst of this sandy waste are found
two or three ponds or lakes, which are worthy of notice. They are
nearly circular, having a circumference of about four miles, and
discharge themselves by small outlets into the Alatamaha and Ca-
nouchie— they are surrounded by a thick growth of dwarf-baysf and
andromeda.J In approaching them, you come, as it were, to a
large clearing, and upon entering, you find nothing in the form of
trees, except dwarf or stunted pines. The surface is covered over
with sphagnum and ferns, and here and there clumps of the androm-
eda and the bay, intertwined with the vines of the smilax.|| The
soil on the top is nothing but a complete mat of fern roots, covered
with the sphagnum, upon penetrating which, you may sink a rod to

* See Appendix, Note A.

tLauras Carolinianus. i Andromeda racemosa, (I Smilax laurifola.

1845.] of Liberty County, Ga, 547

any depth, apparently, without finding bottom. The subsoil is dark,
but when dry has the appearance ofsnuft', and (as I am informed by
an intelligent gentleman,) will burn readily; indeed these ponds
have all the features that characterize the peat-bogs of Ireland, the
moors of Scotland, and the turf-bogs of the north of Europe.

In both portions of the county the surface is covered over in many
places with a very coarse white sand and gravel : this is particularly
the case at " Gravel Hill.''

In several places there are to be found lower and level tracts, of
considerable extent, destitute of shrubbery and covered over by
herbaceous plants, interspersed with tall pines. These tracts are
known among us as savannas. In the adjoining county of Mcintosh
they are very conspicuous, and running nearly east and west, present
very much the appearance of water courses that have been gradu.
ally filled up by alluvial deposits from the higher grounds. These
savannas are capable, I believe, of great improvement by culture,
but they are kept in this waste and barren condition by the custom
of allowing fires to sweep over them at least once a year, in order to
afford pasturage for cattle. In the summer and autumn they are cov-
ered with the most beautiful flowers, &;c., and present a fine field for
botanical researches.

AUhough not immediately connected with our subject, I cannot
omit to mention the existence in many places of Indian mounds, or
tumuli, which were probably used by the Aborigines as places of in-
terment, and in and around them are found various instruments for
domestic or warlike purposes — such as, arrows and spear-heads,
hatchets, and mills for pounding grain, made of hard stone or flint,
and pieces of pottery, made of clay, on which at times various images
were curiously wrought.

After penetrating the superficial soil, which, as we have seen,
varies greatly in depth at different places, we come down to a bed or
sub-stratum of red clay, which is generally from 8 to 10 feet thick ;
after passing this, we next come to a bed of sand, usually white, and
containing gravel or pebbles, either angular or rounded, by attrition.
This is the depth to which we have to penetrate in digging our wells,
the deepest of which are from 10 to 20 feet. In some places, we
come to a kind of sand-stone, of a very dark color, and very hard,
when in situ, but upon exposure to the air, it assumes a ferruginous
tint and crumbles readily beneath the pressure of the fingers. In
some places an ore is found which is very rich in iron.

548 Observations on the Soil, Climate and Diseases [October,

No fossil bones have, to. my knowledge, been discovered within
the limits of the county. I have, however, in my possession, por-
tions of a coprotiie, that v/as found at the bottom of a well 17 or 18
feet below the surface. It is composed of silicious sand, loosely
held together by a small portion of alumine and phos. lime. The
proportion of the latter ingredient is so small that I am disposed to
regard it as the coprotite of a gramenivorous animal.

A few feet below the surface, oyster shells of the neighboring
rivers may be found in various localities, particularly in the eastern
part of the county, from 20 to 40 miles from the ocean. Marie
beds also occur in many places, which I have no doubt are the pro-
duct of the decomposition of the shells of the oyster, (ostrea edulis)
although I have never been able to identify the shell. The marie is
sometimes very rich in carb. of lime, and might be made available as
an excellent manure — I have also some beautiful crystals of the
sulphate of lime, found in Bulltown swamp.

Petrified wood is dug up at various depths below the surface ; and
on the north Newport and Midway rivers, the stumps and trunks of
Cypress trees and arrow-heads are found at the depth of ^ feet or
more — a fact which was noticed by Bartram, in his travels through
this State and Florida, nearly seventy years ago — and in some places
I am informed, a black, soft mud, has been found, having all the smell
of ''Marsh Mud:'

These various facts seem to me .o shew conclusively that the soil
of this county, and more particularly the eastern portion, is entirely
alluvial, and, like that between the Alatamaha and Turtle rivers,
described by Mr. J. H. Couper in a paper read before the Geological
Society of England, belongs to the post-pleeocene epoch.

The Sylva and Flora of this county is unsurpassed* by those of any
other district of equal extent in the world. Our swamps abound
with the tallest and most magnificent trees of various Jcinds, and the
open woodland is covered over at certain seasons with the richest
and most beautiful plants and shrubs —

" Arboribns varia est natura creandis
Namque alias, nullis hominum cogentibus, ipsae
Sponte sua veniunt composque etflumina late
Curva tenent." — Virgil. Georgics lib. 2.

It is true, that some of our most luxuriant forests have fallen under
the ruthless attacks of man for agricultural purposes, and from a mis-

* See Appendix, note B.

1845.] of Liberty County, Ga, 549

taken system of culture, much of our virgin soil has been worn out
and left in the garb of widowhood ; but it is to be hoped that greater
iraprovement in agricultural science will cause the most of it to be
reclaimed, and although disrobed of its natural beauty, that it may
yet put on the mantle of art and civilization.

Climate. — In determining the temperature of our climate, five
observations of the thermometer have been taken every day for a
period of one year, commencing in August, 183S, and ending in
August, 1839. The hours chosen for these observations were as
jllows : 7 o'clock, A. M., and 1, 3, 7 and 11 o'clock, P. M. From
ihese observations, it appears that the mean annual temperature is
66^ 41'. The year 1839, a part of which is included in these obser-
vations, was unusually hot and dry, the thermometer rising in the
month cf June to upwards of 100*. This may tend to raise the
mean of this year, but it is probable that the above is not far from
the mean cf any given series of year^.

Although my observations with the thermometer have not been
sufficiently long continued to warrant it, yet I have no doubt that
there is a small oscillation in the mean temperature of our climate
during a certain period of time. This seems evident from the effects
of the climate upon some of our tropical and even indigenous
'lants. Thus there are seasons with us in which the cotton plant
j> scarcely killed, and assumes nearly the character of a peren-
nial, and again it is so injured by ihe cold that hardly a single
root wiii sprout up in the ensuing spring. • The orange tree (Citrus
Aurantiura) will for many years do well amongst us, particularly along
the sea-coast, when a winter or number of winters will succeed, ia
which they are nearly destroyed. In the winter of lS34-'35, which
was the coldest winter recollected by the " oldest inJuibitanty'^ they
were killed even in Florida, to the great pecuniary damage of the
citizens of that State. Indeed so intense was the cold, that the
hedges made of the Cherokee rose, (Rosa levigata,) one of our most
hardy perennials were very seriously injured.

The annual range of the thermometer during this year was 83^* —
the minimum on the 24th December, 1S38, being 18® — the maximum
in June, 1839, being 101° — I am disposed to believe that this is not
far from the mean annual range, although we are subject to the ex-
tremes of Zero during the winter, as was the case in January, 1835,
and 100® in the summer, as happened in 1S39. The greatest range
olserved in any one month took place in March, 18-39, when the ther-

550 Observations on the Soil, Climate and Diseases [October,

mometer on the 5th was at 22^, and rose on the 23th to 82° ; and
in December, 1838, when the minimum was IS*^ and maximum 78°.
The least monthly variation was 22° in August, 1838, and 23° in
July, 1839.

The mean diurnal variation for the whole year was 17° 16' — the
greatest variation taking place in the winter and the least in the
summer months — the greatest mean diurnal variation took place in
the month of March, 1839, and was 22° 19'— the least in the month
of September, 1838, and was 9°. The greatest variation between
the maximum and minimum for any one day, was 43° in March,
1839 — the least in June and July, when it was only 14°. In the
months of June, July, August and September, the greatest diurnal
range was not more than 18° — proving conclusively what has been
stated above, that the temperature is far more agreeable during the
summer, than at any other season of the year.

The months, whose mean temperature corresponds most nearly
with the mean temperature of the year, are April, the mean tempera-
ture of which is 68° — and October, whose mean temperature is 65°.
These are decidedly the most pleasant and agreeable months in the
year.

The coldest month observed was January, the mean temperature
of which was 51°. There can be no doubt that the coldest weather
we experience takes place after, rather than before, the winter sol-
stice, and I believe January is usually our coldest month. So, too,
our warmest weather is for the most part after the summer solstice.
In 1839, the mean temperature of August was 63°, which was also
the mean for the month of June. This last month, however, was
unusually hot. The mean for July was 80°.

The temperature of our wells I have found to be in the summer
74° — which is 8° above the annual mean. I have no doubt that
they are measurably affected by the temperature of the air, on ac-
count of their being at so little depth below the surface.

The hottest part of the day is after the sun passes the meridian,
and generally, unless interrupted by clouds or rain, there is a gradual
rise of the thermometer from the rising of the sun until 3 o'clock,
P. M., when it attains its maximum. After this, there is a gradual
fall, until 11, P. M., when it is nearly as low as at any other part of
the day. I find the mean difference between the temperature at 3
o'clock, above that at one o'clock, to be about .65 of a degree for
the whole year — so that the hour of 3, P. 31., may be considered the
warmest part of the twenty-four hours.

1845-] of Liberty Counfy, Ga, 551

I have made no observations upon the barometric state of the
air, nor have I measured the annual amount of water that falls, my
observations having been confined exclusively to the general condi-
tions of the weather, in respect to clouds, wind and rain. By con-
sulting, however, the meteorological tables kept in Savannah by Mr.
Oemler and Dr. Posey, I find that the mean quantity of water that
fell at that place during six years ending in 1842, was 41.52 inches.
It is probable that this is not far from the quantity that falls annually
in this county.

Many of our heaviest raijisseem to be irregular, but I am inclined
to believe that long continued pluviometric observations will serve to
show that we are situated in that zone which has been happily termed
sub-tropical by M. de Buch — where the climate, in respect to seasons
of rain, partakes of the nature of that w ithin the Tropics — but the
semestrial period of rain within the Tropics, instead of passing into
one trimestrial period, which is estival in our hemisphere, as stated
by M. Fournet,* seems to me to be divided into ttco trimestrial peri-
ods— one of which is estival and the other hyemal — the latter ta-
king place in the months of January, February and March, and the
former in the months of July, August and September, or probably
more correctly the first from the winter solstice to the vernal equinox,
the latter from the summer solstice to the autumnal equinox.

By consulting the Savannah tables above referred to, it appears
that the mean quantity of rain in inches that fell during the first
trimestrial period for six years, was 8.04 — for the second during the
same time, 17.72 — whereas the quantity for the intermediate periods
from April to July, and from October to January, was for the first
10.50 inches, and for the second 5.26 inches. The apparent contra-
diction to the law assumed above in the mean quantity for the period
between April to July, is explained by the fact, that an annual quan-
tity of water fell during the month of June', 1838, amounting to
10.03 inches, and again in May, 1840, when it amounted to 10.08.
Omitting these, the quantity wopld be probably more near to the
mean average for that period.

There can be no doubt that our irregular rains are sometimes our
heaviest — so that if we are guided alone by the absolute quantity of
water fallen, we might be led to doubt the correctness of the law ;
whereas we may have rainy seasons when very little water actually

* Annales de Cliiraie ct de Phisique, N. S. Tome onzierne p. 116.

552 Observations on the Soil, Climate and Diseases [October,

falls. By referring to the same tables, I find that taking the number
of rainy days we have for the first trimestrial period, an average of
19.25 — for the second 14.25 — whereas for the other periods, we have
for the first 11, and for the second 13.75. From our own observa-
tions, I find that of 90 rainy days, 18 occurred during the first, and
43 during the second trimestrial period, and for the two others,' 17 for
the first and 16 for the latter. Of 119 clear days, 37 occurred du-
ring the period from January to April, 11 from July to October, 31
from April to July, and 40 from October to January. From general
observations of the weather for some years past, I am decidedly of
opinion that our dryest months are April and October, and our wet.
test the months of February and August. The dew-point always
appears to me to be highest in the latter month. There is then more
of sensible perspiration from the skin, and leather, wood and clothes,
are more liable to mildew and mould, and iron to rust.

As we are subject to great extremes of temperature, so we are also
liable to great extremes iii regard to the quantity of water tliat falls
at different seasons. Sometimes we have seasons of great rain, and
sometimes seasons of great drought. We are subject, at times to
great inundations from excessive rains:

Ssepe etiam immensum ccelo venit agmen aquarum,
Et todam gloraerant tempestatem imbribus atris,
CollectoB exalto nubes. — Virgil, Georgics, lib. 1 — 332.

The quantity of water that falls in a short time is almost incredible.
These rains are for the most part irregular, but they more commonly
occur during one of the above named trimestrial rainy periods. The
greatest freshets within my recollection occurred in March, 1831, and
March and September, 1841. At these times, the swamps and rivers
overflowed their banksand produced great injuryto flocks and growing
crops, as well as to the roads and bridges. In 1841 we were two
weeks without a mail from Savannah, although running previously
three times a week. The rise of water in our swamps is fully six to
eight feet. The year 1839, and the present year up to this time,
have been attended with the greatest drought that I remember to
have observed.

Thunder storms are very common in our climate, and are at times
very disastrous in their effects. It is a curious fact in regard to
them, that they always have a tendency to the sea-coast. As soon as
they are formed they move onwards in this direction, and, unless in-
terrvpied by winds, I think I have observed a marked disposition to

1845.] of Liberty County y G a. 553

follow wafer courses. During the falling'of the rain from a thunder
cloud, I have often noticed that there is a strong current of air setting
in every direction from the cloudy so that a vane on this account
always points towards the cloud when near enough to be influenced
by it, both when corning up and after it has passed, provided the rain
is still falling.

Our winds are, for the 'most part, very variable — if we divide them
into easterly and westerly, by a line passing from north to south, I
find that for the periodof my observations, the wind was easterly 124
days, and westerly 138 days. Upon looking at the prevailing winds
for each month, I find that they are more prevalent from the west,
during the winter, and more from the east, during the summer months.
During the warmest days of spring and summer, we enjoy the de-
lightful sea-breezes that comes up about 10 or 11 o'clock in the
morning, and prevail until 3 or 4 in the afternoon, when they die
away and give place to the land-breeze, which sets in an opposite di-
rection during the night. Very near the sea-shore, these sea-breezes
continue much longer, and may even blow during the early part of
the night. At a distance of forty or fifty miles from the coast I believe
they are rarely if ever felt.

During our eslival rainy season, we are subject to what is com-
monly known among us as ^^ north-east weather ^''^ when the wind
prevails from that direction, sometimes without, but most commonly
with, clouds and rain. I am inclined to believe that these winds are
really the trade winds of the tropic, carried beyond their northern
limits probably by the influence of the sun. However this may be,
it is a remarkable fact, that these winds afi*ect a certain pei'iodicity,
and are apt to recur at weekly or semi-monthly pe?-iods. It is at these
periods that we are liable to have the most dreadful hurricanes or
typhoons. The most memorable of these, of which I have any ac-
count, occurred on the 15th August, 1752, " which vvas in Carolina,
the most violent that was ever known since the settlement of the
English there, and which, in many places, left not one tree in twenty
standing." — [See an account of the Congregational Church at Mid-
way, by John B. Mallard, A. M.] Another occurred on the 8tb day
of September, 1804, which, from all that I can learn, must have been
equally violent. I was mj'self a witness of the last great hurricane,
that took place on Wednesday night, the 14th September, 1844 — It
commenced to blow from N. E. about 3 o'clock in the afternoon, and
gradually increased until probably 1 o'clock at night, when its rio-

554 Observations on the Soilf Climate and Diseases [October,

lence was greatest — the wind then suddenly shifted S. E., and soon
began to moderate. The night was very light, although I do not re-
member the state of the moon. The rain, or rather mist, that fell,
had a saltish taste for miles in the interior, evidently being mixed
with spray from the sea-water. The appearance of desolation that
was presented to the eye on the next morning, was awful in the
extreme. There is a disposition to these storms to a greater or less
extent every year, and we frequently experience slight ones : indeed
we always have some indications of all the hurricanes that take place
in the West India Islands.

Tornadoes are by no means frequent, but we sometimes have them.
Besides one or two of which some traditionary account still lingers
with us, as having passed through the county many years ago — I
remember one that took place in March, 1836 — I have myself observed
the track ; traces of which are probably still visible — Its course was
from S. W. to N. E.; almost every tree of any size was prostrated by ~
it, in its path, and the most of them turned in towards the axis of
the storm. Its track was probably fifty yards in width, and passed
through the north-western part of the county.

Although not confined to our county, I desire to record here the
following remarkable meteorological phenomena :* One week after
the great hurricane of 1804, on the night of the 15th of September,
there was an appearance of a very large and splendid meteor, which
caused great consternation. The moon was shining brightly at the
time, when suddenly there was heard a rumbling noise like distant
thunder, which gradually increased until it was sufficient to awake
the sleeping, and at the same time a bright light was seen, superior
much to the light of the moon. This noise was continued for a {ew
moments, and subsided as it had commenced. The direction is sup-
posed to have been from west to east. There can be no doubt that
this was an aerolite, but whether it fell to the earth or not, I am unable
to say. Another meteor of a similar kind, although not as large,
passed over the county on the night of the 10th day of July, 1826, at
about 11 o'clock.

All of us remember the very remarkable meteoric shower that
took place on the night of the 12th November, in the year 1833 — I
was called up about a half hour before day-light, and watched them
until they were very faintly visible — The meteors fell in almost un-
interrupted succession, in a direction apparently very little inclined to
our horizon — Many of them were larger and brighter, and left lumin-

1845.] of Liberty County, Ga, 555

ous trains that were visible for some seconds. The scene was far
more magnificent than any I had ever witnessed, and to describe it
accurately defies all power of language — it was such a scene -^is
makes the beholder gaze in mute astonishment, and the moral im-
pression of which can only be conveyed to others by expressive
silence.

Diseases. — Liberty County has shared the fate of most newly
settled districts where there are rich lands, and for many years after
its first settlement was very sickly ;* but for ten or fifteen years past,
according to the testimony of all, it has proved to be as healthy as
any other county with the same population in our State. I am sorry
that no public records are now kept, by which I might ascertain with
certainty, the proportion of deaths to the number of inhabitants ; but
from my observations, I am sure that for ten years past, the proportion
has not exceeded two per cent, per annum.

Many cases have contributed to bring about this state of things.
For many years after its first settlement the culture of rice was the
chief business of the inhabitants. At present the dry culture system
is every where adopted, and nothing but cotton and corn is raised as
articles of export. Some of the people d!irly introduced the custom
of removing from their plantations during the summer and fall sea-
sons, but it was not generally adopted until of late. It is now very
rare for any family to reside on their plantations during the sickly
seasons, and indeed many have entirely abandoned them for healthier
locations in the pine lands of this or the adjoining county of Mcintosh.
But probably a more important cause may be found in the change of
habits of the people. The black population is better fed and clothed
now than formerly, and the habitations of both white and black are
greatly improved. The use of intoxicating drinks has been almost
entirely given up — and I cannot but add, that the system of practice,
both domestic and professional, has been greatly altered for the bet-
ter. Less drastic and poisonous medicines are now employed, and
indeed the heroic treatment of the early schools of medicine once
followed in this country has been exchanged for the milder and more
rational method of assisting Nature and guarding against the " nimia
diligenlia Medici.^^

Epidemics may be said to be entirely unknown among us, if we
except the Influenza, which in its progress through other parts of the

* See Appendix, note C.

556 Observations on the Soil, Climate and Diseases [October,

country sometimes makes its appearance here. The Asiatic Cholera
in 1832 prevailed to some extent on the Ogechee river, in Bryan
county, within a few miles of Liberty, but not a case occurred within
the limits of our county. There are seasons, however, in which our
common endemic diseases are far more prevalent and fatal than at
other times, although I have not been able satisfactorily to refer this
partially epidemic character to any particular constitution or condi-
tion of the atmosphere. I am disposed, however, to believe that dry
seasons are more healthy than those which are attended with exces-
sive rains or dampness of the air.*

Sickly seasons have appeared to me to observe a certain periodicity,
or to prevail once during a C3xle of years. This cycle, so far as I
can determine from a very general and brief experience, seems to be
a period of about ten years, and may correspond with the cycle
through which passes the small oscillation in the mean temperature
of our climate. Thus lam informed that the years 1817 and 1820
were unusually sickly — so also was the year 1830. The last sickly
year that we have had was 1840.

In regard to the relative salubrity of the separate seasons of the
year, I would give it as my opinion, that there is more sickness during
the autumn and winter, and less during the spring and summer.
Winter diseases are far more fatal than summer diseases. The
healthiest month in the year is probably May.

The only contagious diseases to which we are subject are, Pertus-
sis or Whooping cough, Rubeola or Measles and Syphilis — Varicella
or Chicken pox sometimes prevail, Variola never — Scarlatina has
sometimes shewn itself in a sporadic form, but has never extended far
within my observation — Whooping cougb and Measles are common,
and 1 have known them to exist together on the same place, and, if I
mistake not, in the same person : which has led me to suspect that
the two diseases are isopathic, or in other words, that whooping cough
arises from measles in the lining membrane of the air passages. The
venereal disease is probably more common than my observations
would lead me to believe ; but being a disease that seeks concealment,
it is often cured in its simpler forms by the aid of empiricism, with-
out the advice of the physician. It is confined almost exclusively
to the black population. Gonorrhcsa is universally known among
them as '•^running reins,'' and is attributed in every instance to

♦ See Appendix, Note D.

1845.] of Liherty County, Oa, 557

blows on the back or perineum, or some violent strain. The history
of a very curious case has come to my knowledge — in which a man
with gonorrhoea communicated it to his wife during pregnancy.
The child, after birth, was affected with a disease which was suppos-
ed (by a physician, I think,) to be syphilitic, and died. I am sorry
that it did not come under my own observation ; but still it tends to
confirm a suspicion long entertained, and upon which the medical
world is yet divided, that gonorrhoea and syphilis are isopalhic
affections.

But by far the most common diseases of our climate are the febrile
and infiammatory. During the course of my experience, I have met
with only two species of essential fever — one, and by far the most
common, is our "Marsh-miasmatic fever," an account of which, to-
gether with its various modifications, I have given in the October
number of the American Journal of the Medical Sciences for the year
1844. The other has been described in the August number of the
same Journal for the year 1840.

The form in which the ^^ marsh fever^^ usually makes its appear-
ance is the double tertian, with one severer and one milder paroxysm.
The first paroxysm, or the more severe, is marked by a more decided
chill or cold fit, and by a more complete apyrexia, usually beginning
in the morning and leaving in the afternoon, so that the patient will
spend a comfortable night, and the next morning feels better ; but
sometime after midday another paroxysm comes on in a more disguis-
ed or insidious manner, which continues all night and runs into the
paroxysm of the next morning, without any perceptible remission,
except in the heat of the skin. The crisis or acme of the fever is
usually at the third 'or fifth tertian paroxysm, or on the fifth or sev-
enth day.

The other species of fever I have supposed might be the Dothinen-
terite of the French. If it is not, it is, so far as my reading has gone,
an undescribed form. I have called it the Sandhills fever, from
the fact that I have met with most cases of it in that part of the coun-
ty. Its progress is slow, and its duration from twenty to thirty days.
It most commonly affects the young — all the cases I have seen have
been of persons under twenty years of age.

True Typhus, the typhus gravior of authors, which I take to be
the same as the so-called camp, jail and hospital fever, I have never
seen, nor do I know any physician here who has seen it. Being the
product of crowded and ill-ventilated places, it is not to be supposed

558 Observations on the Soil, Climate and Diseases [October,

that it would be apt to appear in the country. One case of true
Yellow fever, attended with " blaek vomit" brought from Augusta,
Geo,, during the prevalence of the epidemic there, I attended in this
county, in the fall of 1839. This case, in my opinion, differed in no
essential particular, from the case of a foreigner who was attacked
with our common Remittent, in October, 1842, which afterwards
assumed the congestive form and terminated with black vomit.

Puerperal fever occasionally occurs. This fever, I believe, is en-
tirely isopaihic with erysipelas — or in other words, nothing more
than erysipelas of the womb and its investing membranes. This was
the opinior of the Father of Medicine, as appears from the following
remark in his aphorisms: "If a pregnant woman be afflicted with
Erysipelas of the womb, it will prove fatal to her." — [Hippocrates :
Aphorisms, sectio 5th — 43. My reasons for this opinion I hope to
give at some other time. Milk fever is common after acouchement,
but rarely attended with serious consequences. It is sometimes fol-
lowed by collections of matter of a milky purulent character in the
mammae, and sometimes by phlegmasia dolens. The best prophylac-
tic against both results is the early application of the child to the
breast.

* Inflammatory affections prevail mostly during the winter months.
Those of the head are extremely rare. I have only met with one
case of acute inflammation of the brain or its investing membranes,
and this occurred in a child about three months old. It terminated
in effusion of water within the cranium.

Inflammations of the respiratory organs are most common. Croup
in its inflammatory form is rare. Laryngismus stridulus is the affec-
tion mostly known among us as croup. Pneumonia, bronchitis and
pleurisy are here, as almost every where, of frequent occurrence in
relation to other diseases. Gangrene of the lungs sometimes occurs.

Acute inflammation of the abdominal organs is not very common.
Acute hepatitis is, in my opinion, far less common than it is general-
ly supposed to be. Functional disorder is frequent, but I have rarely
met with sfny violent acute form of disease that could be referred
with certainty to the liver as its primary source. It seems to be an
universally entertained opinion, that in hot climates the liver must
be often diseased ; but according to my observation, that organ is

* I use this term as commonly understood, without pretending to endorse the
correctness of its application to the many different diseases included under it.

1845.] of Liberty County, Ga. 559

often blamed for disorders of which it is entirely guiltless. Dr. John-
son's works on Tropical Climates and Diseases of the Liver, are, I
fear, somewhat of a libel upon both topics of his very fertile and
ingenious pen. Were intoxicating drinks, the use of opium and
tobacco,* the immoderate eating of animal and vegetable food, and
more particularly the former, entirely abandoned, and people to live
with a strict regard to temperance in all things, the liver would no
doubt perform its functions with as much regularity and certainty as
any other organ in the body — and the equable and balmy air of the
tropics would be redolent of health. For my own part, I cannot see
why the liver has been so much singled out by authors as the strong
hold of disease, as it were, and so many articles of the Materia Medica
collected together undfjr the name of Cholagogues for its especial
benefit. Every young practitioner is for the most part directed to
look to it in almost every case, and he begins his career with the
^^ Sampson^^ of the Materia Medica as the ground of all his hopes,
and whenever put to it to tell, in obstinate cases, what is the matter
with his patient, clothes all his raisgivipgs in the sapient reply, that
it is Chronic Hepatitis,

A paralysmic state of the liver and spleen very frequently arises
as sequelae of intermittents when long continued, and should no doubt
be treated in a similar manner. They are of far less common occur-
rence now than formerly, which is to be ascribed, I think, mainly to
the fact that blood-letting is not pushed to so great an extent, and
quinine earlier resorted to, in the treatment of this fever now, than
it was even a few years ago. It is but just to remark here, that the
"observations" of Dr. Wm. C. Daniell "on the Autumnal Fevers of
Savannah," published nearly twenty years ago, contain the first
efforts that have been made to introduce a practice in our autumnal

* Excess in eating and drinking is injurious to health in three different ways.
It immoderately strains and thereby weakens the digestive organs ; it prevents
digestion, since it is impossible that in so large a quantity every particle should
be digested properly, and it produces crudities in the colon and morbid hu-
mours Finally, spirituous liquors, of whatever name they may

be, must, by all means, be considered as substances that shorten human life.
They are a liquid fire, accelerate the consumption of the powers of life in a
fearful manner, and in fact transform life itself into a process of combustion.
Moreover, they create cutaneous diseases, aridity and torpor of the fibres, pre-
mature old age, cough, asthma, pulmonary complaints, and — what is worst of
all — an awful dullness and insensibility, not only with regard to physical, but
also with regard to moral impressions. — Hvfdand Makro/)istU\2d-, 39. 44.

500 Observations on the Soil, Climate and Diseases [October,

fevers, which in a modified form is beginning to be universally
adopted.

Bowel affections are among our most ordinary diseases, but in most
cases may be traced, I think, to errors or irregularities in diet, indi-
gestion and dyspepsia, and rarely call for medical aid ; but I think the
former is common, while the latter is rare. Cholera morbus, diarrhea
and dysentery, most commonly arise from acrid or unwholesome
food or drink. The latter prevailed to some extent in 1827, in the
form of a local epidemic, and was very fatal. This was, however,
before my admission to the pra'ctice of medicine, and I know very
little about it. Cholera Infantum sometimes, although rarely, occurs
and generally terminates in marasmus.

Inflammatory rheumatism is not frequent, but the neuralgic form,
or what is known as chronic rheumatism, is more common. Gout is
rarely met with, and probably will be unknown to the coming gen-
eration. Calculous affections are extremely rare — I have never met
with a case ; and I have never heard of a case of stone in the bladder
within the limits of our county. Phthisis pulmonalis or consump-
tion, is also very uncommon among our native population — I have
only seen three cases among the whites, and about the same number
among the blacks, during the course of fifteen years. Scrofulous
enlargement of the lymphatic glands, however, is frequently seen
among the latter. This seems to indicate that our climate is not
favorable to the development of scrofula in the internal, but rather
in the external organs, for I hold scrofula and tubercular consump-
tion to be truly isopaihic affections.

Two or three cases of Goitre have come to my knowledge ; but
surely the remark of Juvenal, in reference to the Alps, has no appli-
cation here —

"Gluis guttur tumidum miratur in Alpibus."

Of the cachexies, however, among the most familiar to us may be
enumerated cacuexia africana or dirt-eating, and dropsy. My read-
ing and observations in regard to the former disease have led me to
the following conclusions : — The eating of earthy subslances has at
all times prevailed to a greater or less extent among certain classes
of men. Celsus distinctly alludes to it as a cause of disease in his
day — *' Quum din color sine morbo regio malus est, hi vel capitis
doloribus conflictantur vel terram edunt.^' — [Medicina, lib. 2.] — and
Baron Humboldt mentions it as being common among certain tribes
of American Indians, as well as other people la various parts of the

1845.] of Liberty County, Ga. 661

world. — [Personal Narrative passim.] Among the negroes here, I
believe it to be a very common habit, and one that is taught them
from childhood, I remember to have eaten clay myself when a child
from the example which was set me by negro children.

It does not appear that the habit is necessarily productive of ill
consequences. This was the observation of Humboldt in regard
to the Otomacs and others. Among us, I know that it does not
in most cases bring on disease. It is, in my opinion, almost uni-
versal among negro women who are in a state of pregnancy. I
have seen places in the fields where the clay has been recently dug
at by their fingers for the purpose of being eaten. I have also known
a pregnant female to eat chalk in large quantities, and declare it to
be a most delicious morsel. In such cases, the desire no doubt arises
from demand on the part of the system for inorganic elements, arid
more particularly lime, and should be gratified in a proper way. If
birds are entirely deprived of all substances which contain lime, their
eggs will be soft, as I have observed to be the case with fowls that
have been long kept in a coop, and I have seen them, under such
circumstances, eat pieces of mortar thrown into them with i\iQ great-
est avidity.

The disease connected with dirt-eating is evidently chlorosis. It
is for the most part confined to females, and appears to arise from
mal-assimilation and defective hcematosis, whereby the blood is near-
ly deprived of its coloring matter, although the relative proportion of
albumen and fibrine is in a great degree preserved. That this dis-
ease may be brought on by eating clay, when indulged in to too great,
an extent, I will not deny ; but it is certain that I have seen it when
the fact of eating it could not be proved, and indeed where the proba-
bilities were strongly against the suspicion. It is certain, however,
that the disease, when it occurs, is always aggravated by it, and that
it should be prevented if possible.

I believe the disease to be curable — and I will here depart a little
from my plan, and give the treatment, which I believe to be best
adapted to its cure. In all cases, if the patient is young, and the
pulse and state of the system will allow it, I begin the cure by blood-
letting. In two cases I bled the patients from six to eight times in the
course of two or three months, taking away from half to one pound
at a time, and when I commenced, the blood would hardly have
reddened a white handkerchief. My object in doing this is not to
subdue inflammation, but to remove from the vessels an impure fluid»

562 Observations on the Soil, Climate and Diseases [October,

which is not blood, so that the system may have a better opportunity
of making good blood. The blood-letting is intended to act the part
of^vascula?' cathartic. My next object is to stimulate the digestive
organs to the proper performance of their functions, and this I believe
to be best accomplished by occasional mercurial cathartics, and the
continued use of the sesquichloride of iron — a preparation which is
not found in the shops, but which can be very easily made. The diet
should be generous, and consist of such articles as they fancy most.

Dropsy, as stated above, is very common, and appears in the forms
of hydrothorax, ascites and anasarca. A great proportion of the
older negroes die of this disease. In the young it sometimes occurs,
but in them it is almost always curable. From the result of one case
recently under my care, I beg leave here to suggest an early resort to
paracentesis in cases of ascites in young persons.

Passing over some other affecfions, which are either common every
where, or too rare to be regarded as peculiar any where, I would con-
clude this brief sketch by a few observations in regard to the Surgi-
cal, and Obstetrical practice o( the county.

Surgical cases are of extremely rare occurrence — I know not
whether this is to be attributed to the want of subjects, or to the want
of confidence in the art itself, arising from the small number of striking
cures that have been performed among us by its aid. Some few
cases of dislocations or fractures, call for surgical interference, and
occasionally a small encysted or sarcomatous tumor has to be remov-
ed, or a limb to be amputated — omitting these and such-like, I beg
leave to record the following cases, which have occurred in my
practice :

The first was an operation on both eyes, for cataract, by depression
or couching, in the case of a negro man about 80 years of age. The
instrument used was a No. 6 or 7 sewing needle, which I ground to
suit myself, and then fixed into a handle. The case terminated fa-
vorably. The second was a case in which I extirpated the right
mamma for a carcinomatous affection. The wound healed readily,
and the patient appeared to be well for one year, when the disease
returned, and although removed a second time, the woman died in
six months after. On the 2nd March, 1843, I divided the tendo
achillis for talepis equinus, and applied an apparatus of my own con-
struction upon the principle of Stromeyer's. The operation has been
as successful as could have been expected. The last two cases were
both hydarlhrosis of the knee joint ; in the first of which I operated

1845.] of Liberty County, Ga, 563

by the introductiox of a seton, a practice which I had never heard
of before. In this case the fluid was so much like blood that I
thought I had punctured an aneurismal tumour.* In the second
case, I simply opened the sac, and introduced tents and injections
of salt and water. Both cases have terminated favorably.

Obstetrical cases, requiring either instrumental or manual assistance,
are equally rare — of the tormer, I have only met with one, and that
was a case of locked head, in which the child was dead, and the wo-
man so much exhausted that I thought it absolutely necessary to
perform embryotomy. The woman, however, was too far gone to
recoTer. Besides this, the only cases that have come under my
care requiring manual assistance, are the following : — One case of
footling, in which the long diameter of the head was engaged in the
short diameter of the superior strait ; one case of face presentation,
in which I rectified the position of the head, without turning ; and
three cases of shoulder and arm presentations. The first of these has
been reported in the August No. of the American Journal for 1833.
In the last two, the delivery was efl?ected by turning : one terminated
favorably — the other died of puerperal fever. I have also seen one
case of severe haemorrhage during labor, in which turning was ne-
cessary in order to expedite delivery. Cases of retention of the
placenta are common. I have met with one case of miscarriage, in
which it was adherent, attended with most profuse haemorrhage.

In closing these observations on the Soil, Climate and Diseases of
Liberty County, I am tempted to use the language of Pliny, in praise
of his beloved Italia — of the justness of its application to this county,
let others judge. *' Nee ignoro ingrati ac segnis animi exisiimari
posse meriio, si breviter atque in transcurser ad hunc modum dicatur
terra nomine Deum electa qucB coslum ipsum clarius faceret et collO'
quia humanitatemqiie homini daret, Sedquid agara ? tanta nobilitas
omnium locorum, tant a rerum singularum populorumque claritas
tenet — Jam verotota ea'yitcdis ac perennis salubritatis coeli temper ies,
tam fertiles campi, tarn aprici colles, tam innoxii saltus, tam opaca
nemora, tam munifica silvarum genera tot amnium fortiumque uber-
tas-''— {Natural History, lib 3, 6.)

* This case, I believe, has been reported in the rs'ew-York Journal of Medicine,
but I have not seen the number.

564

Observations on the Soil^ Climate and Diseases [October,

APPENDIX.
Note A. I have made no anal)'sis of the soil of the county, but I subjoin
here analyses of two specimens, from different parts of the county, by Mr. Cot-
ting, formerly State Geologist, which will give some idea of its constituents. —
(Vide his Essay on the Soils of Georgia, p. 111.)

1st analysis

Water of absorption 10.00

Organic matter 8.00

Sulphur 1.40

Silica 54.00

Alumina 18.00

Humin 2.00

Apocrenate of Iron 1 .00

Sulphuric Acid 2.04

Protoxide of Iron 50

Magnesia 96

Phosphate of Iron 2.10

100.00

2nd analysis.

Water of absorption 1.28

Coarse and fine sand and gravel . , 78.00

Organic matter 3.00

Humate of Lime 2.00

Phos. and Crenate of Lime 4.00

Apocrenate of Magnesia 2.00

Sulphate of Iron 4.72

Alumina and Silica 5.00

100.00

Note B. The following catalogue of the phenogamous plants found within
or near the limits of Liberty County, will exhibit the natural growth of its soil.
Jam aware that it is very incomplete, and in some cases even inaccurate, but it
is sufficiently full and correct for our present purpose. Many plants among us
have, no doubt, escaped my notice, and there are some which have been omitted
merely because I have not been able satisfactorily to distinguish them. This is
particularly the case with species belonging to the natural order of the Graminos
and the families of the Lcguminosa and Composita, and it is possible, that of
those enumerated, there are many to which I have affixed a wrong specific name.
In all cases of doubt, however, I have added a note of interrogation. The most
of these plants have been seen and determined by myself— a. few have been given
from the statements of others upon which I thought I might rely : these are dis-
tinguished by an asterisk. T^e list is in alphabetical order.

Acalypha virginica

Acer rubrum

Acerates longifolia

Achyranthes repens

Acorns calamus

jEscuIus pavia

Agave virginica

Agremonia eupatoiia

Agrostis alba
" indica
" sericea, &c.

Aira obtusata l

Aletrisaurea
" farinosa

Alopecurus gcniculatus

Allium inodorum

Amaranthus lividus
" spinosus

Amaryllis atamasco

Ambrosia paniculata
Ammi capiUaceum

Amorpha fruticosa
" pubescers

Amsonia latifolia
" angustifolia

Anagallis arvensis

Andromeda ferruginea
" mariana

" nitida

" racemosa

" spcciosa, &c.

Andropogon celiatus

" dissitiflorus

'* macrourus

" nutans

" scoparius,&c

Antirrhinum canadense

Apios tubcrosa

Apocynum androsasmifo-
lium

Aralia spinosa

Argemone Mcxicanum

Aristida spiciformis
" striata

Aristolochia serpentaria

Aronia arbutifolia

Arum triphyllum
" virginicnm

Arundinaria macrospcrma

Asarum virginicum

Asclepias amplexicaulis
" cinerea
" connivcns
" angustifolia
" obtusifolia
" paupercula
" tuberosa
" verticillata

Ascyrum crux-andraea
" hypericoides
" pumilum?

Asimina pygmoca

Aster carolinianus

1845.]

of Liberty County, Ga.

565

Aster divergens

" diversifolius'?

*• foliolosus

" obovatus]

" paludosus

" racemosus'?

" squarrosus

" teniufolius

" toitifolius

" virgatus] &c.
Aulaxanthus ciliatus
Azalea nudiflora

" viscosa*
Baccharis halimifolia
" sessiliflora 1
Balduina uniflora
Baptisia uniflora
'• alha
" lecontii*
" tmctoria
Batschia gmelini
Bidens bipinnata

" chrysanthemum
Bignonia capreolata

'• radicans
Bletiaaphylla*
Borkhausia caroliniana
Briza eragrostis
Buchnera americana
Buraelia tenax
Bup^thalmum frutescens
Cacalia atriplicifolia ]
Cactus opuntia

•■* pes corvi
Callicarpa americana
Calopogon pulchellus
Campanu'a amplexicaulis
Canna flaccida
Caprifolium serapervirens
Cardamine pennsylvanica
Cardiospefmum halicaca-

bum
Carex glaucescens, &c.
Carya aquatica'?

" tomentosa 1
Cassia marylandica

" chamEBchrysta

" nictitans
Castanea nana

" pumila
Catalpa cordifolia
Ceanothus amcricanus

" microphyllus

Centaurella verna
Cephalanthus occidentalis
Cerastiura hirsertum
Cercis canadensis
CharaEBrops hystnx
•' palmetto

Chaptalia integrifolia
Cnenopo<tiu!n antheimin-
ticum

Chenopodium album Eleusine indica

Chionanthus virginicus Elodea virginica
Chrysobalanas oblongifo- Eiytraria virgata

Epidendrum conopseum
Erianthus alopccuroides

" brevibarbis
Erigeron canadense
'• nudicauie
" philadelphicuml
" strigosum, &c.
Eriogonum toraentosum
Eriocaulon decangulare

" villosum 1
Eryngium aquaticum 1
" virginianum
Erythrina herbacea
Euchroma coccinea*
Euonymus americaiius
Eupatorium ccclestinum
" fceniculaceum
" hyssopifdlium
" linearifolium
" perfoliatum
" rotundifolium?
" scabridum
" verbenaefolium
Euphorbia corollata
'* cyathophora

'• depressa

'' hypericoides

Fagus sylvaticus
Fragaria virginiana
Fraxinua acuminatus, &c.
Galactia elliotti

" glabella
Galardia bicoior
Galium hispidulum
Gaufa angustifolia
Gelseminum serapervirens
Gentiana catesboei

" ochroleuca
Gerafiium carolinianum
Gerafdia fasciculata
" filifolia
"■ linifolia
'* pedicularia
"" purpurea
" quercilblia
Gleditschia monosperma
" triacanthos

Glycine erecta

" moliissiraa, &c.
Gnaphalium polycephalum
•' purpureum. &c.
Dracocephalura obovatum'? Gonolobus macrophyllus'?

" variegatum " prostratus

Drosera rotijndifolia Gordonia lasianthus

Eclipta erecta " pubescena

'• procumbens Gratiola pilosa

Elephantopuscaroliniensis '' tetrngona

" nudicaulis " virginica

Ekufine cruciata Gvmr.ostvlcs stolonifera

llUs

Chrysocoma nudata
Chrysopsis argentea
■' tricophylia

" scabra
Cicuta maculata
Cissus bipinnata
" hederacea
Clematis viornal
Cieome cuneifolia
Clethni alni folia

" tomentosal
Clitoria mariana

" virginiana
Cnicus glaber

'* repandus
Comraelina communis
Convolvulus raacrorhyzus
" panduratus

" speciiisus

" tenellus

Coriopsis gladiata

" nudata, &c.
Coronupus didyma
Cornus tlorida
" stricta
CratsBgus lucida 1
" pyrifolia
" parvifolia '?
Crotalaria ovalis

" sagittalis

Croton argyranthemum

" glandulosum
Cupressus disiicha
Cuscuta americana
Cyrilia racemiflora
Cyperus flavescens
'• hydra
" mariscoidesi
" tenuiflorus
" virens, &c. &c.
Datura stramonium
Decodon verticillatum
Decumaria sarmentosa
Dichromena leucocephala
Digitaria dactylon

" sanguinalis
Diodia hirsuta
'• tetragona
" virginica
Diospyros virginiana

566

Observations on the Soil^ Climate and Diseases [October,

Hamamelis virginica
Hedyotis glomerata
Hedysarum canadense
*' glabellum'?

" nudiflorum

" rotundifolium

" strictum

Heleniurn antumnale
Helianthemum carolinian-

um
Helianthus angustifolius

" scaberrimus? &c.
Helonias erythrosperma
Herpestis acuminata
" cuneifolia
" rotundifolia

Hibiscus moscheutos
" scaber
" virginicus
Hieracium gronovii
Hopea tinctoria
Houstonia ccerulea

" rotundifolia

Hydroeharis spongiosa
Hydroeotyle umbellata
" repanda

" vulgaris

Hydrolea quadrivalvis
Hypericum angulosum

" fasciculatum 1
'• nudiflorum

" parviflorum

" rosmarinifolium
" simplex, &c.
Hypoxis erecta
Hyptis capitata
Ilex cassena
" myrtifolia
" opaca
" prinoides
Indigofera caroliniana
Ipomoea nil

" trichocarpa
Iris hexagona
" verna
" versicolor
Itea virgineca
Iva frutescens
Ja.tropha stimulosa
Juglans nigra
Juncus acutus
« " acuminatus?
" aristatus

Juncus effusus^

" cchinatus, &c,
Jnniperus virginiana
Jussieua grandiflora
Justicia humilis
Kalmia hirsuta
Krigia caroliniana
Lachnantbes tinctoria
Lactuca elongata 1 &c,
Lamium ampiexicaule
Laurus caroliniensis
" geniculatus
" sassafras
Lechea minor
" villosa
Leersia oryzoides 1

" virginica
Lepedium virginicum
Lespedeza frutescens
" stuvei

" violacea? &c.

Liatris gracilis
'•' graminifolia
" odoratissima
" secunda
" scariosa
" spicata, &c.
Lilium catcsboci

" coruscum*
Lindernia dilata
Linum virginianum
Liquidambar styraciflua
Liriodcndron tulipifera
Lobelia amoena
" cardinalis
" glandulosa
" puberula
Ludwigia capitata
" cylindrica
" dicurrer.s
" linearis
" mollig
" pilosa
" virgata
Lupinus perennis

" villosus
Lycopus angustifolius
Lycopus virginicus
Lythrum lanceolatum

" lineare
Magnolia glauca

" grandiflora
Malva caroliniana

t Manisuris granularis^
Mariscus cylendricus

" retrofractus
Marrubium vulgare
Marshallia angustifolia
Melananthera hastata
Micranthemum orbicula-

tum
Mikania scandens 1
MitcheJlarepens
Mollurge verticillata
Monaida punctata
Minocera aromatica
Monotropa uniflora
Morus rubra
Mylocariam ligustrinuxD
Myrica cerifera

" caroliniensis^'J
Nelumbium lutiuca
Neottia tortilis
Nuphar advena
Nymphea odorata
]Nyssa capitata
" multiflora
" uniflora
CEnothera biennis

" hybridal

'•' pumila

" sinuata

Olea Americana
Onosmodium hispid ufh
Ophiorrhyza mitreola

" lanceolata

Oplotheca flloridana
Orchis blephariglottis
" ciliaris
" nivea, &c.
Orobanche virginiana
Oxalis stricta

" violacea?
Pancratium mexicanum
" maritimum'?

Panicum anceps

" crus galli

" gcniculatum

" hians?

" italicum

" lanuginosuml

" latifolium

" virgatum

" viscidum, &c,

" $ species an nova?
Paspalum dasyphyllum

■j- I am very doubtful whether the plant referred to, under this name is the plant described
by Mr. Elliott. If it is not, however, I think I can safely say, that it has not been described
by him at all.
'l The following is a description of this rem*rkable plant : —

P. Stem procumbent 1—2 feet long, glabrous, geniculate, pubescent at the joints, com-
pressed, striate leaves 6 to 9 inches long, .3 to 4 lines wide, slig:htly pubescent above, glab-
rous beneath, a little sca])rous at the edges, expanding horizontally, linear lanceolate,
tapering to a point, beautifully marked by purple bands, which fade by age — Panicle com-
posed of alternate spikes, expanding. Spikes compound with spikelets, 2 to 3 flowered,

1845.]

of Liberty County, Ga.

567

Paspaluni distichum

" floridanum

" Ictve

'' purpurascens
Passiflora incarnata

" lulea
Pedicularis canadensis
Pentstemon levigatum
Petalostemuni corynibosum
Phlox Carolina
" nitida
" pilosa
Physalis lanceotata

" viscosa 1
Phytolacca decandra
Pinckneya pubescens
Pinguicula elatior

" lutea

" pumila

Pinus palustris
" inops]
" ta;da
Planera aquatica
Plantago intcrrupta

" Virginia
Platanus occidentalis
Poa annua
" eragrostis
" quinquefida
" retVacta, &c.
Podostigma pubescens

virides
Pogonia divaricata
Polysrala corymbosa

" cruciata

" lutea

** polygama*

" pubescens

" purpurea

" raraosa

" setacea
Polygonum punctatum?

" sagittatuiu

" scandens

Polypremurn punctatum^
Pontedcria cordata

" lancitolia

Portulacca oleracea

" tspecies an nova
Potamogeton heterophyl-

lum
Prenanthes virgata
Prinos ambiguus

" glabra
Prunella vulgaris

Prunus chicasa

" umbellata

" virginiana
Psoralea canescens

" melilotoides
Ptelea tritbliata
Pterncaulon pycnostachy- Salix nigra

urn Salvia azurea

Pychnanthejnum incanum " lyrata

Sebbatia corymbosa
" gracilis
" paniculata

Sagittaria lanciiblia
" graminea'?

Salicornia herbacea

Pyrus angustifolius
Quercus aiba

" aquatica

" catesban

** chinquapin

" cincrea

" falcata

" laurifolia

" lyrata

" nigra

" obtusiloba

" phellos

" })uinila

" prinus

" rubra

sempervirens

Sambucus canadensis
Samolus valerandi
San^uinaria canadensis
Sanicula marylandica
Sarracenia variolaris
Saururus ccrnuus
Schoenus cffusus
Schrankia uncinata
Schwalbea americana
Scirpus autumnalis

" capiilaceus

" capitatus, &c. &c.
Scleria obligantha, &c.

" reticulata
Scutellaria integrifolia
•' ovalilblia

Ranunculus oblongifolius? Senecio tonientosus
" lobatus
Seymeria tenuifolia

pusiiius
Rhamnus carolinianus
Rhexia ciliosa
" glabella
" lutea
" mariana
'• virginica
Rhus copallinam
" radicans
" toxicodendron
" vernix
Rhynchospora cymosa

'' longirostritj 1

Rosa lucida

'• lev'igata
Rubus trivialis
" villosus
Rudbeckia hirta
" leviirata

" mollis

Ruellia oblongifolia
" strepens
" tubi flora
Rumex acetosella

" crispus, &c.
Sabal pumila
Sabbatia angularis
" calycosa
" chloroides

Sicyos angulata
Sida gracilis

" rhombifolia, &c.
Siegesbeckia lacinieta
Silphium compositum

" pennatiiidum
Sisj'rinchium anceps
Sium terelitolium
Smilax laurifolia
" p&eudo-china
tamnoides
Solanuai carolincnso

" nigrum
Solidago pyramidata

" retrorsa

" tortitbha

'' tenuifolia

■' villosa

" virgata, &c. &c.
Sonchus carolinianusl
Sparganium americanum
Spanina glabra
" JLincea
" ])olystachya
Spergula arvensis
Spormacoce diodina
Spigclia marylandica

spikelets on one side of the Rachis, appearing to be in 3 or 4 rows. Calvx, 2 flowered her-
maphrodite and neuter, accessary valve miu-ronate, all 3 to 5 nerved ; nerves <;recn, pubes-
cent, the upper valves purple, stigmas purple. Common in low grounds, flowers in July
and August. — {Jin s,ibhum of Elliolt.)

t This plant I have now growing. Tt is very similar to the pilosa in the stem and leaves,
but ditFors entirely in its flowers, which are white and very minute. §

568

Observations on the Soil, 6fC. of Liberty County. [October,

Stachys aspera
Steuartia virginica
Stiliingia lesastrina
" sebifera
'' sylvatica
Slipa avenacea
Stylosanthes elatior
Styrax grandiflorum
" Iseve

" pulverulentutn
Tephrosia paucifolia
" virginiana
Tetragonotheca helianth-

oides
Teucrium canaciense
" virginicum
Thalia dealbata
Thyrsanthus frustescens
Tillandsia bartrami

" tisiieoides

Tipularia discolor
Toiieldia pubescens
Tradescantia virginica
" rosea

Tragia urens

Trichostema dichotema

Trichodium laxiflorum

Tri folium repens, &c.

Tricophorum cyperinum

Tripsacum monostach3^on

Typha latifolia

Ulmus alata

" americana

Urtica capitata

Utricularia inflata
" purpurea 1

" setacea

Vaccinium arborcuin
" corynibosum

" dumosum

" frondosum

" niyrsinites *?

" stamineum —

Verbaseum tbapsus

Verbena urticitblia

Verbesina sinuata

Vernonia altissima

" noveboraccnsis

Vernonia oligophylla
" scaberrima
Veronica arvensis

" peregrina
Viburnum nudum

" prunifolium 7
Viola cucullata

" palmata

" pedata

" primulifolia
Viscum verticillatum
Vitis rotundilblia

'• ffistivalis

" cordifolial
Xanthium strumarium
Xyris flexuosa
\ucca filamentosa

" gloriosa
Zanthoxylon tricarpum
Zapanianodillora
Zizania raileseca
" palustris
Zizyphus volubilis.

Note C. In order to give some idea of the health of the county, soon after its
first settlement, I add the following table, which has been prepared by Mr. J. B.
Mallard, from the records of Midway Church. — (Vide his acco^int already
cited, p. 20.)

Year. |Births.|Deaths. |

Year.

Births.

Deaths.

Year.

Births.

Deaths.

1754

1771

8 '

1788

1755

1772

14 1

1789

175G

1773

1790

1757

1774

1791

1758

1775

1792

1759

1776

1793

1760

1777

1794

1761

1778

1795

1762

1779

1796

1763

1780

1797

1764

1781

1798

1765

1782

1799

1766

1783

1800

1767

1784

1801

1768

1785

1802

1769

1786

1803

1770

1787

' 47

600

621

I would remark that this table includes the deaths, from casualties, as well as
from disease ; but of course those from the former, are comparatively few.

Note D. The following quotations from the Problevts of Aristotle, will shew
that he also regarded wet and rainy seasons as productive of diseases :

" 1. Whjft is the reason that, if a rainy and moist spring follow upon a cold

1^45-] Clmicifuga in Nervous Diseases, 569

winter, the succeeding summer becomes sickly, fevers and inflammation of the
eyes prevailing 1

^' 2. What is the reason that, if a dry and cold Spring follow upon a moist and
rainy winter, both spring and summer become sickly'?

" 3. What is the reason that, if upon a dry and cold summer a rainy and moist
autumn follow, headaches are frequent during the succeeding winter, and hoarse-
ness and coughs, terminating in consumption 1

"4. What is the reason that, if, after a cold winter, and a rainy and moist
spring, the summer be very dry, autumn becomes most especially fatal to little
children, whilst among the rest of mankind, dysentery and quartan ague are of
frequent occurrence ]

"5, What is the reason that, after a rainy and moist summer and autumn, a
sickly winter fellows'?

'■6. What is the reason that, if, in consequence of the heat of the sun, evapo-
rations rise from the ground in large quantities, the year becomes pestilential 1

" 7. What is the reason that those years are always sickly, when the small
frogs are very numerous '?"

It were perhaps well, if, like Aristotle, we paid more attention to climatic
influences in the aetiology of disease, and less to the undefined and undefinable
malaria or miasmata arising from the decompositio?i of vegetable substances!!

The following extracts will shew his opinion, also, in regard to the relative
or comparative influence of seasons :

"1. What is the reason that, although men are more afflicted with diseases
during summer, the sick die in larger numbers during winter'?

" 2. What is the reason that spring and autumn are sickly 1 Is it because
changes produce diseases'? — Autumn is more sickly than spring,

"3. What is the reason that, in winter there are less diseases than in sum-
mer, but that they are more fatal in the former season 1

" 4. What is the reason that burning fevers most frequently occur in autumn
and winter, i. e. during the cold seasons ; and chills in summer, when the wea-
ther is hot 1"

ARTICLE II.

Cimicifuga in Nervous Diseases. By H. V. Wootex, M. D., of
Lowndeshoro\ Ala.

Of all the diseases which the medical practitioner is called upon
to treat, none are so puzzling to his skill, or exhausting to his pa-
tience, as those usually denominated nervous : their pathology is less
understood — their therapeutics is less reliable, and consequently,
their treatment is more empirical and less satisfactory, than that of
any other class of diseases. Under these circumstances, it is not
surprising that any new remedy, that is respectably recommended,
or even suggested, for any of these diseases, should be so readily
tested by the physician.

570 Cimicifuga in Nervous Diseases. [October,

In 1839, Dr. Young, of Pennsylvania, (Am. Jour., Nov.,) report-
ed a [ew cases of chorea, which he cured by the use of the cimicifuga,
and suggested its use in other nervous affections, as epilepsy, &;c.
Not long after I read his paper, I was called upon to treat a case of
epilepsy, and from the embarrassment and failure which I had usual-
ly met with, in the use of other remedies, I determined to give the
cimicifuga a trial. My success in the case induced me to employ
the remedy in othes cases — all of which I will give.

Case 1st. A girl, of delicate constitution, aged 11 years; had
been subject to the "fits" for six months, at irregular intervals, at
first about once in two weeks, but of late more frequently. The fits
were not long, but violent, and usually left the patient in a complete
stupor for a few hours. Her general health was pretty good, but of late
the intellect had been growing obtuse and irregular. Purgatives,
indigo, blisters, assafoetida, and all the usual routine of remedies had
been used in the case, without effect. I gave a purge of calomel and
aloes, which acted thoroughly. I then prescribed the pulverized
cimicifuga in doses of 5ss., to be given morning, noon and night;
and the purgative of calomel and aloes to be repeated twice a
week. During the first two weeks of the treatment, she had two fits,
but stated that her feelings were much better, and the obtuseness of
intellect had disappeared. The treatment was continued, increasing
the dose of the powder to 5ii., and giving the purgative once a
week for six weeks longer, during which time she had no fit ; her
general health and strength appeared much improved. One year
afterwards, she had had no return of the disease. Since that time I
have known nothing of the case.

Case 2nd. The mother of the girl above mentioned, aged about
40, of slender frame, but good general health, had been subject to
epileptic fits for about eight years ; at first occurring about once a
month, but for the last three years oftener, if the patient was fatigued,
or in any way excited unusually. I put her under a similar course
of treatment to that of case 1st. For four weeks she had but one fit,
and it was a light one ; but she continued the remedy until it seem-
ed to lose its power on her system, and she was not cured. She dis-
continued the medicine, and I know not what became of the case.

Case 3rd. A girl, aged 13, of good health and full habit of body,
was seen to fall from a height of a few feet, and was picked up in a
stupor, with her extremities spasmed. The symptoms were attrilju-
ted to an injury supposed to have been received in the fall ; but

1845.] Cimicifuga in Nervous Diseases. 571

none could be discovered, though the head was shaved, and well
examined. She was bled freely; cold applied to the head, and blis-
ters along the spine. The fits ceased, but returned again in about
a week, and continued to recur about 6nce a week for three months ;
at the end of which time I first saw her. Of late her paroxysms had
become more violent and exhausting, and were preceded by a fit of
mania, during which she would scream violently, and endeavor to
destroy every thing in her way. This would last about fifteen min-
utes, and would end in a stupor, which would last about the same
length of time, when the epileptic fit would ensue. During the
intervals, her intellect appeared tolerably good, and I could discover
no particular disease or organic disorder about her, except of the
nervous system. When she would attempt to stand erect and still,
she exhibited a restless eye, and a slight tremor of the extremities.
I was accidentally present when one of her paroxysms occurred, on
which the history of the case was given me, with a request for a pre-
scription. It occurred to me that the fall was more likely the effect
than the cause of the fits, and as no physician was in attendance on
the case, nor had been for several weeks, I gave a prescription found-
ed on that view of the case. Her general appearance was good;
muscular and vascular systems sufficiently full and active ; pulse 100.
I bled her fxii., gave a purgative of calomel and aloes, and continu-
ed the same prescription as case 1st. She had but two paroxysms,
about five days apart, after she commenced the use of the remedies,
and they were light, and without the antecedent mania. She had,
when I first prescribed for her, a long blister on the dorsal spine.
The course was steadily pursued for six weeks, when the patient ap-
peared well, and the medicine was discontinued. She remains well
to this time — three years. It may be proper to state, that neither
this patient, nor case 1st, had menstruated before they came under
my treatment, nor had they done so when it ceased.

Case 4th. A child, aged 4 years, was seized with "fits," which
occurred once every day, at irregular hours, for three days. The
symptoms were attributed to worms, and the child was drenched with
the usual amount of " worm physic." The fits ceased, but returned
in four days, and continued to recur about twice a week, for three
weeks, when I saw it. It was pale, somewhat emaciated ; appetite
good, but digestion much impaired ; abdomen tumid, d:c.

I gave X. grs. blue mass, with ii. grs. Dover powder, which seemed

572 Cimicifuga in Nervous Diseases. [October,

to act well upon the intestinal secretions. I then prescribed the
cimicifuga in the following form :

Cimicifuga, powd. . . . §iss.

Water, Oiss.

Boil to Oi. — strain, and add loaf sugar §iss. Of this, give b\. three
times a day.

This was continued three weeks, — the child had no more "fits,"
and its general health became very good.

Of the above cases, three at least were epilepsy ; three of them were
cured, and one scarcely benefitted. So far as these cases go to
establish the character of the cimcifuga as a remedy in this disease,
it would appear that it is not to be relied on in cases of several
years' standing ; but that in recent cases, it is a valuable remedy,
and worthy of diligent trial.

I could not say, positively, that the 4lh case was epilepsy, as I
did not have an opportunity of seeing a paroxysm ; but from the
account given me of it, I felt convinced that it was truly epileptic in
its character.

The account which I have given of the above cases, is not so
minute and full as I would wish it to be ; but every physician ac-
quainted with practice in the country, over a scope of many miles,
will understand the reason, why it is necessarily as it is.

The cimicifuga seems to act as a tonic to the general system ; but
its peculiar and most valued effects are displayed particularly on the
nervous system. To this system it imparts permanency of tone, and
equanimity of action. I have used it in several cases of delicate
females, whose nervous action was much disordered, producing hys-
teria, and its kindred disorders. I have also used it with great bene-
fit, in cases of dry, hacking cough, occurring in persons of weak
habit, and disordered nervous power, with neuralgic pains about the
chest. I have, myself, been astonished at its effects in restoring the
vigor and healthful action of the system in such cases.

I could detail such, but it is perhaps unnecessary. I will only
remark, further, that in using the cimicifuga, it is altogether im-
portant, though often difficult, to get that which is good and pure.

1845.] A Case of probable Extra-Uterine Pregnancy » 573

ARTICLE III.

A Case of probable Extra-Uterine Pregnancy.

The interest at present existing in the profession on the subject of
Extra-uterine Pregnancy, has induced us to solicit and to place on
record, the following facts. — Edts.

OXFORD, Ga., March, 1845. '

Dr. Joseph A^ Eve, Prof, of Obstetrics^ <^c. :

Dear Sir — Your views are desired in relation to an interest-
ing case connected with the branch of the profession to which your
attention has been particularly directed, for some years. Early in
March of last year, I was called to a negro woman, belonging to
Mr. Worrill, of this place, who complained of pain and tenderness in
the hypogastric and iliac regions of the right side : upon examina-
tion, I found the parietes of the abdomen for a circumscribed space
indurated, as if covering a schirrous tumour as large as an orange,
the hardness, or apparent hardness of the skin was peculiar; and
the tumour, which appeared intimately connected with the skin,
was distinctly perceptible in the iliac region.

I bled, blistered and gave gentle purgatives, for the subduction of
inflammation, with decided benefit to the patient; the pain and
febrile symptoms subsided, and she was able in a short time to go
about ; the hardness, however, and likewise the tenderness or pres-
sure continued. The enlargement of the tumour progressed gradu-
ally, and the woman supposed herself pregnant. She is about forty
years of age, and her youngest child about eighteen years old.

She remained in feeble health, often in bed, until September, when
her strength gave way and she was again prostrated. I found her
apparently in labour, her pains, however, short and ineffectual ; upon
examination per vaginam I was satisfied that the uterus did not con-
tain the foetus ; after some twenty-four hours unavailing efforts to
bring forth, her pains subsided, lactation supervened, but the abdomi-
nal enlargement remained unchanged. She was soon again able to
attend to business, and has continued about ever since, with occasional
short intervals. Within the last two months the catamenial dis-
charge has returned which was before interrupted. At my request,

574 A Case of ijrohahle Extra-Uterine Pregnancy. [October,

my friend, Dr. Gaither, visited her with me a few days ago. The
size of the tumour is about that of the gravid uterus at six months ;
it extends up to the epigastrium, and has inequalities to the touch which
very closely resemble the prominent points of a foetus; — it seems to
occupy the centre of the abdomen, not being confined to either side,
and has neither increased nor diminished for several months. The
woman's general health is tolerably good. She is a valuable ser-
vant, and her owners feel great solicitude on her account, not know-
ing what may be the final result. I am deeply concerned as to the
issue, and should be thankful for your opinion with respect to its
nature, and the most advisable course to be pursued. I am inclined
to view it as a case of extra-uterine pregnancy, but do not feel cer-
tain whether it may not be ovarian schirrous or dropsy, as some of
the earlier symptoms seemed to indicate : in either case, would you
advise an operation ?

Your views at length, as I have said, will be thankfully received,
and highly appreciated.

Very respectfully, yours,

George G. Smith.

AUGUSTA, March 27th, 1845.

Dear Sir — Your very interesting letter df the 19th instant, should
have received an immediate reply, had not the pressure of business
and previous engagements, absolutely prevented me.

After the most attentive and careful perusal, I cannot arrive at
any other conclusion than that to which you have come, that it is a
case of extra-uterine pregnancy.

With respect to the peculiar hardness of the skin over the tumour,
I cannot account for it, but do not suppose that it is connected with
or depend on the tumour within.

My opinion is most decidedly against undertaking an operation
unless indicated by nature herself, or as it were in cooperation with
nature. When she manifests an endeavor to make a way for the
foetus to escape, by instituting the process of ulceration, the surgeon
I think may, with propriety, and often with advantage, anticipate
the more tardy course of spontaneous ulceration, by making an open-
ing in advance or enlarging that which may have been commenced,
through which to extract the foetus and secundines.

But when nature is quiescent, I am decidedly of opinion that sur-
gery should not interfere.

1845.] A Case of probable Extra- Uterine Pregnancy » 575

Time has permitted me to refer only to a very few of the most
recent authorities.

M. Chailly remarks — "The danger of the operation ig far greater
than in the gastrotomy practiced in cases of normal pregnancy.
The placenta does not separate of itself from the internal surface of
the cyst ; it adheres so intimately to it that it seems to be an integral
part of it: its extraction is therefore very difficult and dangerous."

"Again, how can we decide to perform this operation when we
know that the unhappy woman, if she should not die immediately,
will undoubtedly sink gradually, and in the midst too of the most
excrutiating sufferings."

"In a word, it is my opinion, that if the labour cannot be quieted
by opium, the cyst being intact, nothing should justify an operation ;
and the objection, if possible, is still stronger, should the cyst be
ruptured."

"Art cannot profitably interfere until the first phenomena have
passed by, whether there has been rupture of the cyst or not, and
there should be no haste ; the cyst should be allowed time for a
new formation, and this is a slow process, and then the operation is
only to be attempted in order to prevent imminent danger, or to re-
lieve the woman from habitual suffering which renders life a burden
to her."

M. Moreau admits that very little assistance can be rendered, and
that it would be worse than rash to attempt an operation before the
rupture of the cyst, but he declared himself decidedly of opinion that,
if called very soon after its rupture, gastrotomy ought to be perform-
ed ; he thinks the danger of hsemorrhage has been exaggerated, and
that it promises more for the safety of the mother as well as the child,
than abandoning the case to the unaided resources of nature.

Of all the recent authors with whose writings I am familiar, M.
Colombat expresses himself most decidedly in favor of an operation.
After weighing the arguments and opinions of authors for and against
it, he observes — "However it may be in regard to the different opin-
ions we have just mentioned, we believe that the operation ought to
be performed, even after the rupture of the cyst, and that in general
we ought not to wait until the symptoms of peritonitis shall have de-
clared themselves, because in that case we are almost sure to see the
child and mother perish, when by operating earlier, we might perhaps
have saved both."

Although I deemed that candor required I should give the opinions

576 A Case of probable Extra- Uterine Pregnancy, [October,

of Moreau and Colombat, which militate somewhat against my own,
I am decided in my opposition to an operation, except under the cir-
cumstances already stated, and feel myself satisfactorily sustained, not
only by the authority of M. Chailly, but also by that of Dr. Churchill
and Dr. Lee, whose views I will give you in their own words.

" If we find, after a time, that any effort is made to remove the
foetus, by the formation of an abscess or fistulous communication and
discharge of fcetal bones, it may be advisable in some cases to assist
the process by enlarging the opening in the abdominal, vaginal or
rectal parietes, but this should be done with great judgment and care,
as serious haemorrhage may ensue, and we are never to forget that
nature is generally competent to complete the process she commen-
ces."— Churchill.

*'ln the treatment of these cases, the best plan is to subdue the
inflammation by leeches and other means, and when the bones ap-
proach the surface, to make an opening through the abdominal
parietes, or to enlarge the natural opening of these, and extract the
bones like any other foreign bodies lodged in the abdomen. Even if
the diagnosis in these cases of ventral gestation were more perfect than
it is, I do not think we would be justified in performing the operation
ofgastrotomy with the view of extracting the child alive." — Lee.

In addition to the many cases on record in which women have
lived several years — some even twenty and thirty years — with an
extra-uterine foetus in the abdomen. Dr. Bacchetti, of Pisa, has re-
cently related an extremely interesting case of a female who in
1836 manifested signs of pregnancy, and in the ninth month signs
of true labour, which after recurring fifteen days successively, sub-
sided entirely, the volume of the tumour continuing of the same size.

In 1838, and again in 1841, she became pregnant, and was happily
delivered each time. Ten months after the last birth the tumour in
the abdomen became painful, and she gradually sunk in 1842. On
examination, post-mortem, a male foetus was found entire with the
exception of the bones of the cranium which were separated.

This is a truly interesting subject, and although pressed for time,
I dislike to dismiss it. I would be happy to hear from you again, and
learn the progress and termination of this case ; in the mean time
I do not think you can adopt any better course than that you have
pursued to combat symptoms as they arise, and endeavor to improve
and support her general health and strength.

With highest respect, your obedient servant,

Joseph A, Eve.

1845.] Sulphate of Quinine in Diseases of the South, 577

PART II.— REVIEWS AND EXTRACTS.

Extracts from on Official Report of J. J. B. Wright. M. D., Sur-
geon U. S. Army, to the Surgeon-General U. S. Army, on the use
of large doses of SuJphafe of Quinine in Diseases of the South,
Communicated by W. H. Van Buren, M. D. {Fro7n New-York
Journal of Medicine.)

* * * Previous to April, 1841, I had never exhibited qui-
nine in larger quantity than twenty-five grains, in twelve consecutive
hours. I have a distinct recollection of the circumstances under
which, with a trembling hand, and doubting hope, I gave the quinine
for the first time to the extent specified. The patient was a lady of
great worth to the community and her family, and the disease, which
made its approach in the shape of remittent bilious fever, had lapsed
into intermittent, assuming a malignancy of aspect which awakened
apprehensions for the issue. I did not leave the bedside of my pa-
tient during the continuance of the last paroxysm, for it presented
all the symptoms which indicate serious tendency to congestion ;
and I was persuaded that if another could not be prevented, she
would not survive its termination. Under this impression, and hav-
ing confidence in the medicine, (if it could be introduced in sufficient
quantity without incurring the risk of injurious effects,) 1 resolved to
disregard the rule under which I had hitherto acted, and to exhibit
the quinine to an extent to be determined by its effect upon the sys-
tem, given in divided doses. Commencing, therefore, as soon after
the subsidence of the paroxysm as in my judgment was safe, I gave
the lady four grains of sulphate of quinine every two hours, (increas-
ing the last dose to five grains) until twenty five grains had been
given — anxiously watching the effect of each dose. With a degree
of satisfaction I have seldom felt under like circumstances, I witness-
ed the index of the clock pass the mark which had indicated the
period of approach of the previous paroxysm — for I felt that my
patient was safe. Her convalescence dated from that time.

Subsequently, whilst engaged in private practice, and for the first
years of my service in the army, I acted under the rule comprised in
the particulars of the case to which I have alluded.

In 1834, whilst on duty in Arkansas, I witnessed many cases of the
malignant bilious fever of that country. The cases which came
under my charge were treated in the usual way. Quinine entered
into the list of remedies, but it was only exhibited under the canon^
when an approach to intermission, or a distinct remission, was ap-
parent. One case, however, occurs to me as an exception to what
I have stated, which I will relate.

Lieutenant (now Captain) H. of the 7th Regiment of Infantry,

578 Sulphate of Quinine in Diseases of the South. [October,

whilst on detached service in August or September, sustained an at-
tack of remittent bilious fever, and with a large majority of his com-
mand in like condition, was brought into Fort Gibson. For several
days the fever pursued a regular course, and a favorable crisis was
hoped for. Suddenly, however, a total change succeeded. The
paroxysm anticipated the usual hour of incursion, and was charac-
terized by all the sym.ptoms of grave congestive fever, — the brain
being the principal seat of congestion. In one hour after the occur-
rence of the paroxysm, the sensorial functions were abolished, and
very soon profound coma supervened ; the extremities were cold as
marble, — the pulse almost extinct, — the sphincters of the bladder and
rectum utterly paralyzed, — the respiration labored and irregular, — •
the eyes upturned and injected ; — in fine, the patient seemed in the
agonies of death. All my sympathies being awakened for my friend,
and all my anxieties for my patient, T hastened to the encounter ;
but I must confess with painful misgivings of my ability to contend
successfully with the disease. Having at that time no precedent or
authority for the exhibition of quinine in large doses under such cir-
cumstances, I gave it in divided quantities, in union with calomel
and camphor, to the extent in all of twenty-five grains; — applied
cold to the shorn head, — epispastics to the thighs, sinapisms to the
legs and arms, and, if I mistake not, opened the temporal arteries, and
applied cups to the neck. Under this treatment the patient gradu-
ally recovered, with the loss of his hearing — almost total for some
time, and though ultimately greatly improved, audition is to this day
somewhat defective.

In this easel confined the use of the quinine within the limit
which my previous experience had taught me was safe, under dissim-
ilar circumstances, and I shall never cease to award to it the credit
of having saved to his friends, and to the service, a most worthy and
meritorious officer.

If it be said that the favorable result in this case was due to the
other remedies employed, and that quinine was not the efficient agent
in accomplishing the cure, I can only say, in support of its claims,
that I had never, at that time, witnessed recovery in a case apparent-
ly so utterly desperate, and that since then, I have only known a fatal
issue averted when the quinine has been administered in large doses.

In 1840, 1 was assigned to the Florida army, and ordered on duty
at Fort Heileman, Garey's Ferry. I arrived early in October, and
succeded to the charge of a full hospital. A majority of the cases
(excluding those of intermittent fever), were bilious remittent with
manifest tendency to irregular sanguineous determinations, and local
congestions. Not yet having met with any notice of the modern
practice with the quinine, and having as an example of the safety
and advantage of its exhibition during the paroxysm of fever, only
the solitary case of Captain H.,I did not rely upon it as a principal
agent, but confined its exhibition to the apyrexial period of conges-
tive intermittent, and the period of remission, in the more continued

1845.] Sulphate of Quinine in Diseases of the South. 579

forms of fever. My late experience in the use of quinine has indu-
ced me to marvel at the over-caution with which I exhibited it on this
occasion and formerly, and I can hardly repress a smile when I bring
to my mental vision the spectres which my imagination conjured up.

In November, 1S40, I joined the 1st Regiment of Infantry, which
had recently taken post at Sara-sota, on the western coast of Florida,
a position which combined in an eminent degree all the circum-
stances calculated to affect unfavorably the health of troops. Du-
ring the winter, the command sutfered, only as might have been anti-
cipated, from its exposed situation, taking into consideration the fact
that the regiment had been three years in the field, and deprived for
the last few months at least, of a full supply of vegetable aliment.
Intermittent fever prevailed to a considerable extent among the troops,
and was interrupted, ordinarily, by the use of quinine in doses of
five grains, repeated three times during the interval.

My largest experience in the use of quinine having occurred during
my service with the 1st Infantry, and in the quarter ending June
30th, 1S41, I beg leave to quote from my Report to the Surgeon-
General's office, for that period. * * * * "That
the 1st Infantry has encountered disease since the last Quarterly
Report, the present will abundantly testify. A strong scorbutic
diathesis pervaded the command from the commencement of winter,
which imparted to most of the forms of disease which occurred during
that season some of the features of its own character. Dysenter)',
with tendency to total cachexia, and intermittent fever, constituted
the bulk of the Sick Report. About the 1st of April, there occurred
more cases of remittent fever than we were prepared to expect so
early in the season, but surprise gave place almost to consternation,
when, towards the close of the month, there were added to the sick
list twenty cases per diem of congestive fever."

The post at Sara-sota was abandoned on the 2nd of May. The
sick, to the number of two hundred, or more, were taken to Cedar
Keys, and ultimately transferred to Cantonment Morgan, where, the
Report goes on to state, "after considerable delay, and some hurtful
exposure, we are very comfortable in hospital." * * * "The
seat of congestion in this fever varied in different cases. In some
the brain, in others the liver and spleen, and in some others the lungs,
constituted the principal seat of engorgement, as was evidenced by
the symptoms, and by autopsic examination in the fatal cases.

"Excessive prostration of physical power occurred simultaneously
with the attack, and the mental functions sustained early impairment.
The whole surface of the body, but particularly the extremities, be-
came preternaturally cold after the first paroxysm, (in which, howe-
ver, but a small degree of increased heat was developed). A cold,
clammy, or limpid perspiration accompanied this condition of the
skin. The tongue, at first pale, and indented, sometimes smooth and
shining, became dry and hard ; the teeth were encrusted with sordes ;
the pulse was tVequent, irritable, and often intermittent ; and the

580 Sulphate of Qtiiiiine in Diseases of the South. [October,

alvine discharges watery, and sometimes bloody, with tenesmus.
The whole surface of the body presen<:ed a shrunken and contracted
appearance; the respiration was hurried and irregular; the patient,
in fine, presented that indescribable picture of wretchedness peculiar
to those forms of disease, in which the Icedentia impress with such
intensity as to overwhelm the vital energies, and prevent the develop-
ment of /lormaZ reaction.

"The treatment need not be fully detailed.

" But though my observation during the progress of this fever,
corresponds with all my previous experience in regard to the impo-
tence (to say the least,) of the lancet as a remedy in advanced con-
gestive fever, and will induce me to banish it from my list of curative
means in such cases in all future time, I am happy in having been
directed to a practice, of which, if I obeyed the impulse of my feel-
ings, I should express myself in terms of extravagant commendation.
I allude to the exhibition of sulphate of quinine in twenty, thirty,
and even forty grain doses, alone, or in combination with calomel.
I will content myself for the present with saying, that in numerous
instances, it has seemed to rescue the subjects of this form of disease
from the most impending danger." * * * * "It is
due to Drs. Harvey and Randall, of the army, to admit that I entered
on this practice at their urgent suggestion, — for I will confess that I
entertained much misgiving of its safety. My doubts are now utterly
dissipated, and I would give a half, or even a whole drachm of qui-
nine, with as little hesitation as the old-fashioned 'ten and ten' of
Dr. Rush."

Having no precise statistical record in my possession of the cases-
of congestive fever above alluded to, I can only state, in general
terms, that the cases of disease to which I refer, in the Report, as
exposed to the '• most imminent danger," and to whom the quinine
was administered in large doses, with advantage, could not have been
less than fifty. I will further state that it was the sulphate of quinine
that I prescribed, that it was obtained in every instance from the
Army Medical Purveyor, and that in my opinion it was pure.

My subsequent experience with the article relates principally to
its use in the remittent and intermittent fevers, which came under
my notice in the summer and autumn of 1842, in Florida, a few cases
only of congestive fever having presented themselves during this
year. As a remedy in all these cases, the article fully sustained the
favorable character it had previously established in my estimation.

I am not aware that I have discovered any disparity of effect in
the action of the remedy determined by the ditlerent states of the
system, in reference to its tonic or atonic condition. 1 have never
exhibited it when there seemed to be present an inflammatory dia-
thesis, (contra-distinguished from a febrile condition,) nor would my
recent experience induce me to rely with confidence on the quinine,
as a supporting agent, in a prostrate condition of the system, unless
the prostration could be regarded as the effect of the febrific agency
(malaria,) still in operation.

1845.] Sulphate of Quimtie in Diseases of the South, 581

I have not witnessed injurious effects from the medicine in any
case that I can call to memory, and the only unpleasant symptoms
that I have observed to follow its use, were more or less buzzing in
the ears, and, occasionally, slight dizziness. These symptoms have
uniformly subsided with the paroxysm.

Modus Operandi of Quinine. — It is said that the cotemporariesof
the Countess of Cinchon — the Friars who first published the fame,
and disseminated the use of the Peruvian Bark as a remedy for in-
termittent fever, — regarded it as a specific, perhaps as an antidote to
the poison of malaria; and modern observation seems to have fur-
nished some reasons for doubting, if the speculations which have been
indulged by their successors have led to any better conceptions of the
modus operandi of its efficient principles. With the profession it is
dangerous at the present day to talk of ^' specijics,^^ or even o^ anti-
dotes, unless we are ready with a philosophical rationale o{ every
step in the process by which tho end is attained ; — yet, however hu-
miliating to the pride of science, we must admit that there are many
things connected with the principles and practice of medicine that we
do not comprehend. Individuals form theories, they indulge in
elaborate and ingenious hypotheses, and admire the creations of
their fancies — the fictions of their closet speculations, until they
actyally persuade themselves, and others too, that their conclusions
are the result of legitimate deductions from ascertained facts, — that
even the spirit of Lord Bacon himself presides over their delibera-
tions and has affixed its seal to the truth of their philosophy. These
systems are destined to last until some successful revolutionist in
medicine saps their foundations, to erect on their ruins a superstruc-
ture no less comely to look upon, but awaiting, in after time; a similar
fate ; because speculations, and not facts, constituted their basis.
Thus it has ever been since the dawn of medicine, and we apprehend
its future historians will but record a succession of like events, until
it shall have established for itself a place among the fixed and cer-
tain sciences.

We would not controvert the truth of the position that medicine
has made great strides in the way of improvement, within the last
century. On the contrary, we are proud to boast that every year
has added to the resources of the art ; for genuine inductive philoso-
phy has infused its spirit into the investigations of many of its ardent
cultivators. But there are many secrets yet undivulged in philoso-
phy and therapeutics, and perhaps a precise and definite conception
of the manner by which certain medicines effect a cure in diseased
conditions of the system, will remain among the desiderata until
medicine shall have received the last finishing touch from the hand
of science.

We mean these remarks as prefatory to the expression of a doubt
whether the bark or its proximate principles, arrest intermittent fever,
and other forms of febrile disease dependent on miasmatic origin, by-
virtue of the tonic property inherent in them. We are not prepared

582 Sulphate of Quinine in Diseases of the South. [October,

fully to deny that the medicine possesses tonic properties ; it is an
opinion sanctioned by the concurrent belief of the profession for more
than a century. But my ]ate experience authorizes and inclines me
to believe that the remedy exercises over fevers of this genus a pecu-
liar and specific control, independent of, and distinct from, any effect
which it may be presumed to have upon the tonicity of the muscular
fibre.

Some practitioners, whose experience in the use of this medicine
has been by no means inconsiderable, have been led by observation
of its eifects, to class it among the Sedantla, and several plausible
articles have been written in support of this view of its properties.
It must be admitted tiiat if I were reduced to the alternative of
adopting one or the other of these opinions in regard to the character
of the medicine, my late observations would incline me to entertain
the latter — although some unexplained facts would still stare me in
the face, and perplex my understanding.

They who contend that its curative agency is due to a direct
effect on the tonicity of the muscular fibre, would proscribe its use in
all cases where this vital property, or the contractibility of the mus.
cular system, might be presumed to be in an exalted condition. But
the physician experienced in diseases of southern climates will tell
you that he is in the practice of administering it when the condition
of these vital properties is, seemingly at least, above par. For in-
stance, he exhibits the article at the very height of the paroxysm of
the remittent fever of his climate, and finds as a result of its action,
a reduction in the force and frequency of the pulse,— a diminution of
animal heat,<r— a moist condition of the skin,— a subsidence of pain
and restlessness ; in fine, a sudden conversion from febrile disturb-
ance to fair convalescence. Now, if the experience and observation
are right, can the theory be otherwise than wrong? On the other
hand, those who mauitain that the remedy acts by sedation, do not
hesitate to exhibit the article when the powers of life are depressed
to the utmost limit compatible with existence ; and they aver that its
agency is curative under these circumstances. True it is that the
writer has himself frequently given the quinine in both of the con-
ditions stated, and in both his experiejice teaches that advantage
resulted from the practice. He has witnessed a decided improvement
to follow the exhibition of Sij. of quinine, repeated in two hours, in
advanced congestive fever, when the condition of the case was
characterized by a lethargic state of the sensorial functions, verging
on coma, — cold extremities, — cool surface, bathed in limpid per-
spiration,.— dry and pallid tongue, — feeble and fluttering pulse, &;c.
And again, whilst on duty in Florida, in the summer of 1842, in
charge of the General Hospital; it was his usual custom, after atten-
tive observation of the safety of the plan, to exhibit twenty grains of
quinine at nnypcriod of the paroxysm of the remittent fever of that
country, and he i.^ s:iC<« in (Icclarint; lh;it the practice was cMrresslhl
— as the Quarterly Ut.port to the Surgeon-General's Office will

1 S45. ] Sulphate of Quinin 2 in Diseases of the South. 583

testify, not a single death from remittent fever having been reported
during the season, nor from its sequelae.

In southern climates, where high atmospheric temperature pre.
vails, the system, it is well known, becomes languid and relaxed. This
condition is the eflect, no doubt, of the exhausting influence of the
prolonged action of caloric. Indirect debility is induced, and with
this loss of tone in the system, its irritability is exalted. Excessive
mobility is impressed on the whole apparatus of life. The pulse is
quickened, morbid sensibilities and new susceptibilities, mental and
physical, are awakened, and hence do the "children of the sun"
become dislinguished for all that relates to temperament and disposi-
tion— all that constitutes peculiarity of sectional character, from
their cool, calculating, deliberate brethren of the North.

But if this is true in regard to the system in health, it is no less so
when it is under the influence of morbific agents ; and it might, with
some show of plausibility, be maintained that, in this condition, ^owic^
operate indirectly by sedation, — quieting excitement by imparting
tone. And thus, perhaps, would they who entertain this view of the
medicinal properties of the quinine reconcile their notions of it with
its efl^ects, as illustrated in the cases of fever in which it has been
given with advantage in the ijyrexial period.

It is said that recent observations in other countries have demon-
strated the advantage of quinine in acute inflammations, rheumatism,
and other forn)s of disease in which stimulant tonics are, confessedly,
not only inappropriate, but manifestly pernicious. We have the
testimony of such men as Morton, Fothergill and Haygarth, of the
last age, in favor of Peruvian bark in inflammatory rheumatism ;
and the present professor of midwifery in the University College,
London (Dr. Davis), furnishes unequivocal evidence of the paramount
advantage of the remedy in such cases. (London Lancet, Febru-
ary, 1841.) The writer has no experience of its effects, when
exhibited in such conditions of the system, but if time should verity
its claim to confidence in these diseases, it will but furnish another
argument in support of the position assumed, that its medicinal pro-
perties are not fully comprehended or established.

There are strong reasons for believing that the antimonial medi-
cines possess direct febrifuge virtues, independent of any influence
they exert over the heart and arteries by their mere nauseating effect
upon the stomach.

The action of mercury in the cure of lues venerea, has never been
explained in a way that can seem satisfactory to those who profess to
exhibit no article of medicine, the precise physiological effect of
which they do not understand. To designate a whole class of rem-
edies as "alteratives,'' is but to admit that they produce their effects
in some occult way which we do not comprehend,— in ffict, I might
go on to enumerate almost one-lialf of what is contained in the
armenlarimn of physic, and include tho whole in this category, —
but I will conclude what 1 have to say in regard to the inoJus operandi

584 Sulphate of Quinine in Diseases of the South. [October,

of quinine in the fevers of malarial regions, and write myself the
advocate of the notion entertained by the Jesuits, to- wit; its agency
is specific.

It is thought that this article, in combination with mercurials —
calomel particularly — accelerates the supervention of plyalism. I
have no doubt of the fact. I am disposed to ascribe it to a presum-
ed chemical decomposition in part of the combined articles in the
stomach, and a new arrangement by which the activity of the mer-
curial would be increased ; or, if the chemists advise that no incom-
patibility exists between calomel and quinine, and that no such
presumed change can take place in the stomach to account for the
alleged fact, then I would suggest that the latter article facilitates
the mercurial action simply by counteracting the morbid impression
of the febrific agent, and the diseased condition hence resulting, by
its specific effect, thus bringing the susceptibilities of the system to a
condition approximating the healthy standard ; for it must be admit-
ted that first, in proportion to the intensity of morbid action, is the
difficulty in establisliing the constitutional operation of the mineral
in any given case of disease.

Has the free use of quinine increased the disposition to diseases
of the boicels — e. g., Diarrhoea and Dysentery ?

Broussais, in his " Chronic Phlegmasia," has shown, as we think,
very satisfactorily, that long-continued atmospheric heat, combined
with moisture, has an invariable tendency to induce chronic inflam-
mation of the mucous coat of the larger bowels, thus giving origin
to diarrhoea and dysentery, with ultimate liability to ulceration of
the colon and rectum. High and long-continued heat and moisture^
distinguish the climate of Florida ; and when it is remembered that
the centripetal tendency of the fluids, in the cold stage of intermit-
tents, (so frequently recurring among the troops serving in that Ter-
ritory,) determines congestive accumulations and irritations in the
internal organs, we think that the prevalence of diarrhoea and dys-
entery, under these ciicum^tances, is susceptible of explanation with-
out ciiarging anything to the account of quinine.

No patiiological view of these diseases can, it is believed, be cor-
rect which is irrespective of the condition of the skin. It is fair to
presume that this organ is primarily impressed, and that the lining
membrane of the primae vise is implicated in virtue of the intimate
sympathy which is acknowledged to exist between it and the former.
The persistence of the bowel affection is then probably due to the
derangement of the dermoid apparatus, and, until the latter is restored
to its integrity of function, the morbid condition of the bowels can
hardly be expected to suhside under any plan of treatment.

Broussais has remarked somewhere that when the skin in these
forms of disease presents a straw-colored appearance and inelastic
condition, ulceration of the mucous coat of the howels may l)e ap-
prehended ; and that, in a large majority of such cases, a fatal result
will ensue.

1845.] Tables nf Mortality after Operations, 585

A very enlarged experience with the bowel affections of Florida
has impressed strongly on my mind the opinion, that there are few
forms of disease in the catalogue less amenable to the resources of
the art.

Post-mortem examinations were instituted in a large majority of
the fatal cases in the General Hospital at Cedar Keys, as well as the
Post Hospitals at different times under my charge in Florida. My
observation teaches that the liver and spleen, less frequently presented
evidence of diseased condition, than is usual in section5^-of the coun-
try where miasmatic causes of disease prevail. The proportion of
cases in which these complications existed, was infinitely smaller in
Florida than I had previously observed in Ari^ansas. Even the swelled
spleen, so common in other aguish districts, was a rare spectacle.

I can readily conceive, in explanation of this apparent immunity
from congestive enlargements, and from other obvious disease of the
liver and spleen, that, where ulceration exists in the larger bowels,
in obedience to the law, pathological as well as physiological, " ubi
irritatio, ibi affluxus," the fluids impelled towards the central organs,
(under circumstances calculated to produce irregular distributions,)
are diverted to the point where irritation exists in greatest intensity.
In other words, the irritation of the bowels serving as a "diverticu-
lum," secures the liver and spleen from an influx of blood, sufficient
to derange their healthy functions, much less to leave, after death,
appreciable traces of organic lesion. I have no reason, therefore, to
think that the use of quinine had any agency in inducing acute and
chronic affections of the liver and spleen.

With the exception of some few cases of acute dysentery, the
fevers above alluded to, and some cases of inveterate ophthalmia, the
great majority of the sickness which came under my notice while
serving in the Territory of Florida was of a chronic character, and
mostly consisting of the protean forms of malarial disease.

Surgeon GeneraVs Office, July, 1845.

Tables of the Mortality after Operations. By Thojias Inmax, M. D.
(From London Lancet.)

The history of the following tables is this. A year or two ago, I
was struck with the number of deaths occurring after amputation, and
about the same time met with Dr. Lawrie's and Mr. Phillips' paper
on the same sul;(ject ; from that date I have been occasionally jotting
down the reports I have met with in the different periodicals, but did
not do much till a \c\v months ago, when circumstances induced me
to extend my inquiries, and to comprehend other capital operations
besides amputation.

586

Tables of the Mortality after Operations, [October,

As I have been myself considerably surprised by the results, I
have thought it worth while, for the information of others, to give
them a wider circulation.

I doubt not that many living operators, if they ever happen to cast
their eyes over the columns, will find I have in some degree mis-
stated the results of their operations. This arises from many of my
notes being taken long ago, and consequently representing what was
correct only at the time they were written. The table would have
been much more perfect had I been able to obtain an authentic ac-
count of the practitfe and experience of our most eminent living
surgeons.

I cannot help thinking that it would be exceedingly beneficial, if
all the hospitals in England, especially the larger (mes, would publish
an annual record of their operative practice, such as is given for
Scotland in the "Edinburgh Medical and Surgical Journal," for
January, 1844, No. 158.

TaUe sliewirig the Average Mortality of Amputations generally ^including secondary ,
primary /for accident or disease.

Where occurring, or by whom reported.

Cases ^^^^^^- Proportion.

Cases collected and reported by Mr, Phillips, occur

ring in France, Germany, America and England .
Cases collected from the various journals by the same

author, all probably occurring in Britain . . .
Private notes of London hospital surgeons, by the

same author

France, as reported by Malgaigne: Parisian hospit

als for four 5^ears

Guthrie, on the field of battle

Guthrie, secondary in hospitals

Glasgow Infirmary, Dr. Lawrie

Pennsylvania and Massachusetts hospitals

Northern hospital, Liverpool

Gendron, Paris

University College Hospital

Emery, after battle of Navarino

Liverpool Infirmar}'^, three and a half 3-ears

Guyon, African a/my of the French, i837-9

Edinburgh, last year —

Larger extremities, 18 cases, 13 dead

Lesser extremities, 20 " 2 "

Dupuytren

Scotch Hospitals, during last year, exclusive of Edin-
burgh

Larrey and Roux

Larrey, primar)'', on field of battle

Dubois

After revolution of 30th July, at Paris, the proportion
of deaths was three in four

Bell states, that out of operations performed on the
liela of battle, he lost one in 12

Total

G40
308
107

587

291
551
276
14G
9G
79

G8
5G
C3

38
59

GO
38
13
28

150

301

2G5

101

1 in 4 1^8
lin4

1 in 3 3-4

Jl in
\ nearly 2
1 in 11 1-2
1 in 2 1-2
1 in 2 7-10
lin4
iin5
1 in 2 1-2
1 in G 1-G
1 in 4 4-5
1 in 14
1 in 4

1 in 2 1-2
1 in 4

1 in 4 1^3
1 in 2 1-2
1 in G 1-2
lin9

358G IMG J in 3 7-10

1845.] • Tables of the Mortality after Operations,

587

TaJ)le sMwing the Mortality attending the Operation of Amputaiivn.

Opera, lull.

No. of
Cases.

Dead.

Proportion.

Remarks.

Amputation

of the thigh

of leg

201
192
38
13
91
'IS
24

r2G

lUG

1 in 1 3-4
1 in 1 3-4

1 in 4 1-4

2 in 3

1 in 2 1-4
1 in 3 3-4
1 in 25

Collected by Malgaigne from
the records of the Parisian
liospitals, from 183G to 1840,
in elusive. — Archives "enef-

of foot

ales de Medicine d Pans

of siioulder joint.

of upper arm

of fore-arm

of wrist and hand

April, 1842.
These include amputations for
accident and disease ; the
average mortality of the two
is nearly equal.

Amputation

of the thigh

of leg

128

1 in 2 3-4
1 in 2
1 in 2 1-2
1 in 1 1-2
1 in 2 1^2

Glasgow Infirmary, from 1795

of foot and ankle.
Bt shoulder-joint,
of arm

to 1840, reported by Dr.
Lawrie -^Medical Gazette,
1841.

of fore-arm

Amputation ot upper
extremities, collected
from V arious sources
(French military) . . .

Amputation of lower
extremities

123
107

J 1 in

1 about 2

2 in 3

These are chiefly taken from
the reports of Malgaigne,
chiefly military surgery.

Amputation of upper
extremities (various
sources)

144

296

18
75

1 in 8
lin4

These are collected chiefly
from American and British
reports, where no distinction
has been made between arm
and fore-arm, thigh and leg.

Amputation of lower
extremities

Table shewing the Mortality attending the Operation of tying

the Large Arteries.

Artery subjected to Ligature, &c.

iSo. of
Cases.

Deaths.

Proportion.

Ca.ses collected by Phillips from the works of BoycC)
Lancici, Scarpa, Pelletan, &c., where old opera-
tion was performed :
Femoral tied

22
/

8
4

27
42

2
9

1 in 3 3-4

Humeral tied

1 in 7

Hunterian ojjeration —

Ligature of arteria innominata*

all die

Li""ature of subclavian

1 in 2

1 in 4

Abdominal aorta

all die

Common iliac

1 in 2 2-3

Internal iliac

1 in 2

External iliac

1 in 3

Femoral

1 in G

Total

199

1 in 3

* The only successful case, if so it may be called, is related by Mr. Porter, of
Dublin, where the artery was cut down upon and found too much di.'^eased to
bear the ligature ; the v^-ound closed readily, and the aneurism wa.s cured.

588

Tables of the Mcrtality after Operations. [October,

Some discrepancies exist in the calculations of various authors as regards the
mortality of this operation. Phillips states that out of 171 cases he has collected,
57 died. Lisfranc states that he has collected the reports of 180 cases where the
Hunterian operation has been performed, and gives the deaths at 40 only.

The above table is drawn out after carefully examining all the medical' periodi-
cals for a long series of years, and the author believes it may be relied on as
being the closest possible approximation to the actual truth.

Table shelving the Mortality attending the Operation for Lithotomy.

iNature of operaiion, wlit-re recorded, by whom or
where performed.

Frere Jacques (recorded by various author?)

Raw (the only official register extant that 1 can find

noticed)

Cheselden

Naples : lateral operation — cases operated on in the

public hospitals, from 18-21 to 18'28

Dupuytren — bilateral operation

Dupuytren's account of the practice of the Parisian

hospitals and private cases, 1636

Dudley, Kentucky

Chrichton, of Dundee

Norwich hospital for the last GO years

Leeds Infirmary, from 1767 to 1817, according to Dr.

Piout

Bristol Infirmary

Bransby Cooper

Liston

Hotel Dieu and La Charite, Paris

Luneville

Frere Come

Pajola

Pauza

Ourrard

Joucil

Total

-NO. of
Cases.

1-24

2-2
213

643

356

153

704

197

104

1200

1629

100

Dtaths

100
19

61
4

8
93

225

147

5900 765 1 in 7 3 4

Proportion.

1 in 17 5-7

1 in 5 1-2
1 in 10 1-3

1 in 6 1-2
J in 6

1 in 6
1 in 38 1-4
1 in 9
1 in 7 3-5

1 in 7
1 in 4 1-2
1 in 10
1 in 11
1 in 5 1-2
1 in 11
1 in 5
1 in 10
lin 14
1 in 12
1 in 17

Table shewing the Mortality aitending upon the Operaiion of Gastrotomy and the
Casariayi Section.

Where or by whom recorded, nature of operation, &c.

Csesarian section. Dr. Churchill :

414 cases, 186 died, = 1 in 2 1-2
Cases collected bv Mons. Figuera: 790 cases, 424
fatal.. = 1 in l"3-4

Cases well authenticated, collected by Dr. Churchill,
all occurring since A. D. 1750*

Pcemoval of Dropsical Ovarium, where operation was
completed

Operation for extirpation, where either no tumour ex-
isted, or wherrir^surmountable obstacles prevented
the removal of the diseased mass

Total 363

No. of
Cases.

321
33

Deaths.

173
11

ISu

Proportion.

1 in

nearly 2

1 in 3

1 in
about 2

♦Out

of twentj'-eight persons who had the operation performed on them more

1845.]

Turning,

589

Table shewing the Mortality attending the Operation for Hernia.

Where or l)y whom recorded, «&c.

In Sir A. Cooper's work on klernia

By Travels

Dewar, of Dunfermline

Scarpa, (on Hernia) ,

Lawrence (on Hernia) ^

Clement

Hey (he performed the operation forty times, but no

detailed account is given of all the cases)

Wurtzburg, from 1816 to 184'2

Recorded in diflercnt periodicals as isolated cases, &c
Malgaigne, Hos^iitaU of France :

Patients between fifty and eighty years of age . . .

Other ages

Guy's Hospital/from Sept. 1841, to Dec. 1842.

Scotch Hospitals during 1843

Cases witnessed by the author

Liverpool Infirmary, for two years

Liverpool Northern Hospital — nine years

No. of
Cases.

77
14
17
16
2-2
8

12
56

97
86
19
11

4
12

Total

545

Deaths

36
8
4

6
24

70
44
10
3
3
1
6

Proportion.

-2

in 2
in I
in 4
in 3
in 3
in 2

in 2
in 2 1-2
in 3

in 1 1-4
in 2
in 2
in 3 2-3
in 2
in 4
in 2

260 1 in 7 3-4

Turning.— By J. Y. Simpsox, M. D., F. R. S. E , (kc. (From
London and Edinburg Monthly Journ. of Med. Science.)

[Many writers on Midwifery recommend that in the operation of
turning, both feet should, ifpossibie, he grasped and pulled down.
We entirely ngree with Professor Simpson in the following very
judicious remarks.]

In most cases I hold this method to be improper and unjustifiable,
because it is almost always more difficult to seize both extremities
than to seize one ; because one is quite sufficient for our purpose,
and more safe for the life of the mother; and because by pulling at
one extremity (when pulling does happen to be required after the
version is accomplished) we more perfectly imitate the natural oblique
position and passage of the breech of the infant, that when we drag
it down more directly and more upon the same plane, by grasping
and dragging at both limbs equally. The infant also assuredly in-
curs less risk of impaction of the head, and above all, less chance of
fatal compression of the umbilical cord, when the os uteri and ma-
ternal canals have been dilated by the previous passage of the breech,
increased in size by one of the lower extremities being doubled up
on the abdomen, than when both extremities being seized and ex-

thanonce, only three died — i. e., there were seventy-three operations on twenty-
eight persons, an& only three deaths. — [From Dr. Churchill's Midwifery, &c.

590 Turning, [October,

tended, these same passages are more imperfectly opened up by the
lesser-sized wedge of the breech alone. Notwithstanding, however,
the great difficulties and consequently the greater dangers attendant
on the operation, when we search for, and grasp both lower extrem-
ities, instead of one, it is still so dogmatically laid down as a rule by
most obstetric authorities, that many practitioners seem to deem it
a duty, not to attempt to turn the child without having previously
secured both feet.

In ^ew or no cases of turning is it proper or requisite to bring
down both extremities, unless in the complication of turning under
rupture of the uterus. In that case, but in that only, ought we to
follow at once this procedure — and here we follow it because, if we
left the other extremity loose in the uterus or abdomen it would be
apt to increase the lesion in the walls of the organ, if it happened to
get involved in the aperture, or impacted against its edges. In some
very rare instances in which, after version by one leg has been effected
and immediate delivery is necessary, the cervix and os internum
occasionally contract so forcibly and strongly upon the protruded
limb, whenever we drag upon it, as not to allow a sufficient amount
of traction being applied to this extremity without fear of lacerating
its structures. In such cases it may be well to attempt to repass the
hand to secure the other extremity, for then by pulling at both extrem-
ities together, we incur less chance of injuring them than if we ap-
plied the same required amount offeree to either of them singly.

Should we seize one extremity ojiJy ? — From what I have already
stated, you know my opinion as to this being the proper method of
proceeding in almost all cases of difficult turning. The method was
long ago spoken of by Portal ; and within the present century, Hoff-
man and Jeorg in Germany, and my friend, Dr. Radford, in this
country, have severally written on the subject, and upheld, that, in
no case of turning ought we to lay hold of more than one extremity,
for the purpose of effecting the version of the infant. I have just
pointed out what I conceive to be two — perhaps the only two — ex-
ceptional conditions to this general rule.

I believe the seizure of the knee to be preferable, in most, if not
in all cases, to the seizure of the foot, or, rather, as it should be more
correctly stated, to the seizure of the ankle of the child, I speak,
you will recollect, of turning in cases of shoulder or arm presenta-
tion, in which the liquor ajunii has been for some time evacuated, as
in Anderson's case, and the uterus by its tonic contraction has
clasped itself around the body and head of the child. Under such
circumstances, it is an object of importance not to be obliged to
introduce our hand farther than is absolutely necessary, into the
cavity of the uterus, because the contraction of the organ, in many
cases, opposes its introduction, and the forced introduction of it is
apt to produce laceration. It is an object also of equal moment to
attempt to turn by a part which produces as little change as possible
in the figure and form of the infant ; because, if wc thrust any of the

1845.] Turning. 591

angulated parts of the child against the interior of the contracted
uterus, we should also thus be still more liable to produce rupture of
that organ. Now, holding these points in view, it appears to me,
that the turning of the child, by seizure of the knee, presents several
derided advantages over turning of the child by seizure of the foot.
For, 1st. The knee is more easily reached. As we slip our hand
along the anterior surface of the protruding arm, and along the
anterior surface of the thorax of the child, we always, if the at-
titude of the child has not been altered by improper attempts at
version, or very irregular uterine action, find the knees near the
region of the umbilicus of the infant — the lower extremities, as you
are aware, being folded up in utero so that the knees are brought up
to that part, and the legs flexed upon the thighs in such a manner
that the heels and feet lie nearly in apposition with the breech of
the child. To seize a foot, therefore, we should require to pass our
hand about three inches (or, in fact, the whole length of the leg)
Jurther than we require to do in order to seize a knee. 2nd. The
knee affords the hand of the operator a much better hold than the foot.
By inserting one or two fingers into the ham or the flexure of the
knee, we have a kind of hooked hold which is not liable to betray us.
Every one, on the other hand, who has turned by the foot or feet,
knows how very apt the fingers are to slip during the required
traction, and how much in this way the difficulties of the operation
are sometimes increased. 3d. We produce, I believe, the necessary
version of the body of the child more easily by our purchase upon
the knee-^because thus we act more directly on the pelvic extremity
of the infant's spine, than when we have hold of a foot. 4th. Turn-
ing by the foot appears to me to endanger greatly more the laceration
of the uterus than turning by the knee. The reason of this is suffi-
ciently evident. When we turn by the foot, we have to flex the leg
round upon the thigh, and thus, at one stage of the operation, and
during one part of the flexion of the leg, we are obliged to have
the leg bent to a right angle with the thigh, and the foot of the
infant thus projected and crushed against the interior of the uterus,
lou see this when, on the infant before me, I seize hold of the foot
and turn it round from its position at the breech, till I bring it up to
the shoulder, the part which we are supposing to present at the os
uteri. You can easily thus perceive that, when the angled and long
leg of the child is thus brought round, it must rasp and scratch (if I
may so speak) along the interior of the contracted uterus, and endan-
ger, to a fearful degree, the laceration of the organ. It is needless
to say how much all this danger is increased, when, after having
brought down one foot, we pass again our hand, and attempt to bring
down a second foot (as is recommended by some authors), for thus we
only double the danger of the laceration of the uterus, from the forced
and obstructed passage along its interior, of this other extremity.

One point remains for our consideration. Granting that it is pro-
per to seize a knee, I think it matter of the very first moment to know

5#i Turning, [October,

which knee should be seized. On this point you will find no direc-
tions in any of our modern obstetric works, British or foreign, as far
as I know them ; and yet I believe the secret of turning with facility
and safety in such a case as Anderson's — with the waters evacuated
and the uterus contracted — depends upon the knowledge of which
of the two lower extremities of the infant should be seized. If we
turn with one of the extremities — and whether the foot or the knee —
it should be the foot or knee of the limb on the opposite side of the
body to that which is presenting, Thus, if the ri^ht shoulder or arm
presents, we should take hold of the left knee or foot : and if the
left arm or shoulder presents we should take hold of the right knee
or foot. I repeat, that I believe this point to be of the most essential
importance ; and the reasons for the rule are simple. In bringing
down the foetus in the operation of turning, we may, and should
produce two kinds of alteration in its position and figure. Thus,
we may bend or flex the body forward upon the transverse axis of
the trunk ; and we may rotate or turn the body round upon the Jon-
gitudinal axis of the trunk. If we merely flex it, the operation of
version will be one of difficulty ; if we both flex and rotate the
trunk at the same time, the operation will be one of comparative
facility. By merely flexing the body upon its transverse axis, we
are liable to bring down one of the lower extremities, while we do
not displace the upper extremity, which is primarily presenting at
the OS uteri. If we both rotate and flex the body — that is, turn it
both on its transverse and longitudinal axis — at the same moment,
while we bring down the pelvic extremity of the child, the turning
of the body of the infant carries away from the os uteri the part
originally presenting.

Many of you must be acquainted with the fact, that obstetric authors
have proposed various methods of removing away from the cervix
uteri the presenting arm or shoulder, in order to allow of more space
for the part which is brought down, and to produce the necessary
evolution of the child. Thus some recommend the presenting part
to be pushed up before we seize the feet ; others advise the foot to be
seized with the one hand, and the presenting part to be pushed up
with the other; and others again counsel us to bring down one or
both feet, secure them with a tape (as you see in the plate of Moreau),
and, whilst pulling with this tape, to introduce the hand, after the
lower extremities are brought down, for the purpose of pushing up
the presenting portion of the upper extremity. All these rules and
complications are at once avoided by following the principle that I
have just stated to you, of bringing down, whenever it is possible,
the knee opposite that of the presenting arm or shoulder. When
we do this, by carrying the knee diagonally across, if I may so speak,
the abdcrmen of the child to the os uteri, we both, as I have said,
flex and rotate at the same time the trunk of the infant, and in doing
so, the semi-rotation of the trunk inevitably carries up the present-
ing arm, in proportion as the knee which is laid hold of is pulled

1845.] Ditisionof the Sjpinal Marrow. 593

down by the operator. I would add this, as another of the advanta-
ges of turning with one extremity, for if we pulled down both knees
or both feet, or the foot or knee which was nearest to us, we should
produce in many instances mere flexion of the body wiiJiout that ro-
tation of it which is necessary to carry up and out of the os uteri,
the presenting part of the infant.

I have insisted upon the advantages of taking hold of the knee that
is highest and furthest from you, and believe this is to be a matter
of the very first moment. Now, it may appear to some of you that
it would be more difficult to seize this knee than the knee of the side
corresponding to the presenting arm ; but if you reflect for a moment
you will see that this difficulty is more imaginary than real. Both
knees of the child, as the infant lies folded up in utero, are generally
in juxta position, and lying upon the abdomen of the infant, near
the umbilicus. If, therefore, in passing your hand into the uterus,
you insinuate it as you ought to do, along the anterior surface of the
thorax and abdomen of the child, you come in contact with both
knees at the same time, And the rule which I v.ould give you is
this, that instead of hooking your finger, or fingers into the flexure
of the lower or nearer knee, you hook them instead into the flexure
of the upper, more distant, or opposite one. Both are so far, in gen-
eral, equally near, or equally distant, and you seize the one or the
other according as you take care to turn your finger so as to hook it
into the flexure of the lower or the flexure of the upper.

PART III.— MONTHLY PERISCOPE.

Case of Division of the Spiiial Marrow, By Eli Hurd, I\r. D., of
Middleport, Niagara County. New York. (Communicated for the
N. Y. Journ. of Medicine, by Jas. Webster, M. D., of Rochester.) —
The following remarkable case of injury of the spinal marrow is
believed to be without precedent, or at least to present sufficient
points of interest to warrant its publication :

On the 24th of April, 1829, J. S. Spalding, of Hartland. N. Y.,
jumped from the top of a lumber wagon box on to a slick of timber
iving upon the ground : and as his t'eet struck the timber, the surface
being wet, they slipped instantly from under him, and he fell upon
his back and left side. When he came to a rest, he found himself
partly under the wagon, and between tbe wheels, the wagon and
timber being parallel to each other. From this position he endeavored
to extricate himself, but found his lower extremities benumbed and
powerless. He then called out for assistance, saying that he had
bnjken his back on the edge of the timber in his fall. He was im-
mediately extricated from his perilous situation, and informed by his

594 Division of the Spinal Marrow, [October,

assistants that there was a chisel sticking in his back. This chisel,
when he" jumped from the wagon, was in his coat-pocket. An at-
tempt was promptly made to extract the instrument, which resulted
in pulling off the handle only.

I was then called, and in a few moments was on the spot, where I
found my patient in the arms of three or four men, his back exposed,
and an iron tool, which proved to be a part of the shank of a chisel,
projecting from the skin. This I seized with a pair of blacksmith's
pincers, such as are used for pulling off horse-shoes, and bracing
myself, endeavored to extract it, instead of which I pulled him out
of the hands of those who had hold of him. We then braced our-
selves once more, and after a prolonged and severe effort, succeeded
in drawing out a chisel, ^ue inches in length to the shoulder, seven-
eighths of an inch wide, and from a quarter of an inch at the shoulder
tapering to less than one-eighth of an inch in thickness at the cutting
extremity.

The wound was then dressed, and the patient carefully conveyed
home. At the time of extracting the instrument, he says that he
saw "vivid flashes of light, which were apparently followed by total
darkness." During the operation he was conscious of very little
pain.

The wound made by the chisel was opposite. the spinous process
of the lower dorsal vertebra, on the left side. At its superior ex-
tremity it was half an inch from the spinous process, and one inch
at its inferior extremity; so that a line drawn parallel to the spinous
process of the vertebrae, and three-fourths of an inch to the left,
would have intersected it in the middle. The direction of the instru-
ment was upwards, at an angle from the surface of twenty to twenty-
five degrees, and to the right of about twelve degrees, penetrating the
spinal column, and undoubtedly entirely dividing the cord. Perfect
insensibility of the skin below the wound, with paralysis of the lower
extremities, bladder and rectum, was the immediate consequence.
The shock that the system received produced great prostration for
some forty hours, when reaction took place, and was followed by
fever for ten or twelve days. The external wound cicatrized in a
few days, scarcely discharging a spoonful of pus. The urine was
drawn off hy means of the catheter for six days after the accident,
when the bladder began to resume its functions, and two days after
the instrument was discontinued. Cathartics failing to move the
bowels during the same period of time, and for two or three days
longer, dejections were procured by stimulating enemata. Return-
ing sensibility occurred in the skin the fifth day, -and an imperfect use
of the limbs about the fifteenth.

My attendance was twice and thrice daily for the first six days,
once daily for the next eleven, then occasionally until the twenty-
first after the accident (May 15), when the patient was dismissed
from my charge. He first commenced locomotion on his hands
and knees, then by pushing a chair round, and afterwards by moans

1845.] Division of the Spinal Marrow. 595

of crutches, which he has been obliged to use ever since. Distortion
of the feet and ankles commenced some weeks after his efforts to get
about on crutches, and increased for several years thereafter ; yet his
general health continued good.

The treatment during tlie state of prostration was by diffusible
stimulants, through the febrile stage by antiphlogistics ; wliile fric-
tion, with stimulating liniments to the paralyzed parts, was used
throughout both stages, and for months afterwards.

[The followinfT additional particulars, written subsequently and re-
cently communicated, complete the history of this remarkable case.]

Sensibility of the skin and action in the inferior extremities returned
very slowly ; so much so, that four years and seven months after the
accident above-mentioned, carelessly sitting or kneeling with his left
knee nearer than usual to the hot fire, without feeling any pain, or
being conscious of suffering, the skin and integuments over the
knee-pan and on either side of it were so badly burned, that mortifi-
cation and sloughing took place. This was so deep, that the cavity
of the joint was opened and exposed to view. The patella was cov-
ered only by the periosteum, and after a few days, as he was endeav-
oring to draw his leg up in bed, broke transversely across. The
superior portion of the patella protruded so much from the wound in
consequence of the retraction of the extensor muscles, that, after
various unsuccessful attempts to reduce and keep it in place, it was
removed by amputation. The knee was now much inflamed and
swollen. The wound gaped horribly, and every symptom gave
indication of a flital issue. A fungus vegetation sprang up from every
side of the wound, filled up the cavity, and formed a spongy protu-
berant mass above and around it. Hemorrhage followed every appli-
cation of caustic that was made to check its exuberant growth, as
\vell as compression, even the slightest touch. The miserable patient
became extremely exhausted, and amputation of the diseased and
crippled limb seemed the only alternative, and even that a doubtful one.

At this juncture, December 23, 1833, which was more than three
weeks from the time of the burn, and the seventh of my attendance,
I commenced dressing the wound with " Singleton's Golden OinU
jnent,^^ according to tiie analysis of Mr. Thomas Clark, of Glasgow,
Scotland.* This soon arrested the morbid action, reduced the size of
the fungoid mass, and gave it a healthy appearance. Convalescence
slowly followed. January 22, 1834, 1 introduced a seton in the sound
parts above the wound, and on February 4th the patient was dismissed
cured. He has since remained well. No anchylosis of the joint at
the time occurred, nor has since taken place. On the contrary, he
has complained of its being rather too flexible.

A large, ugly-looking puckered cicatrix remains over and above

* See No. 12 of theGlas^gow Journal, or Medico-Chirurgical Review, new se-
ries, vol. XIV.

596 Conclusions regarding Tubercles. [October,

the left portion of the joint. The inferior portion of the patella is
drawn round upon the outside of the knee-joint. The leg is rotated
outwards, and the heel thrown in so as to point to the hollow of the
right foot. The toes are thrown out and drawn up towards the me-
tatarsal bones, and the whole foot is drawn inwards, and flexed upon
the tibia in such a manner as to make almost a right angle with the
leg. There is also considerable deformity of the right foot and
ankle, though less than of the left.

The general treatment was by wine, tonics and opiates. The
local unimportant otherwise than above mentioned. He was under
my care, in the treatment of the limb, for thirty-three days, and
slowly thereafter recovered the use of his limbs, except the previous
decrepitude, which has considerably increased since.

Such is a brief account of this extraordinary case ; embracing
and detailing, however, all the important and material facts that
transpired both with regard to disease and treatment, from the time
of its first unfortunate occurrence till its final termination in health.

There is no curvature of the spine, nor has there been at any time.
Nor is there any complaint whatever of the back. He can get into
and out of a carriage, mount a horse from the ground without assist-
ance, and ride off at any pace. He has bejen elected constable and
collector of the town where he resides for a number of successive
years, discharged the duties of his office acceptably to the public,
and attends to many other kinds of business. He has married within
two years, and has one child. In fact, he is, in every sense of the
word, as well as he ever was, except his crippled condition.

[We regard the above case as unique, as far as our knowledge ex-
tends, and the facts are abundantly corroborated. That the spinal
marrow was completely divided, and afterwards united, there seems
to be no doubt whatever. Perhaps it may be deemed not more re-
markable than the union of nerves after division for tic douloureux,
a fact well authenticated, as the spinal cord maybe considered no
more than a bundle of nerves contained within a common sheath.
Cases also are recorded where incised wounds of the brain have
united, and the patient recovered ; but, so far as we arc informed,
this is the first instance on record of a total division of the spinal
Qoxd.—Ed. N. Y. Jour, Med.]

Conclusions regarding Tubercles. — 1. Tubercle is a secreted sub-
stance, deposited under the form of yellowish opaque grains. It
grows b)' superposition. 2. There are two species of tubercles, the
simple and the multiple; the latter forms by the aggregation of
several simple tubercles. It contains organized parts within. 3.
Granulations are a form of chronic pneumonia : they do not pass
into tubercles. 4. The softening of a tubercle depends on the action
of the surrounding living parts. 5. Simple tubercle never softens
from the centre to the circumference. 6. The multiple tubercle
often softens from the centre to the circumference. 7. The most

1845.] Various opinions respecting Hooping Cough, 597

frequent seat of tubercle is the cellular tissue. Tubercle is some-
times to be seen in the lymphatic vessels. Tubercle does not occur
on the free surface of mucous membrane so long as it is entire. 8.
Tubercles are often hereditary. 9. The lymphatic and sanguineo-
nervous temperaments are predisposed to tubercles. 10. Infants
and females are most subject to tubercular diseases. 11. Inflamma-
tion is an exciting cause of tubercles. 12. The same is to be said
of passive congestions, of over-activity or deficient activity of an or-
gan, and probably also of the alterations of the fluids. 13. No certain
sign of the rise of tubercles is known. 14. The hectic fever which
occurs in tubercular diseases results from the act of elimination.

15. To prevent the tendency to tubercles, we must counteract the
influence of hereditary disposition, of temperament, of age, of sex.

16. In persons with predisposition to tubercles, inflammations should
be guarded against with the greatest care, or arrested as prompti}- as
possible. 17. The same rules apply to passive congestions. 13.
The absorption of tubercles is very probable. 19. To obtain the
cure of tuberculous ulcerations we must prevent the formation of
new tubercles, and confine the work of elimination within certain
limits. 20. Tubercles may remain long in the organs in a latent
state: to obtain this result we must seek to arrest the process of
elimination by antiphlogistic means, and above all by revulsives. —
From Jf. Lombard. — {Xorthern Jour, of Med.) Braithwaiie.

VAKIOUS 0PIXI0^-S EESPECTENG HO0PI>-G-COrGH.

Dr. Waller has tried belladonna in two cases of hooping-cou^h,
with the best results. He gave the extract in a twelfth of a grain
dose, three times a-day, to a child four years of age. In his cases
there was no indication of the presence of inflammation, but sim-
ply the spasmodic cough. Prussia acid and conium had tailed in
affbrdin^I any permanent or marked relief.

Mr. Crisp views the disease generally as inflammatory, or at least
congestive, and usually finds the antiphlogistic plan the best treat-
ment in the early stages. He has proved prussic acid of ser-
vice only for a day or two.

Dr. Willshire has treated simple uncomplicated hooping-cough
with two or three ipecacuanha emetics, one every alternate mornino^,
followed for two or three days with nauseating doses of antimony,
and has found this plan of great service in the early stages. Co-
nium and ipecacuanha were afterwards useful. He is atVaid to
employ belladonna, as some have found that it has a tendency to
increase vascular action in the brain, and to produce hydrocephalus.

Dr. Chowne lays particular stress on the necessity of keepinc^ the
patient in a warm temperature, and using every means to prevent
his catching cold. Nauseating doses of ipecacuanha were fre-
quently of benefit. He does not believe that emphysema could be
produced by hooping-cough.

5^ Effects of Conium Maculatum or Hemlock. [October,

Dr. Clutterbuck looks upon hooping-cough as a specific disease,
produced by a specific cause — an inflammation of the bronchial mem-
Israne of a specific character, apt to induce inflammation of other
organs, as of the lungs or head, and these complications constitute
the character of hooping cough. He has little confidence in any
remedy for this affection. The disease should be narrowly watch-
ed, with the view of prevention rather than of active treatment ;
if mild, it would terminate spontaneously ; if it tljreatened the
complications alluded to, decided antiphlogistic means were de-
manded.

Dr. Golding Bird regards hooping-cough in the first stage, as inva-
riably inflammation of the lining membrane of the bronchial tubes,
larynx and trachea, of a specific character, and implicating in some
peculiar manner, the par vagum. This inflammation lasted a definite
period, which was influenced by constitution, and other causes. In
the second stage of the affection, the disease was nervous, the speci-
fic irritation of the par vagum being kept up, altogether independent
of inflammation; or if this were present, it was accidental; the
hooping was afterwards protracted, by the influence of habit. In the
first stage, the remedies for bronchitis were advisable — such as
emetics, diaphoretics, the warm-bath, and a warm temperature.
When the inflammatory stage was passed, the object of the practi-
tioner was to subdue irritation in the par vagum, and this was efl^ected
by the agency of narcotics — such as conium, in conjunction with the
carbonate of potash, hemlock, and hydrocyanic acid. Embrocations
to the spine and chest were also useful. When bronchorrhcea be-
came troublesome, small doses of alum, with sedatives, were employ-
ed with advantage. When the bronchoorhoea had ceased, tonics
were indicated — the kind of tonic to be determined by the constitu-
tion of the patient. Emphysema does not, in his opinion, occur as
the consequence of hooping-cough.

Dr. T. Thompson has found, in some cases, where belladonna was
given, that the poisonous, rather than the curative effects of that
remedy developed themselves, even though the doses administered
were remarkably small. With reference to the irritation of the par
vagum in hooping-cough, he relates a case in which this nerve had
become exposed, from the formation of an abscess, or other cause ;
and it was remarkable, that when the nerve was in contact with air,
a spasmodic action resembling hooping-cough was produced ; when
the nerve was covered over by a cicatrix, the hooping-cough ceased..

{Lancet, and Braithwaite.)

Phiisiological Effects of Conium MacuJatum or Hemlock. — In the
July No. of the American Journal of the Medical Sciences, is an
Article entitled " Experiments to determine the Physiological eflTects
of Conium Maculatum, by Pliny Earle, M. D." Dr. E. is well and
favorably known to the profession and community, as Physician to

1845.] Effects of Coniiun Maciilaium or Hemlock, 599

the Bloomingdale Asylum for the Insane, located near New- York
city ; and he has contributed largely to the pages of the valuable
quarterly just mentioned. In the Article before us, he says:

"Theconium maculatnm, in the form of extract or inspissated
juice, is somewhat extensively used in general practice ; and, being
considered, as it unquestionably is, a narcotic, is not unfrequently
prescribed as a soporific. Having for several years been accustom-
ed to the free use of this preparation in the treatment of insanity,
without ever procuring sleep as its effect, even in doses gradually
raised to sixty, eighty and ninety grains, three times in the day, —
and having not long since heard an eminent physician, who prescribes
for his patients 'nearly a hundred dollars worth' annually, express a
doubt that this extract has 'any medicinal virtues whatever,' I deter-
mined to asceitain, by self experience, the nature of its immediate
effects upon the human system."

Having obtained a good preparation, he commenced his experi-
ments by taking on the 1st January last, 1 gr. coses three times a-day.
These were gradually increased every day, until he took the enor-
mous dose of 60 gis. three times daily. Indeed, of the English
preparation, he ventured to take 80, 90, and even 100 grs. at a dose —
^ i. e., in the course of some twelve or fifteen hours, he swallowed 270
grs, of Cicuta.

The effects were negative until he reached 25 grs. taken fasting,
when he " felt a disagreeable sensation, ' like the fulness of the head,'
occasioned by a ligature around the neck ; accompanied by a very
slight vertigo." The two subsequent doses on this day (the 15th)
were unattended by these effects. 30 grs. the next day produced
symptoms similar to those of yesterday ; 40, 45, 50 and 60 gr. doses
gave rise to sensations of fulness of the head, vertigo, dimness of
sight, dilated pupils, double vision, weariness and weakness in the
limbs, particularly in the knees; heat in the gastric region, 6cc. In
ten minutes after taking a dose of 60 grs., warmth in the stomach
was perceived ; in 15 minutes the cerebral symptoms commenced,
and in about half an hour the action of the medicine had reached its
maximum. In less than two hours, the apparent effects had entirely
disappeared. Throughout the experiments, the sleep seems to have
been natural, appetite good, and the pulse regular, perhaps a littlo
slower, but stronger and fuller. The effects, as might be expected>
were greater when tlie medicine was taken fasting.

600 Anti-gastralgic Pills — Dropsy — Cephalalgia^ ^c. [October,

' Anti-gastralgic Pills. — {Journal des Connaisances.) M. De Larue
asserts that, for the last six years persons laboring under truegastral-
gia, have generally found prompt relief from the use of pills made
according to the following formula :

Extract of Opium, 30 cent. (1^: gr.)

Sub-Sesqui-Carbonate of Iron, ... 60 "
Magnesia, ......... 120 "

Gum Syrup, q. s.
Make 24 or 43 pills, according to age, individual susceptibility, &c.
Give one two hours before breakfast, and another three hours after
the last repast in the evening. They should be administered alone,
or associated with other auxiliary remedies, and taken with or with-
out interruption, according to circumstances.

They accomplish a cure most commonly in a month or six weeks.

Treatment of Chronic Dropsy. By Dr. Kerxee. — Journal des
Connaissances. — The inhabitants of Weinsberg, no doubt in honor
to the name of their locality, are great drinkers, and are therefore
very frequently hydropic. When their anasarca does not depend
upon any organic visceral or vascular lesion. Dr. Kerner effects a
prompt cure by prescribing a decoction of

Digitalis Purpurea, 2 gram. (40 gr.)

Root of the Ononisspinosa, 4 "

Senega root, 6 "

The whole acidulated with the citrate of potassa. This diuretic
formula causes a rapid disappearance of the serous swelling of the
abdomen and feet.

Treatment of Nervous Cephalalgia. — ^lany different preparations
have been proposed to combat simple nervous head-ache ; and all
practitioners have had numerous occasions to regret the failure of
these different means. M. Scheneider, one of the most distinguished
physicians of Germany, recommends the administration, either in the
form of pill or potion, the alcoholic Extract of Aconite (aconitum
napellus) in doses of ^ to 1 gr. — {Gaz. des Hopitaux, Bulletin
Gen. de Therapeutique.)

Employment of Cochineal in the treatment of Hooping Cough. —
Durino- an epidemic of hooping cough which prevailed with measles
last winter in Berlin, Dr. Beunewitz says he had frequent occasions

1845.] Cases of Burn — Amputation of the Penis. 601

to satisfy himself of the therapeutic efficacy of cochineal in the first
of these diseases. Not only did the attack sensibly diminish in
force and frequency, but complete restoration was often effected in
at least fifteed days. After previously giving an emetic, Dr. B.
prescribes the medicine as follows :

a. Cochineal, 4 grammes (about 4 3.)

Salts of Tartar, 8 gram.

Boiling water 45 gram.

Simple Syrup, 30 gram.
Mix. Give this in forty-eight hours. The author says he did not
succeed by this preparation in the treatment of the cough complica-
ted with the measles. — (Casper^s Hochensclirift^ et Journal de Med,,
1843. Bulletin Gen, de Therapeutique.)

Treatment in Cases of Burn. — Dr. Wm. Jones, of Lutterworth,
has sent to us for publication, the following fact : — About twentyfivo
years since I was called to a young lady who was dreadfully burnt
on the thighs and abdomen. It appeared to us a hopeless case. It
immediately struck me that the administration of a very strong opiate
afforded the only shadow of a chance for the patient. That, there-
fore, I immediately gave her. A tranquil sleep resulted. When its
effects went off I repeated it, and I was quite surprised not only to
see how little she suffered, but how kindly the burnt parts cicatrized
and healed. I have always used it with great advantage. — Lancet,

This treatment has been successful in the hands of others. — Edts.

On Amputation of the Penis. By Robert Barxes, M. D. — M.
Ricord's proceeding is this : — having performed the amputation, with
the precaution of preserving sufficient skin, and no more, to sheathe the
corpora cavernosa, and secured the vessels, the surgeon seizes with
the forceps the mucous membrane of the urethra, and with a pair of
scissors makes four slight incisions, so as to form four equal flaps ;
then using a fine needle, carrying a silk ligature, he unites each flap
to the skin by a suture. The wound unites by the first intention ;
adhesion being formed between the skin and mucous membrane,
which become continuous, a condition analogous to what is observed
at the other natural outlets of the body. The cicatrix then contrac-
ting, instead of operating prejudicially, as in the old methods, tends,
on the contrary, constantly to open the urethra, whilst a perfect
coveringis provided for the ends of the corpora cavernosa. In the
spring of 1843, I had the satisfaction of seeing this ingenious opera-
tion performed by M. Ricord, at the liopital du Midi ; when I saw
the patient, eight days afterwards, the sutures had been removed,

602 Excision of Urethra — Ulcers on the Cornea. [October,

union had taken place between the skin and mucous membrane, and
the urine had freely passed without the intervention of a catheter.
I saw this patient again when he was about to leave the hospital, at
which time the cicatrix was complete, the orifice of the urethra patent ;
there was an excellent stump, and, in short, the operation appeared
to be perfectly successful. M. Ricord has performed the operation in
other cases, and, he reports, with the same happy resultc. I have
performed the operation many times on the subject, and have found
no difficulty in the execution of it.

Another inconvenience mentioned by Mr. Hancock, the difficulty
of directing the stream of urine, is one which becomes troublesome in
proportion to the shortness of the stump. It may be obviated by the
contrivance recommended by Ambrose Pare. The patient must pro-
vide himself with a funnel-shaped canula, made of box, ivory, or
metal, the base of which, being applied over the stump, and resting
on the pubes, the other end will serve to carry the urine clear of the
person. — London Lancet.

Excision of the Urethra performed successfully in a wowan.
By Prof. RiBERi. — Archives General es.

In this case there vyas a cancerous tumour developed in the walls
and existing in the cavity of the urethra in a woman of 60 years of
age — the tumour projected towards the vagina, whose orifice it
diminished; it caused almost continual pains and great difficulty in
urination.

M. Riberi made an antero-posterior incision on each side of the
urethra, in the vagina ; then he dissected on each side of it so as to
leave the tumour adherent only by the neck of the bladder. Having
reached this point of the operation, he cut circularly in front of the
neck of the bladder, and thus removed the tumour. Finally, a sound
was introduced into the bladder, through the very small portion of
the urethra which remained, and the haemorrhage was arrested by a
tampon. The patient was cured, and what is important, without
incontinence of urine.

The author believes that this operation is unique in the science,
and gives a more advantageous process in case it should again
become necessary. This process consists in placing the sound in
the bladder, before the excision is made, and in slitting the urethra
upon that instrument, in order to be enabled to remove the tumour
with greater facility.

Treatment of Ulcers on the Cornea hy occlusion of the eye. —
M. H. Lasrey, Professor at theVal-de-Grace Hospital, speaks high-

1 845.] Camphor to a Blister — Bile — Secale Comutum. 603

ly of a mode of treatment he has adopted for ulcers on the cornea.
He places on the eye a little wad of cotton maintained by adhesive
strips and a bandage. At the end of ten or twelve days, the con-
junctivitis which accompanied the ulcer is found to have disappeared,
and the latter h&s cicatrized or been very much reduced in size.

{Gazette des Hopitaux. Bulletin Gen. de Therapeutique.)

To apply Camphor to a Blister. — This is often recommended to
prevent strangury. To obviate the difficulty in powdering the cam-
phor sufficiently fine, we see in the 28th vol. of the Bulletin General
de Therapeutique, M. Vei proposes a saturated solution of this arti-
cle in ether. Spreading this on an oily or greasy rag, the camphor
is deposited by evaporation.

Test for Bile^ by M. Pattexkoffer {Lancet, Oct., 1844). — Add
to the fluid supposed to contain bile, concentrated sulphuric acid
until it becomes hot, and then drop into it a solution of sugar ; the
presence of the bile is manifested by the mixture becoming of a deep
pink, or red color, varying in intensity.

Secale Cornutiim, its therapeutic action — by M. Payax. Gazette
Medicale de Paris, June, 1845. — Since Dr. Olivier-Prescot introdu-
ced secale cornutum into therapeutics, numerous researches have
been made upon it. For a long time it was regarded only as an ex-
citant of uterine contractility, and even this specific property has
been sometimes denied. At the present time it seems to be admit-
ted that the secale cornutum acts not only upon the uterus, but also
upon the rectum, the bladder and the inferior extremities, whenever
these parts are in an asthenic condition. Its therapeutic effect being
thus complex, we are compelled to refer its action to some organ
which has the power of acting at once upon all these parts. Accord-
ing to M. Payan, the spinal marrow is the organ primarily affected
by the action of the secale cornutum, and this opinion of the direct
influence of this article upon the spinal marrow is supported by very
ingenious reasoning, and what is better, by very interesting cases.
These cases place beyond doubt the efficacy of this medicine in in-
complete paralysis of the bladder, rectum and inferior extremities ;
and in all these cases, according to the author, the excitation is
transmitted bv means of the nerves which have their origin in the
medulla spinalis or of the plexuses which emanate from it.

604 Amenorrhcea — Suicides — New Medical Journals, [October,

Treatment of Amenorrhcea. — Dr. Chaumet, of Bordeaux, pre-
scribes the following enmanagogue pill, which many times has pro-
duced the happiest effects :

R. Ext of Gentian, .... gr. V. ^

Aloes, } . . , < Mix.

Calomel J • • • • «« gr. 1 ^

Take a pill thus made morning and evening. To aid the purgative
effect of these pills, apply mustard and hot water to the feet, and dry
cupping to the hypogastrium, and internal parts of the thighs. — {Bul-
letin de VAcad. de Med. Bulletin Gen. de Therapeuiique.)

Return of Suicides in France, during the year 1843. — According
to the official returns made for 1843, there were 3,020 suicides in
France that year. The Department of the Seine, of which Paris is
the capital, furnished 551, or nearly a fifth of the whole number.
Submersion or drowning was the mode generally resorted to — 1096
individuals had recourse to this means — 954 to strangulation or hang-
ing— 450 to fire arms — 206 to asphyxia by charcoal. A fourth of
the suicides did not possess the intellectual faculties entire. Among
the number were 729 females, nearly a fourth — 15 were under six-
teen years old, 20 octogenarians, 170 septuaginarians, and 384 sexa-
genarians.— {Bulletin General de Therapeuiique.)

MEDICAL INTELLIGENCE.

New Medical Journals, — We have received the first four numbers of the
Missouri Medical and Surgical Jmirnal, a new periodical, which is published in
St. Louis, under the editorial management of R. T. Stephens, M. D. These
numbers give evidence of a degree of enterprise and professional ability highly
creditable to our brethren in the far We^t. The Journal is published in month-
ly numbers, each containing 24 pages. Price two dollars per annum.

We have also received the four numbers of The Buffalo Medical Jmirnal, a
monthly periodical of 24 pages, published in Buffalo, N. Y., and edited by Austin
Flint, M. D. The original department contains a number of useful articles,
and affords proof that there is in that section "sufficient material to commence
an enterprise of this kind." Although, from the location of Buffalo, this Journal
will come into close competition with some of the older, and established medical
periodicals, the field is large enough for many laborers, and we doubt not the
ability of the phj'sicians of Western New- York, to perform their part, in the
cultivation, of the Medical Sciences — and establish a Journal of high character.

1845.] Necrology — FortunCf ^i-c. — New Instrument, 605

Our valued cotemporary, the Nao Orleans Medical Journal, comes to us with
a new name — The Louisiana Medical and Surgical Journal, and with the addi-
tion of Profs. Harrison and Carpenter to the Editorial department. These
changes have resulted from a union of the New Orleans Medical Journal, with
a projected work, under the direction of the Professors just named. We doubt
not that this union will prove highly advantageous, as it will enlist the whole
profession in that section in its support. The ability with which this Journal
has been heretofore conducted, and the valuable accession to its Editorial de-
partment, which it has just received, will most certainly secure for it an exten-
sive patronage. We most cordially wish it success. The work is published
every other month, in numbers containing 144 octavo pages, — at five dollars per
annum, payable in advance.

Necrology. — The death of M. Breschet, one of the Professors in the Faculty
of Medicine at Paris, &c., &c., is announced in the French Journals as having
taken place on the Uth of last May, He was one of the most industrious and
honorable of the Surgeons in the French Capital.

The fortune let> by the late Dr. Abercrombie of Edinburg, was SoO,000 to each
of his seven daughters, besides a considerable sum to the free Church of Scotland,
of which he was an Elder. His family presented his library, consisting of
10,000 volumes, to the Roval Collesre of Surgreons of Edinburg.

Ax IXSTRUMEXT DESIGXED FOR THE PERMANEXT CURE OF HeRXIA, HyDARTHRO-
SIS, H'i'DROCELE, GoiTRE, ExCYSTED TUMORS, AXD TO DEPOSIT MEDICIXES IX THE

TISSUES OF THE BODY. — From the favorable opinion expressed by a few friends
in regard to the Instrument, a cut of which may be seen on the opposite page, I
am induced to offer it with a few remarks to the profession.

It is known that for the past eight or ten years, considerable attention has been
bestowed on the subject of hernia. That the interest is not yet exhausted, and
the matter still subjudicc, may be seen by the following question proposed for the
Boylston medical prize for 1847 — "Is there any safe and certain operation for
accomplishing the cm^e of common reducible inguinal hernia 7"

The recent investigations upon this subject have resulted, I believe, in the
pretty general adoption of some modification of the Truss, first proposed by
Stagner, (Chase's or Landis's for instance,) and the rejection of any operation
for the permanent cure of hernia. The dread of peritonial inflammation, the
occasional success ot the Truss, and the affection being considered simply an
inconvenience, have induced great caution in the adoption of an operation not
absolutely required. While a properly adapted apparatus is the correct treat-
ment for rupture in children, and sometimes relieves the adult, still we can with
no certaint)^ promise a cure by it in the latter. To effect this we must resort to
other means.

That even reducible hernia is something more than an inconvenience to pa-
tients, and that the Truss is but a palliative treatment, the many suggestions
made, and operations proposed within the few past years, sufficiently attest.
Some of these are, (Belmas.) by bladders of gold-beater's skin, sticks of gelatin,
&c., deposited in the sac; (Gerdy.) by invaginating the skin and stitching il

606

New InsirumenU

[October,

P5
<

a
w

o
o

;z:

^ ^

^ i5

— CO ^

^ ^ > b

J3 O ^ ''^

S g o '-'

o ^ o

O H ^

1845.] New Instrument. 607

about the neck of the hernial sac ; (Guerin and Velpeau,) by subcutaneous in-
cisions and scarifications of the neck of the sac; (Bonnet,) with pins and rolls
of linen; (Jameson,) by incision and intrusion of a piece of integument into
the ring and retaining it by sutures; (Stith,) incision and insertion into the sac
of a piece of kid or buck skin softened in mucilage ; (Pancoast,) by trocar and
injected fluid. Of these means, that by injection, from the uniform success ex-
perienced by it in hydrocele, would seem to merit most favor — the objection to-
the operation being the want of a suitable instrument, for Prof. Pancoast used a;
trocar, canula and syringe.

Having been recently consulted by a physician, who had been under the pro-
fessional care of Professors Dudley and Geddings, and who was read)*, as he
stated, to submit to any operation, I had concluded to propose to him incision of
the sac. A few days after this, Dr. Wozencraft, of Nashville, Tenn., called,
and exhibited a small syringe, invented and patented for the cure of hernia, by
a Dr. Ja)'nes, formerly of Virginia, but now of Missouri. This instrument is^
simply the upper part of a common silver pencil case, having a piston adapted
to one end, and the other terminated in a gold pointed canula. An eye or
opening near the point, allows the fluid to be injected into the sac after the her-
nia is reduced. Dr. W. prefers oil of cloves, from three to six drops is the
quantity generally introduced, and he says that though hundreds of cases have
been operated upon by the inventor and his agents, still no unpleasant conse-
(juences have followed. The operation requires repetition in some instances,
and he also acknowledges that the spermatic cord has been punctured. His
case operated on here, is doing well, and promises success ; and so is the one
upon which I have operated.

As a substitute for the patented Instrument, the one represented by the cut is
suggested, and it may have some advantages over it.

1st. Not being patented, it may be used by every ph5'sician.

2d. The point being moveable, there will be no danger of wounding other
parts, in ascertaining when the canula is in the hernial sac.

3d. The S}Tinge being of glass, the action of the piston upon fluids, either in
injecting or withdrawing them, can be seen.

4th. It may be employed as an exploring needle, to ascertain the contents of
tumors, &c.

5th. The canula opens at the extremity and not at the side of the instrument.

6th. In its application to various affections. In h)-drocele, for example, a
puncture having failed to cure the patient, as soon as a re-accumulation com-
mences, half-a-drachm of tinct. iodine may be injected. I believe the very last
suggestion for this affection, was to pencil the timica vaginals through the canula
of a trocar with this article.

Operation v:ith the Instrument. — Fill the s}-ringe with the injecting fluid, by
withdramng the piston. Project the point of the steel stilet beyond the gold
canula, and fix it by the thumb-screw in the handle, or ring of the piston.
Place the patient in the horizontal position, reduce the hernia for instance, then
with the fore-finger of the left hand invaginate the skin of the scrotum and
spermatic cord into the abdominal canal. The instrument held as a writing
pen, in the right hand, is introduced from above downwards upon the tip of the
left fore-finger. The stilet is now withdrawn, the canula ascertained to be in

608

Meteorological Table* — Errata'

the sac, and the pistoi^ushed home into the syringe. A Truss ought previously
to be well fitted to the internal ring. The patient should be confined for a day or
two, and the Truss unremittingly worn for a month. The fluid I should select
is diluted tinct. iodine, and the quantity, which of course must vary, about 3ss.

The new principle,4jf indeed it be novel, is simply the union of the syringe
and trocar in the above described instrument.

Since the above was devised. Dr. A. L. Hammond of this city, one of our
recent graduates, has' suggested the addition of a spiral spring to the stilet, by
which after the introduction of the canula, it is withdrawn, and the piston at
once pushed down in the syringe. Paul F. Eve.

METEOROLOGICAL OBSERVATIONS, for August, 1845, at Augusta, Ga.
Latitude 33° 27' north — Longitude 4° 32' west Wash. Altitude above tide
152 feet.

>
c
a

Thermometer.
Sunrise. 4, p. m.

Barometer.
Sun rise. 4, p. m.

Wind.

Remarks.

29 74-100

29 80-100

S. E.

Variable— rain at 10, p. m.

" 88-100

" 87-100

N. E.

Cloudy. [sprinkle to-day.

'« 85-100

" 80-100

Cloudy-^rain last night-

" 85-100

Cloud)-— sprinkle.

" 79-100

'■' 79-100

Cloudy— sprinkle.

" 79-100

N. W.

Fair.

" 80-100

S. E.

Fair— breeze.

" 82-100

S. E.

Fair, do.

" 82-100

S. E.

Variable — a few drops rain.

" 82-100

" 75-100

Fair— Blow at night.

" 70-100

" 62-100

Cloudy— blow at 4, p. m.

" 64-100

" 68-100

Cloudy.

" 78-100

" 74-100

S. E.

Showery.

" 80-100

" 76-100

Fair.

" 76-100

" 70-100

s, w.

Fair.

" 76-100

" 73-100

Fair— breeze.

« 76-100

" 70-100

Cloudy— thund. & light.

" 74-100

" 68-100

Fair— breeze.

" 77-100

" 67-100

N.W.

Fair — breeze.

" 68-100

" 06-100

Light .shower.

" 66-100

" 62-100

S. W.

Shower.

" 68-100

" 67-100

N. E.&S.

Fair.

" 78-100

" -100

S. W.

Showery— thund. & light.

" 81-100

'' 78-100

W. & E.

Fair— thunder & lightning.

72'

" 81-100

" 75-100

S. E.

Rain— th. & light, at 3, p. m.

" 83-100

" 75-100

Do. do.

" 75-100

" 73-100

Cloud}- — light shower.

" 79-100

" 73-100

S. W.

Do. " do. do. [to-day.
Cl'v — rain last night — sprk.

" 81-100

'' 80-100

S, E.

" 80-100

" 74-100

•S.E.

Cldudy— sprinkle.

" 75-100

Fair.

12 Fair days. Cluantity of Rain, 3 inches and 4^-10

ERRATA — Notwithstanding all our care,several errors, we regret, have been detected
in the 1st Article of this No.

On page 550, 14th line from top, read equable for acrreeablc

" "• 551, 9lh " " hottoTT, read nmtsiwl for annual.

" " 553, ."^rd " " bottom, i-ead 1S24 for 1844.

" " 555, lOth " " top, read casex for causes.

" " 560, 4th and 5th line?, put period after the word diei— change semi-colon to
comma, after the word aid, and efface the word and before rarely.

On page 567, read procvmhens for punctatum.

We are responsible for the translation of the Greek and German of this Article.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. L] NEW SERIES— NOVEMBER, 1815. [No. 11.

PART I.— ORIGINAL COMMUNICATIONS.

ARTICLE I.

Case of Tetanus^ continuing tJiirfy-four d ay S'^— Recovery. — With
Remarks, By J. P. Stevens, M. J)., of Liberty County^ Ga,

On the 6th April, I was called to see Fanny, a negro girl, about
eight years of age, who, for about twelve hours previous to my visit,
had been suffering from slight paroxysmal attacks of pain, and con-
traction of the muscles of her abdomen and back. Her eyes were
natural and bright; respiration easy ; no fever; tongue a little red
at the edges, with a whitish fur in the centre ; slight pain in her
bowels, and a moderate contraction of the dorsal muscles ; bowels
torpid.

Prescription. — Apply sinapisms to her extremities, and to the
whole length of her spine; §ii castor oil.

April 7th. Fanny's condition this morning is evidently worse in
every respect. The muscles of her back are rigidly and permanent-
ly contracted, causing her body to assume a semilunar form ; deglu-
tition is almost impossible ; at intervals of fifteen minutes there is
forcible contraction of all the muscles of her body ; the angles of
her mouth are violently retracted, causing that peculiar aspect of
countenance indicated by the term risus eardonicus ; her teeth are
firmly set ; the muscles of her abdomen are as hard and resisting as
a hoard, and her extremities are firmly flexed. When interrogated
with regard to pffin, she refers us to the umbilical and epigastric
regions. This state of things continues for about a minute or two,

610 Case of Tetanus, [November,

when there is comimrative relaxation of the muscles concerned in
deglution, as well as those of the abdomen and extremities. Daring
the paroxysms, a profuse perspiration bathes the cutaneous surface.
Oil operated twice ; skin of natural temperature ; pulse 90 ; respi-
ration 30. — Pres» Tinct. camphor, tinct. opii., aa 20 gtt.

4, P. M. No change.

R. Calomel, 1

Nitr. potass, aa 20 grs. ^ M.
Opium, 2 " )

Divide into two parts, and give at an interval of two hours. Epispas-
tic three inches wide, to be applied from the occiput to the sacrum.

April 8th. Powders operated copiously, bringing away one large
lumbricus; blister drew well. — Pres. Tinct. camphor, 5i. ; tinct,
opii. 5ss. In the afternoon, 10 grs. calomel ; and 25 gtt. laudanum,
to be taken at night.

April 9th. No change in symptoms; bowels moved with assist-
ance of an enema. — Pres. Turpentine enemata, at intervals of two
hours ; sponge the body with hot brandy and vinegar.

April 10th. Bowels evacuated of a very black offensive matter;
blister upon the spine still continues sore ; spasms recur much less
frequently. — Pres. r'x. castor oil, sinnpisms to extremities ; 10 grs.
Dcver's powder, morning, noon, and evening.

April 11. Slept well during the whole night, spasmodic pains
recur but seldom ; skin moist ; pulse 108 ; thirst moderate ; abdo-
men soft, but bowels not moved by oil ; lying upon her hack. —
Pres, Castor oil, §i. ; oilterebin. 5ss. Mustard poultice to abdomen.

April 12th. From this time, her master. Dr. Jos. Le Conte,
visited her regularly with me. Since last report, Fanny has passed
three worms.

There is st'iW co?isf ant rigidity of tne dorsafi muscles, and general
spasms occur four or five times during the morning, which are pro-
voked by the slightest foiicJi or menial emotion. — Pres, Decoction
spigalia ; blister to thighs.

April 13. Rigidity of muscles of lower jaw so great as to preclude
the admission of any liquid. Spasms more frequent ; pulse 108 ;
skin natural. — Pres. Tinct. opii. 5i. ; frictions over the spine with
turpentine and tinct. cantharides ; 10 grs. calomel, to be divided
into two parts — take them at an interval of two hours.

April 14. Bowels moved three times ; the first very dark and
offensive ; voided two worms. Spasms frequent, but of transient
duration.

1845.] Case of Tetanus, 611

April 15th. Countenance much better; indications more favora-
ble.— Pres. 5ss. turpentine, ^i castor oil ; re-apply blister to spine.

As it is unnecessary for me to continue a narration of the symp-
toms and treatment of this protracted case, I will only remark, that
anthelmintics, derivatives to the spine, and opiates, were continued
with very decided advanta^^e. Five worms were brought away
simultaneously, soon after which, her countenance assumed a calm
and natural aspect ; all the secretory functions of the economy were
discharged normally ; the respiration and circulation perfectly natu-
ral, but spasmodic movements of the abdominal, dorsal, and the
muscles employed in dio;lution, recurred at regular intervals, the
attacks of each succeeding day diminishing in force and frequency,
until they finally ceased entirely.

During the last two or three days of our visits, we prescribed
36 grs. sulp. quinine, divided into six parts, one of which was ad-
ministered every fourth hour, but we did not observe any very marked
benefit to follow its employment. The warm bath, which is always
a valuable adjuvant in spasmodic diseases, could not be employed,
save in the recumbent posture ; and as the facilities for making use
of such remedies are rather meagre upon a j)JantaHon, we were com-
pelled to defer its trial until the patient could tolerate the erect
posture.

On the 10th May, I see noted, that " Fanny is this morning sitting
up alone ; muscular contractions have ceased, with the exception of
occasional twitches during the day." She is at this date, Aug 15th,
perfectly well.

Remarks. — There is perhaps no disease to which the human
frame is subjected more to be dreaded, not only from the excrutiating
agony which is endured by its victims, but the almost certain fatali-
ty which marks the progress of tetanus. It heeds not the tenderest
sympathies of our nature, and has persisted invincible against the
united power of the most gigantic intellects, from the time of Hippo-
crates, down to the present day. Another feature which mantles it
with horror, is the extremely trivial nature of the cause which often
induces its attacks. Lacerated and punctured wounds, principally
of the extremities, of tendons and ligaments, may be classed amom^
the m(jst ordinary causes of the disease. " Tetanus has been
occasioned by a bite on the finger from a tame sparrow, the
siroko of a whip-la^h under the eye, although the skin was not

612 Case cf Tetanus. [November,

broken, a fish bone sticking in the pharynx, a seton in the chest, the
stroke of a cane on the neck and hand, flagellation, extraction of
a tooth, Clipping and venesection, <k;c., &;c. It has also followed
severe fractures, lacerations, contusions, punctures, amputations,
excision of the mamma, tying arteries, gunshot wounds, castration,
injection for hydrocele, (fee, &;c. — (J. H. Bennet. Tweedie's Li-
hrary of Pract. Medicine, p. 71.)

The case which we have just reported, was doubtless occasioned
by the irritation of worms in the alimentary canal. Although, during
the whole course of the disease, there were but eleven worms dis-
charged, still at every evacuation of these troublesome parasites, a
manifest improvement in the general symptoms supervened. Many
writers regard worms as almost the only cause of tetanus. How
often it is, that almost incredihle numbers of them have been voided
without previously having excited little or any constitutional disturb-
ance. I was informed, not long since, of an instance which occur-
red in this county, where a little negro passed, per rectum, upwards
of seven hundred worms, in {\^q course of two days, without having
suffered any inconvenience, with the exception of a moderate pain in
the bowels ! Any irritating substances in the stomach and intestines,
such as indigestible articles of diet, indurated fasces, &;c., are not
unfrcquently exciting causes of tetanus. I recollect in the practice
of Dr. B. B. King, six years since, of having seen a case terminate
fatally, from intussusception. The subject was a negro boy, about
9 years of age, who was attacked in the morning while pursuing his
usual routine of labor ; and notwithstanding a most energetic and
judicious course of treatment was vigorously pursued, he died in the
course of twenty-four hours. Constipation of the bowels was an
insuperable obstacle in the management of his case, and upon post-
mortem examination, the doctor discovered an intussusception of
about three inches of the ileum. There Mas no wound or external
injury discovered upon any part of the body, save a superficial abra-
sion of the cuticle, of about three lines in length, which did not, at
that time, or previously, excite any attention.

Vicissitudes of temperature are among the most common causes
of the idiopathic form of this disease. Sudden alternations from heat
to cold, exposure to rapid currents of air, while in a perspiration,
have induced its attacks. A ^e\Y weeks since, a gentleman informed
m\\ that his father lost a negro woman who had aborted in about
the sixth monlh of her pregnancy, and was doing very well, v/hen

1845.] Case of Tetanus. 613

" she took cold," a tetanus supervened. The first case of tetanus
which Dr. Dunglison ever observed, was caused by a suppression of
perspiration. "A young man, when in a profuse perspiration, went
into a river to bathe. He was immediately struck with tetanus,
from which, however, he recovered." — (Dunglison^s Pract. Physic^
vol. 2, p. 329.) Dr. Chalmers gives an instance, where it was
brought on by sudden change of weather, in a man who slept without
his night-cap.

A high degree of temperature is said to predispose to this disease ;
hence the extreme liability of the system to its attacks, when a very
hot season is followed by much cold and wet weather. " Thus it is
stated, that after the battle of Muskow, in the midst of great heats,
very few of the French troops were attacked with tetanus : vvhereas,
those who were wounded in the battle of Dresden, when the weather
was cold and wet, just after a very hot season, were decimated by
that complaint." — (Watson's Pract. of Physic, p. 311.) I think
we may venture the opinion, that negroes are much more liable to
this complaint than whites. This fact may, in a measure, be attribu-
ted to the frequent exposures to which they are subjected, not only
to changes in the weather, but irregularities in diet, and bodily
wounds which are accidentally received.

The j^athology of tetanus is involved in some obscurity, although,
from searching into the results of the post-mortem observations of
others, I am inclined to the belief, that the spinal marrow and its
afferent nerves may be regarded as the seat of this disease. Inflam-
maiion of the spinal chord, and its nerves, is not discovered in every
case, but the phenomena observed during life, refer to derangement
of the excito-moiory division of the nervous system. The intellect
is unclouded during the whole progress of this malady. Conscious-
ness of danger, and a perfect knowledge of surrounding objects and
circumstances, render the condition of the patient peculiarly deplora-
ble. He feels the omnipotent grasp of the monster, and is fully
aware of his almost inevitable dissolution.

Dr. Marshall Hall, in his work upon the nerves, p. 57, declares his
belief, that the whole order of spasmodic and convulsive diseases be-
longs to this, the true spinal, or excito-motory division of the nervous
system, and that they cannot be understood without a previous accu-
rate knowledge of this system. His experiments, showing the inde-
pendent action of the spinal marrow and its nerves, in the production
of certain phenomena, are highly interesting. After decapitation,

614 Case of Tetanus, [November,

and otherwise removing the influence of the brain, certain muscular
movements were provoked by the application of appropriate irritants,
which he found impossible to accomplish, when the spinal medulla
was destroyed. Upon severing the head of a turtle, and exposing
the spina! nerves, and pinching one of them with the forceps, violent
contraction of the muscles ensued, not only of the parts supplied by
the irritated nerves, but of those situated above and below this point
of junction with the chord. — He proposes to divide tetanus into cen-
tric and eccentric. When the irritating cause affects the parts within
the spinal canal, he denominates it centric ; a punctured nerve,
lacerated wound, or other injury, produces eccentric tetanus. When
we observe the spinal marrow inflamed, with the co-existence of
tetanic spasms, we refer the phenomena to centric irritation ; when
intestinal irritation, and injuries of any kind, are tbUowed by spasmo-
dic contractions, even though upon post-mortem examination no
decided evidence of pre'existing wjlammalion can be discovered, we
fairly ascribe the symptoms to eccentric irritation.

Dr. Gerhard declares, that he has examined "the brain and spinal
^narrov/ of tenor twelve subjects dead of tetanus, and could not dis-
cover any traces of organic lesion ; no softening of the spine, or
inflammatory congestion, beyond what is discovered in bodies where
no spinal symptoms evinced themselves before death." But admit-
ting^ the accuracy of his observations does not disprove the previous
existence of a high grade of irritation. How often do post-mortem
researches reveal the entire absence of any morbid lesion of structure,
where, during the life of the patient, we were certain of a high de-
gree of abnormal action. But let us refer to the testimony of others.
" The spinal chord usually evinces manifest congestion, both in itself
and its membranes ; more especially at {\\q origin of the nerves, and
the amount of the serum is preternaturally and considerably increas-
ed. In the traumatic form, it is in the nerves of the part that inflam-
matory change is to be locjked for — not in the spinal chord ; for
the disease is to be regarded as an extreme example of irritation in
the whole spinal system, induced by inflammatory products in some
portion of its sy^iem.— {Miller's Principles of Surgery, p. 474.)
Alterations in the spinal chord and its membranes, are by far the
most common appearances found in tetanus, and in such caSes there
have generally been traces of spinal meningitis. These instances
are too numerous to be spoken of individually. Several have been re-
corded by Reid, Kennedy, Brayue, and others, in Britain ; Larrey,

1345.] Case of Tetanus. 615

Broussais, Magendie, Recamier, Ollivier, and others, in France;
Bergamaschi, Brera, Bellingeri, Uralli, Poggi, in Itally ; and Frank,
Funk, &c., in Germany. In some cases, the inflammatory appear-
ances were more or less diffused over the spinal chord ; and in others,
recorded by Ollivier, Pclletier and Curling, they were limited to par-
ticular portions of it. — (J. II. Bennet.) Tetanus is evidently depen-
dent upon a state of undue excitability of the whole spinal system,
and this may be produced by different causes. That which is terra-
ed the idiopathic form of the disease, has its origin in the centres ;
it may result in man from the operation of various predisposing and
exciting causes, and may be produced in animals by the operation of
strychnine. — (Carpenter's Human Physiology^ p. 217.) In an in-
teresting case of tetanus, given by Dr. Reid, in the Transactions of
the Association of Physicians in Ireland, vol. 1, p. 113, great vascu-
larity, and an effusion of blood, were found around the spinal mar-
row. In another case, detailed by Mr. Brayne, of Banbury, in the
London Medical Repository, vol. 14, p. 1, two or three inches of the
inferior dorsal portion of the spinal marrow were suffused by a con-
tinuous blush of inflammation, and three small, white, hard laminae
were seen between the aracnoid and pia mater. — (Hall, on the Nerves^
p. 214.) * Here then we have the evidence of some of the most dis-
tinguished pathologists and physiologists ia confirmation of the
pathological views which we entertain. If they be correct, the
indications of treatment are obvious. It was the opinion of Hippo-
crates, that tetanus supervening upon a wound is mortal, and statis-
tical records of the present day lead us to infer, that the number of
those who die from its attacks is incomparably greater than those
who survive. Of two hundred cases of tetanus which came under the
observation of Dr. O'Beirne, not one recovered. Sir J. McGregor
saw several hundred cases, and but very few recoveries. Sir G.
Blane mentions that three out of twenty recovered that occurred in
the West Indies, after the battle of April, 1782. Of thirteen cases
witnessed by Mr. Dickinson, Surgeon at Grenada, four were cured.
(J. H. Bennet.)

In, prescribing the treatment, it is unnecessary to notice the
effects of every remedy which has been employed by physicians,
but merely to refer to those which seem to be most imperiously de-
manded. In conformity with the benevolent principle inculcated by-
Prof. Ford, that the mitigation of pam, is the first consideration
which ought to engage the attention of the practitioner, the differ-

616 Case of Tetanus, [November,

ent preparations of opium may be considered as indispensable
adjuvants. But, I apprehend, that injury has been incurred rather
than benefit, from the inordinately large quantities of opium which
have often been forced into the stomachs of patients. It is affirmed,
that Mr. Abernethy found thirty drachms of undissolved opium in
the stomach of a man who died of tetanus; and that four pounds, *
seven ounces, and six drachms of laudanum, and six ounces, four
drachms and forty-five grains of solid opiurn^ were administered to a
patient in ten days. Such a course of treatment may in a measure
account for that degree of constipation of the bowels which is so
often deplored, ^yhen called to a case of tetanus, we should exam-
ine first into its cause. If the symptoms be dependent upon centric
irritation, induced by a sudden check of perspiration, sudorifics
should be perseveringly employed. Much vascular excitement should
be met with general and local blood-letting, more especially, if there
be evidence of spinal engorgement. Blood should be ^ abstracted
from the arm until an impression be made upon the pulse, to be
succeeded by the abstraction of twelve ounces from the spine, if
practicable, hy cupping; if not, by leeches. We are told that in one
case which recovered, M. Lisfranc bled 8 times, and applied 792
leeches to the spine. Sixty gtt. of laudanum every hour, to be gradu-
ally increased in quantity, until some appreciable influence is exerted
upon the system, will tend to assuage the agonizing pains of the suf-
ferer. Calomel, in combination with opium, given in sufficiently
large quantities to purge freely, may act beneficially, not only by-
dislodging any irritating substances, in the form of vitiated secre-
tions, or accumulation of worms, but by its revulsive influence. A
vesicatory three inches wide, extending from the occiput to the
sacrum, should be applied immediately after the acute symptoms
have subsided in a measure, and repeated sufficiently often to keep
up a sufficient irritation. The warm bath should not by any means
be forgotten, for its effects are sometimes astonishing in relaxing the
cutaneous emunctories, and overcoming spasmodic rigidity. Should
eccentric tetanus be caused by the presence of worms in the intes-
tines, §i. turpentine, and the same quantity of castor oil, should be
given at once, to be repeated in two hours, if necessary, and assisted
by enemata. In case of the failure of this prescription, two drops of
croton oil, with one drachm of turpentine, will generally prove effect-
ual. We are amazed at the great quantities of drastric purgatives
which are sometimes endured by the constitution. "Dr. Briggshas

1845.] Case of Tetanus. 617

recorded an almost incredible case {Edin. Med. and Surg. Journ.., ▼ol.
5, p. 141,) in which, in forty-eight hours, the patient took 210 grains
scammony, 89 grains gamboge, one ounce and four scruples of jalap,
two pounds and a half of infusion of sena, and 8 grains of calomel,
with decided benefit !" The nature of the wound in traumatic
tet;yus, should be carefully observed. If a foreign substance exists,
it should be immediately removed. It is frequently necessary in
cases of punctured an<H|acerated wounds, to dilate the orifice by
deep crucial incisions, for the purpose of encouraging haemorrhage
from the part, and relieving the excessively pair^ul distension.
Complete section of a partially divided nerve has been practiced by
some, but with little success. With regard to amputation of the
wounded limb, I am impressed with the conviction, that when teta-
nic symptoms have fairly supervened, the records of surgery will
scarcely warrant such cruel interference. The disease having fairly
commenced, is very rarely influenced by any local treatment to the
otTending part. "Tetanus is one of those diseases which renders
null the axiom" — ' suhJata causa, iolliiur effecius.' " It would be as
vain to hope to cure rabies by amputating the bitten finger ; consti-
tutional cancer, or syphilis, by removing the local disease, as to ex-
pect to cure tetanus, after it had set in, by removing the limb." —
(Dupuytren's Surgery, p. 548.) It becomes a constitutional disorder,
and our remedies must be directed accordingly. The use of mercury
carried to salivation has been extolled by many, as possessing pecu-
liar charms in controlling this disease.

Should deglutition be impossible ill the use of medicines, we must
inject large quantities into the rectum, and employ inunction upon a
Yesicated surface.

It would require a volume to enter into a narrative of the effects
produced by the different powders, pills and tinctures, which have
been employed by different medical men. Suffice it to say,
that antimony, prussic acid, tobacco, brandy, musk, quinine, phospho-
rus, electricity, strychnine, ether, stramonium, coichicum, the prepa-
rations of iron, digitalis, &c., have been employed to an unlimited
extent, and neither one, nor all combined, have exerted any very re-
markable curative influence. The vapor bath and cold affusion have
borne no better testimony to the curability of this disease. We have
already remarked, that the Ancients regarded an attack of tetanus
as necessarily mortal ; and as at the present day we do hear of occa-
sional recoveries, we are encouraged with the hope, that erelong, the

618 Thoughts on Syphilitic Ulcers. [November,

unprecedented advances which are now being made in the Sciences
of pathology, physiology, and chemistry, in elucidating the hidden
mysteries of organism, will place even tetanus in subjection to the
magic influence of the " Divine Art."

ARTICLE II.

Thoughts on Syphilitic Ulcers — their treatment, <^c. By Robert
Edmonds Little, M. D., of Quincy^ Middle Florida*

Opinions in regard to the origin, nature, and progress of diseases
arising from impure coition, are not more numerous and directly
opposite in character, than those maintained by the profession in
relation to their treatment ; opinions which not unfrequently yield
to the scrutiny of experiment — not, however, without first entailing
much difliculty on those who have been so unfortunate as to
place too great a reliance on any specific mode of cure, modified
by peculiarity of constitution. Notwithstanding the partiality of
many for the antiphlogistic treatment of syphilis, and the gen-
eral concession that mercury is a specific against its ravages, our
principles want stability, for neither the non-mercurialists, nor their
opponents, are guided by any fixed or definite standard. As a
consequence, cases are daily met with which being thought amena-
ble to mercury alone,- have been rendered truly deplorable by a too
free use of the article — while others are immolated at the altar of
fear, from a supposition that the remedy inflicts on the system evils,
scarcely less to be dreaded than the disease for which it was given.
We do not propose at this time to present any thing like an elaborate
notice of syphilitic ulcers, or their peculiar treatment; — for this, our
means of observation have been too limited, removed as we are frbm
an extensive field for a thorough investigation of the subject. We
design to produce observations not presented in the illimitable field
of speculation, but the result of cases seen. In our conclusions, we
have been uninfluenced by preconceived opinions, or ex cathedra as-
sertions, well knowing how little reliance there is to be placed in
assertions and theories, when not backed by facts. All, however,
are not destined to look through the same medium — hence, in a great
measure, the conflicting evidence of different individuals, not only in

1945.] Thoughts on Syphilitic Vlcers, 619

regard to medical, but all other subjects, plain and intelligible though
they be to the unprejudiced.

In the July number of the Western Lancet, Dr. E. L. Dudley de-
votes several pages to a consideration of diseases resembling syphilis.
Dr. D. seems to have been a close observer of the treatment pursued
by the Professor of Surgery in Transylvania University, in the
numerous cases presented for cure ; and the conclusions to which
he has come — if we do«ot misapprehend bis meaning — arc, that all
ulcers on the genital organs, save the true Hunterian chancre, are
to be regarded as not syphilitic, and consequently not requiring
mercury for their removal : conclusions which we apprehend will
not be adopted by a very large number of the profession. To ditfer
upon subjects purely speculative, is allowable among men ; but for a *
dilTerence to exist between those who are capable of observing with
regard to facts, is contrary to reason, and can be accounted for upon
no other principle, than that of one or both parties at issue, are led
astray by a partiality for opinions adopted without a sufficient exam-
ination, and maintained on account of the ancient relationship exist-
ing between these opinions and their supporters. It has been, and
still continues to be too much the fault of medical men to receive the
dogmas of those who rank high in the profession, without taking upon
themselves the trouble of investigating them, and relieving them-
selves from the errors into which they have been led by their sacred
authority. From the time that John Hunter's work on the Venereal
Disease first appeared, his authority has generally been deemed
supreme, and his followers blinded by his errors. Following in his
footsteps, they regard the ulcer so well described by him, as the only
one legitimately venereal ; thus lessening the number of cases of pox
so greatly, as to cause one to imagine that the disease had almost
disappeared from the long list of those to which flesh is heir, were it
not for the deformed faces and altered voices so often encountered.

From the opinion of Dr. D. we beg leave to dissent. No one
form of ulcer is exclusively to be taken as an index of syphilis — they
are as numerous almost as the hues of the chameleon, and he who
undertakes to diagnosticate the disease, or the reverse, as the ulcer
may, or not, present the characteristics of the Hunterian chancre,
will, in a majority of cases, fail, and suffer the mortification of hav-
ing patients return to him after a few months afflicted with secondary
symptoms in all their virulence. Syphilitic ulcers appear isolated
and in clusters, with and without indurated bases, and present all the

620 Thoughts on Syphilitic Ulcers. [November,

numerous varieties from a healthy to a sphacelated ulcer, whether
they be seated on the genitals or in the throat. Like Dr. D., we
were taught to regard a majority of these as the result of irritation,
requiring for their removal a simple antiphlogistic treatment. Fully
impressed with the truth of this doctrine, we acted upon it, and gave
it up only when convinced of its futility, and of the injurious conse-
quences attendant upon it. Ulcers on the glans penis, and other
parts of the genitals, were, in the beginning of our practice, treated
by us as pseudo syphilitic, by mild aperients, and absence from all
general and local stimuli, but without in the least benefitting the
patient. When suffered to remain untouched, for the purpose of
having our " doubts enlightened," we were not unfrequently mortifi-
♦ ed by the appearance of syphilitic psoriasis and lepra, symptoms
similar, we presume, to those attributed by Dr. D. to the use of cor-
rosive sublimate. From his statement, it is to be inferred that
secondary symptoms never supervene upon any other, than the true
Hunterian chancre. Here we are at issue. We have been more
unfortunate than he has — our success less signal than his. How to
reconcile these conflicting statements we know not, both being made
in good faith.

Dr. Dudley says, " the enquiry may be made, does a syphilitic
chancre ever secrete pus — and is not the fact of a chancre having
commenced to form purulent matter to be considered evidence that
the disease is mastered, and that healthy granulation is about to take
place?" We unhesitatingly affirm that it does not unfrequently
secrete pus. Several months ago, a young man consulted us, in re-
lation to an ulcer on his glans penis with an elevated border, concave,
and discharging a considerable amount o( uniformly consistent cream-
colored pus. Our advice was not adopted, as we recommended a
mercurial course. Three months afterwards he returned, and pla-
ced himself under our care for the removal of a long train of second-
ary symptoms. We have every reason to believe that they would
not have manifested themselves if our advice had been adopted.
Similar cases might be multiplied almost ad infinitum.

Dr. D. considers the Hunterian sore the only index of the exist-
ence of primary syphilis — hence the diagnosis between true and
bastard syphilis is easy. Ricord says, " no affection is so ill defined,
and no diagnosis so uncertain" as that of syphilis. But doctors as
well as philosophers will disagree. With a majority, the matter
remains in doubt — and until the diagnosis is understood — safety can

1815.] Thoughts on Syi)liililic Ulcers. 621

only be ensured by a judicious use of mercury ; yet in avoiding
Scilla, let us not run on Charybdis.

The case of the medical student reported, is defective in descrip-
tion— the ulcer is described as being " a long, narrow, superficial
affair"-^yet notwithstanding the omissions, it is fair to presume that
the ulcer was legitimately syphilitic, and that the dangerous symp-
toms were the result of the injudicious treatment pursued. In its
early stages, a light regimen, gentle purgatives, and cleanlmess,
adopted for the space of two or three days, failed to improve its ap-
pearances. Becoming dissatisfied at the progress m.ade, he consulted
a second physician, who advised a mercurial course ; the sore in-
creasing in size, a third was visited, and he in turn considered the
use of mercury necessary. Blue pill and opium caused " profuse
salivation, and threw the bowels into a state of excessive torpor."
The ulcer spread, and an inguinal gland suppurated, and exposed a
foul ulcer as large as the palm of a man's hand. The glans penis
was destroyed, and the scrotum covered with ulcers. Professor
Bush was now consulted — all medicine was suspended — a mush
poultice was kept constantly applied, and a light nutritious diet
adopted. Under this course, the pritient recovered in six weeks,
with the loss of the glans penis. He was afterwards operated on
for phymosis by Prof. B. The "dangerous extremity to which
he was reduced,*' is attributed by Dr. Dudley, to the "improper em-
ployment of mercury." So far we agree with him. The sore is
recognized, although the description is vague. The ulcer, from its
situation we presume, commenced on the glans penis in the form of
a vesicle, which finally assumed the characteristics mentioned. We
have met with two cases similar to the above in almost ex^ry respect,
and producing like it, phymosis. The ulcerations succeeding vesi-
cles discharged a large quantity of purulent matter, and inoculated
the neighboring parts, including the scrotum, which in each case was
covered with a crop of pustules scattered over its entire surface*
Unlike Dr. Dudley's case, they were treated without the use of mer-
cury— secondary symptoms in both cases supervened. In our cases,
"the dangerous extremity" to which our patients were reduced was
certainly not to be attributed to that disease producing remedy —
mercury.

We have said that the ulcer on the glans penis of the student was
in all probability syphilitic — and we now add that the violent symp-
toms produced, as well as the cure, were the result of the mercury

622 Thoughts on Syphilitic Ulcers, [November,

administered — injudiciousljas it was. The propriety or the reverse
of the administration of mercury in the treatment not only of syph-
ilis, but all other diseases, should be based on the peculiar state of the
system of the individual for whom it is prescribed. Preparatory
treatment should in all cases be resorted to, and to an observance of
this precaution, is in a great measure to be attributed the success of
our fathers in the management of venereal diseases, as well as the
great length of time that elapses between the cessation of the treat-
ment of the non-mercurialists and the appearance of secondary
symptoms. No practice is more injurious, or likely to do harm,
than that of giving mercury for the cure of a venereal ulcer, simply
because the former is deemed a specific for the latter, without first
investigating the condition of the general health of the patient,
which should always be prepared for the proper use of that remedy.
We could adduce instances of young, robust men, having their con-
stitutions impaired to a serious extent by an injudicious prescription
of mercury which acted on the salivary system — but instead of
healing the ulcers, only tended to enlarge them — thus disappointing
the hopes of the physician in regard to a speedy cure. Such a case
no doubt was that of the student of medicine. Had he been bled,
purged, and subjected to a meagre diet for a week or ten days prior
to the commencement of the mercurial course, by which means the
inflammatory condition of his system would have been reduced, the
ulcer would in all probability have disappeared in a short time — the
patient would not have been reduced to a dangerous extremity, and
Prof. Bush not compelled to doubt the correctness of the diagnosis
of the physicians who deemed the ulcer truly venereal. Dr. Dudley
properly observes, that the alterative doses of blue pill and opium,
induced mercurial erethism; thus substituting one disease for ano-
ther— converting the venereal, into a mercurial sore, after which a
withdrawal of the mercury, and the use of a generous diet, were all
that was necessary to relieve him, of a disease which at first was an
ulcer — "long, narrow and superficial."

In urging the necessity of preparatory measures, we do not mean
that depletion is in all cases to be used. Individuals vary as much in
their habits and constitutiouy. as do syphilitic ulcers. We must be
guided by the condition of the patient and appearance of the ulcer.
In America, where venereal patients are usually in the l.eginninT
hardy and robust, drpletion is rarely required to prepare the system
for tije beneficial itifiuence of mercury. In the hospitals of Europe,

181.J.] Thoughts on Syphililic Ulcers. , 623

the reverse is trile ; hence the value to surgeons of the advice of John
Hunter, who said, "I think no kind of diet has any effect in retard-
ing tlie cure of syphilis, and I think a man would get equally as well
if he lived ever so luxuriant, got drunk every day, and slept in the
fields." To a certain extent, Hunter was right — his advice should
be followed only in cases of debility, either from previous dissipation
or the inordinate use of mercury.

To surgeon Rose, of the Cold-stream Guards, is due the credit of
having introduced to the notice of the profession the fact that syphilis
in all its stages could be cured without mercury ; his announcement
was accompanied by reports of numerous cases so relieved. The
pretensions of the anti-mercurialists we do not intend examining, as
it is conceded that instead of advancing in popularity, they are losing
ground. A majority of the cases reported by him and his followers,
(among whom may be mentioned M. Guthrie, Dr. Green, and others
equally distinguished,) as cured finally, had secondary symptoms —
such as had not, are considered by Dr. Dudley (in his attempt to
limit the number of true syphilitic ulcers) as pseudo-syphilitic sores.
They may or may not have been syphilitic; and although we are an
advocate for the use of mercury in all cases as a means of safety,
still we are ready to admit that a case now and then occurs, in
which the primary ulcer is destroyed by means of cscharotics, with-
out the supervention of secondary symptoms; although mercury
was not used either internally or externally. Has Dr. Dudley never
seen a case parallel to the following, mentioned by Rousseau : A
young man, having forgotten in a spell of merry enjoyment that he
had left at home his female companion, indulged himself in a taste of
variety: came to himself again, and hardly recollecting his dream,
he returned to his wife, without any apprehension of being in a situa-
tion to infect her ; a day or two after, beginning to feel an uneasy
sensation upon glans penis, he found on examination that he had
three little sores as big as the head of a pin. He applied sulphate of
copper, and in the course of three days was as well as ever. Shortly
after he went to sea, leaving his wife unapprised of the impending
evil. A few days after his departure, painful sensations in her ingui-
nal regions were soon followed by the appearance of swelling : sup-
puration and ulceration occurred, and she was relieved only after the
use of medipne for six months. The husband never afterwards had
any symptom of venerial affection, Cases similar to the foregoing
are we presume familiar to every physician. Spoken of as they are

624 Thoughts on Syphilitic Ulcers. [November,

by Ricord and other writers on venereal, we are inclined to believe
that the small sores on the glans penis of the husband, and the buboes
in the groin of his wife were truly syphilitic : the disease in the for-
mer was destroyed by the use of an escharotic, without causing
secondary symptoms — while the latter, was less fortunate, being re-
duced to a "dangerous extremity," whether by the injudicious use
of mercury or not, we are not informed. In regard to escharotics,
we can truly say, that we have always found them useful — oftentimes
indispensable. Their employment is never dangerous, or likely to
disguiso, or lock up the disease ; they always leave behind them a
certain index for the employment or otherwise of mercury. We refer
to the button-like hardness of the cicatrix.

After all that has been said in favor of the non-employment of
mercury, its advocates are beginning to change their opinions, and
acknowledge that mercury is the antidote for syphilis. From the
arm\' reports, most of the cases said to be cured, were cases of recent
origin, no further advanced than the simple venereal pustule, or
original chancre — 'while the others were almost universally attacked
with secondary symptoms. Although mercury is the only acknow-
ledged specific against its ravages, it is not unfrequently advised-
given, when its use is certain destruction. Its d,dministration is not
well understood, if we may judge from the conflicting statements of
various writers, and knowledge in regard to it can only be gained
by experience. The use of mercury being in itself an evil, and its
effects frequently so deplorable, it has become an object M^th the
profession to know to what extent it should be carried to be benefi-
cial—^a problem which experience has heretofore found difficult to
Solve : a part of the profession contending that it should be carried
to the extent of producing salivation, while others deny the necessity
of its being carried so far. Our observation leads us to believe, that
A tnodorate soreness of the gums, continued for a time, proportioned
to the violence of the symptoms, and temperament of the individual,
is all that is necessary (so far as mercury is concerned) to effect a
radical cure of syphilis. The remedy should be gradually introduced
into the system, taking due care not to enfeeble the powers of life to
an unnecessary extent. We regard not so much the amount of sore-
ness of the gums, as the amount of mercury taken, and the effects
produced — viz. healing of the sore, or destruction of tlie indurated
cicatrix, if an escharotic has been used. A speedy salivation is to
be deplored — while, on the other hand, a too great tardiness in the

1845.] ' Acute Traumatic Tetanus. G25

specific effect of the mercury is to be guarded against : in the former
case, its effects are to be counteracted by appropriate living, and the
use of adjuvant remedies — in the latter, the dose is to be increased.
The danger arising from profuse salivation, we need not mention ;
its effects have been witnessed by almost every practitioner. It be-
comes the profession to be cautious in its use. Its consequences are
so dreadful under certain circumstances, that it is better to err on
the safe side, and give too little rather than too much. When not
enough has been given to effect our object, the dose can be increased :
when too much is administered, its ravages are almost without limit,
not unfrequently leaving the original disease uncured, in addition to
its own poisonous effects.

In conclusion: much has been said and written on the subject of
syphilis, and still the disease is but little understood. Revolutions
are constantly going on in regard to its treatment, and it is to be
feared that we are not more successful in its management than our
fathers. In each successive change, there has been but a subslitu-
tion of error for error. To arrive at any thing like perfection, in the
treatment ofthis or any other disease, we must rely upon ficts only,
disregarding the cherished opinions of teachers when not in accord-
ance with experience. By such a course alone shall we be enabled
to gain true knowledge concerning the nature and treatment of
syphilis, and thereby disarm the disease of all its terrors.

ARTICLE III.

Case of Acute Traumatic Tetanus, treated with the Cannabis Indica
{Indian Hemp) unsuccessfully. By Paul F. Eve, M. D., Pro-

fessor of Surgery in the Medical College of Georgia.

To Professor O'Shaughnessy, of the Medical College of Calcutta,
the profession is indebted for the introduction of the Indian Hemp
into the materia medica; and in noother disease is it more recom-
mended than for traumatic tetanus. Within the past few months,
there have been various and somewhat conflicting reports respecting
the efficacy ofthis article as a remedial agent, in the British medical
journals, and the subject is beginning to attract attention in our own
periodicals. In the 4th number of this Journal, we published some

626 ^ Acule Traumatic Tetanus, [November,

notice oi' the experience with il by Mr. Donovan of Dublin, and Dr.
Lavvrie of Glasnjow ; and under a ditJerent head of this number, the
reader may find the subject continued.

The prognosis of acute traumatic tetanus is so exceedingly unfa-
vorable, that the profession is prepare! at all times to give a fair
trial to any suggestion or agent promising success in its treatment.
The aphorisms of Hippocrates, that te'anus swpervening on a wound,
is mortal — they who are seized with tetanus, die within four days, are
just as true now as when they were written. The great military
surgeon of England, the late Dr. Hennen, confesses that he never
saw a case of acute symptomatic tetanus recover. In the acute
species, Dr. Dickson of Europe, found all curative measures followed
by unqualified disappointment. Mr. Morgan's testimony is still
stronger; he says, I have never yet seen or heard of an instance of
recovery from acute tetanus.* The fact that Dr. O'Beirne witnessed
two hundred cases in the peninsula of Spain, not one of which re-
coverec. ; and the experience of Sir James McGregor, in several hun-
dred cases which occurred among the British troops in that country
and Portugal, very ^e\w of whom, he says, were benefited by any
medicine or plan whatever, is already alluded to in this number
of the Journal, by our valuable collaborator, Dr. Stevens, of Liberty
county. Mr. Alcock, surgeon to the British Legion serving in Spain
a few years ago, noticed seventeen cases of traumatic tetanus, one
of which number alone recovered. And where, we ask, is the prac-
titioner of medicine or surgery, who cures trismus nascentium 1 It
is true that occasionally, by almost any plan of treatment, and even
by very opposite ones, this affection, in some of its varieties, is cured.
Cases to this effect may be found detailed in every medical journal,
(several even in this very number) still no one will deny but that
acute traumatic tetanus ought to be considered an opprobrium medi-
corum.

We find it stated in Druitt's Surgery, that with the resin of the
Cannabis Indica, or Indian Hemp, Dr O'Shaughnessy and others,
cured eight out of twelve cases of tetanus; and Mr. Donovan says it
was almost uniformly successful in his practice. The variety of the
disease is not mentioned. In a debate which occurred the 22d April
last, in the Royal Medical and Chirurgical Society, and reported in
the London Lancet, on the reading of a "case of traumatic tetanus
successfully treated by large quantities of wine and brandy, with

» Vide Cyclopaedia of Practical Medicine, vol. iv,, p. 369.

1815.] Acute Traumatic Tetanus. 627

other means," and in which Drs. Watson, Wilson, Davis, King,
Snow, Curling, (author of a work on tetanus,) Solly, Simon, CaBsar
Hawkins, &;c., took part, we are surprised to see no allusion made to
the Indian Hemp.

In the case of Prof. Miller, (who has recently published the best
work on the Principles of Surgery.) reported in the London and
Edinburgh Monthly Journal of Medical Sciences, for January, 1845,
the success cannot be ascribed exclusively to any one agent employ-
ed. We refer to another part of this number for the history of this
case, where also may be found two or three others, taken from the
last number of Braithwaite's Retrospect.

In the September number of the New Orleans Medical and Surgi-
cal Journal, may be found a case detailed by Dr. Willson of that
city, in which the Indian Hemp was used with success, at least for a
time. The tetanus occurred in a negro man, and on the 25th May,
1845, Dr. W. was called to it in consultation with Dr. Farrell. Two
weeks before, he was attacked " with stiffness and uneasiness in the
hack of his neck, consequent upon exposure to wet and inclement
weather." " We subsequently learned (says Dr. Willson) the fact of
his having suffered, about two months previously, from a punctured
wound of his foot, that suppurated, but healed in a short time without
any untoward symptom." This was a chronic case, continuing more
than a month, but in which the Cannabis Indica was employed with
good results. In a postscript, however, by Dr. Farrell, a few weeks
after the patient was dismissed, cured, he says — "the case has ter-
minated fatally." In live days from the time he was considered
well, he was unfortunately attacked with measles — clonic spasms
immediately supervened, and notwithstanding the "Indian hemp was
given in large doses — also, brandy, morphine and quinine — without
for a moment checking the progress of the disease," Dr J. Farrell
adds that, " two years ago I treated a case of traumatic tetanus with
the Cannabis Indica ; on the fourth day ♦he symptoms were much
alleviated, even in a more marked degree than in the preceding cure ;
unfortunately the supply of the medicine became exhausted, and
Bone could be procured."

From the account of all the cases of tetanus published, in which
the Indian hemp was tried, it still remained an unsettled question,
whether it could be relied upon in the acute traumatic variety. So
far as one instance can decide the matter, wherein Xhe. remedy was
faithfully employed, and it alone almost exclusively, we are inclined

628 Acute Traumatic Tetanus, [November,

to the opinion tiiat it may relieve, but will not cure. Certainly if
ever there was a case well adapted to give the article a fair trial, this
was one. An acute attack from a nail in the foot, entirely neglected
for near thirty hours after the incursion of the symptoms, the failure
of the ordinary means to afford even relief, and then the steady appli-
cation of increased doses of the hemp for twenty-four successive
hours, under unremitting personal attention, were well calculated to
exhibit the remedial powers of the medicine.

The article used had just arrived from England, and was obtained
through one of our apothecaries, a graduate of the Philadelphia Col-
lege of Pharmacy. It was insoluble in water — was precipitated when
the tincture was much diluted, and adhered to the hands and vessel.
The tincture was made by adding an ounce of the extract to a pint of
undiluted alcohol.

Case. Richard, a black man, aged 25, and a carpenter by trade,
had a nail run into his foot, by treading upon it, on Friday the 26th
of September. He was of good constitution, well made, and enjoyed
excellent health. He had a small umbilical hernia, supposed to be
congenital, but which gave him little or no inconvenience. It, how-
ever, rapidly increased in volume during the attack of tetanus, and
pressure was required over it at every paroxysm, to restrain the pro-
truding bowels.

The wound made by the nail was upon the planter surface of the
left foot, opposite the metatarso-phalangeal articulation of the
little toe, and was thought to have pent trated deeply. A lye-poultice
was immediately applied, and Richard returned to his work, using
frequently a ladder. On the evening of October 2d, the seventli
da}" after the accident, he complained of pain in his neck and back.
The next day he kept his bed and took salts and senna, which freely
moved his bowels. At midnight between the 3d and 4th, he had
spasms, and Dr. Joseph A. Eve was sent for. He enlarged the
wound with a lancet, aiad some pus was evacuated — a lye-poultice
was then applied to the foot. A blister was placed over the
whole length of the spine ; a gr. of morphine given, and half a tea
spoonful of laudanum directed every hour until relief and sleep were
obtained.

Oct. 4th, 7 o'clock, A. M. This is the ninth day since the acci-
dent, and about thirty-five hours from the commencement of his
present symptoms. Dr. E. found he had taken the laudanum
three or four times, and in addition to the narcotic and revul-

1845.] Acute Traumatic Tetanus. 629

sive treatment, gave 20 grs. calomel. The body was found arched
backward.

I was invited to see the patient at 10, A. M. Symptoms — trismus
and opisthotinos ; great distress of countenance ; drops of sweat on
his face and neck ; decubitus on the l)ack ; great ditFicuUy of deglu-
tition ; pulse 90 to 100, full but not 'strong; respiration 30 to 40 —
variations dependent upon convulsive spasms which occur every few
seconds. Prescription — 2 grs. of the Extr. of the Cannabis Indica,
in tincture, every fifteen minutes. He swallowed two doses with
great difTiculty, and then vomited. It will be remarked here, that
the 3rd was a cloudy day, with the wind at N. E. — Thermometer
60 to 69 — Barometer falling. On the 4th, it rained steadily all day,
resembling the 3rd in other respects. As the patient's accommoda-
tions were not good, he was brought to my otFice, and I was not ab-
sent from him more than three or four hours altofrether duri^noj the
whole treatment. I administered every dose of medicine, and gave
him nearly all the nourishment he could be induced to take.

At 11 o'clock, examined the wound ; it is healing under the lye-
poultice; and finding the stomach very irritable, I gave of the tine,
of the Indian hemp 5 grs. diluted in tepid water in an enema. At
12, M., injected into rectum 10 grs. At half-past 12, gnve 5 to 6
grs. per orem, but which were immediately rejected. At 1, injected
10 grs. more. By great persuasion got the patient to take some
brandy and water, and a few table-spoonfuls of Madeira wine. To
this he was violently opposed, and though he could now swallow
freely and his stomach retained these stimulants, he would not be in.
dnced to drink them freely. At half-past 1, the patient has evidently
improved — the paroxysms of spasms are now less frequent and less
violent — he sleeps quietly, and occasionally snores. He lies on his
back, keeps his eyes closed, can open his mouth a little, but has no
disposition to talk — seems to be in a half narcotised state. No ma-
terial change yet in the pulse or respiration.

At 20 minutes past 2 o'clock, gave 4 grs. of the hemp per orem in
brandy and water ; repeated the same quantity in 5 minutes; they
are vomited in 8 minutes. At 3, administered 15 grs. to rectum.
Gave 5 grs. sulph. quinine in brandy and water; vomited in three
minutes. Drs. Newton and Ford now saw the patient, and were sat-
isfied that the rigidity of the muscles was not great, as he could open
the mouth to about half its usual extent, and he laid nearly straight
on his back — the convulsive paroxysms recurring about* every two to

630 Acute Traumatic Tetanus, [November,

seven minutes, Richard was observed to scratch his face with his
hand, and to draw up his left thigh and leg.

At 4 o'clock, with assistance, he turned on his right side, and at 5,
called for a vessel and passed about half a pint of high colored urine.
Half-past 5, gave 15 grains of the Cannabis Ind. At 7, took a little
arrow root and immediately vomited. Past 7, injected into rectum
24 grs., and at 9 o'clock gave 48 grs. of hemp in enema. Half-past
11, seems to be doing well, pulse still 100, respiration 30, paroxysms
some minutes apart. We recommended the brandy and arrow root
to be freely given.

Oct. 5th, 3 o'clock, A. M. Called up to patient, and find him
worse ; pulse 130 and respiration 40. Complains of difficult breath-
ing, and his convulsive spasms come on every minute or two, and
are more severe. Administered 16 grs. of hemp per anum ; and the
patient was evidently improved by it. The respiration became bet-
ter, the pulse fell to 110, and quietude and sleep followed. 6, A. M.
Is again worse ; swallows with dirficulty, cannot open the mouth,
and has obstinately refused to lake brandy or wine. Immediately
injected 48 grs. of the Hemp. At half-past 8, repeated the 48 grs.
The patient is impressed with the belief that he will die. His respi-
ration is 26, pulse 100 to 110 ; lies with his eyes still closed and his
mouth half opened ; spasms about half an hour apart.

Half past 10. The wound has healed, and the patient has not
complained of it at all from the time it was lanced. Gave |^ 5 of
tocacco in decoction per anum. The patient cannot be roused either
by calling or shaking him. In a few moments after this, he vomited
a dark colored fluid. Appears to be sinking. Injected brandy*
toddy into the cBsophagus through a catheter past into the nostril,
but it was returned by the mouth. At half past 12, applied electro-
galvanism, with the assistance of my friends, Messrs. Martin and
Milligen, students of medicine. One wire was placed near the
occipito-spinal junction, and the other to the sacrum. It operated
for fifteen minutes, and agitated convulsively and forcibly all the
muscles. The effects were increased activity in the circulation,
(pulse 160,) relaxation of rigidity in the muscles, and much improved
respiration. "

Halfpast3, P. M. The patient unexpectedly asked for water —
urged hot brandy-toddy and wine upon him, hut he would swallow
only a little water. Pulse 150 — respiration 38. At 4, gave in
enema 1 § ti'nct. assafcelida and 1 § tinct. hemp, in a little water.

1845.] Acute Traumatic Tetanus, 631

Tried electro-galvanism again, but found the patient sinking — he
died quietly at 6, P. M. This was within four days from his attack
with the tirst symptoms of lock-jaw. He retained all the injections;
and I find, by examining the bottle, five ounces of the measured pint
of the tinct. of the hernp remaining. I estimate the quantity admin-
istered in 24 hours to he near 6 5. It preduced no aphrodisiac symp-
toms— he once asked for bread ; took a morsel, but did not swallow
it. At another time he called for chicken-soup. Only half a bottle
of Madeira wine and about the same quantity of brandy were con-
sumed.

With regard to the fact that there were complete relaxations of the
muscles during the treatment of this case, I think I am positively
certain. That those of the lower jaw, neck and abdomen — indeed
I may add too of the lower and upper extremities — were rigid only
at certain periods during the spasmodic contractions, all who saw the
patient will admit. The pulsations of the abdominal aorta were
easily counted through the opening of the umbilical hernia. The
spasmodic convulsions recurred at first every ten or twenty seconds,
and the longest intervals were about half an hour. They more fre-
quently came on spontaneously, or in the natural course of the afiec-
tion, but were occasionally excited by efforts of deglution, &c. — the
exacerbations never lasted more than a few seconds. The tonic
contractions or spasm seem to start convulsively from the spinal
column and agitate the whole frame. There was no peculiar action
©r movement in the leg or thiglj of the wounded foot. His bowels
were not moved during the whole progress of his attack, to the fatal
termination. For several hours he passed no urine, and after the
first evacuation, it would be squirted forth with much force, and be-
fore the vessel could be prepared to receive it. His face and neck
were bathed in perspiration at several different times, but at other
moments was of natural condition in this respect. He sometimes
asked to be fanned, but never complained of pain.

I believe this is a faithful narration of all the phenomena which
transpired during the progress of this case. And though the con-
clusion drawn from it is rather ad i^erse to the exalted opinion enter-
tained by some of the curative powers of the Cannabis Indica in
acute traumatic tetanus, still if it can give only relief, it is certainly a
valuable acquisition in the treatment of this almost constantly fatal
disease. As the opportunity is now generously ofl!ered by the spirited
editor of the Boston Medical and Surgical Journal, of procuring the

632 Amputation of the Limbs. [November,

article from the original source, Calcutta, ray next supply will be
genuine, whatever doubt may arise as to the character of that which
has just been employed.

(Through a mistake, I regret that a post-mortem examination
was not made.)

PART II.— REVIEWS AND EXTRACTS.

Amputation of the Li.mhs, in consequence of gun-shot wounds. By
M. LisFRAXC — being a part of the yet unpublished Treatise of
Operative Medicine, by that distinguished Surgeon. {Translated
from the Bulletin de Thcrapeutique.)

Gun-shot wounds are among the most frequent of the causes of
amputation: they produce very often comminuted fractures; they
penetrate often into the articulations ; they cause cpntusions and
lacerations of the soft parts ; the bodies put in motion by gun-powder
convert superficially into an eschar the flesh with which they come
in contact. When a projectile has removed the muscles of the pos-
terior part of the thigh for about two-thirds of their length, when a
wound of this kind occupies the gastrocnemial muscles, I think that
it is necessary to amputate, although the arterial and nervous trunks
may not have been sacrificed. The extent of the solution of con-
tinuity is very considerable ; the surface presents conditions less
advantageous than the wound resulting from an amputation : the for-
mer will cause more serious accidents than the second. The cutting
instrument will indeed produce much suffering, but if we do not have
recourse to it, the gun-shot wound will cicatrize with difficulty, and
in (general after a very long time, the cicatrix will be profound, ad-
herent and of large dimensions; it will be easily lacerated; the loss
of substance experienced by the muscular system, will embarrass the
movements and render many of them impossible. 1 have seen some
subjects, upon whom amputations were not performed after wounds
of this character, and the slowness of the cicatrization, the accidents
which preceded it, and the bad result obtained, caused much regret
that the limb had not been removed. J>ut should the wounds of
which we treat, occupy the arm or forearm, inasmuch as their func-
tions are not the same, I think that an operation may be generally
avoided.

1845.] Am-putation of the Limbs. 033

When projectHes have reduced \(he muscular system into a pulpy
state in a great extent, without having lacerated the skin, the patient
ought to be subjected to the. precepts which we have established, and
which as we have just seen, vary in different localities.

Amputation is especially required by vast solutions of continuity
complicated with opening of* voluminous vessels, or laceration of the
nervous trunks.

We should recollect that on the field of battle, in the camp, we are
obliged to perform amputations much more frequently : the opinions
which we are about to advance, will be based upon facts observed
when the wounded were in circumstances to receive all necessary
care ; these opinions would be essentially different in the contrary
case.

It has been pretended in modern works, that wounds of the ariicu-
lations produced by a ball, were less serious when the articulation
had not been largely opened. We do not entertain this idea, because
the fluids furnished by the solution of continuity do not then find a
ready escape, because they remain between the wounded articular
surfaces and determine much irritation, and inflammation almost
always fatal.

Larrey was so well convinced of this truth, that he has given the
advice to make when necessary large openings to prevent the de-
tention of pus. Experience has sanctioned this excellent practice
in the hands of its author, and I have adopted it often with success.
When the projectile opens the joints largely, without occasioning a
too considerable loss of substance, it produces then a solution of con-
tinuity less disadvantageous than if it were narrow.

But is it necessary to resort to an amputation, when an articulation
of the first or second importance has been opened? Labastide re-
ports many cases which shew that the articulations of the wrist,
elbow, foot and knee, having experienced penetrating wounds, the
patients were cured without the removal of the limb. Dupuytren
obtained the same success in those wounded during the revolution of
July ; Lombard, Leveille, Percy, Faure, &;c. cite facts of the same
kind. It is said that these cases of success are but few in number,
and that they are opposed by a greater number of cases of failure.
This assertion is not exact with respect to the practice of Dupuytren,

I always suppose the patients, I repeat, placed under favo,rable
circumstances as I have above stated, and I maintain that by employ-
ing the method of treatment wluch I have modified, wounds of the

634 Amputation of the Limhs. [November,

articulations should very seldom require amputatioBs, unless the soft
parts surrounding the articulation have experienced too great a loss
of substance : of this I have given the proof at the Hopital de la
Pitie and at the hospital of Grenier-d'Abondance, where I have pre-
served limbs for a great number of patients whose scapulo-humeral,
humero-cubital, radio-carpal, carpo-metacarpal, tibio-femoral and
tarso-metatarsal articulations, had been profoundly wounded.

It is generally believed that gun-shot wounds, although produced by
a ball, almost always require amputation, if the body of a long bone
and more particularly of the inferior limb, has experienced a commi-
nuted fracture. I reject this precept; my opinion is based upon a great
numher of successful cases in which my mode of treatment was employ-
ed, and without which 1 am certain I should have been unsuccessful,
like the practitioners who do not adopt it. Among a great number of
facts, the following may he cited ; but let us premise that in fractures
with solution of continuity of the soft parts, the detention of even a
small quantity of pus may produce general accidents of a very se-
rious and often fatal character.

Lieutenant-Colonel Grand, was grievously wounded near Grenier
d'Abondance ; many halls riddled his arm, and the humerus was frac-
tured in two places. Amputation was proposed ; I did not entertain
that opinion ; I employed the medication above indicated, and for
ten days every thing announced that it was about to be crowned
with complete success. Suddenly a severe chill supervened ; the
appetite was lost, and a serious gastro-enteritis was developed. No
error of regimen had been committed ; the tumefaction had some-
what increased in the unsound limb, and also the pain. I believed
that all these accidents depended upon the presence of pus, for
which I sough with the greatest care. I recognized a slight fluctu-
ation, and gave issue to scarcely two tea-spoonfuls of purulent matter
— the next day the chill did not return ; the affection of the intestinal
canal had already disappeared, the appetite was restored, and the
arm had greatly diminished in volume. M. Grand was cured, and
is now colonel of a regiment of dragoons. This fact alone is suffi-
cient to excite the attention of the practitioner. We have observed
a great many others of the same kind, which it is unnecessary to
cite. It is hardly necessary to say that by an early evacuation of the
pus, the local and general accidents which it produces, are dissipated
even with rapidity, but that if on the contrary, it is suffered to re-
main, these accidents may become very serious and often fatal. I

1845.] Amputation of the Limbs. 635

will add, (hat amputation then oAen becomes indispensable, and that
frequenlly also tlie accidents are so intense and rapid, that there is
no opportunity for performin": it.

The brave Colonel Lebeau had a comminuted fracture of the arm
at its superior third, tVom a ball at the battle of Waterloo ; eighteen
days afterwards he came to Paris, with the commencement of a very
vicious callus; I broke it and placed the fragments in very regular
contact, and the fracture was cured without deformity.

When I was charged at the Hotel Dieu, with a service in which
were the soldiers who had been wounded at the battle given under
the walls of the capital, Dnpuytren and myself saved from amputa-
tion six patients whose arms had experienced comminuted fractures
by balls ; in two of these subjects, the solution of continuity of the
bone occupied the middle part of its body, in three of them, it was
observed upon the inferior third of the humerus, and in one, a little
above the insertion of the deltoid muscle; in all these subjects the
suppuration was of long duration ; no spicula of bone was extracted ;
four were cured perfectiv, \\ith a more or less pronounced shorten-
ing of the limb, two left the hospital with fistulas which furnished a
small quantity of purulent m:itter ; one of them returned after several
years to show me his wound, wiiich did not prevent him from exer-
cising the business of a jeweller; sometimes, however, the arm was
slightly tumefied, because the pus remained in the fistulous passages.
I enlarged their orifices, and the accidents disappeared.

But when the thighbone is the seat of a comminuted fracture, it is
generally believed to be necessary to amputate. Lombard, IM. Gaul-
tier de Claubry, S. Cooper, Percy, Larrey and Guthrie, say that they
have only seen a few patients saved ; most succumbed when the limb
was not ampiJtated ; Ravaton assures us that the wound of which we
speak is almost always mortal ; M. Ribes has not met with a single
cure ; he has observed ten soldiers, upon whom the suitable care was
bestowed, and they all perished ; he adds, that in four thousand sol-
diers in the Hopital des Invalides, he has never seen one recover after
the accident of which we speak. We should remark, however, that
with the exception of the ten soldiers mentioned by M. Ribes, the
others appear to have been treated in the army, where the necessary
means for the care of the wounded are almost always defective, and
where these unfortunates are ^.^nerally transported to great dij^tances
in unsuitable veliicles and over bad roads; the reverses which were
experienced must (hen almost necessarily have occurred. It has

636 Amputation of the Limbs. [November,

been said that in Paris and Belgium, patients do not suffer for the
Avant of any of the means necessary for their cure, and that never-
theless more success has not been obtained ; but I do not think that
they have employed the mode of treatment which I have indicated^
and by whose aid we may almost always avoid or victoriously combat
inflammation. I believe then, that in the accident of which I now
speak, amputation of the thigh ought not in general to be performed
before the inflammation is developed, and before we have acquired the
certainty that it will resist a well-directed medication ; the formula of
M. Serres d'Uzes for mercurial ointment should not be forgotten.
All surgeons know, that with the exception of phlebitis and the
absorption of the pus, which may take place in all wounds, inflam,-
matory engorgements and its consequences are the only things for-
midable in the solutions of continuity, of which we treat. I cunfess,
however, that my opinion is not yet based upon a sufficiently great
number of facts ; but it reposes upon analogies furnished by the thor-
acic extremities, whose comminuted fractures caused by fire-arms
and treated in the manner which I have stated, are almost always
unproductive of any grave accident.

Dupuytren has cured one patient. I have saved several ; I have
not lost one. I have preserved in my Surgical Clinique the two fol-
lowing facts: "I cured without amputation, at the Hopital de la
Pilie, two patients wounded in July, 1830; one had received a ball
which caused a comminuted fracture of the femur ; the other had a
fracture of the same limb, which was caused by a bullet, that had
also caused a very violent contusion for a pretty considerable extent ;
no accident supervened; the constitutions of these two wounded persons
were very good ; their internal organs were in an excellent condition,
a circumstance which ought to be much considered in determining
the question of an amputation or of the preservation of the limbs.

I also shewed this morning at my Clinique at the Hopital de la
Pitie, a patient who was affected in 1814 with a fracture, with
wound and spiculas at the junction of the superior, with the middle-
third of the femur ; a complete cure was obtained in the course of a
year, without a fistula, and was maintained until 1835, at which
period the patient walked very well and experienced no other incon-
veniences, except those resulting from a shortening of the limb, he hit
it very violently against one of the corners of an anvil, and there su-
pervened an abscess, of which he was cured.

It has been said that a comminuted fracture of the femur, produced

1845.] Amputation of the Limbs, 637

by a ball, is almost always followed, when it is cured, by fistulse and
engorgement of the limb, which not only prevent the complete exer-
cise of its functions, but which also cause eventually the death ofthe
subjects, in a very great number of circumstances. I cannot admit
these ideas; I have had the honor of some experience in military
surgery ; I have preserved relations with officers in whom the fistulous
passages of which we are speaking, persisted ; I have already said,
that there is developed, it is true, from time to time, tumefaction,
which is owing to the presence of pus in the substance ofthe tissues,
but which disappears when the fluid is extracted. These persons
walk very well ; the suppuration which persists in a small quantity,
incommodes them but very little ; they are in a more advantageous
condition than if they had been subjected to amputation, which it is
hardly necessary to say is too often falal.

The fistulas of which we treat, may be complicated with even a
considerable engorgement of the limb ; sometimes it is the result of
the inflammations which have primitively existed ; at other times it
is owing to phlegmasia neglected or badly treated, and occasioned
by the presence of pus retained in the fistulous passages ; this latter
cause may be prevented by maintaining an easy escape for the purulent
matter. In all cases, we have been in the possession for a great
many years of powerful means to combat simple indurations ; whe-
ther by the aid of local sanguine evaluations wisely directed when
sub-inflammation exists, or with discutients when phlegmasia is
absent. I have succeeded by following this treatment, in dissipating
considerable hypertrophies of the thigh, and the patients afterwards
walked with tolerable facility.

If the treatment be directed by surgeons who believe in the in-
contestable advantages of the alliance of medicine with surgery,
and who are not entirely mechanical in the exercise of their profes-
sion, it seems to me impossible that patients should succumb in
consequence of their fistulae, unless their constitutions present some
irremediable vitiation.

A soldier experienced a fracture of the right thigh, produced by a
ball ; the solution of continuity occupied the central region of the
bone ; amputation was not performed ; the bone had consolidated,
but there remained three fistulas which penetrated to a great depth
into the substance ofthe limb ; no spicula was detected by the probe,
which did not reach to the osseous tissue ; the suppuration was abund-
ant ; the induration of the soft parts was very considerable throughout

638 Amputation of the Limhs, [November,

almost the entire extent of the thigh whose volume was augmented
by one third, and symptoms of sub-inflammation existed. I employ-
ed emollient cataplasms ; I applied twelve leeches ; this evacuation
was repeated every ten or fifteen days, according to the strength of
the patient, and the progress or suspension of the amendment.
When the phlegmasia disappeared, and the disease no longer contin.
ued to diminish, we suffered seven days to elapse, when we had
recourse to discutients, and suspended the employment ofthem when
they caused too much excitement or when the inflammation returned.
Five months were sufficient to restore the limb to its normal volume ;
there remained no induration appreciable by the touch ; the pus was
formed in small quantity, and the patient walked tolerably well
when he left the hospital. We have seen this man for several years^
and the success has continued about the same. In cases of this kind,
the iodide of potassium, administered internally, would produce ex-
cellent effects. •

Captain V. received at the battle of Waterloo a ball, which frac-
tured the femur at the point of junction of its superior with its middle
third ; the fracture was consolidated, but fistulas persisted. The
patient walks sufficiently well. From time to time pus is retained,
when pain and difficulty in taking exercise ensue ; but when the pur-
ulent matter is evacuated, the tolerably good condition which we
have indicated returns. I have been the physician of Capt. V. for
eight or ten years.

Two or three times a year, there comes to my consultation an old
soldier, whose femur has been fractured about an inch above its mid-
die; he walks almost without lameness, and has two fistulae, one
upon the anterior and the other upon the external region of the limb,
which is slightly atrophied, although there exists a very limited indur-
ation. He sometimes experiences pain, and tumefaction superverfes ;
he has learned to dilate the orifices of the fistulous passages by means
of prepared sponge, the pus escapes and the accidents disappear;
incisions are very rarely employed.

Let us say, in concluding, that if fractures caused by gun-shot
wounds are complicated with laceration of the principal blood-vessels
of the extremities, it is advised to perform amputation. But in cases
in which the soft parts have not experienced considerable laceration
or loss of substance, and more particularly in wounds of the thoracic
extremities, may not an opposite course be pursued? If, indeed, by
the method of tieutment which I have indicated, we succeed almost

1845.] Amputation of the Limbs. 639

always in avoiding or in combattinir victoi iouslv acute inflammation,
woiilJ not the ligation of the bpened artery succeed, though we
should make abstraction of the various kinds of apparatus intended
to maintain the fragments? We know that many fractures are
cured without this apparatus, and that frequently the callus is not
too tiisadvantageous — sometimes even it is not too irregular. I leave
to practitioners the care of meditating upon these ideas.

Guns bursting in the hand ordinarily produce very extensive
wounds, in consequence of which, however, amputations are very
rarely performed ; the flaps which cannot live are removed, the sur-
face of the solution of continuity is made as smooth as possible, and
a cure almost always takes place, though the first metacarpal bone
may have been removed with the thumb — though the articulations of
the bones of the carpus with each other, and with those of the meta-
carpus, may have been more or less opened. I have seen my father
obtain very great success in c'rcumstances of this kind. I should
remark, however, that he practiced in a very healthy climate, where
men enjoyed excellent constitutions. Would it not be possible in
cases of this kind to avoid an amputation of the fore-arm, when the
disorders in the radio-carpal articulation were not too extensive?
We have cited above, a case which inclines towards the affirmative
of this question.

Other things being equal, fractures complicated with a solution of
continuity of the soft parts, and occasioned by ordinary causes, are
less serious than those produced by gun-shot wounds ; they offer also
less danger in the thoracic, than in the abdominal extremities. It is
often very difficult to distinguish the circnmstances in which amputa-
tion should be performed, from those in which it should be rejected.
If several surgeons are assembled to decide this important question
with respect to a patient who is before them, it is not uncommon to
hear them pronounce opinions essentially different. Let us repeat,
that if the locality be advantageous, if tlie patient be well constitu-
ted and the intestinal canal in an excellent state, if his moral con.
dilion be good, if the animal economy be not tainted with any virus,
operations should be more rarely performed ; for in the favorable
circumstances which we have just indicated, success has exceeded
frequently all hope. lam fond of repeating, to young surgeons who
have pursued their studies in the hospitals of large cities, that they
should distrust the cases and observations which they have there col-
lected, and that elsewhere amputations should be much more fre-
quently rejected.

640 Amputation of the Limbs, [November,

When the principal vessels of the fractured limb are divided — when
there exist considerable ecchymosis.and sanguine efTusion — when the
soft parts are pretty extensively lacerated or contused, and the arti-
culation, either of the shoulder or of the elbow, or of the wrist, or of
the hip, or of the knee, or of the foot, with the leg, is opened, it is
necessary to amputate. But when the large vessels have been spar-
ed, when the large joints are not in contact with the air, we do not
have recourse to the removal of the limb, though the fracture be com-
minuted, though the effusion of blood be pretty considerable, and
though the soft parts be lacerated and bruised to a certain extent.
We succeed better, I repeat, upon the arm or fore-arm, than upon
the thigh or the leg. I have frequently applied these principles at
the Hopital de la Pitie, and all know the great success which I have
obtained. A patient who occupied No. 14of the ward Saint-Antoine
of our hospital, was cured of a fracture of the inferior third of the
leg, which presented the following circumstances: obliquity of the
osseous solution of continuity for two inches upon the tibia, which
was denuded to the extent of about two inches and a third from the
tissues which should have covered it; the superior fragment of the
bone crossed the direction of the inferior one and was lodged at the
external side of the latter. In consequence of the dimensions of the
wound, I was enabled to recognize this displacement. I produced a
relaxation of the muscles ; I seized the former of these fragments
with the thumb, and index and middle fingers ; I raised it at first,
and then carried it easily inwards and a little backwards, where it
remained without the assistance of any apparatus ; the limb was
only maintained in a semi-flexed position by cloths folded like a cravat,
and disposed transversely upon it. I will remark that, before I had
recourse to the manoeuvre which succeeded so well, it had been im-
possible for me to reduce the fracture, although the displacement
longitudinally was very slight, and although I had employed great
efforts, extension and counter-extension having been established. It
would be useless to say, that the soft parts had been extensively
lacerated, and that much blood had been effused among the tissues.
The cure certainly did not take place without deformity of the limb ;
but it is evident that the subject is in an infinitely more advantageous
condition than if amputation had been performed. The inflamma-
tion and tumefaction were slight, and a counter-opening was made
behind the fibula to flicilitate tiie escape of the pus, the quantity of
which was inconsiderable. General bleeding and diet were employed,

1645.] Ampulalion of the Limbs. G41

according to the principles upon which we have insisted. I combatted,
victorioii!.'!}-, a delirium which was very violent and without fever,
with musk administered internally in large doses; the sulphate of
quinine triumphed promptly over the extreme prostration which had
followed the exaltation of the nervous system.

A Professor of one of the Colleges of Paris, had an oblique frac-
ture of the inferior third of the leg, with laceration of the soft parts,
to a great extent ; the superior fragment projected through the flesh ;
an extensive ecchymosis existed. A surgeon, attached to one of the
hospitals of Paris, had already proposed the removal of the limb. T
was called — I did not entertain that opinion. I employed my method
of treatment ; the apparatus was not applied even until the sixth day ;
no accident occurred ; the cure was complete, and the patient does
not limp. If the nature of this work permitted, I could analyse
here the cases of patients, cured without amputation at the Hopital
de la Pitie, though their limbs had been crushed by the wheels of
vehicles.

When the fragment? have traversed the skin, and cannot be re-
duced, in consequence of the narrowness of the opening, we make a
suitable enlargement of the wound, and we remove that part of these
fragments which is denuded of its periosteum. I have never met
with cases in which an enlargement of the wound was not sufficient
to permit the reduction of the fracture with the assistance of appro-
priate means.

When the large vessels have not been divided, and the soft parts
do not present a too extensive laceration and attrition, although a
large articulation is opened, I think that it is not necessary to ampu-
tate. I have saved the limbs of persons in whom the articular sur-
faces of the elbow, wrist, (fcc, had been exposed. Would the same
success be obtained with respect to the knee, and tibial and tarsal
articulations?

Much controversy has existed respecting the questions which we
have just discussed. There are indeed some surgeons who have col-
lected numerous facts in favor of the preservation of the limbs — there
are others who report a great number of cases in favor of amputa-
tion. I think that opinions would be less discrepant, and that per-
haps even all dispute would be ended, if medical knowledge was more
generally diffused, and if pre-conceived ideas or a spirit of exaggera-
tion or an education in a bad school, did not so frequently serve as a
guide to the physician. Read, indeed, the cases which have been

642 Pathology, <S^c.^ of the Urinary Deposits. [November,

published, and you will see that in the majority of them, truly medi*
cai ideas have been singularly neglected. "N.

On the Pathology, <^c., of the Urinary Deposits. By Dr. Golding
Bird. — {Ranking's Abstract.)

Although the important researches of Dr. Golding Bird are now
somewhat destitute of novelty, having been some time since embo-
died in the pages of the Medical Gazette, yet we think that we
shall be conferring a benefit upon our readers by reproducing the
more important portions of them in a condensed form, especially as
the publication of a separate and most valuable work on "Urinary
Deposits" comes within the limits of our retrospective labors. We
feci convinced that the brief summary which we shall give cannot
fail to produce the desire for a perusal of the original work : —

The principal pathological conditions of the urine which are com-
monly met with are the presence of uric acid and the urate of am-
monia, the oxalate oflimcjof the phosphates, and of certain elements
of the blood.

URIC ACID.

Diagnosis of uric acid deposits. Uric acid does not dissolve by
heat, but on the contrary is rendered more distinct by the solution of
the urate of ammonia which frequently accompanies it. Hence, in
examining for this deposit, heat the urine in a watch-glass; the uric
acid becomes visible as the urate of ammonia dissolves. Heated with
liquor potassas, the uric acid dissolves. With nitric acid it is also
dissolved ; leaving, on evaporation, a residue of a beautiful pink,
which becomes purple when held over the vapour of ammonia.

Microscopic characters. The original form of the uric acid crys-
tal is the rhombic prism. In order to observe these crystals, allow
the urine to repose in a tall vessel, decant the greater portion, and
place some of the turbid layer into a watch-glass and warm it gently ;
remove the supernatant liquor by a pipette, and replace it with dis-
tilled water ; the crystals' then become distinct. "All that is then
required, is to place on the stage of the microscope and under the
watch-glass, a piece of black velvet ; by means of a condensing lens,
let a strong light be thrown upon the crystals ; then bring the object
glass into proper adjustment, and the colour, as well as figure of the
crystals, will become beautifully defined on the black ground."

The rhombic form is, however, frequently replaced by others, espe-
cially by the square. Sometimes the crystals approach the figure of
a fleur-de-lys, at others, they appear as flat tables, curiously mark-
ed with longitudinal strite, giving the appearance of a fimbriated

1845.] PaihoIogy,t^''C., of the Uriuanj Deposits, 643

edge. The coarse sand, which is of a red or deep orange color, is
crenerally composed of cohering, thick, rhomboiual prisms, forming,
indeed, minute calculi.

Diagnosis of urate of ammonia. These deposits vary in colour
from absolute whiteness to a pale fawn colour, brick red, pink, or
purple. The deposit does not appear until the urine has cooled, and
disappears on the application of heat. If urine containing this de-
posit be placed between two glasses and examined with the micro-
scope, it is found to be cojnposed of myriads of minute globules,
forminfj linear masses, or delicate stellate figures.

Circumstances giving rise to the uric acid and its compounds,
" Excluding all abstract theories, whenever an excess of uric acid, or
its combinations, occur in the urine, a normal quantity of water being
present, it may safely be inferred that one or other of the following
states exist : —

A. Waste of tissues more rapid than ) Fever, inflammation, rheu-
the supply ^ matism, phthisis.

B. Supply of nitrogen in the food^ Excessive indulgence in an-
greater than is required for the repara- [> imal food, or too little ex-
tion of tissues J ercise.

c. Supply of nitrogenized food not in '^
excess, but digestive functions unable I All grades of dyspepsia,
to assimilate it J

D. The cutaneous outlet for nitrogen- "^

ized excreta being obstructed, the kid- ! All diseases attended with
ney is called upon to compensate for [ arrest of perspiration,
this deficient function J

^ ^. r .1 1 • 1 'I Blows, and strains of the

E. Lon«xestion of the kidnevs, pro- i ■ j- r *i

J , , "^i , . 'I L loins, diseases 01 the cren-

duced bv local causes I . i .

J ital apparatus.

The medical treatment of this condition of the urine must be based
upon the due discrimination of the exciting cause. If the first con-
dition be the cause, the remedy obviously consists in the withdrawal
of a portion of the animal food, or aii increase in the amount of ex-
ercise. Under the other conditions of the system the treatment
resolves itself into the following indications : —

1. Attention to the functions of the skin. This is an indication of
much consequence. Warm clothing, with repeated friction by means
of a hair glove, removes the deposit of uric acid gravel. The warm
bath, and still better, the vapour bath, is also a most valuable diapho-
retic. The latter, is conveniently applied in private practice by
means of Duval's apparatus. Actual diaphoresis is by no means ab-
solutely necessary.

2. Restoring the tone of the organs of digestion. This part of the
treatment of calculous affections must be modified by the peculiarities
of the case, and is identical with that of the different forms of dys-

644 Pathology, <^c.i of the Urinary Deposits. [November,

pepsia. Great relief may be obtained by careful attention to the
bowels, and minute doses of mercury, as a grain of hyd. c. creta,
with three grains of extract conii, given three times a day, with mod-
erate doses of the carbonate of potash in infus. serpentariae. Gas-
trodynia and pyrosis may be met with half grain doses of argente
nitras, given immediately before a meal.

3. Remedies which act as solvents. These chiefly consist of alka-
lies and their carbonates ; the biborate and phosphate of soda, and
benzoic acid. The liquor potassae may be employed in half drachm
doses thrice a day. The carbonate of potass and soda are, however,
more agreeable forms, and of these the bicarbonate of potass is to be
preferred. The latter may be usefully combined with citric acid, in
the proportion of grs. V. to 3ss. of the bicarbonate, dissolved in a
tumbler of luke-warm water. This mixture evolves enough carbonic
acid to be "sparkling," and is taken M'ith readiness.

It is to be remembered that some persons cannot bear the free u^e
of alkalies without suffering severely in their general health. Dr.
Front affirms that their injudicious use may lead to the formation of
oxalic acid.

Other solvents are the biborate and the phosphate of soda ; the
latter is specially recommended by Liebig ; the dose should be 3j. to
5ss, largely diluted. Dr. Bird states that he has administered this
drug in two or three chronic cases of uric acid gravel with great
effect.

The benzoic acid has likewise been much praised of late, having
been first introduced by Mr. Ure. It may be given in ten-grain
doses, dissolved in a weakselution of phosphate of soda, as below : —

R. Sodsb carb. 3jss.
Acid, benzoic!, 3ij.
Sodse phosphatis, 5ii^.
Aquae ferventis, giv.
AquaD cinnamoni, sviiss.
Tinct. hyoscyami, 3iv. M. ft.
Sumat. seger. coch. in magna ier in die.

It is important to bear in mind, that, by the employment of reme-
dies capable of dissolving a deposit in the urine, we are merely pallia-
ting, and not curing the disease. Its entire removal can only be
accomplished by remedying that state of the system, or of a par-
ticular organ, which may be the exciting cause of the calculous
formation.

PTJKPURINE.

Urine containing this substance is of a pink or purple colour, and
of variable specific gravity. The purpurine is deposited in conjunc-
tion with urate of ammonia, where that product is in excess, and
gives to it a deep carmine colour. If the urine be evaporated to the

1845.] Pathologic <^c,i of the Urinary Deposits. 645

consistence of an extract, and treated with alcohol, it yields a fine
purple tincture. This property will at once distinguish the colouring
matter from that of blood, for which it might otherwise be mistaken.
Pathological indications. The presence of purpurine in excess is
almost invariably connected with sotne functional or organic mischief
in the liver, spleen, or some other organ connected with the portal
circulation. It is, therefore, in its lighter shades, a common occur-
rence in the dyspepsia of the intemperate. Pink deposits are almost
constantly present in cirrhosed or contracted liver.

OXALATE OF LIME.

Dr. Bird was the first to point out the frequent occurrence of this
deposit ; neither Prout, (until his last edition,) nor Rayer, nor Willis,
have given to it the importance which it is now sufficiently clear that
it demands. It is, according to the observations of Dr. Bird, of far
more frequent occurrence in the densely populated cities than the
deposits of earthy phosphates.

Diagnosis and microscopic characters of oxalate of lime. To ex-
amine for this deposit, allow a portion of urine, passed soon after
meal, to rest in a glass vessel ; decant the upper fluid six-sevenths;
pour a portion of the remainder into a watch-glass, and warm it '
gently. This proceeding removes any obscurity arising from the
presence of urate of ammonia. Having then allowed the urine to
repose for a few minutes, remove the greater portion of the fluid with
a pipette, and replace it with distilled water. A while glistening
powder will now become visible, which, under a low magnifying
power, is found to consist of octohcdral crystals of oxalate of lime.
These crystals, ignited on platinum foil, give a residue of carbonate
of lime. The octohedral is the ordinar\^ shape of the crystals, but
the}'^ sometimes assume other forms, the most usual of which is that of
a dumb-hell.

A very constant phenomenon observed in the microscopic examin-
ation of oxalic urine, is the presence of epithelial scales. So constant,
indeed, is this occurrence, that the presence of the latter has fre-
quently led to the suspicion of the presence of oxalate of lime.

Pathological origin of oxalate of lime. This is a question of very
great interest. It is scarcely possible to avoid being impressed with
the probable physiological connection between this matter and the
presence of sugar. It is indisputable, that saccharine matter finds its
way to the blood under certain circumstances, and is eliminated by
the kidneys; and vve know that, under certain morbid influences,
the blood may, while in the stomach, be rapidly converted into suo^ar,
and pass by the kidneys as an effete matter. Recollecting, also, the
facility with which sugar and its chemical allies, as gum, starch, &;c.,
are, under the influence of oxydizinjr agents, converted into oxalic
(icid, we are tempted, with Dr Prout, to the conclusion that the
oxalate of lime owes its origin to sugar.

i)r. Bird, however, has observed in oj)position to this opinion : —

646 Pathology, i^'C, of the Urinary Deposits. [November,

1. That in the urine oxalate of lime is diffased through the fluid, and
in a crystalline form. 2. That the urates are in excess in the ma-
jority of cases. 3. That in all there is more urea than in healthy
urine of the same density. 4. That there is frequently an excess of
the phosphates attending the oxalate of lime. 5. That no evidence
of free sugar has occurred in the specimens submitted to examination.
Now, in diabetes there is seldom an excess ot'urea or the urates, the
increased specific gravity depending solely on the presence of sugar.
Thus so far as the abstract examination of the urine is concerned, no
countenance is given to the idea of there being any relation between
oxalic p.nd saccharine urine. What then is the source of the oxalate
of lime?— from the symptoms alone which accompany the deposit,
there can be no doubt of the existence of serious functional derange-
ment of the digestive organs, especially of the stomach, duodenum,
and liver. Whatever, therefore, be the immediate agent which cau-
ses the kidneys to secrete oxalic acid, the primary cause must, as
shown by Dr. Prout, be referred to the digestive apparatus. It must
be recollected, also, that an excess of urea, and often of uric acid, in
most instances accompanies oxalic urine ; it is probable, therefore,
that both these products are the result of the same morbid influence ;
and when the close chemical relation between urea, uric, and oxalic
acid, is borne in mind, is it not a legitimate conclusion that the dis-
ease under consideration is a variety of azoturia, in which the vital
chemistry of the kidney converts part of the urea, or the elements
%vhich in health would have formed urea, into oxalic acid?

Symptoms accomj^anying the secretion of oxalic acid. As a gene-
ral rule, persons aflected with oxalic urine are remarkably depressed
in spirits, and exhibit a peculiarly melancholy aspect. Dr. Prout
mentions a lurid tinge on the skin. They are generally emaciated,
hypochondriacal, and irritable in temper. The sexual power in men
is deficient or absent. There is usually a constant pain or sense of
weight in the loins, with great derangement of the assimilative pow-
ers.— [To these may be added, according to Dr. Bence Jones, fre-
quent desires to micturate ; the urine in some cases being scanty, at
others profuse in quantity.]

The most common exciting causes appear to be exposure of the
lower part of the spine to cold, mechanical violence in the same re-
gion, and unnatural excitement of the sexual organs, as is shown by
the frequent concomitant of involuntary seminal emissions. In ma-
ny cases there v.-as no obvious cause beyond mental anxiety and
attention to business.

Therapeutical indications. The treatment in the majority of
cases is very successful. As a general rule, all the functions of the
body, when obviously imperfect, should be corrected; the skin
should be protected by flannel ; and the diet carefully regiilated.
This should consist of well-cooked digestible food, of vegetable and
animal subslances ; all things wliich tend to produce flatulence being
carefully avoided. Beer and wine should not be allowed, especially

1815.] Pathology,<^c.,of the Urinary Deposits. 647

the former. If some stimulus be required, the best is weak brandy
and water. The nitric acid, or the nitro-muriatic acid in infus.
gentianae, if continued sufficiently lonrr, will generally be found suc-
cessful. In cases where these have failed, active tonics, especially
the sulphate of zinc, or if the patient be anemic, the salts of iron,
appear to be of great use, as is likewise the shower-bath. There is
one remedy which appears to exercise a marked influence over the
characters of the urine, and which holds out great promise of utility
inoxyluria — this is colchicum. In two instances in which oxalate of
lime existed in abundance before its employment, uric acid reappear-
ed and replaced the oxalic acid in a few days.

EARTHY PHOSPHATES AXD CARBONATE OF LIME.

Diagnosis. The earthy salts are always white unlesss coloured
with blood ; they are soluble in dilute hydrochloric acid, and insolu-
ble in ammonia or liquor potassa?. Heat does not clarify the urine.
The chief errors in diagnosis arise from the presence of mucous and
pus in the urine, which mask the chemical character of the earthy
deposit.

The physical appearance of these deposits is variable; where it
consists chiefly of the triple phosphates it subsides as a white crys-
talline gravel, or if the quantity be small it appears on the surface of
the urine in the form of an iridescent pellicle. At other times the
phosphates will fall to the bottom like a dense cloud of mucus, or
hang in ropy masses so similar to that product as not to be dis«
tinguished from it by the naked eye.

The urine which deposits these salts is not necessarily alkaline ;
it is pale, secreted in large quantities, and of low specific gravity
(1*005 — 1'014.) In the ease in which the iridescent pellicle ap-
pears, there is usually present a form of irritative dyspepsia, but this
is merely a functional and not an organic derangement, the urine
being often of high specific gravity (1-020 — 1*030,) and containing
an excess of urea. At other times, the urine is deep brown, fcEtid,
generally alkaline, and loaded with ropy mucus, in which the crystals
of the triple phosphate will be discovered.

Pathological indications. These deposits always denote a serious
state of things, being generally indicative of severe functional, and
oftentimes of organic mischief. They always co-exist with a de-
pressed state of nervous energy, which is often generally and more
rarely local in its seat. Of the former we have instances in the wear
and tear of body and mind in old people ; of the latter in injury to the
spine. The occurrence of the triple salt, unconnected with deposit
of phosphate of lime, exhibits the least alarming course of events. It
is generally in these cases signalized by irritability of temper, rest-
lessness, uncertain appetite, and fatigue on slight exertion.

In the milder cases of indiij;estion, especially in gouty habits, the
phosphates appear in the form of the pellicle before mentioned.
This condition of tiie system is disinclined to the formation of stone,

648 Pathology, <SfC.,nfihe Urinary Deposits. [November,

but is rather to be regarded as an index of the state of the assimilative
functions. A valuable diagnostic mark in these cases, in contra-
distinction to those where organic mischief is to be apprehended,
consists in the fact that in the slighter cases the phosphates appear
only in the urine passed at night.

The triple salt likewise appears in the urine of very old people,
especially if they have been deprived of the ordinary comforts of life,
and occasionally also, as has been noticed by Simon, in acute dis-
eases, as pneumonia and pleurisy, at a time when convalescence has
barely commenced.

In those cases in which the phosphates appear in the form of
strings resembling mucus, the two classes of salts are usually found
mixed. The urine is then almost invariably alkaline, and more or
less foetid. The prognosis is always unfavorable in such instances,
as either organic disease of the urinary apparatus, or some serious
lesion of the spinal marrow, is almost invariably to be suspected.

Therapeutical indications. In considering the treatment of the
phosphatic diathesis, as it is sometimes called, four different patho-
logical conditions are to be taken into account, each of which is de-
monstrated by a separate process of symptoms.

A. Cases in which dyspepsia, with some febrile and nervous irrita-
tion, exists independently of any evidence of antecedent injury to
the spine.

B. Cases characterized by high nervous irritability, with a varying
amount of marasmus, following a blow, or other violence inflicted on
the spine, but without paralysis.

c. Cases in which the phosphatic urine co-exists with f>araphlegia,
results of spinal lesion.

D. Cases of diseased mucous membrane of the bladder.

Of these it will be only necessary to direct attention to the first,
second, and fourth series of cases, as in the third the deposition of
phosphates is a mere symptom of a serious lesion, which, whether the
result of violence, or of insidious disease, must be treated according
to the particular disease existing.

The first class of cases indicative of the presence of irritative
dyspepsia is by no means uncommon. The treatment must be di-
rected rather by general principles than limited to the solution of
the phosphates. The exliibition of acids is merely palliative, and
rather does harm in some cases, by masking an important symptom,
while the 'fons et origo mali' still continues in full force. After a
certain attention to the moral bearings of the case, our principal
attention should be given to the re-esfablishment of the general
health. The bowels are to be regulated l>y mild mercurial laxatives,
active purging being striclly avoided. When this has been accom-
plished, the following combination will be of use: — Tine hyoscyami,
et Sp. ammon. aromat. aa T^lXX, et Misfur. gent. c. § j. Should
gastrodynia exist, great relief will be obtained by the administration
of the oxyde of silver in halfgrain doses. As the patient apprcachts

1945.] Pathology f <^^c.f of the Urinary Deposits, G49

convalescence, considerable benefit will be derived from the sulpliate
of zinc in increasing doses, till four or five grains are taken thrice
in the day.

The second form of the disease, which is characterized by a higher
amount of nervous excitability, and by rapid emaciation, is more
rare, but less amenable to treatment than the preceding. In this
form the deposit is copious, and sometimes consists nearly exclusively
of the phospfiate of hme. The symptoms are lumbar pain, dry
skin, red and varnished tongue, great thirst, and other symptoms
closely resembling diabetes. The history generally affords some
evidence of a strain or hurt of the back.

In the treatment of these cases, our chief aim must be to tranquil-
lize the brain and nervous system by narcotics, as opium or morphia,
as was first suggested by Dr. Prout, after which a generous diet,
With the mineral tonics, as bismuth, zinc, or silver, are called for.

In some cases the symptoms are of a milder character, but there
is a great tendency to the formation of a calculus : it is in these
cases that acids are called for, but there is much uncertainty attend-
ing their use. The nitric appears the most serviceable; and the
benzoic as recommended by Mr. lire may be occasionally beneficial ;
but Dr. Bird puts but little faith in either, especially the lattef.

The third class of cases, in which the phosphates are in all pro-
bability secreted by the unhealthy mucous membrane of the bladder
are familiar to all, as frequently following chronic cystitis, retention
of urine, from stricture and enlarged prostate. Here of course the
primary disease must be treated, and not the mere symptom. It is
in this form in which much good occasionally follows the injection of
dilute acid into the bladder. An interesting case, in which this mode
of treatment was completely successful after every other plan had
failed, is related by Dr. Bird, to whose work we refer, as our space
will not allow of its extraction. Deposits of carbonate of lime,
and silicic acid are occasionally met with, but not sufficiently often
to render their notice of any great importance.

ALBUMINOUS URINE.

Detection of albumen. As a general rule, if urine becomes opaque
by heat, and on the addition of nitric acid, albumen is present; but
if one of these tests alone be employed, there is the possibility of
being misled by the following sources of fallacy : —

1. Heat will produce a white precipitate in urine, containing an
excess of the earthy phosphates. This is dislingtiished from albu-
men by disappearing on the addition of a drop of nitric acid.

2. Ileat, when applied to urine containing deposits of urate of
ammonia, will sometimes, if actual ebullition be prolonged, produce
a deposit of an animal malter insoluble in nitric acid. But this ap-
pearance is rare, and is distinguished from albumen by being depo-
sited only after protracted ebullition.

3. Nitric acid will produce deposits in the urine of persons who

650 Treatment of Traumatic Tetanus. [November,

are taking cubebs or copaiba ; this is distinguished by notbeing pro-
duced by heat.

4. Albumen may be present, and yet not be precipitated by heat,
if the urine be alkaline ; nitric acid must be used in this case as a
test, since albumen combined with alkalies is not affected by heat.

Therapeutic indications. When albumen is the only constituent
of the blood present in the urine, the treatment will vary, accordingly
as the kidney is merely congested or is structurally affected. [The
treatment of the latter is not here alluded to, but the reader is refer-
red to the works of Blight, Christison, &;c. The management of
the congested kidney, as it occurs in the dropsy of scarlatina, is thus
described :] — The warm bath is the most valuable prophylactic re-
medy. I scarcely recollect, even in a large experience, a case of
dropsy after scarlet fever, when the warm bath has been daily used as
soon as the skin has begun to exfoliate, and continued until a per-
spiring healthy surfc\ce was obtained. When anasarca has occurred,
strict confinement to bed must be enjoined, the warm bath used
twice a week, and free action of the skin encouraged. This plan
must be continued until all anasarca has vanished, and the urine is
free from albumen. When this has taken place, the ammonio-tartrate
of iron and more liberal diet will speedily remove the anaemic condi-
lion of the patient.

BLOODY URINE.

The presence of the blood-globules in the urine may be recognised
by the microscope. The treatment will vary according to the imme-
diate cause of the hemorrhage. Absolute rest, cold to the loins, the
mineral acids, and acetate of lead administered boldly, and for a
short time, are our principal remedies. No remedy has, however,
appeared to Dr. Bird so efficacious in the treatment of hsematuria as
the gallic acid. It should be given in five grain doses with mucil-
age and tincture of hyoscyamus.

Treatment of Traumatic Tetanus. By James Miller, Esq., Profes-
sor of Surgery in the University of Edinburgh. — {Braithwaite)

The case which calls forth the following comments, by Mr. Mil-
ler, was that of a girl of seven years of age. We refer to it in this
place chiefly to show the value of the Indian Hemp in its treatment.
The wheel of a cart had passed over the middle finger of the right
hand, and of course had inflicted a severe injury. Tetanus gradual-
ly made its appearance.

The peculiar risus had begun ; the jaws were clenched ; the mas-
seters and temporals were tense and hard, and the seat of much pain ;

1315.] Treatment of Traumatic Tetanus. 651

the limbs, especially the upper, were becoming rigid; the abdominal
parietes were hard ; the least exertion, such as endeavoring to open
the mouth, and show the tongue, induced ag^jravation, with marked
opisthotonos ; and then, too, pain was complained of, not only in the
jaws, but in the back. The finger had never promised well for sat-
isfactory recovery ; and I had no doubt as to the propriety of its
immediate sacrifice ; being well aware, that although in it resided
the exciting cause of the formidable train of symptoms fast setting
in, yet that removal of this could be expected to prove beneficial,
only at a very early period of the case, ere the spinal cord had been
all but irretrievably involved. Amputation was accordingly per-
formed, with as little delay as possible, at the metatarso-digital arti-
culation. Little pain was complained of; and blood flowed but spar-
ingly. I abstained from deligation of any vessels ; partly, because a
moderate loss of blood might not be without its use, at this the com-
mencement of the treatment ; but chiefly, because I was anxious, by
avoidance of the use of ligature, to leave the wound in as favourable
a state as possible — free from al! source of further irritation. For a
like reason, no stitches were employed; sufficient approximation be-
ing effected by tying the adjoining fingers together by a slip of
bandage.

Water dressing was applied, and 20 drops increased to 30 drops
of the tincture of Indian hemp every hour or two, were administered.
The further account and result of the case will be best seen in the
following remarks by Mr. Miller.

Perhaps the first questions which present themselves, in regard to
the foregoing case, are — was this an example of acute tetanus? or
was it, from the beginning, of the chronic character ? According to
my own conviction, I have no hesitation in answering the former
question affirmatively : and the latter, by a negative. And this I do
on the following grounds : — 1st, The case was traumatic : the affec-
tion following a wound, is usually acute. And, in this instance, the
accession was at the usual time, and in the usual way. 2nd, The
symptoms, at first severe, gradually, yet very perceptibly, gave way
before the treatment employed. The trismus, opisthotinos, and
rigidity of the upper extremities, as well as of the abdominal muscles,
were at first great, and underwent frequent and cruel exacerbation ;
and these aggravations were induced by the slightest exciting cause.
Rigidity gradually relaxed ; and the exacerbations became less pain-
ful, less frequent, and less easily induced. 3rd, During a temporary
interruption of the treatment, the symptoms threatened to return to
their original severity ; and again yielded to the resumption of the
appropriate remedial means.

Then, as to the treatment- For some time I have been satisfied
that in the treatment of traumatic tetanus, the most likely means of
relief are to be found — 1st, In early amputation of the irijured part,

653 Treatment of Traumatic Tetanus. [November,

or isolation of it from the general nervous system by suitable incision
on the cardiac aspect ; 2nd, In effectual and early evacuation of the
bowels, and maintenance of free movement in them ; 3id, In main-
taining a sedative effect on the nervous centre implicated in the dis-
ease, by cold applied to the spine ; 4th, In the continued use of some
one remedy calculated to allay muscular spasm — perhaps, aconite,
Indian hemp, or tobacco; 5lh, In careful administration of nourish-
ment, so as to husband the strength as much as possible ; 6th, In
maintaining quietude, and avoiding all excitement likely to induce
aggravation of the spasm.

1. As already stated, there could be no doubt as to the propriety
of amputating the offending part in this case; and the operation was
accordingly performed, as soon as the tetanic symptoms were fairly
declared. The comparative absence of pain and bleeding, during
the incisions, was characteristic of the disease. The nerves of the
removed finger were examined by Mr. John Goodsir, and found im-
bedded in dense inflammatory exudation — themselves expanded in
bulk, and presenting the appearance of considerably increased vascu-
larity. Were a similar case of injury to present itself, with like ten-
dency to spasmodic flexion of the parts implicated, I should be
inclined to regard that symptom as ominously premonitory, and should
feel called upon, by early amputation, to sacrifice the part, even
though it might otherwise afford good prospect of its own recovery.

2. The first prescription was a full dose of calomel and jalap, while
the power of swallowing was yet comparatively free. It answered
well, bringing away much foetid and dark-colored matter from the
bowels, as usually happens in such cases. Sufficient action was af-
terwards maintained by enemata, containing turpentine and tincture
of assafoetida. During convalescence, a marked perversion of the
intestinal secretions persisted, and was got rid of only by a corres-
ponding continuance in the use of alterative aperients.

3. Since the perusal of a case of hydrophobia, treated by Dr. Todd,
of King's College, London, and published in the Lancet, No. 960,
p. 583, I have felt very hopeful of ice applied to the spine, as a reme-
dial agent, not only in that disease, but n)ore especially in tetanus.
And I was determined to make trial of it on the first opportunity.
Its action is obviously sedative on the nervous system ; powerlully
and directly so. So soon as circumstances permitted, it was had
recourse to in this case, and was maintained in constant, or almost
constant operation for ten days ; the bngs of ice being laid along the
whole spine, but with the chief efiect directed on the upper part.
Forewarned by the circumstances of Dr. Todd's case, I was prepared
to use this remedy with much caution, aware that the sedative pow-
er might prove excessive, and might demand not only considerable
intermission of the application, but a cotemporaneous use of general
support, and, perhaps, of stimuli. I was surprised to find, however,
that no occasion for either presented itself. The pulse kept low,
cerlainly, and of but sparing strength, but not too much so. And the

1845.] Treatment of Traumatic Tetanus* 653

only complaint made of the application, by the patient, >vas the at-
trihnting to it the severe pain folt in the back, which was caused,
doubtless, by the opistihotonos. When the sytnptomd had plainly
begun to yield, the ice was discontinued ; particularly as, about that
time, tendency to free perspiration began to manifest itself. Very
shortly after discontinuance of the cold, two marked exacerbations
occurred — at a time when these had greatly abated ; but as there
was no recurrence, I did not think it necessary to resume the ap-
plication.

4. Of the three anti-spasmodics formerly enumerated, I was afraid
of the tobacco, in so young a patient, having both seen and heard of
its unmanageable action. Few will deny, that, with every precau-
tion in its use, it has again and again seemed not remotely connect-
ed with the fatal issue, more especially in urgent cases of hernia. Of
the aconite I had no experience, as an opponent of spasm. Of the
cannabis I had ; having used it in private practice. Besides, the
report of Dr. O'Shaughnessy's success with this remedy, in at least
mitigating the sufTerings in tetanus, naturally leads to a prepossession
in its favor in an unprejudiced mind. I resolved to give it a fair
trial. It was begun in a very moderate dose, which was gradually
increased, until about three grains of the resinous extract were taken
every half hour — a full dose for an adult, in ordinary circumstances,
without repetition. A few dosesusually induced sleep, with marked
mitigation of the spasm ; and on the patient's emerging from the
state of narcotism, the remedy was resumed, and steadily continued
until a siinilar result was obtained. The period of narcotism, and
consequent intermission of the medicine, did not usually exceed two
or three hours. The sleep was deep and unbroken, and seemed to
be refreshing. It certainly was followed by no headache, or other
apparent inconvenience. The eyelids were seldom, if ever, shut, as
in ordinary sleep; but remained half open, disclosing the eyes, dull
and upturned, and giving to the countenance a very peculiar expres-
sion. While the exhibition of the drug was at its maximum, great
irritability and peevishness of temper was shown by the patient, dur-
ing her waking moments ; but it were, probably, unfair to attribute
this to the medicine.

As the symptoms began to recede, the cannabis was proportiona-
bly diminished in dose. Ultimately, it was discontinued altogether,
while yet a hardness of the abdominal muscles remained ; it seeming,
then to meet with comparatively little tolerance in the system, and
to induce a quick and irritable state of the circulation. Throughout
the whole period of its use, its effects on the appetite was most obvi-
ous; but greatest, as was to be expected, during convalescence.
The craving for food, of all kinds, was stated to be, at times, abso-
lutely voracious.

In this case the CoIeraTiCe of the cannabis, engendered by the teta-
nus, must be apparent to every one. A slim girl, seven years of age,
took every half hour — and sometimes for many hours in succession —

654 Treatment of Traumatic Tetanus. [November,

a dose of hemp sufficient to throw a healthy adult into strong narcot-
ism. Also, the unfavorable effects which commonly follow experi-
ments with it, on ordinary patients, whose ailments (if any) do not
require the remedy — -as headache, delirium, visions, vertigo, vomit-
ing, palpitations, general feeling of great discomfort, &;c. — seem to
have been wholly absent in this case, where uature demanded the
use of the medicine.

The Indian hemp I believe to be comparatively valueless, as an ano-
dyne, as well as a hypnotic, in ordinary circumstances ; and as such
I would not think of administering it. Its virtue seems to consist in
a power of controlling inordinate muscular spasm ; and the result
in this case has certainly tended to confirm that opinion. I shall
not attempt to separate the various remedial agents employed; ap-
portioning to each their share in the fortunate issue. I consider that
the early amputation, and subsequent gentle treatment of the wound,
may have done some good. I have no doubt that very great benefit
followed on the due evacuation of the bowels. The cold to the spine
may have been beneficially co-operating, perhaps in no inconsidera-
ble degree. Yet, I am inclined to ascribe the greatest portion of the
benefit to that remedy of which the system proved so remarkably
tolerant — the cannabis Indica.

5. The fifth indication of cure was never lost sight of. From the
first, very strong beef tea was ordered to be always in readiness, and
to be frequently administered. As the trismus yielded, and the power
of swallowing was regained, ordinary food was offered in addition,
and usually was taken with greediness.

6. In the open ward of a public hospital, it is not easy to obtain
quietude for the patient, and avoidance of excitement to spasmodic
aggravation. I have no doubt that, latterly, many of the aggrava-
tions were attributable to the circumstance of this indication being
necessarily so imperfectly fulfilled. In conclusion, I would beg to
state, that I have no wish to arrogate for the cannabis more virtue
than what may seem its just due. The case may have been of a
chronic character throughout, though, in my humble apprehension,
it is very far from being apparent that such was its nature. At all
events, by this case, evidence as to the action of the cannabis Indica
seems to be borne to the following effect : —

1st. It has the power — probably not slight — of controlling inordin-
ate muscular spasm. 2d. In tetanus there is a marked tolerance of
the remedy ; both as regards the safe exhibition of large doses, in
frequent repetition, and the absence of such unpleasant consequen-
ces as the usual dose, in ordinary cases, is apt to induce. 3J. With
its anti-spasmodic virtue, in appropriate cases, it probably conjoins
hypnotic and anodyne properties, though in a minor degree. 4lh.
It has the effect of remarkably increasing the appetite ; and digestion
does not seem to be impaired. The dejections, though dark and
offensive, contained no unchanged ingesta. 5th. It does not induce
constipation. 6th. On recedence of the tetanic symptoms, the dose

1S45.] Treatment of Traumatic Tetanus, 655

of the medicine should proportionably decrease. The tolerance is
passing off, and if the original dose be continued, some of the unto-
ward effects are not unlikely to occur.

In a case of idiopathic tetanus which occurred in Guy's Hospital,
and reported by Mr. Arnold, the symptoms were chiefly those which
characterize this disease, and Dr. Babington prescribed the Cannabis
Indica as follows : —

Extract of Indian hemp, three grains ; rectifie'd spirit, half a drachm.
Mix tor a dose, to be taken every half hour in a spoonful of barley-
water. The effects of each dose to be carefully watched. The first
dose was taken at twelve o'clock. At half past twelve the pulse was
92, and intermitting. In a quarter of an hour after the second dose,
the patient showed symptoms of excitement ; his eyes brightened,
and the masticatory muscles seemed to him to be less rigid ; no pri-
apism, but some little flushing of the face ; pulse 102. A moisture
on the face and hands now appeared, amounting, on the latter, to
profuse perspiration, accompanied with tingling. Just before the
third dose the pulse was 107, and still irregular; the rigidity, howe-
ver, was decidedly less. Third dose — He swallowed better than the
preceding. Fourth dose — Respiration twenty-two ; pulse 1'2S ; dis-
posed to sleep. Fifth dose — Respiration the same. He complains
of pain in the back and occiput, and of lying, as it were, on some-
thing very hard ; but he rests motionless, with composed features,
and is drowsy. He swallowed this dose without much difficulty. At
a quarter past two (fifteen minutes after taking the dose) he fell into
a quiet sleep. The dose of Indian hemp was now augmented to five
jjrains in fiity minims of spirits to be taken in barley-water every two
hours. The sixth dose was taken at three o'clock. Respiration
twenty ; pulse 110, full and strong. He had a general perspiration,
swallowed well, and said that the pain in the back and occiput was
relieved ; bowels not yet moved.

Ordered, at half-past four, a turpentine enema, and to continue the
extract; and at eleven, p. m., twelve grains of calomel.

May 3d. Ten o'clock, a. m. — No dose had been administered
from eleven o'clock on the preceding night, utill two; and again at
four, one was given. He has had in all forty-eight grains of the ex-
tract, up to the present time, and has now just taken another dose.
He dozed all night, but had no sound sleep. Bowels still constipated.
Ordored, in the afternoon, an enema of turpentine, with two ounces
of castor oil. To repeat the extract of Indian hemp every hour, and
to have one plaster of this material placed on the chest, and another
along the spine. The patient was at this time in nearly the same
state as when admitted, but complained of greater pain in the lumbar
and dorsal regions. No spasm in the extremities, but some numb-
ness in the fingers. He feels that he has less power over himself
than before, and cannot now turn in his bed. Perspires a great deal

656 Treatment of Traumatic Tetanus, [November,

on the face and forehead, as well as on other parts ; and the skin is
warm as well as moist. Pulse about 80, (thoujrh it varies considera-
bly at difTerent times,) regular and strong. The patient does not
swallow better than he did yesterday; there is a catching in the
epigastrium when he swallows or speaks, though the ordinary breath-
ing is more free than yesjerday,

4th. Ten o'clock, a. m. — Buwels freely opened last night, and
again this morning ; motions are solid and shapeless, "just like a
piece of liver" in appearance, and smell strongly of the remedy. He
passed a very restless night. Great pain is induced by attempting
to speak; the mouth is quite closed, and the disease appears to be
slowly gaining ground ; pulse 100, with less power than before. The
patient complains of the medicine as burning his throat. Ordered,
six ounces of wine, and to continue the extract. Two, p. m. —
Spasms in the trunk have grown stronger since the morning, and
incretij^ed in frequency, occurring now about every five minutes, and
sometimes apparently extending down the left leg, causing violent
pain throughout the whole body, and occasionally jerking the patient
off his back; pulse the same. At four, p. m., Mr. Stocker saw him,
. and ordered the extract of Indian hemp to be administered, in an in-
jection ofa pint of beef-tea and wine. This was done at the hours
of tour, six, nine, and twelve, the last time with the addition of an
egg ; and on the 5th, at two, four, and six o'clock, a. m.

5th. Eleven, a. m. — The injections have all been retained. He
got a little sleep, at intervals, during the last night, and says that he
is in less pain than yesterday, yet still complains of much pain about
the mouth. The muscles of the face are less contracted, and the
teeth can be separated to the width of about a quarter of an inch.
He has a control over his arms and legs, and can draw the latter
upwards ; spasms less violent, though more frequent, occurring every
two or three minutes; bowels confined; pulse about 100 ; more
feeble; breathing easy. Ordered, four ounces of brandy, with two
eggs, in a pint of beef-tea, and a little decoction of starch, to be ad-
ministered as an injection, every four hours. This was done at
eleven, a m., two, six, and eleven, p. m. ; and on the 6th, at two,
half-past five, and ten, a. m.

6th. Three, p. m. — Injections retained. Very restless all the
past night; complains of feeling cold this morning, and drowsy;
could not sleep, however, for the spasms, which have become strong-
er; there is more difficulty of breathing ; but he retains the free use
of his arms and legs. His mind has wandered at intervals during
the day, but he now answers questions rationally; pulse 110, with
some sharpness; much less perspiration to-day. He had, a little
while since, requested to have a little brandy in barley-water, but the
first gulp of it brought on a violent spasm, that prevented its being
swallowed. Complains of the light and noise of the ward.

7th. Half-past twelve, p. m. — The injections have been continu-
ed. He craves after brandy, and the previous night some was given

1845.] Treatment of Traumatic Tetanus, 657

him in water, which he contrived to swallow ; his mind rambled dur-
intjthe night, as it has durin;^ the day, but he answers questions ra-
tionally ; perspiration returninfr, and spasms diminished; he can
open his month better ; pulse 120 ; bowels still constipated. Ordered
the enema of turpentine and castor oil, as before, and to continue
the Indian hemp. Two, p. m. — one injection had returned ; the
rest were retained. At 6 o'clock Mr. Stocker visited him ; the
spasms were again more frequent; the thoughts of the patient still
wandered, but he protruded his tongue when told ; pulse 160 ; powers
rapidly declining; and at half-past two the next morning. May 8th,
he died.

The exact quantity of the extract of Indian hemp administered,
whether by the mouth or per anum, is ascertainable from the dis-
pensary book, which shows that the following quaq^ities were made
up for this patient : —

May 2d. Eleven, a. m., twenty-four grains. Four, p. m., twenty-
four grains.

3d. Nine, a. m., twenty-four grains. Four, p.m., forty-eight grains.

4th. Ten, a. m., forty-eight grains. Ten, p. m., twenty grains.

5th. Seven, p. m., forty-eight grains

6th. Ten, p. m., forty-eight grains. But, of the last named quan-
tity, thirty. six grains remained after the patient's death. It thus
appears that the total quantity taken amounted to two hundred and
forty-eight grains. It was obtained from three several sources, in
nearly equal proportion — viz: the first from Mr. Squire, of Oxford-
street ; the second, through Mr. Pearce, from a gentleman who
brought it from India ; and the third from Mr. Rouse, in the Borough.
The gentleman who supplied the second portion tested the effects of
one grain on his own person: it produced the symptoms of intoxica-
tion, with the excitement common in that state, to such a degree,
that it was found necessary to call in medical aid — a sufficient proof
of the potency of his specimen of the extract.

Mr. Potter, of Newcastle, thinks that the power of Indian hemp in
spasmodic affections is not sufficiently appreciated ; and publishes a
case of traumatic tetanus, in which it was used, and seemed to pos-
sess great control over the tetanic spasms. The patient had received
a severe laceration on the upper part of the right thigh, which ex-
posed the femoral vessels. Everything went on well till the twelfth
day, when symptoms of tetanus appeared. A large dose of calomel
and Dover's powder was then given, followed by ten grains of extract
of Indian hemp, repeated every two or three hours. As his bowels
were confined, two drops ofcroton oil were placed on the tongue, and
an injection given made \\\i\\

Tobacco leaves, one scruple ; boiling water, eight ounces ; macer-
ate ; strain for an enema. These produced free action of the

658 Treatment of Traumatic Tetanus. [November,

bowels. In consequence of the difficulty in swallowing, I determin-
ed to give the extract in the form of injection, and therefore ordered
him to have the following enema every two hours: — Extract of In-
dian hemp, one scruple ; strong beef-tea, six ounces : mix. This
was done, and the injections retained. No violent spasmodic actions
took place, but the back became gradually more and more arched,
so that it was necessary to place a pillow beneath. The extract did
not cause any marked symptom of intoxication, though it evidently
produced, at intervals, calm sleep. Without suffering any pain, the
disease gradually progressed, death taking place on the fourth day
after symptoms appeared. In this case, four drachms and two scru-
ples of the extract were administered, and to the action of this medi-
cine I attribute the freedom from pain and clonic spasm, which surely
is sufficient to induce any one to give this remedy a full trial in so
fearful a disease.*

The following case of idiopathic tetanus is given by Dr. Newbig-
ging : — The patient was a baker, who, while perspiring profusely,
went out to chop wood, at a time of intense cold. In the evening of
the same day he complained of tetanic symptoms, which gradually
increased. Dr. N. saw him first a week after the attack. The
pulse was natural; bowels constipated ; urine scanty. He was bled
to 12 oz. ; a drop of croton oil was administered, and a large blister
was applied to the upper part of the spine. The bowels were opened
by the oil, and he felt altogether relieved. Three days after, he was
again bled to 14 oz. ; and a strong dose of morphia with 30 drops of
tinct, cannabis ind. were given at bedtime. Three days after this,
spasmodic action had commenced in the limbs ; the dose of morphia
was then increased, and ordered to be given four times a day, and
elaterium to be used as purgative. Next day, croton oil was again
had recourse to, the elaterium having proved ineffectual. Dr. Aber-
crombie, at the same time, recommended the use of arsenic, which
was given with the morphia. He continued to improve for a week,
when he was suddenly seized with great dysphagia and tremors,
which were soon removed by placing him in the erect position. His
medicines having been discontinued for two or three days, were re-
newed. About five weeks after the commencement of the attack,
he expectorated a quantity of pus mixed with mucus, whick expec-
toration continued three weeks. He had afterwards thickening of
the spinous processes of the cervical vertebrae, and was attacked with
anasarca, which was subdued by diuretics, actively administered, and
in about three months he was able to return to business.

The principal features of interest in this case of what is considered

1845.] Opium in Fevers and Injlammatory Affections, 659

a rare disease in this country, are, the jrradual affection of the differ-
ent muscles of the body, commencing with those of the jaw, and the
successful issue of the treatment, which, however varied, may be
considered to have resulted from the persevering employment ofcro-
ton oil and opium ; for although arsenic, Indian hemp, colchicum,
&;c., were administered to him at different periods, I believe, to none
of these was so much benefit attributed by us — and he was occasion-
ally visited by Dr. Abercrombie, Sir George Ballingal, my father,
and Dr. Duncan — as from the exhibition of opium in full doses, with
the occasional use of croton oil ; for, whether we consider this medi-
cine to be endowed with any specific effect or not, as reasoning from
somewhat analogous cases of nerv^ous atrections I feel disposed to do,
it certainly seemed to be followed !)y greater relief to the tetanic
symptoms than when an ordinary purgative, such as scammon3% gam-
boge, &;c , was exhibited. I have occasionally observed benefit from
the Indian hemp in allaying irritation and causing sleep, particularly
when opium was contra-indicated ; but I am somewhat doubtful of
the value of this remedy in tetanus, and am disposed to think, that
no case where opium is so decidedly indicated can be benefited by
the administration of hemp, if the former powerful remedy has failed
to be of service.

Large Doses of Opium in the Treatment of Fevers and Inflamma-
tory Affections.

In the August No. of the 3Iissouri Medical and Surgical Journal,
we find an interesting article by A. G. Henry, M. D., of Pekin,
Illinois; on the treatment of Fevers and Dysentery with large doses
of Opium : and in the September No. of the same Periodical, Prof.
Thomas Barbour, M. D., of Kemper College, St. Louis, continues
the subject. After congratulating the profession on the appearance
of Dr. Henry's communication, who gives opium in four to six grs.
doses in fevers and dysentery, Prof. B. says —

There are two propositions which, I suppose, every accurate observer
will admit to be true, and if true, will afford a satisfactory explana-
tion of the utility of full doses of opium in febrile and inflammatory
affections : 1st, That all the j)henomena of the initial stage of mias-
matic fevers, and, I may add, of the acute phlegmasia?, clearly de-
monstrate that the first link in the chain of disordered actions which
constitute fever or inflammation, is a morbid impression on the ner-
vous system, the immediate ofiect of which is exalted sensibility, or
irritability, of which the successive events are necessary sequences:

660 Opium inFevers and InfMmmatory Affections. [November,

2d, That it is of paramount importance to control the nervous sys-
tern — the "the primum mobile" — the mainspring which gives impulse
to all the complicated actions that make up lever and inflammation ;
and that, in proportion as we do so, shall we be able to modify the
results of its action on the vascular and secretory systems.

The generality of practitioners attempt the accomplishment of the
important ohject referred to, by the use of agencies calculated to
subdue the effects of an unduly excited nervous system, and thus but
too often prostrate the powers of life ; the object of the opiate treat-
ment in connection with such agencies, to a prudent extent^ is to
directly modify and control the fountain of vital action, in order to
obviate its effects upon the animal economy, without the necessity of
so great an expenditure of the resources of nature.

Having these principles in view, I have been in the habit, during
the last four years, of using large doses of opium — say, 3 to 5 grs.,
in all the various modifications of fever, for the purpose — 1st, of
counteracting the febrile periodicity; 2d, of promoting the reactive
powers of nature ; 3d, of diminishing excessive evacuations ; 4th, of
quieting nervous irritability, and thus guarding against locaj conges-
tions and inflammations ; and, 5th, of shortening the course of fever.
1 have not regarded this valuable agent as the '•'febrifugum mag-
num,^^ to the neglect of any of the remedies of acknowledged effica-
cy ; but have used it as a powerful auxiliary to those means, and I
acknowledge that the efl'ects have been most gratifying. The con-
ditions in which I have used full doses of opium, say from 3 to 5
grains, are the following :

1st : Simple Intermittent. — I administer it — say 1 drm. tinct. opii,
or 30 to 40 grs. of Dover's powder, either alone, or in connection
with calomel and quinine, in the latter part of the apyrexial period, to
prevent the recurrence of the paroxysm ; and in the cold stage, to
shorten its duration, and lessen the violence of the succeeding hot
stage. So frequently havo I succeeded in warding off a chill by the
use of opium, together with warm stimulating drinks, that if quinine
could not be obtained, I would place more confidence in it as a sub-
stitute than any other agent with which I am acquainted.

2d: Remittent Bilious Fever. — Having bled, if necessary, or ad-
ministered an effectual mercurial cathartic, it has been my practice,
for several years, to give a full opiate — say, 3 to 5 grs. of opium, or
from 30 to 40 grs. of Dover's powder every night, or every other
night, with 10 to 20 grs of calomel. I am not deterred, generally^
from its use, even when those conditions exist which authorities
declare to be centra-indications, namely, red and dry tongue ; dry
skin, excited pulse, and moderate cerebral disturbance, provided the
liver is acting, and the bowels have been freely opened. Under such
circumstances, instead of an aggravation, I have generally witnessed
a decided amendment. Nor should this excite astonishment, when
it must be conceded that, most generally, all of the above phenomena,
occurring in the early period of fevers, are dependent on high

1845.] Opium in Fevers and Inflammatory Affections, 661

nervous excitement, and not on an inflammatory condition of the
vessels. Even in the latter stage of remittent, and typhoid and
typhus fevers, when there are unequivocal evidences of cerebral in-
flammation, after general and topical blood-letting, cathartics,
refrigerants to the head, and revulsives to the nucha, we are justified
in the use of large doses of morphia or common opium, as no other
remedy will so effectually relieve the restlessness, jactitation, subsul-
tus tendinum, and other urgent symptoms, and impart reactive energy
to the nervous system. Indeed, opium and stimulants constitute the
sheet-anchor of hope under such circumstances. For this purpose,
the following combination is an exceedingly valuable one: — R. :
Mist, camphorae, 4 oz.; moschi, ^ drm.; antim. tart., grs 2; morph.
acet., 3 to 4 grs. Dose, a table-spoonful every 4th or 6th hour.

3d : The Congestive modification of Intermittent or Remittent
Fever. — Opium is a most valuable adjuvant in these cases, in order
to the developement of full reaction. Its mode of operation is diffi-
cult of explanation ; I suppose, however, that it tends to equalize the
circulation, by allaying the excessive nervous excitability, which
rapidly induces exhaustion. For the above object, I would especial-
ly recommend the following preparation : — R. : Opii, 2 oz.; camph.,
capsic, cinnam., ol. caryophy!., aa I oz.; Hofiman's anodyne liquor,
1 pint. Dose, 1 drm., equal to 4 grs. of opium, every fourth or
sixth hour, in connection with calomel, quinine and revulsives. Its
effects are often wonderful.

In the treatment of both intermittent and remittent fevers, during
the past sickly season, I have used the two following prescriptions
with the very best effects : 1st — R. ; Hydrarg. chlor. mit-, 1 drm.;
opii, 24 grains, made into 24 pills, of which I have given four every
night until slight mercurial action is induced : two doses are gener-
ally sufficient. 2d — R. : Mass., hydrarg., sulph. qnina?, aa. ^ drm.,
made into fifteen pills, of which I have given two every two hours
during the intermission or remission. Among the many cases that
have come under my care, very few have continued beyond the third
or fourth day.

4th : Puerperal Fever. — After copious blood-letting, our chief
reliance should be placed on opium in large doses, combined with
calomel — say 4 to 5 grs. of the former with 10 of the latter, to begin
with ; then 2 grs., each repeated every two or four hours, until the
abdominal pain is relieved. I believe that the full developement of
this dreadful malady may, generally, be prevented by opium thus ad-
ministered, together with hot fomentations.

5th : Acute Rheumatism. — In the treatment of this painful afTec-
tion, I would especially recommend the following combination, after
one full bleeding : — R. : Rad. colchici p., | drm.; antim. tart., grs.
3 ; morph. acet., grs. 3, made into twelve pills, of which two may be
given every fourth hour, until relief is obtained.

6th : Acute Pleurisy. — After one full blood-lotting, the best means
of relief in acute pleurisy is a full dose of opium, in combination with

662 Opium in Fevers and Inflammatory Affections. [November,

calomel and tartarized antimony. The following is a convenient
mode of admifiistration : — B. : Opii, hydrarg. sub. miir., aa., grs.
12.; antim. tart., grs. 2, made into 6 pills, of which two may be given
at first, and afterwards, one every two or four hours. With this mode
of practice, it will rarely be necessary to bleed a second time.

Tth : Acute Pneumonia. — In pneumonia, the fidl doses of opium
are of great value, after full blood-letting, but they should be used
only once in twenty. four hours ; the calomel and antimony being
used, as is customary, at short intervals.

8th Gastritis. — After free, general and topical blood-letting, my
reliance is on opium and calomel ; 4 or 5 grains of the former with
2 of the latter at first, then 1 to 2 grains each, every two hours, with
cold drinks, purgative enemata, hot poultices, and a blister, in the
severest cases, over the epigastrium.

9th : Enteritis. — in this form of inflammation, so rapidly fatal in
its tendency, after free general blood-letting, I would resort, with
great confidence, to opium in the fullest dose, 4 to 6 grains, combined
with 1 to 2 grains of calomel, after which, 1 to 2 grains of each may
be safely given every two hours, with oft-repeated hot poultices, an
occasional mild aperient, as castor oil, and a large vesicatory, after
the more acute symptoms are relieved.

10th : Acute Dysentery. — If there is much fever present, with
great abdominal tenderness, I think it safest to commence the treat-
ment with one full blood-letting, alter which, 35 or 40 grains of Do-
ver's powder, or, if the stomach is very irritable, 4 grains of pulverized
opium, with 5 to 10 of calomel, mixed in an ordinary dose of castor
oil, is the best remedy I ever used. If there is no necessity for bleed-
ing, the above portion may be administered at once; and not unfre-
quently, it will relieve the disease without other means: generally,
however, it will be necessary to continue the use of 2 grains each of
calomel and opium every four or six hours, until the abdominal ten-
derness, tormina and tenesmus, are removed. As auxiliary to the
above, mucillaginous drinks should be freely allowed ; occasional
portions of castor oil, or oleaginous mixture, should be given, and
anodyne injections, as tinct. opii, 1 drm. ; assafcetid., ^ drm., in
aqueous sohilion, repeated twice or thrice daily. When the more
acute symptoms are relieved, and there exists chronic irritation, with
copious mucous and bloody discharges, I use, with great efiicacy, the
acetate of lead, combined with opium, in the proportion of 5 to 10
grains of the former to 2 of the latter, every six or eight hours ; and
ifthe disease persist under this course — and especially, should there
be tympanitis. I would recommend a large blister, and the following
mixture, which is applicable to the chronic stage of mucous inflam-
mation of ihe whole alimentary canal, whether it be gastritis, ilietes,
or colitis : — B:.: Mist, camph., 4 oz. ; tinct. opii acet., 2 drm. ; acid,
nitric, |drm. ; spirit, terebinth., -i oz, ; dose, a dessert or table-
spoonful every four or six hours.

In conclusion, I will express the hope, that all medical men wjio

1S45.] Source of Convulsions. 663

may read this, or Dr. Henry's paper, may so far confide in our judg-
ment, and the results of our experience, as to wive nfair trial to the
use of opium, as recommended in fevers and inflammatory afTections ;
if so, I do not doubt but that the testimony of all would tend to estab-
lish the safety and value of the practice. It is a subject of vital
interest, and is worthy of the candid investigation of the whole pro-
fession.

PART III.— MONTHLY tERISCOPE.

Source of Convulsions. — By T. Wilkinson King, Esq. It is a
little remarkable, that hitherto there has been no settled opinion in
the profession, as to the primary seat of derangement in convulsive
affections. Dr. Hall and some others, seem to refer the spasms to
general disorder of a specific nature in the spinal marrow. Others
impute them rather to meningeal or to superficial affections of the
cerebrum.

Convulsions, which leave the patients as well as ever, even after
many attacks, cannot be expected to have any visible permanent
local alteration connected with them.

In the first place, I shall proceed to show what I have concluded
the pons varolii has to do with convulsions — for, here, all motor tracts
converge — and, here, one thrust, as it were, may stir up every muscle
of the body. I assume that no affection of bone, nor, indeed, any
meningeal affection, necessarily affects brain or nerve, and I could
almost add no tumour. I see that all the affections here named begin
and go on to a great extent without nervous symptoms, and that the
signs of nerve-disease, when they do supervene, proceed independ-
ently, and without any strict relation of duration, degree, or conse-
quences, to the extraneous disorder. I find, moreover, two sets of
real nerve disorders, i. e., Istly, with a palpable cause and a definite
site ; and, 2ndly, devoid of visible local change ; and I cannot doubt
but that some of the latter are fairly illustrated by the former. A
new and gradual growth deranges no new fibre^ — a strumous tubercle
in the thalamus gets large, unsuspected ; and consequent affections
of the opposite arm come and decline variously, according to the
varying incidental changes in the brain, around the tubercle. Such
a body, in a renovated constitution, rather wastes, turns to cholester-
ine and may be unheeded through a long life. Strumous, cancerous,
inflammatory, and apoplectic diseases of the brain are occasionally
found to become arrested at every stage of their course, as when
wasting or other disorders, elsewhere, come into greater activity.

On the other hand, I think it is, in the main, pretty certain that
cysts, tumours, inflammations, softenings, extravasations, whose size
or extension may gradually encroach on the pons, induce convulsions

664 Explanation of the sizes in the Urinary Bladder. [November,

before the final coma — a certain state of injection, or nutrition, or of
nerve-irritation, preceding total oppression.

Every known disorder of the spinal cord causes lesions of motion
(rigidity, spasm, or palsy) and of sense (pain darting, or numbness)
in proportion to its severity, and only in parts below the seat of the
disorder ; but, if these affections involved the excitor cords of some
physiologists, surely we should have universal disturbances. The
convulsions of known spinal diseases are all comparatively limited
or insignificant. To what nervous lesions do we not look, for most
general palsy, or tremor ? As disease approaches the centre of the
pons, so general convulsion or fatal paralysis attends. Slow tumours
thus indicate the site of th# transitory actions which cause convul-
sions. The same diseases in the cerebrum, cerebellum, and spinal
marrow, cause no general convulsions. These assertions I hope to
make good. If any one should think he can do as much in opposi-
tion, I can only wish to see it.

1. There are various diseasesof the cerebrum, which approaching
the pons varolii, produce convulsions, first of the opposite side of the
body, and then generally.

2. There are various diseases of the cerebellum, which, gradually
advancing upon its cura, &lc., cause convulsions, first of the opposite
side of the body, and then generally.

3. There are various diseases of the tuber annulare itself, which,
in their course, usually set up universal convulsions.

4. There are some exceptions to the above statements, but the
consideration of them rather illustrates than refutes the main princi-
ples advanced. — Medical Times.

On the Explanation of the Difference in size of the Male and Fe-
male Urinary Bladder. — By John LeConte, M. D., of Savannah.
The fact that the urinary bladders of women are considerably more
capacious than those of men, has been observed by anatomists from
the earliest ages. This was attempted to be explained by supposing
that the conventional rules of society, together with the sedentary
habits of females, rendered extraordinary distension of that viscus
from protracted retention of urine, more frequent and extensive
among them, — and thus the organ became enlarged mechanically.

This explanation appears to be exceedingly plausible. Indeed, it
has found its way, as if by general consent, into almost all our stand-
ard works on anatomy and physiology.

It seems that no one has heretofore noticed the unquestionable
fact, that the same difference in the size of the bladder, in favor of
the female, obtains in many of the inferior animals ; where, of
course, this cause cannot be presumed to operate in the slightest de-
gree. It most assuredly does exist in the hog, the sheep, and the
cow. I have remarked it so often among these animals, as to be
able to select out the bladders of the females from among a number
of others of those of both sexes. In view of this established fact,

1845.] Explanation of the sizes in the Urinary Bladder. 665

therefore, the received explanation becomes at once untenable. We
must, therefore, seek for a more rational explanation. Let us appeal
to nature — let us see how she accommodates herself to circumstances.
It is well known to every observant surgeon, that when the urethral
passage is constricted from any cause, whether mechanical or the
result of disease, the bladder very soon diminishes in capacity, and
becomes contracted and thickened. This occurs when there ia no
disease of the bladder itself, and when that of the urethra has com-
pletely subsided, leaving nothing behind but a mechanical obstruction
of the passage. Now, what is the deduction to be drawn from this
natural process ? The conclusion seems to be inevitable, that the
diminution of the capacity of the bladder, under such circumstances,
is an expedient of nature to meet the exigencies of a contracted out-
let. Herein, I think, we are furnished with a clue to the true expla-
nation of the difference of size of the male and female urinary
bladder, when every thing is in a normal state. The female urethra
is not only larger and more dilatable than that of the male, but is
also shorter and straighter. It is generally of uniform diameter,
varying trom three to four lines, slightly curved, with the concavity
looking upwards, and so extensible that calculi as large as walnuts
have been known to pass. (Vide Lond. Lancet, 1841-2, vol. 1st,
p. 583 ; also vol. 2d, p. 41.) Now, as we have shown that the size
of the bladder is in proportion to that of the urethra, it follows, a pri-
or/, that the male must have it smaller than the female ; a process of
reasoning which has the advantage of being equally applicable to
many of the inferior animals. In this, nature has not departed from
her ordinary hydrodynamical laws; the size o^ \.\\e outlet is propor-
tional to the capacity of the reservoir, and vice versa. Perhaps, it
may not be beyond the resources of the analytical mathematician to
deduce the capacity of the bladder from a single measurement of the
diameter of the urethra! At any rate, ^formula might be easily
obtained from hydraulics, which would give us approximative values,
not only of the size, but also of the contractile force of the bladder !
It Will be observed, that one of the conditions induced by a con-
stricted state of the urethral passage, is a marked augmentation in
the thickness of the coats of the bladder. I consulted Dr. Alban
Goldsmith, so well known in the treatment of diseases of the genito-
urinary apparatus, whose skill and long experience in these affec-
tions entitles his opinion to great consideration. He informs me,
that he has had numerous opportunities of observing the changes
which are wrought in the bladder by obstructions in the urethra. He
finds that the organ diminishes in size, and that all the coats are
affected, but particularly the muscular ; the fibres growing fleshy
and strong, are collected into bundles, giving the surface a fasiculated
appearance. This strengthening of the coats of the bladder, seems to
be another device of nature — in addition to the diminution of capa-
city— to increase the propulsive power, which is required to force the
urine through a small outlet. In accordance with our preceding

666 Castration. [November,

mode of reasoning, we should be led to expect that the urinary blad-
ders of male animals should also possess a greater degree of muscu-
larity than those o^ females. So far as recollection serves us, we
think that such is actually the case in nature ; and we venture to pre-
dict, that minute measurement and close inspection will demonstrate
that the urinary bladders of male animals are both thicker and more
muscular than those of the opposite sex.

Why the urinary bladders of the females of many animals, — and
as a natural consequence, the urethra, — should be larger than those
of the males, is a problem which admits of a far less satisfactory so-
lution. The supposition most in accordance with design, is, that a
greater quantity oi urine is secreted in the female.* This idea seems
to be fortified by the anatomical characters of their system, in which
the fluids appear to bear a greater proportion, and which predomin-
ance has been supposed to have some necessary connection with the
functions of reproduction. But, of course, this question can only
be settled by an appeal to expertmental determinations of the rela-
tive amounts of urine secreted, under the same circumstances, by
either sex. At any rate, be this last conjecture right or wrong, we
trust that we have established beyond a reasonable doubt, that the dis-
parity in the size of the organ in the sexes, is a natural conformation,
andwoi the result of mechanical distension. — Transaction of the Soci-
ety of Alumni of the College of Physicians and Surgeons of N. Y,

Castration^ when two years old, in a man now quite aged. — In the
Hotel of the Invalides is a man aged 71 years, who was castrated at
Sens when two years old, by a villanous quack, to cure him of hernia.
This mutilated person is of small stature, his extremities are slender,
his bones feeble, his voice sharp, and his chin without beard. He
does not detest women, but when near them has only fugitive desires,
and his enjoyment in coition has always been scarce appreciable.
His penis, like all organs which do not perform their functions, is
atrophied, and the prepuce is much longer than the gland. In this
stunted body, which has evidently been arrested in its development,
there has nevertheless been energy and courage. This individual,
though exempt from military service, joined the army — he was in the
wars of the French Empire, and the scars which he bears are authen-
tic certificates of his ardor in battle, and of his bravery. At present,
one is struck in passing his bed, with all the traits of an old woman.
Notwithstanding his advanced age, his memory is good ; he relates,
with precision, the events in which he assisted, and his language is

* Since the above was written, this point has been clearly demonstrated by
the experimental researches of Dr. Wm. Prout and Mr. Alfred Becqnerel, of
Paris. J. LeC.

1845.] Reunion of Nerves — Reproduction of Jaw-hone^ S^c, ' 667

expressive of much goodness of heart. Every thing about him
breathes the air of sadness and the impress of a vague melancholy;
a regret attaches to each step of his life, and which has its origin in
the dreadful mutilation to which he was made to submit in childhood.
(Journal des Con. Medico- Chiriirgicales.)

Re-union of divided Nerves. — M. Marjolin takes great pleasure in
relating an operation which he witnessed, where the surgeon, M.
Michon, found it necessary in extirpating a degenerated mass, to in-
clude more than an inch of the trunk of the sciatic nerve. Paralysis
of all the movements of the limb ought to have been the consequence.
Nevertheless this person, after his cure, recovered such a degree of
muscular agility, that he could dance and waltz as formerly.

In the Provincial Medical and Surgical Journal, Dr. Oke reports a
case, where he had to cut the musculo-cutaneous nerve in operating
upon a necrosed humerus. This brought on paralysis instantly of
the movements of the right hand. This patient was an excellent
scribe. He took lessons for four months to learn how to write with
the left hand, at which time he began to feel movements in the fingers
of the other, and in a few weeks he had so far recovered, that he
could write well with both hands. — {Jour, des Con. Medico-Chir.)

Reproduction of a portion of the lower Jaw-hone with Teeth. —
By E. S. Bennett, M. D., of Charleston, S. C. Early in the
month of i\Iarch, 1845, I was requested to visit, professionally, a
negro child about thirty months old, the property of Col. J. L., of
our city, who was reported to have a singular appearance about
the mouth, resembling a piece of bone growing from and connected
with the inferior maxillary, preventing the child from mastication,
and it could only take fluids, and that but sparingly. I found the child
in an extremely emaciated condition — having been suffering for five
months; upon examining it with some care, I found the bone (infe-
rior maxilla) in a state of necrosis, extending from the canine tooth
on the right side, along the whole bone on its entire aspect, to the ar-
ticulation on the left. The anterior portion of the bone had been
raised from its natural position, and becoming elevated as far back
as the ramus on the left, and its point, which was rough and very
rugged, iixed in the soft parts on the right side of the corner of the
mouth, and from this state of irritation an extensive and frightful
nicer was developed. The only question suggesting itself was,
whether the child, in its then emaciated condition, could survive the
operation ; the chances I considered as equal, and determined upon
dilation of the soft adhering part within the mouth, and removing the

668 New Hemostatic Means. — Operation of Rectum, [November,

whole mass, which' was accordingly done, and with a pair of strong
curved forceps, the bone was seized as far back as the bend, and by
a careful rotary motion of the hand, the disarticulation was ac-
complished, and the bone removed. Within a few days a decided
pleasing improvement was observed ; and in four weeks, I was ena-
bled to return the little sufferer to the country.

It may be asked, and with propriety, what was the exciting cause
of so frightful state of things? — had the child taken mercury in any
of its forms? I think I may safely say no; having been myself in
attendance on the plantation for ten years, and can safely say none ;
but the disease may be, and probably was, sui generis, or the result of
some local hyperemia — the result of the process of dentition.

This case settles the question definitely as to whether nature of
herself is capable of reproducing the bony structures entirely ; in this
case, not only the whole bone has been reproduced, but dentition
also — bemg now armed with two formidable grinders. — American
Journ. of Denial Science.

A new hcemostaiic means — sheep brains. — M. Dupuy, at the sitting
of the Academy of Medicine in Paris, 17th June, stated, that the
cerebral matter of sheep possessed in a very high degree the proper-
ty of coagulating the blood, and of immediately arresting hoemorrha-
ges. A small portion of the brain injected into the femoral vein of
an animal produced death in a few minutes. The blood was found
coagulated in the heart, and in the vessels, as M. D. had predicted.
He thought that surgeons might profit by this fact. — {Journ. des Con,
Medico- Chirurg.)

A new operation for defect of rectum in the infant. — M , Baude -
locque proposed to the Academy of Sciences on the 26th August, a
new operation, as a substitute to opening the colon either in the
lumbar or iliac regions, when the infant at birth is found to be deprived
of a rectum. The absence of this intestine being established, it is
necessary at first to dilate the natural anus by prepared sponge, then
to introduce a speculum two and a half inches long; at the sacro-
vertebral angle the cul-de-sac of the descending colon will be found,
and may be seized with a tenaculum. If this cannot be done, then
an incision is to be made in the linea alba of the abdominal wall, and
the cul-de-sac of the colon carried down to the natural anus, to which
it is to be attached by sutures.

We find this proposed by M. B., in one of the last numbers of the
Journal des Connaisances MeJico-Chirurgicales. We are not dis-
posed to place a very high estimate upon it, for the operation, as

1845.] Employment of Blistei's — Ale aline Medication, 669

described, we do not hesitate to say cannot well be performed without
opening the abdomen. In the first place, infants having a malforma-
tion or defect of the rectum, have also generally an imperforated anus.
Secondly, there would be considerable difficulty to dilate a passage
from the anus to the sacro-vertebral junction for a speculum. Third-
ly, when arrived at, who could distinguish, at this depth, the descend-
ing colon from the surrounding tissues ? Still, however, we confess
we have no objection, in defect of the rectum, to opening the abdo-
men in the linea alba, if by this operation, the intestine can in any
way be attached to the anus.

The employment of Blisters in acute diseases of the Brain, By
Dr. Tritschler. — Blisters are frequently used, and applied to all
parts of the body, except the frontal region, which, according to Dr.
T., is the best place to make them act in acute affections of the brain.
He covers the whole frontal region, and even the root of the nose,
by a vesicatory, and remarks, that besides a free suppuration produc-
ed by it, there is generally a copious flow of mucous from this organ.
We learn, too, from the Journal des Connaisances Medico-Chirurgi-
cales, that the physicians of the Parisian Hospitals employ these
blisters with success against cerebral symptoms in severe fevers.
The application of a single one is not sufficient to disfigure a patient.

FormulcB of Alcaline Medication. By M. Devergie, Physician
to St. Louis Hospital, Paris. — At the close of an article by M. D., in
the Bulletin General de Therapeutique, on the Alcaline Medication
for diseases of the Skin, we find the following prescriptions :
Artificial water of Vichy : R. Bicarbonate of Soda, 31

Spring water, pint, 1^
To take in two portions during the day. The dose of the bicarbon-
ate may be increased to 2, 3, or 4 3 each day ; it is proper then to
augment the water to 3 or 4 tumblers. Gaseous or the Soda water
of the shops, will make this drink more agreeable.

Alcaline Syrup. R. Bicarbonate of Soda, gr. xv.
Syrup of Sugar, . . § x.
Dose, a table-spoonful, morning and night, in a fourth of a tumbler of
water. For an infant, a tea-spoonful is the dose in the same quanti-
ty of water.

Alcaline Potion. R. Bicarbonate of Potash, . 3v.
Infusion of Linden, . . §iv.
. Syrup of Mucilage, . . §i.
Distilled water of mint, gtt. xxv.
Dose, two or three tablo-spoonfuls each day for an adult.

670 Poison by Tartaric Acid. [November,

Alcaline Wash. R. Carbonate of Soda, ^ss.
Water, O. 1^

More active Alcaline Wash. R. Carbonate of Soda, 3vi.

Comnion Salt, . f ii.
Water, O. li

Alcaline Liniment. R. Carbonate of Soda or Potash, gi.

Olive 01!, f iv.

Yellow of egg, .... one.
Moisten the carbonate before adding the oil.

Weak Alcaline Ointment. R. Carbonate of Soda, gr. x.

Lard, . . . . §i.
The carbonate may be increased to 4 or 6 3, when a more active
ointment is desired ; and 3 4 of slacked lime may be added — using
then the carb. of potash.

Alcaline Bath. Carbonate of Soda or Potash, from a half to a
pound.

Alcaline and Tonic Bath. R. Carbonate of Soda, froma half tea
pound ; Common salt, 1 to 2 pounds. Gelatine or soap may be ad-
ded to this.

When sulphur is added to the alcaline preparations, the latter have
only a secondary place in the composition.

Poison hy Tartaric Acid. — It has been questioned if this acid be
a poison. Pommer and M. Orfila are for the affirmative; Coindet
and Christison for the negative. The followi^ng fact strengthens the
opinion of the two first named : Wm. Wats, being affected with
rheumatism, applied the 7th Dec, 1844, to ChaTles Watkins, drug-
gist, to purchase 2 5 of Epsom salts. Before leaving, the thought
suddenly occurred td him of changing it for another salt less bitter.
This was granted to him, and having returned home and dissolved
the new article given him, he swallowed it. His face, some moments
after this, became red. He cried out he was poisoned, and then
ceased to speak. Other symptoms were developed, and Mr. Wats
died on the 16th. Mr. Brood, charged with the examination of what
remained in the glass from which he had drank, recognized Tartaric
Acid. The apothecary, Mr. Watkins, confessed his error, and attri-
buted it to the change which some one had made of the bottle of the
acid, for that commonly occupied by an insipid salt. — [Pharmaceuli-
calJournal.)

1845.] Uva Ursi — Treatment of DysmenorrhcBa, 071

Lithontriptic action of the Uva Ursi. By Dr. Fenolio. — An
old calculous patient had fever, and experienced severe pain in the
bladder. He would not consent to be sounded. Dr. F. prescribed
a decoction of the uva ursi, prepared thus : IX, Uva Ursi, §ss. ;
Water 5ix. Boil for fifteen minutes; strain, add syrup of gum, 5 v.,
and take the whole in three doses. After using this tea for three days,
the patient passed 13 pretty large gravels, and in five days more, 90
others. The whole formed a considerable mass. His suflfering and
fever disappeared. — {Jour, des Con. Mtdico-Chir.)

Treatment of Dysmenorrhcea. — Dr. Rigby, in his treatise on this
subject, considers that it depends, in common with some other uterine
affections, on derangement of the assimilating processes which may
be merely "the local phenomena of a general condition of the sys-
tem." This general condition, he thinks, is chiefly dependent on a
gouty or rheumatic diathesis. He generally begins the treatment
with one active dose of calomel, from five to eight grains, followed
by a mild purge of rhubarb or magnesia next morning. Leeches to
the anus, either immediately before the menstrual period, or equi-
distant between the two periods, are very efficacious; but often re-
quire repetition before their full value is seen.

"The attention of the practitioner must now be devoted to the more specific
treatment in the case. If the circulation be plethoric and strong, the urine
scanty, high-colored, with considerable excess oflithic acid and lithates, colchi-
cum,in the form of the acetous extract, with extract of hop or henbane, may be
given at night, or night and morning, and some mild saline, with sp. aslheris
nitrici, occasionally during the day.

" The salines, as recommended by Dr. Prout, are well worthy of attention ;
the}' not only diminish the disposition to the formation oflithic acid during the
processes of primary assimilation, but allay the irritable state of the digestive
organs, and the urine becomes increased in quantity and more healthy in its
, characters.

" Where the disease assumes the rheumatic or rheumatic-gouty character, we
usually find it associated with less power of general circulation, and with local
symptoms of less active character. Guaiacum and iodine are valuable reme-
dies in these affections, either separately or combined. The tinctura guaiaci
ammoniata may be taken in milk night and morning; or ten grains of pulv.
guaiaci and of magnes. carb. every morning, and from two" to five grains of
potass, iod. with extract of hop or henbane at night; or if it be deemed unneces-
sary to use the guaiacum, the potassae iod. may be given two or three times
a-day in sarsaparilla with liq. potassae, and the bowels regulated by an altera-
tive or laxative pill at night ; or, if it be desirable to promote diaphoresis, by a
dose of Dover's powder.

"There are few remedies which keep up a healthy action of the liver so well
as the taraxacum, especially when preceded by a dose or two of mercurial med-
icine. In most of the afiections under consideration, where it is important to
maintain this function indue activit)^, and j'et where the constant use of mercu-
rials is highly inexpedient, taraxacum becomes a valuable adjunct. It is pre-
pared under a variety of forms, but I preler the extract as being the most certain
and convenient; half a tea-spoonful at night, dissolved in a little warm milk,
forms a, by no means, disagreeable cocea-like drink; or it may be taken with
milk and lime-water if necessary. Besides its ordinary eflect on the liver, and

672 Surgical Anecdote — Meteorological Observations,

therefore indirectly upon the bowels, by supplying them with healthy bile, I have
reason to think that it also acts upofi the skin like sarsaparilla, and (or this pur-
pose may sometimes be advantageously combined with it."

Braiihicaite's Retrospect.

A Surgical Anecdote. — We find the following in the last No. of
the Journal des Connaissances Medico-Chirurgicales : — One of the
most distinguished surgeons of Paris, being about to operate upon
what he supposed a common cataract of the eye, observed to the
students present, at the close of a brilliant lecture, — Here is a cata-
ract easy to operate by displacement. The needle introduced into
the eye was manoeuvred for a long time without causing the opacity
to disappear. The instrument was then w thdrawn, and the opera-
tor, without saying a word, turned his back upon the patient. A
witty confrere, wishing to ascertain the cause of this bad humor,
examined the eye, and laughingly said, "I see what it is. It ap-
pears that there has only been here a displacement of diagnosis.

METEOROLOGICAL OBSERVATIONS, for Sept., 1845, at Augusta, Ga.
Latitude 33'' 27' north — Longitude 4° 32' west Wash, Altitude above tide
152 feet.

Thermometer.
Sunrise. 3^ p. m.

Barometer.
Sunrise. 3, p.m.

Wind.

Remarks.

71 88

29 74-100 29 63-100

Cl'dy, th. & light. & sprink.

71 82

" 65-100 '

' 63-100

s. w.

Clotidy.

72 86

'* 62-100 '

' 68-100

s. w.

Fair. [p. m.— sprinkle.

71 90

" 73-100 '

' 72400

s. w.

Fair — thunder — light, at 5,

71 93

" 73-100 '

* 68-100

s. w.

Fair.

70 88

" 71-100 '

' 78-100

N.W.

Fair.

71 89

" 80-100 '

' 70-100

s. w.

Fair.

72 92

" 70-100 '

' 73-100

Fair. [rain 2-10 in.

72 92

*' 73-100 '

' 71-100

Fair — storm at 3, p. m. —

70 87

" 78-100 '

' 87-100

N. W.

Fair.

64 84

" 80-100 '

' 81-100

N. E.

Fair.

65 86

" 95-100 '

' 92-100

N. E.

Fair.

67 83

" 95-100 '

' 92-100

Fair. [blow last night.

64 77

" 81-100 '

' 66-100

Variable, cl'dy, rain 1-10 in.

64 81

" 69-100 '

' 72-100

Fair.

58 79

" 78-100 '

' 82-100

Fair.

66 82

" 85-100 '

' 81-100

N. E.

Cloudv.

62 79

" 87-100 '

' 85-100

N. E.

Variable.

64 88

" 82-100 '

' 78-100

Fair.

68 84

" 75-100 '

' 58-100

Fair. [a.m. & ceased 1, p.m.

69 . 68

" 53-100 '

' 47-100

Rain 7-10 in.— began at 3,

60 70

" 65-100 '

' 72-100

Fair.

58 76

" 80-100 «

' 78-100

Fair.

52 71

" 79-100 '

' 84-100

N. W,

Fair.

51 72

" 87-100 '

' 85-100

N. E.

Fair.

48 76

" 82-100 '

' 82-100

N.E.& S.W.

Fair.

49 80

" 85-100 '

' 90-100

W, & E.

Fair.

52 80

" 93-100 *

' 93-100

S. E.

Fair— some clouds.

56 82

" 90-100 '

' 85-100

P. E.

Fair do. do.

59 73

" 76-100 '

' 73-100

vS. E.

Cloudy — sprinkle.

23 Fair davs. *iRain, 1 inch.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I.] NEW SERIES.— DECE)IBER, 1845. [No. 12.

PART I.—ORIGIXAL COMMUNICATIONS.

ARTICLE I.

On the Treatment of the Tertiary Symptoms of Syphilis hy Hydrio-
date of Potash, with Cases. By Paul F. Eve, M. D., Professor
of Surgery in the Medical College of Georgia,

It is not my intention, in the present article, to enter upon the
subject of the venereal disease further than, to exhibit the speedy and
potent effects which the combination of Iodine and Potash has over
its last or third order of symptoms.

It is known to the profession, that within a few years, an effort has
been made, particularly by M. Ricord of the Venereal Hospital of
Paris, to divide the constitutional symptoms of Syphilis into seconda-
ry and tertiary. The following classification of the phenomena of
this disease, according to its pathology, appears now to be gaining
favor with the best informed physicians :

The venereal disease employed as a generic term, embraces two
distinct species — viz : Gonorrhoea and Syphilis. These do not de-
pend upon the same virus. Gonorrhoea has probably prevailed from
time immemorial, and is not accompanied with peculiar constitutional
symptoms. Syphilis was first observed about the close of the 15th
century, and if not aborted by treatment, almost invariably infects
the system, and becomes a constitutional disease. Both, however,
are contagious, and propagated in the same manner, (by the promis-
cuous intercourse of the sexes,) and both may exist simultaneously
in the same person. One is generally confined to the mucous surfaces

674 Treatmentof Tertiary Symptoms of Syphilis. [December,

of the genital organs ; the other, though local at first, soon extends
to nearly all the tissues of the body.

The primary symptoms of syphilis, are chancres and buboes. The
matter or pus produced in these is contagious, and will transmit the
same disease by inoculation. This virus may be destroyed, by
caustic, (for example,) if applied within five days from the appearance
of a chancre, and then no general or constitutional effects are likely
to occur.*

When a bubo is the first symptom discovered, it is supposed to be
dependent upon a previously existing but concealed chancre ; and it
will communicate syphilis, if it be genuine. Buboes may, and often
do arise sympathetical or symptomatica! of other diseases ; but then
they contain no virus, and attempts at inoculation fail.

The secondary symptoms of syphilis appear on the mucous mem-
brane and skin, as the ulcerated sore throat, and lenticular eruption
upon the surface of the body — some add alopecia, or falling of the
hair, and condylomata, or tubercles about the anus and genital or-
gans. These result from the absorption of the syphilitic virus, and
are the first series of constitutional infection. They generally appear
about four or six weeks after the existence of the primary symptoms.
The disease cannot be communicated by any secretion taken from
the second class of symptoms ; but though non-contagious, still it is
hereditary, descending through parents to children.

The tertiary phenomena, or third class of symptoms of syphilis,
exhibit themselves in the shape of nodes, deep-seated tubercles,
warts on the genitals, chronic ulcerations of the throat, rhagades or
eruptions in the hands and feet, ulcerations of the nose or about the
face, horny excrescences, &;c. Although the system is more pro-
foundly affected, yet the disease in these forms is neither contagious
nor transmissible by inheritance. These symptoms never occur
without being preceded by the primary and secondary, and seldom
appear before these have existed for some six or eight months, and
sometimes not until years afterwards.

To recapitulate. — 1st, the primary symptoms of syphilis, chancres
and buboes are contagious ; 2nd, the secondary, sore throat, blotches,
&c., are hereditary, but non-contagious ; 3rd, the tertiary, nodes,
chronic ulcerations, &.C., are neither contagious nor hereditary.

* The prophylatic soap of Dr. Pfeffqr used with success in St. Petersburgh,
contains in 500 grains of the substance, 6 grs. of bichloride of mercury, 4 of
tannin, and 45 of chloride of lime, incorporated into a soap with soda. In its
application, some difficulty, of course, is experienced in the female.

1 845.] Treatment of Tertiary Symptoms of Syphilis. 675

Not only in a diagnostical point of view, is ttiis classification of the
phenomena of syphilis important, but we shall find it equally so in a
therapeutical. If nature has been followed in the description of the
symptoms, and the changes from a healthy to an abnormal condition
defined in the order of their appearance, we are surely in the right
path to correct this state. Phenomena difliering so widely as do the
primary and secondary symptoms of the disease under consideration,
have always been admitted to require modifications in the modes of
treatment, and so indeed must it necessarily be with the tertiary.
The discrepancy in reference to the best plan of curing the constitu-
tional symptoms of syphilis, may be explained by the want of discrimi-
nation in the general classification of all these phenomena under the
head of secondary. It is only during the past few years that ano-
ther division has been insisted upon, and a third order attempted to
be established.

Nodes, exostoses, caries of the bones, chronic ulcerations of the
mucous membrane and skin, tubercles, &;c., have co-existed with
other symptoms of syphilis, and have all, until recently, been sub-
jected to the same treatment. So indiscriminately was mercury
employed in this disease, that the question arose, whether these very
phenomena were not the sole effects of the remedy itself. In his
system of clinical medicine, published in 1843, Dr. Graves, of Dub-
lin, remarks on this subject, " notwithstanding all that has been said
and done, a good deal still remains to be accomplished, before the
treatment of syphilis can be said to be placed on a solid and rational
basis. * * * In treating cases of primary or secondary symp-
toms, which have existed for some time, and where the patient has
been taking mercury, it is hard to unravel the perplexities which sur-
round the case, and ascertain whether the mercury has been proper-
ly administered or not.

" Where a patient laboring under syphilis has been salivated with-
out being improved, one of two things must be inferred — either that
the mineral has had no effect on the disease, or that it had an injuri-
ous effect on the constitution. The great point to arrive at in the
treatment of syphilis, is to make the mercury act on the disease, and
not on the constitution. This I have often endeavored to impress
on my class. I will venture to say, that I would engage to give a
patient, laboring under primary symptoms, any quantity of mercury,
without producing a favorable effect on the disease, or doing him
any good. I would engage to salivate a man affected with sore throat.

676 Treatmentof Tertiary Symptoms of Syphilis, [December,

and yet leave him as bad, or even worse than ever. 1 have witness-
ed this occurrence over and over again, and have laid it down to
myself as a proposition — that the venereal may be treated with mer-
cury, to the fullest extent, without being cured."

Of the opposite plan of treating syphilis, i. e., the non-mercurial,
it is known that a good deal was said and published, especially by
some of the army surgeons of Europe, fifteen or twenty years ago.
But the very favorable statistical reports then made, have not been
sustained by subsequent observations and experience ; it is even said,
that Mr. Rose, formerly one of the most zealous advocates of the non-'
mercurial plan, has not only abandoned it, but adoped the mercurial
course of treatment.

With regard to the propriety of insisting upon the classification
of the symptoms of syphilis, advocated by this article, it may be re-
marked that John Hunter divided the parts afl^ected by the secondary
symptoms, into two orders, and these included the second and third
class of M. Ricord. In the edition of his work on the Venereal,
edited by Babington, (1839,) he says, the first symptoms of the dis-
ease, after absorption, appear either on the skin, throat, or mouth ;
and again, in the second stage of Lues Venerea, in the deeper-seated
parts, as the periosteum, tendons, fasciae and ligaments. He also
distinctly states the order in which these parts are affected — viz :
1st, the mucous membrane and skin, and 2nd, the internal or deep-
seated organs. We may also observe, that Samuel Cooper, and
others, often allude to, and speak of the secondary venereal ulcera-
tions. Still, with scarcely an exception, their countrymen, even to
the present day, admit but the two classes, the primary and second-
ary ; we are therefore, compelled to request the reader to make the
distinction, when we refer to writers in Great Britain on this subject.
By the term secondary symptoms, they include all those which occur
after chancres and buboes, while the French divide them into se-
condary and tertiary.

Of the recent contributions of chemistry, none seem to promise
more in the practice of medicine than the preparations of iodine ;
and of these, one of the most valuable is certainly the hydriodate of
potash. Its synonyms are potassii iodidum, potassse hydriodas,
iodide of potassium, proto-ioduret de potassium, hydriodate of potassa
or potash. Its medical properties and uses have not yet been fully
ascertained. Even its dose is not satisfactorily defined ; for while
some give only a ^QVf grains, others have ventured to administer half

1845.] Treatment of Tertiary Symptoms of Syphilis. Gil

an ounce of the pure salt. It is generally considered to be diuretic,
alterative, resolvent, and deobstruent.

The introduction of this article into the treatment of syphilis, may
be learnt from the following extract of a report on the subject, made
by M. Rattier's on M. Ricord's practice : — In our researches on
the administration of the ioduret of potassium, we have been able to
follow out the treatment of all the various forms of tertiary syphilis.
Often the ioduret alone has been found sufficient for the cure ; but
whenever any complication has happened to be present, it has re-
ceived an appropriate medication. By having recourse at one time
to tonics and stimulants, at another time to antiphlogistics, M. Ricord
combines the various resources of therapeutics, according to the cir-
cumstances of each case ; and in some patients who, in consequence
of successive infections, have exhibited the disease in all its stages —
primary, secondary, and tertiary — a local treatment has been direct-
ed to the chancres, the use of mercury (proto-iodide) has caused the
secondary symptoms to disappear, and the hydriodate of potash has
been equally successful against the tertiary symptoms. Such is the
basis of M. Ricord's treatment. If those principles, now explained,
be not attended to, the physician will be apt to commit many serious
errors ; of which we meet with numerous examples in the assertions
of those writers who have attempted to disparage the utility of the
ioduret of potassium, on the ground that they have observed certain
secondary symptoms resist its administration. Had a few mercu-
rial pills been exhibited at the same time, these symptoms would
speedily have vanished. In conclusion, the proto-ioduret of potas-
sium amply deserves, in the treatment of tertiary syphilitic symp-
toms, all the praise which mercury is entitled to in the treatment of
the secondary symptoms — with this difference, that, very seldom, or
never, has it given rise to those numerous and distressing accidents
which are too well known to have been frequently induced by the
injudicious administration of its rival. (La Lancette Frangaise —
Medico-Chirurg. Review.)

M. Ricord, in his practice, commences with 10 grs. a-day of the
iodide of potash, in some convenient vehicle, as the decoction of hops,
&;c., and increases the dose every third or fifth day, until it amounts
to 36 grs. during the twenty-four hours. He has administered as
much as 5ii. a day; but thus given, it is apt to produce the iodic
intoxication, a certain nervous tremor of the muscles with confusion
of the brain.

678 Treatment of Tertiary Sym'ptoms of Syphilis. [December,

CuUerier's prescription is R. Iodine, gr. 1 ; Potassae lodid., ii. ad
iv. ; Aquse, ^i. M. This is put into a pint or quart of decoction of
sarsaparilla, and is to be given at intervals during the da3^ The
dose of iodine may be increased to 2 grs., and that of the iodide of
potass to 6 or 10 in the day.

The Reviewer, in the Mcdico-Chirurgical Journal, 1840, says that,
in the mixed symptoms of cachexia, (resulting from syphilis,) the
preparations of iodine act almost marvellously. In the rupial or
ecthymatous ulcerations of the skin, in diseases of the bones that
sometimes may result from syphilis, and often do result from mercu-
ry, the iodide of potassium is highly beneficial ; yet he adds, it seems
inconsistent and uncertain in its operations.

While we admit that preparations of mercury do oftener, more
speedily, and with more certainty and permanency, cure confirmed
secondary symptoms of syphilis than any other plan yet adopted,
still, in the ^er^zcrr?/ forms of this disease, its rival, iodide of potash,
has decided preference. The late M. Biet, whose extensive oppor-
tunities at the St. Louis Hospital, in Paris, entitle his opinion on this
subject to some respect and weight, stated "that mercury did not
produce any marked effect over the syphilitic tubercula." Samuel
Cooper, Prof, of Surgery in the London University College, says, " I
doubt whether secondary symptoms are more frequent after the
treatment of primary sores with iodide of potash and sarsaparilla,
than after mercurial treatment." James Miller, Prof, of Surgery in
the University of Edinburgh, in his Principles of Surgery, observes
on Diseases of Bones, " but, as a general rule, mercury, in any form,
is never to be given in periostitis, more especially so as to produce a
constitutional effect, unless other and safer means have proved una-
vailing. For that mineral we well know to be as likely to cause as
to cure." He gives the preference to the iodide of potassium. " Dr.
Williams, of London, considers it (hydriodate of potassa) applicable
to the treatment of various forms of secondary syphilis. He used it
with success, in a majority of cases, in removing hard periosteal
nodes, and found it beneficial in the treatment of tubercular forms
of venereal eruptions. It is also considered as one of the best altera-
tive remedies in mercurio-syphilitic sore throat." Mr. S. Cooper
not only doubts which is the best mode of treatment for primary
sores — the mercurial or iodide of potass, with sarsaparilla— but he is
a strenuous advocate for the use of the latter in the various secondary
and tertiary venereal affections. He recommends its employment

1845.] Treatment of Tertiary Symptoms of Syphilis. 679

in the eruptive form, in nodes, phagedenic ulcers, d:;c., and these
belong to the tertiary division. He generally gives from 3 to 5 grs.
of iodide of potassium in decoction of sarsaparilla thrice a day. In
Listen's Elements of Surgery, edited by Prof. Gross, of Kentucky,
the latter says in a note, " it is surprising that the author has made
no mention, in connection with this subject, (constitutional symp-
toms of syphilis,) of the iodide of potassium, so justly lauded by
Mons. Ricord and some other French surgeons. For the last two
years, or more, I have been constantly in the habit of employing this
article in Zerifiary syphilis, in mercurial diseases of the bones, and in
chronic rheumatism, in which, I am convinced, it is as much of a
specific as quinine is in intermittent and miasmatic neuralgia."
Dr. G. gives the article in large doses, even half a drachm, after
having commenced with 10 grs. three or four times a day. He adds,
"patients who have labored under nodes and nocturnal pains for
months, whose health has become greatly impaired, and who have
not slept soundly perhaps for weeks together, have often perfectly
recovered under this treatment in less than a fortnight." In the
Bulletin of General Therapeutics, of last year, is an article from M.
Ricord, on what he terms Syphilitic Chlorosis. He states that, in
his examinations of the blood taken from patients laboring under
syphilis, he has found a diminution in its globules ; a condition which
obtains in common chlorosis. This particular state of the blood
grows worse as the syphilitic infection gives place to secondary or
tertiary symptoms. It may continue in different degrees after they
disappear. The first conclusion to be drawn from these considera-
tions is, that syphilis being an anemic disease, or, at least, always
complicated with anemia, the antiphlogistic method of treatment is
dangerous. The second conclusion is, the necessity of a nutritious
diet. "The treatment that I adopt," says M. R., "consists in the
combination of ferruginous and mercurial preparations, if there ex-
ist no counter-indications. When the secondary symptoms pass to
tertiary, the mercurials, combined with iodide of iron, or with iodide
of potassium, suffice to reconstitute the blood."

In Braithwaite's Retrospect for July to January, 1845, No. 10,
may be found an article by Dr. Skae, taken from the Northern Jour-
nal of Medicine, on Condyloma. This writer refers to the Lectures
of the late Dr. Wallace, of Dublin, as published in the London Lan-
cet, who gave the name of "exanthematic primary syphilis, to the
group of symptoms consisting of moist elevated patches upon the

680 Treatment of Tertiary Symptoms of Syphilis. [December,

mucous membrane of the lips, cheeks, tonsils, &;c., of a whitish color,
as if touched with nitrate of silver, or coated with milk, mucous tu-
bercles about the genital organs or anus, &c. ; and which are asso-
ciated with the eruption on the skin. Dr. Skae says, these are cura-
ble without the use of mercury. "My treatment consisted chiefly in
the application of stimulants to the condylomata; the use of astrin-
gent injections and cold washing, for the cure of the vaginal and
uterine discharges ; and incases of the latter kind, the internal admin-
istration of tinct. of cantharides. In several cases, when there ex-
isted cutaneous eruptions, the iodide of potassium was given. In no
instance was any mercury administered, except in the case of the
woman affected with iritis." For the treatment of these symptoms,
which are now classed under the head of tertiary, in the September
No. (1844) of the London and Edinburgh Monthly Journal of Medi-
cal Science, Dr. Rose Cormack writes, " besides corrosive sublimate,
(which he recommends in repeated small doses, largely diluted,) there
are several valuable therapeutic agents, which may be given inter-
nally in the treatment of condyloma. As the chief of these, I would
mention hydriodate of potash. * * * I generally prescribe three
grains of the hydriodate of potash to be taken in twenty-four hours,
in four or six doses, each being dissolved in several ounces of water,
with or without infusion of gentian." He also recommends in
syphilitic skin diseases, after repeated small bleedings, the hydriodate
of potash. He says it was first employed in secondary and tertiary
syphilis, by Brera, in 1821 ; and his example has since been follow-
ed by very many, among whom deserve special notice, Ricord, Biett,
Baumes, Wallace, Sperine, (of Turin,) Schultzemberger, (ofStras-
burg,) and Guetine, (of Antwerp). In the hands of these physicians,
he adds, it seems to have cured every form of secondary and tertia-
ry venereal disease.

We give the following extract, as it bears so forcibly in favor of
our position :

The report, which M. Gauthierhas recently published respecting
the curative power of this salt of Iodine in secondary and tertiary
syphilitic affections, is on the whole highly favourable to its use.
He has administered it in a vast number of cases, and has rarely
noticed any injurious or even unpleasant effects fairly attributable
to its operation. On a few occasions it appeared to cause a saliva-
tion ; which, however, speedily ceased. Now and then, an innocu-
ous exanthem made its appearance on the surface. In some persons
it causes slight gastric irritation; but in most, the digestive functions

1845.] Treatment of Tertiary Symptoms of Syphilis, 681

appear to be decidedly improved under its use. In no instance has
any wasting of the body seemed to be induced by it, as has occa-
sionally been observed with respect to Iodine. One of the most
constant effects of the loduret is to increase the flow of the urine.
It seems to pass very rapidly into this and the other secretions; its
presence is readily discoverable by its well-known appropriate tests.
M. Gauthier has often detected it in the saliva.

The following are the forms of the syphilitic disease in which he
has witnessed the most decided curative effects. Pains of the bones,
even when most severe, are often very rapidly and effifctually subdu-
ed ; nay, when caries exist, a salutary change is not unfrequently
obtained. Thus in Ozoena, complicated with disease of the palate,
or nasal bones, we seldom fail in greatly benefiting, if not in curing,
the disease. In various tubercular affections of the ski?i and mucous
membranes, the loduret will be found most useful. Deep ulcerations
of the throat and pharynx, rhagades or fissures about the anus and
nails, will not unfrequently heal up most satisfactorily, even when
mercury has been previously tried and tailed. It is sometimes truly
marvellous to witness the decided improvement of the general health
in the course of a few days, under the use of the loduret when judi-
ciously administered. M. Gauthier considers that it is a most valu-
able remedy in many cases of mercurial cachexy : an ioduretted
gargle will often serve to check salivation from this cause.

He invariably begins its administration in small doses — from two
to four grains, or even less twice a day. The quantity should be
doubled every third or fourth day, until it reaches 15 or 20 grains.
This dose should be continued for some time ; but, if it fails in pro-
ducing any decided effect upon the disease, it may be increased to
two scruples or even a drachm. In a few cases, he has given as
much as two drachms in the course of twenty-foui- hours.

A solution of the loduret in water, to which some tincture of
Iodine has been added, may be advantageously used as a gargle in
ulcerated sore-throat, and as a wash to ulcers on the surface, or on
the Schneiderian membrane.

The average period, during which the internal use of the loduret
should be continued, may be stated to be from six to eight weeks.
Much will depend on the gradual increase of the doses given. Many
cases will remain stationary, if the quantity of the salt administered
be not progressively — and this, too, rapidly — augmented. — Jled.
Chir. Rev., from Observations pratiques sur le Traitement des Mal-
adies Syphilitiques par VIodine de Potassium, by M. L. Gauthier.

In the General Bulletin of Therapeutics, for January, 1845, will
be found an article on the efficacy of corrosive sublimate in the treat-
ment of the secondary and tertiary symptoms of syphilis, by M. A.
Devergie, Physician of St. Louis Hospital. In this is reported an
interesting case of an officer long affected by the disease, and where-

682 Treatment yf Tertiary Symptoms of Syphilis. [December,

in the iodide of potassium alone, failed to produce a cure. This was
finally affected by the combination of the mercurial with the iodide
of potash and iron, quinine, &;c. In general, M. Devergie's treat-
ment for the secondary and tertiary symptoms of syphilis, is "a quart
of sudorific ptisan, in which from 5 to 20 grs. of the ioduret of potash
have been dissolved, and also to take every morning, fasting, a pill
composed of guiac, opium, and a minute quantity of the corrosive
sublimate. In the course of a week or so, a second pill is to be taken
at night also. ' These medicines are to be persevered with for two,
or even three months, without intermission. A tepid bath is to be
taken once a week."

To that variety of the venereal disease, known as the most intract-
able and destructive — 1 mean the constitutional effects of syphilis in
a scrofulous diathesis — the iodide of potash seems peculiarly appro-
priate. Indeed, should this fail to cure, mercury being out of the
question, we may try iodide of iron or preparations of arsenic; but
fortunately, the hydriodate is usually well adapted to the case.

In the use of the article, we remark a considerable difference in
the dose as employed in England and France. While the English
recommend it in doses of 3 to 5 grs., the French give 10 to 20 grs.
a day. The preparation which I first used was obtained from Pelle-
tier dc Berthemot, of Paris. My mode of administration is to put §i.
of the salt into 8 ounces of water, and give a half tea-spoonful three
times a-day, increasing the dose to a full tea-spoon. This will make
from 10 to 20 grs. in twenty-four hours. I have thus directed the
hydriodate of potash, in a goodly number of cases in private practice,
and in the majority have lost sight of their issue — the result not hav-
ing been reported. It is well known, that but little that is satisfacto-
tory can be derived in the treatment of the venereal disease out of
hospitals. Few patients, in private practice, will submit to the diag-
nostic test by inoculation, and fewer still will make regular reports
to the physician or surgeon of their cases. Of those I have treated
with the hydriodate of potash, the following three cases have been
the most striking, and exemplifies the good effect of the medicine in
persons of different age, sex and color :

Case i. Philip, a black man, aged about 50, has had syphilis for
many years. When purchased by his present owner, I was requested
to give an opinion as to the state of his health. He was pronounced
unsound, and to be then laboring under the tertiary effects of the

1845.] Treatment of Tertiary Symptoms of Syphilis. 683

venereal disease. This was in the sumhier of 1843. In May, 1844,
he was placed under my care. He was then in a very desperate
condition. His master tiiought his death inevitable, and only ex-
pected some mitigation of his suffering. He could scarce articulate
so as to be understood ; and deglutition was affected with great pain.
Has had alopecia to some extent. Tiie surface of his body in pla-
ces, particularly on the forehead and breast, was covered w ith irregu-
lar tubercles, varying in size and shape. The frontal bone exhibited
ulcerated nodosities, and the extremity of his nose was greatly en-
larged. The whole of the soft palate had been removed by ulceration,
and the throat presented one large irregular and offensive ulcer.
Philip, it need scarce be said, had been subjected to a variety of
treatment, for he was a favorite and valuable servant, being an ex-
cellent cook.

I immediately put him upon the hydriodate of potash in 10 grs.
doses, in conjunction with sassafras tea, the warm bath and good
light nourishing diet, such as he could conveniently swallow. The
iodide was ordered to be increased to 1*2 or 15 grs. three times a-day,
if the previous doses were tolerated. In ten days the improvement
was most gratifying. He took about iii 3 of this preparation during
the treatment, and by kind attention and good nursing, perfectly re-
covered. He married the following winter, and may be now seen
almost any day, and in all kinds of weather, driving a market-wagon in
our streets. The defect of palate is scarcely detected by his speech.

Case ii. This is a mulatto man, aged 40, and a brick layer by
trade. He has had the venereal disease several times, the first attack
near twenty years ago. He has been for several months under the
care of another physician, and been thoroughly treated by the usual
method for a chronic sore throat. In November, 1844, 1 commenced
to give him the hydriodate of potash. It was with great difficulty
he could swallow the dose of 5 grs. three times a day. In a day or
two the soft palate dropped off, the immense ulcer then began to
heal, and in less than a month he asked permission to go to work.
The quantity of the iodide used in this case was greater than
in the first reported, and it had to be continued much longer. He
tookoveriv5 ofthe hydriodate, and was under treatment two months.
This patient too, had had alopecia and chronic ulcerations upon the
skin. In both these cases the iodic intoxication was slightly felt,
although the quantity of the preparation never reached 50 grs. in
twenty. four hours.

684 Treatment of Tertiary Symptoms of Syphilis. [December,

Case hi. For the notes of this case, I am indebted to my friend,
Mr. Jeter Martin, who has been acting as resident physician to our
city hospital during the past summer. This patient, although not
cured by the hydriodate of potash, owing, as is believed, to her ina-
bility to retain it in sufficient quantity, was nevertheless so strikingly
improved by it, and that too in a very short time, and witnessed by a
whole class of students in attendance, as to be worthy of notice here.

S. C, aged 17, of luco-phlegmatic temperament, and of small
statue, had the misfortune to be attacked in March, 1844, with syph-
ilis. It commenced with chancres, and being in the country, she
took no medicine for the disease. In August following, she says
she was covered with small yellow blisters, and in six weeks there-
after each blister had become an ulcer, and these in their turn as-
sumed the appearance of small irregular horns.

When she arrived at the hospital, so entirely was she covered with
ulcerations, that she \vould allow no one to assist her in moving, for
fear of increasing her pain and suffering. On the 29th September
she entered under the service of Dr. Garvin. Her forehead present-
ed some five or six excrescences, projecting from half to three-fourths
of an inch beyond the skin, but attached to it, (tubercular syphilida,)
her elbows and knees were covered with large ulcerations, she had
chronic sore throat, &:c., &c.

Dr. Garvin first put her upon the blue mass, and directed chloride
of soda to the ulcers. This treatment was changed to corrosive
sublimate and a wash of decoction of sage, tinct. of myrrh, borax
and honey. This preparation of mercury affected the bowels and
had to be discontinued, and the iodide of mercury was substituted for
it ; the ulcers were then dressed with calomel 13 and simple cerate
15. She also took some quinine. This was the treatment pursued
up to December 1st, and under which she had somewhat improved.

So evident were her chlorotic symptoms, that upon entering this
month on duty at the hospital, I first prescribed the iodide of iron in
simple syrup three times a day in 3 grs. doses. December 3d, the
hydriodate of potash was given in the same doses, as the iodide of
iron is not retained upon the stomach. December 8th, the hydrio-
date is increased in quantity; and on the 15th, she takes 25 grs. per
twenty-four hours. Up to the 15th January. 1845, this treatment
was perseveringly attempted to be continued, but no effort could suc-
ceed in getting a larger quantity of this medicine into her system.
Indeed, it had frequently to be interrupted on account of the irrita-

1845.] Case of Fungus HcBmatodes. 685

bility of her stomach. Still her improvement was such, that her
ulcers almost entirely healed up, her horny excrescences ceased to
be reproduced, her throat appeared healed, she gained much flesh,
and left her bed to take regular daily exercise.

ARTICLE II.

Case of Fungus Hcematodes. By Gilbert H. Wootten, M. D.,
of Florence, Ga.

The extreme infrequency ofsuch cases in the United States, induces
me to prepare this brief history of one that partly came under my
management. The patient, the Rev. David Cox, aged about 40, of
leuco-phlegmatic temperament, was attacked some time in the year
1840, by the disease in question. The tumor formed about midway
between the trochanter major and the knee, on the external part of the
thigh. In its formation it presented the usual characteristics of fun-
gus haematodes, and was developed quite rapidly to the size of a
cocoa nut. At this juncture Mr. Cox, acting under the advice of a
gentleman ofthis county, (Stewart) who practices medicine, submitted
to an operation. The wound healed kindly, but the tumor re-appear-
ed very soon, at the place from which it was excised, and on the
1st of June, 1844, about six months subsequent to the operation, had
attained to about its original size. Up to this time, I am indebted
to the family for the details of the case. Dr. Strawn, my co-partner,
and myself, were now consulted, and requested to take control of the
case. The patient was importunate for a second operation, which
we discouraged, and declined performing, for the following reasons :
1st, we regarded the disease as constitutional, and not local; 2nd,
there were few, if any cases recorded, of success by an operation ;
3rd, the previous operation had not only failed, but had evidently
augmented the rapidity and violence of its formation ; 4th, the sys-
tem gave evidence o^ jjarticipation, by the intensely inflamed, and
very much enlarged condition of the inguinal glands. Had we have
seen the«ase previous to the condition of our " 4th reason," we might
have counselled as the only prospect of success — amputation of the
thigh. Would it have been good practice ?

The tumor in the groin (I mean the enlarged gland) continued to

686 Case of Fungus HcBmatodes. [December,

develope very rapidly and fearfully, and on the 1st of August, there-
after, had acquired the dimensions of a half-bushel measure — the
original one on the thigh having ceased to grow, remained the size
previously indicated. The inguinal tumor now shot out fungus ex-
crescences, (till its surface was dotted all over,) whose mouth resem-
bled an inverted stocking, and over all its surface the meanderingsof
large veins could be distinctly traced. It now bled frequently and
copiously, owing, as I presume, to the perforation of its vessels by
an ulcerative action. The bleedings were controlled by tamponing
these orifices, and by compression. The odour it emitted was ex-
tremely offensive, rendering the sick chamber a place of absolute
suffering to the attendants and visitors. I should perhaps remark,
that in the progress of this tumor, and before its character was so
well defined, we were frequently importuned by the patient to punc-
ture it, he hoping and believing it to be only an abscess, contrary to
our assurances. We refused to operate, but gave our consent to its
being done, merely to gratify and convince him. We remarked,
however, that it yielded physical indications of distinct fluctuation.
He procured the services of a Botanical physician to open it. Blood
in small quantity was the only result of the puncture. After attain-
ing the dimensions and character before described, sphacelation en-
sued, and the entire tumor sloughed out, leaving a cavity or basin
that would have contained two or more gallons of fluid, with a sub-
tegumentary hollow or channel, communicating with the original
tumor on the thigh. Knowing that Sir Astley Cooper had reported
one case of recovery, by the occurrence of the same process, we en-
tertained some hopes that the sloughing would proceed and eradicate
the original tumor, and thus save our patient. But contrary to our
hopes it did not do so. The patient was now extremely emaciated,
aspect ccfJareroiw, breathing scarcely perceptible, voice entirely inau-
dible, with almost constant sleeping. At this stage, after putting
him under prescriptions, the case, owing to incidental circumstances,
passed to the control of another physician, and was not seen again
by us, until about the middle of November, a period of two months.
When we again visited the patient, he had recovered his strength,
the cavity left by the sloughing of the tumor had filled up kindly,
but on the margin of the cicatrix, six or eight other tumors, about
the size of lemons, had formed. The patient died about the 15th of
December, with rigors. During the progress of the disease, we
frequently interrogated the various organs of the system, to discover,

1845.] Case of Secondary Syphilis. G87

if possible, whether they had taken on lesions. The most prominent
evidences discovered were furnished by the lungs, the spinal column
and the rectum. These we briefly mention. The expectoration was
profuse, and resembled thick mucus, having a very unp easant odour.
No blood was discovered with it. Hemiplegic paralysis ensued,
and there was tenderness upon pressing the vertehrce. This we
made no effort to relieve, as it occurred only a few days prior to his
demise. The rectum was the seat of excrutiating pain, in voiding
i\\Q fcBces^ or in the escape o^ flatus. This we supposed was owing
to an inflammatory action, resulting from the contiguity of the tumor.
It would seem useless to give in detail the system of medication
adopted in the management of this case. SuflSce it to say, that we
directed opiates in sufficient quantities to lull the sufl^ering ; zf-'Z7jeand
ammonia to support the patient under the sloughing process ; elixir
vitriol to control the colliquative sweats ; saline aperients to keep
the bowels gently open ; and the pyroligneous acid locally, to correct
the fetor of the exhalations. We should perhaps mention the fact,
that the patient was also visited occasionally by Dr. Hay, of this
county.

ARTICLE III.

Case of Secondary Syphilis. Read before the Georgia Medical
Society, December lith, 1843 — By Johnstox B. Tufts, M. D.,o/
Savannah, Ga.

The patient in this instance was a native of Ireland, aged 32 years ;
a man in good circumstances, but of very intemperate habits; gen-
eral health not very good, owing, no doubt, to his liberal use of ardent
spirits. This individual had contracted a venereal affection some
months before he applied to me for advice. For this primary disease,
he had been under the hands of two medical gentlemen of this city,
who, according to his account, dismissed him as cured. The primary
affection seems to have consisted of a large chancre on the glans
penis, and a bubo in the right groin. These two, viz., the chancre
and the bubo, he states were evidently cured ; but upon making an
examination of the seat of the former, I found quite an induration
existing there : thus verifying M. Ricord's opinion, that induration

688 Case of Secondary Syphilis. [December,

may remain after cicatrization, and being generally a sign of future
symptoms, requires peculiar attention. Not very long after his sup-
posed cure, he was attacked with a sore throat, as he imagined, which
terminated in a large ulcer in the left side of the fauces, and likewise
one on the velum pendulum palati, which were soon succeeded by the
following symptoms, at the time (the 3d of November, 1842,) the
case fell into my hands : The glands on the right side of the neck,
to the number of four or five, were very much enlarged, painful,
hard to the touch, and slightly red externally. The iris of the right
eye was intensely inflamed ; in fact, a pure syphilitic iritis. This
also was quite painful, particularly on the application of a strong
light. Some contraction of the pupil. The ulcer in the fauces dis-
charged freely ; so also did that of the uvula, three-fourths of which
latter was destroyed. He also complained of osteo-copic pains gen-
erally, but more particularly in the lower extremities. These seemed
to annoy him more at night than during the day; although, even
then, at times. I had good reason to believe from his statements,
that he had never sufTered from any thing like a rheumatic afTection;
no fever or other indisposition than as noted above. From the his-
tory of the case, as narrated by the patient, together with the present
symptoms, it will be perceived that this was a case of secondary
syphilis, resulting from an induration, in accordance with which, I
ordered the following treatment : —

R. Proto iodide Merc 3i.

G. Opii grs. v.

Ext. Guaiac 3i.

Ft. pill No. 36

Of these pills, I directed one to be taken every day, two hours after
supper. I was thus guarded in using the protoiodide in so small a
dose, because I had no great experience in relation to its activity,
and was desirous of becoming better acquainted with its strength,
before pushing it actively. As a gargle for the throat, I ordered the
following :

Corrosive Sublimate, . . . grs. xv.

Water, lb. 1. (mix.)

With this, the patient was directed to gargle the throat three times a
day. He was also advised to bathe the eye in warm milk and water
— to use the diet drink, in the proportion of three tumblers full du-
ring the day — to abstain from drinking and exposure — and to live
upon a vegetable diet ; in which latter particulars, he, like most of

1845.] Case of Secondary Syphilis, 689

devotees of Ventis and B.u-chns, heeded me )»ut little; inasnuich as
he got diunk several times during]; his illness — exposed himself to all
sorts of weather — and fed largely on bacon.

Nov. 4. 'I'he same treatment was continued, except that the
quantity of the proto-iodide was increased. I directed him to take
one pill in the morning and one in the evening, I thus increased
the quantity of the proto-iodide much sooner than I expected to do
at first, on account of an increased pain in the eye and throat during
the night. At this time, the patient was in a very desponding mood
— thought that he did not get well fast enough — (rather early I think
to complain on this score) — and stated to me, after I had ordered an
increased dose of the pills, that he had taken /owr already this morn-
ing— on the principle that as they had no taste, they consequently-
had no strength. I requested him to sin no more in this respect, but
to stick to the two per diem until further orders ; to which plan, by
holding the fear of salivation before his eyes, he adhered.

Nov. 5. Same treatment continued. I would remark here, that
I have been touching the ulcers in the throat every morning with
nitrate of silver.

Nov. 6. Same treatment continued.

Nov. 7. Same treatment continued, except an alteration of the
gargle. The ulcers in the throat having assumed more of an irritable
appearance, 1 ordered the following:

R. Corros. sublim. . . . grs. xv.

G. Opii 3i.

Aq. pur lb. 1. (mix.)

The throat to be gargled with this, as before.

Nov. 8. The same treatment continued.

Nov. 9. Same treatment continued, with this addition : I order-
ed him to rub in, night and morning, upon the malar process of the
right side, a lump of ung. mere, about the size of a nutmeg. Order-
ed likewise a blister upon the right temple. This particular symptom
(iritis) would have been treated actively before could leeches have
been obtained, or the patient have been induced to submit to cup-
ping. But the exhibition of the mercurial internally alone, had
evidently produced a change for the better, before recourse was had
to the topical application. I was also desirous of seeing how soon
the internal exhibition of the remedy would act independent of
assistance externally.

Nov. 10. Same treatment continued. Blister has drawn well.

690 Case of Secondary Syphilis. [December,

A considerable improvement of the eye has taken place in this short
time. Directed the blistered surface to be dressed with mercurial
ointment. The ulcers in the throat have improved rapidly since
using the gargle last ordered. There is not the least evidence of
ptyalism.

Nov. 11. Same treatment continued.

Nov. 12 and 13. Did not see the patient, as he had felt so much
better, that he took the liberty of leaving his house, and strolling
about the streets, notwithstanding the inclemency of the weather.

Nov. 14. Patient has improved very much. Ulcers doing well,
and the eye nearly clear. Says he took the last of his pills to-day.
He has therefore taken the 36 pills in twelve days. Continues the
use of the ung. mere, to the molar process, and as a dressing to the
blistered surface. Directed the following :

R. Proto iodide Merc. . . 3ss.

G. Opii grs. ix.

Ext. Guaiac. . . . 3ss.
Ft. pill No. 36.
One pill to be taken every evening two hours after supper.

Nov. 15. Patient doing remarkably well. The eye is at this
time perfectly free from inflammation. Ulcers in the throat healing
rapidly. No mercurial effect upon the system perceptible, except the
check upon the disease. He has discontinued the use of the ung.
mere, as a dressing to the blistered surface, substituting ung.
simplex, to which I assented, considering the state of the eye.
The other remedies continued as before.

Nov. 16. By reason of other engagements, I did not see the pa-
tient to-day. On the 17th and 18th, he was absent from his house,
and therefore I did not see him.

Nov. 19. He is now perfectly cured. There is no evidence
whatever of the affection remaining. The ulcers in the throat have
entirely healed ; no tumefaction of the glands of the neck whatever ;
710 induration of the former seat of the chancre; and he is entirely
free from pain in all parts of his body. During the whole treatment
he has not had the least soreness of gums, or any other symptom in-
dicative of the specific action of mercury, other than the cure of the
disease.

Remarks. — This cure presents at least one singular feature. The
resistance to the specific action of the proto-iodide, which is gener-
ally considered as very active in producing ptyalism.

1 S45.] Case of Dry Mortification, 691

Note, — Since the above was reported, I have had a number
of similar cases, which have terminated in the same happy man-
ner, and in no single instance have I been under the necessity of
producing ptyalism. Taking these cases into consideration, I am
somewhat inclined to think that the remedy acts more beneficially
when this latter is not produced.

Our experience corobnratesthat of Dr. T. We have not remark-
ed that the proto-iodide of mercury is more apt to salivate than the
other preparations of this mineral, but the reverse we believe is
true. — Edts.

ARTICLE IV.

Case of Dry 3Toriif cation, occuring immediately after Delivery —
amputation of the Leg — recovery. By John G. Westmore-
land, 31. D., of Zebidon, Ga.

Mrs. , aged about thirty, in the eighth month of utero-gesta-

tion, suffered two or three weeks from great irritability of stomach,
and during which time, very little nourishment was retained. Pre-
mature labor then came on, and she was delivered. Soon after this,
she complained of pain and uneasiness in her second toe, with cool-
ness of the foot, which she had felt several hours before delivery.

On examination, I found an unusual coolness of the right foot and
leg ; but thinking that notiiing serious was to be apprehended, pre-
scribed some warm application, and left her. I returned late the
next day, and to my surprise found her suffering excruciating pain
in her toes and the contiguous part of the foot. The toes were
shrivelled, and the whole foot deathly cold. I immediately pronoun-
ced it a case of dry mortification, and which it has, unquestionably,
proved to be.

The acknowledged proximate cause of this disease being an oblit-
eration of the calibre in the principal arteries of the leg; or from
disease, in some other way interfering with the circulation of blood
through them, I have thought proper to mention the situation of my
patient previous to the attack, that your readers may have the better
opportunity of determining the predisposing cause in this case.

Immediately on discovering ihe lady's true situation, I applied a
blister to the foot, and wrapped the part, thickly, with carded wool,

692 Case of Dry Mortification. [December,

to the extent of spveral inr-hes above the ankle. In twenty-four
hours aft<T these applications, the toes presented a more natural ap-
peararu-e, the tenjpcra'ure of the font fjeneraliv. was raised, and the
pain diminished: in fact, every thing seemed to flatter us witli the
hope that the part was reviving. In two davs m')re, however, nil the
symptoms grew worse — the foot became swollen, and the arterial
action, which for the first two or three days was moderate, now as-
sumed a decidedly febrile character. The only position which
afforded any relief for the excruciating pain, was with the shoulders
elevated, and the foot hanging out of the bed. Warm applications
increa ed the pain, and venesection, to say the best of it, did no good.
In this state of extreme suffering. I made an application of cold wa-
ter by afl^usion, which in an hour gave almost perfect ease ; and from
this time she could rest, in the recumbent position, with her foot on
the b 'd, better than in any other way.

This treatment, with nauseating doses of ipecac, allayed the pain
and fever, increased the temperature of the foot, and restored a
cheerful countenance. But this apparent amendment was of short
duration. In two or three days the pain, and other symptoms, indi-
cating rapid progress of the disease, returned. Tho toes became of
a dark color, the cuticle separated, and in a few days more most of the
foot was sphacelated. Large and repeated doses of opium, with the
cold affusions, were now brought into constant requisition, to moder-
ate the excessive pain, which threatened her dissolution. About the
twentieth day the line of demarkation began to form an inch or two
above the ankle ; and in five or six days, was complete. I amputated
about the thirtieth day. The leg was taken ofl^above the knee ; and
now (ten days since the operation) the slump is healing kindly, with
every prospect of speedy recovery.

[Upon the reception of the above communication, we addressed a
letter to its author, requesting a few a(iditional particulars, to make
the article more complete and satisfactory. We give below the ad-
ditional facts.

We recently noticed a very similar case in a late Journal, with the
diff*erence, however, that our contributor and estimable pupil saved
his patient, while the one mentioned in the foreign periodical died.
The mortification in these cases may have originated either from
inanition, the result of the irritable condition of the stomach, or more
probably to some pressure upon the vessels or nerves of the pelvic
region. — Edts.]

1845.] On the Buffy Coat of the Blood, 693

I\Iy patient had i)orn two childrpn — she felt the pain in her toe the
day preceding the night she was dtlivored, perhaps six or eijiht hours
previous to delivery. I have no idea thiit (his pain induced lahor,
for it was inconsiderahle at the time; but 1 tijiirK labor was brou^iht
on by exces>ive vomitinrr. Her temperament is more l)iHous than
otherwise — there is no hereditary disposition to mortification. I
judged of the temperature by my own feelings in touching. She
used no particular article of diet, before nor after the attack. 1 nev-
er could feel the pulsation of any artery lower down than the femoral.
About a week elapsed from the commencement of the pain, to the
separation of the cuticle. The arteries divided in amputating had
their caliber almost entirely destroyed ; so much so that not a drop
of blood escaped from them, consequently no ligatures were requir-
ed. The arteries had the appearance of white cords, with capillary
orifices the size of the point of a pin.

There is no disease in any other artery of the body that I can de-
tect. The sturnp now (twenty-seventh day since the amputation)
has nearly healed, and the patient is doing very well.

PART II.— REVIEWS AND EXTRACTS.

On the Buffy Coat of the Blood. By George Gulliver. F. R.*S.,
Surgeon in the Royal Rpgimrnt of Horse Guards. — Read at the
Royal Medical and Chirurgical Society, February 11, 1845.
(From the Edinburgh Med. and Surg. Journal.)

I. Historical notices of the consistency of the Blood, and of the con-
dition of the red corpuscles in inflammation. — Boerhaave* and his
commentator Van Swieten maintained that a lentor or vicidity of the
blood is connected with inflammatory disease. Langrishf describes
the blood in acute fevers as being more than usually viscid and tena-
cious, and as containing an excess of red corpuscles. He held the
incorrect opinion, common to many eminent men, either his cotem-
poraries or immediate predecessors, as Boerhaave.lj: Keill,§ Jurin^H

* Aphor. lOD, 119, 117, 375, 6G3.

t Pn.ctice of Pb\-sic, pp. "22 and 74, 8vo. Lend. 1735.

t Praslectiones AcademicaB, ed. Alb. Haller, § ccxxvii. t. ii, Svo. Gottingae,
1743.

§ Essays on several parts of the Animal Economy, p. 95, et seq. 2d ed. Svo.
Lond. 1717.

li Phil. Trans. 1719, vol. 30. p. 1000.

694 On the Buffy Coat of the Blood. [December,

and Haller,* that coagulation is caused merely by a running together
of the red corpuscles. Triiler,"}* Sch\venke,:j: Dr. Francis Home,§
Huxam,|| and Marherr,1[ concluded that the viscidity of the blood is
increased during inflammation ; and this state of the blood was made
the subject of several dissertations about the middle of the last centu-
ry, as by Klein,** Goeslingjff PohliuSjJt and Nicolai,§§

On the contrary, Buechner|||| wrote a treatise on the thinned state
of the blood. Quesnay^^ believed that the floating of the humour
which forms the buffy coat, and which he states is of the same na-
ture as the lymph, so far from indicating a thickening, really shows
that the fluidity of the blood is increased.

Quesnay also states, in anticipation of a very recent doctrine, that
the buffy part is formed from the red corpuscles, destroyed and re-
duced into a glaire by the action of the arteries, and that this glairo
abounds in acute diseases at the expense of the corpuscles, sometimes
to such an extent that the red part is much diminished. Bordenave***
held somewhat similar views.

Dr. Richard DavieSjfj'f observing the quickened sinking of the
red corpuscles in blood becoming buffy, inferred that there was a
preternatural attenuation of the coagulable lymph. He called this
spontaneously coagulable matter, after Borelli^tt *^^^ gluten. We
owe to Dr. Davies the earliest correct description, printed in our
language, of this principle of the blood; which I mention with the
hope of drawing him from the oblivion to which he has been so long
and so unjustly consigned, and to notice the strange silence of the
Hunters and their encomiasts about his researches.

It is now well known that the buffy coat is formed of fibrin left at
the surface of the clot by the sinking of the red corpuscles. Like
Davies, Mr. Hewson§§§ and Dr. Davy|||||| attributed this sinking
chiefly to an increased tenuity of the coaguhible lymph, an inference
which the two last distinguished physiologists drew from the fact
discovered by Hewson, that the corpuscles fall more rapidly in the
entire mass of the blood, during the formation of the buffy coat, than
they will do in the serum alone. Similar views were adopted by

* Deux Memoires sur le Moiivement du Sang, p. 21-22, 8vo. Lausanne, 1756.
t Com. de Pleuritide, §§ xxviii, and xlvii. 8ro. Francof. et Moenum, 1740.

I HfEmatologia, p. 154, et scq. 8vo. Hagsee Com. 1843.
§ Principia Medicinse, p. 101. 8vo. Edin. 1758.

II Essay on Fevers, chap. 4, p. 30. 8yo. Lond. 1760.

IT Prselectiones in H. Boerhaave, lust. Med. t. 2, p. 254. Vien etLips. 1773.

** De Massse Sang. Viscedine. 4to. Argentorati, 1737.

+t Diss. Inaug. de Spissitudine Sanguinis. 4to. Gottingae, 1747.

U De Spissitudine Sanguinis a neglectomotu. 4to. Lips. 1749.

§§ De Spissitudine Sanguinis. 4to. Halse, 1749,

III! De nimia Sang. Flui'dit. 4to. Haloc, 1749.

HIT Traite de la Saignee, pp. 405, 406, 415, 416. 8vo. Paris, 1760.

*** Essai sur la Physiologie, p. 155-150. 8vo. 4eed. Paris, 1787.

ttt Essays on the Human Blood, p. 23. 8vo, Bath, 1760.

J+J De Motu Animalinm, Op. posth. pars. alt. Prop, exxxii. 4to. Roman, 1681.

§§§ Exp. Inq. Part 1, p. 45, d scq. 8vo. Lond. 3d ed. 1780.

mill Researches, Phy. and Anat. vol. ii. p. 48. 8vo. Lond. 1839.

1345.] On the Buffy Coat of the Blood, 695

Thomas Houlston,* Dr. George . Ford\'ce,f Dr. William HLiDter,J
Dr. James Makittrick,§ Dr. George Levison.|| Dr. James Gregory,^
Dr. Cullen,** Hugh Moises,tt James Wilson.ijit ^"d others. But
Mr. Hey§'$> maintained that the blood is not thinned during inflano-
mation : Air. Grainger|j|| is of the same opinion, and Professor
Henle and ]\Ir. Wharton Jones^? state that the coagulable lymph is
really thickened.

The last two authors and Professor Wagner ascribe the formation
of the bulTy coat to an increased disposition of the red corpuscles
to run together, as originally explained by Professor Hermann
Nasse*** of Marbourg. and thus described by Mr. Jones : " The
minute process leading to the separation of the liquor sanguinis from
the red corpuscles, the visible condition for the formation of the huffy
coat, consists in an exaltation both of the rapidity and closeness with
which the red corpuscles aggregate into rolls, and these again into a
sponge-work, thus squeezing out the liquor sanguinis from among
the corpuscles, and allowing the greater specific gravity of the latter
to come more fully into play, whereby the liquor sanguinis, which in
such cases is in relatively greater quantity, collects at the top, and,
coagulating, cives rise to the buffy coat."

Dr. Davyftt observed, that, in certain cases in which the inflam-
matory state is best marked, the separation of the corpuscles and
coagulable lymph is most rapid. Dr. Stokeriii has also shown that
the buffy coat may occur in blood which coagulates more quickly
than usual. In a thin film of such blood, Schroeder Van der Kolk,
and Dr. Alison. •$*§§ observed that the corpuscles separate laterally,
giving it a mottled appearance, as characteristic of the state of the
blood as the butTy coat itself: a fact which seems to have been des-
cribed by ]Nlr. Hunter, as follows, in his Surgical Lectures, when
speaking of the blood in inflammation : " The blood has an increased
disposition to separate into its component parts, the red globules be-
come less uniformly diffused, and their attraction to one another

* Diss. Med. laaiis:. de Inflammatione. p. 14. 4to. Liisrd. Bat. 1767.

t Elements of ihe Practice ol Physic. Part 2, p. '2S-S0. 8vo. Lend. 1768.

J Lectures, p. 8-9, 4to, MS. press mark D. D. f. 6, in Lib. Roy. Med. Ch. Soc.
No date, but some of Hewson's experiments are noticed.

§ Com. on the Princ. and Practice of Physic, p. 154. 8vo, Lond. 1 1 i2.

II An Essav on the Blood, p. 86. 8vo. Lond. 1776,

^ Conspectus Med. Theor. t, 1, §§ 503 and 504. 8vo. ed. alt. Edin. 1782.

** First Lines of the Practice of Physic, vol. i. § ccxli. 8ro. Edin. 1789.

tt Treatise on the Blood, p. 48. 8v6. Lond. 1794.

tz Lectures on the Blood, p. 53. 8vo. Load. 1819.

§§ Observations on the Blood, p. 14. 8vo. Lond. 1779.

nil Elements of G^en. An at. p. 41. 8vo. Lond. 1829.

ir^ Report. §§ 1, '2. 40. 45, 49, in No. 34 of Brit, and For. IMed. Rev., and §§ 9,
107 in Xo. 35 of same Review.

♦** Henle, Anat. Gener. tr. par Jourdan, p. 463. 8vo. Paris, 1843; and Mr.
Jones's Obs. on the Blood, pp. 1*2-17, reprinted from No. 28 ot Brit, and For.
Med. Rev.

ttt Phil. Trans. 1822, p. 271.

i:: Pathological Observations, np. 37 and 44. 8vo. Dublin, 1823.

§§§ Outlines of Phys. and Path. p. 47. 8vo. Edin. 1833.

696 On the Biiffy Coal of the Blood. [December,

becomes stronger, so that the bloo^ when out of the vessels soon be-
comes cloudy or uiiid<ly and dusky in its colour, and, when spread
over any surface, it appears mottled, the red blood attracting itself
and forming spots of red. This is so evident in many cases that it
is hardly neeessary to wait till the whole coaL^ulates to form a judg-
ment of it."* Dr. Charles J. B. Williams-]- thinks that the agiirega-
tion of the corptiscles may be a mechanical one, induced bv a change
in the relative dilution of the /z'^wor sanguinis, or serum, within and
without the blood corpuscle.

S nee the publicatiou of the accurate description by Dr. Hodgkin
and iNIr. Lister. :j: the running together of the red corpuscles of the
healthy blood of mammalia into piles has become well known §
The effect of mucilage or white of eug in promoting their further
aggregation was observed by Mr. Wharton Jone>|| and Professor
Henle; and I have been informed by Mr. Jones that there are some
observations on the subject by Nasse.lT The efF^ct of neutral salts
in separating the corpuscles from each other was noticed by Eller,**
and since by Dr. Dav\-j"|- and others.

II. Separation of the red corpuscles and liquor sanguinis in the
blood of the horse. — When the venous blood of this animal is re-
ceived into a small narrow vase, an upper buffy part regularly forms,
quite equal in perpendicular measurement to the lower red part of
the riot. This s|)ontaneous separation was pr(il);i!)ly known to Har-
vey:|:± ; it is mpntioued by Dr. Allen Thomson. §§ and more particu-
larly bv Andral {||{ Gavarret, and Delafond. My observations, unless
otherwise expressed, were made on the blood of the horse.

III. Sinking of the corpuscles in the liquor sanguinis and in the
serum. — It is certain that the corpuscles sii»k at least twice faster in
the entire mass of the blood, during the formation of the buffy coat,
than they will do in the serum alone, as is shown in the details of
experiments 4-10.

IV. Spontaneous acceleration of the rate of sinking of the cor-
puscles in the liquor sanguinis and in the serum. — During the forma-
tion ofthe buffy coat, it is very remarkable that the corpuscles fall
much faster after the first two or three minutes than before. In a
mixture of serum and corpuscles, either fresh or after it has been kept
some hours and occasionally agitated, there is also an acceleration,
though to a less dejjree, in the rate with which the corpuscles subside.

* Hunter's Works by Palmer, vol. i. p. 235. 8vo. Lond. 1835.
t Principles of Medicine, p. 89. 8vo. Lond. 1843.
: Philosophical Magazine, vol. ii. p. 135, July — December, 1827.
§ Dr. Daw has lately des^cribed the viscid or adhesive quality ofthe corpuscles.
See Trans. Rov.Soc. Edin. 1845, vol. xvi. p. 54-55.
II Report, §§"2 and 3. Brit, snd For. Med. Rev. No. 34.
IT Das Elm. pp. 223, 225, and 231. Svo. Bonn, 1836.
** Hist. del'Acad. des Sceinces. annce 1751, pp.13. 14.
++ Res. Phy. fnd Anr.t. vol. ii. p. 178. 8vo. Lond! 1839.
:: De Generctione Animilinm, p. 1()0. 4to. Lond. 1G51.
0 Syllabus of Lectures on Physiolos^y, p. 13. 8yo. Edin. 1835.
nil Hematologie Pathologique, pp. 28 "and 50. 8vo. Paris, 1843.

1845.] On the Buffy Coat of the Blood, CQI

It is commonly greatest in the liquor sanguinis he\\veen the third and
sixth minutes, and s^ofnelimes hiler ; and latter siill in the sernm.

V. The fallini: of the corpusclts rather retarded than hastened
hy a thinning of the liquor sanguinis — If the rnpid faHino: of the cor-
puscles, dnrin*! the formation ol tl:e biiffv coat, be du«* to an aiteniia-
lion of the liquor sanguinis, it follows, that, if we increase thisqiiality
without ha«!tening co;j<iula(ion or makin«: the corpuscles lighter in
rei.ilion to the cfinlaining fluid, ihey will sink still more quickly,
and he suspended aga.n wlu^n the mixed fluid is made thicker. I
accordiniriy mixed dilute saline solutions and urine with the blood, by
all of which its consisiency and specifif gravity were reduced, and
its co;igilation somewhat retarded. Yet in none of these mixtures
was lliH falling of the corpuscles so rapid, nor the biiiTy coat so thick,
as in some pure blood set apart for com])arison ; while in one mix-
lure of urine and blood, which remained liquid for upwards of fifteen
minutes, the corpuscles never sank enough to leave the slightest
buffy surface.

It was remarkai)le, too, that whrn there was a falling of the cor-
puscles in these mixtures, the acceleration above noticed in the rate
of sinking after a few minutes was prevented.

When the same quantity of salt was dissolved in mucilage and
mixed with the blood, the corpuscles, so far from being susj)ended,
always fell more rapidly than in blood thinned by saline matter in
water, sometimes as quickly as in pure blood, occasionally quicker;
and now and then with such velocity, that a clear floating portion of
liquor sanguinis, two inches de« p, appeared in five minutes.

In this case, the acceleration in the rate with which the corpuscles
sunk, after the first two or three minutes, was still greater than in
pure Idood.

Some trials were next made on the falling of the corpuscles in
serum made thinner and lighter by the weak saline solutions, and in
serum made tliicker and heavier hy mucilage ; whence it resulted,
calculating from the time required for the appearance of a clear
stratum of fluid at the top of the mixtures, that the corpuscles subsided
more rapidly ^n the thicker than in the thinner fluid.

'Vhai [he liquor sanguinis becomes viscid in chanrring from the
liquid to the solid stale, as originally described by Dr. Davy,* is a fact
easily shown. But. on the other hand, it has never been supposed
that it becomes thinner bef »re it coagulates, after its abstraction from
the animal. Yet to this improbable conclusion we shall be led. if we
admit that the sinking of ihe corpuscles in the liquor sanguinis is a
correct measure of its consistency or tenuity.

VI State of the red eorpuscles in huffy blood. — As it is certain,
ccEteris paribus, that the falling of particlts throujih a light and thin
fluid must be quicker than throu.<rh a heavier and thicker one, the
state of the corpuscles in these difii;renl fluids cannot be equal.

And that such is really the case, may easily be seen with the naked

• Phil. Trans., I8i>2, p. 273. ~

698 On the Buffy Coat of the Blood. [December,

eye. Thus, in thin layers of those viscid mixtures in which the
corpuscles sunk most rapid!}', they were so clustered as to appear
like particles of coarse and dark red powder in an excess of limpid
fluid ; while the thinner mixtures, in which the corpuscles fell most
slowly, were of an uniform and lighter red colour, from the separa-
tion and equable diffusion of the corpuscles throughout the fluid.
With the aid of the microscope the corpuscles of human blood, which
had no buffy coat, were seen frequently in piles; but these were
only occasionally grouped into clusters, and by far the greater num-
ber of the corpuscles were either separate or very loosely connected
together. In buffy human blood the corpuscles are more aggregated.
But it is in the naturally buffy clot of the horse's blood that the ag-
gregation of the corpuscles is most remarkable ; they appear as if
melted together, and are almost universally collected into clusters,
the piles sticking to each other. These observations were made at
various times after coagulation.

Yll. Agents which prevent and increase the aggregation of the
corpuscles. — When a saline solution was mixed with the clustered
corpuscles, their connection was quickly dissolved, so that they were
all separated and equably diffused throughout the liquid. Either
urine or syrup had the same eflect. On adding mucilage, the cor-
puscles again became aggregated, and they were again dispersed by
another dose of saline matter. A small proportion of salt mixed
with the mucilage promotes the clustering of the corpuscles more
than the mucilage alone, as is shown in experiments 22-25. The
salt alone had the effect of more or less reducing the size of the cor-
puscles, as if it dissolved a part of their surface. The serum of one
animal often causes the corpuscles of another animal to become ag-
gregated very quickly.

VIII. A probable cause of the efUcacy of saline medicines in in-
flammations.— As only a very weak saline solution is required to
prevent or destroy the aggregation of the corpuscles, and to correct
the tendency in the blood to the formation of the buffy coal, may
not this action of the salt be one cause of the well-known utility of
saline medicines in inflammatory diseases ?

IX. Cause of the rapid sinking of the corpuscles, and of its ac-
celerated rate during the formation of the buffy coat. — The aggrega-
tion of the corpuscles was connected with their most rapid sinking,
and their separation and diffusion with their most tardy sinking;
while their rate of falling was hastened by a thickening and retarded
by a thinning g^ the liquor sanguinis. The largest particles of a
powdered substance will sink quicker in a fluid than the smallest
particles. In some experiments with magnesia in a solution of Ep-
som salt, and with poppy seed in mucilage, there was no evident
acceleration in the rate of sinking, similar to that of the red corpus-
cles through the liquor sanguinis. I know not that this acceleration
can be explained otherwise than by the increasing aggregation of
the corpuscles during their descent. Yet there was a like accelcra-

1S45.] On the Buffy Coat of the Blood. 699

tion, though to a less degree, in the falling of the corpuscles through
the serum, in which they were clustered from the beginning of the
experiment, or even many hours before. But the masses may
coalesce still further during their descent ; and it will be recollected
that the accelerated sinking is quite prevented, or even reversed,
when the corpuscles are kept apart by weak saline solutions.

X. Details of Erperimcnts. — For the sake of precision, which
appears the more necessary since Mr. Prater* has shown the opposite
etlects on the blood of ditlerent quantities of the same substance, I
shall detail some of the principal experiments made in the course of
the present inquiry. They will be found to illustrate many points
foreign to the subject now considered, such as the elTects of various
substances on coagulation and on the contraction of the clot. The
experiments were all conducted under the following circumstances,
unless otherwise mentioned ; and my best thanks are due to Mr. Sid-
dall, the able veterinarian of the Blues, for his kind assistance. The
blood used was drawn trom the jugular veins of troop horses; and,
in comparative trials, in order that every portion of it should be as
nearly as possible alike, the blood was received from the animal into
a pitcher, stirred for a few seconds with a stick, and then quickly
poured into the ditlerent vases for observation. These were com-
mon circular glass bottles, with the tops cut off, and holding about
six ounces when filled within about half an inch of the rim ; thus
filled, the column of fluid measured about four inches in length, and
one and three-fourths in diameter. The agitation used to mix the
ditferent matters with the blood was also applied to the pure blood
set apart for comparison. As the corpuscles in pure blood are soaked
in the liquor sanguinis, they were well mingled with the artificial
fluids. If dropped on or only just dipped in a dense saline solution,
they may remain awhile at the top, just as a piece of fibrin will do,
though it sinks at last, in a saturated soluiion either of Glauber salt,
of nitre, or of muriate of soda. This is an important fact in rela-
tion to the use of such solutions in estimating the specific gravity of
fibrin, as was done by that excellent observer, Dr. Benjamin Babing-
ton.* His estimate was probably too high, as the saline solution
deprives the fibrin of some of its natural moisture. In a weak saline
solution, the corpuscles will fail rapidly before they become disjoined
and saturated, though very slowly afterwards. If they become speci-
fically heavier or lighter by endosmosis or exosmosis. it may be sup-
posed that their specific gravity would only be approximated, within
certain limits, to that of the fluid in which they are placed ; and that
they would difler no more from the fluid in that respect than they did
originally from iheliquor sanguinis. When the corpuscles are stated
to have sunk to any extent, it is merely meant to express that a clear

* Experimental Inquiries in Chemical Physiolog)'-, Part 1, p. 37, 8vo. Lond.,
1832. He observes that adding serum to blood hastens its coagulation. Op.
cit. p. 105.

* Cyclop, of Anatomy, vol. 1. p. 418.

700

On the Buffy Coat of the Blood,

[December,

su[>ernatant stratum of fluid was left, corresponding to the given
measure; and when it is nofed that there was no sinking of the cor-
puscles, it is simply to affirm that enough of them remained at the
top to preserve its opaque red colour.

XL Sinking of fhe corpuscles in blood received from the animal^
and not agitated aflcrwards,

I. In 3| minutes the corpuscles sunk | inch.
51- ... 1

7^ . . . li

8| . . .2 inches.

n ' . . . n-

Xir. Sinking of the corpuscles in the same blood, broken up in the
serum twenti/fonr hours afterwards, and strained through linen,
II. In 6 minutes the corpuscles sunk ^ inch.
8 . . . i

11 . .

16
26
34

3. In some blood from another horse, treated in the same way
aft€r keeping seven hours, the corpuscles fell, in eleven minutes, one
inch, and in twenty-three minutes, two inches.

XIII. Comparative sinking of the corpuscles in the liquor sangui-
nis and in serum.

4. Blood divided into three portions. In the liquor sanguinis the
corpuscles sunk.

In 2^ minutes, . . ^ inch.

2 inches.

4^
5

5. In a second portion, deprived of fibrin by whipping, the corpus-
cles sunk,

In 5 minutes, . . ^ inch.

7 . . . i

10 ...

13 ... f

15 . . .1.

6. In the third portion, deprived of fibrin by agitation with nails
in a bottle, excludinir air as murh as possihle, the corpuscles fell at
the same rate. The specific fjravily of the serum at G0° was 1029;
and it roajriilated at a heat of 158*^.

7. In the liquor sanguinis of another horse the corpuscles subsided.

In 2| minutes, . . i inch.

3i . . . i

4i . . . I

1845.J

On the Buffy Coat of the Blood,

701

In 4^
5
6

8
9

10|-
At the end of roiiitoon minutes
nealh quite liquid; coafrnlnted in

inch.

. If
• u

2 inches,
there was a film on the top; be-
sixteen minutes. Final perpen-
dicular (neasuremimt ot the upper butiy part two and a-half, and of
the lower red part, one and three-fourth inches.

8. In a second portion, immediately after removing ihe fibrin in a
bottle, excluding air, the corpuscles subsided,
In 8 minutes,
11 . . .

12^... I

13 ... ^

14 ... f
15^ ... I

^ inch.

17^
20
21
24

1
If

H
^\

2 inches.

9. A Her the lapse of twenty-four hours the superstratum of serum, in
Exp. 8, measured two and seven-eighth inches, and the substratum
of corpuscles one and three-fourth. The mixture was then shaken,
when the corpuscles sunk as follows :

In 11 minutes, . . |- inch.

14 . . . i

iH ... I

16i . . . i

17f . . . f

19 ... f

20 ... i

21 ... 1
22^... IJ
23| . . . li
25 . . . If
27 . . . l|
31 . . . 1|

36 . . .2 mches.

10. In the same mixture, after ajritation the next day, the corpus-
cles fell at the same rate. They subsided most slowly in the newest
serum in Exp. 35 and 38.

XIV. Sinking of ike corpuscles of one animal in the serum of
another.

11. Corpuscles of human i)lood which took 13 minutes to sink ^th
of an inch in their own serum, sp. gr. 1028, sunk in horse's serum,

702 On iJie Bvffy Coat of the Blood. [December,

of the same sp. gr., above twice as rapidly, and with a remarkable
acceleration after they began to sink. The aggregation of the cor-
puscles was very plain to the naked eye quickly after they were put
into the horse's serum. See Exp. 37 and 41.

12. Corpuscles from horse's blood sunk quicker in human serum,
sp. ^r. 1032, than in their own serum, sp. gr. 1028.

XV. Slow sinJcing of the corpuscles in iceaJc saline solutions.

13. f ss. of mixed serum and corpuscles agitated with giv. of solu-
tion of nitre, 10 grains to an ounce of water, sp. gr. 1020. The
corpuscles to9k an hour to sink an inch.

14. A similar trial, substituting urine, sp. gr. 1024, for the solu-
tion of nitre. The corpuscles fell equally slow.

15. In the serum, sp. gr. 1028, for comparison with Exp. 13-15,
the corpuscles sank half an inch in 15 minutes.

XVI. Formation of the hxiffy coat prevented or lessened hy making
the blood thinner and lighter, and its coagulation retarded. — Sinking
of the corpuscles slower after a few minutes, contrary to their rate of
falling in pure blood. — N. B. Sp. gr. of the weakest saline solution

1011, five grains of common salt to an ounce of water; the weak
saline solution, sp. gr. 1020, 10 grains to the ounce. Urine, sp. gr.
1023.

16. Equal parts of urine and blood. Liquid at the end of fifteen
minutes; began to coagulate around the margin in seventeen min-
utes; a soft jelly in twenty. two minutes. There was no buffy coat.
See Exp. 19.

17. Pure blood, for comparison with Exp. 16. The corpuscles
fell an inch in seven min.ites, and it coagulated in twelve minutes.

18. Blood for this and the next three experiments from another
horse. A portion of the unmixed blood coagulated in ten minutes,
and the corpuscles sunk very nearly as noticed in Exp. 4.

19. Equal parts of urine and blood. In four minutes the corpus-
cles sunk one-fourth of an inch ; and ultimately no more than three-
eighths of an inch. Coagulation did not begin until after sixteen
minutes. Differs from the like Exp. 16, in which there was no
sinking of the corpuscles.

20. Equal parts of weakest saline solution and blood. In four
minutes the corpuscles sunk one-eighth of an inch ; in eight and
a-half minutes one-fourth of an inch; and never more than three-
fourths of an inch. Mixture liquid at the end of twenty-two min-
utes; viscid in twenty-five ; jellied in twenty-eight.

21. Equal parts of weak saline solution and blood. In four min-
utes the corpuscles sunk one-eighth of an inch ; and finally, no more
than three-eights. Coagulation two minutes sooner than with the
weakest saline solution, Exp. 20.

XVII. Sinking of the corpuscles accelerated by adding mucilage
and salt to the blood.

22. giss. of mucilage, sp. gr. 1030, seven and a-half grains of
muriate of soda, §iii. of blood. Sinking of the corpuscles very ra-
pid, and the rate much accelerated after a minute or two, viz :

1S45.] On the Bitffy Coat of the Blood. 703

In 3 minutes,

J inch.

2 inches.

. 2|.

Coagulated in eighteen minutes; butTy part throughout firm and
contracted next day.

23. siss. of the same mucilage, ten grains of muriate of soda, and
Siii. of blood. The corpuscles sunk.

In 3 minutes, . . | inch.

4 ... 1

5 . . . H
9 . . .15.

Coagulated in thirteen and a-half minutes. Bufiy part firm and
contracted next day. Aggregation of the corpuscles, as in Exp. 22,
quite plain to the naked eye.

24. gi. mucilage, sp.gr. 10S5, and giv. of blood. The corpus-
cles sunk.

In 4 minutes, . • I inch.

7 . . . i

9 . . , i ■

10 ... t

13 . . . 1^.

Not coagulated in less than twenty minutes. Contraction of clot
very slight next day. The corpuscles sank rather slower than in
pure liquor singuinis, but much taster than in blood, mixed with dilute
saline solution without mucilage.

25. fi. of the same mucilage, ten grains of muriate of soda, and
§iv. of blood. The corpuscles sunk.

In 6 minutes, . . f inch.

8 . . . t

10 ... H

13 . . . li.

Coagulated two or three minutes quicker, and the clot contracted
rather more than in Exp. 24.

26. giss. weakest saline solution, and giii. of blood. In three
minutes the corpuscles sunk one-eighth of an inch: in five minutes
one.fourth ; in ten minutes one-half. A film on the top in twelve
minutes; coagulated in fourteen.

27. giss. weak saline solution, and fiii. of blood. In three and
a half minutes the corpuscles sunk one-eighth of an inch ; in six
minutes one-fourth; and finally, only three-eighths of an inch.
Viscid in ten minutes : a trembling clot in twelve.

28. A portion of blood used in the experiments from 22 inclusive,
coagulated in ten minutes, and had an upper bufiy^ part equal in per-
pendicular measurement to the lower red part.

In all the trials of urine and the saline solutions with blood, the
contraction of the clot was either much diminished, or prevented;

704

On the Buffy Coat of the Blood [December,

Conoiilation

tho.mh not so w!,Pn mncilage was arlded with the salt. v.wu.,
wa^most retarded hy the weakest snhno s„hition.

XVI! I. Sinking of the Corfwsrhs more rapid in serum made
thirn-sr an I h,,LH^r, th.n m serum made fhhi.rr and li.h'^r. The
accehrnted^rale oj si^^ ^^^^j ."rf^trn^ed! or

aiminixhorJ hii iho th:»y^„^ -0..:.! nt r» o. . . . ^

1 i-;''a.ns of .n-.nate of soda to an ounce of water. Urine sn. gr.

10.6 -Mnc.Ia^o sp. .r. 1085 ^'v. of cru.n aral.ic to a pint ofwater.

hinod m Exp. 29-30 drawn twenty four hours; fihrin separated
from It m a hott!e excludincr air; sp. gr. of serum 1028.

29. Kqual parts of saline soh.tion and hhmd without fihrin. In
forty minutes the corpuscles fell one-twelfth of an inch, in 150 min-
utes three-eirrhthsof an inch.

30 The same, addina gj. of mucilage. Sinking of the corpuscles
rapid but the separation of them from the fluid at first imperfect It
was clearer in one minute half an inch from the top. In six minutes
the corpuscles had fallen through the column of the fluid, the line of
separation between it and the corpuscles being distinct one inch from

he hottom. After shaking the mixture next dav, they subsided in
two mmufes one-fourth of an inch, and then with the same velocity
as the day before. "^

31. Equal parts of urine and blood without fibrin. In forty min-
utes the corpuscles fell one twelfth of an inch ; in 150 one-fourth of
an inch.

32 The same, adding one ounce of mucilage. In fourteen min-
utes the corpuscles sunk one-fourth of an inch; in seventeen minutes
hnit an inch ; in twenty-three minutes one inch ; in thirty-one min-
utes one and a-half inch ; in forty-eight minutes one and seven-
eighths of an inch.

33. 5i. of saline solution and giii. of blood without fibrin. In
eleven minutes the corpuscles sunk one-eighth of an inch; in
fifteen minutes one fourth of an inch.

34. ^i. of mucilage and fiii. of blood without fibrin. Sinking
of the corpuscles quick, but the line between them and the superna-
tant fluid at first indistinct. In six minutes they suhsided about
one eighth of an inch; in eleven minutes three-fourths of an inch;
in fifteen minutes one and a half inch, with a distinct line between
tfie corpuscles and the fluid.

35. Blood without fibrin f:)r comparison with Exn. 29-35 The
corpuscles sunk in six minutes one fourth of an inch; in elev'en and

LV,"';^^'^^ ^^''^ •'" '"^^5 in fifteen minutes one and a half inch.

35. J he same, only an hour after it was drawn. The corpuscles
fell in twelve mmutes a quarter of an inch; in fifteen minutes half
an inch ; m thirty minutes one and a half inch. Thus the sinking

^'''''o^ i'„ ''"""^ '" ^^"^ "'^"'^''^ ^'^'■""'' ^^""'T-v to Exp. 8. 9. and 10.

37 IJlood without a l.ufl'v coat, taken twentv-four hours before

from the basdic vein of a man, aged forty, aff-. cted with pulmonary

catarrh. Clot broken up in the serum and strained throucrh tow.

1 845.] On the Buffy Coat of the Blood. 705

The mixture thicker and darker than horse's blood, apparently from
a greater proportion of corpuscles. They took sixty minutes to sink
one-eighth of an inch. See Exp. 11 and 41, The three next ex-
periments with parts of the same hlood.

38. gi. of mucilage mixed with giii. of the strained blood. The
corpuscles sank in thirty-two minutes one-eighth of an inch; in
forty minutes one-fourth.

39. gr. of saline solution and giii. of the strained blood. In forty
minutes the corpuscles subsided one-tenth of an inch.

40. Sp. gr. of the serum 1027. It congulated at a heat of 159.

41. Blood with a thick bufTv coat from a young man with pulmon-
ary catarrh. Strained as in Exp. 37. Thicker and darker, appa-
rently from a greater proportion of corpuscles than horse's blood.
They sunk in thirty nine minutes one-tenth of an nich ; in fifty-six
minutes one-eighth of an inch. See Exp. 11 and 37.

XIX. Effects of syrup made of equal parts ofivhite sugar and water.

42. §iss. svrup and §iii. of blood. No sinking of the corpuscles.
A weak jelly in twelve and a half minutes. No contraction of clot
or exudation of serum.

43. siss. svrup, ten grains of muriate of soda, and giii. of blood.
Same as the foregoing, except tha- coagulation was two minutes later.

44. Blood for comparison with Exp. 42 and 43. Coagulated in
eleven minutes, with the usual deep buffy coat.

XX. Effects of increasing the proportion of serum and of water
in the blood.

45. §ss. serum added to ^iv. of blood. The corpuscles sunk in
two and a half minutes one eighth of an inch ; in three minutes one-
fourth, and never subsided further. Coagulation took place in eight
minutes.

46. ^iss. of serum to §iv. of blood. The corpuscles fell in 3
minutes \ of an inch; in 5 minutes | an inch, and sunk no further.
Coagulation in 7 minutes.

47. Some blood, for comparison with Experiment 45 and 46,
coagulated in 10 minutes, and the corpuscles sunk as deep as
usual.

48. §i. of serum and ^iv. of blood from another horse. The cor-
puscles sunk only fths of an inch. Coagulation took place in 4
minutes.

49. §ii. of serum and ^iv. of blood. Coagulation and sinking of
the corpuscles the same as in the foregoing.

50. Blood, for comparison with Experiment 48 and 49, coagulated
freely in 6 minutes, when the corpuscles had fallen one inch.

51. §i. of serum and §iii, of blood from another horse. Corpus-
cles sunk ^th of an inch. Coagulated in 3^ minutes. Clot much
contracted next day.

52. fi. distilled water and §iii. biood. No sinking of the corpus-
cles. Coagulated in 6 minutes. Clot contracted next day, but less
so than the preceding.

706 On the Buffy Coat of the Blood. [December,

53. Blood, for comparison with Exp. 51 and 52. Coagulated in
three and a-hah^'niinutes. No buffy coat.

54. §i. of serum and §iii. of blood from another horse. Corpus-
cles sunk in four minutes three-eighths of an inch ; in five minutes
two-thirds of an inch ; in six minutes one inch ; in seven minutes one
inch and a quarter, and never further. Coagulated in eight minutes.

55. gii. distilled water and giii. blood. Corpuscles sunk in seven
minutes one-eicjhth of an inch, and finally no more than on'e-third of
an inch. Began to coagulate in thirteen minutes, and a feeble jelly
in fifteen.

56. Blood, for comparison with Exp. 54 and 55. Corpuscles sunk
in four minutes one-eighth of an inch ; in five minutes one-fourth of
an inch ; and finally one inch and three-fourths. Coagulation the
same as in Exp. 55,

XXI. Ejects of increasing the proportion of the corpuscles.

57. Ij. of corpuscles and serum, obtained b*y straining the broken-
up clot and serum through linen, mixed with §iv. of blood, part of
that used in Exp. 48. 49 and 50. No sinking of the corpuscles.
Coagulated rather firmly in three minutes.

58. The same, whh an additional ounce of strained cruor, gave the
same result, except that coagulation was half a minute later.

59. svj. of whipped blocd and giv. blood from another animal.
No sinking of the corpuscles. Coagulated firmly in seven minutes.

60. The same with double the quantity of whipped blood, gave
the same result.

61. §j. of whipped blood and "^W. of blood. The corpuscles sub-
sided in three and a-half minutes one-eighth of an inch ; in four and
a-half minutes one-fourth of an inch; in six minutes three-eighths of
an inch ; and, finally, no forther. Coagulated in less than eight
minutes. In this experiment the corpuscles sank more quickly, when
added to blood just drawn, than they would do in the serum alone.

62. gvi. of corpuscles, from which as much serum as possible had
been decanted, and ^iv. of blood. No sinking of the corpuscles.
Coagulated in six minutes.

63. A portion of the blood used in Exp. 50 to 63, set apart for
comparison, coagulated in fourteen minutes, with a buffy part two
inches deep.

Some of the conclusions from the preceding experiments may
here be recapitulated.

1. There is a remarkable acceleration, after a few minutes, of the
rate with which the red corpuscles sink in the liquor sanguinis ; and
in the serum alone, though to a less degree.

2. This acceleration may be increased by increasing the aggrega-
tion of the corpuscles; and prevented or reversed by preventing or
destroying the aggregation of the corpuscles.

3. The sinking of the corpuscles may he slower in blood thinned
by weak saline solutions than when mucilage is added with the salt.

1845.] Galvanism applied to Uterine Hemorrhage. 707

4. The sinking of the corpuscles is slower in serum made thinner
and lighter by weak saline solutions, than in serum made thicker and
heavier by mucilage.

5. In the blood of the horse, the huffy coat forms regularly ; and
the red corpuscles unite, as if partly fused into each other, and collect
into masses.

6. There may be no burly coat, or but a comparatively thin one, on
this blood, when it has been made thinner and its coagulation retarded.

7. The formation of the biifly coat is neither due to an attenuation
of the liquor sanguinis, nor to a diminution of its specific weight, nor
to slow coagulation ; but to an increased aggregation and quickened
sinking of the corpuscles.

8. These facts are favourably to the old doctrine of lentor, or vis-
cidity of the blood and union of the corpuscles ; and against the more
recent doctrine of attenuation of the blood in inflammation.

9. The corpuscles of the horse sink much quicker in his serum
than the corpuscles of man do in his.

10 Increasing the proportion of the corpuscles hastens coagula-
tion and diminishes the formation of the bufly coat more than in-
creasing the serum only.

11. Increasing the proportion of water simply, does not hasten
the coagulation of the blood, as increasing the proportion of serum
does.

On Galvanism applied to the Treatment of Uterine Hemorrhage,
By Thomas Radford, M. D. {From Prov. Medical Journal.)

Uterine hemorrhage is usually divided into that which takes
place in the early months, and that which takes place in the latter
months of gestation. The latter class is again subdivided into what
are called accidental hemorrhao;es, unavoidable hemorrhages, and
the after hemorrhages. Accidental hemorrhages are those which
arise from accidental causes; unavoidable hemorrhages are those
which arise from a particular location of the placenta in the imme-
diate neighborhood of the os uteri ; and the after hemorrhages are
those which take place after the delivery of the child, and they may
occur either before or after the expulsion of the placenta. You will
be also aware that there are a number of other uterine hemorrhages
which are unconnected with gravidity; but it is my object in this
lecture more particularly to dwell upon those discharges of blood
which are connected with pregnancy in the latter months and with
labour. It is not my intention, on the present occasion, to enter into
a full consideration of the subject, but more particularly to connne
my remarks to that condition which is the result of profuse and long-

708 Galvanism applied to Uterine Hemorrhage. [December,

continued bleeding, viz-, exhaustion, a state highly interesting to the
obstetrician, and which seems tome to require more than the recog-
nized means for its management.

Now, we know that exhaustion may arise in all the varieties of
hemorrhage ; but we find that it is more especially produced i y those
impetuous and large discharges of blood which take place before,
during, and after labour.

With regard to those cases of flooding, before and during labour,
which have proceeded to a state of exhaustion, it has been the custom
of many obstetrical writers to recommend the practice of delivery.
Others have discountenanced delivery in this particular condition ;
and of course, where the principles of practice are unsettled in a case
so important, it is very desirable that we should endeavour to dis-
cover some new method of treatment which shall place the question
beyond dispute. Although such high authorities as Burns and Ham-
ilton advocate delivery in these cases, it has always been my practice
to recommend non-delivery ; and if we were to analyse the cases that
have been published in the reports of hospital and private practice,
and those that have accidentally come to our knowledge, we should
be startled at the immense loss of life arising from these extreme cases
of hemorrhage, where delivery has been adopted.

Now, I regret to say, I believe that the g^reat ruling influence upon
the mind of practitioners, in determining them to deliver at all ha-
zards in these cases, is the dread of popular opinion. It is usually
stated that no woman ought to die undelivered ; and where a woman
does die undelivered, it produces a very considerable sensation, both
in the neighborhood and in the mind of every party who may come to
a knowledge of the circumstances. On this account a practitioner
dreads the procrastination of delivery, lest death should occur before
it can be accomplished, and his character consequently involved in
censure. Now it appears to me, that when a practitioner is thus
placed, he ought to possess sufficient moral courage to resist the
pressure of popular opinion, and be guided by a higher principle in
the discharge of his duty ; and I am convinced that if the matter is
fairly and dispassionately considered, it will be found that there is a
great advantage in not delivering in these cases of exhaustion.

And first, with regard to the child, it is stated by the advocates for
delivery, that there is the greater probability of its being saved hy the
immediate adoption of this operation, than by its delay. But if we
take the pains to investigate the reports that have been published, as
well as to examine into the results of the practice of private individu-
als, it will be found that the child is nearly always dead in these ex-
treme cases. Therefore this consideration ought not to have much
weight with us in deciding upon the principle of practice. And if
we reflect upon the causes whirh give rise to hemorrhage, more espe-
cially in placenta praevia, we shall find sufficient reason for under-
standing why the child should be generally dead. Inthe accidental
species of hemorrhage, if the cause has been such as not only to lead

1845.] Galvanism applied to Uterine Hemorrhage. 709

to a separation of the placenta, but to something like a disruption or
a wounded state of that organ, the death of the child is nearly inevita-
ble ; and in the unavoidable species, from the particular location of
the placenta, if we recollect what must be the influence of labour
upon the placenta itself, not only in producing detachment and a
separation of its connection with the sides of the os uteri, but also the
mechanical intluence applied by the child's head corning upon it, we
must see that in this case there is generally more or less of a disrup-
tion and breaking up of its structure; and consequently the child
dies from bleeding from its own particular system.

If we go into inquiries as to the intiuence of the death of the child
upon the hemorrhage, we must look upon it as being rather an ad-
vantage to the mother, because it takes off a certain demand upon the
blood, or lessens what Hunter calls "the stimulus of necessity," and
therefore makes such a change in the balance of her circulation, as
would be a means of checking, rather than increasing, the discharge.

We will now proceed to consider the question as regards the life
of the mother; and when we are contemplating a subject of this
kind, a woman placed under extreme circumstances of inanition or
exhaustion, we ought not to ask, "Ought a woman to be delivered ?"
but, " Can a woman be delivered safely?^' That is the question we
ought to endeavour to settle in our minds before we proceed to the
operation. If we have a woman already in a state of exhaustion
from large evacuations of blood, we must be certain that a plan of
treatment which, in any way, produces an unfavorable change upon
the nervous and circulatory systems, must add to the evils already
existing. We have here sufficient prostration ; and the mere empty-
ing of the uterus will most inevitably increase it. Every surgeon is
aware of the influence that is produced by the operation of tapping
in cases of ascites in men strong in comparison of some of these poor
women, reduced as they are by the loss of so large a quantity of
blood. Sync«^pe, nay, even death, is sometimes the result of the
abstraction of the ascitic fluid. We know also in some cases, and
especially where there is a particularly exalted state of the nervous
system, or some particular idiosyncracy, that simple evacuation of
the uterus, by the natural efforts, will produce death ! This very
change then has in itself a very unfavorable influence upon a woman
thus prostrated. But, besides this, we must bear in mind that there
must necessarily be a great dt^mand upon their powers by the stimu-
lus of forcible delivery.

There are a number of other circumstances which ought to be
taken into account, as regards delivery. And one of the most im-
portant of these is the physical or structural impediment that may
arise from a rigid os uteri. And when we come to the bedside of a
patient, (I am sure every gentleman who has had much practical ex-
perience, will bear me out in this statement,) we shall find that some
of those dogmas which are laid down in books are wholly untrue. I
now refer particularly to that assertion of certain writers, who say,

710 Galvanism applied to Uterine Hemorrhage. [December,

that by the evacuation of blood, the soft parts become so weakened
and dilatable, that delivery can always be accomplished. 1'his I
most positively deny. And therefore I say that there are conditions
of this kind which will be an obstacle to delivery.

The OS uteri will continue undilataUe, although the woman may
be in such a state of exhaustion as to be literally tottering on the
brink of the grave ! It is true that this state of matters does not
generally exist, but it is too frequent to be overlooked in determin-
ing our line of practice.

Again, v»'e should be aware that hetnorrhages take place, and pro-
duce this state of exhauslion, before the woman has progressed to
that period of pregnancy that would justify a practitioner in having
recourse to forcible delivery; and this is a point not sufficiently
dwelt upon by obstetrical writers. In proportion to the early occur-
rence of hemorrhage, so will be the obstacles to delivery, as regards
the introduction of the hand into the uterus. And when we are
considering i\\Q chances of delivery, and taking into account the
dilatable state of the cervix and the os uteri, we should never forget
the length of the former as regards the particular period of pregnancy.
And not only is this to be taken into account, but there is another
circumstance which must not be overlooked, viz., the degree of sub-
sidence of the uterus into the pelvis ; for according as the uterus
remains high in the pelvis, so we may be certain that the difficulties
of delivery will be proportionate.

In all uterine hemorrhages connected with pregnancy, there are
certain attendant circumstances, viz., separation of the placenta,
with or without disruption of its structure ; exposure of the large
orifices connecte<l with the uterine sinuses, rupture of the decidual
vessels and atony of the uterus, which is either primary or secondary.
The natural means lor suppressing the discharge are the formation
of coagula, and the contraction of the uterus. As to the adhesion
of the placenta, when once separated, or the cicatrization of this
organ when disrupted, the practitioner can place no reliance on them
in checking the flooding.

With respect to the coagulation of the blood, it may become in-
fluential in arresting slight discharges, but never ought to be depend-
ed upon in those profuse hemorrhages which we are now more par-
ticularly considering. The coagula which forms in the vagina, and
which are stated to be so important in the suppression of the bleed-
ing, may become indirectly an evil instead of an advantage, by deter-
ring the practitioner from making a proper investigation of the case,
under the idea "that the disturbance of these, congula is death."
In my opinion, the coagula which are more particularly to be depend-
ed upon, are those in the immediate neighborhood of the venous
orifices that have been exposed, and I repeat that these are of no
avail in the more serious cases; and therefore we mt;st solely trust
for the suppression of these large discharges of blood to that most
important agent, contraction of the uterus.

1 S 45. J Galvanism applied to Uterine Hemorrhage, 711

The ordinary means ofproducing uterine contraction are so well
known that I need merely refer to them before the present audience.
We have the bandage, friction applied briskly over the uterus, grasp-
ing pressure, secale cornutum, the application of cold, and, in the
after hemorrlia<res, tiie introduction of the hand into the uterine
cavity. But all these means may fail in producing this desirable
change, and will fail and do fail in the extreme cases.

A fatal case having recently occurred in this town [Manchester],
which produced a considerable sensation at the time, where delivery
was adopted, contrary to the principles which I had always publicly
inculcated in my lectures, 1 was led to investigate the arguments of
those who advocate that practice, more closely than I had perhaps
ever before done ; and it struck me that we were deficient in a means
on which we might always depend for inducing uterine contraciion,
and so placing the woman in such a state of safety that the operation
of delivery might be deferred. Whilst my mind was so much occu-
pied upon this subject, I was consulted by my friend Dr. Goodwin, in
a case of protracted labour, where the long forceps were required.
The lady recovered well, with the exception of not being able to pass
her urine. We administered all the usual remedies for a fortnight or
more, using the catheter twice, sometimes three times a day, but
without the least amendment. Upon Dr. Goodwin's suggestion, we
decided upon the application of galvanism, which was undertaken
by him, and the result was most gratifying, for the first application
proved permanently successful. The decided efficacy of this plan
in restoring the energy of the bladder, immediately led me to con-
clude that it was the very agent that I have already stated v.as a
desideratum to ensure uterine contraction incases of severe flooding,
attended with exhaustion. We have here a woman reduced by loss
of blood, with an atonic state of the uterus, either primary or as the
result of the discharge. Now, as the advocates of delivery (vide
Burns and Hamilton) say that this proceeding gives the woman the
only chance of living, because, so long as the uterus remains distend-
ed by its contents, and its parietes atonic, those large venous orifices
which have been exposed by the separation of the placenta, are so
situated, that the chances of further effusion of blood exist ; it occur-
red to me that the application of galvanism would so effectually act
upon the uterine tissue as to induce firm contraction of its fibres, and
thereby at once lessen those large openings, and bring the walls of
the uterus into firm apposition with the body of the child, so as to
entirely close them. This great object having been attained, we
might safely procrastinate the delivery, and adopt such means as
would tend to raise the vital powers of our patient, such as the ad-
ministration of opium, stimulants, and support ; and the performance
of the important operation of transfusion. With the uterus in this
favorable condition, our restorative means, and particularly transfu-
sion, would be far more likely to be attended with successful results
than if the organ were distended and atonic ; for in this case, the

712 Galxanism applied to Uterine Hemorrhage. [December,

blood which is introduced into the system, either directly by transfu-
sion or indirectly by nourishment, produces no permanent benefit,
because it is rapidly discharged again. Analogy further led me to
believe that my conjectures would not prove unfounded, for galvan-
ism is particularly impressive in its influence upon the muscles of
recently. killed animals, and we know how strictly allied inaction, if
not in structure, the uterus is to muscle.

1 mentioned my views to a number of medical friends, who gener-
ally much approved of them; and 1 was soon enabled practically to
prove their correctness, by being called in consultation to a case of
frightful hemorrhage during labor, attended with extreme exhaustion,
and where the os uteri was so rigid that the advocates of delivery
could not possibly have carried their views into practice, without
lacerating the os and cervix uteri. By this case I ascertained that
galvanism produces an effective and powerful contraction of the
uterus; and not only so as regards its tonic contraction, but it has
also the power of energetically exciting alternate contraction when
applied at intervals. I can tell you, most seriously and most solemn-
ly, that it produces these two important changes upon the uterus in
such a degree as, in my previous reflections on the subject, I had no
conception of. The alternate contraction excited by this agent is
analagous to, and as powerful as, that which is observed in normal
labour, and the tonic contraction is greater. I shall not relate cases
in detail, because it would occupy too much time; but I may state
that I applied galvanism in a case where the membranes were unrup-
tured, and the uterus in a state of great inertia, and alternate con-
traction was immediateh'^ produced. Before this the membranes
were very flaccid ; but as soon as the galvanic circle was completed,
they became extremely tense, and protruded low down into the vagi-
na ; and this stare of tension did not subside when the alternate con-
traction ceased, as is observed in some degree in normal labor; for
although the galvanic conductors were removed, so great a degree of
tonic contraction of the uterus had been induced, that this mem-
branous bng could not collapse.

I am thus satisfied, that by the application of this means, we can
induce such a state of chronic contraction in the uterus, that in these
extreme cases of exhaustion from hemorrhage, the woman may be
placed in such a state of safety, that delivery may be postponed until
a time arrives when it can be safely accomplished, and in the mean-
time we can have recourse to those measures which tend to raise the
vital powers.

I think it probable that it may also produce one of the other natural
means of suppressing hemorrhage which I have already referred to,
viz., coagulation of the blood ; but this I have not yet positively as-
certained by experiment, although I am led to conclude that such is
the fact, from some remarks miule by Dr. Apjohn, in the article
Galvanism, in the Cyclopaedia of Practical Medicine.

In my previous remarks, gentlemen, I must be understood to refer

1845.] Galvanism applied to Uterine Hemorrhage. 713

to those cases of hemorrhajie where the placenta is not placed over
or near the os uteri ; but 1 shall now proceed to speak of those cases
in which uterine contraction has a tendency to increase the dis-
charge, cases which are usu;illy described as belonging to the class,
unavoidable hemorrhage. In these cases, wjiere the peculiar loca-
tion of the placenta deprives us of the benefits that usually accrue
from uterine ct>ntraction, and as it is the special influence of galvan-
ism to prodtice this effect, it ought to be the object of the obstetrician
so to modify his practice, as to place them within the range of this
remedy Before entering upon a description of the plan which I
would recommend to be adopted in these cases. I shall first direct
your attention to the practice of the older writers; and secondly,
refer to the mode in which nature sometimes terminates them when
left to herself. In looking over the authorities from 1612 to 1790,
we find that they vary in their practice. Some recommend the re-
moval of the placenta before the child ; others advise the same
course conditionally, that is, providing it is offering itself very largely
or decidedly to the finger of the attendant ; others again, say that
where it cannot be pushed back, it should be brought away before
the child. It must he understood that many of these writers had
not a correct knowledge of the true anatomical condition of parts
in cases of placenta pravia, and I do not think it necessary to enu-
merate their names, as it would be occupying too much of your
valuable time. You will find that in some of these cases, where the
placenta was brought away before the child, according to the state-
ment of these writers, the latter was even born alive, and in most of
them the hemorrhage was suppressed. And whilst on this subject, I
may call your attention to a few cases of more recent occurrence,
where this practice has been adopted. It happened to me in 1819,
to have a case of placental presentation, where I detached the pla-
centa, because it was hanging down so low in the vagina, that there
was no chance of doing any thing else; the hemorrhage was imme-
diately suppressed, and the child expelled by the natural efforts. I
am also indebted to my friend Mr. Jesse, who is present, for the de-
tails of a case in which he detached the placenta, and in which the
hemorrhaore thereupon subsided. It was the practice of the late Mr.
Kinder Wood, of this hospital, in many of these cases, to detach and
bring away the placenta, and afterwards to leave them to the opera-
tion of nature, or to extract the child by the feet, as the case demand-
ed. A case also occurred to Mr. Wilson, of this town, who kindly-
related the circumstances to me ; the placenta had been rudely
brought away by the attendant, and Mr. Wilson found the patient in
a state of exhaustion, with the child still in utero. He extracted the
child a considerable time after the removal of the placenta It has
occurred to me, in my hospital practice, to find that the placenta bad
been brought down in mistake by the midlives in these cases, and
this without causing an increase of the flooding.

Smellie mentions cases in which the placenta was brought away.

714 Galvanism applied to Uterine Hemorrhage, [December,

and where the hemorrhage subsided. In Dr. Collins's Reports of the
Dublin Lying-in Hospital, there is a case in which the placenta was
brought away by the midwife the evening before the admission of the
patient iuto the hospital, and the hemorrhage was thereby suppressed.
Baudeioque relates a somewhat similar case. And now let us con-
sider the method in which naturesometimes terminates labours where
there exists placenta prsevia ; and for this purpose I have, without
any great pains, collected 36 cases, illustrative of her powers in sepa-
rating and expelling the placenta before the chil(i.

Gitfard mentions one case ; Perfect, one case ; Smellie, four cases ;
Chaptnan, one case ; Ramsbotham, sen., six cases ; Merriman, one
case: Hamilton, two cases ; Collins, one case ; Barlow, one case ;
Dr. Robert Lee, two cases; Gower, one case; Millington, one case ;
Bailey, one case ; Wood, three cases ; Lowe, one case ; Huut, one
case; Wm. Lowe, three cases; Dorrington, two cases; and I have
met with three cases of the same nature myself. Besides these, Mr.
Jesse has related to me a case of placenta praevia, where the entire
ovum was expelled ; Mr. James Kenworthy, a similar case ; and the
late Dr. Rigby has published a case also. Now, the bulk of these
casus, gentlemen, have been detailed without any specific practical
object, and consequently are more valuable to my present purpose
than if they had occurred to myself, and had been brought forward
to serve my own particular viev*'s. You may refer to many of them
yourselves; and you will find in nearly all of them that the hemorr-
hage was suppressed immediately after the placenta was thrown off.

These cases, then, and the practice already referred to, as adopted
by the older writers, and several modern obstetricians, appear to me
to furnish data of a most important character, whereupon a practice,
adapted to cases of exhaustion from unavoidable hemorrhage, may
be based, in order to bring them within the sphere of the application
of galvanism. And before entering upon a description of my pro-
posed plan of managing these cases, I beg to remind you that it is an
established fact, that partial separation of the placenta, whether in
simple or in complicated retention of that organ after labour, or in
placenta praevia, is attended with far more profuse bleeding than total
separation.

In the early part of the lecture, I stated that one means of adding
to the exhaustion already existing, is the evacuation of the uterus,
Avhether that evacuation be partial or entire ; therefore I consider
that in these cases of placental presentation, it would be a decidedly
important point of practice to draw off the liquor amnii ^racZ?*<7//v, as
the first step in the management of the case. For this purpose 1 have
somewhat modified Mr. Holmes's instrument for perforating the
membranes, making the canula much larger, and having an oval
aperture placed on each side near its open extremity. The entire
instrument consists of a canula and trocar, which latter always lies
concealed within the canula, by means of a spiral spring, except when
pushed out by pressure on its button-like extremity. This trocar can

1845.] Galvanism applied to Uterine Hemorrhage, 715

be entirely withdrawn from the canula, so as to leave the latter free
for the passafje of fluid. Now I propose to pass this instrument
through the placenta into the amniotic bag, and then remove the
trocar, so that the li(}uor amnii may escape, a plan which I prefer to
rupturing the membranes at the side of the placenta, because the
water in tiie latter case would flow too rapidly, on account of the prac-
titioner not being able to limit The size of the opening he might make,
and al>o because by the plan now recommended, the integrity of the
membranes be in 2: preserved, the placenta is thereby maisitained in a
belter position for acting as a tampon against the open venous aper-
tures when the head comes to press upon it.

In rupturing the membranes in the ordinary method, it is quite ob-
vious that as the connectiop between the membranes and placenta is
broken, the latter is liable to fliil down more or less into the vagina.
Having thus drawn ofFthe liquor amnii, the next step will be to intro-
duce the hand into the vagina, then to pass the fingers to the edge of
the placenta, and carrying them on between it and the os uteri, to
sweep the hand round its whole circumference, so as completely to
detach the placental mass, care being taken to avoid rupturing the
membranes. We have now brouirht the case into such a stale as to
be within the influence of galvanism; for although this practice of
detaching the placenta may be a means of suppressing the bleeding,
yet it will not restore the depressed pov,ers of the woman ; and on that
account we still require an agent to induce such a degree of uterine
contraction as will secure her from all chances of further hemorrhage,
while we have recourse to such measures as will tend to support her
strength.

In order, then, to insure uterine contraction, we must have re-
course to galvanism, and the subsequent management of the case
must be conducted on ordinary principles, such as supporting the
woman by stimulants, nutritious articles of diet, and transfusion.
The delivery should be deferred until the powers of the patient are
so far rallied as to justify its being undertaken, however long the in-
terval may be ; and that mode adopted which makes the least de-
mand upon her constitutional powers. It rnay happen that a repeti-
tion of the galvanic shocks may, after a certain period, induce such
uterine action as will expel the whole of the contents of the organ ;
and if this should not happen, it appears to me that it would be the
best practice, to apply the long forceps, having previously removed
the placenta, that is if the head presents. If any other part of the
child presents, the case must be managed on ordinary principles.

The novelty of these views may produce an impression unfavora-
ble to their proper estimation, but I hope, gentlemen, you will recol-
lect that it has been my object to bring I hern before the profession
in order that their correctness may be tested. I wish to benefit poor
suffering women in their hour of danger, and to be candid in my
communications to my professional brethren. In my own mind I
am satisfied as to the influence of galvanism, and its power of pro-

"716 Galvanism applied to Uterine Hemorrhage, [December,

ducing uterine contraction. Tarn also convinced that it has no evil
influence on the life of the child in utero, and after its birth that it
is an important means of resuscitation in cases of asphyxia. Ob-
jections may be raised that we have not always the apparatus at
hand. The answer to (his objection is the same as that which refers
to the application of all instrumental means. In my opinion, no
gentleman who possesses the principles of a correct obstetrician,
would carry his forceps, veclis, perforator, crotchet, or transfusion
apparatus along with him. These things are to be sent for in emer-
genrios only, and the same remark applies to the galvanic apparatus.

My remarks have hitherto been confined to the treatment of those
cases of hemorrhage that are attended with exhaustion before deliv-
ery, but there are other cases to which galvanism is equally applica-
b'e. If we investigate tne cases given by authors, we shall find that
there are many cases of accidental hemorrhage before delivery, where
artificial rupture of the membranes has not succeeded in arresting
the discharge, on which account several writers, Burns and Hamilton
amongst them, advocate delivery in preference to this operation.
Now, the artificial rupture of the membranes is recommended for
adoption without reference to the condition of the os uteri ; and it
must be obvious, if this part is rigid and undilatable, and the flooding
should continue although the membranes have been ruptured, that it
would be highly hazardous to introduce the hand and to deliver by
force. In such a case galvanism would place the woman in a state
ofst^curity, by exciting the contraction of the uterus. I also consid-
er that this would be useful in some of the hemorrhages of the early
months of pregnancy.

With regard to the after hemorrhages, especially those attended
by exhaustion, I consider it particularly applicable where atony of the
uterus is the principal feature of the accident. In those cases which
occur previous to the expulsion of the placenta, it would be the duty
of the practitioner to assure himself that this mass was not morbidly
adherent to the sides of the uterus.

In hour-glass contraction, and other forms of irregular uterine ac-
tion nfier labour, I anticipate great benefit from its use. In these
cases there is a loss of balance between the contractile power of dif-
ferent parts of the uterine fibre, one part being in a state of atony,
whilst the other is in a state of firm contraction. Now, if the gal-
vanic current be directed in the longitudinal axis of the organ, it
strikes me that you might excite the longitudinal fibres to contrac-
tion, and thereby restore the balance.

There are several other topics not directly connected with the
subject of this evening's lecture which I shall slightly notice, in re-
ference to galvanism. lam satisfied from positive trial of the reme-
dy, that it will be foiind a most important agent in tedious labour,
depending upon want of power in the uterus, and where no mechan-
ical obstacle exists. I would also suggest the probability of its prov-
ing valuable in originating uterine action de novOy in cases where it

1845.] Galvanism applied to Uterine Hemorrhage. 717

may be consiHered iipcessary tn indiiro premature labour. It seems
to me aKso to be worthy of trial in certain cases ofmenorrhafiia in the
ungravid state, where, on vajiinal examination, the uterus is found to
be'atonic, as evidenced by its large flaccid condition, and the patu-
lous state of the os uteri.

Having made this dic;ression, it is proper that I should remark, m
reference' to cases of hemorrhaore, that I am not urging this plan of
treatment upon the profession, with the view of superseding the or-
dinary means, but rather with the view of supplying a remedy in those
extreme cases where these have failed. I do unhesitatingly say that
the obstetrician has the power in most cases tocontroul uterine hem-
orrhage, so as to prevent them ever reaching this extreme state of
exhaustion. But, nevertheless, we do meet with this condition fre-
quently in a large hospital practice, and also in private consultation
practice. A number of cases have come to mv knowledge within a
very few months, where d^ath have resulted from this excessive ex-
haustion. I there-fore say that we ouizht to have some more certain
means than delivery to depend upon in these cases; for, if this expe-
dient be so important a means of saving life, how is ijt that it so often
fails?

With regard to the mode of applying galvanism in these cases, I
have used an electro-macrnetic apparatus, contrived by Messrs. Abra-
ham and Dancer, of this town, for medical and other purposes. It
consists of a battery in a small jar, and a helix with conductors.
For the sake of convenience, the latter are connected with the hebx
by means of long v/ires covered with an isolating material. The
strength of theshuDck is regulated by a small contrivance situated on
the st'and of the helix, by means of which it can be either diminished
or increased. One of the conductors, which is applied externally,
has a hollow wooden handle, through which passes the wire before
alluded to, in order to join a brass stem terminating at its extremity
in a ball. The other conductor, which is contrived by myself, con-
sists of a strong brass stem, seven inches long, curved to suit the
vagina, and covered with a non-conducting material, having a small
screw at its distal extremity for attaching it to a silver ball ; at its
other extremity it is received within an ebony handle, which is hol-
low, and through which passes a strong: brass wire, looped at the end,
and connected with the long wires before alluded to. This wire is
kept disconnected from the brass stem by means of a spiral spring
concealed within the ebony handle. The loop is covered with silk,
and is intended for the thumb of the operator, when he is bringing
the wire into connexion with the stem.

When the remedy is applied, the brass ball of the vaginal conduc
tor is to be passed up to the os uteri, and moved about at intervals, on
to various parts of this organ. At the same time the other conductor
must be applied to the abdominal parietes over the fundus uteri.
Shocks may be also passed transversely through the uterus by simul-
taneously applying the conductor on each side of the belly.

718 Epidemic Erysipelas, with Cases. [December,

The application should be used at intervals, so as to approximate
in its effects as nearly as possible to the natural pains. It may be
continued until it meets the exisencies of the case.

An Account of the Epidemic Erysipelas ; with Cases. By R. G.
Whaetox, IM. D., of Grand Gi/lf, Mississippi. [From the New
Orleans Medical and Surgical Journal.)

During the months of April and May, 1844, and the first quarter
of the present year, the town of Grand Gulf suffered very much
from an epidemic, which has been described very properly by Drs.
Hall and Dexter in the January No. (1844,) of the American Jour-
nal of Medical Sciences, as an erysipelatous fever; the same disease
has, since that time, prevailed very extensively in isolated localities
throughout most parts of the United States, and even now, is sweep-
ing with unabated violence over many parts of this State. It has
assumed in no place a more malignant form than it did in this town ;
and I am, consequently, enabled to give a description from observa-
tion of a form of disease, which whether we regard its frightful
appearance, or, in many cases, its intractableness to all remedial
means, is unsurpassed by cholera. The name of black tongue, ac-
corded to it in the newspapers, was well calculated to inspire terror
at its approach, and though unappropriate and vague, that very
vagueness rendered it more fearful.

It attacks in so many different forms, and assumes such a variety
of appearances, that it is impossible to give any description which
will apply to all cases. The first cases assumed the form of acute
laryngitis of the most obstinate kind, and several proved fatal in
spite of the most active depletion by the lancet, frequent emetics of
tartar emptic, warm baths, and blisters to the throat. At the time, I
did not suspect this inflammation to be of the erysipelatous kind,
but in a short time I became convinced that it was. These cases
occurred in March, 1844. Early in April, several were suddenly
seized with violent fever, swelling and slight redness of the parotid
glands, headache, drowsiness almost approaching to stupor, severe
pain in the ear and pains in the limbs. In the course of 36 to 48
hours, the swelling and inflammation extended from the parotid to
the larynx, producing all the symptoms of acute laryngitis, such as
great difficulty and pain in deglutition, which was performed with a
convulsive effort, and with a gurgling sound; small quick pulse, ten-
derness on pressure of the larynx, anxious countenance, &;c.

After these sj^mptoms had continued for two or three days, or had
been somewhat relieved, a slight swelling and great tenderness and
redness might be seen in some part of the face, generally about the

1845.] Epidemic Erysipelas^ with Cases. 719

ear or in the ear — sometimes about the nose ; the throat symptoms,
thoufih much slighter, still harrassed the patient : there was a conslant
hawking up of a tough mucus, and a difficulty of deglutition differ-
ent from that first experienced, and now depending apparently on a
paralysis of the muscles of the throat. The uvula and velum were
ot a dark purple, and very much swollen ; also the tonsils in many
cases; the pulse rose very much in frequency as the swelling of the
face progressed ; and the drowsmess or stupor also kept pace with it.
The swelling extended rapidly, and involved, in most cases, the
whole of the face, ears, forehead, and, in a few cases, the whole scalp,
sometimes extending down the breast or back. In these cases there
was total blindness for five or six days from the swollen state of the
face and eyelids; and the patient generally lay either drowsy,
with, a muttering delirium, or stupid ; feet and hands cool or cold ;
head hot ; with great pulsation of the carotids. The pulse is now
very weak and rapid, and it is with the Utmost difficulty, that the pa-
tient takes any medicine or water. In favorable cases, the swelling
gradually subsides, first on that side of the face on which it com-
menced ; a copious secretion of purulent matter torms under the
cuticle: the eyes open ; fever gradually abates; and in the course
of eleven to fifteen days the patient is convalescent. It may prove
fatal in the early stage, (if not actively and promptly treated,) from
suffocation. Laryngeal symptoms in the swelling even may subside,
and matter may be freely secreted, yet there is an absolute impossi-
bility of swallowing, from the paralysis of the muscles of deglutition ;
nervous symptoms supervene — tremors; inability of urinating, and
the patient dies about the tenth day, sometimes as late as the fifteenth.

This was the form the first cases assumed ; but soon after others
occurred, in which the first symptoms were precisely similar to those
above detailed ; there was violent fever: pain and swelling of the
parotids. Sometimes, however, these glands were unaffected, the
disease attacking the muscles and tendons on the side of the neck,
causing the most excrutiating pain, swelling and tenderness on pres-
sure; there was soreness of the throat, pain and difficulty of degluti-
tion, the fauces were of a dark or livid color, the tonsils "were
enlarged, and patches of ulceration might be observed, or a tough
mucus, which looked like ulcers. In these cases there were severe
pains felt in different parts of the body, generally on top of one or
both shoulders, shooting up the sides of the neck; sometimes there
was violent pain in the feet and legs. Numbness of limbs was a
very general symptom. Though these cases constituted a much
milder form of the disease than the first, the pains were often excru-
ciating, the fever very high, with a pulse always frequent, sometimes
strong and full.

Sometimes, without any external inflammation, the disease attack-
ed the lungs, producing the most malignant form of pneumonia;
sometimes the stomach and bowels, producing the most intractible
form of gastritis or enteritis. We consider these to be cases of erv-

720 Epidemic Erysipelas, with Cases, [December,

sipelatoLis inflammation, because they appeared at the same time, in
the same families, some members of which were attacked in this
manner, others with the other forms of the disease; and because
these are symptoms common to nearly every form of it. I had one
patient who was attacked in the usual manner, with chill and high
fever, violent pain in the side of the neck, with soreness, pain, and
difficulty of deglutition, pains in the limbs. Me was relieved in the
course of fi)ur or five days; when, from imprudent exposure to the
sun, he relapsed, and the disease attacked the lungs, stomach and
bowels; producing pneumonia with gastro-enteritis, which nothing
could relieve. In the relapse there was severe pain in the neck, and
sore throat. Again, in other cases, after suffering for two or three
days in a slight degree with fever, pain in the neck, and sore throat,
the patient was attacked in the stomach with nausea and vomiting,
and other symptoms of gastritis which was, as far as I have seen
and heard, always fatal. When the viscera, lungs, stomach, or
bowels were the seat of the disease, I have never yet seen a case
recover. It generally attacked these organs when the patient was
in general bad health, was addicted to habits of intemperance, or
dyspeptic; always attacking the weakest organ. In these visceral
cases there was a degree of malignancy which I have never before
witnessed in any disease. In the course of a very few hours the
countenance is entirely changed and collapsed ; the pulse not very
weak and not very frequent ; the prostration of strength astonishing.
You may })leed — which, however, must be cautiously done ; cup,
bathe and blister ; and though you reduce the patient by these means
as much as you dare, he still complains that the pain is only partially
relieved, and the disease proceeds with more or less rapidity to a
fatal termination, while the physician can scarcely even palliate
symptoms.

I had a number of slight cases characterized by chill, fever, pains
and numbness in the arms and legs, pain and soreness in the side of
the neck, slight soreness of the throat. These were generally re-
lieved in the course of four or five days ; the patient, however, was
left in a very weak and languid condition for several weeks.

The tongue, in most cases, where the stomach was not particu-
larly affected, was not much changed from its natural state ; some-
times it was dry and glazed, and in a few cases it was covered from
the beginning, with a heavy coat of dark fur.

I saw several cases where the violence of the disease was concen-
trated in the muscles of the neck, causing the most exquisite tender-
ness and swelling, which often, in the course of two or three hours,
was as large as a hen's eo:cT ' this swelling and tenderness would
remain stationary for several days, and then disappear, or disperse,
by extending in the form of erysipelas of the skin around the neck.

In all forms of the disease there was a remarkable tendency to
relapse. Often, when the patient was apparently out of danger, the
slightest imprudence was sufficient to produce a relapse of the most
formidable kind.

1845.] Eindemic Erysipelas^ with Cases, 721

The question whether or not it be contaj^ions, was much agitated
on its first appearance here ; sufficient proof, however, has since that
time accumulated to convince the most sceptical that under certain
circumstances it is contafjious. It may be taken by inoculation ;
several cases of this kind have occurred in this county. One of
them was that of a physician, who lost his life in consequence.
When proper cleanliness and ventilation are neglected, it is very
apt to be communicated to the nurses and attendants. This is not
peculiar, however, to this disease, but is common to it with many
others not usually considered very contagious. By observing the
precautions of cleanliness and free ventilation, every member of
one family, the head of which had a most violent attack, escaped
entirely ; whilst in another family, where these wholesome safe-
guards were neglected, the disease attacked every member, several
of them more than once. I have thought that those cases where the
throat was deeply affected were most contagious; probably from the
fact that the breath of the patient is then more highly charged with
the morbific miasm.

Prognosis. Those cases where the viscera are attacked, are, so far
as I have seen or heard, been always fatal, and especially if our reme-
dies produce only a partial relief. While the pulse is weak and com-
pressible the prognosis is unfavorable.. Next in the order of malig-
nancy are those in which there is deep seated disease, swelling and
ulceration of the throat, while the face is swollen at the same time.
In these cases, if the mind remains clear ; if our remedies, especially
emetics, are borne well, and if the pulse, though small and rapid, does
not give way ; and if the nerves are not much affected ; though
most dreadful, we may entertain a reasonable hope of recovery.
The intemperate, and those delicate constitutions whose viscera are
unsound, and those of advanced age, are those most likely to suc-
cumb under an attack.

Trealment. From the description which has been given of the
various forms which this disease assumes, it will at once be readily
understood that considerable modification is required in the remedies
in consequence of this variety ; and that, like all other disease, it
must be treated according to the indications in each particular case.
When the erysipelas attacked the face and head ; and when the
throat was at the same time affected, as was the case when the dis-
ease first appeared ; if the pulse was full and strong, as it was in
nearly every instance, free and early depletion with the lancet was
indispensable. I had to bleed most of those who suffered under this
form of the disease twice, with most happy effect. A few cases oc-
curred in this form in old and debilitated, or intemperate subjects
who could not bear the lancet. The next remedy, and a most im-
portant one it is, is the free exhibition of antimonial emetics; the
laryngeal symptoms here were most urgent, and nothing has such a
controlling power over them as tartar emetic. Besides rdieving^e
Upatient of the symptoms of suffocation, which were most distres

4ri

lothc

722 Epidemic Erysipelas, with Cases. [December,

and alarming, the frequent exhibition of emetics had a most happy
effect in keeping down the arterial excitement, which ran high ; it
equalized the circulation, and removed the stupor caused by so great
a determination of blood to the head. This emetic, or nauseating
course, I had to pursue in some instances for three, four, or even
five days.

The throat required some especial remedies ; and when the velum
and uvula were swollen, as it was in many cases very much from the
commencement ; free and deep incisions were necessary to relieve
the patient of the difficulty of breathing and deglutition ; and after
this had been done, or without it, when the parts were not much
swollen, but very sore and ulcerated, a strong solution of argent,
nitrat. (5i. to gi. water.) as recommended by Tissot in chronic
laryngitis, was applied to the throat by means of a mop or sponge
fastened to the end of a whalebone, being careful to make the patient,
take a litile salt and water in case any of the solution might be swal-
lowed. I saw several cases where the uvula and velum were so
enormously swollen as almost to impede the entrance of air into the
larynx. By free and deep incisions a large quantity of purulent
matter was discharged, to the great relief of the patient.

Many of these cases were most distressing to witness; the patient
lay drowsy or perfectly stupid, snoring, his face enormously swollen,
and of a dark purple color, almost black, so that it would be impossi-
ble for his friends to recognize him ; eyes closed, a constant sense
of suffocation, extreme difficulty (sometimes, for seven or eight hours,
an actual impossibility) of swallowing, and it was necessary to raise
him to a sitting posture every time he attempted to swallow. This
motion almost exhausted him. The pulse is weak and rapid, and
altogether the case appears desperate. After remaining in this ap-
parently hopeless condition from 24 to 48 hours, the throat appears a
little better; the patient can, by great exertion, take a little water ;
and now a state of collapse or great debility occurs ; and by the cau-
tious exhibition of carb. ammon. and quinine, the pulse becomes
firmer, more steady, the s\i»elling of the face rapidly subsides, and
with the improvement in swallowing there is a return of appetite.

The convalescence is most tedious ; desquamation of the cuticle
takes place; large collections of pus form under the cuticle, as well
as in the deep seated cellular substance, requiring deep incisions to
the bone to discharge it. For a long time the patients looked badly ;
the skin was red and claret colored, like that of a patient recovering
from the small-pox.

In those forms of the disease where the internal organs were at-
tacked, though the indications were plain, unfortunately medicine
afforded only a temporary relief. The pulse in these cases was weak
and soft ; and though the severe pain seemed to require venesection,
great caution was necessary in its use, on account of the prostration
of the general system. I bled, however, a majority of the patients
a^||cked with this form of the disease, and some of them two orj

1815. J Epidemic Erysipelas, with Cases, 723

three times, and yet I could attribute only a very temporary amelio-
ration of symptoms to it.

Cupping was resorted to, and carried as far as could be borne ;
and this, too, afforded only a partial relief.

Hot mustard baths was the remedy on which I placed the greatest
reliance, both on the general principle of a strong revulsion, and es-
pecially because it appeared to be the only remedy which afforded
more than a very slight mitigation of the patients' sufferings. I
usually ordered it I'rom three to six times in the 24 hours, and con-
tinued it each time, as long as the patient could bear it.

Large blisters were applied over the seat of the pain, and in most
cases it was difficult to get them to draw ; like all the other remedies,
however, they afforded little, or only a very partial and temporary
relief.

Calomel and opium, in large doses, were used in addition to the
revulsive means ; and this, too, instead of doing good in many cases,
evidently aggravated the symptoms, inducing irritation in the
bowels, and great distress; and thus, in spite of every rational re-
source, we were destined to see our patients, in the midst of tlie most
horrid tortures, snatched away by the relentless hand of the scourger.

In some of these cases, hovvever, tovvards the close of the disease
the patients sunk into a state of quiet delirium, unconscious of every
thing ; and with little suffering, breathed their last; the sensibilities
having been previously exhausted by the violence of the pains, [n
one case that I saw, the force of the disease was concentrated on tiie
feet and legs, producing the most excrutiating pains, as severe as an
attack of the gout, extending up the body ; with great restlessness,
fever, full and strong pulse. In this case I bled freely ; and at the
suggestion of my friend, Dr. Wilson, of Port Gibson, (who saw many
of these cases with me, and whose practical suggestions in all cases
of disease are characterized by a discriminating tact rarely met with,)
had the patient's feet and legs immersed in a hot lime bath, made by
dissolving one gallon of lime in four gallons of hot water. This had
a most happy effect in relieving the pains, and, together with other
means, which were indicated, soon restored the patient to health.
There were a number of cases comparatively mild where the vio-
lence of the disease was spent on the lace and head, producing fever
and pain of the face, which was so much swollen that the person
could not be recognised, nor see at all for several days. The pa-
tients were very drowsy — constantly in a state of muttering delirium ;
the feet and legs disposed to be very cold, with great heat of head.
In these cases the throat was unaffected ; consequently there was no
difficulty of deglutition ; the pulse, though frequent, being sufficiently
firm ; therer was. besides, no malignancy. A very simple course of
treatment was sufficient for these. Mild saline purgatives, the con-
stant application of cold cloths to the head, and hot mustard baths
to the feet and legs, wherever there was much delirium or stupor;

these were the means which being persevered in for six to ten days

724 Epidemic Erysipelas^ with Cases. [December,

would always bring the case to a favorable issue- A mild anodyne
at night was sometimes required in the latter stages of these cases.

There were a number of other cases in which the patients com-
plained of severe pains in the sides of the neck, shooting down the
arms; soreness of throat, with considerable difficulty of deglutition ;
fever, severe headache, numbness of the limbs, and a great depression
of spirits, attributable in part to the alarm occasioned by the preva-
lence of the epidemic. The stomach was generally irritable ; the
tongue red ; pulse weak, and rather frequent. All these cases were
successfully treated by hot mustard baths, and copious draughts of a
strong hot infusion of eupatorium perfoliatum, which produced a co-
pious perspiration, v.'hich was kept up for two or three days, to the
great relief of the patient.

I have said nothing as yet about the local treatment for the erysipe-
las when it attacks the surface, being well convinced from large
experience that no local applications have any great effiict in the
worst cases, and in the milder cases they are not much required. I
have, however, in nearly every case endeavored to arrest the progress
of inflammation by surrounding it with blisters, or cauterising the
skin around with argent, nit. In many cases the disease was arrest-
ed by the lines drawn around it ; but in the bad cases where such
effects were most desired, they did no good — the inflammation ex-
tending as rapidly as if they had not been applied. I have covered
the face with mercurial ointment, and have applied nearly every kind
of lotion, and from the result of this experience have as much faith
in cold water as in any other one remedy. Still it is well to try a
variety of them, as there are some patients who receive more benefit
from certain lotions than others. For this purpose we may use solu-
tions of sal. ammon., plumb, acet., a mixture of equal parts of alcohol
and ether, &c.

Case 1st. — April 6th, 1844, called to see Mr. T. A. Applegate,
who was the first one attacked with the erysipelas of the surface.
He was taken down the day previous with high fever, swelling of the
parotid glands, inability to protrude the tongue. He was very rest-
less— severe headache — tender on pressure over prtecordia — drowsy,
and rather stupid. Bled to ^xvi, cupped over the stomach, and or-
dered warm bath. 9. P. M. — Bath produced perspiration, but the
fever continued high. 7th. Rather better this morning; still con-
siderable fever; gave mass. hyd. grs. xii. At 7 P. M. not much
better; complains of general fullness about the head; ordered blister
to nape of neck. Was called up at one o'clock, A. M. — found him
laboring under acute laryngitis, the inflammation having extended
from the parotids, which were still very much swollen and inflamed.
There was considerable difficulty of deglutition, which was perform-
ed with a convulsive effort, and with a gurgling noise ; there was
also tenderness on pressure of the top of the hirynx. Used frictions
of Granville's liniment to the throat, without benefit. At 4 A. M.
he was much worse ; gave emetic of tartar and ipecac, which af-

1845.] Eindemic Erysipelas, with Cases. 725

forded considerable though temporary relief. 8th, at 6 A. M., in a
very bad condition ; countenance frowning ; extreme pain in swal-
lowing ; pulse quick and tense ; frequent watery discharges from the
bowels. Bled to fxvi; ordered laudanum enema, and applied
emollient poultices of onions, tansy and rue, as hot as they could be
borne, changing them every fifteen minutes. The poultices had a
most happy effect in relieving the urgency of the laryngeal symp-
toms ; much better than blisters to the throat, which I now never
use in such cases. At 12 M. still improving, can swallow without
that convulsive effort so characteristic of laryngitis. At 3 P. M.
pulse 100, soft; free perspiration — gave 10 grains Dover's powder
at bedtime. 9th. Slept well — pulse 90, soft; feels much better,
still there is considerable pain in swallowing; has much thirst. Order-
ed ^ grain tartar, antim. every two hours, and the hot poultices to
be continued to the throat. Visit at 9 P. M. He had vomited two
or three times during the day ; spits frequently a tough mucus which
is secreted in large quantities ; pulse 100, quiet; had two opera-
tions ; ordered 6 grains Dover's powder ; discontinued the poultices.
lOih. Passed a tolerable night. At 3 P. M., he was rather drowsy
and stupid ; pulse 110. Ordered the solution of tartar every two
hours; this reduced the pulse to 104 by 9 P. M. and produced free
secretion from the throat, which appears to be almost entirely re-
lieved. There is still, however, a great determination to the head
with considerable discharge from the nostrils. He complains of
tenderness and swelling of the leftside of the face, in front of the
ears. 11th. Face still swelling on the left side. Ordered the tartar
water during the day ; at night gave hyd. chlorid. mit. grs. vi. ;
pulv. jalap gr. iv. to relieve the bowels. 12th. The face very much
swollen this morning; pulse 110; medicine acted well on the
bowels, with some relief; scarified the velum and uvula, which were
very much swollen, and impeded the passage of air. I now became
aware of the necessity of arresting, if possible, the extension of the
erysipelas, and for this purpose surrounded the inflamed parts with
strips of emplast. episp., about 1^ inches broad, and covered the face
with unguent hydrar. At 7 o'clock, A. M., no better ; pulse 116;
gave hyd. chlorid. mit. grs. viij. 13th. Medicine taken last night
operated once ; pulse 100 ; blisters drew well ; face still more
swollen ; quiet, disposed to sleep. 3 P. M., pulse 120 ; still drowsy,
intelligent when aroused; great difficulty of swallowing from appar-
ent immobility or paralysis of the muscles of mouth and throat.
Ordered carb. amm. of which he took two doses without any good
effects. 14th. Passed a tolerable night; pulse during the last night
varied from 120 to 112, changing every half hour ; it is now 112.
Ordered 2 grains quinine every three hours; this had a fine effect ;
under its use the pulse became firmer and more steady. 15th.
Much better ; pulse 108 ; continued quinine ; the swelling is now
abating; swallows much better. Ordered light broths, with a little
wine whey. lOth. Improving rapidly ; pulse 88 ; continued qui-

726 Epidemic Erysipelas^ with Cases. [December.

nine every two hours. 17th. Pulse 82; quinine, broths, wine
whey ; at bedtime ordered a dose of laudanum to quiet the bowels.
He was now rapidly recovering, and in the course of four or five
days was able to sit up. Large quantities of purulent matter formed
on the cheek bone and between the upper eyelids, which had to be
opened with a lancet.

Case 2d. — Tiie following case has some peculiarities, worthy of
notice. It is the only one that Isaw where the tongue was so much
affected. June 5th, at eleven, A. M., called to see W. Gott, a boy
aged sixteen, who had returned from school about two hours before,
complaining very much of his tongue, which he said felt very sore,
and was swelling rapidly. Found him with a frequent pulse, rather
hot skin, complaining of his tongue as well as a pain on each side of
neck, the surface of which looked a little red, and was painfully sen-
sitive to the slightest touch. The tip of the tongue for an inch was
very much swollen, and there were several white specks on it. Or-
dered warm mustard baths, blisters to the painful surface of the neck,
red pepper tea as a drink, and as a gargle or mouth wash. At four
P. M. he was much worse, his tongue enormously swollen, so that his
jaws could not be closed, and he could not speak; great difficulty of
swallowing, mind stupid, does not complain of pain in the tongue.
Pulse 120, and very small ; great heat of skin. Ordered mustard
bath again — in two hours bled to f xvi, cupped on back of neck and
behind the ears, to relieve the determination to the head. I request-
ed Dr. Wilson, of Port Gibson, to meet me; we applied a strong
solution of argent, nit. to the fauces, which appeared ulcerated and
dark colored, and scarified deeply under the tongue. At midnight
ordered another bath, and gave strong infusion of serpentaria and
chamomile flowers. 6\h. — Somewhat better this morning; head
clearer; pulse 120, and rather small ; continued the infusion. Swell-
ing of the tongue subsided, so that he could articulate. Throat
better ; repeated the caustic, and gave a cathartic last night of sulph.
magnes. which operated well. There was not much change during
the day — at midnight was sent for in haste, and found him suffering
from intense pain of the throat, so that every breath caused him to
cry out ; pulse 120, weak and quick, skin moderately hot — mind not
clear. Ordered him to be put in a mustard bath for twenty or thirty
minutes, and a large blister to be applied to the abdomen. 7th. —
Somewhat easier, though not relieved of the pain. Countenance
bad — sleeps with eyes half open — rather delirious ; pulse 130, weak
and irritable. Continue the chamomile and serpentaria with eupa-
torium. Towards evening became much worse; the pain left the
stomach and bowels, and attacked the throat, so that every inspira-
tion caused him to cry out as if he had been stabbed. The pain was
deep seated, and changed its seat constantly — first on the right, then
on the left side; pulse 140, weak' and quick; countenance more
cadaverous. Again used the hot bath, as it was the only remedy
which seemed to afford even a temporary respite to his ngony. The

IS 15. J Epidemic Erysipelas, with Cases. 727

skin having relaxed, added 3 grains quinine to the other medicines.
8th. — Pulse intermitting ; delirious all night ; skin cool and relaxed ;
talks coherently when roused ; pain still severe, though much light-
er ; pulse 140 to 150 ; gave the quinine in large doses, but as it did
no good, and he was sinking fast, discontinued every thing. ' He
expired about day, on the morning of the 9th. This boy was appa-
rently of a good constitution. His family had suffered very much
from the erysipelas for six or seven weeks, and his was the last case
that occurred during the last year. The attack appears to have
been brought on by his bathing in a muddy pond of water during
the heat of the day.

Case 3d. — April 26th, 1844. Visited Mr. Calahan, who was
suffering with acute pains in the feet and legs, arms, stomach and
bowels. Pulse 85 ; stomach tender on pressure ; tongue clear and
rather red ; no headache. As he had taken some cathartic pills over
night which operated harshly, ordered nothing biit a hot bath.
At 7, P. M., the bath had not relieved the pains, which were very
severe in the abdomen. Cupped very extensively. 27th. Passed
a very restless night ; the pains are very severe in the hollow of
both feet, and in both big toes, one spot being particularly painful.
The pain extends from this up the legs and thighs ; pulse 80, and
rather full; skin hot ; very restless. Bled to ^xxiv ; put him into a
hot bath. 11, A. M. The bath relieved him for one or two hours ;
as the pain in the abdomen is severe, cupped again, and gave the
following : R. mass. hyd. grs. vi., extract conii. grs. iij. M. ; or-
dered the bath again at 1, P. M. At 2|, P. M., more quiet, and
easier than he had been ; dozes occasionally ; pulse 80, and softer.
Says the pains are much slighter, though still severe. Ordered the
same dose at 4, P. M. At 6, P. M., complains very much of the
pain in his feet and legs, which is very excruciating; has a most
distressinfy nausea and vomiting. Requested Dr. Wilson to see him.
We had his feet and legs immersed in a hot lime bath several times
during the night, and applied a large blister to the abdomen. The
]>ath relieved the pain very much; the nausea was partly relieved by
the blister. 28th. Slept very little, skin hot ; pulse 85 ; complains
still of nausea. Gave snlph. morph. gr. i, and as soon as the stom-
ach is composed, ordered hot infusion of eupatorium perfoliatum and
a general warm bath. These means relieved him very much. At
8, P. M., complained of inability of urinating — relieved by sp. a3th.
nit. and emollient fomentations over the bladder. 29th. Slept rather
badly, feverish, some pain in the abdomen. Another bath, with the
infusion of eupatorium. This again relieved him, and in a day or
two he was convalescent. This case differed very much from the
ordinary forms of the disease ; still I class it with them as it occurred
at the same time, and in a family where several others were then suf-
fering with the more common forms of the disease. I have seldom
seen a patient suffer more than did this one from the pain in the feet
and legs, and I feel confident tiiat without prompt treatment he
would have .sunk ujKlcr it.

728 Bibliographical Notices. — Digestion. [December,

BIBLIOGRAPHICAL NOTICES.

A neiD edition of '•' Ramshotham' s Process of Parturition.^^ —
Messrs. Lea & Blanchard have recently re-published the last London
edition of this invaluable work, carefully revised and considerably
enlarged. Ramsbotham's Process of Parturition, has been so long
and favorably known to the profession in the United States, that it
needs no commendation. It certainly stands at the head of the long
list of excellent obstetric works published within the last few years
in Great Britain, Ireland and continental Europe. So far as respects
the science and practice of midwifery, both in description and
demonstration, it is comprehensive and complete, leaving little if any
farther to be desired in this department. We consider this book
indispensable to the library of every physician engaged in the prac-
tice of midwifery.

The present edition contains six additional figures, and fifty-nine
pages of interesting and useful matter, worth alone the price of the
whole work. j. a. e.

A new edition of Professor Meigs'' Translation of Velpeau's Mid-
wifery ; with notes and additions, by William Harris, M. D. Pub-
lished by Messrs. Lindsay dc Blackiston, Philadelphia. — If the
reputation of this work, were not already sufficiently established in
tho United States, the names of Velpeau and Meigs would be ample
recommendation ; but we can with propriety and truth say, that it is
rendered much more perfect and valuable by Dr. Harris' interesting
and useful notes and additions. J. a. e.

PART III.— MONTHLY PERISCOPE.

The chemical 'phenomena of Digestion. — MM Bernard de Ville-
franche and Barreswill, whose researches on digestion we some time
since published in the Lancet, have addressed another communica-
tion to the French Academy, in which they observe, " We formerly
stated that the gastric juice contains two active principles, 1® free
lactic acid, 2° an organic matter, which is precipitated and destroyed
by a heat of 85°, or 90^ cent. It is the presence of this organic
matter which gives the gastric juice its digestive power, since it loses

1845.] Antagonism of CachexicB, 729

this power, when the said matter is destroyed by an elevated tem-
perature.

One of the remarkable properties of this organic matter is, that
its digestive powers vary, according as it is associated with a fluid
having an acid or an alkaline reaction. Thus, in the gastric juice,
which is acid, it readily dissolves (as is well known) azotized substan-
ces, fibrin, gluten, albumen, 6:c., whilst it is altogether without action
on starch.

The object of the present paper is to show, that if we destroy this
acid reaction of gastric juice, and render it alkaline by the addition
of carbonate of soda, its active organic matter, being now in presence
of an alkaline fluid, changes its physiological action, and becomes
able rapidly to modify starch, whilst it loses its power of digesting
meat and azotized substances. As the latter is exactly the charac-
ter of saliva and the pancreatic fluid, it was interesting to know
whether a change in the chemical reaction of these two fluids would
produce in them the same change of properties as in the gastric juice.
Our experience has demonstrated that it does so. If we render the
pancreatic fluid, or the saliva, (which are both naturally alkaline,)
acid, we invert their ordinary action, and give them the power of dis-
solving meat and azotized substances, whilst they lose their influence
upon starch.

The numerous and varied experiments related in this memoir
fully support these assestions, and prove that in the gastric juice, the
pancreatic fluid, and the saliva, exists an organic principle, an active
agent of digestion, which is common to all of them, and that it is
the nature of the chemical reaction associated with it, which alone
determines their power of digesting the different alimentary prin-
ciples.

In an alkaline fluid, all three have the power of transforming
starch, and do not digest meat, whilst in an acid fluid they dissolve
meat, but do not act upon starch. Thus, it appears easy to transform
these fluids into each other, and to make an artificial gastric juice
from the pancreatic fluid, and vice versa. The action of saliva,
however, is less energetic, whether on meat or starch, than the pan-
creatic juice. — Compies Rendus. Lancet.

A.ntagonis7n of Cachexur. — In the Foreign Department will be
found a brief analysis of an essay lately published by M. Trousseau,
(the well known pathologist, and professor of therapeutics in the
Faculty of Paris,) to which we wish to draw attention. The views
contained in this essay are ingenious, and deserve to be seriously
considered ; although they are much too speculative to be adopted in
the present state of medical knowledge.

M. Trousseau first points out, in an extremely lucid and forcible
manner, a fact in general pathology which is generally admitted,
although ot'ten lost sight of, viz., that anaemia, as indicated by the
cha-nges that take place in the composition of the blood, is the pre-

730 Antagonism of CachexicB. [December,

dominant symptom of very varied morbid states, each of which
requires different treatment. So far every one will agree with the
Parisian professor. This, however, cannot be the case when he at-
tempts taestabhsh a kind of antagonism between these varied each-
ectic states, — when he asserts, for instance, that the cachexia of
chlorosis preserves from that of tubercuhzation, and that by restor-
ing, through the agency of ferruginous preparations, to its normal
condition, the blood of a weak, or chlorotic person, in whom there is
the slightest predisposition to phthisis, we expose him to immediate
manifestation of the latter disease. M. Trousseau, it is true, asserts
that this opinion is the result of lengthened experience ; but we have
a right to question his interpretation of the facts he has seen, when
we find it running counter to the experience of the great majority of
physicians. That chlorosis does not so often lead to phthisis as
might be expected, when we consider that it is a disease of debility,
we must admit. The chlorotic cachexia is evidently different from
the tubercular cachexia, or we should not sec so many young females
remain during several years in an anaemic condition, and yet ulti-
mately rally, under proper treatment, without tuberculization taking
place. But there is a great difference between admitting that such
is the case, and looking upon the chlorotic cachexia, along with M.
Trousseau, as absolutely guaranteeing persons against scrofula and
phthisis. It is difficult to believe that a disease which breaks up the
health, depraves the fluids and the solids of the body, and gradually
depresses its vitality, should preserve from another disease, the man-
ifestation of which is generally considered to be induced precisely
by those causes that tend to reduce the powers of life. It is equally
difficult to believe that a therapeutic agent which is calculated to re-
store the diseased blood of a chlorotic patient to its normal state,
should expose that individual, as M. Trousseau says it does, to the
attacks of phthisis, precisely because it vitalizes and animalizes the
animal fluids.

M. Trousseau has, we believe, fallen into the very error with
which he reproaches M. Rayer, when the latter recommends iron in
albuminuria, on account of the anaemic state of the blood. He has
allowed himself to be led away by a theory. That theory is, the an-
tagonism of cachexiae, which may exist even to the extent supposed
by M. Trousseau, but the existence of which has certainly yet to be
proved.

The learned professor brings forward, in support of this view, the
reputed antagonism of intermittent fever and phthisis. Our readers
will remember that we have, at various periods within the last few
years, laid before them accounts of the labours of different conti-
nental practitioners who assert that there is an evident antagonism
between the cachexia of intermittent (ever and that of phthisis, and
that in marshy districts, where all the population is more or less under
the influence of the miasmatic cachexia, scrofula and phthisis are
nearly unknown.

1^45.] EJicient modes of administering Medicines. 731

The recent researches of French pathologists have rendered it
very prohable that such reallv is the case, but they cannot be said
to liave proved it. M. Trousseau's views respecting the antagonism
of chlorosis and nhthisis were, nnost likely, suggested to him by the
discussions which have taken place on that subject. He has endeav-
ored to generalize a principle of pathology, which he has accepted as
proved, althoui^li, in reality, it is yet sub lite. Such an attempt at
generalization'cannot but be looked upon with interest, especially
when made by a man of M. Trousseau's scientific authority, but it
ou«Tht not to be adopted without due reflection and proof.

Although we are thus inclined to receive with doubt and suspicion
the theor'v of "the antagonism of cachexiae," yet we must confess
that its verv simplicity renders it attractive, and that it is one of
the questions of general pathology which is most deserving of eluci-
dation. Indeed, principally with the view of drawing the attention
of British pathologists to the consideration of this asserted pathologi-
cal law, do we now so pointedly allude to it, wishing to stimulate our
readers to inquiry, and taking the present opportunity of mention-
incr that we shall be happv to give publicity to any researches which
may be made in this direction. The marshy districts of Lincoln-
shire, and of other parts of England in which intermittent fever
reigns supreme, must afford as good opportunities of observing the
ant'igonism of miasmatic cachexia and phthisis, as those of France.
On the other hand, our large manufacturing towns, in which both
chlorosis and phthisis are so extremely prevalent, must present ex-
cellent opportunities for observing their connexion one with the other.
The influence of preparations of iron over tuberculization is a
question which also deserves to be seriously investigated. The opin-
ion of M. Trousseau is certainly opposed to the opinions and experi-
ence of many practitioners, who have been in the habit ofadininis-
terintr iron in the incipient stages oftuberculization, with, we think,
marlfed benefit. In works on pathology, experiments are mentioned
in which rabbits and other animals fed on moist unwholesome food
mixed with iron, and kept in damp, dark localities, did not beconie
tuberculous : whilst others, fed and kept in the same way, but with-
out iron, rapidly fell victims to tubercalization. These experiments
might be easily repeated, especially by practitioners living m the
country. — London Lancet. «

Some hints on the most efficient modes of administering Medicines.
By a nractitioner ofhalfa'^century.— Many of the most important
discoveries and improvements in medical science are rendered com-
paratively useless, in consequence of being unskilfully applied to
actual practice. In no department of knowledge is this detect more
conspicuous than in therapeutics. Man (and I believe the same re-
mark applies to all created beings) is born with a kind of instinctive
antipathy to physic, which antipathy he retains from the cradle to
the Ti-ave. Look at the ingenious spoons that have been invented to

733 EJicientmodesof administering Medicines. [December,

force physic down the throats of infants ! Observe the mantle-pieces
of sick chambers, and count how many phials are either uncorked,
or only half emptied ! How great a proportion of mankind hate the
very name of physic ! If the stomach is apt to turn at the thought
of medicine, when we are in health, how much less capable is it to
bear nauseous drugs in the various forms of disease, nine-tenths of
which affect the stomach sympathetically with squeamishness,
nausea, and aversion to food as well as physic ? The evil consequen-
ces of nauseous forms of medicine being used in sickness, are great
beyond all calculation or belief. One result is, that medicine is not
taken in sufficient quantity, sufficiently often, or for a proper length
of time.

What practitioner will fail to recognize the following picture of
almost daily occurrence ? A medical man is in anxioiis attendance
on a patient — say a lady after confinement, and threatened with
some grave malady, peritonitis, for instance — he prescribes what he
conceives to be active and etEcient remedies for the night, and gives
strict injunctions to the nurse. In the morning, when he calls, he
meets the nurse on the stairs. Have you given your mistress the
medicines punctually ? Most punctually, sir. Well, what has been
the effect? " Brought everything up again sir." What, all? "Eve-
ry drop, sir — and I thought she would have brought her very heart
up with it." After such intelligence, the feelings of the doctor, on
entering the chamber, are not particularly enviable. Now all this
is more frequently owing to the form than the substance of the medi-
cine exhibited.

In chronic diseases, where the remedial process is necessarily
chronic also, we are daily baffled by the repugnance, nay, the resist-
ance of the patient to a protracted course of physic. Yet it might
very generally be so contrived, that the patient would desire rather
than loathe his medicines.

I am aware that in some acute diseases, the state of nausea itself
is desirable and salutary. But it is not the mere nausea or sickness
which lessens the velocity of the circulation, opens the secretory ves-
sels, and checks inflammation. These remedial processes depend
much upon the quantify of medicine, say antimony, which the patient
can bear in order to induce them. Thus double or triple the quantity
of tartrate of antimony will be borne, before sickness is induced, if
g*iven in an effervescing draught, as compared with the same medi-
cine given in plain water. And the remedial effects will be in pro-
portion. This is a truth that should ever be held in mind, and the
principle was well understood by Rasori, Thomasini, and others.
The contra-stimulant effects of antimony are trifling during the
nausea and sickness at the befjinnino;. It is when the tolerance is
acquired that the inflammation or high fever is controlled.

But there is a large class of diseases in which the stonsach is mor-
bidly irritable, and where nauseating medicines are positively injuri-
ous. Putting aside the multitudinous forms of dyspepsia, we have

1845.] Constipation. -^hifantile Gastric Fever, 733

affections of the uterus, the kiclne5% the liver, the pancreas, (Sec, where
the stomach is prone to disordered function, and where it i^ of the
greatest consequence to exhibit medicines in forms that will tranquil,
ize rather than nauseate the stomach. Diseases and disorders of the
kidney are now acknowlcdored to be much more frequent than they
were formerly suspected to be — and these are very generally attend-
ed with gastric irritability. In these it is of great importance not
to ruffle the stomach by medicines. In affections of the brain, now
so exceedingly common in consequence of the advanced stage of
civilization, and the operation of various perturbing moral causes, the
stomach is often the organ most conspicuously deranged — and we are
not seldom foiled in the exhibition and perseverance of proper reme-
dies, from the sympathetic disorder of stomach.

Nine-tenths of the cures that are said to be performed by homceo-
pathy, result from the spare diet and the nullity, as it were, of the
medicine employed. Of all the medicines that are prescribed by the
physician, the class of salines are the most generally beneficial, as
opening the secretory organs, as the skin, the liver, the kidneys, &;c.,
besides improving the state of the blood, and restraining febrile ac-
tion in the constitution. These, when exhibited in an effervescing
state, are far more palatable, as well as more efficacious, than when
given in a plain form.

Tonics, on which the routine practitioner so much relies, and
which he exhibits with no sparing hand, are more frequently injuri-
ous than beneficial. They give a feeling ot tone for a time ; but they
lock up the secretions, increase too much the appetite, and lay the
foundation for future states of plethora, congestion, or indigestion.

Now saline effervescents may be made the vehicle for many of the
most powerful tonics, and indeed the most potent medicines which
we possess. The citrate of iron, colchicum, antimony, arsenic, qui-
nine, iodine, &;c., &;c., may all be exhibited in a form that increases
their remedial efficacy, and lessens their tendency to nauseate the
stomach. — Bulletin of Medical Science.

Ox-gall in Constipation. — Dr. R. H. Allnat, in a paper in the
Lancet, (June 7th, 1345.) relates several cases, illustrative of the
good effects of inspissated ox-gall in the cure of habitual constipation.
In a subsequent No. of the same Journal, (July 12th,) he recom-
mends that the ox-gall should be prepared in a water-bath, the gall
being frequently stirred, to produce a perfectly homogeneous extract.
The addition of a small quantity of magnesia will, he says, expedite
the process. He gives it in doses of five grains made into pills,
three times daily. He administers it also in some cases, in the form
of enema. — American Journal.

Treatment of Infantile Gastric Fever. By Goldixg Bird, A. M.,
M. D. — The origin of gastric fever occurring among children is
usually to be ascribed cither to unhealthy ingesta or depraved secre-

'34 Sulphate of Quinine. — Vaccination, [December,

tions. The pulv. sodae comp.* of Guy's Parmacopceia, in doses of
three to eight grains at night, and a full dose of the pulv. rhoei salin.f
every morning for a week or so, will in most cases be found very
successful treatment. To the latter compound, so well known to the
profession for its almost specific power in these affections, Dr. For-
dyce accorded this elaborate praise — '• Had I been more ambitious
of dying a rich man, than of living a useful member of society, the
powers of our anti-hectic powder in curing, as if by miracle, the
hectic fever and the swelled bellies of children in this town would
have remained a secret while I lived." — Guy's Hospital Reports. —
Braithwaite's Retrospect.

Sulphate of Quinine not absorbed when applied Endermically. By
M. Martix Solon. {Bulletin de Therapeutique,T>ec. 1844.) — Many
medicines, when applied to the skin either whole or deprived of ils
cuticle, act energetically on the economy, and may be detected in
the secretions, thus showing they have been absorbed. Sulphate of
quinine, when given internally in the dose of one grain, may easily
be detected in the urine by means of the ordinary tests, as iodide of
potassium, &c. Martin-Solon, however, has made many experiments
on twenty individuals affected with various maladies, relative to this
medicine being absorbed when applied to the skin, and in no case
has he succeeded in detecting the slightest traces of the medicine in
tne urine. The sulphate of quinine w^s applied by fliction to the
sound skin, and to that denuded of cuticle, in baths and by means of
ointments. The effect was null in all.

Report relative to Vaccination. — The French Academy of Medi-
cine offered a prize of 10,000 francs for the best report upon the
following questions, viz :

1st. Is the preservative power of the vaccine permanent, or is it
merely temporary ? In the latter case, the time during which vacci-
nation will protect from small-pox, is to be determined by precise
observation, and well authenticated facts.

2d. Does the cow-pox afford a more certain or permanent preserv-
ative effect, than the vaccine which has been employed in a number
of successive vaccinations, more or less considerable ? Does the
intensity of the local phenomena of vaccination, bear any relation
to its preservative effects ?

3d. In case the preservative property of the vaccine becomes en-
feebled by time, must it be renewed, and by what means ?

4th, Is it necessary to vaccinate the same person several times,

* Sodae Carbonatis exsiccataB 5v. Hydrarg}Ti Chloridi 51. Pulv. Cretae
' ompositi 5x. m,
t Rhaei radicis pulv. 5i. Potassae Sulphatis 3ij. m.

ISlo.J Vaccination. 'i''^^

and if so, after the lapse of Iiow many years, should a now vaccin-
ation be made ?

The questions were proposed by the Academy for 1842, but in
view of the great number (35) of works which were sent to the
concours, a decision upon their respective merits was postponed until
1843 — Even up to that time the whole of the articles had not been
examined, and a further postponement of the report of the commis-
sion was decreed.

In April 1845, this commission, consisting of M. M. Magendic,
Breschet, Dumeril, Roux, and Serres, made a report, which from its
length we cannot give entire, we will therefore only extract their
conclusions.

1st. The preservative power of the vaccine is permanent in the
greater number of vaccinated subjects, and temporary in a small
number. Even among the latter, it affords an almost entire protec-
tion up to adolescence.

2d. Variola rarely attacks vaccinated persons before the age of
ten or twelve years — It is from this period up to the thirty-fifth year
that they are principally exposed to its attacks.

3d. Besides its preservative property, the vaccine effects a modifi-
cation of the organization, which renders variola more mild, and
abridges its duration.

4th. The cow-pox gives to the local phenomena of vaccination a
marked intensity, and its effects are more certain than when old vac-
cine matter has been employed — But after some years of transmission
through the human subject, this local intensity disappears.

5th. The preservative property of the vaccine does not appear to
be dependent upon the intensity of the local symptoms ; nevertheless
to preserve its properties, it is prudent to renew the vaccine as often
as practicable.

6th. Among the means proposed for its renewal, the only one in
which confidence can be reposed, consists in procuring the matter
from its original source.

7th. Re-vaccination is the only mode by which we can distin-
guish those vaccinated subjects who are fully protected from variola,
from those who are only partially so.

8th. The proof afforded by re-vaccination, does not furnish certain
evidence, that the vaccinated persons in whom it succeeds, would
have contracted variola ; but it merely offers a probability that such
would be the case, as it is only among such subjects, that the disease
is developed.

736 Meteorological Observations. — Medical Intelligence.

9th. In ordinary times re-vaccination should be practised about
the fourteenth year ; during an epidemic, it is prudent to renew it
at an earlier age. — Jour, des Connaissances Med. and Chir.

MEDICAL INTELLIGENCE.

Medical College of Georgia. — The annual course of Lectures in this Institu-
tion, began on Monday the 10th November. The Introductory Lecture was
delivered by Prof. Ford, to a large audience of students aDd citizens. The claps
now in attendance, both in numbers and general intelligence, is not surpassed
by any which has preceded it.

METEOROLOGICAL OBSErxVATlONS, for October, 1845, at Augtista, Ga.
Latitude 33° 27' north — Longitude 4° 32' west Wash. Altitude above tide
152 feet.

Thermometer.
Sunrise. 3, p. m.

Barometer.
Sun rise. 3, p. m.

Wind.

Remarks.

29 71-100

29 74-100

Fair.

" 81-100

" 87-100

N. E.

Fair.

'« 90-100

" 87-100

N. E.

Cloudy— sprinkle, [night.

" 84-100

" 72-100

N. E.

Rain from 4, a. m. till mid-

" 64-100

" 70-100

N. W.

Flying clouds— fair.

" 81-100

" 83-100

N. E.

Fair. [rain.

" 87-100

" 86-100

N. E.

Cloudy, sprinkle — 11, p. m.

" 84-100

" 76-100

S. E.

Cl'dy — spr. — 9, p.m. r. blow.

" 84-100

" 73-100

CI 0 udy — sprin kle .

" 68-100

" 59-100

N. E.

Rain all day, and at night.

" 55-100

" 37-100

N. E.

Rain all day, and at night.

" 35-100

" 56-100

N. W.

Fair — breeze.

" 91-100

" 98-100

Fair.

30 3-100

N. W.

Fair.

29 98-100

Fair — some clouds.

30 14-100

30 10-100

Fair.

30 6-100

N. E.

Fair.

. 46

30 4-100

Fair— some clouds.

29 95-100

N. E.

Cloudy.

29 85-100

29 77-100

N. E.

Rain all day.

29 76-100

29 82-100

N. E.

Cloudy — breeze. [night.

30 5-100

30 3-100

N. E.

Fair — some cl'ds— bio w last

30 6-iOO

30 4-100

N. E.

Fair.

30 4-100

Fair.

30 7-100

Fair.

30 7-100

Fair.

30 7-100

30 3-100

Cloudy.

Fair.

29 95-100

29 90-100

Fair.

29 92-100

29 90-100

Flying clouds.

18 Fair days. (Quantity of Rain, 7 inches.

tj^iii

INDEX.

Age of puberty Page 41

Albumen as an antidote, caution in giving 155

Aloes, its action and uses 251

Araenorrhoea, treatment of 604

American Journal of Medical Sciences 23

Amputation of limbs 633

Amputation of penis 601

Anasarca, causes of 90

Antidotes of Corrosive Sublimate, &c 154

Antigastralgic pills 600

Ascites 467

Ash well, diseases of females 274

Ataxic Pneumonia with delirium 394

Auscultation, essay on 68

Bebeerine, medical properties of 347

Biett's formulary for skin diseases 155

Bile, test for 218-603

Bile, secretion and properties of 536

Bismuth, subnitrate in gastric affections 353

Bladder, difference of size in male and female 664

Blisters in acute inflammatory diseases 83

" in children 422

" in acute diseases of the brain 669

Brigham on mental cultivation, &c 274

Bronchocele encysted 286

Buffy coat of the blood 693

Bulletin General de Therapeutique , 202

Burn, extensive 226

Burns, treatment of 601

Cachexia Africana 126

Cachexias, antagonism of ■ 729

Calomel 79

Campbell, Dr. H. F. on Gonorrhoea 15

" " " *' case of tubercular development 317

'' " " " abuse of Diuretics 360

Camphor, a preservative of ergot 95

" to blisters 603

Caoutchouc in toothache 410

Case of sharp pointed body in intestine 344

Cases Surgical, by Dr. Mercier 346

IV INDEX.

Case of Twins Page 478

Cases, by Dr. W. H. Robert 502

Castor Oil 222

Castration, case of 666

Caustics, different sorts 412

Cauter}^ actual in gangrene of the mouth 404

Chronic rheumatism and neuralgia 151

Cimicifuga in nervous diseases 569

Climate, diseases, &c., of Middle Florida 526

Cochineal in hooping cough 600

CoBcum, diseases of 502

Conium Maculatum^ effects of 598

Contributions to Therapeutics 141

Convulsions, pathology and treatment of 49

Convulsions, source of 663

Copaiba pills 286

" with purgatives in gonorrhcea 475

Cornea, ulceration of 157

Cornealini, in chlorosis 404

Cooper's first lines 272

Corrosive sublimate in Epilepsy 403

Cough and pleurodynia from spinal irritation 229

Creosote in case of vomiting 280

Croton oil in Dropsy 280

" ' for Neevi 157

«' " piaster: ...222

Gumming, Dr. W, H. letter from China 47

" " " " on Auscultation 68

Cunningham, Dr. S. B. Case of Monstrosity , 79

Death of Brcschet 605

Dental Surgery, principles and practice of .... 535

Diabetes, treatment of 279

Diagnosis, cause of error in 346

Digestion, chemical phenomena of 728

Digitalis in diseases of the heart 405

Diuretics, abuse of 360

Dropsy, chronic 600

Dublin Journal 193

Dugas, Dr. L. A. on Convulsions 49

" " " " case of extirpation of Mamma 122

« " " " remarks on lecture on Mesmerism 236

" " " " case of extirpation of the Tumor 508

Dysmenorrhcea, treatment of 671

Ears, discharge from 343

Emetics in Bronchitis 543

Epidemic Erysipelas 281-718

Epilepsy cured by blisters 150

Epi.sioraphy, cases of 112

INDEX. V

Eiysipelas, epidemic in Parisian hospitals Page 403

Escape of ova, in iependent of fecundation 38

Eve, Dr. P. F. on bilateral operation of Lithotomy 19

" " " " Lecture on Mesmerism 167

" " " " case of Hydrocele, - 367

" " " " case of Tetanus 625

" " " '■ on Tertiary Symptoms of Syphilis 673

Eve, Dr. Joseph A. on Secale Cornutum 289

" " " " letter to Dr. Smith 574

Evolution and Delivery, with presentation of shoulder, &c 479

Excision of the urethra in a woman 602

Extirpation of Mamma 122

" of superior cerv^ical ganglion, &:c • • • 221

'* of schirrus tumor 5^^

** of lachrymal gland l^^

Extra-uterine pregnancy ^'^

Fisk fund prize questions, 96

Ford,. Dr. L, D. on Intermittent fever _2as488''~ ^ ._

Foreign bodies, extraction of from GEsophagus 137

Formulae for alcaline medication • • 669

Forry, Dr. death of 47

Galvanism 220

Galvanism in uterine hemorrhage "707

Gangrene, dry, case of , 691

Gardner, Dr. J. M. on Jasminum Revolutum 447

Garvin, Dr. L P. on Sub-nitrate of Bismuth 353

Gazette Medicale de Paris 202

Generation, mysteries of 339

Geophagy 417

Gonorrhoea, treatment of 1^

Gordon, Dr. J. M. case of Volvulus 444

Graduates of Yale College 160

Groce, Dr. B. W. case of Lithotomy 246

Gums, scarification of, during dentition 277

Harden, Dr. J. M. B. notice of Holdat's Memoir 161

" " " case of Procidentia Uteri 248

" " " soil, climate, &c. of Liberty county 545

Heart, diseases of 328-370

Hemicrania and Tic Douloureux, treatment of 343

Hepatitis and Hepatalgia, diagnosis of 542

Hernia, strangulated, operation for 358

" statistics of 477

Hogs lard in obstructions of the bowels 313

HoopingCough 213-597

Hydatids, uterine, case of 250

Hydrocele, treated with ioduretted injections 92

'* case of. 367

Hysteria, local 260

INDEX.

Immoveable bandages of starched paper Page 285

Indian Hemp, effects of 216

Infantile gastric fever 733

Inflammation of synovial membrane of knee joint 477

Inhalation of oxygen gas, an antidote lor carbonic acid 348

Instruction of Midwives in Paris 415

Intermittent fever 3-481

Intermittence of intermittent fever 43

Inverted toe nail *. 259

Iodide of Potassium in Asthma 151

" " " in primary S}Tphilis 539

Itch, treatment of 44

Jasminum Revolutum in Syphilis 447

Jaundice 4l0

Journal des Connaissances Medico-Chirurgicale 202

Kilpatrick, Dr. A. scraps from case book 306

Lake, Dr. John, cases of Episoriaphy 112

Le Conte, Dr. John, on Geophagy 4l7

Letter from Dr. John McLester 414

Levert, Dr. H. S. on Opium in Abortion 225

Liquor Potassse 159

Lithontriptic action of Uva Ursi 671

Lithotrity 284

Lithotomy, bilateral operation of 19

" cases of 116

" in the female, case of 246

Little, Dr. R. E. on Syphilitic ulcers 618

Lumbar abscess 505

Lupus, treatment of • 282

Malaria 45

Malformation of the heart 275

Malignant tumor, case of 684

Mammary abscess treated by the breast pump 476

Mayes, Dr. J. A. on Hogs lard in obstructed bowels 313

Means, Dr. Alex, on Calomel 79

Medical Memoranda 219

" College of Georgia, annual commencement 223

" «< " State of South Carolina 224

" Statistics of France 415

" Society for East Tennessee 480

Medicinal Substances, passage through the economy- 218

" " efficient modes of preparing 731

Meigs' Columbat De L'Isere 274

Mesmerism • 1 67

" remarks on a Lecture on 236

" true and false 544

Miller's principles of Surgery 373

Monstrosity, case of • 120

, INDEX. ^^'

Negro population, diseases of Page 3^^H|

Nervous action re-established after autoplastic operations ^''^

Nervous Cephalalgia 600

Neuralgia '• 407

New instrument, by Dr. P. F. Eve- 605

New hasmostatic means 668

New Medical Journals 604

New York Journal of Medicine 25-96

Nitrate of Silver in chronic diarrhoea 216

Nitric Acid in Purpura Hemorrhagica 471

Obituary of Prof. Sewell 352

Observations on soil, climate, &c. of Liberty county 545

Ointments, preparations of 286

Open foramen ovale 38

Operation for defect of Rectum 668

Opium in large doses, in abortion ^ 225

" in fevers, inflammatory diseases, &c. 659

Ovariotomy 92

Ox-gall in Constipation 733

Pains in the loins 152

Paracentesis thoracis in acute pleurisy 88

Patholog}' and Therapeutics, essays on, by Prof. S. H. Dickson 448

Pendleton, Dr. E. S. case of Lumbar Abscess 505

Pennsylvania University 352

Period at which the foramen ovale is obliterated 38

Periodic discharge of ova 402

Periodicity, febrile, influenced by Q.uinine 410

Pillulas Ferri Iodine 96

Placenta praevia 348

Poison by Tartaric Acid 670

Pregnancy, term of exceeded 479

Premature Delivery 160

Preparations of Mercury and Iodine 266

Presentatfon of arm and shoulder 479

Process of secretion • 37

Procidentia Uteri during labor 248

•' " cured by excision, &c. 310

Punctured wound, case of 380

Cluinine, Sulphate, in enlarged spleen -OSS' 5- / %

" " in acute Rheumatism 538

" " in diseases of the South -593 iS" 7 7

" " employed endermically, not absorbed 734

Ramsbotham's Process of Parturition 728

Reproduction of a portion of the lower jaw 667

Reunion of divided nerves 667

Rhatany in chronic catarrhal opthalmia 96

Robertson, Dr. J. J. on Cough and Pleurodynia 229

Robert, Dr. W. H. Cases 502

VIII INDEX. •

r^ecale Cornutum Page 289-603

Smith, Dr. G, G. Case of uterine hydatids 150

Spasmodic Stricture of the urethra 414

Spinal Marrow, division of 593

Spleen and its functions • 338

Stevens, Dr. J. P. Case of Tetanus 609

Strictures of the urethra 345

Suicides in France 604

Surgical operations in Cancerous diseases 91

" " dangers of 284

" anecdote 672

Syphilis treated with Tartar Emetic 285

" treated with Iodide of Potassium 320

Syphilitic ulcers 618

S}'philis, treatment of tertiary symptoms 673

" case of 685

Tables of Mortality 585

Turpentine, use of — • 217

Tetanus, case of 609

«' traumatic, treatment of • 625

" ■ treatment of. 650

Therapeutics applied to chronic diseases 30-77

Throat and Larynx, diseases of 216

Thymus gland, uses of- 221

Tracheotomy in (Edema of the throat 411

Transylvania University 351

• Tubercles, conclusions concerning 596

Tubercular development in an infant 317

" thickening of the lip 414

Tufts, Dr. J. B. Case of secondary syphilis 686

Turning 559

Typhus, treatment of 470

Ulcers of the Cornea, treatment of 602

Urinary deposits • 642

Vaccination, Report on 734

Vaccine ••- 276

Valerianate of Gluinine 473

Velpeau's Midwifery 728

Venous pulse 399

Vesicatories in Sciatic neuralgia 387

Volvulus and strangulation of the intestines •• 444

West, Dr. Charles. Case of Hernia 358

Westmoreland, Dr. J. G. Case of dry Gangrene 691

Wildman, Dr. P. H. Cases of Lithotomy 166

Wooten, Dr. H. V. Case of Procidentia Uteri 310

«' " " " onCimicifuga 569

" " G.H. Case of Malignant tumor - 684

Date Due

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Southern Medical and
Surgical Journal

New Series

volume 1, 181|5> copy 2

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